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HomeMy WebLinkAbout1000-85.-2-79 PLANNING BOARD MEMBERS JERILYN B. WOODHOUSE Chair RICHARD CAGGIANO WILLIAM J. CREMERS KENNETH L. EDWARDS MARTIN H. SIDOR October 13, 2004 PLANNING BOARD OFFICE TOWN OF SOUTHOLD Messrs. Robert & Mark Van Bourgondien 580 Grigonis Path Southold, NY 11971 Re: C.J. Van Bourgondien Green House, Main Road, Peconic SCTM# 1000-85-2-7 Zone A -C Dear Messrs. Van Bourgondien: P.O. Box 1179 Town Hall, 53095 State Route 25 Southold, New York 11971-0959 Telephone (631) 765-1938 Fax (631) 765-3136 The above site plan application was reviewed at the Architectural Revie Committee (ARC) meeting held on October 7, 2004. A copy of the meeting minutes is enclosed. Please review the pertinent comments and inform us in writing if you are in agreement with the conditions. In addition, if required, please modify the site/construction plan, and submit the revisions to the Planning Board. If there are any questions, please contact me at 765-1938 between the hours of 8:00 a.m. and 4:00 p.m. Respectfully yo , Bruno Semon Senior Site Plan Reviewer cc: file enc. ARC minutes SOUTHOLD TOWN ARCHITECTURAL REVIEW COMMITTEE OCTOBER 7, 2004 The ARC met at Town Hall Annex at 4:00p.m., Members present,were: Garrett A. Strang, Co -Chairman; Robert I Brown, Co -Chairman Herbert Adler, Jr., Landmarks Preservation Committee; Herbert Ernst, Southold; Ron McGreevy, Mattituck Nicholas J. Planamento, Southold Also present were Bruno Semon of the Planning Board Staff, Michael Sirico for Fitness Advantage, Tom McCarthy, Len & Penny Vaccariello for Southold Floor Covering. Moved by Garrett Strang and seconded by Robert Brown, it was RESOLVED to defer reading of the minutes of the August 17, 2004 meeting until the next ARC meeting. Vote of the Committee: Ayes All. Marts Hardware (Main Road, Southold) SCTM# 1000-70-5-6.2 The applicant submitted a written request to substitute "Hardi Plank" texture horizontal siding for the previously approved vinyl siding. The color will be "Cabots Driftwood Gray" # 01-0644. Moved by Robert Brown and seconded by Herbert Ernst, it was RESOLVED to accept the modification to the original approval. Vote of the Committee: Ayes All. Applicants are reminded that deviations from approved drawings without the review and approval of the Architectural Review Committee will cause rescission of the original approval and may negatively impact securing the Certificate of Occupancy. C.J. Van Bourgondien Green House (Main Road, Peconic) SCTM# 1000-85-2-7 The Applicant proposes to construct a new greenhouse addition on the south side of the existing greenhouse building. The committee applauded the applicant for proposing an aesthetically pleasing traditional glass and metal frame structure in lieu of a plastic "Quonset Hut" type structure. Moved by Herbert Adler and seconded by Herbert Ernst, it was RESOLVED to approve the application as submitted. Vote of the Committee: Ayes All. Applicants are reminded that deviations from approved drawings without the review and approval of the Architectural Review Committee will cause rescission of the original approval and may negatively impact securing the Certificate of Occupancy. Sender: Subject: 0 0 Submission Without a Cover Letter �S \/a a r 5 C <,I P"r\ SCTM#: 1000 - IJL z' l Date: / D/&/ 0 - Comments: O -f -p1-" a O, ,J GS�- C U r\ d h -Q s– Q— G r' Q— Gr- 0 (� C fv\ �rl� • SUBIMAL CHAKRABORTI, P.E. REGIONAL DIRECTOR September 2, 2004 STATE OF NEW YORK DEPARTMENT OF TRANSPORTATION 250 VETERANS MEMORIAL HIGHWAY HAUPPAUGE, N.Y. 11788-5518 Mr. Bruno Simone, Senior Site Plan Reviewer Town of Southold P.O. Box 1179 Town Hall, 53095 State Route 25 Southold, NY 11971-0959 Dear Mr. Simone: % ,21:5 ,JOSEPH H. BOARDMAN COMMISSIONER Your August 11, 2004 Submission Van Bourg_ondien C.J. Inc. -Proposed Greenhouse 39395 Main Road Route 25, Peconic SCTM# 1000-85.-2-7 Our Case No. 04-237P This is to acknowledge receipt of your submission on the above permit application. This permit application should be sensitive to the unique visual and historic setting of the Long Island North Shore Heritage Area, which runs from the Queens/Nassau County line to Orient Point, and from Route 25 or I495, whichever is farther south, north to Long Island Sound. The information that you provided is helpful, however, in order for us to commence a review and determine if any changes/improvements are warranted at this location the applicant should submit four (4) sets of site plans to us. The site plans should contain all of the information noted on the attached checklist. In all future correspondence, please refer to the subject case number. Review of the subject material is being coordinated by Mr. Mark Wolfgang. He can be contacted at (631) 952-7973 if you have any questions regarding this matter. Please send all correspondence to his attention. Thank you for your cooperation concerning this matter. Very y yours, �,�.--'� HAIK A. SAAD, P.E. Civil Engineer III Traffic Engineering and Safety Soy hoed Zow Attachment P�a�n,r,�80a cc: Ms. Wendy Brodsky, Administrative Assistant, Long Island North Shore Heritage Area Planning Commission SITE PLAN REOUI&NTS CHECKLIST: • X A. Location and dimensions of existing highway pavement, curb, sidewalk, median, median openings, guide rail, utilities, signs (including size and text), pavement markings, bus stops, overhead and underground traffic signal equipment, right-of-way lines, controlled access lines and property lines. X B. Existing and proposed buildings, appurtenances and drive-through windows. X C. Design features, referencing the latest edition of the NYS Standard Specifications, to be incorporated in proposed work: X 1. Driveway pavement type and dimensions. X 2. Radii of driveway returns and other points of curvature. X 3. Driveway grades or profiles, indicating low point on private property. X 4. Angle of driveways relative to roadway center line. X 5. Dimensions of roadside control islands and driveway medians. X 6. Dimensions of curb and sidewalk relative to pavement edge. X 7. Details of internal traffic circulation, including proposed signs, pavement markings and traffic signal equipment. X 8. North arrow and scale on each applicable sheet. X D. Size, type and grade of existing and proposed drainage features. Plastic pipe is not permitted within State right-of-way. X E. Distance from each existing and proposed driveway to each adjacent driveway and cross street, including adjacent property lines and streets and driveways opposite the site. X F. Maintenance and protection of traffic plans. A Maintenance and Protection of Traffic plan must be provided for work on Route . The plan must include the note "All lanes must be open to traffic before AM and after PM. No lane closings are permitted on weekends or holidays. Nighttime lane closings will not be permitted without prior approval from the State Permit Inspector." G. Traffic signal plans must be shown on a separate sheet including pavement markings, turn lanes, driveways, sidewalks and pedestrian ramps, crosswalks, buildings, poles, power supply, pullboxes, conduit, controller, head layout including face numbering, detection, right-of-way lines and signing. All work must be referenced to the latest edition of the NYS Standard Specifications. The plans must show existing features, such as drainage and utilities, which may conflict with the proposed signal. Tables of Operations, Clearances, Switchpacks, Input Wiring and Loop Wiring must be included along with a Phasing Diagram and Estimate of Quantities. H. Aerial photograph of the site and environs. X I. Beginning and ending reference markers. • PLANNING BOARD MEMBERS JERILYN B. WOODHOUSE Chair RICHARD CAGGIANO WILLIAM J. CREMERS KENNETH L. EDWARDS MARTIN H, SIDOR 0 MEMORANDUM PLANNING BOARD OFFICE TOWN OF SOUTHOLD Date: August 11, 2004 To: Southold Town Zoning Board of Appeals Southold Town Building Department Southold Town Clerk for Southold Town Board Josh Horton, Southold Town Supervisor Southold Town Board of Trustees Southold Town Engineer Suffolk County Department of Health Services NYSDEC - Stony Brook U.S. Army Corp of Engineers New York State Department of Transportation Suffolk County Water Authority Suffolk County Planning Department Suffolk County Department of Public Works From: Bruno Semon, Senior Site Plan Reviewer& P.O. Box 1179 Town Hall, 53095 State Route 25 Southold, New York 11971-0959 Telephone (631) 765-1938 Fax (631) 765-3136 Re: Agency Referral requests required under Southold Town Code Article XXV 100-254 Review Procedure part C the Planning Board refers this site plan for concerns, comments and Jurisdiction requirements if applicable. Dear Reviewer: The site plan status is a New Active Site Plan. Attached is a copy of the site plan application information pertaining to the listed project: Van Bourgondien C.J. Inc. 39395 Main Road, Peconic SCTM# 1000-85-2-7 This site plan is for new 17,640 sq. ft. green house addition to an existing building on 33.68 acres parcel in the A -C Zone located at approximately 3,665' e/o Bridge Lane n/s/o New York State Route 25 in Peconic. SCTM#(s)1000-85.-2-7 Please respond on your agency's position of the above action. Thank you in advance. cc: File PLANNING BOARD MEMBERS BENNETT ORLOWSKI, JR. Chairman RICHARD CAGGIANO WILLIAM J. CREMERS KENNETH L. EDWARDS MARTIN H. SIDOR 0") PLANNING BOARD OFFICE TOWN OF SOUTHOLD APPLICATION FOR CONSIDERATION OF A S New —Change of Use Re -use '---Extension —Revision of Approved Site Plan Name of Business or Site: SCTM#: Address P.O. Box 1179 Town Hall, 53095 State Route 26 Southold, New York 11971-0959 Telephone (631) 765-1938 Fax (631) 765-3136 --Date Received _ Date Completed —Filing Fee VOL *-1 0 , d ^I��' 0 �'-�i' -­�C- C� 1000- -3 C40 IVI NaME of Aj)pjjCjrj'C: - _13 t>j � I ON 1 " Address of Applicant: P o Pe q".' Telephone: 7-3 V -S_3 o p Owner of Land: N6 QIA Agent or Person responsible iso be -1- &L N Q 0 V r, for application: �cLw Address:A))( s,4LIJ Telephone: Site Plans prepared by: te License No. Address 0 Telephone: I ,t. I*'). 10) Site Plan Applications Public Hearings Under the current site plan application procedure, the process for reviewing a site plan application is: a public hearing is not scheduled and held by the. Planning Board until after, among other things, the site plan has received a stamped Health Department approval. The applicant shall now have the following options: 1. To follow the established procedure, or 2. To have the Planning Board schedule and hold a public hearing on the site plan application and have the- Planning Board vote on the proposed conditional site plan prior to the applicant receiving Health Department approval subject to the following conditions: A. The applicant herehy agrees and understands that if the site plan which receives stamped -Health Department approval differs in any way from the proposed conditional site plan on which the Planning, Board held a public hearing and voted on, then the Planning Board has the right and option, if the change is material to any of the issues properly before the Planning Board, to hold a public hearing on this "revised" site plan application and review its conditional approval. B. The applicant agrees not to object to a new public.hearing and Planning Board review of the revised application. Applicant Agreement on Site Pians.. The applicant is aware of the terms of this approval and certifies to these terms by his/her signature below. Re: SCTM#: 1000 - Applicant 1� . 00 t' ge 3 Planning Board Site Plan Application • 6 'Notal Land Area of Site (acres or square feet) _ C Zoning District 1 tt AG Existing Use of Site S©d o,44'r— l//// ,jr-e p�a,"4-S 4-60`"e'�g Proposed Uses on Site. Show all uses proposed and existing. Indicate which bullding will have which use. If more than one use Is proposed per building, indicate square footage of floor ar,ea th� t will be reserved per use. Se,-- Sejaf� a c e d Gross Floor Area of Existing Structure(s) j 4VI y3 y(t? Fjr PR cc f� . Gross Floor Area of Proposed Structures) l7, 6 vo(S P O=T) 7 3 Percent of Lot Coverage by Bullding(s) Percent of Lot for Parking (where applicable) Percent of Lot for Landscaping (where applicable) Has applicant been granted a variance and/or special exception by Board of Appeals - Case # & date % Board of Trustees Case # & date NY State Department of Environmental Conservation - Case # & date Suffolk County Department Health Services - Case # & date Case Number Name of Applicant Date of Doclslon Expiration Date Other 1 e d v WIII any toxic or hazardous materials, as defined by the Suffolk County Board of Health, be stored or handled at the site? _Ve75 If so, have proper permits been obtained? $v(s ame of Issuing agency / —o j s - Number and date of permit Issued. NO ACTION (EXCAVATION OR CONSTRUCTION) MAV BE UNOERMCW UNTIL APPROVAL OF SITE PLAN BV PLANNING BOARD. VIOLATORS ARE SUBJECT TO PROSECUTION, f Page 2 Planning Board Site Plan Application ApPUCANT'S AFFIDAVIT STATE OF NEW YORK COUNTY OF SUFFOLK being duly sworn, deposes and says that he resides at 4L - A_Ao!J A) -y rrq-7r in the State of New York, and that he Is the owner of theabove property, or that he is the of the o (Title) (Specify whether Partnership or Corp.) which is hereby making application; that there are no existing structures or Improvements on the land which are not shown on the Site Plan; that the title to the entire parcel, Including all rights-of-way, has been clearly established and is shown on said Plan; that no part of the Plan infringes upon any duly filed plan which has not been abandoned both as to lots and as to roads; that he has examined all rules and regulations adopted by the Planning Board for the filing of Site Plans and will comply with same; that the plans submitted, as approved, will not be altered or changed in any manner without the approval of the Planning Board; and that the actual physical Improvements will be Installed in strict accordance With the plans submitted. /r Signed rartne er)SI ne P.�egr or Corporate Office and Title) Sworn to me thIsA day of 2� "`��60 — V,a (Nota cl SUSAN K TOOKER NOTARY PUBLIC,;State of Now York No..01TO5078120 Qualified in Suffolk County Commission Expires May FORM NO. 3 NOTICE OF DISAPPROVAL DATE: July 19, 2004 TO: CJ Van Bourgendien PO Box 2 Peconic, NY 11958 Please take notice that your application dated June 14, 2004 For permit to construct a greenhouse at Location of property: 39395 Main Road, Peconic County Tax Map No. 1000 -Section 85 Block 2 Lot 7 Is returned herewith and disapproved on the following grounds: Note to Applicant: Any change or deviation to the above referenced application, may require further review by the Southold Town Building Department. CC: file, Planning Board d CEIVE JUL 2 1 2004 Southold Town Planning Boarl • PLANNING BOARD MEMBERS JERILYN B. WOODHOUSE Chair RICHARD CAGGIANO WILLIAM J. CREMERS KENNETH L. EDWARDS MARTIN H. SIDOR August 9, 2004 PLANNING BOARD OFFICE TOWN OF SOUTHOLD Mr. Robert Van Bourgondien 580 Girgonis Path Southold, NY 11971 Re: Proposed site plan for C.J. Van Bourgondien 39395 Main Road Peconic, NY SCTM#1000-85-2-7 Zone: AC P.O. Box 1179 Town Hall, 53095 State Route 25 Southold, New York 11971-0959 Telephone (631) 765-1938 Fax (631) 765-3136 e-ar Mr. Van Bourgondien, /'In reviewing the site plan application materials submitted to the office on July 29, 2004, the Planning Board held a work session on August 2, 2004 and accepted this application. The site plan application will need to include the following to be processed: 1. The site plan will need to meet the Town of Southold Zoning code. 2. Please indicate dimensions on all structures new and existing and distance to property lines. Add the tax map number, key map and zoning district. 3. Please submit information for presentation to the Architectural Review Committee. See the checklist. 4. The site plan indicates a roadway will go through the new addition. This needs to be clarified and or removed from the site plan. 5. No road access is detailed from the Main road. The document needs to indicate the driveway and dimensions of access. 6. No use of the existing structures and new addition are indicated. The use should be detailed of each structure along with total square foot of the structures. 7. The document needs to detail lot coverage percent, landscape percent, zoning districts and grading/drainage calculations. 8. Parking Calculations, actual parking and or loading needs to be shown on the site plan. Page Two, August 9, 2004 The site plan will require the following approvals before PB Final Approval: Fire Department, A.R.C., Town Engineer and Southold Town Building Department. Please contact the NYSDOT for requirements they have. To expedite the process please submit seven revised site plans with a design professional seal to the Planning Boards Office. If there are any questions you can contact us at (63 1) 765-1938 x5019 between the hours of 8:00 a.m. and 4:00 p.m. Senior Site Plan Reviewer CC:file The following information is to be submitted to the Architectural Review Committee after the Planning Board notifies you iu writu4g that the application is acceptable. The Planning Board office will attach a copy of a site plan to the following material: �• Notations as to the type of building construction, proposed occupancy or use and the location of fire separation walls (if it projects beyond the building envelope). 4• Floor plans drawn to scale (1/4 " =1' preferred) Elevation drawings to scale of all sides of each building (114" = l' preferred). The follow information shall be shown on the drawings: o Type and color of roofing — include sample o Type and color of siding — include sample o Type of windows and doors to be used, material and color of all windows and door frames — include sample o Type and color of trim material — include sample 4 Rendering of building if possible 4• Notation of the type of heating/cooling equipment to be used. Show or indicate exterior locations of all equipment i.e., heat pumps, air conditioning compressors, etc. on plans and/or elevations. �• Type and locations of all roof -mounted mechanical equipment �• Type and locations of all mechanical equipment, plumbing and/or attic venting through roof or building sidewall. •� Type, color and style of proposed masonry material for chimneys or accent walls - include samples or photos. •� Details; color, type and style of any proposed ornamentation, a7zi-ings, canopies or ter.'ts //� + Phc! os of existing buildings and/or neighboring properties fr(m four directions of project site, if possible. �• Type, color and design of all exterior signage, both building -mounted and free standing. Please use this list as a checklist. Regretfully, we cannot accept incomplete submissions. Place all materials in a large manila envelope with your application name printed on the outside. Large samples should be labeled. If you want samples returned, please note same on the label. THE ARCHITECTURAL REVIEW COMMITTEE WOULD BE HAPPY TO MEET WITH YOU AT A PRE -SUBMISSION CONFERENCE PRIOR TO YOUR ACTURAL SUBMISSION r ,ilog WASkXIVIIPX�.Z*1d.► S YSRPS ASSESSMENT INQUIRY DATE 08/11/2004 473889 SOUTHOLD SCHOOL SOUTHOLD SCHOOL ROLL SEC TAXABLE PRCLS 170 NURSERY TOTAL RES SITE 85.-2-7 TOTAL COM SITE 39395 MAIN RD ACCT NO 10 OWNER & MAILING INFO =__ =MISC________ ______ ASSESSMENT DATA VANBOURGONDIEN C J INC RS -SS **CURRENT** RES PERCENT MAIN ROAD 1 LAND 8,400 **TAXABLE** PO BOX 2 BANK TOTAL 53,400 COUNTY 34,400 PECONIC NY 11958 **PRIOR** TOWN 34,400 LAND 8,400 SCHOOL 34,400 TOTAL 53,400 ==DIMENSIONS =__ ______= SALES INFORMATION ACRES 33.68 BOOK 10711 SALE DATE 00/00/00 PAGE 00139 PR OWNER __=====TOTAL EXEMPTIONS 2 _____________1_= TOTAL SPECIAL DISTRICTS 3 CODE AMOUNT PCT INIT TERM VLG HC OWN CODE UNITS PCT TYPE VALUE 41720 7,300 04 FD028 41700 11,700 97 07 WW020 SWO11 F1=NEXT PARCEL F3=NEXT EXEMPT/SPEC F4=PREV EXEMPT/SPEC 75.10- 03-050 F6=G0 TO INVENTORY F9=G0 TO XREF F10=G0 TO MENU • PLANNING BOARD MEMBERS JERILYN B. WOODHOUSE Chair RICHARD CAGGIANO WILLIAM J. CREMERS KENNETH L. EDWARDS MARTIN H. SIDOR MEMORANDUM Date: August 2, 2004 PLANNING BOARD OFFICE TOWN OF SOUTHOLD To: Planning Board Members From: Bruno Semon, Senior Site Plan Reviewe Re: Review of proposed site plan for CJ Van Bourgondien 39395 Main Road Peconic, NY SCTM#:1000-85-2-7 ,5/11- P.O. 5/ P.O. Box 1179 Town Hall, 53095 State Route 25 Southold, New York 11971-0959 Telephone (631) 765-1938 Fax (631) 765-3136 This is review report of the above listed pre -submission site plan. The followiptig are recommendations of missing details on the site plan received by the Planning Board on July 29, 2004: 1. Setback dimensions are not shown from all the as built structures or the new proposed addition. The document will require all distances to structures be shown. 2. The site plan indicates a roadway will go through the new addition. This needs to be clarified and or removed from the site plan. 3. No road access is detailed from the Main road. The document needs to indicate the driveway and dimensions. Will the applicant need to go to NYSDOT for a curb cut before final PB approval? 4. No key map is illustrated and needs to be added. 5. No use of the existing structures and new addition are indicated. The use should be detailed of each structure along with total square foot of the structures. 6. The document needs to detail lot coverage percent, landscape percent, zoning districts and grading/drainage calculations. 7. No parking and or loading is detailed on the document and needs be added. The incomplete file is available in the Planning Board Office for review. Thank you in advance. Cc: file, vs Enc. • • 49 FORM NO. 3 NOTICE OF DISAPPROVAL DATE: July 19, 2004 TO: CJ Van Bourgendien PO BOX 2 Peconic, NY 11958 Please take notice that your application dated June 14, 2004 For permit to construct a greenhouse at Location of property: 39395 Main Road, Peconic County Tax Map No. 1000 - Section 85 Block 2 Lot 7 Is returned herewith and disapproved on the following grounds: Note to Applicant: Any change or deviation to the above referenced application, may require further review by the Southold Town Building Department. CC: file, Planning Board JUL 2 1 2004 10 Southold Town Planning Boar+ AbA 0 • FOR INTERNAL USE ONLY SITE PLAN USE DETERMINATION • Initial Determination Date: �p / / ff /� Date Sent: 6 / / r / Project Name: �� VAN � n ), &4ih ice/ Project Address:,?) 132 S— /'� )U, f�=�� - Suffolk County Tax Map No.:1000-�- � Zonin gDistrict: Request:./'!,,,-s46faa X4-4 • • (Note: Copy of Building Permit Application and supporting documentation as to proposed use or uses should be submitted.) Initial Determination as to whether use is permitted: 1Aae 0g=&:,-,�.� Initial Determination as to whether site plan is Sig Planning Department (P.D.) Referral: P.D. Date Received: Comments: ired: Date of Comment: pector slc '71V Signature of Planning Dept. Staff Reviewer Final Determination Date: rinrieinn- Signature of Building Inspector 4 • FOR,INT6RNAL USE ONLY 10 SITE PLAN USE DETERMINATION Initial Determination Date: 4 / / (f / Date Sent: K // r / 4— Project Name: (;J V,4m n rr e64m/Ik-hJ Project Address: 3 c13 c! 57— o� - Suffolk County Tax Map No.:1000-�- � Zoning District: kc Request: (Note: Copy of Building Permit Application and supporting documentation as to proposed use or uses should be submitted.) Initial Determination as to whether use is permitted: • Initial Determination as to whether site plan is required:,d Signature of Building Inspector Planning Department (P.D.) Referral:_ P.D. Date Received:66 0"S /01" Date of Comment: 06 / o-3 /0'1� Final Determination Date: 0 0 Decision: ;.._ of Adiienflinrg Dept. Staff Reviewer So Signature of Building Inspector Ll vAA.AJ*4'j'% : AJLl til\11Y1L` 1\ 1. TOWN HALL SOUTHOLD, .Y 1147,04 TEL: 78-1802 Examined , 20 Approved 20 Disapproved a/c Do 40ve or need the following, before applying ` Board of Health 3 sets of Building Plans Survey { PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees — Contact:. X�I Z Mail to: A01g 16 Phone: -23-1-5'300 Building Inspector APPLICATION FOR BUILDING PERMIT , INSTRUCTIONS Date 20 a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on*premises, relationship to adjoining premises or public streets or Q=d. waterways. TM'•�"'•cKieD•uuvneD fNT - commenced before issuance of Building Permit. DATE ON TH• FpU-pW'NO gGj'M AMOUNT onnlicant.. Such a permit C. J. VAN BOURGONDIEN, INC. SAY IT WITH FLOWERS 22429 P.O. BOX 2 PECONIC, NY 11958 TOTAL OF INVOICE LESS _% DISCOUNr PAY TO THE DATE. v�/;Zao�-32/210 - LESS FraEioHT ORDER OF OGt,/ o—�-S�° LESS TOTAL DEDUCTIONS U � YlT' AMOUNT OF CHECK '`/ OFeet Oil AR5 ,'` agn SmalB�ness Services WW4ksw,n,Qy rov 11000 2 2 4 91I. alp• .0 2 1000 3 2 21: 0 71 10 0 20, q, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,url,var V. Name of owner of premises c, T V A..•i 13 a,/ Q A- l' a co ora . n, si (Name and title of cori Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. (as on`the tax roll or latest deed) f duly akoriztd officer officer) I. Location of land on which proposed work will be done: ivumoer Street Hamlet County Tax Map No. 1000 Section Block 1238 J:1 -7 Subdivision Filed Ma OT01Mt0.0N Lot (Name) WK;5t a �. State existing use and occupancy of premises and a. Existing use and occupancy ..._� intended use and occupancy of proposed construction: Intended use and occupancy �rPov)l�7 P �. Nature of work (check which applicable): New Building Addition_ —Alteration Repair Removal Demolition Other Work OE'stimated Cost If dwelling, number of dwelling units If garage, number of cars (Description) Fee (to be paid on filing this application) Number of dwelling units on each floor 4. If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front Rear, Height Number of Stories Dimensions of same structure with alterations or additions: Front Depth �epth Height Number of Stories Dimensions of entire new construction: Front �� RearlC,r Depth Height Number of Stories a. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner )1. Zone or use district in which premises are situated ) 2. Does proposed construction violate any zoning law, ordinance or regulation: i o l3 M Will lot be re -graded Will excess fill be removed from premises: Names of Owner of premi sed"130 Or,60 'J 4 FWAddress Phone No Name of Architect Address Phone No Name of Contractor Address Phone No. 15. Is this property within 100 feet of a tidal wetland? *YES NO 00 • IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED Rear 1 YES NO 73 y–i-100 (6 Provide survey, to scale, with accurate foundation plan and distances to property lines. rJ o 0 u t4)4 -n 4J t7. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. TATE OF NEW YORK) SS: 'OUNTY OF� 6-btf being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contrao above named, is the Agent, Corporate Officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; at all statements contained in this application are true to the best of his knowledge and belief; and that the work will be -rformed in the manner set forth in the application filed therewith. 'von) to bq ore me this` ' day of !{U--ne, 20bi No ry Public BET W-71 %00 � � mp ;11WI tj � SignatureAf Applicant I A ` � . * r�l PLANNING BOARD MEMBERS BENNETT ORLOWSKI, JR. Chairman RICHARD CAGGIANO WILLIAM J. CREMERS KENNETH L. EDWARDS MARTIN H. SIDOR 1] PLANNING BOARD OFFICE TOWN OF SOUTHOLD APPLICATION FOR CONSIDERA11ON 01- A Sl New --Change of Use --Re-use ------Fxtensior) —Revision of Approved Site Plan Name of Business or Site P.O. Box 1179 Town Hall, 53096 State Route 26 Southold, New York 11971-0959 Telephone (631) 765-1938 Fax (631) 765-3136 Date Received Date Completed .Filing Fee F7 CA �z L SCTM#: 1000- E57 Qv' Location 2 5 — ---------- - Ad (I_J12. e- j3 Address of Applicant: Telephone: Owner of Land: Agent or Person responsiblE for application: Address: Telephone: Site Plans prepared by Licerise No &L ----S-ec> -6 * -jLAO -14f- 4 q AdiresC,x -Root Telephone: ' 1 Page 2 Planning Board Site Plan Applicatlon APPUCANT'S AFFIDAVIT STATE OF NEW YORK COUNTY OF SUFFOLK being duly sworn, deposes and says that he resides at in the State of New York, and that he is the owner, of the above property, or that he is the _of rrltie) (Specify whether Partnership or Corp.) which is hereby making application; that there are no existing structures or improvements on the land which are not shown on the Site Plan; that the title to the entire parcel, Including all rights-of-way, has been clearly established and is shown on said Plan; that no part of the Plan irfringes upon any duly filed plan which has not been abandoned both as to lots and as to roads; that he has examined all rules and regulations adopted by the Planning Board for the filing of Site Plans and will comply with same; that the plans submitted, as approved, will not be altered or, changed in any manner without the approval of the Planning Board; and that the actual physical Improvements will be Installed in strict accordance with the plans submitted. Signed — ( er) Signe (Partner or Corporate Office and Title) Sworn tyhisdao n'—"2w% (Notar SUSAN K TOOKER NOTARY PUBLIC, State of New York No .01705078120 Qualified in Suffolk County Commission Expires May 1 % /,i r1! ' +! , r Page 3 Planning Board Site Plan Application 23-4F -4 otal Land Area of Site (acres or square feet) A c zoning District /// AC Existing Use of Slte Soca l(osj;ccJ 4r -e P/Q.4S +- Flower Proposed Uses on Site. Show all uses proposed and existing. Indicate which building will have which use. If more than one use Is proposed per building, indicate square footage of floor ar,eea that will be reserved per use. Gross Floor Area of Existing Structure(s) J 44/1 y3 V �s�' r)Gross Floor Area of Proposed Structure(s) 17, 6 �5 4 F PR&E-A /p .7 3 Percent of Lot Coverage by Buildings) Percent of Lot for Parking (where applicable) Percent of Lot for Landscaping (where applicable) Has applicant been granted a variance and/or special exception by Board of Appeals - Case # & date Board of Trustees -Case # & date NY State Department of Environmental Conservation - Case # & date Suffolk County Department Health Services - Case # & date Case Number Name of Applicant Date of Decision Expiration Date Other v P°t. Will any toxic or hazardous materials, as defined by the Suffolk County Board of Health, be stored or handled at the site? e's if so, have proper permits been obtained? $ ame of Issuing agency /o —o t S 1 Number and date of permit Issued. ghlo 3-81%/09 )9tV'V '.-'/ NO ACTION (EXCAVATION OR CONSTRUCTION) MAV BE UNDERTAKEN UNRL APPROVAL OF SITE PLAN BY PLANNING BOARD. VIOLATORS ARE SUBJECT TO PROSECUTION. - ! • Site Plan Applications 14 Public Hearings Under the current site plan application procedure, the process for reviewing a site plan application is: a public hearing is not scheduled and held by the Planning Board until after, among other things, the site plan has received a stamped Health Department approval. The applicant shall now have the following options: To follow the established procedure, or 2. To have the Planning Board schedule and hold a public hearing on the site plan application and have the Planning Board vote on the proposed conditional site plan prior to the applicant receiving Health Departrpent approval subject to the following conditions: A. The applicant hereby agrees and understands that if the site plan which receives stamped -Health Department approval differs in any way from the proposed conditional site plan on which the Planning Board held a public hearing and voted on, then the Planning Board has the right and option, if the change is material to any of the issues properly before the Planning Board, to hold a public hearing on this "revised" site plan application and review its conditional approval. B. The applicant agrees not to object to a new public hearing and Planning Board review of the revised application. Applicant Agreement on Site Plans The applicant is aware of the terms of this approval and certifies to these terms by his/her signature below. jo SCTM#: 1000- 1Aq o Applicant D to FORM NO. 3 NOTICE OF DISAPPROVAL DATE: July 19, 2004 TO: CJ Van Bourgendien PO BOX 2 Peconic, NY 11958 Please take notice that your application dated June 14, 2004 For permit to construct a greenhouse at Location of property: 39395 Main Road, Peconic County Tax Map No. 1000 - Section 85 Block 2 Lot 7 Is returned herewith and disapproved on the following grounds: The proposed construction on this conforming lot in the AC district requires site plan approval from Note to Applicant: Any change or deviation to the above referenced application, may require further review by the Southold Town Building Department. CC: file, Planning Board JUL 21 2004 11 Southold Town Planning Boar+ • FORfINTERNAL USE ONLY • SITE PLAN USE DETERMINATION Initial Determination Date: �p / / ff /� Project Name: (fj- V4,V Project Address: �3 c'3 7 r Mct,;, Date Sent: ( / //g- / 4— Suffolk County Tax Map No.:1000- Y - � Zoning District: A -6 - Request: (Note: Copy of Building Permit Application and supporting documentation as to proposed use or uses should be submitted.) Initial Determination as to whether use is permitted: 4 c.,—Ie Initial Determination as to whether site plan is required:,d�� Planning Department (P.D.) Referral:_ P.D. Date Received:06 1,'S /07"( Signature of Building Inspector Date of Comment: 06 / 23 /074 `gnat re of Plddhifinrg Dept. Staff Reviewer Final Determination Date: / / V0,004 Decision: 0 Signature of Building Inspector NYSRPS ASSESSMENT INQUIRY DATE 07/26/2004 473889 SOUTHOLD SCHOOL SOUTHOLD SCHOOL ROLL SEC TAXABLE ORCLS 170 NURSERY TOTAL RES SITE 85.-2-7 TOTAL COM SITE 39395 MAIN RD ACCT NO 10 = OWNER & MAILING INFO =__ =MISC________ ______ ASSESSMENT DATA VANBOURGONDIEN C J INC RS-SS **CURRENT** RES PERCENT MAIN ROAD 1 LAND 8,400 **TAXABLE** PO BOX 2 BANK TOTAL 53,400 COUNTY 34,400 PECONIC NY 11958 **PRIOR** TOWN 34,400 (LAND 8,400 SCHOOL 34,400 TOTAL 53,400 ==DIMENSIONS =__ SALES INFORMATION ACRES 33.68 BOOK 10711 SALE DATE 00/00/00 PAGE 00139 PR OWNER =======TOTAL EXEMPTIONS 2TOTAL SPECIAL DISTRICTS 3 CODE AMOUNT PCT INIT TERM VLG HC OWN CODE UNITS PCT TYPE VALUE 41720 7,300 04 FD028 41700 11,700 97 07 WW020 SWO11 F1=NEXT PARCEL F3=NEXT'EXEMPT/SPEC F4=PREV EXEMPT/SPEC 75.10- 03-050 F6=G0 TO INVENTORY F9=G0 TO XREF F10=G0 TO MENU S��-2 -7 g ri AC R-80 473889 85.-2-7 OWNER: C J INC VANBOURGONDIEN NUMBER #% DATE TYPE CO USE/DESCRIPTION 11553 8/06/84 PERMIT STORAGE BUILDING 12852 2/01/84 PERMIT AGRIC BLDG PERMOT ##12852 CONS 14001 6/03/85 PERMIT 16188 GREENHOUSE 17511 10/06/88 PERMIT PERMIT #17511 AGRICULTURAL G 21774 11/12/93 PERMIT 23873 BP# 21774Z Construct an addit 23042 10/04/95 PERMIT REMOVE BUILDING 23544 6/28/96 PERMIT 25592 ADDITON 0/00/00 0/00/00 0/00/00 F1=More F7=Permit Detail F8=Co Detail F9=Preco F12=New Swis/Parcel F3=Exit BPXO1 *** BUILDING - - - - - - - P R - MIT -APPLICATION-***----- ------7/26/04--11_31_03 -------- : ---------- TAXII7: 473889 85.-2-7 PERMIT##: *52 APPLY#: OWNER: VANBOURGONDIEN, C J INC MAP: LOT: ADDR: PO BOX 2 MAIN ROAD LOC: 39395 MAIN ROAD/ROUTE 25 PECONIC, NY 11958 HAMLET APPLY DATE: 0/00/00 PERMIT DATE: 2/01/84 DENY DATE: 0/00/00 VERIFIED BY: VERIFY DATE: 0/00/00 EXPIRATION: 99/99/99 USE CODE: USE: BUILDING#: 0 OF: 0 SUBDIVISION RO#: MAX HGT: ZONING DISTRICT: PLOT SIZE: AREA: YARDS SETBACK FRONT: SIDES: REAR: PERMIT OWNER/AGENT: VANBOURGONDIEN, C J INC ADDRESS: PO BOX 2 MAIN ROAD CITY: PECONIC STATE: NY ZIP: 11958 DESCRIPTION: AGRIC BLDG PERMOT 12852 CONSTRUCTION OF AG. BUILDING COZ-16188 WETLANDS Y N: _ COASTAL EROSION Y N: _ TRUSTEES APPROVAL DATE: 0/00/00 PLANNING BOARD APPROVAL DATE: 0/00/00 DEC APPROVAL DATE: 07-00-7-00- ZBA APPROVAL DATE: 0700700 FLOOR AREA: 0 VALUE OF WORK: .00 FEE CODE: FEE: .00 ADD/CHG/DEL: CHANGE F1=Next Permit F2=Summary F3=Exit F7=Reprint F8=C0 F9=Denial F12=Clear BPXO1 *** BUILDING P,�RMIT -APPLICATION-***----- ---------v-------------- -�- ------7/26/04--11_31:07 -- TAXII7: 473889 85.-2-7 PERMIT##: lfoo1 APPLY#: OWNER: VANBOURGONDIEN, C J INC MAP: LOT: ADDR: PO BOX 2 MAIN ROAD LOC: 39395 MAIN ROAD/ROUTE 25 PECONIC, NY 11958 HAMLET APPLY DATE: 0/00/00 PERMIT DATE: DENY DATE: 0/00/00 -6/037-85 VERIFIED BY: VERIFY DATE: 0/-0-0--/-00 EXPIRATION: 99/99/99 USE CODE: USE: GREENHOUSE BUILDING#: 0 OF: 0 SUBDIVISION RO#: MAX HGT: ZONING DISTRICT: PLOT SIZE: AREA: YARDS SETBACK FRONT: SIDES: REAR: PERMIT OWNER/AGENT: VANBOURGONDIEN, C J INC ADDRESS: PO BOX 2 MAIN ROAD CITY: PECONIC STATE: NY ZIP: 11958 DESCRIPTION: ADD GRNHSE PERMIT #14001 CONSTRUCT AG. BUILDING COZ-16187 WETLANDS Y N: COASTAL EROSION Y N: _ TRUSTEES APPROVAL DATE: 0/00/00 PLANNING BOARD APPROVAL DATE: -0/00/00 DEC APPROVAL DATE: 0/00/06 ZBA APPROVAL DATE: 0 00 00 FLOOR AREA: 0 VALUE OF WORK: .00 FEE CODE: FEE: .00 ADD/CHG/DEL: CHANGE F1=Next Permit F2=Summary F3=Exit F7=Reprint F8=C0 F9=Denial F12=Clear BPX01 *** BUILDINGRMIT- APPLICATION -***----- - - --------- Y - - - - - - - - - - - - - - - -w ------------------------ ------7/26/04--11_31_11 TAXIIT: 473889 85.-2-7 PERMIT#: 17511 APPLY#: OWNER: VANBOURGONDIEN, C J INC MAP: LOT: ADDR: PO BOX 2 MAIN ROAD LOC: 39395 MAIN ROAD/ROUTE 25 PECONIC, NY 11958 HAMLET APPLY DATE: 0/00/00 PERMIT DATE: 10/06/88 DENY DATE: 0/00/00 VERIFIED BY: VERIFY DATE: 0 00 00 EXPIRATION: 99/99T99 USE CODE: USE: BUILDING#: 0 OF: 0 SUBDIVISION RO#: MAX HGT: ZONING DISTRICT: PLOT SIZE: AREA: YARDS SETBACK FRONT: SIDES: REAR: PERMIT OWNER/AGENT: VANBOURGONDIEN, C J INC ADDRESS: PO BOX 2 MAIN ROAD CITY: PECONIC STATE: NY ZIP: 11958 DESCRIPTION: PERMIT #17511 AGRICULTURAL GREENHOUSE WETLANDS Y N: COASTAL EROSION Y N: _ _ TRUSTEES APPROVAL DATE: 0/00/00 PLANNING BOARD APPROVAL DATE: 0/00/00 DEC APPROVAL DATE: 0 00 00 ZBA APPROVAL DATE: 0 00 00 FLOOR AREA: 0 VALUE OF WORK: .00 FEE CODE: FEE: .00 ADD/CHG/DEL: CHANGE F1=Next Permit F2=Summary F3=Exit F7=Reprint F8=C0 F9=Denial F12=Clear BPXO1 *** BUILDINGRMIT APPLICATION-***----- 11:31:15 --------- .----------------- --------- ------7/26/04- ------- TAXIa: 473889 85.-2-7 PERMIT#: 21774 APPLY#: OWNER: VANBOURGONDIEN, C J INC MAP: LOT: ADDR: PO BOX 2 MAIN ROAD LOC: 39395 MAIN ROAD/ROUTE 25 PECONIC, NY 11958 HAMLET APPLY DATE: PERMIT DATE: 11/127-93 DENY DATE: 0/00/00 -0/00/00 VERIFIED BY: VERIFY DATE: 0 00 00 EXPIRATION: 5/12/95 USE CODE: USE: BUILDING#: 0 OF: 0 SUBDIVISION RO#: MAX HGT: ZONING DISTRICT: PLOT SIZE: AREA: YARDS SETBACK FRONT: SIDES: REAR: PERMIT OWNER/AGENT: VANBOURGONDIEN, C J INC ADDRESS: PO BOX 2 MAIN ROAD CITY: PECONIC STATE: NY ZIP: 11958 DESCRIPTION: BP# 21774Z Construct an addition to existing agricuI-t—ural--su—ildin as applied for. WETLANDS Y N: COASTAL EROSION Y N: _ TRUSTEES APPROVAL DATE: 0/00/00 PLANNING BOARD APPROVAL DATE: -0/00/00 DEC APPROVAL DATE: 0 00 00 ZBA APPROVAL DATE: -0-TO-0-7-00 FLOOR AREA: 0 VALUE OF WORK: .00 FEE CODE: FEE: .00 ADD/CHG/DEL: CHANGE F1=Next Permit F2=Summary F3=Exit F7=Reprint F8=C0 F9=Denial F12=Clear BPXOl-***-BUILDING RMIT APPLICATION-***----- ------7/26/04--11:31:18 ---------; -- TAXID`: 473889 85--2-7 PERMIT##: 23042 APPLY##: ---- OWNER: C J INC VANBOURGONDIEN MAP: LOT: ADDR: MAIN ROAD LOC: 39395 MAIN RD PECONIC NY 11958 HAMLET SOUTHOLD APPLY DATE: 9/18/95 PERMIT DATE: 10/04T9-5 DENY DATE: 0/00/00 VERIFIED BY: JMB VERIFY DATE: 10 04 95 EXPIRATION: -4-70-4-79-7 USE CODE: USE: REMOVE BUILDING BUILDING#: 0 OF: 0 SUBDIVISION RO#: MAX HGT: ZONING DISTRICT: PLOT SIZE: AREA: YARDS SETBACK FRONT: SIDES: REAR: PERMIT OWNER/AGENT: C J INC VANBOURGONDIEN ADDRESS: MAIN ROAD CITY: PECONIC NY 11958 STATE: ZIP: DESCRIPTION: REMOVE AN EXISTING 24 X 30 BARN FROM A FARM AREA AS APPLIED FOR. WETLANDS Y N:_ _ COASTAL EROSION Y N: TRUSTEES APPROVAL DATE: 0/00/00 PLANNING BOARD APPROVAL DATE: 0/00/00 DEC APPROVAL DATE: Z70070-0 ZBA APPROVAL DATE: -Z7-0-0T—OO FLOOR AREA: 720 VALUE OF WORK: 1,000.00 FEE CODE: DEM FEE: 57.00 ADD/CHG/DEL: CHANGE F1=Next Permit F2=Summary F3=Exit F7=Reprint F8=C0 F9=Denial F12=Clear BPXO1 *** BUILDINGP RMIT-APPLICATION-***----- ------7/26/04--11_31_23 -------------------------- Y TAXID: 473889 85.-2-7 PERMIT#: 24044 APPLY##: OWNER: C J INC VANBOURGONDIEN MAP: LOT: ADDR: MAIN ROAD LOC: 39395 MAIN RD PECONIC NY 11958 HAMLET SOUTHOLD APPLY DATE: 6/06/96 PERMIT DATE: 6/28/96 DENY DATE: 0/00/00 VERIFIED BY: JMB VERIFY DATE: 6T28 96 EXPIRATION: 12/28/97 USE CODE: USE: ADDITON BUILDING#: 0 OF: 0 SUBDIVISION RO#: MAX HGT: ZONING DISTRICT: PLOT SIZE: AREA: YARDS SETBACK FRONT: SIDES: REAR: PERMIT OWNER/AGENT: C J VANBOURGONDIEN, INC. ADDRESS: MAIN ROAD CITY: PECONIC NY 11958 STATE: ZIP: DESCRIPTION: CONSTRUCT A GREENHOUSE ADDITION TO AN EXISTING FARM BUILDING AS APPLIED FOR. WETLANDS Y N: COASTAL EROSION Y N: _ TRUSTEES APPROVAL DATE: 0/00/00 PLANNING BOARD _ APPROVAL DATE: 0/00/00 DEC APPROVAL DATE: 0 00 00 ZBA APPROVAL DATE: 0 00 00 FLOOR AREA: 0 VALUE OF WORK: 68,000.00 FEE CODE: FAR FEE: 50.00 ADD/CHG/DEL: CHANGE F1=Next Permit F2=Summary F3=Exit F7=Reprint F8=C0 F9=Denial F12=Clear C. VAN BOURGONDIEN RC. WHOLESALE PLANT & FLOWER GROWERS P.O. Box 2 - Main Road - Peconic, NY 11958 (631) 734-5300 - FAX (631) 734-5480 h - /-/ V, 0 lo A+ al, 3 -/ V a V C- V o70 PNi 3,3Sln°I I ce cj L(? S � EQ �5,'9� � / • q S el) �r'tB�.l a � 'A 696 --a C-6 _ u -71 S- I o W y -S -- C l96 ) - 0 GC- 6- Xd���.c 6 o /° o Fri Lf, r 44s'04't ° 50 + 21 394 50 + 3 9 07ff ° y.0 + 3»5)2 ° 90 24'2.4' 41. 10 948-00 + 53921.40 49600.10 0 696.20 715.00 1'961.00 q la 3 QGAK 19gCA s'ro gA" 3jL% pga Jc,'��,-33;6 S TO OLM-9 Svpp Ll 6-1C, B/ v t��'i�•q � O r G �°`�� O J p pAb0vcr/oN Rjj© vTIL-(ZED Fv(L G-Roc.V p�73 % AroN 4- 17, 6 Yn l 3 162) / 617.20 • Appendix C • State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only ..�.,.� ,r ►. .., (mart by Annlirnnt nr ProieCt Sponsor) PART I - PKUJtG I IIVrUKmH i 1VIV t r v uc 2, PROJECT NAME n rr 1. APPLICANT/SPONSOR rn,✓ �vt- a� d i e.� .�iv� 7,8%- 2 -e 3. PROJECT LOCATION: rj 1 I� Municipality aC0rNt sov� hp T c��..�'v County ,J o d. PRECISE LOCATION (Street address and r d intersections, prominent landmarks etc., or rovide map) PQ_C_C V �..�U y l 0 9 3 5 n��!,�• 9 14 c f -o sS 5 . /1/ea,e ACROSS _,prom 5. PROPOSED ACTION IS: ❑ New ? pEnsion 1:1 Modification/alleration 6 DESCRIBE PROJECT BRIEFLY. 1 I" ¢e O cJ S� s �t J J Yd s IV F7- j 7 c) 7. AMOUNT AFFEC Initially Ultimately =actes 8. WILL PROP ED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 20'Yes No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? RResidential LJ Industrial Commercial Agriculture D Park/ForesUOpen Space Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR UL 11MATELY FROM ANY OTHER GOVERNMEN iAL AGENCY (FEDERAL, STATE OR LOCAL)? Yes No If Yes, list agency(s) name and permit/approvals: 1 t W DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 9 -yes ❑ No If Yes, list agency(s) name and permiVapprovals: l o� N S J4 I C t/ LIrU F -4-64 4A VEL I A RPPR aVa�z �R Y 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? Yes ®'No _ I CERTIFY THAT TqE INFORMATION PROVIDED A OV_E IS TRUE TO THE BEST OF MY KNOWLEDGE E. 1 d C �+ , t-- Date: Q ApplicanVsponsor name: C ~ i3 U 4j' n-27,V10/6'/ Signature. If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with is assessment OVER 1 A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review process and use the FULL EAF. El Yes E?No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be supersededk another invotved agency. [] Yes No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C 1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding prob ms? Explain briefly: b, `i"w o, d ve/'s r 1y ss-i���-I� W"'M I f +y of �� _1y - C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: iN C C3 Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain bfiefly. V 0 C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: NO CS. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: WA C6. Long term, short term, cumulative, or other effects not identified in C1-057 Explain briefly: C7. Other impacts (including changes in use of either quaint _4 orof energy?, Explain briefly: E F F( C if Er- C r tars y it s X cr j A, L51 s r.vF kG-)i' us E 4R M INVIO-a L. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL REA (CEA)7 13 Yes FNo If Yes, explain briefly: E. -IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Yes lK N If Yes, explain briefly: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude, if necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental charactenstics of the CEA. Check this box If you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL and/or prepare a positive declaration. 0 Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determination, Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Date Title of Responsible Officer Signature of Preparer (If different from responsible officer) Town Of Southold�- • P.O Box 1179 Safi Southold, NY 11971 ***RECEIPT*** Date: 08/09/04 Receipt#: 2471 Transaction(s): Subtotal 1 Application Fees $1,182.00 Check#:2471 Total Paid: $1,182.00 Name: C, J Van Bourgondien Inc POBox 2 Peconic, NY 11957 Clerk ID: LINDAC Internal ID: 99310 14 I)N ia- 'al(; No( W ..1 W� ��(( ci <W +vay ftox 34:130:0 l, E-- ng ZI wu zWZ A0 W�S��W1�� W<T w ju I-Zzwzwzt iicPC<w ! rAhhn-P-K—t ,UIG N**21,VQ g-J-21w9v gg.vq .OZ = ..I ,)q 110a)J3 NOu:)nvIs NO:) 40 NDIS30 b0j 31%ilSN04S* ION ^glildWol 90f M314M IVNIJ '-E '-N11"d4a ONI "NVAIVYLS VO N-011 ON1 1110009 3%dOA39 t S��7I1���#SNt �•, �? N YYd* 01 '.NV6 099Z-S`V DMIC-uns ),4110N C1310N W (31AOUIV 0 I J H W ..1 W� ��(( ci <W +vay ftox 34:130:0 l, E-- ng ZI wu zWZ A0 W�S��W1�� W<T w ju I-Zzwzwzt iicPC<w ! rAhhn-P-K—t ,UIG N**21,VQ g-J-21w9v gg.vq .OZ = ..I ,)q 110a)J3 NOu:)nvIs NO:) 40 NDIS30 b0j 31%ilSN04S* ION ^glildWol 90f M314M IVNIJ '-E '-N11"d4a ONI "NVAIVYLS VO N-011 ON1 1110009 3%dOA39 t S��7I1���#SNt �•, �? N YYd* 01 '.NV6 099Z-S`V DMIC-uns ),4110N C1310N W (31AOUIV 0 m 'r 22 FLOOR PLAN � /8 1) 1'_0" u FAI=m iV. OA CB) 0 (D) OE iu -0.uuu , I _0.uuu I -0.uuu I iu -0.uuu , lu —0.uuu , I —0.uuu iu —0.uuu I Iu —0.uuu r t t I I I I 1 I I I I I N _O I _0 I a� 4 %n _N 0 v) 3 _N O 2 LO N T7 O I - FOUNDATION DETAILS 0 0 0 0 - I r 7E � _ I N O I n N O I r n � I I N O N O I I r n I I N O 0 0 I I M I N I I Y I N 0 I I r XT REHUE - II I I I I in - 0.125" 0.125" 1'-8.000" Y k_ INTERIOR POST DETAIL 1'-8.000„ GABLE POST DETAIL 0.125' 0.125" DRAWING LIST 009-002—LD-001 FOUNDATION PLAN 84'— .000" 009-002—LD-002 FLOOR PLAN / ELEVATIONS 009-002—LD-003 STRUCTURAL SECTION 21'—C.000" 21'—C.000" 21'—C.000" ,-GEN"RAL 21'—C.000" 1.00 STRUCTURAL STEEL TUBING ASTM A500, GRADE B. .01 ` ALL STRUCTURAL STEEL HOT DIP GALVANIZED AFTER FABRICATION PER ASTM A123—G85. .02 iu -0.uuu , I _0.uuu I -0.uuu I iu -0.uuu , lu —0.uuu , I —0.uuu iu —0.uuu I Iu —0.uuu r t t I I I I 1 I I I I I N _O I _0 I a� 4 %n _N 0 v) 3 _N O 2 LO N T7 O I - FOUNDATION DETAILS 0 0 0 0 - I r 7E � _ I N O I n N O I r n � I I N O N O I I r n I I N O 0 0 I I M I N I I Y I N 0 I I r XT REHUE - II I I I I in - 0.125" 0.125" 1'-8.000" Y k_ INTERIOR POST DETAIL 1'-8.000„ GABLE POST DETAIL 0.125' 0.125" DRAWING LIST 009-002—LD-001 FOUNDATION PLAN 009-002—LD-002 FLOOR PLAN / ELEVATIONS 009-002—LD-003 STRUCTURAL SECTION ,-GEN"RAL NOTES 1.00 STRUCTURAL STEEL TUBING ASTM A500, GRADE B. .01 ` ALL STRUCTURAL STEEL HOT DIP GALVANIZED AFTER FABRICATION PER ASTM A123—G85. .02 ALL STANDARD FASTENERS NON—MAGNETIC GALVANIZED STEEL. 2.00 ALUMINIUM EXTRUSIONS 6061—T6 OR 6063—T6. .01 ALL GLAZING BAR CLIPS WITH STAINLESS STEEL T—BOLTS .02 STEEL GUTTERS MODEL APD COMPLETE WITH STANDARD ACCESSORIES. .03 STANDARD ALUMINIUM ROOFVENTS WITH RUBBER GASKET. .04 STANDARD ALUMINIUM GABLE VENT SECTIONS. .05 ALL GLAZING BARS IN DE OUTSIDE WALL EN PARTITIONS COVERED WITH NEOPRENE RUBBER OR HOSTALITE BARCAPS .06 ALLUMINIUM MULLIONS AT ALL HORIZONTAL JOINTS BETWEEN THE GLASS LITES. 3.00 ALL TEMPERED GLASS MANUFACTURED AS PER ASTM C-1048-92; 5/32" THICK. rr...wr r' ,Ilf PROJECT C.J. van Bourgondien, Inc Main Road Peconic, NY 11958 SUBJECT FLOOR PLAN DATE 01-06-2004 DRAWN KvR SK DRAWINGNUMBER FORMAT (34"x34") SCALE NOTED 019—LD-01 REVISIONS -- — -- — -- -- — -- — -- �.-.�� I iilWl f I I 6 200-,� i d Town ELEVATIONS 1 2 C-33) 4 (5) 6 7 8 9 n10 11 n12 n13 5 6 7 8 9 n10 n1l n12 13 NIVN I LLLVA I IUN (13 12 11(DO 9 8 7 6 5 13 n12 11 nio 9 8 7 6 5 4 n,3 2 1 84'- .000" 21'-C.000" 21'-C.000" 21'-C.000" 210'- 0.000" 21'-C.000" I 21'-C.000" 21'-C.000" 21'-C.000" „ 9'-10.125" g'-10.125" 9'- 10. 125 9 -10.125 9'-10.125" -10.125 g'-10.125 9 -10.125 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125L4 9 -10.125 9'-10.125" 13 -1.500 9'-10.125" 9'-10.12'5" 9'- 10. 125 9'-10.125" 9'-10.125" NIVN I LLLVA I IUN (13 12 11(DO 9 8 7 6 5 13 n12 11 nio 9 8 7 6 5 4 n,3 2 1 I I I I I I I I I I LEFT ELEVATION (EXISTING SIDEWALL) OA O lb D I 84'- .000" 21'-C.000" 21'-C.000" 21'-C.000" 210'- 0.000" 21'-C.000" I 21'-C.000" 21'-C.000" 21'-C.000" „ , ,. , is 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 13'-1.500" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 9'-10.125" 4 I I I I I I I I I I LEFT ELEVATION (EXISTING SIDEWALL) OA O lb D I 84'- .000" 21'-C.000" 21'-C.000" 21'-C.000" 21'-C.000" 21'-C.000" I 21'-C.000" 21'-C.000" 21'-C.000" „ , ,. , is , „ 10'-6-000" 10'-6.000" 10'-6.000" 10'-6.000" 10'-6.000" 10'-6.000" 10'-6.000" 10'-6.000" 43 IN IN 10 - 6.000 10 - 6.000 I 10-6.000 10-6.000 1 10'-6.000" 10'-6.000" I 10'-6.000" 10 - 6.000" I NUN I LLLVA IIUN BACK ELEVATION -." PROJECT C.J. van Bourgondien, Inc Main Road Peconic, NY 11958 SUBJECT ELEVATIONS DATE 01-06-2004 DRAWN KvR SK DRAWINGNUMBER FORMAT ARCH D (36"x24") SCALE 1/8' 1'-0" 019 -LD -02 REVISIONS -- - -- - -- -- - -- _ -- -- _ -- _ -- 84'-Q.000" 21'-C.000" 21'-C.000" 21'-C.000" 21'-C.000" „ , ,. , is , „ 10 - 6.000 10 - 6.000 I 10-6.000 10-6.000 1 10'-6.000" 10'-6.000" I 10'-6.000" 10 - 6.000" I NUN I LLLVA IIUN BACK ELEVATION -." PROJECT C.J. van Bourgondien, Inc Main Road Peconic, NY 11958 SUBJECT ELEVATIONS DATE 01-06-2004 DRAWN KvR SK DRAWINGNUMBER FORMAT ARCH D (36"x24") SCALE 1/8' 1'-0" 019 -LD -02 REVISIONS -- - -- - -- -- - -- _ -- -- _ -- _ -- STRUCTURAL SECTION )ETAIL 1 3"=1' PROJECT SUBJECT DATE FORMAT REVISIONS 1/2" = 1' C.J. van Bourgondien, Inc Main Road Peconic, NY 11958 STRUCTURAL SECTION 01-06-2004 DRAWN KvR SK DRAWINGNUMBER (24"x24") SCALE NOTED 019-LD-03 ------------------------