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1000-145.-4-17
OFFICE LOCATION: ���OF SO(/���1 ��NG ADDRESS: Tovvn Hall Annex � � P.O. Box 1179 54375 State Route 25 ` . �,� " Southold, NY 11971 � (cor. Main Rd. &Youngs Ave.) u9 ' �'�. �c Southold, NY 11971 � � '�p� Telephone: 631 765-1938 �`�COUIVrI,�� 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 � July 21, 2015 Re: Coastal Consistency Review for ZBA File Ref. CHRISTOPHER ARIENS #6875 SCTM# 1000-145-4-17 CHRISTOPHER ARIENS#6875 - Request for Variances from Article XXIII Section 280-124 and Article , XXII Section 280-116B and the Building Inspector's May 29, 2015 Notice of Disapproval based on an � application for demolition of existing single family dwelling and construction of a new single family dwelling, at; 1) less than the minimum code required front yard setback of 35 feet, 2) less than the code required bulkhead setback of 75 feet, located at: 455 MacDonald Crossing (corner MacDonald Road) (adj. to Great Peconic Bay) Laurel, NY. SCTM#1000-145-4-17 , 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 actions are CONSISTENT with the below denoted Policy Standards and therefore are CONSISTENT with the LWRP based on the following: 1. Site inspection immediately following the storm Sandy revealed that this area was subject to severe flooding and damage. 2. Due to the size of the parcel there is no to little ability to relocate structures outside of the 0.2 Percent Annual Chance Flood Hazard Areas (figure 1). Due to the extent of the flood zone, a shift of the structure would not prevent flooding threats; rather the raising of the first floor elevation would be more effective. The base flood elevation is 6'. The proposed floor elevation is 10'. 1"he new design mitigates (lessens) threat of property damage from storm . events and furthers the LWRP policies. 3. Storm water controls are not show on the plans, it is recommended that subsurface storm water controls be sited landward of the structure. 4. A test hole is not shown and the depth to groundwater is unknown. A test hole should be required to appropriately site the sanitary systems with consideration to the structure. 5. In the event that the action is approved, the establishment of a landscaped or non-turf, vegetated buffer of native plant species should be required landward from the bulkhead to . further Policy 6. 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Ya../;� :�VJ.d'}�" �' ,�j'�.�',��f��,��� ,t�� `�rf� �t,�'r•+'s ,r �,�j� ....Yd''"Ae,d.^.7f 'C.�.�. _._...�..._._�___.._-------- � .°� ..d�,r.�s�'! .��r'f�,!'!!Y.'a .�.ff.+"{f�.�",/�.!�,'S ``r .,')li'.f"�f!=..r°'�.°J``,�,.�.�, J°t".�".�..:i:�,�.-9 vY.r".°.ri.a�.ze.m.� ��,f°.s�' ! Figure 1. Subject parcel � 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: Stephen Kiely, Assistant Town Attorney BOARD MEMBERS . OF $���, Southold Town Hall Leslie Kanes Weisman,Chairperson �� yp 53095 Main Road•P.O.Box 1179 �� �O Southold,NY 11971-0959 Eric Dantes �c �c Office Location: Gerard P.Goehringer G Q Town Annex/First Floor,Capital One Bank George Horning �'� � ,��`a� 54375 Main Road(at Youngs Avenue) Kenneth Schneider ly�'Q�����v Southold,NY 11971 http://southoldtown.northfork.net � ZO1vING BOARD OF APPEALS D �' (� � � � � TOWN OF SOUTHOLD Tel.(631)765-1809•Fax(631)765-9064 .���9 � � 2Q9� June 23, 2015 sautho�dToam � P�an�ring Board Mark Terry, Principal Planner LWRP Coordinator Planning Board Office � Town of Southold Town Hall Annex . Southold,NY 11971 Re: ZBA File Ref.No. #6875—Ariens, Christopher Dear Mr. Terry: We have received an application for demolition of existing and construction of a new dwelling in Laurel. 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 K. Weisman Chairperson BY'C,�� � L� � Encls. FORM NO. 3 � !� TOWN OF SOUTHOLD ���v BUILDING DEPARTMENT SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL DATE: May 29, 2015 TO: Christopher Ariens 455 MacDonald Crossing _ Laurel, New York Please take notice that your application dated May 15,2015 For permit for demolition of an existing single familv dwellin�and construction of a new sin�le family dwellin� at Location of property: 455 MacDonald Crossin�, Laurel,NY County Tax Map No. 1000—Section 145 Block 4 Lot 17 Is retumed herewith and disapproved on the following grounds: The proposed construction on this non-conforming 14 235 s�uare foot parcel in the Residential R-40 District, is not permitted pursuant to Article XXIiI Section 280-124 which states that lots measuring less than 20,000 square feet in total size rec�uire a minimum front yard setback of 35 feet. Following the proposed construction the sin�le familv dwellin�will have a front yard setback of 20 feet. In addition the proposed construction is not permitted pursuant to Article XXII, Section 280-116B, which states; � , � � "All buildings'1'ocated on lots�upou�which a bulkhead, concrete wall,riprap or similar structure exists � ' ' , � , � �' arid'which`a're adjacent to'tidal water bodies`otlier'tlian,sounds shall be set'back not'less'than severity- , �, ` �_' �_, _ �.=•five(75) feet•from the.bulkhead."� - :- .. = --- - --.�� . _._ .-_ -. . __ _`_ . . ., i�.. ' �_: '__� '_ . . . . . - .. _. - = - - - - - - -- - - - - - - � ; .� , - -- ._ '.� - - , - ,- _- -. -- --- ---.--- , -- - - -- ; _- -•-�-- , - _ '�y, - ..� �, . .- `_ • -- - , . , 4.`� �•,The'p'roposed�constr-uctio'n'notes a setback�of'+/-;33 feet�to the existin�-bulkhead.:��,- , . � , . " , '- ' ; ,`, . • ' - � . � . . . ,_ -, . _ :� ., `- . ,; , ,�. , _ -. : , . :. I ,. ' ','' , . • :. _ „ _ ', , . .:- . - . - �1��_ - _ ,: _ . ._ � , .,, ' . ' ' _ ' E , , `_<'��� � ` ',, ., . , ' ; - _ ' „- - , ,_- .'�, " �_ ` , , , , , , . ,. . . - - ------------'�=- -- ---=-=------- � � , .- , , , ., . , . . , - �'- �. ,- � . . ` _ ,, � , _ � -Aut �riz Signature . . - ' - -� , , ' , .,, � , . ' ' .. . . : �� �, , `', ,' � � ' , � , , . , . ,��'"` � - ' , , , ., Cc:File, ZBA Fee:$ Filed By: Assignment No. APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS AREA VARIANCE House No. Sl� Street'i"1�(i 4�J n.��1�1,��.��'_��et Vl�'l1� SCTM 1000 Section��Block�Lot(s)��Lot Size �� Zone� I(WE) APPEAL TI�WRITTEN DETERMINATION OF THE BUII.DING INSPECTOR DATED�� I��`,�BASED ON SURVEY/SITE PLAN DATED MT J�T2,0_I{� Owner(s): � �1��� � ��1 Qv�� Mailing Address:�� �i� �D �� �����_�y w������ Telephone: Fax• r� Email• G�c5 � �iI�V� t��6��� ��� NOTE:In addition to the above,please complete below if application is signed by applicant's attorney,agent, architect,builder,contract vendee,etc.and name of person who agent represents: •� Name of Representative:��� �l�f fe�('�Owner( )Other: Address: ��7,� �� i�1�� �o ��c��,�'� 1�� , Telephone• �j���j•���'ax� - Email• �U�� /�.��'!�IL'-� �Q���, �Ua�� D V�.� ` Please check to specify who you wi h correspondence to be mailed tv,from the above names: - - -� �pplicant/Owner(s); ' ��uth�rized-Represeutative; -(-j-Other-Name%Address below: -- � � -- -- -- __..___._,___._---,...�W�IEREBY�T-I�BU--II,DING-INSPEC-TOR REVIEWED-SURVEY/SITE PLAN-�-..�.�-.-..�__._.�-�.__.._.__^., �-..�---- , ' �DATEDI I�--.��(S �and�DENIED AN APPLICATION DATED /�' 2 ( FOR: �� � , .,`,y _'4 ;� -'�,-z. `_ ,4�.�� � - v''; "c, ' � .F�� � Vt 1 'E,«a�,` _ ;t:,. - , � ';�� r{,• _ ,'x , uildin' Permit, ;�,A _ .. , - - - .g- . -.,� - - . . . ;�: �f�i5 f� . 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Y _ , 9_ )' _ _ -. :, - , , ,.,-, _ �,- - _ - - - _ ��,. _ • - ectio"n�:� :��, - - . . - •;,Article.,` �)C� - _ .°Sectioii:: *b�,� �. -:Su6's _ - _,- ' -- . e�of A� 'eaL��tAn A eal',is�:made�for:'. =` - ''' �, - � - ;;� -- - �,. - - ��'P, PP� �� P.R ��,',,, „ � ' ' � ``�,' �� 'A,Variance'to the,Z`oning'Code'or'�Zoniiig-lVlap. , _' ,' � <", , �, , • � ,',' ,- � � ' ' \�A Va'riance-due:to lack'_of access required by New`York Town Law-S.ection'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 property, UNDER Appeal No(s). Year(s). . (Please be sure to research before complet:ng lhrs quest:on or call our office for asststance) Name of Owner: ZBA File# Name of Owner: ZBA File# REASONS FOR APPEAL (Please be specifzc, additiorral sheets may be used with preparer's signature notarized)• 1.An undesirable change will not be produced in the CHARACTER of the neighbor or a detriment to nearby properties if granted,because: �'1 �- �(��-n�� ����C',-��?� ' ��,����� gy /rS�y�� .�S (��t �—�cr�i��� �� N� I �7� �� I—�� � (...��� �� I�kc�- � C=.����1 v t�-��i �'�4(t.� �' (�U�-IL�� � �d� 'C�-IK� p(L��'��� �NS��f�or� - 2.The benefit sought by the applicant CANNOT be achieved by some method feasible for the ap licant� pursue,other than an area variance,because: �t..�,� ���– �,��j� O � '� 1 y�Pds� CfltvSi�C`n al� l�'�S ��l 't2��� � � } '� �I1��5 �� (��0 t�C� �--�7 T�" �(.)E�!/'�� � 11-(� � (LL.��� �[ I�.�I ��ig� 3.The amount of relief requested is not substantial because: �T �� �-S ���� � �(Sn�C� �(�/�GI�MeN�"�5 (A�� (1�0 t�S �-�'�/�.Sc.��/ � �ZA�C 4.The variance will NOT have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because: C,� ������.�����J ��� ��S � � ���i�-S (,� �� )� ��7� v-�s+'^� � �� �S �� ��I,��f�:� 5.Has the alleged difficulty been self created? { } Yes,or No Why: `j"j.�.rS CS /.� �.�(3U��� �c�C `� �`�� ��1 C�� L�IC)2ft�¢��.-�.�C` ��� Are there any Covenants or Restrictions concerning this land?�No { } Yes(please furnish a copy) This is the MINIMUM that is necessary and adequate,and at the same t' reserve d protect the character of the neighborhood and the health,safety and w e o the ity� . Signature of Applic t or Authorized Agent (Agent must submrt wntten AuthonzaYion from Owner) Sworn to before me this �-1�day of��UYl�, ,2��J � � o ary Publ� ,., ,TRACEY I�. DWYER NOTARY PUBLIC,StATE OF NEW YORK " •- NO.O1DW6306900 G2UALIFIED IN SUFFOLK COUNTY C�M�?lISS10N EXPIRES JUNE 30,2D�8 _ APPLICANT'S PROJECT DESCRIPTION APPLICANT: ������(�'� �L.�-S DATE PREPARED:� �� ��Z�p�— 1.For Demolition of Existing Building Areas Please d�)escribe areas bein�emoved: �q�'3 � �` �} C�� ={`��Q`-(,� ��� ��(�P�(�, II.New Construction Areas (New Dwelling or New Additions/Extensions): Dimensions of first floor extension: ��-- � �(��.�i� ��''3��, `�" ��, Dimensions of new second floor: ¢Q; �' - -r Dimensions of floor above second level: 1,1�N� ✓ Height(from finished ground to top of ridge):_ 2�f'�—�� - Is basement or lowest floor area being constr�cted?If yes,please provide�height(above ground)measured from natural existing grade to first floor: �S III.Proposed Construction Description (Alterations or Structural Changes) (Attach exira sheet if necessary). Please describe building areas: Number of Floors and General Characteristics BEFORE Alterations:_ j��`�,zj ������-� �- �� �Q Pr �`�{! , 37 Z �� G���: �S�i�z;� Number of Floors and Changes WITH Alterations: 7 5'�(�,,�� ��2. �� �, '(-- �� �3 �5� 0� S� 5� � ..� ���c'� �IV. Calciilations of building areas and lot coverage(from surveyor): Existing square footage of buildings on your property: 2.?�j,�' � � -�r-oposed increase of-building coverage: -— [;'7�� _ � .___._ _ __ . Square footage of your lot: � 'L3 � Percentage of coverage of your lot by building area: �- ' ' � Cj'� -��� �- ,' -, ;____� � _;y,pur �ose.of New-Const'ruction:_---t���9C.� - �- -���.� - -r�:��f�'`f=� �'��y - •- ., -: s _ , ' ;�..=l�t�.itil C�.1�C' �_`e��•`f � --_ ,.' - --. - . � . , r�k, 'x "1� �, �s� , - S _ • _ �f L� _ �+, i • .. � - � - --_ ' '�1,i _ ?h ' ' ' .1},� _ _ ' ' -_ ' ' ' _t' _ . '�. _ _ _ .+����,.. _ . ... _ _' _ _ _ - V - �!h. tFi`u .r,a. _ _ f:`• �S t .1• _ _ � _ . `1. Fue _ - - 1-.� - ,l." _ : e).r,�. 'i`:l 1:': `i:� ��P�` - �j.Yi_'-�` i 3.r;•��� _ 1'r ' M)'.., �,"t '•+'i•' �.f �if�i.+..,C.. T`t� �<Y.. - Fs,i }'i' ' " ' ii�'i' _ �.,t. ..4"..,, - • " 'rY�^ - JL�.'_ _ _ _ _ " - - - 5,�� " - - 4r 'j.-e. - - =.!!, _ {:�":;` _ _ - „t� .Yc.. L'?c.`. `�,;' _ �'' _ v�� _ _ - ',�.. 'P1,1. ' - _ -�-.j�i�in.. _ _ ' F ' C�. " .�tv - " - ' ' '.i'i _ ' ..`{n - ' ,i�i ',h: ,�. �.t _ _y y. _ ;_�,,T;•, ,,�: ,r "t y' i:f:"y �"t� _ "j` «' � 'S=�� _ ,a�, f�, •4t ���; - i`�'' •f«' - -^e�F-`•-`.. - �ti�°� ��.` v�„ �'�;i. y�d t 'u�F� .'���. }e ,.r.: 1'�.. _ *�.. " Y ! _ _ - .��;:.` $i� ;k�,��,i 'i,,_�f';. ��„�'.. x�-� i,. i at ,, �r, - zi� a� �.�:, x�� _ ':K.:. ,�;,^, .r. 'q`, f�; %`s _ �,: �'�"�� fi, ' �a'"". ' %�Y�� 4i ��1� (;7 ,S'y'.. .`i �L:."�.4iy.� �. !�., s1• Ma'_�� :i.�u ,r'ti,.:' '•t't ,.��;,`,� _ ��� ^"ff; .�F�. ,:"'...y .� �3 �=V'Y'r , ''f� 't�ry � :,t.<,� ��� '~,;. `�YI.,Plea�e des'c''li'e��•tlieland<cont' ;:�:,;°:� rt h _ ours�(flat;�;slo`e,:/o,;:,lieavil"�=wooded��'�mar's'h-�area�'etc:�,on n:our�land.sand. - .�`��,. �.��... ,�, - ..r: _ .nr ,;�_ _y.=,�. , ., )�. -y, ;. - -_ _ ,.�: •,�.'er'.. - 'Jpf.�' - �r'.' ..£:_=,J��'�.. J'a�t-`:. - r.:r�-�:�.. "�^ _ - _;'tj' �r�`- "iL -;x` -_ - t,i,'i�''Y,. .�' :.r_�, _ 1� —t, . �'�''-,':c' ...ey:-a;�:. °i�y— "�•_«;�- •!�- ' '.� Gl�:= _ i::� _ ;,� „r,. S •�\���, :ho� i�:r'I'". , ;k, r�' w t e ate's�to:,tli'e�diff u�T� ,�i "-�;`�� �,,` .,,� ;;�. c, n�meetin� ,tlie`code;�re "d'irement�'.s .�:__ =,� �.;� �•>, ;��.;,,- :t>�:��,a�� •�-. ;t3,'�:>,k ,g,,,,�,. �,9 � )�;,,'a�� ;�i�` �,;�r;,,,:� �,t _<� �.r.� - ���>>� r, .,� ,>f. �•�.:;� ;�. �:��'' �r�� ':�� ;;�. t:t" �:t'� i.y.', .� rvz� S�i%:.i.i..�t�`y�.�'�rR, Z! ��.i ��� ' - �tf�x"�. � 't� e.11n - �{"`J \ ' -��. - +A .. f.,� �.Sv�.�� �:t� e��" _ „�Y'-i.,� :'1j�i"�i '� �^"}�°• Ji����Y��C. ��'Z �) - !�::�"�:��i ' V�) .S`'!r'^�� `l !- '.%F ♦� _ :^�/n�.19+�•i - - - '�J'�=`�r=;..�`7,s�-�.4=:��,;,:�'=:�.�i=�C�c= .� �'��� - _�;�,�.r�=` _ �SY���t �-�-��Y, =[��-` _ ��$i " `..k'� '`1'Y /�j �;t.�.�7 ��6"' ..t., - - � C' - 1 r3� /� _ '4� - �.i_ �}� _ C �}��/� '<` /� �S � �j� `,��A]'-- 5, •�. t 1 "� �{ �� =�I�a., 2 `4�, i vV 1.'\. ' — ,7} , �/'���")�' �� r � ��',�`' f�c Ull3. J 4.^`�L✓1� �v:�� - ,j�, .y� "i-"'��, . � ` �'1- �� L� � 4t _ '_ ' ', , '� r _ '�_ __ i . _ _ ` �-l. "' , ' _ _ '_ ._ ` �' __ � . � 't• ' , � � , , . - i - y` _ ;.ti _ � - .. . � il - ^ .. � i �, . ' ,�`�y`� �S'i � • 1 , � - .. � . .�. � � , + ' �,. � ' � . 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 FTLING WITH YOUR ZBA APPLICATIOIV A. Is the subject premises listed on the real estate market for sale? Yes �No B. Are there any proposals to change or alter land contours? �No Yes please explain on attached sheet, C. 1.)Are there areas that contain sand or wetland grasses? �� 2.)Are those areas shown on the survey submitted with this application?� 3.)Is the prop�rly b�ulk headed between the wetlands area and the upland building area? 4.)If your property contains wetlands or pond areas,have ou contacted the Office of the Town trustees for its determination of jurisdiction?_`�Please confirm status of your inquiry or application with the Trustees: ��(� (� ��)�r� and if issued,please attach copies of permit with conditions and approved survey. D. Is there a depression or sloping elevation p��the area of proposed construction at or below five feet above mean sea level? )�'G� E. Are there any patios, concrete barriers,bulkheads or fences that exist that are not shown on the survey that you are submitting? � Please show area of the structures on a diagram if any exist or state none on the above line. F. Do you have any construction taking place at this time concerning your premises? �C If yes,please submit a copy of your building permit and survey as approved by the Building _ Department and please_describe: G. Please attach all pre-certificates of occupancy and certificates of occupancy for the subject _ premises. If any are lacking,please apply to the Building Department to either obtain them - , - - -- =-�-- - --or to obtain an Amended Notice�of Disapproval. -- � --- ---- -�-• -,- -- --�- � --- ------ -- . � : , -'� , .M1; ' �. - . - '' .� � - � ', ' - _- : " ' ' � � _ . , , . - = � � ��H: =�Do.:,ou',or:anf `co-owrier�also o,vcwn�other�l�and�ad'oinin or�close'to this�� �arcel�?�� ' -� Y Y _ J g - P. , ' � � - - � � `����"'Tf.:p�es= '1'e`ase?label�the:`n"'roXimif�/:of�"oui'lands ori�V'our.'surve�/ �� `_�= '�:�'� � ��'-- � _A,�r�; I" �.�J . �.�, " .0 ,.. �tLf4�"= ,v. t. _ 't'- ,'J�,- ,��.:i.�'a,;�.. -J. r>� :'l� r-'' _ 'I " ` _ .�Y`} "2'' _ _ i��`�_ -_ _ _ - _ _ - __ _ _ ;� 't _ 'l• "(� _ - _ � , ' ' _ _ 'r " _..5� f� - ' � - -,�.1 ' - -i__' -- - = . - :x^ LS� .�- - - - - - �i4 �r.E - - .:.(� ��'� - - � ,r^� _ _ n�. _ i �f�=' �` s:. „�'� ..x Y�i•�,, _ - f .f»,�'. , 'r�, I:�� .Rlea e•l�ista'�re'e�t. �e�� +ti"r �'orid�cted`a �ae� ��r'-',,<`. ,. f, s s n �i''s .or;o�`=era oris�c u t;this�ar. Y�.,y_,I'�(��,°<�t` :-;t�; - , `;£�, ;��:, - p.., _ ,p ,,,� - � ,P,_ �;:`�,,. �::,,�',�.. - .;,;,.- ` ,.k.. .,�: } ,,,,�, „r,- _ ,�;:.F,,; �,:� �r�,a+' - ,t '�s. r - - - - - Y "r^_ _ �-,;�,�Y;� :,`;���; ',j: ',j' ��5 '1�. 4( _ .fxu �r�. :T';,` (�.����1.._ �-aaid,;ttie>'ro osed,use ,�- , _ � � .,P :.P_, � ���i�'l� - '�F. ���;��s`, r;,,i` - �.r �"�,,�: - z.. '�w - - �. t- _ '.�• - ,�'r:= �i -�'�. �?= - �r -�=�`':• - ",P:: - - - -.r'. ,'t; , �x ,l'� - ''ti:' 1 4 a,t r`t,'- � �:::• � ..,�� - �ez.'iezistin` sin`le;fainil' io 'osed: "s'ame�wi�h�.'. , ��= ;I`-� �'� g g ,Y,`p R ., t,.:r� '� ., - I`i�. _ - _ " " '+Fr - ' n � - �{. - }'Yr�. ;� e� ool�oi-o er �'t�L - - - - -'�,; - _ - „P. )` ', �i;;�`°s'='' ����:`� -i . - , ,_ - _ `.�, t�_= � � `�,j 4. � ' ���t -• � - _ � � � • _ " ,• -'V��, ` ' `11_f'���." _ - - � - .�Iv{,' � \ '.7� - ' � � . _ �{.. _ .�,, rt� - .. , � r�.Y ;`"+r.r' . ' ., � . . , i _ ' '�' � ' , , ' ' ' .;i . . . .. -- ,� -, � � •` - . • , ; , . .. , . , �� „ . - _ , . ��;' ; ,����. 2, 7A IS . . , . . . . , , . , . . . . , , Autliorized signature arid Date 80� xa s TOWN OF SOUTHOLD BUII.,DING DEPARTMEN'r Town Qerk's U$ice Southold, N Y. . Cer�ificate Of O�cupancy No. .���:$$. . . . . Date ... . . . . . . . . . . .p�y� . . . �9. . ., 19.��. THIS CERTIFIES that the building Iocated at .�a,c�or�alc� �Rd. . . . . . . . . . . . . Street Map No. Ed�Qy��,�. :Block No. . . . . . . . . . .Lot No.�Q.&pt .'�. . .Laur.al. . . . . . . . . . . . . . conforms substantially to the Applicativn for Building Permit heretofore filed in this office dated . . . . . . . . . . . .Apsi1. . •1,�19. � pursuant to which Building Permit No. .��$OZ• dated . . . . . . . . . . . .April .t�., 19. .,?4, was issued, and conforms to all o# the require- men#s of the applicable provisions of the law. The occupancy for which this certificate is issued is . . .Pri�rata• �,ne. fami�,y . .dwe1.l�.ng.w,#,tb. an.additioa . . . . . . .. . . . . . . . The certificate is issued to . . �.C,J.es sup . . . . �tner. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Heal�h A,pproval . �.R.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _.�_ '__.�__� s�_ UNDERWRITER - -- - - - - � -��- _ -- -� -._.. � - -.--- - �_---:-:- ---___-�=- -=�.�r�_-_ _- SfrCERTI-FICATE No- -.�1��6�+.78 �, :Ap�+i,l��,�9_�;��'�?t.�_ '_ - ._�,�,r: � ..1_ ,t..�: ��.' ;,t� - �'�� ��r,,,�':Y��� �= _ :3. ',•;;. _ ,1.�t`:;,_ �."�.� �1�� �:.\., - 1� '�4"� ���� ,4± '��e _ th;,,`�, ,j'. ")^ , - irt��'�t�r .Lt�`n,{,�' �..1'��' '1,. i .� ir`� ��t, .�f t �i �{. ':�+.';;r i� :��� f `L' .4. - V. _ - y(•��` YC` :)+ r.;e. i� ni( 'K4 J _ i-f, .E:� - 1 a��F�' '.(� _ '�t�^�'�M�"�.- _ I. .(. C ' .� 1 �. 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':i� ^ik' 7 - .lP,: - ��4�. f," - ..FF �'f"; �fi. - 4.. _ �s� 8 :d. y��., i Z �FC ' i;�' �'3` �s/: ��s"' ':I�"r:�' ��.�4.' _4^`~� � 7'L��s � i�}' gm '�hr�• h �S' ,KMw. r�l�� �f �, - - r'i�t�^ ' j' ^ �^��ic � y. :'k� �r`j'_'+ _ '},''( _ „t u��'�•' _ �4 t.�:u ,�, .'C� r:KY�J1:.-= -..sr.� - �'"�` Y }�? �' - - - ��.ki; �-a' il]1(j1A; "'TIIS:�:. ;�T ' .r,.,.[~ rt�."' - .�.F=`> - 4i t4 � " - - V ' . - _��'i .°,4.�f � �).t �:1�' - '�.-.."�.:' _ � .�� .�- _ .5,,.�� .''.tli',� ,�(� `il�-ii - '-3::'v`..._ s1:. s3+�.�.- _ ' „}_ � - _ ' ^l .t� - ���,;s� '� �i`�� �z\•'� _ ' ' i t` _5� - .� - aJ.}- °J�>e?� - 2� `t� �`" - 'y!`_ ' ..,�a :tF� ,%T: "'�. _ +-'-L"- �c �'): _ ,"q ' y:`' _ y`' . ' ' _ - - - - �'a- -- - i� - - - - - ,i :��r ''�. '.�r�.� :��- - �' " - - - - - - - - - , �m'` - - '} ; - _ �'L� - '=a,�-. ``"v, - ,{` _ 'f'• ',q',. _ �:�`�::; ' �� - �.i�% "�i �'x�- ' - �,K.i,t� �ir �' s�.i• :F�r �+ti. ' 'f: '4; h:` . ' � '(� '�L'R - ' -3 _ 5•i,, _ .�' >�7� � - S� `z' .�,.. r„ - ,y�� ',i� - - 'p. 'y, . "��' , _ r�,� ,:': ;�,. - - - .z: yf �'nv, %v'I .�P. 4.�i �a ' 'v).�' \r =5. .`T i �t�`� �+y�� �, ��7�' �r ';�i�'' ,r •i' .�, 1r' .��;.��,;','';,; :'i _ 14� e "'�' ;}�:;,,. ���:�. ,4 ',�,.,�� ,1` (' I .. �+�,; ' - . , , � . , .'i� M'f', ��Fr.�, i.,, , � , . �. :�r�. �'P,o , � � -,ry�' � . , . � . :��'y�,� � � . FORM N0. 4 ZOWN OF SOUTH�LD BUILDING AEPARTMENT Office of fihe Building Inspector Town Hall Southold, N.X. c�x��zc��� oF occuPxNc� I3o �ZOIb6 Date AUGUST 23, 1991 THIB CERTIFIES �hat the building ALTBRATION I,ocatxon of Property 4�5 MC DONALDS RD. I,Ai3REL House No. Street Hamle� County Tax Map No. 1000 SectiQn 145 �1ock 04 I,ot 17 Subdivision F`iled Map Na. Lo� No. conforms substanta.ally to �he Application for Building Permit heretvfore filed in this office dated MAY 23, I991 pursnant �a which Building Permit No. 19893Z dated NlgY 28, 1991 was issued, and conforms to al.l of the rec}uirexnents of the appiicabl.e prQuisions o� the law. The occupancy for which this cer�ificate is - - -issued is .TNST:�LL A WINDQW.,ZN.EXISTING_.GARA�E AS APPLIED FaR. _ -- �---- •- - r--^-�_--- -. �. -._ _,-�� --� - � - -- - --e -- — - - ---- ---. . _ ,__- - � - - - --- - "t� ' ;,�� ',;,::Tlie;;cer�i�idate ;:is�`issued'..to � ;�EL�T�$EZ`I3 ,C. �ESS[IP � � , , - - � � '';; �; , _ �',.- �,. ,:,. , _�� _ , - :S(:awna`r, � ' � -' � - � -i - �,Yr.t., ii:o - .,L _ � - , � , �� , ,� , .' • -- , '— -. _ n�:' __ '_ _ �5::.�' _:,7.j.�;,._�,.. . . ', ' ` _ � ...-. _ . .^ _.Yt' - _ ' ,Xi�:_ - _ _ - _ _ _ ' _ _ ' . , ' _ . , _ - - - `'"}- ' - - - � - - - - _ --- _ _- ._ - ' - - � - _ ' - - - - - ' - .'3�-`r�-� - -. - - -- -. ;J: - - u�of�=t�ie'�-af oresaid;=bu�:].d�iri} =�-• . . - - .,�, ,3_ - ,g• �r" , __ , - : �, :��': - s�.�-y� - .;� - - - .. -- � - _ _ �.«� - - .11.� _ - �'4.. � -- -{�. 1 J�^vT� - - - .. - � - 7' . � - '_ �� {. " ' �,:_�"� ' j+ ' - _ --;.• M1r ' �'' '1; �E; - �S�` �F�. ' - . �1,. 4tj� .�"_ •r,+:.. �'t"., s�s�= _ - _ - '�y;-- - - - ' - ." 1"'- - � � ��i ,i ;�„� - t,��;'`„'r' _ tr' �,a�. '�'s�ro" '�;co'vr�ry E - �`' >;�' - �� yK „ :D PARTME�TT'�4F;rHEAL�TH'APP�ROVAI,, ,N,�A�- •s, _���, _ , -- - r� - � - ;.>;�: �'�`� :�. -;�,,. ��f: �;,• ur� �F� ,.:;; '� .,r 'u. .'�,• .� ;y; ;r. �.;�.�,,,.,. .';�` _ �ti. �i.'r I`, � ,> `aK�` - ''b5` t,t - `�Y�-' �P�'C' ,:.t�� ^,t,t;- K .,¢'.r a: ,x' `�a. '�'�� �.15:C: ��xe '� . ��l:i�:;,'� if_ - :t; t"f�� ��jt, �C; - ':�;.��,�1. =`=r-�_ ,c� - rv�1-' :'r'' ' -.,�. J h A,t�.+ �i`.°' .)1 - :�t-Rn�S�. r���: l.p. - =j '��t� �7� 7��i /-��p�p- � .S�- - �f ' ' ' •'l�� , , - ;�.,. -'7' (� 'i.' T ;+ aT/,�7��{�. p7 '"i" _ "�ri+•'< 1 _ t. '1� . - ' LJ��fll\J.`:• - " - �.RJ.\:1:�F\��1:ll'%t3:4G�%LR�.:+' � ' �,, - , _ '�.- :NJA' - , ..�,•'�' � Y.� - _- ' _ . ���_ J: - - _ _ -_ 1 �R _ . ' _ 'A�"1 _ _ _ - - - __ - t � _ - � i . . •� . . - ' - �_ _� 1 '(W? --� - " _ ' � ., �-�, � ' J - " -_ �'P�T]MBERS�`CERTIFICATION.�DATEL?;'. _', —_ "g�g - - _- - � � . _ _ . , , , _ .. . : ; :R_ : • �. �. , � • ,. - `- - - ` r .. '��, . ,<� . . r _ , , , , . , `r.-„ � � ,. - 1•:.�• , ' -:���_„'�-.� . , ,. ,� ., ,,. , ' ' •, • ,' , . . � ' , � ii � r , � � . �k``n " .� . � i �,.� � � �\ � i 1 � r � . . , �. � � � � " ..��� Building Inspector Rev, ]./81 ; Fos,a� rro. z � 7�'WN OF SOUTHOLD 6UILDING bEPARTMENT TOWN CLERK`S OfFICE SOUTFiOLD, N: Y. , SUILDING PER�hIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTlL FULL CQMPLETION OF TNE WORK AUTHORIZED) �� ���o � Date ..........................a��,�...... .�. .. ., i 4�}.... Permission is hereby gronted to: . �r...�'A��t.. ''"...aA218..�IIQ..�{�i...�.�.�sa���i� ......�.��.�.�G.................................................... ................................................................................ to�ia..�?..�as;ti�.on,.on,�Y��.���...�x�.�,���....................... .......................................... ................................................................................................................................................................ at premises located at �d�lBt�T4..P�....Zot...�..�.:.�,�.�.�............................................................. ...................����i�...�d..��ari�rat�.�....Lau,��.��............................................................... � -- --- -- -- ---..................................a........................................................................................................,............,........ --- - -- � ' ��ur"suont',;to_:;a� lication.'dated :'":::''' �,�..:�:"1" �-`�l �..: :anci a �oved�by"��#he �� � . �,.�P � FP , , :�. :�' ;,�i...`:::....:: :,, „�i- •,. PP , - „ ' _ _ '' {i _. " _ ' _ -5; _ , ' ' ' ' , . . . . ' . - _ . - -, �=' - - ' .=4i', - _ '�s ��• , - - - - , � , ',�,., j� - �Buildin� `�1n': "`ecto�. •;�' �:_�� • ,. :r`, 9� ,SP _ '.!;„ :<� - � - �,- �_ .,�- _ - ;�_ - - - - - - ., - - - � - - �:>� �s-.-- - - - -_- , - . - - - , - � - , . ,��`- , '�{ ��: _ . - . - - _ - - - ' , ' 'f - _ - " r.G" �J'.r . • , .f^�.'� _ - __ '_' 4 - .i . • _ ' - `�%h,r�v 1l�'f :�v _ �•3.` :�f. ':l'� 1 I✓ ' .ilr� ,,� ., f'ry,�„ ma;. _ �l �'J .`f.. .r'.��JI "5. :`t'�i, .'S'J' ' .��t� - - ,j, 'x� '(' �`ji�� y- ,.�;u �., ,J: a y �' ,�„ 1'' � - ��r - - ,' - „Fe�� .�. �F' - e. _;t� - �;,-.�; ,� �'�.c�.'� - �.�t' `f? -_ _' 'rl; -_C: ,'!` ,_y` y�_ _ _ •1� _ _ �l. ' ' - _ _ �__ - _ - _ ---. �;S _ .y._ -' ,�• ' li'�. - ' _ _ _ - -' _ _ - _ - �'y. - 'Fi - 4� ' .f.� _ " , - r:�� ...1� t - - - � - a^rl.. '1, _ ' �:` ^� ;. `,f_• - � ��� - _ hZ�:' - .f� �`Mt�• 2. �`. _ :�. f'4 :+ 'i�. ' �' t. �,, :�J �Y�� - �;i� , �,r: ''i� - - 5'U - _� "3 l - _ 7• - ' �w�. - _ �1�.�`,y, _ - '_ - -;r2.-„" _ �',i „ , ,�,'. „t' _ __ ' �i� '/, . , .7�r-', I _ _ ' - .. - - , _ - _ - '='i'"- ' _ " ' ' - . . - � -'1" -_ �:� _ - - _' -- - _ j� ��' " ' _' _ � _ � _ - � - .Ji'i"'�= j: ey,i `{• � _ . . _ _ .I.` . �L,' - '.'G, - .'� �V �','a'' . „ ' � 't , _ - � . , ��'r � .. i , . ,. � - ' w�� � � '. ' s , • , _ ;�t. �': .. ''/� , �"��.�'� ��n" _ . , -=�.,. ..�- . � . , . , . - .. . : - = - . .: _ - _ .. ;�. . , . .:.:..... �:.. .. _ ..... _ . . . , . . , - , , �Btiildin ';In� �ecto� . . �� . ., . . :�.� � ,�•�� . , , , �'�' . . ,. , ., � . . • , , � , , , g ,� � �� . , , . , �.. FORM N0.4 � 'TOWN OF SOUTHOLD 8UlLDING DEPARTMENT Office of the Building inspector Town iia!! Southold,N.Y. Certificate Of Occupancy No. . . ��'>.773 . . . . . . . Date . . . . . . . . . .August 'f 6. . . . . . . . . . ., 19 85 THIS CERTIFIES that the building . . . . . .�en.ovat�.o�l .&, �dd7-t�..o.r�.. . . . . . . . . . . . . . . . . Location of Property ,455 &,260 MacDonald Crossing I,aurel House No. Street �Hamlet County Tax Map No. 1000 Section . . . . .'I?I:� . . .Block . . . . . . . . . . .�}. . .Lot . . . . . .�� . . . . . . . . Subdivision . . . Edgemere Park , , , ,F�ed Map No. . .���. . .Lot No. . . . . .�.�. . . . . . conforms snbstantial�y to the Application for Bttilding Permit heretofore filed in this of�ce dated November 'I'I 84 '13562Z . . . . . . . . . . . . . . . . . . 19 . . .pursuant to which Building Permit No. . , . . . . . . . . . . . . . . . . . . . dated . , ,November 2'I , , , , 19 84 ,was issued,and conforms to a1I of the requirements of tlie applicable provisions of the law. The occupancy for which this certi�cate is issued is . . . . . . . . . Renovation and addition to exis-�ing one—family dwelling. The cartificate is issued to . . . , , , , ROBERT JESSUP (owner +� . . . . . . . . . . . . . . . . . . . . of the aforesaid building. � 5uffolk Counfiy Department of Heal#h Approval . . .-. . . .. . . . . . - . , , . ,; . - - - -, -=,--------- -- —- -- �--- • N - --- - - - • �� ;UNDBRWR�IT•E�RS;CERTIFICATENO.':�,�.�._�: . .�: � - I��37��°- r - � ' ' ' ' - , . , , • : , - . �'� - � • - - � , . �� � _ � , , � ,. - - _ _ - - - � ; ,.. � - , ��;� - ' , . _.. _ - _:_ ,;' ,� ;��. ' �°' ,t " �' ,.<�' ,r� T, _ _ _ , , , . . - . � - - - - - - •� '` - --- --- -`t--•� -. : . -� - —.,, - - -'i,.- -- , .-, , , ,. _ __ - _ � - _ - - - , 'L'� - ,y: :-. - ., .-_ _ " - , - ,_ , _ - ; . - . ' . ' �y;, .j �G� �s..si _ -- - - - � � - .t. ;�' �'- _ • `i°y ' _ '` .- �; - i_ . ' - ��: .. f�`��z, :r.,- - -- '`%;' ' `.�,�; '_ _- .:"t - . �.s. _ _ — �?� .�a;'t � _ _ , _' _= - _ = _ � `l. - _ -. - h� • _ :I'.. , �. . - , - •`, _ T3 " _ 'S`� - � �i..°=�. - "5 - ,S• �,' _ - �r ' _ ' _ _ .� , _ ' ' ;�" ' _, _ '�. �l� If•' - _ (�� - I 'i, , .i�,: �ij � 5 - - /�' j� ` , �� ' . . ' . , - ,;lV'�, T ' . `.r �,�� . ��i�'"'' , , ' . ,y' . =�'��?_::.'l'. , - , , , . - .-�:, _ _ . _ . -- . ' � _ -__ _ � � . . - �_ -� -�` - - _ = - _ -, ' - ' - ' . � ,: . , „� - - ; ,Biiilding,Irispector , , .. ' " , , ; � ,:� _ . _ ; ' . - ,. . - , �� � _ � ,, ± ' : � -' . _� ,' � .. _ , , ` . . . ' ... �, s ' , , � , ,��Rev.'1/Bi � .. ,��. , . . -, , „ � , . ' _ '_ , ,, ' ., , . , , ., � � �, . " ' �� ; - • - ----------- - .. ____. ' �.-- -- • --- , . ..__ AGRICULTUR.AL DATA STATEMENT ZONING BOARD OF APPEALS TOWN OF SOUTHOLD WHEN TO USE THIS FORM: This form must be completed by the applicmit for any specia!use perntit, siteplmt approval,use variance, area variance or subdivisio�:approval on property within a�: agricultural district OR within S00 feet of a farm operatio�i located i�: an agricultural tlistrict. All applicatio�is requiring an agricultural data stateme�:t must be referred to t/te Suffolk County Department of Planning in accordance witlt Section 239m and 239n of the General Mu�iicipal Laiv. ' 1. Name of Applicant: ���j��1� f-'���� 2. Address of Applicant: � 3. Name of Land Owner(if other than Applicant): 4. Address of Land Owner: 5. Description of Proposed Project: ��(� ��(�� � ,. �.� v � ) - 6. Location of Property: (road and Tax map �" ��4�`-,-� v ` `� � number) �`-(� (�P�i �1��fl�� � 7, Is the parcel within 500 feet of a fann operation? { } Yes No 8. Is this parcel actively farmed? { } Yes �No 9. Name and addresses of any owner(s)of 1 d within the agricultural district containing active farm operations. Suffollc Couniy Tax Lot numbers will be provided to you by the Zoning Board Staff,it is your responsibility to obtain the current names and mailing addresses from the Town Assessor's O�ce (765-1937)or from the Real Property Tax Office located in Riverhead. NAME and ADDRESS 1. � � 2. . 3. _. . . 4. 5. - - - -- � --------------- ---- - -- - - - --- - -- - - -- - -� - -- — r_ __ , . . .- �-- - - - ,- --- - - - _, 6. - _-_ - � - - . - _ �..' - : �(Please u'se tlie�back'of this'pa'e if th'ere are �ddition�al'�property�owners) ' � � � ,_' ', , , � . � ' , � � -� ,r" - -�^ '4' +N��:r4 ' .(. ' :'_ .. " , - ' . ' i , _' ' ' _ � _ " _ ' ' ' _ " - " .d - ._ _ .S'�_ - _ ` ' - _ ., v 6�� - �7` - � ' " . .5` � „ - -- �,4( ,�' - '"�," $i•'J� � I:'" -� h5`i• • " " • , � , . , ,."h - ,{c�� -_ �d '�a.. - , _ , , i , � �'r - = - - +� -- - _ - 't: - ° - � f,�; - =.r° , , - :+..` ' - - - ` _ ,'y_,� - r _ . s _ _ _ ;H .�� - .s., _ F'S: �`v� _ ,:� 'z; ' .'i.., ,h _ _ �' ��,� ;4�j :t'• :�#'. ' }'1 _ "i'4 �{` •:r!'J .��+ „i+ y �, 5* i��,w . �( IJ � _ �1' .. � �M1n. _ :ti^+ '� �%��;+rf . . " �_`^oa'f _!/lJ .tir V� I:: " ' J �i� � " _ 'S_ _ _ " _ ,/.,-,'�.`.�, ' ' :� L''�',l - 'A� " - , '4" ` ' .�. '" _ :Si` atur,'e,;,of�A��'licant.= ��� ,, ,,::;� F -,��,;� �.ti� �'bate� � � - , �gn ,x;�PP,. - .,���- �.- , •r".s ',,` :�� , -� •5 � - . .�, .a,,; , - '�.t,';, „ ,�>._-. _.. � ; ,_ , _ �'= ._, ��, , . . .. ;' _ �a'_ :;;'��,' °�., � � _ , _ - :�'�_„ _- , _ - _ . _ - , - , - , ' ` . - - '1 . - , - ,y: x' , , �. ' � � - -, _ - . , , , _ ' - _ � , ., ,� � , � `.� 'Note•�,, ' ,-� '^ . ;' �- � -$ '. ' - - , , ' � .�' ' ; ' � _ ' , ' . - y , , ; ; -� ', _ ; �� `1'.'The local$oai�d�wi]]�solicit comments from�the owneis of land-identified above in oider to consider the effect of the � � � proposed action on their farm operation. Solicitations will be made by supplying a copy of this statanent. 2.Comments returned to the local Board will be taken into consideration as part as the overall review of this applicat�on. 3.Copies of the completed Agricultural Data Statement shal]be sent by applicant to the property owners identified above The cost for mailing shal]be paid by the Appl�cant at the time the applicat�on�s submitted for rev�ew. 6I7.20 Appen�lix� Short EnvironmentalAssessment Form Instructions for Completin� Part 1-Project]nformation. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part] based on information current)y available. If additional research or investigation would be needed to fu]]y respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part i -Project and Sponsor Information 0 � �1 i�G��C �1 I t- �� 9�8'v�� ' �ti�•- �`� Name of Action or Project: t �.�� ��=�'i�t�� C� �19�1� �, �? 1 Project Location(describe,and attach a location map): � C;�,�-� i'1.��J Sf�l 6't� iL� Z �TCf��t--� �I�� Brief Description of Proposed Action: / C� ►� ��l � Name of Applicant or Sponsor: Telephone: ��7 � � i� � �1��� � .���`�.� ,�� � � E-Mai1:��.�5 � '-� �-c� Address: � ��� �f�� ���t � ���-i �i°yC.1�` i City/PO: State: Zip Code: ... . . � - - -_-_C�f`�� - _=_ - ----- �--�.----- ------- -----� - - - - - =I� Y ---- -- - - -t=1�'7� - - - ; • -I.�Does'the proposed•action'only inv,olve the legislative adoption of a plan,local law,ordinance,� ' ,, , , •� NO, 3'ES � ' �'��administrative•nile;or regulation? ; '�-� �-� '.` • ' , • � . ,,, - � . -- - , ' � ' . _ y ' `IfYes;;attacfi.a•narratiye',descrip'tion,of,the�intent�oftheproposed�actionandtheenvironm�ntal'resourcesthat ,_ � ' - <1„�fmay,�be�affected in��t}%e�muiiicipality and proceed'to Part�2. :Ifno,;continue�to ue f ` -. ` _ , _ �.,`- _,'�{' - _ - - - -- -_ _ _ q s ion`2. "-j�<�- :�� _ - . �- - � _i2:,;�Does,the�pioposed,ac`tion"re,quire�a.�"erriiit=a� ioyal�or fundin ,fr " :,, _ .,�.;y;, --;�.; - - ,.,r , .P .�, .�.,PP_ g, om,any..ottier govainmental'�Agency7 .NO.,;;;'XES� - _'�=-�; "� 't,,-:,.'FIfYes,�;li'st:agency(s)�name`and�; e'rriiit�or a' rovaE' -'� -`_, . = . _ . _ P., .AP, �;�=�"� � - ;j' - _ = - ''� _ _ - ' 'ti.�, , y'�,' _ .,5."_ . , .r,`_ .� , ' ,- '"_ - — - - ; - _ _ ' - dz . - :i� �a�- - - . ,i �,�' _ _ r�,, �(1: - _ ,, _ T,� =F,'' _ �.`' �;� ��- .,�-. �_, ,���i' ��t, :5 . ,.� c� ,Pc�i���: � ; - , =,. t. _ - ,j. �;� 1T���; ' , ` - , � �� �3:a:Toial'acreage`of tlie`site�oftfie� ro~osed�action�� - - ' - - � - � � `� , . �„;b."Tot � P R _ ; _ - �acres . . .. F�� ,�, , al acreage�to be pfiysically.disturbed?� � . _� C7 - "��,acres • � ' � � ' � ' - �� . , . -- ;c.Total acreage(project site�and any contiguous^properties)owned `��'. , � � � �, �' _' � � ' " ` ' , . . . .orcontrolled by the applicanfor`'project sponsor? ; , ,','„ �.,� -� -�acres , - , , ; � ` , 4. Check all land uses`�hat occur on,adjoining and near the proposed action. ❑Urban �Rural(non-agriculture) ❑Industria] o Commercial �Residential(suburban) ❑Forest �o Agr�culture Guatic ❑Other(specify): ❑Parkland � Page l of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7. Is the site of the proposed action]ocated in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? � , c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? � 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action wi]]exceed reGuirements,describe design features and technologies: ' � 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: 11.Will the proposed action connect to existing wastewater utilities? NO YES ��1`7�IG � �� S I (i If No,describe method for providing wastewater treatment: 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? � b.Is the proposed action located in an archeological sensitive area? , 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by-a federal;state or local agency? - - b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? � If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: ___ ' '_ _ _ _ _ _"._ __ . ________.__ - . . � - ' - � _ ___ _____ _____ _ _ _— _ �/i1-'NiY (.C/`,�:'1^ _ _ _ _` _ ' - - -;•<<, '�'�:..�=�r`�� � , �i- - - - - . , , _ _ ,_ - .:.;.,.ut:.�.:,it: .y;w.s�iA4. �. .#.'.1�'` ` Y ' . � ;`:,i� , . . - _ _ - t:.:5'�:•`;r`5L�i3'nfi9.i , , „ . • F;,�. '=14.��I�entify;flie,typical`-fiabifat'types�ttiat.occur-on-or are lik'el to�be�found on th � ^ ` � - _ - � . ,_,y� � , e project site. Check all thaf a ]' „ - = „5;, Shoreline r;0 Eorest _ . — � ltur"aU assland - " pp Y� �- �-� � _ _ _ :_ _ _ `�''�'Agricu gr s 'D�Early mid=succe§sional . ., „ _" _ �.� - _ - : - - _�;, _- -�- -• - - ' ---- � - _ - _ _ _. _-_,,. _ - �Wetland� ���Urlian - -_ - � � , - , - - ;:n"_ - �°OrSuburbari _ - �, , - • .. - " -.`;, - - -' +;� - _ - - = - _- - - . - = - " - � `�' - "'1�5:Doe's'�fli" - �;' - ,',• �',-� - e site�of thefproposed�action:coritain ari`rs�ecies.of�anima] or` - �i� ��� - „ _ ,Y, p , associated,flaUitats�lisfed• , t'�NQ ;,YES - .�,ii ;�Y 'tc,:�:,..:- _�il �- :1_ _ '.G:: '«7 -_- °'-- E' " ""r:' r`7 �E �rL ��;' ti' �fh'erStat` 3 '=6 ;�,: e or Federal�"'ove' ��,� ,Y rnmenf�asr`tHreatened- � ``�:��� ��'�' ��� :r-r �;t t�_ .�g. or.'endan'ered. �.ti ,r� - r '� 3,. u.� �s,yr�,,�1�� ,�,. •�- ,P. - '�:1_: ..,;, ,>% _ :�4,s �tt �,�,�" i� rr,;�,,. .�, "�v= _ a: -;Ar.:� _ _ ,N �J. !M' •''1" __ r�}� , �-i� +�..,, - ,4.0� - _ 7.i� ,,�' . , � , �--+ - - - _ - - �+ - - _ - ' . - ;i1'6:�Is�}ie.'ro'e' - _ - � , ;i,=, p,_� ct;site`.located.in"the'100,r�ea'r.flood;;"lain?' •:,�- - - . - � - - , = , _ _ _ .<<<. ,�, Y. P _ ;. . . - . - . , , . , ',`:n'O �t",YES=, � - _ -";:3' - � `,�,= `,- _- ,-- , ,._ . _ __ ..' � .. __-' � _ - "_ � ' , . -.- _- - . -� -- , � � r� �17:Will'the.proposed�action create sform°wafer�discharge,�either frorrm'point or non=poirit sonrces?, � - �� :NO �`YES� � ` � , ,, . .�IfYe's -- . .�,, , - - ,� . �--- . , , �, ; „ , , _ .,,.�,:;��, � � ; � .�-,-.��_", _°,�., .,-• �, ; ` , , °, , , ., - , , �. ', ' � a.'Will storm water discharges f]o�V'to adjaceat,pr'operties? ' �NO�YES ' � b.Will-storm water discharges be directed to established conveyance systems(runoffand storm drains)? � If Yes,briefly describe: � �� ❑NO(�YES �� ( Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: � l 9.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: � 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: � I AFFIRM THAT THE I � ATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor nam . � ("� W �C}(�-�� �C_- Date: �(�(��� �r,5 Signature: � , ; �/ Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Fart 2. Answer all of the following questions in Part 2 using the information contained in Part] and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" ' , � � � ` � ' - ' tix;;�. � No,or Moderate • - • � . . `, _ - , -�� ; small to large , ,----- • --- . --.. ,... . _. -__..... ------- �--- - -- - - --- �- --- - --------------- -- �- impact impact ' - , ' � . , ' �. , = may may '�• ' ' � ' . occur occur -1. --Will��tie proposed action create a material conflict�with an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of]and? , 3. WiII the proposed action'impair the;character,or�yuality of the existing cominunity? �� - ; " _ , - � , - 'X � , - ��,, _ . , , i.. . , � , ,- + ,' . 'Y'`� „;5�4. _"Will,the`�proposed�action�haye",an',impact�on�the environmerital�charactenstics'thaf caused�ttie • -� - � ,. - ��''�" '�`�;; '" ;establisfimenf"ofa:Critical'B�vi'" �� n�` E� - ` .+; � �'n ' . � _ ` _ , - =�.=- _ - - n, ronmental Aiea-.(CEA)• - -- - -- - �r: - _ -- - - - = -i ; � - - - - �;u' ��� _ - "-"-- -- " _ - - - - - , , ! ,,"- .1=:_ - _ _ =5�� - �'� - - - - - ' >>{'�5,. :�Vliill;the; ro"osed�acfion�result�in a � ;: `f :�, .,.,,;,. �,,. _<P,;,o.P; n�adver'se'�chan"e�in the�existin 'slevel of traffic oi;" - Y�• _ "�+- ,';:;� :�:° i-x, r�_ �, _ �.�., ,.,;,.,,,._ .g .g. ,,r; - - :,; �,.,r - •r� s: - _a>. _ ,�; f �affe Q - c��e' 's;' . -„•° xi`stin' ;infrasfruc �"���'�' - . ;,�' _ ,g_ ture for_mas's'�transit'liilc�n -orwalkwa ,- - - _ _ _ `dy L"�L_. .�. - 'I �D�--r..�, 'k hY.i� ..\ " " _ 4`^rtc ' :i':� ,I'-`���t ' ' " _`�.f" ' _ ' - "t ' �,4`�_ _ -45�.�� ' ' ' ' _ ,� i', .i _ ' ,s't F " _ ' :t." 'i � �,6. �,�, °-Wi 11 ttie� `r, � TO��OSCa»` Q�J ���,�� -��'S� action�oause+an�iiioiease•�in� - `<" ��.y ;.,, ,.P-:�P; ..�, _ the',use of,ener" ��and�it�fails�to�inco�` or`ate . - - ���.1�.J� ,YSa�t Sh -.�''.. __bJ f � .iY� = Y`C - �y5` .°,°,_ =reasonabl - ;.::��;�- - - _. - , ;,'� ,f,.'r,�':�, _ y_,a,vailable-erier' ';conservationorrenewable�e3�er' �'' ,ta.s, : _ �' _ b�'oPPorfuriities. - y�= - - ' - -.., ;�: Y:==' _ --;: _ ,,, _ _ .-- - - - ��`' � :;7: -�yVill''the;pro"`o'sed�acfiori;im "act�existin` - �"� . � . . � _ , _. - .{. P_ . P g' �� _ - . �c ';� ,- ; , ., , , �a.aputilic%,.private water snpplies? ' ' � ,�,� • '-. .. , �- ,- � - � _ • . -' ' � � _1 , , � � ' , '�,b:pulilic'Ppnvate wastewate`rtreatmenfutilitie's? ' � ' ' � � 'r , ' ,;�� , � , `' , � , , ' ' � 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large - impact impact � may may � occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage prob]ems? 1 l. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of signiSicance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 shouid,in su�cient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or wi]]not be significant.Each potential impact should be assessed considering its setting,probability of occurring, dwation,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. , � , � � � ' � ��'�' , ' , . . F , „ „ , , . _ � ,_ ' - ` " ,. '� i;' - , . .",- , . . � � '� i '�-. -• ' " ;.i, ., � .i,' � - . ` a - �� _ , . . , ., ' . ' < ' , ' • ' � . -4 �-�t; - _ . - __ - -. ..,.� _„ �jc,- '_ _ ..,' � . "' _ ' __ - _ -. ,- -V :.�_ � ����.1�`�.. "'�':� - �t. 'r - ' � - p'1'. _ ,'� - S,S�C _ __ :.�:,.n� ' - .ta` il..i��ri . � _ ` .;�Mo�' r-�Clieck'tlii's'box'if"ou�fiave�determined`' - '~ - - - - _ '' _ F. _ y, _ ,lia'sed;on ttie�information�and,analysis;above,`and•any supporting d"ocumentatiori,' �';•. _ _- ',r:; '�;,�fhat:the;proposed���action';ma`:iesult�in'one�:or�more"'otentiall�'lar'e oi si nificant•adv` '"' ' ' ' , - �,, .Y �. .P._„ -Y g g, erse'-im acts•:and an - e.'�^ 't',;:,�;, �'`��'^ >+'�'.,: 'e. - ^�:z�- ,i., ,, .�t ��:�c.. e.,'.e�, �v:<° '��^ :�. .C�e»,P- - 'E'" _ - _ :1� ;env�rorimenfal?iin actstatement'is�re nired: ���`r, •,�- - ';�' ,,,; p �9 . - �, _ ��,� ';` �., {� ',:_ -.} - ,;S'� _ t;S;;. __'Y'� �,t - •"$"..: ' - .it' ' i'� 5 - - `Y' _ . t -o, - aChec' - k�,f}iisbox�if".ou�have>i3et' - `�;� rT„ _ „_ _ y, eimiried,�based�oa:the'infomiahon and�arial sis'a6ove'��and an�.su ortin �docuriienfation°` - __ �� , �, . A .,. .,,;. .. ;. � „ _ _ _ .Y., r� Y PP, g , _ - =,�;;��,� - _,:thattlie�proposed�action:will�not'Tesult�in;ariy significant`adveTse�en'vironmenfal:im adts: _ - - � - ��� �-��� ��,.:�: �-�. -� p . . '.,, , Nr� 'y =,s' '•� , . _ _ ,' ,.. _ _ , . ,a�i , _ `, '" �" � � r` - , � ' ' ' , ` �- '� - . ' . � � : •- ' r� � ', . , . iName"of L•ead"Agency '; � , ; - . . ' ` �Date ° - ^ . . , , . . , , t" , � , ,_� ;� .. . � , , . , , . " , ' , � „ � , , � , Print or Type Name of Responsible Officer in Lead Agency Title of Responsib]e O�cer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) Page 4 of 4 Board of Zonin�Appeals AppIication AUT�-IORIZATION (Where the Applicant is not the Owner) I, C�-�l�'j��/;{�, �-)�� residing at fQ.�e G� ����� `�//� (Print property owner's name� (Mailing Address) /� �' � ���� �t do hereby authorize (Agent) ' ������s `� S'�//�� to apply for variance(s) on my behalf from the Southold Zoning Board of Appeals. � ` (Owner's Signature) -� - ._. . � -���?S��i��-- �✓�1�� -' -..- --- -- -- - - - � ; , l �. � , . : ;�, ;;; _,� ;,(Pririt.;C��?vner'�s Name); 'r Y- , �`�`.��` '- ., : ' � � ' ' ',� ; � ' , � � - '=,-, , � _ •'� . . . � , ��- =�n =t:��_ - , _ _ 'F; .. , - , �-�� � � ., _, . _ _ , - ',. ``� ;�. - ,_ ��:.::� ;.;, _ - . _- - _ .. �y: -- , - _ - ;.x • - �r'. �� 'x'=� - - -.K -- . � � - �.Y - - � — %�� • . - � _ -�,y _ �E�.; ry3 ,S�_ " _ - - ^al��•u " , , f .. - _ " - �y'y - Y -- _ " - . _ . �5 , `f:S�� - - " - :f,-." l; _ ., - .,.. ' �7'� '�l`S " .I.t-1iF'+ � � . 'T�� ���,� �'� `;14 - y�r�� - �4' _ _ _ _ _ _ " - � �f �ti' _ - i: �.}°_- _" ;('�' - - �,7a+ ' `�:��ry - ' .f� � + - f�• ,�: �"t.'^'"�` •t, - �t ��.1t� - 3�1': - � "�. . ,_.;� - ' ,t'� _ ' t�y `T`":� " • _ _ . /:i`< >,�;� �:��, _ ' _ ' , .,' , _ _ ' �, ' �'a ' t^ ' _ `,F+�; ����^, # - �:v, `•l,' `tis� ' 'i i�: .. ,k.. _ ' c�x.� ,` + ��: , "�.• _ 'i - .i,.'";i,': '�^ .t'�� ';�- �L�• ' - '�u - '�i�� ti` - Y,' j 'T� F - t�Y,� „M'' - ;t _r ' �i" - '�3 V " ' r.1.� �f. �1'��.>` -!��' - ,. , . " _ t` �f� , �_ •,� - ' - - - e , - ' `f ' _ . ' ^� ',� r�� "{;�,� •�_ 'i+s - � - -' ,9' � , ,'a. � , ' - � ^ '{`• . � �;i�� "'YY 1 'r. ` - ' � .�' .. . _ . _- . � . � � . � _ " ^ 7 � 'A e. � � .1 . � , � `�t ' . , ,. � " � r �. '• �_ ' . _ , � . , ' ' , ' '• , ,. � ,� � ' 4.,�� , -. - ' . ', � „. o � i, ' , � r . , � , � r"— � n'_ �.`l+j'.�rSm...� CC�-.�:�G�a��s�.�','.,�...-�--�---!a�`<c�'u P.i �' � AiaH M GHVIL�,I�IES �,� � No1ur�� PUhIiC • SYnie OS�°�'T�6r` Y � NG.01CA527i162 �, � �uairfiea in Bronx Cou ly1 �_, �' �iv Gcminission Exp��E�'s� �,��—�,.�s�, ,-,�;�,�y��;�,.�. � �r�"s�aiM z, APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM � The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emplovees.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 : t)O'L�1Z��f�'1�J� C�� Uv (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or.company's name.) , TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit . Change of Zone Coastal Erosion " Approval of Plat y�� Mooring Other(activity) _B(�tV'� U 7—C�f�� 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 of�cer or employee owns more than 5% of the shares. YES NO � I If No,sign and date below.If YES,complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. - �i#her check the appropriate line A}through�)and/or describe in the space-�rovided. � - -- - - - - The town officer or employee or'his or her spouse,sibling,parent,or child is(check all that apply): _, ,_�. _ �_ __�„A)�the owner-of_gr-eater.,that 5%-of the shares of_the�corporate stock of the applicant_(when the applicant is a___ . ._ �__..-, .� . • r: �-carporation) , � _ _ � , � , ;r� ^;�'' - -. - - _ ,,,__' '�,� .��` :t.;�` �-r' �'x,' `�. x �`>� .�,� `r ,a; - - ��� �,: _ ��, ,�, - ��' 'r� r`ation �t' �`��� '�a �enti �when the�a' °licant is.not a;co 'o - .,�; .B�-;the'�le��al or'bene'fi�cial owner"'of�an ,interest�in�a non-corpor teF ty,( ,pp. p ) .),, g, Y. i�. .,�,..,� ° � s;'S. " - J,t,^.. �.R� _ �.�.�7'�:�.'..^: ��� � �A`� _f«��, ',a`s " ,i: �'i.a - - � a ,,p": ���':� N�,y,_ �t.�",;"v �r� ' ri..� `r'M., - - = r,�`�: 1�a `i �it, Iv-' _ _ _ - 4�"� k�� ' t` _ _ ' " _ _ _ _ _ " _ _ - ._'it `_•Rr' - _ �^�.' _ ���f -�r' - i���'` "Y 'I'cant•$o r' :t}ie a` � 4�� �eeiof ��k; '�r;em'�`lo ���c` `-��K'� �'rector. "ar`tne'r.'�'o C�an,o�'cer'.�:di .pp �, ,'��' �, ,:P. � �P.Y =:b�� =��s,�:�'' `��,_� =rt.•. k� ), , t µ;��`' - x, _ .,, _ - ';,,�" r�-„ 'l'+�' ' - �4':� �2 't` "�� - _ �`e" ' y1•".'.: _ �i•, ?+: ',u� ��, "`F' �` _ ,,;t y;� ,a:� .t. .i. - '�p ' ' "i' :i�+'; ' ' - ',;1� .iS` . �i�� �ki+,� " _ �.,��u �d4, _ ♦�i� ..�'k' ci".` _ ' ',FY" .yi ,f `4 l iv 'ykr ��i: 1l�' a,�� - .a f�/ `�4 �`v .�.. s:.14� 4h�� ' '1'�i •�,�•' .{v �1 N� .�{�� ( .�yri '�r�v• r; n�*s - `�24:. v'?r.0 e`..:s .'S.��s - ."�+ t, 's,; ^F� Yti�, .,:��r 5' - _ u i;�., :� s Ilt-'' �`�;':�F r�. al• lica "�'r r_ D� '�the�a`c'tu a� .,` - '� P,P. y�:,��" ) � -���:�' '� a=; _:�` : „ - �:�F� ,�,�;». ;c„x�e:�;: •� �t�: :��+;:"::=r=,: c`.. �;F, ��.o-� �,•�_ ,;� ,�; ;s, .,5�;,°� .;x " ^F ''�.'_ °-r'" - •,, ,•;y., ���, "'.R�. r '.i.�� ``w, '"> - .!' s";k �i`" � !' "� �r �' ^i,t�, _ _ 'c{„' :C,. . ,$� . e�t;;.'i: "��,�i. _ :q�:7 ;) '��t .7,.. +�v .���+ .,s` .,�,F . ,.t..' " - 'y',- ;�i' 4�f �:v, 1 - r _ s' ' ' .Y ny-; i1�Y•+•u'::��i�}�. .r'p`���W _ ,F.�� i L�'r F t�±' "Z '- _+(�i �.{, .'f+', �x 1� �h a,�� _ 5 p �.,�„ ;��'v ,y - .�q„ _ d} - _o '�r� .-y. _ �'z' ``�', t'i ��� .q J' �.l 1 ' d� "rl, :y.,r_ �' �;4t'_.1^+ _ .'li.. D.:��>. Cf,'. 1., ' i. - .,f. �'�` r :��� .\ 1 �+�n a 44 a 2� ....{-'-; - :�2 L Y IOIVSHIP+��-.,:,; �,,- :'s�; �ESCRI�P�TION�UFARELAT �>�;"-M, ;.�` - ="D ;,� :,- i�_ q�I � S .4+ .��: .��M1�r: r�!,�� ^�h�. �Ire ,f%�' '�.�r " _ =y; - >'"r. �_j.; �'r=` - t`y`� %'s �� :�w �, _ } �' - ,�.. :r. .�`-'= =�i+'^ ��;�; s' 'w 9�t ,$". - 1r - T r'r�- .+�' ..,,c' ,z"� - .;,r�: t - <+S` i�`:, ��'j! ♦:I n ,���r'�a ��,v '"_�.:' _ _ !%A. _ � *�j.'. t:,•1 _ +V+ r�h ';�� _ z��. 'v � '1��� _ p "y](.�r'�," _ _ ✓r_5* :s.f�v - . - n ]:.- . �1 ' _ _-GEi^'• - _ ��s'. .'i t ' " �SF .3. 'J�. „}'���.�'� ' " Ri�'! - - ..�1.�'�. - _ (,l, � �.� _ - - - . � r.�':5 ' _ _ _ Y'" ' " �' - i��s - � - �- " .... i . Y:� . 'Si� - �'F.� , - _ .; ..i�w'r��` � . f�FtU e?Fiiw _ _ - - � _ e�7� �'��i" "i, - - . ���r} - - . ' - ' ' - . ,'� TA�� � - -�n•�i� _ `i.=' _ . . , � , , , ' ,, . � �Submitted this -�1.c1 f �� , 0 � Signature � / Print Name �f c �� A GENT/REPRESENTATI VE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emplovees._The purnose of this form is to Urovide information which can alert the town of poss�ble confl�cts of mterest and allow�t to take whatever action is necessarv to avoid same. , YOURNAME: V�lh�, S ��11��U����- , (Last name,first name,middle inirial,unless you are applymg m the name of someone else or other enttty,such as a company.If so,indicate the other person's or company's name.) � TYPE OF APPLICATION: (Check all that apply) � Tax grievance Building Permit Variance Trustee Permit Change of Zone Coastal Erosion ` Approval of Plat Mooring Other(activity) Planning - Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any offcer or employee of the Town of Southold? "Relationship" includes by blood,marriage,or business interest."Business � interest"means a business,including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5% of the shares. � � YES NO � If No,sign and date below.If Yes,complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person _ � Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. - --- - �- _ — - — ----. _ .. _.__ _ __ _ . .. _ _. _---- --- ---- ----- � ------ - ------ -- - Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): ^ � '~ �� ,��A)�the owner of greater that 5%0 of the shares of the corporate stock of the applicant(when,the applicant is a �'f�,5.,~-����F_��s - � � . � :n - . , � � , � ,� ' _ , „ . " . , ,. v. `cor`poratio )-_ _ „ , _ _ `� '•i' cs , - = ' nt is not-a cor`oration - . `te'rest��in a non=eo`r 'orat'e.enti wheri the,applica , p� )f° _ , 'B ;the'=legal or�beneficiaT"owrier'of any,in _ ,p tY�. '' '��° � ��_ +--. :�- _ _ _ - - - �:'�'`1 �',, � - _ - - _ _ _ " — _ " _ _ _'^Y r - � - �'Si _- _ � "_ __ '.y��» ✓-L� .•"u`n,", - ��S'� ^^T3 � � � �:� - . _ . ��x �`ar. ��� �he:a I'►'canf �3direcfor 'a'rtner` or em" lo�ee;,of�t ,. _ ":�'� 'G),an'officer, ,,�P � _ .P .Y „PP. ',i': _ , ,,;'� �� Y. ," -�,!� _t, - ,,: ,����. - - - ,, � _ ' _ _ �_ �4 �k. 3: t. ' ' - - - ��\�� ' - _ - - If _ l i. :y�� �"}_ .�i' _ i . — ':t, _`� `r'" 't;�' ;i;`. =3.: �lican :,��:a.. - . �" �"actua ��. tlie - !.r. ,D' - '.,°. .:�` ,'`� - ), PP. ��•� ,r.. , ,r� - 'r' a�s';' • . Q',� - �,Y.' 3� - . - �ti� - - ti}' � - �� _ �.Fi . �.'f � - � . � - �ti:�� - ,�t�t ..t.' Y"' ?, _ ' - C'•' - ,a' _ __ ,;�' - - - }a - - -t, "5s +,�� , �r� .� !} - ,r'�� �_.. t:n". - •3. ;,q"` 1�,- - 1:+` - - - ' ' ' " - -s.' ' �t` . :}. �„' '�t�ii��� � "�t � ���c �` e� �-TION >, �LA h_TION OF'� - - ��� "�• �;DESCRTP , �;.� � ..�r�`. .,�. �z�,' ��4� �,F-� ;ti`' - ., _ ���y�.� -y�a . - .,^�i. '{ff`'� "- -.t 1,'� 3 yYy ��.+ �1T ' m��� .f! - - � �:t�'' ..5� . � . " i�'^ . + ��` �F? - '� - � irh)a - ` . . _ " . " " _.1^r+ *�s, "r r "_ _ Y �'i',i. ' _ - " � - . , i _ `!:r - r �J} ' " r ; ! _` , ,. F� ` ..� � �i� ,..}� - _ _ . , , � �_" _ t. r . ' � � . , .� � 'l� - � '�.��;�in;'Y .� � . � _ , . � . � ae _ - ` ` .� ` '���� ' � � � �. � � . , , ��� . ' ' ' . ' .i . . . Submitted this day of���'20� Signature ' Print Name ��v ���� Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTTONS 1. All applicants for permits* including Town of Southold agencies, sha]] 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 exernpt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes al] of Southold Town). 3. If any question in Section C on this form is answered "yes",then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. j A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION - -- - �- =- - _ ..- - - - - - - - - - SCTM# -�C� -��?�_� The Application has been submitted to(check appropriate response): ,. °Town.Boa'r,d� �;,L�J .�'Planning Dept.,;�. ��Building Dept.` .,��Board of Trustees , . , , , _ - , • ' -.. � � ,, .. ;ti� �� • ` ,_ -� ,: , . - ' . � _ , . .r - „ � . � � , , _ -.. .� , - . , - , - ._ , , �. . � . , � . � • , , , � H,- , '.l. ;,�°�',Category:of Tovi%n"of Southold agency'action_�(check��appropriate.response): - ' � �- �-. � � � � - � _ _ -, , . - , � _ ;'�;_-._- . � - -- � . , -- : - = = - , �_ - _ :- . _ - .w , - , . _.. - . � - �� •- _ _ " _ -� lf_. - _ _ ' , y.._ � � _ `' ''a'''�' .� � _ - i . - � ��' �.a� ':Acti" �u"de``a���e ,ds,e`t�. - . , ',�. ��;', ;��i( ),' _ an, n rt k n �r c Iy=by,;Towri,'agency.(e.g:caprtal _ . . f� . � _ '{• _ tF'. 'l.'..= " �A�d` ';Y."• �- _ " ' _ ' , . . . � � ,�,� . - _ - _ :construc't,ion,?plari'r'iing,activity;=agency,�regulation,-]apd.tr'ansaction' , • ., . - - - _ . , - =%�-:s`���- - -- _ , , ) - - ;t. ;t� - - ;� c,�� . , .�, c`�-'� '�,° _ �54>;'.��;.' - ;,t'," °{- . , - °�;. ;-�` 's� '` - Y�: . . . . � . - , , , _ . - _ --(b)` �:�Finan"aialr�ass'istance�(e.g�:=grant, lo'an,"s�ubsidy�)- , �' -_ ` , � , ' '' • � � �, '' � - . .. .' . � � � ,..' _ ' . - -' - � �; � ", , ' . . ' . , - ', . , . _ .,- ; ,. - , �. � .� ;`(c) --Perrriit,�approval; license,�certification:' � �.; � , , � ; ,� � ,' `� - � " � - �. , , � „ , � ,. � _, � , � �� . , , , . , , � . . Nature and extent of action: ��.� �r � c�a������- �i��� ,� ��Ic� � �s � � � P�� Location of action: � '�`�� ��'�� <���f�� Site acreage: o �j�� Present land use: 5(�j��(�= �� � (,� ��(��-� Present zoning classification: ��� 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: � ��� �� (a) Nameofapplicant: ���i�Sj� e' (b) Mailing address: ��� (� 1 j� �� � �� [�j �v y, ���r �d�? L� (c) Telephone number:Area Code( )�� `,� �� -- �j� �,� (d) Application number, if any: 'Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ILJ No❑ Ifyes,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,inakes efficient use of infrastructure,�makes benefcial use of a�coasfal location,and minimizes adverse effects of development. See LWRP Section III—Policies;Page 2 for evaluation criteria. .--,� - ��Yes ,;�,•�No '(Not Applicable—;pleas.e explain)-- - , , - - ` ' -` ' ',,' .� �.- -- • � � . � � � ... � ., , , � - _ ;•,;:� _ -, - ';t- . � - ' � , , _ J" � M1 ' _ ' _ " _�' ,� ^' - � ' ` '' ". ' - , �_^ _ � . . ' , t' � _ ��,,, ' - ' _ _ �.' _ _ -" ''" ' :_t`'�'4_ ' . '_' _ " ' ' _ ' � . , "_ ' _ t ., " " '.S - " ' 'f� ' _ ' ' 7i� _ _ ' ' _ _ "n�• ' <ti'^ �f� - ':7, �efi�" __ ..� ' ' r ' - 3 -_ " .1 - - -�; ,�',7 _ - - .y. - _ :1� ..J.' - '1' ' . 4 ' ;��� "�' ' �,l" - - '�� .".�`G `1'C f . '.t `'��:. •l'.�...�� �,b� r i.'� 't' �1' �'1� „l' i.l�� F�� Ii. - _ �'R .�`i �I'��i 'f.` 'r�. 1 " .1„ - T-Sit^:`st " .,1A " .y. " � , `," _.• yz .' 'nr r`',i' ``�� .�S �-��� _ 1�. ��'-' ,1 _ ' ' - _ ':n� �'l�l�s���. _ _ ..lt..+�' ' ,]'�� �� ' -, ' - . '�" ,o, t ;s' - - - — " , `. . _°Attach�additional�'stieets�if necessa� ' - - -- - - •� � , - -- ' - + - � �`�` � ,�}' � �� . ;4�:. ; _ t_+ _ ry ��f�`_ ;,�:� _ .- _ , _ -_ . , ,__ : , ,. , �';' _-, _ "__ _ - , _ -.-�,�. �� , :'. , - , , ;- _ __ . . . , . . .- .. ' � a' ' ; { . . .�';.�,. � ; , �.. _ , �. , . , _ . , , . - , '. . , ` . � , .• ' ' _ „ _,,.- '. ..� ; ' �.:.;.,,� , � . ... ,� �. , ,.. ,,. ,. ;,, ,. .. . . :� � :,� � � , . 'Policy 2. P'rotect and 'p'r�serve historic and �arcliaeblogical resources of the Town of�Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria 0 Yes 0 No (Not Applicable—please explain) ' .:- � � 0 1�'tS���4�'� �'L /�c�?�.':�- �L � �'� � r��- �- 1�, T-� Attach additional sheets if necessary - Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria � Yes � No � (Not Applicable—please explain) -����!�`�` �,��'�� `��� �`� ���`' �� � �� � Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria - 'i�` Yes � No � (Not Applicable—please explain) � � � r � \ d tJV�J� � `(� - — ` � } 5 Attach additional sheets ifnecessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria �._ , __,.. .�-_��, Yes,, �No..�`(Not Applicable, .—��lease,explain) �--F--� ,.�___.___ _-.- -- -..--- -- .,.--- -- _.__r. � �___,_. " 1,�1'�a`.�!'' .y �ti .S�- _ �. S_ . _ ' i r � . ���_ _ _ " `k ���. ^�.. ._ - _ _ t�. - " - �:L.� '- :a�`�. ' - 1 f - i:f� - :l:[:'-,� " _ - Yt - n°�t'1r'� _ Jj� �}r. :�k _ „4k.u���> - ' � �./v�~ mlbt. t�S'.J _ 'As� _ _ _ _ _ _ _ _ Mn'tr " _ _ � - ,ft.� _ - _ _ ' - - - ,�f. - � _ _ _ wl."� •�24_. _Yr _ ��i Y�" r':l ^iL'.. - 'F.'. �Y}e Y�•1` _ �'S'�"+. A�r _ J ki'� �M1I`�` .==1 .Y'-�n 'r''' `�, 1. =.}, _ 'r'�, - .✓- .`.�"� .-:i. ,u--�< �i�, ,..4 1 '�. ��. - -_ :'r'`c_ _ Y„ �'h� - _ _"_ _ _ " ' " _ ' ' ' '"' ' " _ ' _ ' " y'�9 '��'.,"; ;,iY� " _ _ �_a^�, _ '+S" H"t� �..- =z� . .�F,..�. 4�, •+M1`% _ �g, '�1. 1°4 �"x " i��� i�['M1� �:Tc�ri § Y�ll:..n.-. ��l.) 'jii.' _ �.��:�i� " .'Y` ��, ,<`'"�. `�"` _ _ ���tt� - ;�y;.'� _ _ ' ..��. .'t'��' -- -1i�_ -t+:ky r S"ri� ',x«r���� n.i. - KN��� ME '4� 1' .y� _ .�,t �is; �,�i �t�.p ' ' _ x,e _ :1 - - '�:'� `+'� - ,e�`�` ai. _ i'� .�^: ,�• ,Y `{'� �,�:�. -={, - } .�i; ,'�r :t�. 'ix'V ' '#:�..r 'S'� 'rr� �'v�.-'..�'�,'. ' � '.y;' .=y�' .t ..�a;-`,'� - F:Y ' `u-. �rr-r" r.F_�•,�' ,A� - - -`i.' - �is-:: a�'•,:-.^^ �,;�"" �t;z tL�q.� '-X'" �'i '�� �yria':�;� �� n�C' ���t :.$Y. :1'r ' <'i,{'•�� Y�''Y,`i!,_3. - ';1 n {..y .h' " »~J.� rt-• _ _ ' _ ' .�f�����;,'�.�'"-i i�j.s �:;.� k r !.("' 'ts.' - - ��".i -r"*{' ! `'S. { - ��:r, - - _ _ - - "�S( ^.t'°-��p4 .,�:.4 -•1? ft g _ -�> .�;��„ - '�r1,.x:..� iY:..v� �"i'�„� ;r - _ 1-.'� �r r�4 Y. r_ .:.� ' �r ..1J „ �;"v � �S'� f. ..1'�' ��bX�i �^;'� �1C, `.�`.S'.' i£?-`v'*�. �N� t�3g` i�+,� �:,i �^•s` 'Y��, ^'i;, r-�4 °zz.,x� �.S •, •4 4=. .t�. �'4'�,y y�,> '.SR:'' '���. - .,��;«;" ' ' ,�„` - ':s`t.`��".r;'�" �i� .f�;t - . ' ' �ty ,k:' - - �4',•f "�'a�7 ,'xY - t°�'` _ Pry> �'h'. .rc �K', - .`h.. - �n,: ',f �i..�� <<i� ��l._ - " F�. ..a<i+ '�t's -�IY''=..�r,:w'... �ijJt"e .`t:��:ry' �„'� - _ ,°j_'�G' - - - 'j°:. __�_,V:� _ ;x�.;`:� "t �'s� -r^_ 6, �i��� i3�[., rF F;� ��c�. ' ' 4„'�' ti�.� 't- ✓S" :t� .:E�"� - .5.�. �..`4y :{....+':+1.. �li' t�iti�''. - _ _ m�k -{� � .'r{`: tl�. - _ f'F. ' .'y.:� _ '����z �ij�^ :1; '%�'.`� �_:j?�� r�, y�` .-,z.w ' +�.,; 1„ �j,l..'� :1�: t° rn�- "r' <��• ��p. ',�F• 4:•s y�. � p,. n�_ _p. " _ 4-f�'.. _ .,'j' f'" _ _ i�' -�:t' :t� y1� ,�'�'r�. _ " y tt� . } [ V�.�. � a�: - :a_`> k` 'l • Y.. `f' l. ��� ��A - ttach�ad� t'� d1 ionai'-slieef''if• ec > s n essa` _ _ �:�: ��'' � _ . , .+ ,�.. - ``�, -, - ;;�';, .� �, _ _ .��- �f��'' - ,����> °�;:�. "',Y,, �„' z,�- - , a=� c - ,. -r�,. - ;+=' �G',' '.Y� �i�u t�'�'� .�t^ t. - �i, _ _ _ - _ - ',y`u'1�` -. .1' `'f� r}'. '4. :}• Y�;s .��" '�4�:;r. x�y. .1 ::�k' _ - _ _ ' t^ ti. ` �y ..T� � �:;Y'~ i Y�� - ,e:," '�I•� ir-�- - "e;[..' - - - '_ ' '�;. - "� �'�J� - - ',,�. .� _ � l�;f.- _ � _ t r� 'ti` �1�' ' - _ �`�p� - . olic ��6. ��Protect�`a d'���'e"" �y, n r_storefbtlie;giiality;and��fiir�ction�';of``t}ie" Towii.'of�Southold�.;ecos��steins';includin� �� � '"Significan"t Coastal��Fi'sh`and�Wildlif'e�Habitats aud'wetlarids. See LWRP Section�ITI—�Po�licies; Pages�22 through 32 for evaluation criteria. � � Yes No� (Not Applicable—please explain) Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. See Section III—Policies Pages; 34 through 38 for evaluation criteria. � Yes No� (Not Applicable—please explain) Attach additiona]sheets if necessary �olicy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. �Yes � No � (Not Applicable—please explain) PUBLIC COAST POLICIES , , � ,Polic'y, 9.,,'�;Provide"for:public access'to,,arid�'recreationaI_use of, coa"stal rvaters;•public lands,�and p,ublic. , , ,, . , � '; 'resources"of=the'Town of SoutHold.':�ee�LWRP�Sectio`n�III—Policies;-Pages 38�th'rough 46 for�evaluation . . : ;criteria: --—_ - :� _ '•, - _ ;;;� _ --._ _ ,. � , ... � - • • _ >- --. ' _ _ ' ._ - � . - � _ . 13'� . '� � u.l� _ " � _'�^�_Y _. _ _ _``'a�''_ _ _ � � _� _ _ _ _ - . " _.. ' _ t . _ I�. y. .�`!�_ .'y `!: . - , �w i l" I i t" - - - {�� �'+�.^ - � � - "- � y 3` - ' � 'I'i� � ' �1� _ , � <,' - ,i' -�� ,�1 i� ar.' '�t�, ' . a , _ f ' , ' _ x - •ZY f 't ' ' ::+�' ' - . _r_ . , )`. ' , - , . .,{� _ _ '�^ �� ,,� Ye -1vo �ot�A' �licab'le�= `lease�:ex��'lain�� - -, . , - �rz�� - ��,. ,PP_ - _- :P, . P .)_W'�,.- . - - - _ - _ .-i• �t. - _ - . _�,,;: - - _ - � - �� --- ' — .'4 '�i.}.. ' " `... -•f . `"r • - '- ` , �,� , 1., ' `?`. .�A;� - ,S {� " - ..t.� .. . - y _ _ - '1�_ . , . - - , � �. Sy , _ ... . - . 'y-` � .1." - {` 'Jx` ,i� ' �} . „ _ � �^ F`?.:`:,'",J'��,. _ "a p � �`y . �'(/1 �t t�.I1:�- - �5--� �' _ _ ' ` - - _ ' _' • ~�;",.e' , t-, , _ , yl . , . _ - _ - _ - _ r„'' - '�-'y--- , ,- , - _ - - - _ . -- ^ - ,_ ' ' " , a ' . , . . ,--_ - -- „ _ -, � _ - ' __ . " -.,' .i . - ` , ' ,-_ , ' ` ' , y , � ' ,t',�' ' - ' -' � , � . , . ' .� �. � , 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—please explain) , • , 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. � , � 0 Yes � No 0 Not Applicable—please explain � Attach additional sheets if necessary � Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III —Policies; Pages , 62 through 65 for evaluation criteria. � 0 Yes No� Not Applicable—please explain , Attach�additional'sheets ifnecessary _ � � _ � ' - .�l'� �� ' ..i �lJ-- •, ,t - " � ` . �� `1 -- (' � _ - *VS i. " _� �zl �' �';." Si� " ^'}�,�. i�; ..�{.`,.�_ " ."�, - �' ' �- j . - ���•. _ � _t j "'S�tiL' _ ' _ �t� .�l` _ " - - - - :;Polic� �t;' - ��13:�. ,Promote`;.,a�`"ra� riate, user=and:.develo ment;"of��ener �and'�zinine�al°�resoiirces.�",�See.�I:�WRP : �` 3' ,,r. `°E, PP.. ,�P:.,. p �'- �,_ ���. -��+�; "� �'�� „�,�� .r�� �:���, , - +,.;; � . �� _{, -'.;,,:.`,� - -�'�' �y-` �Cf� ;�� - - Se io�:III' Poli� `e -a`e` 'S th�T�'u' '=e ,�u ti� y ci s�``P s`6 r,o 1i.68;fo'r• val a on;;criferia:ti�" `Y: - ��. ��.. .�, g � �g., �Y, ��;-�;- � �'��� ";,:, `�-' <:>-, _ -.d� ;t�_ :��-: �.�-� - �..,- - ;:. �,;�, �,; „ :_�. _ �r� :�':° ��. - ;,�:;�'� - _ . _ ;.�.,.w_ az= _ - - - �.,���;-_ _ :�-;� =��`�r - _�_ =.t.. ;��. �;'. ':� t .r.�.�,. �. - '�t Y r_ _ _ �i,1 w 'i f �i'' ._. =P. +r ;��' `•ii r .f:`: i 1��� i+�3d ''�7'r �f �2�' '�4�4i t F r�; 4`c ,i: �� 1' � 'l, .4` -:j ti'. - i'y y'r - .�r`��:`,r - ' '�5, - _ 'l�t, r� � �f l - � •������'.�`� _ - �Yes=. .� `No� �o't=�� �Yicable> eas"��ex'�laim: A' `1 e, - ,=�:, <:�; j� w< „0":��N ''1� C��Si� - .rt'...�- ��E, PP.._ �.P.. R �'' n:r'. -:�� r��� , �i>,:�'_ .4�, �,,�;. - ,�kv ;".3 - ' _,yt, ..1�`. :,a°, .�� _ "n�, ' ' ';'4',•� '.i� ..l, - .t �;�' .�`V i�' •+t�:= " .s - =,kp� - '2"� :f' - f}'{ ;!< - _ ;.'L�f" �.i° '�^: 4 x ..°M i �i"`S„".� f,- _ ^•'"P� - ' -�5,.�. . ..�, t�� �t` " ' ' .;r, ���,�„ � - ia� �'.�.. :5":� •1 , �••h. «i":= x5 Y Z,S��' fi, `�4; a�4; a+" ' ' .;l�_�'"` :.1:i ,t,�u 1�.� �t A ; ,� �,:.,�: �,�". =i'' ,t-. - - ' _ - ,_�"�` - - 'y,', ' _ _ . p- `•'f'' - _ r�:� _ } �tt..'..s'�t•r• i:ti 'u .�:. - .' i T�y =�+��, ��,f - 7" '`2 "h�. .��v k�y� ';j�e'.' Y''+ e�' =��t :.{'.' 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LOT /,��_ �.�,,.,� � �,/� �.�;,Y►��:Y������I��_�s�����,s��.-, J��I��R������r����t3�,�.� ' � �` y ,� ��' .� f ,�.�,_,� J � � ' � ��� ��� ' �����..�-����.�.�.. �' �:.�c�" ��!_ FORMER OWNER � {.��y`�`��'S��` :N�� _�, ' ? •. , E � � � �J�"1�'�u' ,i'�P'i�� ���,�J�� ��' ��=�� __ _ - _ _ _ ACR. ? �l' �-. � ,. ,; ,� ��� _ - - �(a Of� � '���:� �I�''�G'G� `J� i ' S-S -�i --- . -S' ' ' - : W TYPE OF BUILDING `� . �l''���,+r-�:'.��f's r r^^'lr.d 'p_/�,�...,.n..xw�� .- -- - - ' - -'- J�,,�._ �r�G(v'°��G,�'+«....�' �ES. ,� � �`_.� SEAS. `� VL-. - :=� FARIVI _- ' COMM. CB. MISC. Mkt. Value �-�; !�-_ - �.. _, � - . _,�� _. y ., i :;�.,�. .,,, ,,..._,-=�=-�,_ � - - - - -, _ - _-_�FcYJ�C LAND IMP. .-.TOTA`L•'- ���- -'.: D/ATE REMARKS • '� .� 1a . , y /i� c`:M'D 3 c:Z�+j� � .��s�,�� � - - -, . ' � 1J v`-�/Z,.� ,v�^L".�C... 1 ✓t-t'_ ��"'.�..._ �,�'G� O � � G � .--��-at`j- _ F 'i��(��,� -� .;'�' �'��at--.'� � ,�:=�'.•• � ��;?�t"' �40"���., �;� / �T �f U � .� � � ..� � .°� �.�,�'�-''�.��J7 '`� �.� 7 �.��.������. -���d ��.,�� � � � f �. �, �k {��. `f�.�'V i! d f I � � 1 r� �,�-"r " I � tY � 1 ` s-- z.- � ^�, I �• ' � � �� i� � t�,r:F:`:�,. �t�><.�[a /f � �5�._'�Cl_. Q�,°'r' � •�/. •�� � � 1�� I�� �� r� '�'F r �. � I �t�Gt�u� c� �-�..lr�.._,{1�C, ►?'� F �C�?i �JO• .'r'.l+ f�"'� (�'' � �'_'� '� •r" �>'�, ,-:.sr' �1'� so�� ' � �-�:�.,....:- ��-.-�� �� ��f���/ ' - i cel ,n �.�i s.� �nuv-�t. � `. �� .�. � ;;� �?�i% C) C� �- t�;����'��I``�";���S' r~��-''� �' / QL9L �C �tv A �ll � y`�' . -- _ � d i �- N Q'�YV NORMAL EL=OW`�-;,: - ' ,AB� V � G <�,. I ` �-���� ��:�o o :� _ � �.z;•. + .�r.-j� �l'1 —� � Q � � C S� C� Y,IIY'� F RM Acre 'Q�(Z _ Value Per�� t� ' :,. ' �'/,a'lue ��;--�. � 1! �Y«'•,���?�. ��l�`� -',V/C- � � �7 0 �72��,.,�/u�..�-�:�` �'� $ r�7 D -L��t�f� �6 ��'7-�'r.r� I !` �� ��, ..-� �.��f.�.t� �. ���-�. Tilfa'ble . ' �� � ' r i1f�� ' - �� - - ��� � - - � o � y=L. z-� -�'�- 3: ���I�s �'�����-� ' � �, . _ _:j:�,Y�f':(4'i^S. ���'� r^�'� Ti I la�le 2 -.- � -- ' ' �----� _ �.. „ Tillable 3 � _ - , , ; - _ _ , - - -- = n � Woodland � � ' - ' : : � , - ; - 1��+L� 3.�-. �.�� ?S�l'� - - �' � I � u Swampl•and _ _ .- . . ;,�,�•;,;, _�_, FRON AGE ON WATER �`� L r, �� . Brushland - � _ , ' FRONTAGE ON ROAD ����- � , . •_ _ • �;.x House Plot � -� = _ � ' • DEI�TH �J� � �• - - '� �' '`r� BULICHEAD . - _ .- -' � � ir Total - - ' � � � DOCK APPLICANT'S PROJECT DESCRIPTION � APPLICANT: � � (�- ��� DATE PREPA�2ED:� �= �-�Z�}� � �_ 1.For Demolition of Existing Building Areas Please describe areas being removed: q�?j � � �} �Q -{�c '��� � ��y���-o � �-- Z ) n II.New Construction Areas (New Dwelling or New Additions/Extensions): Dimensions of first floor extension: ��S �- � j (�,�i� ��� � p�� Dimensions of new second floor: ¢� �' % S Dimensions of floor above second level: 1,.1Q tJ� Height(from finished ground to top of ridge):_ Z�f'f—�� ' ' � Is basement or lowest floor area being constructed?If yes,please provide height(abov�e ground)measured from natural existing grade to first floor: �� � III.Proposed Construction Description (Alterations or Structural Changes) (Attach extra sheet if necessary). Please describe building areas: Number of Floors and General Characteristics BEFORE Alterations: ���"�j ��.�' �� ��t 4 �� � P�- t1� , °37 Z �S�- C��R.� (s� Number of Floors and Changes WITH Alterations: 7 �5`�(�� [�Z.. �� �� �- �� � �� �5� �� .� 5-� ��r�� ��� �IV:Calculations of building areas and lot coverage(from surveyor): , Existing square footage of buildings on your property: 2,?�],�' � �—j - Pr-oposed increase of-building coverage: .-- �.y'��-j� ._ �r�`� _ . _ Square footage of your lot: �L�.,'L3,���= , Percentage of coverage of your lot by building area:_�p�' �,- � � �j'� �C},�,�/� -,_"'_ ���,�'_ m_�_:_�;Y..P,ur''ose-of New--Construation:�-- -�,�C.��-- -'=�'��f�-�� -=Q��;CI���. --�C �- - - - :;:� �i , .. , , �y�___.-. `1,`r' _ y � • �p `! ,r'f<j ;��,.;., _ _ ' _ ' -, . ,� , . � _ ::,� _ -�t;� z t� � t -%_s;'' - `.�. f � - Y�.. �"�'" {,fj _ 5:\ � ��M��)�}' ,�i t �� " '1Yi �C'3-`1'v'i�+�/ ,"'i ��i y 1,• �`J 2� ;�.f�c... 'i _ 'Z` �j. .f- �l_ - , �y�. 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X ta� `'�� I '2� � ;g� d'�s „+. - `:i'a; '��,,� �( r- '.�;n j sy _ }a 't` .,�i . !� '\i1'J��• � V ,.'1 �"=e*.' ,-L: i%�' ��` �. } ^/1`,.��ti�;�� h, � 4�' '/I'�F_ ' WI.JL�) i`T C ��"�� §. �'�'�' ���Y - F-==�� ��_�" � t` �'lt i:�" �..}, ` „`ry/ _ '4 yt`� r.ks' :'�s�'�{ :-i1^e 'r�. �f ' a"r i''" � ,-�:1, ,a,�., v;�� -.s` "{.i - •1 e - ;',y`�ry' •�z' ;t. t� +T�� i. - "fy - `ts ' -`Yr" 1:Q� ;''i6r,a _ `n��.��a i� ��. _ _ #r�� � ..�iNrl - " - . - - . �` _ �� '�tv �7� - ' ';��.� ' ' �{ �t��.;.�• ' ' ' ' - - - - '�4'. 't. - rJ .:*�. , 3��� - - "'r " " - • _e ' .- J: .y;�i - j�� , - .�b _ t.t'.. it�`- ^i ' � � .���. ' '1, ' r,f - - - � �` , . .. _ ' 'l ' „.� ' ` , .- . ' , �'.. , ' . . „ ' - ' ' ;, �� �, , ' ' .. 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 market for sale? Yes �No B. Are there any proposals to change or alter land contours? �No Yes please explain on attached sheet. C. 1.)Are there areas that contain sand or wetland grasses? �� 2.)Are those areas shown on the survey submitted with this application?� 3.)Is the prop vrly b�ulk headed between the wetlands area and the upland building area? 4.)If your properiy contains wetlands or pond areas,have ou contacted the Office of the Town trustees for its determination of jurisdiction?_�Please confum status of your inquiry or application with the Trustees: (��M (� (?��)y�,� and if issued,please attach copies of permit with conditions and approved survey. D. Is there a depression or sloping elevation p�the area of proposed construction at or below five feet above mean sea level? � E. Are there any patios, concrete barriers,bulkheads or fences that exist that are not shown on the survey that you are submitting? IJ'C� Please show area of the shuciures on a diagram if any exist or state none on the above line. F. Do you have any construction-taking place at this time concerning your premises? �1�C 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 certif'icates of occupancy for the subject _ __ _ _ _ premises._If any are lacking,please apply to the Building Department to either obtain them .,_ ________r._.________��_T,--orto;pbtain-anAmended�Notice•of-Disapproval. - ---� - �-�-�- ~- -•-- --�- � =--� - �-- �-- = -� � .\ _ � ,,L ,�� ,� ,r , - - - , • . ,F' .;, _ - , ,� �y„'. � �+., r'' .,:; , ,4'' ' r.� - 'r. . ��;�a :�r�. - �'' •'+f�t - ',� '�}' � '�. - s� �"'� , r' t _- _ ..�t �, :�H: ,D�� �u=� r' ,?1,'; .'��i, o;,'o o an,`�co'owner also'own.other�larid'ad'oiiiin -or,dlose�to tlus,' arcel. �', i;' - -• - ,Y .Y _ J g _ P, ��� � „ � - _ - F.. __ - ,;._ _ -,,, _ _ _ - :;�s<' . r �r ,t,.c - - - - -d� - ;�Tf es" �lease label`the:�roxiini� ��of=``our��laiids o . �s'-s� - -�sTr�' '��- �- -�1? ,.P, ,fY- Y: _ � ri�your'=suivey. _ .}. _ �-�.: �„r ���-��-= = - - - .t_.- - �.�._ -- - .X; �;;'`' -= - _- - - - - - -- - - - - ,;-:• �;. ^'l (• {~i"r..l�.+�i \f.._� ' ' .�...li F t.t'�• ' - ... 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'�, :'ar R .,. , ,�'. �:7; ,.,;� :l ,N., ,�,:,,','��#{ �, � .(:�?;�, �,� �arid;tYie�:�'rort'o'sed��use;-,�� '� x;- -»F. �',• �,t�� � ..,,-.P,., P,. n�('� - — .,,«.x�r�;:,,.�• � �s°'sy= .;�:- }, r;, i, : tr '.;'�1 ,'�::•� '�. „�` �z' '1l)» ^`�� ?.lY'_n ,`t, „'i^' s�"', y.. � �,,• ;4 '�'w ,�.. ,'<`c4:` ' o�hj. _ �'� `+�4 �h 4 ' rr� v"`�+ �_� - ,+f= ,." fS *,i',� _ _ :g - _ , ,•f •s� 1•�' +z: LiL _ ,s�`, ..e ;� x:�ezi'sfvi'"'s"�n"le famil� - �.�,, �;, ;�,:4 ',ti{, ,`r,�, _ .:,:...,....r,�F� �.�_ B g Y,' .ro'^osed=5ame=�vi{h _ '��', :;'- ��.,;>;: .�,'�„ - _ P .P_. I�:t�r,. t '1�5 � -t;• ;t�� ' `�" ""Li '" 2.: al_ - A:".t.i.:..,� " " ,.,� _ '`•:.ri,�`j}� `;s;, "'e, 'ool:oiio er; -} . _ - �'r.`:- . ,P ) '�c...� ,� - - ,. - �4 - _ ' � _ '-_ - - - - �r�� �4�.r ' ' _ _ s i •�:.r ' `:?*' � -- � . � . - - _ " _ _ 'R� -_ _ __ :� .��. 't :{c _ - - ' .J`� _-- , _ _ _ _ � _ •'�' - -1 =• i`t,�' �'" �� A _ 7„' `� � - "_ • - � - � ' y\`� • - . _ �•�'� � ' ' - _ " �j• e} - _� _ � �_ ., � � . "� 'Z . . �1 • , , f. ^�1 r . _ , ' j`:'�%�1i.,,, . , 'i �_ � , - , , '" � „ . '�� �. ;'� 1 , { . " �I' _ " � '• ' , •` � , . � � Y`� • , .. . . '�J�jj�;r'�����?ls , k , Aiitfiorized sigriature'and Date BOBaH NQ � TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Qerk's Q$ice . Soathold, N Y. Cer�ificate Of Occupancy No. .�G�+$$. . . . . Date ... . . . . . . . . . . .p��r . . . . �9. . ., 19.?�. TffiS CERTIFIES that the buildi.ng Iocated at .�c�ot�alc� �Ad. . . . . . . . . . . . . Street Map No. Ed����o. :$lock No. . . . . . . . . . .Lot No.�0•&pt .�. . ,Laur.al. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit hereto#ore �ed in this office dated , . . . . . . . . . . . Ap�i1. • .1,�19. �4 pursuant to which Building Permit Na. . ,�1$OZ- dated . . . . . . . . . . . .April .15., 19. .,'Z�F, was issued, and con#orms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is iseued is . . .Pr��rato• ane. fami��► . .dwe.1.].�.ng.w�,th. an.ardditiou . . . . . . . . . . . . . f . The certificate is issued to . . �.C.JassuR . . . . &�tner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) � of the aforesaid building. Suffolk County Department of Heal�h Approval . �,A.. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . - _--;,� . �- .� -UNDERWRITER�-;CERTIFICATE;-No.^Hf�564�a'- :�i�il,--�`�9 ,V4__... -. ' _�__� _ _� _-_.._----�__,._ --_ _- �di �C ti1� �� :+;'Pi':=;'�. _ "a:. :;'-:" �1 }^'•; :,5"_ �� .,������;r �Y�,. "i' _ ,4�- .l� _ . 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".y`,'� - - �`` - - -c, _ _ rg, ! _E,. '�,:�' .P� �.=;'` _ e ``_,�;-�.�' _ _ ;;= _ ���� � - - - ,. :-�=�- �- =��=�' - _ �-, _ ,,. . _ _ e.�'; s'y'; i' ":�ir :'r_ - •x-,:> "�;,,..�� _ rw .;f;,l'�•< n'�,� ' _ ' _ ..,.p+_< :,�,.�.�.��>',� ��° t fr�«-"4^ _ ' .•t` �.L_ ,h� - 'rr - - 4t., ;x�,.3 `s �:�- - - �y. _ _ _ .,i... 'p:+ - "`" " ''r� ?4, A' l - - .y' .1 - i r''=` ' �}� - - :.t ' ^�^ - _ - t„y• -�:� sF_, _ - - �d"- .i� �z'� �.i��°� __ ,�{,s,:. �„> _ .r' �`�= ,'�' '� - .y" ��,;�.� _'x,.r^ ' ';;PT :r� - - +,4�`"` '�: i - `'y' - - �, _ 7' .:h'_ - Y„+4iiv'Y�e .} _ -- - ' 1' _ '�t.� - _ " ' •t� ��1`� ., i .li `<� - " -i' � ' ''1,� i:'.'��v %•�u- _r� ��. ;t'..ei` "1' '.jx .7. ' � - "4`. 'f�!%� . `�1. f, r{'�, iq;' 7��� �I�� ��t y�� 7`�' .l� p�. :,�, ',��e; - � `ye' TM�4• ,�:, ��i � �1i' .��+;' 1�1 ,( j,( ti�3Mt�,' � , �r♦� �. ('" . , 'kt� , � , � , , . - �.7 � iV 'i,f' . .. ' 'i, , ' ''t' ' , , ' 's(� , , , � ' , , ' �. � , , � , , , , i�t , • , � , � ,. � ' , ' ' ' � � �'ORM N0. 4 �OWTI OF SOUTH�LD BUILDIIVG �EPARTM�N�' Office of the Building Inspec�or Town Fiall Southold, N.Y. CERTZF2CATE OF OCCiIPAIdCY No �201b6 Date AUGUST 23, 1991 THIS CERTIFIES that the building ALTBRATION I�ocation of Property 4�5 MC DONALDS RD. LAi3RF7, House No. 5trset Haml.et County Tax Map No. 10fl0 Section 145 �lock D4 I,ot 17 Subdivision F`iled Map Na. Lo� No. canfarms substantially td the Application for Building Permit heretofore �iled in this office dated MAY 23, 1991 pursuant �to which Building Permit No. 19�93Z dated MAY 28, 1991 was issuec3� and coaforms to a11 of fihe reguirements of the applicabl.e provisions of the 1aw. The occupancy for which this cex�ificate is - issued is . INSTALL A WIIVDQW .ZN,EXTST7.NG ,GARA� AS APPLIED FOR. ------ f---- - --- -_—_-- --�-- -------- --• -- -- --• --- -- - - -- - -- � - --- - - ---=- -- , . - , - -_-��- -- --�-. - . . �, '"• T}ie.,;cei���icate� �i:s issued�:��ci` - - �-�LTZASE�H C.„'JESStIP � , ,i;` ` �- . � - : � � � - � _ � - - , -_.`�;t(�owner.)' � --- ; _ � _ _ . -- . . , __ . , , -. - _ _ _ _ 'f� _ �i''_ .��5 4 - - - - _ - - - - _ � - , � � - - . , �a, .4r-' _` "" �c __ ..S ' . _ _ «i. , ti . ;,, ' '�r, _ . - 43, - .t," ' 'r'" - - - +) _ u.J .\` :ti: _ _ . _ " _ ' . !j;':_ _ .j. _ 'y-�.; " ' _ " _ ". 'ti'Y 'F, _ . _ �•f'_'. .I1 - "yY.'•`. '- ' - �:of- lie�:a�oresa� f id,nb'uild�n� - - J,• �� -. _- '_ :'Fe - � - '1t' � _ _ [<• __ ��t '�l: ' ' -l� _+I•1. -_ " _ 4' _ " .riJ " _ _ - 1�. ^.l. ' �f�' " :.�f,i� ..Y. �: - "?�� .�5�', _ } �j� .>' �iw�,�' _ _ v+<"t�, - g• �^!', �'��• '��f�r'a - _ .1!' .1.1u�` :Ri �cr p`�r 'tsa�;., ,r. :�a�,- 'r� _ .��j! i, ;.{1�.�` r1'�:.'u'4r 1'`a:k.� �,4 "r: .p,` -�� `I'` . :r� - ��� '�Sn - i` - '�j� ��`� ,t ;,�� M�{��^, �'i ';1.:. ! ,� �1'� .:i- "�,',- - ,:ir'.`�:� - _ _ '.,�.; -`SUFrOI,K CO[JNTY i�EPARTMEI�ITrOF�''HEAI��H'�APPRO, ;r`' - ;�, Y;;,` :.fi' _ Q�. _ �;���r: ' - �`S. - `3., - '�'1. - ,+.%�"J�r j,{�'a- " ,.3: - �!ai ___ "_ � -_ ..! ' ":�): ".h1i - 'T 'I-:i�,:'ti'i:.. - .i - _ _ _ 1- _ � ..Y,i, t.a`n " ^4�C:i'.. .e _ ' _ 5. a^Yi� ,l:_" - ..7.- - .✓_ i).` _ ' ��� )�; - ,�:i�.- ;�. r�� �', ;r'' �,=." ;o-. ,p� ,;lt�F` t:4;:��":� �sa� ' 1�� .'-A r'f C �t�, " :'Y'� 4��;�- :h t }� -;'t ' ' .2'�' ...1:4n i'R, «.N�r � It�,. .t ' h""•,' '��%��m - �rt' �:a.:� ��"�' �.r� - ,..a � :.r„ 'i5, .:*;�n '�� �'�, `;j="�' �'. t��7��i �+ m .d,��,;�^•- _t� ;:,' . , �-�•: ct ��',_`:;. - w`=� ''!4 -- ,� , NDL"RY�RI� � 3.Ea7.lU'.�L'/�:L' �L"�'' y�' . , TFI, A7.'E-%N0: ..L= :� -�, - - ��N%A - - t; , - . - _. - . - - _ ;r: -N,;; :_ - , - ,,: - `5::;t _ - - . ;�:.��;� - ,:�;_ :y ,-r: - `;'� - - ,; . • - � ��4� �9.�.; �4.. 'y, :�.� S'.�":i � � ' ' - .. ,S - 'i'." �Y: .. . _ ' , _ � - ,�PI;UMBEIZS''CERTI�I�ATZON.'DATEI3;. - �,, `�`•,:�-`- , • , ,� - - s ---- - �� `N/._A,-�.; ;,`,:. . �= - . .":�. ,..'�, � " .. : �.�'� ,'� „' - • ';, - ��. . _:, ,ti ,� . _ - .� _ . . , , - ' _ -, , ',.' .. , . , " _' .�� , y� '`��'.,:1��� ,.t' , , .' . ;�; ,. ;,',i � . . � , .. ., � . , ;, ` , - , , , _ � ���� � Buz�ding Tnspector Rev. ]./81 ; FUS�M NO. 2 TCWM OF SOUTHOLD BUILDING pEPARTMENT TOWN CLERK'S OfFIC� SOUTHOLD, N: Y. BUILDING PERAhIT tTHiS PERMIT MUST BE KEPT ON THE PREMISES UNT�L FULL CQMPLETION OF THE WORK AUTHORIZED) N� ��.8� Z Date ..........................k��,�.......�......, 14f!}.... Permissfon is hereby gronted to: �r...�R��..�..�A3).e..�Q..�C...$.�.C�.��iii3p ......�.�r.�s�:.�c�.................................................... ................................................................................ toB�314..�!??..81�d1b�o71.,OIl,gX��..�s�?3C...�K�.�,��1�............................ ..................................... ................................................................................................................................................................ ct premises located at L�d��m�P�..p�.k......IOt...�..�...�...�.�............................................................ ...................�f�?�A�4i�...�ad..��ri4ata�....Laur.��............................................................... -- - ------.........................................................................................:.............................................,....::.,.........,........--- - - � •� � f,��pu�suant '�to.�apPf ication���dated ��, , , ':A�S��.....:.1.,��'...:.:..,.: :,'`1�41�t.. ., �.'and �app�oyed by�'the � '�,�' ' ' ;. , ' '- ::: - = -_ '' .,-'_ -- - - - f _. - - _ - _ _ �-- _ � �_ ' - ,,. _. �',:'Buildtn 'ln._.ector. -.��' - , , � „ 9• �i?, .a�; 'r� _ _;,� ' _ �� _ - , _,�:- - - - - - - -. , .. ,,' -- , - - - - x -- - .- - -�r :. ^z�� . . - . , - ., - _ ' -, _ - _ _ _ - , - , _ -- - = _. . -- - .F' - _ ;.'Zi - - i` ' �" ���-�"; •"$.`� a_, - ',t_ � :4; 1'` - a: - `',e. - ' �.: ,i� - .,e.: ��' ;r:�' '��', •��r' . �°'�_ 'r:'';- �.'r � _ - �q.' - :a`c a�.� _ - ..d "'£' _ .��' _ '�{�'� .p..:; ;'y,; ±r,��`. �;}. '�� T�.F., � }`. _Z _ , ' _ f+l" �.�.: c;r.� _ " - "y' - 'p; , �Fe h �... �•.. :;�� e`�t1 - - �i � �z:� i . '� •iS " _ s = ��y..'� __ �(�! - _ y[�•.� - _ . _ - _- ' " . »f�' u � _ __ _ _ _ - . " _ _ _ _ - `� i4� �til +y� _'y_.. ..1. i.k _ �t. _ -�l_ _ _ .�f._ _ 't _ - " �.�' : ��`.`��i�� "=�'F.;1 �l�. - `i V - - _ - - "Y' -L.i -1Y _ •'S• - '.���..Y'6.� - ��5� t:, f'r"5 f A� 'S� �+p�` ..�' . , t S^.` '41�. _ �� ' ' �.q-` .t,�, r , � __ ' t< _ _ �'3i, ",j. 'f. " _ + `l�, ' ' _It� .1 . _ _ - •I.••-� _ .. �.. '.i.� ' rl'S''-' i , 'y�i ' P _ "' ' ' _ . - _. . " :1: `_.:1. - : • -" "" ' '- _ '.J"'��+��-�' ' .� � " ' . " _ � . ' '•1; �'t., - ' , . ��" ". (�. _ r",' � `�., - el4 `5�� • �S� r , �,', . .. v` , � � .. -'r`, - - - . . . „ , , . ,a€^,'` - ' � �• , l 1 , ' , � . . , •.ii . r ' ' ' ^ ' _ .. , �-` 1�'.,:'� ., - ' . , - . . �'.n.�=_�-.�: _ . � .- , ,• ..T, , � �� , , , , , . , , .,;: . _ ' , .... .'�Building..'Pnspecto .. . .... I ... _ ; . ;- . . _ �. � - FORM fd0.4 � TOWfV QF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town fia11 Southold,�S.Y. Certificafie O� Occupancy Z�377� August i6 8 No. . . . . . . . . . . . . Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 19 . . . THIS CERTIFIES that the building . . . . . .rex�.ovat7,oz1.&, ra,dC��-�a-.4�. . . . . . . . . . . . . . . . . Location of Property . ,455, & 260 MacDonald Crossing Zaurel House No. Street �Hamlet County Tax Map No. 1000 5ection . . . . .:I?�:� . . .Block . . . . . . . . . . .�1-. . .Lot . . . . . .�� . . . . . . . . Subdivision , . , Edgemere Par].� , , , ,Filed Map No. . ��2. . .Lot No. . . . . .�.�. . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated November 'I'I . , , , 19 8�.pursuant to which Building Permit No. , , , , , . �3562z dated November 21 8� . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 . . . ,was issued,and conforms to a1I of the requirements of tiie applicable provisions of the law. The occupancy for wl�ich this certificate is issued is . . . . . . . . . Renovation and addition to exis�ing one-family dwelling. The certificate is issued to . . . , , , , ROBERT JESSUP �(owner � � of the aforesaid building. , -- -- - - _-_- Suffolk County-Depar-tment of Health Approv_al -_-, ,-- -r_ -N�A _ _- ` _ - -__- _^ • -_ ------_ _. -_- --__ • ,. •. � ITND�ER'WRTTERS;CB�RTI-FICATE NO'.� �;:: .�. . , . .�T;�.379� . ,;'. '. .: . .' , ' � '- � . - : .4'tr= � " " "' . :. '- ' . _- - �� • - - '' �i ' ," -' .3.. � • i _;'.I•� 1 .�:� ,. . � " _, ` � ' � •L " _ _ .. _ = ' _k+� " - " ,j"`: ' _ _ _ "�S" _ i _ �'i" ' _ _. rt' "_ - _ - ` _ . _ - _ � ".- • -- � - ' � ` _ r, r " _ r . S _� _ " _ � _ 't' _ __ 'l..'�, `1 - - - ,f � _ - `r ` -, � ,r - ;i - :�i'�' �i' •,}? ��+,ii�"� - '.�`�-���i, �1. �Ai� _ - - � i:i '�'y.ii� �' ' K I�t,�' �: - . �,;f, �{�,4` 1T� r�'� '���`-��:�5��` nS F�e` - ',}r '.1., .1 . - _ _ :�is� �f. � - _ t - _ _- .f� ��, �. . .� 't� � - - - •;=LL ,F:' � w,a' ,� ' -.l, : _ - f''/• _ i _ ' _ 'y - "z�'� ' . - {.. - - � '.(,.`r: - ' <�5""�:' ' ' _ ' ' ..t ' _ ' "-' " . . _" tt%Sn ,7,1t. .::_ .���� " ,4 -•'r�-. �A: ' " ' ' _ ' , , 'fx% '�v.�'a�:``.,: - .f� _ ,n� .�f ro� f ''r: 3 `�' , C � - .{, ,{�; ;y;,. 1 - �.c�� ' �e�.-. ',+x, '.4 , ?�° . ,.I1' 1 4`!. i" / �i 'E��. "i;+ ' _,_ ' �! r � '�•S� eh��' - J I^ �Il��• -. .ti, - (1 x .. . � .!�. 't' ���: e s �J/ _ +V�• , �`�1'.� " �, i�� �'�i i S� P t�r�„ _ ' - . .�. - - _ 'v`_ - - ' .. r':,�� .� . - _ . _ ., r , � ,' = �r`, �:z� - _� "a-�r - . - r•�Rll(�1D� I !C � , . - , , �,�". - g nspe tor� , - . , :S','� , . � - - ' ' . - ' �' ;�i. '', , ".. , - , ' � _ = , , Y ' , :i.� ' % - , „ ' , - ; ' _ V , f , ' , ';. � ;,f . ' �4j� Y'.� � •� ,'r-'� � + t . .. , ' , , • � , , 1.�t ;��" :t. , . ,. . ,� , `! ,. �t . , , , < , , � , , �,' , Ruv.�1%81: , , � . _� • � - --- ---- --___ .�_. ---- - --- _ � . ---- --- ----- -'- ___ _ .__ -�. -- �- - --- -- - � ---- - _.-__ ._— - --- —•---- ----- - AGRICULTURAL DATA STATEMENT ZONING BOARD OF APPEALS TOWN OF SOUTHOLD WHEN TO USE THIS FORM: This for�n must be completed by the applicm:t for any special use permit, site plm:approval,use variance, area variance or subdivision npproval on property witl:in a�:agricultural district OR witliin 500 feet of a farm operatio�:located in an agricultural rlisirict All applicatio�:s requiring an agricultural data staterree►:t must be referred to tl:e Suffolk County Depart�nent of Planning in accordance witlt Section 239m and 239r:of the General Municipal Laiv. ' 1. Name of Applicant: ���j��l� ��� 2. Address of Applicant: ," 3. Name of Land Owner(if other than Applicant): 4. Address of Land Owner: 5. Description of Proposed Project: �;�.�(°�(� �(�� , ,. �� � � - -r 6. Location of Property: (road and Tax map �,'� number) �(� (�,1P�s'� CI L�S�O�� � 7. Is the parcel within 500 feet of a farm operation? { } Yes No 8. Is this parcel actively farmed? { } Yes '�}No 9. Name and addresses of any owner(s)of land within the agricultural district containing active farm operations. Suffolk County Tax Lot numbers will be provided to you by the Zoning Board Staff,it is your responsibility to obtain the current names and mailing addresses from the Town Assessor's O�ce (765-1937)or from the Real Property Tax Office located in Riverhead. NAME and ADDRESS 1. � � 2. _ . _ 3.__ _ 4. 5. - - - - - ----�- ----�--�-- � -- - -- -- .._ - -------- --- -� ------. -•-T- -�-- -- -- - ---� - -- - --- - --- - -- --- , 6.� - � . � " ; ! n,��'(�Please�use��the�back:of�this pa�e,ifthere�are' ddition�al property�owiiers) �_ ' � -� : ' " � � � '�, � '� . _- ,' ' - ,{r , —� - - :x - =e - ;�• � �`l•` " .: . . , . , _ • ;-- ' � �.:... � ,{,_ ��i� '�"'c -''� - - - - •`r - : - _ - -".'c,,'' -_ - - - - � - -- a, - 5s= - .�;�`_. _, y -_. . - - ' __ , _ ' - - � _ _ " _ +:}'� �~ ' ' _ - - • - , l�- - -- _ �ir�; -- �i v x ' - � _ - - ' � - --= _ �- _ _"ti� _ _ ?� �. ' rt�� —�1r�� ,l.— � . .,4� ~�: i y.�.� _ — ��.. �';i, � ;:Fr •r<1r.,� d "�'� .x. ';3: �b' 'r;" �F t ,t't ::�i. k ,t t=�� i� �- �' �. - � - - - - ,��. � - ';+:.`{ i` ��': - - - �-�' ,i�' - - - x� - " - ,�� - , [�:)" 'f .� — _ _ _— . � �i.":'— �.{^i ���� —_ ��- �x'r � e.� ��Ji _ �^� . .��y1y` ' t•t� _ � . .f — . _ .�. —. �i.i . — M1tr( " .4 ' ' i�ti " rt.: _ .,/± .�.� ',/ 1'i .+�=�SfF` �, ' ' �. — ^,�� �' f` �t� `�4'.r "7,� 'F�v'1 '^ " y;F,� .r���. . 't'} ' ' ° }' ` `A ��"In '.,f`i. ���1� �{v " `i:—'.�, 't �Yi �-1���r r �� ' - �;t- .�Signatqreiof A J 'licant';. ;��- _ '_;:� .Date' ';f� , � . _. 'E�:. - - - _ . • _ � �_�„- ,. Pp_ �: .�r -- __ ,,�=��- � . _- . , - - . , � _ - �, , `�:' ,„ � __ . , _ ; - . �„(,` : r, ' � : �� -- ' .,y"+ .x.'-a' _ - �a - -,, ' _" - . _ . . ' �'�ti �,�. _ , ,y:,w'- , S,� ` Y _ � - ' , , � , ' , . ' , ' _ -�• : - _ � - � _ . , . ,,_ . , , � . ,�`� , . _ _ _, ' - ; _� . . � " , , ..' ' , '""NOtO. ,,, ��,� ��- 3; ,. • . - , ., ' - , ,_ � _ , �1.The local Board�wil]solicit commerits from°'the owners of]and ideritified above m oider to consider�the effect of the � � propo'sed action on tHeir farm operation. Solicitations will be made by supplying a copy of this statement. 2.Comments returned to the]ocai Board will be taken into consideration as part as the overall review of this application 3.Copies of the completed Agricu]tural Data Statement shal]be sent by applicant to the property owners identified above The cost for mailing shall be paid by the Applicant at the time the appltcation is submitted for review. 617.20 Appendix B Short EnvironmentalAssessment Form Instructions for Comnletin� Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part ] based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information - � , ,� �I�G�,� i�- (� 9��'�C� - Q�A42�-� �'� Name of Acrion or Project: �S� ��=�t�� C' �I 9�1� � t Project Location(describe,and attach a location map): c�� I'�,�;�1 5f�G� �� ��� S� ��� Brief Description of Proposed Action: ' / C� � fi�l � Name of Applicant or Sponsor: Telephone: �� i �` �' ����� �V �����,� V��— E-Mai1:�f�S � -�'� �� Address: � �35 �r�� L��� (� �������, - c��y�o: - - � - - - - � - - - - - - - -�-- --- ---- ��_.�_�C7:C.�-�.-_=-r� ___--------_-T--�--- = --- -- - - -- ---. - - - - -- . -- --- -.- e: ip o e• -----�--- -- . - �-�{y - � 1�I�t'�� „ •1.;Does the proposed�action`only,�involve'the,legislati�e�"adoption of a�plan,�local law,,ordinance, . �NO , ,'YES_ ' • ,`' '� `;ad`m'inistrative�"n "� �, �� �',:� .., �- , - � ' . .,_',�" =�';,� : r le;•orregiilation' -• _ _ � _ �.,_-' -, � - � _ � � . , -":- ,�,_ � �`5If Yes,;aftacfi a narratiy'e description�of�the�intent`ofthe,�ro��osed'action and the enviroiunental � � ` resources.that` x4�; -�,,,.: �°;" :may°be,affected:in the'muriici'�ali'-�=and�,�r' `P p - .. _ .i `�� ,•�`::� =`' � � _,, ��r� :F. p ty_ w p oceed:to=P.ait`Z:�:t1f no;continue to�"uestion�2. _ , ; - �ti, ;:i:=s :,s-- - ..,y..:-,� _ - :,,.,�., ..r., �. „ „9 :;;;. .� ,�j, �,Y. �S�a._ _ _ � Y>,f_ _ �Y''.''����i_ - -"'.��' ' ��;�:'2:"D`oese�he:`"ro`osed�action�r`e`uiie�a eririit-,'a` io`va1=-�� ' � .-� ' � - ;,�,{ ,t. P.�;P. _ �y .`t,A .p, r,.pp,� or'fundirig:from�any'otlier.g'overiimenfal Agency. �NO'� :,YE3 -�r,�` '';�IfYe"-; - - �-.�,s :r_..,{�- - - � = = � -j�` -- - - .�;'�.��, •� �_�s,list- eric" 's�bnatrie-and-`erriiit or - � ; - .;,�;�� ,�. ,Y�_). P, ,a roval'.`,;� ,�� -.t - ,PP_ �i. - - .f;;�"= 'r°,��° •, '',;�_ ,`,� ;f_� , r�, :;r'. ;'3 ,h+ - 39C.. ���i�- - .r :,i'' ^`4 ',-! M:n,���2 S m^� =�.i rV Flr�. ."f:, i.r`r` •,HrY"2� ,`.�.1: ,,j .,�% ,' �u.. _ .lr 3'^� tP�:,, ���, �..;;� �"i�:+'. ,nt.` `,v" i ri ti;f,,, _ 1.=` �;'; „"r''> ,� Y, - +t M3 ��iE��' .f, �"�♦ .`,`�i. a�.�;. S Sr '`F'i �'3" ;i'' 4l= .i i•J� •'7 r _ ' M'S. ' ' - ' " . _ ' �•1, _ '1� - Y.. �'�: ,j. r,�� ' ' , . - ' ' � :U�� _ ,' �� - Mf� - ..z ��'��� �.� _ .��;: 5 �;� - :��' �� 'tt� `� �` -j:�`} - .�ia�� t:.Q _�f��!_ ,. lT:��°:;' ':`� - - - =P ��� - - �h�-} _ . �. - �� - - - _ .��_:. _ _ - _ - , _ . :<` - - - - �. ��F iM � ;'r �'3'3:a`.�T� 7 ',;,s`;� ..,:'�� _ s otal'aoi;ea�`e'of�tie�site'o � "� - - � :;. g. ,� fffie'pro�osed�acfion. - ;acr'e� .s.' . `�` , '.t�' `•S:I"` G$1' - ��, iif _ Y,. - _ '`3v` i _ `S' i ' ''in�r^: .�j _ ' '�' , � ���; �`b::T'otal;acieage�to3be"h sicall� .di`stiirbed?:,= .-'s� _ "'-'' ��' - -'' . , - _ -� - , . ,' . • ,- . ; - P_ Y � ,Y, _ ' _ �,� ��acres _ - - - . -', • �'c:�Tofal acreage•(projectsite�and;any contiguous�properties)�owtted - � ` - -- � � � - ' � >,'� ;or controlled"by,the�applica'nf or�pro�ect spohsor?,` � �.�r. � aacres ` ' �• � � ` , . ����� - . : . ., ti��, . , <, ,. . , , , ":' . . t�' . .f.` + , , ,' � , . , 4. Check all land uses�jhat occur on,adjoining and near the proposed action. ❑Urban ,�-Rural(non-agriculture) ❑Industrial ❑Commercial �Residentia](suburban) ❑Forest a Agr�culture quatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? 6. 1s the proposed action consistent with the predominant character ofthe existing built or natural NO YES landscape? 7. Is the site ofthe proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO �YES 1f Yes,identify: 8. a.Wil]the proposed action result in a substantial increase in traffic above present levels? NO YES X b.Are public transportation service(s)available at or near the site of the proposed action? � c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? � 9.Does the proposed action meet or exceed the state energy code requirements? NO YES Ifthe proposed action will exceed requirements,describe design features and technologies: � 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: 11.Will the proposed action connect to existing wastewater utilities? NO YES �(�7N� � �� SI (� If No,describe method for providing wastewater treatment: 12. a Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.Is the proposed action located in an archeological sensitive area? , 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES -wetlands or-other waterbodies Tegulated by a-federa7;state or loca]agency? �� ,�� - b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ti/ lf Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: ��` a - -- - -- ------ - - - _ . . . . -- ;,:,�,�'�`� �$�`�^,t - " ----- , - �"Y'vy�r.�..: Y�yT,$.+SiT.: , .. ' , �� _ _ 1 ' , _ _ ,, - l�-:3.'�'-:.��'� .}w5:,;:�x . . �14:�I�eritify`t}ie:typigal'habitat�types,thaf occur on,o'r�are likely�to�iie found on the pioject site:Check�all thatapply: _ _ >_ ' � , .�, = w��� �-Sfioreline�=•` ,�:Forest, ,.; • =ri�.AgFicultural/grasslands t�O�Ear1 mid-successional -°� `' �" " - - ,,_ ;.::�• ;,:' ,r: _ - .�s �,��.; - �_,�„ .�.._�;� - Y - '::a. ;�: - ;r.:��i.. ';i, ";,,,; ?,."� - . .F?.. .p' - �a - . ..� �7't }' 'p�' _ _ ir`" _ ' - l`Si ;y�Wetland` :;t''s�°Urban` - "':D;�S' . - - �;�� ��N uliurban`' _ _ , ,:.�': _ - _:s- _ _ - - - - _ - _ = - - _ - - � - - , - - q; `1.' -- - - �r,� :-r�� •:,;� "'�15=Does�f '��` ;{ - ;,_ y lie�site'-o�,the�'ro`'osed:action;eontain an};s�ecies�o.f�animal oi,a'ssociated]ia6itats'.listed ��;``NU� .YES� � -�a�=rn .;�.�;;; ,P,�,P.:.,, ,�� �Y-_p �,�,�. - - �- .�.;', 's: ,`.�+'�1.�� - - '.�:.� �Y:� �,F' -..�Ht..v�. - 'F�li,.' ' �i, ;�F;.al c?" - ,� ;y„ � , ..v:" - .y,'•'f. i'; .,a.- ;{4:'' b "',f' ,�. ;,it� - i, ��. �the�5'tate�or�Eede'ra1E ovemmen�;as'• - �°�: =r�._X� ,g. t .tlireatened or endari"ered. '�; - ,,. ,,.,_ .5- .,_. ,� g,: ,,V _ '[:; '.3 ' _ .3.� - . " uty t"!,.A'. �7, ' ' �- . ' - =A ' ��t. _ ' .i. +'=: - � - - " , ��; 1� ,t'_"_ - `t�;f ,;.. . _ _ - .:N. _ _ _ _-- _" "- - _-- - ' - - �- ; '�.r� r -�16;Is ttie,"o'e'� _"t — >� '� - - , .�� - . - . � ,pr � ct,si`te locafed;in,the`1'00.�;ear.�flood, ]ain. - ;' - _a,� - .r,; Y,�, .P. vs;� - . "NO - '�YES, ;�r, - ,7:�r=;�+:�7. ',�y; ,,:h� �s��::,,'Y,.� �} ;.t,<?;.,� - . - � - - . _ `{� -. _ -n " � ;'i (• ' " ` . _ ., .� . ' ' = - �`j _ 'rE, - - - - - �- - - - - - - - , ' .,� • �-;'.�1�Z:�Will't}ie proposed'action�create�storm�wate'r discharge;,either from point or non=point�sources? � - , = ,rNO `�'ES� '` - ' . , . ;IfYes ,•:, � .�''„�,.:;,�•• ' ,;,°`.,.,,:� ' : - '�,; �„''�.;,.-�_,.:�, ,:,, �,�{ ;, � ' . :�'r � �� . �' , ' - - . i , . � e. ,... �.,.,,,'r`l � ••, ,. „ r^� , ti,,� , , „ , . � ' :� ' ' � � ' ' ' a Will�stor'm�water'discfiarges f�ow�to adjacent properties? � ❑NO�YES � r b.Will storm water discharges be directed to estab]ished conveyance systems(runoff and storm drains)? ' If Yes,briefly describe: ❑NO LS�,YES ��.`�"�,��..- � _ Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? 1f Yes,explain purpose and size: 19.Has the site of the proposed action or an adjoining properry been the location of an active or closed NO YES solid waste management faciliiy? If Yes,describe: . ( 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE I RMATION PROVIDED ABOVE 1S TRUE AND ACCURATE TO THE BEST OF MY - KNOWLEDGE � -� Applicandsponsor nam . ` � �"�-'"y!� W ���� ��--- Date: �(��� ���,5 Signature: s� Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer al]of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" � - � " ` � - � ' ' ` �'�'` ''' � No,or Moderate -, -- - : • � ' - • ' , . ';-�''- small to large ... - ,,..._ ..,_ .�.r.� ..•,., ,,.. _.�-- ,.. ., -- -- ._ ,_ ' .._ - - --- � --- -� --- -- . - - � t , impac impact � - , , - - _ = may may - • ' � - " . � � . ' � • - � � occur occur "1. "Will tfie proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. Will the proposed action resu]t in a change in the use or intensity of use of]and? _ '�3., Will,theproposed action'impairthe character or;quality�`ofthe existing community?,_,, ' '_ ,� . � ; „ .-" . ., . `_ . . „ r _r -,... "' t �: . _. . .'.`, - ; `" �, ': ,-` , ;�.. ;, .; ,. � ., . . - ,. . . . - ., ;r: `4::.��:Will the',proposed actiori have;an imp'act;on=the'enviionmental characteristics that caused fhe-� �- - - ��. _ � •-• � '•;>�����.. '�'. ��esfablishinent_ofa;Critical�Erivironmenfal"A e"� �� '^' . r. - - - � � :,.� - - _.,4,. r a'=(CEA). ;��,_ - ,5'� ,;;,~ :•�, _ ::; - - � , . ��:.. - u:�m - - - -- - - - ��� =�i�- - ,z.. '�F -- - - _ =�� _ :, :;5:;�1Ni11'ttie:�proposed acfion'iesult��in;aniadverse:cfian"e�in:tlie;existin level oftr�c.or, - - - - .-� � � - _ „�<< � .a- _ _ ��� =g - -g,,, - -:.��' , 4= - - ',s'' ': _ `' ==�y .,. - _"'r _+ - . •,�y� affect�existin`�:infrastnicturefoi�mass�transit��'`i �, ��''u'r� :�y��;,.. .,._ .g .��king or'walkway. _ .��" , �_,� M ''i' =.t:� - :r. _ - _ _ .'� - - - - -•�t.i . , - - '`�,'- Y - - � - ,��, �F - . , >` _ �, - "�. = le - • _ - �t " '.. � - ':�'1�`�6:�:Will`.ttie�"ro'osed�action.oauseian7ncrease�'in�th"e'u§e�of•ener fa"nd' - �-� -� ' - � - _ - _ .,._�,,P�. .P - _ _ �t:fails to i'ncoipor'ate _ , � - ,;; . F� .�,:'�; r1,. . �1 '�:'4�r.^G�-':.•.';`t-,: �' _ �f�. i� �1 - rv _ . , h } ' ' . ,�4, '.�reas`onalily�-avatlable',energy'con'ser.uahon-or r ' � �?-�; - - _ _ eriewable:energy;,oppoitunities _ .- � ''"°,7.`'=Wi11��tlie;�ro"1o'sed`action�im �act existin' � -,_ ' •- -�" , "' ., . '.` � ` ' _ �r - . ,,rP P, �. -� :- , p. � g`• , _ - , - . . . , , - � _ . � - - ��.a:FpuBlic�/.piivatewafer`supplies?�,,- ` - _ = � - , ; - , � - _ � . . - ' " � � � ;b;•public%pnvatewastewater'treatirient�'utilities?� � . ' ' ' ` ' ' ' � � ' � ' � 8. Wi,ll tfie proposed action impair the character or Guality of important historic,archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? Page 3�of 4 No,or Moderate small to large • impact impact � may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? 1]. Will the proposed action create a hazard to environmenta]resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or wil]not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in su�cient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 shou]d also explain how the]ead agency determined that the impact may or will not be significant.Each potentia]impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. , ' , ' ' 1 � " Y' , � „ i_ � i 1- - �' ' �rk'. „ . , , ' . � � : ` -', ` , � ' � , � .. '_y'�..�_ � '. _',t/ _ " _ ._ _ " _ ,{� �. ,J3'`�'" - ' , _ I,} ._ ' � • _ : ' . ' t id `:t.-�5�,,��,� :�..',S�' _ _' " ' "' ' - ' ' Yf^R.;l'���•'� i.'. _ , '', . . ' _ _ _ ' "...' _ `FE'� `\�e . 'r}� �a❑�; ';�Clieck�tHi"s, ' j - � - - - - - - - � , _ ..t ,Box�ifyou;liave'iiefemiined,based:on;the-infoimation and anal�sis�above�and�ari ;su �or`tin -d`ocumentation - `r•-".�= - � _ - _>> Y �_. �.- . .Y ,PP, g,.. , - � . .'s ���; -';�haf.tlie;�pioposed;�action'=may.eresult:in,one:or•more;'otentiall"�lar'e`orsi'nificant;adver'se� - � 'r# - _ ,, - .P, Y, g ,,g .impacts-and�an _, ;�., � , ..;.. ,'- .�".,. �,':z, :,�,. .�- a.,. ,r, "�� ;erii!iion ental�i"`m"act�,state" .�' ��- -� >�.- , �4,'=.,_ 1�1 rrient;is;re uired:' '�: , .;� .,. ��: P 9 '-�,�' •� ,, ; �"i� <� ��b,� r, .a. ',r�, - - �a;�`.� ,. , 'r'' 'i i �'�.: � ''I•-• - i/' _r." �'.�^ - . , _ �� ��fi�eck,this=box�if.�ou'tia�edeterinine8�•liased�on� e�t " - � yz __ _ , _ fh information�ari$:analysis;a6ove,�and`ariysuppor'bing"documenta'tion;:�' - - ���: �;F -:�tfiaf,tlie;pro"'osed'.action will°nof�'resulYin�an �si''�'ificanf'advers'e�e�' - � � - .. - ,,,_. P. ,.Y:_�? nvironmental:iinpacts., - � - -.�:',- . -�.� � ., °,r - . si' ,;,� ,;�,, - -, . . . „ ,�",' ;;r�'-'.� '; `�` - ' _,`4�-- ' , , .- ' .,- - _ - ,_ = - . -k ; , , ., ,_ � .. •-, - �,� -. , ., , ' , . � _ , - ' �, � � , . 'Nairie ofLead'Agency � - ., , � •-, ��' . ` �'Date - - , , _ - , ' , � - " ' ` , ,,'. - .: . ' �"' , , , . , � • „ _ , - ., . - .. - Print or Type Name of Responsible O�cer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) Page 4 of 4 Board of Zonin�Anpeals Application AUTHORIZATION (Where the Applicant is not the Owner) I, �177�1�j�f� �1���residing at �Q� //� f���� �//� (Print property owner's name� (Mailing Address) /� � � �%�Q� �t do hereby authoriz� (Agent) ����_S � �'�/J'��to apply for variance(s) on my behalf from the Southold Zoning Board of Appeals. ` � - - / (Owner's Signature) . .__ . _ _ . . - - --- - -�� ���iS�7"�,�/�� ��1���, - ------ -- - - - `- . , -- � - - 4 - , - - .-- � � • - � f� ��. ���rint�Owrier',s,Nariie)�_.'�' ' � �� =_ _ , _ .,. . . : • .. _ - . � . .. � ..._, _ , ; . � �' . Y: _ _ - __ .- _ —� _ _ �J'n• • ,� _ _ . = - .. r � �; , _ '' - " ' - ,!" - _ ' ' _ '�� � . � _ •t��. ' . _ ���� 1�.� � � �t�- ' 4 � , � � -� � _ ' ' _ )'`'�, - _ ' _ `�l� - ` _ '6� _ - _ _ _ ,- ,-, . • j, • - _ ' 3 .., �"_ � _ � , .�Y`I - - - ' - ''Y. °1�'+ ri.. - " :.i." . __, , 4 � � �y " 3 _ - - 1,, �d'.: - � Vy G` •'�,; lY - ;a �` (" _ iJ "��r'.���,�2� .i..' �h`-�T ,'�Spi':'��i:.:` j�r . . � , . � 1 . - i�.,. Y.'�"�: �` �G�J.. .Y ` - ,C.� :�(�`' 'A�, _ 1{`_ - .�V�''���'� .4'..�:,��` .- i').-� _;��• �}'�;�i�� .F i i , ' i- � �' : � '�� _ �f�� - '�{n�.� ,1. �4 r �.��' ' _ Y� ' s ' " . S r . � ' . . . 'p„�R� ,y, ,�i: - --:Ytt: - ..- ` _ :,r:; ' ' -t-� _ ''t " .- ' , �'�i.,;' _ " ' " - ' '° ' ' l..� • ' - i,i';'' � � ;.:j' ;,S, .. ,`r P�"_ - - �r. - , . , -�E- �,i, � ' -- _ . __ - :�,,.t�', ,•f♦ _ � •,f�4-�;:,�' ,�_ _ _ ' , ' , , � - - 'aa�� 'i *_ `7 :�1� , , , . „ - '1N � .� . , t � -. nt�� _ _ � _ . _ �_ ' ` � . rl-r . �- ' ' � + , , ' . , - ' _ ,' - ,' . ' ' r�, ' � . ., . , „ . � , �. _ , ' ' ' � ' . � �, ' '� ` , . . , . ,, . � , ' � ' '..: , . , ., - .. � , . , � , , , . 1 � ,�'iL•st'4.����5'1+'� ��y!(_�.:s�'ipc_-F.:=;:=.u�- i;{VN M CNJ�LAPIE$ � , , Staie af I�evr Yotl: � €� I�oiBf� PubflC- �p p1GA�77716? � `� (luai�iied in Bron��Cou-ty� � My Canmissio��n�r,s �,,�„'"� '-�,;,:� �1F�Atf''Y-'^'l<i�`-•i�ss�-'�'r'�7.ro •S� - APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emplovees.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 necessarv to avoid same. YOUR NAME : t)O���1����1` CC"� }9"}��_�' �1v (Last name,first name,middle initial,unless you are applymg in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit �— Change of Zone Coastal Erosion �- Approval of Plat Mooring Other(activity) �(�}�(�1(� ��� 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 a�vhich the town officer or employee owns more than 5% of the shares. YES NO � �— If No,sign and date below.If YES,complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Tiile or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. �i#her-check the-appropriate}ine-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 - . - • - - - - - •corporatioii) ; . - - �, _ , . ' .; , �� _ 't,�;�`, ,, = �, , ,,,. , ��„_ ," �,�-,;,,` `,;,'; ,� ,'•..,: •, ,`,�' ;_ , .. ,,,� � '� : � _,;��'�•� -�'� ,� ._„'• ' - '; �'. , , - ;, • . � - , � - � • � :�B)�tfie�legal o'r'.b`eneficial�owner of=any=interest in a non-corp�orate entity(when'the applicanfis not a corpora'tion) . , ' ' '_ '!.. i. _ �4' , _ .... _" "'_�L, �!. �A��-' _ - ' ' _ ' "' k' � " " � , -" ' r ' . ,5 L, - 1. - " " ' :L'. ' _ E�,,..' '_' .z:',.�' ' ' _ ' ' ' " '� " ... '"" ' - _ 1_ , : -'C)�an"officer,�director;`parfiier;o`r�employee�ofthe�applicant;"or. ' � - rv � �� ' ' _ � � ��'` � _ ��,;.;,'- - =_';`:,;'� :r,=�' = '- `: �r, - -- „ -- ,. - . ?t:� �a. -,`�; �n"' � _ '.•r:�:' _ ,� ��n' �'�'� ���`t� :,; '',' � . � � - �:r:� ,. �`�.: - ',:� , , ,�._ _ .,�� ,x. �'1 a` 'licarit`� _ - - ,k `;D��he'-'actda ;�;},_- _ ;;_ - ;;�^ ,), _PP �`';�� .- + �1� F': �l'., _ - " - �.1. " - ' _ 5 � = _ • _ _ - - -_ _ ' ' - -_ - - . . - , " ' 't _ " _ -7�� ' - j��:..1:�� :L.-v:Y'` 2�,.• _ ' " _ _ _ 't:.i' .'Tl';�,- Jt� " P�`'� , - �� �' �'Jt�' .��,., , . � 'y.,. � � ' •,rllESCRTPTION`OF�RELA�IONSHI�P.'. `�'�� _�, , . , - _- , - _ �; , .- . - - _ ~''< ., � � � ��;' . �. :,.;` _ - , - , _ . �� - � _ - ._ _ .-. , :�,;�'�- . . --. - . � . � �-. - -, . : i � . 1 `G. ' •}'I - i ; " " __ ' _ . - . _ . < . � � ' ' - 1 _i . '- .- • - � f A _ - _ • _ ' � - _ � _ __ ..r �'. . .. . I .. ' � - . � � . � Submitted this � f �� , 0 . Signature PrintName �� _ ` �1 �� Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTTONS 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 exenzpt actions including Building Permits and other ministerial pernaits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes",then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. i A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION i -- - - - - -- . _�CTM#�- �G - _- -��-- -_� /Iif� �I_-- --- - - - ---- - - -��--� The Application has been submitted to(check appropriate response): ,Town'Boa,'rd: �Planning�Dept:,� �BuildingDept. Board "ofTrustees . , ,. , � _ " ' , , _`�y�� -. ,3 ,� � _� . . � � v. . . . � � i� . , _'F � � � . t� _� � , " ` "_ ' . , _ " -� - _ . �- ' > � , . - "l;. �Cateao' �aof Town�of�Soutliold�aaenc .'aation`�,cYieck�a �ro�riate res"onse , _ " � - -_ - �� •` -" �- h;;� ,-b rY., - ��� � o ..�'�. � 4 ,. ..PP.,.P. ,P,. )� . . F` - - - �,�,�: _ �4.,;> ,�,��, �. � � -- - - `.'' - - _ - - - - _ - --- - - : -.- --, _ . -_ - '�3�;.=�_' - - - -, � _ - - - - �,'- - - - . - � , - , �'1, ..t - - - - �f�� �r '`F�� '�� �=F' " " _ _ " " _ _ _ ..£� l. " _ �� `t `'6 �r�. �:a *,h`� �.s.� Actio' �under•t� `e* �directl;`� �.oi�v� `�enc` �e,� �ca�ita n ak ri, ,b..���T .n�'a 1 �r.�� �.�� ..,. ���:, i:;? ':�.� .'�( )_�,, •;:�: Y �Y,�•. g -:Y�<<�g•�� .P �'_, :i� -1"r'b'i',4, '"F� r'-�:-Tt• ,:F; - .r'�'=�;� -•s ;.r..r` - - - „a, ,1� - ":``r i a`' - - :s- " _ _ -' . '„;: s`'j`ry �v� - �ct `ct'" =�a e"c' "e'�`ulati`" - d� -ari'act'� - - ���;: ,';� �corist.r.0 ion�: larinin`,'a n%i n :;r on�`'lan tr s �onr - ��,' - _; - - - -�,P �g .� .�'�__b _Y....,,.g, .,. _ _ .� ,)" .i�" .z` - x=`� �`'�•,'' -:.r z� - _ - ,. ,;�. _ �_ „� .tb,� - 't' �:a ._�. rN :t� - [r� ..y. A ]^ ��T^, C. ,. ��''~' ��';r1`,'1.` ��� O� .R. .���� �.�2{ �'.��' f.N . � it�1,. ' - �? ' �� - w{,i�' " _ ' i4: _ �"S� � ' •t� ' ��� � - 'C� - ��' :{yt - --'�L�J � .-4 - - . .}` r _ _ � . , ' �1 _ �'�a� . - �;s �:b� -Fin ncial�assistance�`ye:' -ant>loa�n�=su6sid�'' - . _- z t� '� )�,4� �.,o.g.•`�?'-,,. ,,: ��_ Y)��� - _ . . _ - , ,. . . ��' r •."'_`� ��- � ''�`- - , _,�, ' ' -- , , . , , , ��: . i ,r�,=.,.,; �� r`s,--:>- ; .., , , . ��' � _ - , - _ . -. . ; � � °�`, �� ��(c)4, 'Perii�iit,;app'roval,��icerise,'�certificatio'n:-� • �;�', , ; �,1 • -� . :. -� -, � , � ' � ; � , :. . , _- , , t_., . : � � . , � . - . ., � . , , . `Y `, , �� � ,. , ,��, . � . . - , . , Nature and extent of action: ��.'�� ir �� c�ti 5�.�� �i�6�.� �Ic� �� �� � �� ��� Location of action: �� '�`-�� ��(�,�� ��_���� Site acreage: e �j�� Present land use: �(�j��L�- �� � (,`� ��I�j�`�`�� Present zoning classification: ��� 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shal] be provided: a Name of a licant: a � ) PP � ��9i�ST��`�� � �� (b) Mailing address: 7 �6 (� ��(� �� � �� Lj �V�� ��]�i ����� (c) Telephone number:Area Code( )��7 �,��Z�� �� (d) Application number, if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes LLJ No❑ If yes,which state or federal agency? ������� DEVELOPED COAS7C.POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, � preserves open space,anakes effcient use�of infrastructure,makes benefcial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III-Policies;Page 2 for evaluation criteria. �-- -- ;: ;,:'��Yes ,�.•'•1Vo- �(1Vot A,pplicable-'.please explain).- - - --- -'. �---- - - - -_ . _ -- -- - �, � - . -. „ - - - , , , - ��r -. - ' 1'. ---' - , - �� .-_ . ` _ ' .�, -� , . ' ` � - . - - � ' , - ,. ' -;s.•� �r�'4� - � � �4 .� � ' _ ' -- - ' :i, � - .' ,� - iiYa. " "q^_ _ .,''i :f, _ ' _ k� _- , ':n, , '-- .. ` _ _ _ - _ /S�``. _.,ri/ ��. ��y:. eY'. _ -�4�'�,: rJ`_ >L,_ ' _ - -_ `4f• _ - - _ - _ " � `�y 'Fr -l;,�. '- `�i..`� iy - _ _ - � . - - _ - '.4` ' _ fif� "' ' " " ^I, _ ' ' i '�tia`' ��,'�+�` _' �T� " ' _ .I.:' _ "" ' ' ' - - - �-`.. " �t+• '" ' ' l 'f ' - - %i» .s„�t nt:- *"'i: �.r �6i�,.' - _ .�r;� - � _ `C e`x✓ ;t 7' - �Y`.`'.' �6'u� �.�i.•a�,i �V�iw� 5��'�� �,t.� - i�l;,� ,�k.�n� "�'ir�, '_sh ;i; '..`t?'�i';.�, :i'.. - �;. ,� _ _ _ .�f�.,;� - °,;'7�, - _i^- _ 1','• --',��. - ,, "�i' .ti - �Y' _ �.t " -I� _ • _ • i " _ _ :£`�_ "_ - " _ ' _ i�� - .}ry" - - _ ....y _ _ ' � � - . ;1' `*�, - _- " - " - _ - - - — -,r. - r-�•`- ��Attach-�addiiiorial�,'sheet' -r' •� - - ;',4.,. - s=if�necessary ,�, - �� ,,. ., ., -, - ;'r�r '���� �,,<., -_ '�''� ;�_' ; _ . ,;.-,r' . , - _ �lt.,,�- : . �,._ . - . ' - ' r , , ^ _ , - . � � �;f� - ' „ - _ 't . ' , , • ,. , . , - . , . , . . : -. _ . .' . . -� _ ,` �._ . - -� ,. �_ � . : , . ' , ` ' . ` , , ,� . � , "'' ';; `; . �',;' '^ ; ':��i; �„' ;a .',� ,'�,� ,, � ,' ,,. : ;,�,.,� ',1t '� ',.�,;,��•„ ; ' ,, `,. ''-' ' . ' �•� � '' .� ; '., ,.. , �„ ` ,,,i � � � Policy 2. Protec't �and 'preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-Policies Pages 3 through 6 for ev�luation criteria � Yes 0 No (Not Applicable-please explain) �-� /'�`F �J 0 �-h�����'� �?('� i��.���L�G )�' ��� _ �� ���� Attach additiona]sheets if necessaiy 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 � (Nof Applicable—please explain) �(�-f l��'�'-- :l ��'i C� �r�� 1 l� � ���'�' �� �f-� ti� �— Attach additiona]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—please explain) �, r � C � �J.��t7)r� ��0 t . ` � 5 1 Attach additiona]sheets if necessary Policy 5. Protect and improve water quality and supply in the Torvn of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria - - -- _T -�� ;Yes -- No v�(Not Applicable,�please explain)- ----- - �------ --- - ._, . _----- - - _ - - _ .- -- - , . ,� ,. _ , ,�z-. .,. ,. �,� , � _ . • , ' . J . . _. - , _ - . , ., , .�, . , _- ' -� - _-- - - _: r,� _ , - - , _- � � { . .� . , c - -_ .- ' ' ' , ' - - ° .�..`,. �� - ' - ' - , 'i,r- - - _ - _ - - - .� -� - - - ' _' - „ , . , , .- , ,._ '- ;`}� --- '- �'�` -- --{�` - - - iyr.' _ .�' - ' - - -- — - ,{�: ' - - - - ' - -- , - , �• r'�'' 'i� �.�, `l�v � —— � .'{ . �,t, r. �. —5'S, e ..Jlr — _ — _ .F1� _ _ _ _ �k.. _ _ .. 1 :} • _ '.r, — 'I _ � __ � _ — _ r 1— �"_ _ .._ '�1• � � — — _ " `!�. ' _ _ _ _ .. Ce _ _ _ �'+i. �`l� '�: ..�� +3•��n. kr — �ki'�� _ L��� __ _.1� — " " _ _ _.,�y. _ — ��{` — •t �"�� " — ' —i . i la " '3:. ...I' — Yll��� ' _ . " S _ - - +.r,� ' - .',,.' - -_ •,U:i �f , _ ' - • � - _ _ ' -°.t� _ y� - - _ ' ' .,1._ _' '_ _ _ _ - - _ _ _ _ , :� _ _ -��; -r.� _ - .i�,�.., -" ..a�zr:.._, - ' ' ' - - - ,;>v �� -•!�- - '^l'`u�� ',d��= �::� ,�w�', �r'� - � `•�� +"" • ''ii' _ i��l'�`� • �l'` ' ' " ' ' ' ' . -, �iArtach}aaa�itiorial�sfieets-�if�necessary ' � ' " - _ _ - - _ " - ` __� ,- - ' ' " , _ , --� � � ; ' - - , ,- �i. , --� - y'�Si� - �- 7.}J.: . ;;� , . - -, .� , � .l`� � , � � , ' ' , .. •� . . , . '' — '�"�' Tr i' — _ ' - �, — —' � — . � , r .. , - _ �� ' ,, � , ' , �Policy�6:��Pr.otect'arid�re'sto're,the,quality'and function'of�the Town�of,Southol'd ecosystems including,' Significarit' Coastal Fisfi�and�Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. � Yes No� (Not Applicable—please explain) Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. See Section III—Policies Pages; 34 through 38 for evaluation criteria. � Yes No� (Not Applicable—please explain) Attach additional sheets ifnecessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. 0 Yes No 0 (Not Applicable—please explain) PUBLIC COAST POLICIES . ` ; Policy,,9�: ,�Provide''f.or-:public,acce5s,�to, an�d `recreatiorial use of, coastal waters, public larids,�and public , � � ' � • reson"rces o'f,tHe;-Tor'vn of�-Soiithold. :SeeZWRP,Section IfI—Policies;P�ges 38 through 46 for evaluation " " ' , '.4._ _ - . ri_ .._ �. ..., . .- ,,. -, ` ' -_, :i_ � ,. , _ ,criteria. �, . _ _ _ i.. .t, _ . . . - _ ���- . �.`,; , - - - - -�.x�- -•��.{�,: ::n�:.�' -�`+�- -- - =a � '� , - - -�,,= - - , � - - - -- � _ � ,. - „ - , ' i '�Y. _;I _ ,' " i �a� � •`<_'�, ,� „ . , �Y.S„ .. _ _ f. ' ' _ _-_J., ' �,""'d.�`5� - - ' . - " _ -" ' . j��� - ".t - .4�" - , .s ' ' 9i� �t�.. - - ' - - �`� "ix �t�/ r+`, "�' � '-��`F . f�. �= x ,���- ��Ye' :No.,. ,�(NotAp`plicable=•;please,explain)���� , . � �« , - - - ,..` � .�. =',' - � • �,� ., _.;,;. - -_ ;t•� _- _ � �- - ,_ : _. - - :; '-, -.ei' -_ _ -- .,.,;. _ _ , r - :k` - - �,4-'i:` - �'+.' _ :��,t`f -- - n �h, - _ Y'_ . . - .(' ' .f: " , _ , ` ., . �'� . f� u . _ _' ('`� - - }9�� ' �t";` ''�,�� . , ' " - �. .. - " ' _ . - ' _ ' ',i^ - _ . '-' _ ' - - ��f/J(� - - - (v�,.=; - - , �+� . - -y��^ - - " - •f lii �"-• - - *'� ' ' ' - - _ - _ �k ' ; � ' ,''y�, "' . � � ' f.<� , � • _ '� _� ` , . .. � .c , . ` +a'" ',• ' �-f'� ,� : � '�� „ " , 1 ' < ' _ .. _ �- � � • , , - � - _ " �i." , , . � .�� , - � _ ' � - . - � _ ,..' ' - _ __ . _ r , ' _ ' , ' 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 LWI2P Section III—Policies; Pages 47 through 56 for evaluation criteria. �Yes �No 0 (Not Applicable—please explain) � Attach additiona]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—please explain Attach additional sheets ifnecessary 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—please explain � Attach additional sheefs ifnecessary; � „ , � , : • ; � . ,- , � - ,', .. � . - ; '��Policy� h13.-"���Promote�rappropria'te�=.u`se��and development' of_energy ;arid',mineral resources._�See I:;WRP - .�'F� -'lSect'ion�I;II _- - ," , ,• ;_:., •ir.��.<<i�"r�<^.:s;at�r;`-' - --,. •;-rrt;•=.=�`A�P�-M,-'- -_ '- o -.._ - • .. - • , - ' ^`' �% `c - ' `"',, ! � ( _ !' ; � � ,-' .. ?" . 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GOI�Qf tl0'J�OVO �^ YU(Id D I0� ��CIFO PfOm p e� 'VndOfl1eayment FFIGZOr /" ��----- -- I I----- � � lhlyd paU oP raPte Load d weathorN D th Termlke v T ��� 435 8ay Homo Road , �mphalt sF,Ngle o-ntalled in � I I I I �o+ i�o e c severe 9 Paot od-f+e sMod n wA Soutlwld, New York 114'll accordcmce wlth eocpon R9o52, � 15w Pelt.I/2•plywood aheathing i �. Phone(631) 47I-5228 Aluminvm 6uttan l leadero ,./ � � �'�_ MEGFif�NIGAL EQUIPMENT NOTES: aw�arch�tect�opton�menat 9°R-90 batt Irrwlatlon Wulaklon baff ee I Heattrg eyotem ehali be a Natvml bae hot air eyetem.The hoaCer ehall prwlde a minlrr�.m oP 90p00 bhh. Min I"airopace!o be malntained The heeting xptem ehall hwe a mintr'um raling aP BO%ePPlcbncy �lacatlon oP all rldgo t eaPFlt ve � 2 The alrcondlblonUg eyeFem ehail provido a minurum oP 5 hcm oP coolHg `. . Tho hecter eFwll be oP a mlNmim S�t 19A ratlrg ' , I/� gjpsum board wall t eetling 9.5yetorro�Fall be controlled by a minlmun ol one procpammd�le thermaetat. - 4 All duatr�ork d+all be Mwlotod nllh a minirtum ol R-8 Meulallon ° 5 All waler plptrig ehall be Ineulatod wllh a minlmurn oP R-4 _ 2 x b etude e 16°o.c, ' b.TTn water heater eha��be m on demmd eyslem oP a mN�nurn aP 8�m ak IZS degee rvater I/2"plywood eheathing,cementloue 9/4 Ttb plywood eheathing 9/4 Ttb plywood eheathing Ih nhali be have ai efticiency ralmg oP BOAs mmlmun plank eldNg,I/2°5heaMock,5 I/2° glued 1 ecrened ta Joleks glved t ecrerved ko Jolate R-�I Irnulatlon.and R-5 rlgId Irnulatian on exterlor.Note�All Ine�latlon to be Imtailed w/molaWre vapor relarder on warm-In-wlnEer elde In accordcmce wlth eectlon R310 � F,F�isT��� • _ � � 3/4 Ta6 plyWood ehealhing � 9/4 Tt plywood sheathing 3"vent thrv � � �S�� �� - ProPoSAd Floor EI+100' glued 6 screwed to Jolele Iued ecrewed to oiate ���a+E�+ V� a �� �0 � : il rooP rooP (J� ---_,�m?+. (�i n ;� � ' ` Z°verd z^vent D � ;;'�,��,�`-�i';:S�;r '� =C Mln Floor EI+0A' � �,w;; „�;.�,r"�•`,{- . ?� —1 Praposed 6ara e EI+'f O' n � 'Lv 1°� 'lv =� S� m 7' h>"-���:1' �� Basa F — —kitchen � u� J y Lowest cyad eink tolle lava � Pr er kor di hwasher �\ � - S '�.�3 `/� �� {�i• X' 7nd Floor S s —� —� SEGTION EAST TO WEST � � �� . =n . scale I/4°=I'-0• s s°��t °1 3'vent . � �8 c , y �� c€ �� S� � ry; _y� ry; > lav waeher 6•step dorm � Ilet Ilet apa tub =_ � ao- � 2'deckmg �xlo Flox JalaR� �A �'+� eho r Ist F oor I 2z ec Jals - ' � L� m� 4� m� C � r � ry i naete - I I 6r°d° I/2 g�peun ba6id r+all�eelling 70�weqrg emitay � , Plumbing Riser Diagram �`w 'y'�"' � , �,oor to xa�e. , , � . , , ' ' _ ,�� _ . , , ,_ , .. -, - . � ., � � ' - - . , ,. , ' ' , _ . , � - " .�uNio�qor ttss nuw ' " , - , � � NOTE� ' • � �.. � , , , � . ' , , , � - _ - ' - , '�' - - , , - ' , - -' - - F� - � - ' x,oar�wer�utrea�ure . - _ .5older ahall eoritain no more th���OAS laad , , , . '� - . - , - . - �i .{t . - � ktaw I In ehaiPbe'PEX' . - - - - ns sr+Nt wor �Water.a I . -. . r^ R� . 5 , , . „ . �+PP P P 9 . k••, y _ .Y�', :11^ �II !,$�' � . - . 1 � .-`� - , - - �2_ ' , , - _ A ' PAf�6E OP � - " -' t, . �-. . -. „ tCl l� f� - - T�Pi v n ehall PVG:'orco er __ - - �ka cmd e t be - - _ - - -Ww - --. . _ - e d D I , - - - " _ $BGEIO/19 �'�OtO BfQIO . - _ __ � . _ ' _ ' ' _ ' -� . _ '� . ', ' " IN DI : ' . _ . ' _ �. - - - 4 INGLi ' • " __ " � - - _ . ' : �� _ " ' . .. __ - . , ' " " _ " _ " ��� ' ' ' ,. . - ' ' '" _ ' - ' __ -' ' - � : - -._ ' • . - _ , . . . _ ' ' = -�SGQ�O��c�1��-0a .. " ' " . , " _ , : - . . , _.. � - - - - ,l:' , - - _ } �I toroh down roaPln , � - , , . _ - . 9 9' , . . . ',' 2P _ ` -- ' -- • ' � � . ' � ' -- _ -' - _ � ' - - ' - '� - .. - - , . - .- . - = o s ea In - . ' „ . � . - _ . � - , _ - - - , , . .- - - - ' - - .�, �ti'' - , _ - P Yr'° _ 9 - - - � . - . - - . - -,- - - - , - - - - ' ' e` - - _ . _ - - - - -. - - - ` - - , , " - - - - „ � - - t 'D IU , � - - , - - - - - . �Ix6�.T 6 Gedar x , . _ - _ - ia,' � , _ " . - - ^9 . - , . ',i�_ ' - , - � -- � - - . - ' . � - , � - , , - . , � - , " - - = -' - . ' - ' ' ' -- . _ _- ,- , .-, . � ' - - `5_ art'�2'-O°,ot.` ' - -- . - � - . - � . . /4°51e _ - - . ,a - - - - �P , „ � - - - , - - _ - - : _ �_��. . : . , .- "' " ' .5. - - _ - - _ _ " _ , _ _ 1 -_ � .. " ' - � . 1 )': . ,i . �. � l'.4� - - . _ _ - - _ ' � � r - _ . , " ` ' _ " , _ _ _ -' _ } - ,. ' _ _ _ " " _ .t.. r � _ .. . . ' - . - _ " � � . - - ^ycw ' � _ - _� - -' � � o . _ - r - , f, . - , , . ' ' , ^t ,S`. yl• - � - - e��• � _ . - � ,r, :E �, _ - - � . � . ia . - _ , . . - ,. . .. , - . , i" _ ' - . " '" _ �_ . . , � . ' . - . _. : . - ' , � - , ' . ��j ' - , ' ", ' . ' _ , . - - - � - ., - _ , t • ' ' r •� -- - ., - � �• ` " V , . �{-� . . ` < _ r nY:- ' i " • ' � _ , '• � _ '� � - ' � ' . . � - __ � � ..., a. ., . . � ' � � � . ^ . . �J " _ ,.t` - _ - . . ' ' � � , . . � , , : �- ,.� - - ` . - ' , - -� � � ',' ` L _ �� �`"_ ' ' :. - „ . ,.- _ . ` - , „�' ' - , "_ � , 2x6 Treated Iate .- .., _ . - , . ' . . ' � , , ` . .; , _ • '' ,- ' � . , � - - , , . � � . � , � . . . � ' ,_, , , ; i- . , _ . , � , .,. , „ , � , , ,5/B°xl2°long�ehor � � ' � ' - , , - � ' - - � � - - - ' . - � _, i , � ' bolks�33°oa , �� Pro ased Floor EI+100' Phoposad Fioor EI+100' _ �aler'neuiato'n GhNs e h Ariens P 57B eq PF Ihe(�8'x 9Z` � " Mln Floar EI+BO' - Plood venm�e•dwve gade � 4°cororeke nlab Proposed baraqe EI+'I O' Proposed 6arage EI+'fA' 0 ��apor barrler< on compacted clean PIII Base Flood EI t Hlahest Grade+6.0' I eealer Im�latlon Lowas gra � . - e•crncreta IaundaVon r+all ' 8'thkk x 16 nide coricreta - tootmg�vanpprootrg 455 MacDonald Grossing Lcurel,Na„York II . � � • SGTM k 100-145-04-017 SEGTION NORTH T SOUTH — II?3,2015 � , ecale I/4'=I'-0' - � 5,2015 - �m� � • oF 5 harles W Southard Jr Holddotine Eo be min 14 guage x 3°wlde A R G H I T E G Metal w/min.holddown capaclty 3000M Test holas by Gounty hiarina �aomero Fcutoned ae per mcmufaaturer ' � show at 10'-12'balow grada we have 5W soil=3-6 ton becring wpaa�txj USE,9 Ton daslgn=6000�/sc{ft 435 Bay ome Roa ��a11 Southold, New York 11971 U5E lo°dta wood plie9='185 sq.In U5E 5 Ton deelgn baeed upon elde frlctlon �*�s��^a�� Phone(69U 4'11-5228 ���'*P�°t"'� cWsarchltect�optanlinanet 2-16d camwn naiia Laad oP SFrvcWre� 0• �b'oc Flrot Floor - Dead Laod.IO�/eq.Pk x 1552 eP o155Zd 5/8'dla.Anchor bolG LNe Lood.40�/eq Pt x 1552 eP.62600� Mn 1'Into Foudaqon oRry Yiall Load•IW/IIn Pt x 8'h x I'f5 11•14p00� I I I Saeond Flaor 4 I 4°eonCrete Olcb I on vapor bartlar t I Dead Load•Id�/eq Pt x1409 eP•14890N � i on cmnpacted cle�flll ]xl1 rooP raPtero �i LNe Load o gG�/sq.Pt x 1489 nP=44,490� 8,�, 4,�0• 8� � I 9d Wqll Load=IOM/Iln It x 9'h x I51 11=I9S00� 0l6'OG. p„ RooP pltch I/4'/I' E I Dead Load•10�/eq.fC x 1409 eP v 14830� . I/�'�7�-'w-- � I 9 I/7�'d x I/4't tlan Yl�li I r� Llve Laod o�py ett Pt,x I409 e1.24660M 4I b lally�olumn I "i Gara e '° I � I � g - TOTAL LOADf� } I Dead Load. 159200M.14B3W t 148�•45180M J m' 91B aq.Pt. Uee(71 8'x 97' LNe Laad= 648oOM�444A0��29660+=19�090� 4 'xlb�'d � ^�I llood venta�B•dzva grade Wan Load.1'r5oo� co cretq foating I I � To�a��.on�s, zo�,,�o. i Garage Gorner Holddown Gonnectfon use io'DIA PILES •ao��=s rm+crwnurr e(4'I)Plloe �, i 528 sf - KTs � I USE 6X6 �Ib'LON6 lreaCed poeb Por deck PILE SHALL PROVIDE BEAR GAPAGITY A5 SHOYPI I �/H'Tpp X eheeMock (�9x 12 treated girder ❑ walle�keilUg per code �_—_—_�_—_—_—_—__ b��� � 6 x 6 treaFed poet _ � � STORAGE , . _ � � - ' � ( ZO x 4/O 5/8 Plr a 5/8�de• - m_ � ' ___'_'—' '_'_'_' _—' � ' —'—'—'— _'_'_ '—'—' ' (31 2x0 � ,�p m x- 5 e X ehee ck T kleee wa hoater ------ - ----� ----- - i �--- --- i i-------- -i i----------i i � x x �o J rw�b centrg per co j-I— — I-I---- x�, �i o o a. �o x b p m m . 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' �� � ' - {� �: ' ' , , '•� �. ` , "' . . _,. - _ � -� ' '_ , , .' . - . � _ = '��_-' , I - - - • ' . - _ , , ,_ , , _ ' - ` , _ ,_ ' ' ' - _ - - ' _,- +' . - ' '. , , ' 7xlo treated noor jo�e _ .. _ , � � r - ' ' - • ' . , ` - �.� ___—�-- �6 z b treaked poet I I y I I � 5 I'I� •Ib'OL ' I (917z12 header u _ _ � Naw Residence for � ' Ghristophar Arlans y� I,__'______-�_�a_—___— —�'—' 12/O x b/H eldr � N---�--t-r--�--� � � � � � � � � � �-------��_--� I � � I � - � � � � _ not wb " � .k - ry rT.----------1-�-n----1 � i i I � ' ' � � x '__ —_ _' _ _ p� � � 9/4 x b decW n g I I m �_—_�_—_ I � � $ 6 x 6 trqc�ed 455 MacDonald Gossing � � �— ----ry------, - �__ _—_ll_—__—�a I I I S ! ! FIRST FLOOR PLAN �aurel,New York II ��--------------�-�------------- � � _ � I � � ^ � � Habitable Floor Area = 1552 sq,.Pt. x�t-t�ioo-ia5-oa-oi1 -�� 6x6 K.A poete i i i i I I m I I rll 23,2015 _LJ min�m�m 6'Into �...I___'_"___'_�.'�'_-_____ I I 9fO1�'d 6 x 6 Mealed poe! � � 6 x 6 treated b 5.2015 �6 x b treated p o et '_' ' '_'_'_'_"_ ===_-__�--_=-====�=_=---- - -_�__=_=__ ---------- �m� FIRST FLOOR PLAN F#edaltable Floor Mea=1553 ee{P! 0 Floor Area Ratla Galwlat�ons harles W.Southard Jr Date�Aprll 22,2015 Pro�ect ntie�NEW RESIDENGE A R G H I T E G �s z9s»aepFw�t enug�m - - _ , b� conblriuoue rldge venk A �rv H�'�' J 435 Bay Home Raad First Levoi. I$52 sq ft. ' 5econd Lovol 1483 sq;Pt Southold, New York 119'il �� TOTAL HABITABLE SGi.FT. 3p35 eci f!. 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SGTM M 100-145-04-017 rll 23,2015 , 5,20I5 SEGOND PLOOR PLAN - , � �_� Habltable Floor Area=1483 x{.Ft � � of 5 � ����, f.�lacDonald GrosSing ona�d Grossing EP+4.0�� 5urvey of Propert� Ma�n �h�rle� W. 5o�th�rd Jr ti 6a.o� EP+5.12� 6a.o� id 51d O�1' �� E Lot 10 � Westerly Half af Lot 9 �y 51d O�I' 00" � � {� w Map of Edgemere Park _ �t � � � � � � � Pfled �-2-1a31 Map # 742 � � R=�S� O ' 435 Ba Home Road R=15 5ltuate , N �=24. a� " � �Q„rei L=24. a � � Southold, New York IIq71 �' � Town of Southold �' 3 � ry Suffolk Gounty, New York --,` N > 9 m Lot �4rea = 14,235.17 sc�, ft. � pp,o�x_imbte Iocatio N i -6 � � �� �!1 Vertical Datum Mean Low Water 0.00 t r 5 s m Phone �6��� 4�1-5228 6 ; � 6 f Sanita ��y�je � � l ! Lot Surveyed by Michael K. Wicks � -� \J - o Appro imate ko2 t1oP�J Land Surve in June 5, 2014 � o isting Pra e {r �} GWSQrGhlteGt�OK7tOYlIIne.Y12t � � of San tary S�ster� y g �Y a W Garage \ / � � s 3-r2 Sa. ft. 2q.83 - Site Plan � Lo�ation Plan � 12.66 � 6 � � � 2 � � � (Y N u�-, m °� � m .t_ . - - � � � � umi — — � ���1STERF� - iz.io �,�,ES W,S, '9,p �7.3, �' sQ' �� �G�`'y c� ,,.�,,,y� 2 =� 20.0' ,,,., � cn ?r�Y�_�l• � ' � � ...._ �„ O -6 --� .�::�- _ >:� ,s;.�,;_. 6 0 0 r� ` �.�-� �� � � o �/ Existing Frame Reside � -� FF +q.0 � O 6 _ ,,..� � Habit ble Ploor Are = Iq43 scj,. f � Q1' Pr osed loor EI +I O' Q Deck ,4rea = 430 s . ft. � q,� Demo I ish � Re UI�C.� wOOG'� � � , Frame Residence � i io � , 'B+'7.66' 20 O' +8.14' Iq.'f0 + .-12� - + .72� �L od bulkhead 6 6 ---- � -- -----� - --� --__ -� --- - -- •-- . - - -- - � - - - - .. _--------.... -� - - -�, - - - - --- -- --- - � - - - - _ - _ _ -- ..- - - --- --- - �- - - -- - - - �- - -- ' . , , � � . 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' . : , , ' '', 'r' Laurel, New York - - -- - ----- -- - - - . . .. < TB+6 9' --- -- - --- --- -------- - -- -- -- —-- - - -� -- �------tlandy --i'� -- - � - -- ---- - e ,� Edge �f � 46�� E v . 3�� 46' � S.G.T.M. NO. 1000-145-04-I� g ater Mark N 46d 3� � e�on� a Mean High Water Mark , Mean Hi h , t N `�6d , _ hl 52d 44' I I" E 32•2� v O �1 52d 44' I I" � 32 2� N �eb. I�, 20I S 43.��' s 43��� May. 14 2015 wood �etty ter M '-"�-�� � ' � I�T I NG �I T� i�L�N � Ntean Low � 6 ac�ona rossing _______ � 6 p Lot �ea = 14,235.1� scl. ft. to mean high water mark = -p� I /� �I �I \ @II y��/� I y�� 6 0 � e Locat�on Imper us coverage area = 2315 sq,. ft Building Area � �������� �� I � �l�f�l`� �I`l l�l����ll`ll7 1�������1`l 6 . `� Perviou coverage area = 430 sc�. ft Raised wood de s � Lot Area = 14,235.17 sq,. ft. to mean hlgh wate mark = 1022 sc�. ft gravel driveway Impervious coverage area = 2082 scl,. ft Building Area Pervious �overage area = q43 sq,. ft Raised wood decks Great Peconlc Bay -�-he existing lot coverage = 2,315 sc�. ft./ 14,235 or 16.3 9b - = 120a sq,. ft gravel driveway LO�,�TION �L,4�1 Of 5 The proposed lot coverage = 2,082 sc�. ft./ 14,235 or 14.6 90 � ` • " �,r� ��' ;y '(� ' , . i , _. , 'r t u,z.•'�:,1�.�' ,�¢�. - ,-,�.' __' l �. '� _ ' ����>��i:� ���� - k�J��" t �i - ' � ~ _ ���`i.{�� _ `•:v ,i`,�� ,� ' F : '✓fr��- �{�'''I I � . � , z��-. 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