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HomeMy WebLinkAbout1000-137.-4-35 OFFICE LOCATION: ® o� S®UTy®� MAILING ADDRESS: Town Hall Annex ~ ® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) N ° G ® Telephone: 631765-1938 Southold, NY 11971 �+ y Q Fax: 631 765-3136 �`�COU01 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Leslie Weisman, Chair Members of the Zoning Board of Appeals From: Mark Terry, LWRP Coordinator Date August 15, 2016 Re: LWRP Coastal Consistency Review for VINCENT ILLUZZI#6980 SCTM#1000-137-4-35 VINCENT ILLUZZI #6980- Request for Variance(s)from Article XXII,Section 280-116A(1), and the Building Inspector's June 2, 2016 Notice of Disapproval based on an application for a building permit to legalize an 'as built' wood deck addition attached to an existing single family dwelling, at; 1) 'as built' wood deck addition is less than 100 feet from the top of the bluff, located at: 1615 Fleetwood Road, (Adj.to East Creek) Cutchogue, NY. SCTM#1000-137-4-35 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 is INCONSISTENT with the Policy Standards and therefore is INCONSISTENT with the LWRP. Policy 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction. The as built deck was constructed without a Board of Trustees Wetland Permit or Board of Appeals review. E. Maintain buffers to ensure that adverse effects of adjacent or nearby development are avoided: 1. Maintain buffers to achieve a high filtration efficiency of surface runoff. 2. Avoid permanent or unnecessary disturbance within buffer areas. 3. Maintain existing indigenous vegetation within buffer areas A vegetated buffer is not proposed to protect water quality. 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. Office Location: QF SOUlyol Mailing Address: Town Annex/First Floor,Capital One Bank 53095 Main Road 54375 Main Road(at Youngs Avenue) P.O. Box 1179 CA Southold,NY 11971 Q Southold, NY 11971-0959 http://southoldtown.northfork.net D E C E nn BOARD OF APPEALS lir `/ TOWN OF SOUTHOLD JUL 0 7 2016 Tel. (631)765-1809 Fax (631)765-9064 South6ld Town Planning Board July 7, 2016 Mark Terry, Principal Planner LWRP Coordinator Planning Board Office Town of Southold Town Hall Annex Southold,NY 11971 Re: ZBA File Ref. No. # 6980 ILLUZZI, Vincent Dear Mark: We have received an application to legalize an "as built" wood deck to existing single family dwelling. A copy of the Building Inspector's Notice of Disapproval under Chapter 280 (Zoning Code), and survey map, project description form, are attached for your reference. Your written evaluation with recommendations for this proposal, as required under the Code procedures of LWRP Section 268-51) is requested within 30 days of receipt of this letter. Thank you. Very truly yours, Leslie K. Weisman Chairpe n By: 5 �.1t� 4 L- Cl --F Oq Maji V "f-D ` N \ q_-3q ti ,, 1 ( -'mf a \ 1 e j 1sFS TOWN Of SOUTHOLD TOWN OF SOUTMOL 65 ii O cm• 13A �� > •� 132 .31 is\ �, 1 •,p \ \ \ \ is 20 �6 's 23 24 26 21 0 ` \ `\ ` 21 22 29 •� ' 12A(L) a AA 7 5 6 0 8 OQ A N O as ` Ib '•b q N 310 2112 !' J /3TJ �P G1, SECTION NO K TOWN of SOUTHOLD NOTICE (-7Nnum, hCOUNTY OF SUFFOLK © E 137 p rtyTax Service Agency YNLLAGE OFMAINTENANCE ALTERATION SALE OR Real Pro e� County Center Riverhead,N Y 11901 MNy01WT- SUFE LKCOUOFANY PORTION OTHE SCALE SN FEET A DISTRICT NO 1000SUFFOLK NRITT N PE MISMAP SION OF THE O A D I� 20o PROPERTY MAP yNTMO R WRITTEN PERMISSION OF THE I� P na VaslerD\lER- REALPPOPERTY T/Of SERVICEAGENCY LONVEft510N DATE FeE 10 N11 5 690) 19-yo FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD,N.Y. NOTICE OF DISAPPROVAL DATE: June 2, 2016 TO: Patricia Moore (Illuzzi) 51020 Main Road Southold,NY 11971 Please take notice that your application dated May 17, 2016: For permit to legalize an as-built wood deck addition to existing single-family dwelling at: Location of property: 1615 Fleetwood Road, Cutcho ug e,NY County Tax Map No. 1000 - Section 137 Block 4 Lot 35 Is returned herewith and disapproved on the following grounds: The as-built deck addition, on this nonconforming 18,541 sq. ft. parcel in the Residential R-40 District is not permitted pursuant to Article XXII Section 280-116A(1), which states; "All buildings or structures located on lots upon which there exists a bluff landward of the shore or beach shall be set back not fewer than 100 feet from the top of such bluff." The as-built construction is±14 from top of bank. 1. �flh Authorizeure- Note to App . Any change or deviation to the above referenced application may require further review by the Southold Town Building Department. CC: file,Z.B.A. Fee:$ Filed By: Assignment No. APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS AREA VARIANCE House No. 1615 Street Fleetwood Drive Hamlet Cutchogue SCTM 1000 Section-137 Block-4 Lot(s) 5 Lot Size-18,541–Zone—R-40 I (WE)APPEAL THE WRITTEN DETERMINATION OF THE BUILDING INSPECTOR DATED June 2,2016 BASED ON SURVEY/SITE PLAN DATED—April 18,2016_. Owner(s):_Vincent Illuzzi_ Mailing Address:_7 Cowdray Parkway,Far Hills New Jersey 007931 Telephone:-908-310-8559 Fax: Email: villuzzi@msn.com 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:_Patricia C. Moore Esq._for(X) Owner()Other: Address:_51020 Main Road, Southold NY 11971 Telephone:–631-765-4330 Fax:_631-765-4643_ Email: pcmoore@mooreattys.com Please check to specify who you wish correspondence to be mailed to, from the above names: ()Applicant/Owner(s), (X)Authorized Representative, () Other Name/Address below: WHEREBY THE BUILDING INSPECTOR REVIEWED SURVEY/SITE PLAN DATED-4-18-16 and DENIED AN APPLICATION DATED June 2,2016_FOR: (X)Building Permit () Certificate of Occupancy()Pre-Certificate of Occupancy () Change of Use ()Permit for As-Built Construction () Other: Provision of the Zoning Ordinance Appealed. (Indicate Article, Section, Subsection of Zoning Ordinance by numbers. Do not quote the code.) Article:_XXII_Section: 280_Subsection: 116A (1) Type of Appeal. An Appeal is made for: (X)A Variance to the Zoning Code or Zoning Map. ()A Variance due to lack of access required by New York Town Law- Section 280-A. () Interpretation of the Town Code,Article Section ()Reversal or Other A prior appeal (X)has, ()has not been made at any time with respect to this property, UNDER Appeal No(s)._5212_Year(s)._2003_. (Please be sure to research before completing this question or call our office for assistance) Name of Owner: ZBA File# Fee: $ Filed By: Assignment No. REASONS FOR APPEAL(Please be specific, additional sheets may be used with preparer's signature notarized): 1. An undesirable change will not be produced in the CHARACTER of the neighbor or a detriment to near by properties if granted,because: The house and decks have certificates of occupancy (Exhibit 1). The repairs Mr. Illuzzi was making to the existing decks were less than 75% of the existing structure. The repairs to the existing deck was inspected and certified to be less than 75% by Angel B. Chorno, Architect and his plans with the certification are herein attached ( Exhibit 2) The plans used by the builder to obtain a building permit and certificate of occupancy required proper footings (Exhibit 3). The existing deck was suppose to have proper structural footings, however, when Mr. Illuzzi was replacing the wood boards on the deck with trex, he found that the footings had not been constructed to code, as the plans required. I have attached a photograph of the inadequate footings which were at most 1' x 2' cylinders. (Exhibit 4) Mr. Fish appeared while Mr. Illuzzi was working on the existing deck and directed him to get a building permit. Mr. Illuzzi did not believe he needed a permit to make repairs to the deck in accordance with the original building permit and certificate of occupancy, particularly since the footings were already on the Town's approved plans. He was making the footings conform to the 1997 architectural plans which were the basis of the Building Permit and CO. A letter to Gary Fish was submitted on October 23, 2015 detailing the work done and we hoped that this matter would be resolved. I was directed to file a building permit even though repairs were made in conformity with an issued permit. After an initial review, the building department did not know if a variance was required so they asked me to refer the matter to Chairperson Weisman to determine if the retaining wall of boulders to retain the soil was considered a "marine structure". I submitted a letter to Chairperson Weisman on December 10, 2015. At about this same time the Town of Southold was amending the zoning regulations to remove the 75' setback to man made structures, bulkhead, etc. from water bodies. Therefore, the boulders were not going to be an issue and the building department believed that a building permit application could be issued. At the public hearing the Town of Southold code change was intended to treat a property containing a bulkhead the same as a property without a bulkhead leaving setbacks to wetlands up to the Trustees. In this same code amendment, the Town Board retained the 100 zoning setback from a bluff (bluffs are found along Long Island Sound and Fishers Island Sound). The issue of whether a bank and a bluff are synonymous was now left without a definition. It is subjective and on a case by case inspection of the building department. The owner again had to wait for the building department to inspect the property and determine whether the bank along East Creek, Cutchogue required a zoning setback from a "bank or bluff'. Town Code 280-116 (A) (1). The original house and deck has a certificate of occupancy. The rear deck was constructed in 1980 (Permit#10840Z). The owner purchased the house with the deck,repaired the deck and merely wants to retain the same deck which was made conforming to the specifications in the building permit plans. 2. The benefit sought by the applicant CANNOT be achieved by some method feasible for the applicant to pursue, other than an area variance, because: The owner wishes to retain the existing structure,the Town Code changes adversely affect the preexisting lot and places the house and deck into greater nonconformity. 3. The amount of relief requested is not substantial because: The code changes make these variances "substantial"on existing structures which were constructed with certificates of occupancy. The 75%repair before a structure was considered a demolition and reconstruction is applicable and no variance is required. 4. The variance will NOT have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because: The property has been developed prior to zoning,the existing house and deck have a pre-c.o issued in 1982. The house was expanded landward and a second floor was added with a second floor deck in 2006. Mr. Illuzzi purchased the house in 2007 from Frank Scavone and specifically checked that all the structures had permits and had the Trustee's wetland permits transferred into his name. The repairs to the existing deck will not have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district,the repairs assure the neighbors and community that the structure remains safe and well maintained. 5.Has the alleged difficulty been self-created? {} Yes, or {X} No Why: The Town Code changed while the owner was requesting a building permit for the repairs to the existing structures. Are there any Covenants or Restrictions concerning this land? {X) No {} Yes (please furnish a copy) This is the MINIMUM that is necessary and adequate, and at the same time preserve and protect the cha acter o =Authorized ood and the health, safety and welfare of the communi� Signature of Applicant Agent (Agent must submit written Authorization from Owner) S o n to before me thi day 0( Jrn 2— �, Le_ 1� tary Ppb ' BETSY A.PERKINS `` Notary Public,State of New York No.01 PE6130636 Qualified in Suffolk Couto/ Commission Expires July 18i Board of Zoning Appeals Application AUTHORIZATION (Where the Applicant is not the Owner) I, V 1 h[-r rjf- residing at 7 Cow cA ra �k (Print property owner's name) (Mailing Addr ) IS 1 do hereby authorize -T-r4 Y(Cs C _1 I /V D ff (Agent) to apply for variance(s) on my behalf from the Southold Zoning Board of Appeals. (Owner's Signatu ) //'i/I ce-vlf Al. --,L//vZZj , (Print Owner's Name) FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31529 Date: 04/12/06 THIS CERTIFIES that the building ADDITIONS/ALTERATIONS ,Location of Property: 1615 FLEETWOOD RD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 137 Block 4 Lot 35 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 29, 2003 pursuant to which Building Permit No. 29854-Z dated NOVEMBER 6, 2003 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to FRANK SCAVONE (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-03-0072 04/06/06 ELECTRICAL CERTIFICATE NO. 3407 02/02/05 PLUMBERS CERTIFICATION DATED 02/04/06 J ZEES PLUMBING & HEATING //,,&Ut,vrize Signature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-23712 Date JUNE 16, 1995 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property, 1615 FL MTHOOD ROAD CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 137 Block 4 Lot 35 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a One Family Dwelling built Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-23712 dated JUNE 16, 1995 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH ACCESSORY TWO CAR GARAGE The certificate is issued to WILLIAM & AVA KENNEDY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. lding Inspector Rev. 1/81 • _ BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 1615 FLEETWOOD ROAD CUTCHOGUE, N.Y. number S street municipality SUBDIVISION MAP NO. LOT(s) NAME OF OWNER (s) WILLIAM KENNEDY & WIFE OCCUPANCY A-1 RES. OWNER type owner-tenant ADMITTED BY: WILLIAM KENNEDY ACCOMPANIED BY: SAME KEY AVAILABLE SUFF.CO. TAX MAP NO. 10 - - - SOURCE OF REQUEST: PAUL CAMINITI, ATTY DATE:JUNE 6, 1995 DWELLING: TYPE OF CONSTRUCTION WOOD FRAME # STORIES 2 # EXITS 3 FOUNDATION CEMENT BLOCK CELLAR CRAWL SPACE % TOTAL ROOMS: IST FLR. 3 2ND FLR. 3 3RD FLR_ BATHROOM (s) 2 TOILET ROOM (s) UTILITY ROOM PORCH TYPE_ ENCLOSED PORCH DECK, TYPE REAR WOOD• PATIO WOOD (FRONT 6 SIDE) BREEZEWAY FIREPLACE ONE GARAGE DOMESTIC HOTWATER YES TYPE HEATER ELECTRIC AIRCONDITIONING TYPE HEAT ELECTRIC WARM AIR HOTWATER OTHER: ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST. WOOD FRAME-2 CAR STORAGE, TYPE CONST. WITH ATtAE1�E-@FF]EeE-ROONf-- SWIMMING POOL , GUEST, TYPE CONST. OTHER: DOCK ON THE WATER VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART_ SEC. 1 i REMARKS: BP #10840 CO Z-10107 (DECK ADD) BP #11488-CO Z-10889 (ADD) INSPECTED BY DATE OF INSPECTION JUNE 6, 1995 GARY FI H TIME START 9:30 END 9:50 FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. . . . . Al.Q1 U.7. . . . . . Date . . . . . . . . August .?� . . . . . . . . . . . 1980. THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property615 I+'leet. .9od ,I�Qe►c , , , , , , , ,Cutchogue, ld.Y. , House No. Street Hamlet County Tax Map No. 1000 Section . . . .1.37. . . . . .Block . . .94 . . . . . . . . .Lot . . . . . 035. . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated August. i . , , , . . , 1980.pursuant to which Building Permit No. . . . . . .:I 049?. . , , . . , . dated . . . . . . 21. . . . . . . . . . . . 1980. ,was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is . . . . . . . . . . . . . . . . . Deck addition 'fico Existi.r Dwel].ir . . . . . The certificate is issued to . . . . . . . . ..Ki4P A, Fr. Aya M. ?C rz407 , , , , , , , , , , , , , , , , , , (owner,/9990 7EaDM) of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . .K/R. . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . N�R. . . . . . . . . . . . . . . . . . . .. . . . . . . .. .. . . . .4. . . . . . . . . Building Inspector Rev 4/79 i i F L FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold,N.Y. Certificate Of Occupancy No. —7.103.134 • . Date . . . . . . .FeAruary.•.23. . . . . . . . . . . .. 19 .e2• THIS CERTIFIES that the building . add i bion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . Location of Property .1 f.t.5 . . . . . . . . . . . . . . Ej'Q0laogd, Roar. . . . . . . . . . . .Ctitcho j'uo House No. street Hamlet County Tax Map No. 1000 Section . .137. . . . . . .Block . . .04. . . . . . . . . .Lot . . .43 . . . . . . . . .. . Subdivision . . . .%. . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. X . . . . . .Lot No. . X . ... . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated .19 oxetrabor. .I t;. . . . . . . . 19 A 1 pursuant to which Building Permit No. .11 NIS.Z. . . . . . . . . . . . dated . . .D.agember.2. . . . . . . . . . . . . 19 $1. ,was issued,and conforms to all of the requirements of the applicable provisions of the law.The occupancy for which this certificate is issued is . . . . . . . . . an. .addi.t< ori. .b�. alri. .4?��,s,ti�.�t;. oxlg;-family„dwol];i n�.•. . . . . . . .. . . . . . . . . . . . . . . The certificate is issued to . . . . . . . .Zfila.Wft. A,JKPArMy. .4 wife . . . . . . . . . . . . . . . . . . . . . (owner,hmr vr"wrn} of the aforesaid building. Suffolk County Department of Health Approval . . . .n/r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . .3Vr . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . . .. . Building Inspector Rev.1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29437 Date: 05/.14./03 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 1615 FLEETWOOD RD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 137 Block 4 Lot 35 Subdivision Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 23, 2003 pursuant to which Building Permit No. 29327-Z dated APRIL 23, 2003 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITION & ALTERATION TO EXISTING SINGLE FAMILY DWELLING AS APLIED FOR. The certificate is issued to FRANK SCAVONE (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1131744 05/05103 PLUMBERS CERTIFICATION DATED 05/08/03 BERTSAND PLUMB.&HEATING """� t 1"f-� - tho ized ignature 71 Rev. 1/81 ,1 APPLICANT'S PROJECT DESCRIPTION APPLICANT: vwz k - /v!l (&z"-"j • DATE PREPARED: 7- 1.For Demolition of Existing Building Areas Please describe areas being removed: WOOd Cl c-rA w' � 'o ,p II.New Construction Areas (New Dwelling or New Additions/Extensions): Dimensions of first floor extension: t\f f A Dimensions of new second floor: �j(A Dimensions of floor above second level: /vi(A Height(from finished ground to top of ridge): N[A Is basement or lowest floor area being constructed?If yes,please provide height(above ground)measured from natural existing grade to first floor: N f A M.Proposed Construction Description (Alterations or Structural Changes) (Attach extra sheet if necessary).Please describe building areas: Number of Floors and General Characteristics BEFORE Alterations: Ic•44-(5f tMQ 6eCV- XVI i5�Ucci iN 2a,3 (f3-P- z-gc65- r) Number of Floors and Changes WITH Alterations: neEme- i n p(fe(e- jt IV. Calculations of building areas and lot coverage(from surveyor): / \ Existing square footage of buildings on your property: 11J0 C OAV—lP ( I Proposed increase of building coverage: r)ovl-- Square footage of your lot: bg r `9-3 Percentage of coverage of your lot by building area: -7-c> "A -,g2�fr►r V.Purpose of New Construction: VI.Please describe the land contours (flat,slope %,heavily wooded,marsh area,etc.) on your land and how it relates to the difficulty in meeting the code requirement(s): QYL .00-%t- C r'r-pA-*--. 6'oTyl n o a1VJ 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 X No B. Are there any proposals to change or alter land contours? __No Yes please explain on attached sheet. C. 1.)Are there areas that contain sand or wetland grasses? Yes 2.)Are those areas shown on the survey submitted with this application? :°S 3.)Is the property bulk headed between the wetlands area and the upland building area? yep 4.)If your property contains wetlands or pond areas,have you contacted the Office of the Town trustees for its determination of jurisdiction? YeS Please confirm status of your inquiry or application with the Trustees: and if issued,please attach copies of permit with conditions and approved survey. D. Is there a depression or sloping elevation near the area of proposed construction at or below five feet above mean sea level? /Vv E. Are there any patios, concrete barriers, bulkheads or fences that exist that are not shown on the survey that you are submitting? Alc, 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?_'YA_If yes,please submit a copy of your building permit and survey as approved by the Building Department and please describe: jvu' l•�ocr/Cl��cf� y�, Gd�xhDs�l� G. Please attach all pre-certificates of occupancy and certificates of occupancy for the subject premises. If any are lacking,please apply to the Building Department to either obtain them or to obtain an Amended Notice of Disapproval. &-)&- H. Do you or any co-owner also own other land adjoining or close to this parcel?Nd If yes,please label the proximity of your lands on your survey. I. Please list present use or operations conducted at this parcel Wau2 e icy de G and the proposed use tj. (ex:existing single family,proposed:same with garage,pool or other) Authorized signature and Date APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. ( / YOUR NAME : V M Q-0 ALJ (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest" means a business,including a partnership,in which the 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%of the shares of the corporate stock of the applicant(when the applicant is a corporation) B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation) C)an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this y of 720 Signature Print NameV�n���fi M AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same f J� YOUR NAME : 0 A- C (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business,including a partnership,in which the 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%of the shares of the corporate stock of the applicant(when the applicant is a corporation) B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation) C)an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this U� ay '20 l� Signature Print Name //�vm/r� q �OdP i � T• f � - r T dpw:, +T L. 6 . J r .R A r '..y.,Ir ow 4.9.. 4 �ir;A�4r. f... `�. • +;;,>"`'�"��' wn, Il�r 1 k ayC '!'1!i�'�a `+t vR„7y� of 1. .. .... r-.yar, ay.. ....r- ..:ww�.�i-�r�n++.a•4c+w. f. .. _ 4.. :I�r-Fi�+Ayr 1-:'i�'^��—;_...itA�u+ dPyb+✓'Nn4n�."11M1�°i�. 'rR - >z I r I SURVEY OF PROPERTY A T CUTCHOG UE TOWN OF SOUTHOLD SUFFOLK COUNTY, MY 1000-137-041-35 SCALE 1'=30' JAN. 9, 2003 AUG 20, 2003 (REVISION) `,e Zo,g SEPT. 2 2003 OCT. 8,(2003,(RESONS)DI710N) . MAY 6, 2004 (FOUNDA77ON I0CA770N) MARCH 21, 2006 (SEP77C SYSTEM) APRIL 20, 2006 (CER77RCA770N) N/O/F APRIL 18, 2016 MARY FLORE ROGER FLORE Q�� BULK ig 0.s'S o x o QED 262.39 REr wa l o FEN WALL METER � WOW ?2 2.6& X - FY 0.5'S 5 �'A EL 2a0' OUT.SHOWER o0 1.8S c i CT SPIKE N85'57'20HE -- EL X17.0' . ,` ni FLOAnNG DOCK WALL 2.4'S. RETAIN G WALL- - �j-Mynd CANT. 18.0' r E. 33.8 �. BRICK WALK c 42.1' . 5 , RA P ni Z - 13.8' 0 25.5' p, WOOD DOCK 21.7' 9.6' in +, �'= (31 BOW '° i y 2 STY. FR. HSE. F.F. EL. 21.7' � � WINDO c 13.5' "' .y0 a � � � '� � m.r \ DRIVEWAY :, 16.0' ' -o .o_ fts' S. G- O o R5 coNc to.4'� �= 2.4 _ 6 s PAVE 21.7' ---- �s.6 NI -m I ', to b 6.3' STONE BRICK WALK 18.5' EL 5.0' ETAINING W BRICK W WATER METER E 25 9• ST eta �' 33.9' w 13.5'' Z6 s rSarm N lrQ�s O - -- - -------wA UNfj �2 2nd FLR PORCH EL, 8.0' 7/E LINE'- O z S85-57'20"W z / E ASC CANT. UNDER ALONG MHW1N v � aO 39.50 16.3' �� STONE \\TbWE R AI~/Nc WOW STEPS rte, �O C R 0.5'W. 1 STI: ro STAINING WALL so __.1, b .5 S. FR. WORK N V �{/NDERGROUND GAR ? SHOP {' EL 26.3' / PROPANE ANK 2p 0 1.6 %°j CA, R. z FE SPLIT RAIL FENCE:' '122.1 3' � �7 z WALL 0.4'W. 0.3w 015 5 a0b0 3. E. N �� CON`VM WALL S85'57'20"W o cin C3 oNo N/OIF s ROBERT GRISSEL EAST ROAD X% ON •= SPIKE ELEVATIONS REFERENCED TO N.G. V.D. LOT CO VERA GE <- 3775 118,853 sq.f t = 209 .4 NO. 49618 ANY ALTERATION OR ADD177ON TO THIS SURVEY IS A V70LA77ON OF SECTION 7209OF THE NEW YORK STA 7E EDUCA77ON LAW. MORS, P.C. EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CER77FICA770NS (631 -5020 FAX (631) 765-1797 HEREON ARE VALID FOR THIS MAP AND COPIES 7HEREOF ONLY IF AREA=18,853 sq-ft- P.O. BOX 909 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF 77-IE SURVEYOR TO TIE LINE 1230 TRAVELER STREET 0,2-352 WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y. 11971 I , I r ' ZI 17 �11 771— S. k/- `, " -- - -_- • - - 'jf'� ___ ..✓�•'b..t�._�_^5:.� rY� �V ``i - ,... -�i� 'o _ f����J��� �/•�� .-.—"--.. _y .... __. _. _ ..»._.,..rr...a. - tvy<S" "-o" -4-Oz- �f�ba�".. J� --_'� l � aY'�/ .�f��I�Gw#i„ l�-!/.y.!�s, �. a•y^.......�.- -- - _ - »t:'- '�[ - t. ,.b t`�. • �� "S.,T �.`_-3S'a `-�•-c.4.i�£�iv+`"•_°_'��t?v€a-T��� .�Ct_"S- �'"C [ _�ar .. . -l I- �, �- • � EL 7:.4 �e-,�-. t>A '.-`°.' 'si� ° �'� { ��-�, -,.,+e; :te•.t�,-.t'""T=c?n'—Y�y s,.. 72 p�` - 'tea:tea• {. - ..�' stl� %*�1� -t, _ I CHO N40:ASS:OCtATIS' h $OUTHOLD;PIEW YORK AGRICULTURAL DATA STATEMENT ZONING BOARD OF APPEALS TOWN OF SOUTHOLD WHEN TO USE THIS FORM: This foryn must be completed by the applicant for any special use permit, site plan approval,use variance,area variance or subdivision approval on property within an agricultural district OR within 500 feet of a farfn operation located in an agricultural district. All applications requiring an agricultural data statement must be referred to the Suffolk County Department of Planning in accordance with Sectio:2319/m and 239n of the General Municipal Law. 1. Name of Applicant: V`n C n t & 2. Address of Applicant: ! 'lam - ry 3. Name of Land Owner(if other than Applicant): 4. Address of Land Owner: 5. Description of Proposed Project: W D S 6. Location of Property: (road and Tax map _ number) -- /3 7 — V— 3 s 7. Is the parcel within 500 feet of a farm operate n? { } Yes { 'o 8. Is this parcel actively farmed? { } Yes td 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 Office (765-1937)or from the Real Property Tax Office located in Riverhead. NAME and ADDRESS 1. 2. 3. 4. 5. 6. (Please use the back of this page if there are additional property owners) '7 Signature FoApplicant Date Note: 1.The local Board will solicit comments from the owners of land identified above in order to consider the effect of the proposed action on their farm operation. Solicitations will be made by supplying a copy of this statement. 2.Comments returned to the local Board will be taken into consideration as part as the overall review of this application. 3.Copies of the completed Agricultural Data Statement shall be sent by applicant to the property owners identified above. The cost for mailing shall be paid by the Applicant at the time the application is submitted for review. TOWN OF SOUTHOLD PROPERTY RECORD CARD00 OWNER STREET �j r VILLAGE DIST. SUB. LOT Lei r �v FORMER OWNER N E C-;. ACR.. m i� �� / t W .,� ' TYPE OF BUILDING N RES o��v SEAS. FARM . C01!hM. CB. MICS. Mkt. Value - ✓ d �e I r i,� r7.vEMRKS LAND IMP. TOTAL HATE �.-. PF-1-a !� .L;'='s• >� , ����6 :�/' /� �Y`o t'sr,s�r• /o%�� n c� ��1Q , t: L; �Y�j ej d da 51DoV7a-t.7 11 050 — Jvo»3% o-a ! Zli�' ?Soo o as /S 9O4 y 9 0° . 00 D 07 • b IO AGE BUILDING CONDITION nq NEWNORMAL BELOW ABOVE . cn FARM Acre Value Per Value Acre Tillable FRONTAGE ON WATERell S, !Moecdo�vtand odland FRONTAGE ON ROAD �6. Cf •c:;r DEPTH P a o D v BULKHEAD � House',?Iat;.,;,� a Totol DOCK , m F- U. , MEN MOMMIMME Vj 4,< ; fll;t rk.> ,' .•. ;zMEN.■■■■■!■■di■■■■■■■ice■■1f'� ■■■■��`�■NO■■■■■■�,■ ,� ■ _ •, `h. , ONE i■�iM■■■■■■■■■■■f� 1i ■■ ■ mass■■i■si■■moi■■■■■ r■i■IMMUNE'URNMERM, WIN ■ • - :: - \■■■■■moanF Ism t3T ' � r---rte '• .r ��\,■����■ J�1J �■■■■■■��� ■ ■ \■■�■ i1 .�►oL1i■■■i■■■1��l1ll■1 - - �■fief!■'1ii■■■'�i�i®fid■■■ I■�.1■1t■ - ■■■■Si■MIFound ■■■©riT■iii■■■■■■■ '"'�■` _ ati r ♦ I - tion Roo Room,s 2nd Floor MEMO 1 t Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits*including Town of Southold agencies,shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C,the preparer of this form should review the exempt minor action list,policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program.A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered"yes",then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law.Thus,the action should be analyzed in more detail and,if necessary,modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions.If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places:online at the Town of Southold's website (southoldtown.northfork.net),the Board of Trustees Office,the Planning Department,all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 1000-137-4-51615 Fleetwood Road,Cutchogue NY 11935 AGENT: Patricia C. Moore Esq. 51020 Main Road, Southold NY 11971 The Application has been submitted to (check appropriate response): Town Board ❑ Planning Dept. ❑ Building Dept. ❑ Board of Trustees ❑ Zoning Board of Appeals X 1 Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant, loan, subsidy) ❑ (c) Permit, approval, license, certification: ❑ Type:_ Town of Southold LWRP 1 Consistency Assessment Form 7 , . r' Nature and extent of action: "as built" in kind replace wood with trex and in place repairs of less than 75% to existing rear deck Location of action: 1615 Fleetwood Road, Cutchogue Site acreage: 18.541 sq.ft. Present land use: house with deck Present zoning classification: R-40 2. If an application for the proposed action has been filed with the Town of Southold agency,the following information shall be provided: (a)Name of applicant: Vincent Illuzzi (b)Mailing address: 1615 Fleetwood Road, Cutchog ge (c)Telephone number: c/o Pat Moore(631 )765-4330 4330 (d)Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No x If yes,which state or federal agency: I DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III-Policies;Page 2 for evaluation criteria. Yes x No ❑ Not Applicable ❑ Discussion (if appropriate): Property owner was repairing an inadequately constructed deck built which has a certificate of occupancy and replacing the wood decking with trex. Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-Policies Pages 3 through 6 for evaluation criteria Yes ❑ No ❑ Not Applicable X Discussion(if appropriate): Disturbed property with no historical archeological resources l Town of Southold LWRP 2 Consistency Assessment Form i 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 X No ❑ Not Applicable ❑ Discussion(if appropriate)repairs to a deck on the existing residence no adverse visual impact 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 16for evaluation criteria Yes x No ❑ Not Applicable ❑ Discussion (if appropriate): the existing deck was originally constructed with some inadequate footings,new footings comply with NYSBuilding Code Policy S. 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 x Discussion (if appropriate): _ Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III- Policies;Pages 22 through 32 for evaluation criteria. Yes ❑ No ❑ Not Applicable x Discussion(if appropriate): existing deck is @75' from Mean High Water,the existing bank is not a percipitdus slope and the bank is protected by both a line of bolders and a wood retaining wall. 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 x Discussion (if appropriate): _ Town of Southold LWRP Consistency Assessment Form 3 l� 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. Yes ❑ No ❑ Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters,public lands, and public resources of the Town of Southold. See LWRP Section III-Policies,Pages 38 through 46 for evaluation criteria. Yes ❑ No ❑ Not Applicable x Discussion(if appropriate): _ 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 ❑ Discussion(if appropriate):_ 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 ❑ Discussion(if appropriate): 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 ❑ Discussion(if appropriate): _ Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III-Policies,Pages 65 through 68 for evaluation criteria. Yes ❑ No ❑ Not Applicable ❑ Discussion(if appropriate): _ Town of Southold LWRP Consistency Assessment Form 4 617.20 Appendix B Short Environmental Assessment Form Instructions for ComnletinE 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 l 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 Name of Action or Project: Project Location(describe,and attach a location map): &,,/, Brief Description of Proposed Action: Name of Applicant or Sponsor: �-7 Telephone: V f�G IN , -�(�(/Z�(• (//zS E-Mail: ODi`P 00/1°C1 S f v' Address: (� � OD f"P 5-102,0 /�i(Gt//�1��`�/� City/PO: State: Zip Code: 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: 3.a.Total acreage of the site of the proposed action? 5 acres b.Total acreage to be physically disturbed? f2 acres c.Total acreage(project site and any contiguous properties)owned r or controlled by the applicant or project sponsor? 'Y acres 4. Check all land uses th occur on,adjoining and near the proposed action. ❑Urban ural (non-agriculture) ❑Industrial ❑Commercial ❑Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Pagel 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 located 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 will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? A// NO YES If No,describe method for providing potable water: AIIA 11.Will the proposed action connect to existing wastewater utilities? F NO YES / If No,describe method for providing wastewater treatment: A 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 insquare feet or acres: AIV R 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: E Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, I / a.Will storm water discharges flow to adjacent properties? — O❑YES b.Will storm water discharges be directed to established conveyance systems(runof f4ffid storm drains)? If Yes,briefly describe: M N'O❑YES Page 2 of 4 f 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: 19.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 INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE /y Applicant/sponsor name: 17etcLA Date: Signature:pf - Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all 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 impact impact may may occur occur 1. Will the 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 land? 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? 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 problems? 11. Will the proposed action create a hazard to environmental 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 will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient 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 will not be significant.Each potential 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. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may 'result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Date Print or Type Name of Responsible Officer 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