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10/1/2017 Application
FIRST UNIVERSALIST CHURCH 51970 Main Road Southold, New York '� •� mashal) aetzel S LANDSCAPE ARCHITECTURE NORTH FORK HAMPTONS 5175 Route 48 PO Box 1397 Ups I / Mattituck,NY 11952 530 Montauk Hwy,#203 ` Amagansett,NY 11930 O � phone: (631)209-2410 fax: (631)315-5000 P y email: mail@mplastudio.com ARCHITECT: Peter Marren Architect �G Marren and Newman Architects 1� 177 Duane Street New York, NY 10013 EXISTING STOOP+ `�� WALKWAY % Office: (917) 992-5369 SURVEYOR: uP'a' \\\ \`\ Kenneth M Woychuk Land Surveying, P.C. \ EXISTING P.O. Box 153 EXISTING --�\ \\ PARSONAGE Aquebogue, NY 11931 WALKWAY \ ` Office: (631) 298-1588 TO BE REMOVED / `\ \ LAND N/F CLEMENT CHARNRNEWS 0, \ \ EXISTING lb CONCRETE CURB ti EXISTING ?�� PROPOSED CONCRETE 6 O / /Z GAR�N SPACE SIDEWALK G \� OLD CHURCH h f BUILDING `Up ?� \\ `\ `\ PROPOSED PROP 0, \— / \\ \ WALKWAY�� n I CA6, o \\ \\ �\ �' EXISTING SHEDS SITE DATA: TO BE REMOVED • `\ ��� SCTM#: 1000- 63-6-6.186.2 `�\ a Lot Area: 53,972.09 SF ( or 1.24 acres) PROPOSED \ • . . / / PROPOSED \ PROPOSED $bo�.2Qr ' CHURCH SANCTUARY PARISH HALL PARSONAGE PARKING I EXISTING SIGN ' TO BE RELOCATED �v Q I NOTES: \ / EXISTING 1. Base map information based on survey PROPOSED GATE COURTYARD ���' \\ prepared by Kenneth M Woychuk on 33' `� \ I June 15, 2016. \ PROPOSED CHURCH 2. This drawing is for the purpose of C9 obtaining permits only. NOT FOR UP LO 20 _ CONSTRUCTION. -- PROPOSED WALKWAY \\ �/ 3. Unauthorized alteration of this plan is a N PROPOSED _ \ // // EXISTING SHED violation of NYS Education Law. WALKWAY \ 76' -0"5,0, o / � I r / i/ �l I REVISIONS .0' 3 I DATE DESCRIPTION N RELOCATED SIGN l(2r8'X 20'HANDICAP j!/ /Jl LAND N/F OF a 1 PARKING SPACES 4< /! I SOUTHOLD UNION FREE EXISTING CURB CUT PROPOSED c LU WITH 8'X 20'AISLE ! I SCHOOL DISTRICT }.. z LOCATION TO REMAIN PARKING AREA r Q (ON CONCRETE SLAB) EDGE OF EXISTING — Z PARKING AREA __ EXISTING FENCE TO BE REMOVED 24.0 0 I I s e a / -- ----------- I PROPOSED PROPOSED PARKING PARKING I OQ EXISTING 1 U 15 RESIDENCE I r— - �/ AISLE — _—__— —_ AISLE — I Z I _ � OCT 122017 iu PRODOSED Southold Town Q S 1 PROPOSED 1 PARKING I w Planning Board TITLE: c Z �_ RAIN GARDEN UP� / 02 PARKING CALCULATIONS: L 10.4' I EXISTING 6-0"H. CHURCH: CHAINLINK FENCE 112 SEATS @ 1 SPACE/4 SEATS 247.04' —x—EXISTING 4'-0"H. TOTAL:28 PARKING SPACES+2 STAFF PARKING SPACES PRELIMINARY CHAINLINK FENCE TENANT PARKING: SITE PLAN LAND N/F OF 2SINGLE-FAMILY HOMES C 2 SPACES/SINGLE-FAMILY HOME 51750 ROUTE 25 LLC TOTAL:4 PARKING SPACES TOTAL SPACES PROVIDED=34 SPACES (INCLUDES 2 HANDICAP SPACES) LEGEND 0 10 20 — — PROPERTY LINE H=r==� Scale 1"=20'—O" _______ EXISTING IMPROVEMENT TO BE REMOVED DRAWN BY: S.PRETZEL,RLA DATE:2017.06.05 S P 1 EXISTING FENCE REVISED: TO BE REMOVED SHEET 1 Or S.C.T.M.# DISTRICT 1000 SECTION 63 BLOCK 6 LOT 6. 1 & 6.2 MAIN ROAD -- NYS RT.25 CONC. CURB U.P. Rv'P' N69032'40"E 85.60' v ° 64 a ' CONC. SIDEWALK •• v MON. 482.44' GG ti�1 ' o U.P. ° d v ►� ,16.0 PORCH D vd STY . :::::.:...., DWEWNGtp ?i�:ii`:•:::: BILCO .y :co•::;::•:;::•: 51970 �::::;�N. . O SIGN 4 YJ (� , .::;.17..7'.....::::;.:::::::::1.::;1.... rn;;:•:::•:.orn ::" :�+ ROOF OVER � R.l WOOD pyoP�' DECK CO LAJ GO U7 O MON 04 d v Z LLd Z ° :::::10.1:•`::: W LL (� a 4 HE CN: c d .:•;:•::o•: o Ld 5.3 �S a t1 a C pgR�riNO 4 DE P. a 99 d. d q,Q� a 4 Liad . a 5.8' © d 4 a a ' MON. v . •d a a ' Ara&07, d O 6,44, v MON. da O d a d n� g. ;•:.O :: t :: �4�v OgrFcyq,NC�Nk �� v G ,Y LAND N/F LAND F N/F OF 51750 ROUTE 25 LLC g-c�,� SOUTHOLD UNION FREE SCHOOL DISTRICT 5 A, ti c��tiF g o� do OCT 12 2U11 Southold Town Planning Board 0.6'E 7N£ WATER SUPPLY, WELLS, ORYWELLS AND CESSPOOL LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. AREA: 53,9 72.09 SQ.FT. or 1.24 SQ.FT. ELEVARON DATUM: UNAUTHORIZED ALTERATION OR ADD17YON TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 7711E COMPANY, GOVERNMENTAL AGENCY AND LENDING INS777U77ON LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INS7ITU770N, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE S7RUCTURES ARE FOR A SPECIF7C PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES, ADD177ONAL S7RUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO: FIRST UNIVERSALIST CHURCH; MAP OF: FILED: SITUATED AT: SOUTHOLD TowN oF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design P.O. Boz 153 Aquebogue, New York 11931 FILE P 16-78 SCALE. 1 "=20' DATE:JUNE 15, 2016 FRWJ (631)Z98-1688 TAX (631) 298-1680 N.Y.S. LISC. NO. 050882 maintaining the rsoords of Robert J. Hennessy & Yenneth Y. lroychuk i , William D. Moore Attorney at Law 51020 Main Road Southold,New York 11971 � Tel: 631-765-4663 Fax: 631-765-4643 May 1, 2018 BY HAND Southold Town Planning Board Attn: Brian Cummings Southold Town Hall Annex Main Road Southold,NY 11971 Re: First Universalist Church SCTM 1000-63-6-6.1 and 6.2 Site Plan Dear Brian: On behalf of the First Universalist Church enclosed are the following documents: Notice of Disapproval dated September 8, 2017 Site Plan Application Form 0 Applicant's Affidavit Agent Authorization LWRP Consistency Assessment Form 0 Short Form Environmental Assessment Survey Print of existing conditions (Planning file should now have at least 4 survey prints in file) • Nine (9)prints full size of proposed site plan last revised Nov. 6, 2017 (a pdf copy of same is being emailed to you at the designated email address) This site plan includes the following information items requested in your letter dated November 13, 2017 (received April 27, 2018): 0 (b) Parking calculations 0 (c) Parking stall dimensions • (d) Aisle width dimensions (e) Surface types of walkways etc. We ask that information with respect to the following items be deferred until the applicant and their design professionals have received an initial response and feedback on the proposed layout from the Planning Board., Once the layout has been conceptually agreed upon, we shall have the following information provided: storm water run-off and drainage calculations (item (a)), landscaping plan with details (item (f)), erosion and sediment controls (item g), dumper location (item h), signage (item i) and road access /apron details (item j) and "Photometric Plan" (item 5). • Proposed floor plan and elevations for proposed building dated November 21, 2017 (a pdf copy of same is being emailed to you at the designated email address) and photographs of existing buildings This project must be given the planning board's highest priority and attention. We request an opportunity for our design team (Peter Marren ,Stacy Paetzel) to meet with you and me immediately. The time lost since October has severely delayed forward progress on this important project. Cie xUly irs, at L. core WDM/mr cc: First Universalist Church Peter Marren, AIA Stacy Paetzel, Landscape Architect William D. Moore Attorney at Law 51020 Main Road Southold,New York 11971 Tel:631-765-4663 Fax:631-765-4643 isoV�,�r�i ..., April 10, 2018 Southold Town Planning Board Southold Town Hall Annex Main Road P.O. Box 1179 Southold,NY 11971 Re: First Universalist Church SCTM 1000-63-6-6.1 and 6.2 Dear Chairman Wilcenski and Members of the Board: Please confirm that the site plan application of the church is under the Board's active review. The site plan was submitted in October 2017 and we have received no written feedback since the submission was made. The design professionals working for the church cannot proceed without the Board's input. The church is eager to get immediate response from the Planning Board and staff on this preliminary site plan so that it may get the town review back on track. We look forward to your prompt attention to this matter. Thank you. Ve truly you, , u� onre WDM/mr cc: First Universalist Church Peter Marren,AIA Stacy Paetzel, Landscape Architect Sub- "P(3r William D. Moore ref' ° k' 611 0i., � Attorney at Law 51020 Main Roads i Southold,New York 11971 Tel: 631-765-4663 Fax: 631-765-4643 March 26, 2018 BY HAND Southold Town Planning Board Attn: Brian Cummings Southold Town Hall Annex Main Road Southold, NY 11971 Re: First Universalist Church SCTM 1000-63-6-6.1 and 6.2 Dear Brian: Enclosed please find a duplicate copy of the submission for site plan approval filed in the Planning Board office on October 12, 2017. The church is eager to get immediate response from the Planning Board and staff on this preliminary site plan so that it may get the town review back on track. We look forward to your prompt attention to this matter. Thank you. V-t` truly yout°s, d W pane . Moore WDM/mr cc: First Universalist Church Peter Marren, AIA Stacy Paetzel, Landscape Architect William D. Moore Attorney at Law MI 51020 Main Road Southold,New York 11971 Tel:631-765-4663Fax:631-765-4643 October 12, 2017 BY HAND Southold Town Planning Board Southold Town Hall Annex Main Road Southold,NY11971 Re: First Universalist Church SCTM 1000-63-6.-6.1 and 6.2 Dear Members of the Board: Enclosed please find one set of the following with respect to the above referenced property: • Site Plan Application Form • Check for filing fee • Notice of Disapproval • Applicant's Affidavit • Agent Authorization Letter • LWRP Consistency Assessment Form • EAF • Property Survey(1 print) • Preliminary site plan (4 prints) Please note that the tax map numbers assigned to this property do not reference two separate properties. The second tax map number was assigned to the existing single family dwelling on the property by the Town Assessors reflecting the taxable status of that structure on the church property. They are not two separate parcels of property. The Notice of Disapproval notes that a special exception approval from the Southold Town Zoning Board is required. That application has been submitted to them contemporaneously with this application.\ The church's Board of Trustees and the professionals retained to assist them in the reconstruction of a house of worship on this site look forward to working with the Board during this review process. William A Moore Attorney at Law Re: First Universalist Church October 12,2017 Very truly yours, William D. Moore WDM/mr cc: First Universalist Church Peter Marren,Architect Stacey Paetzel, Landscape Architecture SOU'THOLD PLANNING BOARD SITE PLAN APPLICATION FORM Site Plan Name and Location Site Plan Name: S i V 1 (CgS L e application Date: 10 Suffolk County Tax Map#1000-�- L - Other SCTM# Street Address: R A I, 12Z Hamlet: Distance to nearest intersection: Type of Site Plan: VNew Amended_Residential Zoning District Owners/Agent Contact Information Please list name �atailrrr trdda ss� ajtd �h ��number t��r the ��0 1 below: Property Owner F1�s i �� �'R�4L Street V City %vT1410 Ln State tAt. Zip l ( c) 7l Home Telephone 1 Other Applicant Street City State Zip �._HomeT lephone Other Applicant's Agent or Representative: Contact Person(s)* W Lt-I 64'` Street 9 � �ZO MA, i o City o -State l� `? dip S 7 1 Office Telephone L3 - "(,S 1(�e Other ^ 'w aj 00R1� We 6 'T . *Unless otherwise requested, correspondence will be sent only to the contact person noted here. Slle PlanAppllca/lon Form 211812010 Sitio Data ( Proposed construction type: X_New Modification of Existing Structure Agricultural Change of use Property total acreage or square footage: ac,/sq. fl. Site Plan build-out acreage or square footage: ac,lq. ft. Is there an existing or proposed Sale of Development Rights on the property? Yes No If yes, explain: Does the parcel(s) meet the Lot Recognition standard in Town Code§280-9 Lot Recognition? Yk_N_ If"yes", explain(and attach any necessary documentation—title report, subdivision approval, etc.) Building Department Notice of Disapproval Date: —7—/ il l Is an application to the Southold Town Zoning Board of Appeals required? Yes /< No If yes, have you submitted an application to the ZBA? Yes ><' No If yes, attach a copy of the application packet. Show all uses proposed and existing. Indicate which building will have which use. If more then one use is proposed per building, indicate square footage of floor area per use. List all existing property uses:v 1e-1 SH 1•NN Se _Kluec fAi#1 IWa G List all proposed property uses: S ?4 N 46 A'W V) WE W01?K46r Other accessory uses: Existing lot coverage: % Proposed lot coverage: Gross floor area of existing structure(s): sq. ft. Gross floor area of proposed structure(s): Parking Space Data: #of existing spaces: #of proposed spaces: Loading Berth: Yes No Landscaping Details: Existing landscape coverage: % Proposed landscape coverage: % • property __ Maybe Wetlands: Is thiswithin 500 of a wetland area? Yes No I, the undersigned, certify that all the above information is true. Signature of Preparers �� Date: ✓ 2 Site Plan Application Form 211812010 FORM NO. 3 TOWN OF SOUI HOLD BUILDING DEPARTMENT SOUL HOLD. N.Y. NO7'ICL:OF DISAPPROVAL DATE:September S,2017 TO: William Moore(First Universalist Church) 51020 Main Road Southold,NY 11971 Please take notice that your application dated June 6,2017: For permit to construct a ncww church udI ina Qpr�-existiam�sin�_fattmil�d wellimm�amid�sarislm lmnmtse_t_o remain at: Location of property: 51970 Ronne 25,Sr?uthu_ ld,,Tom' County Tax Map No. 1000—Section 63 Block 6 Lot 6_1 Is returned herewith and disapproved on the following grounds: The proposed church on this 52 272 stl fl. lot in the Residential Office crane rr -lire"S cial Exception tprrnya)froom-the Zot ill(if A Jaeas,res per Ira ,ter 20 3 f3 1. In addition time rn need mmse nC rmires site mlan a rt'awmml frcmrrm time Soutlmnld'Ta-vr-fltmrmmmimt IJoamd. ustly,the prpposed construction is n.ot :mnittel Landmarks Preservation Cotmmnmissionb,ecamu�-lmoguqt revs iemsv eadtmdna rocve- the SnutlTmold Tomvtm York State and/or the National Re misters of Historic )laces and WOW--reviesw"i the Southold Town Landmarks Preservation Comnmmmiss.-i-0 . l ftl'me requirements of the tom-mmm coda ertaim to Landtmmarks Local I aw No.22 are tmtet Rin.Certificate rrG Afrprnpm iateness C of A -will ima.1S'5u d. "1"itc C of A is.re aired befo e a Bulldin,,Permit willbe a a ved. Infdrtrratio about tlme rcr mmir nm nt )rj1pplyimfor of ofA is available at tile information counter in the Bttilditu*De t-'It�t rent. You may now apply to these agencies directly. Authorkdignatuce Note to Applicant:Any change or deviation to the above referenced application, may require further review by the Southold Town Building Department. CC:file,Planning Board,/_BA, Landmarks APPLICANT'S AFFIDAVIT APPLICANT'S AFFIDAVIT STATE OF NEW YORK COUNTY OF SUFFOLK ulSN0v*-�ez, being duly sworn, deposes and says that he resides at `t o in the State of New York, and that he is the owner of property located at JA %-I Z-0 , S CTM# �000—4 —4 4•/ AkA' r that he is the !� of the r• R S. r V Nl VCV C l r C �-�-✓� m (Title) (Specify whether Partnership or Corp.) and said Corporation is the owner of the above property, which is hereby making a Site Plan application; that there are not existing structures or improvements on the land which are not shown on the Site Plan;that the title to the entire parcel, including all rights-of-way,has been clearly established and is shown on said Plan; that no part of the Plan infringes upon any duly filed plan which has not been abandoned both as to lots and as to roads;that he has examined all rules and regulations adopted by the Planning Board for the filing of Site Plans and will comply with same; that the plans submitted, as approved, will not be alter or changed in any manner without the approval of the Plarming Board; and that the actual physical improvements will be installed in strict accordance with the plan as approved by the Planning Board. Signed Owner Signed S(A S,i44 q ,, 10 V g 6 w (Partner or Corporate Officer a rd Title) Sworn to me this rday o _�, otary Public A.PERKINS Notary Public„State of New York No.of PE6130636 Qua rted in Suffolk Cou Commission Expires July 16 r AGENT AUTHORIZATION I Susan Young,President of the Board of Trustees of the First Universalist Church, the owner of property located a SI q1 D Main Road,Southold, NY identified as SCTM 1000-63-6-6.1 and 6.2 hereby authorize William D. Moore, Esq.to act as our agent and handle all necessary work involved with the applications to the Southold Town Zoning Board of Appeals(special exception and variances if necessary)and Southold Town Planning Board for site plan approval. First Universalist Church By: Susan Young, President Board of Trustees Sworn to before me the b7day of October,2017 BETSY A.PERKINS . Notal No.011i'IE61SBS�r�"�ork (juelified in Suffolk COun Cornrnission Expires JULY" Town of Southold LWRP COl' SISTE,NCY 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, . 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# (t, V(cl The Application has been submitted to eck appropriate response): Town Board Planning Dept.� Building Dept. P Board of Trustees 0 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: Nature and extent of action: Location of action: M Site acreage: Present land use: ' i�l d v✓d �1�'� rGII; °ragesCr W-<' Present zoningclassification:—R, cl'� (l M 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: 1 ! ar (b) Mailing address:--& 02 2 (c) Telephone number:Area Code( (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes 11 NoFP If yes,which state or federal agency?' DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure,makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies;Page 2 for evaluation criteria. Yes [] No [] Not Applicable '"�:°� ...._0 N mwr� 6 . `��� ��vt .. , 1 Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria (� Yes 0 No ❑ Not Applicable 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 0 No Q Not Applicable to t Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes D No Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria Yes D No tBNot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes Q No Not Applicable 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. 0 Yes M NoW Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. 0 Yes ❑ No PgNot 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. nn 0 YeD No rffNot Applicable 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. Q Yes ❑ NoW Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No Not Applicable 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 ❑ Jff Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LVW Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑Yes ❑ No, Not Applicable Created on 512510511:20 AM 617 20 Appendix B Short Environmental Assessment Form Instructions for Cowlefin 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 I 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: Vd, C7 14 C"/;? Project Location(describe,and attach a location map): Brief Description of Proposed Action: A/Y Tri. Ct c- Name of Applicant or Sponsor: Telephone: S/ S-- 3 rfrevl- vrl( vc_-X&Atc4-r C[_J-Wv C,(,f E-Mail: 5 q CC Cp Address:. a V-FV Al C r#Wz City/Po: State: Zip Code: . 0 9 V ...... ... 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? YES Ao" If Yes,list agency(s)name and permit or approval: -5;:o oiyoL-fift_iq110�I IV6 e- -'5z V I-f. 'rr 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. 11 Urban 13 Rural(non-agriculture) 11 Industrial 0 Commercial Ve,sidential(suburban) 11 Forest E3 Agriculture 11 Aquatic k-'-'ther(SpceifY).—e-Y llz- 13 Parkland Page 1 of 4 I ` 5. Is the proposed action, NO YES a 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? 10 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: t^ 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? NO YES If No,describe method for providing potable water: �p 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: D 1J 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? �o 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: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑ Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban Wuburban 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? �a 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, a.Will storm water discharges flow to adjacent properties? )KNO❑YES b.'W ll storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes„briefly describe: 110❑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: 19.Has the site of the proposed action or an adjoining property been the location of an active or closed N0 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 Applicant/sponsor name: � P 1� Y A/& ✓��l'( �,K�- <<� � f/��Rate: Signature: 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 reasonabl available ener y conservation or renewable energy opportunitics? y 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 ritay 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. 0 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. 13 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 S.C.T.M.# DISTRICT 1000 SECTION 63, BLOCK 6 LOT 6.1 & 6.2 MAIN ROAD — NYS RT.25 COAG.CURB N60'02'40. 116.CRDr a ww9rta. 402.44' r ' xv,a i` r m � /y1970 CMT '" 14.0' A. r W a x.ati y �b �x b .a 4 a. eA a o d D D e m ak LAND N/F LANOFN/F 51750 ROUTE 25 LLC r SOUTHOLD UNION FREE SCHOOL DISTRICT 5 'AAW4dB"S� m»x aM'rax .r,mlx.tx plmrmtxts er+D \aIV paaSW Wro IXI Owaswrnor's rt eoL S0,11T2.00 50,ft or 1.21 SOFt nrveBaa an.e aawwrauMxxD M xoa.tmae am uKwra n7 aMa'mrrw^ap a asa.tita'a't Or srrAav rtae mr'mw'ora rtorcr armxr rr . teas xq+eCa M m,rm xwaaar an* rt m a cxac x reB ceamxwmr rue mrear oe na arm a rmur aa•r tmaAamBxm as e f at muw tr+r x0 o�e1Tk M+GM mac meaxrr M AMCIrMeci MuuMav Mf mF0e /0 BM Dvucpwraaww,soetM. 'xet�Ra%m1:r AW WOWRaxm�aner 0 r anmB x4arOaC+t+m ro mac.baeurra dr Brt tOararwr rammm+rxrnt rta apC aalf amarB^Vn ontl,urrmn am an�wr,lemer«r emu nrrr�rrrr waeeg uo rorr r�aurca�rcwr a rr+rtrw.'ew�aar�rrac rn»+�r atiT�w m urTwrarar Bd A, xnrr uwcA+w�a�cx ner raaxemmv mr,rxarrsm,waarrxwrMaam.�rr� amaa, �. aeon AFD,M"AMrdw"smucAm ptemID OR IArOICOeAfD AaC MTI"9xa tmr�<rQ tmtCm9 MMSM+UC.Crmaorr am'#Nd' a+4r orm'mmx W'aLMMf >xr'as DESCRIBED PROPERTY CER71nED TO ERST YN OF. FLO OIDAwo mw SOUTHOLD - Tom or,SOUTHOLD MWIPM9 CDUNTt 019W NOAA. � pd.0W, A amarNo7 Aft AN AqUdWM.Manm Yah 1112 E1D7i rma<110-70 wx G I'�20' "m dUNE 15,201 MmaMn1 DmnNA1tpAa 1awu1�a-1w !A K7 1P,pC.ASA.IVG�DAa7 awMww a.�a,r aw.a A a..rm a w r wr++ 1 FORM NO. 3 Y TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD,N.Y. NOTICE OF DISAPPROVAL DATE: September 8,2017 TO: William Moore(First Universalist Church) 51020 Main Road Southold,NY 11971 Please take notice that your application dated June 6,2017: For permit to construct a now church,building l2te_cxisting sina~leµfini ly dwc!ji r&frnj parish house to remain at: mm Location of property: S 1970.Routg 25. Southold NY County Tax Map No. 1000—Section 63 Block 6 Lot 6_1 Is returned herewith and disapproved on the following grounds: It „1 Ical?o ecl claaarela oil this 72 sq II 1tg in the Residential Office Zong requires Special Fxception oaf llt vailmml om tile Ja r�tj-jg Board raf"Ap lis.g5_per pter?80-38 1�,1m In addition, ihlapcaT Lq� ] us�'cquiress,_site plan aDDroyal l�°t M the Soutl1old"T'own 1'''lannino 1Joard. 1 rstly, the prc:apsed cWa(a�lstruction is alit acrmitted without review and aj2proval by the Sout;h,cf d 10 wn, 1 aarrcftnat ks Pr ;Sc p v rlion Cogram'ssAost., accause the lir �gpgrjy is listed on either the Sout}tou" own..New York State andlal_i]tctIsatiaar7al 1aLlola eat I Iistoaic placesLandrea a"rrr s review by the Saautlitall 1�,avaa Landmarks Preservation Coni-mission. I I'Nhe regpjrenienls of the t(,',)wn.codc_ a] "`I"tair� tg tea mlIT i�dm t ks(Local Law No 22:)err!Z jjj7Zt a t_.erd icaw o;l" f�pr_caJrN iamta e s( of"AA1 will be issued, The C—yl.. is required bel"nac a ITttaltltr 11:�tattit..............................J1 b tl �r1 ovecl,,. Inlor°uawa0wn about the rer uT aregjg!tts fo n�al in Y fora C of A is available at the inro sn ation counter in the BuildiN gDe' rriment. ,. You may now apply to these agencies directly. A)�r Awl ' nm Lze",'�Aanhgnaatur°e Note to Applicant: Any change or deviation to the above referenced application, may require further review by the Southold Town Building Department. CC: file, Planning Board, ZBA, Landmarks BOARD MEMBERS Q SDUT Southold Town Hall Leslie Kanes Weisman,Chairperson yQ 53095 Main Road•P.O.Box 1179 ti0 1D Southold,NY 11971-0959 Patricia Acamporatt Office Location: Eric Dantes ces Town Annex/First Floor,Capital One Bank Gerard P.Goehringer � �, 54375 Main Road(at Youngs Avenue) Nicholas Planamento Gaur N Southold,NY 11971 http://southoldtownny.gov ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel.(631)765-1809•Fax (631)765-9064 MEMO H EC � � TO: Planning Board OCT 24 2017 Southold Town FROM: Leslie K. Weisman, ZBA Chairperson PIRnniigBoard DATE: October 24, 2017 SUBJECT: Request for Comments ZBA #7123SE — First Universalist Church The ZBA is reviewing the following application, and enclosed copies of, ZBA application, and latest map. The Planning Board may be involved under the site plan review steps under Chapter 280 (Zoning), and your review and comments are requested at this time. The file is available for review of additional documentation at your convenience for reference if needed. NAME TAX# ZBA HEARING VARIANCE PLANS PREPARER & DATE DATE ZONE STAMPED FIRST 63.-6- #7123SE TO BE 280-38(B)1 10/23/17 Marshall UNIVERSALIST 6.18 DETERMINED Paetzel CHURCH 6.2 AFTER RO SEQRA Zone REVIEW Your comments are appreciated by one week prior to above hearing date. Thank you. Encls. FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD,N.Y. NOTICE OF DISAPPROVAL DATE: September 8,2017 TO: William Moore(First Universalist Church) 51020 Main Road Southold,NY 11971 Please take notice that your application dated June 6,2017: For permit to construct a new U11ill•ch biliIdin-(pre-exiSlim"sinple-rail]ily dwelling aatd parish house to remain at: Location of property: 51970 ROLIte 25, Southold,NY County Tax Map No. 1000—Section 63 Block 6 Lot 6_1 Is returned herewith and disapproved on the following grounds: The nronused church,on lids 52,272 sc. 11. lot in the Itesidentia1(]Mice xonc.requires Stlecial Exception approval from the Zoning,Board or Appeals,as per Cha ler 380-3861)1. In addilion the proposed use requires site plan:approval liDni the Southold Town Planning Board. I.:istly.the -1100011 is WE permitted without review and a>>rovul by the Southold Town Landmarks Preservation Commission,_because the proverly is listed on eitlte;r the S_oulhold TownNew York Strtic and/or the Nat ionaI Re,-,isters of Historic daces and reg wires review by/lie Southold Town Landmarks Preservation Commission. If the requirements of the town code,pertaining to Landmarks(Local Law No.22)are incl,_ss_Certilicale of Appropriateness(C of A)will be issued. The C of A is required before a Building Pe_r_mil will he ttp irsl _tve�l, Information about the requirements for applying for a C of A is available at the information counter in the 3u lding Department. You may now apply to these agencies directly. Auliiori '1 ignaturc Note to Applicant:Any change or deviation to the above referenced application, may require further review by the Southold Town Building Department. CC: file, Planning Board,ZBA, Landmarks ZONING BOARD OF APPEALS TOWN OF SOUTHOLD,NEW YORK Phone(631)765-1809 (631)765-9064 APPLICATION FOR SPECIAL EXCEPTION Application No. Date Filed: TO THE ZONING BOARD OF APPEALS, SOUTHOLD,NEW YORK: Applicant(s), F C/-/V9of Parcel Location: House No. Street Hamlet S 0 VON" Contact phone numbers: 1, 3 Z 4 Sr— 3 +iI 9 3/, _7G S__ 4-16 (, 3 SCTM 1000 Section Block Lot(s) r f G.Sot SizeW1 Zone District hereby apply to THE ZONING BOARD OF APPEALS for a SPECIAL EXCEPTION in accordance with the ZONING ORDINANCE,ARTICLE ,SECTION ,SUBSECTION for the following uses and purposes: as shown on the attached survey/site plan drawn to scale.Site Plan review[ ]IS or[ ]IS NOT required. A. Statement of Ownership and Interest: �`1 l� i U�►r d�—r C ` C H U&C Elis(are)the owner(s)of property known and referred to as i't s RQA--b 'C O J-77410tr'� (House No.,Street,Hamlet) // identi i d on the Suffolk County Tax Maps as District 1000,Section ,Block Le Lot 1 I r - Y,and shown on the attached deed. Q Thd above-described property was acquired by the owner on S 9 1 B. The applicant alleges that the approval of this exception would be in harmony with the intent and purpose of said zoning ordinance and that the proposed use conforms to the standards prescribed therefore in said ordinance and would not be detrimental to property or persons in the neighborhood for the following reasons: C. The property which is subject of this application is zoned )PO and[ is consistent with the use(s)described in the CO(attach copy),or [ ]is not consistent with the CO being furnished herewith for the following reason(s): [ ]is vacant land. COUNTY OF SUFFOLK) ss.: STATE OF NEW YORK (Signature) Sworn to before me this day of ,201'1 , . otary P c BETSY A.PERKINS Notary Public,State of New York No.of PE61 30636 (luaiffited in SuffolkJuly�i8�l Commission EXP MZONING BOARD OF APPEALS TOWN OF SOUTHOLD,NEW YORK Phone(631)765-1809 (631)765-9064 APPLICATION FOR SPECIAL EXCEPTION Application No. Date Filed: Page 2 General Standards,please answer the following as it pertains to your project: A. The use will not prevent the orderly and reasonable use of adjacent properties or of properties in adjacent use districts BECAUSE: The project consists of the rebuilding of a house of worship and fellowship hall to replace the structures lost to fire in 2015 which had stood on the premises for more than 100 years. The project seeks to restore the site to its longstanding use. B. The use will not prevent the orderly and reasonable use of permitted or legally established uses in the district wherein the requested use is located or of permitted or legally established uses in adjacent use districts BECAUSE: The properties in the immediate vicinity are already improved with residences,the VFW Post, existing Catholic church and school district property with educational buildings and ancillary athletic fields. Upon completion of the project,the historic church use of the property will be restored. C. The safety,the health,the welfare,the comfort or the order of the town will not be adversely affected by the proposed use and its location BECAUSE: The project is subject to site plan review and approval of the Planning Board to assure that safety and welfare of users of the property and the community are protected as the use is restored at its historic location. D. The use will be in harmony with and promote the general purposes and intent of Chapter 280-142 BECAUSE the use will be compatible with its surroundings and with the character of the neighborhood and of the community in general, particularly with regard to visibility, scale and overall appearance. The house of worship has been located at this site providing a gateway to the hamlet of Southold known for its architectural style and complementary community use of one of the Town's main byways. E. The use will be compatible with its surroundings and with the character of the neighborhood and of the community in general, particularly with regard to visibility, scale and overall appearance BECAUSE the owner/ applicant has retained the services of professional architects and registered landscape architects to design the church in a manner suited to the site, and honoring the history and tradition of the structures it is replacing in its architectural style to the greatest extent reasonably possible. F. All proposed structures, equipment, and material shall be readily accessible for fire and police protection BECAUSE: The design professionals working on behalf of the owner/ applicant shall work with Town Planning Department to insure that site plan elements are designed in a manner to maximize public safety access and protection. G. The proposal shall comply with the requirements of Chapter 236, Stormwater Management BECAUSE: The project will be designed in such a manner, and with such improvements including on-site collection of stormwater that are compliant with all applicable provisions of the Town Code. 617.20 Appendix B Short Environmental Assessment Form Instructions for Com letin 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 1 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: fl R N r VA/I ✓0A-S4 C d/2 C Project Location(describe,and attach a location map): #J f"4,1/ S C '( Brief Description of Proposed Action: Name of Applicant or Sponsor: Telephone: �", S/— 7L S — 3 LW l'f l2 i t'- ywt ✓L�' S., C.S� C f-fy� C/� E-Mail: d Y fv�-� it[ Address:. 0 P-i-V Al L A"& ` City/PO: State: Zip Code: I 'r V //9-7( 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 th proposed action? acres b.Total acreage to be physically disturbed? .' - acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? O acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban Q Rural(non-agriculture) ❑Industrial ❑Commercial Oesidential(suburban) ❑Forest ❑Agriculture ❑Aquatic �ather(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. 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? NO YES If No,describe method for providing potable water: 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: D Tv yO 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? t?p b.Is the proposed action located in an archeological sensitive area? >10 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: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑ Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban Wuburban 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? �0 16.Is the project site located in the 100 year flood plain? NO YES N7 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? )NO ❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: , DNO❑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: 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 Applicant/sponsor name: e` sr V NI. ✓e�t � - �� e'Wlfe- Date: Signature: 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. C) 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 QUESTIONNAIRE SPECIAL EXCEPTION FOR FILING WITH YOUR ZBA APPLICATION 1. Has a determination been made regarding Site Plan review?XYes No If no,please inquiry with the ZBA office and if site plan is required,you may apply to the Planning Dept. at the same time so both applications can be reviewed concurrently. 2. Are there any proposals to change or alter land contours? a. >5:::) No Yes please explain on attached sheet. 3. Are there areas that contain sand or wetland grasses? N 0 a. 2.)Are those areas shown on the survey submitted with this application? b. 3.)Is the property bulk headed between the wetlands area and the upland building area? c. 4.)If your property contains wetlands or pond areas,have you contacted the Office of the Town trustees for its determination of jurisdiction? Please confirm status of your inquiry or application with the trustees: and if issued,please attach copies of permit with conditions and approved survey. 4. Is there a depression or sloping elevation near the area of proposed construction at or below five feet above mean sea level? 110 5. Are there any patios,concrete barriers,bulkheads or fences that exist that are not shown on the survey that you are submitting?J__Please show area of the structures on a diagram if any exist or state none on the above line. ,�,JJ 6. Do you have any construction taking place at this time concerning your premises? (g0 If yes,please submit a copy of your building permit and survey as approved by the Building Department and please describe: 7. 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 obtain copies of them. 8. Do you or any co-owner also own other land adjoining or close to this parcel? If yes,please label the proximity of your lands on your survey. 9. Please list present use or operations conducted at this parcel AW-t-, Sk/ ,tot-S'6 'A'11? 5,?cJb G �r77e E-y I('0::S. and the proposed use S q i,I //WW tJ'- 0'-- ale SH7 fI C- . (ex:existing single family,proposed:same with garage,pool or otHer or vacant proposed office with apartments above,etc.) Authorized signature and f5ate Form No.6 s TOWN OF SOUTHOLD BUILDING DEPARTMENT I TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines,streets,and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I%lead. 5. Commercial building,industrial building,multiple residences and similar buildings and installations,a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and"pre-existing"land uses: 1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 Date. c�, 1 New Construction: Old or Pre-existing Building: (check one) Location of Property: 6�71 ID I?y J-r& Z 4--- o V House No. Street Hamlet Owner or Owners of Property: C�-R 5 Suffolk County Tax Map No 1000,Section Block 'r. Lot 7 � • v Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: / Request for: Temporary Certificate Final Certificate: ✓ (check one) Fee Submitted: $ Applicant Signatur CONSENT TO INSPECTION Chf YR , the undersigned,do(es)hereby state: Owner(s)Name(s) That the undersigned(is) (are)the owner(s) of the premises in the Town of Southold, located at 1�-! q,"7 0 9 0 d rV7 2A which is shown and designated on the Suffolk County Tax Map as District 1000, Section ,Block ,Lot 6- l , 'Y That the undersigned(has) (have)filed,or cause to be filed,an application in the Southold Town Building Inspector's Office for the following: That the undersigned do(es)hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon,to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws,ordinances,rules and regulations of the Town of Southold. The undersigned,in consenting to such inspections, do(es)so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances,rules or regulations of the Town of Southold. F.✓LS v i�1../i�[i _�C� C/b¢vyZ vF( Dated: 1 V f. L 1 ��ti� a G' (Signatu(e) (Priv Name) (Signature) (Print Name) �;tyr,• ,1 . ..f � � a� 1r �.� f 1 '�` •• -Y a 2�� a Av� 1 .IVB Ll �Y� [ / .st.�. „aP•..� tr `'� Lam; I ly.iil+.�9 •t� •�r � fa .r r�r .+� �.-. ^L r� f##.i^' "`iii,,, 1 r�1 d S i^,.� . �H�r`� � •S . + ,�z• Fir �, ! N 4. r ei + ' i Pr 1. � � � y+l+ r t e.•' `�*� 'f+� OF If [�i. �• ..'Y f 1 f - 7 1 I� I L�: ��"�7'�'e".�"�+4 s. L * ��r'�� a ��' •� �P .r 1 �.� 'F �i .# ��Pslr� a JL_� r i I � i � � � � •r rl 1 '; n rt ;� ;�'�•. V. to ! ;.I Vit! "M F ,fi17 r• c ' r� �.. � '� i, 7, � �w '�. •'1f' ja r 5 .�1 ��r7 •Z-.. - `� ,t X74' _ n"'aaS.w e. klt + - �>?• � _� •rltk �.r a } t -- _�' 'tis+. • . 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'•T `� .� `.ray- is Wli Ir f W PIN, ' � 'vhf � I •r�•r� - �.� ? j:r Y' �i.~ .} ` :r>"ry'�*� `^ �'} Jul T;,��� .. �`' " � ' • -"•• ��J+• Y�J,(.,,},yap�.rs:S� Y� y- � i 1i' 9 } f Pi t ih fy i ► I r ` ^�S O. i Q { 1k 4 Ile t a. .f ' �,.• ,7 .•t• e r -4 �. 1 '• 1 , _ 1 'e bi ZrA 1 � 41 41 . - .�. ,• f - rr a Y+ � , .^-"��,'��. �._ r �y . r. 1. i ' �� ,'. fr:e r � f �� kr•' r Y •f ,� ��. r'�' :� 1 �` � •C .k;�Y dot.!. r'j,`�C ` +{. •+ . y , ` t '� ,"• •r'7 J � _, 7�rJ� •,��, y�yF ��is 4 Y.���i rYr 'h'� .k g. R .' a �1..f rt - 1 '; f r,.. '1'► * •�a',i �+�r�y+ 4 't' a y{r„ I � � • I;�I � �� �rq f Y • 111 s , ��1.-t !{+j\ �j. •� � / �� �• r f ♦�� l�11 ,e�1i 1 �L. �• rf r 1, r William D. Moore Attorney at Law 51020 Main Road Southold,New York 11971 ( yy Irv �� Tel: 631-765-4663 Fax: 631-765-4643 - �.„ , 2617 October 12, 2017 �� �� � leu BY HAND Southold Town Planning Board Southold Town Hall Annex Main Road Southold,NY11971 Re: First Universalist Church SCTM 1000-63-6.-6.1 and 6.2 Dear Members of the Board: Enclosed please fin one set of the following with respect to the above referenced property: • Site Plan Application Form • Check for filing fee • Notice of Disapproval • Applicant's Affidavit • Agent Authorization Letter • LWRP Consistency Assessment Form • EAF • Property Survey (1 print) • Preliminary site plan (4 prints) Please note that the tax map numbers assigned to this property do not reference two separate properties. The second tax map number was assigned to the existing single family dwelling on the property by the Town Assessors reflecting the taxable status of that structure on the church property. They are not two separate parcels of property. The Notice of Disapproval notes that a special exception approval from the Southold Town Zoning Board is required. That application has been submitted to them contemporaneously with this application.\ The church's Board of Trustees and the professionals retained to assist them in the reconstruction of a house of worship on this site look forward to working with the Board during this review process. William D. Moore Attorney at Law Re: First Universalist Church October 12, 2017 ........................ .............. Very truly yours, r— I Wil.liam.D. Mcp WDM/mr cc: First Universalist Church Peter Marren, Architect Stacey Paetzel, Landscape Architecture El SOUTHOLD PLANNING BOARD SITE PLAN APPLICATION FORM NOW T6VW1 Site Plan Name and Location Plannin Board Site Plan Name �' :.. .. �.... � _w .aa. 1 / / l I l`tlalic�tt,�ccw Date; ._. Suffolk County Tax M a p #1 oo -,43__e.- scl,, m s Street Address: °��O �......�� ifs..wwww.....__�...Hamlet ..... O .... .... ..� .. .... .... .... Distance to nearest intersection: D Type of Site Plan: VNew Amended Residential Zoning District Owners/Agent Contact Information Please list rrcrme, mcg hn6,cWdress, and !l?o e number����r Property Owner....... F ..:..L t Street City Smmomm�T -h -„n............... State ..... p l ( 17� Home"telephone � —� Cher Applicant_..... Street City ...... _........... ...... State it ,. Home Telephone _..... h Other Applicant's Agentor Re� ...� � rese ............................_._._.�.�._ _... n ._.,,_.�n_�,m.,,, p ntative: Contact Person(s)* % 1 I�O�� L L vh Street, _ __.! I.0.2'0 M 44 City.,____-Z State I ` ......................... ip_n..( �....S 7 t Office Telephone �i 30 �4� ' f'/�'3 Otl�ex ����.�� � �� � � L . *Unless otherwise requested, correspondence will be sent only to the contact person noted here. Site Plan Application Form 2/18/2010 Site Data Proposed construction type: New Modification of Existing Structure Agricultural .... _t":'liarrge of use Property total acreage or square footage: ac,/sq. Site Plan build-out acreage or square footage: , ti v ......... _._... Is there an existing or proposed Sale ofDevelopment Rights on the property?��Yesmwe.e.e.e.ewa � oNo If yes, explarr ; _www .................... Does the parcel(s) meet the Lot Recognition standard in Town Code §280-9 Lot Recognition? Yk�N_ If"yes", explain (and attach any necessary documentation–title report, subdivision approval, etc.) Building Department Notice of Disapproval Date: / cq / Is an application to the Southold Town Zoning Board of Appeals required? Yes No ,---.-, w. If yes, have you submitted an application to the ZBA? Yes No If yes, attach a copy of the application packet. Show all uses proposed and existing. Indicate which building will have which use. If more then one use is proposed per building, indicate square footage of floor area per use. List all existing property uses:_. S . .. List all proposed property uses; S A 6 A14r) ....... .... � .. .... .. . Other accessory uses;—...................._..............., Existing lot coverage: % Proposed lot coverage: % Gross floor area of existing structure(s): sq. ft. Gross floor area of proposed structure(s): _„www_____ Parking Space Data: #of existing spaces:- #of proposed spaces Loading Berth YeseOetlW� Now— Landscaping Details: Existing landscape coverage:mmm�mIT % proposed landscape coverage % Wetlands: Is th s property within 500' of a wetland area? Yes�w No mmmmITmmmm Maybe_ I, the undersigned, certify that all the above information is true. Signature of Preparers 7 Date: ,,,,, Site Plan Application Fornt 2/18/2010 APPLICANT'S AFFIDAVIT APPLICANT'S AFFIDAVIT STATE OF NEW YORK COUNTY OF SUFFOLK being; duly sworn, deposes and says that he resides at A..%-1 o q�14_ the State of New York, and that he is the owner of property located at a _ SCTM# ) ®/ dor that he is the :.... of the ` R __ V N1 Vl!�S l Title (Specify whether Partnership or Corp.) and said Corporation is the owner of the above property, which is hereby making a Site Plan application; that there are not existing structures or improvements on the land which are not shown on the Site Plan; that the title to the entire parcel, including all rights-of-way, has been clearly established and is shown on said Plan; that no part of the Plan infringes upon any duly filed plan which has not been abandoned both as to lots and as to roads; that he has examined all rules and regulations adopted by the Planning Board for the filing of Site Plans and will comply with same; that the plans submitted, as approved, will not be alter or changed in any manner without the approval of the Planning Board; and that the actual physical improvements will be installed in strict accordance with the plan as approved by the Planning Board. Signed ...:..... ..._ " O.wner.... . ..... Signed,, (Partner or Corporate Officer Id Title) Sworn to me this .� day o1c� . " � otary Public `s, A.PERKINS Notary Public,State of New York ®01 PE6130636 ouanfied in Suffolk Cou Commission Expires July 1 AGENT AUTHORIZATION I Susan Young, President of the Board of Trustees of the First Universalist Church, the owner of property located atj(91 D Main Road,Southold, NY identified as SCTM 1000-63-6-6.1 and 6.2 hereby authorize William D. Moore, Esq.to act as our agent and handle all necessary work involved with the applications to the Southold Town Zoning Board of Appeals (special exception and variances if necessary) and Southold Town Planning Board for site plan approval. First Universalist Church By: Susan Young, President Board of Trustees Sworn to before me the day of October, 2017 13ETSY A,' II t4olatypublic,State of NOW YQrk 140.01 PE 130636 + u lllfi d In s flolk Co un Cornolln�Expires JuI 1 FORM No . 3 TOWN OFSOUT1101A) B1111,I)ING DEPARTMENT SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL DATE:September 8,2017 M William Moore(First Universalist Church) 51020 Main Road Southold,N)' 11971 Please take notice that your application dated June 6,2017: For permit to construct a new church I)tiilding-tl)rc--existing-single-faiiCily_dweiritie_and_parish house to remain j at: Location of property: 51970 25,Southold.Soqh_oldNY County Tax Map No. 1000 -Section 63 Block 6 Lot C.I Is returned herewith and disapproved on the following grounds: 1.11iis 52,272_m �q-zq (;."L 0'�Wggiyj Emgp!J011 aDnroval from the Zoning Board of App als as per Ch pter 280-ULB 1, �Mteljlla tnmn'gj,n nljl'gn_ <tklth J., Sit A , qg B)L(L q�_ 1-1.11 qK)j_ __ki q Lastly,the proposed construction is notpermitted without review and a roval by the Southold Town Landmarks Preservation Commission,because the propej ii ljst�d on either the Southold Town,New York c State an,d,/1qr,tl Re soqr !flhsriqjib q 5 ltttd, relLqjrg )y OL t 'jg- 3y Landmarks Preservation Commission. If the requirements of the town co oeegain pertaining to Landmarks(Local Law No.22)are met®aCertificate of ApIC )�v.ill prODrialenessof A - - ding Permit will be approved, _ .. b-e issued. The C of A is reauired beforeaBuj__ Information about the reguir n ents for.applying fora C of A is available at the information counter in the Building Department, You may now apply to these agencies directly. it nalure Note to Applicant: Any change or deviation to the above referenced application, inny require further review by the Southold Town Building Department. CC: file, Planning Board,ZBA, Landmarks 03! � ° � FOR INTERNAL_ USE ONLY AUG 1,So": oldTOMPLAN USE DETERMINATION plalll�n[ng Boa SITE it itial Dotormination IL ^ Date Sent: A—/ , Date: --- ril LProject ,NarT1e:-.2= _. —. o . Project Address: _ . .:1�Ofg� �Zoning Dist Suffolk ouYTax Map�Norict:. , . Requests � orcin docurnet�tation a*to ^ (Note: copy of B.�i dIng� Permit Application and supp � g proposed use or uses should be submit tedd.) " eter use t permitted* t sp . � "nation to v�'h� - initial Dee � ( . Initial-Determination as to whether site plan is required:_ I ayj (� n [` r Signature of Building Inspector Department (P.D.) eferral: R Planning Dep' 7 -7Date of coent' P..D.Date Received: __---- comments: Signature of Plannin ept.•Staff Reviewer r-Incl Dete rmi>r�lat o1, Date: Decision: cc;nfi,r Rnildina Ing P TOWN OF SOUTHOLD BUILDING PERM- kPPLICATION CHECKLIST BUILDING DEPARTMENT Doyou have, -,ced the following,before applying? TOWN HALL Board ofHealth SOUTHOLD,NY 11971 4 sets ofBuilding Plans TEL:(631)765-1802 Planning Board approval_,,,,,, FAX:(631)765-9502 Survey Southoldtownny.gov PERMIT NO. Check .............................. Septic Form N.Y.S.D.E.C. Trustees C.O.Apptication__ lood Permit Examined..- -.------120 Jingle&Separate Truss Identification Form-.-....................... Storm-Water Assessment Form Contact: Approved 20 Mail*A: MUM, Disapproved a/c -111) 5 Phone: DjU -i'N'i- pector JUN 6 2017 PPLI CATION FOR BUILDING PERMIT Date 0 20_L77 BUILDING DEFT. INSTRUCTIONS TO completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or Regulations,for the construction of buildings,additions,or alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name,if a corporation) OP06 (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder .................... Name of owner of premises (As on the tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer (Name and title o-f-cop p�orate ol icer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License NO. L Local ion of land,on which proposed work will be done: �1- q*lev MAIN ROAD-NYS RT.25SOUTHOLD flouse Numbell Street Hamlet 0 County Tax Map No. 1000 Section63Block 6 Lot 6.1 &6.2 Subdivision Filed Map No. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancyChurch and Parish Hall(destroyed in Flre),Parsonage,Single Family Residence_ b. Intended use and occupancy,New Church l y and Parish Hall,existing Parsonage&Single Family Residence 3, Nature of work(check which applicable):New Building. X Addition Alteration Repair Rentoval _ Dernolitiou Other Work (Description) 4. Estimated Cost e2- Fee (To be paid on filing this application) 5. If dwelling,number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. 7. Dimensions of existing structures,if any:Front Rear Depth _m Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height. Number of Stories,,,, 8. Dimensions of entire new construction:Front Rear Depth Height s� Number of Stories 9. Size of7ot Frotat 343.70 Rear 153.24 Depth EAST 169.97 WEST 247.04 10.Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situated O R-O 12.Does proposed construction violate any zoning law,ordinance or regulation?YES_NO 13.Will lot be re-graded?YES X NO—Will eexxcess fill be removed from premises?YES NO X 14,Namessoof Owner ofremises Address Phone No. 0 Name of Architect Pet"a"I" Address 77 Duane Street,NYNY 10013Phone No 917 992 5369 Name of Contractor Address _v,__v_,_,_Phone No. 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO X O *IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b.Is this property within 300 feet of a tidal wetland?*YES NO X Q *IF YES,D.E.C.PERMITS MAY BE REQUIRED. 16.Provide survey,to scale,with accurate foundation plan and distances to property lines. 17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18.Are there any covenants and restrictions with respect to this property?*YES NO *IF YES,PROVIDE A COPY. STATE OF NEW YORK) S5,: COUNTY 01;5 - 1 -.) � ( being duly sworn,deposes and says that(s)he is the applicant (Name of ind vidiaal signing oiitract,)above named, (S)He is the Corporate Officer (Contractor,Agent,Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief;and that the work w performed in the manner set forth in the application filed therewith. ,SC NOTARY PUBLICC,,STATE OOF F NNEEW YORK Sworn to hefore me thisNO.01 DW6306900 t ®day of _� t 20 –7 QUALIFIED IN SUFFOLK COUNTY 0 COMMISSION EXPIRES JUNE 30,2Dib Notary Public Signature of Appl cant FOR INTERNAL_ USE UNLY SITE PLAN USE DETERMINATION / initialDetermination Date Seni:, Project Name: X, Project Address:— Zoning 3 Zoning District:, Ma. No.:1U0G__L= - Suffolk nth Tax p County � 0. di Request' n it At�n and sup orting docurnentation,a�to (Note: Col jof Bul dillgPer �licatio proposed use or uses should tie suhn �t�t�ed.�) l .ilial I eternitnatior as to whethe r use is permitted: e 49- rw reJ n an - Ian is require lnWal-Dete.rmination as to whether site p ... for Signature of Building Inspeo Planning Dep artment (P.D.) Referral:_.-. .Date of Comment: ..... _.f__-- . --- P.D..-Date Received: j---- - Comments: Dept--Staff Reviewer Signature ofi Planning inai D0191 i"C119a tor" Date:= c;,,nahira of Riiilriina In. nectnr Town of Southold LWRP CONSISTENCY ASSESSMENT FORM 00 T A. INSTRUCTIONS �Ir�ur� �� L 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# The Application has been submitted to (check appropriate response): Town Board 0 Planning Dept.R Building Dept. IR Board of TrusteesEd 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: Nature and extent Of,a lion: �..- Location of action: M J4 Site acreage: Present land use: c7y1-S' Present zoning classification:-....- 2. 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:. ..............fi../ c-- sr (b) Mailing address:____., .....�c 2. . —� .. .. .. .......... m.. ... ..,,.mm._ (c) Telephone number:Area Code( ). ........_ (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 1 No . pl If yes,which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure,makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III-Policies; Page 2 for evaluation criteria. Yes ❑ No ❑ Not Applicable .. �' ' s OV Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-Policies Pages 3 through 6 for evaluation criteria Yes ❑ No ❑ Not Applicable 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 Q No Q Not Applicable w�.. _. Attach additional sheets if necessary � NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes No Not Applicable ...................... �_a.. ..................�_ .............._....._ _..........�_.,........_. Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria 0 Yes D No tBNot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes Q No)F:o;Not Applicable ............ .................. . _...........m _........ da ... ... __......, — .. Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. Yes [:r]- NoW Not Applicable �mm_-_- ....m..........m.......................�,,,,____ w��._...�................................ www . Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. IdYes ❑ st No rim 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. ❑ YeED No Not Applicable ...... ....... _..._.... 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. es [:] No Not Applicable 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. FIF Yes 11 NOX Not Applicable _...�,.i...�,.�......_... —"m�,.,.�..e..,.,�,,,,,,,,,,ssar,,,,,,,,a,,,,,... �...... ... 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. Ed Yes ❑ Jff Not Applicable .�—additional � beets.��..c—essa_. �........... ,...... _ .. � Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No,VNot Applicable Created on 512510511:20 AM 617.20 Appendix B Short Environmental Assessment Form , „ I Instructions for Completingau.u87t�du1 " " ijlsu:uWgu Bo ud 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 fimding,are subject to public review,and may be subject to further verification. Complete Part 1 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: � � �f S Vn/ ✓e' f-_' +Lc sG' C14d/26{� Project Location describe,and attach.... ---- .�___-m........_................ ........ _._.................................,.,..m. ,__,,, �..w... a... � ( ocation map): go S �• c�-1 / — — �- �.. tG. z— Brief Description of Proposed Action: CDi✓S%KifC J-v4/k-f6 f/-h � Name of Applicant or Sponsor Telephone: 6 j/— ?41 S__ 3 c}y S r vl✓1 E-Mail:.._.m. .. .............___mmm Address !J Al L '� C'ty/po: ._ ._ .. .....w ........�...... _.._....... State:� �.........Z......ip Code: . 1 9 ce, O 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, /N YE .... .. NS,,,,,,,,,,, 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. u2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES Il Y s„list agency(s)name and permit or approval: s i C;.f /�L�✓ 3.a.Total ac.re..... .. oft—hesite. ...m .. � .. ....._.. - .. -a eagof the proposed action? acres b.Total acreage to be physically disturbed? mm acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? ,",.acres 4. Check all land uses that occur on,adjoining)nd near the proposed Commercial �esiden action. 11 Urban 11 Rural(non-agriculture) ❑Industrial tial(suburban) ❑Forest ❑Agriculture ❑Aquatic Xbther(specify): �N r3LIG f�$S�'YL1�C y ❑Parkland Page 1 of 4 the proposed action NO YES N/A a.A permitted use under the zoning regulations? �O b.Consistent with the adopted comprehensive plan? 6. Is the proposed action consistent with thepredominant character of the existing built. ................. ilt or natural NO.. „YES landscape? 7 Is the siteof the proposed p p �...........action located in, or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify _ a as as .. 666_._._. .. .... ._... ......, n�.�. 8. a.Will the proposed action result in a substantia ' p ? .�. 1 increase m traffic above resent levels. NO YES b.Are public transportation service(s)available at or near the site of the proposed action? www.............. .................... c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9 Does the proposed action meet or .... _t � exceed the state energy code requirements NO YES If the proposed action will exceed requirements,describe design features and technologies: .......................................................e.... - w ... m...., 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 v If No,describe method for providing wastewater treatment: O 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......., i 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: 14. Identify the typical habitat types that occur on or are likely to be found o . apply: n the project site. Check all that ❑ Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban XUuburban 15.Does the site of thero osed action co _ p p contain any species of animal,or associated habitats,listed NO YES j by the State or Federal government as threatened or endangered? 16.Is the protect site located.,.......................... year in the 100 y flood lam?p � .... NO YES 17.Will the proposed action create storm waterdischarge,either from point or non-point sour e _w_._. g , point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? KNO❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: PNO❑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: 19.Has the site of the ro osed action or an ad oinin roe been the local ion of an active or closed NO YES .....����� P P adjoining property rh' f solid waste management facility? , If Yes describe:esc . ............. .. --- ....�..e... �_ 20.Has the site of the proposed action or an adjoining property been the subject of remediation( g � g on om or N....�.�YE.........._,_. O S d completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURCCUR .... _. .. ....� ATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor n or name: r (Z S r .....v N` ✓en....�,A, c r WIfe l'Date:..�.._......., Signature: 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?" ._............................. ...m..m. --- or.................. Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an a.........�..............an . zoning � dopted land use plan or zoning regulations? www.... ... ....w_ .... .......... 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? m, ... _m__..m.,.,.�............. 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available ener conservation or renewable energortunities? 7. Will the proposed action impact existing: a.public/private water supplies? 66 b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character oruali of important m q ty p 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. ........ ..heck t... bo y have determined,based on the information and analysis above,and any supporting documentation, r.� Check this.......X_�f...�.... . . . . ................................ m��.mm... 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 ......................._.._._........_.._.,_ enc g 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 nsible Officer) Page 4 of 4 OFFICE LOCATION: � ` FU ADDRESS:AIAILING 0 Towyn Hall Annex � �� "p,, P.O. Box 1179 54375 State Route 25 { � +°b� Southold, NY 11971 (cox°. Main Rd. &Youngs Ave.) Southold, NY CA Telephone: 631765-1938 www.southoldtownny.gov . C4UNTY, �' PLANNING BOARD OFFICE TOWN OF SOUTHOLD MEMORANDUM To: Accounting From: Planning Department Date: October 12, 2017 Re: Check Please deposit the attached check into B691: Deferred Revenue. Fee is for a Site Plan Application not yet accepted by the Planning Board. Applicant/Project Name & Type Tax Map # Amount .m.__....._ �_....... .. Check Date/No. First Universalist Church 63-6-6.1 & $1,000. 10/4/17 #1105 6.2 JAM Att. %%/, "� �,,,, i/i6�„ ti AF i//D�i ,�,,;! wwwuw�w�wwnrww �w'rw.n�rvi"�'a / TI"1w,www,,rep� j Co u, mm n Y BNB y 410.021L.0116671". 0500044q20111 Y� a Int jll;. < 44b :!. • ' Or ' T S. A P6 ! w ! + - lS�T ,til ° ;•��, �r . ` ►s rFir��I{I r� Y :� ° r r• f 4# 4'0 ,xA P' �� .2s 'Yu Sd ° ' of " , � '"(i I� t����` , ti' aM — '. , a s � � J�j• :. , a_ - •� ■r - ter(_ ° — _� tt "r-y'. i`l'' j A4 .r AVIN APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the pnrt of town officers and employees.The pose of this farm 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. pax ', I YOUR NAME: 5 tj 5 - 'Y Oy'r A 41 01— +F!(SSC tJAfNVei2:5A to C CC- (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 fiat Mooring Other(activity) 119� '70t✓ 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 you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. Either check the appropriate line A)through D)and/or describe in the space provided. The town 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 day of rZJ1_1240, Signature Print Name &0 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 provideinformation which can alert the town of possibie conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: hW7 t-1-14AyA Q (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) Pt-c 1 tt- q a :a/ Planning f 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 whic •the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. Either check the appropriate line A)through D)and/or describe in the space provided. The town 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 da of ` ,20j_?_ Signature Print Name 1 L A - D - 40� AGRICULTURAL DATA STATEMENT ZONING BOARD OF APPEALS TOWN OF SOUTHOLD WHEN TO USE THIS FORM: This form must be completed by the applicant for any special use pernnit, site plan approval,use variance,area variance or subdivision approval on property within:an agricultural district OR within 500 feet of a farm operation located in an agricultural district. All applications requiring an agricultural data statennennt must be referred to the Suffolk County Department of Planning in accordance with Section 239m and 239n of the General Municipal Law. �1 r 1. Name of Applicant: fI R-5 i !/I\([ f/� ^-C 5"r cl- v2Crt 2. Address of Applicant: PO Z Z t -5-0 t,- L 1 9 7 1 3. Name of Land Owner(if other than AppIicant): Sf1 ai rz- 4. Address of Land Owner: 5. Description of Proposed Project: Y✓r7c?Ji`f�n� W� f9cLq t OWTI'17/7 A(-A t L 6. Location of Property road and Tax map rr number} ,4 r W (?V t4n) 50 v 17 P 4, —6, ( fig&(6 b. L 7. Is the parcel within 500 feet of a farm operation? { }Yes o 8. Is this parcel actively farmed? { ) Yes o 9. Name and addresses of any owner(s)of I nd 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) } I '1 Signature of Applicant Date Note: 1.The local Board will solicit comments from the owners of land identified above in order to consider the effect of the proposed action on their farm operation. Solicitations will be made by supplying a copy of this statement. 2.Comments returned to the local Board will be taken into consideration as part as the overall review of this application. 3.Copies of the completed 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 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. DElS�C,RIPTION OF SITE AND PROPOSED ACTION SCTM# The Application has been submitted to (check appropriate response): Town Board E Planning Dept.'O Building Dept. kftd Board of Trustees 0 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: Nature and extent of action: ! f eV4( y6WG`071 016-- r�S� [Ips i�r/l�,��f�� !•►fj' Location of action: M AI V R a O'lp Site acreage: Present land use: �fc7v!_S o✓d�1�1�� Q, i Stell � w€7 ci W-S Present zoning classification: . C7 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: t 1 �S GI (-r r (b) Mailing address: 2 f -570� (c) Telephone number:Area Code (d) Application number, if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No If yes,which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure,makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. Yes ❑ No ❑ Not Applicable ,,! ON h9•<t iJ r,✓�9 �✓ L c C� e'O Svc s �7 v,✓ fVL- Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria (� Yes ❑ No ❑ Not Applicable l -<I— IC96F s Ar"(6 PAIo-e 4 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 E No L'J Not Applicable -yam Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes 0 No M)Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria E Yes E] No FiNot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Q Yes ❑r NoUq�Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ NoW Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for 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. nn ❑ Ye.0 No Not Applicable 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)�3 Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ NOXNot Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LVWRP Section III —Policies; Pages 62 through 65 for evaluation criteria. Not Applicable Ed Yes 1:1 N Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LVWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No,?Not Applicable Created on 512510511:20 AM 09/14/2017 14:03 631765" 76 SOUTHOLD ASSES-2S PAGE 02/07 ET -- p IA p OC CT y N 4-4 R O p , zt �r -•� � � r � O rcn zt on �I v C7 Z z "' o z z o W r ,c . 0 In C ' 61 w fir � O ( ' `� a� •'rrr" Lfk,r:tit y .,✓�:`. i''1\'fit;:a+-` '`��f}+;,�-, t �'r '� '}' L`'R'.'• a' r rev z'y 0 ' ■�Is■■�s■ref■�■■�s� • • ■N■■■���■■BEEN ■r■N ' ■■!■■SNS■i■■1■s■■� OEM r�■�■N■mass mommumm ,��N■� ■rN■r�Arr 'annow an S■r■■r■1�!! 1 16i■m■`f■r� ■■�■l��NI�x7lt ■■r■ N ■■rr■�r■rwr■IU■■,■r■r■ r■�r■ ■N��rr ■r�rrr� .. ■rorrMENS on �r�r�rrr�rrr■■rrrr■r ■r■■r■rr�r■r■�r■N■rr rarrr�■w■N�r�rr�rr .. r■N■■■■r■N■mN■�Nr ■r�■Nmommmr■rr�rr ■r+�rr■mm"Nu■r�r■rr r ■r�rrrirrrr��■�r■■�■� 09/14/2017 14:03 6317657'x6 SOUTHOLD ASSESPnRS PAGE 04/07 o c o o D X 1 � � d a Q m v rrn A �. �1 6 � X O z E„ m Om r 4, -� O Z O m � Q e a z z � V � f A W Z o D V < m v O C m x "�• �• a {'1 m DG7 m C o m O O z z q f m: r C � O 4 z m aD E• CIA , r • 1•L .!S} ., Yl �'• ,� til..` wr ; • ISS. ;� 7 - + � ' - ti., ,SNR `F• LI . . . ■■�■■o■«noun man ■■■ ■■■■■■ ■«O■■■■■ ■■■■n EVEN ■N ■rte■ ! 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( U r N ZM 0 O X - W D E o > :1 � 4 Q Z < ti 0 m 1 r �r ;a -� z° z m r. z � 9 7 D rG)ii m [cn ', 0 t- o , G) Q Q d cn O �V ' S . g f f l ■ ' 7 7 • J: $rd • ah• 1i ,1 .•11sn ``7 s 4Ctr+ r two 1 • • na■�a■ ■■M■■■ OEM■■��m■■mi■m ■■■■■■rMi■■■a■ aMEN■i■amown ■aar■■aua■■na�a Naa■a■aai��a . 0 so 0 ownia l� a!■■■iwas rr■ I1Maia ia■■rt� iili .m1ra 1003 rsunsaa man man ■a■■■w-No a te MEN■i■aarr■ Eamon ��rr■a■gra■araa■�r Baa■ar■oar�■a■� SEEraiaa�r■■ i�r■■i■■■ri�ar ■ .. a�■■a■a■■■aa�■ �i�i�iiii�a■�a ■■■■aaaaa■�i i��� ■a■ar■a■a■a■�aa AGENT AUTHORIZATION I Susan Young, President of the Board of Trustees of the First Universalist Church, the owner of property located aV5I(R']D Main Road,Southold, NY identified as SCTM 1000-63-6-6.1 and 6.2 hereby authorize William D. Moore, Esq.to act as our agent and handle all necessary work involved with the applications to the Southold Town Zoning Board of Appeals (special exception and variances if necessary) and Southold Town Planning Board for site plan approval. First Universalist Church By: Susan Young, President Board of Trustees Sworn to before me the qday of October, 2017 BETSY A.pERKINS Notary Public,State of New York No.01 PE6130636 Qualified in Suffolk Cou 1 Commission Expires,fuly 18�` TO—OF ' 05-16-05 i ,,,f lv'�tiCN M,li11WG 04-04 10-20-06 ,•-' �r/h Civ37 ,_Cl/ `�' W o� Zi✓/' �/c n/t--7` ° "" r� :a 06-0407 M-02071��/4 I� /v � • n 1" -01 / 1,�J / 11.07 5y' � 3✓ "�CCC111JJJ S 81,1 71A 06.17-08 HDZMENTRIGTS) OZ 02-13-09 Z�' 02-20-09 02-28-09 (19-04-09 1.12 07.20.10 2.SA 02-03-12 12-20-13 �6• Di 90,_x _43 vmi �DEVELOriuEM RIG/RS) � 37 142A(c) Z I a 13-1f�t U N 4" * 1 13 2 12 3 FOUNDERS VIU.A GE CONDOMINIUM aA 1 A SECTON2 -_F�• N I -12.1 2rnA (COMMON AREA) I'll n.• i V '� U I r 12,2 f f] 1.OA (FOR UNITS SEE ' SEC NO MI.M) Ah 1.3 10.IA r� Iln �y 6.eAtq � t n.r gS. T cnL '31 $ 1 4 1 .y1 IM 6-- 41ti� �9 1"1 , � c P h1 Oy ti 2,BAdU] •3 - ST.PATRICKS CHURCH \ fAA(c O f.dq{`y P9 10.2 an r 45 c fj w,0 D / 0. 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