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HomeMy WebLinkAbout1000-111.-9-4.2 OFFICE LOCATION: O��OF SUUTyOIo MAILING ADDRESS:
Town Hall Annex P.O.Box 1179
54375 State Route 25 Southold, NY 11971 -
(cor. Main Rd. &Youngs Ave.) cn =�
G @ Telephone: 631765-1938
Southold,NY 11971 • �O P
p Fax: 631 765-3136
OOUNT
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
MEMORANDUM
To: Leslie Weisman, Chair
Members of the Zoning Board of Appeals
From: Mark Terry, LWRP Coordinator
Date December 21, 2017
Re: LWRP Coastal Consistency Review for ZBA File Ref DAVID HERMER AND SILVIA CAMPO
#7117
SCTM# 1000-111-9-4.2.
DAVID HERMER AND SILVIA CAMPO #7117 — Request for a Variance from Article XXII Section 280-
116 and the Building Inspector's August 7, 2017 Notice of Disapproval based on an application for
building permit to construct additions and alterations to an existing single family dwelling, at: 1) located
less than the code required 100 feet from the top of the bluff, located at: 3675 Nassau Point Road (Adj.
to Little Peconic Bay), Cutchogue, NY. SCTM#1 000-111-9-4.2.
The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of
Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards.
Based upon the information provided on the LWRP Consistency Assessment Form submitted to this
department, as well as the records available to me, the proposed action: 1) Accessory outdoor kitchen
located less than the code required minimum front yard setback of 40 feet, is recommended as
EXEMPT from LWRP review pursuant to:
§ 268-3. Definitions. MINOR ACTIONS item "II" which states:
Additions to an existing building or rebuilt residential structure which results in no net increase in
ground area coverage, except where the parcel is located in a coastal erosion hazard area;
The action is not located within a coastal erosion hazard area.
Pursuant to Chapter 268, the Southold Town Zoning Board of Appeals shall consider this
recommendation in preparing its written determination regarding the consistency of the proposed
action.
Cc: William Duffy, Town Attorney
BOARD MEMBERS ®F so Southold Town Hall
Leslie Kanes Weisman,Chairperson �� y® r 53095 Main Road•P.O.Box 1179
Southold,NY 11971-0959
Patricia Acampora Office Location:
Eric Dantes G @ Town Annex/First Floor,Capital One Bank
Gerard P.Goehringer �® ® a®- 54375 Main Road(at Youngs Avenue)
Nicholas Planamento co Southold,NY 11971
http://southoldtownny.gov
ZONING BOARD OF APPEALS D E C E � VI E
TOWN OF SOUTHOLD -"
Tel.(631)765-1809•Fax(631)765-9064 S E P 0 6 201-1
September 6, 2017 Southold Town
Planning Board
Mark Terry, Principal Planner
LWRP Coordinator
Planning Board Office
Town of Southold
Town Hall Annex
Southold,NY 11971
Re:, ZBA File Ref. No. #7117—Hermer, David and Campo, Silvia
Dear Mr. Terry:
We have received an application for additions and alterations in Cutchogue. A copy of
the Building Inspector's Notice of Disapproval under Chapter 280 (Zoning Code), and
survey map,project description form, are attached for your reference.
Your written evaluation with recommendations for this proposal, as required under the
Code procedures of LWRP Section 268-51) is requested within 30 days of receipt of this
letter.
Thank you.
I Very truly yours,
Leslie K. Weisman
Chairperson
By:
Encls.
FORM NO. 3
TOWN OF SOUTHOLD (
BUILDING DEPARTMENT
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
DATE: August 7, 2017
TO: David Hermer
3675 Nassau Point Road
Cutchogue, NY 11935
Please take notice that your application dated August 1, 2017
For a permit to construct additions and alterations to an existing single family dwelling at
Location of property 3675 Nassau Point Road, Cutcho ug_e, NY
County Tax Map No. 1000 - Section 111 Block 9 Lot 4_2
Is returned herewith and disapproved on the following grounds:
The proposed construction is not permitted pursuant to Article XXII Section 280-116 which states
"All buildings located on lots adjacent to sounds and upon which there exists a bluff or bank
landward of the shore or beach shall be set back not fewer than one hundred (100) feet from the
top of such bluff or bank."
The proposed construction notes a setback of 67 feet from the top of bluff, at its closest point
ed SignAture
Note to Applicant: Any change(or a referenced application may require
further review by the Southold Town Building Department.
CC: file, Z.B.A.
Fee:$ Filed By. Assignment No.
APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS
�,/^r AREA VARIANCE r
House No. �eL'7 Street w%w Hamlet
SCTM 1000 Section �S Blockot(s) 1-fill' Lot Size p% Zone
I(WE)APPEAL THE WRITTEN DETERMINATION OF THE BUILDING INSPECTOR
DATED BASED ON SURVEY/SITE PLAN DATED
Owner(s): .. L V( O
Mailing Address:_6 G®� .P�,. 4D J 0 UQ/
Telephone: Fax: Entail:
NOTE:In addition to the above,please complete below if application is signed by applicant's attorney,agent,architect,
builder,contract vendee,etc.and name of person who agent represents:
Name of Representative: ��V P,(.g for(°Owner( )Other:
Address:Ai'C to F/�DW4A fyJ (I- V �—
Telephone:IIS Fax: Email: GO 19,UYI -WAA6
Please check to specify who you wish correspondence to be mailed to,from the above names:
( )Applicant/Owner(s), ()f-Authorized Representative, ( )Other Name/Address below:
WHEREBY UILDING INSPECTOR REVIEWED SURVEY/SITVjWN
DATED and DENIED AN APPLICATION DATED �� FOR:
( uilding Permit
( )Certificate of Occupancy ( )Pre-Certificate of Occupancy
O Change of Use
( )Permit for As-Built Construction
( )Other:
Provision of the Zoning Ordinance Appealed. (Indicate Article,Section,Subsection of Zoning Ordinance by
numbers.Do not quote the code.)
Article: kt � Section: Subsection: a
Type of Appeal. An Appeal is made for:
()�LA Variance to the Zoning Code or Zoning Map.
( )A Variance due to lack of access required by New York Town Law-Section 280-A.
( )Interpretation of the Town Code,Article Section
( )Reversal or Other
A prior appeal( ) has, 04as not been made at any time with respect to this property,UNDER
Appeal No(s). Year(s). . (Please be sure to research before
con:plehng this question or call our off ce for assistance)
Name of Owner: ZBA File#
REASONS FOR APPEAL(Please be specific, additional sheets may be used with preparer's
signature notarized):
1.An undesirable change will not be produced in the CHARACTER of the neighbor or a detriment to nearby
properties if granted,because:if/wp 1Dog. hmluoOVOZ n 6Tw-
�(W
2.The befit sought by the applicant CANNOT be achieved by some method feasible for the applicant to pursue,
other than an area variance,because:
iT 15 per P�` � 4 ►C� �tlua,
It's 1 � VqAj
3.The amount of relief requested is not substantial because:
(;0
-h t O- eiA 0A� v s&vim
rjgjrj-'0*
4.The variance will NOT have an adverse effect or impact on the physical or environmental conditions in the
( neighborhood/ KNI
or district becausenn��,`T !®�n���ry
®n� C ►5a ".� t� f i" Y v D I
UJ
'
5.Has the alleged difficulty been self-created? { }Yes,or f&No Why:
s o��� �U 9�` V g� y DIRW14T
Are there any Covenants or Restrictions concerning this land? )�No { }Yes(please furnish a copy)
This is the MINIMUM that is necessary and adequate,and at the same time preserve and protect the character of the
neighborhood and the health,safety and welfare of theommunity.
Signature oirApplicant or Authorized Agent
�
n (Agent must submit written Authorization from Owner)
Sw m to before me this ' ' Clay
of Ll 20��
Notary Public
CONNIE D.BUNCH
Notary Public,State of New York
No.01 BU6105060
Qualified In Suffolk County
Commission Expires April 14,2�-l�
APPLICANT'S PROJECT DESCRIPTION
APPLICANT: Nit,,zidz DATE PREPARED:
1.For Demolition of Existing Building Areas
Please describe areas being removed: 1 �
II.New Construction Areas(New Dwelling or New Additions/Extensions):
Dimensions of first floor extension:
Dimensions of new second floor: _
Dimensions of floor above second level:
Height(from finished ground to top of ridge):
Is basement or lowest floor area being constructed?If es,please provide height(above ground)
measured from natural existing grade to first floor:
III.Proposed Construction Description(Alterations or Structural Changes)
(Attach extra sheet if necessary).Please describe building areas:
Number of Floors and General CharactTs ' s BEFORE Alterations: .G
Number of Floors and Chan es WITII Alterations: 1
IV.Calculations of building areas and lot coverage(from surveyo��:
Existing square footage of buildings on your property: 11 LJJ
Proposed increase of building coverage:
Square footage of your lot:
Percentage of coverage of your lot by buiilldiing area: 76
V.Purpose of New Construction:
VI.Please describe the land contours(flat,slope%,heavily wooded,marsh area,etc.)on your land
and how it relates to the difficulty in meeting the cod_a requirement(s):
�fiwm
Please submit 8 sets of photos,labeled to show different angles of yard areas after staking corners
for new construction,and photos of building area to be altered with yard view.
4/2012
QUESTIONNAIRE
FOR FILING WITH YOUR ZBA APPLICATION
A. Is the subject premises listed on the real estate market for sale?
Yes No
B. Are there any proposals to change or alter land contours?
_)�_No Yes please explain on attached sheet.
C. 1.)Are there areas that contain sand or wetland grasses? No
2.)Are those areas shown on the survey submitted with this application? --•
3.)Is the proerty bulk headed between the wetlands area and the upland building
area? qe5
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.
D. Is there a depression or sloping elevation near the area of proposed construction at or
below five feet above mean sea level?
E. Are there any patios, concrete barriers,bulkheads or fences that exist that are not shown
on the survey that you are submitting? W) _ Please show area of the structures on a diagram
if any exist or state none on the above line.
F. Do you have any construction taking place at this time concerning your
premises? alb If yes, please submit a copy of your building permit and survey as approved
by the Building Department and please
describe:
G. Please attach all pre-certificates of occupancy and certificates of occupancy for the
subject premises. If any are lacking, please apply to the Building Department to either obtain
them or to obtain an Amended Notice of Disapproval.
H. Do you or any co-owner also own other land adjoining or close to this parcel? ND If
yes, please label the proximity of your lands on your survey. /
I. Please list present use or operations conducted at this parcel tea d Sd
and the proposed use
(ex: existing single family,proposed: same
with garage,pool or other)
Author zed si ture and Date
! FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y. -
Certificate Of Occupancy
No. , ,
.14 7 21. . . . . . . . . . Date . . . . . .1. . . 2 9.'. . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . .119 .8 6
. .
THIS CERTIFIES that the building . �ne family dwelling
3675 Nassau Point Rd. , Cutchogue , New York
Location of Property Ho. .
use IVa. 8rreet .Hamlet
County Tax Map No. 1000 Section . . . . . . .Block . . . .9 . . . . . . . . . .Lot . . 4 . . . . . . . . . . . . .
Subdivision Club, P P t hled Map No. 15.6 . . . . .Lot No. . . . .1.9 , , , , , ,
conforms substantially to the Application for Building Permit heretofore Bled in this office dated
July 3 , . , , , , , , , 19 8 pursuant to which Building Permit No. , , . 1419 7 z
dated August 12 , 85 . . . 19 . . . ,was issued,and conforms to all of the requirements
of the applicable provisions of the law.The occupancy for which this certificate is issued is . . . . . . . . .
One family dwelling
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to William J. & Lucille V. Schneider
(owner,l axayknox .
of the aforesaid building.
Suffolk County Department of Health Approval . . . . , . . . . . . 85-50-.1.09
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . N756985. . .
Plumbers Certification dated July 28, 1986
. . . `^.-. . . . . . . . . . . . . .
Building Inspector
Rev.1/81
�o�S�FFO Town of Southold
4/11/2016
P.O. Box 1179
r 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38219 Date: 4/11/2016
THIS CERTIFIES that the building RESIDENTIAL ALTERATION
Location of Property: 3675 Nassau Point Rd,Cutchogue
SCTM#: 473889 Sec/Block/Lot: 111.-9-4.2
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/25/2015 pursuant to which Building Permit No. 40112 dated 9/23/2015
was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for
which this certificate is issued is:
INTERIOR ALTERATIONS TO AN EXISTING ONETAMILY DWELLING AS APPLIED FOR
The-certificate is issued to Hermer,David&Campo,Silvia
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED 04-06-2016 David Wermer
A t oriz�d Sign ture
�R
AGRICULTURAL DATA STATEMENT
ZONING BOARD OF APPEALS
TOWN OF SOUTHOLD
WHEN TO USE THIS FORM: This form must be completed by the applicant for any special use permit,
site plan approval, use variance, area variance or subdivision approval on property within an agricultural
district OR within 500 feet of a farm operation located in an agricultural district. All applications
requiring an agricultural data statement must be referred to the Suffolk County Department of Planning
in accordance with Section 239m and 239n of the General Municipal Law.
1. Name of Applicant: Pju
2. Address of Applicant: , 1I,w tQZ1
3. Name of Land Owner(if other than Applicant): ALL-L4ALLIL4 111 Q
4. Address of Land Owner: �,�j' 3t
5. Description of Proposed
Project: "►tea%p ��- 7j ' ! i�t,(�VN
6. Location of Property: (roadd Tax map
number) �,�1 b� 4
7. Is the parcel within 500 feet of a farm operation? { } Yes {a)�No
8. Is this parcel actively farmed? { } Yes {()4.Dio
9. Name and addresses of any owner(s)of land within the agricultural district containing active farm
operations. Suffolk County Tax Lot numbers will be provided to you by the Zoning Board Staff,it is
your responsibility to obtain the current names and mailing addresses from the Town Assessor's Office
(765-1937)or from the Real Property Tax Office located in Riverhead.
NAME and ADDRESS
1.
2. 4
3.
. a
4.
5.
6. t
(Please use the back of this page if there are additional property owners)
w4&--
U 1 1 l �—
Sign ture of A licant Date
Note•
I The local Board will solicit comments from the owners of land identified above in order to consider the effect of the
proposed action on their 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.
a
617.20
Appendix B
Short Environmental Assessment Form
Instructions for Completing
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 I -Project and Sponsor Information
Name of Action or Project: CAM / o AAee' � � ®��� ,W D I
Project Location(describe,and attach a location map): � J�
U15 e^ P®I ��
Brief Description of Proposed Action:
Name of Applicant or Sponsor: (gyp Telephone:
E-Mail: �4irawl Af�OAI �-
rA, LA016
Address:
IN�
�5 kIUU� ;-r, �82
� A
City/Po: 6 Ly State: Zip
-W I
1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES
administrative rule,or regulation?
If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that
may be affected in the municipality and proceed to Part 2. If no,continue to question 2.
2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES
If Yes,list agency(s)name and permit or approval:
3.a.Total acreage of the site of the proposed action? —: —acres
b.Total acreage to be physically disturbed? O acres
c.Total acreage(project site and any contiguous properties)owned r�
or controlled by the applicant or project sponsor? Al acres
4. Check all land uses that occur on,adjoining and near the proposed action.
❑ Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial [ Residential(suburban)
❑Forest ❑Agriculture ❑Aquatic ❑ Other(specify):
❑Parkland
Page 1 of 4
5. Is the proposed action, NO YES N/A
a.A permitted use under the zoning regulations?
b.Consistent with the adopted comprehensive plan?
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape? 0
X
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? X
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? X
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: yy
/o
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:
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? J
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:
V Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional
❑ Wetland ❑ Urban ❑Suburban
15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES
by the State or Federal government as threatened or endangered?
16.Is the project site located in the 100 year flood plain? NO YES
17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES
If Yes,
a.Will storm water discharges flow to adjacent properties? ANO ❑YES
b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)?
If Yes,briefly describe: ❑NO❑YES
Page 2 of 4
18.Does the proposed action include construction or other activities that result in the impoundment of NO YES
water or other liquids(e.g.retention pond,waste lagoon,dam)? J
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 'Q
Applicantlsponsor ' Date: 'A NI�!
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?"
:f ='`•';'r= No,or Moderate
small
to large
impact impact
;A'?_,�, 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 y
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, >11
architectural or aesthetic resources?
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands,
water'bodies,groundwater,air quality,flora and fauna)?
Page 3 of 4
No,or Moderate
small to large
impact impact
may may
occur occur
10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage
problems?
11. Will the proposed action create a hazard to environmental resources or human health?
Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every
question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular
element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3.
Part 3 should,in sufficient detail, identify the impact,including any measures or design elements that have been included by
the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact
may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring,
duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and
cumulative impacts.
❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action may result in one or more potentially large or significant adverse impacts and an
environmental impact statement is required.
❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action will not result in any significant adverse environmental impacts.
Name of Lead Agency Date
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer)
Page 4 of 4
AGENT/ PRESENTATIVE
TRA SACTI AL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this
form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is
necessary to avoid same. � `' '�,
YOUR NAME: N12 �,,�
(Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a
company.If so,indicate the other person's or company's name.)
TYPE OF APPLICATION: (Check all that apply)
Tax grievance Building Permit
Variance ✓ Trustee Permit
Change of Zone Coastal Erosion
Approval of Plat Mooring
Other(activity) Planning
Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or
employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest"
means a business,including a partnership,in which the town officer or employee has even a partial ownership of(or
employment by)a corporation in which the town officer or employee owns more than 5%of the shares.
YES NO Y
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 {• y of ,20�
Signature n(� �✓
Print Name
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. *Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
2. Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its significant
beneficial and adverse effects upon the coastal area(which includes all of Southold Town).
3. If any question in Section C on this form is answered "yes", then the proposed action may affect the
achievement of the LWRP policy standards and conditions contained in the consistency review law.
Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a
determination that it is consistent to the maximum extent practicable with the LWRP policy
standards and conditions. If an action cannot be certified as consistent with the LWRP policy
standards and conditions,it shall not be undertaken.
A copy of the LWRP is available in the following places: online at the Town of Southold's
website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all
local libraries and the Town Clerk's office.
B. DESCRIPTION OF SITE AND PROPOSED ACTION
SCTM# L l i - I -k,1
The Application has been submitted to(check appropriate response):
Town Board 0 Planning Dept. E Building Dept. 0 Board of Trustees
1. Category of Town of Southold agency action(check appropriate response):
(a) Action undertaken directly by Town agency(e.g.capital 0
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
aIJ i Ott OV (�
o� " V,1TWL�J
Location of action: N"NJ PO I O PO C
Site acreage: l7 Lp
Present land use:
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:
(b) Mailing address:
(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 LVWRP Section III—Policies;Page 2 for evaluation
criteria.
❑Yes ❑ No 'Not Applicable
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
LVWRP Section III—Policies Pages 3 through 6 for evaluation criteria
❑ Yes ❑ No VS 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.
riz❑ Yes ❑ No L4J-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.
❑ Yes ❑ No® Not Applicable
Attach additional sheets if necessary
Policy 13. , Promote appropriate use and development of energy and mineral resources. See LWRP
Section III—Policies; Pages 65 through 68 for evaluation criteria.
❑Yes ❑ No ' Not Applicable
Created on 512510511:20 AM
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 ' Not Applicable
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 11 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
0 Yes 0 No 19 Not 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 [E No F"-X 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 ❑ No F 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 N 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.
❑ YesEl No lik 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.
0 Yes ❑ No Not Applicable
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PAUL RICE HERMER CAMPO RESIDENCE DRAWING NO:
ARCHITECTURE 3675 Nassau Point Road,Cutchogue,NY
45 Mam Stzeet Studio 1210 Proposed Site Plan
Bmoklyo,NY 11201 Date:24JUL17 SK-01
718 254 9477 Fax 718 254 9772 Scale.1"=40'
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Board of Zoning Anneals Application
AUTHORIZATION
(Where the Applicant is not the Owner)
I, 11)11ej ' � 14 C—YZ'— residing at '
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(Print property owner's name) (Mailing Address)
V\J do hereby authorize LM L
(Agent)
to apply for variance(s) on my behalf from the
Southold Zoning Board of Appeals.
(Owner's Signature)
(kv i Q H erC,c-
(Print Owner's Name)
APPLICAN /OWNS )
TRANSACTIONAL D E FORM
The Town of Southold's Code of Ethics Prohibits conflicts of interest on the part of town officers and employees The Purpose of this
form is to Provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is
necessary to avoid same.
YOUR NAME:_ k C -�L"�( 1) AV`� I �►
(Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a
company.If so,indicate the other person's or company's name.)
TYPE OF APPLICATION: (Check all that apply)
Tax grievance Building Permit
Variance Trustee Permit
Change of Zone Coastal Erosion
Approval of Plat Mooring
Other(activity) Planning
Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or
employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest"
means a business,including a partnership,in which the town officer or employee has even a partial ownership of(or
employment by)a corporation in which the town officer or employee owns more than 5%of the shares.
YES NO
If 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— 2 day of l�1^,20_L7_
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MAINTENANCE ALTERATION SALEOR E 1
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SUFFOt COUNTY TAX MAP Is PROHIBITED County Center Riverh..d.N Y 11201 m 134111 LIAGE Or AAA
WTI1OuT WRITTEN PERMISSION OF THE Z00OSCALEWFEETM
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