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HomeMy WebLinkAbout52355-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 52355 Date: 10/15/2025 Permission is hereby granted to: JSK Park Ave LLC 159 W 24th St Apt 7B New York, NY 10011 To: construct accessory in-ground swimming pool as applied for per DEC Non-Jurisdiction,Trustees,ZBA approvals with SPDES permit. Premises Located at: 2150 Park Ave, Mattituck, NY 11952 SCTM# 123.-8-10.1 Pursuant to application dated 09/23/2025 and approved by the Building Inspector. To expire on 10/15/2027. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total S400.00 6lding Inspector %` TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone 631 765-1802 Fax 631 765-9502 lhttns-Hwww.soltitholdtowiiny.szov Date Received APPLICATION FOR BUILDING PERMIT CCE9WE Fpr Office Use Only p PERMIT NO. � Building Ins ector, ISjmmP ,gym 3 Pr�'P-p Applications and forms must be filled out in their entirety. Incomplete pullding nelpartment applications will not be accepted. Where the Applicant is not the owner,an Town. of gnu*hoicl Owner's Authorization form(Page 2)shalFbe completed. Dater OWNER(S)OF PROPERTY: Name: �- KTmi 1000- J �� v e��e Lt✓c Project Address: Phone#: a$� y<�©� Email„ Mailing Address: CONTACT PERSON: Name: ) 0—ce.6 L e_��-� Mailing Address: \ O 1A, \\ Z �. W2S�h�M '\oc� \3� C 1\(:,\n$ Phone#: l93\< c3$$.`t450�, Email: cx«d \ e_�k e, C 0 CM3 r CC "Ax DESIGN PROFESSIONAL INFORMATION: Name: .." � � p Mailing Address: > 0 11 5 .��t \,k% i/\/1c4 Avck -Q Phone#: � �Lk_�o Email: �v.Ncrl•\AC' w+ e\, 3*IJ 0. CONTRACTOR INFORMATION: Name; \NC . Mailing Address: \'1y M:, \\ \2�,q e S�Y�0.,r \ Q.CV, 113 Phone#: �,�\ Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑Ne Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ther $ Will the lot be re-graded? 64s [--]No Will excess fill be removed from premises? Dyes P< 1 PROPERTY INFORMATION Existing use of property: _ Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to \:2, O -Z \'*-J(D this property? Dyes [Ao IF YES, PROVIDE A COPY. Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by chapter 236 of the Town Code. 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,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and,reguiations and,to admit authorized inspectors on premises and in bullding(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal1aw. Application Submitted By(print name): 3o-Ce.6 `�'r'�`�� IJAuthorized Agent El Owner Signature of Applicant: Date: STATE OF NEW YORK) S : COUNTY OF � � ) being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the — o.CChro� (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/her knowledge and belief; and that the work will be performed in the manner set forth in the application file therewith. Sworn efore me this day of 20 Notary iublic Kathleen K.Hanna NNary Pubfic-State of flew Y** NO.fiflauelified in Su BOSS olk CounV PROPERTY OWNER AUTHORIZATION Commission M29--.:. (Where the applicant is not the owner) 1, �� " ✓v` residing at Z oO a��. 4VCAvL I,ti do hereby authorize �JG� - i"1 to apply on my behalf to the Town of Southold Building Department for approval as described herein.. Owner s Signature Date Print Owner's Name 2 KATHY HOCHUL Governor AMANDA LEFTON Commissioner August 07, 2025 Lettieri Construction Inc. Jared Lettieri 170 MILL RD W HAMPTON BCH, NY 11978-2346 RE: Letter of Authorization (LOA)for Coverage Under SPDES General Permit for Stormwater Discharges from Construction Activity(CGP) General Permit No. GP-0-25-001 Dear Owner or Operator, The New York State Department of Environmental Conservation (NYSDEC) received a complete electronic Notice of Intent(eNO1) for coverage under GP-0-25-001 for construction activities located at: Project Name: JSK Park Ave, LLC Project Address: 2200 PARK AVE MATTITUCK, NY 11952-2228 Project County: Suffolk Through submission of the eNO1 on August 07, 2025, the owner or operator certified that the eligibility requirements in Part I.A. of GP-0-25-001 have been met, where required. As a reminder, the owner or operator must meet the requirements in Part I.E.6. of GP-0-25-001 prior to disturbing greater than five acres of soil at any one time. Further, this LOA is not the permit document. The owner or operator is required to comply with all requirements in GP-0-25-001, which is accessible on NYSDEC's website: dec.ny.gov The project is authorized to commence construction activity in accordance with Part I.D.3.b. of GP-0-25- 001 as follows: • Project Name: JSK Park Ave, LLC • eNOl Submission ID: HQE-3TZM-B6RB2 • Date authorized to commence construction activity: August 07, 2025 Note that the NYSDEC SPDES Permit Identification No. (SPDES Permit ID)for this project will be sent in a separate correspondence. Also, please be advised there is an annual regulatory fee of$110, which is billed by NYSDEC in the late fall. The regulatory fee covers a period of one calendar year. In addition, there is an initial authorization fee of$110 per acre of land disturbed and $675 per acre of future impervious area. The initial authorization fee covers the duration of the authorized disturbance. If there are any questions regarding the requirements in GP-0-25-001, please contact me. Sincerely, 96V6f, aufW John Muthersbaugh Assistant Engineer Division of Water, Bureau of Water Permits 625 Broadway, Albany, NY 12233 1 dec.ny.gov I john.muthersbaugh@dec.ny.gov 1 (518)402-8188 NEW Department of YORK STATE Environmental Conservation MS4 No Jurisdiction Form for construction activities seeking authorization under the SPDES General Permit for Stormwater Discharges from Construction Activity, GP-0-25-001 (CGP) (In accordance with CGP Part I.D.2.b.,the completed form must be attached to the eNOl and submitted to NYSDEC electronically.) I. Project Owner/Operator Information a. Owner/Operator Name: Lettieri Construction Inc. b. Contact Person: Jared Lettieri c. Street Address: 2200 Park Avenue d. city/state/zip: Mattituck, NY 11952 II. Project Site Information a. Project/Site Name: JSK Park Ave, LLC. b. Street Address: 2200 Park Avenue c. city/state/zip: Mattituck, NY 11952 d. eNOI Submission ID: HQE-3TZM-B6RB2 III. Traditional Land Use Control MS4 Operator Information a. Name of MS4 Operator: Town Of Southold b. MS4 SPDES Permit ID Number: NYR20A 524 c. Street Address: 2200 Park Avenue d. City/state/zip: Mattituck, NY 11952 e. Telephone Number: 6317651560 IV.. Certification Statement in accordance with CGP Part I.D.2.b.ii.3., I hereby certify that the Traditional Land Use Control MS4 Operator identified in section III. of this form does not have review authority over the construction project identified in section II. of this form,which is owned/operated by the entity identified in section I. of this form. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. a. Printed name of the principal executive officer or ranking elected official for the MS4 Operator or their duly authorized representative in accordance with CGP Part VII.J.2.: Albert J. Krupski, Jr. b. Title/Position: Town Supervisor c. Signature: ,. � 41,2 �` ` d. Date: 7/a s- /'7- 5 - Bunch, Connie From: Glew, Claire Sent: Wednesday, September 24, 2025 10:14 AM To: Bunch, Connie; Fuentes, Kim; Kreshon, Catherine; Lanza, Heather; McCullough, Lillian; Michaelis, Jessica; Sakarellos, Elizabeth;Westermann, Donna Subject: Municity Number changes Good morning, The parcels below have been changed as follows: 123.-8-9 & 10 — Deleted 123.-8-10.1- New Parcel bulk moved the information in Municity, except for ZBA. Please review to be sure that all looks good. Thank you. Assistant to Assessor Town of Southold Board of Assessors (631)765-1937 (0) (631)765-1356 (F) www.southoldto n r_g y claireg@southoldtownny.gov i � w w� BOARD OF SOUTHOLD TOWN TRUSTEES S S SOUTHOLD, NEW YORK PERMIT NO. 10673 DATE: NO'VELBER 13 2024 ISSUED TO: ,ISK PARK AVENUE LLC PROPERTY ADDRESS: 2150 & 2200 PARK AVENUE, MATTITUCK SCTM# 1000-123-8-9 & 1000-123-8-10 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on Noy9mber 13 2024, and in consideration of application fee in the sum of$1,250.00 paid by JSK Park Avenue LLC end subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to upon merger of lot#'s 1000-123-8-9 & 1000-123-8-10, demolish two existing single-family dwellings and appurtenances,and construct a two-story,2,670sq.ft. (footprint) single-family dwelling with a 562sq.ft. roofed-over unenclosed masonry patio, a 463sq.ft. raised (12"-16") uncovered masonry patio, and 141sq.ft.grade-level masonry patio with outdoor j kitchen; construct an 18'x50' saltwater-filtration swimming pool (including 5'x10' spa),and a 872sq.ft. grade level masonry pool patio; install a pool drywell,4' high pool enclosure fencing, and a 113sq.ft. grade-level pervious gravel pad; remove existing septic systems and install an All sanitary system landward of dwelling; install stormwater drainage system; and to establish and perpetually maintain a 20-ft.wide vegetated non-turf buffer along the landward edge of the top of bank to preserve and integrate existing vegetation, allowing for a 3-ft wide stepping stone path to proposed 3.5' x 4' wood platform,3.5'-wide wood stairs, 6' x 16.5' grade-level wood platform, and 3.5' x 4.25' wood platform with 3' x 9.16' steps to beach,to be constructed in place of existing stairs and platform on west side of property; and permanently remove existing stairs, platform, and steps on east side of property; and as depicted on the site plan prepared by Marshall Paetzel Landscape Architecture, received on November 8,2024,and stamped approved on November 13,2024. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of the day and year written above. A. Nicholas Kru skt— Na LA M y TERMS AND CONDITIONS The Permittee JSK Park Avenue. I...LQ. ?I a0& 2200 Park Avenue. mattittick Nero "ti°`(ttk as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense,defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 36 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4, That the work involved will be subject to the inspection and approval of the Board or its agents,and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5, That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. T That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8, The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety(90)calendar days of issuance of this permit. 9, That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 11, No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights,title, or interest in real or personal property held or vested in a person not a party to the permit. 07 . - JSK PARK AVE,LLC I APPROWD By y SOhRD OF dl: x s p -I_- ss.� .€.+w-a _ _ •a _ ...tea F V ( s, I - a_ O yyy r �- _ 1 - �. = _ : II a, j aa� 333 r. .a u w�a ( —LEGEND `� [ - ZONING COVEMGE CALCULATIONS I JI _ E I Lz a t � j ✓� .. �. .,-. ., _ .r ��_Sx - SITE PLAN r f � F 3 t i 3R'E=?L�R.i-fs4S�ItaC[ PRELASi CONCWEIE DWYWE46 �-�--y4 x axta-xa axa± _ - BOARD MEMBERS rif S0(l Southold Town Hall Leslie Kanes Weisman,Chairperson , 53095 Main Road •P.O.Box 1179 \ Southold,NY 11971-0959 Patricia Acampora Off ce Location: Eric Dantes sir 'Town Annex/First Floor, Robert Lehnert,Jr. ` `,/ 54375 Main Road(at Youngs Avenue) Nicholas Planamento Soullml NY 11,971 EHIVED http://southoldtownny.gov d- 6 ZONING BOARD OF APPEALS SUN 2 5 2024 TOWN OF SOUTHOLD Tel. (631) 765-1809 " CONFIDENTIAL PRELIMINARY DRAFT FINDINGS for meeting of: June 20,2024 Assigned member: PA ZBA FILE: #7913 NAME OF APPLICANT: JSK Park Avenue,LLC PROPERTY LOCATION: 2150&2200 Park Avenue, Mattituck,NY SCTM#1000-123-8-9 SCTM#1000-123-8-10 SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without further steps under SEQRA. SllFO1� COCINTY ADMINIS IRATIB CODE;: This application was referred as required under the Suffolk County Administrative Code Sections A 14-14 thru A. 14-25,and the Suffolk County Department of Planning issued its reply dated March 18, 2024 stating that this application is considered a matter for local determination as there appears to be no significant county-wide or inter-community impact. LW11 P ""1 hEIIi M1N'ATI This application was referred for review under Chapter 268, Waterfront Consistency review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP).Policy Standards. The LWRP Coordinator issued a recommendation dated May 17, 2024. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department,as well as the records available, it is recommended that the proposed action is CONSISTENT with LWRP policy standards and therefore CONSISTENT with the LWRP. w PROPERTY FACTS/DESCRIPTION.- The subject property currently consists of two lots SCTM#1000-123-8-90 and SCTM#1000-123-8-10,totaling 65,340 square feet,with a buildable lot area of 58,885.50 square feet and located in the Residential R-40 Zoning District. LpL I23-8-t� The northerly property line measures 50.77 feet and is adjacent to Park Avenue, the easterly property line measures 588.77 feet and is adjacent to lot 123-8-10,the southerly property line is 50.38 feet and is adjacent to Great Peconic Bay,the westerly property line is 577.68 feet. The lot is currently improved with one single-family dwelling on the north portion of the property; another single-family dwelling is located at the southerly portion of the property seaward.A shed is located between both dwellings on the westerly border of the lot. Lot 123-8-10: The northerly property line measures 50.27 and is adjacent to Parr Avenue,the easterly property line measures 599.85 feet and the southerly property line measures 50.34 feet and is adjacent to Great Peconic Bay,the westerly property line measures 588.77 feet and is adjacent to lot 123-8-9. It is improved with one single-family dwelling on the northerly portion of the property and another single-family dwelling is located at the southerly seaward portion of the property. The properties share an asphalt driveway with parking on the east and west sides Page 2,June 20,2024 97913,JSK Park Avenue SCTM No. 1000-123-8-9& 123-8-10 of each lot along with each lot has stairs to the beach. Both lots areas shown on the survey map prepared by Kenneth M.Woychuk, LS, and last revised March 25, 2024. BASIS OF APPLICATION: Request for Variances from Article III, from Sections 280-13A(1);Article IV,Section 280-17A(1); Article IV, Section 280-18; and the Building Inspector"s January 8,2024 Notice of Disapproval based on an application for a permit to merge two adjacent lots and to demolish three(3)existing single-family dwellings, keep one existing single-family dwelling and construct an additional new single-family dwelling, an accessory in- ground swimming pool and accessory detached ;garage; 1) proposed lot is less than the minimum lot width of 150 feet; 2) one-family detached dwelling, not to exceed one-single family dwelling on each lot; located at: 2150 and 2200 Park Avenue, (Adj.to Great Peconic Bay)Mattituck,NY. SCTM#1000-123-8-09 and 1000-123-8-10. R ,LLEE RI3 I.JE T D; The applicant requests variances to permit the merger of two adjacent lots and to demolish three(3)existing single-family dwelling, keep one existing single-family dwelling and construct an additional new single-family dwelling, accessory inground swimming pool and accessory detached garage at: Location of property: 2150 and 2200 Park Avenue, Mattituck,NY: Suffolk County Tax Map 41000-123-8-10 and Suffolk County Tax Map#1000-123-8-9. The proposed lot line change to merge tax map# 1000-13-8-10 to the western adjacent lot tax map# 1000-123-8-09 is not permitted pursuant to Section 280 Attachment 3 Bulk Schedule for Residential Districts R-40,which required a newly created lot to have a lot width of 150 linear feet. The proposed merger will create a lot width of 100.54 linear feet. The proposed merger will create a lot that requires approval from the Southold Town Planning Board. Additionally,the proposed new construction,on the potentially created lot having a buildable lot area of 58,885.80 square loot in the Residential R-40 Zoning District, is not permitted pursuant to Article IV, Section 289-17A(1), reference Article. III 280-13A(1)which states: One-family detached dwelling, not to exceed one dwelling on each lot. PLANNING BOARD MEMORANDUM- On May 24, 2024, the Zoning Board of Appeals received a Notice of Memorandum from the Southold Town Planning Board in reference to this application. The Planning Board supports the substandard and nonconforming width of 100.54, where 150 feet is required. The merger would result in the elimination of a nonconforming lot. If the lots are merged,the resulting parcel would be made less nonconforming in the R-40 District. The proposal will eliminate the nonconformity of the two dwellings on one of the parcels. The buildable area of the lot and new dwelling are not located within a snapped. FEMA Flood Zone. While the Planning Board agrees with the merger it had pause to approve the allowance of the one existing single-family dwelling being allowed and the code does not allow for more than one dwelling per lot, However,the Board reconsidered the request to allow the existing dwelling if it were to be put on the Town Affordable Mousing'Registry and rented year-round. There is no basis for the ZBA to impose covenants and restrictions on the second existing dwelling for use as a year- round affordable rental as suggested by the Planning Board ADDITIONAL INFORMATION; The proposed remaining dwelling on parcel 123-8-10 is a legal pre-existing nonconforming,residence. Prior ZBA decision#7589 in 2022 variance relief was granted for the construction of a new single-family residence on a neighboring property with an existing second dwelling. The applicant will be installing a new(I/A) Innovative Alternative Onsite Wastewater Treatment System for both existing and proposed dwellings. The Site Plan for the new dwelling along with the in-ground swimming pool and the one and one-half story garage was prepared by Jonathan Karl Paetzel, Landscape Architect, and dated March 25,2024. Page 3,June 20,2024 #7913,JSK Park Avenue SCTM No. 1000-123-8-9& 123-8-10 F The Zoning Board of Appeals held a public hearing on this application on June 6,2024 at which time written and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property and surrounding neighborhood,and other evidence,the Zoning Board finds the following facts to be true and relevant and makes the following findings: 1. Town Law 4267-bQ(bXl).1 Grant of the variances will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The neighborhood is mixed with parcels meeting the 150-foot width requirement while there are others that do not. Also,there are other improved properties,in the neighborhood that have two single-family dwellings on one lot. If the merger is approved, it will not change the character of the neighborhood. 2. Town,Law k267-bQ)(b)f2). The benefit sought by the applicant or cannot be achieved by some method,feasible for the applicant to pursue,other than an area variance. Without approval to merge the two lots,and demolish three of the existing dwellings,the applicant cannot achieve the benefit of combining these substandard parcels to create a single parcel with a conforming lot in the absence of variance relief, as there is no way that the code required lot width can be achieved. 3. Town Law §267-W)ffl3 . The variances granted herein for the lot width is mathematically substantial, representing 33% relief from the code. However, the merger will reduce the nonconformity of the lot and the lot width,is consistent with other parcels in the neighborhood. 4. Town Law 62:67-bQ(b)(4). No evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood. The applicant must comply with Chapter 236 of the Town's Storm Water Management Code. S. Town Law §267-bQJb1 U5 . The difficulty has been self-created. The applicant purchased the parcel after the Zoning Code was in effect and it is presumed that the applicant had actual or constructive knowledge of the limitations on the use of the parcel under the Zoning Code in effect prior to or at the time of the purchase. 6. Town Law,§267-b. Grant of the requested relief is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of a single merged lot with a new single-family residence with a new in-ground swimming pool and a new 11/2 story garage and keeping the existing single-family dwelling while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUT1 DN, OF THE BOARD: In considering all of the above factors and applying the balancing test under New York Town Law 267-B,motion was offered by Member Acampora, seconded by Member Weisman(Chairperson), and duty carried,to GRANT the variances as applied for, and shown on the Site Plan prepared by Jonathan Karl Paetzel, Landscape Architect and last revised March 25,2024 SUgLECT TO TIEE FOLLOWING CONDMONS: 1. The septic system on the subject property must be approved by the Suffolk County Department of Health Services for a new I/A OWTS Innovative Wastewater Treatment System for both the existing and proposed dwellings. 2. The new proposed accessory garage shall remain unfinished and uninhabitable 3. The applicant shall receive approval from the Southold Town Board of Trustees for a Wetland Permit. p Page 4,June 20,2024 #7913,JSK Park Avenue SCTM No. 1000-123-8-9& 123-8-10 4. The applicant shall receive approval from the Southold Town Planning Board 5. Pool pump equipment/mechanicals roust be located a minimum of 20 feet from any property line or be contained in a shed type enclosure with a lot line set back that is in conformance with the bulk schedule for accessory structures 6. Drywell for pool de-watering shall be installed. This approval shall not be deemed effective until the required conditions have been met.At the discretion of the Board of Appealsfaiture to comply with the above conditions may render this decision null and void That the above conditions be written into the Building Inspector's Certificate of Occupancy, when issued The Board reserves tlse right to substitute a similar design that is de minimis in nature for an alteration that does not increase the degree of nonconformity. IMPORTANT LIMITS ON THE APPROVALS GRANTED HEREIN Please Read Carefully Any deviation from the survey,site plan and/or architectural drawings cited in this decision,or work exceeding Ilse scope of the relief granted herein, will result'in delays and/or a passible denial by the Building Department of a building permit and/or the issuance of a Stop Work Order,and nsay require a new application and public hearing before the Zoning Board ofAppeals. Any deviation from the variance()granted herein as shown on the architectural drawings,,site plan anda'or survey cited above,such as alterations,extensions,demolitions,or demolitions exceeding the scope of the relief grassted herein,are not authorized under this application when involving nonconformides under the zoning" code. This action doer not authorize or condone any current or future use,setback or other feature of the subjeet property that.may violate the Zoning Code,other than such uses,setbacks and other features as are expressly addressed in this action. TIME LII" TS ON IRIS A' PROVALt Pursuant to Chapter 280-146(B)of the Code of the Town of Southold any variance granted by the Board of Appeals shall become null and void where a Certificate of Occupancy has not been procured,and/or a subdivision asap has not been filed with the Suffolk County Clerk,within three(3) years from the date such variance was granted. The,Board of Appeals,may,upon written request prior tsa the date of expiration,grant an extension not to exceed three(3)consecutive one(1)year terms.1T IS THE PROPERTY OWN'M S RLSPONSIrBILICTY TO ENgjU_RE COMPLIIANCB WUH T E CODE REQUIRED TIIM FRAME DESCREBEDHEREIN.Failure to comply in a timely manner may result in the denial by the Building Department of Certificate of Occupancy,nullify,the approval variance relief",and require a new variance application with public hearing before the Board of Appeals Vote of the Board: Ayes: Members Weisman(Chairperson),Dantes, Planamento, Acampora and Lehnert. (5-0) c fslienes Wei an, Chairperson Approved for filing .6 /2,/ /2024 u i i JSK PARK AVE,LLC APR 44 ID2E - i,'S:NG a 5-d d ---`- m - mareull opeT ' c. ....__ € +tea-% €sc€ ur=•::. E - � S^ r.> >RCH. vi 3 v�,6Rs-P. tIlarse�m<tit -4z FT rn - 3 t —_ 3 m 7 ,, — x t f fr a — m e . ., 4 m asp €mot Z a ,.� i dxxl.e--haa k ate_ FINAL"A']REVIEWED BY ZBA - DATED'(Na ar = 3 LEGEND CALCU6aRON5. sd� � ZONING COVERAGE CALCULATIONS €`- ivauaa� > a€Ta• Eaea Y 3>T. 'F Sa r3 4 �ae=s 1Ac'E i ,-•_,� -�.�- [€ IN NGWWMGEC LWO Tf0N F � I •� -` � � �-�sa�ra�-. �s€an�a:�+-asp -. - } [ffiiz + ;C t3-t- .;il-s -4).2&.;,-t>e�-{•;" ., `�R ;xisi+' �mtE ' �� -- fil�` ��: � SITE PLAN I f 1 -_ -> f; ; PRDPOSED COVEEAGE GlQ1tAT1PN -- `-' ..teems ` rn: �` 4 �- -: 7 AY$ 8'�a� � L. [ € l3FEAE• �'� E=J � x e L 3 ta•U':eS�.-°�.... _ _ I 3i".nre c€€��§ = � - � 1�3�: - cL_ 'd S�G3�£€$T't€`[$L NOfE-eOROM DF TDeEMIN SABDVEGHDDNRYATEREIEV.£ 0u€3:S?- €vpw9iR %3#,fy#..: §: --- S 7 ^ YEa. €.�z2 - S 1 AS SXGWN ONTEiT@gBEOaTA PBf:FARFD • . ° SP tN MdbNAl0 GE0.5OFN�MBFDDlI85Rffi3 F�NAaXCe�r�- �:i RF.S_[b*Fi � 3 �.s € q .. - �. 1 .�,�'.z.a SXEET B OF9 A� '�9A1`° ti Dyr 1.err1,••14 4 Y l N9hNS eUttnMSTINGAOU 2071T VERAGmAtREs V47BXN° .aE DA� .: a FXISTINGL07COVEWIGE 4 ^ n BULLMBLEIANO 28 7775E BBACRES OWELLMG( 2 'a.DBl BF. 4 ,T *. JB� 4 OwaUNGINORTN)fm RE 4'uAECNdwA7 dr,p, SA DAEUM VILaRTTM.I L�CN S.F. fNElLING(5DUIH)'168d SF. TOTAL 2765 SF.ar B e% TO TO TAL 2M I SF.wBBR ry 4eAR0. O AnNO N w` d� DaGrrNvv yJ A.a J Ky N LpMy y Si. MA 4Y wo Y" M VA AA 1A 4 S.C.T.M.#1000-123-8-11.3 e,^rr � ,I Iaw4ax� �mrd« LAND N/F OF X r P CNC PARK AVENUE LLC min"�Ayr^+4°A yr" � N d r rAs I 41;,,�« Iwr"mra g DWELLINGS IN/PUBLIC WATER 0 (n�'� 150,, rN i m ti r u °r I., ; lirytlar°a " 5.6i.M.11000-123-8-8.3 LAND N/F OFyA'�„• e° /� TIMOTHY MURRAY '% DWELLINGS \ W/PUBLIC WATER .tiv A.mNnLT V 150' DRNENAY rr^arw AM 0'9w yN° ii tlm' yfiA VN° Ai4' Ad"GM1A p M'tlrA 'CW dly� nD•igMBi � °p��w wq p^^�� — IqP•� 1 .° y�r{LYry4• P T�' W�R:LLING 1 J Ski SLIT SAAa 5.0' 2 z I 1 ym4 keel SP N" rv+A 4 SP 1YA M \ DAE rNG \\ w•" ,m.. BAOM T.ON•E�x SI b IkWNAD LEOWIFNLE ,,•r' AA FEMA MAP#36103CO482H REVISE LOT AREAS TO CURRENT MHW 03-25-24 LOT 9:29,171.71 S.F.or 0.67 ACRES STAKE PROPOSED STRUCTURES 02-25-24 LOT 10:29,714.09 S.F.or 0.68 ACRES �• AREA 58..,885..�80 50"P`T,.qY 1,35,.ACRES ELEVARd7 DAINW. NAVD88 ' asa,J'Y d VI ZONE VE(EL 8) LNAUNOMgO ALTERAnav aR ADwnov ro nns svgcer rs A aa.Inav rr sEcnW rzoB ar rNE A/EW rom srATE EWc.Inaw uA: cOwEs a nus sURLET ,."� •P. ` NAP NOT BEARMC ME LAND SIREWE 'S ENBO5H0 SEAL SHALL Nor W MWERM TO W A VWO TRUE COPY. GUARANTEES IA'O' TV HEREON 9 Al RUN Myto DIE PERSCYI A B R SUBLET 6 PREPARED AND W E BENAL£TD W RRE COMPANY,W°ERNMENTAL AGENCY AND LENDING MSRNTGN USIED HEREON,AND TG ME ASSIL 4M OF NE LENAWC NSI71V N.WARAN7 ARE NOr WANSAER .. THE pFTS£IS OR dMFN510Y5 SNGNN NDYEOV AROM RIE PROPERTY LLNES TO DIE SIRULTIMES ARE ApP A SPEDMC PURPOSE AND USE RIENEFOFE RIFT IRE �°lOUES ° °WNW L� NOT NIDIDED 10 GLWUMENT illE PROPERTi'LV&3 M)o WpE NE ERELROV A<AEWCf'S.A001 RLWAd 51RUCNRES LW ANO DRIER ONN)4EMEN75 EA4 E— ICIfNTTD N Qr�_ __ FRT]MLltW1511-O�I2 a� wnR oc DESCRIBED PROPERTY MNnccaROEG ARE Nor WaRAxrEED INLEss nlrsr CERTIFIED To: SK PARK AVE.RLLC; BLED smATED AT:MATTITUCK m-m-,SOUTHOLD N g ry?r 11. PLLC.. V SUFFOLK COUNTY,NEW YORK p f eioael Lead S—ying ead Dejign P 0 Hoz 153 A ue6ogUe N York I1031 OIE WATER SUPPLY.*ELLS;OR&D S AND CESSVM RMS 4 LOCA BONS SHOW ARE AROAI RE30 DHSERVARWS E1LE 8222-113 seA1c•1"=30' DATE:AUG. 30, 2022 N xx V {NFO PHGne(eeL)eae-Lees FAX(631)M-IM AAV LR DATA OBTANED PRaV OTHERS p!EOwwDepartment of KATHY HOCHUL sTAT� Irvironenta[ Governor Conservation AMANDA LEFTON Commissioner PERMIT MODIFICATION August 7, 2025 JSK Park Avenue LLC c/o Sarah Kim 159 West 24t" Street, Apt. 713 New York, NY 10011 Re: Permit#1-4738-03280/00005 JSK Park Avenue LLC — 2150 & 2200 Park Avenue SCTM# 1000-123-8-9 & 10 Dear Permittee: The Department of Environmental Conservation (DEC) has reviewed your request to modify the above referenced permit in accordance with the Uniform Procedures Regulations (6NYCRR Part 621). It has been determined that the proposed modifications will not substantially change the scope of the permitted actions. In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your modified permit. Please carefully read all permit conditions and special permit conditions contained in the permit to ensure compliance during the term of the permit. If you are unable to comply with any conditions, please contact us at the above address. This revised permit is a modification to the original permit and must be available at the job site whenever authorized work is in progress. Sincerely, Kim Garguilo Environmental Analyst cc. Robert Herrmann, En-Consultants BMHP File Division of Environmental Permits,Region 1 50 Circle Road, Stony Brook,NY 11790 1 dec.ny.gov I dep.rl@dec.ny.gov 1 (631)444-0365 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION � Facility DEC ID 1-4738-03280 PERMIT Under the Environmental Conservation Law (ECU Permittee and Facility Information Permit Issued To: Facility: JSK PARK AVENUE LLC JSK PARK AVE LLC PROPERTY C/O SARAH KIM 2150 &2200 PARK AVEISctm# 1000-123-8-9& 10 159 W 24TH ST APT 7B MATTITUCK,NY 11952 NEW YORK,NY 10011 (917) 520-9967 Facility Application Contact: EN-CONSULTANTS 1319 N SEA RD SOUTHAMPTON,NY 11968 (631) 283-6360 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Facility Principal Reference Point: NYTM-E: 709.407 NYTM-N: 4540.003 Latitude: 40°59'03.6" Longitude: 72°30'38.8" Project Location: Great Peconic Bay Authorized Activity: Remove lot line between two existing lots to merge lots into one; remove existing wood platform and stairs on the northern and southern lots; construct new access stairs and 59.2sf platform landward of the bulkhead; construct 3.5' x 4'landing with 3' x 7.33' stairs on the seaward side of the bulkhead. All work shall be done in accordance with the plans prepared by Jonathan Karl Paetzel, last revised 7/29/2025, and stamped'NYSDEC Approved'Modification on 8/7/2025. KLG NOTE: All work landward of the top of bank, as shown on the approved plans, is beyond Article 25 (Tidal Wetlands)jurisdiction. In accordance with the current Tidal Wetlands,Land Use Regulation (6NYCR.R661), no permit is required to conduct activities landward of that contour. Permit Authorizations Tidal Wetlands -Under Article 25 Permit ID 1-4738-03280/00005 New Permit Effective Date: 4/17/2024 Expiration Date: 4/16/2029 Modification# 1 Effective Date: 8/7/2025 Expiration Date: 4/16/2029 Page 1 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-03280 NYSDEC Approval By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations,and all conditions included as part of this permit. Permit Administrator:KIMBERLY L GARGUILO, Deputy Regional Permit Administrator Address: NYSDEC Region 1 Headquarters SUNY @ Stony Brook150 Circle Rd Stony Brook,NY 11790-3409 Authorized Signature: Q4 y Date Bl� Distribution List EN-CONSULTANTS Bureau of Marine Habitat Protection File _..__m�.. Perm.._ Permit Components NATURAL RESOURCE PERMIT CONDITIONS GENERAL CONDITIONS, APPLY TO ALL AUTHORIZED PERMITS NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following Permits: TIDAL WETLANDS 1. Conformance With Plans All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or applicant's agent as part of the permit application. Such approved plans were prepared by Jonathan Karl Paetzel, last revised 12/18/23, 2. Post Permit Sign The permit sign enclosed with this permit shall be posted in a conspicuous location on the worksite and adequately protected from the weather. 3. Notice of Commencement At least 48 hours prior to commencement of the project,the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project,the bottom portion of the form must also be signed and returned, along with photographs of the completed work. Page 2 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION r Facility DEC ID 1-4738-03280 4. Storage of Equipment,Materials The storage of construction equipment and materials shall be confined to the upland area landward of the top of bluff. 5. Equipment,Material Stored Away from Crest of Bluff The storage of construction equipment and materials shall be confined to upland areas landward of the crest of the bluff or hill. 6. Maintain Erosion Controls All erosion control devices shall be maintained in good and functional condition until the project has been completed and the area has been stabilized. 7. No Disturbance to Vegetated Tidal Wetlands There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activities. 8. No Alteration of Bluff for Stairway Alteration of the existing grade of the bluff or hill during construction of the stairway is prohibited. 9. Stairway Design The stairway must be elevated a minimum of 3 feet over grade to minimize disturbance or loss of the natural vegetation and reduce the potential for causing or accelerating erosion of the bluff or hill. Disturbance to the natural vegetation or topography seaward of the crest(top) of the bluff or hill must be restricted to an 8-foot wide area,including the width of the stairway,as shown on the approved plans. lo. Wood Preservatives a. Pressure treated wood used for construction of in-water structures must have undergone a treatment process approved(stamped or otherwise marked as certified)by the American Wood Preservative Association. b. Wood treated with Pentachlorophenol(PCP)must not be used in marine or brackish waters. Wood treated with PCP must be aged in the open air for at least three months prior to in-water use. c. The use of creosote treated wood is prohibited both in the water and upland areas. d. Chromated Copper Arsenate (CCA)pressure treated wood must be clean and free of CCA surface deposits. Wood with surface deposits must be washed for at least 5 minutes under running water prior to use. The washing must occur greater than 100 feet landward of any regulated wetland and/or water body. (Note "E." below for handling wash water.) e. Any wood debris such as sawdust or wash water must not enter any water body, including wetlands or protected buffer areas. 11. Clean Fill Only All fill shall consist of clean sand, gravel, or soil(not asphalt, slag, flyash,broken concrete or demolition debris). 12. Department Jurisdiction The department retains jurisdiction of all regulated lands where fill has been permitted. Placement of fill shall not be used to alter the department's Tidal Wetland jurisdictional area at the project site. The area remains a regulated area subject to Tidal Wetland Land Use restrictions of 6 NYCRR Part 661. 13. Vegetate All Disturbed Areas The permittee shall revegetate all exposed faces and disturbed areas to prevent soil erosion prior to the project completion or expiration date of this permit,whichever comes first. Page 3 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION 'Raw Facility DEC ID 1-4738-03280 14. Seeding Disturbed Areas All areas of soil disturbance resulting from the approved project shall be stabilized with appropriate vegetation(grasses, etc.) immediately following project completion or prior to permit expiration, whichever comes first. If the project site remains inactive for more than 48 hours or planting is unpractical due to the season,then the area shall be stabilized with straw or hay mulch or jute matting until weather conditions favor germination. is. Temporary Mulch,Final Seeding If seeding is impracticable due to the time of year, a temporary mulch shall be applied and final seeding shall be performed at the earliest opportunity when weather conditions favor germination and growth but not more than six months after project completion. 16. Plant Beach Grass The area of fill placement shall be planted with American Beach Grass planted 12 inches on center during the first growing season following placement, but not more than 6 months following the placement of fill. The permittee shall maintain a beach grass survival rate of at least 85% after 3 years. Any grass planted after April 15 of any calendar year shall be irrigated. 17. Long-term Plant Survival The bluff shall be planted with American Beach Grass and the permittee shall ensure a minimum of 85% survival of plantings by the end of five growing seasons. If this goal is not met,the permit holder shall re-evaluate the restoration project in order to determine how to meet the mitigation goal and submit plans to be approved by the office of Marine Habitat Protection NYSDEC Region I Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony Brook,NYl 1790 -3409 18. Contain Exposed, Stockpiled Soils All disturbed areas where soil will be temporarily exposed or stockpiled for longer than 48 hours shall be contained by a continuous line of staked haybales/ silt curtains (or other NYSDEC approved devices)placed on the seaward side between the fill and the wetland or protected buffer area. Tarps are authorized to supplement these approved methods. 19. Materials Disposed at Upland Site Any demolition debris, excess construction materials, and/or excess excavated materials shall be immediately and completely disposed of in an authorized solid waste management facility. These materials shall be suitably stabilized as not to re-enter any water body, wetland or wetland adjacent area. 20. No Construction Debris in Wetland or Adjacent Area Any debris or excess material from construction of this project shall be completely removed from the adjacent area(upland) and removed to an approved upland area for disposal. No debris is permitted in wetlands and/or protected buffer areas. 21. State Not Liable for Damage The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 22. Precautions Against Contamination of Waters All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants,epoxy coatings,paints, concrete, leachate or any other environmentally deleterious materials associated with the project. Page 4 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION 'Row Facility DEC ID 1-4738-03280 23. State May Require Site Restoration If upon the expiration or revocation of this permit, the project hereby authorized has not been completed,the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may lawfully require,remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 24. State May Order Removal or Alteration of Work If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if,upon the expiration or revocation of this permit, the structure, fill,excavation,or other modification of the watercourse hereby authorized shall not be completed,the owners, shall,without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require,remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. ...._._. . GENERA._. _�.. L CONDITIONS Apply to ALL Authorized Permits: 1. Facility Inspection by The Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation(the Department)to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71- 0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. 2. Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department,issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. Page 5 of 7 n � .NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION 'Raw Facility DEC ID 1-4738-03280 3. Applications For Permit Renewals,Modifications or Transfers The permittee must submit a separate written application to the Department for permit renewal,modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal,modification or transfer granted by the Department must be in writing. Submission of applications for permit renewal,modification or transfer are to be submitted to: Regional Permit Administrator NYSDEC Region 1 Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony Brook,NY117§0-3409 4. Submission of Renewal Application The permittee must submit a renewal application at least 30 days before permit expiration for the following permit authorizations: Tidal Wetlands. 5. Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to exercise all available authority to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a.. materially false or inaccurate statements in the permit application or supporting papers; b. failure by the permittee to comply with any terms or conditions of the permit; c. exceeding the scope of the project as described in the permit application; d. newly discovered material information or a material change in environmental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e. noncompliance with previously issued permit conditions, orders of the commissioner,any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. 6. Permit Transfer Permits are transferrable unless specifically prohibited by statute,regulation or another permit condition. Applications for permit transfer should be submitted prior to actual transfer of ownership. Page 6 of 7 Y ,NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-03280 NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee, excepting state or federal agencies, expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York,its representatives, employees, and agents ("DEC")for all claims, suits, actions, and damages,to the extent attributable to the permittee's acts or omissions in connection with the permittee's undertaking of activities in connection with, or operation and maintenance of, the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions,or damages to the extent attributable to DEC's own negligent or intentional acts or omissions, or to any claims, suits,or actions naming the DEC and arising under Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors,employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of- way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights,title, or interest in real or personal property held or vested in a person not a party to the permit. Page 7 of 7 Albert J. Krupski, Jr. � S F O�]E�l��]MA\T]EIK SUPERVISOR 1�v1[A\IAA\�G�]EI��I[]E1��C' SOUTHOLD TOWN HALL-P.O.Box 1179 `w *53095 Main Road-SOUTHOLD,NEW YORK 11971 T y l oW n of So u th o l d J ; 17 � 4 w; M"� 1 6 - STORMWATER MANAGEMENT REFER'. FORM (APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) NAME: ....... Date: rur c�1 RA_-.�e I%c n s Contact Information: _www____mmmmm . �2 l ...�mm. �'�,�c- �-,�.... �....._�...___.�...- (E....Mad& Fele GaBrwe Number) Pro e Address / Location of Construction Site: 4e' ... S.C.T.M. #: 100IT0 v e.l� v e, District ......... 0 a G - o o . o o Section Block L..t_ 0 TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT - Area of Disturbance is less than I Acre. No S.P.D.E.S. Permit is Re aired ! Project does Not Discharge to Waters of the State. No S.P.D.E.S. Permit is Re aired ! - Area of Disturbance is Greater than I Acre & Storm-water Runoff Discharges Directly to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Bu(Idst'a Permit. ❑ - Area of Disturbance is Greater than I Acre & Storm-water Runoff Flows Through Southold Town's MS4 Systems to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit through the Southold Town En ineerin De artment Pr to issuance issuance of a Buaup(Lrng Permit, Reviewed B): •_-•— FORM " SMCP-TOS December 2024 r,