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HomeMy WebLinkAbout#8092SE - Schrank ZBA application Revised 6121123 TOWN OF SOUTHOLD ZONING BOARD OF APPEALS , >ti 5'"�';a�s Phone(631)765-1809 APPLICATION FOR A SPECIAL EXCEPTION PERMIT FOR AN DEC I J 2025 ACCESSORY APARTMENT IN AN ACCESSORY BUILDING Zoning Coard of A\ pc,,- Applicant(s)Name(s) Ci 4 rN Applicant(s)Address >♦ is Phone: I.411. &, 1 Email: rw�� era � , a MI/we are the owners of the subject property [ ] I am the agent for the property owner and my Letter of Authorization and Transactional Disclosure Form is attached. Representative(if other than applicant): rr Address I " Phone: &121 .JS1 . 059 a Email: CALF epn., A. Statement of Om m^mership and Interest_: d wet 1 w,,. � is(are)the owner(s)of the property known and referred to as House No. S et. Hamlet ip od'e Identified olt the Suffolk County� Maps as District 1000,Section�Block Lot(s) Lot Size 1 * done District as shown on the attached deed and survey The above-described property was acquired by the owner(s)on I/we-hereby apply to the Zoning Board of Appeals for a Special Exception Permit pursuant to Section§280-13B(13)of the Zoning Ordinance to establish an accessory apartment in an accessory building as shown on the attached survey/site plan and floor plan(s) B. Pr2ject Descriiiption: /ft dl tode—kVV-Yl 4 July 2023 Application Page 2,Special Exception for Accessory Apartment C. The applicant alleges that the approval of this special exception would be in harmony with the intent and purpose of said zoning ordinance,and that the proposed use conforms to the starstc�re' therein and would not be detrimental t or Rersons in the nei hb orb0o fbrt id ollowirt reasons: y F ,,�ri (01 ?oning IV— D. The applicant alleges that the following standards prescribed by Section§280- 13(13)(13)(a)-(k)of the zoning ordinance will be met: a. The accessory apartment will be located in the accessory building. b. The owner of the premises shall occupy either the existing single-family dwelling or the accessory apartment in the detached accessory structure as the owners'principal residence.The other dwelling unit shall be occupied by a family member as defined in Section§280-4 of the code or a resident who is currently on Southold Town's Affordable Housing registry and is eligible for placement,evidenced by a written lease,for a term of one or more years. c. The accessory apartment shall contain no less than 220 square feet and does not exceed 750 square feet of livable floor as defined in Section§280-4 of the code d. The accessory apartment will be located on one floor of the accessory building and will contain No more than two bedrooms and No more than one bathroom. e. A minimum of three on-site parking spaces shall be provided as shown on the attached survey. f. Not more than one(1)accessory apartment shall be permitted on this parcel. g. No Bed and Breakfast facilities,as authorized by Section§280-13(B)(14)hereof shall be permitted in or on the premises for which an accessory apartment is authorized or exists. h. The accessory apartment will meet the requirements of a dwelling unit as defined in Section 280-4 of the Zoning Code. i. This conversion shall be subject to a building permit,inspection by the Building Inspector and Renewal of Certificate of Occupancy annually. j. The existing accessory building which is converted to permit this accessory apartment has been in existence and has a valid Certificate of Occupancy for po less Chan threes,and is attached hereto. k. The existing building,together with this accessory apartment,shall comply with all other requirements of Chapter§280 of the Town Code of the Town of Southold. 1. This conversion for the accessory apartment shall comply with all other rules and regulations of the New York State Construction Code and other applicable codes. E. The property which is the subject of this application (check all that apply): [ ]has not changed since the issuance of the attached Certificates of Occupancy [ ]has changed or received additional building permits.Certificates of Occupancy for these changes are attached or will be furnished [ ]has been the subject of a prior ZBA decision(s),copies are attached Owner Signature L aAl COUNTY OF SUFFOLK) ss.: STATE OF NEW YORK) Sworn to b re me this (� day of ,20 a S (Notary Public) 4 Notuy Public,Stft ofNew Yorla 6/21/23 IS r raararar a REM No.010MMM Qualified to lk Co/ty July 2023 '�/PPgl R444M°�M. d. Y FORM Na 4 TOWN OF SOUTHOLD D BUHMING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z7730 . . . . . . Date . . . . . . . . . . . . Juhe . . . 2.2 . . THIS CERTIFIES that the building located at . .Westphalia Road „ , Street Map No. . . XX}L. . , . . , Block No. . .XX . . Lot No, XKX Mattituck N.Y. w . requirements for one family dwelling & Reusing Code conforms substantially to the built before Apr 23 57 Ce ca a of occupancy dated . . . . .. . . . . .. . . . . . , , . . , . ., 19. . . . pursuant to which t No.Z7730 dated . . . . , , . . . . . .June. . 22. . . .. 1977. ., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is Private on family dwe' ling with acces^ory garage issuedis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . The certificate is issued to .Gerald B. Armstrong & 'wife Owners of record (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval pre- existing. . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. pre-existing . . . . . . . . . . . r . HOUSE NUMBER . . . . . . �86?. . . Street Westphalia Road Mattituck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . , . . Building 4 Inspector FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT °r Office of the Building Inspector Town Hall DEC 1 G 2025 Southold,N.Y. Certificate Of Occupancy No. . . Z191 -7. . . . . . . . Date . , . . . . . . . December 26. . . . . . . THIS CERTIFIES that the building . . . . . . . a.ddit:�-Qrx. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property Westphalia. Rd, Mattituck Houma No. Street Hamlet County Tax Map No. 1000 Section . . . . 4 . . . ,Block . . . . . . . .3� . . . . . .Lot . . . .4. . . . . . . . . . . . Subdivision . . . . . . . . . . .X. . . . . . . . . . . . . . . . . .Filed Map No. . . .?f. . . .Lot No. . . . . . .X. . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . June. 25 . . . . . . . . , 19 8.5 pursuant to which Building Permit No. . . . . . . . . . . dated . . . . . Auly. .2 . . . . . . . . . . . . . . . 19 85 ,was issued,and conforms to all of the requirements of the applicable provision,of the law.The occupancy for which this certificate is issued is . . . . . . . . . . . . . A:ddati,4Ki. to .(��0.9tiria .4X1e..9gLM;.?y. . . . . . . . . . . . . . .. . . . . . . . . . . . . The certificate is issued to . . . . . . . . . . . . EDWARD NOLAN of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . .. . . . . . N/A„ . . . . . . » . . . . . . „ . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . . . . , . „ . . . „ . , „ _ . „ „ . sit { „ . . . Building Inspector . . . . . » . Rov.1/a1 FORTS NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT , Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17373 Data SEPTEMBER 30 198 THIS CERTIFIES that the building ALTERATION y Location of Propertyy I865 WESTPHALIA ROAD MATTITUCE. House No. Street Hamlet County Tax Map No. 1000 Section 141 Block I Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 5, 1988 pursuant to which Building Permit No. 172I3Z dated JULY 14 1988 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued i PARCH ON EXISTING DWELLING. The certificate is issued to ED NOLAN (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A tA144-J Building Spector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. �� CERTIFICATE OF OCCUPANCY ti No Z-23303 Date OCTOBER 24 . 1994 THIS CERTIFIES that the building ADDITION Location of Property 1865 WESTPHALIA ROAD MATTITUCK NY House No. Street Hamlet County Tax Map No. 1000 Section 141 Block 1 Lot 4 Subdivision Filed Map No. Lot No. T_ conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 30 1985 _pursuant to which Building Permit No. 14419-Z dated NOVEMBER 4 1985 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 A DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to EDWARD A. NOLAN, JR. & ELIZABETH NOLAN (owner's) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Bui ding inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26726 Date: 10/06/99 THIS CERTIFIES that the building ACCESSORY Location of Property: 1865 WESTPHALIA RD MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 141 Block 1 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 9 1995 pursuant to which Building Permit No. 22642-Z dated MARCH 23 1995 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY TOOL SHED AS APPLIED FOR. The certificate is issued to PAUL LICHTENBERG (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A t /Xilding Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building InspectoOn��� O�id ' Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33369 Date: 10/31/08 THIS CERTIFIES that the building ALTERATION Location of Property: 1865 WESTPHALIA RD MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 141 Block 1 Lot 4 Subdivision Filed Map No_ Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 70, 2008 pursuant to which Building Permit No_ 34230-Z dated OCTOB'ER 15, 2006 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 "AS BUILT" ALTERATIONS TO AN EXISTING NONHABITABLE ACCESSORY GARAGE AS APPLIED FOR. The certificate is issued to LORI CARSON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ N/A PLUMBERS CERTIFICATION DATED N/A Aigho,i,ed Signature Rev. 1/81 TOWN OF SOUTH OLD PROPERTY � 3 f c � ��-� STREET 1 VILLAGE DIST. SUB. LOT ' t OVER OWNER .` s E �' - b a S W TYPE OF BUILDING � - 1 SEAS. _ VL. FARM COMM. CB. MISC, Mkt. Value - LAND � I�vIP TOTAL DATE I REMARKS 00, s , t E a a N � L-— l�� &oos 33Iy e a t AGE IL l G N iT �� - -NEW A NORMAL BELOW ABOVE f FARINA Acre I Value Per Value Acre 1G I ll o ion Jr ��' Tillable" 1 � ' � a �' � x : � Tillable 2 E - I tillable 3 s /n Noodland i j �' � �� rs g l IQ8 3wompl,and - - -- FRONTAGE ON WATER sn . FRONTAGE ON ROAD 3rushland t DEPTH douse Plot E 7 1BULKHEAD rotoI I �DOCK L tJC� f \\\Flg, \ 31 IN \\\ \\ \ \ \ \ a s > v v v w 3 41 yv \\ ham :: Ka v A Vv Me m y v 9 A y Ix o 41-1 \ \mammil.�7 - 1 _ IOOfs \, ,Wim il ter In "tor Ffini a�s. \. \ o\ \ _ > Heat \\\ \ \ \ ~ \ t Type,Roof - \\\ \ _. :Recreation Rooms 2 d F �� Y a . y_ h v y A � W!0710!�54-15, lvw yv v _L �v ..:; y;_. .A v� \. y. v,_. �.� �_ Ef � � - \ -.`ems. y aa:h A Owl" ����� �\�.�Av - eA\ A — - a\ a. gw y y »,y ;.. HI MEN .�'- ` y •��. , ti _ CC# : C25-38800 COUNTY CLERK'S OFFICE E STATE OF NEW YORK COUNTY OF SUFFOLK ' � The Clerk of the County of Suffolk and the Court of Record thereof do hereby certify that I have compared the annexed with the original DEED recorded in my office on 12/30/2020 under Liber D00013084 and Page 890 and, that the same is a true copy thereof, and of the whole of such original. In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 07/23/2025 SUFFOLK COUNTY CLERK VINCENT PULEO SEAL i lil Illilli II II Illll Iliii II IIi 111 l l llll l l 11 11 lull I II i 1111i IIIIIIIIIIiiI SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DEED Recorded: 12/30/2020 Number of Pages: 4 At: 04:23:06 PM Receipt Number : 20-0217963 TRANSFER TAX NUMBER: 20-16110 LIBER: D00013084 PAGE: 890 District: Section: Block: Lot: 1000 141 . 00 01 .00 004 .000 EXAMINED AND CHARGED AS FOLLOWS Deed Amount: $650,000. 00 Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $20 .00 NO Handling $20.00 NO COE $5 .00 NO NYS SRCHG $15.00 NO EA-CTY $5.00 NO EA-STATE $125 .00 NO TP-584 $5.00 NO Notation $0. 00 NO Cert.Copies $0.00 NO RPT $200 .00 NO Transfer tax $2 , 600.00 NO Comm.Pres $10,000 .00 NO Fees Paid $12,995.00 TRANSFER TAX NUMBER: 20-16110 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County 1 Number of pages RECORDED 2020 Dec 30 04:23:06 PM / Iw1 H NAG. PASCRLE A �lJ This document will be public JUD d' record. Please remove all "- uLERk 0E -8UF'EOLK COUNTY Social Security Numbers L DOOO prior to recording. ;MF��d9 0T# 20-16110 Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps 3 FEES Page/Filing Fee r Mortgage Amt. Handling 20. 00 f 1.Basic Tax 2. Additional Tax TP-584 Sub Total Notation Spec./Asslt. or EA-52 17(County) Sub Total Spec./Add. EA 5217(State) TOT.MTG.TAX R.P.T.S.A. Dual Town Dual County Held forAppointment Comm.of Ed. TransferTax + �, �m�� Affidavit � Mansion Tax Certified Copy The property covered by this mortgage Is or will be Improved by a one or two NYS Surcharge 15. 00 family dwelling only. Sub Total Other YES or NO Grand Total _ _,. FIfNee appropriate tax clause on of this Instrument. 20052389 42 -,3-a Ua--0 4 Dist.1 2.000 14100 0100 004000 0,10-DEC �I 5 unity Preservation Fund Tax Service SMI 1111111111101111111 Real Consideration Amount$ � Agency CPF Tax Due Verification �- _ ........ _ .m- .., _ ._ __ ..... 5,.�, _..,,,m... / �e Improved +� 6 SatNsfactlons C€ischarg E�II i s R p1�C1gy Owners Mailing Address Vacant Land � � 1 TO TD TO Mail to:Judith A. Pascale,Suffolk County Clerk Title Company Information 310 Center Drive, Riverhead, NY 11901 www.suffolkcountVny.gov/clerk Co.Name ty y.gov/clerk Titlefi $ Suffolk County Recording & Endorsement " g ent Page This page forms part of the attached_... Dec°''( made by: (SPECIFY TYPE OF INSTRUMENT) The premises herein Is situated in SUFFOLK COUNTY,NEW YORK. �+ TO�i In the TOWN of In the VILLAGE or HAMLET of 13OXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. over CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY THIS INDENTURE,made the 3'd day of 111clln 6.6-- 2020 BETWEEN Susan Maushart, residing at 1865 Westphalia Road, Mattituck, New York 11952 party of the first part, and Caroline Schrank, residing at l0zl cfh-CGf' .1•i a,-ile4. IlLl/GOL`l party of the second part, WITNESSETH, that the party of the first part, in consideration of TEN dollars paid by the party of the second part, does hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, ALL that certain plot, piece or parcel of land,with the buildings and improvements thereon erected, situate, lying and being in the See Schedule A attached hereto and made a part hereof. Being and intended to be the same premises as conveyed by Grantor by deed dated December 30, 2009 and recorded January 22, 2010 in Liber 12614 at Page 140, in the Office of the Clerk of Suffolk County, State of New York. TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof;TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said premises; TO HAVE AND TO HOLD the premises herein granted unto the party of the second part, the heirs or successors and assigns of the party of the second part forever. AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatever, except as aforesaid_ AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose.The word"party"shall be construed as if it read"parties"when ever the sense of this indenture so requires. IN WITNESS WHEREOF , the party of the first part has duly executed this deed the day and year first above written. IN PRESENCE OF: Susan Maushart a' " C�r\fs A r �t� n t °`V Standard N.Y.B.T.U. Form 8002 Bargain and Sale Deed,with Covenant against Grantor's Acts-Uniform Acknowledgment Form 3290 P'1 Peconic Abstract, Inc. Title No.641-S-04412 � �. .. Schedule A Description ALL that certain plot, piece or parcel of land, situate, lying and being at Mattituck, In the Town of Southold, County of Suffolk and State of New York, bounded and described as follows: BEGINNING at a point on the Southwesterly side of Westphalia Road, distant 332.45 feet, Southeasterly from the corner formed by the Intersection of the Southwesterly side of Westphalia Road;and the Southerly side of Youngs Avenue; RUNNING THENCE along the Southwesterly side of Westphalia Road, South 70 degrees 00 minutes East(deed; South 70 degrees 21 minutes 20 seconds, actual), 82.50 feet, to land now or formerly of Robert and Kathleen Royer, now or formerly of Roberta and William Lindsay; THENCE along said land, South 26 degrees 49 minutes West, 264 feet(deed; 263.38 feet, actual), the land formerly of Walter Armbrust, now or formerly of Dorothy'and John Zawaky; THENCE along said land now or formerly of Eunice Armbrust, North 70 degrees 00 minutes West(deed; North 70 degrees 21 minutes 20 seconds West, actual), 82.50 feet, to land now or formerly of Virginia Armbrust, now or formerly of Gla and John Hoeg; THENCE along said land, North 26 degrees 49 minutes East, 264 feet (deed; 263.38 feet, actual), to the Southwesterly side Westphalia Road and the point or place of BEGINNING. TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE IN NEW YORK STATE State of New York,County of Suffolk ss: State of New York,County of as: On the *Id day of &e4-7&6- in the year 2020 On the day of in the year before me,the Sd undersi ned,pers nall appeared before me,the undersigned,.personally appeared personally known t o me or prayed me on the basis of personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s)whose name(s)is satisfactory evidence to be the individu Bits)whose name(s)is (are)subscribed to the within instrument and acknowledged to (are)subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their me that helshelthey executed the same in his/her/their capecity(ies),and that by his/her/thei r signature(s)on the capacily(ies),and that by his/her/their signatOre(s)on the instrument,the individual(s), or the person upon behalf of which instrument,the individual(s),or the person ul:ioh behal f of which the individual(s)acted,executed the instrument. the individual(s)acted, executed the instrument. (signature a d office of In •' lE (signature and office of individual taking acknowledgment) AT�Q'�I O NOTARY R/BI.IC,STATE OF NEW YORK Reoamfios No.01016094250 Qmh5W in 9o4olk Coaay Coommis fim FVbw lone 16.2023 TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE OUTSIDE NEW YORK STATE State(or District of Columbia.Territory,or Foreign Country)of ss: On the day of in the year before me,the undersigned, personally appeared r personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s)whose name(s) is(are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capecity(ies), and that by his/her/t heir signature(s)on the instrument,the individual(s),or the person upon behalf of which the individual(s)acted, executed the instrument, and that such individual made such appearance before the undersigned in the _in (insert the City or other political subdivision) land insen'the State ou t t e t e Arkno n) (signature and office or individual taking acknowledgment) DISTRICT 1000 SECTION 141 BARGAIN ANDSALE DEED BLOCK 1 WITH COVENANT AGAINST GRANTOR'S ACTS LOT 4 Mattituck Title No. &ti/l�`, Oyyr� COUNTY OR TOWN 1865 Westphalia Road Maushart STREET ADDRESS TO Recorded at Request of Schrank RETURN BY MAIL TO: DISTRIBUTED BY Karen Hagen, Esq. 16 Vista Court Riverhead, New York 11901 W 9 O [7 0 ar O ca w 0 W W N K s W V Q a N N z o< W y W QUESTIONNAIRE FOR FILING WITH YOUR ZBA APPLICATIONO2 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? a/ No Yes,please explain on attached sheet. C. 1.)Are there areas that contain sand or wetland grasses? lV 2.)Are those areas shown on the survey submitted with this application? 3.)Is the property bulk headed between the wetlands area and the upland building area? ND 4.)If your property contains wetlands or pond areas,have you contacted the Office of the Board of 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? Py E. Are there any patios,concrete barriers,bulkheads or fences that exist that are not shown on the survey that you are submitting? E, 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? f J 0_ G. If yes,please submit a copy of your building permit and survey as approved by the Building Department and please describe: H. 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. I. Do you or any co-owner also own other land adjoining or close to this parcel? #40 If yes,please label the proximity of your lands on your survey. J. Please list present use or operations conducted at this parcel 1-51' I/MtL P and the proposed use K. (example,:existing single family,proposed: same with garage,pool or other) Au 11orized srature ar,d D to July 2023 617.20 Appendix B Short Environmental Assessment Form r 0 Instructions for Completing Part 1-Project Information. The applicant or project sponsor is responsible for the completion,o£Fpaw '1."R ponses become part e'fthe application for approval or funding,are subject to public review,and may bdsubject 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:. Project Location(describe,and attach a location map): Brief Description of Proposdd Action: /,- s'L po5c� JA-o u A-cte55� ayvGllwi d r� � �70fr Wt* � Name of Applicant or Sponsor: Telephone: G3� 1 J4 _J#,4JC OA E-Mail: v Address: 4 rq-e---✓1.0 city/Po: State: Zip Code: o waL 1 Wifa l.Does the proposed alti6n 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 slte 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? 0 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial ZResidential(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 bu`ijt-(!r natdr�l,,. NO YES landscape? proposed J N, 7. Is the site of the ro osed action located in,or does rt 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: 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.Is the proposed action located in an archeological sensitive area? 13. a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? V/ 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 Pf 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? '1 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? ZrNO ❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO AYES 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- Date: z Zd L 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 ener ,Y conservation or renewable eraerppnrtunities` 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 d o,or Moderate small to large r 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. IZA / JJ(W�10 A to I�Fm� I�_t tv�s - '4 ZPZi__ I Name of Lead Agency i6ate Print or N 11 am R I onsible Officer in Lead Agency TiTle"A kespons6ble Officcerr ig attire o p risible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) Page 4 of 4 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# - I The Application has been submitted to(check appropriate response): p� Town Board 0 Planning Dept. E] Building Dept. 0 Board of Trustees L d'. 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: ( fVVx V Location of action: Ow- 0' I4 + Site acreage: Present land use: Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: GG- (b) Mailing address; It c Telephone number: Area Code - 1 � 0 ❑ p O (d) Application number, if any: Wild action be directly undertaken,require funding, or approval by a state or federal agency? es LJ Nog 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 F] No ❑ Not Applicable 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 1 V � Yes 11 No ❑ Not Applicable Board of Zoning AD12eal§Ay 12lication, OWNER'S AUTHORIZATION (Where the Applicant is not the Owner) I, residing at S P MA k k- (Print property owner's name) (Ailing Address) do hereby authorize . (Agent) to apply for variance(s) on my behalf from the Southold Zoning Board of Appeals. By signing this document,the Property Owner understands that 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 map 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 to the date of expiration,grant an extension not to exceed three(3)consecutive one(1) year terms. IT IS THE PROPERTY OWNER'S RESPON IBILITY TO ENSURE COI PLIANCEWITH THE CODE REQUIRED TIME FRAME DESCRIBED HEREIN. Failure to comply in a timely manner may result in the denial by the Building Department of a Certificate of Occupancy, nullify the approved variance relief, and require a new variance application with public hearing before the Board of Appeals 0. (Owner's Signature) Ca (b6t �Okr-�nv— (Print Owner's Name) July 2023 AGENT/REPRESENTATIVE / TRANSACTIONAL DISCLOSURE FORM The jown of Southold1j,fode of Ethics prohibits conflicts of i n the part of t wvn offleea a r se f this f rm is to provide inf rt ation which can alert the town d,pqsgible,Sgafligts If interest and allow it to tanke whatever actign is necessgry,to avold same. YOUR NAME: ,l rK Cdlt)N t i P-A 7,0 e A,1,0 l,. ., (Last name,first name,middle initial,nntess yore 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 day P44 ,20 Signature Print Name July 2023 APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM The Town of Sou_lhold1j.Cqde of Ethju.,11rolijbits Sonflictsf'ntere toll thp.,12art of town 2ifficerlrtt I s.The 'puEpoH of this form-is to nrovide informa ion whigh can alert the t wn of possible conflicts of interest and It w it to take wliatev r aetion 11 ngegslan,to avoid-sarog.,, YOUR NAME: t L (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) Q an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this day of C ( ) Signature &tVA Print Name July 2023 r Schrank Residence 1865 Westphalia Road,Mattituck,NY 11952 SCTM# 1000-141-1-4 Property photos—12.12.2025 Page 1 of 2 �r p I n� Y; o w r r, is � t � It Main house-to remain unaltered Schrank Residence r 1865 Westphalia Road,Mattituck,NY 11952 SCTM# 1000-141-1-4 Property photos—12.12.2025 Page 2 of 2 -� Accessory Structure to be removed. I s Fur' Shed and Gazebo to be removed.