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HomeMy WebLinkAbout#8101-Gaillard CS Revoc Trust ZBA application FORM NO.3 TOWN OF SOUTHOLD '`�I BUILDING DEPARTMENT SOUTHOLD,N.Y. Received NOTICE OF DISAPPROVAL FEB 0 2.2026 Date:November 21 uoaro of '4pp"s TO: Gaillard CS Revoc Trt 430 E 57th St#3D New York,NY, 10022 Please take notice that your application received October 9,2025: For permit to: constnwct additions and alterations to an existing seasonal dwelfi ng and convert the Gotta" into a ear-round sin le-famil dw Iin at: Location of property: 556 Bel l Hill Avenue Fishers Island.NY County Tax Map No. 1000—Section 9 Block 3 Lot 4 Is returned herewith and disapproved on the following grounds: The propgsed construction on this nor-coi forming 29.272 s . ft. parcel in the Residential R-SO ursuant Article XXIII 20-124 which states lots measurin between 20.000 and 39 999 s uare feet iun total size reou.ire a minimum front yard setback of 40 feet. The proposed construction as shown.on the site V1an.has a front and setback of 9.25 feet. 4 'r A.64orized Signatu Note to Applicant: Any change or deviation to the above referenced application may require further review by the Southold Town Building Department. CC:file,Z.B.A. Fee:$ Filed By: Assignment NO. ' lrt APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPE 0 2 20?_9 AREA VARIANCE 20 ing Boaro House No. 556 ,Street Bell Hill Avenue Hamlet Fishers Island SCTM 1000 Section 9 Block 3 Lot($) 4 Lot Size .67 ac. Zone R-80 I (WE) APPEAL THE WRITTEN DETERMINATION OF THE BUILDING INSPECTOR DATED 11/21/25 BASED ON SURVEY/SITE PLAN DATED 10/6/25 Applicant(s)/OwnerO: Gaillard CS Revoc Trt, c/o Christopher Gaillard Mailing Address: 430 E. 57th Street, #3D, New York, NY 10022 Telephone:(212)456-8805 Fax: Email: christopher.gaillard@gmail.com NOTE:In addition,to the a_b2ve please complete below if application is signed by applicant's attorney,agent, architect,builder,contract vendee,etc.and name of person who agent represents: Name of Representative: Sam Fitzgerald Architect, PC for( )Owner(X)Other: Agent Address: 15 E. Putnam Avenue, #234, Greenwich, CT 06830 Telephone: (860) 287-3808 Fax: Email: sam@sfapc.net Please check to specify who you wish correspondence to be mailed to,from the above names: ( )Applicant/Owner(s), ()Q Authorized Representative, ( )Other Name/Address below: WHEREBY THE BUILDING INSPECTOR REVIEWED SURVEY/SITE PLAN DATED 10/6/25 and DENIED AN APPLICATION DATED 10/7/25 FOR: (K)Building Permit ( )Certificate of Occupancy ( )Pre-Certificate of Occupancy ( )Change of Use ( )Permit for As-Built Construction ( )Other: Provision of the Zoning Ordinance Appealed. (Indicate Article,Section,Subsection of Zoning Ordinance by numbers.Do not quote the code.) Article: Section: 280 Subsection: 124 Type of Appeal. An Appeal is made for: Qg A Variance to the Zoning Code or Zoning Map. ( )A Variance due to lack of access required by New York Town Law-Section 280-A. ( )Interpretation of the Town Code,Article Section ( )Reversal or Other A prior appeal( ) has, M has not been made at any time with respect to this prope , UNDER Appeal No(s). Year(s). . (Please be sure to research before completing this question or call our office for assistance) Name of Owner: ZBA File# - 2 - REASONS FOR APPEAL.(Please be specific, additional sheets may be used with p c� Ceived signattn•e notarized): Jun 1.An undesirable change will not be produced in the CHARACTER of the neighbor or a detri>�EBto� attYy�fiOI properties if granted,because: Zoning Boara of Appeals The existing house on the subject property is located almost completely within the required front yard. The applicant is seeking to expand the footprint of the existing house by constructing: 1) a two-story addition of 281 sq. ft., of which only 16 sq. ft. is within the required front yard; 2) a 273 sq. ft. open-roofed pergola structure, to cover an existing patio. The existing house is by far the smallest in the neighborhood. With the additions, the house will still be the smallest, and will be of a size, scale, volume and height that fits well within the character of the neighborhood. The existing house is set well away from surrounding houses, and the proposed additions will have no detrimental impact on neighbors' properties. 2.The benefit sought by the applicant CANNOT be achieved by some method feasible for the applicant to Pursue,other than an area variance,because: Any work to a portion of an existing structure within existing non-conforming setbacks must go through the variance process. 3.The amount of relief requested is not substantial because: The proposed two-story addition is mostly conforming except for a very small piece, 16 sq. ft. With the proposed work, the lot coverage will increase by only 1% over existing, from 4.8% to 5.8%, well below the maximum 20%. Except for the front yard setback, the proposed additions otherwise conform to the zoning ordinance in every respect -- GFA, Sky Plane, building height, etc. 4.The variance will NOT have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because: No adverse impact. The proposed addition constitutes a very small expansion of the building footprint within the required front yard. No increase in traffic as a result of this work. i. Has the alleged difticufty been self created? (X; Yes, or { t No why: even though the location of the N addition as proposed works the most logically with the existing house and is the most cost M effective and architecturally appropriate expansion, the house in theory could be radically reconfigured and restructured so as to move the addition to a completely conforming location. Are there any Covenants or Restrictions concerning this land? (X No } Yes(please fitrnish a copy) W b '� This is the MINIMUM that is necessary and adequate,and, the sane tine.preserve and protect the $ c character of the neighborhood and the health, safety and w `itrt!of the t(ar III unity. N E E � !" .u '- . �. of ts�l�eBi'ror mIS� �! Si �t'!at of A t l c. t( th(t zed Agent (Agent t Mwr submit xr a « Otto).'t rc7rexatpopg.from Owner) Notary d tt. _ tyre - 3 - APPLICANT'S PROJECT DESCRIPTION Samuel W. Fitzgerald, agent, for APPLICANT: Gaillard GS Revoc Trt DATE PREPARED: 11/30/25 1. For Demolition of Existing Building Areas G'Celvpr4 Please describe areas being removed: None II.New Construction Areas(New Dwelling or New Additions/Extensions): FEB 0 2 2026 Addition: 1 V-6" x 12'-8" (146 sq. ft.); Zoning Boatu o, Hppeals Dimensions of first floor extension: Pergola: 9'-0" x 30'-4" (273 sq. ft.) Dimensions of new second floor: Addition: 1 V-6" x 1 V- " 1 5 sq.ft Dimensions of floor above second level: n a Height(from finished ground to top of ridge): 22'-7" Is basement or lowest floor area being constructed?If yes,please provide height(above ground)measured from natural existing grade to first floor: n/a III. Proposed Construction Description(Alterations or Structural Changes) (Attach extra sheet if necessary). Please describe building areas: Number of Floors and General Characteristics BEFORE Alterations: Two-story frame residence of 1,374 sq. ft. Number of Floors and Changes WITH Alterations: No change in number of floors or building height. Existing house footprint: 708 sq. ft. IV. Calculations of building areas and lot coverage(from surveyor): Existing one-story garage: 657 sq. ft. Existing square footage+ofbuildings on your property: Existing TOTAL coverage: 1,365 sq. ft. Proposed increase of building coverage: 146 sq. ft. addition + 273 sq. ft. pergo a ---TOTAL 419 s . ft. Square footage of your lot: 29,272 +/- sq.ft. Percentage of coverage of your lot by building area: Existing --4.7% Proposed --6.1% V.Purpose of New Construction: Single-Family Residence VI. Please describe the land contours(flat,slope%,heavily wooded, marsh area,etc.)on your land and how it relates to the difficulty in meeting the code requirement(s): The property is mostly all flat but with a fairly steep hill on the rear of the property. It is by and large open lawn, with a garden on the north side of the property and decorative landscaping around the house. There is no difficulty in meeting code requirements. Please submit 8 sets of photos,labeled to show different angles of yard areas after staking corners for new construction,and photos of building area to be altered with yard view. -4 - annip) QUESTIONNAIRE o FOR FILING WITH YOUR ZBA APPLICATION eceivw A. Is the subject premises listed on the real estate market for sale? Yes X No FEB 0 2 2026 B. Are there any proposals to change or alter land contours? Zoninc, ,L®,L U, _%poeals X No Yes please explain on attached sheet. C. 1.)Are there areas that contain sand or wetland grasses? No 2.)Are those areas shown on the survey submitted with this application? n/a 3.)Is the property bulk headed between the wetlands area and the upland building area? n/a 4.) a your property contains wetlands or pona areas, nave you contactea ine urnce or the Town trustees for its determination of jurisdiction? n/a Please confirm status of your inquiry or application with the Trustees: n/a 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? No E. Are there any patios,concrete barriers,bulkheads or fences that exist that are not shown on the survey that you are submitting? No 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? No If yes,please submit a copy of your building permit and survey as approved by the Building Department and please describe: G. Please attach all pre-certificates of occupancy and certificates of occupancy for the subject premises. If any are lacking,please apply to the Building Department to either obtain them or to obtain an Amended Notice of Disapproval. H. Do you or any co-owner also own other land adjoining or close to this parcel? No If yes,please label the proximity of your lands on your survey. I. Please list present use or operations conducted at this parcel single family residence and the proposed'use Single family residence (ex:existing single family,proposed:same with garage,pool or other) Authoosignat§' a d Pte - 5 - `l FOBM NM 4 TOWN OF SOUTHOO BUILDING DEPA � I C Tom Clerks Offim Southold, N. Y. Received FEB 0 2 2026 Zoning tiUhrU o, �peals Certificate Of Occupancy No. . . . . . . . Date . . . . . . , , , . ". . . . , . . . . 19�1 .., THIS CERTIFIES that the building located at M/O. A@U. 44 AV9. . . . . . . Street Map No. . Ax. . . . . . . . Block No. . . 74 . . . . .Lot No. ;mac . . 'i�k��t�C . �. ��#�d, . . .•X e . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . . .JVAY. . 1.2, 19. 7.4. pursuant to which Building Permit No. .?�1 944. dated . . . . . . . . . . .Auk . .?— . . ., 19. A, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Private .(aAaessQry). .garago. huildj. 9. . . . . approved by Bd App®als) The certificate is issued to . . Wt .P.•. -Q0 Utr0. !fir. . , . ftlor . . . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval , N.R. . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. . N.R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSE NUMBER _ .none. . . . . Street , . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ! / .. . . . . . . . . Building bapeato - 6 - b Town of Southold 12/14/2019 P.O.Bog 1179 53095 Main Rd Southold,New York 11971 Received CERTIFICATE OF OCCUPANCY FEB Q 212026 Zonirit, u("diG ui >,wp®als No: 40934 Date: 12/16/2019 THIS CERTIFIES that the building ELECTRICAL Location of Property: Bell Hill Ave,Fishers Island SCTM M 473889 Sec/Block/Lot: 9.-3-4 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/28/2019 pursuant to which Building Permit No. 44339 dated 10/28/2019 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' electrical nary The certificate is issued to Gaillard Wm D Revoc Trust of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTMCATE NO. PLUMBERS CERTIFICATION DATED A.utho ' Sigila - 7 - Town of Southold 10/22/2020 P.O.Box 1179 53095 Main Rd Southold,New York 11971 sece1\/P CERTIFICATE OF OCCUPANCY Zoninc, No: 41530 Date: 10/11/2020 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: Bell Hill Ave,Fishers Island SCTM#: 473889 Sec/Block/Lot: 9.-3-4 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/31/2020 pursuant to which Building Permit No. 45320 dated 10/11/2020 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 builtV"additions and alterations including ara a converted to li "n aceesecond flPor deck and a teri r irs to second 'oar,to existingseasons one fa "ly dw- elling as ggplied,,for pqr New York State Petition number 2019-0556. The certificate is issued to Gaillard Wm D Revoc Trust&Ano. of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED AutlaoW SignaWe - 8 - , 1 Town of Southold 10/22/2020 53095 Main Rd Recei pr' Southold,New York 11971 FEB 022026 ��� Zoning Boar' 01 "'Weals PRE EXISTING CERTIFICATE OF OCCUPANCY No: 41531 Date: 10/13/2020 THIS CERTIFIES that the structure(s)located at: Bell Hill Ave,Fishers Island SCTM#: 473889 Sec/Block/Lot: 9:3-4 Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 41531 dated 10/13/2020 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: seasonal wood i"n rre one i dwellin with covered en and a under.' Notes: BP 7496 a=ssM garage CO 22 . BP 44339 electrical gurypy C Z:40934 4 320 "as built"ad_`tions/alterations COZ-41530 The certificate is issued to Gaillard Wm D Rev Tr&Ano. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. ' AuthoWed Sina - 9 - AGRICULTURAL DATA STATEMENT ZONING BOARD OF APPEALS TOWN OF SOUTHOLD WHEN TO USE THIS FORM: This form must be completed by the applicant y permit, site plan approval, use variance,area variance or subdivision approval on property within an agricultural distriet OR within 500 feet of'a farm operation located in an agricultural district. A9 FRP104%W 6 gj requiring an agricultural data statement crust be referred to Cite Suffolk Counly Department of Planning in accordance with Section 239m and 239n of the General Municipal Law. Zoning -OWO 01 ,appeals 1. Name of Applicant: Gaillard GS Revoc Trt, c/o Christopher Gaillard 2. Address of Applicant: 430 E. 57th Street #310 New York NY 10022 3. Name of Land Owner(if other than Applicant): 4. Address of Land Owner: Same 5. Description of Proposed. Project: Pro osed 281 s . ft. two-storV addition to existing: single family residence. Proposed 273, s . ft open roofed pergola over existing patio. 6. Location of Pro erty:(road and Tax ma number)8 8 elN l 111 ,Avenue, FisAers Island, NY SCTM# 1000 --- 9 --- 3 ---4 7. Is the parcel within 500 feet of a farm operation? { } Yes PQ No 8. Is this parcel actively farmed? { } Yes Q(}No 9. Name and addresses of any owner(s)of land within the agricultural district containing active farm operations. Suffolk County Tax Lot numbers will be provided to you by the Zoning Board Staff,it is your responsibility to obtain the current names and mailing addresses from the Town Assessor's Office (765-1937)or from the Real Property Tax Office located in Riverhead. NAME and,ADDR.ES , 1. 2. 3. 4. 5. 6. (Please use the back of this page if there are additional property owners) IL 7 CL Signature o p licant Date Note: 1.The local Board will solicit comments from the owners of land identified above in order to consider the effect of the proposed action on their farm operation. Solicitations will be made by supplying a copy of this statement. 2.Comments returned to the local Board will be taken into consideration as part as the overall review of this application. 3.Copies of the completed Agricultural Data Statement shall be sent by applicant to the property owners identified above. The cost for mailing shall be paid by the Applicant at the time the application is submitted for review. - 10 - 617.20 Appendix B Short Environmental Assessment Form Instructions for Corn let&n Received <A C) Part 1 -Project Information. The applicant or project sponsor is responsible for the comple#"J"112Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or inw sti tion would bg�noe�edNeo 1y respond to any item,please answer as thoroughly as possible based on current inforationornny uoarc, 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: Additions to the Christopher Gaillard residence Project Location(describe,and attach a location map): 556 Bell Hill Avenue, Fishers Island, NY SCTM# 1000 --- 9 --- 3 ---4 Brief Description of Proposed Action: Proposed 281 sq. ft. two-story addition to existing single family residence. Proposed 273 sq. ft. open roofed pergola over existing patio. Name of Applicant or Sponsor: Telephone: 860-287-3808 Samuel W. Fitzgerald, agent E-Mail: sam@sfapc.net Address: 15 E. Putnam Avenue, #234, Greenwich, CT 06830 City/PO: State: Zip Code: Greenwich CT 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that X 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: ZBA and Building Department X 3.a.Total acreage of the site of the proposed action? - acres b.Total acreage to be physically disturbed? .0046 +/- acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? •67 +/- acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial X Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 - 11 - 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? X b.Consistent with the adopted comprehensive plan? Received X 6 Is the proposed action consistent with the predominant character of the existing r tti obrft�tais D NO X S landscape? rt LUL ` 7. Is the site of the proposed action located in,or does it adjoin,a state liste�oqj�Lcaj,Egv#onlneMA pga? NO YES If Yes,identify: Fishers Island X 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES X b.Are public transportation service(s)available at or near the site of the proposed action? X c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? X 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: X 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: X 11. Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: X 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? X b.Is the proposed action located in an archeological sensitive area? X 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? X b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? X 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 ® 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? X 16.Is the project site located in the 100 year flood plain? NO YES X 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, X a.Will storm water discharges flow to adjacent properties? IN NO❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and stone drains)? If Yes,briefly describe: ❑NO C9 YES xis Irw an new ownspoutied o new ewe Page 2 of 4 - 12 - 18.Does the proposed action include construct,. _or other activities that result in the impoundm, of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: X ww 19.Has the site of the proposed action or an adjoining property been the location of an Gliv6,f NO YES solid waste management facility? llii 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: X I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE pplicatttlportst name: W- 001 Date: ail 14#0 * Signature: li�r 41 A 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 eneMy conservation or renewable suer o oriunities? 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 - 13 - No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Pa vd question in Part 2 that was answered `moderate to large impact may occur",or if there is a need to exp a Mh ' particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Pant 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that hav470t muaghy 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,pro bil" 0�1� rr 0gkppeals duration,irreversibility,geographic scope and magnitude.. Also consider the potential for short-e n -term and cumulative impacts. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) Page 4 of 4 - 14 - Board of Zoning Appeals AP12fication c Received AUTHORIZATION FEB 0 2 Z026 (Where the Applicant is not the Owner) Zoning boai o 01 Appeals I Christopher Gaillard residing at 430 E. 57th Street, #31D (Print property owner's name) (Mailing Address) New York, NY 10022 do hereby authorize Samuel W. Fitzgerald, (Agent) Architect to apply for variance(s)on my behalf from the Southold Zoning Board of Appeals. (Owner's Signature) (Print Owner's Name) - 15 - APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM The Town of$oHj -es own officgrs em[!1oyje_&The pj!IM�ne of _h2ld's Cade Ethics prohibits conflicts of interest this(_orm is to provide info_rMatjon wbicb can alert the Lowlj of go.Mb,le conflicts,qfinterest and allow it to take whatever action J2 necessary to avoid same. YOUR NAME: Christopher Gaillard (Last name,first name,middle initial,unless you are applying in the name of someone else or "06 COMPIMY.If so,indicate the other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Fe - Tax grievance Building Permit Variance X Trustee Permit 7-cming n'6391 0i 9006d1g 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 X. 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 9640' .201#*!r Signature Print Name - 16 - AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The _p Tow p of Southold's Qo_de q_f Ethics prohibits conflicts 2[interest on the part of town officers and cm jqv2ees..The ourposeq this form is to provide information which can alert the town of Possible conflicts of interest and allow it to take whatever action is necessary to avoid same. Received YOUR NAME: Samuel W. Fitzgerald (Last name,first name,middle initial,unless you are applying in the name of someone else or other I s company.If so,indicate the other person's or company's name.) . TM WVIA26 SjcA TYPE OF APPLICATION: (Check all that apply) Zoning Ljo&r_ o, Appeals Tax grievance Building Permit Variance X 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 X 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 &oo Submitted this (lay f Signature A) I Print Name q Yj- 17 - town of Southold FEB 0 2,2026 LWRP CONSISTENCY ASSESSMENT FORM Zoning Board of Appeals k. INSTRUCTIONS 1VbA I. 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. 3. DESCRIPTION OF SITE AND PROPOSED ACTION 3CTM# 9 .. 3 4 the Application has been submitted to(check appropriate response): town Board 0 Planning Dept. 0 Building Dept. Bowl of Trustees 0 Z B A Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g.capital 0 construction,planning activity,agency regulation, land transaction) (b) Financial assistance(e.g. grant, loan,subsidy) (c) Permit,approval, license,certification: lature and extent of action: Seeking a zoning variance to construct 281 sq. ft. two-story addition to existing single family residence; and a 273 sq.ft. open roofed pergola over existing patio. - 18 - Location of action: 556 Bell Hill Avenue, Fishers Island, NY 06390 Site acreage: .67+/- acres Present land use: Single family residential 2 Present zoning classification: R-80 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: Samuel W. Fitzgerald, agent (b) Mailing address: 15 E. Putnam Avenue, #234, Greenwich, CT 06830 (c) Telephone number: Area Code( ) 860-287-3808 (d) Application number, if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes No Z 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. See LWRP Section 268-3(F)-minor LWRP actions are exempt Li Yes E No XZ Not Applicable The proposed two-story addition will be set way back from the road. The additions will be of a scale commiserate with the neighborhood. 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 0 Yes D No 1�1 Not Applicable See LWRP Section 268-3(F)-minor LWRP actions are exempt The proposed two-story addition will architecturally improve the house by cleaning up a previous mesys additi0n. No issues of historic or archaeological preservation are relevant here. - 19 - Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes [] No Not Applicable See LWRP Section 268-3(F)-minor LWRP actions are exempt 6 The proposed additions are quite small and will have no impact on the visual guality of the the town Attach additional sheets if necessary Zoning NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes D No © Not Applicable See LWRP Section 268-3(F)-minor LWRP actions are exempt Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria 0 Yes 0 No ©Not Applicable See LWRP Section 268-3(F)-minor LWRP actions are exempt Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes []] No© Not Applicable See LWRP Section 268-3(F)-minor LWRP actions are exempt - 20 - Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. Yes NO© Not Applicable See LWRP Section 268-3(F)-minor LWRP actions are exempt ry Rec N1P(1 u Qeaia Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. Yes ❑ No © Not Applicable See LWRP Section 268-3(F)-minor LWRP actions are exempt PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. YeD No© Not Applicable See LWRP Section 268-3(F)-minor LWRP actions are exempt Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. Q Yes No R Not Applicable -21 - Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. 13 Yes1:1 No © Not Applicable See LWRP Section 268-3(F)-minor LWRP actions are ex oCeavP Zoning i:3O w k c7 Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. 0 Yes El No© Not Applicable See LWRP Section 268-3(F)-minor LWRP actions are exempt Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. QYes ❑ No © Not Applicable See LWRP Section 268-3(F)-minor LWRP actions are exempt Created on 5125105 11:20 AM - 22 - ScTm TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DIST, SUB LOT or 1- le,A ACR. REMARKS f ja vx a- ka- :L L�La (LL�' TYPE OF OLD. Icee Lm 11 PROP.CLASS n C 24- ,et LCA n- LAND IMP, TOTAL DATE 44CO 4550C� /al LC� cl--.D c-j- FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL TOWN OF SOUTHOLD PROPERTY RECORD CARD ) J OWNER STREET VILLAGE DIST. g a R13 /a OWN N E yr ` 10 r c Ki ()(A b 4s fnt -et- W TYPE OF BUILDING - RED. / D SEAS. VL. FARM COMM. CB. MILS. Mkt. Value < LAND IMP. TOTAL DATE REMARKS �,y 4/.c & ge di D p 4 0 `. E _ g _ � ^ .- � ® L i2-67 7if !12 w Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowtand DEPTH Douse Plot BULKHEAD Total TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET (� VILLAGE DIST. R 3 /a?j AFL Av-.L,.-N v f- r ACR. 64 as fvus4tt TYPE OF BUILDING RE$. ' SEAS. VL FARM Cothm. CB. MILS. Mkt. Value LAID IMP. TOTAL DATE REMARKS v rz _ 100 0 O �90 3/ 1/ 9-1 -#_ p 4 t d - ,1 Y" _ ") z ' LlI E. =mot ._ s 3 _ O r 4 Ives -- - Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD McQdowland DEPTH House Plot BULKHEAD Total