The URL can be used to link to this page

Home My WebLink About#8113 Cox-Carlsen ZBA application FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Received SOUTHOLD,N.Y. MAR I 7 2026 NOTICE OF DISAPPROVAL Zoning Board 01 Appeals Date: January 27,2026 TO: Cox/Carlsen Liv Trust 3527 Webster St San Francisco, CA,94123 Please take notice that your application received November 25,2025: For permit to: Replace and rebuild in kind an existing deck addition to a sin le-farnil dwelling at: Location of property: 2250 North Sea Drive Southold NY County Tax Map No. 1000—Section 54 Block 5 Lot 2 Is-returned herewith and disapproved on the following grounds: 1"he_ rro osed cons ction ors this non-conforming 18.622.41 s . ft. p1rcel in the Residential l 4 District, :�ct,is not ennitted ursuant Article XHI 2,80-124 which states,. lots measuring less than 20,000 s uare feet in total size re uire a minimum front vard. setback of 35 feet. The or000sed construction as shown on the survey, has a front vard setback of 27.4 feet. �rAtrtl ecl,Signature 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. APPLf.CATION TO THIS SOUTHOLD TOWN BOARD OF APPEAL A 1L ARL�1C P FI o. StreetA) lets House N 0 Id Lot SCTM 1000 Section: Block. Size: ) �1 U�yl Lot(s) onelV I(WE)DATEAPREAL THE D WRITTEN DETERMINATION OF THE BUILDING I 61" BASED ON SURVEY/SITE PLAN DATED Owner( ): Sh d4-cox MAR 1-1 2026 Mailing Address: 536 JaCkSan rd of Appeals Telephone: 4.08-202-3672 Fax:, Email:carisenkatnryne@gmail.com NOTE:In ad' t a v please complete below if application is signed by applicant's attorney,agenk architect,builder,contract vendee,etc.and name of person who agent repress. Name of Representative° a a'l for(r Owuer( )Other: Address: 01 &vewTele hone Fax: Email: ('yv p Pkase chei*to veco v* pan h r pondenc to be to,from,the . ApplicantlOwner( ), Authorized Representative, ( )Other Name/Address below: WILEREB TIE BUILDING INSPECTOR REVIEWED SIJRVEYISI I'L DATED and DENIED AN APPLICATION IIAa'ED FOR: (wilding 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.Don t quote the code.) Article: Section: 90 Type of Appeal An Appeal is made for: (v-YA 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 thp Town Code,Article Section ( )Request for Rever ail or Overturn the Zoning Officer's Denial Other A prior appeal( )has, dhas not been made at any timg LNith respect 12 this ro , UNDER Appeal No(s). Year(s). (Please he sure to research before completing this question or call our office for assistance) Page 2, Area Variance Application ' eceelved Revised 6/2023 C 3 MAR 112026 REASONS FOR APPEAL eats (Please be specific,additional sheets maybe used with preparer's signature notarizzdhing `" DPP 1.An undesirable change will not be produced in the CHARACTER of the neighbor or a detriment to nearby properties if granted,because: OeCA A01r GPpiq 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: doori Ao✓se jfo ovl ohA0 oderAl- 3. The amount of relief requested is not substantial because: l / � dech hCA e Gy.e reb w -SaP'l 4� rj 4. The variance will NOT have an adverse e't ct or impact on the physical or environmental conditions in the neighborhood or district because: sCl 5.Has the alleged difficulty been self created? { ) Yes,or {/No Why: Se ch WCt5 l e .4 I f We Q tic -t l x/� l� . • Are there any Covenants or Restrictions concerning this land? VNo { )Yes(please furnish a copy) • This is the MINIMUM that is necessary and adequate,and at the same time preserve and protect the character of the neighborhood and the health,safety and welfare of the community. 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 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 RESPONSIBILITY TO ENSURE COMPLIANCE WITH THE CODE REQUIRED TIME FRAME DESCRIBED HEREIN. Signature Applicant or Authorized Agent (Agent in t submit written Authorization from Owner) Sw to before me this day JAMIE FRANCIS OEM „20 NOTARY PUBLIC,STATE OF NEW YORK Registration No.01 FR6112394 Notary Pu a Qualif ir►Suffolk County Cttruisirrr 1 ttpir�t .lull+06,2028 061v�' Zoning Board of Appeals APPLICANT'S PROJECT DESCRIPTION ` �,ppea►s APPLICANT:MkMRINIM( SCTM No. Existing1.For Building Areas ll 1 Please describe l g areas being : ) e C�_ Pi' g rl ..removed - II.New Construction Areas(New Dwelling or New Additions/Extensions): Dimensions of first floor extension: Dimensions of new second floor: Dimensions of floor above second level: Height(from existing natural grade): Is basement or lowest floor area being constructed?if yes,please provide height(above ground)measured from natural existing grade to first floor: III.Proposed Construction Description(Alterations or Structural Changes) (Attach extra sheet if necessary).Please describe building areas: Number of Floors and General Characteristics BEFORE Alterations: Number of Floors and Changes WITH Alterations: IV. Calculations of building areas and lot coverage,sky plane(From Surveyor,Design Professional): Existing square footage of buildings on your property: Proposed increase of building coverage: Square footage of your lot: Percentage of coverage of your lot by building area(lot coverage) Gross Floor Area(GFA)of single family dwelling including the attached garage and/or habitable detached accessory structure: (Please refer to Chapter 280, Section 280-207 of the Town Code): For Residential lots, is project within the allowable Sky Plane?(Please refer to Chapter 280, Section 280-208 of the Town Code): V.Purpose of New Construction: Yf ° l� � -e �?C VI.Please describe the land contours(flat,slope %,heavily wooded,marsh area,etc.)on your land and ty' grequirement� (s): Describe on: parate page if needed: hy how it relates to the difficulty in meeting the code � 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. J Revised 6/202, QUESTIONNAIRE FOR FILING WITH YOUR ZBA APPLI.CA'I IOIJ A. Is the subject premises currently listed on the real estate markZPRfP9aM d °f Appeals ?ar Yes XNo B. Are there any proposals to change or alter land contours? _,K' No Yes,please explain on separate sheet. C. 1.)Are there areas that contain sand or wetland grasses? n V 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? 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 Board of Trustees: If issued,please attach copies of your permit listing conditions of approval with a copy of the approved survey, D. Is there a depression or sloping elevation near the are of proposed construction at or below five feet above mean sea level? E. Are there any patios, concrete barriers,bulkklVads or fences that exist that are not shown on the survey that you are submitting? If any of the aforementioned items exist on your property,please show them on a site plan. j� F. Are there any construction projects currently in process on your property? �6 If yes,please submit a copy of your building permit and survey as approved by the Building Department and please describe scope of work: G. Please attach all pre-certificates of occupancy and certificates of occupancy for the subject premises. If none exist,please apply to the Building Department to 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? n 0 If yes,please label the proximity of your lands on your survey and identify the Suffolk County Tax Map No. p rt and/or the proposed use I. Please list rese�'r s° or o era s c d ted o r o l„ (ex pies:existing single family,pro s sed: me with garage,pool or o ter) AuPfbrizff si 'nat r Date Town of Southold sece!V /2024 P.O.Box 1179 53095 Main Rd MAR ' Southold,New York 11971 zoning Board of Appeals CERTIFICATE OF OCCUPANCY No: 45625 Date: 10/4/2024 THIS CERTIFIES that the building ELECTRICAL Location of Property: 2250 N Sea Dr, Southold SCTM#: 473889 Sec/Block/Lot: 54.-5-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed°in this office dated 9/12/2024 pursuant to which Building Permit No. 51179 dated 9/12/2024 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: 200 aLmp electric service :y The certificate is issued to Chihlas,John&Helen of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 51179 9/24/2024 PLUMBERS CERTIFICATION DATED �rizedture FORM NO. 4 TOWN OF SOUTHOLD Received <�It BUILDING DEPARTMENT Town Clerk's Office MAR �.9 2026 Southold, N. Y. Zoning 'guard of Appeals Certificate Of Occupancy No. Z43 +. . . . . . Date . . . . . , . . . . . A ,u$t . . ? . , . ., 19.71 . THIS CERTIFIES that the building located at .61S. .horth Sea -Dr. . . . . . . . Street Map No. . x.-oc. . . . . . . Block No. .X=. . . . .Lot No. . .x= . . . . S*Uthola. • -h.Y.. • . . • . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . .April- - -2Z 19. 66 pursuant to which Building Permit No. .30.62z. dated . . . . _ . . . . . . Kpril. 25- ., 19 b6 ., 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. one .family. dwelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . Fred. Kuhlman•4.• ::iie. . - - -Owners • . • . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval July. . 1.v .19.71 . - by .R.. Villa . . . . Underwriters # N896551 - House i� 2250 +. . . . . . . ". . . .Building Inspe40 . . . r FORM NO. 4 i TOWN OF SOUTHOLD �u BUILDING DEPARTMENT Received Office of the Building Inspector Town Fall Southold, N.Y. LIAR 7 2026 CERTIFICATE OF OCCUPANCY Zoning Board of Appeals No Z-20211 Date SEPTEMBER 12 1991 THIS CERTIFIES that the building ADDITION Location of Property 2250 NORTH SEA DRIVE SOUTHOLD, N.Y. House No.. Street Hamlet County Tax Map No. 1000 Section 54 Block 5 Lot 2 Subdivision Filed Map No._ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated. APRI'L 16 1990 _____pursuant to which Building Permit No. 18962-Z dated APRIL 19 1990 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to JOHN CHIBLAS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE NO. N-199386 - AUGUST 9 1991 PLUMBERS CERTIFICATION DATED N A uilding Inspector Rev. 1/81 f FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Received Town Hall Southold, N.Y. 1OR � CERTIFICATE OF OCCUPANCY 26ntrg `� �� 4i. yA No Z-20212 Date SEPT. ER 12, 191 THIS CERTIFIES that the building ADDITIONS Location of Property 2250 NORTH SEA DRIVE SOUTWIDi N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 54 Block 5 Lot 2. Subdivision, Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 7 1990 ____pursuant to which Building Permit No. 19313-Z dated AUGUST 7 1990 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 ADDITION & DECK ADDITION TO EXISTING ONE FAMILY D ING The certificate is issued to JOHN CHIHLAS (owner) of the aforesaid, building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ffz A UNDERWRITERS CERTIFICATE NO. N-199386 - AUGUST 9 1991 PLUMBERS CERTIFICATION DATED APR. $ 1991 - PECONIC PLUMBING & HEATING B 1ding Inspector Rev. 1 f 81 AGRICULTURAL DATA STATEMENT 1 ZONING BOARD OF APPEALS Received �l TOWN OF SOUTHOLD MAR 17 2026 WHEN TO USE THIS FORM: This form must be completed by the applicant for any special use permit,site plan approval,use variance,area variance or subdivision app& r '% a an agricultural district OR within 500 feet of a farm operation located in an aglicultural district: All applications requiring an agricultural data statement must be referred to the Suffolk County Department of Planning in accordance with Section 239m and 239n of the General Municipal Law. 1. Name of Applicant: 2. Address of Applicant:. 3. Name of Land Owner(if other than Applicant': 4. Address of Land Owner: Prose �, :5. Desca't t"on of � i 6. L cation of Pro ) y:(Ro an Ta map 1'� her) cr„ 7. Is the parcel within 500 feet of a farm operation? { }Yes �(No 8. Is this parcel actively farmed? { } Yes KNo 9. Name and addresses of any owner(s)of land within the agricultural district containing active farm operations. Suffolk County Tax Lot numbers will be provided to you by the Zoning Board Staff,it is your responsibility to obtain the current names and mailing addresses from the Town Assessor's Office(765-1937)or from the Real Property Tax Office located in Riverhead. NAME and ADDRESS 1. _. 2. 3. 4. 5. . 6. � Ause of this page if there are additional property owners) ant 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. 61720 Appendix B Received Short Environmental Assessment Form '6 Instructions for Completing MAR 1,72026 IS Part I-Project Information. 'Ube applicant or project sponsor Is responsible for become part of the application for approval or funding,are subject to public review, and may be subject to further verification. Complete Part I based on information currently available. I fadditional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency; attach additional pages as necessary to supplement any item. Part I -Project and Sponsor Information Name of Action or Project: -T-TJE�--- A>( 0 tc� Project Location (describc,andattac a location map): 0 --Brief Descr-iption of Pro poied Action: 1-e / o 7C cj-e-,c— /x0yA (b ckj/cp C)LY, CA 631- 7,3�2-- 00/ 0 Nanic`of—Applicant or Sponsor: Tele p h o ne: Address: A-, City"PO: ------ State: Zip Code, IL)Y // 777 1.Does the proposed action only involve the legislative adoption ofa plan, local law, ordinance, t 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. It'no,continue to question Z. 2. Does the proposed action require a permit, approval or funding From any other governmental Agency'! NO YES lryes,list agency(sW miner and craut or approval: 1. a.-T-o-tadac-re"age of the site of the proposed actwn" acres b.Total acreage to be physically disturbed'? acres o. Total acreaew,(proivct site and and ou contigus properties)ownecl or controlled by the applicant or pro wet sporisor" 01A --aCTCS 4. Check all land use .. that occur on,adjoining and near the proposed action, C3 L!rban 11 Rural(non-agriculture) 0 Industrial 11 Commercial XResidential 0 Forest 0 Agriculture Ll Aquatic ul Otber(specify}; :1 Parkland Pagel of ® t p pop use tinder rite zoning'Y �. Is h ra posed action, � YESa. At cta-a regulations'? ✓ ._w P p plan? _ _ MAR 20 � �X fa is tlpr ro oscd action consistent wx ith the rcdonpinant character of th � b Consistent with the adopted comprehensive nst�e an. p p � p e existing built or natural �iQ YES u landscape" Zoning Board of ppea 7. is tlae Site of the proposed action located in,or does it adjoin,a state listed Critical Environmen tal Area? NO YIDS If Yes,identify: m -__..... —_w__ � ✓ 8. a. Will the proposed ? ed action result in a substantial increase ua traffic above present 0 I YES . 1 p 1C1yC resent levels. b.Are public transportation service(s)available at or near the site of the proposed action? .✓ ..... _ code eel a re neat a site of ilia proposed action? . c, Are any pedestrian accommodations or bicycle routes avails p _9.If shoes the ro osed action meet or exceed the 9. Do p p _ tsttc energyq NO� S proposed action will exceed requirements,.describe design feature;and technologies: l O. Will the proposed action connect to an existing public/private water supply? � NO YES If No.describe method for providing potable water: � ,. , �.�.., _� � ✓ _ Y ...... 11.Will the proposed action connect to existing wastewater utilities? � � �� ES If No,describe method for providing wastewater treatment: . �� .�. on either the State orNati . . .. __...�. �. sitestructure that is ltsted� � l'. a.Does the contain a.. National.Register ofBistoric Na YES Places`? b. Is the proposed action located in an archeological sensitive area:' t;3.a_Does any portion(if tile i proposed g yp I O YES site of the ro cptied action,or lands adjoining the proposed action.contain N„ wetlands or other waterbodies regulated by a federal,state or local a gene ✓ 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: y t occur on.� cultural era 5b ads found oil tile❑ Early site. s ahecksupnahat a l C] Shoreline typical Forest types that ._.__ A a � 1�, ldc.nttf'th.. p p o opp %`: s '01, Wettand 0 Urhaaa IRbSuburban 15. DepGS�e site of the proposed oscd action contain p s of animal,or associated -� p p to an y s ecie habitats,listed N YFS _.. _ m.. by the State or Federal uovernnpent as threatened or endatpuered°: . .. — 1C. Is thti ptiplect site located to the lt)Ll year flood lain_ NO FS . , I+,Will tkte '€ntoseJ action eieatetur7rr �itliwr from point or non-point.surecs? NO YmL If Yes, m._ a.Will stomp water discharges floe to adiacent properties" 0 NO 0 YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO YES Page 2 of 4 f ES IS. fat roes tor Cher liquidshe proposed t(e.gion��tentian pund,twaste lagoon or other �dam�es that result in the itnpoundtnen�.l�I� i NO� Y If Yes,explain purpose and size: ��........ 1 .Has the site of the proposed action or an adjoining 3-property been location of �tct �r o�o l._. NO YES- J bp' p' y solid waste managennent facility? If Yes.describe: Zoning r�oard of � � Cl.I las the site of theproposed action or an adjoining property�been the sul}jee r � ES d .� J �,p }� ) _..�.t of remediation(ongoing or �+� �'�� completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Appl:icaaat'aponso c: �� Y ' ► Date: 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 inliarmation contained in Part 1 and other materials submitted by the project spunsor or other °ise available to the,reviewer. What ttnswcring the questions the reviewer should be guided by the concept"Have any responses been reasonable considering the scale and context of the proposed action?" __._.. . .�,..... .. ...._.�.___..._. .. e_ �. _... . . n __ .. N0,or 1tItatlet~ate .... small to large impact i impact may may occur occur �,_. Will themm proposed action create material c onflict with an adopted l..�.W._. e plan zon'-.�r P P � do ned Land use tic, regulations? 2, Will the proposed action result in a change in the use or intensity of use of[and:' ;, Will the proposed action impair the character ar quality of tlnc existinz z.arnmunity`' 4. Will the proposed action have an impact can the environmental characteristics that caused the establishment of a Critical Environmental Area(CFA)? proposed - twin an adverse.change to the existing level of traffic� 4Vall the action result � . �. -._ ,_ ldie or �.'W'__._.....�... affect existing infrastructure for mass transit,biking or walkway'? rcausc a._�. n increase. in the use of energy and it fails to incorporate {� rcasonabl«v available, Will the proposed tettc g conservation or renewable able ener M' czatunitiea m.._..._ .. ...... ...... e. __ _ _�....._ 7. Will the proposed action impact existing: b. public t private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources .ti _ ... _._ _....._. ., _..... 9 Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies.groundwater,air quality,flora atria fauna)? Page, 3 of 4 No,or 1 "'�ee ecei . poet int� p1 ae^t. may inlay occur tutr.. 10. Wit]the proposed action result in an increase in the potential for erasion,flooding or drainage problems? pin his� t°cl f App eaI 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lend Agency is responsible for the completion of Part 3. For every question in Fart 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 Fart 3. flail 3 should,in sufficient detail, identify the impact, including any meas'ures or design clernentw dial have been included by the prk�j ct sponsor to avoid or reduce mipacts. 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. ❑ ...that the his box if proposedvou actioave im may resulttin based a to oron the ramor potentially t 'large analysis s significant above, and any s p�Yand an °n rtin documentation, cant adverse impacts environmental impact statement is required. Check this box ifvou 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. ',lame of Lead Agency Date Print or Type,Name of Responsible Officer in lead Agency m. Title of Responsible Officer r....m.�ignature of Responsible Officer in .cad Agency � Signaturef�of Pre parer(if dif3er6nt from.Responsible Officer)er) Page 4 of 4 Board of Zoning,Appeals.Application Received G I OWNER'S A°TIOI (Where the Applicant is not the Owner) MAR 1.7"2026 Zoning 130ard of Appeals residing at azD Up ' _ q .......... .._ print lam owners name) (Mailing Address) l do hereby authorize el (Agent) ...__... _. _ to apply for variances)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. 1T 15 THE PR PERTV QWNERI-S RASP` N&B1L1TY TO ENS B.E COMPLIANCE LIANCE WITH Tll Ol)E RR RF1) 1°11.11�1RA �UbS Rl if 11' . (Owner's Signatur (Print wvnr''s Name) ,eive Board 2f Zonin s A l canon MAR 1�.7.2026 Zoning r30ard of Appeals AMU`HORM&T-10N (Where the Apglicaint is not the Owner) I, S K �/ residing at ;�' - (Print property o 's name) (Mailing Address) do hereby authorize OF (Age) to apply for variance(s)on my behalf from the Southold Zoning Board of Appeals. :: . (04ner' Signature (Print �or's Name) APPLICANT/OWNER Received TRANSACTIONAL DISCLOSURE FORM MAR IT 2026 Th n of Sop d's Coda o cs obi ontl" is aaterrt a art o wn offw and 1 e s ' o is to ormide info Lion whi ert t e of e c flic irate ER i sa to v YOUR NAME: f A Qj (Last name,fi mane,nliddleiwtia4un1myonareappwminthe 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 W101 Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning Do you personally( r 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 applicanttagent/representative)and the town officer or employee. Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply) A)the owner of greater that 5%of the shares of the corporate stock of the applicant(when the applicant is a corporation) B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation) C)an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this day of Signature 20-- PrintName �t AGENTIREP'RESEN 'ATIVE TRANSACTIONAL DISCLOSURE FORM The Town of outhold's Code of Ethics 111rohibilts conflict ! 1, of town officers Rangcmalve0he urnoseof is form is to orwide,information which can alert the town oil iossiblegonflicts of interest and allow it to take whatever action is necess lLtLo avoid same. I 11-VP �7O 6� YOUR NAME : all first e, middle imhal,unless you are applying in the name of some r t' 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) 13)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 20 Signature Print Name Town of Southold Received ��I LWRP CONSISTENCY ASSESSMENT FORM MAR 112026 A. INSTRUCTIONS Appeals Zoning Board of 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). 1 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# 5 q - r5 - D_ The Application has been submitted to(check appropriate response): Town Board D Planning Dept. Building Dept. 0 Board of Trustees 0 I. 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: �I Location of action: 0—) C�� ' �SKJO 67 Site acreage: +► ke-j Present land use: Present zoning classification: 1 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: &(Itlevv ci I/, Y ^�` (b) Mailing address: 1 3 A 1Y) I ItA/ (c) Telephone number:Area Code (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No IX If yes,which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP-Section III—Policies; Page 2 for evaluation criteria. Yes ❑ No 16 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 ZNot ie Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Received c6 ��•� Q Yes 11 No Not Applicable MAR 17 2026 Zoning mid of-Appeals Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pa s 8 through 16 for evaluation criteria 11 Yes 11 No Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 thro ' 21 for evaluation criteria Yes No Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluatio criteria. Yes � No Not Applicable Attach additional sheets if necessary Received Policy 7. Protect and improve air quality in the Town of Southold. WRP Section III — Policies Pages 32 through 34 for evaluation criteria. AR 12026 11 Yes [] No Not Applicable Zoning Board of Appeals 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. LJ Yes ❑ No WNot Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. 1:1 Yescl No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. 11 Yes [:] No Not Applicable Receivted MAR 17 26 Attach additional sheets if necessary Zarling aarcl of Appeals Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. Yes 1-1 No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 forZNot on criteria. El Yes ❑ NoApplicable Attach additional sheets if necessary Policy 13. Promote ap ropriat+e use and development of energy and mineral resources. See LWRP Section III—Policies; ages 65 through 68 for evaluation criteria. El Yes n No Not Applicable Created on 5125105 11:20 AM 9 y e r IsAg PC �, „ 1 it ✓ "�,r' w' ✓'� 'h"" �i ; m �i,�"�i J / m w ; VA r 420 r it s � X r " � r i we wy, , N "no y tiiv r ro t I �I�'il�dyl'p r e u � heeeived I� MAR 17 2026 wu I �I, rtn ✓ 'N%d7"� 'I�m w�f M'�.'H/,</��ilu�c,�o. rw,��+Yl �u'v dj a�� C m�a NY�'�fli«w lNa,. ri"�i r ti� ,.� `,�" ��, �5r«. «Q� ur �n rN�„�ir �n r�y�� r,�l��/��n a�� >>ull�l� �p Y r��„rr, r�;��"i " I � �`�✓I�elk (P�� " � I� .a .�Y., w w N ^';rw�a�rs°`��'a�""�`��j9��fwra M��:�' ��p"�"��r?�,i�7��ar✓�i�� (�;r Y��,��,;i, r� �� .�"� �� IIN�N' . r � �f4', Y r�� `", �. �w P I �4i r MMI�� U�9N all rrrr ry � � f vF N ■�," $; vl 1i 1I ir � �M Pe/rc / r rf rJ yq'J J V✓�p b - �"' � � TMd e � ti � lr ^� r«'�,,/fer rr m r µar ✓T r v r'rwl r I W� f� ar I '` data ✓ rl Yf�"�� Iw„��?^ � �� `w�n;'�fl'��Yi rt Kxa`a i��rrk rPr�� o� � eW r>i�/�,r y I( ^' S Received MAR 1 7 2026 �r�� r �1 iofA Zoning emol", , mmvn �n u, r r OF, ZZ OF P r I ry r ��,��/i !m r fix/- r i ✓ rrl mitlf x r i /1��1r��g7;rv� m�� . ";,�" yJ �✓r � i r of �r �iT� DY r #fd'^ �/:d` � 'r N � � r ,;. eaG lmW 7 � CH ✓ c � i t�r r rL� /lr�i�r I� � ;Mi��l��r�� ri✓rr� i �/�G fps '�✓ : rl'il '"f 4%,✓�>,F r�� m'� �lf,G�],,�� Y Ip� � �m �n � �v,,r� Y I�� r o,�6rysY,r r J e 6r r dm �� "� y J��r�'m dar✓;�,„ r YI"'�m iy��r:%�mrw;fly✓1/r°,�� rr�� ,� ��,�� r i„ � r✓r�t ��rP� u 1 r � � l u��r o� ��i ��I �� ✓u �W�� a I!��7�� +"� �'° j gym'9q y "G' k§i`''w ��uuu a�,�j ��',m,,��a 1 ''�� F�,,f"o��'"��'��` r��n��r�✓ ,w��`�IP�� r"�+✓+��'��„��` � �'"� �`pl 1° r'� It )il, r ✓ ✓ Prb r r mh r r t r hr � r��r I� �,r�11 ;� N 1 d"W mP f � , '� 6 a" '�N,I� y pl�! MY,l��mvJG /✓�p 1i��/i p ya�I �/9'��'�i��iV Y�'�6Y b �(y I� � ,n,;i�' w. it �"mah „�,�' � �� p ,rv"wn' ,�wv+u i j r ✓fir, � ' I r � / y r/I f r ° MIarrY ,N tl f `. i W � ' TOWN OF SOUTH011-D PROPERTY RE"'CORD CARD �� - - --- - �m d VILLAGE — DIST. SUB. LOT °..- .a OWNER t! , E ACR z b COS VL. FARM comm. CS. miss. M' value, LAND IMR TOTAL DATE REMARKS ` _ - - m cm a _ N 5 - o _ NEW NORMAL BELOW AXIVE FARM! Acre 'Ja4u$ Par �Volue Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD .�� DEPTH TOWN Or S UTHOL Hose Plot SULKHEA0 Total DOCK i m s :. n CR I RflVi Ti 77 j `_ — _ E CL E _ y i 54-5-2 9/01 M. Blda. E 1 7 3 s Extension CD -- Extension 6-0 €� i y s ? € E ! Extension �Foundation Bath L�irr _ I 1 Porct% e �' , e Baser E gent Flcors << ;_i r Porch L �' Ext. V�Ja:!S Interior Fii—i ;-R. i Breezeway Fire Pace � H ai j 3 E r-r, Garage hype Roof Rcr.F;5 Esc Floor P'. PctioRecrearion Room, Rc•or, s 2nd Floor EN O. B. _ 'Dormer DriveWo i Total E _ }