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HomeMy WebLinkAbout#8123-O'Grady ZBA application FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD,N.Y. Ftecelve NOTICE OF DISAPPROVAL APR 0 2026 DATE: Februa;4ri �0 �2cO APPeals RENEW1� � 3,2026 TO: McDermott T&R Irry Trt t�16; _,. PO BOX 343 315 Old Salt Rd PO BOX 343 ��� Mattituck,NY, 11952 Please take notice that your application dated December 19, 2025: For permit to: legalize an as built shed accessoly to an existing,single-family dwelling at: Location of property: 315 Old Salt Road M ttituck NY County Tax Map No. 1000—Section 144 Block 5 Lot 20 Is returned herewith and disapproved on the following grounds: The as built construction. on this non-conforming 19,191 s .ft, Parcel in the Residential R40 is not permitted pursuantto Article 111 Section 2110-15 which states accesso! buildings and structures shall be located in the re uired rear and and in the case of a waterfront parceL accessoKy building and structures m4y be located in the front and provided principal front yard setbacks are met. The survey shows the front yard setback of 16.9 feet which does not meet the required front and rinci al setback of 35'. Z LCUPA' A�Ithorized Signatud Note to Applicant: Any change or deviation to the above referenced application may require further review by the Southold Town Building Department. CC: file, ZBA y n"r APPLICATION TO THE SOU'I HOLD TOWN BOARD OF APPEALS D 1 A:2 AREA VARIANCE Received House No._3 L5 Street_,Q ? 4 ( f- -- + _Hamlet M q i t SCTM 1000 Section: Block: __J__Lot(s) Lot Size: Zone 11,Al 0 Zoning �r� cat Appeals I (WE)APPEAL THE WRITTEN DETERMINATION OF THE BUILDING INSPECTOR �- DATED DATED BASED ON U' . VFrk'/SITE PLAN „._ Owner(s): w. r WVA4 fi Mailing Address: b D q,?—r1 c U //I T 2 SJL Telephone: 3/2— 7L1 4 1 Fax: Email: NOTE: In addition to-the a ove 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: t a, 0 �o R t `Z— for O) Owner( ) Other: Address: �7 t Telephone: jr 9— J 3 Fax: Email 9r74 o A e X^etc'',71'?'e-0 A4A r ory Please check to specify who you wish correspondence to be mailed to,from the above names: ( ) Applicant/Owner(s), 04 Authorized Representative, ( ) Other Name/Address below: WHEREBY THE BUILDING INSPECTOR REVIEWED SURVEY/SITE PLAN DA"ITED I" �I�and DENIED AN APPLICATION DATED ),. ,�/C'h _AFOR: ( )Building Permit ( ) Certificate of Occupancy ( )Pre-Certificate of Occupancy ( ) Change of Use b-41permit for As-Built Construction ( ) Other: Provision of the Zoning Ordinance Appealed. (Indicate Article,Section,Subsection of Zoning Ordinance by numbers.Do ypt quote the code.) Article: 1 Section: 6),90 Subsection: Type of Appeal. An Appeal is made for: t,4"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 ( )Request for Reversal or Overturn the Zoning Officer's Denial Other A prior appeal( ) has, j`has not been made at any time with respect to this proarty, UNDER Appeal No(s). Year(s). (Please be sure to research before completing this question or call our office,for assistance) � 1 � Page 2, Area Variance Application Revised 6/2023 -` Received REASONS FOR APPEAL (Please be specific, additional sheets may be used with preparer's signature notarized): APR 2 O 2026 1. An undesirable change will not be produced in the CHARACTER of the neighborgarj�ttbftMtV ,appeals nearby properties if granted, because: /1- 1 j lez ., -f h trc f-o r A It - y 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: /I- l f h I r✓�� �Y W V/c v 3. The amount of relief requested is not substantial because: /q— t f 0� Iy q 5kP,71 o Ic 2 savcfc- /I-- 4.The variance will NOT have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because: l f c t y �-ti -e v e- r Z t9 f yea r-f 5. Has the alleged difficulty been self created? ( } Yes, or ()q No Why: 9,,y-- w Are there any Covenants or Restrictions concerning this land? { } No KYes (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. nature of Applicant or Authorized Agent ff (Agent must submit written Authorization from Owner) Sworn to be'1bre me this q day of � 20 SAND A V. SAI-0 NOTARY PUBLIC,STATE OF NEW YORK Registration No. 02SA6407223 Notary 1"tuh Qualified in Suffolk County Commission Expires 05/1W�VO Zoning Board of Appeals }� APPLICANT'S PROJECT DESCRIPTION i Received APPLICANT: AI a v ® 2026 SCTM No. U �_ 1. For Demolition of Existing Building Areas Please describe areas being removed* f/� Zoning Board of Appel 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: 14 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 roperty: 15 0 n Proposed increase of building coverage: TA -C< Square footage of your lot: Percentage of coverage of your lot by building area(lot coverage) v Gross Floor era dGFA:I 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: 5✓ K e ,✓/ 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): Describe on separate page if needed: 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. Revised 6/2023 QUESTIONNAIRE FOR FILING WITH YOUR ZBA APPLICATION A. Is the subject premises currently listed on the real estate market for saReceived Yes X—No B. Are there any proposals to change our alter land contours? APR ,2 02026 _�S_No Yes, please explain on separate sheet. , Appeals C, 1.) Are there areas that contain sand or wetland grasses? 0 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 w Y inquiry pp with the Boar o J BOAS OF"ll"RI.IS�'"o I'your int u determinationorr aliation Trustees: Please confirm status 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 area of proposed construction at or below five feet above mean sea level?. _1_J D E. Are there any patios, concrete barriers, bulkheads or fences that exist that are not shown on the survey that you are submitting? V If any of the aforementioned items exist on your property, please show them on a site plan. F. Are there any construction projects currently in process on your property? Lf O If yes, please submit a copy of your building permit and survey as approved by the Building Department and please describe scope of work: & 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? Al 0 If yes, please label the proximity of your lands on your survey and identify the Suffolk County Tax Map No. 1. Please list present use or operations conducted at your property, and/or the proposed use r AMi ly Lije. (examples:existing single family,proposed:same with garage,pool or other) Authorized signature Date (2015) The Code of Salt Lake Village S) Preamble Received In Order To: Perpetuate the delightful environment of the Community APR 2 0 2026 Enhance its beauty Protect its values Zoning Board of HppEais The members of Salt Lake Association,Inc.,jointly and severally agree,to this Preamble and the following Principles: 1. General a.Protection of the Rights of each property owner is a responsibility of all members of the Village. By contributing respect and consideration,each one is assured the privacy he or she chooses, and the friendliness from all members of the Community. b. A property owner,when planning to sell or rent has the responsibility to respect the meaning of the above Preamble and the Principles listed herein.He or she is obligated to advise brokers and interested Buyers and Tenants of,"The Code of Salt Lake Village". c. Property owners are responsible for the conduct of their dependents, guests,tenants and employees and to inform them of our Code. 2.Architectural Design—New Homes and Additions to Existing Homes a. The exterior appearance of such construction is to conform to the general architectural design of the existing homes and out structures. b. Dwellings are restricted to one-family c. Buildings shall conform to the current code of the Town of Southold for single family residential homes. First floor living area to have not less than 1,000 square feet. d. Exterior walls and trim to be white in color e. Roofs to be either green or black f. Window shutters to be either dark green or black. g. All out buildings shall conform to the above colors for the home h. All fences shall conform to the Town of Southold rules and regulations and be white in color. 3.Landscaping,Lawns and Hedges a.All planting, including hedges,to exhibit a sense of beauty. b.All open ground,except service and planting areas,to be in grass lawn. c. All vegetation to be properly maintained.Lawns and hedges to be kept neatly trimmed. 4. Cesspools and Fresh Water Wells. a. Locations and construction specifications of all cesspools and fresh water wells to conform to the Health Codes of Suffolk County, Town of Southold and Salt Lake Village Association,Inc. 5.Village Roads a. Speed limit for vehicles is to 15 miles per hour or less. b. Road repair and maintenance expense is to be assessed to all property owners on,a pro-rata basis,except as covered in C. c. Damage to roads caused' "" eh:icles performing a service fora property owner shall be repaired and paid for by the owner. d. Snow removal costs are to be shared on a pro-rata basis by all 2 members from the Association's treasury. e.End of roads are private property and not to be used as "turnarounds". F3 P.ce ived 6.Boat Basin APR 2 0 2026 a.Facilities are restricted to use by members and their invited guests. b. The use of the facilities obligates such persons to respect the rights Zoning Board of Appeals of property owners whose land adjoins the Village owned bulkheads, docks, common areas and walkways. c. Swimming is not allowed in the boat basin.Persons disregarding this assume all risks. d.All children 12 and under be they children of owner's or guest's must wear a Coast Guard approved floatation device(life preserver)when on the boat basin dockage. e. Dumping of refuse anywhere in the Village, discharging boat heads in the boat basin or near any waterfront property is prohibited. f.Late night partying, swimming, disorderly conduct,boisterous language and obnoxious conduct is prohibited. g. There are currently 7 boat slips in the boat basin"marina".All slips are to be assigned on an annual lottery style process (Drawing names from a hat) . The current cost of a slip is $1,000.00 per boat per season. Only property owners may enter the lottery initially. Should slip be available after owners needs have been satisfied then boats of children of property owners and second boats of owners may lease a slip on a lottery style process among this class. h.In the event that there are more private property owners desiring a boat slip,the HOMEOWNER(S) losing out in the lottery shall be reimbursed by the winners of the lottery on a pro rata basis for the difference of off sight dockage and$1,000.00 or the then cost of occupying one of the Village's slips. Only one boat slip is to be available to any property owner. The losers of the annual lottery are guaranteed a slip the following year. i.No tenants, guests or third parties of property owners are to rent boat slips in the marina unless approved by a majority of homeowner. 7. Village Common Areas,Roads and Beach a.Every effort is made to keep the area neat and tidy. 8.Beach and Right of Way a. The rights of property owners whose land adjoins the Beach Right of Way and Village roads are to be respected at all times. Guest and family members are to be told of the size and extent of the beach. The village beach is 100 feet wide as measured fifty feet on either side(east and west of)of the midpoint of the steps leading down to the beach.Beyond that is private property to the mean high tide line. b.Any person consuming beverages or food on the Beach are to be responsible for any refuse left on the beach and remove the refuse to their private property. c.Fires are not allowed on the common property or Beach. d.No Life Guard is on duty.Bathers assume all personal risks. 9. Other Restrictions a. Owners are prohibited to burn rubbish or refuse. b. All pets that are taken off owner's private property are to be held on a leash in accordance with the rules and regulations of the Town of Southold. I-) '- ) c.No pets on Village Beach d.Performance of repairs, others than minimal,to mobile equipment, boats, and vehicles, shall not be performed in public view. e.Owners or their guests shall not park or store campers,trailers, trucks and unsightly vehicles and objects on their private property � or common area or roads of the village. f.All boats stored on private property must be out of public view. Received g.It is each property owners responsibility to politely request outsiders they observe to leave the private property of the Salt APR 2 Q 2026 Lake Village,Inc.,if not an invited guest or service employee. Zoning Board of Appeals FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Received TOWN CLERKS OFFICE SOUTHOLD, N. Y. APR 2 0 2026 Toning Board of !-appeals CERTIFICATE OF OCCUPANCY No ..?:. 73. ........ Date .... Mareh. 14... ............... .....19... .8. THIS CERTIFIES that the building located at ...,-pJ;Fate. ftoad............ . •••••.•• •••••.•• Street Map No Salt. Lake •Villa&ock No .... ... .. ...... . ......, Lot No 11_,......Xattltueks•• N.Y. conforms substantially to the Application for Building Permit heretofore filed in this office dated Jimuary. .9........19.5t8..., pursuant to which Building Permit No ...........Z...21:X...... dated 19..5$., 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 ............ . .......... . . ............ . ....... . ..YRIYATE-DWELLING....................... . .................. ......................... This certificate is issued to ..... . Hewy.....gQe1bli ......... ................... .„.,........... (owner, lessee or tenant) of the aforesaid building Building nsp I ector FORD[ NO. 4 j TOWN OF SOUTHOLD BUILDING DEPARTMENT ecP, Town Clerk's Office Southold, N. Y. APR 2 0 202E Zoning Board of Appeals Certificate Of Occupancy No. Z7878 . . . . . . Date . . . . . . . . . . . . . .wept . . . 9. . . . .. 19.77. THIS CERTIFIES that the building located at . .Ci1«. -,salt.. Rc)ad . . . . . . . . . . Street Ma No V:'R&R No. . . . . . . . . . .Lot No. . . . . . . . . . . . P halt -Lak-e $ r att3 tuck. . .P.I`. conforms substantially to the" code buiAedbe.fore 19 pursuant to which � �� �ccupanc�* 2;pr. �3 . 77• • P dated . . . . . . . . . . . e p . . ,,. . . ., 19 77 ., 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. -fari•1•y-dwelling. • • • • • • . . . . . . . . . . . . . . . . . . . . The certificate is issued to .;,�.tp:ui, i+. 1 .1•lrich • owner • • . • . . . • . •• • • • . • • .• • • . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval pre— exd:stinig . . . . , • • . . . . . UNDERWRITERS CERTIFICATE No-pre—arxist•ing• • • • • • • • • • • • • • • • • • • • • • • • • • ' • • HOUSE NUMBER . . . . 3.1.5. . . . . . Street . .Old• i3-alt- Road• • • . . .fiattituck. . . . . . . . Building Inspec4r F FORM NO.4 TOWN OF SOUTHOLD Received BUILDING DEPARTMENT Office of the Building Inspector Town Hall —b j APR 2 0 2026 Southold, N.Y. Zoning Board of AppeaI6 Certificate Of Occupancy No. . . .Z 1.44 9 7. . . . . . . Date . . . . . . 6ay. 13. . . . . . . . . . . . . . . . .. 1981. THIS CERTIFIES that the building . . , . . . . . . .. . . . . . . . . . I . . . . . . . . „ . „ . . . . . . . . . . . . . . . . . Location of Property ,. . Oj 5. -Old• S•alt. Road,. . . . eetMat.t,ituckp. .Nox .yorx House No. Street Hamlet County Tax Map No. 1000 Section . . 1.4.4. , . , , , ,Block . . . P5. . . . . . . . . .Lot . . . P O . . . . . . . . . . Subdivision . .Sal-t .Lake .Vil-lage. . . . . . . . .Filed Map No. . . 1.3.10.Lot No. a . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated October. .23• • • • • • „ • . • • • • • • , 19 .80pursuant to which Building Permit No. . . . .1091+.5 .Z. . . . . . . . . dated . . . . .Oo tober• 2.7 . „ • • • • • . • • • 19'. .BQwas issued,and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is . . . . . . . . . . . . . . . . . . .AdO.Jtiows. .axid. .41t?.r.4t1PA .�Q. .Pr�y�,t� , P71A F�lni]y. nr'relling. . . . The certificate is issued to . . . . . .Edwar:d • aad •Cather i ne ,Buckley. . . . . . • • • . . . . . . . . . . . Townes VLsj o." of the aforesaid building. Suffolk County Department of Health Approval . . . . . .X/.R. . . . . . . . . . . . .. , , . . . . . . „ . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . „ . . . . , „ Building Inspector Rev.1/81 AGRICULTURAL DATA STATEMENT ZONING BOARD OF APPEALS TOWN OF SOUTHOLD WHEN TO USE THIS FORM: This form must be completed by the applica r any special use permit, site plan approval, use variance, area variance or subdivision approval on in an agricultural district OR within 500 feet of a farm operation located in an agri�ltral district. All applications requiring an agricultural data statement must be referred to the 'u o1A C8{J 8 % Department of Planning in accordance with Section 239m and 239n of thenicipal Law. I. Name of Applicant: 2. Address of Applicant: 3, Name of Land Owner(if other t a Applicant'): 4. Address of Land Owner: 5. Description of Proposed Project: 6. Location of Property: (Road and Tax map Number) 7. Is the parcel within 500 feet of a farm operation? { } Yes { } No 8. Is this parcel actively farmed? { } Yes { } 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 ADDRESS l, __�... 2. 3. 4. 5. 6. (Please use the back of this page if there are additional property owners) l Signature of Applicant 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. 6JZ20 Appendix B Short Environmental Assessment Form Instructions for Completingla d di 7.00119 Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part 1, Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I 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 I. 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 n Name Action or Project: Project Location(describe,and attach a location map): c - / Y Brief Description of Proposed Action: �^ L9 h Nam e of Applicant or Sponsor: Telephone: G Address: 'L E-Mail:t, v on rrcf'r� u. cor.r City/PO: State: Zip Code: fi 1.Does the proposed action tamely involve the egislative adoption of a.plan,local law,ordinan c, � 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: rTotal age ofthe site of the proposed action? acres age to be physically disturbed? acres age(project site and any contiguous properties)owned ed by the applicant or project sponsor? __acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban 0 Rural(non-agriculture) ❑Industrial ❑Commercial XResidential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page I of 4 . l� EbConsistiepint osed action, NO YES N/A ed use under the zoning regulations? �p2� with the adopted comprehensive plan? 6. Is the proposed action consistent with the predominant character of the existi " gnat rai NO I YES landscape? 201" 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO I 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: l r/ 10. Will the proposed action connect to an existing public/private water supply? J NO YES If No,describe method for providing potable water: " 11. Will the proposed-action connect to existing wastewater utilities? NO YES kIf 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? 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: o 14. Identify the typical habitat types that occur on,or are likelyto be found on the project site. Check all that ❑Shoreline ❑Forest ❑Agricultural/grasslands p 3 aPp� ❑Early mid-successional ❑ Wetland horban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? 16.Is the project site located in the 100 year flood plain? NO Y ES 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? `g(NO❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describer ❑NO❑YES Page 2 of 4 FHasthe proposed action include construction or other activities that result in the impoundment of NO YES other liquids(e.g.retention pond,waste lagoon,dam)? ain purpose and size: h X site of the proposed action or an adjoining property been the location of an active or closed N YES te management facility? Board of Aibe: Zon�n9 =siteposed action or an adjoining property been the subject of remediation(ongoing or NO YES ous waste? I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: c� t Date: f Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Dart 2. Answer all of the following questions in.Part 2 using the information contained in'Part I 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 1Moderate 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 IN 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 reasonabl available energy conservation or renewable energy opportunities'? 7„ Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, 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 Z� r01 o,or Moderate small to large OR 2 0 ct impact y may occur occur 10. Will the proposed action result in an increase in the potential for erosion,floo3A2i 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. 0 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. 0 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 ' 2 Use Variance i?pplicitli�m, iteb�i�ion 02 �-inv. -��1 Board of lot ing A�� ���'b��: ��I���l� it�c�r� seceived OWNER'S AUTHORIZATION APR �, Q 2026 (Where the Applicant is not the o%vner) Zoning Board of Appear' residing xW at.315^ 4 l�c%l� /C-L( �/1ct7y771LfC�t (11fir t property owner's name) (Mailing Address) �" •` do hereby authorir_c k h (Agent) to apply for variance(s) on my behalf from the Southold Zoning Board of Appeals.. � pursuant Chapter r 280- I3s•signing this document, the Property Owner understands that pursua p 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 1S °1'°VIF PROPERTY OWNER'S lZl,SP0NS1B1L1TN/TO ENSURE COMPLIANCE. NA,I"1"ll T11E CODE RF L'IRED TIME F 1AME, DESCRIBED 11EREM v 4 �": 21 ;ZdZ6 (Owner's Sig11, s°.�) (Dated) (Print Owner's ame) R0 i;vd I.'.; (;- o APPLICANT/01,VNEA I TRANSACTIONAL DISCLOSURE FOR�Nl s flic-s ol-11—re n t e is ill s0ollk !-�JL • cr m� ilik,61rill is it --jL nnl-T.. !j�tilli�!(,i 0 6, e�lir� y I i a j Ile.YOU NAME : 2, ............ ;Ippl%illt!in me tame ofsorneone else or other eniils ast name,rir,l ninic, linlels vfn 0, TV P,'.so o VI) Coolpall),if so,ill(licaw the oilier liplrin)'s name.) TYPE OF APPLICATION: (Check all that apply) B u i I(I i n 9 Pe r m i t Zoning Board 01 AppeaI6 Ta%grievance _—/. ...... Variance Or Trustee Permit ....... ....Change of Zone Coastal Erosion —-—------- Mooring Approval or III I at Plannin- Other(activity) llav,c t ��jt�j �jny Do you personally(or through your company,spouse,sibling,Inlrent, ellilid) -Bus officer or employee or the Town of Southold?"Relationship" includes bN blood, ituarriage,Or btlsiClvss if"t' interest".meatus;a business,including a partnership,in which tile tow,11 officer or egnplciyee ha� eN en a parfloffl oi%nership of(or employment by)a corporation in which the town officer or vmpI())cv owns titters lha'1 5","u, Of the shares. YES NO If wou answered "YES",complete the balance of this form and date and sign ivhcre indicated. 1,'jme of person employed by the Town of Southold .............. Title or position of that person Describe the relationship between ,ourself(the applicant/agent/representative)and the to%%n officer or employee. Either check the appropriate line A)through D)and/or describe in the space pro%ided. 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(%,I hen the applicant is a corporation) B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not;I corporation) C)an officer,director,partner,or ColploN.Ce of the applicant; or D)the actual applicant r)l:sCIZIIITION OF RELATIONSHIP .............. 06" 20 Si IV 11.1 t lire &, 6"', Prilit 'Nanic— kA J- , 67 j—ei AGENT/REP'RES ANT ATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code or Ethics prohibits conflicts of interest on the Dart (town officers and em I ose of jjMR!2XggL_The purl) this fgrm is to provide information which can alert the town of 2ossible conflicts of interest and allow it to take whatever action,is necessary toavo id same. YOUR NAME : Last name,first name,middle initial,unless you are applying in the name of someone else or other tity,fu 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 \30atd 01 NPP ea Change of Zone Coastal Erosion 7_06ing 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�0 20 Signature Print Name E Town of Southold 6 LWRP CONSISTENCY ASSESSMENT FORM QpR1.0 TO A. INSTRUCTIONS $oa(d o{ Appeal zonm9 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# The Application has been submitted to(check appropriate response): Town Board E Planning Dept. [�< Building Dept. 2 Board of Trustees 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: J r t i Location of action: /e fi �✓ D r u )-C_ Site acreage: APR2 � Present land user � eA '' Present zoning classification: " '-IV 70ntn9 Board of �pP 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: C i f m a 1 h (c) Telephone number: Area Code (d) Application number, if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No If yes, which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. Yes K No ❑ (Not Applicable- please explain) 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 Yes Z No ❑ (Not Applicable—please explain) - _ sn __ - Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources thr ughou ilwn of $puthold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria QR Q 202a Yes �No (Not Applicable—please explain) $oa�d o1 PPp Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages S through 16 for evaluation criteria Ed Yes I No E (Not Applicable—please explain) 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 Yes [A No G (Not Applicable—please explain) 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—please explain) Attach additional sheets if necessary APR Q 2026 � Policy 7. Protect and improve air quality in the Town of Southold. See LW1PAAr III — Policies Pages 32 through 34 for evaluation criteria. See Section III—Police HIV through 38 for evaluation criteria. Yes [nNo M (Not Applicable—please explain) 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. Pul Yes Ln No (Not Applicable—please explain) h 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. Yes No 0 (Not Applicable—please explain) 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. Yes N No E (Not Applicable—please explain) YSw" Attach additional sheets if necessary �pt1 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. Ed d Yes IF4�N71 No E Not Applicable—please explain 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 tg No 0 Not Applicable—please.explain 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. 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VILLAGE DIST. S118. LOT 1 v� FM£R MINR E AR e S W TYRE OF BUILDING e z I RES. 0?f 0 SEAS. V FARM OMM, CB. misc. Mkt. Value LAND IMP, TOTAL DATE REMARKS - ., e _ AGE BUILDING CONDITION NEW NORMAL BELOW � ABOVE - FARM Aare Value Per � Value s Acre _ r o t �5D D0 Tillable l o - z, _ v - Tillable 2 - Tillable 3 > Woodland Swampland FRONTAGE ON WATER Brushlond FRONTAGE ON ROAD House Plat [DEPTH Total DOCK t �y. e� � v COLOR f _ v s� a �f `PRIM - x U' e � 1 ` - _ _ — € 77T r ` �� ®s , i r M. Bldg a _ - ,ti Four�t i on z Bath Dinette Win—I— Extension Floors = K Extension Interior Finish - = LR. _ _ _ _�_ xt Walls Extension Fire Place Meat D . R 'Type Roof Roams 1st Floor ; BR Rooms ons Floor' FIN. B. Po RecreationRopm �t Porch - jD orrrser _ a Driveway Breeze �— -� _ j, Patio O. B, Total