HomeMy WebLinkAbout#8129-Colbert ZBA application 2-
TOWN OF SOUTHOLD SAY 0
BUILDINGENT
SOU HOLD,N.Y.
Zoning 13oarb oa
NOTICE OF DISAPPROVAL
DATE: April 7,2026
AMENDED: April 28,2026
TO: Brooke Epperson(Colbert)
PO Box 152
Mattituck,NY 11952
Please take notice that your application dated March 13,2026:
For permit to: constructadditionsand alterations to an e::istima sin le-fa�xtiln dwelling at:
Location of property: 2155 Long Creek Drive. Sguthold.,NY
County Tax Map No. 1000- Section 55 Block 7 Lot 7
Is returned herewith and disapproved on the following grounds:
The gropgsed construction on this nonconfonhLn 41 26 s � ft.lot(34,810 so. ft.buildable
land in t1 Seetion 280-124 which
states lots measuring 40 000-59.999 square feet in total size reouire a minimum side vard setback
of20feet. The proposed minimum side vard setback will be 15.2 feet,
Additionally,the groWsed construction is not permitted Pursuant to Article XXXVI
Section 280-207A 1 d which states" "the gross floor area shall not exceed the permitted
uare footage calculated as follows:Lots containing up to 40 000 square feet of lot area:
4,150 square l"eet plus 7.5% of the lot area in excess of 30,000,s uare feet,91 to a total of
5 I00 sa Mare feet maximum." The USrmitted gross floor area is 4,710.75 s . ft.and the,
proposed gross floor area is 4,995 s .ft.
This Notice of Disapproval has been amended to reflect the revised site plant last dated, 4121126.
Authorized 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.
�J(A
eceiv ';
APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPOW 0
AREA VARIANCE
House No.2155 Street Long Creek Drive Hamlet Southold Zoning Board
SCTM 1000 Section: 55 Block: 7 Lot(s)7 Lot Size: 0.94 acres Zone R-80 NC
I(WE)APPEAL THE WRITTEN DETERMINATION OF THE BUILDING INSPECTOR
DATED 04/28/2026 BASED ON SURVEY/SITE PLAN DATED 04/21/2026
Owner(s): John &Wendy Colbert
Mailing Address: 1 Lincoln Ave, Old Greenwich, CT 06870
Telephone: 203-536-8511 Fax: Email: johnjcolbert@gmail.com
NOTE: In Iddition to the above 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: AMP Architecture for><Owner( ) Other:
Address: PO Box 152, MAttituck, NY 11952
Telephone:631-603-9092 Fax: Email: bepperson@amparchitect.com
Please check to specify who you wish correspondence to be mailed to,from the above names:
( )Applicant/Owner(s), Authorized Representative, ( )Other Name/Address below:
WHEREBY THE BUILDING INSPECTOR REVIEWED SURVEY/SITE PLAN
DATED 04/21/2026 and DENIED AN APPLICATION DATED 03/13/2026 FOR:
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: XXlll Section: 280 Subsection: 124
Type of Appeal. An Appeal is made for:
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, ghas not been made at any time with resjject to this 12rol2erty
UNDER Appeal No(s). Year(s).
(Please be sure to research before completing this question or call our office for assistance)
Page 2, Area Variance Application
Revised 6/2023
MAY 0 6`2G7�'
REASONS FOR APPEAL
(Please be specific„additional sheets may be used with preparers signature notarized): Zoning Board of
1.An undesirable change will not be produced in the CHARACTER of the neighbor or a detriment to
nearby properties if granted,because:
The areas of proposed work are well within required zoning setbacks of the buildable lot area. The area in
need of a side yard setback variance is the proposed second floor above the existing attached garage. The proposed
second floor also stays within the allowable sky plane despite portion of the existing roof not complying.
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:
Area where second floor addition is desired and most feasible is above the first floor that is already encroaching
the required side yard setback.
3.The amount of relief requested is not substantial because:
The proposed second floor addition stays within the existing first floor footprint that has an existing
non-conforming yard setback.
The GFA is for more living space where a large portion of the existing square footage is double height
space not being able to utilize for liveable floor area.
4. The variance will NOT have an adverse effect or impact on the physical or environmental conditions in
the neighborhood or district because:
The proposed addition will have gutters and downspoats leading to a proposed drywells which will
be located away from protected wetlands per state and local requirements.
5. Has the alleged difficulty been self created? { } Yes,or No Why:
The existing dwelling is already encroaching the side yard and sky plane in question. The GFA can only be calculated
from the area landward of the Wetlands.
• Are there any Covenants or Restrictions concerning this land? XNo { } 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 of Applicant or Authorized Agent
(Agent must submit written Authorization from Owner)
Sworn to before me this 2_9_ day MARIA PRIKAS GANI-EY
Of 1 20 / Notary Public-State of New York
b N0.01 PR5003206
Qualified in Suffolk County
My Commission Expires Oct 19,2026
Notary Public 0
. cep
Zoning Board of Appeals
APPLICANT'S PROJECT DESCRIPTION Receive
C.
APPLICANT: AMP Architecture SCTM No. 1000-55-7-7 .M4
1. For Demolition of Existing Building Areas Zoning Board Of
Please describe areas being removed: Exterior walls on front of home, covered front porch„ roof above attached garage,
as well as windows and portion of wall at rear,
I1.New Construction Areas(New Dwelling or New Additions/Extensions):
Dimensions of first floor extension: 30'-6 1/2"x 23'-2"
Dimensions of new second floor: 21'-5'x19'-11 1/2"
Dimensions of floor above second level: N/A
Height(from existing natural grade): 27'-6"proposed second floor roof,
Is basement or lowest floor area being constructed? If yes, please provide height(above ground)measured from
natural existing grade to first floor:
First floor and basement area being constructed w/first floor height at approx, 2'a.g,
111. Proposed Construction Description(Alterations or Structural Changes)
(Attach extra sheet if necessary). Please describe building areas:
Number of Floors and General Characteristics BEFORE Alterations: Existing 2 story framed dwelling w/covered
front 2orch,attached 2 car garage, basement and rear wood deck.
Number of Floors and Changes WITH Alterations: Existing 2 story frame dwelling with renovated portions of interior„
1 story addition at front and side, 2nd floor addition above existin attached garage, and on side of home 4.5'x4.5'
outdoor shower open to sky(<8"above grade).
IV. Calculations of building areas and lot coverage,sky plane(From Surveyor,Design Professional):
Existing square footage of buildings on your property: 2,362 S.F.
Proposed increase of building coverage: 657 S.F. building +96.2 S.F. covered porch = 753.2 S.F.
Square footage of your lot: 41,526.31 Total area;34,810 sf buildable area
Percentage of coverage of your lot by building area(lot coverage) 7.3% Existing, 8.9% Proposed
Gross Floor Ai
Lea m(GFAI 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):
4,995 S.F.
For Residential lots, is project within the allowable S Plane?(Please refer to Chapter 280, Section 280-208 of
the Town Code): All proposed work is within the allowable sk lane. Portion of the existin roof is not
within the allowable sky plane but is not being modified in proposed work. See proposed plans.
V. Purpose of New Construction: 1 story addition to home with 2nd floor addition above existing attached garage for
added living space. Reconfiguration of portions of interior of home and proposed outdoor shower in side yard.
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:
Land around existing structure is typically flat, sloping gradually to top of bank and then down to Arshomaque
Pond on side and rear of property.
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 ���IVe41
�
A� Is the subject premises currently listed on the real estate market for sale? MAY ®5 207_�
Yes _XNo
B. Are there any proposals to change or alter land contours? Zoning Board of
_X_No Yes,please explain on separate sheet.
C. 1.)Are there areas that contain sand or wetland grasses? Yes
2.)Are those areas shown on the survey submitted with this application? Yes
3.) Is the property bulk headed between the wetlands area and the upland building area?
No
4.) If your property contains wetlands or pond areas,have you contacted the Office of the
BOARD OF TRUSTEES for its determination of jurisdiction? Yes
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 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
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? No
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? No
If yes, please label the proximity of your lands on your survey and identify the Suffolk
County Tax Map No.
I. Please list present use or operations conducted at your property, and/or the proposed use
Existing single family home. Proposed is the same.
J. (examples:existing single family,proposed:same with garage,pool or other)
42
na Authorrxed i
' g Date
I
FORM NO. 4
TOWN OF SOUTHOLD eceiver g
BUILDING DEPARTMENT
Office of the Building Inspector MAY 05 2025
Town Hall
Southold, N.Y.
Zoning Board of Aopeals
CERTIFICATE OF OCCUPANCY
No Z19520 Date NO ER 20 1990
THIS CERTIFIES that the building ONE FAMILY DN'E ,L'ING'
Location of Propertlr 2155 LONG CREEK DR. SO OLD
House No. Street Hamlet
County Tax Map No. 1000 Section 55 Block 07 Lot 07
SEC. ONE
Subdivision LONG POND ESTATES Filed Map No. 8037 Lot No. 5
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOV. 24 19,89 ursuant to which
Building Permit No. 18667Z _dated NOV. 24 1989
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 ONE FAMILY D INC, AT'T .CN,E'D GARAGE AND DECK.
The certificate is issued to MIND ENTERPRISES INC.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 89-SO-105 JULY 26 1990
UNDERWRITERS CERTIFICATE NO. N158426 OCT. 31 1990
PLUMBERS CERTIFICATION DATED CHARL S ERS--NOV, 16 1990
N
Bu" ding Inspector
Rev. 1/81
A
f Fe Town of Southold 10/11/2020
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
Receive-
CERTIFICATE OF OCCUPANCY Zoning Board of rctJ,'"Jeais
No: 41533 Date: 10/11/2020
THIS CERTIFIES that the building HVAC
Location of Property: 2155 Long Creek Dr, Southold
SCTM#: 473889 Sec/Block/Lot: 55.-7-7
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
6/30/2020 pursuant to which Building Permit No. 44970 dated 7/10/2020
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 built"c trai air conditioning as aRpligd for.
The certificate is issued to Colbert,John&Wendy
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 44970 10/2/2020
PLUMBERS CERTIFICATION DATED
+red Signature
7I
�fllxp� Town of Southold 7/18/2021
P.O.Box 1179 Received
53095 Main Rd
Southold,New York 11971 MAY 0 5 2026
aid
CERTIFICATE OF OCCUPANCY
No: 42177 Date: 7/18/2021
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 2155 Long Creek Dr, Southold
SCTM#: 473889 Sec/Block/Lot: 55.-7-7
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
4/16/2021 pursuant to which Building Permit No. 46096 dated 4/16/2021
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:
eleg1jig wiring for kitchen renovation and sub anel.
The certificate is issued to Colbert,John&Wendy
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 46096 6/22/2021
PLUMBERS CERTIFICATION DATED
as&h ze ignatur6
AGRICULTURAL DATA STATEMENT Receive
ZONING BOARD OF APPEALS
TOWN OF SOUTHOLD MAY p 2026
WHEN TO USE THIS FORM: This form must be completed"by the ap licantfqr an p special use
permit,site plan approval",use variance,area variance or.subdivision
an agricultural district OR within 500 feet of a farm operation located in an agricultural 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: A '
2. Address of Applicant: ; 1-Q,,-vC
3. Name of Land Owner(if other than Applicant):
4. Address of Land Owner:
5. Description of Proposed Project: I s\,4
6. Location of Property: (Road and Tax map Number)_ 6 c . -
7. Is the parcel within 500 feet of a farm operation? { } Yes No
8. Is this parcel actively farmed? { } Yes 4 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
1.
2.
3.
4.
5.
6.
(Please use the back of this page if there are additional property owners)
�eb
Signature pp scant 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.
I
617.20
Appendix B Receive F
Short Environmental Assessment Form
Instructions for Comnleting
MAY Q 5 2026
.Zoning Board of Hi.,peals
Part 1 -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 1 based on information currently available. If additional research or investigation would be needed to fully
respond to any item,please answer as thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency;attach additional pages as necessary to supplement any item.
Part 1 -Project and Sponsor Information
Name of Action or Project:
Colbert Addition
Project Location(describe,and attach a location map):
2155 Long Creek Drive, Southold, NY 11971
Brief Description of Proposed Action:
1 story addition at front and side of existing single family dwelling, 2nd floor addition above existing
attached garage, and 4.5'x4.5' outdoor shower open to sky on side of home.
Name of Applicant or Sponsor: Telephone: 631-603-9092
AMP Architecture E-Mail: bepperson@amparchitect.com
Address:
PO Box 152
City/PO: State: Zip Code:
Mattituck NY 11952
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
may be affected in the municipality and proceed to Part 2. If no,continue to question 2.
2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES
If Yes, list agency(s)name and permit or approval:
3.a.Total acreage of the site of the proposed action? 0.94 acres
b.Total acreage to be physically disturbed? 0.019 acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 0.94 acres
4. Check all land uses that occur on,adjoining and near the proposed action.
❑ Urban Rural(non-agriculture) ❑ Industrial ❑Commercial Residential(suburban)
❑ Forest ❑Agriculture ❑ Aquatic ❑Other(specify):
❑Parkland
Page 1 of 4
5. Is the proposed action, 1�rA NO YES N/A
a.A permitted use under the zoning regulations? (�I V
b.Consistent with the adopted comprehensive plan?
deceived ✓
6. Is the proposed action consistent with the predominant character of th% i ti i f tatural' NO YES
landscape? T V
7. Is the site of the proposed action located in,or does it adjoin,a state liglte & kltifa tal Area? NO YES
If Yes, identify: 7-oni tg
................................................ ........
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
b.Are public transportation service(s)available at or near the site of the proposed action?
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action?
9.Does the proposed action meet or exceed the state energy code requirements? NO YES
If the proposed action will exceed requirements,describe design features and technologies:
....... .....
10. Will the proposed action connect to an existing public/private water supply? NO YES
If o describe method for providing potable water:
11.Will the proposed action connect to existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment:
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places?
b.Is the proposed action located in an archeological sensitive area?
13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES
wetlands or other waterbodies regulated by a federal,state or local agency?
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: v
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
VWetland ❑ 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?
16. Is the project site located in the 100 year flood plain? NO YES
17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES
If Yes,
a.Will storm water discharges flow to adjacent properties? \VNO❑YES V
b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)?
If Yes,briefly describe: ❑NO4YES
Gutters and dry wells will be installed to catch and retain runoff.
Page 2 of 4
18. Does the proposed action include construction or other activities that result in the impoundment of NO YES
water or other liquids(e.g.retention pond,waste lagoon,dam)? Received
If Yes,explain purpose and size: ^^^ mT
19.Has the site of the proposed action or an adjoining property been the locatic of.an a c s NO YES
solid waste management facility?
oning `%vapd bg *peals:
If Yes,describe:
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed)for hazardous waste?
If Yes,describe:
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE A Applicant/sponsor name: AfchltectU ,fe Date;
Signature:
Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following
questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or
otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my
responses been reasonable considering the scale and context of the proposed action?"
No,or Moderate
small to large
impact impact
may may
occur occur
L 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 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
No,or Moderate
Received small to large
�[ impact impact
may may
Y 0 occur occur
10. Will the proposed action result in an increase in the potential for erosion,flooding or draina e
problems? Z0Ii 0 - , 1s
11. Will the proposed action create a hazard to environmental resources or human health?
Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every
question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular
element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3.
Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by
the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact
may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring,
duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and
cumulative impacts.
Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action may result in one or more potentially large or significant adverse impacts and an
environmental impact statement is required.
* Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action will not result in any significant adverse environmental impacts.
Name of Lead Agency Date
e Name of Responsible Of _ .., .. .mw___ww__ww...,
Print or Type p 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
r�
sm
Received
Board of Zoning Agpeals Apolication MAY 0 5'2026
Zoning Board a. ;appeals
OWNER'S AUTHORIZATION
(Where the Applicant is not the Owner)
I, —jo I� I y C D ,'"l residing at i L� N Co L�) At/E-lwc
(Print property owner's name) (Mailing Address)
C.�do hereby authorize ZAK ` µ 1
(Agent)
to apply for variance(s) on my behalf from the
Southold Zoning Board of Appeals.
By signing this document,the Property Owner understands that pursuant to Chapter 280-
146(B)of the Code of the Town of Southold any variance granted by the Board of Appeals shall
become null and void where a Certificate of Occupancy has not been procured,and/or a
subdivision map has not been filed with the Suffolk County Clerk,within three(3)years from
the date such variance was granted. The Board of Appeals may, upon written request prior to
the date of expiration,grant an extension not to exceed three(3)consecutive one(1)year terms.
IT IS THE PROPERTY OWNER'S RESPONSIBILITY TO ENSURE COMPLIANCE WITH
THE CODE.REQUIRED TIME FRAME DESCRIBED HEREIN.
(Owner's Signature)
�oH-�-1 Co L
(Print Owner's Name)
.........
APPLICANT/OWNER
TRANSACTIONAL DISCLOSURE FORM Flecelve(4
'rhe Town of 5guthgld's_Code
_of Ethic sgrohiib itsconflic-4—of interest on.
tt2 jj:_1jt or 12wil officers and.arnnl 1Me)M*0ost of this
fQrm i§to pr vid2 jq form athan,whjgb can alert the town of npassible conflicts of interest an allow it to taUMMffirhffiq il
necessary to avoid some.
YOUR NAME : ZO,6tng NWd 0'
(Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a
company.If so,indicate the other person's or company's name.)
TYPE OF APPLICATION:(Check all that apply)
Tax grievance Building Permit
Variance 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)
—Q an officer,director,partner,or employee of the applicant;or
—D)the actual applicant
DESCRIPTION OF RELATIONSHIP
Submitted tliftayof 20
Signature
Print Name
..........
Re
MAY 0 20175
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM Zoning EWKd Q'
The Town.of Soujh2ld'2 Code of Ethics vEgbibis sanflim of int—creg gn the port
this L, . . L 2LIown off_wers LrLd-empigyms,The gqWjg of
orm,j2 1p 2Mvidc inf orm.a.liq-owhs"chm alert the town of imssible conflicts of inteLesl and a it Lo take whateveractign is
nccess_M &y9id saMg,
YOUR NAME: Anthony Portillo
(Last name,first name,ipiddle initial,unless you are applying in the name of
someone else or other entity,such as a company.If so,indicate the other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance Building
Variance Trustee
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map Planning
Other
(If"Other",name the activity.)
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 interese'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):
f2A)the owner of greater than 5%of the shares of the corporate stock of the applicant
r--j (when the applicant is a corporation);
B)the legal or beneficial owner of any interest in a non-corporate entity(when the
2 applicant is not a corporation);
Q an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
I M�j �h
Submitted this arc 20 26
Signature_,,,
Print Name n ony ortilo
iy
Form TS 1
Town of Southold
R c ioo=f
LWRP CONSISTENCY ASSESSMENT FORM
MAY 0 5 2026
A. INSTRUCTIONS Zoning Board o'' ,ppeals
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# 55 -7 -7
The Application has been submitted to(check appropriate response):
Town Board Planning Dept. r Building Dept. ® 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:
Permit for 1 story addition to existing 1-family dwelling, 2nd story addition above existing attached garage,
and outdoor shower on side of home.
Received
Location of action:2155 Long Creek Drive, Southold, NY 11971
A 2026
Site acreage:0.94 acres
Zoning hoard of ,4ppe819
Present land use:Residential
Present zoning classification:R-80 NC
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:AMP Architecture
(b) Mailing address:Po Box 152, Mattituck, NY 11952
(c) Telephone number: Area Code( )631-603-9092
(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 ❑ No ❑ Not Applicable
Proposed work in small in area particularly in relation to the size of the site and is
later ely built away from wetlands and over existin strucutre.
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
El Yes 11 No ® Not Applicable
Attach additional sheets if necessary
ecel� ,.
Policy 3. Enhance visual quality and protect scenic resources throughout the Town�oiuthold. See
LWRP Section III—Policies Pages 6 through 7 for evaluation criteria MAY 0UL
® Yes R No F Not Applicable Zoning Boarc`
Proposed work will not affect teh visual quality or scenic resources.
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 8 through 16 for evaluation criteria
® Yes R No El Not Applicable
Proposed work will be in accordance with the most up-to-date construction codes
and environemental conservation practices.
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 r No Not Applicable
Proposed work including dray wells will hold potential runoff therefore protecting the water qualit
and supply in the town.
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.
13 Yes E] No® Not Applicable
The quality and function of the ecos stem will not be affected b the ro osed work.
�170
Attach additional sheets if necessaryordt
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 E No® Not Applicable
All waste will be controlled. All construction debris will be disposed of pro erly,
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
This is a private property that has no public access and the proposed work will not affect neighbors.
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.
YesEl No® Not Applicable
Proposed work is on a private site.
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 ❑ No ® Not Applicable
.. *,
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.
Yes ❑ 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 for evaluation criteria.
Yes ❑ No® Not Applicable
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.
D Yes ❑ No ® Not Applicable
Created on 5125105 11:20 AM
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SIDE YARD SIDE YARD-15.1' BUILDING SETBACK
Application: Colbert Addition
Applicant: AMP Architecture
2155 Long Creek Dr, Southold, NY 11971
All photos taken: 11/21/25 1:OOpm
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SIDE YARD FRONT VIEW
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SIDE YARD—WATER SIDE SIDE YARD-15.1' BUILDING SETBACK
Application: Colbert Addition
Applicant: AMP Architecture
2155 Long Creek Dr, Southold, NY 11971
2
All photos taken: 11/21/25 1:OOpm
TOWN OF SOUTHOLD 1PROPERT � RD
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