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Home My WebLink AboutTR-10960A Glenn Goldsmith,President Q�OSuffO��C� Town Hall Annex A.Nicholas Krupski,Vice President a� Gy` 54375 Route 25 Eric Sepenoski y a P.O. Box 1179 Liz Gillooly �+� • h. Southold,NY 11971 Joseph Finora 'lj aQ�,��' Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction % constructed Project complete, compliance inspection Glenn Goldsmith,President so Town Hall Annex 54375 Route 25 Nicholas Krupski,Vice President �OV� ��® P.O. Box 1179 Eric Sepenoski l l Southold,New York 11971 Liz Gillooly G Telephone(631) 765-1892 Joseph Finora • a0 Fax(631) 765-6641 ®l�COUN N BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10960A Date of Receipt of Application: April 13, 2026 Applicant: James F. Lubin Living Trust Dated August 5, 2021 & Pamela M. Lubin Living Trust Dated August 5, 2021 SCTM#: 1000-86-2-2 Project Location: 2766 Wells Road, Peconic Date of Resolution/Issuance: May 13, 2026 Date of Expiration: May 13, 2029 Reviewed by: Board of Trustees Project Description: Install an 8' x 18' shed and Tx 5' generator pad. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by James Lubin, received on April 13, 2026, and stamped approved on May 13, 2026. Special Conditions: None. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Glenn Goldsmith, President Board of Trustees V / APPROVED BY BOARD OF ', tWS 1 EES N/O/F ,-- TOWN.-OF SOUTHOLD z7 C, S (J DERV I ELLS �l� JOHN PI DEBORAH DEAVER I � (DWELLING w/ PUBLIC WATER) '^'� DATE Mc-o"k ka G Tlz-c-o � / J MAIN ROAD ` j I PROP. BURIED 1000 GAL PROPANE TANK (TO MAINTAIN 100, 100' TRUSTEE5 5 ACK = 10' MIN. SEPARATION FROM ALL SETBACK LINE WETLANDS LINE (PROM TIE NE) EL=5.'I SET - UNDERCROUND STRUCTURES, 1801.40' INCLUDING PIPING PIER LI �: EX15T. STORM p, d W i ATER CATCH CP 3- \ F--APR- Southold Town YL t} — PROP� 1 EL=6.8 HOLE / // - �� - z - -1- - 1 TIE ofTrnstees I 1 I O �\ ( A\� 7BAG p` / M.H.W.M. 1� �---rr'-- I 51D - / EXIST. DOCK 1 PROPI`OUTDOOR�HOWERLAND i cu t 5.0' w/ 40 AL. DRYWELL BY I r ` / I EDGEWOF� "FLO LL" (OR EQ.) WETLANDS I 11 1 ✓/ 1 DELINEATED BY ' j 1 1.0' \ \ 1 r N 1 1 1 SUFFOLK I l 1 ` z P O ENVIRONMENTAL 1 I , CONSULTING INC. t-nI I I PROP. \ r XID 1 1 / ON AUG. 1-7, 2018 I I I I I IPROP. EXIST. 2 STRY WD. SUN ROOM \ �6 1 ( I I I I I I G VERED FRAME DWELLING w � / \ f I 1 PORCH 2ND FLOOR REBUILD \ I I 1 I ` r- NO�TURFD 20' I 1 L J I I L J (4 BEDROOMS) rn 1 \ I \ , f BUFFER; L .-� 1 \ 1 \ I //// APPROX. 1,541 F.F. EL.=q.q' \ n ,2 I I S.F. AREA TO I f GARAGE EL.-8.? \ I n Irn 1 I I \ BE VEGETATED I O' BUFFER ------------------- EXIST. ! n �5.0 WATER I-- — PROF. 0 SUPPLY 1 PROP. ASPHAL2NP FL. T O1 8aq.8 s.F. I \ ADDITION LINE (W.F.) DRIVE 1 \ \ 11 TY\ / /R up.D #3 i ' --7 5' �t�1 (TYPJ M\ 1 IN. \ i 3.2 ID nI I MINI 8 DEEP 13 \ 501 m 1 / i�OP.DY1t2 ID' S1DE sEBA`G Ti�-�= X 1 \ n 1 VfX4 pap . ......... O - _ rn 00 1 "-" _-"�--V MIN. _ `�. ' \ EL="1.8 - _ ,j��. 100 WETLAND5 z °56,50"I„1 SETBACK LINE '/ �� r -I 5-4 t EXIST. OVERHEAD N/O/P 1 ELEC. WIRES 100' TRUSTEES SETBACK WILLIAM VICTORIA CORDON \ LINE (FROM TIE LINE) (DWELLING W.PUBLIC WATER) 1 \ RUSTEES SOUTHOLD .T No. Issued To% �Gr�eS} PG��► 1-�,b;�, Date Address THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765-1892 Glenn Goldsmith,President pp��SUFFO(k�OGti 1 Town Hall Annex A.Nicholas Krupski,Vice President < 54375 Route 25 Eric Sepenoski w ,? P.O.Box 1179 Liz Gillooly �y • p� Southold,NY 11971 Joseph Finora l Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report e�rr Date/Time. Completed in field by: 1� � Sol Searcher Consulting on behalf of JAMES F. LUBIN LIVING TRUST DATED AUGUST 5, 2021 & PAMELA M. LUBIN LIVING TRUST DATED AUGUST 5, 2021 requests an Administrative Permit to install an 8' x 18' shed and 3' x 5' generator pad. Located: 2765.Wells Road, Peconic. SCTM# 1000-86-2-2 Typ f area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: apt. 275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: 1 � 2 ,g}� Present Were: G. Goldsmith N. Krup E. Sepenoski L. Gillooly Finora { Rpgp (S.R.25) SURVEY OF PROPERTY MAINAT PECONIC TOWN OF SO UTHOLD SUFFOLK COUNTY, N. Y N 0 F 1000-86-02-02 JOHN FISCHETTI SCALE.' 1'-20 OR DEBORAH DEAVER i N I SEPTEMBER 19, 2018 N 0' CMF 19-4 FENCE -r FEN.COR. / J I to N84'56'50"E DON / / 1WUF � c►3 _ ,/ , ,, I I R�CHMOND CREEK CMF FEN.COR. —_ _r 0NN �� —7-�' / N O / AC I %/ // /// // WLF I= TIE LINE ALONG MHWM / CHIM. I / / 2 DOCK FLOATING DOCK 7- / I / / D K � cil 0 // 55.0 30.9 t/ \ I I DECK \ \ \ \ LANDWARD EDGE OF WETLANDS 2.1' 2 STY. FR !d \ 1 \ ' OD DELINEATED BY SUFFOLK O HOUSE \ \ \ = . ENVIRONMENTAL CONSULTING, I z t' FF=9'9' \ \\ \ \ W INC. ON AUGUST 17, 2018 I Y\ \ \ v try \ 1 d \ (ri 7.1' \\ l(o \ \\ \ m \ STKDE \ \ \ S1Y. FR ro FE. \\ \ ARAGE \ �• l ma cA N G FF=8.7' � \\ 94,4' \\ ?O S r OR O \ 26-S / I \ \ \WLF 1 \ KEY B O \ a _— / FEN.COR. I \fIPE \ 3 9'N �yL QQ - �LR q 0. � FEN.CAR. � s F I � 97.65 \ \� \� � C E I V � A = STAKE PIPE / FS IJf; IS = TEST HOLE S84'56'50"W � APR 1 3 2026 • = PIPE ■ = MONUMENT .N/O/F Southold Town WILLIAM & VI T RIA Boardolrrustees = WETLAND FLAG GORDON ELEVATIONS REFERENCED TO NAVD 88 ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209OF N.Y.S. LIC. NO. 49618 THE NEW YORK STATE EDUCATION LAW. EXCEPT AS PER SECTION 7209—SUBDIVISION 2. FPEC0NICl&RVEY0RS, P.C. ALL CERTIFICATIONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF (631) 765-5020 FAX (631) 765-1797 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE REA= 18,913 SO. FT. P.O. BOX 909 SIGNATURE APPEARS HEREON. 1230 TRAVELER STREET SOUTHOLD, MY 11971 18-163 1 s YYY7 ,f -�-�.. r, ` �,•�JAr-�- � to - • it - . 9 S - ivjw g41K4 -.� Wr 0 — �►•r 74 t b .1 SEE "TrH- LINE LINE EE, o"P It 3 I �o 'o A 2't 2m M-0. 2m V oO 44, ------- ft%ft. two v qt ......... PP bIN .6 V1 as 1 I A IN') Ewa'MIR LINE 41 COUNTY OF SUFFOLK N 02 y w yN 86 MA E N D (20 p J , 1 OFFICE LOCATION: ��OF SO(/ryO MAILING ADDRESS: Town Hall Annex ho l� P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971O • Q Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees Cc: Honorable Lori Hulse, Attorney From: Heather Lanza, AICP, Planning Director_ LWRP Coordinator Date: May 12th 2026 Re: LWRP Coastal Consistency Review JAMES F. LUBIN LIVING TRUST DATED AUGUST 5, 2021 & PAMELA M. LUBIN LIVING TRUST, SCTM# 1000-86.-2-2 This application is to install an 8' x 18' shed and 3' x 5' generator pad. The proposed action has been reviewed to Chapter §268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the policies of the LWRP as follows: Policy 6. Protect and restore the quality and function of the Town of Southold's ecosystem. 6.3. Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction. D. Provide adequate buffers between wetlands and adjacent or nearby uses and activities in order to ensure protection of the wetland's character, quality, values, and functions. The proposed plan includes actions which are consistent with the "Administrative Permit" requirements of Chapter §275-2 A of the Wetlands Law of the Town of Southold which qualify under Chapter§275-5 (8)(2)(e) Construction of accessory structures for existing single-family dwellings, provided that such activity will not have an undue adverse impact on the wetlands and tidal waters of the Town and the setback is no less than 50 feet. The proposed action has been reviewed to Chapter §268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. 2 J s Glenn Goldsmith,President �\Wo S® Town Hall Annex ' 54375 Route 25 A.Nicholas Krupski,Vice President , .. P.O.Box 1179 :AWEric aepenosld 1 Southold,New York 11971 Liz Gillooly Telephone(631)765-1892 Elizabeth Peeples y® Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Oaly Coastal Erosion Permit Application a Wetland Permit Application Administrative Permit APR 1 3 2026 AmendmenVTransfer/Extension Received Application: Received Fee:$ Southold Tovrn Completed Application: Board'Trustees Incomplete: ... . _... SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report: __Technical Review: Public Hearing Held: Resolution: Owner(s)Legal Name of Property (as shown on Deed): Lubin JF Living Trust; Lubin PM Living Trust. . . Mailing Address: 24 Tower Ct, Syosset, NY 11791 Phone Number: 201-452-7595 Suffolk County Tax Map Number: 1000-86•-2-2 Property Location: 2765 Wells Rd, Peconic, NY (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable):David Bergen, Sol Searcher Consulting Mailing Address:Box 1008, Cutchogue, NY 11935 Phone Number: 516-848-6438 Email. Tx, 7 8 :2 A 6 4. �• c o C..X Hoard of Trustees Application GENERAL DATA Land Area(in square feet);18,913. Area Zoning:R-40 Previous use of property:residential Intended use of property: residential Covenants and Restrictions on property? -JJYes _ No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? _aYes _allo If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? =Yes _R_No If"Yes",please provide copy of decision. ill his project regime any demolition as per Town Code or as determined by the Building Dept.? Yes ✓ No Does the structure(s)on property have a valid Certificate of Occupancy? Yes—D_No Prior permits/approvals for site improvements: Agency Date TR 10587 pips amendment 4/1/24; 6/11/25.. TR 1527, 9983, 1341, 1025 3/82;9/21.;.1.1/78.;.6/74 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?J�]_No_a Yes If yes,provide explanation: Project Description(use attachments if necessary): install a 8'X18' shed and a 3'X5' generator pad Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Storage and to support a generator for the home Area of wetlands on lot: 6,098 square feet Percent coverage of lot: ,14 .. . __. % Closest distance between nearest existing structure and upland edge of wetlands: 81 feet Closest distance between nearest proposed structure and upland edge of wetlands: 70 feet Does the project involve excavation or filling? 0 No Yes If yes,how much material will be excavated? 1 cubic yards How much material will be filled? 0 cubic yards Depth of which material will be removed or deposited: �5 feet Proposed slope throughout the area of operations: none Manner in which material will be removed or deposited: hand dug Statement.of the effect,if any,on the wetlands and tidal waters of the town that may result by reason,of such proposed operations(use attachments if appropriate): no impact 61 Z20 Appendix B Short Environmental Assessment Form Instructions fir.Completine 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 l 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 Lubin Living Trust Name of Action or Project: Lubin shed and generator pad installation Project Location(describe,and attach a location map): 2765 Wells Rd, Peconic NY 11958 .. ......... Brief Description of Proposed Action: Install a 8'X18' prefab shed and a 3'X5' concrete generator pad to support home generator Name of Applicant or Sponsor. Telephone*201-452-7595 Lubin JKF Living Trust/Lubin PM Living Trust E Mail: • I I , . Address: 24 Tower Ct; City/PO: State: Zip Coder Syosset NY 11791 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 Fv� ❑ 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? .43 acres b.Total acreage to be physically disturbed? <,1... ..... acres c.Total acreage(project site and any contiguous properties)owned . or controlled by the applicant or project sponsor? 43 .. acres 4. Che 11 land us"at occur on,adjoining an ar the prop9sc4 action. Urban 1„JRural(non-agriculture) Industrial Commercial ❑✓Residential(suburban) Forest Agriculture kdAquatic QOther(specify): . Parkland Page 1 of 4 5. Is the proposed action, NO - YES NIA a.A permitted use under the zoning regulations? ✓ b.Consistent with the adopted comprehensive plan? fl 6. Is the proposed action consistent with the predominant character of the existing built or natural .NO... YES s . landscape? ✓ 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:_.Richmond-Creek 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? 2/ Li 9.Does the proposed action meet or exceed the state energy code requirements? NO.... YES Iftthhe proposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: 11.Will the proposed action connect to existing wastewater utilities? NO YES alread has an IA If No,describe method for providing wastewater treatment:... y ,........s.y.stem � , ❑ for the house 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO _. YES Places? PNO b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion ofthe site of the proposed action,or lands adjoining the proposed action,containffYES 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: 14. ntify the typic bitat types that oc n,or are likely to be found on ttle�groject site. Check all that apply: ✓ Shoreline Forest Agricultural/grasslands "Early mid-successional ✓ Wetland Urban Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO _ ,YES by the State or Federal government as threatened or endangered? ✓ 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.. If Yes, a.Will storm water discharges flow to adjacent properties? []NO ❑YES El b.Will storm water discharges be directed to established conveyance systemsf an drains)? If Yes,briefly describe: r5O ✓ ES already in place.for house. Page 2 of 4 1 18.Does the proposed action include construction or other activities that result in the impoundment of NO I YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe. .. .. � ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: _. I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name::DaVid.Bergen._. Date4/13/26 Signature: . Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all ofthe.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 Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning Elregulations? 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 Elaffect 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. W i I I the proposed action impact existing: El ❑ a.public/private water supplies? 11 ... b.public/private wastewater treatment utilities? ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ a architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, El Elwaterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? ❑. 11. Will the proposed action create a hazard to environmental resources or human health? . .a o. 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. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Leas!Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Applicu'"in AFFIDAVIT E �)4s� .. U G .:..,.. .�,�i31'` BEING DULY SWORN DEPOSES AND AFFIRMS THAT HEN HE THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND.BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. NN C N Sig a re of Property Owner Signature-of Property:Owner SWORN TO BEFORE ME THIS DAY OF _ems 20 . . ........ Notary Public PAULINE MARULLI NOTARY PUBLIC,STATE OF NEW YORK NO. 01 MA6379366 QUALIFIED IN EOXP RES OOCTC17,2026 MY COSIO Board of Trustees Applic.,-.on AUTHORIZATION (Where the applicant is not the owner) I/We, r-t c5 ��,C Js3/n! O��b l�4 owners of the property identified as SCTM# 1000-_ � Z -Z- in the town of P so o `W ,New York,hereby authorizes LR 6'i-G to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. { a- Pr Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF 20., 02 G Notary Public Pl�I ILIA 1NARULU LQUALIFIED Y PUBLIC,STATE OF NEW YORK NO. 01 MA63719366 MMfSIO�f EXPIRES OCT 17,COU2 26 { APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town'of Southold's Code of Ethics prohibits,'conflicts of.interest on the hart of town officers Arid emalovees.The'gurvose of .this forni`is-to-provide'information which cat alert theaown"of possible conflicts:of interest and allow'it to take whatever actiori`is necessary to avoid same. YOUR NAME: i4V-(Cs 5 F'4 J o i 4 (Last name,first name,-middle initial,unless you are applying inihe 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 rclationship,With anytifficer.or employee of the Town of Southold? "Relationship"includes by blood,marriage,or'liustnessinterest `,'Business intetest",means a business, including a partnership,in which the town offdeeor;employce has even,a:partial ownership of(or.etnploymer t iy)a corporation in which the;town officer,or employee owns more than<5%o ofthe shares. YES n 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): _nA)the owner of greater than 5%of the shares of the corporate stock of the applicant f2 (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 thi 0 d l ill 20 Z 6 Signature: Print Nam Fonn TS 1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold'.s Code of Ethics prohibits cotifficts of interest on the nart'oFtown oDDicers and employees The puivose of- this form is to provide information which can alert the town of nossibleconflicts of inteir«stand allow is to take whatever action is ncomorV to avoid lama. Youitm .David Bergen (bast name,first name,jpiddle 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 Of"Other-,name the activity.) :. Do you personall (or through our,corn y your parry,spouse;sitiling,parent;or child)have a relationship with siriyoffceror:employee_ of the Town of Southold? "Relationship"inclades-t y blood,.rriarriag orbusinesIs interest!%usmess interest"means a.bustrress, including a partnership,in which the townoffcer or employee has even.a,partial ownership of(or employmentby).a:carpo ation in which the town officer or employee owns more thaui.50%df.the shares. nYES 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 Titre or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate fine A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,oir child is(check all that apply): E,A)the owner of greater than'5%of the shares of the corporate stock of the applicW � (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the Aapplicant is not a corporation); C)an officer,director,partnei,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 13 day of A 20 26 Signature •- — PrintName aVl er n Form IS I Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list,policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A..proposed.action. will be evaluated. as to its Ag9ficant. beneficial and°adverse effects.:upori the coastal area(which includes all.of Southold Town). 3: If any question in Section C on this form is answered "yes" or"no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. .Thus, each answer must.be:explained in detaii4.listing both supporting and non- supporting facts. 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# 1000- -86.2 .-2 pROJECi'NAME Lubin Shed and Generator Pad installation The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ 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: Install.a.8X1.8'.storage shed and.a&XV..concrete_generator pad.__ r Location of action: 2765 Wells Rd, Peconic, NY Site acreage: .44 Present land use: residential Present zoning classification:residential 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: Lubin JM/PM Living,Trust (b) Mailing address: 24 Tower Ct, Syosset, NY 11791 (c) Telephone number: 201-452-7595 Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No Rl ff yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. 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. aYes ❑ No ❑✓ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No R] Not 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 ❑ Yes ❑✓ No❑ Not Applicable no impact .:.. .. . 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 RI 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 through 21 for evaluation criteria ❑ Yes 0 No Zot Applicable Already has an:IA.septic system.and a 20 ft.vegitated non-turf. buffer _ ttac honal sheets ifnecessary 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 0 Not Applicable no impact; alrewady has an IA system and 20 ft vegitated non turf buffer; . Attach additional sheets ifnecessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. Yes [--]No❑✓ Not Applicable 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.n No ❑Not Applicable Already.has an IA septic system and a 20 ft vegitated non-turf buffer 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. n ❑ YeEl No 0 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. Fie]Yes ❑ No ❑Not Applicable Shad.will..store recreational water dependent ant 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. ❑Yea ❑ No❑Not Applicable Already,has an IA system and.a 20 ft vegitated non-turf buffer 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 0 Not Applicable Attach additional sheets ifneceway Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies;Pages 65 through 68 for evaluation criteria. .21 Yes ❑`No❑ Not Applicable generator pad will support a generator to be used in power disruption emergencies PREPARED BY David Bergen,Sol Searcher.Con. ALE Agent DATE 4/13/26 Board of Town Trustees Town Hall Annex 54375 Main Road Southold, NY 11971 April 10, 2026 RE: 2765 Wells Road, Peconic SCTM#: 1000-86-2-2 Dear Trustees Please accept this letter as my request for an Administrative Permit providing Trustee approval to install: 1. 3'x 5' Generator 2. 8'x 18' Shed Please accept the accompanying Site Plan denoting the proposed location of the Generator and Shed which conforms to the required 5'setback from the property line. For your reference,the Trustees previously approved the installation of the same Generator and Shed under Administrative Amendment to Wetland Permit#10587. Please see accompanying approval dated October 16, 2025 and subsequent request to withdraw dated January 28, 2026. If there are any questions or concerns, please contact me at 201-452-7595. Thank you for your time and attention. incerely, James F. Lubin 2765 Wells Road Peconic, NY 11958 Box 1008 Cutchogue, NY. 11935 April 13, 2026 Southold Town Trustees Town Hall Annex 54375 Rt. 25 Southold, NY. 11971 Dear Trustees: I am respectfully submitting to you the attached application packet for an Administrative permit for the installation of a 8'X18' shed plus the installation of a generator pad for the Lubin Living Trust house located at 2765 Wells Road, Peconic... Enclosed you will find: Administrative Permit Application fE Short Environmental Assessment FormRD Authorization FormOwner AffidavitApplicant Transactional Disclosure Form 2026 `Agent Transactional Disclosure Form L-:- LWRP Consistency Assessment Form ---_ Copy of Trust Documentation Copy of previous approval and subsequent withdrawal of same request -—__ Site construction plans Property survey Color photographs -Check to cover the$250 application fee Thank you for your consideration of this application. Please do not hesitate to contact me at 516-848-6438 should you have any questions. Sincerely, David Berge ,Sol Searcher Consulting Agent for Lubin Living Trust