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HomeMy WebLinkAbout#8135SE-Becker ZBA application -n) r; y( AQ ( - I Reidsed 612 124, TOWN OF SOUTHOLD ,� ",, , 'C) t t�2 ZONING BOARD OF APPEALS Phone(631) 765-1809 APPLICATION FOR A SPECIAL EXCEPTION PERMIT FOReseived ACCESSORY APARTMENT IN AN ACCESSORY BUILDING MAY 21 2026 Applicant(s)Name(s) m i e . avid c u e e C in oard of Appease Applicant(s)Address 3 a u 2 g 5 1 n ni Ave �0 0q 0O 6ui�� ry Phone:T1 t' Jr I + "" Email: becke-rJo4A mqi 10 (LIM Itwe are the owners of the subject property [ I am the agent for the property owner and my Letter of Authorization and Transactional Disclosure Form is attached. Representative(if other than applicant): t4 /A Address Phone: Email: A. Statement of Ownership and Interest: pp 4 A ti e 10. U A d a s i C U C cle r is(are)the owner(s)of the property known and referred to as SO u f� d l 380 ASktl A AVe, (i-eewi or House No. S4eet Ha et. Zip Code Identified on the Suffolk County Tax:flaps as Di "et 1000,Section Block]— Lot ) Lot Size Zone District as sbown on th+e attached deed and survey �re akaov ecr'i�d property was acquired by than owner() ra 20 6 Uwe hereby apply to the Zoning Board of Appeals for a Special Exception Permit pursuant to Section §280-13B(13)of the Zoning Ordinance to establish an accessory apartment in an accessory building as shown on the attached survey/site plan and floor plan(s) B. Project Description: eMove QX 1 S�iA �'x8 t w antwc ' are e W aatf mfao "e. July 2023 f Application Page 2,Special Exception for Accessory Apartment C. The applicant alleges that the approval of this special exception would be in harmony with the intent and purpose of said zoning ordinance,and that the proposed use conforms to the standards prescribed therein and would not be detrimental to propggy or persons in the ncigWrhood for the M19ming, reasons_ fors C, Z4 and 116 wa5L I 4 I n aye S iMi10kiftld Q u1,Q D. The applicant alleges that the following standards prescribed by Section§280- 13(B)(13)(a)-(k)of the zoning ordinance will be met: Z0=9 BOaCd Of /AppgA1§ a. The accessory apartment will be located in the accessory building. b. The owner of the premises shall occupy either the existing single-family dwelling or the accessory apartment in the detached accessory structure as the owners'principal residence.The other dwelling unit shall be occupied by a family member as defined in Section§280-4 of the code or a resident who is currently on Southold Town's Affordable Housing registry and is eligible for placement,evidenced by a written lease,for a term of one or more years. c. The accessory apartment shall contain no less than 220 square feet and does not exceed 750 square feet of livable floor as defined in Section§280-4 of the code d. The accessory apartment will be located on one floor of the accessory building and will contain No more than two bedrooms and No more than one bathroom. e. A minimum of three on-site parking spaces shall be provided as shown on the attached survey. L Not more than one(1)accessory apartment shall be permitted on this parcel. g. No Bed and Breakfast facilities,as authorized by Section§280-13(B)(14)hereof shall be permitted in or on the premises for which an accessory apartment is authorized or exists. h. The accessory apartment will meet the requirements of a dwelling unit as defined in Section 280-4 of the Zoning Code. i. This conversion shall be subject to a building permit,inspection by the Building Inspector and Renewal of Certificate of Occupancy annually. j, The existing accessory building which is converted to permit this accessory apartment has been in existence and has a valid Certificate of Occupancy fdr no less than thre ears,and is attached hereto. k. The existing building,together with this accessory apartment,shall comply with all other requirements of Chapter§280 of the Town Code of the Town of Southold. 1. This conversion for the accessory apartment shall comply with all other rules and regulations of the New York State Construction Code and other applicable codes. E. he property which is the subject of this application(check,all that apply): has not changed since the issuance of the attached Certificates of Occupancy C ']has changed or received additional building permits.Certificates of Occupancy for these changes are attached or will be furnished [ ]has been the subject of a prior ZBA decisions) opies are attached "A-1 O er Signature COUNTY OF SUFFOLK) ss.: STATE OF NEW YORK) Sworn a me t i (o day of � � ,20 7{. otary Public) NOTARY FUBI tC STATE OF NEW YOR UFFOLK COUNTY 621123 LIC #018R22 1 6 C&4Mc, FXpl 0 "0 1 July 2023 QUES'T"ION AM Received FOR FILING WITH YOUR ZBA APPLICATION MM 21 A. Is the subject premises listed on the real estate market for sale? Zoning gird ol` p , Yes I+lo .. B. Are there any proposals to change or alter land contours? No Yes,please explain on attached sheet. C. 1.)Are there areas that contain sand or wetland grasses? G gran �' �..� .— 2.)Are those areas shown on the survey submitted with this application? 3.)Is the property bulk headed between the wetlands area and the upland building area? 4.)If your property contains wetlands or pond areas,have you contacted the Office of the Board of Trustees for its determination of jurisdiction? Please confirm status of your inquiry or application with the Trustees: and if issued,please attach copies of permit with conditions and approved survey. D. Is there a depression or sloping elevation qe4r the area of proposed construction at or below five feet above mean sea level? E. Are there any patios,concrete barriers,bulkheads or fences that exist that are not shown on the survey that you are submitting? -.,Please show area of the structures on a diagram if any exist or state none on the above line. F. Do you have any construction taking place at this time concerning your premises? G. If yes,please submit a copy of your building permit and survey as approved by the Building Department and please describe: H. Please attach all pre-certificates of occupancy and certificates of occupancy for the subject premises. If any are lacking,please apply to the Building Department to either obtain them or to obtain an Amended Notice of Disapproval. I. 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. J. Please list sent use or o rations co ducted at ias ar l CIL ` nd the proposed use atpa K. (example:existing single Arnily,p posed':same with garage,pool or other) Na D 2AZL- 0� a Auithorized signature and Date I I i j July 2023 i p � Town of Southold 2/3/2016 J"� 53095 Main Rd w;✓hw Southold,New York 11971 Fleceived MAY 212026 . .... ... .� EAST STING Zoning Board of appeals-- CE .TIFICATE OF OCCUPANCY No: 38082 Date: 2/3/2016 THIS CERTIFIES that the structure(s)located at: 380 Washington Ave SCTM#: 473889 Sec/Block/Lot: 41.4-39 Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER 2r 38082 dated 2/3/2016 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: 1 "ood frame one and a halfsto oxre farnil dwellin oath closed front trywy y and 2 s�orag ;, h9ds. rich slate patina area N te: BP 40400-el tr e('10 M,111141 911 4 131I %s, Milt„bA1hy%)&M mo alkni L( 3I1tI81_ The certificate is issued to Stepnoski,Jean (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. /Signature BUILDING DEPARTMENT TOWN OF SOUTHOLD Received HOUSViG CODE INSPECTION REPORT MAY 212026 LOCATION: 380 Washington Ave ---- -------0-i-Appeals SUFF.CO.TAX MAP NO.: ....4...131- 9 SUBDIVISION: 'Zon1j)g Board NAME OF OWNER(S): Stepnoski,Jean OCCUPANCY: ADMITTED BY: Josh Whalley----------- ............... SOURCE OF REQUEST: Stepnoski,Jean DATE: 2/3/2016 ............. DWELLING: #STORIES: 1 1/2 #EXITS: 2 FOUNDATION: Cement block CELLAR: full CRAWL SPACE: ................ ... . .................. TOILET R BATHROOMS) 2 OOM(S): UTILITY ROOM(S): PORCH TYPE: DECK TYPE: 'PATIO TYPE: slate-shed area BREEZEWAY: FIREPLACE: I GARAGE: no DOMESTIC HOTWATER: yes TYPE HEATER: Super store AIR CONDITIONING: TYPE BEAT- oil WARM AM- HOT WATER: yes ..............I.......... .......... ---- #BEDROOMS: 4 #KITCHENS: I BASEMENT TYPE: unfinished OTHER: .................. .... .............. ......................... ... ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: 2 wood frame sheds SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: ............. REMARKS: -----------...... . ... .................. INSPECTED BY: GARYF DATE OF INSPECTION: 1/15/2016 ................ TIME START: END: IOt�C� Town of Southold 2/3/2016 P.O.Box 1179 53095 Main Rd Southold,New York 11971 F3eceived CERTIFICATE OF OCCUPANCY MAY 212026 y())s Zoning Board of Appeals No: 38081 Date: 2/3/2016 THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 380 Washington Ave, Greenport SCTM#: 473889 Sec/Block/Lot: 41.-1-39 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/20/2016 pursuant to which Building Permit No. 40430 dated 1/26/2016 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"BATHROOM RENOVATION TO AN E ISTIN ONE FAMILY DWELLINO AS APPLIED FOR. The certificate is issued to Stepnoski,Jean of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40430 01-20-2016 PLUMBERS CERTIFICATION DATED rSignat4re ��� rytl6! Town of Southold 2/3/2016 P.O.Box 1179 53095 Main Rd Received Southold,New York 11971 CERTIFICATE OF OCCUPANCY Zoning Board of Appeals No: 38080 Date: 2/3/2016 THIS CERTIFIES that the building ELECTRICAL Location of Property: 380 Washington Ave,Greenport SCTM#: 473889 Sec/Block/Lot: 41=1-39 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/11/2016 pursuant to which Building Permit No. 40400 dated 1/12/2016 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: E1,EC'1"11C I^01 I+CIIAGE SIIEIIS AfiIO l;I EC"1"RICAL SURVEY The certificate is issued to Stepno ski,Jean of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40400 01-20-2016 PLUMBERS CERTIFICATION DATED %utlwi�� i ed Signature I 1 Jr Town Hall Annex '' Telephone(631)765-1802 54375 Main Road Fax(�—As 31)7 P.O.Box 117940 Southold,NY 11971-0959 roger.richett@t0 BUILDING DEPARTMENT Zoning Boafd 0f Appeals TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Stepnoski Address: 380 (28)Washington Avenue City:Gteenpod St: New York Zip: 11944 Building Permit P 40430&40400 Section: 41 Blodc 1 Lot: 39 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE contractor DBA: Dan Wilcenski Electrical License No: 4723-ME SITE DETAILS Office Use Only Residential X Indoor X Basement X Service Only Commerical Outdoor X 1st Floor X Pool New Renovation 2nd Floor X Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph 200A Heat OIL Duplec Recpt 39 Ceiling Fixtures 18 HID Fixtures Service 3 ph Hot Water GFCI Recpt 8' Wall Fixtures 8 Smoke Detectors Main Panel 200A A!C Condenser Single Recpt Recessed Fixtures 13 CO Detectors Sub Panel A/C Blower Range Recpt 20A Fluorescent Fixture Pumps Transformer Appliances IDW I Dryer Recpt Emergency Ffxt+ure Time Clocks Disconnect 200A Switches 21 Twist Lock Exit Fixtures TVSS Other Equipment: Certificate Includes 2- Storage Sheds. Notes: "Electrical Survey"-"As Built" "No Visual Defects", 2-Exhaust Fans Inspector Signature: Date: Janua 20, 2016 Electrical 81 Compliance Form.xls 1 I TOWN OF SOUTHOLD �s -`" BUILDING DEPARTMENT auc�, SOUTHOLD, NY ed O RG 2� 2026 BUILDING PERMIT MAY eat (THIS PERMIT MUST BE KEPT ON THE PREMISES Z°nin9 Board of App WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 52924 Date: 04/29/2026 Permission is hereby granted to: Becker D8J Revoc Trt 10909 Grapevine Ln Austin, TX 78759 To: install a generator as applied for. Premises Located at: 380 Washington Ave, Greenport, NY 11944 SCTM#41.4-39 Pursuant to application dated 04/21/2026 and approved by the Building Inspector. To expire on 04/28/2028. Contractors: Required Inspections: Fees: GENERATOR $125.00 CO-RESIDENTIAL $100.00 Total $225.00 Building Inspector��� 617.20 Appendix B Short Environmental Assessment Form Received _ InsLru+cli�ons for I^ S '` canntleiln* MAY 212026 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,224 I �erification. 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 ction or Project: � e( q e: � a fa(fAnevif a v Project Location(describe,and attach a location map): 2 � � 3 � jA161 Ave Wick— �� r a 4 ` 4c � p r Brief Description of Proposed Action: Remove, 111)1 ,r CV14 LPG 1 ' e a v e. COA511, L)cf- Name of Applicant pliant o pry or: Telephone: s z "t 1 E-Mail: q� a 4 c� r-f I A Address: (oi 63 $ 01) �45�(Aq �Ofl ANJe' cityState:. , Zi Co 9r le- 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? acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. .100 ❑Urban 0 Rural(non-agriculture) 0 Industrial 0 Commercial Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? Cl'/ b.Consistent with the adopted comprehensive plan? ��> �i 6. Is the proposed action consistent with the predominant character of the existin NO YES landscape? 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical ft�i rl a? NO YES If Yes,identify: 13 8. a.Will the proposed action result in a substantial increase in traffic above p esent evels? 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? y� 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: K 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 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? X b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? x If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban VSuburban 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? Nme 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? ❑NO❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO❑YES Page 2 of 4 aJ 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)? x If Yes,explain purpose and size: l 19.Has the site of the proposed action or an adjoining property been the location of an actie�r �ed NO YES solid waste management facility? MAY If Yes,describe: zoning rd 0 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 ANhnn PP�cat/spo or name: UQAI Date: 2 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 1. Will the proposed action create a material conflict with an adopted land use plan or zoning X regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? x 3. Will the proposed action impair the character or quality of the existing community? x 4. Will the proposed action have an impact on the environmental characteristics that caused the X establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or x 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 eLergy conservation or renewable energy op rtumties? 7. Will the proposed action impact existing: X 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, X 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 small to large impact impact lReceNec I may may occur occur -71 IN 10. Will the proposed action result in an increase in the potential for erosion,flooding &81 � ; problems? 11. Will the proposed action create a hazard to environmental resources or human±8000 Board 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. 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 Town of Southold LMM ON ISTENC` E� F A gceiv � .w teko 4 A. INSTRUCTIONS " MAY 212026 1. All applicants for pertnits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Wa Gondstdio ew 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# 40 The Application has been submitted to(check appropriate response): Town Board © Planning Dept. [11 Building Dept. [3 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: Rp �k Sirs 12 'x $ ° fea �64 Location of action: g Z vi tAf Ave- - 6 o cJ 0 1691(w at', "" Site acreage: Z Z. Present land use: n Q Received 5 ( Present zoning classification: MAY 212026 �e$ I Q� � a 2. If an application for the proposed action has been filed with the Town ofoutho��ragencypthe following information shall be provided: (a) Name of applicant: DeLvitej 6 . a oi Q qe M . Be cler (b) Mailing address: Z S W a S 61 k h p A v e— � retn (c) Telephone number:Area Code (d) Application number,if any: Will the action be directly undertaken,require fimding,or approval by a state or federal agency? Yes ❑ NoX 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. E]Yes [:] 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 ❑ Not Applicable APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM Tcrwn f 50 th Id" tlt W hibit confli a the rt of town atticet^s , e a ose of this farm is to grovitle information which can Mka the t wn of ible conflicts of interest and allow it to take whatever AS920 Is-Maori-ho avoid same, MAy 2 126 ' . YOUR NAME: Beck eoe- (Last name,first name,middle initial,unless you area ap plying ymg in the name of someon26Wmgo tf� a {S company.H so,indicate the other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Let p r Tax grievance Building Permit 2 Gi a Ce . �y Variance Trustee Permit a " Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest. "Business interest"means a business,including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5% of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply) A)the owner of greater that 5%of the shares of the corporate stock of the applicant(when the applicant is a corporation) 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 ,20 Signature Print Name r1 l I Q QQ - July 2023 i ll l� 7 j pl' i 1 .r M I I i �l it 1 w p f ` Becker Backyard Site �^ I 28 Washington Ave -2 20 26-03 5 1 J i �/ Number of pages �`°�re!wed � _ REC+�����_ + N_ 0 2 PH Z026 {f�r'•ITH A. PASCAL MAY 1 ,4. , This document will be public C.L�PI � record. Please remove all Zoning Board of /yppeals c��L F"0 031-COUNTY , j Social Security Numbers P 414 prior to recording. Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps 3 FEES �� Mortgage Amt. �....�.._. Page I Filing Fee 1. Basic Tax Handling OQ 2. Additional Tax ✓ Sub Total TP-584 Spec./Assit. Notation or EA-52 17 (County) Sub Total Spec./Add. TOT.MTG.TAX EA-5217 (State) Dual Town Dual County R.RT.S.A. Held.for Appointment Comm. of Ed. 5. 00 �a � � �r ransf6er Tix � anstc�n T� �.�. Affidavit .,.� The property covered by this mortgage is Certified Copy or will be improved by a one or two 15. 00 family dwelling only. NYS Surcharge Sub Total YE5 or NO Other If NO, see appropriate tax clause on Grand Total ,. Page# of thi ins meat. .�m $ Community Preservation 4 Dist. 100 16006534 1000 04100 0100 039000 30 Fund Real Property P S , Consideration Amount $ Tax Service P DHO J A I . Agency t;'M GPF Tax Due $ Verification Improved ✓ Satisfactions/l ischarges/Releases List Property Owners Mailing Address Vacant Land 6 RE,CORI3&RETURN TO., TD 3 SCOTT DeSIMONE, ESQ. P. 0. BOX 233 TD PECONIC, NY 11958 TD Mail to: Judith A. Pascale, Suffolk County Clerk :7:j Title Company Information 310 Center Drive, Riverhead, NY 11901 Co Name aggyart itle Insn ance Com an www.suffolkcountyny.gov/clerk Title# ST16-26259 8 SUffOlk County "eco rd" & 'n dorsement Page q age 9 Page/Filing Fee M1.Basic Taxat Handling 00 2. Additional Taxes TP-584 ��i�e� Sub Total. J� Spec,/ sssr.. Notation 1 r1 EA-52 I7 kCounty) Sub Terri ` e . t Add. B etd °fi EA-5217 (State) TOT.Dual To Dual Count 0 R.P.T.S.A. � � a Hetd for Appointment Y Comm_ of Ed. 5. 0 a nston Tax Affidavit � �",,'��' ,� � �� '' The property covered by this mortgage is Certified Copy or will be improved by a one or two NYS Surcharge 15. 00 family dwelling only. Sub Total YES or NO Other If NO,see-appropriate tax Grand Total clause on ,�' � page� of tr 1"� �a:�.t. ` d° 4 1 Dist. 100 16006534 1.000 04I00 4100 039000 5 Community Preservation Fund A Consideration Amount $ IS Real Property �� P °, Tax Service P DHO Ep'Tax Due $ I Agency MAR-11 Verification Isnprowe.d r 6 SatisfactionsMischarges/Releases List Property Owners Mailing Address RECORD &RETURN TO- Vacan:Land SCOTT DeSIMONE, ESQ. TD P. 0. BOX 233 TD PECONIC, NY 11958 TD Mail to: Judith A. Pascale, Suffolk County Clerk 7 "Title Com]2any Information 310 Center Drive, Riverhead, NY 11901 Co.Neme Stewart'IIt Ie insurance y a w www.suffolkcountyny.gov/cler4c ode ST16-2625 8 Suffolk Counly Recording & rE dorsemea t Page This page forms part of the attached pE zn wade by: (SPECIFY TYPE OF�'",STRI'�'+^IE'"�Tsti THOMAS J. McCARTHY. The premises herein is situated in SUFFOLK COUNTY, NEW YORK. r SOUTHOLD TO In the TOWN of DANIEL 0. BECKER AND JANE M. BECKER In the VILLAGE GREENPORT or HAMLET of BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILD G, k � spy 212026 pes 1 1111111 IN1111111111111111111111111111111111111111111 ��. Il� �l �l111 �11�lI111 ' 1 SUFFOLK COUNTY CLERK RECORDS OFFICE F.ECORDING PAGE Type of Instrument: DEED Recorded: 05/01/2023 Number of Pages : 4 At: 09:22 :25 AM Receipt Number : 23-0057254 TRANSFER TAR NUMBER: 22-26061 PAGE: D00013199 PAG : 529 District: Section: Block: Lot: 1000 041 .00 01 .00 039.000 EXAMINED AND CHARGED AS FOLLOWS Deed Amount: $0 .00 Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $20.00 NO Handling $20.00 NO COE $5 . 00 NO NYS SRCHG $15.00 NO EA-CTY $5.,00 NO EA-STATE $125 .00 NO TP-584 $5 . 00 NO Notation $0.00 NO Cert.Copies $0.00 NO RPT $200.00 NO Transfer tax $0 . 00 NO Comm.Pres $0.00 NO Fees Paid $395. 00 TRANSFER TAX NUMBER: 22-26061 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL Vincent Puleo County Clerk, Suffolk County i 2 )ro i 1W °IIf la �Yrf� ,µ Number of pages ace � This document will be public record.Please remove all Social Security Numbers t prior to recording. 0� " Deed l Mortgageinstrumerrt Deed I MartgageTax Stamp b tcurd6rosy P F irrg marnp 3 FEES Page/Filing Fee MoRgage Amt. . ,... ..... T.Basic Tax Handling 20• 00 2. Additional Tax TP-584 Sub Total Notation �. ._..............._...... or EA-52 17(County) Sub Total i Spec./Add. EA-52 t 7(State) TOT.MTG.TAX Dual Town Dual County R.P.T.S_A. Held friar Appointnu,',nt Comm.of Ed. 5, .00 a Transfer Tax Affidavit Mansion Tax Certified Co The property covered by this mortgage is PY or will be Improved by a one or two NYS Surcharge 15. 00 family dwelling only. Sub Total YES or ND Other _..m Grand Total,.., "As # P s If NO, see a pioopada¢s� tax clause on w Page of Instrument. _. 23 12%12 1000 04100 0100 039000 Fund T�. Co mmunity Preservation Real Pp Od0 i gonsideration Amount S ax ( T Service Agency R �Pf T w Due Verificatioi lm tad 17 rr 6 Sataslaat tgiat�s l im�wg wsdtfeitats s Llst Pr pen^y owners Mailing Andress RECORD&RETURN TO: h Vacant Land Scott DeSimone,Esq- TD ..., ..... Scott DeSimone,P.C. 41245 Route 25 TD._.... _.... �oa. P.O.Box 233 Peconic,New York 11958 i 7 !t,le Company Information Co. TWe z 8 3u1101c ► nly tcecording & Endorsement I Page, This i3 am and Sal made page Forms part of the attached w..... ,__ by: (SPECIFY TYPE OF INSTRUMENT) anl„ Becker andM Ire„ decker The premises herein Is situated in SUFFOLK COUNTY,NEW YORK. TO In the TOVM of ___59utbojtl.. a e... �..,... In the VILLAGE o��ThemDanl��.�sw?CJ��� P.f�gcahle st..�.�. .....m, or HAMLET .......oa. _. .... BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. over r lRecoex 11111111 IN 11111 II II 11 1 11111111 111111 111111111111111111111 III 106119 SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DEED Recorded: 03/08/2016 Number of Pages: 4 At: 12:02:42 PM Receipt Number : 16-0035128 TPIMSFER TAX NUMBER: 15-21919 LIBER: D00012855 PAGE: 414 District: Section: Block: Lot: 1000 041.00 01.00 039.000 EXAMINED AND CHARGED AS FOLLOWS Deed Amount: $525,000.00 Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $20.00 NO Handling $20.00 NO COE $5.00 NO NYS SRCHG $15.00 NO EA-CTY $5.00 NO EA-STATE $125.00 NO TP-584 $5.00 NO Notation $0.00 NO Cert.Copies $0.00 NO RPT $200.00 NO Transfer tax $0.00 NO Comm.Pres $7,500.00 NO Fees Paid $7,895.00 TRANSFER TAX NUMBER: 15-21919 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE }` County Clerk, Suffolk County I i TOWN OF SOUTHOLD PROPERTY RECON of DISTJ e' VILLAGE -OWNER, STREET SUB. _4 -T, 4 A i'l, FORMER OWNER-7-S- N E ACR. W S TYPE OF BUILDING RES. SEAS. VL. FARM comm. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS 2- -Ire C— '0 L AGE 9 BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per value Acre i Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowlands DEPTH House Plot BULKHEAD Total DOCK 3 GLOB ; aI11i _ . ``� i�P -�-, e , 17, a _ i s j _ p—= + i € i i d 3 - 3 , 1.-1 03/17/2017 G t M. Bldg. + 3 , s Extension . Extension' o .3 Extension , t _ /_ ss Foundation G- j Bath �` 3 dine 1 Ks Porch Bose en Floors K. 9 � P Ext. Walls i ;', s=_ !Interior Finish !R. Breezeway Fire Place Heat ��. 3 - x Garage 'Type Roof ;�` Rooms ]st Floor � �. A ;Rooms 2nd Floor FIN. B Patio Recreation Roorn' O B. Dormer Driveway t Ma- Total �- i l % i 7-7-7 rf.ijcn€ � U€ <'