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HomeMy WebLinkAbout#8146-Bender ZBA application FORM NO. 3 TOWN OF SODTHOLD BUILDING DEPARTMENT SO'UTHOLD,N.Y. Received NOTICE OF DISAPPROVAL JUL 0 R 2026 DATE:;%W&9,EjWd of Appeals TO: Marianna Bender 803 Maple Ln Southold,NY, 11971 Please take notice that your application dated December 10, 2025: For permit to: co�astruct an io ro ad swimininpool mid detached garage w i 1 attached pool house/cabana accessor to an existing sin&j!LhpjL dwelling at: Location of property: 803 M le lane, Southold NY County Tax Map No. 1000—Section 64 Block 1 Lot 30.1 Is returned herewith and disapproved on the following grounds: The two (2,) oro osed accessories on this 41 575s .ft. parcelftildable 38 41 .ft. in the Residential R-40 District are not ern-fitted pMrsugat to Article 111 Section 280-15. which states accessory buildin s and structures shall be located i:i the re sired rear yard and fin e case of a waterfrontsarceLaccessorvbuildin . and structures maybe located in the from frovided rinci al front and setbacks are met. Tl e ro osed ool is in the side Yard. The proposedgarage/pool horse is in the side vard. (Note; by town definition a al h oouse/cabana,can be stand alone or a orlon of an eistin suture. 41)n'rA I A 2 A rued 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,ZBA TWIN FORKS PERMITS Received June 17,2026 JUL 0 8 2026 -Via Hand Delivery- Board of Appeals Leslie Kanes Weisman,Chairperson Zoning Southold Town Zoning Board of Appeals 54375 Main Road PO Box 1179 Southold,NY 11971 RE: Zoning Board of Appeals Application Owner:Marianna Bender Situate: 803 Maple Lane,Southold,NY 11971 SCTM No. 1000-64-1-30.1 Dear Chairperson Weisman: Please find the enclosed Wetland Permit Application for the proposed swimming pool,spa,deck/patio additions and proposed detached garage construction to the residential property located at 803 Maple Lane,Southold,NY 11971 (SCTM No. 1000-64-1-30.1). The properly is located along the shoreline of Town Creek. Pursuant to the notice of disapproval,the proposed swimming pool and detached garage/pool house which will be located within the side yard of the primary residence. The proposed accessory structure swimming pool and detached garage/pool house structure have been situated in the proposed location given the unique shape of the parcel(wider lot than depth)and the presence of wetlands along the long side of the property,the only location for the proposed structures. Additional small residential additions will be part of the construction project however these do not require variance relief. All construction activities will be located landward of erosion control silt fencing. In support of this application,please find the following: 1. Application fee in the amount of$1250.00 paid by Twin Forks Permits check no. 1479 dated 6/15/26; Nine copies of the following: 2. Notice of Disapproval dated June 9,2026; 3. Application to the Southold Town Board of Appeals Area Variance,Applicant's Project Description,Questionnaire, Agricultural Data Statement,Authorization andTransactional Disclosure Form from the owner and the agent; 4. Short Environmental Assessment Form; 5. LWRP Form; 6. Photographs of the property; 7. Property Certificate of Occupancy records; 8. Copy of the property deed; 9. Property Record Card; 10.Existing condition property survey as prepared by'Twin Forks Land Surveying,dated June 24,2021,last revised on May 29, 2026; 11.Proposed site plan survey Twin Forks Land Surveying,dated June 24,2021,last revised on May 29,2026;and 12.Proposed garage floor plans and elevations sheet A-9 as prepared by Mark Schwartz&Associates,dated December 9,2025. Please review the enclosed materials for the residence renovation and additions. If you have additional questions proposed regarding the overall project,do not hesitate to contact this office. Thank you. Sincerely, 124c.�— Lisa Poyer Principal Planner 631.644.5998 1 Ilsa@twinforkspermits.com 1 288 East Montauk Highway,Hampton Bays,NY 11946 TWIN FORKS Received PERMITS June 22,2026 JUL 0 8 2026 Revise July 7,2026 -Via Hand Delivery- Zoning Board of Appeals Leslie Kanes Weisman, Chairperson Southold Town Zoning Board of Appeals 54375 Main Road PO Box 1179 Southold,NY 11971 RE: Zoning Board of Appeals Application Owner:Marianna Bender Situate: 803 Maple Lane,Southold,NY 11971 SCTM No. 1000-64-1-30.1 Dear Chairperson Weisman: Please find the enclosed Wetland Permit Application for the proposed swimming pool,spa,deck/patio additions and proposed detached garage with attached pool house construction to the residential property located at 803 Maple Lane, Southold,NY 11971 (SCTM No. 1000-64-1-30.1). The property is located along the shoreline of Town Creek. Pursuant to the notice of disapproval,the requested ZBA application has been prepared and submitted for relief from Section 280-15 to allow for the placement of the accessory structures within the side yard of the principal structure AND for the construction of the pool house attached to a proposed structure(not an existing structure). The proposed accessory structure swimming pool and detached garage/pool house structure have been situated in the proposed location(side yard of the principal residence)due to the unique shape of the parcel(wider lot than depth)and the presence of wetlands along the long side of the property. Additional small residential additions will be part of the construction project however these do not.require variance relief. All construction activities will be located landward of erosion control silt fencing. In support of this application,please find the following: 1. Application fee in the amount of$1750.00 paid by Twin Forks Permits check no. 1479 dated 6/15/26 and check in the amount of$500.00 paid by I\v,in Forks Permits check no. 1490 dated 7/6/26; Nine copies of the following: 2. Notice of Disapproval dated June 9,2026; 3. Application to the Southold Town Board of Appeals Area Variance,Applicant's Project Description,Questionnaire, Agricultural Data Statement,Authorization andTransactional Disclosure Form from the owner and the agent; 4. Short Environmental Assessment Form; 5. LWRP Form; 6. Photographs of the property; 7. Property Certificate of Occupancy records; 8. Copy of the property deed; 9. Property Record Card; 10.Eazsting condition property survey as prepared by Twin Forks Land Surveying,dated June 24,2021,last revised on May 29, 2026; 11.Proposed site plan survey Twin Forks Land Surveying,dated June 24,2021,last revised on May 29,2026;and 12.Proposed garage floor plans and elevations sheet no. 1 as prepared by Mark Schwartz&Associates,dated July 3,2026. Please review the enclosed materials for the proposed residential improvements. If you have additional questions regarding the overall project,do not hesitate to contact this office. Thank you. Sincerely, /2 . Lisa Poyer Principal Planner 631.644.5998 1 lisa@twinforkspermits.som 1 288 East Montauk Highway,Hampton Bays,NY 11946 APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS AREA VARIANCE Received House No. 803 Street Maple Lane Hamlet SCTM 1000 Section: 64 Block: 1 Lot(s) 30.1 Lot Size: JUL40 41,575 sq. ft. (0.954 Acre)) Buildable land 38,415 f 8 oes) I(WE)APPEAL THE WRITTEN DETERMINATION OF THE BUILIIF � DATED June 9,2026 BASED ON SURVEY/SITE PLAN DATED Mark Schwartz Site Plan dated 12/9/2025 Owner(s): Marianna Bender Mailing Address: 27 West 67th street apt 4FE, New York, NY 10023 Telephone: 917-863-5046 Fax: Email: Marianna.bender@gmail.com NOTE: In additiott 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: Lisa Pover, In Forks Permits for( )Owner(X) Other: Agent Address: 288 E. Montauk Highway, Hampton Bays, NY 11946 Telephone: 631-644-5998 Fax: Email: lisa@twinforkspermits.com Please check to specify who yore wish correspondence to be mailed to,front the above names: ( )Applicant/Owner(s), (X)Authorized Representative, ( ) Other Name/Address below: WHERF �E B�iLINt INSPECTOR REVIEWED SURVEY/SITE PLAN OR DATED ar c a " an andDENIED AN APPLICATION DATED June 9,2026 FOR: (x) Building Permit ( ) Certificate of Occupancy ( )Pre-Certificate of Occupancy ( ) Change of Use ( )Permit for As-Built Construction ( ) them,• : Provision of the Zoning Ordinance Appealed. (Indicate Article,Section,Subsection of Zoning Ordinance by numbers.Do not quote the code.) Article: ) e i n• 28Q subgggtion:. 15 Type of Appeal. An Appeal is made for: (X)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, QC) has not been made at any t` i It t to 1his groverty 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 ReceiveW�q� REASONS FOR APPEAL JUL 0 8 2026 (Please be specific, additional sheets may be used with preparer's signature notarized): iBoard of Appeals 1.An undesirable change will not be produced in the CHARACTER of the neighbor�ti$na �trintent to nearby properties if granted,because: The character of the neighborhood is a residential neighborhood and the proposed accessory structures will not change the character of the neighborhood or residential feeling. The proposed accessory structures are commonly associated with a residential property. There are other residential lots in the neighborhood which contain similar accessory structures. 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: The benefit sought can only be achieved by requesting a variance due to the unique lot shape and the presence of wetlands on the property. The property is wider in the lot width than depth, with the presence of wetlands and the road on the long sides of the property necessitate the request for the variance, the proposed placement of a swimming pool and detached garage/pool house are better situated in the side yard vs. the rear or front yards for this particular lot. 3. The amount of relief requested is not substantial because: The amount of requested relief is not a numerical or percentage request, it is for the placement of the accessory structures to be located on the property other than in the front or rear yard of the primary residence and for the placement of the pool house attached to a new structure, not an existing structure. 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 accessory structures and its location within the side yard of the primary residence will not have an adverse effect on the existing residence or surrounding residential neighborhood. The proposed accessory structure are a common structure on private property and is a permitted use within the R-40 zoning district. 5. Has the alleged difficulty been self created? { ) Yes,or{Xj No Why: The owner believes that the requested minor variance is not a self created hardship due to the fact that the property contains extensive wetlands and the unique shape of the property with the wetlands. • Are there any Covenants or Restrictions concerning this land? { ) No {X}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. 1, tgna ure of Applic or�AulffiiedAgent (Agent must submit writtenion from Owner) CASEY L.RYCKMAN Sworn to before me this da OTA Y puBL1C,STATE OF NEW YORK of Registration No.OIRY6216402 RAQualified in Swul1~olk County Notaty� 1 c Corat mission Expires Jan.19,2 ,1 1 4� Zoning Board of Appeals APPLICANT'S PROJECT DESCRIPTION Received APPLICANT: Marianna Bender SCTM No. 1000-64-1-30.1JUL O 8 2026 1.For Demolition of Existing Building Areas Zoning Board of Appeals Please describe areas being removed, Demolition of the existing rear deck at 464 s ,ft. - not 2art of the variance re uest. No demolition required for the proposed structures seeking a variance. II.New Construction Areas (New Dwelling or New Additions/Extensions): detached garage 24'x 24'and pool house Tx 20 totaling 716 sq. ft. Dimensions of first floor extension: swimming ool 16'x 37' 592 sq.ft. pool a ui ment outdoor shower Dimensions of new second floor: N/A Dimensions of floor above second level: N/A Height(from existing natural grade) height variance not re nested, detached ara e/ ool house 15'6" Is basement or lowest floor area being constructed?If yes,please provide height(above ground)measured from natural existing grade to first floor: N/A III. Proposed Construction Description (Alterations or Structural Changes) (Attach extra sheet if necessary). Please describe building areas: Number of Floors and General Characteristics BEFORE Alterations: Proposed n w construction for accp ,ssory strucutres located in greviously cleared and disturbed i nd. Number of Floors and Changes WITH Alterations: N/A- no alterations proposed associated with the variance request. IV. Calculations of building areas and lot coverage,sky plane(From Surveyor,Design Professional): Existing square footage of buildings on your property 3573 sq. ft. Proposed increase of building coverage: 6519 sq. ft. Square footage of your lot: 41,575 sq.ft. (0.954 Acre) Buildable land 38,415 sq.ft. (0.8818 Acres Percentage of coverage of your lot by building area(lot coverage) 17% Gross Floor Area ((_FAI 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): N/A For Residential lots,is project within the allowable Sky Plane? (Please refer to Chapter 280, Section 280-208 of the Town Code): N/A V. Purpose of New Construction: To provide a common accessory structures on a residential property. However due to the lot shape, house location and the on-site wetlands, the only place to locate the proposed accessory structures is located within the side yard of the residence and the inclusion of the pool house attached to a proposed structure, not an existing structure. 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: flat to gently sloping in the area for the proposed accessory,structures, 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. QUESTIONNAIRE Revised 6/2023 I FOR FILING WITH YOUR ZBA APPLICATION Received A. Is the subject premises currently listed on the real estate market for sale? JUL 0 8 2026 Yes X No Zoning Board of Appeals B. Are there any proposals to change or alter land contours? No X 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 suvyey 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 BOARh1 OF 1R,II.1S_TE9'for its determination of jurisdiction? Yes Please confirm status of your inquiry or application with the Board of Trustees: application filed simultaneously 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? None identified 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 residence and proposed continued else as SFR. J. (examples: existing single family,proposed: dame with garage,pool or other) May 28, 2026 it ried sig ture Date FORM Na 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Received Town Clerk's Office Southold, N. Y. JUL 0 $ 2026 Zoning Board of Appeals Certificate Of Occupancy No.Z7455 . . . , . Date . . . . . . . . . Jan. . .6. . . . . . .. 19. .E THIS CERTIFIES that the building located at . .R.p...W,t off.Maple.Lane Vedq Map No. .g . . . . . . Block No.= . . . . Lot No. X= . . $outhQld,. - $.T. . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated gept 1JL9.gg. pursuant to which Building Permit NO.8855z. I . dated . . . . . .Gegt 13 , 1976. , was issued, and conforms to all of the require- ments of the applicable provisions of the law.The occupancy for which this certificate is issued is Private. one .family•dwolll.ng . . . . . . . .. . . . • . The certificate is issued to Brrol 1loebler• inter • . • • . . . • . . . • .. .. • . . . • . w (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Walt. G .1 g7.7 .by. -R. V 11% UNDERWRITERS CERTIFICATE No. .VW;U19. . . . , . . . . .. . . . . . . . . . . . . . • . .. . HOUSE NUMBER . . . . 803. . . . Street . . . Maple -Lan* •(A •4)• • • . . . . . . . . . . . . Building Ixaspector FORM N0.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Received Town Hall Southold,N.Y. JUL p g 205 Certificate Of Occupancy Zoning Board of Appeals No, . Z 1678.7. . . . . . . . . Date . . . .. .A p r i 1 . 12,,. ,19 8 8» a . THIS CERTIFIES that the building A 1 t e r.a t i o n s w .». .» w . . . »» .. „ , •, » Location of Property 8 0 3 R.O:W; Maple Lane Southold , or House No. . . . . . . . � 'Hamlet County Tax Map No. 1000 Section A , , . .. ,. , . . .Block ,. , . »Lot . . .30. 1 . . .. . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . , ... . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated March 2 3, 1 9 8 7 » • . . . . . . . . . pursuant to which Building Permit No. , , 5 8 14 Z . . dated ,March 2 8, . 19 8 7. . . . . . . . . . . . w 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 .. .. .. .. . }te,rations, as. .applied, for. in an, existing• one , family dwelI.ing. . The certificate is issued to . MXA]19 4A .� CORNELIA THEOHARIDES . . . . . . . . . . . . . . . . . . of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . .N/A . „. , , . , . .. .., w ». . ... .. ... UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . .N/A . . . . .. . . . . .. . . . . . . . . . . .. . . . . . PLUMBERS CERTIFICATION DATED: N/A . . . . e . . .». . . . . .. . .. .. Bull g Inspector Rev.1/81 FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Received Town Hall Southold,N.Y. JUL 0 g 2026 Certificate Of Occupancy Zoning Board of Appeals No. „ ,Z16788 . . . . . . . Date , p;P, it ,1.2,. 1988. . . . . . . . . . . .. . THIS CERTIFIES that the building . ,A d d i.t i o n, „ µ . „ . . . ., , » . . » „ . , . » Location Of Property , „ 803 R.O.W. »Maple„Lane , . S,outhold. . . . House Nth» Streei . Hamlet County Tax Map No. 1000 Section , , 0 6 4 . , , , , ,Block .0 1. . . . . .. . . . ,Lot . . 9.3 q: 1 , .,, „,.. , Subdivision.. .. . . . . .. . . . . . . . . . .. . . . .. . „ , , . „ .Filed Map No. . . . . .. . .Lot No. . . . . . .. . . . . . . conforms substantially to the Application for Building Permit heretofore filed, in this office dated . . . . .NAY. . 1 A.,.i 9 0 3. . . pursuant to which Building Permit No. „1,2 3 8„'I .. . . » . ."µ dated . June 15 , 1983 ,, . . * » . was issued,and conforms to all of the requirements of the applicable provisions of the law.The occupancy for which this certificate is issued is . . . . .. . ,. „ Addition to an existing dwelling, , M «. . .# „ „ „ » „ „. w „ + » . . * » » „ » The certificate is issued to . , � CROLAS CORKELIA TREORARIDES (owner,* 1feX$�=XXXXXXX 5 ' „„ M of the aforesaid building. Suffolk County Department of Health Approval . . . . . /A» . . .. , . . . „. .. ... .. .. „ , .. „ . . . . . , . .. . UNDERWRITERS CERTIFICATE NO. .N o 0 8,7 2 4, &, ,N Q 0 8 7 6,, 4/S/8$ . . . . . . . „ , . . ., . PLUMBERS CERTIFICATION DATED: N/A Hai Inspector.. . » . . . . . . . . Rev.1/81 AGRICULTURAL DATA STATEMENT ZONING BOARD OF APPEALS TOWN OF SOUTHOLD pp6 WHEN TO USE THIS FORM: This form must be completed by the applicant for l p'o permit,siteplan approval,use variance, area variance or subdivision approval on propery,within an agricultural,district OR within 500 feet of a farm operation located in an agricultur,41 "4 705 All applications requiring an agricultural data statement must be referred to the Suffolk Count), Department of Planning in accordance with Section .239m and.239n of the Gene fgA . 1pol of Appeals Law. 1. Name of Applicant: Lisa Poyer, Twin Forks Permits 2. Address of Applicant: 288 E. Montauk Hi hway, Hampton Bays, NY 11946 3. Name of Land Owner(if other than Applicant): Marianna Bender 4. Address of Land Owner: 27 West 67th street apt 4FE, New York, NY 10023 5. Description of Proposed Project: Residential additions, residential accessm structure construction on a residential parcel. 6. Location of Property: (Road and Tax map Number) 1000-64-1-30.1 803 Maple Ave., Southold 7. Is the parcel within 500 feet of a farm operation? { } Yes {X) No 8. Is this parcel actively farmed? { } Yes {X) 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 ADD S 1 None identified 2, 3, 4. 5. 6. (Please use the back of this page if there are additional properly owners) May 28 2026 signature or7rpplicant 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. 617.20 Appendix B ��'p Short Environmental Assessment Form Received Instructions for ComWeting JUL 0 8 2026 Part 1-Project Information. The applicant or project sponsor is responsible for the completion.,of 1' tt 1d �i become part of the application for approval or funding,are subject to public review,and may be sNONO er ve 1G boon. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 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: Marianna Bender Project Location(describe,and attach a location map): 803 Maple Lane, Southold SCTM No. 1000-64-1-30.1 Brief Description of Proposed Action: Proposed project consists of minimal demolition of the rear decking, portions of exterior walls and construction of 4 small residential additions, construction of a new detached garage with attached pool house, swimming pool with pool equipment, pool patio, outdoor shower, and walkways. All proposed work will be located within the prior limits of disturbance for the deck and house additions and landward of existing structures for the detached garage/pool house and swimming pool structures. Only the location of the pool, detached garage/ pool house and construction of the pool house attached to a proposed structure are seeking relief from the Zoning Code as to the placement within a side yard. Name of Applicant or Sponsor: Telephone: 917-863-5046 Marianna Bender E-Mail: Marianna.bender@gmail.com Address: 27 west 67th street apt 4FE, New York, NY 10023 City/PO: State: Zip Code: 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 X 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: X SCDHS, NYSDEC, Town Trustees and Building Permit 3.a.Total acreage of the site of the proposed action? 0.954 acres b.Total acreage to be physically disturbed? 0.33 acres c. Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.954 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban R Rural(non-agriculture) ❑Industrial ❑ Commercial ❑Residential(suburban) ❑Forest ❑ Agriculture ❑ Aquatic ❑ Other(specify): ❑Parkland Page I of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? X b. Consistent with the adopted comprehensive plan? e Ved X 6. Is the proposed action consistent with the predominant character of the existing built or natural O YES landscape? JUL 0 8 2 X 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental o e�?of al YES If Yes,identify: N ;Pec is Environs. Re so t t ub is h th w In X 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? p 1? X c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? X 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: X 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: X 11,Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: private I/A septic system X 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? X b.Is the proposed action located in an archeological sensitive area? X 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 55 Wetland ❑Urban ❑ Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,fi NO O YES by the State or Federal government as threatened or endangered? X Common Tern,Plping Plover,Least Tern,Northern Long-eared Bat,Green Turtle,Loggerhead,Kemp's or Atlantic Ridley,Leatherback 16.Is the project site located in the 100 year flood plain? NO YES X 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, X a. Will storm water discharges flow to adjacent properties? IR NO❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO R YES Directed to on-site JN wells tor the residence and structural improvements and a dedicated swimmina Dool dry well. Page 2 of 4 18.Does the proposed action include construction or other activities that result in d'M NO DYES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: X 19.Has the site of the proposed action or an adjoining property been the locatior7dr8ngci$&11b c ose NO YES solid waste management facility? If Yes,describe: X 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: X I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicantlspons r rwrne Lisa Poyer Date: July 6, 2026 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 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 eneM 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 small to large �y1 impact impact x y may may vriccur 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? y Boar Part 3-Determination of significance. The Lead Agency is responsible for the' �iItion 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-terns,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. 0 Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) Page 4of4 Board of Zoning Appeals Application Received OWNER'S AUTHORIZATION JIJL 0 g 2026 (Where the Applicant is not the Owner) Text Zoning Board of Appeals 27 west 67th street apt 4FE, I, Marianna Bender residing at New York, NY 10023 (Print property owner's name) (Mailing Address) do hereby authorize Lisa Poyer,Twin Forks Permits (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 ER.A➢VIE DESCRIBED HEREIN. (Owner's Signature) 1 VIV (Print Owner's Name) Received APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM JUL U g 2026 The Town of Southqld's Cade of Ethics prohibits conflicts of interest on the art (town officers and employees.Th r this nut is to pL(Lyide,informption which can alert the town or pogibittonflicts of interest and '" a s necessary to avoid_ anne, YOUR NAME: Marianna Bender (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 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 7 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) C)an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this day of ,20 S3gnatu: Print Name ,+ �L— t ti u Received JUL 08 2026 11111111 Jill 1111111111111111111111111111111111111111111 Zoning Board of Appeals I 111111111111111111111 IN Jill SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DEED Recorded: 08/21/2023 Number of Pages: 4 At: 04:03:58 PM Receipt Number : 23-0107025 TRANSFER TAR NUMBER: 23-02389 LIBER: D00013214 PAGE: 806 District: Section: Block: Lot: 1000 064.00 01.00 030.001 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 $5.20 NO RPT $200.00 NO Transfer tax $0 .00 NO Comm.Pres $0.00 NO Fees Paid $400.20 TRANSFER TAX NUMBER: 23-02389 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL Vincent Puleo County Clerk, Suffolk County . . . El M Number of pages RECORDED 2013 Aua 21 04:03:58 PM Vincent PVIeQ This document will be public P m�l"ITF record. Please remove all L D00013214 Social Security Numbers P prior to recording. bTtl 2 � I OR Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Rultitlf� am 3 FEES Page/Filing Fee 1. asic,Ta Ntt.BasicTax Handling 20. 00 2. Additional Tax TP-584 Sub Total Spec./Assit Notation or EA-52 17(County) - Sub Total Spec./Add. EA-5217(State) TOT. MTG.TAX Dual Town Dual County Held for Appointment Comm. f Ed. S. 00 - s" Transfer Tax „- - Affidavit Mansion Tax The property covered by this mortgage is Certified Copy 5 Za Z!J or will be improved by a one or two family dwelling only. NYS Surcharge Sub Total 50 YES _or NO Zn Other Grand Total 1f No,see appropriate tax clause on page# _of this instrument. 0' Alo 23 - 4 f0ia1,j p 23035524 1000 06400 olao 030001 1 5 Community Preservation Fund GYA A 11M§1111l � nt Real PropertyT Consideration Amou Tax Service R Agency (2,p C " ,Tax Due Verification - f Irrwprove4 a a s c i-on. asc arg a Property Owners Ma nj A ress RECORD RETURN TO: VJ 6 Vacant Land TD A00 0 ,Gil Ate" // TD w 2' Mail to: Vincent Puleo, Suffolk County Clerk 7 Title Company Information 310 Center Drive., Riverhead, NY 11901 Co.Name vpAw.suffolkcountyny.gov/clerk Title# 8 Suffolk aunt ecor ing & Endorsement Page b This page forms part of the attached made y (SPECIFY TYPE OF INSTRUMENT) The premises herein is situated in ` , s r SUFFOLK COUNTY, NEW YORK. TO In the TOWN of 14AIaZZ�MJ �f 6f�� In the VILLAGE or HAMLET of BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. GVer IMPORTANT NOTICE RCCG'IVend, JUL 0 g 2026 Bar If the document you've just recorded is your SATISFACTION OF MOR T ;AGE, plea�%e%warre ofof Appeals the following: If a portion of your monthly mortgage payment included your property taxes, *you will now nerd to contact your local Town Tax Receiver so that you maybe billed directly for all future property tax statements. Local property taxes are payable twice a year: on or before January 10t, and on or before May 31w Failure to make payments in a timely fashion could result in a penalty. Please contact your local Town Tax Receiver with any questions regarding property tax payment. Babylon Town Receiver of Taxes Riverhead Town Receiver of Taxes 200 East Sunrise Highway 200 Howell Avenue North Lindenhurst, N.Y. 11757 Riverhead, N.Y. 11901 (631)957-3004 (631)727-3200 Brookhaven Town Receiver of Taxes Shelter island Town.Receiver of Taxes One Independence Hill Shelter Island Town Hall Farmingville,N.Y.11738 Shelter Island, N.Y. 11964 (631)451-9009 (631)749-3338 East Hampton Town Receiver of Taxes Smithtown Town Receiver of Taxes 300 Pantigo Place 99 West Main Street East Hampton,N.Y. 11937 Smithtown,N.Y. 11787 (631)324-2770 (631)360-7610 Huntington Town Receiver of Taxes Southampton Town Receiver of Taxes 100 Main Street 116 Hampton Roast Huntington, N.Y. 11743 Southampton, N.Y. 11968 (631)351-3217 (631)283-6514 Islip Town Receiver of Taxes Southold Town Receiver of Taxes 40 Nassau Avenue 53095 Main Street Islip, N.Y. 11751 Southold, N.Y. 11971 (631)224-5580 (631)765-1803 Sincerely, Vincent Puleo Suffolk County Clerk iao�w..oemeia warranty Deed with Full Covenants CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUh1ENT-THIS I;tib'17 UMENTSHOULD BE USED BY LAWYERS ONLY - THIS INDENTURE,made the day ofAme,Two Thousand and Twenty Three BETWEEN 'Received - HELEN HADJIYANNAKIS BENDER,as Trustee JUL 0 g 2026 LIA POLITES,as Trustee NIMET HABACHY,as Trustee of "THE HELEN HADJLYANNAKIS BENDER FAMILY 1996 TRUST" Zoning Board of Appeal6 27 West 671h Street;Apartment 41-E,New York,NY 10023 party of the first part,and MARIANNA BENDER. residing at 803 Maple Lane, Southold,New York 11971 parry of the second part, WITNESSETH, that the party of the first part, in consideration of ten dollars and other valuable consideration paid by the party of the second pan, does hereby grant and release unto the party of the second part,the heirs or successors and assigns of the party of the second part forever, ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon erected,situate,lying and being in the Town of Southold,at Southold,County of Suffolk and State of New York,more particularly bounded and described as follows: Schedule "A" (attached hereto and made part hereof) Being and intended to be the same premises as described in deed from CHRISTOPHER N.THEOHARIDES,as Trustee ofthe"CORN'ELIA THEOHARIDES LIVING TRUST,DATED JANUARY Id,2005".dated August 5,2021 and recorded in the Officc of the Clerk of the County of Suffolk on September 23,2021 in Libe r Al at Page�.,a Said premises are known and designated as District 1000,Section 064,Block 01.00,Lot 030,001 on the Suffolk Counry Tax Map. Said premises are also known and referred to as 803 Maple Lane,Southold,New York 11971. TOGETHER with all right,title and interest,if any,of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof;TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said premises; TO HAVE AND TO HOLD the premises herein granted unto the party of the second part, the heirs or successors and assigns of the party of the second part forever. AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any;part of the total of the same for any other purpose. AND the parry of the first part covenants as follows. that said party of the first part is seized of the said premises in 'fee simple, and has good right to convey the same; that the party of the second part shall quietly enjoy the said premises; that the said premises are free from encumbrances, except as aforesaid; that the party of the first part will execute or procure any further necessary assurance of the title to said premises, and that said party of the first part will forever warrant the title to said premises. The word"party"shall be construed as if it read"parties" whenever the sense of this indenture so requires. IN WITNESS WHEREOF,the party of the first part has duty executed this deed the day and year first above written. Helen Haddjiyannakis Bender,as Trustee Litt P lites,as"T"rustpe e Ni,met Tribachy,as T4jstee ACKNOWLEDGEMEN'TTAKEN IN NEW YORK STATE ACKNOW'LEDG EM ENT TAKEN IN NEW YORKSTATE State of New York.County of Q t- r•'�` ss: State of New York,County of 6J �1 z� On the ZG°N dayof �..� i Ite year On the'Z� day of in the year Zs before me,the undersigned,personally appeared before me,the undersigned,�rsonall ppeared iv HELEN HADDJIYANNAKIS BENDER LIA POLITES ' O qq CC personally known to me or proved to me on the basis of personally known to me or proved t JUL 8the basis of satisfactory evidence to be the individual(s) whose name(s) is satisfactory evidence to be the individual(s)whose names)is(tire) (are)subscribed to the within instrument and acknowledged to me subscribed to the within instrumerZ k gl that he/she/they executed the same in his/her/their capacity(ies), he/shelthey executed the same in his/her/their capacity(ies),and find that by his/her/their siViature(s) on the instrument, the that by his/her/their signature(s) on the instrument. the individual(s),or the person upon behalf of which the individual(s) individual(s).or cite person upon behalf of which the individual(s) aced,ex5puted the instrument. acted.exec fed the instrument. NS BENJAMIN A. IittmAT�8004' Iat�TARY PUB14 a lac, d o aw or Nr�°t'nitY PullLtt lltralili[xl in Queens 13 County NO.DIAT6380048 Coun Qualified in Queens County L6 Commission expires August 27.20 Commission Expires.August 27.20 ACKNOWLEDGEMENT TAKEN INNEWYORKSTATE ACKNOWLEDGEMENT TAKEN OUTSIDE NEW YORK C STATE State of New York,County of 4j{ aI` ` ss: State of ,County of ss: 1,, 20i On the day of in the On the L6 day of )i*- in the year before Il year before me,the undersigned personally appeared me.the undersigned,person y appeared NIMET HABACHY personally known to me or proved to me on the basis of personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s)whose names)is(are) satisfactory evidence to be the individual(s) whose name(s) is subscribed to the within instrument and acknowledged to me that (are)subscribed to the within instrument and acknowledged to me he/she/they executed the same in his/her/their capacity(ies), that that he/she/they executed the some in his/her/their capacity(ies), by his/her/their signature(s)on the instrument,the individual(s) and that by his/her/their signature(s) on the instrument, the or the person upon behalf of which the individual(s) acted, individual(s),or the person upon behalf orwhich the individual(s) executed the instrument, and that such individual make such acted,executed the instrument. appearance before the undersigned in the BENJAMINA.ATKINS (add the city or political subdivision and the stale or country or Notary Public,Stale of New York other place the acknowledgement was taken). NO.OIAT6380048 Queens County NOTARY PUBLIC Qualified in Queo NornRti�ruBLtc Warranty Dried WITH FULL COVENANTS Helen liadj,iyanoakis Bander.t.ta Poilies,and Nimet Habachy.as Trustees or ,the Helen ladi tyannattis Bender Family 1996 Trust^ COUNTY: Suftlk TOWN/CITY: Southold TO PROPEK'I'Y/V.fUI2E$ti;303 Maple Lune Mariana Bender Sr-CTION: RETURN BV WAIL TO: 064'00 Law Offices of F.dinson t.Bolivar,PLLC PO BOX 1288/2411 Main St., I)LOCK: Bridgehampton.NV 11932 P1,00 LOT: uay.nnl a , Received SCHEDULE"A" ALL THAT certain plot, piece or parcel of land, with the buildings and improvements&6CA arkA, situate, lying and being in the Town of Southold,at Southold, County of Suffolk and State of New York, more particularly bounded and described as follows: Zoning Board of Appeals BEGINNING at a point on the southerly side of a certain right of way distant the following courses and distances from an iron pipe set in the easterly line of a private road,49.5 feet wide known as Maple Avenue, which said iron pipe is distant 864.85 feet southerly as measured along said easterly line of Maple Avenue from the comer formed by the intersection of the easterly line of Maple Avenue with the southerly line of Main Road; 1. North 85 degrees 01 minutes East,242.00 feet and from said point of beginning; RUNNING THENCE North 4 degrees 59 minutes West, 20.00 feet to the northerly side of said Right of Way and land now or formerly of Joost; RUNNING THENCE northeasterly along last mentioned land,along the arc of a curve bearing to the left having a radius of 36.82 feet a distance of 49.32 feet to land now or formerly of Whiteside; RUNNING THENCE South 63 degrees 13 minutes 30 seconds East,along last mentioned land,215.00 feet to the ordinary high water mark of Town Creek; RUNNING THENCE southwesterly along the ordinary high water mark of Town Creek, a tie line course and distance of South 4 degrees 29 minutes 40 seconds West, 21897 feet to land now or formerly of Moeller; RUNNING THENCE North 63 degrees 13 minutes 30 seconds West along last mentioned land, 170.00 feet to other land now or formerly of Joost; RUNNING T14ENCE along last mentioned land,the following two courses and distances: I. North 10 degrees 21 minutes 30 seconds West, 172.35 feet; 2. North 52 degrees 40 minutes West 29.58 feet to the southerly side of the above mentioned Right of Way, at the point or place of BEGINNING. Together with a non-exclusive Right of Way,in common with others for ingress and egress over an existing 20 foot Right of Way,more particularly bounded and described as follows: BEGINNING at a point on the easterly line of a private road, known as Maple Avenue, said point being 864.85 feet southerly as measured along the easterly line of Maple Avenue, from the corner formed by the easterly line of Maple Avenue with the southerly line of Main Road RUNNING THENCE from said point or place of beginning,North 85 degrees 01 minutes 00 seconds East, 242.00 feet; RUNNING THENCE North 4 degrees 59 minutes West 20.0 feet; RUNNING THENCE South 85 degrees 01 minutes 00 seconds West, 242.00 feet to the easterly side of Maple Avenue; RUNNING THENCE South along the easterly side of Maple Avenue, South 16 degrees 06 minutes 30 seconds East,20.38 feet to the point or place of BEGINNING. " APPLICANT/AGENT/REPRESENTAT TRANSACTIONAL DISCLOSURE FORM to C c ° nc to tw n . u � pis � vt rrn w " an ssi %v� Whatever -jl ac ma YOURNAME: Lisa Poyer, Twin Forks Permits Received (Last name,first name,gaiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other JUL 0 S 2026 person's or company's name.) „ NAME OF APPLICATION: (Check all that apply.) Zoning boaj-d c,,f yppeals Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map _ _ Planning Other (If"Other',game the activity.) _ — - Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the J own of Southold? "Relationship"includes.by blood,marriagc,or business interest,"Business interest"means a business, including a partnership,in which the town officer or enaployce has even a partial o"wnership of(or employment by)a corporation in which the town officer or employee owns more than %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 applican't/age tImprosentative)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 eater than %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), an officer,director,partner,or employee of the applicant;or T))the actual applicant. DESCRIPTION OF RELATIONSHIP � to Submitted ' of 20 a Signature Print NI1t PB911lt - Form TS I . T Town of Southold LWRP CQN I TENC1'"ASSE NT FORM Received JUL 0 g 2026 `t�U ^ A. INSTRUCTIONS . 1. All applicants for permits* including Town of Southold agencies, sh°a NoBm$fAe°Ai Q?0,kF 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# 64 - 1 - 30.1 Marianna Bender The Application has been submitted to(check appropriate response): X -Zoning Board of Appeals Town Board © Planning Dept. G Building Dept. 0 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: Proposed project consists of minimal demolition of the rear decking, portions of exterior walls and construction of 4 small residential additions, construction of a new detached garage with attached pool house, swimming pool with pool equipment, pool patio, outdoor shower, and walkways. All proposed work will be located within the prior limits of disturbance for the deck and house additions and landward of existing structures for the detached garage/pool house and swimming pool structures. Only the location of the pool, detached garage/pool house and construction of the pool house attached to a proposed structure are seeking relief from the Zoning Code as to the placement within a side yard. Location of action: 803 Maple Ave. Southold Site acreage: 41,575 sq. ft. (0.954 Acre) Buildable land 38,415 sq. ft. (0.8818 Acres) Present land use: Single family residential Received Present zoning classification: R-40 JUL 0 g 2026 2. If an application for the proposed action has been filed with the Town of$@Ci%5l&cW@nO,A" lowing information shall be provided: (a) Name of applicant: Marianna Bender (b) Mailing address: 27 west 67th street apt 4FE New York NY 10023 (c) Telephone number: Area Code( ) 917-863-5046 Marianna.bdnder@gmall.com (d) Application number, if any:. Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ® NoEZ' 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 F-I No ® Not Applicable Private residential property, additl nel residential development. 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 13 No 0 Not Applicable Private residential property, additional residential development. 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 0 Yes © No ® Not Applicable Received ��� Private residential property, additional residential development. JUL 0 S. tQ26 Zoning Board of Appeals Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria 13 Yes 13 No ® Not Applicable Private residential property, additional residential development, 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 0 Not Applicable Septic upgrade to an I/A septic system, Dedicated swimming ool dry well. Establishment of a 30'wide naturally vegetated non-turf wetland buffer, Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. © Yes [3 No D Not Applicable Seotic upgrade,t an I/A se stem. D tdd swlmmin o1 w 11. Estabils t f 30"wid t r Il vegetated non-turf wetland buffer. Attach additional sheets if necessary 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 0 No® Not Applicable �e ce� e JUL 0 8 2026 Private residential property, additional residential development. n ng Board 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. 0 Yes 1:1No Not Applicable Private- i ntial grogerty, aglditional Legiogntigil ggvelggment. 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. 0 YesEl No® Not Applicable Private residential property, additional residential development, 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 Private residential property, additional residential develo mentu Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island SOU11 , the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. 0 No Received Yes © Not Applicable Private residential property additional residential development. 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 Pr[yate reside 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. F Yes ❑ No © Not Applicable Private residential property, additional residential development. Created on 512510511:20 AM Marianna Bender 803 Maple Ave., Southold (SCTM No. 1000-64-1-30.1 a - a 3 „ r - iz oz ti � - _ _ j a Photograph 1) View looking east from the driveway at the front Photograph 2) View looking west from Town Creek at the rear of the existing residence. of the existing residence and deck. Marianna Bender 803 Maple Ave., Southold (SVTM No. 1000-64-1-30.1 z j. E 7r ` Photograph 3) View looking south from the approximate Photograph 4) View looking west from the approximate location location of the detached garage/pool house, swimming pool of the detached garage/pool house, swimming pool location location towards the existing residence. towards the driveway/road. Marianna Bender 803 Maple Ave., Southold (SCTM No. 1000-64-1-30.1 _ e 10 -en- Rzi ti 3 x s d � 3 m - s c Photograph 5) View looking east from the approximate location Photograph 6) View looking north from the approximate of the detached garage/pool house, swimming pool location location of the detached garage/pool house, swimming pool towards Town Creek. location towards the neighboring property. The property contains extensive screening between the lots. — �f2 TOWN OF SOUTHOLD PROPERTY CARD &, 1—, � * J - I — OWNER STREET VILLAGE DIST€ SUB. LOT /0 FORMER OWNER N E ACR. S W TYPE OF BUILDING RES COMM. CB. MISC. Mkt. Value . SEAS- VL. FARM LAND IMP. TOTAL DATE REMARKS a VA- j 4Y� C o -7� iV 4 Tgpwg�g L-� L NEW I NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable 1 Tillable 2 U3 C= m Tillable 3 CD Woodland Swampland FRONTAGE ON WATER Brushlond FRONTAGE ON ROAD House Plot I i DEPTH -BULKHEAD iDOCK Total TOWN, OF SOUTHOLD PROPERTY RECORD —Y DIST. I COUNTY TAX MAP NO. o LAND IMP. TOTAL DATE REMARKS: 11 6) o L v he --r-7 S;- e .*.A CD ai LD. CD I _ SCTM # � TOWN OF SOUTHOLD PROPERTY RECORD CARD n - OWNER STREET _ VILLAGE D15T. SUB. LOT - ACR. - REMARKS TYPE OF BLD. PRO Ct-ASS 6 . LAND IMP. TOTAL DATE { Y �l FRONTAGE ON WATER-, HOUSE/LOT BULKHEAD TOTAL COLOR E TR6M - ti a� 'I-fl, F ; tirY } v 4 1 ° s t t �4 r ay I 9 f i M. Bld g, Foundation i y Dinette Bath Extension ' Floors ` K. X. _ Basement 1- i; I ,^ ! I Extension dExt. Walls a Interior Finish LR. Extension r _ - i Fire Place Heat I DR. rtT 4Rooms 1st Floor BR. r „ t ! yPe Roof Porch ;Recreation Roo Rooms 2nd Floor i FIN. B. � , , Z Y ry �/ `Dormer Breezeway Driveway Garage 7 AIV _ e i �ti v�