Fillable 567 Zoning Board Of Appeals Application (Incorporated Village of Sag Harbor)

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567 Zoning Board Of Appeals Application (Incorporated Village of Sag Harbor)

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BROWSE INCORPORATED VILLAGE OF SAG HARBOR (NY) FORMS

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ZONING BOARD OF APPEALS
55 MAIN STREET. POST OFFICE
BOX
660
SAG
HARBOR,
NEW
YORK 11963
631-725-0224
TO: PROSPECTIVE APPLICANTS
FROM: CHAIRPERSON,
ZONING BOARD OF APPEALS
RE: Instructions and guidelines for preparation
and
submittal
of
applications
to
the
Z-0ning Board
of
Appeal,
All applicants must first apply to the Building Department for a building permit. Building
permit applications must
be
sufficiently complete for tbe building inspector
to
.make a
determination as to what variances arc required.
If
the permit is refused, a written referral
to the Zoning Board
of
Appeals will
be
drafted
by
the Building Inspector. No application
for a variance will be entertained
by
the Zoning Board
of
Appeals without a written
referral from the Building Inspector.
After the application has been reviewed and deemed complete it will
be
scheduled for a
public hearing on the next available meeting date. There are no deadlioes. Applications
are reviewed
in
the order they are received. Although every effiirt is made to expedite
each application, there
i~
no specific time limit
in
which
to
review applicatious.
Applicants should review tlie agenda one week prior to the meetiog. Agenda~ are
available
on
the Village website
or
in person from the Buildipg Department.
Alternatively, applicants may contact the Building Department
at
631-725-0224 to
ascertain the presence
and
location
of
their application
on
the
agenda
The
filing fee for a single family residence
fa
$250.00. The filing fee for all otbcr
applications
fa
$350.00. The filing fee must accompany the application.
The Board may require the payment
of
out-of-pocket expenses incurred
by
the
Village
in
studies/and or
by
retainer
of
advisor
that
are over and above application
fee.
To collect such additional
foe,
the
Board will provide the applicant with ,vrittcn
notice
of
its intent to conduct such studies
by
the Village consultant/expert advisors
related
to
the hearing.
Applicants must submit one original and ten copies
of
the complete application
packet. Each packet must
be
ASSEl\-lBLED
by
the applicant and include one
of
each
of
the
documents enumerated below.
The
Building Department will not
assemble packets, make copies or fold plans. Please denote which application
contains
the
original documents.
Each Zoning Board
of
Appeals packet must include:
a. A completely filled
out
and notarized application
form
The
specific nature
of
the
request should
be
clearly explained, including the specific section(s)
of
the
code
from
which
relief
is requested. Please
note
that the zoning code is now found in
chapter 300, not chapter
55.
b. A completed and notarized application for a building permit.
c.
A complete set
of
drawings at 1/8" scale.
d. A survey.
e. A deed, lease
or
Certificate
of
Occupancy in the
name
of
the
Applicant
f.
A completed and notarized consent for inspection.
g. A completed and notarized authorization form (ifrepresented
by
an agent).
h.
A completed Coastal.Assessment
Form
i. A completed Short Environmental Assessment
Form
In
addition to
the
above,
the
applicant must submit an original and two copies
of
the
following:
a.
Complete set
of
drawings at ¼" scale
b.
Completed and Notarized Disclosure Affidavit
Requests for
relief
from lot coverage requirements, required setbacks
or
the
pyramid law
should contain
the
proper (§300-4.3 for coverage and setback
relief
in
the
R-20 district;
§300-9.3 for pyramid relief)
in
the
AREA
VARIANCE portion
of
the
application.
Applicants for these types
of
variances should furthermore address
the
five questions
found in paragraph 6
of
the
application.
If
the application is for relief from required structure setbacks or lot coverage,
the
applicant must furnish an original and two copies
of
a certified abstract
of
single
and separate ownership.
The
search must go
back
prior to November 17, 1971. Title
reports from property closings generally do not provide
the
required information. Reports
are furnished
to
the Village Attorney for review prior to placing an application
on
the
agenda. Single and separate reports must
be
furnished with
the
initial application,
please retain
the
application until the single and separate search has
been
obtained.
If
the
application is for
relief
from
the
PYRAMID LAW,
the
plans must clearly indicate
the
exi5ting structure, including
the
degree
of
EXISTING non-conformance and
the
amount
of
additional PROPOSED non-conformance.
A calculations in cubic feet shall
be
provided for each existing and proposed building
on
the
subject premises and a calculation in cubic feet as to those parts
of
each
Existing and proposed building which exceed the Pyramid Law, including
the
Percentage
of
the
total volume
of
the
buildings that exceed
the
Pyramid law.
Elevations shall
show
those areas
of
existing and proposed buildings that intrude into
the
pyramid. Pyramid lines shall
be
drawn
on
all.
planes. Pursuant to resolution
by
the
Board,
applicants
MUST
COLOR
CODE ELEVATIONS OF THE STRUCTURE
IN
QUESTION AS FOLLOWS:
A.
THE
EXISTING STRUCTURE SHALL
BE
COLORED GREEN.
B. THE PORTION OF THE PROPOSED IMPROVEJ\.1ENT THAT DOES
NOT
REQUIRE
AV
ARIAN CE SHALL
BE
C.
THE
PORTION
OF THE PROPOSED IMPROVEJ\.1ENT THAT REQUIRES
AV
ARIANCE SHALL
BE
COLORED RED.
If
the
application is fur a road frontage variance, include
ten
copies
of
a
tax
map
depicting the subject parcel and
the
proposed access leading all
the
way
to its connection
with
a public road.
If
the
application is for variances required to subdivide property, include
ten
copies
of
a
tax
map showing
the
subject property and
the
surrounding area.
If
the
application is subject to Suffolk County Health Department ("SCHD") approval, a
copy
of
the
SCHD submission must
be
included. Projects that require SCHD approval
include, but are not limited to, those projects where
the
home is being demolished, and;
where
the
bedroom
count
is
being increased, an; where sanitary service is being added to
an existing accessory structure, and; where
the
sanitary system must
be
relocated to
accommodate an addition
or
accessory structure. Contact the Building Department for
referral guidelines.
If
the
applicant is represented
by
an
agent, a notarized original and two copies
of
a letter
authorizing the agent to act
on
behalf
of
the
applicant must
be
submitted. In
the
case
of
an
attorney acting as agent for
the
applicant, this Board will accept a notarized affidavit
by
the
attorney attesting to
the
fact.
For
commercial uses, include a site
plan
of
the proposed project that includes parking,
vehicular access and elevation sketches
of
the
proposed structures demonstrating
compliance
with
§300-9.6,
if
applicable.
Some applications
may
require a landscaping plan.
Surveys shall
be
current and guaranteed.
If
proposed construction involved,
the
surveyor
should depict the proposed construction
on
the
survey. All surveys must
be
less
than
one
year old and contain:
a.
Setbacks
of
all structures depicted
on
the
survey
b. dimensions
of
all
strudures
depicted
on
the
survey
c. lot coverage
of
the existing principal structure and proposed principal structure
d. lot coverage
of
all structures
on
the parcel
In summary:
The
applicant must provide
the
specific applicable sections
of
the
Village
Code
and
clear, specific descriptions
of
the
request.
The applicant must explain
why
the request is necessary.
The application must contain sufficient information to demonstrate that any request
for a variance meets the applicable tests for a use variance
or
area variance. These
tests are listed
on
the application
form
Certain types
of
applications necessitate inclusion
of
particular types
of
information, such
as
a single and separate abstract.
The submittal
of
an accurate, thorough application with all necessary information
is prerequisite to the scheduling
of
a public hearing.
An
incomplete application
will only delay the processing cycle.
Following a review
of
the Environmental Assessment Form Part
1,
if
required, a
determination will be made as to whether an Environmental Assessment
Form
Part
II evaluation will be required.
If
an EAF part II is needed it will be prepared
by
the
Village Consultant and no public hearing will be scheduled until after it has been
Completed and provided to this Board.
If
an Environmental Impact Statement is
determined to be necessary, no public hearing will be scheduled until it has been
satisfactorily prepared and submitted
by
the applicant to this Board.
DATED: 01/2017
APPLICATION TO THE ZONING BOARD OF APPEALS
VILLAGE OF SAG HARBOR
FOR AN INTERPRETATION
AND/
OR
VARIANCE
(Application shall
be
accompanied by a fee
of
$250.00 payable to the Village of Sag Harbor, and
necessary surveys
or
other documents.) for a single family, all others $350.00.
IN
THE MATTER OF THE APPLICATION OF:
(IF NOT OWNER OF PROPERTY, PLEASE INDICATE RELATIONSHIP, CONTRACT PURCHASER,
ATTORNEY
IN
FACT, ETC.)
Mailing Address:
Telephone:
Attorney or Agent for Owner:
Mailing Address:
Telephone:
QUESTIONAIRE:
1. Location and Description
of
Property:
a.
Zoning District as shown on Zoning Map:
b.
Street Name:
c.
Tax Map Number:
District:
Section:
Block:
Lot:
2. Name and Addresses
of
Adjacent Property Owners:
3.
Date Property Acquired:
From Whom:
4.
Type
of
and Reason for Application:
1
INTERPRETATION OF Section.
_________________
.is
requested to determine whether:
USE VARIANCE OF Section,
__________________
is
requested in order to:
AREA VARIANCE OF Section
___________________
,is
requested
in
order to
2
5.
If this
is
an
application
for
a USE VARIANCE, please answer how the request satisfies the
following requirements
of
the Zoning Law:
a.
Under applicable Zoning regulation the applicant is deprived
of
all economic use or benefit
from the property
in
question, which deprivation must be established by competent financial
evidence.
b.
That
the alleged hardship relating
to
the property in question
is
unique, and does not apply to
a substantial portion
of
the district or neighborhood.
c.
That the request use variance, if granted,
will
not alter the essential character
of
the
neighborhood.
d.
That the alleged hardship has not been self-created.
6.
If
this
is
an
application for an
AREA
VARIANCE, please answer how the request satisfies the
following requirements
of
the Zoning Law:
a. Whether
an
undesirable change will be produced in the character
of
the neighborhood or a
detriment
to
nearby properties will be created by the granting
of
the area variance.
b.
Whether the benefit sought by the applicant can be achieved by some method, feasible
for
the applicant to pursue, other than
an
area variance.
c.
· Whether the requested area variance
is
substantial.
d. Whether the proposed variance will have
an
adverse effect or impact on the physical or
environmental conditions
in
the neighborhood or district.
e.
Whether the alleged difficulty was self-created; which consideration shall be relevant to the
decision
of
the board or appeals, but shall not necessarily preclude the granting
of
the area
variance.
7.
A plot plan
of
the premises shall accompany this application and shall include the following
details: (Any other pertinent information the applicant feels
is
important should be submitted.)
a.
Property line, give length to nearest foot.
b.
North direction arrow
c.
Size
of
lot
in
acres or square feet
d.
Indicate scale
of
survey sketch
3
e. Location
of
building
on
property and distance to property lines.
f.
Floor plan
of
house showing room use.
g. Door and window locations
h. Cesspools, septic tank, and Wellpoint
i.
Driveways, note
if
dirt, asphalt or concrete
j. Any unusual planting of trees.
k.
Fencing
I.
Accessory buildings
on
property.
m. Patios, decks, swimming pools and tennis courts
n.
Proposed building additions in dashed lines
o.
Proposed property divisions in dashed lines.
p.
Location
of
buildings
on
adjacent property.
q.
Distance
of
buildings
on
adjacent property from applicant's property lines.
r.
Elevation
views
of
unusual buildings.
NOTE: If this application is submitted by an agent, a letter
of
authority from owner must accompany the
application.
STATEOFNEWYORK)
SS:
COUNTY OF SUFFOLK)
-----------------------~
being duly sworn deposes and says
he/she is the owner or agent
for
the owner
of
the property above described. That all statements made in
this application are true to the best
of
his/her knowledge and belief, except as to the matters therein
stated to be alleged on information and belief and as to the matters he/she believes the same to be true.
Sworn
to
before me this
_____
day
of
_______
---"20_-
(Notary Public)
4
INCORPORATED
VILLAGE
OF
SAG
HARBOR
BUILDING
DEPARTMENT
55
Ma
in
Street
Sag Harbor, New York 11963
631-725-0224
AUTHORIZATION
The undersigned are
the
sole
owners
ofthe
premises
located
at
---------
___________
_,
Sag Harbor, New York,
SCTM:
#
_________
_
and
hereby
authorize
______________
to
apply for
and
obtain:
Check
as
applicable: (a) Building Permit ( )
(b) Certificate
of
Occupancy (
(c)
Zoning Variance ( )
(d) Subdivision Approval (
(e)
other
____________
_
(Describe)
The Undersigned
hereby
hold harmless
and
indemnify
the
Village
of
Sag Harbor, including its
agencies, officials
and
employees,
against any claim,
cost
or
expense, including
attorney
fees,
by reason
of
their
reliance upon this authorization.
Dated:
--------
Sign Here:
____________
_
Print Name:
------------
Sign Here:
_____________
_
Print Name:
-------------
O n
the
___
day
of
______
-20_
before
me,
the
undersigned personally
appeared
----------------~
personally known
to
me
or proved
to
me
on
the
Basis
of
satisfaction evidence
to
be
the
individual (s)
whose
name(s) is/are subscribed
to
the
within
instrument
and
acknowledged
to
me
that
he/she/they
executed
the
same
in
his/her/their
capacity(ies), and
that
by
his/her/their
signature(s) on
the
instrument,
the
individual(s)
acted,
executed
the
instrument.
(Notary Public)
AUTHORIZATION
AND
CONSENT
FOR
INSPECTION
OF
PROPERTY
INSTRUCTIONS:
This form must be completed, signed and attached
to
the
application form for
an application
to
the
Zoning Board of Appeals.
The undersigned, being
the----------~---------
(owner
or
agent-please print name)
Ofthe
property described
in
the
within application, hereby authorizes
the
members of
the
Zoning Board of Appeals
to
enter
upon
the
property described
in
the
within application for
the
purpose of inspecting such property
in
connection with
the
relief requested
in
the
within
application, and
the
undersigned hereby consents
to
said entry for said purpose.
Date:
_______
_
(signature)
STATE
OF
NEW YORK)
COUNTY
OF
SUFFOLK)
CERTIFICATION
_______________
.being
by me duly sworn, deposes and says:
.L I am interested in an application
for
a variance
or
special exception
now
pending before the Sag
Harbor Zoning Board
of
Appeals.
2. I reside at
_______________________________
_
3.
The
nature
of
my
interest in the aforesaid application is as follows:
4.
If
applicant
or
owner
is a corporation, list officers:
Pres.
_____________
Secretary
__________
_
Vice Pres.
__________
Treasurer
__________
_
Do
any
of
the following individuals have an interest as defined below in the owner
or
applicant?
A.
Any
New
York State officer,
or
B.
Any
officer
or
employee
of
Southampton Town, East Hampton Town
or
Suffolk
County
or
Village
of
Sag Harbor.
For the purpose
of
this disclosure an officer
or
employee shall be deemed to have an
to have an interest in
the
owner or applicant when he, his spouse,
or
their brothers, sisters,
parents, children, grandchildren,
or
the spouse
of
any
of
them.
a.
Is the applicant
or
owner,
or
b.
Is an officer, director, partner, or employee
of
the applicant
or
owner,
or
c.
Legally
or
beneficially owns
or
controls stock
of
a partnership
or
association applicant
or
owner, or
d. Is a party to an agreement with such an applicant
or
owner express or implied, whereby
he
may receive any payment
or
other benefit, whether
or
not
for
services rendered
dependent
or
contingent upon
the
favorable approval
of
such application.
A person who knowingly and intentionally fails to make such disclosure shall
be
guilty
of
a
misdemeanor
as
provided in General Municipal Law, Section 809.
Yes
()
No()
If
yes, state the residence and nature and extent
of
the interest
of
such individual.
Name
Residence
Sworn to before
me
this
(signature)
___
dayof
___
,20
(notary)
VILLAGE
OF
SAG
HARBOR
BUILDING
DEPARTMENT
55
MAIN
ST.,
PO
BOX
660
SAG
HARBOR,
N.Y.
11963
631-725-0224
631-725-4852
FAX
BUILD!NGDEPT@SAGHARBORNY.GOV
RECEIVED
PERMIT
No.
______
_
PERMIT
FEE
_____
_
FEE PAID
______
_
FEE
DUE.
_______
_
BUILDING PERMIT APPLICATION
DATE ISSUED
-
ALL
QUESTIONS MUST
BE
ANSWERED -
THIS
IS
A(N):
0
NEWPERMIT
0
AMENDMENT
TO
AN
EXISTING
PERMIT
No.
__
_
TAX
MAP
NUMBER:
__
_
DISTRICT SECTION BLOCK LOT
PROPERTY
LOCATION:
--c=eG=AL-s=TREET=-AD-
•
_RES_S_AN_D_N_u,-,B-ER--
PROPERTY OWNER:
__________
_
APPLICANT:
___________
_
MAILING ADDRESS:
_________
_
MAILING ADDRESS:
___________
_
PHONE:
__________
_ PHONE:
___________
_
EMAIL
___________
_
APPLICANT IS:
0 OWNER O LESSEE O AGENT O ARCHITECT O BUILDER O OTHER:
IF OWNER OR APPLICANT
IS
A CORPORATION
or
LLC, FURNISH NAMES OF MANAGING OFFICERS
or
MEMBERS:
CORPORATE/LLC PROPERTY OWNER NAME CORPORATE/LLC APPLICANT NAME
NAME:
_____________
_
NAME:
______________
_
ADDRESS:
ADDRESS:
CONTRACTOR RESPONSIBLE FOR CONSTRUCTION:
NAME:
______________
_ CONTRACTORS LICENSE NO:
__________
_
PHONE:
______________
_
ISSUED
BY:
0
SOUTHAMPTON
O
EAST
HAMPTON
O
SUFFOLK
E-MAIL:
THIS PERMIT
IS
TO: 0 BUILD A NEW STRUCTURE O MAKE CHANGES TO
AN
EXISTING STRUCTURE
THIS PERMIT
IS
FOR: 0 PROPOSED WORK O WORK ALREADY PERFORMED
WHAT
IS
THE EST! MATED COST
OF
CONSTRUCTION?
$.
__________
(COST
DOES
NOT
AFFECT
THE
PERMIT
FEE)
CURRENT
No.
OF BEDROOMS:
___
_
PROPOSED No. OF BEDROOMS:
___
_
CURRENT
No.
OF FULL BATHROOMS:
___
_
PROPOSED No.
OF
FULL BATHROOMS:
___
_
CURRENT No.
OF
HALF
BATHROOMS:____
PROPOSED No. OF HALF BATHROOMS:
___
_
IS
THIS PARCEL
IN
THE HISTORIC DISTRICT OR DESIGNATED
AS
A LANDMARK? 0
YES
ONO
FLOOD ZONE: 0 X O V O AE O N/A
ZONING DISTRICT:
0 R-20 0 VB O WF O
OD
O
RM
IS
THIS PARCEL
IN
THE TIDAL OVERLAY DISTRICT? 0
YES
ONO
Briefly describe the scope
of
the project:
____________________________
_
ST
ATE
OF
NEW
YORK
}ss.:
COUNTY
OF
________
~
being duly swam deposes and says
that
he/she is
the
owner
or
agent
for
the
owner and is duly
-au_th_o_ri_zed-,-,to-m-----cak_e_a-nd
7
fi°'ile-thc--is-,a.,-ppc;clic-ca:-otic-on=-c;-:c-that
all
statements contained in this application
are
true
to
the best of his/her
kno\-Vledge
and
belief,
and
that
the work
'Nill
be performed in the manner set forth in the application and in
the
plans and specifications filed therewith.
SIGNATURE
OF
APPLICANT
Sworn to before me this
___
day
of
_______
20
__
Notary Public
_________
C.ounty
APPROVED:---~~-~=~==~--
Thomas Preiato su1LolNG
1NSPECTOR
INC
VILLAGE
OF
SAG
HARBOR
55
MAIN
ST.•
PO IJOX
660
SAG HARBOR,
NY
11963
{ 631) 725-0222
·<
;,
STREET .ADDRESS OF
PROPOSED
AC'J10N:
INSTRUCTIONS
,
COASTAL
ASSESS::\.fENT
FORivl
CRAT'TE:Rl75: WATERFRONT
CDNSJSTENCTllEVIEW
SUFFOLK
COUNTY
TAX
MAP
NU!\IBKR(S):
. L
Applicants--w
iD
the
case
of
direcct
actiO!ls, Village age.ncies-£hall complete this Coastal
AssesSJJ1ent
Form
(CAP) for proposed a::tions which are subject
to
Cb.apter 275
offue
Village
Code, e:utirled Water:front Consistency Review. This
assessment is intended to supplement other
information
u.sed
by
a Village
azency
in
making a
det=rination
of
consistency.
2.
Before
arswerirlB
the
questions m Section
C,
the
prepacer
oft!,~
fo=
should review the policies
wntained
within
the
UJcal Wat,'T.front Revitalization Program
(LWRP)
and
thec.cr
explarurtions. A
copy
of
the
L"\,\,'RP
is
on
file
in
the
Village Clerk's office and on fue
Village's
website A
proposed
action
should
be
evaluated as to whether
it
will have any significant beneficial 2nd
adverse
eflects upon
the
coa.<tal
area.
3.
If
any
question
in
SectiGn C
offuis
form is answered "YES,"
thc.rr
1hc proposed acti.on
may
aife.ct
the
achieveinent
of
the
LWRP
policy
standards and conditions connrined in Chapter 275,
Wate..-front Consistency
Review
Gf
the
Village Code (the "Warerfront Co:usisteocy Review
Law"). Thus, the action
s.':tould
be
analyzed
in
more detail and,
if
n=sery,
modified prior to
making
a determination that
it
1s
consistent to
the
maxi!:rrum extecit practicable
with
the LViRP
policy
s1a:r:.dards
;md conditions.
If
an action cannot be certified as comistent
with
the LViRP
policy standards ,md conditions,
it
shall
not
be
undertaken
A.
CONTACT
I.NFOR'\1ATION (Please
print
or
type answ2rs)
Apj]licant:
-----------------------------------
M,iling
Address:
_____________________________
_
Tcfophone
Number: ( )
------------------------·--·-
Ov.ner
(if
not
the applicant):
___________________________
_
M;ciling
Address:
_______________________________
_
Telepb.one Number: ( )
___________________________
_
Attom:;y
(if
applicable):
____________________________
_
Maifuig
Address:
-··-------------------~------------
Telephone
Number:
( )
___________________________
_
-1-
05-fJ5-201 l
' .
INCORPORATED VILLAGE Of' SAG HARBOR
COASTAL ASSESSMENT FORM
B.
DESCRIPTION
OF
PROPOSED
ACTION
A.ND
PROJECI
SITE
l.
Type
of
Village Agency Action
(che1;k
appropriate resp~nse):
D Directly undertaker, (e.g., c2.pital eonstruction, plann;ng
activity, 2.gency regulation, land transa~tion ).
D Financial
assistmce
(e.g., grant, loan, subsidy).
D Pecmit, approval, license, certification.
2.
lf
an application for tlJe prnposed
aG!:ion
has
beer:
filed with anofoer agency, provide the
Application
Number;
the
Approval/Filing Date; and the Contact Person. Please be sure that al!
approvals are consistent wifu the action seeking
app::-oval
from the Village
of
Sag Harbor.
(a)
NYS
Dept
ofEnviionrnental
Conservation
_________________
_
(b)
NYS
Dept.
of
State
(c) US Anny Corps
of
Engineers
(d) Southarr1pton
Tovm
Trustees----------------------~
(e) Other
(j)
Please provide copies
of
all approvals and approved/submitted plans with this CoaEtal
Assessment
Fonn.
Any
documents that are atrached should
be
indicated in Section E
}.
To
your
knowledge,
has
!his project site every been granted approval
by
any Village Agency for
any
other
project? D Yes D No D
Not
Appli~le
{a)
If
"Yes, ''
please
ir,dicate the agency, type
of
apprDva/, date
of
approval
and
name
of
previous
applicantlifwner
in
SectionE
or
on
a
sep:J:rate
sheet.
If
"Not Applicable," please ir.dicate
why
m Section E
or
on
a separate sheet_
4.
Describe Na::ure
and
E2..1:ent
of
Proposed Action (indicate any proposed structures, inclurling
sanitarv systems, drvwells, swimming pools. patios, driveways, decks,
etc.):
5.
Location
of
Proposed Action:
6.
TotaJ Size
of
Project
Site
(a) Acres:
(b)
Sgnare
Feet:
-· --
INCORPORATED VILLAGE OF
SAG HARBOR
'-
COASTAL ASSESSMENT FORM
7. Land Use:
.... (a) Existing:
____________________________
_
(b)
Proposed:·------------~------------~
8.
Existing Zoning District:
-----------~
9.
FEMA Flood
Zone:
____
_
10. Describe any unique
or
unusual landforms
on
or around the project site (e.g., bluffs, dunes,
swales,
QTOUnd
demessions, other geological formations):
11. Approximate
Depth
to
Groundwater:
__
ft.
12. Percentage
of
site
which
contains slopes
of
15% or greater:
___
%
I 3.
If
there
are
any
wetlands
or
bodies
of
water (e.g., stream, lake, pond, bay, harbor, etc.) located
contiguous with, adjacent to, or entirely within the project site, please indicate the following:
(a)
Name
of
Water
Body
(if
applicable):
___________________
_
(b) Area
of
Wetlands
or
Water on Project Site:
______
sq. ft.
14.
How
much natural vegetation,
if
any, will
be
removed from the project site?
_____
sq. ft.
C.
COASTAL ASSESSME1'1T
INSTRUCTIONS
FOR
COASTAL
ASSESSMENT
lf
the
answer
to
any
questions
within
this Section C is "YES, "
pl
ease provide either further
explanation
in
Section
D
or
attach a separate sheet with the explanation
lf
a separate sheet is
attached,
please
indicate
this
in
Section
D
The
question number
should
be referenced within
each explanation
that
is
provided~.g.,
Question 1 (a).
Please
TJ1Jie
that
answering
"NO"
to every question will not exclude the
proposed
action
from
the Waterfront
Consistency
Review Process.
l.
Will the proposed action
be
located in,
or
contiguous to, or have a
potential adverse
effect
upon
any
of
the resource areas identified
on
the
coastal
map:
(a) Significant fish
or
wildlife habitats? .................................................
__
_
(b) Scenic
resources
of
local or statewide significance? .........................
__
(c)
Natural
protective
features in an erosion hazard area? ......................
__
-3-
INCORPORATED VILLAGE OF SAG HARBOR
COASTAL ASSESSMENT FORM
2.
Will
the proposed action have a.significant effect upon:
(a) Commercial
or
recreational use
of
fish and wildlife resources? ........
__
(b) Scenic quality
of
the coastal environment?····•···•···············'··············-~
(c) Development
of
future
or
existing water-dependent uses? ................
__
_
( d)
Land
or water uses along the shore front
or
within 1,500 feet
of
the
shoreline? ...............
~
................................................................ .
(e) Stability
of
the
shoreline? ................................................................ .
(f) .Surface
or
groundwater quality? ....................................................... .
(g) Existing or potential public recreation opportunities? .......................
__
(b) Structures, sites
or
districts
of
historic, archaeological or
cultural significance to the village, town, county, state or nation? ....
3.
Will
the
proposed action involve
or
result in any
of
the following:
(a) Physical alteration
ofland
along the shoreline, underwater lands,
or
coastal waters? .............................................................................. .
(b) Physical alteration
of
an area
ofland
located elsewhere in the
Waterfront Revitalization Area? ....................................................... .
(c) Expansion
of
existing public services or infrastructure
in
YES NO
undeveloped
or
low
density areas
of
the coastal area? ......................
__
..
(d)
Energy
facility
not
subject to Article
VII
or
VIII
of
the
Public
Service
Law?
..........................................................................
__
..
( e) Mining, excavation, filling
or
dredging in coastal waters? ................
__
_
(f) Reduction
of
existing
or
potential public access
to
or
along
the
shore?
................................................................................ ,
__
.
(g) Sale
or
change-in-use
of
publicly owned lands located on
the
shoreline
or
underwater? ......... : ................ , ...................................
__
_
(h)
Development
within
a designated flood
or
erosion hazard area? ......
__
_
(i)
Development
on
a beach, dune, barrier island or other natural
feature
that
provides
protection against flooding or
erosion?·····•······--·
G)
Construction
or
n;construction
of
erosion protective structures? ......
__
_
(k)
Diminished
surface
or
groundwater quality? .....................................
__
_
(I)
Removal
of
ground
cover
from the site? ... : ........................................
__
-4-
IN
CORPORA
TED
VILLAGE OF SAG
BARBOR
COASTAL
ASSESSMENT
FORM
· 4.
If
the
project
site is publicly owned and located adjacent to the
·
shore,
answer
the
questions below.
If
not, continue
to
Question
5.
(a)
Will
the
project protect, maintain and/or increase the level and
types
of
public access to water-related recreation resources
and
facilities? ................................................................................... .
(b)
If
located in
the
foreshore, will access to those and adjacent
lands
be
provided? ........................................................................... .
5.
If
the
proposed
action is located adjacent to shore, answer the
questions
below.
If
not, continue to Question
6.
YES NO
(a) Will water-related recreation
be
provided
0
........................................
__
(b) Will
public
access to 1he foreshore
be
provided? ..............................
__
(c)
Does
1he
project
require a waterfront site? ........................................
__
(d) Will
it
supplant a recreational
or
maritime use? ................................
__
(e)
Do
essential public services
and
facilities presently
exist
at
or
near
1he site? .................................................................... ..
(f) Is it
located
in
an
area
of
high erosion? ..........................................
..
6.
If1he
project
site is publicly owned, answer
1he
questions below.
If
not, continue to Question
7.
(a)
Will
it
involve
the
siting and construction
of
any major
energy
facilities? ...............................................................................
__
_
(b)
Will
it
involve
1he discharge
of
effluents from major stream
electric
generating
and industrial facilities into coastal facilities? ....
__
_
7. Is
the
project
site
presently used
by
the
community neighborhood
as
an
open
space
or
recreation area?---·--------------------·····-·····•··--·---·······--·-·---
8.
Does
the
present
site offer
or
include
scenic views
or
vistas known·
b
. .
th
. ?
to e 1mpor!ant
to
e
community
...........................................................
__
_
9.
Is
the
project
site
used
for
commercial
fishing or fish processing? .........
__
_
-5-
click to sign
signature
click to edit
INCORPORATED VILLAGE OF
SAG
HARBOR
COASTAL ASSESSMENT FORM
J
0.
Will
the
surface area
of
any waterways or wetland areas be
increased
or
decreased by the proposal? ..................................... .
(a) Increased by:
(b) Decreased by:
_____
square feet
_____
square feet
11. Do
any
mature
forest (over 100 years old) or other locally important
vegetation existing on this site which will be removed
by
the project?
..
__
_
12. Does
any
locally important vegetation existing
on
this site which
will
be
removed
by
the
project? ............................................................. .
13.
Will
the
project
involve any waste discharges into coastal waters
including,
but
not
limited to, storm water runoff? ............................. .
14.
Does
the
project
involve surface
or
subsnrface liquid waste disposal
(e.g., sanitary/septic waste, stormwater runoff; etc.)? ................. .
15. Does
the
project
involve transport, storage, treatment or disposal
of
solid
waste
or
hazardous materials? ................................................... .
16. Does
the
project
involve shipment or storage
of
petroleum products? ....
__
_
17.
Does
the
project
involve discharge
of
toxins, hazardous substances
or
other pollutants into coastal waters? ....................................................
__
_
18.
Does
the
project
involve or change existing ice management practices?
__
19. Will
the
project
alter
drainage flow, patterns
or
surface water
runoff
on
or
from
the
site? .......................................................................
__
_
20.
Will
best
management
practices
be
utilized to control stormwater
runoff
into coastal waters? ..................................................................... .
21. Will
the
project
utilize or affect the quality
or
quantity
of
sole
source
or
surfuce
water
supplies? ............................................................
__
_
22. Will
the
project
cause
emissions which exceed federal or state
air
quality standards
or
generate significant amounts
of
nitrates or
sulfates into
the
atmosphere? ...................................................................
__
_
D.
REMARKS ORADDITIONALINFORMATION
(Please list
any
and
all
additional sheets
that
are
to
be used
to
complete/supplement this
form)
-6-
click to sign
signature
click to edit
Instructions for Completing
617.20
Appendix E
Short
Environmental Assessment Form
Part
1 - Project Information.
The
applicant or project sponsor is responsible for the completion
of
Part
1. Responses
become
part
of
the apphcation for approval or fimdlng, are subject to public review,
and
may be subject to furtlier verification.
Complete Part I
based
on information currently
a:v-ailable.
If
addiiional research or investigation would be needed to fullv
respond
to
any item, please
answer
as thoroughly as possib1e based on current informaiion.
.,
Complete all items in
Pac-t
1.
You
may
also provide any additional infor;nation
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
Project
Location (describe, and attach
alocarion
map):
Brief
Description
of
Proposed Action:
Name
of
Applicant or Sponsor:
Telephone:
E-Mail:
Address:
City/PO:
State:
Zip
Code:
i
1. Does the proposed action only
involve
the legislative adoption
of
a plan, local law, ordinance,
NO
YES
adm.inistrntive rule,
or
regulation?
If
Yes, attach a narrative description
of
the
intent
of
the proposed action
aod
the
environmental resources
that
• •
rnay
be affectedin
the
municipality
and
proceed to
Part
2.
If
no, continue
to
question 2.
2.
Docii
the proposed action reqrrire a pennit,. approvaJ
or
funding from any other governmental Agency?
NO
YES
TfYes, 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) cwmed
or
controlled
by
the
applicant
or
project
sponsor?
acres
4.
Check all land uses
that
occur
on, adjoining and
near
the proposed action.
• Urban
• Rural (non-agriculture)
• Industrial.
D Commercial • Residential (suburban)
• Forest
• Agriculture • Aquatic
• Other (specify):
• Parkland
Page 1
of4
j
s.
Is
the prnpc-scd action.
!NO
YES
IVA
a.
A penrnt:.ed use
under
tnc
zo-rnng
reguim1ons·.
1
I
•
•
i•
b.
Consistent
-.,.;ir:h
the
adopted
comprehensive plan?
i
•
•
!•
I
6.
Is the proposed action consistent
"vith.
the
predomina.r:.t
echaracter
of
the exiscing built or natural
NO
I
YES
land.scape?
DIDI
7.
Is
6e
site
of
the
proposed
action
located
i.n,
er
does
it
adjoin, a state listed Crltical Enviro.nrnental Area{
NO
I
YES
If
Yes,
iderrtifr
•
lo
8.
a. Will
t.1:te
proposed
action
result
in
a substantial increase
in
traffic above present levels?
NO
YES
•
•
b.
Are
public t:ransportation service(s) available at or near the site
of
the proposed action?
•
•
c_
.
.a.re
any pedestrian accommodations
or
bicycle routes available
on
or
near site
of
the proposed action?
•
•
9.
Does
the
proposed
action
meet
or
exceed the state
energ,:J
code requirements?
NO
YES
If
the
pmposed
action
wiJl
e-xceed requirerhents, de.scribe design features
and
techI10logies:
•
0
10.
Will the
proposed
action
connect
to
-an
existing public/private
Vla:ter
supply?
NO
YES
If
No.
describe
method
for
providing
potable water:
•
•
J
l.
Will
the
proposed
action
connect
to
existing wastewater utilities?
NO
YES
If
No,
describe method
for
p,o,~ding
wastewater treatment:
• •
n
a
Does
the
site
cont.a.in a structure
that
is listed
on
either the State
or
National
Register
of
Historic
NO
YES
Places''
•
•
b.
ls
the proposed action located in
an
archeological sensitive area?
•
13
_ a
Docs
any
portion
of
th_3
site
of
the
proposed
action,
or
lands adjoining
ihe
proposed -action, contain
NO
YES
wetlands
or
other
waterbod.ies
regulated
by
a federal"
state
or
Iocal agency?
• •
b.
Would
the
proposed
action
physically
alter,
or
encroach into, any existing wetland onva!erbody?
•
•
·
TfY
es;irlentify
•the
wetland
or
waterbody
and extent
of
alteratiom
in
square
feet
or
acres:
14.
Identify
the
typical
habitai
types
that
occur
on,
or
are likely
to
be
found
on
the project site.
Check
alJ
that apply:
•
Shoreline
•
Forest
D Agricultural/grasslands
D Early mltl-successional
D
Wetland
•
Urban
• Suburban
15.
Does
the
site
oftiie
proposed
ii.ction
contain
any species
of
animator
associated habitats, listed
NO
YES
by
the
State
0r
Federal
government
as
threatened or endangered?
•
•
16. Is
the
project
site
located
in
the
I 00
year
flood plain?
NO
YES
I I
17. Will
the
proposed
action
create stonn.
water
discharge, either from. pcirrt
or
non-point sources?
NO
YES
lfYes,
•
•
a
Will
storm
i.vater discharges
flmv
to
adjacent
properties?
•
NO
•
YES
b.
Wil1
storm
water
discharges
be
directed
to
established. conveyance systems
(runoff
and storm
dr1-in:3
)?
If
Yes,
briefly
describe:
•
NO
• YES
Page
2
of
4
!8
Does
,:he
pr0p,:,sed act.ion include construction or other
2.cfr::.rities
tha; result in the
imp,:,und:T,e.nt
of
NO
i
l'ES
water
or
o[her ilqu1d.s
(e
g.
retention
pond,
wfu.'le
lagoon, darn)"
If
Yes, explain purpose
a.1.d
size·
•
•
19.
Has
tb..e
site of
t.11.e
proposed action
or
an
adjoining propertJ beea the location of
an
active
or
dosed
NO
Y15
solid waste management facility?
If
Yes, d"scribe:
•
•
20.
F...as
the site
of
the
proposed action or
an
adjoining property been
t.'f-ie
subject
of
remediation
(ongoing
or
NO
'{ES
completed) for hazardous waste?
!
If
Yes, describe:
•
•
IAFFllliVl
Til,\.T
TiiE
L'iFOR.c'\>l,\.TlON
PROVIDED ABOVE
IS
TRUE
AND ACCURATE TO
THE
BEST
OF
MY
k"NOWLEDGE
Applicant/sponsor name:
Date:
Signature:
Part
2 -
Impact
Assessment
The
Lead
Agency is responsible
for
the
completion
of
Part
2.
Alli--wer
all
of
fue following
questions in
Part
2 using
the
information contained
in
Part
1 and other materials submitted by fue project sponsor
or
otherv,ise available
to
the reviewer.
When
answering the questions
the
reviewer should be guided
by
the concept
c..Have
my
responses been reason.able considering the scale and context
of
the proposed action?"
No~
or
Moderate
small
to
large
impact
impact
may
may
occur
occnr
L
Will the proposed action create a material conflict with an adopted land
use
plan
or zoning
•
•
regulations?
2.
Will
the proposed actiori result in a change in fue use
or
intensity
of
use
of
land?
•
•
3.
Will
the
proposed action impair
the
char&..~r
or
qualitJ
of
the existing community?
•
•
4.
Will the
proposed
action have
an
impact
on
the:
environmental characteristics
tha±
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 existiog infrastructure fur
mass
transit, biking or walkway?
6.
Vlill
the
proposed
action cause
an
increase
in.
the use
of
energy and it fails to incorporate
•
•
reasonably available energy conservation
or
renewable energy opportunities?
7.
wm
the proposed action impact existing:
•
•
a.
public/
private ,vater supplies?
b. pub'!ic / private
wast~ter
treatment utilities?
•
•
8.
Will
the
proposed action
impair
the
character
or
quality
of
importam bismric, archaeological,
•
•
architectural
or
aesthetic resources?
9.
Will the
proposed
action result in
an
adverse change to natural resources
{e.g.~
wetlands,
•
•
waterbodies, grollildwater, air quality, flora and fallila)?
Page3
of
4
I
I
I
/
Ni\
-or
i'vfodcrate
smaH
ii}
large
impact
impac:t
I
may
may
i
oc:c:ur
occur
1 O Will the proposed action result in
an
ir.crease in
t.J:.ie
potential for
erosion~
flooding
or
drainage
problems?
I
I
I
•
•
11.
\Vill
the proposed action create a hazard to environmer_tal resources or
humar!
health?
I
•
•
I
't
Part
3 -
Determination
of
significance.. The
Lead
Agenc:y is responsible for the completion
of
Part
3. For every
question in Part 2
thai
was
answered
a.IIlodernie
to
large ll!lpact
may
occur", or if there is a D.if...d
to
ex;_Jlain
why a pzrticular
element
of
the proposed action
may
or
v.iU
not
re::.7llt
in a significant adverse environmental impact, please complete
Pai.-t
3.
Part 3 should,
in
sufficient detail, identiff the impac~ including
any
measures or design elements
1i1lll
have
been included
by
the project sponsor to avoid or reduce impacts. Part 3 should also explain how
the
lead agency detennined 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
m3:::,onitude_
Also conslderthe
potentia1
for
s"hort-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
signi.fi.canr
adverse impacts and an
en:Vironme:o1al
impact statement
is
required.
Check
this
box
if
you have determined., based on the information and analysis above,
ar-..d
any supporting documentation.,
that the proposed action will not result
in any significant. adverse
enVITOnmental
impacts.
Name
of~
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
Resporuible Officer)
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Page 4
of4
Kathleen Mulcahy, Mayor
James L. Larocca, Trustee
Aidan Corish, Trustee
Beth M. Kamper, Clerk-Administrator
55 Main St., PO Box 660
Sag Harbor, N.Y. 11963
631-725-0222
631-725-0316 FAX
Thomas C Gardella, Deputy Mayor
Robert Plumb, Trustee
Denise R. Schoen, Village Attorney
Rhonda L. Meserole, Village Treasurer
Disclosure Affidavit
General Municipal Law §809
STATE OF NEW YORK}
} ss.:
COUNTY OF SUFFOLK}
____________________________________, being duly sworn, deposes and
says that:
1. (a) an application has been made by _______________________________
Name of applicant
to the __________________________________________________________, of the
Name of Village Agency
Village of Sag Harbor with respect to property situate at _______________________,
Street address
Sag Harbor, New York. I am the ________________________________________,
Applicant or Agent for applicant
I reside at _______________________________________.
Address of applicant or agent
(b) The shareholders, partners or members of the applicant corporation,
partnership or limited company are (if applicable):
(1) _______________ (3) _________________
(2) _______________ (4) _________________
2. (a) the landowner’s name and address are:
______________________________________________
______________________________________________
(b) The shareholders, partners or members of the landowner corporation,
partnership or limited company are (if applicable)
(1) _____________________ (3) ______________________
(2) _____________________ (4) ______________________
3. (a) the contract vendee’s name and address are (if applicable):
____________________________________________________
____________________________________________________
(b) The shareholders, partners or members of the contract vendee
corporation, partnership or limited company are (if applicable):
(1) ___________________ (3) ________________________
(2) ___________________ (4) ________________________
4. Does any officer or employee of the Village of Sag Harbor have an interest in
the applicant or in the landowner or in the contract vendee?
_______ Yes ______ No
If yes, state the name and residence of such officer or employee and the nature
and extent of such interest.
________________________________________________________
________________________________________________________
For the purpose of this disclosure, an officer or employee of the Village of
Sag Harbor shall be deemed to have an interest in the applicant or in the landowner or in
the contact vendee when he, his spouse, or their brothers, sisters, parents, children,
grandchildren, or the spouse of any of them:
(a) is the applicant or landowner or contract vendee, or
(b) is an officer, director, partner, member or employee of the applicant or
landowner or contract vendee, or
(c) legally or beneficially owns or controls stock of a corporate applicant or
landowner or contract vendee, or is a partner or member of a partnership or limited
liability company applicant or landowner or contract vendee; or
(d) is a party to an agreement with such an applicant or landowner or
contract vendee, express or implied, whereby he may receive any payment or other
benefit, whether or not for services rendered, dependent or contingent upon the favorable
approval of such application.
A person who knowingly and intentionally fails to make such disclosure shall be guilty of
a misdemeanor as provided in General Municipal Law §809.
________________________________________________________________________
________________________________________________________________________
5. Does any officer or employee of the Town of Southampton and/or East Hampton,
County of Suffolk or State of New York have an interest in the applicant or in the
landowner or in the contract vendee?
_________ Yes ___________No
If yes, state the name and residence of such officer or employee, the name of
such governmental entity (Town, County, and State) and the nature and extent of such
interest. ____________________________________________________________
For the purpose of this disclosure, an officer or employee of the Town of Southampton
and/or East Hampton shall be deemed to have an interest in the applicant or in the
landowner or in the contact vendee when he, his spouse, or their brothers, sisters, parents,
children, grandchildren, or the spouse of any of them:
(a) is the applicant or landowner or contract vendee; or
(b) is an officer, director, partner, member or employee of the applicant or
landowner or contract vendee; or
(c) legally or beneficially owns or controls stock of a corporate partnership or
limited liability company applicant or landowner or contract vendee; or
(d) Is a party to an agreement with such an applicant or landowner or contract
vendee expresses or implied, whereby he may receive any contingent upon the favorable
approval of such application.
A person who knowingly and intentionally fails to make such disclosure shall be guilty of
a misdemeanor as provided in General Municipal Law §809
___________________________________
Applicants Signature
State of New York)
) ss:
County of _____________)
On the ______ day of ___________in the year__________ before me, the undersigned,
personally appeared _______________________, personally known to me or proved to
me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are)
subscribed to the within instrument and acknowledged to me that he/she/they executed
the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the
instrument, the individual(s), or the person upon behalf of which the individual(s) acted,
executed the instrument.
______________________________________
(Notary Public)
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567 Zoning Board Of Appeals Application (Incorporated Village of Sag Harbor)

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Completed 16 July 2020

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