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Home My WebLink About44042-Z gUF OF �C 'Town of Southold 7/18/2020 3 P.O.Box 1179 0 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41260 Date: 7/18/2020 THIS CERTIFIES that the building WIRELESS COMMUNICATION SYSTEMS Location of Property: 21855 CR 48, Cutchogue SCTM#: 473889 Sec/Block/Lot: 96.-1-19.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7/1/2019 pursuant to which Building Permit No. 44042 dated 8/7/2019 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: modification to existing communications system(Verizon co-location)as applied for. The certificate is issued to Junge,Arthur of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44042 6/2/2020 PLUMBERS CERTIFICATION DATED h ed Signature TOWN OF SOUTHOLD BUILDING DEPARTMENT ' TOWN CLERK'S OFFICE oy . � �� SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 44042 Date: 8/7/2019 Permission is hereby granted to: Junge, Arthur 6 Tulane Rd Glen Cove, NY 11542 To: modify an existing communications system (Verizon co-location) as applied for epr Planning approval. At premises located at: 21855 CR 48, Cutchogue SCTM # 473889 Sec/Block/Lot# 96.-1-19.1 Pursuant to application dated 7/1/2019 and approved by the Building Inspector. To expire on 215/2021. Fees: WIRELESS COMMUNICATIONS -MODIFICATIONS $500.00 CO -COMMERCIAL $50.00 otal: $550.00 Buildin I spector Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines,streets,and unusual natural or topographic features. 2. Final Approval from Health Dept.of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead. 5. Commercial building,industrial building,multiple residences and similar buildings and installations,a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9,1957)non-conforming uses,or buildings and"pre-existing"land uses: 1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 Date. New Construction: Old or Pre-existing Building: (check one) Location of Property: �-1 ► 5 CAO_ 4. ? L u�C�b�lie House No. Street HanAk Owner or Owners of Property: . uf-)!�-e. I`14�\,ty p Suffolk County Tax Map No 1000, Section Block —Lot—) Subdivision Filed Map. Lot: Permit No. q+D�D Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Applicant Signature urso Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 � sean.deviinl'a-town.southold.ny.us lyCou�,�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To. Arthur Junge Address: 21855 CR48 city,Cutchogue st: NY zip: 11935 Building Permit#- 44042 Section: 96 Block. 1 ot. 19.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL EL CTRIC CODE Contractor: DBA- Charles M Dwyer Inc License No: 4278ME SITE DETAILS Office Use Only Residential Indoor X Basement Service Only Commerical X Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches 4'LED Exit Fixtures Pump Other Equipment* 20A DC Breaker Notes: Modifications to Upper Antenna Inspector Signature: Date: June 2, 2020 S.Devlin-Cert Electrical Compliance Form As OF SOUTyOlo �WO f * TOWN OFSOUTNOLD BUILDING DEPT. co 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ]` FOUNDATION 2ND [ ] SULATION/CAULKING [ ] FRAMING/STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY j ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: (D , t 9iat�I III LAvg..-- libl-9-4COA SSI (� ED p/y. DATE INSPECTOR Of so(/lyO� G Liez— cs # # TOWN OF SOUTHOLD BUILDING DEPT. °`ycoutrtv?�'' 765-1802 : hNS-PECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL [ ] -FIREPLACE-& CHIMNEY [ ] FIRE-SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION ] PRE C/O REMARKS: DATE 6 INSPECTOR �- OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex OF S0 P.O.Box 1179 54375 State Route 25 ®�� Iy®l Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold NY Telephone: 631765-1938 www.southoldtownny.gov G Q D1 �, JUL 1 4 2020 PLANNING BOARD OFFICE Bf7II,PTNGDE . TOWN OF SOUTHOLD rpP�T* 99 MEMORANDUM To: Michael J. Verity, Chief Building Inspector From: Heather M. Lanza, AICP, Planning Director Date: July 14, 2020 Re: Planning Department Report Verizon Wireless Modifications and Up-grades 21855 County Road'48, Cutchodue SCTM#1000-96.-1-19.1 The Planning Board has found that the requirements of the above-referenced Verizon modifications and up-grades have been completed based on the site inspection made July 9, 2020. The improvements are in compliance with the General Requirements of §280-70 and the Planning Department memorandum dated August 5, 2019; therefore, we recommend a Certificate of Occupancy be issued for this application. Thank you for your cooperation. l APT ENGINEERING MAR 2 n 2020 April 13, 2020 Town of Southold Building Inspector's Office 54375 NY-25 Southold, NY 11971 Attention: Michael J. Verity, Chief Building Inspector RE: Verizon Cell Site"Cutchogue" 21855 County Road 48 Cutchogue, NY 11935 Section: 96; Block: 1; Lot: 19.1 Permit#: 44042 Dear Inspector Verity, I am a New York State licensed Professional Engineer, retained by Verizon Wireless (VZ) in connection with the captioned matter above. I have reviewed the completed VZ antenna and associated equipment installation at the existing wireless telecommunications facility. It is my opinion that the completed installation substantially complies with the project plans and specifications, Rev2, dated 6/18/19 as permitted on permit #44042. We trust the foregoing provides the information you have requested. Please do not hesitate to contact us should you have any questions or comments. Sincerely, OF KE►I, M. CHgs r0 APT Engineering ra n eu 2� 2� 078603 �Cr� Scott M. Chasse, P.E. �oFESS10NP~ Principal APT ENGINEERING 567 VAUXHALL STREET EXTENSION•SUITE 311 •WATERFORD,CT 06385•PHONE 860-663-1697 FIELD INSPECTION REPORT DATE COMMENTS �d t� FOUNDATION(1ST) ------------------------------------ F, FOUNDATION (2ND) CPO t� �O i ilk H ROUGH FRAMING& PLUMBING INSULATION PER N.Y. e" H STATE ENERGY CODE 1X054-00" t FINAL ADDITIONAL COMMENTS , Ob 'o -43 l a - E -9 z rn �b u®� 0 ® z d ,nr' y�¢�()��.•.'� BUILDING DEPARTMENT- Electrical Inspector S- ��'V�4yF EB 2 4 2020 TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Zat . f Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(a7southoldtownny.gov — seand(ci),southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 2/21/2020 y Company Name: Charles M. Dwyer Inc Name: Charles Dwyer l License No.: 4278-ME email: nicoler@com-cell.com Address: 1373 Lincoln Avenue Holbrook NY 4 Phone No.: 631-654-5915 JOB SITE INFORMATION (All Information Required) Name: Verizon Wireless Address: 21855 CR 48, Cutchogue NY 11935 Cross Street: Cox Lane Phone No.: Bldg.Permit#: 44042 email: Tax Map District: 1000 -Section: 96 Block: 1 Lot: 19.1 BRIEF DESCRIPTION OF WORK (Please Print Clearly) DC wiring of customer's equipment for for Verizon Wireless' upgrade to lease area Circle All That Apply: Is job ready for inspection?: YES NO Rough In Final Do you need a Temp Certificate?: YES /(!K) Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: -A #Meters Old Meter# New Service - Fire Reconnect- Flood Reconnect- Service Reconnected - Underground - Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH-APPLICATION Request for Inspection Form.As PERMIT# Address: Switches Outlets GFI's Surface Sconces H H's LIC Lis Fans Fridge HW Exhaust Oven Dryer Smokes DW Service Carbon Micro Generator Combo Cooktop Transfer AC AH Mini Special: Comments: �r Suff� ZQ20 --BUILDING DEPARTMENT- Electrical Inspector Q FEB 2 TOWN OFSOUTHOLD • C2" Town Hall Annex - 54375 Main Road - PO Box 1179 y }_ �'� `'t,r ' Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 ro err fsoutholdtownny.gov seand(c�southoldtownny.gov. APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 2/21/2020 Company Name: Charles M. Dwyer Inc Name: Charles Dwyer License No.: 4278-ME email: nicoler@com-cell.com Address: 1373 Lincoln Avenue Holbrook NY Phone No.: 631-654-5915 JOB SITE INFORMATION (All Information Required) Name: Verizon Wireless Address: 21855 CR 48, Cutchogue NY 11935 Cross Street: Cox Lane Phone No.: Bldg.Permit#: 44042 email: Tax Map District: 1000 _Section: 96 Block: 1 Lot: 19.1 BRIEF DESCRIPTION OF WORK (Please Print Clearly) DC wiring of customer's equipment for for Verizon Wireless'upgrade to lease area Circle All That Apply: Is job ready for inspection?: YES � , Rough In- Final Do you need a Temp Certificate?: YES /(qD Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A #Meters Old Meter# New Service- Fire Reconnect- Flood Reconnect-Service Reconnected- Underground - Overhead i # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION a5.D b Request for Inspection Form.xls TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey Southoldtownny.gov PERMIT NO. e4 Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined ,20 Single&Separate Truss Identification Form Storm-Water Assessment Form Contact: Approved ,20 Mail to: Disapproved a/c Phone: Expiration ,20 'n Inspector D) 1-�r 1'tel if' 6R ; D1 1 APPLICATION FOR BUILDING PERMIT JUL 1 2019 Date June 28, 2019 INSTRUCTIONS a. "PhiJUpT01icatton T be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, acct'ir'ate p16t plan tdl�cale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing,the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances,building code, housing code,and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. New Y&Mt � &Pr ship d/b/a Verizon Wireless Na J91 a" enapplica It�e. ngineer W19quipment c/o mato Law Group, PLLC 855 Old C:nuntry Road, Suite 901Garden GitV NY 11530 (Mailing address of applicant) State whether applicant is owner, lessee,agent, architect, engineer, general contractor, electrician, plumber or builder Lessee Name of owner of premises Arthur V. Junge &Valerie Lasser (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer Name John Walden Title: Engineer IV, Equipment (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 21855 County Road 48 Cutchogue House Number Street Hamlet County Tax Map No. 1000 Section 96 Block 1 Lot 19.1 Subdivision Filed Map No. Lot 1 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy public utility wireless communication facility b. Intended use and occupancy same as existing 3. Nature of work(check which applicable): New Building Addition Alteration X Repair Removal Demolition Other Work (Description) 4. Estimated Cost $20,000.00 Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars public utility wireless 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. communication facility 7. Dimensions of existing structures, if any: Front Rear Depth Height 108'-11" Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Hight same as existing Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front 168 Rear Depth Var. Area 1.07 acres 10. Date of Purchase 7/27/2016 Name of Former Owner Arthur V. Junge 11. Zone or use district in which premises are situated Light Industrial 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO_X 13. Will lot be re-graded? YES NO X Will excess fill be removed from premises? YES NO Arthur V. Junge& 21855 County Road 48 14. Names of Owner of premises Valerie Lasser Address Cutchogue,NY 11935 Phone No. Name of Architect APT Engineering Address u,,,TS—a e�oo T^6419 Phone No (860) 663-1697 Name of Contractor Comcell Construction Corp. Address 1475 Montauk Highway E Phone No. (239)462-3304 Patchogue,NY 11772 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO X * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO X * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES NO_X * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF Nassau John Walden, on behalf of New York SMSA Limited Partnership d/b/a Verizon Wireless being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the lessee (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. ��uuunlll/ Sworn to before me this ��`�SSIE Ro ,,� 28th day of June �`� NOTAq GF,p'%� New York MSA Limited Partnership d/b/a Verizon Wireless NQO."R06379887'. = B IFIED IN Notary PublicssAU COUNTY: _ Signature of Applicant �cA�:, v 8/ Na e. John Walden Title- Engineer IV, Equipment %9�F AVBLI�. OPJ N EW 0 . Tc�illall/Sru►cx i t Te vham an?a-1802' : sans Main Roel l+oaer. ohe o f ro --a us. - �Q,>iox1179 •� , • mfivAd.NY 11971=095'9 M BUXTD=D1PAATIh2NT . • TO`A N OF SOUT"DW • APPLIC/ TION FOR ELECTRICAL INS pEC�ION . REQlIESTEQ llf: C�tC � CB1.l Date., $Ic ,Latae Company Name: e t �T - --------- , Alame• . • ------- X1.1 ------_------------------- . -------------- — Uoense.No: Addiess:. f Phone fty.: -19M.111 JOSSITE INFORMATIOM (*jnd1gatea required inforrnaflon) *Name_- 14bij tT -VACA CQ%Z.1 "`/4ddrese: 80- 2H% T Q� c'�=� .eeNpMT_,My- itduu *dross street: y M bQb *Phone No.: '. . :0.130 pormit No.: 'fax Map,PWdct:, 1000 -SO-06n: rab oC Biu. *BRIEF DESCRIPTION OF WORK(Please Print Clearly) • . .(Pteasa Cele Aft'i That Apply] Isjob read lbrinspection: _ jv y - - �! NO , Rough Ing� - nat- *Db you need a Temp Certitleate:_ a Tempinformation(tf.ne0edl • ' . *Service Size: i Phase. 3Phase 100 150 . 200 300 35a 400 Other . "New Selvloe: Re-connect Underground Number of Meters , Change df Service Overhead Addhionat Information: PAYMENT DUE WITH-APPLICATION sszzeez � �ti:st:o�-5�-<< Cl Cin Qr�To /` J OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex rjf S0 P.O.Box 1179 54375 State Route 25 ®� ®�® Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) AL Southold,NY Telephone: 631765-1938 www.southoldtownny.gov �L 4 \ PLANNING BOARD OFFICE TOWN OF SOUTHOLD AUG a 6 2019 MEMORANDUM To: Michael J. Verity, Chief Building Inspector From: Heather M. Lanza, AICP, Planning Director V�-�" Date: August 5, 2019 Re: Planning Department Report Verizon Modifications and Upgrades SCTM#1000-96-1-19.1 21855 County Road 48, Cutchogue As an addendum to the attached Site Plan Use Determination, the Planning Department has conducted a review of the proposed modifications pursuant to §280-74 B.(2), and has received a report from our Wireless Technical Consultant, Cityscape, Inc. (see attached report). The proposed Verizon modifications and upgrades are in compliance with the General Requirements of§280-70, therefore, we recommend a Building Permit be issued for this application and in accordance with the Structural Analysis Report dated April 5, 2019. Thank you for your cooperation. Town Of Southold Ckyscape C ON S U ANTSS INC . Telecommunications Site Review 7050 W.Palmetto Park Road#15-652 Upgrade Application Boca Raton,FL 33433-3483 Tel.877.438.2851 Fax:877.220.4593 July 26,2019 Mr. Brian Cummings Planner Town Hall Annex Building 53095 Route 25 Southold,New York 11971 RE: Town of Southold/SCTM#1000-96-1-19 Verizon Wireless/Cutchogue Dear Mr. Cummings, At your request, on behalf of the Town of Southold("Town"), CityScape Consultants, Inc. ("CityScape") in its capacity as telecommunications consultant for the County,has considered the merits of the above referenced application submitted by Verizon Wireless("Applicant")to modify and upgrade their equipment on an existing one hundred eight foot, eleven inch (108' 11") monopole tower, owned by Crown Communications. There are antennas mounted at the top of the tower that raise the overall height to one hundred twelve feet, six inches(112' 6"). The tower is located at 21855 Country Road 48, Cutchogue,New York,see Figure 1. Support Structure&Equipment Currently, the Applicant has nine (9) panel antennas, six (6) RRHs and three (3) distribution boxes at the one hundred (105) foot level, see Appendix, Exhibit A. It is proposed to replace the RRHs Appendix, Exhibit B. The existing six (6) coaxial and three (3) fiber feed lines will remain. Structural Analysis The Applicant submitted a structural analysis,prepared by Black&Veatch, dated April 5, 2019 and based on ANSI/EIA/TIA-222-H,Category C and Class II standards. The report indicates Town of Southold/SCTM#1000-96-1-19 , Verizon Wireless/Cutchogue CKYScape Page C ON S U LT A N T S , I N C. that with the upgrades,the tower will be loaded to 76.5%while the foundation will be 89.2%,see Appendix, Exhibit C. FCC Compliance The Applicant did not provide a compliance statement as no changed in radiation patter are proposed, thus no impact to the RF exposure levels. Also, as this is an existing array, continued compliance with the policy of addressing any interference the proposed operation may cause is implied. Wireless applications, other than new support structures are governed under the Middle- Class Tax Relief and Job Creation Act of 2012 (Tax Relief Act) and shall be afforded streamlined processing with a qualified application. A qualified application under the Tax Relief Act cannot increase in size of the ground compound,or tower structural changes increasing the height or girth by ten percent (10%) or twenty (20) feet, whichever is greater. Since the Applicant will not be increasing the height or girth of tower, nor the compound, this application is qualified for streamlined processing under the Tax Relief Act and CityScape recommends its approval. I certify that to the best of my knowledge all of the information included herein is accurate at the time of this report. Cityscape is only employed by local governments and has unbiased opinions. All recommendations are based on technical merits without prejudice,according to prevailing laws and codes. Respectfully submitted, Jonathan N.Edwards,P.E. Cityscape Consultants, Inc. Town of Southold/SCTM#1000-96-1-19 CIN1:y�e�� Verizon Wireless/Cutchogue Page 3 C O N S U L T A N T S I N C ' DeLotme StreetAtlas USA®2009 J� 1 " .-- zxJ. OA s R po 114 f, a a� Cutchogue 11` co l G �, � J `r.9@ys O�OS`f73' C w *� O Cutchaeue talion W� MID, a i4�L't4'Ss ma��l�,� Oo�i '9�gzC.^a 010 �acutchogq�e •t' �� 6� ��Po P � ,O�O a O.. W000 WAY .� Data use subject to license ©Del-orme DeLorme Street Atlas USA®2009 ft 0 800 1600 2400 3200 4000 www delorme com MN(13 7°W) Data Zoom 13-0 Figure 1 — Site Location Town of Southold/SCTM#1000-96-1-19 Verizon Wireless/Cutchogue �■ ape Page 4 C ON S U L T A N T S , ] N C . Appendix Town of Southold/SCTM#1000-96-1-19 cftyscal-vl� Verizon Wireless/Cutchogue Page C O N s u L T A N T s I N C . ANR..ntasn7snaa:z?xrbvi.�l�.w � 8972HYBRO(Jl7'lE98(�COA7CC�°:ES�, - R...I^liN.£�LACE(Qo`E�F3�.T. +l+s - i M i oast CAP;---ANI-14AspY.I, t i JI i i i s i J O OQSf 7pg-17•e AG--: - S `Y b > m z F _� a DOW.rwrroN a.a_1F1 EQUIPMENT SHEL7ERW/G3IGPSVWMWjUNES. ,I OAST.CHAIN UNK FENCED COMPOUND(M) i V i i " t Exhibit A - Existing Support Structure Town of Southold/SCTM#1000-96-1-19 C ape Verizon Wireless/Cutchogue Page C O N S U LTA Q t F L3a2'/e (3)EXIST.MDBS TO REMAIN. w� REPLACE(6)RRHe(2 PER SECTOR) (I)EXIST ANTENNAS TO REMAIN(3 PER SECTOR) EXIST 108'-111&AOL MONOPOLE a 11571w Exhibit B—Proposed Antenna Configuration Color Leeend ® Existing Equipment El Replaced Equipment Town of Southold/SCTM#1000-96-1-19 ckyscape Verizon Wireless/Cutchogue Pagel C ON S U L T A N T S , I N C . Table 5-Tower Co ponent Stresses vs.Capacity(Monopole Tower).LC7 Motes Component61H ®ration{fir %capacity Dass J'Fail _Flange Bolts 99.7497 8.� Pass Flange pEatee I x �f,2� Pass Anchor'Bodo 76.5 Pass (Group 1) t J4nrbw Rods 64,$ � Piss (Group 2) II _F f3aso plata 8618 Pass Rase Foundation 57.3 Pass t Base Fatlrttiatian 0 --- .`.."�__�" -- Soil Interaction 89.2 Pass Structure Rating(max from all,companents)= 80.2% -E 1? See eddillowl documrereallm In°AWanadixC--AddiDenal GalculeGane"iarcelmigbnasuppordng the%capaNtyr consumed_Baling per TIA-222-FI SecGan 15.5. 4.11} Reco h1 anditiw',ms The tower and its foundafron have suf iicienl capacity to carry the propend load configuration once ft proposed!modifications.are installed, Exhibit C— Structural Analysis Summary MATO 666 OLD COUNTRY ROAD, 9T" FLOOR AGARDEN CITY, NY 11530 �A,WLAW GROUP, P L L C TEL:516.227.6363 1 FAX: 516.227.6367 June 28, 2019 - -i.. M EXPRLtSSMAI,,L � 2019 El Town of Southold Building Department southal "Own P.O Box 1179 _ planning Board Southold,New York 11971 Re: Building Permit Application (the "Application") by New York SMSA Limited Partnership d/b/a Verizon Wireless ("Verizon Wireless")to the Town of Southold (the "Town") in connection with the maintenance and upgrade of the existing public utility communication facility (the "Communication Facility") located at located at 21855 County Road 48, Cutchogue, New York, with Suffolk County Tax Map designation Section 96,Block 1, Lot 19 (the"Property") ; Verizon Wireless.Ref.: CutchoMe 850/Our File No. 100-0168 Dear Sir or Madam: In connection with Verizon Wireless' Application for the proposed maintenance and upgrade of the Communication Facility at the Property, enclosed please find the following: 1. One (1) original Application for Building Permit; 2. Certificates of Liability, Disability, and Workers' Compensation Insurance from Comcell Construction Corp., the project contractor, listing the Town as the Certificate Holder; 3. Four (4) copies of a survey of the Property; and 4. Four(4) sets of Construction Drawings,prepared by APT Engineering, dated May 29, 2019 and last revised on June 18, 2019. Upon review, please advise as to the Application filing fee required by the Town, and kindly issue the Building Permit at your earliest convenience If you should liave any questions, please do not hesitate to contact me. Thank you for your attention to this Application. qJe -ly, r Zalin . Enclosures cc: Verizon Wireless (via email, without enclosures) , 1 905 LLXINGTON AVENUE I CHRYSLER BUILDING,26T°FLOOR ; NEW YORK,NY 10171 1 212 985 6000 402 NIAIN STREET I SUITE 204 1 NIETUCHEN,NI 08840 1 732 317 1511 COMCCON-01 KEl`-Y '`ate FICATE OF LIABILITY INSURANCE DATE V20"/YI YY) MMID CERTI � „ 21712o1s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms,and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s): PRODUCER i.lCer1S+ #HR-870302, - "- ;c,,,QyJ T"-Qdrleen Asian is,Ext.161 - Millennium Alliance Group,LLC PHONE 516 496-8004 IINc��).(631 768-1342 534 Broadhollow Rd. '�O—q=� } Ste.103 a MAI ss Melville,NY 11747 INSURERS AFF'ORDINGCOVERAGE NIi1Cit' INSURERA;StBtBNAtionallnsuranCe-Go. - 12831 INSURED - 1NSUREFiB;Merr haInts'Preferreid insurance Company 12901 comcetl construction corp1 uR Rc:RSUI Indeimni InsuranCe.COftl An 2231A 1373 Lincoln Avenue ,Ns6 R.o:Endurance American Insu"ranee Co- 10641 Holbrook,NY 11741 it suRERE;TMarkel�lnst ranee Co. 38970 INSURER F; COVERAGES 'CERTIFrCATE-NUMBER': REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO LICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIG H THIS ' CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO A LL THE TERMS, EXCLUSIONS AND CONDITIONS OF,SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN.REDUCE_D BY PAID CLAIMS. tNSR. x .». ..._..... .,.-- DbL-f5U@A -- f..POLICY EPF.('POLICY EXP - -� TYPE OF INSURANCE !IN POLICY NUMBER I p,ip I 1, t M—� LIMITS AI 1100011000 X COMMERCIAL GENERAL LIABILITY i I EACHOCfl7RREh3_C,E__ • I I I J OCCUR 7/8/2018 718!2019 MEMGl5E�5T,Ot£RaE4NtcTuESD CLAIMS-MADE , 00 5,0Q0 t AEO EXP(any orj pRgoP1 "' 1,000,000. 6 al RsaManisV�rtauRv..,. f .. _... I`.. 2;000,000 -GETdLAGGAEC-ATE;,LIMIT.APPLf $.PER J ORO 2'QOb;U00 i Policy�JE4Y LOC � PRgtiU T -C¢tjP�PAGG s E_ POLICY AGGREGAT :3 5,000,000 g i I I COMBINED SINGLE LlbtlT $ 1,000,000 AUTOMOBILE LIABILITY LtE�IFtId I I _ I'X ANY AUTO !CAPIO,52866 8/23/2018 8123/2019 DIY INJURYtFtp°�rn 5' I OWNED i SCHEDULED [1§01Dl!LL_1_INJURY'(Peraccideni S _6 AUTOS ONLY {_ AUTOS q �3 ,g tk§ (PROP£RTYDAItikAOE X AUTOS ONLY X AU{}SONt j atatad°n! S 5 000 QOO C I UMBRELLA LIAB 1 X-OCCUR I EACFI OCCURRENCE _ 3 �,QQQ'QO� —f INHA083545 7/8/2018 7/8/2019 �-_' X EXCESS LIAR .CLAIMS-MADE AGtR>„d"zATE S' I DED RETENTION$ WORKERS COMPENSATION PER j ER OTH AND EMPLOYERS'LIABILITY I �S'TRTUTE' . ArJY PROPRIETOPIPARTNERIEXECUTIVE YIN /Nj i N 1 A �E-4.£:,CN ACCIDENT $ �pFFFiOERiMEMB 't ExCLUDED9" J (Matldalory in Nf1' I 1 EA.DiSESSE-EA E1dPLOYE S /?ryes,dettriib ur5dI ' OE CRIFTEO0 n"OPERATIO:I5 he— I 1 ?E-I-DISEA6[-FOUC�'LIMIT S D :Excess Liab. t EXC30000402401 718/2018 71812019 ;Per,Occ./Per Agg. 5,000,000 E jPollution Liability i I ;MKLCIENV100243 2/1712019 2/1712020 1$1,000,00012,000,000 DESCRIPTION OF OPERATIONS'l LOCA11ONS i VEHICLES (ACORD)01.Additional Remirks Schedule,may be attached it more space is requiredi Equipment Floater-Hartford Ins-Co.,Policy#12MSJE3032 9114118-9!14119'$250,000 limit for leased or rented equipment. Installation Floater-Hartford Iris.Co.Policy'k12MSJE3032 9114118-9114119$1,000,000 limit. Builders Risk-American Zurich Insurance Company Policy#BRI2239424 1117118-1117119$65,000.AI1 Covered Property;$1,000 Deductible at 644-646 Moriches Middle Island Road,Moriches,NY 11955 Town of Southold,53095 Route 25,Southold,NY 11971 Is included as an additional Insured as required by written contract. CERTIFICATE HOLDER CANCELLATION f SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS 53095 Route 25 P.O.Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF INSURANCE COVERAGE 57ATE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured COMCELL CONSTRUCTION CORP. 1373 LINCOLN AVENUE 631-654-5915 HOLBROOK, NY 11741 Work Location of Insured (Only required if coverage is specifically limited to 1 c.Federal Employer Identification Number of Insured certain locationsm New York State,i.e„Wrap-Up Policy) or Social Security Number 27-0807207 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier• (Entity Being Listed as the Certificate Holder) Standard Security Life Insurance Company of New York TOWN OF SOUTHOLD Y p y 53095 ROUTE 25 3b.Policy Number of Entity Listed in Box"1 a" PO BOX 1179 R90293-000 SOUTHOLD, NY 11971 3c.Policy effective period 1/1/2013 to 6/16/2020 4. Policy provides the following benefits: ❑ A Both disability and paid family leave benefits. ❑ B Disability benefits only. ❑ C.Paid family leave benefits only. 5. Policy covers- Rm A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier reference d above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as these*d above. Date Signed 6/18/2019 By (Signature of insurance carrier's authgri; d'repie3entatiJe or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (212) 355-4141 Nameand-rille SUPERVISOR-DBL/POLICY SERVICES IMPORTANT. If Boxes 4A and 5A are checked,and this form is signed by the insurance carner's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If Box 48,4C or 513 Is checked,this certificate is NOT COMPLETE for purposes of Section 220, Subd.8 of the NYS Disability and Paid Family Leave Benefits Law It must be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(Only if Box 4C or SB of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees Date Signed BY (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Narne and Title Please Note: Only insurance carriers licensed to write NYS disability and pard family leave benefits insurance policies and NYS licensed ins urance agents of those insurance carriers are authorized to issue Form DB-120.1 Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) 1�1 11111 B1°°1°1°°�'�l1°°!111°°1111111111111111 New York State Insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORk 11747-3129 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AA^^^^ 270807207 lin_ . 1 MILLENNIUM ALLIANCE GROUP LLC 534 BROADHOLLOW RD STE 103 '�� MELVILLE NY 11747 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER COMCELL CONSTRUCTION CORP TOWN OF SOUTHOLD 1373 LINCOLN AVENUE 53095 ROUT 25 HOLBROOK NY 11741 P.O.BOX 1179 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12108505-5 854182 08/02/2018 TO 08/02/2019 07/16/2018 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2108 505-5, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW'YORK WORKERS'COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN'THE STATE OF NEW YORK,EXCEPT AS INDICATED BELOW,AND,WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK,TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS_IIWWW.NYSIF.COM/CERT/ CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING'AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND 'CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER 503679501 p IIIIINIIIIIfIIIIIIIl00HIM�0100000100100�60162�513�518jlllllllllilll�lllll Frim W(--CFRT-N0PRlNT V,roron 2;9:?254211100 WC Pph.y-:IORSRSj U-26'3 y� ,G:OilP33(1[I6}76�5SJ53��CCtaYnX.l•R05.^.55,173I:a')1a-02'ICtK No=Lc4T_ixOl bHh;lj TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Budding Plans TEL: (631)765-1802 Planning Board approval FAX: (631)765-9502 survey Southoldtownny.gov PERMIT NO. Check Septic Form NYSDEC. Trustees C O Application _ I`J 1� Flood Permit ^ Examined 20 a I Single&Separate L� C Truss Identification Form Storm-Water Assessment Form ,ig Board Approved 120_ Mail to: _ Disapproved a/c Phone Expiration ,20_ Building Inspector `-' APPLICATION FOR BUILDING PERMIT JUL — 1 2019 Date June 28,2019 INSTRUCTIONS a. I'iNIp ac�Ibrnt�v—ST be completely filled to by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,acpriFee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit shall be kept on the premises available for inspection-throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy, f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required -APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or Regulations,for the construction of buildings,additions,or alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to admit authorized inspectors on premises and iii building for necessary inspections. New Yo t i P rship d/b/a Verizon Wireless r i t o of applica r n a if a c r ation Na J i tiir a%en Mtge �ingineer��quip�nent c/o rtiato Law Group,PLLC 668 Old C ignttit RoadShite A0�C^rden t itj NY 11'540 (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Lessee , Name of owner of premises Arthur V Junge&Valerie Lasser (As on the tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer Name John Walden Title Engineer IV Equipment (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No, Other Trade's License No. 1. Location of land on which proposed work will be done: 21855 County Road 48Cutchogue House Number Street Hamlet County Tax Map No. 1000 Section 96 Block—11-0t 19 1 Subdivision Filed Map No Lot 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction• a Existing use and occupancy public utility wireless communication facility b Intended use and occupancy same as existing 3 Nature of work(check which applicable)-New Building Addition Alteration—X Repair Removal Demolition Other Work (Description) 4• Estimated Cost $20,000 00 Fee (To be paid on filing this application) 5. If dwelling,number of dwelling units _Number of dwelling units on each floor If garage, number of cars public utility wireless 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. communicattQn facility 7. Dimensions of existing stiuctures,if any:Front Rear Depth Height 108'-11" Number of Stories Dimensions of same structure with alterations or additions Front Rear Depth HRIght same as existing - Number of Stones 8. Dimensions of entire new construction:Front Rear Depth Height Number of Stories 9. Size of lot:Front 168 Rear Depth Var. Area 1077 acres 10.Date of Purchase 712712016. Name of Former Owner Arthur V Junge 11.Zone or use district in which premises are situated Light Industrial 12.Does proposed construction violate any zoning law,ordinance or regulation?YES_NO X 13.Will lot be re-graded?YES_NO X Will excess fill be removed from premises?YES_NO_ Arthur V.Junge& 21355 County Road 43 14.Names of Owner of premises Valerie Lasser Address ciitcho ue,Hv 91935 Phone No. Name of Architect APT Eniineering_ Address,.oda to roo rive Phone No;(860)663-1697 Name of Contractor_ Comcell Construction Corp. Address 1x75 toontaukHighway E Phone No. (239)462-3304 atch2 11772 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO X * IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b Is this property within 300 feet of a tidal wetland9*YES NO X *IF YES,D.E C PERMITS MAY BE REQUIRED. 16.Provide survey,to scale,with accurate foundation plan and distances to property lines. 17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18.Are there any covenants and restrictions with respect to this property9* YES NO X * 1F YES,PROVIDE A COPY. STATE OF NEW YORK) SS. COUNTY OF Nassau John Walden,on behalf of New York SMSA Limited Partnershiad/b/a Verizon Wrekss being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the lessee (Contractor,Agent,Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ��"�'SSt ..iRp` c%,, 28th day of Rine �1 ^NOTgRf c�� New York MSA LimitedrtWireless c /b/a Verizon iNQ.OlRpg379 B ` _ /•- BHS: - N t iy Public ti cod trJ = Signature of Applicant N�; P•8fz� N7Yc Na e:John Walden Title Engineer IV,Equipment TAX LOT/17.5 N/O/F TOWN OF SOU1110M Qp O 1 BI 100.15' 2.2NW N23 1400 E FE CE t O'NW C AIN LIN STORAGE BIH 10 WSW &4' � 17.7" 8.6'SE MONOPOLE J G R ASS _1 :» �.. 1 STY .. 7 METAL dI FRA1tE T-1M I i`Y GRASS Wei c by OF z l APP'VERIZON EASEMROXIMATE ENT �a > CI (RECORD-EXIBIT'A'V105786) cGA V zo� 9.3'SW N �Y� z I I UNDERGROUND VERJZON M o i 1• WIRELESS CONDUIT i I (RECORD–EXIBIT'A'V105723) N w f I = ASPH ALT PARKING TAX LOT 619.1 EDGE OF ASPHALT N I: AREA 13.1'SW an, Ii 45,589 SqF_ +�* a < ll , 1.0465 Acres fr I A S P H ALT P A R K I N G N` I•• ---------- ROOF_OVER�14.85' � 1 - 105.15- 1 + < f• ,tT CONCRETE 1 STY X1»5 FRAME I STY JdETAL W (AUTO SHOP) + Lj �" i II ' I Q W I1 05.15 I _ _ VI y flIV -- - - 1T -P T—'- e- En 0 C� ai s o N y J = �z �r z II m O TAX-LOT 620-1 o :1_I a x® en !# 1 N/OlF+CStRI5T0?HER ADHD x D 1 f MARY < r r p O I GR ASS z 'S GRASS ?�S z s I1J I � = { 703.32e(ACTUAL) ±750 (DEED) 0 l15N TY P �/ UTILITY POLE nun POLE . 6420 - ..__/ )421 S 255230 W 168.17' _ (MARK-OUT) DLE(120• IMDE)R®� NOTES: (C.R.--48 ► RECEIVE) I I THE OFFSETS 69 DaIENStTNs Stahl HEREON,FROM THE PROPERTY ONES TO THE S7ROCTUSRES ARE FOR A SPMRC PURPOSE ANO USE.THEREFORE THEY (NORTH ROAD) • , ARE NOT INTENDED'TO 1,10"IERT PROPERTY LDWS OR 70 CUM THE L", ERECTION ATF FENCES.AM7MAL STRUCTURES O R ANY 07MM2 CONSULT wTH THE HIGHWAY DEPARTMENT SEF'OiE DESCNNO.ONSTALLNO OR rj �1,nDIE7 TOtVrt MODIFYING ANY NEW OR DUSTING C URILS.UgXS OR ROADWAYS IN THE Planning Board StREEr SMOWN HFTREON _. .----- M stXlqSuUWS ONFOiaNNTION SH496N HEREON WAS R.I.StD ON V.91AL OR.SFRVATtO-NS. ,YiN�D/mTS u°nun'TYD�n wcavfiss�i` �aRATE unurr c�ANacaRD At.CFPIS NO fl[g'OUS011TY F �1��•s� ANY OF THIS DATA. 11\yG 1 �� SUBSURFACE UTIUM ARE NOT CERTIFIED AS TO THE YGWRAGY AND/OR 4.AUC RMCE UTILITY LOCATION AND DEPTH STOVUI EE REC H£D®AND #21855 C.R.48, CUTCHOGUE LEGAL GRADES SHOULD BE VETnFIETy IDTH THE TOPOGWKC&"EM. PRETRADL.Y IN v&TMG BEFORE CO MEKONG PAH t DMC1 OR CONSTRUCRON. TONdN OF SOUTHOLD 5 MS d TO CERTIrr THAT THERE ARE NO VISUDE STREAMS M NATURAL COUNTY OF SUFFOLK WATER CXIRCES W THE PRCPERTY AS SHOWN ON THIS SURVEY- 6 REM TO AMHDCLf 36 OF THE GENERAL EW-q 5S LAW AND THE PROVISONS STATE OF NEW YORK Of INOUSTMAL COOS PMT(RULE NO.53T!�F' ANY EXCAVATION M DISTRICT ....... 1000, SECTION ....... 96 OCUOUTION IS M%WE?NM THESE LAWS BARE EtON EXCAVATOR TO GTE LL ADVANCE NOTICE TO AOPERATORS OF UNDER RMINO FACILITIES OF HIS BLOCK ....... 1. LOT(S) ....... 19.1 INTENT TO PERFORM EXCAVATIGH OR DEW TION IN STHE PECIFIED AREAS 7 ALL DIMENSIONS ARE IN U.S.STANDARD McAa B EASEMENTS NOT SHOWN ARE NOT MORMT® REV-%09S DESCRIPTION w n MTw� I'm p.p1 O ny copses from the algna of tnH cur y morsed with w 1 PROPERTY SURVEY AS CO. 06-04– ASC09112 r,q..l or en.toed.urveya a-.ed seat.hod be k- .'woa,.to Is..md 1'..c Ples � ��• Q 1 i .4r Inwmon.ad ate.o(ta,a oddlnnn to a r.ey map oea,mg ARKADIUS2 JUSLEGA PLS. hcm+ad lona of aeetbn 7209, ys Q ue–do iDsn 2 of the Ne,raw state Educall.n Lo. Ocatndk.t.dpsgnsfy that thH wr.oy erh an .ud repa.d M acc.,j_ce.Rn Use ee st.9 cede off Noot,ae wR OSUSt. JcZ� a ton.51-)p oappted by enc He.Tau Slate A..a,al.a Slide: 'M O CJ t Profee. .Lond S„rWyas Sad—Vncotma snap Nn 1• m .O ty to In.paem fa.h—the W.y Is prapaed on.w 5B EG9t Beverly Pnricway G �. as to he a I.,can_y gwernm.niN 9-c'Ona Valley Stream. NY 11580 Job Na nrsnq tneutwdan s,+ea s..e oneo to t. yo,—a.me .—Caeny_net U11M DESIGN GROUP, Inc. vndng institaPpn ce.t.ncotwn.a not iron.f—W.to ASC-09112 dltbl.�ne41m o a svh.eq�enH o.d.r TEL: 516 792-6676 L APPROVALS I ' Vf_q,li,BIGNATURE BLOCK (v , ` Aff-CVAL SIGNATURE DATE Aly WENTEROCKROAD WEST NYACK NY 10994 SITE ACCUISmON C-111—IoN TAOIo MICROWAVE ver,izon% T— Eo-- CROWN e•HOJECT AWN _-_ a I I li e I wo ADMINSITE C CASTLE �l CROWN CASI LL SIGNATURE Pt CI-11 -- �v 6Txu0ROH YxENtsj 7' ., - REv swx APPROVAL SIGNAnt9C - DAACROWN 1 - --- $ME ACOIUISIRON Ii COUNTY (/�� j`�$, PLANNET 21855. R`M '-1" .... \. a CONSTRUCTION _ e '1 PRDIECTMANAGCR_ i ()I s��/� UTILITY—AGER .Icgr+ �G IE t)- _ —____ �� ® ®LO�JLe, Y 1193 � ``. f r LANCLORD TLE PARTES ABOVE HEREBY APPROVE AND ACCEPTTHESE DOCUMENTS r�'!`<rf•T I) AND AJTMR7E THE CONTRACTOR TO PROCEED WITH THE t CONSTRU(.'IION DESCRIBED HEREIN ALL CONSTRUCTION DU.UMENTsDRAWING INDEX SITE INFORMATION -<, —,�•> ;a ARC SUBJECT TO REVIEW BYntE LOCAL BUILDING DEPARMIEMAND ANT CHANGES ANp MOpIfICATONG THEY MAY VMSC ' RZ E NAME'CUTCHOGVE' -------- --- m. T-1 TITLE SHEET&INDEX VZ STT LP TILT ONCODE CODE I '90F OCAT44800 _ES— LocanoN 21esscouNrvRDAo4e ulO A•1 PLAN&ELEVATION CUTCHOGUE NY 11035 ENGINEER CONTACT SEAN MCDONOUGH ESSIONALS GF ReC A-2 ANTENNA&EQUIPMENT DETAILS (am Bs3-15BT Exf los p—sco sE P e -1 PROPERIY0WNER CROWN CASTLE USA WC COMP AS ENOwEF�G N-1 NOTES&SPECIFICATIONS 20 CORPORATE pRNE Abo-Nnuxawoxnl Ker Pslla CANONSBURG,PA 15317 LATITUDE 41.01'46 50•N MO OAHOxOYE C LONGITUDE 7229.5030 W YAQ PA,NIY ELEVATION 56-AMSL DISTRICT 1000 YI N SECTON B5 IE ATn uwwn,lCu,u aEcln BLOCK 1 (aafOx Axv PE9sOn uNIESEA� LOT.101 ZONE 1P UGHT INDUSTRIAL ENKNUL EwnxeeROx __ RVFYOR TO ALTER Ax 0EY w •FftCACleavUSA Q PROJECT OPE OF WORK /REMOVE(3)B13 700 SRR(1 PER R SECTOR)'• SCOPE OF WORK REMOVE p)zwtD AWS RIMS 41 PER SECTOR) ADD(3)nr1 NOKIA AHBOC B51E13 DUAL RRHe(1 PER SECTOR)ADD 0)NOIOA AHRC 821ESfv CUAL RRHS(1 PSR SECTOR) BYTIIEE WlNitl plr� _ x mb VERIZONTAT� �CUTCHOGUE' �' Ap{MING NUnfettA,xYtoxOM - IOxWM�Bba ww I Mo CO 'K PPROJ[cT c00E' G I(;�tbxAwN er iso i r. 6Nrbfam+Q', •—^�' � �bAiY �vJ>cxEGKEO BY 4PN RECEIVED TITLE SHEET ✓20151 I &INDEX —} 9XEET xuYYER� clurti6� VICINITY MAP Plannln9 Board f l ._... � .�... --- _1 (_Ll A verizonl J,��y STRUCTJRAL NOT n,5 }CFNiEROCK WOAD �,a..__ I��I —/•Pf E��NEEn�LK�80rv1Htl Tb�iEx�M+mAMFM„1��MWMA i rJ,�ILT - �O THEREGORE��S NOREEPor1sI0MYF0a,Nf i W6TNYACK NV 109U4 ""MaEOUWED IMOFAIHE MOs, �s:.=.mz^..I E EW EM EOGL ae 4TnlE Axp PEEE/aLLEOOE6 rw 1 Mouxr Gvsa aE r7 aEo vuz.L nOxi++¢oxMwMMOos ,ds� �m L APT— ENGINUERING ' I � � J O REFER TO STRUCTAnIANnLY56 aE,Car PREPY,EOO+'BLAOK � Mx r { ; /1 K 4VFATON N£NTOax L1P GTEO rPnL4 EO,B,rIX,MO„EIxnL �� e.u�/.Mlus,w* I �^"� I O� n[x/ANgowTW.EA MEOVC Ke15 ui,®,u,iA,� EhL CROWN CASTLE -' `��EONSTNULnox DOGUYEYIs SAO an - - /,4.NOC,Nm uEIIgPOS A'+rv.w uowns—�—— euTe xe\,alox mi EnaT VEwmN Moxovas MouMEO P,wEE �, '-"'._ __ F,xu.E�axx — nNrEn*usn,snso•.ar.s.rrsv/.mMowm tS� LOCATION MAP J xEPucE re w d s,x w. 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I� `A$}®bcNLi �ti' � -- S OIXTENO UNiSIRUTA3 NEFD�ET)B/SEOOu�iFrtTm OF MViFTaN 9ECiOR.00 NOrOTT MD 1M OEPE /J E TEX E G�rUN61nUT rOq MORETInNN BGl'QID NITE M✓9i ADO �6AooEERxDOX ORIV6 .wBORGTERTMM bW LIE£INSTPUi PARr EPm01 LLIxOYMRTII•CElLte �' RR�Gl �_ FA GROMI GbnG usAgC 2 TYPICAL H E UIPMENT MOUNT AODRFAi'3DFl DORIroRAIenrtNe A•3 ecntE 1{••t'-0• � OWoxeOBR4 v.wtT Avq Txvl NMtEt xR y BEcnox ��1 aR unxE Dwlx�xlEss RvnOR Tou F/�il nEu ul M rtEu eGRXOT23Gt OF FH ENGINEER ORlMD3BRVEYOAO wlreRF4TnF eLTE � A vOMFM f�Wol-�1 FRONT SID§ TOP FRO SIDE TOP vnoxOETxEALTOUTgY __J 7 T T LI3� VERIZON110GUV " M n � �CUTCHOGUE' �vruuss urtrwowe»•.n13 �19_ll Al P3 aorrlu�lv_NUXRE rtt�� tCN-E WAL RRX IOREOUW MOODnpPSG4P OlInLRRx10REWUJ ENOwx RUiween- —� �T826Bn 3NWAWfl4C8 ♦ BNb ffigMT0o930 LTEX�ppp tylq 71 reRwoozEno Parro MOTE PAao�wu4 v.Ynw OB.LOR IBOeLIYt KPROlECT COOS—�.� ��IDRA D�iLTE o:R.r��cXecxxD ev iE o MENS N— I-ED ssV61ELTL?O NLTwNOE ILxsEo u,v+nvauwtmninMEams*mx:rro mcU CE PROTODOL sa�ECUTO�E C,RYL^OEiWEEN IVUtseNO 6BV MEfIa EE1 - I R SF9(ON BODIEX�O91 THE f11FmECIICKR EEfWEEN Evu,aYo nas oETNmaErM+oPEo�nPE ETA Ersm ld+oom ENvsB ANTENNAE RECEIVED EQUIPMENT DETAILS �RRH E UIPMENT ;—.— Jul 0 lIIE6TxBYBER ��IjjD; a-a Planning�._..Board- ,� iJ ' - '- ' , � . i ! / � / � ' ' ; � � � ` ` � AMATO 666 OLD COUNTRY ROAD, 9TH FLOOR GARDEN CITY, NY 11530 LAW GROUP, P L L C TEL: 516.227.6363 1 FAX: 516.227.6367 June 28, 2019 VIA EXPRESS MAIL Town of Southold Building Department P.O Box 1179 Southold,New York 11971 Re: Building Permit Application (the "Application") by New York SMSA Limited Partnership d/b/a Verizon Wireless ("Verizon Wireless") to the Town of Southold (the "Town") in connection with the maintenance and upgrade of the existing public utility communication facility (the "Communication Facility") located at located at 21855 County Road 48, Cutchogue, New York, with Suffolk County Tax Map designation Section 96, Block 1, Lot 19 (the"Property") Verizon Wireless Ref.: Cutchogue 850/Our File No. 100-0168 Dear Sir or Madam: In connection with Verizon Wireless' Application for the proposed maintenance and upgrade of the Communication Facility at the Property, enclosed please find the following: 1. One (1) original Application for Building Permit; 2. Certificates of Liability, Disability, and Workers' Compensation Insurance from Comcell Construction Corp., the project contractor, listing the Town as the Certificate Holder; 3. Four(4) copies of a survey of the Property; and 4. Four (4) sets of Construction Drawings, prepared by APT Engineering, dated May 29, 2019 and last revised on June 18, 2019. Upon review, please advise as to the Application filing fee required by the Town, and kindly issue the Building Permit at your earliest convenience If you should have any questions, please do not hesitate to contact me. Thank you for your attention to this Application. Since ely, Je ica Zalin . Enclosures cc: Verizon Wireless (via email, without enclosures) 405 LEXINGTON AVENUE I CHRYSLER BUILDING,26TH FLOOR NEW YORK,NY 10174 1 212 485 6000 402 MAIN STREET I SUITE 204 1 METUCHEN,NJ 08840 1 732 317.1511 Y COMCCON-01 KELLYM '444.� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D19 DNYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#BR-870302 CONTACT Darleen Aslanis,Ext.161 NAME Millennium Alliance Group,LLC PHONE 516 496-8004 A. 631 768-1342 534 Broadhollow Rd. (alc,No,Ext),( ) (AIC,No),(631) Ste.103 E-MAIL Melville,NY 11747 INSURERS AFFORDING COVERAGE NAIC# INSURER A-State National Insurance Co. 12831 INSURED INSURER B•Merchants Preferred Insurance Company 12901 Comcell Construction Corp INSURER •RSUI Indemnity Insurance Company 22314 1373 Lincoln Avenue INSURER D.Endurance American Insurance Co. 10641 Holbrook,NY 11741 INSURER E.Markel Insurance Co. 38970 INSURER F. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO LICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIC H THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO A LL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMIT_S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSRI _ TYPE OF INSURANCE (AINSD SUBD�— POLICY NUMBER POLICY EFF MM DDY EXP? LIMITS LTRA X COMMERCIAL GENERAL LIABILITY I I EACHOCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PS11800082 7/8/2018 7/8/2019 DAMAGE TO RENTED 50,000 I X PREMISES(Ea pccur2erceL___$_ ___-- MED EXP_(Any one person) $ 5'000 1,000,000 PERSONAL&ADV INJURY_-_ $ ---_. GEN'L AGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE__ $— 2,000,000 POLICY[:X:]PRO LOC I PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER POLICY AGGREGAT $ 5,000,000 B COMBINED SINGLE LIMIT 11000,000 AUTOMOBILE LIABILITY E'std dent) $ IX gNYAUTO CAP1052866 8/23/2018 8/23/2019 BODILYINJURY Per erson $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED X NON-O%rED I PROPERTY rraccident DAMAGE $ AUTOS ONLY AUTOS ONLY $ 5,000,000 C UMBRELLA LIAB X OCCUR � EACH OCCURRENCE $ X EXCESS LIAB CLAIMS-MADEI NHAOS3545 7/8/2018 7/8/2019 AGGREGATE _ $_ 5'000'000 DED RETENTION$ I $ WORKERS COMPENSATION PER OER TH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? L J N I A (Mandatory in NH) ( E L DISEASE-EA EMPLOYE $ If yes,descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ —[- D Excess Llab. I EXC30000402401 7/8/2018 7/8/2019 IPer Occ./Per Agg. 5,000,000 E Pollution Liability I MKLC1ENV100243 2/17/2019 2/17/2020 $1,000,000/2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Equipment Floater-Hartford Ins.Co.,Policy#12MSJE3032 9/14/18-9/14/19$250,000 limit for leased or rented equipment. Installation Floater-Hartford Ins.Co.Policy#12MSJE3032 9/14/18-9/14/19$1,000,000 limit. Builders Risk-American Zurich Insurance Company Policy#BRI 2239424 11/7/18-11/7/19$65,000 All Covered Property;$1,000 Deductible at 644-646 Moriches Middle Island Road,Moriches,NY 11955 Town of Southold,53095 Route 25,Southold,NY 11971 is included as an additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 P.O.Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE a ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i vORK Workers' CERTIFICATEINSURANCE STATp Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a. Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured COMCELL CONSTRUCTION CORP. 1373 LINCOLN AVENUE 631-654-5915 HOLBROOK, NY 11741 Work Location of Insured (Only required If coverage is specifically limited to 1 c.Federal Employer Identification Number of Insured certain locations In New York State,i a,Wrap-Up Policy) or Social Security Number 27-0807207 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) TOWN OF SOUTHOLD Standard Security Life Insurance Company of New York 53095 ROUTE 25 3b,Policy Number of Entity Listed in Box"1 a" PO BOX 1179 R90293-000 SOUTHOLD, NY 11971 3c Policy effective period 1/1/2013 to 6/16/2020 4. Policy provides the following benefits- Fol A Both disability and paid family leave benefits ❑ B Disability benefits only ❑ C Paid family leave benefits only 5. Policy covers. Q A All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law ❑ B.Only the following class or classes of employer's employees* Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier reference d above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as d1escp9ed above. Date Signed 6/18/2019 By 1(6eA. �?-(-� (Signature of insurance carrier's authonz d representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (212) 355-4141 Nameand-ritle SUPERVISOR-DBL/POLICY SERVICES IMPORTANT If Boxes 4A and 5A are checked, and this form Is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 4B,4C or 5B is checked, this certificate is NOT COMPLETE for purposes of Section 220, Subd 8 of the NYS Disability and Paid Family Leave Benefits Law It must be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(only if Box 4C or 58 of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note: Only Insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed ins urance agents of those Insurance carriers are authorized to Issue Form DB-120 1 Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) 111111111 !°°1°1°1°°11°1°t°1°!�°�!°!i°�IIIIII ti New York State Insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 270807207 MILLENNIUM ALLIANCE GROUP LLC 534 BROADHOLLOW RD STE 103 MELVILLE NY 11747 NOWY SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER COMCELL CONSTRUCTION CORP TOWN OF SOUTHOLD 1373 LINCOLN AVENUE 53095 ROUT 25 HOLBROOK NY 11741 P.O.BOX 1179 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12108 505-5 854182 08/02/2018 TO 08/02/2019 07/16/2018 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2108 505-5, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK,EXCEPT AS INDICATED BELOW,AND,WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK,TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/ CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND < � - JJ11 41-e- DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 503679501 III1III)III10001010Ilia Ilia 00010010[0�60�625i31i5�8�IIiIDIiIIII Forth WC-CERT-NOPRINT Vasion 2(02/29/2016)[WC Policy-210850551 U-26 3 91 100000000000060625358]10001-000021085055][##I][14924-02][Cert_NoP-CERT_7]101-000011 AMATO 666 OLD COUNTRY ROAD, 9T"FLOOR GARDEN CITY, NY 11530 LAW GROUP, P L L C TEL: 516.227.6363 1 FAX: 516.227.6367 August 8, 2019 VIA EXPRESS MAIL Town 1 Town of Southold ' AUG e 9 2019 Building Department P.O Box 1179 RUQ DR1tf,DIRPT. Southold,New York 11971 Re: Building Permit Application (the "Application") by New York SMSA Limited Partnership d/b/a Verizon Wireless ("Verizon Wireless") to the Town of Southold (the "Town") in connection with the maintenance and upgrade of the existing public utility communication facility (the "Communication Facility") located at located at 21855 County Road 48, Cutchogue, New York, with Suffolk County Tax Map designation Section 96, Block 1, Lot 19 (the"Property") Verizon Wireless Ref• Cutcho¢ue 850/Our File No. 100-0168 Dear Sir or Madam: In connection with Verizon Wireless' Application to the Town for the proposed maintenance and upgrade of the Communication Facility at the Property, enclosed please find a check, made payable to the Town, in the amount of $550.00, which represents the Building Permit and Certificate of Occupancy Fees. Upon receipt, kindly issue the Building Permit at your earliest convenience, and provide the same to this office. If you should have any questions, please do not hesitate to contact me. Thank you for your attention to this Application. a Sin erely, essica Zalin� Enclosures 405 LEXINGTON AVENUE CHRYSLER BUILDING,26T"FLOOR I NEW YORK,NY 10174 1 212 485 6000 402 MAIN STREET I SUITE 204 1 METUCHEN,NJ 08840 1 732.317.1511 AMATO 666 OLD COUNTRY ROAD, 9TH FLOOR (v GARDEN CITY, NY 11530 LAW GROUP, P L L C TEL: 516.227.6363 1 FAX: 516.227.6367 April 15,2020 VIA FIRS'CLASS MAIL Michael Verity, Chief Building Inspector Town of Southold Building Department P.O Box 1179 Southold,New York 11971 Re: Request to Close Out Building Permit No. 44042 (the `Building Permit") issued to New York SMSA Limited Partnership d/b/a Verizon Wireless ("Verizon Wireless") by the Town of Southold (the "Town") in connection with the maintenance and upgrade of the existing public utility communication facility (the "Communication Facility") located at located at 21855 County Road 48, Cutchogue, New York, with Suffolk County Tax Map designation Section 96, Block 1,Lot 19 (the"Property") Verizon Wireless Ref.: Cutchogue 850/Our File No. 100-0168 Dear Mr. Verity: In connection with the close out of the above-referenced Building Permit, enclosed please find one (1) original Engineer's Certification Letter, prepared, signed, and sealed by APT Engineering, dated April 13, 2020. A copy of Building Permit No. 44042 is also enclosed for your reference. If everything is in order, kindly issue the Certificate of Occupancy at your earliest convenience, and forward a copy of the same to this office. If you should have any questions, please do not hesitate to contact me. Thank you for your attention to this matter. S' erely, Jess' ica Zal n Enclosures 405 LEXINGTON AVENUE I CHRYSLER BUILDING,26TH FLOOR I NEW YORK,NY 10174 1 212 485.6000 402 MAIN STREET I SUITE 204 1 METUCHEN,NJ 08840 1 732.317 1511 _ Page 1 of 1 AC V CERTIFICATE ,OF:LIA ,81LITY'INSURANCE DATE(MMI5DIYYY,Y)' �� 03/30/2020; THIS CERTIFICATE'IS ISSUED AS A MATTER OF INFORMATION'ONLY AND,CONFERS'NO,RIGHTS UPON'THE'CERTIFICATE,HOLDER. THIS,, CERTIFICATE DOES, NOT'AFFIRMATIVELY OR.NEGATIVELY AMEND, EXTEND OR-ALTER THE COVERAGE AFFORDED' BY THE POLICIES, BELOW,' THIS CERTIFICATE OF INSURANCE DOES NOT'CONSTITUTE A CONTRACT BETWEEN THE ISSUING'INSURER(S),'AUTHORIZED REPRESENTATIVE OR PRODUCER,AND'THE CERTIFICATE HOLDER. IMPORTANT:' If the certificate,holder,Is an ADDITIONAL•INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,^certain'policles may reoulre an'endorsement. A statement on this certificate does not confer rights mthe certificate holder in lieu,of such,endorseinent(s). , -PRODUCER CONTACT Willie Towers Watson C®xtifi'cate Center NAME:' Willis Towers Watson Northeast, Inc, fka Willislof Pennsylvania, PHO FAX 1-877-945—,7378 AIC No: 1-888-467-2376 Inc. EMAIL certificates@willis.com c/o 26 Century'Blvd ADDRESS: P.O. Box 305191 INSURERS AFFORDING COVERAGE NAIL# Nashville, TN 372305191 USA Federal Insurance Company INSURER A: � y 20281 INSUREDINSURER B`: National Union Fire Insurance Company of P 19445 "Croim Castle International See Attached Named Insured List INSURERC,: Berkshire Hathaway Specialty Insurance Com 22276 ,1220 Auguats,Dr. Suite' 600 dNSURERD: New Hampshire 'Insurance Company 23841 Houston, TX 77057 ' INSURER E INSURER F:, 'COVERAGES CERTIFICATE'NUMBER-W15993118 REVISION NUMBER: THIS IS TO CERTIFY THAT THE,POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE-FOR THE,POLICY PERIOD INDICATED. NOTWITHSTANDING,ANY REQUIREMENT,-TERM OR;CONDITION OF ANY CONTRACT OR,OTHER DOCUMENT WITH RESPECT TO WHICH'THIS CERTIFICATE MAYBE ISSUED.OR'MAY PERTAIN,THE;INSURANCE AFFORDED BY THE,POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND•CONDITIONS OF,SUCH;POLICIE&,LjMITS,SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS., ILTR TYPE OFIN5URANCE ODL SU RI POLICY'NUMBER POLICY EFF POLICY EXP LIMITS X, COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $, 1,000,000 DAMAGE ffffRTEIY;— CLAIMS•MADE OCCUR REMISET XI Ea'ocourrence $ 1,000,000 A MED,EXP(Any oneperson) $ 10,000 3605'-3335 04101/2020.04/0:L/2021 PERSONAL&'ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $• 2,000,000 POLICY X PRO JECT LOC PRODUCTS•COMP/OP AGG $ ;1R00,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000"000 Ea accidentZ` )( ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED CA 6631248 04/01/2020' 04/01/2021 BODILY INJURY(Per accident) $ AUTOS-ONLY AUTOS' HIREDNON-OWNED PROPERTY DAMAGE $ AUTOS,ONLY AUTOS ONLY ,(Per accide t, X; UMBRELLALIABX OCCUR EACH OCCURRENCE $ 5,000,000 C. EXCESS LIAR CLAIMS-MADE 47—UMO-303445-05 04/01'/2020 04/01/2021 AGGREGATE $ 5,000,000 DED X ,RETENTION$"25,000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X' STATUTE OERTH- I YIN D •ANYPFtOPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICEFOMEMBEREXC4UDED9 NO NIA WC 023096097 04/01/2020 04/01/2021 -- -- (Mandetoryin NH) E.L.DISEASE-EA EMPLOYEE $' 1,000,000 llYYe�s,describe under 1,000"000 DESCRIPTION OF OPERATIONS,below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 11 LOCATIONS I VEHICLES(ACORD101,Additional Remarks Schedule,may be attached if more space is required) 'RE: Building Permit Application = BU#806579 — 21855 Country Road, Cutchogue, NY 11935 CERTIFICATE HOLDER CANCELLATION SHOULD,ANV OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ; THE ,EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITHTHE'POLICY PROVISIONS. Town of Southold, Building Department AUTHORIZED REPRESENTATIVE 53095, Route' 25 Southold, NY 11971 V ©1988.2016 ACORD CORPORATION.,All rights reserved. ACORD 25(2016/03) The ACORD name and logo are-registered marks of ACORD SR =D: 19444265 Cro,wri Castle International, Corp. Consolidated.Subs' diaries,as, Named'Insureds Entity Name • Edition 2417 Chesapeake Holdings,LLC Crown Castle GT Corp: . , 2417 Mid-AtlanticNetwork of Virginia,LLC -Crown Castle GT Holding'Sub LLC 2417 Mid-Atlantic Network, LLC Crown Castle International Corp. Access FiberGroup Holdings LLC Crown Castle International.Corp.•de Puerto Rico Access Fiber Group, Inc.' ..Crown Castle International LLC AirComm of Avon, LIC. Crown Castle Investment Corp., Atlantic-Coast Communications LLC Crown Castle Investment 11,Corp. CA-CLEC LLC Crown Castle MM Holding Corp. CC Castle International LLC Crown Castle MM Holding LLC CC Edge LLC Crown Castle MU.LLC CC Edge Solutions LLC ; Crown Castle MUPA LLC' CC•Finance LLC 'Crown Castle NG Atlantic.LLC CC FN'Holdings,LLC' Crown Castle NG Central LLC ,CC Holdings GS VLLC ; . Crown"Castle NG'Easi LLC. CC Site Acquisitions II•LL'C Crown Castle NG Networks LLC: CC Sunesys Fiber Networks LLC Crown Castle NG West,LLC CC TM PA LLC .,Crown Castle Operating Company CC Towers Guarantor LLC Crown Castle•Operating LLC, ' CC Towers'Holding LLC Crown Castle Orlando Corp. CC TS LLC Crown Castle PR LLC CCATT Holdings LLC Crown,Castle PR Solutions LLC CCATT LCC Crovun Castle PT Inc., CCATT PR LLC Crown Castle Puerto Rico Corp. CCGS Holdings Corp. Crown Castle Services LLC' CCPE Acquisitions`LLC _ 'Crown Castle Solutiohs'LLC CCPR VI Tower Newco LLC Crown Castle South-LLC CCS&'E LLC' _ Crown Castle-TPC LLC CCT2 Holdings LLC Crown Castle TLA LLC ' CC,TM Holdings LLC ' ' Crown Castle.Towers 05 LLC CCTM1'LLC.' Crown Castle Towers 06-2 LLC CCTM2 LLC Crown Castle'Towers 09 LLC, CCTMO LLC Crown Castle Towers LLC Chesapeake Fiber,LLC, ;Crown Castle USA Inc, Coastal,Antennas LLC Crown Communication LLC , ComSite Venture,Inc. Crown Communication New York,Inc. Coverage Plus Antenna Systems LLC Crown Mobile Systems,.lnc. Cross Connect-Solutions,Inc.(PA) •DAS Development Corporation Crown Atlantic Company,LLC fiber Technologies Networks,'L:L.C.(NY) Crown Castle AS LLC Fibernet Direct Florida LLC Crown Castle Atlantic-LLC Fibernet Direct Holdings LLC Crown Castle Augusta LLC' Fibemet-DirectTEL,LLC, Crown Castle BP ATT LLC Fibernet Direct Texas LLC Crown Castie'CA Corp: 'Fibertech Facilities Corp.(NY) Crown Castle Fiber Holdings Corp:(formerly LTS,Group Holdings LLC) 'Fibertech"Holdings Corp: Crown Castle Fiber Enterprise LLC'•{formerly Sunesys Enterprise LLC), 'Fibertech Networks,LLC , Crown;Castle Fiber LLC f/k/a Lightner Fiber Networks II,LLC Freedom'Telecommunications,LLC Crown Castle'GS III Corp'. Global Signal Acquisitions 11 LLC Crown Castle GT'Company LLC,, Globa[Signal Acquisitions III LLC Crown Castle International,C;orp.,Consolideted`Subsidiaries as, Named I'ns'ureds Entity Njame • . Global Signal Acquisitions IV,LLC P3,OASA-1,,LLC Global Signal Acquisitions LLC P3 PBA-1,LLC Global Signal GP LLC PA-CLEC,LLC Global Signal Holdings III'LLC Pinnacle San Antonio L.L.C. Global Signal Holdings IV LLC Pinnacle St.,Louis LLC Global Signal Operating,Partnership,L.P.. Pinnacle'Towers Acquisition Holdings LLC Global Signal Services LLC Pinnacle,Towers Acquisition LLC GoldenState Towers;LLC, Pinnacle Towers Asset Holding LLC GS,Savings Inc. Pinnacle Towers Canada,Inc. GSPN Intangibles LLC Pinnacle Towers III LLC High`Point Management Co.LLC Pinnacle Towers Limited ICB Towers;LLC 'Pinnacle Towers LLC' InfraSource FI,,LLC, Pinnacle Towers V Inc.- InSITE'Fiber of Virginia LLC PR Site Development Corporation InSITE Solutions LLC. �PR TDC Corporation Interstate,Tower Communications„LLC, Princeton Ancillary Services II,L'LC Intracoastal City Towers LLC Princeton Ancillary Services,III LLC IX2 Center,,LLC Radio Station WGLO LLC IX2 Wilshire,LLC RGP Tower Group;'LLC JCM"Towers LLC Shaffer&Associates,-Inc. Light Tower Clearinghouse LLC Sidera Networks UK Limited(UK) Light.Tower Fiber New York, Inc.'(NY) 'Siders Networks, Inc. Light Tower Holdings LLC Sierra Towers,Inc. Light Tower Management,Inc. Sunesys Enterprise LLC nikla Crown Castle.Fiber Enterprise LLC Light3ower,Metro Fiber LLC Sunesys of Massachusetts,`LLC Lightower Fiber Infrastructure Corp. Sunesys of Virginia,Inc. Lightower Fiber Networks I,LLC Sunesys,LLC. Lightower Flber;Networks Il,LLC nik/a Crown Castle Fiber,LLC Thunder Towers LLC LL Q1-18, LLC Tower Development'.Corporation LTS Buyer LLC Tower Systems LLC LTS,Group Holdings1l-C'n/kla Crown Castle.Fiber Holdings Corp Tower Technology Company of Jacksonville LLC LTS Intermediate Holdings A LLC Tower Ventures III,LLC LTS Intermediate Holdings B'LLC TowerOne 2012,LLC LTS Intermediate Holdings C1LC ToWerOne Allentown 001;LLC Md7,Capitol One,LLC TowerOne Bethlehem 001,LLC Mobile Media California LLC TowerOne Doylestown,LLC Mobile Media National LLC TowerOne East Rockhill 001,LLC Modeo-LLC TowerOhe Marple,LLC MW Cell REIT 1 LLC TowerOne Middletown 001, LLC MW Cell TRS'1 L'LC TowerOne Middletown 002, LLC, NEON Transcom,Inc. TowerOne Middletown 003; LLC NewPath Networks Holding LLC TowerOne North Coventry,,LLC NewPath Networks'LL'C TowerOne Partners;LLC NY-CLEC LLC TowerOne Richland,LLC OP 2 LLC TowerOne Upper Pottsgrove 002,LLC' OP LLC TowerOne Upper,Pottsgrove,,LLC P3 CHB-1;LLC TowerOne Warminster 001,LLC P3'H6ldings 2014 LLC TowerOne Warrington 002, LLC Crown Cattle International'Carp.;C,onsolidated!,Subsidiaries as Named Insureds Entity Name 7123119 Edition Towers Finco 11 LLC Towers Finco'III LLC Towers Finco LLC Tri$tar,lnvestors LLC TVHT,LLC WA-CLEC LLC WCP Wireless Lease Subsidiary, LLC WCP•Wireless Site Funding LL'C WCP Wireless Site Holdco LLC' a ,; ....., .,,, . .,,..,v. .. w_...„._L w. .............. .,.F....,.,,.,. -.., ,...- -,. WCP Wireless Site Non-RE Funding LLC WCP`Wireless Site Non-RE'Holdco LLC WCP Wireless Site RE Funding LLC; WCP Wireless Site RE Holdco'LLC Wilcon Holdings LLC Wilcon Operations LLC Wilshire Connection,LLC Wilshire Services,LLC Wireless Funding,LLC Wireless Realty Holdings IL LLC Wireless'Revenue Properties,LLC Yankee.Metro Parent,Inc. WILLIS TOWERS WATSON 26 CENTURY BLVD 6TH FL NASHVILLE,TN 37214 12659 1 AB 0.416 TOWN OF SOUTHOLD 53095 ROUTE 25 12659 BUILDING DEPARTMENT SOUTHOLD, NY 11971=4642 TAX LOT #17.5 N/0/F TOWN OF SOuTHOLD „ IB188.15' .2'Nw N 23°1400 FE CE 4.0'NW C AIN LIN STORAGE BIN 17.7' ' ! f7.7" l OWSE MONOPOLE GRASS 165' 1 STY .. .f= .:.. ...........................,r. d- -- -== ..........- -- METAL. FRAME GRASS WWI N W y ev 0 ' APPROXIMATE LOCATION OF Cj OL Jill 00 zVERIZON EASEMENT GA o (RECORD—EXIBIT "A• V105786) g.3'SW • N 1 f C% fY o I LD { N v� UNDERGROUND VERIZON M O VARELESS CONDUIT a (RECORD—EXIBIT A' V106723) N W i I , o I I ASP H ALT PARKING Z TAX. LOT #19.1 EDGE OF ASPHALT AREA 13.1'SW N - < N I 45,589 Sq.F. 4J 1-0465 Acres 'R ' < Ir 3 I ASPHALT PARKING I� J I 16- -------------------------- ROOF OVFR,�14.85'S I 105.15 i )- 3 *1 ' ISN If 1 •� 1855 i < . CONCRETE FRS #2 I 3 to I I C.4 1 STY METAL It J ri (AUTO SHOP) N 05.15.Ln + W A 111 ---QW..6m_ J g 0• M O o It �I IE�t n ii a. O TAX LOT #20.1 o z z A N O CHRISTOPHER UWR kill �vj �'• $° GRASS G R A S S ��_S►a. I `m 13 703.32'(ACTUAL) C. a 3 I WOOD ICU N« 1750' (D®) LILCO z 1.514 UTiUTY POLE T1UTY POLE / X42 #421 MPGR M CURB r 168.17 r - S 25052'30" W (MARK—OUT) NjjDDLE (12W ODE) ROAD (C.R_-48) t. THE OFFSETS OR DIMENSIONS SHOWN ►+ERIE. FROM THE PROPERTY LUES TO THE STRUCTURE'S ARE FOR A SPECIRC PURPOSE AND USE THEREFORE THEY (NORTH ROAD) ARE NOT INTENDED 70 MONUMENT PROPERTY IBES OR 70 GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR ANY 07NM IMPROVEMENT& 2 CONSULT WITH THE HIGHWAY DEPARTMENT BEFORE dFSIG011i INSTALLM OR MODIFYING ANY NEW OR EXISTING CURBS, WALKS OR ROADWAYS IN THE STREET SHOW HEREON. 3. SUBSURFACE INFORMATION SHOWN HEREON WAS BASED ON VISUAL OBSERVATIONS. VARIOUS CITY DEPARTMENTS. AND OR PRIVATE U71UTY COMPANIES RECORDS. AND/OR UTILITY MARKOUTS ACCEPTS NO RESPONSIll FOR ANY OF THIS DATA. SUBSURFACE U71UTE5 ARE NOT CERTIFIED AS TO THE ACCURACY AND/OR SURVEY OF ERQPJM LOCAM Ah 4. ALL BE CE UTILITY LOCATION MID DEPTH SHOULD BE RECHECKED AND #21855 C.R.-48. CUTCHOGUE LEGAL GRADES SHOULD BE vERIFIED WITH THE 7015OGRAPH11CAL.BUREAU. A OLD PRFERBLY IN WWTING BEFORE COMMENCING FINAL.DESIGN OR CONSTRUCTION TOWN OF SOUTH E 5. THIS IS To CERTIFY THAT THERE ARE NO VISIBLE STREAMS OR NATURAL COUNTY OF SUFFOLK WATER COURCES IN THE PROPERTY AS SHOWN ON THIS SURVEY. S. REFER TO ARTICLE 36 OF THE GENERAL BUSINESS LAZY AND THE PROVISIONS STATE OF NEW YORK OF INDUSTRIAL CODE PART(RULE NO. 53) BEFORE ANY EXCAVATION OR DISTRICT ....... 1000, SECT{ON ....... 96 DEMOLITION is COMMENCM. THESE LAWS RO)JUIR E EACH EXCAVATOR 70 GIVE ADVANCE NOTICE TO ALL OPERATORS OF UNDERGROUND FACILITIES OF HIS BLOCK 1, LOT(S) ....... 19.1 INTENT TO PERFORM EXCAVATION OR OINOU7101% IN THE SPECIFIED AREAS 7. ALL DIMENSIONS ARE IN U.S_ STANDARD MEASURE�IEIdTS. B. EASEMENTS NOT SHOWN ARE 240T GUARANTEED. PEPANO . RE111S10NS DE9CRIP7l0(d my GAIE RRE 1 t y copies from the original of this survey marked with on 1. PROPERTY SURVEY AS CO —04-0 ASCO9112 ginal of the land surveyor's embossed seal shall bensidered to be valid true copies. � � �r sir nouthorized alteration or addition to a survey map bearing ARKA01US2 JUSLEGA. Pl.S- * ; licensed land surveyor's sed is a violation of section 7209. ub--division 2. of the New York State Education Low. 4 !� ertification Indicated hereon signify that this survey was repared in accordance with the existing Code of Practice 6"'. 5 or Land Surveys adopted by the New York State Association e 4 Scd f Professional Land Surveyors. Sold certifications shall run }w = my to the person for whom the survey is prepared, and on 58 East Beverly Parkway is behalf to the title company. governmental agency and Valley Stream, NY 11580 Job No: nding institution listed hereon, and to the assignees of the www.aacny.net MTM 11uM +N GROUP, Inc. ending Institution. Certifications are not transferable townTEL- _J516) 792_6676 ASC-09i12 1111�e DM ddItIonol institutions or subsequent ower. APPROVALSJ VERIZON SIGNATURE BLOCK verizon,' APPROVAL SIGNATURE DATE ■ APPROVED AS NOTED 4 CENTEROCK ROAD SITEACQUISITION WEST NYACK,NY 10994 CONSTRUCTION DATE:3iwta B.P.#+ � RADIO MICROWAVE e on% EEF=74- L7- U B Y �- APT riz NOTIFY BUILDING t l 1,I I Il/�}E�1T AT ENGINEERING 1697 TELCO 765-1802 8A TO 4PIvll FOR TI L gWNGWORTHCT9H419 DLEBROOK DRIVE PHOAXNE(880}6�93-MS EQUIPMENT FOLLOWING- INSPECTIONS: NM1YW.ALLPOIMSTECH COM PROJECT ADMIN (111 1VI. FOUNDA I ION - TWO REQUIRED CCCASTLE CROWN WO ADMIN SITE NAME : 2, ROUGH - FRAMIING & PLUMBING CONSTRUCTION DOCUMENTS CROWN CASTLE SIGNATURE BLOCK I I CROWN CASTLE BUM 80657 -VI AL -CO "° DATE REVISION APPROVAL SIGNATURE DATE �,S �CCTIO(`i pp,�CT 9 95=119 FOR REVIEW SPM SITE ACQUISITION BE,COMPLETE 1FOR C 0,MUST 7 05f37M9 FINAL SPM FOR 2 06118119 FINAL SPM 3 PLANNER ALL CONSTRUCTION ION SHALL MEET THE 5 CONSTRUCTION 21855 COUNTY ROAD 48 REQUIREMIEN T S OF THE CODES OF NEW 6 :'. PROJECT MANAGER YORK STATE.ATE. NOT RESPONSIBLE FOR .�-� M cN c; UTILITY MANAGER C U TC H OG U E, NY 11935 DESIGN OR CONSTRUCTION ERRORS. LANDLORD COMPLY WITH ALL CODES O _ THE PARTIES ABOVE HEREBY APPROVE AND ACCEPTTHESE DOCUMENTS NEW YORK STATE TOWN CO AND AUTHORIZE THE CONTRACTOR TO PROCEED WITH THE `r 1, 1 V CONSTRUCTION DESCRIBED HEREIN ALL CONSTRUCTION DOCUMENTS DRAWING INDEX SITE INFORMATION AS REQUIRED AND CONDITION ARE SUBJECT TO REVIEW BY THE LOCAL BUILDING DEPARTMENT AND ANY CHANGES AND MODIFICATIONS THEY MAY IMPOSE VZ SITE NAME 'CUTCHOGUE' T-1 TITLE SHEET$INDEX VZ SITE PROJECT CODE ---- �p 0;1860'6 LOCATION CODE 144800 R LOCATION 21855 COUNTY ROAD 48 soulaoTow�PLAIdNINGBo GFESSI�` A-1 PLAN$ELEVATION CUTCHOGUE,NY 11935 ENGINEER CONTACT SEAN McDONOUGH DESIGN PROFESSIONALSMII\ If1V�lt� OF RECORD A-2 ANTENNA$EQUIPMENT DETAILS (860)663-1697 EXT 205 v S PROF:SCOTT M CHASSE P E PROPERTY OWNER CROWN CASTLE USA INC COMP:APT ENGINEERING ADD: 3 SADDLEBROOK DRIVE N-1 NOTES$SPECIFICATIONS 2000 CORPORATE DRIVE CANONSBURG,PA 15317 KILLINGWORTH,CTC— OWNER. ��9@9 OWNER. CROWN CASTLE USA INC LATITUDE 41'01'46 50"N Cl uc PAADDRESS.2909 CORPORATE DRME LONGITUDE 72°29'50 30'W CANONSBURG,PA15317 ELEVATION 56'±AMSL DISTRICT 1000 USE I u R IS A VIOLATION OF NEW YORK STATE LAWFUL NOT SECTION- 96 �1�� T CERTIFICAT EDUCATIONLAW ARTICLE 145,UNLESC7IDN BLOCK 1 TCI EDU(2)FOR ANYPERSON,UNLESS LOTS 191 �,�°e''tl ACTING UNDER THE DIRECTION OFA ZONE °U°LIGHT INDUSTRIAL V 4 tl LICENSED PROFESSIONAL ENGINEER OR y. / LANG SURVEYO70 ALTER AN ITEM IN _ •C'��" -Kogpert Cress USA PROJECT DESCRIPTION/ REMOVE(3)B13 700 RRHS(1 PER SECTOR) Pte". ANYWAY IF AN R REM BEARING THE SEAL SCOPE OF WORK REMOVE(3)2X40 AWS RRHS(1 PER SECTOE OF AN ENGINEER OR LAND SURVEYOR IS R) - ��011llll'''"' ALTERED,THE ALTERING ENGINEER OR ADD(3)NOKIA AHBCC BRE 5/B13 DUAL RRHS(1 PER SECTOR) LANDSURVEYORSHALLAFFIXTOTHE ADD(3)NOKIA AHFIC B2/B66a DUAL RRHS(1 PER SECTOR) M HIS SEAL AND THE NOTATION SOUttthOld `' "ALTERED BY-FOLLOWED BY THE Landfill-Solid Waste " - e Y SIGNATURE AND THE DATE OF SUCH - - ALTERATION,AND A SPECIFIC DESCRIPTION OF THE ALTERATION :UItt9 tel4v (0 VERI20N AT "CUTCHOGUE- ' - ,C'�J_4 SITE 21855 COUNTY ROAD 48 SITE " ADDRESS.WTCHOGUE,NY 11B35 r 1 a APT RUNG NUMBER: NY7050910 ' - CROWN BUN 80INW9 VZ LOCATION CODE 144890 ' .• VZ PROJECT CODE: — " '8flards Fam _,.,_ DATE 95RBfte CHECKED BY SPM SHEETTITLE K TITLE SHEET $INDEX SHEET NUMBER. VICINITY MAP SCALE 1-=500' T-1 J ' - verizon� A-1 q STRUCTURAL NOTES I APT ENGINEERING HAS NOT BEEN CONTRACTED TO PERFORM A 4 CENTEROCK ROAD STRUCTURAL ANALYSIS ON THIS TOWER OR ANTENNA MOUNT WEST NYACK,NY 10994 1 AND THEREFORE ASSUMES NO RESPONSIBILITY FOR THE 1 fii I p I STRUCTURAL CAPACITY AS REQUIRED UNDER THE MOST CURRENT LOCAL,STATE AND FEDERAL CODES 1 tt 2 REFER TOMOUNT ANALYSIS REPORP,PREPARED BY PAUL 1 i W6INFORMATION ANDpR MOUNT MODIFICATIONS FOR ADDITIONAL lk—tPT GINEERING _ O 3 REFER TO STRUCTURAL ANALYSIS REPORT,PREPARED BY BLACK 1 X &VEATCH FORMA NEW YORK LLP,DATED APRIL 5,2019,FOR ADDITIONAL 3 SADDU3dROOK DRIVE PHONE(850}5631&9 O m INFORMATION AND/OR TOWER MODIFICATIONS IOWNGWORTNSTETH 19 FAX(680}653L935 1 � I Oa YANVJJLLLPOINTSTECH CAM 1 CROWN Lt- v CASTLE ..;; I CONSTRUCTION DOCUMENTS COUP 1TY ROAD 48 ABANDONED METROPCS ANTENNA MOUNTS NO DATE REVISION 0 105MI19 IFOR REVIEW SPM (9)EXIST VERIZON MONOPOLE MOUNTED PANEL 1 05131/19 FINAL'SPM ANTENNAS(115-/130',222'..42-1511).(3)MOBS,(3) 1 2 106118119 FINAL SPM LOCATION MAP 6x12 HYBRID CABLES& COAX CABLES A 2 3 REMAIN REPLACE(6)6)OF(6)IXIST RRHSHS 411 1 5 ( e - 2 EXIST CARRIER ANTENNAS(TYP) I 5 EAST VERIZON CABLE ICE BRIDGE JI (9)EXIST VERIZON MONOPOLE MOUNTED j "I PANEL ANTENNAS(115°/130°,222°,342°/50y, 1 7= Ui (3)MOSS,(3)6x12 HYBRID CABLES&(6) 342°/50° I COAX CABLES TO REMAIN REPLACE(6)OF (6)EUST RRHS 222 X x�xU�L _ r x i RofiESS1o�P EXIST T-MOBILE PAD MOUNTED EQUIPMENT i{� EXIST 108'-111±AGL MONOPOLE I N H DESIGN PROFESSIONALS OF RECORD EXIST 108'-11°x AGL MONOPOLE A. 5, PROF.SCOTT M.CHASSE P E{01 Z o COMP.APT ENGINEERING I p1 Lu ADD 3 SADDLEBROOK DRIVE EXIST CABLE ICE BRIDGE(TYP) x G � 'Z w KILLINGWORTH,CT 06419 C� I r~ 11 °/130° i J m Z 0 'oa OWNER. CROWN CASTLE USA INC IXIST VERIZON(3541 SF)EQUIPMENT I 1u O ADDRESS 2000 CORPORATE DRIVE SHELTERZON(GPS UNITSW/LINES x x x ! Q w p CANONSBURG,PA 16317 Z4 > f �_ NOTE EXIST CHAIN LINK FENCED COMPOUND(TYP) I Q p� F fEDUCATION LAW i IS A VIOLATION OF NEW YORK STATE X%ll EXIST x EQUIP p i x I ZZ F 0 � 7209(2)FOR ANY PERSON,UNLESS ON EQUIP PAD RAD I I w ACTING UNDER THE DIRECTION OFA 3 i I i i I 4 LICENSED PROFESSIONAL ENGINEER OR I �f I Z W LAND SURVEYOR,TO ALTER AN REM IN EXIST VERIZON DIESEL POWERED GENERATOR .-__,_I x F ) ,6 j ] ANY WAY.I EE ITEM BEARING THE SEAL EXIST VERIZON(354±SF)EQUIPMENT q Q 4 O OF AN ENGINEER OR LAND SURVEYOR 15 n SHELTER W/(3)GPS UNITS W/LINESERING I m I]il LANDSU'VEYOR SHALL AF ENGINEER OR ITEM HIS SEAL AND THE NOTATION EXIST COMPOUND ACCESS GATE 9W) / \ I "ALTERED BY'FOLLOWED BY THE ` MOST CHAIN LINK FENCED COMPOUND(IYP) I U SIGNATURE AND THE DATE OF SUCH _ ALTERATION,AND A SPECIFIC I DESCRIPTION OF THE ALTERATION I VERIZON AT NOTE j '°CUTCHOGUE" THESE DRAWINGS WERE PREPARED UTILIZING - INFORMATIONPREVIOUSLYOBTAINEDBYAPT I SITE 21955 COUNTY ROAD 46 - ENGINEERING APT ENGINEERING HAS NOT H-1_ BEEN CONTRACTED TO PERFORM A RECENT COUNTY ROAD 48ADDRESS CUTCHOGUE,NY 11935 SITE VISIT TO CONFIRM THAT THE EXISTING SITE / (BEYOND) CONDITIONS SHOWN HEREIN ARE ACCURATE // APT FILING BER. NY1050910 COMPOUND PLAN °-0 °� CROWN BU a.806579 p_1 SCALE 7"=10'-0' 0 SCALE 1 tNCH=10-0 VZ LOCATION CODE'144800 GRADE Q VZ PROJECT CODE — 56'±AM D DRAWN BY: CSH EXIST ANTENNA SPECIFICATIONS ANTENNA MODELS,DOWNTILTS& nWEST ELEVATION ° ° 6d °-0 DATE: 05129119 CHECKED BY:SPM AZIMUTHS PER RFDS DATED 12/04/1 B 10'SCALE 1 INCH=10•-0' SHEET TITLE: NOTES SECTOR MODEL QTY M- E- ANTENNA CABLE CABLE AZIMUTH (1) CONTRACTOR SHALL PROVIDE MECHANICAL DOWNTILT BRACKETS D-TILT D-TILT STATUS STATUS LENGTH (2) CONTRACTOR TO FIELD VERIFY ALL CABLE LENGTHS PRIOR TO ORDERING NEW CABLE(TYP EACH PLAN 8L ALPHA Al JMAX70CAP-480-VRO 1 0° 0° EXIST REUSE(2)IXIST 116° SECTOR) A2 COMMSCOPE SBNHH-1065A 1 0° 0° IXIST COAX&(1) 133'± 130° (3) VERIFY CABLE DIAMETER WITH VERIZON PRIOR TO ORDERING ELEVATION A3 COMMSCOPE SBNHH-1 D65A 1 0° O° EXIST 130° (4) CONTRACTOR SHALL CONFIRM GPS UNIT MODEL AND CABLE WITH VERIZON A4- _ _ 6x12 HYBRID (5) CONTRACTOR SHALL INSTALL WEATHERPROOF CAPS ON ALL UNUSED PORTS,SWEEP TEST THE - BETA B1 JMA X7QCAP-480-VRO 1 0° O° EAST REUSE(2)EXIST 222° UNUSED PORTS/ANTENNAS,AND PROVIDE RESULTS IN SWEEPS PACKAGE 82 COMMSCOPE SBNHH-1 D65A 1 0° 0° EXIST COAX&A 1333 222° (6) CONTRACTOR TO VERIFY SIGNAGE REQUIREMENTS PER RF/EME REPORT PROVIDED BY OTHERS SHEET NUMBER. B3 COMMS SBNHH-1 D65A 1 0° 0° EXIST 6x12 HYBRID 222° B4 - - - COLOR CODING GAMMA G1 JMAX7QCAP-480-VRO 1 4° 0° EXIST REUSE(2)EXIST 342° w -� G2 GOMMSCOPESSNHH-1D65A 1 4° O° EXIST 50° SECTOR BASE COLOR 850 LTE-C LTE-PCS PCS AWS GPS H G3 COMMSCOPE SBNHH-1 D65A 1 4° 0° EXIST COAX&(1) 133± 50' SECTOR 1(ALPHA) WHITE PINK RED LIGHT BLUE PURPLE YELLOW BROWN G4- _ 6x12 HYBRID SECTOR 2(BETA) BLUE PINK RED LIGHT BLUE PURPLE YELLOW BROWN GPS PCTEL GPS-TMG-HR-26N (3)EXIST TO REMAIN REUSE(3)W 10'±,20'± N/A SECTOR 3(GAMMA) GREEN PINK I RED I LIGHT BLUE I PURPLE YELLOW BROWN verizonit 4 CENTEROCK ROAD WEST NYACK,NY 10994 1-58'HORIZONTAL UNISTRUT, API' ANTENNA PIPE Ul FLAT WASHER(TYP) PART#P1 OOOT ATTACHED TO ANTENNAPIPES CUT TO ENGINEERING38'DIA U-BOLT(TYP�43JW REQUIRED LENGTH(TYP FOR 2) 3 SADDLEBROOK DRNE PHONE(890}883189U-BOLTS TO BE SIZEDB'DIA NUT(TYP)ACCORDING TO CHANNEL NUT WITH SPRING, KIWNGWORTH,CT 05419 FAX(860}863D935 ANTENNA PIP1-58°HORIZONTAL UNISTRUT PART#P1008 WWW ALLPOINTSTECH COM DIAMETER UNISTRUT,PART#P1000T STRUCTURAL NOTES ATTAC UT TO TOR NTENNAQUIRED 38°DIA FLAT WASHER(YP) CROWN PIPES CUT TO REQUIRED42°/5O° 1 APT ENGINEERING HAS NOT BEEN CONTRACTED TO PERFORM A LENGTH(TYP FOR 2) 38°DIA BOLT(TYP) CASTLE STRUCTURAL ANALYSIS ON THIS TOWER OR ANTENNA MOUNT ❑ AND THEREFORE ASSUMES NO RESPONSIBILITY FOR THE /� I 1-5B'VERTICAL UNISTRUT,STRUCTURAL CAPACITY AS REQUIRED UNDER THE MOST '\ PART#P7 OOOT CUT TO cc CURRENT LOCAL,STATE AND FEDERAL CODES I / / \ REQUIRED LENGTH(TVP) CONSTRUCTION DOCUMENTS 2 REFER TO MOUNT ANALYSIS REPORT,PREPARED BY PAUL J I / / FORD AND COMPANY,DATED MARCH 27,2019,FOR ADDITIONAL NO DATE REVISION (3)EXIST MDBS TO REMAIN INFORMATION AND/OR MOUNT MODIFICATIONS / 0 D5129119 FOR REVIEW SPM 1 D5I37/19 FINAL SPM )9= 3 REFER TO STRUCTURAL ANALYSIS REPORT,PREPARED BY BLACK / / 2 05118119 FINAL SPM 222, &VEATCH NEW YORK LLP,DATED APRIL 5,2019,FOR ADDITIONAL / SEPARATION AS 3 INFORMATION AND/OR TOWER MODIFICATIONS REQUIRED TO 4 I I I I SUPPORT 5 I I I REMOTE RADIO 6 REPLACE(6)RRHs(2 PER SECTOR) hz I I I I SHR°UNITS ns PER MANUFACTURER'S "( m Cl/,I O SPECIFICATIONS Al ss� rLe RRH(QTY 3I 1 - VARIES) q_2 3 RRH(QTY (9)EXIST ANTENNAS TO REMAIN(3 PER SECTOR) A_z VARIES) V: t II��1111 1 �y3I \ g/ C3NOTE:ALL EQUIPMENT SHALL BE POSITIVELY ATTACHED TO THE E)OSTING (r 3 ED PLATFORMIMOUNT MEMBERS AS INDICATED UNDER NO CIRCUMSTANCES SHALL BEAM CLAMPS BE UTILIZED TO SECURE EQUIPMENT OR UNISTRUT TO THE STRUCTURE.HEAVY ��On 78 643 Pkv EXIST 108'-11°±AOL MONOPOLE °l130° DUTY STAI NLESS STEEL BEAM GPPS SHALL BE PERMITTED FORSABRINYACHMENTA11 ONLY YFELD DRILLING OF EMSTINLATFORMIMOUN MEMBERS I '70FES S101, PROHIBITED WITHOUT PRIOR APPROVAL FROM THE ENGINEER OF RECORD(EOR) r11ANTENNA MOUNTING PLAN NOTES DESIGN PROFESSIONALS OF RECORD 1 ALL EXPOSED UNISTRUT ENDS TO BE CAPPED WITH UNISTRUT CAP(MODEL#P2860-10) 2 ONLY 1-58°UNISTRUT TO BE USED FOR RACK CONSTRUCTION PROF'SCOTT M CHASSE P E A-2 SCALE Yj" 3 EXTEND UNISTRUT AS NEEDED BASED ON LENGTH OF ANTENNA SECTOR DO NOT COMP.APT ENGINEERING CANTILEVER UNISTRUT FOR MORE THAN 24'BEYOND ANTENNA MAST ADD: 3 SADDLEBROOK DRIVE 00000, 4 FOR HORIZONTAL SPANS GREATER THAN 5'-0'USE UNISTRUT PART#P1001 KILLINGWORTH,CT 06419 OWNINC ATYPICAL RRH EQUIPMENT MOUNT ADDRESS C0000RPROWN CORPORATE TLE AVE ADDRESS 2000 CORPORATE DRIVE CANONSBURG,PA 15317 NOTE R IS A VIOLATION OF NEW YORK STATE EDUCATION LAW ARTICLE 145,SECTION 7209(2)FOR ANY PERSON,UNLESS ACTING UNDER THE DIRECTION OFA LICENSED PROFESSIONAL ENGINEER OR LAND SURVEYOR TO ALTER AN ITEM IN ANYWAY IF AN ITEM BEARING THE SEAL OF AN ENGINEER OR LAND SURVEYOR IS ALTERED,THE ALTERING ENGINEER OR LAND SURVEYOR SHALL AFFD(TO THE ITEM HIS SEAL AND THE NOTATION "ALTERED BY"FOLLOWED BY THE SIGNATURE AND THE DATE OF SUCH ALTERATION,AND A SPECIFIC FRONT SIDE TOP FRONT SIDE TOP DESCRIPTION OF THE ALTERATION VERIZON AT "CUTCHOGUE" cc'v N N N SITE 21955 COUNTY ROAD 48 ADDRESS:CUTCHOGUE,NY 11935 121° 71' 121° 74° APT FILING NUMBER: NY1050910 AHFIC AIRSCALE DUAL RRH(OR EQUAL) AHBCC AIRSCALE DUAL RRH(OR EQUAL) CROWN BU#•806579 4T4R B2/66A 320W AWS/PCS 4T4R 85/13 320W 700850 LTE REMOTE RADIO HEAD(RRH) REMOTE RADIO HEAD(RRH) VZ LOCATION CODE.144800 WXDxH=12 1'A7 1°x22 0'(79 4 Lbs) WXDXH=12 1X7 4°x22 0'(83 8 Lbs) VZ PROJECT CODE: - - D DRAWN BY: CSH NOTES DATE: OSR9H9 CHECKED BY SPM 1 DIMENSIONS SUBJECT TO CHANGE BASED UPON AVAILABILITY AT TIME OF CONSTRUCTION 2 MANUFACTURERS RECOMMENDED RRH CLEARANCES FRONT 36°,SIDES 12°,BOTTOM 24° SHEETTITLE• 3 SFP.ARE PROTOCOL SPECIFIC THE CONNECTIONS BETWEEN RRHs AND BBUs ARE CPRI CONNECTIONS,AND REQUIRE CPRI SFP(ON BOTH ENDS)THE CONNECTIONS BETWEEN BBUs AND 7705 ARE ETHERNET AND REQUIRE ETHERNET SFP(ON BOTH ENDS) ANTENNA& ,/ RRH EQUIPMENT EQUIPMENT DETAILS A-2 SCALE:Yz"=1'-0" ' SHEET NUMBER A-2 r GOVERNING CODESIDE6IGN BTANDARD9 NOfffED BYTHE CONBROICRONro R6UME G4AATpN9 mNSTRLKRION M'DNO6ENOLONOER A8OLL(6iEEARO ALL BENOSSHNI • 2016100 WI2017 NYS UMFORMCODE6IJP EM/ASCE7-10 EXIST ELECMR AND MEGIANICAL FIXRIHE6,PIPING.WIRING BE H-AL.OR DO.YMV TOWARDSE K rIA-2T2-0 AND EDUIPb¢Nf O66TRUCRNOIHE NbRK 6HPLL BE REMOV® NL BOLISSWYLBENVMMUMy6 q.U£IERANDFAONOpiNEORON •MLmFIDUC10RS PA6Swn FROMABOVE-0igUtID TOW�OITID ANDpR RELOGTIDMDIRECTEO BYTHE CONSIRUCBON 6MALLHAVEAD.TMUMTWOBOLT6.LOOKWYSIEiBMENOT CONTECUONB,VMFA0D006m6lWLBE mVERIDANO verizon REFER l0 MOI1NTANDIOWEi ANALY6E6.0\'OIHERS.FOR MANAGEELOOPTEDASDAVICEPDEWiUPfiON6 MUST BE P�NWTm FOgAffi65IEELA65ENffiJE6 IFIFNSION mNIIULWLt6 PRORB^Im WR11ANON�/IETALLICCOPIDUR6E1lID TBORI ADORIONAL INFORMATION CmRQNATLTJ WRH OWNER ARE..CCNNELTONSSHALL BE OE_Fm_QBIIG_ D-IDS IW.OWABLE LGD VAWE9 .R P OR MORE Widi0UN0 mNOLH:fG9ARE w n1E6AME PAnI R 02 DEMOLITION I1E910N mNNECUON9 AT BEAM FNOSFQ31010P6 pH1M RNa6OVE.APRNa BONDPAfOL I3AN-RING OR -B I-- GENERAL SPEQFIGTONS _U�0_OONJECRQJ66lWLBE mMPLE1m WRH DOUBLE P �DREJ AR).mMBwENTIHA6N D6PlliE 0t GENERAL HEfEw NUTS OR A LDGL WA41ER mNOL1CiOR ABBREVATKwa USmINT"^'_6PEGFKARON5 W0.U0E1HE EMOVEANDfE(YlLv d6POSE OFffEMSDGEPTn10.SE INdGTmro CONIRPDIOR 6HALL mMPLV NTMAWB COI7EFORPgOCEOUREE EauRNGNrArm TDJJw GTauNO RwGR 61L1LL 6E 4ST NYACK,N 109 wxLowNTE OAD eEREwsrnLLm suvAom,aRroREMAwTHEovmER6moPErTn. nwEARM�.wOOLIA-rtYOFwaDs ArvOwEMwnPq^�-__6 •aonroFnroaNrcoNoucrrvEoalEcroRsrwx-�uREwmoNs WEST NYACK,NY 10994 AQ AAmaQw mNOFEIE ZNSTm7Te PoorEcrca+mlucnonomlGrmroREMAUIuuwsrGMAaEAw GRAIL BE o.MLRFtEow AcmROANwwn- sA�lr PEsroFEmlvMearGROLwo RW solrowmuNat FSEroF ANSI AME GNN nWAL STANOMOs wS1TME SQlItm WRWIn IT A.LROrv.VMEN PERARR®REAR BE, OUN6)ri1T1GYVAmCHHIES'ALLWEmwa SHI1LL BE PDIroaJED IONETi GROUna WN¢S AV5 AMEGN NEtnw060QETY nEnavmroASUITABLE,RiOfLi:fm GfTAMEARELOLdiNO USra E]dIXELECIROOESAAm 6XALLCDNFCR.TOAHH:AND 011 BALLALMw0.NM1B WCHE9 FROM FOl1rRAnONS,FCORI 9 NSG AMETeGW INSRRIIEOFSIEELmNSTRUCTION OFMGIIHNJMDRO3l CLEMmAND RFwSTAIlm wTMEw OWGPJAL VAfERE Fu1ETwEIns�SAf>ENOTs19WN.RmNDETHEINi[8i� •"" AMECAN fiOQEIY OF GVI ENOTEER9 LOGTNJNB BBB.ET OR MWEK1M AT PERTABLEJ2AINT1EAl6p TMMNLa wsrALLAILIN-ORIXA¢1 Wn49 MOlAL6 BOfJD9 mNNELRWGTIAM, ^IM PMEWCNJ BfAN¢gfi09 ANDtE6RNO NERImS OEMQJSIEO MAlENB 6HALLBEmMEINE mMIRAC10R8 6I�-Q]VSIAM%MN'TTNEmMPLEfION OF WELGM1O PII AfmALL6mnLA9 GROUrIDIMi -1 OONERETERDNFOPCwO6TEELMaTTME DSMSISNA 6 ONE OREOR O1HE8REWTf11FUHMDi 4N.Nfl61DOALVAA®OOAnNGSHNIBEREPNRW 6F£NOIE .UNE, I6BD.ONORAOE.ORBINQIESBEIDWTHEFRO6T APT ICCES WIERNATONALOOOEOO N LEVALGTONaBMOE DSPOETRON ATTHE mNiRPDTORS OPRON -IN. 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