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North Fork Table & Inn 2021-50
��rtSFFQ1��P RECEIVED VED OCT 7 2021 Southold Town Clerk Office of the Town Attorney Town of Southold Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New'York 11971-0959 Telephone : 631-765-1939 Facsimile: 631-765-6639 MEMORANDUM To: Ms. Elizabeth A. Neville, Town Clerk From: Melissa Mirabelli Secretary to the Town Attorney Date: October 6, 2021 Subject: Special Event North Fork Table & Inn With respect to the above-referenced matter, I am enclosing the original application with committee comments and resolution of Town Board approving event. If you have any questions regarding the enclosed, please do not hesitate to call me. Thank you. Cc: Denis Noncarrow /mm Enclosures Southold Town Board - Letter Board Meeting of October 5, 2021 RESOLUTION 2021-772 Item # 5.14 ADOPTED DOC ID: 17424 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2021-772 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON OCTOBER 5, 2021: RESOLVED that the Town Board of the Town of Southold hereby grants permission to North Fork Table and Inn, to hold Special Event 2021-50 at North Fork Table and Inn, 57225 Main RD, Southold,New York as applied for in Application NFTa-b for Weddings on October 2, 2021 and October 30, 2021 from 12PM to I IPM. The conditions of approval are as follow: All parking must be contained on site; no parking on Route 25, and no standing, loading or unloading of vehicles on Route 25. Provided they adhere to all conditions on the application and permit and to the Town of Southold Policy for Special Events and subject to the applicant's compliance with all executive orders of the State of New York. This permit is subject to revocation if the applicant fails to comply with any of the conditions of the approval or is unable to properly control traffic flow into and out of the event. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: James Dinizio Jr, Councilman SECONDER:Jill Doherty, Councilwoman AYES: Nappa, Dinizio Jr, Doherty, Ghosio, Evans, Russell Generated October 6. 2021 Page 24 Special Events Committee Application Summary and Recommendation Application name: o(4� Tock T&Ug- Inn Address: 51a95 Main goad Application number: N F-I OL-b Date of Event: Time: 141 Inn — 1 I Pm Date Received by Town Clerk: l o I a3 I aoat Date Received by Committee:_ Nature of Event (S): Committee Comments Received by: X Denis Noncarow Melissa Spiro Leslie Weisman Missy Mirabelli �C Chief Flatley August Ruckdeschel- County — Heather Lanza James Easton Mike Verity x Claire Glew Bill Duffy Kevin Webster r Committee Recommendation's: Approve as applied (�Approve with Additional conditions: L G41 Sok-- Hold Public Hearing t(kiny, IOOAtrg,sIIMVn ov%fU215 Deny Special Event No: aoa k- C50 Resolution No: o�0a\- �a� Date: a151�oa� NFT a,-b ' 12NnU � S E P 2 3 2029 Southold Town Clerl� TOWN OF SOUTHOLD to,wri Code Chapter 205"Publi:e ti iitei=tainment and Special Events'I SPECIAL EVENT PERMIT INSTRUCTIONS AND APPLICATION FORM Applications for a Special Event Permit are subject to an inter-departmental coordinated review by the Southold Town Board,Town Attorney,Town Assessors,Land Preservation,Building,Planning,Zoning Board of Appeals and Police Departments,and the Suffolk County Planning Commission. Application fee: $150.00 per application. Up to six(6) multiple events of the same type, occurring over a period of three months,may be permitted on one(1)application for a fee of$150.00. However,specific details of each event must be included with this application rill al")p_116 inns nnist-be 5(r1mitted at least 60 bdsiriess -days before the,--,event. AnPlicants are-encouraggc tosubmit applicatiaris as earls as possible. Any completed a-mjlieation that is tidf Submitted 60,or more litisiness da�s rir-ift to the ficheduled event niay he reJect'ed or stain jest:€o a late l_)roeesshig£ee of$250.00 li the Office of ihe_1Tw 4#n Qlez-k, unless a waiver is-oka i`ed. Requesting an expedited review must be submitted in writing to the Town Clerk.The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain comments on all applications from ielevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health,safety,and welfare of the community. Wheiiis A Permit Required? All Special Events,pei Southold Town Code Article I, Section 205-2(Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. ,,use ol'r� ential pr(fx(�dXforrnofi',such as•a venue fqr,�veddings onother events i�pr6hihite . This ap,ilicaticin is deerned't iimplefe once all the fa11'tiwii}g rg_guireineirts°are'sttbmitted-to'the Town; C erk• Please indicate submission Qf tine folldwiiig by citerking tiff t[te_botee and signiin�-,Below A completed apnlicati n forfn signed by the owner and the event manager. Applications without property owner's signature/approval will be rejected. FEE: Is the application being submitted at least 60 days before the event[ ]Yes [ ]No n If Yes, Fee of$ has been submitted $ (50 'ph.cq,�',+�fft- � 44'150 Lea At, If No,Fee of$ �" 00 has been submitted J# ao Updated 8/7/2018 Vi The applicant/owner of the property where the special event is proposed to take place must pzovide a certificate of insurance not less than 2 million dollars naming the Town of Southold as an additional insured A Pai-kiriglExrent-Plan: consisting of a survey, site plan and/or aerial view of the subject property that includes the locations of on-site parking, sanitary facilities, and tents or other temporary structure(s) (See application form for details) — Events for three hundred (300) or more people require submission and approval of a traffic control plan acceptable to the Town of Southold AND a qualified traffic controller must be provided at the event. (See application form for details) Signature of Property Owner on the application authorizing Code Enforcement Personnel of the Town of Southold to enter the subject premises during the hours of the event to ensure compliance with any and all special event permit conditions. My signature below affirms that I have submitted all the information required above in connection with my application. ,Do ed Signature Activities associated with outdoor public events are strictly prohibited from taking place on land preserved through the sale of development rights to the Town of Southold,and can only take place on land preserved through the sale of development rights to the County of Suffolk with a permit issued by the Suffolk County Farmland Committee. If food is to be served, it must be catered and prepared off-site by food vendors who hold a permit to operate issued by the Suffolk County Bureau of Public Health Food Protection Unit. Updated 8/712018 OT a-b r� F r � D l:IEP 2 3 2021 o'd Town terk APPLICATION FOR A PERMIT TO MOLD A SPECIAL EVENT Iee px-a►Fide ALL. cif tii�rnfoirttit�n reau steel heloty Incn�tt�lefe�p�ticatidiiGIL i (�T•1� , reviewel t-> Special Event Permit 4 Applicant(s)name:�I� �� �����a�Ik ter l Date of Submission �i°I�,:te p Event raiL IVA !ro ZS j SCTM#'s 1000-Sec ioit Block- Dates of Each Event: If Multiple Dates are requested, applicant (must give at]information for all dates. ,,J Nature of Event;__ A�l' .- '�'l�Q' C 1'1' '✓�C� 0]�i� CP��lr�� (Please attach a detailed description of EAQ '(� Pmt to ti§applicatioxt) Time Period(lours) of Event From ZP to ice_" -= 'Down Services requested: ( )Yes (uj No If yes,Describe Police Dept._Highway Dept. Describe Services I Maximtun Number of Persons Attending At One Time: Number of cars 9:xpgctc-d ' Is a Te` o+,r otherfeni�porat�+ tzaefuie }eiitMjt�.; a? [ Yes [ ]No If yes provide size(s) Will food be served?[ Yes [ ]No If yes provide number and name(s)of food vendor(s) b 4 g Updated 8/7/2018 t`t�CLli -t � � Suffolk County perrinO(sfI 00D2,35 Will other vendors be on the premises during the event?[ Yes [ ]No Ii yes ho«many? � Describe Type of vendors) �u k t —y _ �` Property Ownei (name/address): (�21�� �k 4% �;)Q�'tV 2-2 Aw 9000 S Contact Person and.Contact TeUt g'1� �lY -_�2- e-snail address L t�--� C �` _ _ CD EN ent Location:Strce.-Hamlet Address: t _ Yt ��u� �� �adi�ig address to Send Event Pei mit to Mn��n I 1 �j C Y t l Have any of the development righis been sold to the Town of Southold [ ] Yes C}No and/or Suffolk County Agricultural Program" [ J�'es [ }iso If •fir'efthdrforboth.�[Aa-iridlr�te.ort-tli�': a!Nc-14ed-nlan_tht lac ihdixt=ie,�i`tlrefc;ert�ed-Al-ea a„ nAvhrch'theevettt.vvill til;ehlacg. 4 ' T CATION � T7,1i PTZT APKPLA� Tl' S P � I± P1 C`L>il 'AT-TFC' 11� ti 5 3�1t)C�211C€�T�1�?E_Oi� l10ti ii�Tt.I�')''�i St3 ATTAG A. T &# i,r€oNTR L_J"I.AM,0 "e:alt?xt P-9-e ., ,rrki ID,enfplhn rztQ e�r sizivev,Citi pi�n.aitti%or aerial,rfety (,`.'ax e�an�fsl� ao ae i attht,al p strhiect nronert';, Il'��)IC,-� "C3� "P,LAI� AT�'f.2rf tlttrhFnllor�itt ,i oa Yri tints:, A,p2rkina/evens Man showing: (1) The size of the property and its location in relation to abutting streets or highways. (2) The size and location of any existing buildinc(s)or structure(s)that Will be in Opelatron during the course of the event and any proposed building,stnicture,or signs to be erected temporarily for the event. (3) Tine location of the stage or tents,rf SMV. (4) The designated areas of use for spectators,exhibitors,vendors. employees and orgar-izers. Location of all entries and exits. (61 The location of all fire ex:ingcnshers and other fire safety equipment (7) The location of all temporary utilities to be installed for the event, if any. (S) The layout of any parking aiea for automobiles and othei vehicles and the means of ir:Vress and egress for such parking areas. The parking spaces must allot- for X00 sq.ft Per car (9) A.traffic control plan for vehicles entering and leaving the site for the p_oposed event (10) Plan for the use of live outdoor music,loudspeakers and other sounds,�vliich will be used; if any.and the type and location of spealceis and other audio equipment (l 1) A description of emergency access and facilities related to the event. (12) Prov.sious to dispose of any garbage, trash,rubbish or othei refuse. (l;} Location and description of any additional lighting to be utilized in conjunction Nvith the event. Lpdated 8;712015 (14) Location of sanitary facilities on site. Traffic f vntrol iii an Events for three hundred(300)or more people also require submission and approval of a traffic control plan,acceptable to the Town of Southold,AND tt rltt aEiflad traffic o i_trollcr nkiut d=raufdbd.Please attached a written description and/or notate on the parking event plan the following: 1)Who will be conducting traffic,2)Where they will be stationed on site,3)How they will direct the entrance_ circulation,parking, and exiting of cars on site,and 4)Contact infonnation for use by Southold Town Police. onrr��r:�sIr 1N�Tz�R�:. I am the Owner of the Property where this event is to be held and I agree to comply with the laws, rules,regulations,conditions,and requirements of the Code of the Town of Southold,including but not limited to the conditions listed below,as well as all other applicable agency rules and re;ulations pertaining to the activities under this event. Furthermore,I hereby swear or affirm that the information contained herein and attachments hereto are true and correct to the best of nzy knowledge, and agree to provide notice to the Town immediately should there be any material changes regarding to this application. . Furthermore,I hereby authorize Code Enforcement Personnel of the Town of Southold to enter the property during the hours of the permitted special event to make any and all inspections necessary in x connection with this Special Event. Print name of Owner Signature of Owner _ - Paint u2me of Authorized Person'Representatrve i,rrature ofAathorzed Person,Repieveiitative BEA Wigql ON`XS RF .�RFM ' -" - IJ) 81j'B °T'T`Y�I�F I:I' NG,Cn 1'TIC}NS: 1. By acceptance of this permit, applica-rt agrees to adequately supervise and direct all parking to be on the premises or at another site, and to provide parking assr,tants and any additional traffic controls necessary for this event.P rkinF is stricti 1 rte I Ntdd ot1'.A-Mt T6wn: Cottncy 6� StatdRoads 6r R.idt"`d ` jV ay 2. Traffic control at events for three hundred(300) or more people shall be provided by a qualified traffic controller in accordance with the attached,approved traffic control plan. 3. One "on-premises" sign not larger than six (6) square feet in size may be displayed not longer than thirty (30) days before this event, and removed immediately after the event. Directional parking signs shall be adequately displayed. 4. Applicant indemnifies and holds harmless the Town of Southold from all claims, damages, expenses, suits and losses including but not limited to attorney's fees arising from activities under this permit S. Tent proposals must receive permit approval from the Southold Town Building Inspector before placement on the property and must meet all fire and safety codes. 6. This permit is valid only for the time, date, place and use specified above, and for the designated event. Each additional day will require a separate permit application, fee, and related documents for review,etc.at least CrO,business dav_.. -rior to the scheduled e,- 7. Adequate temporary sanitary facilities must be provided by applicant for this event and applicant agrees to remove the temporary facilities from the premises within 48 hours after the day of the event. Updated 8/7/2018 S. On-site food preparation is NOT pennitted, although food may be catered subject to all Suffolk County Department of Health regulations. 9 NO-ictivides asso6ate,¢_wiffi,thik event.,ineludirtt_but not limited toap_rking_ ingressfogress/access. e t(s) or tem alp t e-s : r tt? �orat_ sa 't at f< ilii s� s 1 e.c ndueted�o ' w .o:'s ou�in d Pmrchase of Devel'Qmutli�ht_,land, 10 -NO activities associated with this evint..ificluding but"rtnt limited to ptirkin , in ros_sic ri✓ssla d s tent's or ora, t e s1 r,tem oto. rite f c' iii ' 11 :6ndiict d oii S ff 11: ' a iniv ' -chase, of Development Rights land without a pem it issued bar the Suffolk County F 7t�tatt' Somvizi tt 11. Issuance of this permit does not authorize in any manner the occupancy of any building exceeding the legal limitations under the fire code or other codes which would prohibit such increased occupancy. 12. Access shall be provided for emergency vehicles, to all public assembly areas, all buildings, all work areas and any additional area where emergencies may occur. Two emergency-fixe exits and exit paths from the building(s) on the property, to a public way or remote safe area, shall retrain open and unobstructed at all times. 13. Owner assures full compliance with all fire,safety,building;and other Town laws. 14. Music;ti=.-hen outdoors,is requited to stop at the time specified in the permit.Placement of the speakers n.ust be to a location that affords the greatest protection from noise intrusion upon adjacent properties. 15. Owner will allow access to Code Enforcement Personnel of the Town of Southold during the hours of the special event to make any and all inspections necessary in connection with this Special Event. 16. ADDITIONAL CONDITIONS.- ANY ONDITIONS:ANY VIOLATIONS IN CONNECTION WITH THE CONDITIONS LISTED HEREIN WILL TER_VLIlVATE THIS PERMIT. APPROVED Town of Southold Resolution Number: _ Date Issued: Updated 8/7/2018 rl,�G,_ S��ie�, � �Uec��►�. _ . WN ,W,50V 100D yxl wnG a.,.^i4nutAl"A"n t . (;lllrc- J J1 N! T^Ai]Y R �,',t ,.r lose_ ..-. �""•'.�--'"" rmxo.-area+'cv�na.Atnpasaswra-{u��ti'aftg i� S. `� �v, L z>u•r. _ rr-,. <- -i k«..+�'�W.-,r-' 1't,,._ �rfrtars�,uk•u�.'rita.11�4sm+r.« tmu �� x cr� - 1 � t d�:C � � FF1WIariaEw.•a`aP�A'G's.�+n^Pav"°m•2r3ss+ imrt s'' .««..7� — r.,nr.t.'1rar.«»uwelm,+l�tcrfkYuutMSiRM{^sem` KEY A44P •�-t tlMtY. ' �..:. - ' a (� 2a. iF7lhn�fl3f�e*tSZP"slkS+r'+t4 AS CONSTRUCTED 2— d PLAN OF • r�' c�.ncrt.nF}4.rmewd w�w4laM wl. t �I PROPERTY � ��� • d z,l a,te crn eacvo AT SOUTHOLD m — C �i 3erhn 2sferttEtaCescu TOWN OF SOUTHOLD SUFFOLK COUNTY,N.Y. A , �tegwre]MCI,2- CM*,b„ 1000-B3-09-2J5 =� N rrawa tPldw+axr.rox'+l..e xen^+zmP•rm«+ L S-A 1"•20' awww woo.— I.fq 6,2009 n E—V 164 d.av'Orafml CceCa l]`J Paldu aµ/+-a,.11f �ppp owTM?VSI .�.—a � r MkA �•n krLl n e �N 1 :P YL w - —JIVI— SIT ttl1 Ul Rln .��s ttLVUYad IPSIi!15'+13x6 tioi veA tV .•HMil L.«� ��� Y+•* �n,�`n f � � F uvWYl/i110 roc14 1}frMtlKp9wJl�c159I n1 NX .#„-• nt Sf \'1 -•-A•! G{.•(F.7F�}X.'}yRdcW rtes,Pmm +tIl+al.a *. . •� �ydrrr cc;re.kt TIM Proa cnrr><a r fRl � ;ar �: ..--�''.t�\ ,\i Mµ�ron.�wLn•+r'a�euk �..wu e�r1°°riis aw:oarw' 7 C•w I"In"rC" � w. � "^ `�. ,� ` u�iiLO+n.:inu 1 I DEPARTMENT OFFICE FILE r^`•.,.A 1' a -'C ... �t✓.'IY, t 4 INM Y��'7�'�^'� ..a•^ gyp' R&D AREA=10807aerea 88 - 674 � NNP! ,.--'----•,m,��1-sy `���..� � e�� � ,/o' H,. ��'cp�UitiOU.NY. •_""';,�, .�Sd:.^C�3.i'_ NI:.+F Dl I:TC. � -✓.:llv(^-t3r11r>� S, l A5E%n11T�nS�.r� a`i�rrF 1 ..f - all za5- .t WwaaLCMLuj.taa!«s+srm.4flIll33YX+F�'a'm" �'r h` �a }#..S��.Y»}�JTwItRYdsiFT.t_{Ry rtnR'�r•r'rre�� ` FT I �' ,v;:✓ ai �Y1}'fscalaaSatK6eHeS��{t.rlil;a.ler«,t�G"J-v ,[Sannl.esR'serar 'x^s'l.aa eWtareff, Bvx .ticc, z � .�� q...+*r �`-•"" i uxzvlzem�:ktikl�.ax� , KEY MAP v .-yh; ^.• • F260 so ,:t e ! a<r>+"1 /.,•..1 � .��1� t�'� aUnpircnr'MP. AS CONSTRUCTED 9 m•.` PLAN OF k�;�nu�at�l'n.It�Mruo••+*�,Yr�raM KaJmn T.1.1}�u r. ��� � ��- �r•M, PROPERTY ani vn's,..-... _ y, '•<'^ nx,fu crn uno cwr .�? 4 NB ^--r"•`"'"t�- N c„mt,ra fxm ,utorru a fntLL ,+' �W 1 r �,,- �•"tom'^''"""`� r4� !"a ^� EYr'�GCVISF�`:nL�1'+nJ4 U[i�r'N AT SOUTHOLD TOWN OF SOUTHOLD { ° ¢• { r<9ua * SUFFOLK COUNTY,N.Y. t t4_ - ?;, nco�e,u3•lnc::. tMe9•n rNv 7000-69-09-'21.5 I 1 �f � ;—�,�•� «i �1,�?; w ea;ivn filntxi ean,s�ut�r-f w.i ter. s� I".10 �+y -L r L•.n # .`'�,e+ns n. lu iur mlm-ur;rwi c.c9-:.x'nvt„1 ua,f7 8aR7 i�agr•nar,r , jt v:ergv eek-x+ernen _.r.{•-- �,i � y 'u!•'srF`F i _ t.c,va ova+. eM1�.eon c�nrs nrau i � � :N�Yi4 L.. v �i: ��'1, � m 5 •,y.:�uyt<3}fOkd a'a:2lwiAn9 axAair l+t•<i , �,• "�.r°,'.,.,; •y w;� �5znt}ti��t`''sr, auaa'� l..n,u. • �p i '=,k` '•4" x(i4'X'�*'(4Nlin"F -fvetrkv auYMn . ••s"r' .� `�.�-l�f"�a r°` r^'019r.0lUNPrair' }ekStniMAi%�Y pt L c a � T er,wra r�sren,s'r`�- n.rr_ n a KY` y 'Ar'. « ,�_ � � �- r,;..•-�_"'""' f `� pEPARTtJENTOFFICE FILE _ .- ,.y .p n��� 'w}s+i,.• ,ra r-^^-.� "`,+,yt ri inb�}�y'aj�_��`,r, ,*%.=�i'`"w� ¢Fl ,{ •^'_--""."� =..��:.;��` iF_4;�e-^�.r.�m�.r.nw^,„,sln'r'r" (:i�' �.�.11"Yl:�'l::rt.""",i*,.fi'l+"i."3�.,+,,.�w ��";`a�',s%'� AREA-1BBDiacrea M„»,Yy�r ti�m,l...t.w•uw..�- v�•r ''���rc�r+���ir`ht__, S4;.y-rn 674 ' C�� 5722MAI-01 MLEONE ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/24/2021 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 CONTACT NAME E.B.Cohen&Associates Assurance Agency,LLC PHONE,Ext):(973)403-9500 FAX No):(973)403-7755 101 Eisenhower Parkway Roseland,NJ 07068 aDDRIEss:info@COheninS.COm INSURERS AFFORDING COVERAGE NAIC# INSURER A:Westchester Surplus Lines Ins. INSURED INSURER B:Merchants Mutual Insurance Co. 23329 57225 Main Road Restaurant LLC INSURER C•Hartford Accident&Indemnity 22357 515 West 20th Street,4E INSURER D New York,NY 10011 INSURER E 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 POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE ADDL SUBR .POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR G71807952 001 5/18/2021 5/18/2022 DAMAGE TO RENTED 50,000 X PRE ISE Ea occurrence $ X Liquor-$1M/$1M MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICYPRO- LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER $ A AUTOMOBILE LIABILITY Ea MBI COINED SINGLE LIMIT $ 1,000,000 ANY AUTO G71807952 001 5/18/2021 5/18/2022 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED X NON-OSWNED PROPERTY DAMAGE AUTOS ONLY AUTOa OONLY Per acadent $ $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 EXCESS LIAB CLAIMS-MADE EXL0001916 5/28/2021 5/28/2022 AGGREGATE $ DED RETENTION$ I Aggregate $ 5,000,000 C WORKERS COMPENSATION XEROTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 13WECAG2P5V 5/18/2021 5/18/2022 1,000,000 OFFICERIMEMBER EXCLUDED'? ❑ NIA E L EACH ACCIDENT $ (Mandatory in NH) E L DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Town of Southold is Additional Insured,when required in written contract or agreement,as per form number CG 20 43 12 19,as respects work performed by Named Insured at 57255 Main Road,Southold,NY,for events held on October 2nd,2021 and October 30th,2021. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Town Route h ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ES Cohg By /�[ � 5 V P ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Gravel Paiking Lawn 3`I 4' 38'3" x 422 Gravel Paibn/ z : . \ - . 7`14` Restaurant / \ ;� Main Road - ,a§_t< Mirabelli, Melissa From: Lanza, Heather Sent: Thursday, September 23, 2021 2:53 PM To: Mirabelli, Melissa; Duffy, Bill;Verity, Mike;Weisman, Leslie; Flatley, Martin; Noncarrow, Denis Subject: RE: RUSH - Late Applicant.. I looked up whether there is a site plan showing how much parking they have, but this must be an old site because I didn't see a site plan. Can we please have the dimensions of the parking areas? In a quick measure on the aerial I think they can accommodate about 40 cars or so. If everyone wants to approve it without that, maybe add a condition that they can't use Route 25 for parking or loading (cars go fast here and there is a hill and a curve). From: Mirabelli, Melissa Sent:Thursday,September 23, 20212:14 PM To: Duffy, Bill <billd@southoldtownny.gov>;Verity, Mike<Mike.Verity@town.southold.ny.us>;Weisman, Leslie <lesliew@town.southold.ny.us>; Lanza, Heather<heather.lanza@town.southoId.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Noncarrow, Denis<denisn@southoldtownny.gov> Subject: RUSH- Late Applicant .. Hello All, This just came in I clarified they are ending at 11PM she did pay the late fee for this application as the one wedding is listed for 10/2/2021 next week. Please let me know comments.Thank you Melissa iiAl. Mirabelli Secretary to the Town Attorney Town of Southold Southold Town Hall Annex 54375 Route 25 (Main RD) P.O. Box 1179 Southold,NY 11971 Office (631) 765-1939 Fax(631)765-6639 ******************************************************************************************* This electronic mail transmission may contain confidential or-privileged information. If you believe that you have received the message in error, please notify the sender by reply transmission and delete the message without copying or disclosing it. ******************************************************************************************* 1 Mirabelli, Melissa From: Easton,James Sent: Thursday, September 23, 2021 3:07 PM To: Mirabelli, Melissa Subject: RE: RUSH North Fork Table Special Event No objections James Easton Fire Marshal,Town of Southold ©4oSufFotk�Q JarrresE(acz�southoldtownnv.gov (LTJ)631-765-1802 �+ w PRIVELECED AND CONFIDENT14L COA1 JUNICATION CONFIDENTIALITY NOTICE: This electronic mail transmission is intended only for the use of the individual or entity to which it is addressed and may contain confidential information belonging to the sender which is protected by privilege. ff you are not the intended recipient,you are hereby notified that any disclosure, copying distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this transmission in error,please notify the sender immediately by e-mail and delete the original message From: Mirabelli, Melissa<melissam@southoldtownny.gov> Sent:Thursday,September 23,20212:16 PM To: Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Easton,James<jamese@southoldtownny.gov>; Glew, Claire <Claire.Glew@town.southold.ny.us>;Webster, Kevin<kevin.webster@town.southold.ny.us> Cc: Ruckdeschel,August<August.Ruckdeschel@suffolkcountyny.gov>;Amakawa,Andrew <Andrew.Amakawa@suffolkcountyny.gov>;Allegue, Lauren <Lauren.Allegue@suffolkcountyny.gov> Subject: RUSH North Fork Table Special Event Please send me comments this one is a small rush as they are hoping to be approved for a wedding 10/2 next weekend. They have paid the late application fee and I clarified the Weddings both end at 11PM `114 Melissa M Mirabelli Secretary to the Town Attorney Town of Southold Southold Town Hall Annex 54375 Route 25 (Main RD) P.O. Box 1179 Southold,NY 11971 Office (631) 765-1939 Fax(631)765-6639 ******************************************************************************************* This electronic mail transmission may contain confidential or privileged information. If you believe that you have received the message in error, please notify the sender by reply transmission and delete the message without copying or disclosing it. ******************************************************************************************* 1 Mirabelli, Melissa From: Webster, Kevin Sent: Thursday, September 23, 2021 4:29 PM To: Mirabelli, Melissa Subject: RE: RUSH North Fork Table Special Event There are no exemptions on this property. Kevin From: Mirabelli, Melissa Sent:Thursday,September 23, 20212:16 PM To:Spiro, Melissa; Easton,James; Glew, Claire;Webster, Kevin Cc: Ruckdeschel,August;Amakawa,Andrew;Allegue, Lauren Subject: RUSH North Fork Table Special Event Please send me comments this one is a small rush as they are hoping to be approved for a wedding 10/2 next weekend. They have paid the late application fee and I clarified the Weddings both end at 11PM Missy Melissa M. Mirabelli Secretary to the Town Attorney Town of Southold Southold Town Hall Annex 54375 Route 25 ( Main RD) P.O. Box 1179 Southold, NY 11971 Office (631) 765-1939 Fax(631)765-6639 This electronic mail transmission may contain confidential or privileged information. If you believe that you have received the message in error, please notify the sender by reply transmission and delete the message without copying or disclosing it. 1 Mirabelli, Melissa From: Flatley, Martin Sent: Friday, September 24,2021 9:53 AM To: Mirabelli, Melissa Subject: RE: RUSH - Late Applicant.. I'm good with it Missy Sent from my Verizon,Samsung Galaxy smartphone --------Original message-------- From: "Mirabelli, Melissa"<melissam@southoldtownny.gov> Date: 9/24/219:28 AM (GMT-05:00) To: "Flatley, Martin" <mflatley@town.southold.ny.us> Subject: RE: RUSH - Late Applicant.. No problem Chief! Good news is most people are coming in by hotel shuttles from riverhead.Also they took over the lease of the place next door so they have over flow parking but she said at max 25-30 cars they have 40 parking spots on site without counting the overflow next door. Safe travels today Chief! Have wonderful weekend too!! '2 Melissa M. Afirabelli Secretary to the Town Attorney Town of Southold Southold Town Hall Annex 54375 Route 25 (Main RD) P.O. Box 1179 Southold,NY 11971 Office(631) 765-1939 Fax(631)765-6639 This electronic mail transmission may contain confidential or privileged information.If you believe that you have received the message in error,please notify the sender by reply transmission and delete the message without copying or disclosing it. ******************************************************************************************* From: Flatley, Martin<mflatley@town.southold.ny.us> Sent: Friday,September 24, 20219:23 AM To: Mirabelli, Melissa <melissam@southoldtownny.gov>; Duffy, Bill<billd@southoldtownny.gov>;Verity, Mike <Mike.Verity@town.southold.ny.us>;Weisman, Leslie<lesliew@town.southold.ny.us>; Lanza, Heather 1 <heather.lanza@town.southold.ny.us>; Noncarrow, Denis<denisn@southoldtownny.gov> Subject: RE: RUSH-Late Applicant .. I agree with the parking requirements on parking. I am traveling and hard to read on phone Sent from my Verizon,Samsung Galaxy smartphone --------Original message-------- From: "Mirabelli, Melissa"<melissam@southoldtownny.gov> Date: 9/23/212:13 PM (GMT-05:00) To: "Duffy, Bill" <biild@southoldtownny.gov>, "Verity, Mike"<Mike.Verity@town.southold.ny.us>, "Weisman, Leslie" <lesliew@town.southold.ny.us>, "Lanza, Heather" <heather.lanza@town.southold.ny.us>, "Flatley, Martin" <mflatley@town.southold.ny.us>, "Noncarrow, Denis" <denisn@southoldtownny.gov> Subject: RUSH- Late Applicant .. Hello All, This just came in I clarified they are ending at 11PM she did pay the late fee for this application as the one wedding is listed for 10/2/2021 next week. Please let me know comments.Thank you Melissa�'1✓I. Mirabelli Secretary to the Town Attorney Town of Southold Southold Town Hall Annex 54375 Route 25 (Main RD) P.O. Box 1179 Southold,NY 11971 Office (631) 765-1939 Fax(631)765-6639 ******************************************************************************************* This electronic mail transmission may contain confidential or privileged information.If you believe that you have received the message in error,please notify the sender by reply transmission and delete the message without copying or disclosing it. 2 Mirabelli, Melissa From: Flatley, Martin Sent: Monday, September 27, 2021 10.20 AM To: Mirabelli, Melissa Subject: RE: COI certificate and parking plan for North Fork Table & Inn My answer remains yes to approving Martin Flatley, Chief of Police Town of Southold Police Department 41405 State Route 25 Peconic, N.Y. 11958 Tel: 631-765-3115 A— 1'�04 The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s)and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient,you are hereby notified that any review,retransmission, conversion to hard copy,copying,reproduction,circulation,publication, dissemination or other use of,or taking of any action, or omission to take action,in reliance upon this communication by persons or entities other than the intended recipient is strictly prohibited If you have received this communication in error,please(q notify us immediately by telephone at 631.765.2600, (ii)return the original message and all copies to us at the address above via the U S Postal Service,and(iii)delete the message and any material attached thereto from any computer, disk drive,diskette, or other storage device or media From: Mirabelli, Melissa<melissam@southoldtownny.gov> Sent: Monday,September 27, 20218:59 AM To: Lanza, Heather<heather.lanza@town.southold.ny.us>;Weisman, Leslie<lesliew@town.southold.ny.us>; Noncarrow, Denis<denisn@southoldtownny.gov>; Flatley, Martin<mflatley@town.southold.ny.us>;Verity, Mike <Mike.Verity@town.southold.ny.us>; Duffy, Bill<billd@southoldtownny.gov> Subject: FW: COI certificate and parking plan for North Fork Table& Inn Good morning all, Attached here is the parking plan for North Fork Table. As always please send me comments lVelissa J/1 Ifirabelli Secretary to the Town Attorney Town of Southold Southold Town Hall Annex 54375 Route 25 (Main RD) P.O. Box 1179 Southold,NY 11971 Office (631) 765-1939 Fax (631)765-6639 ******************************************************************************************* i This electronic mail transmission may contain confidential or privileged information. If you believe that you have received the message in error, please notify the sender by reply transmission and delete the message without copying or disclosing it. ******************************************************************************************* From: Born,Sabrina<sabrina.born@town.southold.nv.us> Sent: Friday, September 24, 20213:59 PM To: Mirabelli, Melissa <melissam@southoldtownny.Rov>; Neville, Elizabeth<E.Neville@town.southold.ny.us>; Noncarrow, Denis<denisn@southoldtownny.Rov>; Norklun, Stacey<Stacey.Norklun@town.southold.ny.us> Subject: FW: COI certificate and parking plan for North Fork Table& Inn Good Afternoon, Please find attached the COI for the North Fork Table & Inn Special Events. Thank you, 5446" awe Deputy Town Clerk Southold Town Clerk's Office 53095 Route 25 P.O. Box 1179 Southold,NY 11971 Ph: 631-765-1800 ext. 1226 Fax: 631-765-6145 From: Brianna Birtles<bbirtles@ifrestaurants.com> Sent: Friday,September 24, 202110:33 AM To: Born,Sabrina<sabrina.born@town.southold.nv.us> Subject: [SPAM] -FW: COI certificate and parking plan for North Fork Table & Inn Hello Sabrina, Thank you for your help yesterday. Attached please find our Certificate of Insurance. Upon review please let me know if you have any questions or concerns. Missy reached out this morning about our parking plan for both events. I've attached a copy(with dimensions)of the restaurant's current parking. We have marked 40 parking spots but can easily fit more. 10/2/21 110 Guests Parking Plan: Majority of guests will be arriving via a 75 person passenger coach. Remaining guests will park in the NFTI parking lot. We will have a valet to assist with parking. **If necessary we also have an overflow parking lot located at the Southold Venue (previously) Caci we have currently leased located at 10/30/21 80 Guests Parking Plan: Brides have arranged for the majority of guests to arrive via uber/car service. Remaining (estimated max of 30 cars)will park in the NFTI parking lot or if need be utilize the overflow lot at Southold Venue. Valet will also be present for this event. 2 Upon,review please let me know if anyone has questions or concerns. Thank you again for your assistance! Brianna From: Matthew Leone <Matthew Leone@cohenins.com> Date: Friday, September 24, 2021 at 7:57 AM To: Brianna Birtles<bbirtles@ifrestaurants.com> Subject: RE: COI certificate Brianna, Attached is a copy of the certificate of insurance for the Town of Southold. Note that the town did not include their address on the permit application so I used the one I found on their website. If they have any questions or require revisions, please let me know. Matt Matthew A. Leone I Vice President E.B. Cohen I Insurance& Risk Management D: (973) 287-52611 M: (201) 230-7393 1 T: (973) 403-9500 www.cohenins.com I matthew leone@cohenins.com From: Brianna Birtles<bbirtles@ifrestaurants.com> Sent:Thursday,September 23, 20212:45 PM To: Matthew Leone<Matthew Leone@cohenins.com> Subject: Re: COI certificate Hello Matt, I'm including a copy of their special events permit here for your review. Confirming that both events will take place at NFTI. Event dates are 10/2/21 and 10/30/21 Let me know if you have any questions. Brianna From: Matthew Leone <Matthew Leone@cohenins.com> Date: Thursday, September 23, 2021 at 2:17 PM To: Brianna Birtles <bbirtles@ifrestaurants.com> Subject: RE: COI certificate 3 Brianna, Did the town share the specific insurance requirements? If so, please send my way so I can review. Also,to confirm,the events will take place on-site at NFTI and not at a third party location, correct? Lastly, please confirm the dates of the events so we can include on the COI. Matt Matthew A. Leone I Vice President E.B.Cohen I Insurance & Risk Management D: (973) 287-52611 M: (201) 230-7393 1 T: (973)403-9500 www.cohenins.com I matthew leone@cohenins.com k4 From: Brianna Birtles<bbirtles@ifrestaurants.com> Sent:Thursday,September 23, 202111:54 AM To: Matthew Leone<Matthew Leone@cohenins.com> Subject: Re: COI certificate Hello Matt, - I applied for(2) special event permits today for weddings taking place here at NFTI this October. The town requires an updated COI with $2M in coverage naming the Town of Southold. Could you please update and send my way? Thank you and let me know if you have any questions. Brianna From: Matthew Leone <Matthew Leone@cohenins.com> Date: Thursday, September 2, 2021 at 5:35 PM To: Brianna Birtles<bbirtles@ifrestaurants.com> Subject: RE: COI certificate Brianna, Attached is a copy of the certificate of insurance. After reviewing, please let me know if you have any questions. Matt Matthew A. Leone I Vice President E.B.Cohen I Insurance & Risk Management D: (973) 287-52611 M: (201) 230-7393 1 T: (973) 403-9500 www.cohenins.com I matthew leone@cohenins.com 4 Front: Brianna Birtles<bbirtles@ifrestaurants.com> Sent:Thursday,September 2, 20212:35 PM To: Matthew Leone<Matthew Leone@cohenins.com> Subject: Re: COI certificate Hello Matt, Following upon our conversation earlier this week. I have several vendors requiring a COI in order to move forward with our 9/11 event. Would you be able to provide this to me by EOD today? Thank you! Brianna From: Brianna Birtles<bbirtles@ifrestaurants.com> Date: Wednesday, August 18, 2021 at 2:51 PM To: Nicolas G <nicolas@ifrestaurants.com>, Matthew Leone <Matthew Leone@cohenins.com> Subject: Re: COI certificate Hello Matt, Following up on the below request. Are you able to assist or is there someone else that I should follow up with? Thank you. Brianna From: Brianna Birtles<bbirtles@ifrestaurants.com> Date: Thursday, August 5, 2021 at 3:31 PM To: Nicolas G <nicolas@ifrestaurants.com>, Matthew Leone <Matthew Leone@cohenins.com> Subject: Re: COI certificate Thank you both! Matt—Is there any additional information that you need from me in order to move forward? We're now a month away from the event and the Planner is getting anxious. Brianna From: Nicolas G <nicolas@ifrestaurants.com> Date: Monday, August 2, 2021 at 11:08 AM To: Matthew Leone <Matthew Leone@cohenins.com> Cc: Brianna Birtles<bbirtles@ifrestaurants.com> Subject: COI certificate Hi Matt, Hope all is well. Can you please be in touch with Brianna re: COI for the event attached? Thanks 5 x Nicolas Geeraerts VP Operations I JF Restaurants P.646-315-4741 E:nicolas@jfrestaurants.com www jfregaurants Conl 6 Mirabelli, Melissa From: Glew, Claire Sent: Monday, September 27, 2021 7:36 AM To: Mirabelli, Melissa Cc: Webster, Kevin Subject: RE: RUSH North Fork Table Special Event Hi Missy, There are no exemptions on this property. Clair-ems(�iew Assistant to Assessor Town of Southold Board of Assessors (631)765-1937 Phone (631)765-1356 Fax www.southoldtownnV.gov claireg@southoldtownnV.Rov From: Mirabelli, Melissa<melissam@southoldtownny.gov> Sent:Thursday,September 23,20212:16 PM To: Spiro, Melissa<Melissa.Spiro@town.southold.ny.us>; Easton,James<jamese@southoldtownny.gov>;Glew, Claire <Claire.Glew@town.southold.ny.us>;Webster, Kevin<kevin.webster@town.southold.ny.us> Cc: Ruckdeschel,August<August.Ruckdeschel@suffolkcountyny.gov>;Amakawa,Andrew <Andrew.Amakawa@suffolkcountyny.gov>; Allegue, Lauren <Lauren.Allegue@suffolkcountyny.gov> Subject: RUSH North Fork Table Special Event Please send me comments this one is a small rush as they are hoping to be approved for a wedding 10/2 next weekend. They have paid the late application fee and I clarified the Weddings both end at 11PM .41e1issa IV 1. 14firabelli Secretary to the Town Attorney Town of Southold Southold Town Hall Annex 54375 Route 25 (Main RD) P.O. Box 1179 Southold,NY 11971 Office (631) 765-1939 Fax(631)765-6639 i This electronic mail transmission may contain confidential or privileged information. If you believe that you have received the message in error, please notify the sender by reply transmission and delete the message without copying or disclosing it. ******************************************************************************************* z RESOLUTION 2021-772 ADOPTED DOC ID: 17424 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2021-772 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON OCTOBER 5, 2021: RESOLVED that the Town Board of the Town of Southold hereby grants permission to North Fork Table and Inn,to hold Special Event 2021-50 at North Fork Table and Inn, 57225 Main RD, Southold,New York as applied for in Application NFTa-b for Weddings on October 2, 2021 and October 30, 2021 from 12PM to 11 PM. The conditions of approval are as follow: All parking must be contained on site; no parking on Route 25, and no standing, loading oading or unloading of vehicles on Route 25. Provided they adhere to all conditions on the application and permit and to the Town of Southold Policy for Special Events and subject to the applicant's compliance with all executive orders of the State of New York. This permit is subject to revocation if the applicant fails to comply with any of the conditions of the approval or is unable to properly control traffic flow into and out of the event. qoe6 & Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: James Dinizio Jr, Councilman SECONDER:Jill Doherty, Councilwoman AYES: Nappa, Dinizio Jr, Doherty, Ghosio, Evans, Russell NFT vb RI sn E—WD TV Cda SEP 2 3 2021 %vSouthold Town Cfe,rX TOWN OF SOUTHOLD Town Code Chapter 205 "Public Entertainment and Special Events" SPECIAL EVENT PERMIT INSTRUCTIONS AND APPLICATION FORM Applications for a Special Event Permit are subject to an inter-departmental coordinated review by the Southold Town Board,Town Attorney,Town Assessors,Land Preservation,Building,Planning,Zoning Board of Appeals and Police Departments,and the Suffolk County Planning Commission. Application fee. $150.00 per application. Up to six (6) multiple events of the same type, occurring over a period of three months,may be permitted on one(1)application for a fee of$150.00. However, specific details of each event must be included with this application. All applications must be submitted at least 60 business days before the event. Applicants are encouraged to submit applications as early as possible. Any completed application that is not submitted 60 or more business days prior to the scheduled event may be rejected or subject to a late processing fee of$250.00 by the Office of the Town Clerk, unless a waiver is obtained. Requesting an expedited review must be submitted in writing to the Town Cleric. The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health,safety,and welfare of the community. When is a Permit Required? All Special Events,per Southold Town Code Article I, Section 205-2(Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. Any use of residential property for profit, such as a venue for weddings or other events is prohibited. This application is deemed complete once all the following requirements are submitted to the Town Clerk. Please indicate submission of the following by checking off the boxes and signing below. A completed application form signed by the owner- and the event manager. Applications without property owner's signature/approval will be rejected. FEE: Is the application being submitted at least 60 days before the event[ ] Yes [ ]No El If Yes,Fee of$ has been submitted f 150 a p1I.G pet- ® 00 s a5o L�h" If No,Fee of$ has been submitted JN* 1;10T Updated 8/7/2018 The applicant/owner of the property where the special event is proposed to take place must provide a certificate of insurance not less than 2 million dollars naming the Town of Southold as an additional insured A Parking/Event Plan: consisting of a survey, site plan and/or aerial view of the subject property that includes the locations of on-site parking, sanitary facilities, and tents or other-temporary structure(s). (See application form for details) Events for three hundred (300) or more people require submission and approval of a traffic control plan acceptable to the Town of Southold AND a qualified traffic controller must be provided at the event. (See application form for details) Signature of Property Owner on the application authorizing Code Enforcement Personnel of the Town of Southold to enter the subject premises during the hours of the event to ensure compliance with any and all special event permit conditions. My signature below affrnms that I have submitted all the information required above in connection with my application. Da ed Signature Activities associated with outdoor public events are strictly prohibited from taking place on land preserved through the sale of development rights to the Town of Southold,and can only take place on land preserved through the sale of development rights to the County of Suffolk with a permit issued by the Suffolk County Farmland Committee. If food is to be served, it must be catered and prepared off-site by food vendors who hold a permit to operate issued by the Suffolk County Bureau of Public Health Food Protection Unit. Updated 8/7/2018 4FT a--b RE-CEI 2 3 2021 j� Town Clerk APPLICATION FOR A PERMIT TO BOLD A SPECIAL EVENT Please provide ALL of the information requested below Incomplete applications WILL NOT be reviewed. It>6 1� N0Q-R4 Special Event Permit# Applicant(s)name:57-7-Z,�-MMIq Date of Submission C Z Name of E�ent �� - e ll SCTM#'s 1000-Section Block-` 3 Lots) a Dates of Each Event: If Multiple Dates are requested,applicant Imust give all information for all dates. I Nature of Event: l , - e i'1` V- kQ -e-1 T( (Please attach a detailed description of EAC ,ent to us application) r Time Period(Hours) of Event: From 'Z--nm to l m Town Services requested: ( ) Yes AA No If yes,Describe Police Dept._Highway Dept. Describe Services MaximumNumber of Persons Attending At One Time: \ O Number of cars expected P3 Is a Tit or oth`r tenv iporar' stnrctNt`ue emg u� d� [ 1© �No If yes provide size(s) Will food be served? [ Yes [ ]No If yes provide number and name(s) of food vendar(s) �JfAfl+ � Vv�j Updated 8/712018 �LG -f r�` " Suffolk County permit#(s) 1 ©C)C)� 5,21 Will other vendors be on the premises during the event? / ]Yesn[ ]No If yes how many? 1 Describe Type of vendor(s) Property Owner(name/address): INDQZl -Pzt- Dwj 'k- mq� C3-7 2? — M Pok 9^0 Contact Person and Contact Tel.# C'Jr2lGl(lY �l Y�l�� (0-2 e-mail address � � U�e�EJ\ 11U�� Event Location Street-Hamlet Address- s 1�a v tL—, 5 CTM# Mailing Address to Send Event Permit to:��`Z- Y Y 1 t�-lyt fiave any of the development rights been sold to the Town of Southold[ ] Yes C]No and/or Suffolk County Agricultural Program? [ ] Yes 04 No If ves to either or both, also indicate on the attached plan the boundaries of the reserved area upon which the event will take place. YOU MUST ATTACH A PARKING/EVENT PLAN TO THIS APPLICATION IF THE EXPECTED ATTENDANCE IS 300 OR MORE PEOPLE,YOU MUST ALSO ATTACH A TRAFFIC CONTROL PLAN (see next nage) A_Parking/Event Plan may be a survey,site plan and/or aerial view (for example Google Earth) of the subject property.INDICATE ON THE PLAN ALL of the following information: A parking/event plan showing: (1) The size of the property and its location in relation to abutting streets or highways (2) The size and location of any existing building(s) or structure(s)that will be in operation during the course of the event and any proposed building,structure,or signs to be erected temporarily for the event. (3) The location of the stage or tents;if ariy. (4) The designated areas of use for spectators, exhibitors,vendors, employees and organizers. (5) Location of all entries and exits. (6) The location of all fire extinguishers and other fire safety equipment. (7) The location of all temporary utilities to be installed for the event, if any. (8) The layout of any parking area for automobiles and other vehicles and the means of ingress and egress for such parking areas. The parking spaces must allow for 300 sq. ft. per cat. (9) A traffic control plan for vehicles entering and leaving the site for the proposed event. (10) Plan for the use of live outdoor music, loudspeakers and other sounds which will be used, if any,and the type and location of speakers and other audio equipment. (11) A description of emergency access and facilities related to the event. (12) Provisions to dispose of any garbage,trash,rubbish or other refuse. (13) Location and description of any additional lighting to be utilized in conjunction with the event. Updated 8/7/2018 (14) Location of sanitary facilities on site. Traffic Control Plan Events for three hundred(300) or more people also require submission and approval of a traffic control plan, acceptable to the Town of Southold,AND a qualified traffic controller must be provided.Please attached a written description and/or notate on the parking event plan the following: 1)Who will be conducting traffic,2)Where they will be stationed on site, 3)How they will direct the entrance, circulation,parking, and exiting of cars on site, and 4)Contact information for use by Southold Town Police. OWNER'S SIGNATURE: I am the Owner of the Property where this event is to be held and I agree to comply with the laws, rules,regulations,conditions,and requirements of the Code of the Town of Southold,including but not limited to the conditions listed below,as well as all other applicable agency rules and regulations pertaining to the activities under this event. Furthermore,I hereby swear or affirm that tlae information contained herein and attachments hereto are true and correct to the best of illy knowledge, and agree to provide notice to the Town immediately should there be any material changes regarding to this application. . Furthermore,I hereby authorize Code Enforcement Personnel of the Town of Southold to enter the property during the hours of the permitted special event to make any and all inspections necessary in connection with this Special Event. Print name of Owner Signature of Owner Print name of Authorized PersonlRepresentative ignatare of Authorized Persoa Repiesentative PERMISSION IS HEREBY GRANTED,SUBJECT TO THE FOLLOWING CONDITIONS: 1. By acceptance of this permit; applicant agrees to adequately supervise and direct all parking to be on the premises or at another site, and to provide parking assistants and any additional traffic controls necessary for this event. Parking is strictly prohibited on ANY Town, County or State Roads or Rights of �'Vay. 2. Traffic control at events for three hundred(300) or more people shall be provided by a qualified traffic controller in accordance with the attached,approved traffic control plan. 3. One "on-premises" sign not larger than six (6) square feet in size may be displayed not longer than thirty (30) days before this event, and removed immediately after the event. Directional parking signs shall be adequately displayed. 4 Applicant indemnifies and holds harmless the Town of Southold from all claims, damages, expenses, suits and losses including but not limited to attorney's fees arising from activities under this permit. 5. Tent proposals must receive permit approval from the Southold Town Building Inspector before placement on the property and must meet all fire and safety codes. 6. This permit is valid only for the time, date, place and use specified above, and for the designated event. Each additional day will require a separate permit application, fee, and related documents for review,etc. at least 60 business days prior to the scheduled event. 7. Adequate temporary sanitary facilities must be provided by applicant for this event and applicant agrees to remove the temporary facilities from the premises within 48 hours after the day of the event. Updated 8/7/2018 8. On-site food preparation is NOT permitted, although food may be catered subject to all Suffolk County Department of Health regulations. 9. NO activities associated with this event, including but not limited to parking, ingress/egress/access, tent sl or temporary structure(s), or temporary sanitary facilities, shall be conducted on Town of Southold Purchase of Development Rights land. 10. NO activities associated with this event, including but not limited to narking, ingress/egress/access, tent sl or temporary structure(s) or temporary sanitary facilities, shall be conducted on Suffolk County Purchase of Development Rights land without a permit issued by the Suffolk County Farmland Committee. 11. Issuance of this permit does not authorize in any manner the occupancy of any building exceeding the legal limitations under the fire code or other codes which would prohibit such increased occupancy. 12. Access shall be provided for emergency vehicles, to all public assembly areas, all buildings, all work areas and any additional area where emergencies may occur. Two emergency-fire exits and exit paths from the building(s) on the property, to a public way or remote safe area, shall remain open and unobstructed at all times. 13. Owner assures full compliance with all fire,safety,building, and other Town laws. 14. Music,when outdoors, is required to stop at the time specified in the permit.Placement of the speakers must be in a location that affords the greatest protection from noise intrusion upon adjacent properties. 15. Owner will allow access to Code Enforcement Personnel of the Town of Southold during the hours of the special event to make any and all inspections necessary in connection with this Special Event. 16. ADDITIONAL CONDITIONS: ANY VIOLATIONS IN CONNECTION WITH THE CONDITIONS LISTED HEREIN WILL TERMINATE THIS PERMIT. 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".._, = 1-----..-�"-` "��gip° �g•R"2 - • --------- ����=-m -�'� _ _�T�i:� '"""a ��".`o.d;"r!"��ta"�1�,ar".'F"w, �h;•,v_,;aj/i` • - =-w ROAD• met° Na,9 ---�- - -- --- A�� AREAn70901acren ,�w �r ,•r l•EgX+c mss, P 0.80X 909 sOUTYIXD�`�5i1EEr 1B8 - 674 - -- - - t ---^- - e -- spa\ I• G�. t,lr - -- --- — -- -- e k n ��_ Town of Southold P0Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 09/23/21 Receipt#: 287168 Quantity Transactions Reference Subtotal 1 Event Fee NFTa-b $150.00 1 Late Fee NFTa-b Late $250.00 Total Paid: $400.00 Notes: Payment Type Amount Paid By CK#1207 $400.00 North, Fork Table And Inn Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: North, Fork Table And Inn 57225 Main Road Southold, NY 11971 Clerk ID: SABRINA Internal ID NFTa-b Late Born, Sabrina From: Born, Sabrina Sent: Thursday, September 23, 2021 12:00 PM To: Mirabelli, Melissa; Neville, Elizabeth; Noncarrow, Denis; Norklun, Stacey Subject: Special Event-NFTa-b Attachments: SE-NFTa-b_2021092312003S.pdf Good Afternoon, Please see the attached special event application from North Fork Table and Inn received today, Sept. 23, 2021. They are missing their COI; Brianna said she had to get in touch with her ins. co. so that they can add the Town of Southold and she'll either email it to me or drop it off at some point today. I'll forward it as soon as I receive it. Thank you, Deputy Town Clerk Southold Town Clerk's Office 53095 Route 25 P.O. Box 1179 Southold,NY 11971 Ph: 631-765-1800 ext. 1226 Fax: 631-765-6145 1