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1000-31.-3-11.31 12/7/2021
OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex P.O.Box 1179 54375 State Route 25 � � Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY �4' Telephone: 631 765-1938 �a www.southoldtownny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD MEMORANDUM To: Michael J. Verity, Chief Building Inspector From: Heather M. Lanza, AICP, Planning Director � Date: January 25, 2022 Re: Planning Department Report New Cingular Wireless (AT&T) Addition of Generator SCTM#1000-15-3-11.31 Behind the East Marion Fire District at 9425 State Route 25, East Marion The Planning Department has conducted a review of the proposed generator pursuant to §280-74 B.(2), and recommends approval of this application. Town Code §280-70 J (5) states the following: noise from base equipment, including any backup generator, measures less than 45d8 at all adjacent property lines; The new generator will be located within a sound enclosure, which will limit the noise to within the code-required levels. 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Y nl '.n nl I v az ru. a �4k 13NI0V0 0013L 135N30 0O Cd - Aayll 1 1 11 VOLLb A tl 4'1 Id d Q V VL Y 1*fl '�"` C'+ 19+ PJ!'R16C?JfME fN14VVI1 fZd Iq Y f �f Y It r f , m uip'e I mal PI r7 � r r e,n/ o- n xn,u_1j n.%. -'IN 1 - ........... _..._ ....... ....._........ _ ...__ --- .._........ ....... ._._ ._ pe}VM '.nduaao un _. ..... „....... __... _ NpIJ 1/p!N(1WWp 2i3Mpd€....N1N637v- ` 3N!1 3Np T� UI't I'll"I:-IAY16U lNi01 �is da(IU Oslo s, SSne 3ALLV03N 3HL A8 S3SSVd rA 1NVld a3MOd 11 3a3HM MLAA ONnoHo NNWHS 00 I'a01V83N30 1V3H '03NNLL '(1nOS'83dd00 3HL N33M138 HOV3 --'Z# 'ONnow a0d ln0 NOONN,t F ... HHH�MWJ 0/+#�Z�..._.......� lr. , � 0Nf18V0 G, ,ryA HLLN1 511nON00 Z Z \ SN08.VOINHWW00 " L 00W 01 'dN MNil(i l IF swatl v WA%1 v u — ._- aolva3N3s , - 00131 V lydltl .... „_ ..... ...° 1NVld d3MOd .....,., OVd 3138ON00 NO 031V001 a01tl83N30 MNOZ 83MOd ---HVIOd MV 03SOdONd TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 1197 Telephone(631)765-1802 Fax (631)765-9502 hiti)s://www.soiitlioldtow 1w. L,L,fit i4, U 7/—18 Date Recured APPLICATION FOR BUILDING PERMIT For Office Use Only EC E ME PERMIT NO. Building Inspector NOV 19 2021 BUI;DING DEPT TOWN OF SOUT. Ow Date:10/20/2021 -60", N Ilk ff—ME IN k","Offis 1111 Name*.East Marion Fire District SCTM#1000-31-3-11.31 Project Address:9245 Main Road, East Marion Phone#:631,-477-0163 Email:emfdistrict@optonline.net Mailing Address:9245 Main Road East Marion 0-104 N1,1 ,11 A, AM, 777 M 01 JM, ,IN Sm 4 1''[1201 1940,01"111 11111111m� V11 Mill M I M., Name: Patrick O'Rourke c/o Centerline Communications Mailing Address:5550 Merrick Road,"Massapequa., NY 11758 ,Phone#:,516-263-88117 1 1 Emai 1:Patrlic,k(cD-Bren,lna-n,s.hor,el.,com le WvMOM- 7 TH"-�7 'M firer vgly�yyq N I 11 X K 01/11) 01 10 1 ly of M-2 M lymn A i 40111,1#11s) Name:KMB Design Group Mailing Addres-s:.1800 Route 34, Suite.209, Wall, NJ 07719 Phone#:732-280-5623 Email: Name: Mailing Address: Phone#: Email: fR Y-F- f 7 101ES 11P 17/5I", ) jrRINI',,77�f� 77 �,/777 /,�77, E]NewStructure DAddition ElAlteration ORepair ODemolition Estimated Cost of Project: $25,000 _1e(UL XOther Will the lot be re-graded? E]Yes No Will excess fill be removed from premises? E]Yes []No % /r l J� Yr 1 y / 1 !rr / //��� //r.✓/ r , r,,, p�u+'p, uw r R, F rr/iJ 'r ���%�/r�✓b rr/�9 71,S RR" ✓. / lr��✓„ /R% y. f� r N �, A"" l"M.�,IA1& 6R�I; A+ k M1A'RY r r r 1 R � �/ti r f/ /r%/r ur7jN 9 /r r�/rrr/ /�,,r!�%!C(�r�, r r;r,,,(/ fo Existing use of property:FireHouse/Public U01tyCommunlcabonstte Intended use of property:same Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to HB &' R-40 this property? ❑Yes WNo IF YES,PROVIDE A COPY. ✓ - , ,r ,r r r' .� .ti. r%!... r .r ,/....�r 11 .d 77 a oD 0/ !w ., ,,/,,;.. n :.. �,,�,or r V�,��ir,,,9�i'?r',M�,ri,,c :i ,,r,ri, t;.r� ! ,.,,� ,r J,d.,,lv Oyu,,. ✓�, „, ,� r� ,1 ,1, 6, r�i�r , J ��, � it f �' r� ,A,��,.. 1 r'�; f J!d', �wN'r/�'/,1�; rr �"�'. �"V Ir pJ� r J rR irk �/irl 1r �✓'' ,ir, ,�!0, r oar 1. fr' ,� ,i -V,ly rl�'+f ,/'�f,/9✓ r✓rY%fir,�,;;rYjr/?i /�,Y„�r/r/Icr/r�j/„!�al /p/o�/%bl o.,TM'iD r'n;7?,..Id(�O tiRC' 'k rfl,Pi� P "'„ - v� !n, �/fPl r,Y ry I V r.,+T�ll htY,�,ii, G/l v,.. I r � ,V 5 l H )c!t,%, rl,9rry'.1✓,r ri r�i,,,'r, nr;;'i�P,rr grrt :"/ riy I Y/�iYy,ry�'%' ,N'f/ fi. IHp 11.JNA h J v 1rr^'" Yi ror�u er lr i�:.: � t�y//^1� .. Application Submitted By(print name)/' t,,s (' i �,y �f i� ��t IRAuthorized Agent ❑Owner �aM Signature of Appllcant Date: / 100 9_ .. STATE OF NEW YORK) COUNTY OF � ) being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the IN^i o4 C.0 rAM ( ontracto ,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/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this A day of ..:"1 _ Notary P NowV"PWIlk.$tat*of NW y1w, NO. PROPERTY OWNER AUTHORIZATIO ON011fledIn$01A (Where the applicant is not the owner) 0 IC residing at 4245 Main Road, East Marion NY 11939 °krd, b�- FY-k Npk n line Communications LLC do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date 'l � Print Owner's Nam 13 Gl '� 2 TOWN OF SOUTHOLD COUNTY OF SUFFOLK: STATE OF NEW YORK .____-..________..______________..____-___,_.._____..- ,._______..,.______-_,..._.._ _X In the Matter of the Application of New Cingular Wireless PCS, LLC AUTHORIZATION OF OWNER At the premises: East Marion Fire District 9245 Main Road East Marion,NY Section 31, Block 3, Lot 11.31 ..-__..________-_,.___.._..__.._._..________________.._-_-_-w.._____----_....___. _x STATE OF NEW YORK ) ) SS.: COUNTY OF SUFFOLK ) 'tho S eu i 2n being duly sworn, deposes and says: I am the Commissioner of the East Marion Fire District,owner in fee of the premises known as Section 31,Block 3,Lot 11.31 (the"Premises"hereafter),and do hereby authorize New Cingular Wireless, PCS, LLC ('AT&T' hereafter), and its representatives to bring such applications for municipal approvals as may be necessary for constructing or installing on the Premises such antennas,support structures,and related equipment as AT&T may require for the establishment of its public utility wireless telecommunication facility. As such,I will fully cooperate with AT&T and its agents in obtaining any required Approvals. East Marion Fire District By�A Sworn to before me this day of_ � , 2421 ��w � . Mato of,Now Y4* 4- - nTARY P„.,il:1LI" o Workers'YORK Compensation CERTIFICATE OF INSURANCE COVERAGE �� iarr 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 Jacobs Telecommunications,Inc 1000 Wilshire Blvd,Suite 2100 Los Angeles,CA.90017 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.e.,Wrap-Up Policy) or Social Security Number 54375 Route 25,PO Box 1179 22-3514442 Southold,NY 11971 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 Lincoln Life&Annuity Company of New York 54375 Route 25 3b.Policy Number of Entity Listed in Box"1 a" PO Box 1179 Southold,NY 11971 GS4880467229NY -- 3c.Policy effective period - 10/01/2021 to 09/30/2022 4. Policy provides the following benefits: QX 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 referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefifitss insurance coverage as described above. Date Signed 10/28/2021 By r../" 2 wj2l.ClLdByL _ ftnature insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 800-423-2765 Name and Title Statutory Contract Analyst 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 513 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 insurance 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) IrJ i fj / i7i//i ij i / Ir ' C CERTIFICATE OF LIABILITY INSURANCE 10128/202W``�") 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 endorsenae.nt(s). PRODUCER LIC #0437153 1-212-948-1306 .ww CONTACT -.._........... NAME: Marsh Risk & Insurance Services PHONE _ — FAX CIRTS_Support@jacobs.com $Fdl.�.l@s'„.wLxR);,_. ..... ...... ...... ......... ________.............4 L&C.N.gh;.,.,1..212 948 1306 6 MAIL ....... 633 W. Fifth Street ADDFR'A .. ................. ..... IN"+URE'IRjTj AFFORDING f OVE&i,.AG&`. .....NAICd .. ....... ... ........... _... ................_ _.._. ............. Los Angeles, CA 90071 INSURERA: ACE AMER INS CO 22667 .........,. ................---.---- ----------_._-_- _._.._ INSURED INSURER B ........... ....... ............ .. .......____ .....,,..,,.. .........._ -_,........ �, ,,,.,..,,.,, ......-....._,.. Jacobs Telecommunications Inc. '..INSURER C C/O Global Risk Management 1000 Wilshire Blvd., Suite 2100 INSURERD: NSURERE: Los Angeles, CA 90017 INSURERF: wwwwwwww___. COVERAGES CERTIFICATE NUMBER, 63647182 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 O_R_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. .............._ .... _ _..... „_._._............._-_.. .....dACffJL414fi(%..._..-_.. . . .____..__ .........._ ....,.POLIC�YWFF,,,,L.-.POLICY EXP�... ..... ...,. ........-_. w..... .... __. LTR TYPE OF INSURANCE POLICY NUMBER MM/ YYYY jy MyDD/YYj __ LIMITS A COMMERCIAL GENERAL .„,LIABILITY HDO G72493503 07/01/21 07/01/22 �CEaAiCb9rHArO d.C„�CYa-Utp RH RaLaEara�N�C,pgEmr r $ 1,000,000 iTFN CLAIMS-MADE OCCUR q $ 500,000 X ®, CONTRACTUAL LIABILITY MED FXP(Any one per one $ 5 000 PER.�ONALtADVINJURY $ 1,000,000 .. ......._,. ..., . . ... . ..... GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGRE-GATE $ 1,000,000 X POLICY pldkg: ❑ LOC PRODUCTS COMPlOPAC'C' $ 1,000,000 OTHER°. $ A AUTOMOBILE LIABILITY ISA H25545631 07/01/21 07/01/22 tCJI BVNdfN dfdN ILPIMIT $ 1,000,000 tr ng nL_„raflRM ...... .......... X ANY AUTO BODILY INJURY(Per person) $ ._ .._-....,.,,., ........, ..... . ............... OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ ,.,......, HIRED NON-OWNED IAUTOS ONLY AUTO, ONLY _jY tlr r elr ...w •�I�*edh'L HT^�'r)Ap�AfsE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ... EXCESS LIAB CLAIMS MADE AGGREGATE $ _. .. ,.. ...., „_ .. _ ., ... ....„, A tC 11 _ RITENTION$ .-- .. $ WORKERS COMPENSATIONX PERi"J'CFt '� AND EMPLOYERS'LIABILITY YrN WLR C67817540 (ADS) 07/01/21 07/01/22TATI,IT, A ANYPROPRIETOR/PARTNERIEXECUTIVE "' SCF C6781762A (WI) 07/01/21 07/01/22 EL EACH ACCIDENT $ 1 000,000 OFFICE R/MEMBER EXCLUDED? N N/A -- --- - A I(Mandatory inNH) ''WCU C67817588 (OH)* 07/01/21 07/01/22 El DISEASE-EA EMPLOYEE' $ 1,000,000 If yes,describe under ........ _w_ ... ,..,..._.. .. - .,,. ---- ... DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1,000,000 _.--.. ..,. .. .._....................................., -.....,..,,-,_-,-,....._........_.._,... ........,,.,,.,,..............,.......,........... ,.,,.,,.,I ._,..-.,� ,.,.,.,. _.....,-.�........__.�._.._..._ ..u.W,.„„... ...,.,,..,,,,,,. .,.....�,,,...,.. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) PROJECT MGR: Susan Rivells. CONTRACT MGR: Susan Rivells. RE: various projects. CONTRACT END DATE: 7/1/2022. SECTOR: Private. *THE TERMS, CONDITIONS, AND LIMITS PROVIDED UNDER THIS CERTIFICATE OF INSURANCE WILL NOT EXCEED OR BROADEN IN ANY WAY THE TERMS, CONDITIONS, AND LIMITS AGREED TO UNDER THE APPLICABLE CONTRACT.* .... _... ...... _.. .... _.._, _._......_--- CERTIFICATE .,..-.,. _.. HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Route 25 �� ___ _...... ....._.......-,_,.M.,.___-----__. .. AUTHORIZED REPRESENTATIVE PO Box 1179 Socathol.d, NY 1.1971 USA ... ._.._ .. _... _- .. ........... ........... ------._.. _......... O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD nyumdo newgalexy 63647182 NEW YOM Workers' CERTIFICATE OF Board sTA Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE , 1 a.Legal Name&Address of Insured(use street address only) 1b. Business Telephone Number of Insured Jacobs Telecommunications Inc. 213.228.8295 C/O Global Risk Management 1c.NYS Unemployment Insurance Employer Registration Number of 1000 Wilshire Blvd.,Suite 2100 Los Angeles,CA 90017 Insured 45-881150 Work Location of Insured�Onlyrequireditcoueraye is speclfical/v,limiledto 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New Yo,*State,i.e., a Wrap-Up Policy) Number 22-3514442 2.Name and Address of Entity Requesting Proof of Coverage M 3a.Name of Insurance^Carrier_......................._ ... ...m_____w__www www (Entity Being Listed as the Certificate Holder) ACE American Insurance Co. Town of Southold 3b.Policy Number of Entity Listed in Box"1 a" 54375 Route 25 WLR C67817540(AOS) PO Box 1179 Southold,NY 11971 -- 3c.Policy effective period 07/01/2021 to 0 710 1/2 02 2 nµn q^F 3d.The Proprietor,Partners or Executive Officers are ® included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation Insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract Issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: James L.Vogel-Marsh Risk 8 Insurance Services ................... (t'Nri ame of autf mired representative or licensed_._........._... __.-__._-...._......................_, agent of insurance carrier) Approved by: 10/28/2021 —------------- ( _._ .. ..._ ......_ a ;.) (Date) Title: Managing Director Telephone Number of authorized representative or licensed agent of insurance carrier: (213)346-5098 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are„NdT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov 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 ofwater supply and sewerage-disposal(S-4 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. Temporaxy Certificate ofOoc,upancy-Residential$15.00,Commercial$15.00 Date.. New Construction: P rt7'- � g G' - � „ (check one) Location of Property: M Old or Pre-existing Bm6n c ec� House No. Street Hamlet Owner or Owners of Pro e Suffolk County Tax Map No 1000,Section_�_. ._.._ Block. ._ 3 ............__.,Lot Subdivision. ..,..__w Filed MaP•w__ .._ Lot ._.App4cant:______w.. ....... ...... .,_..........._ Permit No...�__... Date of Penrrrt. Health Dept Approval: Underwriters Approval: MM _. __ .. .............. _...M,,,. Planning Board Approval: Request for. Temporary Certificate Final Certificate: (check one) f Fee Submitted:$ Applicant Signature C Centerline Communications LLS 5550 Merrick Road, Suite 302 Massapequa, NY 11758 516-557-2398 Office November 19, 2021 BY HAND Town of Southold Town Hall Southold,NY 11971 RE: New Cingular Wireless PCS, LLC (AT&T)—Building Permit Application AT&T site NYCENY1017 Premises: 9245 Main Road East Marion,NY Section 15, Block 3, Lot 11.31 To whom it may concern: Our office represents New Cingular Wireless PCS, LLC (AT&T) with respect to its Application to modify its existing public utility wireless telecommunication facility at the subject premises.As shown in the plans submitted to the Town, AT&T is adding a natural gas generator inside it's leased premises at the existing facility. With respect to the Building Permit Application, the following are enclosed in this submittal package; 1) Building Permit Application 2) Owners Authorization form 3) Four (4) set of signed and sealed construction drawings, prepared by KMB Design Group and dated 11/17/2021, including site plans and elevations 4) A check for$4,000 (#1221) as a consultant review Escrow fee. 5) Certificates of Insurance from the contractor 6) An application for Certificate of Occupancy form Section 6409 of the Federal Middle Class Tax Relief and Job Creation Act ("Section 6409") was adopted in 2012. Under Section 6409, your city retains discretionary zoning review over the construction of new towers, but simple collocations and/or equipment upgrades at existing telecommunications facilities must be approved, no later than January 18, 2022. The new law provides that: "A State or local government may not deny, and shall approve, any eligible facilities request for a modification of an existing wireless tower or base station that does not substantially change the physical dimensions of such tower or base station." The federal law defines an "eligible facilities request" as "(A) collocation of new transmission e uivrnent;_(B) removal of transmission equipment; or (C) replacement of transmission equipment." Centerline Communications LLS 5550 Merrick Road, Suite 302 Massapequa, NY 11758 516-557-2398 Office Also,the Federal Communications Commission issued a Wireless Infrastructure Report and Order on October 17, 2014 ("FCC Order") which established regulations that clarify and streamline the municipal approval process for eligible facilities requests under Section 6409. A copy of the FCC Order is enclosed herewith. The FCC Order clarifies that municipal review of an eligible facilities request is limited to determining whether the request falls within Section 6409: "a State or local government may require the applicant to provide documentation or information only to the extent reasonably related to determining whether the request meets the requirements of this section [Section 6409]. A State or local government may not require an applicant to submit any other documentation, including but not limited to documentation intended to illustrate the need for such wireless facilities or to justify the business decision to modify such wireless facilities."47 C.F.R. 1.40001(c)(1) The FCC Order also specifies that the term "base station" includes any structure that "supports or houses" communications equipment. Since this structure already supports communications equipment, it is considered a"base station"under Section 6409 AT&T's Application is an Eligible Facilities Request under Section 6409 AT&T's application qualifies as an eligible facilities request under Section 6409 because the proposed installation involves"an existing wireless tower or base station that does not substantially change the physical dimensions of such tower or base station." As shown on the plans prepared by :[FMB Design Group, dated 11/17/2021, AT&T's proposed installation consist principally of the following elements: , Install a Natural Gas Generator inside AT&T's leased premises at the base of the communication tower. Accordingly, AT&T's installation involves the "collocation of new transmission equipment" and that will not increase the height of the tower nor the dimensions of the equipment compound. As a result, the installation "does not substantially change the physical dimensions of such tower or base station." Therefore, these proposed equipment upgrades constitute an "eligible facilities request" under Section 6409, and must be approved. Timeline for Review and Approval We would like to highlight an important timing requirement for processing this application. The FCC Order determined that a municipality must act on an eligible facilities request within sixty (60) days of receiving the application. 47 C.F.R. 1.40001(c)(2) (Emphasis added). (Note, the sixty (60)-day period is also known as the "Shot Clock"). Thus, the city must approve this Centerline Communications LLS 5550 Merrick Road, Suite 302 Massapequa, NY 11758 516-557-2398 Office application within sixty (60) days of its receipt, no later than January 18,2022. The FCC Order provides that upon a municipality's failure to act prior to expiration of the Shot Clock,the"request shall be deemed granted" and AT&T will be legally entitled to proceed with construction. 47 C.F.R. 1.40001(c)(4). Note that the FCC Order does allow the Shot Clock to be tolled if an application is incomplete. However, in order to do so, a municipality must provide written notice that the application is incomplete within thirty (30) days of the submittal. 47 C.F.R. 1.40001(c)(3)(i). The notice must "clearly and specifically" describe the missing documents or information, 47 C.F.R. 1.40001(c)(3)(i), and, as previously mentioned, such documentation must be necessary to the determination of whether the application qualifies as an eligible facilities request. If the municipality requests additional information after the first thirty (30) days have passed, we will still provide any "reasonably related" information allowed under the FCC Order, but the Shot Clock will not be tolled. In light of the foregoing, AT&T respectfully requests that its proposed equipment upgrades be approved. In the meantime, if you have any questions, please feel free to call or email me. Thank you for your cooperation. Sincerely, Patrick O'Rourke Site Acquisition on behalf of AT&T 516-263-8817 Patr c1 1 erna shore r carer