Loading...
HomeMy WebLinkAboutThe Zoom Zoom Drive in Movie Night y) 1 9. Of Fat& RECEIVED DEC 14 2021 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$250.00 by the Office of the Town Clerk, unless a waiver is obtained. Requesting an expedited review must be submitted in writing to the Town Clerk.The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health,safety,and welfare of the community. When is a Permit Required? All Special Events,per Southold Town Code Article I, Section 205-2(Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. Any use of residential propea for profit, such as a venue for weddings or other events is prohibited. This application is deemed_complete once all the following requirements are submitted to the Town Clerk, Please indicate submission of the following by checking off the boxes and signing below. ® A completed application form signed by the owner and the event manager. Applications without property owner's signature/approval will be rejected. ® FEE. Is the application being submitted at least 60 days before the event[ ]Yes [X]No If Yes,Fee of$ has been submitted FXI If No,Fee of$ $250.00 has been submitted 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 0 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 1m acceptable to the Town of Southold AND a qualified traffic controller must be provided at the event.(See application form for details) 0 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. 12/14/2021 Dated 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 APPLICATION FOR A PERMIT TO HOLD A SPECIAL EVENT Please provide ALL of the information requested below.Incomplete applications WILL NOT be reviewed. Special Event Permit# Applicant(s)name: Erik Warner Date of Submission 12/14/2021 Name of Event "The Zoom Zoom" Drive In Movie Night SCTM#'s 1000-Section 473889 Block- 44. Lots)-4-5.1 School Code:239 Dates of Each Event: 12/17/2021 2/12/2021 If Multiple Dates are requested,applicant must give all information for all dates. Nature of Event: The Zoom Zoom Drive In Movie presented by The Halyard Restaurant at Sound View Greenport (Please attach a detailed description of EACH event to this application) Time Period(Hours)of Event: From 6:00pm to 9:30pm Town Services requested: ( )Yes (X)No If yes,Describe Police Dept._Highway Dept. Describe Services Maximum Number of Persons Attending At One Time: 20-30pp Number of cars expected 10-16 cars Is a Tent or other temporary structure being used? [ ]Yes [X]No If yes provide size(s) Will food be served?[X ]Yes [ ]No If yes provide number and name(s)of food vendor(s)To Go Food will be Updated 8/7/2018 prepared by the Halyard Restaurant. Suffolk County permit#(s) Will other vendors be on the premises during the event?[ ]Yes [X]No If yes how many? Describe Type of vendor(s) N/A Erik Warner-SV Greenport LLC dba Sound View Greenport Property Owner(name/address): 58855 Route 48 Greenport NY 11944 Contact Person and Contact Tel.# Scott Sumner,Regional General Manager 401-743-2333 e-mail address ssumner@soundviewgreenport.com Event Location:Street-Hamlet Address: 58755 Route 48 Greenport NY 11944-Southside Parking Area SICTNI# SV Greenport LLC dba Sound View Greenport Mailing Address to Send Event Permit to: 58855 Route 48 Greenport NY 11944 Have any of the development rights been sold to the Town of Southold [ ]Yes Lx ]No and/or Suffolk County Agricultural Program? [ ]Yes [X]No 1f yes 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 page) 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 any. (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 car. (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 the information contained herein and attachments hereto are true and correct to the best of my 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 an 'nspections necessary in connection with this Special Event. Erik Warner Print name of Owner Signature of Owner Scott Sumner Print name of Authorized Person/Representative Signature of Authorized Person/Representative 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 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 I 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(s)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 parking, ingress/egress/access, tent(s) or temporary structure(s). or tempora 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. APPROVED Town of Southold Resolution Number: Date Issued: Updated 8/7/2018 m •� 3��s r�T�`t�y�IC�s�,�CAi�9, ►�5il?�.G��� - =''u'1fi�' -' _ HL M -a :.. .. www.soundviewgreenport.com MAKE WAS' FOR THE ZOOM ZOOM SOUND VIEW GREENPORT POPS UP A DRIVE-IN MOVIE, JUST IN TIME FOR THE HOLIDAYS Just in time for the holiday season,Sound View Greenport and Kulture Collective (the cultural arm of the property)premieres a pop-up drive in movie theater which will debut with the Christmas classic film,Die Hard starring Bruce Willis and continue through the winter with on movie per month in February,March and April continuing through the summer season. Starting the program in December was important to Sound View to show support for the community during the holidays and offer entertainment in the form of an old fashioned drive- in with all the nostalgia of days gone by.The award-winning Halyard Restaurant at the Sound View will supply snacks and lite bites-think elevated sliders with all the accoutrements. $25 per car. Gates open at 6:00pm;movie promptly at 7:00pm Directly across from Sound View Greenport,58775 County Road 48,Greenport,NY 11944 For more information,go to www.soundviewgreenport.com;631-477-1910. Parking Event Plan The Zoom Zoom Drive In Movie Presented by The Halyard Restaurant at Sound View Greenport Drive In Movie Dates 12/17/2021 2/12/2022 Location of Drive In:(see diagram showing specifics) Sound View Greenport—Southside Parking Area (On the Tennis& Basketball Court) 57855 Route 48 Greenport NY 11944 Please note that to go food and snacks will be provided from the Halyard Restaurant to guests in their vehicles during the film Location of Exits and Entrances to the event venue: Guest will enter the Drive-in area by way of the main entrance to the Sound View Greenport parking area on the south side of RT 48 across from the main hotel (See diagram for details) Temporary Utilities Only temp utilities will be a small portal generator to power the movie projector.Audio for the film will be provided over AM/FM radio band into individual guest vehicles. First Aid &Fire Extinguisher Attached diagram denotes the location of First and Fire Extinguisher adjacent to the Movie Screen. Layout of Parking Area See attached diagram showing where the guest vehicles will be parked for the Drive-In Movie. Traffic Control Plan We will have a minimum of two hotel staff present at the time of guest arrival to load in and load out guests and coordinate vehicle parking at the drive-in viewing area (see diagram). i Parking Event Plan Emergency Access In the event that access is needed for first responders,the drive in viewing area is easily accessible within 25 feet of the Sound View Greenport parking lot. Waste-Garbage Hotel staff will distribute multiple trash cans around the drive in on the night of the event for access by guests. ex — ound View Greenport-5 55Rt o�Y — _ \�- — -- — — --- o - $•e . . Gxhojv "VT F- Drive G Drive In!Movie_Located on the Southside of Property on Tennfs and Basketball Courts Y Y Y i A i Y Y L` I Y Yom` I Y IY Y t , I Y Y 34 I ACORO® DATE(MMDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F12/14/2021 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 Monique Podvoisky NAME: Beecher Carlson-Atlanta PHONE (860)961-5111 FAX (678)539-4890 !C No. o Ext• AIC No): 6 Concourse Parkway E-MAIL mpodvojsky@beechercarlson com ADDRESS: Suite 2300 INSURER(S)AFFORDING COVERAGE NAIC# Atlanta GA 30328 INSURERA: American Guarantee&Liability 26247 INSURED INSURER B: Zurich American Insurance Co 16535 SV Greenport,LLC INSURERC' 58775 County Rd 48 INSURER D: INSURER E: Greenport NY'11944 INSURERF, COVERAGES CERTIFICATE NUMBER: CL21121465276 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 CONTRACTOR 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 LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MMIDDYNYYY MMEFF DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENT817- CLAIMS-MADE Fx_]OCCUR PREMISES Eaoccu encs $ 1,000,000 MED EXP(Any oneperson) $ 5,000 A Y CP05538317-06 10/01/2021 10/01/2022 -PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $ 3,000,000 POLICY 0PRO X LOC PRODUCTS-COMP/OP AGG $ 3,000,000 JECT OTHER Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ X UMBRELLA LIAB 1,-,el OCCUR EACH OCCURRENCE $ 10,000,000 B EXCESS LIAB CLAIMS-MADE Y UMB5538318-06 10/01/2021 10/01/2022 AGGREGATE $ 10,000,000 DED I I RETENTION$ $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA EL EACH ACCIDENT $ OFFICEWMEMBER EXCLUDED? (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder named as additional insured as required by written contract,for use of parking area on 12/17/21,2/12/22,3/12/22 and 4/20/22 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 Main Rd PO BOX 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ® a ® e a ;s",ra, ":ry;-,:a,s„fk','.a^„`' }-.-e*i�"__` _,•�£91.3�.:":, -,^S,'- _ _ _ _ *„'�”rFa.. __ =.3-Y 3” �,4b'z,¢ +r«7r R�- _ -- _ �:,,,yr'c`-- ","-'�', 'r F,--�k - _ "'�' __- _.""4�.5,awS�"^n�=" 'is" r.t � "'k=^ - "*-';` " \. _ s�;$'i+.e'.''a:;a _ .ax,,e,,s" =.!_iC"+';""- „".?` ,..,'�"" °x SV,`9Gree" ort''LL a r `t, $ 11k'} :,` ^. -._ ,,,rr. »,.w,_ a np �� ,x.�, „�. sE�. ,.Ct�r a ,� h ,�:,._��Ya,���.:'n.' 1Q06;6`99��K»�- -r ' - -- „+a a „ -r__ s. a 'r+_..';Mi,,�+.ir''= - >,r.;.r=`=^ _ -•r'x _ -x�' „�1`�_4� rx.'-,:`'.- '� �';7a, 'tlr,' SVG m e LL3�J`2' ” / � C" .,>„ /.,%li ' ,.,/�r�ct�Or. \��rn�... r/.. ,SL,%../ _;/ �/�">'t,`,`. \".,,'."�t,�_v �S Y�'�a.was% /r / n/� asP'�,� N\e „`\„`�`a,�,'•, a� \�., _ .%/ // / \j:}:. / / ��/ /�� „/ ;TOO I,'n •C�. \�,.- '4 � �d rjjia / . ��///,,�€.";Ft„,'..,•",.,�,” .\, \\`,•. �, ..�,..`,,�`�.,����P s {/ .'�! .'%� '.✓i' �;\-,\h\" \w,s"" �/�///a;,•,;a r, . %,'% �;..j;iii%�"y,{, �,`\ , „//,�` //,`.,/ //.W i//,%�- - - ��\.,\. .�., \a>\»�\Z.."r:h ,4'•sc a!��r .",5.,�� �,/u3,� w���`,.� r,, �/„i.r�/r,�. �s,s / � `''F�"-�',',\.C\a `a. \a,.`�”.r .. ',._�,\4,a".•_ „'� ,s//t r�F. /�,_," �'r,,U�„ �\,\�`�,,v'r ��e-, \3�.\,l.".. . a;r :Jxtr„ -- = q --I Y+b`<^`"'•r� - """�„',� - ,,N'� �"5h-= �.RsF S' R:rA�`�gy _ _ SIR,` ,. °cf=Ea �-and,00 100 Dollars- "a",�. ,��, �_�_�-,.0 =��,e ,�'_�-��4. ��,"��, �°•"�w.- �;z�� °m�.s 3fi irz.., a' ',\M `\� :�3. \ - - - ,.s,,,.,";�.,,",s-- - _°Yr,_s Fes_- ,,�."%'�z2, •'a"i,;t<„ "�'".✓` /'s / ". - \ .F, �\\`_\ .rs�\\,a€a \..a '"`,sit _ - �t^°s=-- , ,� r �if „///>,` \..,\ ,\ <; \\ ."\. "" CheckNo:` ';:,', _a_,AT ,: .?fi/atC/fOUNT .•* =jr- s// /i 'axa"$- \�sr+--"�\ .\`, ,� �. �`\\\mac,",'-- .rte a`r't, _ - si",""''",".'ti,- „s /_ ,.=. Y,\\ -",-, ,,.` r3.. -T'W*=�`�-'°- a, .�, <," ,>°+o-;",:r✓.9�x-"- //W" r✓ /i/'' e, rs,��\\.- a\t \s \\. , Ph.r R`.crgk,, / e. Z — 69`Vt TP2 14 202'1 v 250.00" N„ , x,,, _ _ - _ / \ s".' - �.r<,�. -_ ,W;^'�.,,='4�„a,a <"a.<=„4„• `°�'�" _ t€3'�, t" e� - - - - ?Y-'� °-tet£R -€k ,�`��,:"",_'� _ da>4 - -_ ";S~F' _„�1 �•+x °�,,,""'�`, =Y-:_ ,.x<"�,�.:�:r=`: .-,,,< ��u -<"ys°s t�+r~w�-„z``,:,i 5;xg'.., ,�„.�.�"r-< _ _ , rye,-, % " o< Aj *3'- "s, ""-'i _,* a+_ ^n s "°,c 'r^ `rv','='" '{ _ m ei ~8:V`',.- §s -- g _ `a” �; < � _ "�^,.'a+ "s '-" a_`rrW`',w�+:-`a ` 'e. 3, `a'?':'''--�Aa5-,'a,a':<.,-,fir -,tsaN!, ' W'` +. OaiH �'O"'-'PF/= OUTtiOLD, ,a r . tt;- .,,,,w - T a izZ°°,. , �5© / ✓ �%Y// ,' VKU _ /ry�1.`J�r--su r\,•,``o ,`,c;-+t�`�k-'*�r�•rx� :- - ,� �.'r'`r,g�.•:"`-',.,.n, -- �,+r;,;aa, _,��„ -^x'"�\\ „?. „�. .\ ry "\`,\ „"\ - •\\` ,,,\\ '. x.•`'`>',,`' _-y -5�\ �. `�'., •\, - %�',� - , ,\ �\���.s �E��nn�t,•' ,� -{t*' - - .-.�?=;..Y+-_ _ -- -= - �.rz_�� - _ _ _ �.- - --W�, 4m, - ,'":"�,��•�+_ - - 'r%3°" - '»t-a.�""`_- ,k - - .r: ,,=�.,,3 w.wa�-_„�:,=-- ��^s- ,r - - :>F.e„rr,,; sr,x',� .;���, � .;. �:"� W - x<" -'.tb' ,�,a+=o=" ,r"�,"ti� - =`i'�a:;="�•'�-+ A E I r��e,�__, €E - �� 11' LOO 669110 1:0 2 10000891: 499869644011' 100669 5V Greenport LLC Date Invoice No. Invoice Date Description Amount 12/14/2021 20211214 12/14/2021 Special Event Permit 250.00 �'9 s n •' ---I <� ti 1 j ir! M N J C9 D ^ C i A` W T KTL r-1 GL1 � •J J-.+ � 1 _ .� � 2 M�cD C m X .y •G O J] J r 1 _ y Check 12/14/2021 check 100669 Total 250.00 Date Number ORDER FORM TP1-B (205)979-6123 Town of Southold P0Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 12/14/21 Receipt#: 288472 Quantity Transactions Reference Subtotal 1 Event Fee SV1a $150.00 1 Late Fee sv1 as $250.00 Total Paid: $400.00 Notes: Payment Type Amount Paid By CK#100669 $250.00 SV, Greenport LLC Credit Card-Ref# $150.00 SV, Greenport LLC Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: SV, Greenport LLC 3 Court Street 2nd floor Brooklyn, NY 11231 Clerk ID: LYNDAR Internal ID.svlaa