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HomeMy WebLinkAboutDuckwalk Vineyard 2022-41 Southold Town Board - Letter Board Meeting of August 9, 2022 RESOLUTION 2022-657 Item# 5.13 y�oQa + ADOPTED DOC ID: 18314 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2022-657 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON AUGUST 9, 2022: RESOLVED that the Town Board of the Town of Southold hereby grants permission to Christopher Richards to hold Special Event 2022-41 at the Duckwalk Vineyard , 44535 Main RD, Southold,New York as applied for in Application DWV2a-e for Weddings on September 24, October 1, October 8, October 9 and October 22, 2022 from 6PM to 11PM. All parking must be contained on site. Provided they adhere to all conditions on the application, the 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. ell Denis Nonearrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Brian O. Mealy, Councilman SECONDER:Sarah E.Nappa, Councilwoman AYES: Nappa, Doroski, Mealy, Doherty, Evans, Russell Generated August 10, 2022 Page 30 ��\Yl VVV:FH'k ••��G��j� 4,- Office 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: Mr. Denis Noncarrow, Town Clerk From: Melissa Mirabelli Secretary to the Town Attorney Date: August 10, 2022 Subject: Special Events—Duckwalk Vineyard -DWV2a-e With respect to the above-referenced matter, I am enclosing the original application with committee,comments and resolution of Town Board approval of event. If you have any questions regarding the enclosed, please do not hesitate to call me. Thank you. Cc: /Mm Enclosures Special Events Committee Application Summary and Recommendation Application name: MkWOA -ChrtS469b9i -hands Address: �-H585 MadA SOkyjjDbld N�'� IRS Application number: DY401Q,—e Date of Event: Ila i t IO [ to I g t® ( q 4 to IM h°�a Time: (Q PM I — I ' PM t Date Received by Town Clerk: a0ao, Date Received by Committee: �"� �I A6aa Nature of Event (S): Committee Comments Received by: PQQO Melissa Spiro Leslie Weisman Missy Mirabelli Chief Flatley,, -*&tRt -'-de9c*el- County Ardt f+V X Heather Lanza James Easton Mike Verity y+, Claire Glew 94H3uFFq �'ohrt'Btr(t�Q �., , Kevin Webster 1R0No PUPMW 0 $Vv S Committee Recommendation's: Approve as applied Approve with.Additional conditions: Hold Public Hearing Deny Special Event No: Resolution No: Date: A :# JUL 202 UL 1 2 Town Att°meys Office TOWN OF SOUTHOLD To, tle� t i•2i1 ==Ptt Iie Edtertal6meln#And:�eeiiil IiJ eti10 SPECIAL EVENT PERMIT INSTIRUCTIONS 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$150.00. However,specific details of each event must be included with this application. Ail'aofiird inns fid Ubci-°s�hjhi etl ft least.60.thugin6e s days before thigevept..Applicants -ire eneout` ped ti2i l ltln.tt lAC tk' I1S 3 �`ly-gs 9a5s ble. Any c rte &&d nbVRatlqfiAh4t is' iat :"hWtted 6 'or jh6re l3:xsin hvs pri4f t'.6 Itht stb 6 itIe" eve t;rna re'ected nf; t- a is a ceg f Oit ltd tie Effice°:of the'I'glt' lerlr, tt€ale s a� is area ic'iit tairtnd. Requesting an expedited review must be submitted in writing to the Town Clerk.The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health,safety,and welfare of the commmiity. All Special Events,per Southold Town Code Article I, Section 205-2(Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings,,graduations, parties or not-for-profit fundraisers do not require permits. tin ti a of es`.,eritial rodeo ..r fit uch it -a venue fore ddift r:` th r events-`s , hi ited. 61's a .•er! n:`.. :deeined &niplAb 6nO WI-the f TI` t e....iretne &-..,e su :n it ed t4 t to .owe" et^ lease isrilAea�e,G.i1��ssinn offl��fallaw�i. lav chi .n�off tie hai��s'ar6el�l.�sii� Iielcidy . 0 A completed-b}lication-�forttt signed-by the owner and the event manager. Applications without property owner's signature/approval will be rejected. /FEE. Is the application being submitted at least 60 days before the event Yes [ ]No If Yes,Fee of$ has been submitted El If No,Fee of$ 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 6gr06- e of-ibsdraiiee.not less than 2 million dollars naming the-Towh cif Southcold a�ail=add'ctional.. insure .A.ParlciriglEuetitPlan: 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'.cont f 11,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. Dated Signature Activities associated with outdoor public events are strictly prohibited from taking place on land preserved through the sale of developluent 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 FOLD A SPECIAL EVENT a` `r`v'cl: the fief atfom.rec�tt t nur:: mite li ations th Special Event Permit# Applicant(s)name:, .. .,� Date of Submission 7/if f t"D9`Xame of Event tl ' SCTM#'s 1000-Section = _ Block- L i{z(s) - Dates of Each Event: am If Multiple Dates are requested,applicant must give all information for all dates. Nature of Event: -- . (Please attach a detailed description of EACH event to this application) Time Period(Hours)of Event: From.. .P_lA to 1 . Town Services requested: ( )Yes (/No If yes,Describe Police Dept. Highway Dept. Describe Services Maximum Number of Persons Attending At One Time: 5_ w Number of cars expected Is a Tent or other temporary structure being used? [ ]Yes INO If yes provide size(s) Will food be served?[ Yes [ ]No If yes provide number and name(s)of food vendor(s) b Updated 8/7/2018 a Suffolk County permit#(s)- Will other vendors be on the premises during the event? Yes [ ]No If yes how many? Describe Type of vendor(s) Do Property Owner(name/address): ilk Contact Person and Contact Tel.#, n3 e-mail addressik FT' Event Location:Street-Hamlet Address:.— o L Mailing Address to Send Event Permit to: Have any of the development rights been sold to the Town of Southold[ ]Yes L4No and/or Suffolk County Agricultural Program? [ ]Yes No IFyes to either orliafh,:also. ndicafe. ri the anached`pjan the.boujt'daries of the res 'area upon--which the everit will take blade: . .�j'C A'I Y= , .F" ' .., ... .{- PLA y{��- ._T�Y T S EX—PEC,' .L' A' T .% C .. ,� 0 . . O ' -PEOG' . . . nA- f FTCCdDNTR,O`L PLAX see,mei4page-) �{ A.P.h.r ina/.l;je 6t:,'P-1 n tna.. `e u" eZ site lap 63eana" le-C,6ii.le:Ldrtl� ,oi fhe s 'e t'prRPert IIaIC;A,'I'lE OJXTE1 1 L ALi.Qi'ttie fol)otiving itafarrnatioit• A parking/ev6nt 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 1 (14) Location of sanitary facilities on site. Tray,Contm -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" iiatified trafk cozitroller n-iugt be providd 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)Now they will direct the entrance, circulation,parking,and exiting of cars on site,and 4)Contact information for use by Southold Town Police. 07RNM"S SIGN. 7' E, 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 ake'..qyj a 11 inspections necessary in 40,11 lection.witl this Special Even r✓0` ►b/toy ! Print name of Owner Sign tare of'o �.er r 4 s Print name ofAutlidtidd Person/Representative Signature of Auihb izgd Prsdti/Represcitiaiive .,R S ON I , " "BX� ''N'li ED SUBJECT TO! LCONDITIONS BTI 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.==harking is strictlyroltibited oti AN'Y`Towii,_ ounty cii State l�o'ade or Rihts'afi Way. 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 creast•-60-business days bribr fo the-schedifed 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. A .;v ie i e 6i- v t. ,? d.. . _ -...ot itetl t ;.._.. pfegg tertlsl orteni orad riI ture(s),-or temvorary sanitary faeiIiiies., sbati be condueted o0 Town of Sii11t]1614" Pr�rcliase a�l?e el4pnient:lZi,�}i�s_laind 10.,. . cti iti > s.- iat `th t i eve 't, i ldd'ii' but,. t litn`t'd to., " ..i, s Ir��asClaecess terit(�) or-tetnpgrary structurcoi,, or'tenrporary san tarti Paciifties• shalt hd eonducted:oii iifrolk:Cai%rit � Pgr6it5bAf L}evelcijiment Rtgittc ,land. without zaen iced tzv the uffolk County Parra=lam Cottrtiiiftee. 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 snake 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 ke-(d II c,,,. Cl 4- e,? Ilell V-A.5 2 '4/( z� 4(4 0 vl4t-q IjC1fZI 5- -31 /0. as- '(4:5 :0, Duckwalk Vineyards, Southold NY 'Ice Over 200 Parking Spaces J, IX- T Parkin (36 spaces jr U�U- 'P, Z' -RA:'r INS), ire:,'7�' .t:-'e> ", S�I N W .4 ie' ME, ? i Mk�' Ilk %sp, a4'?^�i•�`yr`»I ,.� ,� S�,` fs3.. .tz•-�.r':�>,,,,.J ,}bfC:w �•, Venue Entry-N MAIL '�tetk t rp, ;'✓C9• ♦P ,r,:s�4, r.k. .'Y'° .'Rt. �{`k ::?`,"^'... .}�3- ,.�. ".'w' ,.8.' ''M. ', ." •s,=C;c+'••-"'.�i'«:}'T t.-, a:'� ,°3:1"' Ja , ,s�i.� >.�,�9.. r... ,t s.,.+¢,,�a-d",. ^3'-�i,€�'a:; 1.4 , «[�`4� d E,.:° Rl� 1" 'Pap on '4il jurjj4I: -T 104 -bka�ll tit Idl'51 � e r''4 •;'``4'" ,r".'e P� '$.'" V'."w S�:'t•t 171"R ,ti'.-s x,. `5f '�"""✓: `+' ''"Af" ;2:i •r. e�•€'" 4"�i,'.,. 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P6GOTT, M1[�, MPH M l County Executive o,,At,.a h: Commissioner k' O . . .N ER's T <F 'A'A k��fT �,b��`• .ted April 08 , 2021. i? - ' This is to .cerfify that PS I ETCHAIRDS has 1. :� ,� .�.� red. . -irements to ger I 'I � M�=: Fbod Manager, as spedfied' in' the ,_ . � � .ty Ys Sanitary Code. 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S 1 �' •y .,� ,.�b,�+ •�,,� tt"9 wM 'r+W �!' ��..���,,,+++ `. �a r 'i`l�i�'.�h'§�"�4,`,�.� .dxn M,�l'tix°s,.���^irr ,`a"��ti� �'e."s•' -� 4'� ..ys,`� `��,�y ,�r^"`eca ",_,�.�/ny,:r�., vr-`<. `,���< ^��y�'s�e. •"Y�J'`'°.- •"✓r•�"v._,i'" '.,.�tr� J � .»�s.... •ya„}.,,,�¢�„�t.`„'�"�',�, - 18 f#S�Hr r1.2Ul:K F°tKMI I S l U UNtIKA I t A t-VUU tJ IA LIZ171 CM 1 nnu PERMIT FEE PAYMENT S ARE NOT TRANSFERABLE Nofttha$ur u of Public l<eetth Prc'tection bi any chang�.iil awiieE i i ,Vpe of bUsin ss:a&tivity,buslnessnarn cr.biilinc address by calling 631-852-5999,Permits become void upon' Ei2s? 3;o;u-4istab:N&.&'m6Fr rm2li!apply and pa!"W'a n perrail_pncrto- tining,bparat;;j',.(Y, 9,i�tliastav_er'- pernfitmaysubecttyouto.lagaf"s-Ct16-n,inct;�Mga,i�e�iilp `n grid possible suspension of the operating permit CYS AMERICAN GRILL CJ'S AMERICAN GRILUEAST END E 71 WASHINGTON AVENUE PATCHOGUE,NY 11772 DETACH PERMIT HERE AND DISPLAY PROMINENTLY TO THE PUBLIC Suffolk County Department of Health Services 360 Yaphank Avenue Suite 2A Yaphank,NY 11980 631-652-5999 www.suffoikeountyny.govlheaFth ( Facility ID: FA000315 Es Account ID: AR000745 TO OPERATE A FOOD ESTABLISHMENT Issued: 2/2412022 CJ'S AMERICAN GRILL!EAST END E 10095 MAIN RD UNIT 1 W MATTITUCK,NY 11952 OWNER NAME:CSS AMERICAN GRILL,LLC Restaurant•Seats=0 Permit ID Number: PT0002999 Code Vanance Exterior Seats=0 Mechanical Dishwasher Required Catering seats=o Valid From 2124/2022 To 3/31/2023 pis-Premises Catering Approved Bar Seats=0 Total Seats=90 This permit will expire upon the date specified or upon a Change of ownership., This pemit is NOT transferrable and is granted subject to compliance with the provisions of Article 13 of the Suffolk County Sanitary Code and ail applicable state,low municipal laws,ordinances,codes,rules,and regulations. _-THIS PERMIT NMUST_BE PR0M1NENTLY.DI3PLAYED TO,THE PUBLIC Client#: 1650901 PINDAVIN ACORM CERTIFICATE OF LIABILITY INSURANCE DATE(MMI D/YYYY) 7/08120s/2o2z 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Michelle Quirk USI Insurance Services, LLC PHONE 212 842-3700 a/c No AIC.No.Extj: 261 Madison Ave ADDRESS, michelle.quirk@usi.com New York,NY 10016 INSURER(S)AFFORDING COVERAGE NAIC# 212 842-3700 INSURER A:Great Northern Insurance Company 20303 INSURED INSURER B:Federal Insurance Company 20281 Duck Walk Vineyards,Inc. INSURER C 591 Bicycle Path,Suite A INSURERD: Port Jefferson Station, NY 11776 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 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. WSR ADDLSUBR POLICY EFF TYPE OF INSURANCE POLICY FJCP LIMITS LTR INSR WVD POLICY NUMBER MfDD MMIDD/YYYY A (COMMERCIAL GENERAL LIABILITY 35931460 05/31/2022 05/3112023 EACH�O�C�CURRENCE .$1,000,000 _ CLAIMS-MADE 7 OCCUR PREMISES EaO�Turtllence $1,000,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGRErrrG---���A---�T---��tttE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PR POLICY OX JECOT l X1.' LOC PRODUCTS-COMP/OP AGG s2,000,000 OTHER: $ B AUTOMOBILE LIABILITY 73560257 5/31/2022 05131/2022 ING(E /MIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPE, AGE $ X AUTOS ONLY X ;-AUTOS ONLY 3 Ptrac 3detrt B UMBRELLA LIAB OCCUR 79874674 D5/31/2022:05/31/202EACH OCCURRENCE $10,0.OOiOOO X EXCESS LIAB X, CLAIMS-MADEAGGREGATE $10,000,000 DED.I .X1 RETENTION$0 - _ $ WORKERS COMPENSATION PER DTH- AND EMPLOYERS'LIABILITY Y ANY PROPRIETORIPARTNERIEXECUTIVE -N ,E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA - (Mandatory In NH) E.L;'DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S A Liquor Liability 35931460 5131/2022 05131/202 $1,000,000 occ. $1,000,000 agg. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The certificate holder is included as additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 53095 Route 25 ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ±/ >� ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S36674996/M36201351 MXQC1 Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPIT * * * Date: 07/11/22 Receipt#: 303304 Quantity Transactions Reference Subtotal 1 -Event Fee - 5 $150.00 Total Paid: $150.00 Notes: Payment Type Amount Paid By CK#7273 $150.00 CJ's, American Grill Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: CJ's, American Grill 10095 Main Road Unit 8 Mattituck, NY 11952 Clerk ID: DENISN Internal 1D:5 Mirabelli, Melissa From: Flatley, Martin Sent: Monday,July 11, 2022 12:07 PM To: Mirabelli, Melissa;Verity, Mike; Burke,John; Lanza, Heather;Weisman, Leslie Subject: RE: Duckwalk Special Event I have no objections to these events being approved,they have sufficient parking on-site Martin Flatley, Chief of Police Town of Southold Police Department 41405 State Route 25 Peconic, N.Y. 11958 Tel: 631-765-3115 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(i)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<melissa.mirabelli@town.southold.ny.us> Sent: Monday,July 11, 2022 12:03 PM To:Verity, Mike<Mike.Verity@town.southold.ny.us>; Burke,John <johnbu@southoldtownny.gov>; Lanza, Heather <heather.lanza@town.southold.ny.us>;Weisman, Leslie<lesliew@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us> Subject: Duckwalk Special Event Please send comments to me thank you 194 CJJ�, 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 • 1 transmission and delete the message without copying or disclosing it. ******************************************************************************************* 2 Mirabelli, Melissa From: Glew, Claire Sent: Tuesday,July 12, 2022 2:32 PM To: Mirabelli, Melissa Subject: RE: Duckwalk Special Event 2a-e Missy, There are no exemptions on the parcels where the events are being held. Cla,{,rei(�le-w Assistant to Assessor Town of Southold Board of Assessors (631)765-1937 Phone (631)765-1356 Fax www.southoldtownny.gov claireg@southoldtownny.gov From: Mirabelli, Melissa<melissa.mirabelli@town.southold.ny.us> Sent: Monday,July 11, 2022 12:05 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>;Amakawa,Andrew <Andrew.Amakawa@suffolkcountyny.gov>; Killean,Jade<Jade.Killean@suffoIkcountyny.gov> Cc: Kerr, Mikael<Mikael.Kerr@suffolkcountyny.gov> Subject: Duckwalk Special Event 2a-e Please send any and all comments to me Thank you r Alelissa 111 A irabelli 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. ******************************************************************************************* 2 Mirabelli, Melissa From: Easton,James Sent: Tuesday,July 12, 2022 8:29 AM To: Mirabelli, Melissa Subject: RE: Duckwalk Special Event 2a-e I have no objection to this event taking place. Thank you, James Easton Fire Marshal jainese@southoldtownny.gov southoldtownny.gov (W) 631-765-1802 PRIVELEGED AND CONFIDENTIAL COMMUNICATION CONFIDENT[ALITY NOTICE: 'Phis electronic mail transmission is intended only for the use of the individual or entity to which it is addressed and may contain confidential infonnation belonging to the sender which is protected by privilege. If 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 infonnation is strictly prohibited. If you have received this transmission in error,please notify the sender immediately by a-mail and delete the original message. From: Mirabelli, Melissa<melissa.mirabelli@town.southold.ny.us> Sent: Monday,July 11, 2022 12:05 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>;Amakawa,Andrew <And rew.Amakawa @suffolkcountyny.gov>; Killean,Jade<Jade.Killean @suffo lkcountyny.gov> Cc: Kerr, Mikael <Mikael.Kerr@suffolkcountyny.gov> Subject: Duckwalk Special Event 2a-e Please send any and all comments to me Thank you 11felissa 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. ******************************************************************************************* 1 Mirabelli, Melissa From: Lanza, Heather Sent: Monday,July 11, 2022 1:17 PM To: Mirabelli, Melissa;Verity, Mike; Burke, John;Weisman, Leslie; Flatley, Martin Subject: RE: Duckwalk Special Event Ok with me. From: Mirabelli, Melissa<melissa.mirabelli@town.southold.ny.us> Sent: Monday,July 11,202212:03 PM To:Verity, Mike<Mike.Verity@town.southold.ny.us>; Burke,John<johnbu@southoldtownny.gov>; Lanza, Heather <heather.lanza@town.southold.ny.us>;Weisman, Leslie<lesliew@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us> Subject: Duckwalk Special Event Please send comments to me thank you Al C �r CCS(,. r_J Afelissa Ill. 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: Spiro, Melissa Sent: Monday,July 11, 2022 1:31 PM To: Mirabelli, Melissa Subject: RE: Duckwalk Special Event 2a-e Tax map numbers shown on application 75.-2-2.6 and 2.7, are subject to a Peconic Land Trust Conservation Easement. Duck Walk uses another tax parcel (75.-2-2.1) for overflow parking. From the information presented it appears that they are using the 2 tax parcels I show below-with red dots (75.-2-2.7 on the left and 75.-2-2.1 on the right) These parcels are not restricted. This request should be forwarded to PLT as they hold the easement. Melissa S. �p q From: Mirabelli, Melissa Sent: Monday,July 11, 2022 12:05 PM To:Spiro, Melissa<Melissa.Spiro@town.southold.ny.us>; Easton,James<jamese@southoldtownny.gov>; Glew, Claire <Claire.Glees@town.southold.ny.us>;Webster, Kevin<kevin.webster@town.southold.ny.us>;Amakawa,Andrew <Andrew.Amakawa@suffolkcountyny.gov>; Killean,Jade<Jade.Killean@suffoIkcountyny.gov> Cc: Kerr, Mikael <Mikael.Kerr@suffolkcountyny.gov> Subject: Duckwalk Special Event 2a-e Please send any and all comments to me Thank you Melissa Al Mirabelli 1 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 r " RESOLUTION 2022-657 ADOPTED DOC ID: 18314 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2022-657 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON AUGUST 9,2022: RESOLVED that the Town Board of the Town of Southold hereby grants permission to Christopher Richards to hold Special Event 2022-41 at the Duckwalk Vineyard, 44535 Main RD, Southold,New York as applied for in Application DWV2a-e for Weddings on September 24, October 1, October 8, October 9 and October 22, 2022 from 6PM to 11PM. All parking must be contained on site. Provided they adhere to all conditions on the application,the 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. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Brian O. Mealy, Councilman SECONDER:Sarah E.Nappa, Councilwoman AYES: Nappa,Doroski,Mealy, Doherty, Evans, Russell RECEIVED F;4- J U L 1 1 202 Southold Town Clerk TOWN OF SOUTHOLD Tower 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$250.00 by the Office of the Town Clerk, unless a waiver is obtained. Requesting an expedited review must be submitted in writing to the Town Clerk.The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health,safety,and welfare of the community. When is a Permit Required? All Special Events,per Southold Town Code Article I, Section 205-2(Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. Any use of residentialrp onerty for profit, such as a venue for weddings or other events is prohibited. This application is deemed complete once all the following requirements are submitted to the Town Clerk: Please indicatt submission of the following by checking off the boxes and signing below. El A completed application form signed by the owner and the event manager. Applications without property owner's signature/approval will be rejected. /FEE, Is the application being submitted at least 60 days before the event/)Yes [ ] No ❑ If Yes,Fee of$ has been submitted 11 If No,Fee of$ 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 insure A Parkingi-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 i 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. v 5 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 'lease provide ALL of the information requested below.Incomplete applications WILL NOT be reviewed. r Special Event Permit# Applicant(s)name: 1 Date of Submission 1116 (�OalName of Event SCTM#'s 1000-Section Block- Lot(s) oL- h !! Dates of Each Event: If Multiple Dates are requested,applicant must give all information for all dates. Nature of Event: (Please attach a detailed description of EACH event to this application) Time Period(Hours)of Event: From (I P_M to 6' kk Town Services requested: ( )Yes (/No If yes,Describe Police Dept. Highway Dept. Describe Services !y ri Maximum Number of Persons Attending At One x g Time: Number of cars expected Is a Tent or other temporary structure being used? [ ]Yes/No If yes provide size(s) cad Will food be served?[/Yes [ ]No If yes provide number and name(s)of food vendor(s) P � w U dated 8/7/2018 Suffolk County permit#(s) C'0 Will other vendors be on the premises during the event?[� ]Yes [ ]No If yes how many? Describe Type of vendor(s) 0 Property Owner(name/address): on" Contact Person and Contact Tel.# `' � P��S r� �;`�.������ � ���� � � �0 -'- � a�` ��, `''• �r�' f is�;.� �' /` e-mail address J�'�` 'r3 I� �I•� � �iY i. � ,.��4" moi.S Event Location: Street-Hamlet Yr n,:��pAddress: % U Vii; SCTM# F� Mailing Address to Send Event Permit to: 14 J Have any of the development rights been sold to the Town of Southold[ ]Yes I ,No and/or Suffolk County Agricultural Program? [ ]YesNo If yest ither or both, Iso"Indicate on the attached plan the boundaries of the reserve area upon which the event will take place. YOU MUST ATTA PARKING/EVENT PLAN TO THIS . PLICATION IF THE EXPECTED ATTENDANCE IS 300 OR MORE PEOPLE.,YOU MUST ALSO ATTACH A TRAFFIC CONTROL PLAN(see next Pagel 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 p-rovided,Please attaehed'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. 0HMR IS SIG1dATlU7RR 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 ake ny a l inspections necessary in con ection witj this Special Event A/ Print name of Owner Sign ture of Ow er Print name of Authdized Person/Representative Signature of Authofized Person/Representative P-ERMISSION 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 Way. 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(s)or temporary structure(s),or temporary sanitary facilities, shal_l.be conducted on Town of Southold Purchase of Development Rights land. 10..NO activities associated with this event, including but not limited to parking, ingmr ss/egress/access, tent(s) 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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"°•tt' ,^ti.,. ,.',:L',:'. 4&� amore li 5t,4 dU(ldl,51 el Liss 4AakI c — G�� � - �455�� ,�..,�l "( "' i' �`' °"-�' 1`�' ''%y `i*^ ='�'Y 'c>v`'' '_ �.;;7'' •'�"�•roL; +� i9s "'- '.�, i 6 r >r pv - :�'- -y ; s?.�'��y, •y���'��"r. s ��. ��' •� �a�e:�''� E�:�.;�e, ,;,.?'? s.,�r� . 'o� 3 k},�,,f�'"., .a°r .. �'{'�,. ,�� rg ,s �1�1`-�' ','9 � -.!� f3 #-.� ���r�`Aa i?1`=- ��� ''-g�Rr. y��t. '�_ t r rr- - !�*„`'7•., iie.E..��t,'°. �:� rlr s���S,P��•t<<�`�;; - _e'� t� - - =�3 P - �9�', �.'m: � $;A` �, - 1 ;i 9r Suffolk County Department of Health Services r S'T'EVEN BELLONE GREGSON H. PIG®TT, MD,MPH County Executive n.�za7 Commissioner t f: April 08 , 2021 K ate r This is to certify that C14RIS .I �Tc�uaRT�_S � has fit1fiffled the training requirements to be certified as Food. Managre-r, as s erif ed in tie Suffo'k Courbt� ..j Sanitary Code. r� Certificate No. A75101 l Commlssioj xpires 04/08/2024 O ]Public Health , {A����T •i�r 1.IknmMr.1'nnrvl �k�p���' -•.Ff - o,` .z. i31 _ F 1 E: ae ;: 9 .• ij -` '"R111 le; - f 4' Y m.F•- 6 1 1 9 r l r c b�r 1�tR i. r'',. t 4 ='s1 { 1+��;,!�l !i�i ,i: 99'1 x•99 i C-.�Y){1ya�k•�Ot 1 15:.' !,:•? f�.',,.=Y!�14�•.e l7Aut.� Y4 "', 89(4� ,..1 �1 �,! Y �'.!f�*�•': i RfR�3}OI�1 �- F - e:t:..;� .{=.��Yd !".'�'•,1�e�Y�S�,:*, �r .9Ar. �a*F�tlt;q�:, 1 .. • •a�R R AS ,9+e 4!y *I 3f ..:. .a111� '-°l•eirjL �,Ylte aq. �11Yr :flii•1Y,�6tvr1M�,t:pllt�t r YF,e jlivl,.' iti+ e.3" �17* 9�+ Q. :t11":Y .:llr E, _:S,�1J( o + fr !l;<; :�r'1 r,r U: .tp.ae+t Lv � �, I�,�' 'wµ" �'�. ��° . �49 a 1 a a�!�!`t�'.� .�y�s' ,,pq�� a� a'y%'F p+ vj�t s Fn ?e�pw j .�{y� 1 �'�r r���Srt •�W4° q• Ott 0 'Sa off' ,taa'4 .zf1e.�•-S.�.tt q .r� i'��^I'•: t+ '�r_i'e ��'' � ,w��• r�i q• `,.,.iP'•i.+'q''�, r;� rSny` :�°j$+°',•�tiw%�?.��J,rs°tiL �• ✓�,�!F'i 'L'?�• ��,,•?7;'+,y?w w°• 'q•.;'�°�4�`y,�+� f r,:,fr{ �`�'•�`'+� t° �a `!,F ^4�' �. ,�,• � •� a,�•,.�".+ '�4�, . '��' '�,gi ''f��f� �~ 4 r�- i"�5�"�� v '''� �'L`•'�,1�,���'��..,4.. �r �`•Iy y°t }',;, '�+'.t w+i+ �',+�,�,' .C;. '��.;°r f���vw^.' v '',� f ��2�'" 18-11etsr 4/20KK PERMITS TO OPERATE A FOOD ESTABLISHMENT AND PERMIT FEE PAYMENTS ARE NOT TRANSFERABLE Notify the Bureau of Public Health Protection of any change of ownership,type of business.activity,business name,or billing address by calling 631-852-5999.Permits become void upon change of ownership.New owners must apply and pay for a n permit prior to beginning operation.Operating without a valid permit may subject you to legal action,including a hearing,finr and possible suspension of the operating permit. CJ'S AMERICAN GRILL CSS AMERICAN GRILUEAST END E 71 WASHINGTON AVENUE PATCHOGUE,NY 11772 DETACH PERMIT HERE AND DISPLAY PROMINENTLY TO THE PUBLIC Suffolk County Department of Health Services pz�t ��_ 360 Yaphank Avenue Suite 2A srzvals�rxceaum�c-w2/= GAFacusFJ=_a WH Yaphank,NY 11980 631-862-5999 www.suffolkcountyny.govlhealth DEPAT,ME-:T C r w:Trl SoZL1C Facility ID: FA000315, PERMIT A=unt ID: AR000749 TO OPERATE A FOOD ESTABLISHMENT Issued: 2/2412022 CJ'S AMERICAN GRILUEAST END E 10095 MAIN RD UNIT 1W MATTITUCK, NY 11952 OWNER NAME: CJ'S AMERICAN GRILL,LLC Restaur nt'Seats=0 Permit ID Number: PT0002999 Code Variance Exterior Seats=0 Mechanical Dishwasher Required Catering seats=0 Valid From 2/24/2022 To 3131/2023 01-Premises Catering Approved Bar Seats=0 Total Seats=80 This permit will expire upon the date specified or upon a change of ownership. This permit is NOT transferrable and is granted subject to compliance with the provisions of Artcle 13 of the Suffolk County Sanitary Code and all applicable state,local, municipal laws,ordinances,codes,rules,and regulations. THIS PERMIT MUST BE PROMINENTLY DISPLAYED TO THE PUBLIC Client#: 1650901 PINDAVIN ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ,/08/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Michelle Quirk USI Insurance Services, LLC PHONE212 842-3700 FAX 261 Madison Ave E-MAILo,Ext): ac,No ADDRESS: michelle.quirk@usi.com New York, NY 10016 INSURER(S)AFFORDING COVERAGE NAIC# 212 842-3700 Great Northern Insurance Company 20303 INSURER A: P Y INSURED INSURER B:Federal Insurance Company 20281 Duck Walk Vineyards,Inc. INSURER C: 591 Bicycle Path,Suite A INSURER D: Port Jefferson Station,NY 11776 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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A COMMERCIAL GENERAL LIABILITY 35931460 05/31/2022 05/31/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE x OCCUR PREMISES Ea occu nce $1,000,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 r'OTHER: L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY •moi JECOTFX LOC PRODUCTS-COMP/OPAGG $2,000,000 $ B AUTOMOBILE LIABILITY 73560257 05/31/2022 05/31/202 3 COMBINED SINGLE LIMIT Ea ccident $1,000,000 000,000 a X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X AUTOS ONLY X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY Per accident B UMBRELLALIABOCCUR 79874674 05/31/2022 05/31/202 EACH OCCURRENCE $10,000,000 X EXCESS LIAB X CLAIMS-MADE AGGREGATE $10,000,000 DED F XRETENTION$O $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N ISTATUTE E ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F—] N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Liquor Liability 35931460 05/31/2022 05/31/2023 $1,000,000 occ. $1,000,000 agg. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The certificate holder is included as additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION Town Of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 53095 Route 25 ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1179 Southold, NY 11971 AUTHORIZED REPRESENTATIVE 61) ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S36674996/M36201351 MXQC1 Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 07/11/22 Receipt#: 303304 Quantity Transactions Reference Subtotal 1 Event Fee 5 $150.00 Total Paid: $150.00 Notes: Payment Type Amount Paid By CK#7273 $150.00 CJ's, American Grill Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: CJ's, American Grill 10095 Main Road Unit 8 Mattituck, NY 11952 Clerk ID: DENISN Internal ID: 5