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1000-122.-6-35.4 (2)
■ ■ ■ mIN4 o I e m LAUREL 7055 MAIN RD (NY-25) Northeast LLC LAUREL, NY 11952 NSD Q SITE NO.LI-03-1 10-A A R c Li l r E c r s 3500 SUNRISE HIGHWAY,GREAT RIVER,NY 11739 WFC PROJECT NO.22-15175 LOCATION MAP SITE INFORMATION DRAWING INDEX 40 LOCATION OF EQUIPMENT: GROUND DWG. DRAWING TITLE INITIAL SSUANCE NO.IATFST ISSUANCE � _y -- 4 _tt�5 a•. EQUIPMENT SQUARE FOOTAGE: Y220 SQ.IT. T•i 117LESHEEI W/20/22 1 d 1 04/11/23 SCOPE OF WORK: - �' . ® ARCHITECTURAL EQUIPMENT: MSIAII NEW C(N4CRFIL PAD.WSIAII NEW K'f BRIDGE.WSIAI!(I) NEW B160CABWCI.WSIAI111)NEW 6160(.ABINFI NAAII IN NEW A ARCHITECTURAL SITE PLAN&GENERAL NOICS 04/20/22 A p1/11/13 PPG.INSIAII 111 NCW VCW AAV,MSIAll(31 NEW kAOp 1480 INSTAL 13)NEW RADIO N6p,INSIAlll2)NEW RADIO8B" "A'I3)NEW A-2 ENLARGED COMPOUND PLAN&SITE DETAILS 04/20/22 4 04/11/23 � V QUAD DIPIE%ERS.WSIAII NFW WLAIIIFR CANOPY W$IAll 111 NCW „ 48KW UIESEI GENERATOR.MIALI 11)NEW GENERATOR AUTOMATIC fi�{r_.'< TRANSFER SWRCH. AJ ENLARGED EQUIPWNI PLAN 04/20/22 4 04/11/23 ANTENNA! INSTALL 161 NEW COMMSCOPE FW-65B-R3 ANTENNAS.INSTALL 131 +o n S,wS NEW SMART BIAS TEE.INSTALL(241 NEW 7/8'COA%CABLES. A-4 CANOPY FRAMING PLAN AND TYPICAL DETAILS 04/20/22 4 01/11/23 _0 6E 25uf0 rbt vfµfx 41.MSln RY is li5- A-S WEST ELEVATION 04/20/22 4 04/11/23 - —x(µxo p5x xi p5 1 d 11_1f�H=U OT4PROPRTYCONTAC EUTE TOWERSLP A-d EQUIPMENT CABINET DETAILS 04/202 4 04/11/23 lji.fvG— CaVVFN15 U11L1TY CONTACT; 1516154S-2242 LIPA A-7 EQUIPMENT DETAILS 04/20/22 4 DIM I/23 SITE - --— LESSEE APPLICANT: — I-MOBILE NORTHEAST LLC A-8 ANTENNA INFORMATION&ANTENNA MOUNTING DEIAtlS W/20/22 4 04/11/23 DEVELOPMENT MANAGER: DAN GUSTAFERRI A-9 ANTENNA NfORMATION 04170/22 4 04/11123 - - - RE ENGINEER: -- KUMAR NAREN A-10 (RNERATOR,TRANSFER Sµ1TGl DHAQ ANDRKIBCAL RBER DIAGRAM 04/20/22 4 04/11 f23 Ifpmm Ip r LATITUDE: N 40-SIT 43.7268'MAD 83) — S.AST Sa mew i 'i E� Ass LONGITUDE: W 72-32'49.8377-(NAD W) Fo slrvm a liw�i5�pn IXi�Nn� ELEVATION: ,m'IN DISTRICT: KEY MAP SECTION: am ` o In.DD 0 BLOCK: 06.00 W�1E r. LOT: 035.004 y� V REFfE.�,1 _ 9 j ZONING JURISDICTION: TOWN OF SOUIHHOLD •RfO Q NOTE: Tn COORDINATES AND ELEVATK)NSREFERENCCDABOVEWERESUPPLIED BYI-MOBILE Q 7. b T NORTHEAST LLC.THE ARCHITECT MAKES NO WARRANTIES OR GUARANTEES RELATIVE TO[HEIR W. �� y R M®bile Q J ACCURACY OR COMPLIANCE WITH FAA 7C TOT ERA NCE. 9q SEO g e o g �- ' y Northeast LLC APPROVAL REVIEW FORM $ Eo a 4xx.u.xpxxAv.pf6..Ev5A nv,nN AGER u a DEVELOPMENT MAN ' (�� ��L y, 5` L"1 DAN GUSTAFERRI g p z NSD SITE— RfENGINEER: ON ` STO7 W � RECEIVED MAN (�9 '•.� Imign.T lip <F' (� 70fifi TMN ID NY-79 KUMAR NAREN C < LAUIR W IM PROJECT MANAGER: JUL Z�23 (G! u yYI Iw f s MARJORIE LINDSAY d LN7E�Z..S<� F O V OTLE SHEET -. - LEASING SPECIALIST: I 1 ZZow1y<1� 1 f3� bouthold Town NRn COMPLETE DEVELOPMEM3ERVICES_ l LS ^ Planning Board msG LANDLORD: •� wexr wy W ELITE TOWERS LPFRELAW r,,• S,L � 6yN7p f?DVp ASiocv.�EOfOJwMFnf AS Sft Fop II M�NEs�crfrlsl SUGN TON pRA1VNG5 npE illFANfEXAA MClp�fSAnp T- APPROVED BY 9E:NERAL NOTES: 1. ALL WORK SHALL BE DONE IN STRICT ACCORDANCE WITH PROVISIONS OF LOCAL,STATE,MO FEDERAL,LAWS,ORDINANCES, PLANNING BOARD AND REGULATIONS WHEREVER APPLICABLE. 2. EACH CONTRACTOR SHALL BE 1-ELD TO HAVE VIS TED TIE SITE AND TO HAVE VERIFIED AI I FAINTING CONDITIONS PRIOR TO SURM SS-ON TOWN OF SOUTHOLD o<B0 3. IN A_L CASES,DRAWINGS SHALL NOT BE SCALE°FOR INFORMATION. DATE �y FIGURED DIMENSIONS AND CONDITIONS MUST BE VERIFIED IN THE ]t I22 �Qn'2 FIELD, V L7 4, CON-RACTOR SHA_L VERIFY AND BE RESPONSIBLE FOR ALL FIELD DIMENSW4D A4FSLFFOLIC ARCHITECT AND JOB CREPA CIE AND SHALL NOTIFY INE A R C H 1 T E C T S 3CT.AI. WATERAU71rOR17Y ARCHITECT OF ANY DISCREPANCIES.CONFL CIS,AND/OR OMISSIONS /�-06'i59 $' WHICH WOULD INTERFERE WITH NIE SATISFACTORY CONPLE-ION OF I�s'l:iE7lWfr u ZONEB THE WORK.SIOULD HE=AIL 10 FOLLOW THIS PROCEDURE AND w4l�rr4ar ,��r RQW, CONTINUE WITH THE WORK,HE SHALL ASSUME ALL RESPONSIBILITY NEW T-MOBILE COMPOUND (PER OEEDL 12571 CP.H3a) AND IARI.ITY ARISING THEREFROM. DER AREA.SEE A-2 FOR B. ALL ITEMS OF WORK IDENTIFIED ON THE DRAWINGS Br NAME,NOTE, AW ,(L ADDITIONAL INFORMATION OR MATERIAL DESIGNATION ARE NEW,UNLESS OTHERWISE NOTED. `,- - S41T•13'40'E i _ _ 6. ALI.NEW MA TRIALS AND INSTALLATIONS SIALL 3C IN ACCORDANCE ••+ 1 ..I WITH lul MANUr.IJRFRS IAllsl PRIk-ED SPi.CtICA'I S,ANTI ul : WREI Ail APPUCAB.E CODE RE'DUIREMENIS. (�^^ SUBJECTPARCEL A• ALL WO SHALL HE�ERIORMED IN ACCORDANCE WIT BEST SC. WORK T.M.IOW-122-06-35.4 STANDARD TRADE PRACTICES.EACH TRADE SHALL COOPERATE WHIT TS? ZONES OTHER TRADES TO FACILITA-C JOB SCHEDULING AND COMPLETION, 0s..' 4.• -- y�r PARCEL AREA(DEED)= 8. PROPRIETARY NAMES IDENTIFYING ITEMS OF WORK ARE USED TO ' 71,72550.FEET DES GNATC THE STANDARD OF CONSTRLCTKON.ITEMS OF EQUAL 1.640 SO FEE 9. EACH CONTRACTOR SHALL BE RESPONSIBLE FOR ANY DAMAGE TO N V DUAL TY MAY BE SURMITTEC FOR IMF ARCH TFCTS RFVIFW AND OF A PARCEL AREA(AIET LESS SC WA= APPROVAL fC J4DC ——% - curtest 16498 ACRE ) + __ ¢ _ -. _ O CONCINI°NSAR DAMAGED AREAS SURFACES ITOSUHIIR PRESE%151ING AND O ]7164°SO.FEET yyy��f �t j _ 3 AS MAY BE REQUIRED TO COMPLE-E THE ENTIRE SCDPE 01 IHE WORK.PHOIOGHWH ALL AREAS OF NEW WORK -I— Ko4 I Y w> g a ISr..UP.Kaet LL PRIOR-0 BEG NNING CONSTRUCTION. aNla4fi cX � "++ 1 0.ALTERATIONS TO EXISTING WORK SHALL HE PATCHED AND FINISHE], I z AS NECESSARY,To MATCH EXISIING CON'TGUOUS SURFACES OR W FINISIES -- -— N- SHOWN, O I X Ar L 11.AT TH=COMM F.TION OF FACH WORKDAY,FAC•II TRADE SIM HE _ RESPONSIBLE FOR CLEANING UP THEIR WORK,RUBBISH REMOVAL n J \ ` SHALL BE DONE IN A DUST INHIBITIVE FASHION,AND THE JOB SDE °Htl11 Du SHALL BE FREE OF ALL DEBRIS AV3 BROOM CLEAN UPON A.11 C.ONPI FTrnN 12.CLEA ALL FLOORS,WAL_S,DOORS.MISC,CUSS,ETC.LEAVING �eop.cp co slntiw c;4y iuci�nss tIl IrA„ \ 770p N4S _- Jgfl FREE f:f DUST AND OEORIS,1,DIOR TO 11ROJECT COA/PLI:!'Ok. sip 04 oaucr wrc I4 cmmr TrAr�x a i Zl4111y I.EXISTING EQUIPMENT AND MAIEILA-S 10 OF.REMOVED,V011Cr ARC TN.c ut[st Nn p � NOT REOLRLD 10 DE HE.I OCAI EC OR RF1AINED NY TI1i OWNER. SI AIL OFC:IMC TILE PROP_ a ill[CCNIRhCIOR AN.BE •••arwo-. REMOVED PROMPTLY FROV THE PREMISES. I^.INUIC:Al10kS OF WORK"O ITC REMOVED ART GENT:HAT.ONI Y.AN.,) \ u.T• ANT:NOf INIL NOCD TD STOW AU RTNS W11:::I NAY REOUIR! I_�7�'Igx. --EXISTING NON-UTILIZED REMOVAL.SUCH ITEMS SHALL BE REMOVE.,RFLOGTEDE AND/OR T !b> DIES:_TANK BY OTHERS REINSTALLED,AS REWIRED FOR INSULLAT ON OF NEW WORK. ` NISi�Y�CPNCRfTE K SHED --EXISTING FIRE DEPARTMENT 15.THESE DOCUMENTS DO NOT AUTHORIZE DETERMINING THE _ o b.2• 7' $ EQUIPMENT AREA PRESENCE,NOR THE REMOVAL OF ASBESTOS OR OTHER HAZARDOUS ` I , y MATFRALS_IF CURING THE COURSE OF TIC PROJECT,ASBESTOS OR A.5 21Q 'yI EXISTING AT&T DIESEL GENERATOR OTHER HAZARDOUS MATERIAL CONTAMINATON r5 SUSPECTED,THE CONTRACTOR SHALL NOTIFY THE CARRIER'S PROJECT MANAGER WITHIN D HOURS. ILSUCHCONTRACTORTIMSHAIE SUSPEND WORK IN THE .�Mobile• -EXISTING AT&T EOUIPN.EAi AREA AFFECTED AREA UNTIL SUCH A TIME THAT SAID AREA S CERTIFIED ENDEAVOR TONRESCHEDULF.EE IN HWORK TO AREAS UNAFFECTCTOREDBY SMALL Northeast LLC -E3(IS'INC PROPERTY LINL SUSPECTED CONTAMINATON IN ORDER TO VINIMIZE]FLAY TO THE 4a°"rea°¢ Ar,4uwruvq NYnrM PROJECT SCHECULE.PRIOR TO SUSPENDING WORK MAKE ALL AREAS OF WORK SAFE AND WHERE NECESSARY WATERPROOF. LAUREL 16,AL_MECIANICAL AN3 ELECTRIGL WORK SHALL BE IN Fu_L NSD CONFORMANCE WITH N.Y.S.UNIFORM FIRE PREVENTION AND A-MAID-A RECEIVED BUILDING J4� B& CODE,AND ALL OTHER APPLICAR_E CODES AND TOGA MAIN RD W-W REGULATIONS. L W 1 '— 17.ELECTRICAL WORK SHALL BE INSTALLED BY AN ELEC'RICIAN, , JUL 0 6 2023 LICENSE IV NEW MONK STATE AND IN SUFFOLK COUNTY,IN pCCONUAD Nf.E WITH,NEW YOHK SIAIE 1,11)NA IIONAI.ELLI:IWG ARCHITECTURAL SITE PLAN L 6GENEQAL NOTES LODES,A NEW PORK BOAR:OF FIRE UVOERWRITER'S CER-IF GTE SHALL BE OBTAINED FOR Al rLCC-RICAL WORK,AND SUPPUED TO Soutnold lown THE OWNER AND ARCHITECT. _ Planning Board NORTH 16,PRCNIOE ANY AND ALL TREATED WOOD BLOCKING/HACKING OR 14 =Ltd (:A.CAI V.=1.A'STOCK SACKING AS REQUIRED TO FNSLRE PROP4 AND ADEQUATE SUPPORT(IN COMPLIANCE WITH NEW YORK STATE T. BUILDING CODE MINIMUM LOADING REOUIREMENTS WHERE ARCHITECTURAL SITE PLAN MPL CAALE)OF VARIOUS ITEMS INCLUDING,BUT N07 NECESSARILY w cw A SCALE:1"=50' LIVITER TO HANDRAILS,SHELWNG,CABLE TRAYS,CONDUITS,ETC. /`� I9.ADA COMPLIANCE:THE FACILITY IS A NORMALLY UNOCCUPIED MOBILE RADIO FACIUIY. NEW T-MOBILE ANTENNA CABLES --- X X X---- X ROUTED FROM NEW EQUIPMENT ALONG NEW ICE BRIDGE UP EXISTING CONCEALMENT POLE TO NEW ANTENNAS x NEW T-MOBILE ICE BRIDGE. REFER 70 DETAIL 3/A-2 FOR I NEW T-MOBILE EQUIPMENT AREA. MORE INFORMATION I I SEE A-7 FOR MORE INFORMATION + May T-MOBIF II�jI M"WIN R AAI .1 A R C H I T E C T S I � °alvtaernuaer,Nr ilni + r,X,ST,NG NEW T-MOBILE POWER AND TELCOCETER S ROUTED FROM EXISTING APPROVED BY METER BANK/MESASPAN CABINET TO �r�ANEW T-MOBILE EQUIPMENT,REFER TOPLANNING BOARD F + DETAL 4/A-2 FOR MOREINFORMATIONTOWN OF SOUTHOLD FIRE DEPARTMENTRECEIVEDDATE EOUIPMENI ARLA 3 - - I - ----EXISTING ELECTRICAL PANEL JUL 0�2023 `I� n,• a E% DING 110 CONCEALMENT POLE (.�* \ �DuthoTdTown F N E� -EXISTING I.T DIESEL GENERATOR Planning Board " — o aRM S:uEA rAa AEKW f KEVG[pKA'W'IA- --�-EXISTING AT&T EQUIPMENT AREA T L�YpA nxR x — M. I.ao'a•-vTtiTs EXISTING COMPOUND FENCE EXISTING CSC CABINET --x x -- EXISTING TRANSFORMER ® ENLARGED COMPOUND PLAN . SCALE:3/3Y=1'-0•• WITHIN MOBILEXISTINGELECTRIC BANMET NORTII 1x[rcsc°ni°u co'x!r�on[ iimoa ar�irvLEuiisi via°ns.1ga -- -----6`MAICA EXISTING GRADE CONDITION --SAC4FILL AT TRENCH SHALL BE COMPACTED IN '2"LIFTS TO 95% _ nNO�VIDL A MINIMUM OF (2) DRY DENSITY SI/PPORT POSTS PCR TRAY SECTION --COWPAC11D SUBGRADE(COMPACT IN B"LIFTS 10 85%DRY DENSITY - - // - 6'WIDE METAL CORE UNDERGROUND DIRECTION DE REBAR 2A"O.C. EACR 3/4"CHAMFER 7 — WARNING TAPE PRINTED WITH DIRECTION POURLD CONCIRIE 7" NEW GRAVEL COVER N=W IC=RRIDGF KIT Hy SITE / // / "CAUTION BURIED UTILITY LINES" PRO,PART I824D------- ------- ''F'• 2x12 M015TJRE TREATED WOOD PAD WITH HAJNCH AT NEW=LTER FABRIC p / 2 12 W 157JPAI EJ RED,NUMBER OF PERIMTD ER O .- PLANKS AS RCO'D-OR WIDnI Cr m _ NTENNA CABLES ROUTED ALONG TRENCH A T -� ICE BRIDGE---'--------- 4 E y°Mobile. ,1 / PVC coNDUT,TYP,cooaolNnrE Northeast LLC TYPE,SIZE AND NJMBER OF uvu,xr EPu IT - I ti I III- CONDUITS WITH INFORMATION Each°°°mxvev,aaur PflOV UE�'4 NEBAHS - ( (I SHOWN ON ELECTRICAL DRAWINGS 0 12"O-C EA WAv' = 6"THICK DYER Of NEW 8"Xe"Xl/2"STEEL PLATE - �I -(I� AND WITH FIFCTRIC AND IALWL COMPACTED SAND OR in > iU '!I1�,:j{{= -". _. TELEPHONE UTILITY COMPANIES - _Ii>-f}P[[ GRAVEL BASE NSA 4) 1/2"BO_IS IJ-03-110_q WASFED SAND IN 6"-IFTS coM=Acr EXISTING -� l �_ (,WADE 10 95%DRY POJRED CONCRETE FOOTING,SET PIPE l l' 7066 MAN RE,W-28 DENSITY MOUNT AS INDICATED WITH N. Q�ITi' �--UNUIS'UNBE)tAR1H LAl1EL.NY iR62 CONTRACTOR 10'DE-WATER'TRENCH AS REDD RED DURING INSTALLATION OF PLA N N P CONCRETE TO ENSURE PROPER '° - ENLARGED COMPOUND PLAN NBIALLAIION SIRENG!H ILSITE_ ILS 11 CONTRACTOR SHA.I =NGAGF THE SFRVICFS OF AN UNDERGROUND UTRITY IOCATING ^,N COMPANY TO LOCATE ALL UNDERGROUND EQUIPMENT IN THE TRENCHIV G AREA TO"DID ANY °EIRIy /� . •. y-15py UNCISTURBED EARTH- - DAMAGE.2. RAND EXCAVATE WITHIN 5'OF EXISTING UVOERCROUND U-ILTIES(V.I.F.)MAINTAIN 18"MIN. G CLEARANCE,OR AS DIRECTED BY TrF VORC.COVTRACTCR TO MAKE ALL PVC JOINTS Mi WAIERTIGyT. 1W51 PR OR TO BACKFILLING. _ IILtLnt Ravin �1 CONCRETE PAD DETAIL r;;)ICE BRIDGE DETAIL �1 UTILITY TRENCH DETAIL A-2 SCALE:1/2"=1'-0" SCALE:1/2"=1'-O" `�SCALE:3/8"=1'-0" X x- x x- - x x -- x-- x x x x— x x ---- NEW PIODO UN157RUT SECURED TO NEW .i WEATHER CANOPY POSTS NEW T-MOBILE GPS UNIT MOUNTED I TO NEW ICE BRIDGE POST wim1 x NEW T-MOBILE H-FRAME.REFER TO NEW B160 k 6180 EQUIPMENT CABIN DETAILS 1112/A-6 FOR MORE INFORMATION NEW AUTOMATIC GENERATOR TRANSFER SWITCH MOUNTED TO NEW H-FRAME.REFER INSTALL(3)NEW QUAD DIPLE1fER5 TO DETAIL 2/A-10 FOR MORE INFORMATION MOUNTED TO NEW H-FRAME I I x A R C H I T E C T S 1 NEW T-MOBILE pPC CABINET MOUNTED TO TX><apmwnv 0uvr,xx�nuxer.rRv in e elr. INSTALL(3)NEW RADIO 4480,(3)NEW 1 NEW H-FRAME.REFER TO DETAIL 2/A-6 RADIO 4480 k(2)NEW RADIO 8863 I I / FOR MORE INFORMATION n MOUNTED TO NEW H-FRAME(STACKED) Y 1� x NEW T-MOBILE VZW MV CABINET APPROVE NEW T-MOBILE LIGHT FIXTURE SECURED - MOUNTED TO NEW H-FRAME.REFER TO P B DETAIL 1 A-6 FOR MORE INFORMATION A t+il TO UNDERS DE OF CANOPY DECK, / 1 L OPERATED VIA TIMER SWITCH,TP.REFER V I! V .:.I y TO DETAIL 3/A-4 FOR MORE INFORMATION I l I 1 ,•, p pLANNING BOARD LL TOWN OF 5OUTHOLD a t__ _ g RECEI_� r611 DATE $I'Ii�i �23 4�a NEW T-MDRI� k-1 ? JUL 0 6 2023 O IIPM NT Rce w W-O'X 22'-0"1 I 0 a ISWU,fDx AfNtx _ / (LEAS AR Al $DU(hOIUV/fl > AA f-Nlis— Planning Beard a?I'fiP-v.;sT'IX'R7:owfnK a n /a 6� — UNE OF NEW T-MOBILE WEATHER CANOPY ABOVE -j / I a 1 x NEW T-MOBILE ICE BRIDGE. NEW T-MOBILE 48KW DIESEL GENERATOR ATOP eo mrsuunlRx a elwwc Is to rsonfx un:ss 0 ORMATION NEW CONCRETE PAD.REFER TO SHEET A-10 FOR REFER TO DETAIL 3/A-2 FOR p dI MORE INFORMATION Res R 0'1.NE ancvnrN 111xu 1— PRtlA l0 NOpx4 a COxRIRu IRAtp�R MORE INF / Q xmsfsLM 1411 un 1a 1111 R I O NEW T-MOBILE CONCRETE PAO.REFER TO DETAIL a Ix NEW T-MOBILE ANTENNA CABLES ROUTED 2/A-2 FOR MORE INFORMATION FROM NEW EQUIPMENT ALONG NEW ICE / - —_ ip -^•^wwoes BRIDGE UP EXISTING CONCEALMENT POLE TO NEW ANTENNAS /a 10'-W NEW T-MOBILE CONCRETE PAD NEW T-MOBILE POWER AND TELCO CONDUCTS ) / x ROUTED FROM EXISTING METER BANK/MESASPAN CABINET TO NEW T-MOBILE EQUIPMENT.REFER TO DETAIL 4/A-2 FOR MORE INFORMATION _ R a EXISTING=RE DEPAiTMENT —EXISTING COMPOUND FENCE / EQUIPMENT AREA g x T a EXISTING ELECTRICAL PANEL 1 Mobile- a - Northeast LLCI LAu�EL NSD EXISTING A-kT U-03-110-A DIESEL GENERATOR I 70%MAN fD NY-2H I iNEXISTING ATT ENLARGED COMPOPO UNDO PUN EOLIPMENT AREA� A SRE DETAILS EXISTING 110'CONCEALMENT-OLE I A rwR I'XISTING BUILDING a-bps IL oecw.,er: � cwrufne• NI - _ -_ Rrg wlr0 aNIIg21RVn ENLARGED EQUIPMENT PLAN a.N Nxa 1 SCALE:1/4"=1'-O° (e)EXISTING 2"0 3oLT5 A-3 NOTICE DENOTES SPAN OF 27 GA. 3'CALV.STEEL ROOF DECK,TYPE NS AS 9'-2"CANOPY DECK MANUFACTURED BY UNITED _SIL DECK OR X Q X X % t APPROVFn-0 JA1 B•-4•� FASTEN DECK-0 STEE_ WI-H M12 S.S.OR GALV. _ STEE.SELF DRILLING ILK WBX15 SCREWS 0 B"O.C.MAX. �\ X (� LvA SLOPE m a' A"PER FOOT `i A R. 0 H I T E C T S �,wc�mow„You,�urwuze,,Hr arm ' m x Q P.6114B91nw I F nll IL1�1 ww.nw.,w RECEIVED NEW CANOPY KNEE BRACE,TYP. REFER TO DErAIL 2'A3'A-4 I l� x .I F—_ 7 JUL 0 G 2023 ' + out Old own NEW LIGHT FIXTURES SECURED TO i - UNDERSIDE OF CANOPY DECK OPERATED I N! I x Planning Board 1 ti 16VIA ` A APPROVED BY 3/An4EFOR MORE INFORMATIONR SWITCH,TYP.SEE W 15 L C OF PLANNING BOARD .I��u-rva-a-ct- 3"W8"x GALV.STEEL COLUMN WITH 'X1/2"WLV.STEEL BASE AND CAP TOWN OF SOUTHOLD - 2sui�(ori ruwc PLATES,TYP.OF(6)ON CONCRETE PAD z/'A2 a B ++ I Atvsto vlti rorTNc DATE x DASHED W LINE REPRESENTS LINE OF N NEW WEATHER CANOPY ABOVE / n�m[ros nc�wc�uE�sl�u ea sissu Inq ux 10 x Ts iox•,x+M ascwiuo.,`iaul�.ila°P.`. u54 XTx1 �0<"... D U1f51 M 0 �ZCANOPY FRAMING PLAN I2"y SCALE:1/4"=1'-0" NORTH � �i -0" I ICV TOP OF NEW WEATHE9'R CANOPY LIG-ITING F XTURE SCHEDULE -NEW 3"22 GA.TYPE.'B'GALV.ROOF DECK. Fy'.�. o NDIAyP I TACK WELD TO NEW SUPPORTING STEEL 1 �Mobile� PEFITYIEF .WAII LWP 11PE Won/ HN6N WONTING/HI 1 -NEW GALV.STEEL WBz'5 73/)L.V 7SLED t BRNZE SURFA:E VTD. L3x3:7/4'BRACING AT UNDERSIDE OF DECK NortheastLLC -NEW 6"W,1/2'GALV.ST_=_PLAT-- .cun wgzvnr» SFCURFD TO NFW W6z 15 WIIH(4) NEW VERIZCN WRELESS 3/4"0 A325 BOLTS,TYP. ^ FOUIPMEMi PAD LALFEL V NEW}"O GALV.STEEL COLUMN WELDED V 03_� d+ 10 10 NEW 1/2"THICK WE PLATE NEW 3"0 GALV.STEEL 7056 MAN RD pry-28 NFW 6"z6'z1/Y GAI V.ST== PI AT= COLUMN WELL`!. 10 NEW LAJI✓�NY*0 1 SECURED TO NEW CONC.-AD WIT-iX 5/16" 6" 1/2"THICK BASE PLATE (<) 1/7"0 HII TI KWIK GO IT 11 ANGLE 1/;Y NEW 6"z6%112"GALV. CANOPY FRAMING PUN EX-ANSION ANCIIORS(}-1/2'.MIN. STEEL SLATE SECURED TO AND TYPICAL DETAILS EMBED.),TYP.OF(4)PLATES NEW CONC.PAD WITH 4 NEW VERIZON WIRELESS .A325 0 1/2"0 H'I�I KWIK BOLT(1 ouma EOUIPMENT PAD TYP. - _ EX-ANSION ANCHORS 21,Wpy WELDED - (3-1/2'MIN.=VBED.), CJ REAM _ UGHi F1KfUR_ Y�CAL ��'Al' 1" TYP.OF(4)PI I'ES ly Tr•KID BRIM'AT PLAN AT CANOPY POST+A2' �a 49m 9 LIGHT FIXTURE DETAIL �CANOPY POSTS+FRAMING DETAILS A-4 SCALE:N.T.S. 2 SCALE:1-1/2"=1'—O" I.O.1.%rS11NG r,U.W,n1•ANIl ANA FIRE DEPARTMENT WHIP ANTENNAS 10'-0'AC A R C H I T' E C IS ._ aR,se-rnl,Rer,yr inn %iS1iN SON,AI Y.N r,f.i. B" t MfRl x'Rxl Msf l.....xoRwwi 1 I r�RE[�gT 110 CONCEALMENT PO-E- ASCR A. 0.LXrS, C CAV: F ,v / , 1 }t r t.0.L%ISt NC.f.AV15ITl. J UPPER T�,7G�ICEZ`ANISYEN„80 �F��•• (6)NEW T-MOBILE ANTENNAS AND(3)NEW 764'A.G.L. o ex(»/ry rsw[o aoa rava.w SMART BIAS TEES INSTALLED WITHIN EXISTING I U -M IL Itigs i3:vritu W9 wm CONCEALMENT POLE.REFER TO SHEET A-B -} �_x»�,118-Ri - FOR MORE INFORMATION - 70'-0"AG.L. S n CANI °il�r._____. 65' AC Lam�►► I - -- 1 LOWER T-MOBILP CANISTERO I (24)PROPOSED T-MOBILE 7/B'COAX IT.O. 41rkC OAS(. POLIL - -- CABLES ROUTED FROM NEW T-MOBILE EQUIPMENT ALONG NEW T-MOBILE ICE BRIDGE UP TO NEW T-MOBILE ANTENNAS rr�o uisraurnm as eimixo Is,o rRoctm untlss I I fRNRIW[&ORW6 OAIImx6aIRUrtIm t[aXlaattaarrt. NEW T-MOBILE ICE BRIDGE.REFER O R E C E I V E D N,pxa�a,o,�ur«ou DETAIL MOBIL FOR MORE INFORMATION NEW T-MOBILE WEATHER CANOPY.REFER TO p g 2023 • SHEET A-4 FOR MORE INFORMATION Southol APPROVED BY NEW T-MOBILE EQUIPMENT AREA. Panning Board 1 SEE A-3 FOR MORE INFORMATION Planning Board PLANNING BOARD , NEW T-MOBILE ELECTRIC METER WITHIN TOWN Of SOUTHOLD EXISTING METER BANK T•Mobile• i DATE 12a23 EXISTING TRANSFORMER Northeast LLC �I22 I � ' a�a.®aRr�Rw..a.ua r .,aagm,l,n � T.O.NEW T-MOBIL WEATHER CANOPY NSD Ll-03-110-A '°6`,AUM „e WEST ELEVATION Lld RRN/II L-6DR rN OS'WM� 0 WEST ELEVATION A-5 APPROVED BY PLANNING BOARD ENCLOSURE -MFG:ERICSSON TOWN OF SOUTHOLD -PART NO.:0163 NOTE: �I OU CABINET I DC VCRRON AAV M -I ANI O S( DATE /7 ��r7 IT NOBLE, CABINET INSTALLED BY -D NENSIONS(HaWzO):63'k26`x31` a:?— !o T-NTRACT AND TER TO C BY NEW CANOPY POST CONTRACTOR.REFER TO CIONS BATTERENCLO W GIR:WEIG'.295 LBS MANUFACTURER SPECIFICATIONS AND NEW VERTICAL P10DG -BATTERY WCIGIIT: .5HH LOS(3 STRINGS) IA ( L DRAWINGS FOR MCRE INFORMATICN, TOTAL WEIGHT: 1,HH3 LBS SPECIFICATIONS FCR PURCELL SSC. TO BEUT MEMBER, LENGTH 2q"'ALL x 24"WIOF.x Ifi 67"DEEP TO BE VERIFIED IN FIELD (25.24"DEEP WITH HEAT EXCHANGER) BY CONTRACTOR WEIGHT:6-LBS CABINET ONLY, 100 LBS WITH(4)BATTERIES_ ® I A R C H I T E C T S NEW VZW MY i t C C C O Q G Q Q +e,a l(Yxsxi uram I.... ,.Iasm NEW HORIZONTAL P1000 I \�j�0 NBCDR�RC'y� UNISTRUT MEMBER,LENGTH TO BE VERIFIED IN FIELD BY CONTRACTOR 19 � I rr NEW CONCRETE SLAB I C (SEE DETAIL 2/A-2 FOR O - II I ADDITIONAL INFORMATION) I I C S o Ids ° EXITING GRADE Q O Q O Go G O \ 0 b N SSV[ IGR M'MM J U O C C O G 0 0 T .. - o xZ6"p5c -i ii "n�Sv-ti o-ToxTilw_ �P FRONT SIDE BACK TYPICAL VZW AAV DETAIL 3 TYPICAL B160 BATTERY CABINET DETAIL SCALE:N.T.S. SCALE:1/2 I I 0 ox 12CVAC Grl _� $-0 RECEIVED Is.o xoL[ PROTECTED - 2'_ CNCLOSURE: [sut[v[w'Issuro rov x"' CONVEN ENCE I I -MFG.:CZICSSON wo oe[cwisie«rlopciowlrwa v[s OUTLET PART NO.:6160 NNirsr ax[axun NEW CANOPY POST }' ross[ssox or Ixr uiisi v[ � MFCHANICAI NFO JUL 0 G -DIMENSIONS(HxW4):63"x26"x34" 2023 NEW HORIZONTAL P1000 ���"'lll��� •c»ov< UNISTRUT MEMBER,LENGTH 7 -LNCLOSURL WDGI-I:414 L.BS TO BE VERIFIED IN FIELD 200 AMP / -EQUIPMENT WEIGHI:285 LHS Saut Old Town BY DO MRACTOR GENERA TOR -1 CTAL WEIGHT:699 LBS P 1 NLE Planning Board 20C AMP GENERATOR NLEI------ SCRLLN_I I OVTELFRS - FORR TELCO A 12OVAC On PROTFCTF.D COM�ARTNE Ni CONVENIENCE OJRT_T-- Q 0 0 O C C G O C) SCREENED CARVERS FOR T—Mobile. 1 ELCO coM'aRTNENT— ° GENERRAATOR Northeast LLC IN-ET rvxvuv emxvxr,cvz"rnvcq xrn ATTACH ENTIRE Ll • 12CVAC CFI w UNIS-RUT ASSEMBLY TO / PROTEC-ED O LAUREL NEW CONCRETE SUB IN 3-1/2"m PI'E / CONVENIENCE NSD UTII 171NG 3 OUTLET (SEE DI FORM FOR 1 U BO_TS AND NU1S O �-' � ADDITIONAL INFORMATION) 111 AND WASHFRS (TYP.) —NEW'MARCONI' O7066 MAN CR SLRILS O EXITING GRADE \ AlIACII LNISIRUI IC OVER/UNDER EQUIPMENT CABINET DETAILS EACH OTHER USING rI PCWEN 3/8'm SPRING BOL' PROTFG ION O G` O �-� C G `D O(P2380-2)Wln1 NUr CABIVLI (CPC). AND WASHER O NEW uNISTRUT FRAM= — - - 0 \' C' 00 GO TO BE'U'-BOLTED TO I t �P c1 NEW 3-1/2"0 PIPE FREW SIDE BACK N.I TYPICAL PPC CABINET DETAIL H IITR na°n0°IT 11 BE ® � �ZTYPICAL ENCLOSURE 6160 DETAIL A_�j SCALE:N.T.S. DPPEO GALVANIZED. ~ SCALE:1/2"=T'-0` RARIO�L169 RADIO 448p -_ _ -MFG: ERICSSON -MFG:ERICSSON RADIO CSSON 886-PRODUCT NO.:KRC 181 912/3 -'RODUCT NO.:KRC 161 922/1 PRODJCT NO.:841 FOR N3 AND LTE DIMENSIONS: (H%W%D) 170X15 I'XII.9" DIMENSICNS:(HXWxD)21,8"X15.7"X7.5" JIMLNSIONS:(H%WKD) IB.B"X14.8"X6-1' WEGHT/VOLUME: 109.0 LES/ 13 GAL. WEGH-/VOLUME:92.0 LBS WEIGHT/VOLUME:53.1 LRS/ 13 GAL. FREQUENCY BANDS: 3GPP TOO 32/25&366 FREOUENCI BANDS:DUAL BA\D,WCDMA,LTE AND NR =REOUENCY BANDS:841 FOR NR AND LTE 19W:UP 10 65MFz IN B2/25,UP TO 90MHz IN B66 13W: 2X 2.5/4-9/9.8/ 10.1 GBPS CPRI BW:UP TO 65MHz IN 82/25,UP TO 90MHz IN 866 NORMAL OPERATING TEMP:-40- +55'C NORMAL DPLRAIING ILMP,: -40- +SD'C NORMAL O'ERA-ING TEMP: -40- +55'C OUTPJT POWER:UP 10 4.80W IN B2/25,UP TO OUTPJI POWER:UP TO 4%6OW PER BAND,UP TO OLIPUT POWER:UP TO 4z80W IN B2 25,UP TO A R C H I T E C T S 4xBOW IN B66.UP TO '40W IN TOTAL 4xBOW TOTAL W/0=AN.U'TO-.BOW TOT W/FAN 4m8GW IN B66,UP TO 140W IN TOTAL tit 10 Or- BOTTOM BACK SNE BOTTOM BACK SIDE BOTTOM BACK SIDE .-. [Invn issuEQ roR nLvf,% �I7n:s TYPICAL FIADIO 4460 DETAIL TYPICAL RADIO 4480 DETAIL % H5 ' SCALE:N.T.S. 2 scALE:N.T.S. TYPICAL RADIO 8863 DETAIL -- SCALE:N.T.S. - I YANUFACTURC0.- NCRi1M1A �- MODEL: III QUAD DIPLEXER OIMENS10X5(Smoic ."".9 AI"x 4.31'a 1.91(11 z W WFJGM(.wur U411): 5.73 L0S x0[((0 YN[[ss f[OWvx•e0v[. NEW CANOPY POST wn All GRQNND 216 RECEIVED NEW VERTICAL P7000 ).. _ To, UNISTRUT MEMBER,LENGTH _ _ -- TO BE VERIFIED IN FIELD ' JUL 0 6 2023 BY BE VEROTOR NEW RADIO OUIfIOd OWn I I = 1 NEW RADIO _I- -�7 Planning Board BOTTOM - NEW HORIZONTAL P1000 4t3" GROUND UNISTRUT MEMBER,LENGTH TO BE FIELD 'r' �•Mobile- APPROVED CONTRACTTRACT D IN OR _ APPROVED BY Northeast LLC NEW CONCRETE SUB .a� CONN 4.3-10(q PLANNING BOARD LAua-L (SEE DETAIL 2/A-2 FOR (2 OUT/4 IN) NSD ADDITIONAL INFORMATION) U-03-110-(( 95. TOWN OF SOUTHOLD 70%MAN RID W-2@ F.x15T1Nc GRnOC - Z� LMI�NY IN6E qz' -3� I _ � DATE 2Z J2� EQUwMENI pEfAIIs (:ONNECIORS:j.v,,K rvi'OY.(SIIaf.I I'TWIN) ti/ens 4 uv-LAw[p SKUB 34545-MI-54844 I II Rfl3 QUAD DIPLO(ER , 0691M CPAFT A TYPICAL FIADIO MOUNTING DETAIL TYPICAL QUAD DIPLEXER DETAIL 9 A_7 Y SCALE:N.T.S. `A SCALE:N.T.S. 71.811" 7.126" ANTENNA -MFG.:COMMSCOPE C' in, PART NO.:FW-658-R3 NECHAN CAL INFO ®-WEIGHT(ANTENNA):43.872 LBS. mWEGNT(HARDWARE):8.598 LBS. -W "SIGNS(IIXWXO):71.969"x11,81"'x7.126" MA% WINO VELXWX 149.75 MPH EXISTING 12"SC1- -HARCWARE MATERI A R C H I T E C T S AL.GALVANI Si 2EJ EEL60 PPE MA57 W -CONNECTOR tY�E:4.3-10 FEMALE BOTTOM,A NIGH BAND,2 LOW BANDcirenvrus-COLCR:LIGHT GRAYO = L& M 36'O.D.MULTI PART, n a/ Z O ® \5� ^^• MULTI-SICED CONCEALMEN' RADCME,TYP OF(6) i+f Q Z Z (V J� +�/i�.�'^• CL NEW FV AN ANTCNNAS TOO BE BE INSTALLED ALLED 0 R� IN I nI yCQ- B4llPM BACK SLO-L Q �„1 TYPICAL FW-65B—R3 ANTENNA DETAIL °aarr ^�°^ • G '.M"u'Mn PLANa TOP CANISTER T75'1 SCALE:1/2"=,'-O" r -mT'AT.weeu"ALr'xras - P ! iT»Sir' ¢, m ATS8T-T0P-MF-4G - NOTE: INSTALL(3)NEW SMART BIAS TEES. @ (NOT SHOWN FOR CLARITY) r .. Tap Smart Bias Tee 6 T•fh•' �'" �. aA,:,a cApl°,vsme k- rn°hNx+na�q:IrnerV brrNy„xm.xrv:uYs - tlG1E£ Rs[[[o uxl[ss •N4yfwy:wleN.i`.rwxns xfSAueNax'10IX[TN[nos svro ri .��ryxramsues:vux'm.Nra aiDOixa avxcdSrAy__ m�aNnM aNr nu,,.0 sm,a,N.l:,y rrv,tlnna:.xauvepamlrn SFCtpR�. I rn.� m" ,wI it urisivvu wn NA[ oR 3Po 9 I)OOMCLOUSSilicalia0 1e1 b.°rxe wry.. EXISTING 12"SCH Genera15pecificaliarls + 160 PPE MAST RECEIVED ECEIVED N,r°nron °e•slnrol 6Ay;fm� I __— 36"OD.MULTI-PART, n °1S °' rwwe JUL 0 6 2023 MULTI-SIDED CONCEALMEN" . °j r•n.°.a vnm mn, �: � CYLINDER,TYP.OF(5)--�" max' �outhofd'�QWn '' Axr..nA�N,xm.a°r.• Planning Board T'Mobile` (3)NEW FW-658-R3 "'""" ""°°'°' Northeast LLC ANTENNAS TO BE INSTALLED 1. Uimensioas nxavn[amvw.Ar,vAurnvs.AvvunN b LALREL NSD Eirdrical Specifications LW3AO-A 70%MAN ID NY 7B wIN ,a. LAIIQ NY 1AQ �,aam lNo,.M Nmw r.°, °Ib,mmm� ANTENNA INFORMATION PLAN a BOTTOM C NISTTR(85', Z er.aromNn.lm rouuarl[Axq cra Prt°.s aN,,.xrT rso,c I wswn r:.w,A x:[..:zir wN v,.nrN L ANTENNA MOUNTING DETAILS d OU9/n ENLARGED ANTENNA PLANS-0" LAB DTAAENA ,a a A—$SCALE:1'=1' C A frEM A> CABLE SCHEDULE �A���� SECTOR AUT TX- NOTE. ]EMMAL NOTES RX MANUF-MODELS CABLE LENGTH DU LABH/NOTE ALL EXISTING AND NEW ANTENNAS,EQUIPMENT AND 1-ALL INDICATIONS OF NORTH ARE FOR REFER ENCE ONLY.CONTRACTOR TO VERIFY IN TX/RX T%/RX H-t20'-0" _ ]/S• 1 RED ASSOCIATED APPURTENANCES(IE;CABLE TRAYS,ICE FIELD TRUE NORTH PRIOR TO SECTOR ANTENNA INSTALLATION. NEW T%/R%TXfRX . 4. 7l6' 2RED - BRIDGES,ETC)MUST BE GROUNDED IN ACCORDANCE LOMMSCOPE TXIRX N120'-0' )A' 3 REO WITH T-MOBILE STANDARDS. 2-CABLE LENGTHS LISTED qRE APPROXIMATIONS PROVIDED BY OWNER AND ARE NOT TX/R% FVV-55B-R3 l%IRX H-12a4Y 7A• 4 RED INTENDED LE)BE USED FOR ORDERING CABLE.ALL CABLE LENGTHS MUST BE VERIFIED IN TWRX TXIR% M-12W- ]A• 5 RED FIELD. Twu TxNtx .h,2a4r )A 6 RED MIN.CABLE BENDING RADIUS TXIRX CABLE 3-7HE CONTRACTOR SMALL INSTALL BRASS TAGS(SUPPLIED BY 7-MOBILE)AT EACH END TX/RX ./-12a-0' Tlg• 1 WHITE RADLIB 1Yf.FHi FT.0.Q OF ALL ANTENNA CABLES DENOTING THE NUMBER OF TAPE MARKING BANDS AND COLOR B 210' 75' a T%IR% NEW "DURK ./-120'-0' ]A" 2 WHITE 1I2°CABLE SUPERFLE%IFSJ 7l4' 0.71 LBS ST OF TAP E MARKING BANDS. T)URX COMMSCOPE 7X/RX H-120'4Y )/g. 3 WHITE V TX/RX FW-65B-R3 TXlRX +/-12a-0• 7/g" 4 WHITE 1lY'CABLE(LOFJ.Sg7) 5- 0.15 LBS. D.83" 4-ANTENNA CABLES WILL BE COIOR CODEDAT THE ANTENNA,FILTER INJECTION Tom+% M-12a-0' )/• SWHRE )CABLE BOFs mAI 0' 0.33LBS 1.Oa CA6INET,JUMPER CONN(:CTIQNS ANDTHE BTS CABINET. A R C H 1 T E C T 5 U-120'4Y ) 6 WM'ITE 11/4•CARE ) 155" 5-THECONTRACTOR SHALL INSTALL DRIP LOOPS ON ALL ANTENNA AND JUMPER MwI�YA,taolH l�...An�.�m� 12a-0' 7A• •�'A 75° 0.63 LBS CABLES. 11efi°1x TX/R% 15B'CABLE LpF-i-RA YO" 0.82 LBS. P C 3q0• ]5' 0• TwRX NEW TXAUI +/-12P-0" 7A' a BLUE 6•THE CONTRACTOR SHALL INSTALL ADDITIONAL CABLE SUPPORTS AS NEEDED TO 7 e S�L�•J A - COMMSCOPE T%/FIX •h 12a-0' 7A• 3 BLUE O.�S MAINTAIN A MINIMUM SPACING OF 3'-0"ON CENTER. T1URX_ FW-85B-R3 #t1aC /BWE CABLE WE8 TX/RX .l•120'-0' A. 5g(J)E UNLESS OTHERWISE NOTED: 7.THE CONTRACTOR WILL RECORD THEIOCATIpN AND SEflIAL NUMBERS OF ALI /�����J• i1 � ggl FOR SECTOR60'-100'U6E 7�9"O CABLE ANTENNAS,ANTENNA CONTROIIER AWTOXg,qNp 7NE.IN CORRESPONi%NG INSTALLED ^S •t,� ,� n TwR% SIX H 11a-0' 7(6" 1 FOR SECTOR6 101'-150'USE 1-1M"B CABLE LOCATION AT THE TIME OF LONSTRUCiION. I FOR SECTORS 151'g ABOVE USE 15A"B FABLE A 60' 65' a T%rtiX NEW TXAX +h 11a-0' 7A' 2RE0 J TXIRX COMMSCOPE TXAIX H-11a-0' 7/B' 9RE0 B-ALL ANUREWS MOTORS ARE GENDER SPECIFIC.AND WILL BE WIRED STARTING WITH TXg THE MALE END OF THE CABLE AT THE BTS AND CONTINUE ALONG THE RUN FOLLOWING 1` _ FW-65B-R3 7%IRX N•110'-0' )A• q RED THE TEMME UP RULE' ' TNAt% TXRU( ^ iA• BRED 1` . T%/N% TXRUL N-11a-0' T T^N/RX N-11 )A• _1 WHITE Q B 21W 6v p• TAX NEW T)URX •F 110-0• 7Ar 2 WHITE- () T%IRX GOMMSCOPE T%M% *11a-0' 7/g• 3 WHITE �� �•}.�4� S TXAUI FW-65BA3 T1VR% N-11a-0" 7A' 4 WHITE l T%IRX +1-11a-0" 7 0 G[>3 ,Oa ALrtx 7)MIUf fY`rtvti�0 N•110B WHITEGYP — T%IR% N-11a-0' 7!B' 1 BLUE h'.-- ._ C 340' BS a T%T%IRX , 'W 6 W HITE NEW 7XIRX •/-110-0' iA' 2 BLUE 7 a/ii()i 7itN9_S'Xly COMMSCOPE TXM% H•110'-0' )/g• 9 BiUE - T%IRX FVV-65B-R3 , .._h„a-0• __,�. ... ,q SLUE APPROVED BY --- _-- TXIRX I-,IaHr _ — TX/RX J.K(Bl fl' s BLUE f e•11a-0• 8 BLUE PLANNING BOARD - — • — TOWN » „6,�xDiRoa��,,aP�tt OF SOUTHOLD t�,�D�,.Nt•47, DATE <al2?i I2v2� rYm,o mare 4T mniwciln,.`c•'�••nxM1"a N mx,r„�I4 4CPIH,ItD w• �r�•,�I w,,,RA,: RECEIVED L 1.11 °9Board T•Mobile. Planning Board Northeast LLC N.xwcxlcPvxt,I:cix]uv4M'ifs LAUZEL NSD LI-03-O-A 7055 MAN RD W-261 LALIM.,NY"M ANTENNA INFORMATION _outVa n-6vss - --u I".GIANT x�x� A-9 mm GENERAL RD048 (RATED POWER 48kW,31 25kVA,61 APPROVED B Y MENSIONS(LxW.H) 103.4%35"x90" WEIGHT 29,5LBS. IIFI r.DNSI.MPTION 2.15 GALLONS/HOUR PLANNING BOARD W-7 3/8" (50X LOAD)96 HRS 3.06 GALLONS/HCUR I (75X LOAD)67 HRS TOWN OF SOUTHOLD 0 3.98 GALLONS/HOUR 0 (1 002 -OAD)52 HRS ❑ •1FUEL TYPE ULTRA LOW SULFUR DIESEL DATE iI�J�T nh O TOTAL CAPACITY 240 GALLONS SABLE CAPACITY 229 GALLONS A R C H I T E C T S ACOUSTICS 65 EB AT 23 FEET vr. P+xxxm. COOLING AIR FLOW 2824 CLBIC R/MINLTE ¢ N 4.x7.v _ / TEMP. 1120'r,604,4'C I �? p,NDC!%�n, ,•A. ,VOLTAGE REGJIAI ON x - 1.OX SAFETY 48 NET MIN.RUN TIME UL 142 LISTED LOCKABL. ruEL CAP DC TG VERATOR OATS REQUIRED FOR CC GENERATOR RATED ENG NE SP:E 1.800 RPM OPERAFIOVS U'� (j, T: -PROPOSED p2 AWG BARE 7 TINNED SOJND COPPER GROUND WIRE FROM r° _ PROPOSED GENERATOR o •^ �.J xn NO AC POWER MODIFlCATIONS IN GROUND TO EXISTING GROUND P ¢,w� ssslxo FOR av,;., 7, 7 RING. PROVIDE 2-HOLE LUG ��n---- SCOPE OF W03K - 1 !n7»_as stout+arri CONNECTION TO GENERATOR i"m-En 7 isso r7.wiii i I AND CADWFI D C0 NFCTION TO -3-sUai n- us57aT•Cwt. EXISTING GROUND RING(TYP) °'/�7»=gt�u6 arbTo,v PROHOSLID 1"SCH, 80 PVC CONDUIT WI H CATfi CABLE 7-11" EXISTING "20/240V 200 FROM PROPOSED DC AMP AC PANEL NO WORK GENCRA-OR TO EXISTING SWITCII _ e'-7 3/B- O .N AC SERVICE DURING FOR DATA CIRCUIT (TYP) ------ EXISTING CDNCRETE SLAB THIS SCOPE OF WORKoxPxucrnx¢x Ro¢w¢a s¢mrous¢uxuss EXISTING AC PROPOSED 2"SCI I. 80 PVC runs Ixu sxs sinmsn xsu¢mx SECURE NEW GENERATOR TO CONDUIT WI"H 2 2 D AWG TYPE Rio R¢�¢xcm4Msb�q.c0¢¢:..i1w' COniROLLER XHiW-2 CONDLC ORS FROM MS0 CP11O 1"010 '""'^x xn+` TA EXISRNG CONCRETE BLAB W/1/2- 1 SCALE: S/S ROD/SET IN HILT(N�tlY'150, PROPOSED GENERAIOR (TYP.) °N690 a uua MIN.3-1 2"EMBEDMENT NOTE: NEW CANOPY POST O _0 DAISY CHANGE (2) 2/0 AWC (1)AUTOMATIC GENERATOR TRANSFER CONDUCTORS TO -XIS ZING - SW70 SWITCH SUPPLIED BY T-REFER PSU/REC EXISTING 1 AND INSTALLED BY CONTRACTOR.REFER NEW VERTICAL P1000 EQUIPMENT 6A ERY CONNECTION A B3 I _ 1 TO MANUFACTURER SPECIFICATIONS AND UNISTRUT MEMBER,LENGTH -� -- CABINET WTH PROPOSED REMA S',350 . CRAWINrIS FOR MORE INFORMATION. TO BE VERIFIED IN FIELD PCUACO6 WVS-9H CONNECTOR ASSFMBIY HEIGHT RANGE:36"-48 BY CONTRACTOR-n WIDTH RANGE:24"-30" ^1I DEPTH RANGE: 10"-14-8" EXISTING 50 AMA/2P BREAKE T Mobile• --- - NEW AUTOMATIC GENERATOR TRANSFER SWITCH Northeast LLC x.wxnux ma r,¢w.uvu,ivr nav NEW HORIZONTAL P7000 TO BE UT MEMBER,LENGTH UN BE VERIFIED IN FlELD N$(� LAUREL By coNmASTOR \ U-03-110-A 7066 MAN RD NY-2B - LAMdL NY VM NEW CONCRETE SLAB RECEIVED GENERATOR,TRANSFER SWITCH DETAIL (SEE ONALIL,2/A-FORMATION)R I I ry 8 ELECTRICAL RISER DIAGRAM EXISTING GRADEADDI - 1 JUL 06 CI]23 _-----'---_�Na \ _ w SOU( O YOWn 2 AUTOMATIC GENERATOR TRANSFER SWITCH DETAIL ELCTRICAL RISER DIAGAM R Planning Board A_1 O SCALE:N.T.S. SCALE:N.T.S. Southold Town Planninq Board Work a a io m-ry t kaer 25 —,2023 Pam _www_......_... _w..w. m_..._ _....mm._. T Mobile Colocation at Laurel Stone Celt Project Name � SCTM# 1000-122-6-35.4 4P Tower Location: 7055 Main Road, Mattituck _...... ..... ........ . .. _ ......__ c _ ...www.. _._... r .._. _ ,, . ._w..__..... .. This amended wireless communications application is for a proposed T-Mobile coloration between 60'-80' a.g.l. on an approved existing 110' tall concealed monopole, along with associated ground equipment within a 220' sq. ft. lease area inside an Description: existing fenced-in compound. There are two carriers already located on this tower along with equipment from the local fire district. There are±5,078 sq. ft. of existing buildings including a stone supply yard and associated accessory structures, all on 1.6 j p ..._. .. a... . r?g.Distract. ,_. . ...,..__ ._ ....ww ._.....Nacres in the General Business Zoning .. . _www. .. _. .. . .. Status.._ PPrrvd , Action: _...... Review Site Ins eot��n .....n... Attachments. Staff Reportll .. .. ....._. Discussion: August Monthly Report Final •3 ZBA Request for Comments: o North Fork Project 2 & 3 LLC, 10020 &9650 Sound Avenue, Mattituck, SCTM#1000-122-2-8.1 &24.1, HEARING: October 5, 2023 Site Plan Use Determinations (SPUD): o Koehler Family Limited Partnership Multiple Dwelling Units, 645 North Street, Cutchogue, SCTM#1000-102-5-9.2 o Tesla Charging Stations at 46455 CR 48, 46455 CR 48, Southold, SCTM#1000-55-2-20 Southold Planning Department Staff Report Site Plan Application Work Session —Wireless Update Date September 25, 2023 Prepared By: Mara Cerezo I. Application Information Project Title: T-Mobile Colocation at Laurel Stone Applicant: T-Mobile Date of Submission; July 6, 2023 to Planning Tax Map Number: 122.-6-35.4 Project Location: 7055 NYS Route 25 Hamlet: Mattituck Zoning District: B- General Business II. Description of Project Type of Site Plan: Wireless Colocation Acreage of Project Site: 1.6 acres Building Size 110' Existing Concealed Monopole ±5,078sf existing This Amended Wireless Communications application is for a proposed T-Mobile colocation between 60'-80' a.g.l. on an approved existing 110' tall concealed monopole and the addition of associated ground equipment within a 220' sq. ft. lease area in the General Business Zoning District. III. Update 1. The Planning Board granted approval with conditions for this proposed project at the August 21, 2023 meeting. One of the conditions that needed to be addressed prior to the issuance of a certificate of occupancy related to the maintenance and/or replacement of three trees planted along the street. Staff: The tower owner's agent reached out to state that they had sent a landscaper to review the property due to the condition regarding the trees. The landscaper found that the existing trees were now in bloom. They stated that the trees were delayed in leafing out due to drought conditions, however they are now healthy with fresh leaves. On September 21, 2023 while conducting a final site inspection for a separate colocation on this same site, Planning Staff noted the trees were in bloom and have photos for the Planning Board to review. IV: Planning Board Items To Consider: Based on the site visit findings and correspondence from the tower owner's agent, the Planning Board may consider the condition regarding the maintenance of trees to be sufficiently completed. 1 i Al r r - 1 t'll Ri �717 I 4 n rt - _ _ 07 71 fA Tr 1 Y • r f I r ..cam ->�� s � wrn rZ��y � ��" \ "i �b'+SF_.�y� • r 4� -r I n �I ALI et SUPPLY &LANDSCAPE MATERIALS 631-298-7021 r. � 7 MULCH TOPS®I f - 1 S T i - YG Y � 1 4 `fl r ---- - - - - - .-. 'TOFF' .....liltlul r,.... - qpmmw 1, 'l:r 1� FT '+alt8 ° r■■7 ti i _ IV VIAN IN e..;., �. , t 1 ` F STONE &,UPPLY y - _ _� � ��t its d�e � \A ; �_� - �i•- FFFy r c �. F I - aw IL ��, v... i n s ` v Wj.44 _Y 'apm: '' n r, �" a VIA-- N3, 4. 1 i I i i a I "{•~��a`,�. Y� �i�l,II� �� r m i Ipr�� a - w s y - ?k .'1 v IF : � ; ► � w, ol 215 0704 �S 1523 _ Iu A I <s j •\> ` ...._ - __may.. __�� �_` -- _7 � A Westermann, Caitlin From:Cindy Key - K2 <ckey@k2towers.com> Sent:Monday, September 18, 2023 8:40 AM To:Cerezo, Mara Cc:Westermann, Caitlin; Lanza, Heather Subject:\[SPAM\] - RE: 7055 Main Road Mattituck - Cell Tower Facility He is supposed to be sending me pictures over. I will see if he can send that to me in wri?ng and get that over to you as well. Thank you, Cindy K EY K2 Towers, LLC 57 E. Washington Street Chagrin Falls, Ohio 44022 440-836-4557 direct www.k2towers.com From: Cerezo, Mara <marac@southoldtownny.gov> Sent: Monday, September 18, 2023 8:27 AM To: Cindy Key - K2 <ckey@k2towers.com> Cc: Westermann, Caitlin <caitlinw@southoldtownny.gov>; Lanza, Heather <heather.lanza@town.southold.ny.us> Subject: RE: 7055 Main Road Mattituck - Cell Tower Facility Hi Cindy, Would you be able to get that in wri?ng from the landscaper? I will then forward that to the Planning Board for their review. I can’t make that call on my own. Best, Mara --------------------------- Mara Cerezo, Planner Southold Town Planning Department 54375 NYS Route 25 P.O. Box 1179 Southold, NY 11971 Phone: 631-765-1938 Email: MaraC@southoldtownny.gov From: Cindy Key - K2 <ckey@k2towers.com> Sent: Friday, September 15, 2023 3:37 PM To: Cerezo, Mara <marac@southoldtownny.gov> 1 Cc: Westermann, Caitlin <caitlinw@southoldtownny.gov>; Lanza, Heather <heather.lanza@town.southold.ny.us> Subject: \[SPAM\] - RE: 7055 Main Road Mattituck - Cell Tower Facility Hi Mara, I wanted to reach out. I have had a landscaper get out there to the site to look at replacing the trees. He said the trees are alive at the site now with fresh leaves popping out. Do we need s?ll need to replace live trees? He said they apparently from the drought were delayed in leafing out but they seem to be healthy and have fresh leaves on them. Please let me know if you could as one of the carriers is being their building permit to be approved. Thank you, Cindy K EY K2 Towers, LLC 57 E. Washington Street Chagrin Falls, Ohio 44022 440-836-4557 direct www.k2towers.com From: Cerezo, Mara <marac@southoldtownny.gov> Sent: Wednesday, August 30, 2023 10:35 AM To: Cindy Key - K2 <ckey@k2towers.com> Cc: Westermann, Caitlin <caitlinw@southoldtownny.gov>; Lanza, Heather <heather.lanza@town.southold.ny.us> Subject: 7055 Main Road Mattituck - Cell Tower Facility Hello Cindy, I’m wri?ng in regards to your ques?on about the wireless facility located at 7055 Main Road in Ma?tuck, NY. The language in the approval for the original site plan for this tower stated that three (3) Zelcova or Linden trees approximately 2-3” caliper shall be planted along the street, at the por?on of the lot abu?ng Route 25, spaced approximately 30-40 feet apart, on center. The approval notes that survivability of these tree shall be guaranteed and maintained for the life of the wireless installa?on. Thank you for reaching out and for the con?nued care for this wireless facility. Please feel free to contact us with any addi?onal ques?ons. Have a great day! Best, Mara --------------------------- Mara Cerezo, Planner Southold Town Planning Department 54375 NYS Route 25 P.O. Box 1179 Southold, NY 11971 Phone: 631-765-1938 Email: MaraC@southoldtownny.gov 2 MAILING ADDRESS: PLANNING BOARD MEMBERStit P.O. Box 1179 VS DONALD J.WILCENSKI 4 Southold, NY 11971 Chair �� OFFICE LOCATION: JAMES H. RICH III Town Hall Annex MARTIN SIDOR „ 54375 State Route 25 PIERCE RAFFERTY (cor.Main Rd. &Youngs Ave.) AMELIA JEALOUS-DANK 1' ' Southold, NY Telephone: 631 765-1938 www.southoldt ownny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD August 22, 2023 Ryan Bourke c/o T-Mobile Northeast LLC Complete Development Services 898 North Broadway, Suite #5 Massapequa, NY 11758 Re: SEQRA Classification, Determination, &Approval T-Mobile Colocation @ Laurel Stone Located at 7055 Main Road, Mattituck, NY SCTM# 122.-6-35.4 Dear Mr. Bourke: The following resolutions were adopted at a meeting of the Southold Town Planning Board on Monday, August 21, 2023: WHEREAS, this amended wireless communication facility application is for a proposed T-Mobile colocation between 60'-80' a.g.l. on an approved existing 110' tall concealed monopole and the addition of associated ground equipment within a 220' sq. ft. lease area. There are two carriers already located on this tower along with equipment from the Mattituck Fire District. There are also ±5,078 sq. ft. of existing buildings including a stone supply yard and associated accessory structures, all on 1.6 acres in the General Business Zoning District; and WHEREAS, on September 8, 2022, Ryan Bourke, authorized agent, submitted a Building Permit application to the Building Department; and WHEREAS, on September 15, 2022, the Planning Board authorized CityScape Consultants to review the application for completeness of technical information; and WHEREAS, on September 27, 2022, CityScape notified the applicant of missing technical items to be addressed; and Southold Town Planning Board P a g e 12 August 22, 2023 WHEREAS, on April 11, 2023, Ryan Bourke, authorized agent, notified CityScape Consultants that the applicant was compiling the required documentation and that the Tower owner requested a relocation of ground equipment that required reconfiguration; and WHEREAS, on May 8, 2023, Ryan Bourke, authorized agent, submitted technical data to CityScape Consultants; and WHEREAS, on May 12, 2023, the Planning Board due to the nature of the proposed colocation notified the applicant that a Site Plan application and associated fees were required by Southold Town Code; and WHEREAS, on July 6, 2023, Ryan Bourke, authorized agent, submitted a site plan application for review; and WHEREAS, on July 6, 2023, Ryan Bourke, authorized agent, pursuant to 280-74A(4) of the Town Code, submitted a check in the amount of$8,500 into an escrow account with the Town Comptroller's Office to cover the cost of the Technical Consultant's Review; and WHEREAS, on July 6, 2023, the Planning Board authorized CityScape Consultants to proceed with the work as outlined in the agreement; and WHEREAS, at a Work Session on August 21, 2023, the Planning Board accepted the application as complete for review; and WHEREAS, pursuant to Southold Town Code 280-131(H), this application is eligible for a waiver of the requirement for a public hearing because the colocation will not be visible as the new antennas and cables will be placed inside the already existing monopole, with no extension of the height of the pole, and ground equipment will be placed inside an already existing fenced-in compound; and WHEREAS, at a Work Session held on August 21, 2023, the Planning Board reviewed the report issued by CityScape Consultants on August 2, 2023; and, determined that the action falls within the FCC regulations of the Middle-Class Tax Relief and Job Creation Act of 2012. Therefore, it is recommended for approval with the understanding that the proposed cable (see Conditions below) will be installed inside the monopole shaft; and WHEREAS, at a Work Session held on August 21, 2023, the Planning Board found that all applicable requirements of the Site Plan Regulations, Article XXIV, 280 — Site Plan Approval of the Town of Southold, have been met; and WHEREAS, the Southold Town Planning Board, pursuant to State Environmental Quality Review Act (SEQRA) 6 NYCRR, Part 617, has determined that the proposed action is an Unlisted Action as it does not meet any of the thresholds of a Type I Action, nor does it meet any of the criteria on the Type 11 list of actions; and Southold Town Planning Board P a g �; G 3 August 22, 2023 WHEREAS, the Planning Board performed an uncoordinated review of this Unlisted Action pursuant to 6 NYCRR Part 617, Section 617.7 of the State Environmental Quality Review Act (SEQRA); therefore be it RESOLVED, that the Southold Town Planning Board has determined that this proposed action is an Unlisted Action under SEQRA as described above; and be it further RESOLVED, that the Southold Town Planning Board, as Lead Agency pursuant to the State Environmental Quality Review Act, makes a determination of non-significance and grants a Negative Declaration; and be it further RESOLVED, that the Southold Town Planning Board hereby waives the public hearing as noted above; and be it further RESOLVED, that the Southold Town Planning Board grants an approval with conditions to the site plan entitled "T-Mobile Northeast LLC, Laurel, 7055 Main Rd. (NY-25), NSD @ Site No. LI-03-110-A", prepared by Neil Alexander Macdonald, Registered Architect, dated April 20, 2022 and last revised April 11, 2023; and authorizes the Chairman to endorse the Situ Plan including the following plans: T-1 Title Sheet A-7 Equipment Details A-1 Architectural Site Plan & General Notes A-8 Antenna Information &Antenna Mounting A-2 Enlarged Compound Plan & Site Details Details A-3 Enlarged Compound Plan & Site Details A-9 Antenna Information A-4 Canopy Framing Plan and Typical Details A-10 Generator, Transfer Switch Detail & A-5 West Elevation Electrical Riser Diagram A-6 Equipment Cabinet Details Conditions: A. Prior to endorsement of the site plan, a use certification must be obtained from the Chief Building Inspector as required by Town Code. B. Prior to the issuance of a building permit: 1. Ensure the osprey nest located on top of the existing monopole is removed in accordance with all state and federal requirements. 2. A preventative device shall be installed on top of the pole and in other locations if found to be necessary to prevent the nesting of osprey, and other birds and wildlife. C. Prior to the issuance of a certificate of occupancy: 1. The three trees planted along the street, at the portion of the lot abutting Route 25, must be replaced in accordance with the original site plan approval for this wireless facility granted on June 29, 2020. D. Additional conditions of approval (ongoing): 1. All of Applicant's feed lines/cables shall be installed inside the monopole structure. Southold Town Planning Board P a g e 14 August 22, 2023 2. No exterior lights were reviewed or approved in connection with this site plan. Any exterior lights on or around the outside of this area must be reviewed and approved by the Planning Board prior to installation and must meet Town Code §172 Lighting. 3. All ports shall remain sufficiently sealed to prevent access by birds and other wildlife. 4. Survivability of the three trees planted along the street, at the portion of the lot abutting Route 23, shall be guaranteed and maintained for the life of the installation. 5. The facility shall remain secured and protected from unauthorized personnel. Please note the following requirements in the Southold Town Code relating to Site Plans: • Approved Site Plans are valid for eighteen months from the date of approval, within which time all proposed work must be completed, unless the Planning Board grants an extension. • Any changes from the Approved Site Plan shall require Planning Board approval. • Prior to the issuance of a Certificate of Occupancy, the Planning Board must inspect the site to ensure it is in conformity with the Approved Site Plan and the conditions above, and issue a final site inspection approval letter. Should the site be found not in conformance with the Approved, Site Plan, no Certificate of Occupancy may be issued unless the Planning Board approves the changes. A copy of the Approved Site Plan is enclosed for your records. One copy will also be sent to the Building Department and the Town Engineer/Highway Department. If you have any questions regarding the above, please contact this office. esp tf�y Donald J. Wilcenski Chairman Encl. cc: Michael Verity, Chief Building Inspector, with map fix ° a MAILING ADDRESS: PLANNING BOARD MEMBERS �� P.O. Box 1179 DONALD J.WILCENSKI " M Southold, NY 11971 Chair OFFICE LOCATION: Town Hall Annex JAMES H. RICH III 54375 State Route 25 MARTIN SIDOR PIERCE RAFFERTY (cor.Main Rd. &Youngs Ave.) AMELIA JEALOUS-DANK Southold, NY Telephone: 631 765-1938 www.southoldtownny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD State Environmental Quality Review NEGATIVE DECLARATION Notice of Determination Non-Significance August 21, 2023 This notice is issued pursuant to Part 617 of the implementing regulations pertaining to Article 8 (State Environmental Quality Review Act) of the Environmental Law. The Southold Town Planning Board, as lead agency, has determined that the proposed action described below will not have a significant effect on the environment and a Draft Environmental Impact Statement will not be prepared. Name of Action: T-Mobile Colocation at Laurel Stone SCTM#: 122.-6-35.4 Location: 7055 NYS Route 25 SEAR Status: Type I ( ) Unlisted (X) Conditioned Negative Declaration: Yes ( ) No (X) Description of Action: This Wireless Communications application is for a proposed T-Mobile Wireless colocation at 60'-80' a.g.l. on an approved existing 110' tall monopole and the addition of associated ground equipment within a 220 sq. ft. lease area. There are two carriers already located on this monopole (all concealed within the pole). There are also ±5,078 sq. ft. of existing buildings including a stone supply yard and associated accessory structures, all on 1.6 acres in the General Business Zoning District Reasons Supporting This Determination: An Environmental Assessment Form has been submitted and reviewed and it was determined that no significant adverse effects to the environment were likely to occur should the project be implemented as planned. The property is currently improved with a 110' tall monopole. AT&T currently occupies the top two canisters on the pole at 105' a.g.l. and 95' a.g.l. Existing equipment cabinets are located in a fenced compound surrounded and not visible from public areas. The new T-Mobile equipment will be located within a 220 sq. ft. lease of a 2,500 sq. ft. area of equipment area, will be screened by an existing fence, and will not be readily visible from public vantage points. The property is zoned General Business (B). The land use on site is commercial. The surrounding land uses within the vicinity of the site are also commercial. The proposed action of adding an internal concealed antennae will not cause a substantial intensification of the current use. The monopole is visible from New York State 25 due to its height; a New York State Scenic Byway. All antennae will be internal, and no change to the current view shed will occur. The new supporting infrastructure will not be visible from roadways. The Planning Board has determined that the placement of antennas in the monopole will not result in significant impacts on the view sheds important to the community due to the current use and operation of a wireless facility on-site. Further, the proposed action will not cause significant impacts to agricultural, open space, or recreational resources. The proposal will minimize ground disturbance. No substantial adverse change in existing air quality, ground or surface water quality or quantity, traffic, or noise level is expected due to this colocation. No major change in the use of either the quantity or type of energy will occur. The applicant has submitted an assessment of a Structural Analysis Report (2023). Cityscape, the Town of Southold consultant on the project, indicates that the structural usages were determined to be 60.8% of Maximum Tower Capacity under the allowable 110%. The Applicant provided a Radio Frequency Electromagnetic Energy (RF-EME) Maximum Permissible Exposure (MPE) Study Report, prepared by Pinnacle Telecom Group dated March 23, 2023. The report omitted one existing antennae and needs to be corrected. Nevertheless, the Town's consultant CityScape conducted an estimated worst-case scenario calculation and found that the public exposure level would be compliant. The combined emittance of RF from all antennae equipment located on this stealth pole does not exceed the maximum permissible % RF exposure levels for the FCC general population Maximum Public Exposure level (MPE). Therefore, no known creation of a hazard to human health is expected to occur as a result of the proposed action. The site is improved, no significant removal or destruction of large quantities of vegetation will occur. An active Osprey nest is located on the monopole. The Osprey is a bird of Special Concern in New York State. NYSDEC protocol is to wait until the nest is inactive and then remove it after September 1. 2 In the event of other species that interact within the area of the monopole, the New York Department of Environmental Conversation in a 2009 policy memorandum entitled Guidelines for Consultation with NY Natural Heritage regarding Proposed Collocations of Telecommunication Facilities on Existing Towers and Buildings (2009) has determined that proposed actions involving the colocation of new equipment on an existing structure (monopole) are not likely to adversely affect Federally-listed species in New York, nor have any significant impacts on migratory birds or other trust resources. Therefore, no substantial interference with the movement of any resident or migratory fish or wildlife species, or significant habitat area or result in adverse impacts to a threatened or endangered species or the habitat of such a species are expected to occur. No significant, new ground disturbance will occur; therefore, the action would not result in adverse impacts on cultural/historic resources nor impair the character or quality of important historical resources. The site is currently improved and the proposed action will not result in significant adverse impacts to aesthetic resources or to existing community or neighborhood character or result in a material conflict with the community's current plans or goals as officially approved. Based upon such, no significant adverse environmental impacts are expected to occur should the project be implemented as planned. For Further Information: Contact Person: Mark Terry, Assistant Town Planning Director Address: Southold Town Planning Board Telephone Number: 631-765-1938 cc: Town Board Building Dept. 3 Agency Use Oznly [IfA3npttc able( Project; r-Mobile Coloration Laurel Stone 99p9p9p9pip9 Date„ ft ust 2l0 2023 Full Environmental Assessment Form Part 3-Evaluation of the Magnitude and Importance of Project Impacts and Determination of Significance Part 3 provides the reasons in support of the determination of significance. The lead agency must complete Part 3 for every question in Part 2 where the impact has been identified as potentially moderate to large or where there is a need to explain why a particular element of the proposed action will not,or may,result in a significant adverse environmental impact. Based on the analysis in Part 3,the lead agency must decide whether to require an environmental impact statement to further assess the proposed action or whether available information is sufficient for the lead agency to conclude that the proposed action will not have a significant adverse environmental impact. By completing the certification on the next page,the lead agency can complete its determination of significance. Reasons Supporting This Determination: To complete this section: • Identify the impact based on the Part 2 responses and describe its magnitude. Magnitude considers factors such as severity, size or extent of an impact. • Assess the importance of the impact. Importance relates to the geographic scope,duration,probability of the impact occurring,number of people affected by the impact and any additional environmental consequences if the impact were to occur. • The assessment should take into consideration any design element or project changes. • Repeat this process for each Part 2 question where the impact has been identified as potentially moderate to large or where there is a need to explain why a particular element of the proposed action will not,or may,result in a significant adverse environmental impact. • Provide the reason(s)why the impact may,or will not,result in a significant adverse environmental impact • For Conditional Negative Declarations identify the specific condition(s)imposed that will modify the proposed action so that no significant adverse environmental impacts will result. • Attach additional sheets,as needed. See Negative Declaration narrative dated August 2023 attached. Determination of Significance-Type 1 and Unlisted Actions SEQR Status: ❑✓ Type 1 ❑Unlisted Identify portions of EAF completed for this Project: ❑✓ Part 1 ❑✓ Part 2 ✓❑Part 3 Upon review of the information recorded on this EAF,as noted,plus this additional support information mm_.._.._............................ .__.........._........_._. __...............__wwwwwww. ._.........__...._.................. .__.......... �._ ._ _...�___............._ .._._........... a_-.._www_ww......._..... ............ and considering both the magnitude and importance of each identified potential impact,it is the conclusion of the Southold Town Board www. _. �............. w.w..__.._._._.�.__......._w as lead agency that: ❑✓ A. This project will result in no significant adverse impacts on the environment,and,therefore,an environmental impact statement need not be prepared. Accordingly,this negative declaration is issued. ❑ B. Although this project could have a significant adverse impact on the environment,that impact will be avoided or substantially mitigated because of the following conditions which will be required by the lead agency: ...... ...... .... �.... .. ... ...... ... There will,therefore,be no significant adverse impacts from the project as conditioned,and,therefore,this conditioned negative declaration is issued. A conditioned negative declaration may be used only for UNLISTED actions(see 6 NYCRR 617.d). ❑ C. This Project may result in one or more significant adverse impacts on the environment,and an environmental impact statement must be prepared to further assess the impact(s)and possible mitigation and to explore alternatives to avoid or reduce those impacts. Accordingly,this positive declaration is issued. Name of Action: T-Mobile Antennae Co-location at Laurel Stone Name of Lead Agency: Town of Southold Planning Board Name of Responsible Officer in Lead Agency: Donald Wilcenski,Chairman Title of Responsible Officer: Same ...___-._.........._.,wwww.w......_...._. _.............�.._.._._..._...__�......_...... �,.. . ryµ...� .... .. _�.�� .�......... Date....N August ...._ . t 22 2023 Signature of Responsible Officer to Lead Agency: . u — . s . ... Signature of Preparer(if different from Responsible Officer) Date: August 22,2023 For Further Information: Contact Person: Mark Terry,Assistant Director of Planning Address: P.O.Box 1179,53095 Main Road,Southold,NY 11971 Telephone Number:631-765-1938 E-mail: Mark.Terry@town.southold.ny.us For Type 1 Actions and Conditioned Negative Declarations,a copy of this Notice is sent to: Chief Executive Officer of the political subdivision in which the action will be principally located(e.g.,Town/City/Village of) Other involved agencies(if any) Applicant(if any) Environmental Notice Bulletin: kit:p:p��w yw dggW,ftymegcty/oatkl ,Mab.htm PRINT FULL FORM Page 2 of 2 Southold Town Planninrd Work Session August 21 2023Page 2 Proiecation N 55 Cox Neck Road, 90' north of Sou0ndlAven 1000-113-7-19.23 ......._ es at R_ _._.. ,,. Loca ct N d a roximatel .._4.........'._ Avenue, Mattituck . _......... . ...._�a m.e .The. ..stat... ....._,�w ' ._ `� . ......... .�. �. ..�.-M This is an approved Standard Subdivision of a 36.9-acre parcel into 12 Description: lots located in the A-C Zoning District. This subdivision includes 15.2 to access Lots 1 — 11. } .� p.w..m...._. acres of o... .�..._ .�� for a new road ... w...-. . ..�.. ..�a.� ... acres ._�_ . . .._ .� . e and Action: Review for Subdivision Map .. .....w _ Attachments. Staff Report se w.... . . ......._ ..... .W. .. ...... elea........ .. Project Name: Stone Cell Towerion at Laurel � SCTM# 1000-122-6-35.4 ]T-Mobile Colocat Location: 7055 Main Road, Mattituck _. ... _ _ This amended wireless communications application ` ion is for proposed T- Mobile colocation between 60'-80' a.g.l. on an approved existing 110' tall concealed monopole, along with associated ground equipment within a Description: 220' sq. ft. lease area inside an existing fenced-in compound. There are two carriers already located on this tower along with equipment from the local fire district. There are ±5,078 sq. ft. of existing buildings including a stone supply yard and associated accessory structures, all on 1.6 acres Zoning District. Status: . � in the General Business, � ,�w. .... r Pending -. ....... ......._ _d Review for Determination Attachments Staff ................._ deport Action: _- 1-1-1111 Discussion: Planning Board Required Training Southold Planning Department Staff Report Site Plan Application Work Session —Wireless Analysis Date August 21, 2023 Prepared By: Mara Cerezo I. Application Information Project Title: T-Mobile Colocation at Laurel Stone Applicant: T-Mobile Date of Submission; July 6, 2023 to Planning Tax Map Number: 122.-6-35.4 Project Location: 7055 NYS Route 25 Hamlet: Mattituck Zoning District: B- General Business II. Description of Project Type of Site Plan: Wireless Colocation Acreage of Project Site: 1.6 acres Building Size 110' Existing Concealed Monopole ±5,078sf existing This Amended Wireless Communications application is for a proposed T-Mobile colocation between 60'-80' a.g.l. on an approved existing 110' tall concealed monopole and the addition of associated ground equipment within a 220' sq. ft. lease area. There are two carriers already located on this tower along with equipment from the Mattituck Fire District. There are also ±5,078 sq. ft. of existing buildings including a stone supply yard and associated accessory structures, all on 1.6 acres in the General Business Zoning District. A. Existing: 1. July 2020 site plan for construction of 110' tall monopole with a 50' by 50' (±2,500 sf) ground equipment compound area. AT&T occupies the top two canisters on the pole at 105' a.g.l. and 95' a.g.l.; 2. August 2022 site plan for Dish Wireless Colocation, including two mounted panel antennas at 85' above ground level, along with ±35sf equipment lease area within an existing ground equipment compound, and GPS and cable transfers; 3. All related equipment cabinets, cables, and hardware are within the ±2,500sf fenced equipment compound. B. Proposed T-Mobile Wireless Colocation: 1. Three antennas at 65' above ground level; 1 T-Mobile Colocation @ Laurel Stone (7055 Main Road, Mattituck) 2. Three antennas at 75' above ground level; 3. Related cables and equipment; 4. ±220sf equipment compound lease area, including a new 10' x 22' concrete pad to support all equipment. C. CityScape Technical report dated August 2 2023: 1. Structural Analysis dated July 27, 2023 shows the tower at 60.8% of maximum usage capacity (out of an allowable 105%), and the base and foundation would be 63.4% of capacity (up to 110% allowed), thus the tower with the proposed modifications would be structurally compliant. 2. The RF Exposure Safety dated March 22, 2023 omitted the Dish Wireless antennas from the analysis. The applicant has contacted the preparer of the RF exposure analysis to send a corrected report. At the time of the writing of CityScape's report, the corrected RF Exposure report had not yet been received. In lieu of this report, CityScape conducted an estimated worst-case scenario calculation and found that the public exposure level would be compliant. 3. The Applicant provided a letter stating it will comply with the FCC rules and the FCC Best Practices Guide regarding interference to other radio facilities. 4. Conclusion: CityScape verified this application to be an "eligible facilities" request which meets the definition of a non-substantial change. Therefore, this application qualifies for streamlined processing and recommends administrative approval with the understanding that the proposed cables will be installed inside the monopole shaft. i. Note: Applicant states that T-Mobile feed lines and cables will be mounted entirely inside of the shaft of the monopole in their letter dated July 10, 2023. III. Analysis 1. This is a colocation on an existing cell tower with no extension of height proposed. 2. The technical consultant for the Town, CityScape, has reviewed the application and found that it is complete, meets all requirements and recommends approval (see attached report and summary above). 3. Site Plan issues: a. Prior to a building permit being issued, ensure the osprey nest located on top of the existing monopole is removed in accordance with all state and federal requirements. 2 T-Mobile Colocation @ Laurel Stone (7055 Main Road, Mattituck) b. Installation of device to prohibit creation of future osprey bird nests on top of the monopole. c. Include a condition that all cables must be installed inside the monopole. d. The trees that were required to be planted and maintained on site have died and must be replaced prior to a certificate of occupancy being issued. These trees are shown on the original approved site plan for this monopole. The trees are not shown on the current site plan for this proposed colocation. Include a condition that these trees must be maintained and replaced if they die as long as the monopole exists at this site. 4. Public hearing, and the timing of the decision: a. This is an existing tower with the only visible addition being an ice bridge and weather canopy inside the ground equipment area. The new antennas for T- Mobile will be incorporated inside the existing tower and it will appear the same as it is now. b. FCC rules require a decision within 60 days for this type of colocation. This application was first submitted in September 2022. However, the delay of this application review was due in large part to T-Mobile's redesign of the ground facility as noted in CityScape's report. The applicant submitted the majority of the required technical materials in May 2023, and the Site Plan Application in July 2023. c. Consider waiving the public hearing due to the tower already existing, and to meet the FCC timeline. 5. SEQRA Analysis (See separate report.) a. SEQRA Assessment and Negative Declaration (attached) completed by Mark Terry, Assistant Town Planning Director. A SEQRA determination is scheduled on the Planning Board's Public Meeting agenda tonight. IV: Planning Board items to consider: 1. Accept the application as complete. 2. Waive the public hearing based on the reasons provided above„ 1 Based on the analysis referenced above and included in the CityScape Technical Report dated August 2, 2023, all site plan requirements have been met and the Planning Board may make a determination at tonight's Public Meeting including SEQRA classification and SEQRA determination from an uncoordinated review. A determination may include the following conditions: 3 T-Mobile Colocation @ Laurel Stone (7055 Main Road, Mattituck) (a) Prior to a building permit being issued, ensure the osprey nest located on top of the existing monopole is removed in accordance with all state and federal requirements. (b) A preventative device shall be installed on top of the pole and in other locations if found to be necessary to prevent the nesting of osprey, and other birds and wildlife. (c) All of Applicant's feed lines/cables shall be installed inside the monopole structure. (d) Trees, required on the original site plan for this monopole, must be replaced and maintained for the duration of the wireless facility's operation, as long as the monopole exists at this site. 4 Michaelis, Jessica Subject:RE: Application for T-Mobile collocation at 7055 Main Rd, Mattituck NY (Southold) From: Elizabeth Herington-Smith <elizabeth@cityscapegov.com> Sent: Tuesday, September 27, 2022 4:40 PM To: Michaelis, Jessica <jessica.michaelis@town.southold.ny.us> Subject: FW: Application for T-Mobile collocation at 7055 Main Rd, Mattituck NY (Southold) FYI, this is for completeness only and is marked as incomplete. I didn’t see you on the original email. Thank you, let us know when they submit the required docs and when it is ready for our technical review. Thank you! Elizabeth Herington-Smith | 561-541-3104 From: Ben Evans <ben@cityscapegov.com> Date: Tuesday, September 27, 2022 at 4:23 PM To: "Ryan.Bourke@completedevs.com" <Ryan.Bourke@completedevs.com> Cc: Brian Cummings <brian.cummings@town.southold.ny.us>, Elizabeth Herington-Smith <elizabeth@cityscapegov.com> Subject: Application for T-Mobile collocation at 7055 Main Rd, Mattituck NY (Southold) Dear Ryan, I am the engineer at CityScape performing the review of your application to the town of Southold NY for T-Mobile to collocate on a monopole tower at 7055 Main Road in Mattituck, NY. The application is incomplete. We require the following items to be addressed: 1) Provide an RF human exposure analysis and report showing compliance with the FCC maximum RF energy levels and in accordance with Bulletin OET-65. The analysis should include all current transmitters on the tower, the proposed Dish facility, the proposed T-Mobile facility as well as other proposed facilities or upgrades if any. 2) Provide a PASSING structural analysis report, signed and sealed by a structural Professional Engineer licensed in the State of New York, stating that the monopole and foundation will structurally support the additional T-Mobile equipment. 3) Provide a signed and dated letter on T-Mobile letterhead, writer identified by name and position, stating that T- Mobile will comply with FCC rules and the FCC Best Practices Guide regarding interference to other radio facilities. This letter must come from T-Mobile. 4) Confirm that the proposed T-Mobile feed lines will be routed inside the monopole shaft. Once we receive the above-requested information and the info is acceptable, the application will be deemed complete and the review report will be completed in one or two business days. Thank you in advance for providing the above info, and if you have any questions don’t hesitate to call or email me. Best Regards, 1 Ben Evans CityScape Consultants, Inc. (262) 518-0178 Sent from Mail for Windows 2 TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax(631) 765-9502 liglj, Date Received APPLICATIONF011- BUILDING "R ' l'T i1e :xa,,. V For Office Use Only J PERMIT NO. Building Inspector. Applications and forms must be filled out in their entirety. Incomplete �I I,1h applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S) OF PROPERTY: Name:Laurel Stone Supply sCTM #1000-122.00-06.00-035.004 Project Address:7055 Main Road, Mattituck NY 11952 Phone#:631-298-7021 Email: Mailing Address:7055 Main Road, Mattituck NY 11952 CONTACT PERSON: Name: Ryan Bourke / Complete Development Services Mailing Address:898 North Broadway, Suite #5 Massapequa NY 11758 Phone#:631-896-2392 Email:ryan.bourke@completedevs.con DESIGN PROFESSIONAL INFORMATION: Name:William F Collins Mailing Address:12-1 Technology Drive, E. Setauket NY 11733 Phone#:631-689-8450 Email:neii.macdonald@wfcaia.com CONTRACTOR INFORMATION: Name:Milicia Electric Corporation Mailing Address:87 Eads Street, West Babylon NY 11704 Phone#:516-694-0751 Email:jlavalle@miliciaelectric.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition *Alteration ❑Repair ❑Demolition E18e666t of Project: ❑Other V ((JJ Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes *- No 1 ._..� " Existing use of property:Active stony supply store withwirelessfacility inbackoflot Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes *No IF YES, PROVIDE A£OPY. «rri It 1 Application Submitted By(print n e in t ,her SchaafAgent []Owner®Authorized Signature of Applicant: Date: " STATE OF NEW YORK) SS: i COUNTY OF Suffolk ) Christopher Schaaf being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Authorized Agent (Contractor,Agent, Corporate Officer, etc. of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/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 _,,day of �� s 20 Z? � •°� N d tart' Public JEt+WIFER DONOHUE Notary Public-State of Now York PROPERTY OWNER AUTHORIZATION '0400tie I° folkCounty (Where the applicant is not the owner) orhmis i n Expires 09/08/26"'25, 9r�ra/ 6'25' I rk d L 1 residing at_ Irt i 1 S� Christopher Schaaf / T-Mobile' do hereby authorize � to apply on my behalf to the Town of Southold Building Department for approval as described herein. Ow4rSignature Date I�Auj �v-A �A� Print Owner's Name 2 ACORD' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDnrvY) `i 0910712022 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 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'tMAnthonf DlGenflar0 ' m...... .._. ,�. DiGennaro&Associates, Inc. PHONE Est)631 243 9014 315 3750 •f�Alt �- 999-32 Montauk Hwy Suite#421 ADDSEwSA. tlu +a'bl"w 01 paol conw co11 m_ Shirley NY 11967 ..w� INsp_R.FF31§)AFFPRo1NG CPVFRAP_ ... .................... .---_ l�Alc INSURED_ .m.......�..e.....".ww...�.. ........... �.�..-....,. ._..........w.............e..e..-....,. ..,.�.,�,...�"""".�..,,,... (NpR "R Hartford Ins Co 41513 NlpspRRpmmeHartford Ins Co of The Midwest m a 23809 .. Milicia Electric Corp. iNspBF�" AIGePropert�r Casualty"Co 19402 JMSpR� .o. 9445 ._ The Travelers Indemlt Co.... 1:..... .. 87 Eads Street ltd)51.1?6R _ .::.............. ..........___... 24260 West BabyIon, NY 11704 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. _:....., ___1_...._. r .....�.................._... ...._�mw. ..r..... �w. ..w. .._ ......... .w. _...- ........, INSR ADDL SuBR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLI.Y MB RMWO X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1 99M-00 .DAPw7AGETO R NTED .. A CLAIMS-MADE x OCCUR -WREMISE, ( .octut'ra adM) ."s 100,000 x Contractual Liability X 12SBAAD1391 06/01/2022 06/01/2023 MFD r(Anyoq,R,persnn)„_ $10,000 rlmary&Non Contributory.:.” P,ERsorJAG_a ADv INJURY„® ,,�$1 000000 X P ......... ..m GEN1 AGGRE(ATE LIMIT APPLIES PER: CFNE,ft L ACGREGATP ,.. POLICY _,,.—I PRO- ROEl LOC OTHER,_R, $ AUTOMOBILE LIABILITY COMDINE'D SMGL E L 0Mh`R $1 000 OOO A X ANY AUTOBODILY INJURY(Per person) $ ALL OWNED SCHEDULED 12UECGA0393 06/01/2022 06101/2023 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X.....,, HIRED AUTOS _X.... AUTOS (Pmr accddranQ ............ $ X UMBRELLA LIAB X . OCCUR EACHCLIRRPNCE �X55�,0�0�0,00000 'A EXCESS LIAB 12SBAAD1391 06/01/2022 06/01/2023 AGGREGATE , .___ RFT NTIN _-. . e_., __. D 0 10,000 Follows Form $ WORKERS COMPENSATION X PER✓�TLLTE d CJrH- ANY PROPRIETOR/PARTNER/EXECUTIVE F L. EACH ACCIDFNT AND EMPLOYERS'LIABILITY YIN $1 000,000 B OFFICER/MEMBEREXCLUDED? F—] N/A 12WECKZ6547 06/01/2022 06/01/2023 �” " """"""'"."__"I (Mandatory in NH) EASEmmmEA EMPLOYEE„„,1r 00,999 E L.DIS If yes,describe under 1 DF QRIPTI N OF P TI N I w EL.DISEASE-POLICY LIMIT $1,000,000 D Excess Liability ZUP-51N20885-19-NF 09/13/2021 09/13/2022 5,000,000 Occurrence C Pollution Liability CPO 28802609 07/19/2022 0711912023 1,000,000 Occurrence DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate holder is named as a additional insured with respect to work done by the insured on their General Liability Policy 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 Southhold, NY 11971 AUTHORIZED REPRESENTATIVE <CNV> ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Workers' Compensation CERTIFICATE OF INSURANCE COVERAGE �t�rr Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW ........ _ ...... .. ........ PART 1.To completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrie 1 a. Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured MILICIA ELECTRIC CORP. 631 6940751 87 EADS STREET WEST BABYLON, NY 11704 1 c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State,i,e., Wrap-Up Policy) 800003633 2. Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold 53095 Route 25 3b. Policy Number of Entity Listed in Box"1 a" Po Box 1179 DBL432238 Southold NY 11971 3c.Policy effective period 01/01/2022 to 12/31/2023 4. Policy provides the following benefits: © A. Both disability and paid family leave benefits. ❑ B.Disability benefits only. F] C.Paid family leave benefits only. 5. Policy covers: © 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 Benefits insurance coverage as described above. Date Signed 9/7/2022 By hf (Signature of insurance carriers authorized representative or NY e .s.. .c,�f tha.., a _....................r) p S Licensed Insurance Agent of that insurance carrier} Telephone Number 516-829-8100 Name and Title Richard White. Chief Executive Officer 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 emailed to PAU@wcb.ny.gov or it can 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 4B,4C or 513 have 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(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed BY ..... _. _......... ....... wwww ....._._._._._.�.... (Signature of Authorized NYS workers'Compensation Board Employee Telephone Number Name and Title _WWW.._. ....... ...... ........................ _ _. ...._ 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. D13-120.1 (12-21) I I III °��°!°°11°1111111111°°1°11°°°IIIIII) Additional Instructions for Form 10113-120.1 By signing this form, the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in Box 1 a for disability and/or Paid Family Leave benefits under the NYS Disability and Paid Family Leave Benefits Law. The insurance carrier or its licensed agent will send this Certificate of Insurance Coverage (Certificate)to the entity listed 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 cancelled 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 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 NYS disability and/or Paid Family Leave benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or Paid Family Leave benefits 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 Insurance Coverage for NYS disability and/ or Paid Family Leave Benefits or other authorized proof that the business is complying with the mandatory coverage requirements of the NYS Disability and Paid Family Leave Benefits Law. NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand and twenty-one, the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand eighteen, the payment of family leave benefits for all employees has been secured as provided by this article. DB-120.1 (12-21) Reverse 11-1 ZWorkers' CERTIFICATE OF MA W z1ttIrrl NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia.Legal Name&Address of Insured(use street address only) Ib.Business Telephone Number of Insured Milicai Electric Corp 631 6940751 87 Eads Street ic.NYS Unemployment Insurance Employer Registration Number of West Babylon NY 11704 Insured Work Location of Insured(ONy required if coverage is specifically limited to id.Federal Employer IdentKcatlon Number of Insured or Social Security certain locations in New Yarit State,i.e.,a Wrap-Up Policy) Number 80 0003633 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carder (Entity Being Listed as the Certificate Holder) Hartford Ins Co. Town of Southold 3h.Policy Number of Entity Listed In Box"l a' 53095 Route 25 12WECKZ6547 Po Box 1179 Southold NY 11971 3c.Policy effective period 061011209 to 06/01/2023 3d.The Proprietor,Partners or Executive Officers are included.(only check box if all parinerstofacers included) E] all excluded or certain partners/officers excluded. This certifier.that the insurance carrier indicated above in box"3"insures the business referenced above in box'1a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NYS must be listed under Item�A on the INFORMATION PAGE of the workers'compensation Insurance policy). The Insurance Carrier or its licensed agent will send this Certifleate of Insurance to the entity listed above as the certificate holder in box'2". The insurance camer must notify the above certificate holder and the Workers'Compensation Board within 10 days IF s policy is canceled due to nonpayment of premiums or within 30 days IF theta are tsasons other then nonpayment of premiums that cancel the policy or elimk»ate the insured from the coverage indicated on this Certific ate.( hese notices may be;sunt by regular mate)Otherwise,this Certificate Is vaild for orale year after this form Is approved by the Insurance carrier or Its licelrtse d agent,or until the policy expiration dab 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 arose contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensalion contract of insurance only while the underlying policy is in effect. Please Nob:Upon cancellation of the worklitrs'compensation policy Indicaliipd on this form,if the business continues to be nomad on a permit,license oar contract Issued by a certificate holder,the buslness must provide that certificate holder with a new Certificate of Workers'Compensatlon 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 poilriury,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. An'thonv DiGennaro t name ofauk ad're me"or licensed agent of insurance carrier) Approved by: 09/07/2022 191"ahrrrr) (Date) Title: Anent e Telephone Number of authorized representative or licensed agent of insurance carrier. 631 2439014 Please Not#:Only Insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue It. C-105.2(9-1T) www.web.ny.gov LONG ISLAND RAILROAD i 176 50' �.r.^. rm a" y a;e A a a .a I } m� ,re Y M i q a i LIWL 1J'01N .�- S38'03 31 Y! 7EaCAU p„ r PP -, 1M 4 a r p s e � f 4 4(IX ap1I`W �S40'4 �r,811"W ,...., 4 i..., �4411� w MAIN ROAD YiS,YrS�y1 �y, sa all r ��a r7' I U Mli rn� Tj"),p J kL z 713N p R k x Y Z ol LO 2 C, 7 fle oz- 4I z 2: 0 < U 2 2 LL, t5 LU 0 Lo ce ol w a- < LO < U 0 LL 7 d 0 < :-5 Q > UJ OT 0 LL > ui &Z H6 0rc 0 0- ORO <q- 3 0 3� W. z 6 .0 0 T 2 w 0 S", ........... PA, aro - 0 tn ui < 0 LU I.- 'Lu re4 a u11 < ANN, IN vT Z,! 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