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TOWN OF SOUTHOLD
Town Code Chapter 205 "Public Entertainment and Special Events"
SPECIAL EVENT PERMIT INSTRUCTIONS AND APPLICATION FORM
Applications for a Special Event Permit are subject to an inter-departmental coordinated review by the
Southold Town Board,Town Attorney,Town Assessors,Land Preservation,Building,Planning,Zoning
Board of Appeals and Police Departments,and the Suffolk County Planning Commission.
Application fee: $150.00 per application — up to six (6) multiple events of the same type 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 coM len ted application that is not submitted 60 or more business days prior to the scheduled
event may be rejected or subject to a late processing fee of$250.00 by the Office of the Town Clerk
unless a waiver is obtained. Requesting an expedited review must be submitted in writing to the Town
Clerk. The Town Clerk will forward all applications to the Special Events Committee for processing.
The Committee will obtain comments on all applications from relevant Town, County and/or State
agencies and will forward completed applications to the Town Board with a recommendation as to
whether to grant or deny the application.
The Town reserves the right to request additional information from an applicant to address issues related
to the health,safety,and welfare of the community.
When is a Permit Required?
All Special Events,per Southold Town Code Article I, Section 205-2(Definitions)must obtain a permit.
Occasional events on private residential properties hosted by the owner thereof that are by invitation such
as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits.
Any use of residential property for profit,such as a venue for weddings or other events is prohibited.
This application is deemed complete once all the following requirements are submitted to the Town
Clerk: Please indicate submission of the following bcechkng off the boxes and signing below.
P(A completed application form signed by the owner and the event manager. Applications without
rope rty owner's signature/approval will be rejected.
FEE: Is the application being submitted at least 60 days before the event ] Yes [ ]No
❑ If Yes,Fee of$ has been submitted
❑ If No,Fee of$ has been submitted
Updated 8/7/2018
U 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
A Parking/Event Pian: 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)
#A vents for three hundred (300) or more people require submission and approval of a traffic control
acceptable to the Town of Southold AND a qualified traffic controller must be provided at the
ent.(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.
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1 Signa re
Activities associated with outdoor public events are strictly prohibited from taking place on land
preserved through the sale of development rights to the Town of Southold, and can only take place on
land preserved through the sale of development rights to the County of Suffolk with a permit issued by
the Suffolk County Farmland Committee.
If food is to be served, it must be catered and prepared off-site by food vendors who hold a permit to
operate issued by the Suffolk County Bureau of Public Health Food Protection Unit
Updated 8/7/2018
APPLICATION FOR A PERMIT TO HOLD A
SPECIAL EVENT
Please provide ALL.of the information requested below.Incomplete applications WILL.NOT be
reviewed.
Special Event Permit# O `r Applicant(s)name:S h W46 19
Date of Submission Name of Event M{AS G" V"n(•�/�
SCTM#'s 1000-Section Block- ` Lot(s) -"3
Dates of Each Event:
If Multiple Dates are requested,applicant must give all information for all dates.
Nature of Event: w- WA I or
(Please attach a detailed description of EACH event
ACHevvent to this application)
Time Period(Hours)of Event: From S•.-j=09M to -lop n
Town Services requested: ( )Yes 'ANo If yes,Describe Police Dept._Highway Dept.
Describe Services C�
Maximum Number of Persons Attending At One Time: 100 Number of cars expected
Is a Tent or other temporary structure being used? V1 Yes[ ]No If es provide size(s) 01�
Will food be served?K]Yes [ ]No If yes provide number and name(s)of food vendor(s)
Suffolk County permit#(s)
Will other vendors be on the premises during the event?[�]Yes [v No If yes how many? Describe
Type of vendor(s) ok ,p
Property Owner(name/address):
Contact Person and Contact Tel.# L( l ` g--S�k b3( ANA '-7R& b
e-mail address i�� WI AL[OV . 037n
Event Location:Street-Hamlet Address:b j,&,k 65A Ow S� g cb n a VIA
SCTM# s-7- -- -3
Will any services be requested [ ]Yes /No. If Yes describe Police Highway Other:
Mailing Address to Send Event Permit to:
Updated 8/7/2018
f
Have any of the development rights been sold to the Town of Southold[ ]Yes [ ]No and/or Suffolk
County Agricultural Program? [ ]Yes [ ]No Ifyes to either or both,also indicate on the
attached.plan the boundaries,of the reserved area upon which the event will take place,
YOU MUST ATTACH A PARKKINGIEVENT PLAN TO THIS APPLICATION IF THE
EXPECTED ATTENDANCE IS 300 OR MORE PEOPLE,YOU MUST ALSO ATTACH A
TRAFFIC CONTROL PLAN(see next nage)
A Parldng/Event Plan may be a survey„ site plan and/or aerial view(for example Google Earth)of
e subject propea.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.
(14) Location of sanitary facilities on site.
Traffic Control Plan
Events for three hundred(300)or more people also require submission and approval of a traffic control
plan,acceptable to the Town of Southold,AND a qualified traffic controller must be provided. Please
attached a written description and/or notate on the parking event plan the following: 1)Who will be
conducting traffic,2)Where they will be stationed on site,3)How they will direct the entrance,
circulation,parking,and exiting of cars on site,and 4)Contact information for use by Southold Town
Police.
0HAVER'S MG NATURE-
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..
Updated 8n12018
• Furthemrore,I hereby authorize Code Enforcement Personnel of the Town of S'omthold to enter the
property during the hotirs of the permitted special event to make any and all inspections necessary in
coaaecdoa with this Special Event.
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Print name of Owner Si ature of Owner
L Cs` QQ Js'&k�e- o
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Print name of Authorized Person/Representative Signature of Authorized Person/Representative
PFF.l ISSION IS 1fI 1�By igPANTFfi D SM&YIEC'� TO T�1�OLI,OWII��C01`�ITI®10TS:
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.
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 narking_ ingress/egress/access,
tents)or temporary structure(s),or tempoE= sanitary facilities, shall be conducted on Town of Southold
Purchase of Development Rights land.
10. NO activities associated with this event including but not limited to parking ingresslemss/access,
tent) or temporary structure(s) or ternpprar}r 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 erraergency 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
Updated 8/7/2018
from the building(s) on the property, to a public way or remote safe area, shall remain open and
unobstructed at all times.
13. Owner assures full compliance with all fire,safety,building,and other Town laws.
14. Music,when outdoors,is required to stop at the time specified in the permit.Placement of the
speakers must be in a location that affords the greatest protection from noise intrusion upon adjacent
properties.
15. Owner will allow access to Code Enforcement Personnel of the Town of Southold during the
hours of the special event to make any and all inspections necessary in connection with this
Special Event
16. ADDITIONAL CONDITIONS:
ANY VIOLATIONS IN CONNECTION WITH THE CONDITIONS LISTED HEREIN WILL
TERMINATE THIS PERMIT.
APPROVED Town of Southold
Resolution Number: Date Issued:
Updated 8/7/2018
This is a private event for the MHS class of 2003 reunion. The organizers will invite fellow
classmates to come to Brick Cove for an evening of food, music and to reminisce.
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BRICCOV-01 LSERIO
ACORO�
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)11/9/2022
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(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
CONTA
PRODUCER NAME:CT Lois Serio
Fleetwood Insurance Group PHONE 443 282-3133 FAX
100 Talbot Blvd. (A/c,No,Ext):( ) (A/c,No:(410)778-0304
Chestertown,MD 21620 AUURIES :lois@fleetwoodins.com
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:The Travelers Indemnity of Connecticut 25682
INSURED INSURER B:
Sage Basin Partners,LLC DBA Brick Cove Marina INSURER C:
PO BOX 12 INSURER D:
East Marion,NY 11939
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
INSD D MM DD M DD
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000'000
CLAIMS-MADE F—]OCCUR X ZOL71 N3292322 10/20/2022 10/20/2023 DAMAGE TO RENTED 1,000,000
PREMISES Ea occurrence $
MED EXP(Any oneperson) $ 100,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000
POLICY 1:1 PROECT- F-1LOCPRODUCTS-COMP/OPAGG $ 2,000,000
J
OTHER: $
AUTOMOBILE LIABILITY Ee accidenttSINGLE LIMIT $
ANY AUTO BODILY INJURY Perperson) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per accident $
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB HCLAIMS-MADE AGGREGATE $
DED I I RETENTION$
WORKERS COMPENSATION PT7LITE ER
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $
(Mandatory in NH)EXCLUDED? E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Additional insured: Southold Town
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Southold Town ACCORDANCE WITH THE POLICY PROVISIONS.
54375 Main Road
PO Box 1179
Southold,NY 11971-1179 AUTHORIZED REPRESENTATIVE
ACORD 25(2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Noncarrow, Denis
To: Mirabelli, Melissa
Cc: Sabrina Born (sabrina.born@town.southold.ny.us); Mudd,Jennifer; Franke, Diana
Subject: Special events
Attachments: sage 2_20230626140556.pdf, sage 1_20230626140348.pdf
Hi Missy -
Please see 2 permits from Sage marina.
.Thank you
Denis Noncarrow
Southold Town Clerk.
Town of Southold, New York
www.southoldtownny.gov
denisn @southoldtownn y.aov
631-765-1800
CONFIDENTIALITY NOTICE: This communication with its contents may contain confidential and/or legally privileged
information. It is solely for the use of the intended recipient(s). Unauthorized interception, review, use or disclosure is
prohibited and may violate applicable laws including the Electronic Communications Privacy Act. If you are not the
intended recipient, please contact the sender and destroy all copies of the communication.
• Town of Southold
P.O Box 1179
Southold, NY 11971
r
* * * RECEIPT * * *
i
Date: 06/26/23 Receipt#: 312241
Quantity Transactions Reference Subtotal
1 Event Fee 8.25.2023 $150.00
Total Paid: $150.00
Notes:
Payment Type Amount Paid By
CK#9554 $150.00 Partners, Sage Basin
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Partners, Sage Basin
1760 Sage Blvd, Greenport ny
Clerk ID: DENISN Internal ID:8.25.2023