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c,UEF®t,�C�ri Town of Southold 8/4/2016 P.O.Box 1179 0 co 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38427 Date: 8/4/2016 THIS CERTIFIES that the building WIRELESS COMMUNICATION SYSTEMS Location of Property: 1000 Pike St, Mattituck SCTM#: 473889 See/Block/Lot: 140.-3-11.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/29/2014 pursuant to which Building Permit No. 40365 dated 12/22/2015 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: wireless co-location and equipment for Verizon Wireless as applied for. The certificate is issued to Mattituck Fire District of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40365 4/20/2016 PLUMBERS CERTIFICATION DATED N Auth6ifded Signa re OFFICE LOCATION: r ., MAILING ADDRESS: Town Hall Annex N" �olt " P.O. Box 1179 54375 State Route 25 �� � +.. Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY ' Telephone: 631 765-1938 www.s outhol dtownny.gov " �4UIdT`I'�� i PLANNING BOARD OFFICE TOWN OF SOUTHOLD December 8, 2015 John Coughlin, Esq. 36 North New York Avenue Huntington, NY 11743 Re: Approval - Amended Site Plan for Verizon Wireless @ Mattituck Fire District 1000 Pike St., s/w corner of Wickham Ave. and Pike St., Mattituck SCTM#1000-140-3-11.1 Zoning District: Hamlet Business - HB Dear Mr. Coughlin: The following resolutions were adopted at a meeting of the Southold Town Planning Board on Monday, December 7, 2015: WHEREAS, this Amended Wireless Communications Application is for a proposed Verizon Wireless co-location of an interior mounted antenna within the concealment cylinder between 11 0' and 120' above ground level of the approved 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District, Mattituck; and WHEREAS, on October 2, 2015, John Coughlin, Esq., agent, submitted a Site Plan Application for review; and WHEREAS, on October 19, 2015, the Planning Board found the application incomplete for review; and WHEREAS, on October 29, 2015, the applicant submitted the required materials for review; and WHEREAS, on October 21, 2015, pursuant to §280-74A(4) of the Town Code, the Planning Board entered into a Letter of Agreement with Cityscape Consultants, Inc. to assist the Board in reviewing and evaluating the proposed wireless application to co-locate; and WHEREAS, on November 6, 2015, the Planning Board formally accepted the application as complete for review; and Verizon Wireless Mattituck FD Page 2 December 8, 2015 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 II list of actions; and WHEREAS, on November 9, 2015, the Planning Board received a report from their Technical Consultant, CityScape Consultants Inc., regarding the proposed co-location; and WHEREAS, on November 10, 2015, the Planning Board, pursuant to Southold Town Code §280-131 C., distributed the application to the required agencies for their comments; and WHEREAS, the proposed action is exempt from Suffolk County Planning Commission review because the proposed action is less than 5,000 sq. ft. of renovated floor area or less than 10,000 square feet of land disturbance; and WHEREAS, on November 15, 2015, the Southold Town Fire Inspector reviewed and determined that there was adequate fire protection and emergency access for the site; and WHEREAS, on November 17, 2015, the Southold Town Chief Building Inspector reviewed and certified the proposed Wireless Communication Facility as a permitted use in the HB Zoning District; and WHEREAS, pursuant to SEQRA 6 NYCRR Part 617, the Planning Board performed an uncoordinated review of the Unlisted Action; and WHEREAS, pursuant to §280-131(H), the Planning Board determined to waive the requirement of a public hearing for the proposed co-location because there will be no changes to the appearance of the tower and the roof equipment, which were the subject of a previous public hearing and were approved on August 3, 2015; and WHEREAS, the Southold Town Planning Board, pursuant to §280-133 C of the Southold Town Code, has the discretion to waive any or all of the requirements in §280-133 for those applications involving modifications to existing structures with no substantial change to the existing footprint where the Planning Board determines that such modifications or any change in use will not require significant changes to existing major site design features, as long as they are not necessary to further the objectives set forth in Town Code §280-129 to maintain public health, safety, and welfare. The Planning Board has found that this application is eligible for a waiver of certain elements of the Site Plan requirements because it is a co- location to a recently approved Wireless Communications Site Plan issued August 3, 2015; the details of which are included in the Staff Report dated October 19, 2015; and WHEREAS, the Southold Town Planning Board, pursuant to Southold Town Code §280-131 B (5), has the discretion to vary or waive the parking requirements for Site Plan Applications where doing so would not have a detrimental effect on the public health, safety or general welfare, and will not have the effect of nullifying the intent and provision of the Site Plan Requirements chapter of the Town Code. The Planning Board has found that this application is eligible for a waiver of the parking requirements because the proposed co-location does not generate the need for parking, with exception of a single vehicle periodically; there is ample existing parking on the Mattituck Fire District site; and Verizon Wireless (a_ Mattituck FD Page 3 December 8, 2015 WHEREAS, at a Work Session held on December 7, 2015, the Planning Board reviewed the report issued by Cityscape Consultants and determined the requirement of three (3) conditions; and WHEREAS, on December 7, 2015, the Southold Town Planning Board determined that all applicable requirements of the Site Plan Regulations, Article XXIV, §280 — Site Plan Approval of the Town of Southold, have been met; therefore, be it RESOLVED, that the Southold Town Planning Board hereby waives certain Site Plan Application requirements as noted above; and be it further RESOLVED, that the Southold Town Planning Board hereby waives the parking requirements as noted above; and be it further RESOLVED, that the Southold Town Planning Board, as Lead Agency pursuant to SEQRA, hereby makes a determination of non-significance for the proposed action and grants a Negative Declaration; and be it further RESOLVED, that the Southold Town Planning Board approves the Site Plan with three (3) conditions entitled "Verizon Wireless Mattituck Relo at 1000 Pike Street", prepared by James H. Fahey, P.E., on July 15, 2014, last revised July 17, 2015, and authorizes the Chairman to endorse the Site Plan including the following fifteen (15) plans: 1. Drawing C-1: Site/Roof Plan, Main Garage Roof Plan, Project info, Maps and Notes 2. Drawing S-0: Structural Specifications and Notes 3. Drawing S-1: Antenna Orientation Plan, Antenna & Cable Schedule, Cable Routing Details 4. Drawing S-2: RRH/SDB Mounting Details and Roof Access Hatch Safety Rail Details 5. Drawing S-3: Equipment Support Framing Plan, Sections, Details and Notes 6. Drawing S-4: Equipment Platform Details and Roof Access Ladder Details 7. Drawing S-5: South Building Elevation 8. Drawing P-1.0: Plumbing Specifications 9. Drawing P-2.0: Plumbing Ground Floor & Roof Plans 10.Drawing P-3.0: Plumbing Riser and Details 11.Drawing E- 1.0: Electrical Specifications 12.Drawing E- 2.0: Electrical Plan 13.Drawing E- 3.0: Electrical Riser, Panel Schedule and Phone Board 14.Drawing E- 3.1: Electrical Grounding Notes and Details 15.Drawing E- 3.2: Grounding Riser and Details Conditions: 1. All of Applicant's feed lines/cables shall be installed inside the monopole structure; and 2. All ports shall remain sufficiently sealed to prevent access by birds and other wildlife; and 3. The facility shall remain secured and protected from unauthorized personnel. Verizon Wireless (a). Mattituck FD Page 4 December 8, 2015 Please also note the following requirements relating to Site Plans: 1. Any changes from the Approved Site Plan shall require Planning Board approval, including new uses, additional or new lighting, additional or new signs, and additional pavement or parking spaces. 2, Proposed storm water run-off containment systems must be inspected by the Town Engineer at the time of installation. Please call the Southold Town Engineer prior to beginning this work. 3. 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. 4. 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 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 to the plan. 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. Very truly yours, _ � o Donald J. Wilcenski Chairman Encl. cc: Building Dept. w/map Town Engineer w/map By signing this letter, the applicant acknowledges that there are Town Code requirements and conditions, including those listed above, that must be satisfied prior to the issuance of a Certificate of Occupancy. Print name: ; Applicant/Agent Signature: Date: i " �ld , ICE LOCATION: r" MAILING ADDRES 0 so Town Hall Annex ^ P.O. Box 1179 54375 State Route 25 � �✓ c Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY Telephone: 631 765-1938 www.southoldtownny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD December 8, 2015 John Coughlin, Esq. 36 North New York Avenue Huntington, NY 117431 ° ° �' Re: Approval - Amended Site Plan for Verizon Wireless @ Mattituck Fire District 1000 Pike St., s/w corner of Wickham Ave. and Pike St., Mattituck SCTM#1000-140-3-11.1 Zoning District: Hamlet Business - HB Dear Mr. Coughlin: The following resolutions were adopted at a meeting of the Southold Town Planning Board on Monday, December 7, 2015: WHEREAS, this Amended Wireless Communications Application is for a proposed Verizon Wireless co-location of an interior mounted antenna within the concealment cylinder between 110' and 120' above ground level of the approved 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District, Mattituck; and WHEREAS, on October 2, 2015, John Coughlin, Esq., agent, submitted a Site Plan Application for review; and WHEREAS, on October 19, 2015, the Planning Board found the application incomplete for review; and WHEREAS, on October 29, 2015, the applicant submitted the required materials for review; and WHEREAS, on October 21, 2015, pursuant to §280-74A(4) of the Town Code, the Planning Board entered into a Letter of Agreement with Cityscape Consultants, Inc. to assist the Board in reviewing and evaluating the proposed wireless application to co-locate; and WHEREAS, on November 6, 2015, the Planning Board formally accepted the application as complete for review; and OFFICE LOCATION: x crime MAILING ADDRESS: Town Hall Annex esF;t� P.O. Box 1179 54375 State Route 25 ;£ , Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) , Southold,NY cry v '' � Telephone:631 765-1938 '�. i www.southoldtownny.gov PLANNW IN O�UTH OLD OFFICE D [EC[EUVE March 22, 2016 L 2 7 2 04 D SUILDMO DEPT. John Coughlin, Esq. TOWNOFSOUTHOLD c/o Re, Nielsen, Huber& Coughlin, LLP 36 North New York Avenue Huntington, NY 11743 Re: Approved Site Plan: Mattituck Fire District Telecommunications Facility 1000 Pike Street, corner of Pike St. &Wickham Ave., Mattituck SCTM#1000-140-3-11.1 Dear Mr. Coughlin: The Planning Board has found that the requirements of the above-referenced Site Plan have been completed based on the site inspection made March 11, 2016 and the Work Session held on March 21, 2016. The site is now in conformance with the Site Plan entitled "Mattituck 1000 Pike Street", prepared by Gary Musciano, RA, on March 14, 2013, last revised on May 20, 2015. This letter does not condone any changes from the approved Site Plan and from approvals permitted by other agencies; Planning Board approval is required prior to any significant changes to the site. Please, if you have any questions regarding this site plan or its process, do not hesitate to call this office at 631-765-1938. Very truly yours, Donald J. Wilcenski Chairman cc: Michael Verity, Chief Building Inspector Jamie Richter, Town Engineering Inspector WORK SESSION AGENDA SOUTHOLD TOWN PLANNING BOARD Monday, March 21, 2016 4:00 .m. Southold Town Meeting Hall 4:00 p.m.Executive Session — Matters of Litigation 4:30 p.m. Applications Location: 41.. ±850' s/w/o 1 r150 CRR 48, CRL j Project Name: C LC l" 1111111,1111.SCTM#. 1000-59-10-4 t 48 & Tuckers Lane, Southold � Description: This proposed Site Plan is for the renovation and conversion of an existing 60' x 40' (2,400 sq. ft.) masonry building, formerly a machine I shop, to a 16 seat take-out restaurant with six (6) parking stalls on .33 acres in the LB Zoning District. Status: Approved Site Plan j Action: eview comments from Final Site Inspection [ R � Attachments: Staff Report Project Name: Mattituck Fire District SCTM#: 1000-140-3-11.1 Telecommunications Facility Location: i 1000 Pike Street Mattituck Description: This proposed wireless communications a p p p ons Site Plan is to replace an existing +84 communications tower 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District. Status: Approved Site Plan Action: Review comments from Final Site Inspection, Attachments. Staff Report Project Name: Verizon Wireless at Mattituck Fire District SCTM# 1000-1407.37.1 1.1 Location: 1000 Pike Street, on the s/w corner of Pike Street &Wickham Avenue, Mattituck Des1.cription: This Amended Wireless Communications Application is for a proposed Verizon Wireless co-location of an interior mounted antenna within the concealment cylinder between 11 0' and 120' above ground level of the approved 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing j firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District Status: Approved Site Plan Action: Review comments from Final Site Inspection. Attachments: Staff Report Soutnold Planning Department Start Report Site Plan Application Work Session — Final Site Inspection Date March 21, 2016 Prepared By: Brian Cummings I. Application Information Project Title: Verizon Wireless Co-location at Mattituck Fire District Applicant: Verizon Wireless Date of Submission: October 2, 2015 Tax Map Number: 140.-3-11.1 Project Location: 1000 Pike Street Hamlet: Mattituck Zoning District: HB-Hamlet Business II. Description of Project Type of Site Plan: Wireless collocation Acreage of Project Site: 1.38 acres Building Size ±100sf Approved January 11, 2016 This Amended Wireless Communications Application is for a proposed Verizon Wireless co-location of an interior mounted antenna within the concealment cylinder between 110' and 120' above ground level of the approved 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District, Mattituck. III. Analysis A. Existing: 1. Mattituck Fire Department (MFD) a. ±14,370sf of existing buildings associated with MFD operations 2. Approved site plan to remove existing 84' wood pole and replace with 120' monopole; a. Diameter: 44" at base; 36" at top b. MFD emergency communications (4 sections) proposed on exterior at 30', 46'8", 62'9"- 647", and at top b/t 120' — 1267' c. Three (3) empty 10' sectors proposed between ±90' - 120' high for collocation 1 Verizon Wireless @ MFD 3. MESA Span Cabinet and LIPA Transformer to be mounted on the ground with protecting bollards (±180sf) located ±22'8" from rear of MFD firehouse (±15' from monopole) B. Approved Verizon Wireless collocation: 1. Three (3) interior mounted panel antennas within the concealment cylinder between 110' and 120' above ground level; 2. ±184sf wireless telecommunication equipment platform located on the roof of the existing two story fire house with vinyl brick fagade enclosure, GPS and cable transfers; 3. One (1) back-up natural gas generator with sound enclosure on the roof of the existing fire house; i. Sound enclosure includes vibration isolation springs and expanded metal underlayment supported on new steel framing; 4. The application conforms to the requirements of Town codes and the State of New York and is recommended to be approved with the following three (3) conditions: i. All of Applicant's feed lines/cables shall be installed inside the monopole structure; and ii. All ports shall remain sufficiently sealed to prevent access by birds and other wildlife; and iii. The facility shall remain secured and protected from unauthorized personnel. IV: Staff Recommendations 1. Three (3) conditions from the consultant report and as required as conditions of site plan approval have been sufficiently completed; 2. All site plan requirements have been sufficiently execuated and it is recommended that the Planning Board support the issuance of a CO to the building department. 2 WORK SESSION AGENDA SOUTHOLD TOWN PLANNING BOARD Monday, December 7, 2015 2:30 p.m. Southold Town Annex Board Room 017—Floor, Capital One Bank Building 2:30 p.m.Executive Session: Advice from Town Attorney 3:00 p.m. Applications — begin Public Work Session 4:00 p.m. Review Public Meeting Agenda Project Name: Verizon Wireless at Matt'stuck Distri�ct� SCTM# 1000-140-3 11.1 Fire,., .. Location: 1000 Pike Street, on the s/w corner of Pike Street &Wickham Avenue, Mattituck Descriptio _ n: This Amended Wireless Communications Application is for a proposed Verizon Wireless co-location of an interior mounted antenna within the t concealment cylinder between 110' and 120' above ground level of the approved 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District. Status: Pendine Action: Review referrals. Attachments Staff Report Project Name 13400 Main Road Cor SCT J p. M# 1000-114 11-9.6 Location: j 13400 NYS Route 25, ±10' s/w/o Wickham Avenue & NYS Rt. 25, l Mattituck Description: [This, proposed Site Plan, in conjunction + tion with a pending Lot Line Modification, is for the addition of_9,258 sq. ft. of land for _23 parking stalls on 1.05 acres in the Hamlet Business Zoning District. Status: New Application Action: Review for completeness. Attachments: Staff Report Project name: N & L Properties SCTM#: 1000-73-2-4 1 � Location: Located on the north side of Bridge Lane at the intersection of Oregon Road, in Cutchogue. Description: This Amended Site Plan is for the construction of an 8,635 sq. ft. building for the purposes of a private wine-making facility on a 31.07-acre parcel in the A-C Zoning_,District,,, Status: Pending l Action: Review revised Amended Site Plan, I Attachments: Staff Report Southold Planning Department Staff Report Site Plan Application Work Session — Referral Review Date December 7, 2015 Prepared By: Brian Cummings I. Application Information Project Title: Verizon Wireless Co-location at Mattituck Fire District Applicant: Verizon Wireless Date of Submission: October 2, 2015 Tax Map Number: 140.-3-11.1 Project Location: 1000 Pike Street Hamlet: Mattituck Zoning District: HB-Hamlet Business II. Description of Project Type of Site Plan: Wireless collocation Acreage of Project Site: 1.38 acres Building Size ±100sf This Amended Wireless Communications Application is for a proposed Verizon Wireless co-location of an interior mounted antenna within the concealment cylinder between 110' and 120' above ground level of the approved 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District, Mattituck. III. Analysis A. Existing: 1. Mattituck Fire Department (MFD) a. ±14,370sf of existing buildings associated with MFD operations 2. Approved site plan to remove existing 84' wood pole and replace with 120' monopole; a. Diameter: 44" at base; 36" at top b. MFD emergency communications (4 sections) proposed on exterior at 30', 46'8", 62'9"- 647", and at top b/t 120' — 1267' c. Three (3) empty 10' sectors proposed between ±90' - 120' high for collocation 1 Verizon Wireless @ MFD 3. MESA Span Cabinet and LIPA Transformer to be mounted on the ground with protecting bollards (±180sf) located ±22'8" from rear of MFD firehouse (±15' from monopole) 4. Related equipment cabinets (2) for future colocations, cables, and related hardware are proposed to be mounted on future steel platform w/screen enclosure on roof of existing MFD firehouse 5. Proposed 10' x 4' "natural gas backup generator" mounted on roof of existing MFD firehouse (see elevations) B. Proposed Verizon Wireless collocation: 1. Three (3) interior mounted panel antennas within the concealment cylinder between 110' and 120' above ground level; 2. ±184sf wireless telecommunication equipment platform located on the roof of the existing two story fire house with vinyl brick facade enclosure, GPS and cable transfers; 3. One (1) back-up natural gas generator with sound enclosure on the roof of the existing fire house; i. Sound enclosure includes vibration isolation springs and expanded metal underlayment supported on new steel framing; C. Referrals; (similar to wireless upgrade/modification) 1. Fire Marshall No comments or concerns regarding the proposed Site Plan 2. Suffolk County Planning Commission (SCPC) exempt from review because the proposed action is less than 5,000 sq. ft. of renovated floor area or renovated floor area or less than 10,000 square feet of land disturbance; 3. Chief Building Inspector/Zoning Administrator certified the proposed Wireless Communication Facility as a permitted use in the HB zoning district; D. CityScape report received November 9, 2015: 1. Following reports included in proposal are sufficient: i. Structural analysis dated February 19, 2015; ii. Federal Communications Commission (FCC) dated August 2007; iii. RF Report dated July 1, 2015; 2 Verizon Wireless @ MFD 2. The application conforms to the requirements of Town codes and the State of New York and is recommended to be approved with the following three (3) conditions: i. All of Applicant's feed lines/cables shall be installed inside the monopole structure; and ii. All ports shall remain sufficiently sealed to prevent access by birds and other wildlife; and iii. The facility shall remain secured and protected from unauthorized personnel. IV: Staff Recommendations 1. It is recommended to implement the three (3) conditions from the CityScape consultant report as conditions of site plan approval; 2. This is an Unlisted Action under SEQR, please review the negative declaration to be included as part of the determination resolution; 3. All site plan requirements listed in §280-133 of the Town Code have been met and it is recommended that the above referenced site plan application be scheduled for determination by the Planning Board at tonight's public meeting.. 3 OFFICE LOCATION: ��� � MAILING ADDRESS: Town Hall Annex ;��� '��; P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) . � Telephone: 631 765-1938 Southold, NY 119.71 , G, vul LOCAL WATERFRONT REVITALIZATION 1PIRO�:. Is ... ' TOWN OF SOUTHOLD �� �i �r MEMORANDUM U! rlis P43rlrwiwc 1i�wao m�. .......ti..m mro To: Donald Wilcenski, Chair Town of Southold Planning Board From: Mark Terry, Principal Planner LWRP Coordinator Date: December 4, 2015 Re: Proposed Site Plan Verizon Wireless at Mattituck Fire District SCTM#1000-140-3-11.1 Zoning District— HB This Amended Wireless Communications Application is for a proposed Verizon Wireless co- location of an interior mounted antenna within the concealment cylinder between 110' and 120' above ground level of the approved 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District, Mattituck. The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, the proposed action is recommended as CONSISTENT.with the LWRP. Pursuant to Chapter 268, the Board shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Brian Cummings, Planner Xcrido-f No. Town of Southold, New York ® Payment 3373 Vendor Nwue _ v ._& Address Entered t CITYSCAPE CONSULTANTS, INC. 7050 W Palmetto Park Road .0 S c `Vendor Telephone Number (561)555-2606 #15-PMB 652 ToWn Clef Vendor Contact Kay Miles(954)609-9797 Direct Boca Raton,FL 33433 - Invoice invoice Invoice Net Purchase c�rdar Nu^,bcr I Date � Total Disco 'Anicunt Clairnec Number Nsoription ofeoods or Service General 3245 7/1(/2015 $4,000.00 n/a 1 $4,000.00 29176 Consulting services re:Wireles, Verizon at Mattituck Fire District SCTM#1000-140-3-11.1 ; I i Payee Certification Department Certification The undersigned(Claimant)i.Acting on bchalf of rhe above razed claimant) 3 hereby certifp that the materials abuve NpeuiCed have been received by me docs hereby certify thst-he foregoing clause is true and earreet,that no part has in good condition without suhstituiion,the services properly peen pard,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have bcen verifwd with the exceptions due and owing,and that taxes ffroin which the Town is exempt are excluded, or discrepancies noted payment is approved. S Tztley s Corn Panv Nimt: a Tit ` _tom s CITYSCAPE CONSULTANTS, INC. 7050 W PAIMMO PARk Rd #15.652 BocA RATON, FL 33433 CkyScape, INVOICE C O N S U L T A N T S I N C 9 DATE INVOICE# 7050 W. Palmetto Park Rd #15-652 11/5/2015 3245 Boca Raton, FL 33433 �� BILL TO Town of S... ... �.. ... . outhold Heather Lanza, AICP, Planning Dir P.O. Box 1179 Southold, NY 11971 Project Ref/PO: VZW(Colo) 1000 Pike Street Description Rate Amount Site Application Review and,., pp Analysis: VZW"Mattituck Relo" 4,000.00 4,000.00 Site Application submitted by New York SMSA LP d/b/a/Verizon Wireless; to colocate and install new equipment on a facility located at 1000 Pike Street, Mattituck, New York Review completed 11-03-2015 Public Hearing N/A SCTM: 1000-140-3-11.1 PURCHASE ORDER#29176 Please check your records to reflect that CityScape address Is noted as per below: CityScape Consultants, Inc. 7060 W Palmetto Park Rd. Suite#15-PMB 652 Boca Raton,FL 33433 Total $4,000.00 Should you have any questions or need information,please contact Cityscape Administration. Tel:(877)438-2851 Fax(877)229-4593 www.CityScapeGov.Com TOWN OF SOUTHOL_u Purchase Order# _ 291,76, ,�,.. Date � . . " Account# i Deliver and send billing to: "endor D NInNe� tf �'� ���+ ISM@��� aUlf Address P(, �'..... �' �� fi Ver ^� "� v � il�� � .�' 4. VENDOR "Return this copy and Town of Southold voucher itemized and signed for payment" ITEM QUANTITY DESCRIPTION UNIT COST TOTAL a r e M- THIS PURCHASE ORDER IS NOT VALID WITHOUT THE SIGNATURES OF THE DEPT. HEAD AND THE SUPERVISOR I CERTIFY THAT THERE ARE SUFFICIENT FUNDS AVAILABLE IN THE APPROPRIATION CI-IARGED e� I'Dept. Head CERTIFY THIS TO BE A JUST n � AND TRUE PURCHASE ORDER � _.. ._. Supervisor DI: PAR MLN F COPS' Town Hall Annex Telephone(631)765-1802 u�� Jai it 54375 Main Road � � �� Fax(631)765-9502 P.O.Box 1179 [ Southold,NY 11971-0959 BUILDING DEPARTMENT < F TOWN OF SOUTHOLD •., y p7p 1 i7 I„ MEMORANDUM ,a'TF TO: Donald J. Wilcenski, Planning Board Chairman FROM: Michael J. Verity, Chief Building Inspector DATE: November 16, 2015 REQUIREMENTS FOR SITE PLAN ELEMENTS & CERTIFICATION Project Verizon Wireless Co-location,_(_Mattituck Fire District Location: 1000 Pike Street,_Mattituck SCTM# 1000— Section 140 - Block 3 —Lots 11.1 Date: July 21, 2014 Revised Date: July 17, 2015 1. ALL BUILDINGS AND USES SHALL COMPLY WITH CHAPTERS 144 AND 280 OF THE SOUTHOLD TOWN CODE. 2. OFF STREET PARKING BY AUTHORITY OF THE PLANNING BOARD. 3. ALL FENCING, SCREENING AND LANDSCAPING BY AUTHORITY OF THE PLANNING BOARD. 4. THE PROPOSED USE Wireless Communication Facility IS A PERMITTED USE IN THIS HB DISTRICT AND IS SO CERTIFIED. Zlty Michael J. Chief Building Inspector OFFICE LOCATION: I;( �,, MAILING ADDRESS: Town Hall Annex so P.O. Box 1179 54375 State Route 25 ��� '' r ?, Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY Telephone: 631 765-1938 www.southoldtownny.gov ,. z X PLANNING BOARD OFFICE TOWN OF SOUTHOLD MEMORANDUM To: Accounting From: Planning Department Date: November 17, 2015 Re: Deferred Revenue The Site Plan Application referenced below has been accepted by the Planning Board and the funds may be processed to Planning Applications Revenue Account B2115.10. Thank you. Applicant/Project Name & Tax Map # Amount Check Tl?e�wdmm Date/No. _............... ..w__w.................ww__.... Verizon Wireless at Mattituck�Fire 140-3-11.1 $1,000.00 0 9/28/15 -#5938 District—Amended Site Plan Amato Law Application Fee Group, PLLC JM OFFICE LOCATION MAILING ADDRESS: Town Hall Annex 0P.O. Box 1179 54375 State Route 25 tr A Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) cw. Southold, NY Telephone: 631 765-1938 www.southoldtownny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD MEMORANDUMNOV 0 5 To: Michael J. Verity, Chief Building Inspector From: Brian Cummings, Planne� Date: November 10, 2015 Re: Use Certification Amended Site Plan for Verizon Wireless Co-location @ Mattituck Fire District 1000 Pike Street, corner of Pike St. & Wickham Ave., Mattituck SCTM#1000-140-3-11.1 The Planning Board has found this Site Plan Application suitable for determination pursuant to §280-131 F (1) and refers the application to you for final review and certification. This Amended Wireless Communications Application is for a proposed Verizon Wireless co- location of an interior mounted antenna within the concealment cylinder between 110' and 120' above ground level of the approved 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District, Mattituck. Your certification is requested by November 27, 2015. Thank you for your cooperation. Encls: Site Plan Application Site Plan MAILING ADDRESS: °'* P.O. Box 1179 PLANNING BOARD MEMBERS ` � Southold, NY 11971 DONALD J.WILCENSKIw Chair °' OFFICE LOCATION: WILLIAM J.CREMERS c Town Hall Annex PIERCE RAFFERTY 54875 State Route 25 JAMES H.RICH III (cor. Main Rd. &Youngs Ave.) MARTIN H.SIDOR co ,� f Southold, NY Telephone: 631 765-1938 www.southoldtownny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD November 6, 2015 John Coughlin, Esq. c/o Re, Nielsen, Huber & Coughlin, LLP 36 North New York Avenue Huntington, NY 11743 Re Amended Site Plan for Verizon Wireless Co-location @ Mattituck Fire District 1000 Pike Street, corner of Pike St. & Wickham Ave., Mattituck SCTM#1000-140-3-11.1 Dear Mr. Coughlin: I am writing as a follow-up to the Work Session held on November 2, 2015 where the Planning Board accepted the above-referenced Site Plan Application as complete for review. Due to the fact that there is a recently approved tower application for emergency communications on the subject site, the Planning Board determined to waive the public hearing for the proposed co-location because the appearance of the tower and the roof equipment were accounted for in the approval of the tower issued August 3, 2015. Pursuant to §280-130A of the Southold Town Code, the Planning Department is required to provide a report concerning the proposed co-location to determine whether the guidelines for wireless facilities are met. Our consultant, CityScape Consultants Inc., may contact you directly regarding this application. The Planning Board, its Staff, Town departments and relevant agencies will provide additional comments following full review. If you have any questions regarding this Site Plan or its process, please do not hesitate to call this office at 631/765-1938. Very truly yours, Bri6n Cummings Planner OFFICE LOCATION: rr MAILING ADDRESS: Town Hall Annex �� � �, �" P.O. Box 1179 54375 State Route 25Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) ¢I " Southold, NY Fj Telephone: 631765-1938 www.southoldtownny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD MEMORANDUM To: Michael J. Verity, Chief Building Inspector From: Brian Cummings, Planne Date: November 10, 2015 Re: Use Certification Amended Site Plan for Verizon Wireless Co-location @ Mattituck Fire District 1000 Pike Street, corner of Pike St. & Wickham Ave., Mattituck SCTM#1000-140-3-11.1 The Planning Board has found this Site Plan Application suitable for determination pursuant to §280-131 F (1) and refers the application to you for final review and certification. This Amended Wireless Communications Application is for a proposed Verizon Wireless co- location of an interior mounted antenna within the concealment cylinder between 110' and 120' above ground level of the approved 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District, Mattituck. Your certification is requested by November 27, 2015. Thank you for your cooperation, Encls: Site Plan Application Site Plan MAILING ADDRESS: PLANNING BOARD MEMBERS +� P.O. Box 1179 DONALD J.WILCENSKI Southold, NY 11971 Chair OFFICE LOCATION: WILLIAM J.CREMERS Town Hall Annex PIERCE RAFFERTY 54375 State Route 25 JAMES H.RICH III MARTIN H.SIDOR " (cor. Main Rd. &Youngs Ave.) Southold, NY Telephone: 631 765-1938 www.southoldtownny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD November 5, 2015 Mr. Richard L. Edwards d/b/a Cityscape Consultants, Inc. 7050 Palmetto Park Road Boca Raton, FL 33433 Re: Consulting Services for Verizon Wireless at Mattituck Fire District Located at 1000 Pike Street, Mattituck, NY 11952 SCTM#1000-140-3-11.1 Zoning District: Hamlet Business Dear Mr. Edwards: The Planning Board has authorized your scope of services in connection with the above. This letter will authorize you to proceed with the consulting work as outlined in the Agreement. Enclosed is the approved Purchase Order#29176 with amount not to be exceeded. Any work beyond this amount must be authorized in writing prior to being started. Also enclosed for your convenience is a Southold Town Voucher Form for your use with each invoice submitted to this department. Following are directions to review the file: 1. Go to the Town of Southold website www.southoldtownny.gov; 2. Click on Weblink located on bottom left of home page; 3. Click on "Planning Dept." folder; 4. Click on "Applications" then "Site Plans" then "Pending;" 5. Click on the SCTM# (tax map #) of the application (found above). If you have any questions, please contact me directly at 631/765-1938 between 8:00 a.m. and 4:00 p.m. Sincerely, Brian Cummings Planner Encls, TOWN OF SOUTHOLD Purchase Order# 2 9-1..7 6 Date —, ..� ._m._ �... — .... Account Fnnn,(, elivr and send Iillin to; Vendor 3�073 tnrenl�,1 ni .y]� y Address �1 9 LLoo-6holal /19'7(. VENDOR "Return this copy and Town of Southold voucher itemized and signed for payment" ITEM QUANTITY' DESCRIPTION UNIT COST TOTAL r r rI �� r Al Ma r� r ;rr �1��Ir /�%��� %➢����� �� ! f�� Jl,�lf� 1, y/ JJ �f nI d ' G m �pGo"�7raiirYN/ rin t �ra4 rr�o AN, 'P, aim t, /)4' � r r . e,n I THIS PURCHASE ORDER IS NOT VALID WITHOUT THE SIGNATURES OF THE DEPT. HEAD AND THE SUPERVISOR I CERTIFY THAT THERE ARE SUFFICIENT FUNDS AAVAILAh F IN THE OI�f 1XFBARGED Dept Head CERTIFY ToflIS TO BE A JUST AND TRU -1URC 3E ORDER Supervisor I I � I E •� .a U "s7 Y 'w c 2 -S baa c > ro N 0 a� .... > VW N u ro e7 ro � U w ro G L U m ® o 0 n lc 0 cu `' ria °•- Q° ami I x v Z Cj a E ro °� °' U CUG U ¢U tl U 'y ..................f.... .... .... —... .,,,.r.., ,,,a..n., .�. N 41A 7 C O U .19 E U > U G N N O N a._ _— N v n Y U U L -® G G ^ C W G 3 U a� ca a. E OE L N aJ =a U O c O O O O aGi ', aGi aGi Southold Town Planninq Board Work Session — NovernDr 2, 2015 Page 2 y # 0 Beyond LLC Greenhouse Project Name: Peconic Land Trust/The Farm SCTM100-55-1-11.3 Location 45025 CR 48, ±240' s/w/o CR 48 and Youngs Avenue, Southold Description: This Agricultural Site Plan Application is for the proposed construction of a 48' x 35' (1,680 sq. ft.) greenhouse for vegetable production and not open to the public on a 3.6 acre farm where the Development Rights are held by Southold Town, in the Limited Business Zoning District. Status Pending Action: C Review referrals, . _ Attachments Staff''"Report _ a ., Project Name:e Convenience Store Southold Gas Station & Convenie SCTM# 1 1000-55-5-2.2 ; . w corner of CR 48 and Location n: This Site Plan s for the proposed ed onvoers on of an sting old Descriptio i 3,476 sq. ft. building (formerly for vehicle detailing, RV sales and servicing) to a convenience store and vehicle fuel sales, with: 6 fuel pumps (12 fueling stations), two canopies, one at 50' x 24' (1,200 sq. ft.) and the other at 50' x 50' (2,500 sq. ft.) and 29 parking spaces on 1.46 acres in the General Business (B) Zoning District. Status Pending .,., Action State Environmental Quality Review (SEQR) .. Attachments Staff Report Project Name Verizon Wireless at Mattituck Fire District; SCTM# 1000-140-3-11.1 E Location: 1000 Pike Street, on the s/w corner of Pike Street & Wickham Avenue, Mattituck Description: This Amended Wireless Communications Application is for a proposed Verizon Wireless co-location of an interior mounted antenna within the concealment cylinder between 11 0' and 120' above ground level of the ' approved 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District. Status: ! New Application Action: Review for completeness, Attachments. Staff Report � I Southold Planning Department Staff Report Site Plan Application Work Session - Completeness Date November 2, 2015 Prepared By: Brian Cummings I. Application Information Project Title: Verizon Wireless Collocation at Mattituck Fire District Applicant: Verizon Wireless Date of Submission: October 2, 2015 Tax Map Number: 140.-3-11.1 Project Location: 1000 Pike Street Hamlet: Mattituck Zoning District: HB-Hamlet Business II. Description of Project Type of Site Plan: Wireless collocation Acreage of Project Site: 1.38 acres Building Size ±100sf This Amended Wireless Communications Application is for a proposed Verizon Wireless co-location of an interior mounted antenna within the concealment cylinder between 110' and 120' above ground level of the approved 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District, Mattituck. A. Existing: 1. Mattituck Fire Department (MFD) a. ±14,370sf of existing buildings associated with MFD operations 2. Approved site plan to remove existing 84' wood pole and replace with 120' monopole; a. Diameter: 44" at base; 36" at top b. MFD emergency communications (4 sections) proposed on exterior at 30', 46'8", 62'9"- 647", and at top b/t 120' — 1267' c. Three (3) empty 10' sectors proposed between ±90' - 120' high for collocation 3. MESA Span Cabinet and LIPA Transformer to be mounted on the ground with protecting bollards (±180sf) located ±22'8" from rear of MFD firehouse (±15' from monopole) I Verizon Wireless �,7a MFD 4. Related equipment cabinets (2) for future colocations, cables, and related hardware are proposed to be mounted on future steel platform w/screen enclosure on roof of existing MFD firehouse 5. Proposed 10' x 4' "natural gas backup generator" mounted on roof of existing MFD firehouse (see elevations) B. Proposed Verizon Wireless collocation: 1. Three (3) interior mounted panel antennas within the concealment cylinder between 110' and 120' above ground level; 2. ±184sf wireless telecommunication equipment platform located on the roof of the existing two story fire house with vinyl brick fagade enclosure, GPS and cable transfers; 3. One (1) back-up natural gas generator with sound enclosure on the roof of the existing fire house; i. Sound enclosure includes vibration isolation springs and expanded metal underlayment supported on new steel framing; C. With regard to the Planning Board letter dated October 5, 2015: 1. Provide at least eight (8) prints of the proposed amended Site Plan; Submitted: Yes, eight (8) prints of the proposed site plan have been provided; 2. Please remit a check in the amount of$4,000.00 payable to the Town of Southold: Submitted: Yes, a check for the amount specified above has been provided; V: Staff Recommendations 1. Accept the application as complete for review and processing; 2. Due to the fact that there is a recently approved tower application for emergency communications on the subject site, consider waiving the public hearing for the proposed colocation because the appearance of the tower and the roof equipment were accounted for in the approval of the tower; §280-131(H) The Planning Board shall hold a public hearing to consider the application. Notice shall be provided pursuant to Chapter 55, Notice of Public 2 Verizon Wireless @ MFD Hearings. Notwithstanding this requirement, with respect to applications involving modifications to existing structures with no substantial change to the existinq footprint where the Plannir-)g Board determines that such rnodificatiqLi��_��_qriy change inuse will trot regi ire s�qnificantctiqn to existing or site deso(,n featyres, as well as @pplications involving used strictIfated to amicullare, but excepting retail wine o eratiorrs the Plat?170g Board shall have the discretion to waive thg o iblic hearing requiremerit and may act on such a ,o noticed public meeting. 3. Conduct a review with the aid of CityScape to ensure all other coloration requirements have been met prior to determination (structural, RF, etc.) 3 RE, NIELSEN, HUBER & GOUGHLIN, LLP ATTORNEYS AT LAW 36 NORTH NEW YORK AVENUE HUNTINGTON, NEW YORK 11743 harnniiiJ Board TELEPHONE: (631) 425-4100 - FACSIMILE: (631) 425-4104 OF COUNSEL WILLIAM J. NIELSEN October 28, 2015 BY HAND Town of Southold Planning Board Town Annex Building 54375 Main Road Southold,NY 11971 Attn.: Mr. Brian Cummings, Planner RE: New York SMSA Limited Partnership d/b/a Verizon Wireless("Verizon") Amended Site Plan Application to Co-locate on Approved Mattituck Fire District Upgraded Public Utility Telecommunications Facility Premises: 1000 Pike Street,Mattituck,NY SCTM#: 1000— 140—3 — 11.1 Dear Mr. Cummings: As you know, we represent Verizon with respect to the subject application. In furtherance of your attached correspondence of October 20,2015, we enclose, herewith,the following documents: 1. Eight (8) additional sets of Construction Drawings with Site Plans and Elevations, prepared by Structural Consulting Services, P.C., Revision No. 5, dated July 17, 2015; and 2. Amato Law Group, PLLC Check No. 6066, in the amount of$4,000.00, payable to the Town of Southold,to be held in escrow for the technical consultant review fee. We request that our office be provided with detailed invoices for all expenses billed against this escrow amount. Should you have any questions with regard to the foregoing, please do not hesitate to communicate with the undersigned. Very truly yours, RE,NIELSEN, HUBER& COUGHLIN, LLP By- JJC:mk Enclosures MAILING ADDRESS: PLANNING BOARD MEMBERS � ,V so� , P.O. Box 1179 DONALD J.WILCENSKI r Southold, NY 11971 Chair OFFICE LOCATION: WILLIAM J.CREMERS Town Hall Annex PIERCE RAFFERTY 54375 State Route 25 JAMES H.RICH III � � (cor.Main Rd. &Youngs Ave.) CO MARTIN H.SIDORw UN 1�, Southold, NY Telephone: 631765-1938 www.southoldtownny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD October 20, 2015 John Coughlin, Esq. c/o Re, Nielsen, Huber & Coughlin, LLP 36 North New York Avenue Huntington, NY 11743 Re: Amended Site Plan for Verizon Wireless Co-location @ Mattituck Fire District 1000 Pike Street, corner of Pike St. & Wickham Ave., Mattituck SCTM#1000-140-3-11.1 Dear Mr. Coughlin: I am writing as a follow-up to the Work Session held on October 19, 2015 where the Planning Board determined that the above-referenced Site Plan Application is incomplete. Before the Board can commence its full review, it is necessary to complete the application by submitting the following directly to this department: 1. Provide at least eight (8) prints of the proposed amended Site Plan; 2. Please remit a check in the amount of$4,000.00 payable to the Town of Southold: Pursuant to §280-130A of the Southold Town Code, the Planning Department is required to provide a report concerning the proposed wireless communications to determine whether they meet the guidelines for wireless facilities. Pursuant to §280-74A(d) of the Town Code, the Planning Board will hire a Technical Consultant to aid in the review of the application and hereby requires the submission of $4,000.00 into an escrow account with the Town Comptroller's Office to cover the cost of the Technical Consultant's review. Our consultant is Cityscape Consultants, Inc. They may contact you directly regarding this application. If you have any questions regarding this application or its process, please do not hesitate to call this office. Thank you in advance for your prompt payment. Southold Town Planning Board Page 2 October 20, 2015 If you have any questions regarding this Site Plan or its process, please do not hesitate to call this office at 631-765-1938. Very truly yours, Brian Cummings Planner w Consultants, Inc. 7050 West Palmetto Park Road#15-652 Boca Raton,Florida 33433 Tel: 877.438-2851 Fax: 877.220-4593 LETTER OF AGREEMENT October 21, 2015 �w nIkjii fflri p Board UL 6L Heather Lanza, AICP, Planning Director Town of Southold 53095 Route 25 Southold,New York 11971 Re: Agreement between Town of Southold, New York(Town) and CityScape Consultants, Inc. (Consultant) dated March 5, 2013 (Agreement) Dear Ms. Lanza, As per the above referenced Agreement between Town and Consultant, Consultant agrees to provide a review and analysis for an amended site plan application for Verizon to co-locate at Mattituck Fire District Telecommunications Facility located at 1000 Pike Street, Mattituck, SCTM #1000-140-3- 11.1. Review services for the Application will be performed at an agreed upon rate of four thousand dollars ($4,000). There will be no additional costs of fees associated with the review of this Application and/or follow-up letters relating to this Application. Consultant will provide the services as outlined in Exhibit A, Scope of Services, of the Agreement. Sincerely, Elizabeth Herington-Smith "; m.. MAILING ADDRESS: PLANNING BOARD MEMBERS , l, r P.O. Box 1179 DONALD J.WILCENSKI Mew° Southold, NY 11971 Chair � OFFICE LOCATION: WILLIAM J. CREMERS " M$ Town Hall Annex PIERCE RAFFERTY 54375 State Route 25 JAMES H.RICH III f" (cor. Main Rd. &Youngs Ave.) MARTIN H.SIDOR � " Couro,� �~ Southold, NY Telephone: 631 765-1938 www.southoldtownny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD October 20, 2015 John Coughlin, Esq. c/o Re, Nielsen, Huber & Coughlin, LLP 36 North New York Avenue Huntington, NY 11743 Re: Amended Site Plan for Verizon Wireless Co-location @ Mattituck Fire District 1000 Pike Street, corner of Pike St. & Wickham Ave., Mattituck SCTM#1000-140-3-11.1 Dear Mr. Coughlin: I am writing as a follow-up to the Work Session held on October 19, 2015 where the Planning Board determined that the above-referenced Site Plan Application is incomplete. Before the Board can commence its full review, it is necessary to complete the application by submitting the following directly to this department: 1. Provide at least eight (8) prints of the proposed amended Site Plan; 2. Please remit a check in the amount of$4,000.00 payable to the Town of Southold: Pursuant to §280-130A of the Southold Town Code, the Planning Department is required to provide a report concerning the proposed wireless communications to determine whether they meet the guidelines for wireless facilities. Pursuant to §280-74A(d) of the Town Code, the Planning Board will hire a Technical Consultant to aid in the review of the application and hereby requires the submission of $4,000.00 into an escrow account with the Town Comptroller's Office to cover the cost of the Technical Consultant's review. Our consultant is CityScape Consultants, Inc. They may contact you directly regarding this application. If you have any questions regarding this application or its process, please do not hesitate to call this office. Thank you in advance for your prompt payment. Southold Town Planning Board Page 2 October 20, 2015 If you have any questions regarding this Site Plan or its process, please do not hesitate to call this office at 631-765-1938, Very truly yours, J/ „ Brian Cummings Planner WORK SESSION AGENDA SOUTHOLD TOWN PLANNING BOARD Monday, October 19, 2015 4:00 p.m. Southold Town Meeting Hall 4:00 p.m. Applications: Prosect Name: Olde Colonial Place, LLC SCTM#: 1000-140 2 21 Location1 615 Pike Street, Mattituck Description: This Site Plan Application is to demolish an existing 2-Y2 story dwelling and construct a 60' x 93' (5,580 sq. ft.) multi-use 5-unit commercial building (no basement) and 21 parking stalls on 0.5 acres in the Hamlet Business Zoning District. Status. Pending l Action Review referrals. Attachments. .Staff Report Project Name: Verizon Wireless at Mattituck Fire District; SCTM# 1000-140-3-11.1 Location:. 1000 Pike Street, on the s/w corner of Pike Street &Wickham Avenue, Mattituck Description: This Amended Wireless Communications Application is for a proposed Verizon Wireless co-location of an interior mounted antenna within the concealment cylinder between 11 0' and 120' above ground level of the approved 120' antenna support structure/tower with associated i equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the j main fire house and associated accessory structures, all on 1.38 acres in j 1 the Hamlet Business Zoning District. Status: 1 New Application Action: Review for completeness. Attachments: Staff'Report eport. Project Name11: Boyle Agricultural Barn II SCTM#: 1000-18-'2-34 Location: j 24435 Route 25, ±125' n/e/o Platt Rd. and NYS Rt. 25, Orient Description., This Amended Site Plan Application is fora 60' x 130' (7,800 sq. ft.) metal agricultural barn where there exists a 60' x 120' (7,200 sq. ft.) metal barn and a 25' x 95' (2,375 sq. ft.) metal barn on 22.3 acres in the R-80 Zoning District. Status: New Application Action: Review for completeness. Attachments. Staff Report Southold Planning Department Staff Report Site Plan Application Work Session - Completeness Date October 19, 2015 Prepared By: Brian Cummings I. Application Information Project Title: Verizon Wireless Collocation at Mattituck Fire District Applicant: Verizon Wireless Date of Submission. October 2, 2015 Tax Map Number: 140.-3-11.1 Project Location: 1000 Pike Street Hamlet: Mattituck Zoning District: HB-Hamlet Business II. Description of Project Type of Site Plan: Wireless collocation Acreage of Project Site: 1.38 acres Building Size ±100sf This Amended Wireless Communications Application is for a proposed Verizon Wireless co-location of an interior mounted antenna within the concealment cylinder between 110' and 120' above ground level of the approved 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District, Mattituck. A. Existing: 1. Mattituck Fire Department (MFD) a. ±14,370sf of existing buildings associated with MFD operations 2. Approved site plan to remove existing 84' wood pole and replace with 120' monopole; a. Diameter: 44" at base; 36" at top b. MFD emergency communications (4 sections) proposed on exterior at 30', 46'8", 62'9"- 647", and at top b/t 120' — 1267' c. Three (3) empty 10' sectors proposed between ±90' - 120' high for collocation 3. MESA Span Cabinet and LIPA Transformer to be mounted on the ground with protecting bollards (±180sf) located ±22'8" from rear of MFD firehouse (±15' from monopole) 1 Verizon Wireless @ MFD 4. Related equipment cabinets (2) for future colocations, cables, and related hardware are proposed to be mounted on future steel platform w/screen enclosure on roof of existing MFD firehouse 5. Proposed 10' x 4' "natural gas backup generator" mounted on roof of existing MFD firehouse (see elevations) B. Proposed Verizon Wireless collocation: 1. Three (3) interior mounted panel antennas within the concealment cylinder between 110' and 120' above ground level; 2. ±184sf wireless telecommunication equipment platform located on the roof of the existing two story fire house with vinyl brick fagade enclosure, GPS and cable transfers; 3. One (1) back-up natural gas generator with sound enclosure on the roof of the existing fire house; i. Sound enclosure includes vibration isolation springs and expanded metal underlayment supported on new steel framing; C. CityScape Report (see attached) V: Staff Recommendations 1. Due to the fact that there is a recently approved wireless communications site plan for the subject site, consider waiving the following application items for this amended application: i. Separate key map showing the locations, names and widths of all rights-of-way within 500' of the subject site; Staff: use information provided in approved site plan, aerials, GIS and/or site visit ii. A separate key map showing location and owners of all adjoining lands within 500 feet, as shown on the latest tax records, at a scale of one inch equals 100 feet; Staff: use information provided in approved site plan, aerials, GIS and/or site visit iii. Separate key map showing all existing buildings and uses within 200' of the subject parcel and include key elements of those 2 Verizon Wireless @a7 MFD existing sites (e.g. buildings, curb cuts, parking area(s), landscaping, etc.). Staff: use information provided in approved site plan, aerials, GIS and/or site visit 2. Find the application incomplete and require the following to be provided:. i. Eight (8) prints of the proposed amended site plan; ii. Application items as detailed above (if decided not to be waived); iii. Provide $4,000 for the technical wireless consultant fee; iv. Any application items the wireless consultant may require. 3 Southold Planning Department Checklist for Site Plan Application Completeness - Section 280-133 Project Name: Verizon Wireless Collocation @ Mattituck Fire District Completed by: Brian Cummings Date: October 19, 2015 Received Comment A. Submission of a complete site plan application shall consist of: (1) A completed site plan application form. (2) The site plan review fee, as specified in Subsection B $1,000; site plan below. Editor's Note: See now § 280-138, Fee schedule for application site plan applications. modification (3) A completed environmental assessment form. Full (4) Nine copies of the site plan. X (1) Submitted (1) Four copies of a property survey, certified by a licensed land surveyor. X (1) Submitted B. Standards. Site plan design shall include the following items: (1) Technical data: (a) The lot, block and section number of the property, taken from the latest tax records. (b) The name and address of the landowner on record- [1] ecord:[1] The names and addresses of adjoining landowners. [2] The name and address of the applicant, if not the same as the landowner. (c) The name and address of the person, firm or organization preparing the map, sealed with the applicable New York State license seal and signature. (d) Date, graphic scale and North point, whether true or magnetic; if magnetic, show the date of reading. �l (e) A survey prepared by a licensed surveyor or civil engineer. The site plan may reference a land surveyor's map or base reference map. All distances shall be in feet and hundredths of a foot. All angles shall be given to the nearest 10 seconds or closer. The error of closure shall not exceed one in 10,000. (f) The locations, names and widths of all rights-of-way Waive: use within 500 feet of property lines. If none exist within 500 X aerials, GIS and feet of the subject property, indicate the distance to the info from original nearest intersection with a public street. approval (g) A separate key map showing location and owners of all Waive: use adjoining lands within 500 feet, as shown on the latest X aerials, GIS and tax records, at a scale of one inch equals 100 feet. info from original approval (h) The location, width and purpose of all existing and proposed easements, setbacks, reservations and areas dedicated to public use within or adjoining the property. 1 Checklist for Site Plan Application Completeness Southold Planning Department (i) A complete outline of other existing easements, deed restrictions or covenants applying to the property. Q) Existing zoning, including zone lines and dimensions. X Use GIS (k) Site plans drawn at the scale of one inch equals 20 feet. If all required information cannot be shown clearly on one plan, the information should be separated as �l follows: [1] Alignment and schedule plan. [2] Grading and drainage. [3] Landscaping. [4] Other, e.g., site utilities. (2) Natural features: Received Comment (a) Existing contours with intervals of two feet or less, referred to mean sea level as per United States Geological Survey datum. (b) Boundaries of any areas subject to flooding or stormwater overflows, tidal bays, saltwater marshes, beaches and all freshwater bodies, including wetlands N/A and intermittent streams, perimeter boundaries of shoreline bluffs, dunes and beaches. (c) The location of existing natural features, including but not limited to natural drainage swales, watercourses, wooded areas and wetlands, as defined by the New York State Department of Environmental Conservation and the Board of Trustees of Southold Town, marshes, ponds, dunes, bluffs, beaches, kettleholes, N/A escarpments, wildlife habitats, flood hazard areas, erosion-prone areas and trees of six inches in diameter at a point three feet above the trunk base. (d) The location of any existing cultural and historical features within 500 feet of the property boundaries. N/A (3) Existing building structures and utilities: (a) The locations, dimensions and outlines of all buildings, as defined in § 280-4 of this chapter, and all uses of the �l site. (b) Paved areas, including parking areas, sidewalks and vehicular access between the site and public streets. �l (c) The locations, dimensions, grades and flow directions of any existing culverts, waterlines or sewage disposal systems, as well as other underground and aboveground utility poles and utility lines within and adjacent to the property. (d) The location and use of all buildings and structures, including curbcuts, within 200 feet of the boundary of the subject property. 2 Checklist for Site Plan Application Completeness Southold Planning Department (4) Proposed construction: Received Comment (a) The location of proposed buildings or structural improvements, indicating setbacks from all property �l lines and horizontal distances from existing structures. (b) The location and design of all uses not requiring structures, such as off-street parking and loading areas and pedestrian circulation. (c) The location, direction, power level and time of use for any proposed outdoor lighting or public address N/A systems. (d) The location and plans for any outdoor signs must be in accordance with applicable sign regulations. �l (e) The location and details of aprons, curbs, sidewalks, fencing (type and location), and grading, including existing and proposed topography with two-foot contours (on site and 200 feet beyond the property line) and spot elevations for buildings and all structures, drainage calculations, details of drainage structures and watershed areas, where applicable. (f) Grading and drainage plans shall be based upon site stormwater retention, in conformance with Chapter 161, N/A Highway Specifications. (g) The location and listing of landscaping, buffering and street tree plans, including type, material, size, quantity N/A and location. (h) The location of water and sewer mains, electrical service, cablevision and telephone installations, ground transformers, fire wells and fire hydrants and/or any alternate means of water supply and sewage disposal and treatment. (i) Building elevations for all facades and floor plans showing the proposed use of floor area. Notes: N/A = Not Applicable Site Plan Application elements waivers: § 280-133 C. Notwithstanding the foregoing, the Planning Board shall have the discretion to waive any or all of the requirements of this § 280-133 by resolution at a duly noticed public meeting, for those applications involving modifications to existing structures with no substantial change to the existing footprint, where the Planning Board determines that such modifications or any change in use will not require significant changes to existing major site design features, as well as applications involving uses strictly related to agriculture (but excepting retail winery operations), if it determines such requirements are not necessary to protect and maintain the public health, safety, or welfare and to further the objectives set forth in § 280-129. 3 Checklist for Site Plan Application Completeness MAILING ADDRESS: PLANNING MEMBERS 71 S1 P.O. Box 1179 DONALD J.WILCENSKI � Southold, NY 11971 Chair OFFICE LOCATION: WILL J.CREERS a Town Hall Annex PIERCE RAFFERTY 54375 State Route 25 JAMES H.RICH III (cor. Main Rd. &Youngs Ave.) MARTIN H.SIDOR ww � :� , Southold, NY Telephone: 631 765-1938 www.southoldtownny.gov PLANNING BOARD OFFICE October 9, 2015 TOWN OF SOUTHOLD Mr. Richard L. Edwards d/b/a CityScape Consultants, Inc. 7050 Palmetto Park Road Boca Raton, FL 33433 Re: Amended Site Plan Application: Verizon Colocation at Mattituck Fire District Telecommunications Facility Located at 1000 Pike Street, s/w corner of Pike St. &Wickham Ave., Mattituck SCTM#1000-140.-3-11.1 Dear Mr. Edwards: The Planning Department is in receipt of an amended application for Verizon Wireless to co- locate on the approved wireless communications facility located at 1000 Pike Street, Mattituck. For your convenience, electronic copies of the application materials have been provided to you via email. The application is also available to be viewed on our website at www.southoldtownny.gov: 1000-140.-3-11.1, Verizon Wireless at Mattituck Fire District Amended 1. Go to the Town of Southold website 2. Click on Weblink located on bottom left of home page; 3. Click on "Planning Dept." folder; 4. Click on "Applications" then "Site Plans" then "Pending;" 5. Click on the SCTM# (1000-140.-3-11.1) of the application (found above). Please provide an estimate for the cost of your consulting services to determine the completeness of the application and assist with the review as we move forward. Should the Planning Board approve your estimate, a purchase order will be provided authorizing this application's review to begin. Please, do not start any review until you are authorized to do so in writing. If you have any question or comment, please contact me. Best regar� ',� , Brian Cummings Planner RE, NIELSEN, HUBER & COUGHLIN, LLP ATTORNEYS AT LAW 0C. 0 2 '(} 36 NORTH NEW YORK AVENUE Swlhoki�( C'V HUNTINGTON, NEW YORK �lann-�u Board 11743 „� �,,, „�, TELEPHONE: (631) 425-4100 FACSIMILE: (631) 425-4104 OF COUNSEL WILLIAM J. NIELSEN October 2, 2015 BY HAND Town of Southold Planning Board Town Annex Building 54375 Main Road Southold,NY 11971 Attn.: Ms. Heather Lanza, Planning Director RE: New York SMSA Limited Partnership d/b/a Verizon Wireless("Verizon") Amended Site Plan Application to Co-locate on Approved Mattituck Fire District Upgraded Public Utility Telecommunications Facility Premises: 1000 Pike Street, Mattituck,NY SCTM#: 1000— 140—3 — 11.1 Dear Ms. Lanza: We are the attorneys for Verizon in connection with its proposal to co-locate its public utility wireless telecommunications facility at the subject premises. As you know, the Planning Board recently reviewed and approved the Mattituck Fire District's Site Plan and Special Exception Permit applications related to its proposal to upgrade the public utility telecommunications facility at the subject site. Copies of the Planning Board's August 4, 2015 Decisions are attached hereto, together with a copy of the approved Zoning Drawings, including Site Plan, Vicinity Plan and Elevation Drawings, prepared by prepared by Gary Musciano, RA Architect, Revision 11, dated May 20, 2015 (item 21 below). Specifically,the Planning Board approved the replacement of the existing 84' communications tower with a 120' antenna support structure/tower along with associated equipment and generator to be mounted on the roof of the existing firehouse. Verizon's proposed installation was considered as part of the Planning Board's review and approval of the Mattituck Fire District's proposal. As part of the Town's review, Verizon's lease was requested and submitted in support of the Mattituck Fire District proposal. In fact, the Site Plan Approval included a condition, inter alfa, that"Elite Towers has stated that a Wireless Personal Service Provider, more specifically, Verizon Wireless, shall occupy the top(canister) position on the tower...." Verizon is seeking permission to install its public utility wireless telecommunications antennas inside the approved telecommunications pole/antenna support structure and install its related equipment within the approved screened rooftop equipment area. Notwithstanding our understanding that Verizon's proposal would qualify as requiring only the issuance of a Building Permit, in furtherance of the enclosed Notice of Disapproval, dated August 31, 2015, and subsequent conversations with Brian Cummings of your office, we submit herewith Verizon's Site Plan Amendment Application, as follows: 1. Town of Southold Planning Board Site Plan Application; Town of Southold Planning Board Verizon at Mattituck Fire District Amended Site Plan Application October 2, 2015 Page 2 of 3 2. Applicant's Affidavit; 3. Applicant's Transactional Disclosure Form; 4, Owner's Authorization Affidavit; 5. Owner's Transactional Disclosure Form; 6, Amato Law Group, PLLC Check No. 5938 in the sum of$1,000.00, which sum represents the fee for a modification, pursuant to Town Code § 280-74A(2)(b); 7. Copy of Notice of Disapproval from the Town of Southold Building Department, dated August 31, 2015; 8. Copy of Building Permit Application form; �-9. Copies of Verizon's FCC Licenses; �10.. Copy of Building and Tower Sublease Agreement between Elite Towers, LP and New York SMSA Limited Partnership d/b/a Verizon Wireless, dated December 17, 2013; N, 11. Copy of RF Report, including Gap and Propagation Maps, prepared by C Squared Systems, LLC, dated July 1,2015; and 12. One set of Construction Drawings with Site Plans and Elevations, prepared by Structural Consulting Services, P.C., Revision No. 5, dated July 17, 2015. Additionally, we submit copies of the below documents, which were previously submitted to your office and approved by the Planning Board in connection with the Mattituck Fire District's Application and which apply to the instant Verizon proposal: X13. Environmental Assessment Form, prepared by VHB Engineering, Surveying and Landscape Architecture, P.C, dated January 16, 2015 [Specifically addresses Verizon's proposed facility]; \ 14. LWRP Consistency Assessment Form, prepared by VHB Engineering, Surveying and Landscape Architecture, P.C. [Specifically addresses Verizon's proposed facility]; \,15. Engineering Report, prepared by Scinetx, LLC, dated September 4,2014, demonstrating the project's compliance with the Maximum Permissible Exposure Regulations [Specifically addresses Verizon's proposed facility]; 16. Structural Certification Letter, prepared by William R. Heiden, III, P.E., of Valmont Industries, Inc., dated February 19, 2015, and executed February 20, 2015, documenting the proposed facility's structural compliance with local, state and federal codes* (*Note: this letter references a preceding revision date of plans approved by the Planning Board in connection with the companion application of Mattituck Fire District); x°-17. FAA Determination of No Hazard to Air Navigation, dated June 13, 2013, along with copy of Extension Letter, dated November 14, 2014, pursuant to Town Code §§ 280-74C(1), 280-74B(1)(c), and 280-74C(2); 18. Deeds, pursuant to Code §§ 280-74C(1) and 280-74B(1)(g) 19, Lease Agreement between Mattituck Fire District and Elite Towers, L.P.,dated May 16, 2011, together with Amendment to Lease Agreement, dated April 22, 2015; '--20. Visual Analysis, prepared by VHB Engineering, Surveying and Landscape Architecture, P.C, dated January 2015,pursuant to Town Code § 280-74C(3) [Specifically addresses Verizon's proposed facility]; 21. Zoning Drawings, including Site Plan,Vicinity Plan and Elevation Drawings, prepared by prepared by Gary Musciano, RA Architect, Revision 11, dated May 20, 2015, addressing Town Code §§ 280-74C(4), 280-74C(5), 280-74C(9), 280-74C(10), 280-74C(11),280- 74C(12), 280-74C(13)and 280-133A(4) [Specifically addresses Verizon's proposed Town of Southold Planning Board Verizon at Mattituck Fire District Amended Site Plan Application October 2, 2015 Page 3 of 3 facility]; 22. Photographs of existing pole, pursuant to Town Code § 280-74C(8); and 23. Property Survey, prepared by Peconic Surveyors, P.C., revised July 1, 2014, pursuant to Town Code § 280-133A(5). Please note that PDF copies of the above mentioned filing deliverables (items 8-23) have been previously provided to your office and CityScape Consultants. We will forward PDF copies of items 1-7 to your attention by email. We respectfully request waiver of the additional sets of filing copies of the above documents as well as the required digital information depicting the search ring of the proposed facility, required by Town Code § 280-74C(7). Additionally, we respectfully request that the Public Hearing in connection with this Site Plan Amendment proposal be waived. Please advise as to when we should appear for a work session with the Planning Board to discuss this matter. Should you have any questions with regard to the foregoing, please do not hesitate to contact me. Thanking you for your courtesies,we remain Very truly yours, RE,NIELSEN, HUBER&COUGHLIN, LLP 13y: .... JJC/mk Enclosures cc via email: Mr. Brian Cummings, Planner(with attachments, Items 1-7) PLANNING BOARD MEMBERS MAILING ADDRESS: F,O. Box 1179 Southold NY 11971 RONALD J.WILCENSKI ��� ��wµ '���: ��� + Chair � OFFICE LOCATION: WILLIAM J,CREMERS ° Town Hall Annex PIERCE RAFFERTYp �t 54375 State Route 25 JAMES H.RICH III Z "1 (cor.Main Rd, &Youngs AveJ MARTIN H.SIDOR y Southold,NY Telephone:631 765-1938 www.southoldtowuny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD August 4, 2015 John ,Cou hlinEs - 9 q lajw4l bum c/o R6, Nielsen, Huber & Coughlin, LLP 36 North New York Avenue Huntington, NY 11743 Re: Approval: Proposed Site Plan for Mattituck Fire District(MFD) Communications Facility 1000 Pike Street, on the s/w corner of Pike Street &Wickham Avenue, Mattituck SCTM#1000-140-3-11.1 Zoning District: Hamlet Business-- HB Dear Mr. Coughlin: The following resolutions were adopted at a meeting of the Southold Town Planning Board on August 3, 2015: WHEREAS, this proposed wireless communications Site Plan is to replace an existing ±84'communications tower with a 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District, Mattituck; and WHEREAS, the agent to the applicant, John Coughlin, Esq., submitted applications for Site Plan review and Special Exception review on January 21, 2015; and WHEREAS, on February 9, 2015, the Planning Board found the application incomplete for review with revisions to be made and further information to be submitted; and WHEREAS, on February 10, 2015, pursuant to §280-74A(4) of the Town Code, the Planning Board entered into a Letter of Agreement with CityScape Consultants, Inc. to assist the Board in reviewing and evaluating the proposed wireless application; and WHEREAS, on February 23, 2015, the agent to the applicant, John Coughlin, Esq., submitted a portion of the information requested; and MFD Telecommunications Pae 12 August 4 2015 WHEREAS, on March 9, 2015, the Planning Board received a report from CityScape Consultants outlining concerns with the Lease Agreement; and WHEREAS, on April 22, 2015, the agent to the applicant, John Coughlin, Esq., submitted the remainder of the information requested including a revised Lease Agreement; and WHEREAS, on May 5, 2015, Elite Towers submitted a letter to the Planning Board agreeing to the construction of the proposed monopole within six (6) months of receiving Building Permits; and WHEREAS, on May 18, 2015, the Planning Board formally accepted the application as complete for review; and WHEREAS, on May 21, 2015, the Planning Board, pursuant to Southold Town Code §280-131 C., distributed the application to the required agencies for their comments; and WHEREAS, on May 21, 2015, the Southold Town Planning Board, pursuant to §617,6 of the Environmental Conservation Law acting under the State Environmental Quality Review Act, initiated the SEQR Lead Agency coordination process for this Unlisted Action; and WHEREAS, on May 24, 2015, the Southold Town Fire Inspector reviewed and determined that there was adequate fire protection and emergency access for the site; and WHEREAS, on June 1, 2015, the Southold Town Planning Board, pursuant to State Environmental Quality Review Act (SEQRA) 6 NYCRR, Part 617, 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 II list of actions; and WHEREAS, on June 1, 2015, the Southold Town Planning Board, pursuant to the State Environmental Quality Review Act§617.6, established itself as Lead Agency for this Unlisted Action; and WHEREAS, on June 1, 2015, a public hearing was held and closed by the Planning Board for the above-referenced Site Plan; and WHEREAS, on June 17, 2015, the Southold Town Engineer reviewed the above- referenced application and determined the project meets the minimum requirements of Chapter 236 for Storm Water Management; and WHEREAS, on June 18, 2015, the Architectural Review Committee (ARC) reviewed the proposed project and approved the design as submitted; and WHEREAS, on June 30, 2015, the Mattituck Fire District determined there was adequate fire protection and emergency access for the site; and MFD Telecommunications Pae 13 August 4, 2015 WHEREAS, on July 1, 2015, the Town of Southold LWRP Coordinator reviewed the above-referenced project and recommended that the proposed project be found consistent with Southold Town LWRP Policies; and WHEREAS, on July 6, 2015, the Southold Town Planning Board, as Lead Agency pursuant to SEQRA, made a determination of non-significance for the proposed action and granted a Negative Declaration; and WHEREAS, at a Work Session held on July 6, 2015, the Planning Board reviewed the report issued by CityScape Consultants and determined the requirement of nine (9) conditions; and WHEREAS, at a Work Session held on July 6, 2015, the Planning Board reviewed the recommendation to waive §280-701(2)for the maximum height of 80 feet in this Hamlet Business (commercial) Zone. They found that the overall height of the proposed tower of 120' with potential future co-locations would achieve the result of improved emergency communications for the MFD and fewer antenna support structures in the immediate area of this commercial zone; and WHEREAS, at a Work Session held on July 6, 2015, the Planning Board reviewed the request to waive §280-701(3)for the minimum distance of all wireless equipment to adjacent residential property lines. They found that the proposed ground equipment is contained on the roof of the existing fire department and the proposed tower has been certified to be constructed with a smaller fall zone; and WHEREAS, at a Work Session held on July 6, 2015, the Planning Board reviewed the request to waive §280-70N(4) for base equipment and shelter landscaping. They found that the proposed ground is contained on the roof of the existing fire department which accomplishes the goal of concealing the base equipment shelter from other properties and roads; and WHEREAS, at a Work Session held on July 6, 2015, 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, on July 22, 2015, revised Site Plans showing the nine (9) conditions were submitted by the agent to the applicant, John Coughlin, Esq., and reviewed by Cityscape and the Planning Board and accepted; and WHEREAS, on July 27, 2015, the Southold Town Chief Building Inspector reviewed and certified the proposed Wireless Communications Facility as a permitted use in the Hamlet Business Zoning District; and WHEREAS, at their public meeting on August 3, 2015, the Planning Board granted approval to the Special Exception Application for this site; be it therefore RESOLVED, that the Southold Town Planning Board hereby waives §280-701(2) of the Town Code for the maximum height of 80 feet in this Hamlet Business Zone as described above; and be it further MFD Telecommunications Pae 14 August 4. 2015 RESOLVED, that the Southold Town Planning Board waives §280-701(3)for the minimum distance of all wireless equipment to adjacent residential property lines as described above; and be it further RESOLVED, that the Southold Town Planning Board waives §280-70N(4) for base equipment and shelter landscaping as described above; and be it further RESOLVED, that the Southold Town Planning Board has determined that this proposed action is consistent with the policies of the Town of Southold Local Waterfront Revitalization Program; and be it further RESOLVED, that the Southold Town Planning Board grants Approval with Nine (9) Conditions to the Site Plan entitled "Mattituck 1000 Pike Street", prepared by Gary Musclano, RA, on March 14, 2013, last revised on May 20, 2015, and authorizes the Chairman to endorse the Site Plan, including the following five plans: 1. Z-1 Title Sheet 2. Z-2 Site Plan 3. Z-3 Compound Plan 4. Z-4 Elevations 5. Z-5 Vicinity Map & Radius Map Conditions: 1. Elite Towers shall begin construction within six (6) months of receipt of all Building Permits and completion including the installation of the Fire District's antennas, feed lines and mounting brackets up to operational condition; 2. Should three (3) months pass following the date of issuance of all Building Permits and there has been no construction, Elite Towers will update the Fire District with an updated schedule and reassure the construction will begin prior to the six (6) month period; 3. Elite Towers shall make best efforts to protect the wireless communications frequencies utilized by the Fire District and will not deny the Fire District the ability to expand to additional frequencies as either mandated by law or by need of the Fire District; 4. Elite Towers has stated that a Wireless Personal Service Provider, more specifically, Verizon Wireless, shall occupy the top (canister) position on the tower. Furthermore, Elite Towers shall inform all parties that the top positions will be whip-type antennas operated by the Mattituck Fire District and installed at the top most position, better defined as the top of the tower's steel structure which is assumed to be one hundred twenty (120)feet above ground level; 5. All feed lines for antennas mounted above the forty-five (45)foot level shall be concealed within the tower proper. Elevations below forty-five (45)feet may be installed on the outside of the tower; MFD Telecommunications Pae 15 Auaus 4. 2015 6. Elite Towers shall remove the existing tower and return the area around the former site to standard expectations; 7. All feed line and antenna access ports shall be reasonably sealed to prevent inhabitation by birds and any other wildlife; 8. Elite Towers shall assure the noise output of the emergency power generator shall comply with the Town's Noise Requirements which are as low as 45dB at certain times and that any testing of the generator shall be between the hours of 9:00 a.m. until 4:00 p.m., Monday through Friday. 9. Elite Towers shall adhere to the Fire District's antenna allocations as represented on Figure 3 in the approved plans, unless the FD proposes a change. Please note the following requirements in the Southold Town Code relating to Site Plans: 1. Any outdoor lighting shall be shielded so the light source is not visible from adjacent properties and roadways. Lighting fixtures shall focus and direct the light in such a manner as to contain the light and glare within property boundaries. 2. All storm water run-off from grading, driveways and gravel areas must be contained on site. 3. 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. 4. Any changes from the Approved Site Plan shall require Planning Board approval. 5. 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 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 to the plan. 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. Very truly yours, Donald J. Wilcenski Chairman MFD Telecommunications Pae 16 August 4, 2015 Encl. cc: Building Dept. with map Town Engineer with map By signing thisletter, the applicant acknowledges that there are Town Code requirements and conditions, Including o listed above, that must be satisfied prior to the issuance of a Certificate of Occupancy. Print name: N �ti- , Applicant/Agent Signature: ate: l MAILING ADDRESS: PLANNING BOARD MEMBERS P.O.Box 1179 DONALD J.WILCENSK] ��y` `, Southold, NY 11971 Chair OFFICE LOCATION: WILLIAM J.CREMERS Town Hall Annex PIERCE RAFFERTY a � "��� 54375 State Route 25 JAMES H.RICH III , i " (cor. Main Rd.&Youngs Ave,) MARTIN H.SIDOR ��. � w� ��. � Southold,NY Telephone:631 765-1838 www.southoldtownny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD August 4, 2015c John Coughlin, Esq. "` ( 9 q c/o Re, Nielsen, Huber & Coughlin, LLP 36 North New York Avenue (w000 TUM Huntington, NY 11743 N=±11 t!2i Re: Approval: Special Exception for Mattituck Fire District Communications Facility Located at 1000 Pike Street, on the s/w corner of Pike Street&Wickham Avenue, Mattituck SCTM#1000-140-3-11.1 Zoning District: Hamlet Business-- HB Dear Mr. Coughlin: The Southold Town Planning Board adopted the following resolutions at a meeting held on Monday, August 3, 2015: WHEREAS, applications for a Special Exception & Site Plan Approval for a Wireless Communications Facility were accepted for review on May 18, 2015, including a Site Plan prepared by Gary Musciano, RA, on March 14, 2013; and WHEREAS, the Southold Town Planning Board reviewed the above-referenced request for a Special Exception for a Wireless Communications Site Pian to replace an existing ±84' communications tower with a 120' antenna support structure/tower with associated equipment and a generator to be mounted on the roof of the existing firehouse. There are ±14,370 sq. ft. of existing buildings including the main fire house and associated accessory structures, all on 1.38 acres in the Hamlet Business Zoning District, Mattituck; and WHEREAS, on June 1, 2015, the Southold Town Planning Board, pursuant to the State Environmental Quality Review Act§617.6, established itself as Lead Agency for this Unlisted Action; and WHEREAS, on June 1, 2015, the Southold Town Planning Board, pursuant to Part 617, Article 6 of the Environmental Conservation Law acting under the State Environmental Quality Review Act, initiated the SEAR Lead Agency coordination process for this Unlisted Action; and MFD Telecommunications Pae 12 Auaust 4. 2015 WHEREAS, the submission by the applicant has been reviewed and corroborated with an independent Radio Frequency Engineer retained by the Town to assist in the review process; and WHEREAS, on June 1, 2015, a public hearing was held and closed; and WHEREAS, on July 6, 2015, the General Requirements in §280-70 were met; and WHEREAS, on July 6, 2015, the Southold Town Planning Board made a determination that the applicant has satisfied the requirements for a Special Exception pursuant to Town Code Section 280-142 and the additional standards for a Special Exception in Town Code Section 280-73B as detailed in the Staff Report dated July 6, 2015; and WHEREAS, on July 6, 2015, the Southold Town Planning Board, as Lead Agency pursuant to SEQRA, made a determination of non-significance for the proposed action and granted a Negative Declaration; and WHEREAS, on July 27, 2015, the Southold Town Building Inspector reviewed the plan and certified that the proposed Wireless Communication Facility is a permitted use in the Hamlet Business Zoning District; be it therefore RESOLVED, that the Southold Town Planning Board hereby finds and determines that the standards for Special Exception Approval have been met; and be it further RESOLVED, that after deliberation of the application and consideration of the above factors, the Southold Town Planning Board grants a Special Exception for the Wireless Communications Facility as shown in the Site Plan Application for "Mattituck 1000 Pike Street", prepared by Gary Musciano, RA on March 14, 2013, last revised on May 20, 2015. Please also note the following requirements in the Southold Town Code relating to Special Exceptions: 1. Any Special Exception Approval granted under this article shall have a term of five years, commencing from the granting of the Special Exception, which may be extended for an additional five-year term upon application to the Planning Board. 2. On a renewal application, the applicant shall demonstrate that the wireless communication facility is in compliance with all applicable laws, rules and regulations and with all of the conditions of the Special Exception Approval and Site Plan, that the facility is necessary to provide adequate service, and that there is no reasonable alternative available to the owner which will provide adequate service without the continuing use of the facility. 3. Subsequent Special Exception renewals shall be subject to review by the Planning Board and subject to such standards that shall be included in the Town Code at that point in time. MFD Telecommunications Pae 13 August 4. 2015 If you have any questions regarding the information contained in this resolution, please contact the Planning Board Office. Very truly yours, Donald J. Wilcenski Chairman Encl. cc: Town Engineer Building Dept. a pIy SOUTHOLD PLANNING BOARD C 1 01` SITE PLAN APPLICATION FORM sow� .,,, _rW„7_ She Plan Name and Location Site Plan Name: Verizon @ Mattituck Fire District Application Date: Io / 2 / /S Suffolk County Tax Map#1000- 140 - 3 • 11.1 Other SCTM#s Street Address: 1000 Pike Street Hamlet: Mattituck Distance to nearest intersection: at intersection with Wickham Avenue Type of Site Plan: New X Amended_Residential Zoning District HB-Hamlet Business Owners/Agent Contact Information Pleaso/ rrartrc rrrr///rrc ^ rurdrtre rrlrrrrbr rrr /tc ole belox: Property Owner Mattituck Fire District Streat PO Box 666 City Mattituck gtata NY �ip 1 192 Home"fele hone Other 631-298-8833 Applicant New York SMSA Limited Par terslii d/b/a Verizon Wireless Street 4 Centerock Road Cid West Nyack State NY Zip 10994 Home Telephone Other 914-714-7371 Applicant's Agent or Representative: Contact Person(s)* Re,Nielsen„Huber&Ccu hlir LLP I Street 36 N.New York Avenue . w City Huntington Statc NY Zi,p 11743 Office Telephone 631-4254 100 _Other, . ° � d here. *Unless otherwise rreested,correspondence will be i ent onl to the contact erson not Sile PlanApplicallm Pornt 2 18'2010 Site Data Proposed construction type: New X Modification of Existing Structure Agricultural Change of use Property total acreage or square footage: 572052 )wdsq. ft. Rooftop aquippment �l4 Vlf��l Site Plan bPPV square footage: 184+1- Jsq,ft. Is them an existing or proposed Sale of Development Rights on the property? Yes No X Tf 'e e lain: Does the parcel(s)meet the Lot Recognition standard In Town Code§280-9 Lot Recognition? Y_X�N If"yes", explain(and attach any necessary documentation-title report, subdivision approval, etc.) Building Department Notice of Disapproval Date: 8 / 31 /15 Is an application to the Southold Town Zoning Board of Appeals required? Yes No X- if yes,have you submitted an application to the BA Yea No If yes,attach a copy of the application packet. Show all uses proposed and existing. Indicate which building will have which use. If more then one use is proposed per building,indicate square footage of floor area per use. List all existing property uses: Fire District/'lie aartrrer�t ose,with communications licilmt List All proposed property uses: Public utility Wireless Telecommunications Faci lit Other accessory uses: NO CHANGE Existing lot coverage:/ % Proposed lot coverage: % Gross floor area of existing structure(s): sq. ft. Gross floor area of proposed stmcture(s):_ „-- NO CHANGE P'arllt Space Data #of existing spaces:.#of pro osed spaces: Load Berth:Yes„Nom NO CHANGE Landtca In Details: /Ilxisti.ng land pe covers e: /e Pro osed land cca a covers e: LW�etlands: Is this property within 500' of a wetland area? Yes No X Maybe I, the undersigned, certify that all the above information is true. New Y i� S P'ld its �artnership d/teVerizon Wire less' Signature of Preparer: Walden / Sentor U Lr�er n - Equipment ri Name I Title vre Plan rt pplicanon Funn 248 2111 APPLICANT'S AFFIDAVIT 0 C T 0 2 2 01'"°� STATE OF NEW YORK S u i(U `�'aZ COUNTY OF SUFFOLK Manr0rig Board John Walden being duly sworn, deposes and says that he resides at c/o 4 Centerock Road,West Nyack,New York 10994 in the State of New York,and that he is the owner of the above property,or that be is the John Walden of the Lessee/Applicant-New York SMSA Limited Partnership d/b/a Verizon Wireless, (Title) (Specify whether Partnership or Corp.) which is hereby making application;that there are not existing structures or improvements on the land which are not shown on the Site Plan;that the title to the entire parcel,including all rights- of-way, has been clearly established and is shown on said Plan;that no part of the Plan infringes upon any duly filed plan which has not been abandoned both as to lots and as to roads;that he has examined all rules and regulations adopted by the Planning Board for the filing of Site Plans and will comply with same;that the plans submitted, as approved,will not be alter or changed in any manner without the approval of the Planning Board;and that the actual physical improvements will be installed in strict accordance with the plan as approved by the Planning Board. Signed OiaX New Y L �"itia �ttri°shilr d/b/a Verizon Wireless Signed 1Par p( r taer or Corporate Officer and Title) N a : John Walden Title: Senior Engineer Ecom u'140'rA X14 w Rile Sworn to me this 4 day of -w Suru zu; co01int ; e � OFa 'z/f , Notary P;alic w APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM e�ath i����arn 91a It to take whatever Id µ YOURNAME: New York SMSA Limited Partnership d/b/a Verizon Wireless (Last Dome,fust name, nlddlo lnld ,ool you are mpplytug to the name of someone the or otder entity,eueb as a company.if to,indicate the other person's or company's name.) TYPE OF APPLICATION:(Check ail that apply) Tax grievance Building Permit Varlance Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning X Do you personally(or th"ugh your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold "Relationship""Includes by blood,marriage,or business interest."Business intereat"means a business,,Including a partnership,In which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicaut/agent/representative)and;the town officer or employee. Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child Is(check all that apply) A)the owner of greater that 5%of the shares of the corporate stock of the applicant(when the applicant 1s a corporation) B)the legal or beneficial owner of any interest In a non-corporate entity(when the applicant is not a corporation) Q an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this d `of /" r�t�,r� 1 Verizon Wireless Signature � t �:�d/b/a Print Name l a sQ► IkIdeii Title:: ni.+oc so True r � �ei:t pao r:t 0C 2'' 20 5 TOWN OF SOUTHOLD ° COUNTY OF SUFFOLK: STATE OF NEW YORK ���aipBPhig BoaYrd � d<�ru�nn�a U���� In the Matter of the Application of New York SMSA Limited Partnership AUTHORIZATION OF d/b/a Verizon Wireless OWNER At the premises ("Premises") Mattituck Fire District 1000 Pike Street Mattituck,New York Section 140,Block 3, Lot 11. 1 STATE OF NEW YORK ) ) SS.. COUNTY OF SUFFOLK ) � C_ " , being duly sworn, deposes and says: I am the 'Scar aAa" of the Mattituck Fire District,owner in fee of the premises known as District 1000, Section 140,Block 3,Lot 11. 1 (the"Premises"hereafter),and do hereby authorize New York SMSA Limited Partnership d/b/a Verizon Wireless("Verizon"hereafter),and its representatives to bring such applications for municipal approvals as may be necessary for the installation of its public utility wireless telecommunications facility. As such, I will fully cooperate with Verizon and its agents in obtaining any required Approvals. Mattituck Fire District -"It Sworn to before me this )'I'd&ly of kb)Jmb' , 2013 ... "1 1 " _IUBL1 ..... . EMILY A. WILSON NOTARY PUBLIC-STATE OF NEW YORK No. 01W16286377 Qualified In Suffolk County My Commission Expires July 22, 201 APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM w W 01 10°TheTo �c l'u gens and tInu alo cc � � �ll,�Board __....�._.. ows ...��.� � sour tlae art of town ol" � i f tthis lirrrau is tray alrosatls information talai aar�aaasralcrtftlre town conflicts of inter est rand allow it to iake whatever �_ — action is necessary to avoid same. YOUR NAME: Mattituck Fire District (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning X Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest"means a business,including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X— If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply) A)the owner of greater that 5%of the shares of the corporate stock of the applicant(when the applicant is a corporation) B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation) C)an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this 22- day of_&a; 20�?L Signature Print Name. 'w_ TOWN OF SOUTHOLD FORM NO. 3 NOTICE OF DISAPPROVAL DATE: August 31, 2015 TO: Nelson, Huber&Coughlin, LLP (Verizon Wireless) For Mattituck Fire District 36 N. New York Avenue Huntington,NY 11743 Please take notice that your application dated August 10, 2015 For permit for a co-location on an existing wireless facility at Location of property: 1000 Pike Street, Mattituck,NY County Tax Map No. 1000- Section 140 Block 3 Lot 11.1 Is returned herewith and disapproved on the following grounds: ec.►1 .sed c -1c tion o _1 �m arc t 1I1 c ne p -Kgjt:t�;a —11t Lia a site lean at-nendynent i t e Sopthol�d Pl n in Board. �n r-ized : gn , CC: file, planning Note to Applicant: Any change or deviation to the above referenced application, may require further review by the Southold Town Building Department. TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL:(631)765-1.802 Planning Board approval FAX:(631)765-9502 su vey SoutholdTown.NorthFork.net PERMIT NO. Septic Form N.Y.S.D.E.C. Trustees Flood Permit . Examined ,20 , Storm-Water Assessment Farm Contact: Attorney for Applicant: Approved .20 Mail to: Re,Nielsen,Huber&Coughlin,LLP 3 Disapproved do 6 N.New York Ave.,Huntington,NY 11743 l�luone: 631.425.4100 Expiration ,20 Building Inspector APPLICATION FOR BUILDING PERMIT Date P �.�,r�V s f r D20 1 s INSTRUCTIONS a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate pint Iden to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County„New York,and other applicable Laws,Ordinances or Regulations.for the construction of"buildings,additions,or alterations or For removal or demolition as herein described.The applicattl agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to adroit authomizati inspectors on,premises:and in building for necessary inspections. New York SMSA Limited Partnership d/b/a S-r. 1 s (Signanrre,ofapplicarrt or name,if liasn) Limited Partnershilu 4 Centerock Road,West Nyack,NY 10994 (Mailing address ofaa0pllcant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Applicant is Lessee Mottituck Fire District Lir . arrmersI' (As on the tax roll or latest deed) Name o owner o premises If lic e t" a sl lag:ire pf dulyy aauthorized officer t evYo c rtners ip Wa Venzod Wireless may, ,.. ._�....� (t9arne and title rettporattax�e j �rutxrcp.6uldoe Tit:le: :iarWor Engineer - Hgaipomt Builders License No. ••••M�- ____... - Plumbers License No._ Electricians License No.„._.... Other Trade's License No._ 1. Location of land on which proposed work will be done: 1000 Pike Street ,,„ Mottiluck ........�_ .. . House Number Street l•fittttldt . ��J11 4 7,.16N Coun Tax Ma No. 1000 Section.--140 Blot r a a Lot 11.1 h, p � loo Etl ap Nd Lot Subdivision -- ------••�--•--� 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing uac and occupancy Fire District/Department use,incluctuail communications facility b. Intended use and occupancy Same as above with Public Udlit+Wireless Telecommunications Facility 3. Nature of work(check which applicable) New I3nild7tug Aclzlutton _Alts Patton Repair . . Removal Demolition Other Work InstafI iublic unlit warekess )cleeoa urira rata n iitute�uutts ivas de l2� bcommtrnicat$, resit lrauw aotu + b 1Na tutu r tstrict stsri ition atm d ru °ta 1 rtlat i.c uu inent on t�t roof o�an axistang biui mg,a as ifep�ot, in ie 1�)ane st�m ttrtl here 1 ) atciro9 �a _ neo �. (To be paid on filing this application) 5. If dwelling,number of dwelling units n/a Number of dwelling units on each floor If garage,number of cars Fire District/Department 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use, use,includin communicationsact uty gp _ . 7. Dimensions of existing structures,if any Of S t Depth , - Rear Hei ht Number of Storit t iti' roved 120' I A telecommunications pole Dimensions of same structure with alterations or additions: Front Rear Depth __,Height. Number of Stories 8. Dimensions of entire new construction:Frons —.----Rear Height Number of Stories .. 'Wop'usr'd centerline height of antennas: 115kt 1.3097 acres '- s47-lr:equipment'platform 9. Size of lot: 'tont �_—_�Rcutr �Dtslth 10.Date of Purchase I See attached Deeds - Name of Former Owner �....� 11.Zone or use district in which premises are situated_.IT,-Hamlet Business 12.Does proposed construction violate any zoning law,ordinance or regulation?YES_NO X 13.Will lot be re-graded?YES_NO X Will excess fill be removed from premises?YES_NOS PO Box 666 14.Names of Owner o tcuru`ses lwlatttitttek Fir°e I]istrict Atldress ra�tatt ox NY 11952 l'lione No. 631-298-8833 Name of Architect' Address o f �Ittaaic No 203-740-7578 �_�.... - G�'rorwe No. Name of C'otttraa.tor 15 a.Is this property within 100 feet of a tidal wetland ora ti°eshwater wetland?*YES. NO X *IF YES,SOUTHOLD TOWN TRUSTEES&D3.E,C.PER,IVII'1'S MAY BE REQUIRED. b.Is this property within 300 feet of a tidal wedand?*YES-NO_„X *IF YES,D.E.C.PERMITS MAY BE REQUIRED. 16.Provide survey,to scale,with accurate foundation plan and distances to property lines. 17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey, 18.Are there any covenants and restrictions with respect to this property?*YES NO X *IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF---) Malden being duly sworn,deposes and says that(s)he is the applicant (Nme of _..__. ,.......... riindividual signing contract)above named, (S)He is the IT a r YJ (Contractor, " tq ''� •nt of New York SIASA Limited Pattrucrslt d/bla Verizon R'iraless,Lessen (Contractor,Agent,Corporate Officer,etc.) or 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 knowledge and belief;and that the work will be performed in the maturer set forth in the application filed therewith. Sworn to before me iluis d of - +" � 20�" ; o r ' " lew t orA " rite 'al°oaenalu'ita d/b/a Verizon Wireless LORD rut e r t/ y � wo.atraaaxxsia"` �� _ o�t'°r is t. iaturc of Applicant. h10 is it: � gsua<roiat ooraitru« codtrsr,i»z Join trw:i�tear k r 9�a30� Title: Seninr Engineer -Equipment ,r0 , a 4 a , w .tN �W W-ar�Wa• i� ��" ^�d''« :�N.. � ��W r'W .r�a " q f �%.. t'�Cw^R'O (24'� S." 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Kelsey apo Irene L. aelsey, his wife, residing- at 10 Alias ocurt, Lpm rook, Long Island, New York. 1 Panes ol prrl por4 q * ted fine.aiaprist'�a 1 and TFD: 1[A7TX'lUOS 1<Il1E DI5TRIOT, a dgly inaorpora - ." thold Towh. SRffolk County, 'New Yorl� With:principal' ],oaated 'in Bou ,. . Off ion,at Mattitupk, New York. .1 ;1► , ,port y a�� .� re,ld"ps"r"l,; "► .�� � 11111a8srtl� /hot u4r,part isp of rl+r Jil l part,w oonrrddrsbou of �*�,�► �.� Dol/nri,'laovjul Pil l•of lhi•fhirted Ton (10j � 1•. , I lv►rd 61,1�6d/I,0 les of life rawNd part do hrnbp�ra"el amirrleate n>t1b thi prrrl7 ;', " , o/'Ihdr�ruNll/kirl, their suaaessolra I , , grid amtgtrr fwrarr,� 1�. U'tbmt Certain piece Or parallel br land. situate, lying sad being'• " at iiattltuak, Town of Gouthold, County o! Si<ilollc and r9tate of Ns1r „* 1 4 York, bounded'and described A's lo4owal BmImmm at a point an the southerly iins of Pike Street,u W11ioh point ii distant 110.67 feet btne�e oorner formed by the { 0 interseotion of the uoutllerly'll" of Plko Street*and too Westerly � line of Iliokham lvenue, running thenoq south E0' 21t BO" E., '193.31^ft• i piWallel w;th Wiokluua 4vrnue to land pf,AlexclUar K. Brown, thong* " „ der K. Brown 45.33 south 71! b61 E0 west along 1e]Id gT llesan feet, . bhru a line •of'folr►oe'poets to a post and land of >rrank G. z Durlar, thence north 66' 42160" Wcat 175.45 feet to tb* (southerly jibe of Pike utreut,'thanoe north: 63' 411Upst along'ebutherly w °N • w lin6 01• Tike Utroet, 65 root to the point or VXcoe pf.beginni , I ;laid oourgoo Ua 1111, takuu From n murvey made by Otto N. Van TU4Yl, t jr-onu rry 10th, 1026. I I . . iiiii o " W11 1 11 1 1 Y # up 1716 i ma 79. QFoOrIller ret(h the.r/rr•rrirmanres,dud roll 111d esine(tool ng to r!/Jhr/f rr'I y u! � , # " rn rrrtr!hr rrrrd p}rnrerrr. , 'ffa dant nab to 400 Dale rhe/wrl y of the r+Yrrad mi ll k their successors ' rlUdufa{•rrafrrreRer. , k C k Alla the.mrdpaities of the first part 1btYnaUl of lPI/OmJr ' r, " •ACst.--That mord parties of the Brat pert are � rnmf o!the lard (roux(rry/rr arra li" nod ha7e d n hr ro cyarrry/lie tarn( d - srmad—77roJ//r/+r►Mt o/the Jhr s,rrll prewrxso (0fcil--Thar the mrd punto((ary/ore/rain rAaavrhranar; 'No M1 „• TAW theAou!'ian of the frrst pal wd/irrenrs or.,proame'arry,/arihrr" arurx tr�r ant, kruniv of the hdr la said ltnrrxrsur ! u ffp•» t7bct rmr parties of the-first part, G " aull�orearr awmrirr the lirlr ry ralf prrnrrul. �n ei�nf, the mut ies df I/re firs/earl hale .147vWidi irl /andand seat the,dq ur :r.Wr firrd a/ trtorrl/em. . xa AY • •1 x r •A a w 4 x a" 4 � a ,.� ' e r ° sitat�,O( NOW ri•Me � a • r r` y , " r�Yq�e qll � M 11 x �r a n • � 1 . F� r'.t.'�y .�r r1. • " " • .rrn the `,� dqr umt' littteber ,mmtwmatuwemu bmm"rmJGt d*"a thirty ; btimrmis cam Uaville A. 1Ce].ssy Txe ,L.1 s1.seyr, hie.'1,6, r •, to are kaam to t •intl�vjdvds h Fray who exe r+rd„„the lwnra� ° aad rrmaraa k ommd i'. ;n "s festrumcat,Sh rapt lent tum ahwt t Irks urte ,tlkur e. JUN 1 1 13« rj� rom on T. uv—r o a" m.kL z&..9"mi t11.a440 int ra- 1.or It....1 l►n"R'h..1.IWWWF r...4 d.F=11.—.4 1w►pH Ntli+�'n d.w+^Ar wY nwr,kli firww.RFk. ,. r" &L 9s ro s Mx Gds the 20th day of January Au"Oea Bwulred and "� � fort,-sight. ' ![II/Y11.L6 A. ULUr and MM L. MU.Mr, his wife. re» aiding at 19 Altos Court, Lynbrook, Nassau County, Nov Ymk, mad t To 3t MTM YM MMsc'r, Tear of t a morx r OOWff, MM YMMI with office Lod principal plans of business at uattituok, Suffolk County, Now rack, P Nott r of ahs 0000"pare, � " k the rt po is■ of as first part, M oarm m of as Thouaaasd (/0,000.00 of tho �a9P a� wtdre Pak Air the Fare y at the*OOMW part, do. hw vby front sad IrO10046 WUIV qhs pmky of the o Orad part, ivo auccessara ono curse f"oraear,WX that trso't or parcel of land;, actuate at uattitusk, Tawn'or Southold, 9arrblk Oouuty, New York, boundsd and described as failowsl Beginning at a point toed by the iuterssoticn of the wdsterly line or•9lokbam aTsnus with the southerly 11ne of Pike gtrest and running'thsncs along-the westerly line of " Wickham Lvenine, 8. 800 Mao 80„ X. 109.1 fest to land at Auggrt .zsbruat m. y thence alohg said land of August Armbrust, g. 710 06, ROs *.110.08 fest { to land of Mattituok Z%ee District; theme along said land of Maftltnok a � Me Airtriot A. 20 $1' 40" W: 180.51 feet s to the wrath 1 1 ► as r in or said Pike Btrest; thence along the southerly Sias of Pike street, H. as 40' 40^ M. 110.07 fest to the point of bogihniog. I r, or TOORTIA with all the right, tit2s and interest of the parties of the first part of. is sad to Wickham Avenue Lad Pike atreet. to the , „ center lines thereat, 1 h. q rJ „ �I a „ M e n� o t ' inTmith the Oyu► aar and aii the estate and rights of the ! Port o 'the lint part to and to pr as a:0 bj-�W Mlb to11011 the prerrdee+h g,a7itod mto the Part 7 + 'of the reoond Partp its eusseseors and ausign+fOr'"or. .a M Yhs flrB*- &A Bald art iso o! D ^�it1 n 1 1 � WUMant as 190MV: R`e Mt ,mid Uel-yWo A. YslesY is Jot"d of sawdd'pr,,i s in ibe sbnpk,and has food right to -MV the:saes.; *Ma. TW the party of Cha soma pwnt ehia8 gwrwlp evoy the Bald �� ! Prarrniseea: ' p yQjrb. na the x0 pmmirs,my rroa from lns ►woos; yhg the !es 'of the or W w` � '"—,sWF.,=FuTWW of the a& to Promises; asid parties of SM forst pert ! rll � w sow f ttl`rplIt the to P YI IT hart Chs n'alor 10M "-ble the ear rwra 00"fiat (hU aaawarntyawnee and w,rriCi� r44�I is r,nrantaa 0tW4 oarnetjamtlootw arca a tmat fac to bo �3eewl' Py � firs0 for theaartora of PopCw tha cast of Maw t ea7naPnt a nd Xarili aplr Aho:aactrrwa,�t to the patylarwaont Oft aaeaat of itae wrra tawvenwtr�t taafore racing wxrni P"6 of th of same for any othar Pair .sAr. w f w pmoled of 90 flr#pot have Room a. a e8 P I r M n . " 1 Torr-aigfy0 � , the r �Parronc7iy�cAPo+atd i�.VII.i.E 1.OR mar ear. MM L. nJ,MY. to ane perrmwttfl 4 mon and bWo* to ane tothe rwne on■ d++ePAw{t 140 Md WW 4AMW aw WUhk ANSOUmen�e,—d her 91"raper y ou7bwwted�s 0e me t71a4 4hrr executedtu ;5 x i Y y1A M?4' .x� r. li RECORDED 14 IL rr•rr xuaimo f�(� � asMtvrr„�+vnnaou�T1� , n Ll ., r p � fir' • F d �� " m. u X46 a. ON dWad ,an iww. - 11 t, "Ading at two@) Tom" Avansso Nattituck, NOW Rork 11107 S mhTrrm r n of R no nn?Rwe ® munialpitl sorporetios having its rind place of burin at 1000 tikes t, Nath s now York 11912 ."Mmom to sm'br N wM rss�oad pd ° vele of 60 be P14,M smd&Wm of UZI No ?i---�•••••• ..®...�-----------...«....__. and other vahubls 003408rationPU Isle 04 Pft d 60 NOW PO4 to lulu W q W do WV d on - r « WW ld 104 VAO do t"V AW WpWdUO OWN 0004 Alk DIlTUC7 Wq W bier la ver llemist of Nattituak s Town of Southold, County of Suffolk and stats of Now Park, more pattioularly !founded and described as follawaw 0,40KNINg at a drill hots in this concrete sidewalk located at the northeast corner of this paras% and the northVest somas of leads Of fete at, hi ® i which drill hole in tb tJ a • ItoN the lfattitcat lies 45 minutes 10 seoonds Meat, 179.97 het from the 00=619 forsed by 140.00 the southerly line of tike litzeat and the westerly tins of NIckhm Avenues iNo TWcNY said point of be innings South 25 dogrses 42 SLOM minutes 20 seconds xast, along ■aid lands of the Nattituck lire District and lands now or tomarly of Joan A. Or kis 315-65 fast 93. to a point) d u CI along Undo now or formerly of the staniolow Miniars Votates, Routh 07 degrees 10 Minutes 20 seconds Meet, 37-97 test to a point being' the sootheaxt ®ornor of lands now or tczmirlY Of Ruth No xroomal 0Cx along the lands of xrausu, North 29 de es 49 minutes 20 secands Meets 212.0/ fast to a point ere► the southerly side of like Strom tl T1liNCti !!019th sJ dog ■ IS minutes /0 asoode Neots 59,00 feet to the q int or plan of as Ilio. 151110 MW "IIITIMII'sD to bsz. �pLisless ad to the sty of in � the first art by ad a Nutt I. xrause da 17 day of tiov r, 1002, and recorded in the office of the Clark of WfOlk County ars November 730 1902 in Libor 9271 page 119, n party of the ifirstpert eervem an saes nt i t ingress ag se to with the land for the benefit of the ad cuing PAXV61 on the sh wor the westerly 9 feet at,the promises groinabove 0 veyad, which formsrt of a prow tly - seistiog o d ftivoweys and S par* II riin favor9ai„0h of • ski, the prevent t a a of such adjoinin is statehis t on the pad in the fear 09 baa havoinaboveya•" del dee '+ . u .. .1, „ 'Ii00�11M#MIII�Ii�M,1i rw UMrwf,N�,r flr trb■t�Ertl tut ti n■i w w'MrNM t►M ® fl A MUM*16 6o wommom Old d IM wide mod P*b W Ike of In ligm psi to Old fad am PWAIM "MEM Ed mw�u so of do smand fart omw. v AM "ft Of bot PA WWWAIM dill OU PM ' C p " ry r. f Y ®f ■T FISHOd OWN" N 0! Of ■bW&W W ba WpW IM for do rvWm of pWIM OW mad of Ohl kgpVMUM and WIS of* ■f do Old r!IM bqcwmmW kkn Wq Gmy pd of Ik OW of do ON fat If u 1:11 wnmu"MOM on P*it so Am PA bal use"dh d"61 dw ow yw AlItown ,� Jr4W .yf AL 1" 1 a jw4 Wi' nl'•E+»+wnr. 1,.,: M. .� NI 1rilY1{f MI 1 �A 1 a b M Jan"17, 1N9i'mm as 016, �dw a vam A. MIWAAU L%ftwmok am to owsm ago d mm mom • N• PATE G r$U$k ,st,m4,4.w.wa JAN 9 «w w1.011,010.,0 a.x.j 0 04n,.4 COO" �ca Int TAS T N It t on vm, ilk VA +' 1* d" ow low"fisism ke haft A humm Owleft Am via" vasm WWI r q 4 a gg i M OF FM So IM ItMA MMIMMA r it...... PA A 30 04 4 ° e Ao w af to o y� • a.+a ao W rR 9A l IPr t e..rw.v.l�NMbr..d M�tw,ll,a �,.1,, woo wNM�-na IMM"M plow M�rr awww•14r Cp �• W 13 � January ,daManUaltelasdninetytwo rl WHOM A. MAICULOKI, residing Hattltuokt Now York 11937 po C�.� sees. . �•r 1 . N sa nllassr of the Irl IN4 am gINNelat d A. MICUIIIIti (Outten o mtp bus Ac"t•to Court P11e No. 771 p 1991) Wael lHattituaitt mutton( County, Naw York Id the Ard pap,ad NA" °I'"CX ?IRG olsTRICT, 4 reuniolpal corporation Wino its principal placo of businoss at 1000 Pike $treat, I4ettituc)tt New York 11951 laity at tM mad pre, " dw Wly of dh Am"K by VMw al ON pe-r red s 00 ft 0M In cad IN■al W Till 49M 'JlIWAAND SIX t1N RRD TH 7'Y raril sd tulstearl,and In eoseldsntlsa of ONE H D ItulNOR91) NIHICCM AHb 3S/IOD--------+(/173,619.791---------•'••'• � kwf An►sNwsN sI 0w UAW Sm"% PM by Ow pont'd tba tat sd W%den ImeW MM slid"km sola IM Wy d the woad pot%D•hdn of IsltMtwa ml " s al lha 1&4'f tin WAWA put kt MI, +w DISTRICT Aid.IW twills pias can w poral al fool,eilk w Iaiid m sod IMpwmoml thnas.snow,hoick, p�ea�(' w feHamlet of H.lttittick, Town of Southold count of Load, �u folk and State of Now York. being Mon particularly bounded and danoribed as follow■1 Iltal"IMINQ at n drill bole in thol annarate eidawalk 1e atoll at tha gzt:rloN northwest corner of this �aarca% and tha nurthanet omrnor of lands at the Nattittich Piroftiel�rict, 'which drill hole is South 63 day r. 1Aq.0o 45 minutes* 4o snconda (Nast 979.75 toot from, tiro corner formed by the southerly iine of Pik* Ntrsat and the weaterl^y line of Wickho Avanu*1 HIM"INti TIIENCR from said point or pleas of boiginnifiq South 25 dogrceast BLOCK 56 minutoat to seconds Rant along said land of the PAttituck ?ire tllstriat 55.00 toot to a points 03.00 *nJrMCIN still along said Irnd of the Nattituck Piro District Smith 61 d■Droar, 45 minutes, 40 seconds Host 15.01 foot to a monument and iande now or formerly of Ovorge L. Cullant LIYf1 do TI(r��R along said lands of Cullen Mouth 25 dogreee, 57 minutes,. 009.041,• aanowda East 152.36 toot to a monuwnt crud lands now or foraorly of 44MOa IMValtt vMiici4 Horth 69 degrees, 70 minutest 20 seconds least alone lands. of Navas and iandim now or formarly at the Stanislaw Hinlars Estate 15.00 feat to if polett ■ s1 land now • Iii D North t'1 d• nes. 40 minutes► 70 a aonds Eart tag Tilt C r l t S enlslaw 1liniars Gtet• 51.70 feet to land of the c e Natt� i .a piStrict? � ry Tliitm t North .26 depress 45 minutes, 20 soaonds Ifeak 212.04 test to the aouthorly line of degree;, streets l"ZHC'R South 61 degrees• 43 minuteep 40 second# Nest $1.08 feet to the Point or p14of DLGINNiN7. DICUMI Aso INTRNDID to be the saw premiaoo conv9yed to /marl A. syuiaki by deed dated Ncyaaar 171 1.#17 nods by Pndei�lok Nlllism 1 i '; w U 114�'7P�139 Krause a/k/a Allalm Yrudnri0k Kraure arA Auth Is %muse end recordod in the office of the Suffolk county Clark oa Rovj*w s1, 1932 In 6ibar 9210 cp 114. x} 4 W d � I .r w b n o I a Y 1 i + x I j F u www�mi �..mw.un 1 . 1 11407040 7 Wan= RU1 fnlrrrrt,Irmy of dw goryi1 dw SM 160164. 1,r rr UM Ill"Odi TOMMU fold,do opp000mmims,@rJ do ON Ik gibilt 1 *tWooes&4 In 4 a r 6"fingwMA do Mrq'+f On W Portless w bi Pwwi a wooer or&Pow d,wMtwn 1044duaw,a by Woo o)MIA WN or Alm". 70 NAVi AND TO Mala dre proline%MIN BMW.1b dw Mrry of do WMA p%w Mln w ®f dw prtr of 00 Wood PO( r r 4 I 4 L u AMD 1i1e Fm al to Mit p.N *a dN Mow of the deet pert Iw no d"N wlfewl m**jm ruby%he old M .ed ®°rf AND r e ratty of OOr wot p rt,10 p mq v1rb Wkm1y of do Iko I^comolAt OW Orr P411Y.f tlo #",pool Will rgerfa+r dao ftwAAmolon W thio twolum vA WM 1lalfd Oso r01,to rr dv#lmb 001191101104 for 4 trust food to 6 PMAIJ A1eir Iw dor "I Pq4V aw COO Of Ow "Wi*41 woo Rest to*4 par""of On tort 01 Ora lolprr+owd wrl"rre VAV Oor)*ft of ON f of I14r WAN for � 4111 04hcr Tho "pore ""Owl hs If N "11011ke rprr the flow.f Ildt I yd 09 Int par Red wrgM1n ®e1 v`W IN � ,01 •sea® ®®� W p . �p A. Itlt'NI OUi , as 'brr4410uwr Irrtsto OG l�rla�i*rL AB IVs� nt�stb . I 11407U41 surrO i wiw P3, A �1 Irw 1 f I ® f 11 ! U Ki pener* to Dim kwa b be do MOMWt to dill WWWW w Ii on W"Pimo twmmw% r « o kv tw 0tbo of 11 ,ur day aq of 10 r� w r � atb rom is kI dim atWhim wl f bill t or t goo ai + of f Itl1 flaw t � 1 t� rAt I M p w ttw r kr wI 04 do mm I P ftKutwo Meet r I I G t tlrU YM P h. LC Xi. q� It CUCor t ®tato of P"r6h. mauguliaki / 1M'1"1't"m PIPJA DINTRI I Rom bf do w Omn111111/2 w m W I"Wer go on.IAIR loco= a vir a .. I « 1 , j w r I Full Environmental Assessment Form Part I-Project and Setting 0 2 r'J' Instructions for Completing Part 1 oufRl Tc�ws� P g Plarw4io Board Part 1 is to be completed by the applicant or project sponsor. Responses become part of the application for approval or funding, are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information;indicate whether missing information does not exist, or is not reasonably available to the sponsor;and,when possible,generally describe work or studies which would be necessary to update or fully develop that information. Applicants/sponsors must complete all items in Sections A&B. In-Sections C,D&E,most items contain an initial question that must be answered either"Yes"or"No". If the answer to the initial question is"Yes",complete the sub-questions that follow. If the answer to the initial question is"No",proceed to the next question, Section F allows the project sponsor to identify and attach any additional information. Section G requires the name and signature of the project sponsor to verify that the information contained in Part lis accurate and complete. A.Project and Sponsor Information. _... .... �. e.,....... _...---. ......... .... ...__. Name of Action or Project: Proposed Upgraded Communications Facility at the Mattltuck Fire Department Project Location j (describe,Pro .� .� �._.mwm� ..,.��. ......_. .......,��. ...� and attach a general location map): 1000 Pike Street,hamlet of Mattltuck.Town of Southold(see attached site location map) Brief Desc r'option of Proposed Action(include purpose or need).�mmmmmm The proposed action involves the upgrade of the Mattiluck Fire District's exlsting communicalions facility located at"1000 Pike Street„Mattltuck Specifically,the Fire District intends to remove an existing 84.5-foot-tall wooden polo with whip antennas thereon and replace It with a 120-fool-tali blue/gray sloallh r.unlpcle and associated equipment, The proposed urrlpole would support multiple Fire Distrlctwhip antennas at various hMghts,the uppermost cif which would reach a top heiglit of 132-foot 6.1a-inches above grado level(agl).In addillon,a mesa span cabinet and a.Iransformer would be Installed at ground level,proxirnate to the base of the proposed unipole."I-I"io proposed stealth unipole would also facilitate fulaara collocation,as II would be able to conceal the antennas of rnuillple wireless service providers within. Associated roollop equipment of future wirelc,cornmunlcallonsproviders would be situated on two proposed steel platforms measuring 336 and 184 square feel,behind screening enclosures designed to match the hulidind fagade. The proposed screening enclosures for future wireless communications roofiop equipment woulid extend to a height of 31-feet2i-inctaes agl, which Is approximately nine feet higher than the existing building parapet. Additionally,a natural gas powered generator(associated with future collocation)could be located upon the building rooftop proximate to the proposed equipment platforms. Name of Applicant/sponsor: Telephone: (631)298-8833 Mattltuck Fire District E-Mail _.. Address: P.O.Box 666 ..{..y ...__....�._ _ .._...,... ...__ .. Nfet ff: p State:New 1152 Za Code " 9 Project Contact if not same ass sponsor;give name and J ( ..ww..�. p .. ,g d title/role): Telephone:(631)425-4100(Att: John Coughlin,Esq.) w Re,Nielsen,Huber&Coughlin,LLP E-Mail:leoughlln®rnhclaw.com _ .......- n Address: Ci /p0; 36 York Avenue North New -. _ ... �w...... -... _. _.... State: Zip Code.New wYork 11743 Property Owner (if not same as sponsor): Telephone: _.W..., �.__.. ........... ....... E-Mail: - -- _.__---- ........... m Address: City/PO: State: ;dip Code: Page 1 of 13 B.Government Approvals B.Government A_ rovals,I-undin oronsorshi . ("Funding"includes grants.,loans,tax relief,and any other forms of financial assistance.) Government Entity If Yes:Identify Agency and Approvals) Application Date Required (Actual or projected) a.City Council,Town Board, ❑YesmNo or Village Board of Trustees b.City,Town or Village mYes❑No Site Plan/Special Permit-Town of Southold TBD Planning Board or Commission Planning Board c.City Council,Town or ❑YesmNo Village Zoning Board of Appeals d.Other local agencies mYes❑No Building Permit-Town of Southold Building TBD Department e.County agencies ❑YesmNo f.Regional agencies ❑YesmNo Stat- _. g, e agencies ❑YesmNo h.Federal agencies ❑YesmNo __... _.. ...._. _. - - .....� i. Coastal Resources. i. Is the project site within a Coastal Area,or the waterfront area of a Designated Inland Waterway? ®Yes❑No If yes, U. Is the project site located in a community with an approved Local Waterfront Revitalization Program? 0 Yes❑No P J _.. .._..._ ......_ No M. Is the ro'ect site within a Coastal Erosion Hazard Area? ❑Yes® C.Planning and Zoning C.I.Planning and zoning actions. Will administrative or legislative adoption,or arnendn ent of a plan,local law,ordinance,rule or regulation be the MesoNo only approval(s)which must be granted to enable the proposed action to proceed? • If Yes,complete sections C,F and G. 0 If No,proceed to question C.2 and complete all remaining sections and questions in Part 1 C.2.Adopted land use plans. y._. 1 y l (city,town,village or count com reliensivc land use plan(s)Include the sit( 6zlyer+.... a.Do an r�:tua�rcl call -adopted ci , g y) � p ❑"Ntw where the proposed action would be located? If Yes,does the comprehensive plan include specific recommendations for the site where the proposed action ❑Yes®No would be located? b.Is the p the of site ' e proposed action within any local or regional special planning district(for example: Greenway GDYes❑No Brownfield Opportunity Area(BOA);designated State or Federal heritage area;watershed management plan; or other?) If Yes,identify the plan(s): F#erlta a rea�_... _...�.... �.. ...m- ... _l,canp lstand��lp lt, . ..�,.� ... ...... .m...�.. _ ....__�. .. ...m. ..,.....�a., _—_ c. Is the proposed action located wholly or partially within an area luted in an adopted municipal open space plan, ❑Yes®No or an adopted municipal'farmland protection"plan? If Yes,identify the plan(s): Page 2 of 13 C.3. Zoning a. Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance. ®YesONo If Yes,what is the zoning classification(s)including any applicable overlay district? klamletusfness.( _ - _--- mm b. Is the use permitted or allowed by a spe�mmmmIT � ��-- _ -.... cial or conditional use permit? ®YesONo w.... ......... ... �...._- .._ __ _..� _._....._ c.Is a zoningchange requested as part of the proposed action? []Yes®No If Yes, L What is the proposed new zoning for the site? CA.Existing community services. a.In what school district is the project site located? .MLitiutnron School .u4rlct ... _...m„ _ b.What police or other public protection forces serve the project site? Town aSOulk?ocg� .... .. c.Which fire protection and emergency medical services serve the project site? Matkltuck Flre rsgarwrinten holh(Ire and emergent r_ odl(,Aa services ._ _— ...__ d.What parks serve the project site? N/A—the proposed action Is an unmanned facilitythat would not be served b or utilize any parks D.Project Details D.I.Proposed and Potential Development a.What is the general nature of the proposed action(e.g.,residential,industriail,,commercial,recreational;if mixed,include all components)? Upgraded communications facility b.a.Total acreage of the site of the —1-,.3.6 acres (a oundtdlst b Total acreage to be physically d ropo cG1 action? ().018± acres (Ground disturbance property) g } uti ty isturbed7 urbance associated with pole and C.Total acreage(project site and any contiguous properties)owned cabinet Installation end utility routing.) ± acres or controlled by the applicant or project sponsor? 0 002 (Represents ground level area to contain uni ole and uttllty cabinets)' c.Is the proposed action an expansion of an existing project or use? ❑Yes®No i.If Yes,what is the approximate percentage of the proposed expansion and identify the units(e.g,,acres,miles,housing units, square feet)? % _ Units: d.Is the proposed action a subdivision,or does it include a subdivision? .. _._..- - Yes Ohwlo If Yes, i.Purpose or type of subdivision?(e.g.,residential,industrial,commercial;if mixed,specify types) fi.Is a cluster/conservation layout proposed? � NO ❑Yes ONO ifi,Number of lots proposed? _...................__.. iv. Minimum and maximum proposed lot sizes? Minimum _............. Maximum e.Will proposed action be constructed in multiple phrases? E]YesONo f. If No,anticipated period of construction: 1-3 months ff. If Yes: • Total number of phases anticipated ........ . • Anticipated commencement date of phase I(including demolition) month year • Anticipated completion date of final phase month _year • Generally describe connections or relationships among phases,including any contingencies where progress of one phase may determine timing or duration of future phases: ..— "Note that assoclated equipment may also be installed upon the rooftop of the existing Fire Department building In the future to facilitate collocation of wireless communications providers. Page 3 of 13 f.Does the project include new residential uses? E]YesoNo If Yes,show numbers of units proposed. One Family 'Iwo Family Three Family Multiple&w:11y(four or more) Initial Phase ............ —— ___- At completion of all phases ......................... g,Does the proposed action include now non-residential construction(including expansions)? OYes[]No If Yes, 1.Total number of structures (Unipole)* diameter (Represents proposed fl.Dimensions(in feet)of largest propose I d structure: 12o height; 3.6"*"X""XXXXXKftW unIpole dimensions) iii, Approximate extent of building space to be heated or cooled: _„^.......... .................... square feet h.Does the proppied action include construcion or other activities that will ret in the ipoundment of any rJTesQ1No liquids,such as creation of a water supply,treservoir,pond,lake,waste lagoonsulor othermstorage? If Yes, 1.Purpose of the impoundment: ........................... fl.If a water impoundment,the principa I source of the water: round water E]Surfaco water streams[Jother specify: ............ M.If other than water,identify the type of impounded/contained liquids and their source. iv. Approximate size of the mmmm proposed impoundment. Volume:_-—------—",—million gallons;surface area: acres v.Dimensions of the proposed dam or impounding structure: .....——height;_length vi. Construction method/materials for the proposed dam or impounding structure(e.g.,earth fill,rock,wood,concrete): .............. ____........w._. D.2. Project Operations a.Does the proposed action include any exenvation,mining,or dredging,during construction,operations,®rJ7o1_JY1 []`Yes7N_o (Not including general site preparation,grading or installation of utilities or foundations where all excavated materials will remain onsite) If Yes: at is the purpose of the excavation or dredging? ...... U. How much material(including rock,earth,sediments,etc.)is proposed to be removed from the site? • Volume(specify tons or cubic yards):. • Over what duration of time? .......... ---------.................... M.Describe nature and characteristics of materials to be excavated or dredged,and plans to use,manage or dispose of them. No iv. Will—there Won"Wit—edewa"ie'—ring'®r processor of of e—xcav"-at-e"d—m—at-e-r-i'a"'Is?-----, Ycs- If yes,describe, -—--_-----___------- ------------ ........ v.What is the total area to be dredged or excavated? acres vi.What is the maximum area to be worked at any one time? acres vii.What would be the maximum depth of excavation or dredging? feet viii.Will the excavation require blasting? []Yes[]No & Summarize site reclamation goals and plan: .......... b.Would the proposed action cause or result in alteration of;,increase or decrease in size of,or encroachment Yes No into any existing wetland,waterbody,shoreline,beach or adjacent area? If Yes: i.Identify the wetland or waterbody which would be affected(by name,water index number,wetland map number or geographic description): ........................................... ...................... ................ .......I'll... ............................................. *The proposed action also Involves the Installation of accessory equipment cabinets at ground level. "Diameter at the base of proposed unipole,which tapers to 3.0 feet at the top, Page 4 of 13 U.Describe how the proposed action would affect that waterbody or wetland,e.g.excavation,fill,placement of structures,or alteration of channels,banks and shorelines. Indicate extent of activities,alterations and additions in square feet or acres: ......... _. .� iii. Will proposed action cause or result in disturbance to bottom sediments? es❑No iv. Wproposed m ... . Yes❑No....,m,.. 1 CSro osed action cause or result in the destruction or removal of aquatic vc elation d 0 If Yes: • acres of aquatic vegetation proposed to be removed, _ _... ___ ..... _. • expected acreage of aquatic vegetation remaining after project completion ........... • purpose of proposed removal(e.g.beach clearing,invasive species control,boat access): _. • proposed method of plant removal: • if chemical/herbicide treatment will be used,specify product(s): _ .,.......,. v. Describe any proposed reclamation/mitigation following disturbance c.Will theos ro p p ed action use,or create a new demand for water? Unmanned facility-no potable water required ❑Yes mN'o If Yes: i. Total anticipated water usage/demand per day: _ ? gallons/day rr. Will the proposed action obtain water from an existing public water supply ❑Yes❑No If Yes: • Name of district or service area: g p supply have capacity to serve the • Does the existing public water su 1 proposal? ❑Yes❑No • Is the project site in the existing district? ❑Yes❑No • Is expansion of the district needed? ❑Yes❑No • Do existing lines serve the project site? ❑Yes❑No iii. Will line extension within an existing district be necessary to supply the project? ❑Yes❑No If Yes: • Describe extensions or capacity expansions proposed to serve this project: • Source(s)of supply.�....�_ .��._ .. ... . T_... .. .._. _�._ for the district:__ _ iv.Is a new water supply district or service area proposed to be formed to serve the project site? ❑Yes❑No If,Yes: • Applicant/sponsor for new district: ,_-------,.. ._m • Date application submitted or anticipated:, .... _m --- . ... _ • Proposed source(s)of supply for new district: v. If a public water supply will not be used,describe plans to provide water supply for the project: vi.If water supply will be from wells ublic or private),maximum to pp y (p p ) pumping capacity: gallons/minute. d.Will the proposed action generate liquid wastes? Unmanned facility-no liquid waste generation ❑Yes Zio If Yes: L Total U.Nature of liquid wastes obe generated(e.g.,sanitary wastewater,industrial;P q g P Y gallons/day if combination,describe all components and approximate volumes or proportions of each): di. Will the proposed action use any existing public wastewater treatment facilities? mm,.------ ❑Yes❑No If Yes: • Name of wastewater treatment plant to be used: .....,. ........... ..............._m.....,._... ___. • Name of district: • Does the existing wastewate.r treatment m............ plant have capacity to serve the project? []Yes[]No • Is the project site in the existing district? []Yes❑No • Is expansion of the district needed? ❑Yes ONO Page 5of13 • Do existing sewer lines serve the project site? ❑Yes❑No • Will line extension within an existing district be necessary to serve the project? ❑Yes❑No If Yes: • Describe extensions or capacity expansions proposed to serve this project: iv. Will a new wastewater(sewage)treatment district be formed to serve the project site? ❑Y _ es❑No If Yes: • Applicant/sponsor for new district: • Date application submitted or anticipated • What is the receiving water for the wastewater discharge? _ v. If public facilities will not be used,describe plans to provide wastewater treatment for the project,including spccriynrg proposed receiving water(name and classification if surface discharge,or describe subsurface disposal plans): Vi.Describe any plans or designs to capture,recycle or reuse liquid' c p y quid waste e.Will the proposed action disturb more than one acre and create stormwater runoff,either from new point ❑ Yes®No sources(i.e.ditches,pipes,swales,curbs,gutters or other concentrated flows of stormwater)or non-point source(i.e,sheet flow)during construction or post construction? If Yes: i.How much impervious surface will the project create in relation to total size of project parcel? Square feet or acres(impervious surface) Square feet or acres(parcel size) U.Describe types of new point sources W.Where will the stormwater runoff be directed(i.e,on-site stormwater manage ..nt pr _. management facility/structures,adjacent properties, groundwater,on-site surface water or off-site surface waters)? • If to surface waters,identify receiving water bodies or wetlands • Wry]s r rrnollltp to adjacent iv.Does proposed plan inrar�xs�a rrrrervroussurfrces use pervious materials or collect and re-use stormwater? ❑Yes[]No t Docs the proposed action include,or will it use on-site,one or more sources of air emissions,including fuel ❑"des i o combustion,waste incineration,or other processes or operations? If Yes,identify: i.Mobile sources during project operations(e.g.,heavy equipment,fleet or delivery vehicles) ... - s iiStationary sources duringconstructron(e.g.,power generation,structural heating,batch plant,crushers) in. Stationary sources during operations(e.g.,process emissions,large boilers,electric generation) in sources named in D 2.f above,require a NY State Air lie rpt g. �?i;ll any air er ( ) q ' g rat i<;rrr,Air Facility Permit, []Yes No or Federal Clean Air Act Title IV or Title V Permit? I If Yes: i. Is the project site located in an Air quality non-attainment area? (Area routinely or periodically fails to meet ❑Yes❑No ambient air quality standards for all or some parts of the year) U. In addition to emissions as calculated in the application,the project will generate: • Tons/year(short tons)of Carbon Dioxide(CO2) • Tons/year(short tons)of Nitrous Oxide(N20) • _ _ 1"011s/year°(short tons)of Perfluorocarbons(PFCs) • Tons/year(short tons)of Sulfur Hexafluoride(SF6) Tons/year(short tons)of Carbon Dioxide equivalent of Hydroflourocarbons(HFCs) • Tons/year(short tons)of Hazardous Air Pollutants(HAPS) Page 6 of 13 G h.Will the proposed action generate or emit methane(including,but not limited to,sewage treatment planes, Ycs No landfills,composting facilities)? If Yes: t.Estimate methane generation in tons/year(metric):. . ....... i.Describe any methane capture,control or elimination measures included in design(e.g.,combustion to generate heat or electricity,flaring): L Will the proposed action result in the release of air pollutants � ... such ��. t l1 nts from crl;aerr-air�apoaatr��ars or processes,such as ❑YesjNu quarry or landfill operations? If Yes:Describe operations and nature of emissions(e.g.,diesel exhaust,rock particulates/dust): j.Will the proposed action result in a substantiul increase in traffic above present levels or generate substantial ❑,YesoNo new demand for transportation facilities or services? Unmanned facility If Yes: i. When is the peak traffic expected(Check all that apply): []Morning ❑Evening ❑Weekend ❑Randomly between hours of to R.For commercial activities only,projected number of semi-trailer truck trips/day: . iii. Parking spaces: Existing Proposed Net increase/decrease iv. Does the proposed action include any shared use parking? ❑Yes❑No v, If the proposed action includes any modification of existing mads,creation of new roads or change in existing access,describe: ,,..-- ......mm _ --------- ................------- --____ ._........ ..... ......,W, p taptp service(s) iaof the proposed sate? c� ❑Yes❑No vii Will the proposed action include access to public transportation or accommodations for use of hybrid,electric []Yes❑No or other alternative fueled vehicles? viii.Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing ❑Yes❑No pedestrian or bicycle routes? k.Will the proposed action(for commercial or industrial projects only)generate new or additional demand Yes❑No for energy? If Yes: L Estimate annual electricity demand during operation of the proposed action:w TBD-minimal Increase In electricty usage to operate I _prop sed U.Anticipated at sources/suCppliers of electricity for the project(e.g.,on-site combustion,on-sate renewable,via grid/local utility,or other): in. Will the proposed action r _........ ....._ w.... .--- .— .... _.... ......... ............— es❑ local aPRlttlt t� E Cr _ equire a new,or an upgrade to,an existing substation? leo 1.Hours of operation, Answer all items which apply,. i.During Construction: fl. During Operations: • Monday Friday: 7:00 a.m.-7:00 p.m. • Mondy. 24 hourss/day"" Y YSaturday: ._. a • Saturday: NIA • Monday Friday: • Sunday: NIA 9Sunday: 24 hours/d ay" • Holidays: NIA • Holidays: 24 hours/day "Construction would be limited to the hours of 7:00 a.m.-7:00 p.m.pursuant to noise regulations set forth In Chapter 180 of the Code of the Town of Southold. "*Remotely monitored,communications facility. Page 7 of 13 m.Will the proposed action produce noise that will exceed existing ambient noise levels during construction, ®Yes[]No operation,or both? If yes: i. Provide details including sources,time of day and duration: Ambient ncilo _which would be limited to 7:00 a,m,to 7:00 p.m.oise levels maybe temporarily exceeded during conalru__ cllon, _ .. ii. Will proposed action remove existing natural barriers that could act as a noise barrier or screen'?"'' cree ? ❑Yes®N Describe: n.,Will _.... the proposed action have outdoor lighting? [J—Yes❑1*l'o If yes: i.Describe source(s),location(s),height of fixture(s),direction/aim,and proximity to nearest occupied structures: U. Wili proposed action remove existing natural barriers that could act as a light barrie" r or screen? �Yes No Describe: o.Does the f Yes,describe ossible sources,potential frequency _ proposed the_ p produce_ odors for more than one holo per(Bay? n Yes O No p q ncy and duration of odor emissions and proximity to nearest occupied structures: .. .. ® .- —......... _.. r p.Will the proposed action include any bulk storage of petroleuln(combined capacity of over 1,100 gallons) El Yes 0N or chemical products 185 gallons in above ground storage or any amount in underground storage? If Yes: i,Product(s)to be stored__. -- ii Volume(s) per unit time (e.g.,month,year) ii, Generally describe proposed storage faed ides .�._........_____._.. ...�..�. .... ......-----— .m ,the proposed action(commercial q•Will p p industrial and recreational projects only)use laestac:icleli(i,iW.,„herbicides, ❑Yes O1ti10 insecticides)during construction or operation? If Yes: I Describe proposed treatment(s): enlent Yes_ No r,Will tNl the hYe proposed ed ctioosed n(coiniincrciall oron use 1!Lic industrial dust aliptoic is only)tinvaolve or require the management or disposal El Yes ONov� of solid waste(excluding hazardous materials)? If Yes: L Describe any solid waste(s)to be generated during construction or operation of the facility: • Construction: tons per.........._,_. ............_(unit of time) • Operatirin; —— m _. tons pu , ... ....... (unit of time) ii. Describe any proposals for ori site lninimization,recycling or reuse of materials to avoid disposal as solid waste: •, Construction: -- —�--- • Operation: ___..m........... .. ... — iii,Proposed disposal methods/facilities for solid waste generated on-site: • Construction: -......�.� ..... � —� Operation: .. ..... Page 8 of 13 a s,Does the proposed action include construction or modification of a solid waste management facility? Yes 0 No If Yes: i, Type of management or handling of waste proposed for the site(e,g,,recycling or transfer station,composting,landfill,or other disposal activities) �.._r_.. ... _m. __....... .._m �mmm� ................�... ._... �. . -------- _..... .. ii. Anticipated rate of disposal/processing: r • Tons/month,if transfer or other non-combustion/thermal treatment,or • Tons/hour,if combustion or thermal treatment ill.If landfill,anticipated site life: _- „ years t.Will proposed action at the site involve the coinmercial gencratiori,treatment,storage,or disposal of hazardous D'qesoNo waste? If Yes: 1. Name(s)of all hazardous wastes or constituents to be generated,handled or managed at facility: ...... _ ... ......�................._ ii, Generally describe processes or activities involving hazardous wastes or constituents: r,,,,,.. iv. Describe any proposals for on-site minimization recycling or reuse of hazardous constituents: ___—._.t to be handled or generated t ill. ons/month Y g nts m_,_.... __ ... Will any hazardous wastes be disposed at an existing offsite hazardous waste facility? ? � V. If Yes:provide name and location of facility: proposed management of any hazardous wastes which will not be sent to a hazardousfacility: If No:describe ro osed ma .. .. _ �� waste E.Site and Setting of Proposed Action E.1.Land uses on and surrounding the project site �. a.Existing laird uses. i. Check all uses that occur on adjoining and near the project site. Residential suburban ❑Rural non-farm) Commercial ( Comore ® (suburban)El Urban ❑ Industrial ❑Forest ❑ Agriculture ❑ Aquatic ® Other(specify):Municipal-flre department educational ii. If mix of uses,generally describe: The sub eect,proparty Is a tlre,rlrmparknrrr t_wllh co m rslal,rr s4c rart1!p!cnd educetlonal uses lis„the Burroe ...... ---- mm. b,Land project uses and covertypes on the ste � — ........ ..� 1 _ . ....._.� ..��Curre��t ..w_..� ...Acreage After _..._.'...('..Change ) Land use or g t Vert. W ..._ Ac�;ca'o I'iolcot�t onr Lenon • Roads,buildings,and other paved or impervious 002” 0.002* 0 surfaces • Forested ....__�_.. � ._... �..� 0 ' _WWW .��.. 0 _..._,, _0. . endows,grasslands orrushlas(nn0 o 0 L rultural,lreud agricultural) �. �._��... .�.m-_._�...._... • Agricultural 0 0 0 (inciudew active orchards,field,gccihcue ctc _.___....... —.. _. _.. W .... .r. • Surface water features 0 0 0 ( y � ,'rivers,etc es Vol:old .) .� __....� __ ....... ...._ lakstieams _.m_ �. .. _.... Wetlands(freshwater or tidal) 0 0 • , Non-vegetated(bare rockearth o g ..r fill) p 0 0 • Other Describe: _ ..._. .m._ "Represents proposed ground level facility area(unipole and cabinet area)only. I Page 9 of 13 c.Is the protect site presently used by members of the community for public recreation? ...._�..�_.. ...�_��� � �� ❑YcsNo L If Yes:explain: ......... d.Are there any facilities serving children,the elderly,peoplewithdisabilities(e.g.,schools,hospitals,licensed Yes N._.. p ® ❑ o day care centers,or group homes)within 1500 feet of the project site? If Yes, t. Identify Facilities: Mattlluck Hlgh hou tlMatlituck-Laurel Lmlbra, e.Does thero'ect e .. p t site contain an existing dam? ❑Yso No' If Yes: I Dimensions of the dam and impoundment: • Dam height: .... feet • Dam length: feet • Surface area: �...................—... acres • Volume impounded: __gallons OR acre-feet ii. Dam's existing hazard classification _ mm.. . . m W.Provide date and summarize results of last inspection: 6 .�_.�,. ❑Yes�N f.Has the protect site ever been used as a municipal,commercial or industrial o e ma ..... lit al solid waste management facility, ��o or does the project site adjoin property which is now,or was at one time ed as a solid waste management facility? If Yes: i. Has the facility been formally closed? ❑Yes No I • If yes,cite sources/documentation; U. Describe the location of the project site relative to the boundaries of the solid waste management facility: _ �. .. .........._.. _._.___ ...... m _�.—"development ,m....._. P �.. .. -- W. Describe anY develo ment constraints due to the prior solid waste activities; � ........ g. ssgmdisposed the site,or does the dispose Ye No property whchis now or was at one time used to commercially treat,store and/or of hazardous waste? If Yes: L Describe waste(s)handled and waste management activities,including approximate time when activities occurred: � tt .... Ycsl Noh. Potential in here been a red s ill at the rosed ProJect se or have anY _. remedial actions been conducted at or adjacent to the proposed site? If Yes: i. Is any portion of the site listed on the NYSDEC Spills Incidents database or Environmental Site ❑Yes❑No a Remediation database? Check all that apply: ❑ Yes—Spills Incidents database Provide DEC ID number(s): .., ❑ Yes—Environmental Site Remediation database Provide DEC ID number(s):_,.. ,mm, ❑ Neither database ii. If site has been subject of RCRA corrective activities,describe control _ W. Is the project within 2000 feet of any site in the NYSDEC Environmental Site Remediation database? ❑Yes❑No If yes,provide DEC ID number(s): .,... ..... — ._,. _ ..........,.. iv. If yes to(i),(ii)or(iii)above,describe current status of site(s); Page 10 of 13 ..._._-...-- .m_ ❑ V. Is the project site subject to an institutional control limiting property uses? - m ❑Yes No ° If yes,DEC site ID number:_._ a Describe the type of institutional control(e.g de —._. ed restriction or casement): 4 Describe any use limitations: ........ ........ _ ....... __...... ....,.-..._ ...... Describe any engineering controls: _ _ _ ... m.. ______ ......w I Will the project affect the institutional or engineering controls in .--- place? ❑Yes❑No 0 Explain: _..... ...... --- E.2. Natural Resources On or Near Project Site a.What is the average depth to bedrock on the project site? 89 1 feet below grade su.. g p p J surface b.Aretherebedrock outcroppings on the project site? ❑Yes❑No._m. m If Yes,what proportion of the site is comprised of bedrock outcroppings? w... .w..__-.... -- ..... o e ers o ro'os-a C.Predominant soil type(s)present on project site: Riverhead and Haven sone,graded,0 to 8 percent slopes(RhB) 100 / ... P P — % facility location) — .. _..... ... d.What is the average depth to the water... ......�.m-........_ �- table on the project site? Average; 7t,feet below ...__m slow grade surface ........ . ..._...-_ a.-. „_...__. _ ------------ e,Drainage status of project site soils:®Well Drained: 100"%of site ElModerately Well Drained; mm_ %of site ❑Poorly Drained %of site ® _.. _....._...._. ....- f.Approximate proportion of proposed action site with slopesm-..... 0-10%: of site t p Refers to proposed 0 100 o/o posed facility location) ❑ 10-15%: %of site ❑ 15%or greater: y.,_,,,,,,,,,,,,,,,,,,,,,,,,,,%of site g.Are there any unique geologic features o .. ...... g n the project site? Yes®No If Yes,describe:.......... .w. m. .. ... .....-- ..... ............... ..-.. h.Surface water features. i.Does any portion of the project site contain wetlands or other waterbodies(including streams,rivers, ❑Yes®No ponds or lakes)? ii.Do any wetlands or other waterbodies adjoin the project site? ❑Yes0No If Yes to either i or ii,continue. If No,skip to E.21. iii. Are any of the wetlands or waterbodies within or adjoining the project site regulated by any federal, ❑Yes❑No state or local agency? iv.For each identified regulated wetland and waterbody on the project site,provide the following information: • Streams; NameClassification., 0 Lakes or Ponds: Name w, a. ., ,m , „ Classification • Wetlands: Name �... _....__ Approximate Size 0 Wetland No, if ulated (water bodies listed i v. Are any of the above n the most recent compy ) _.... ' of NYS water quality-impaired Y.....[ dation.uu�. ❑ es❑No waterbodies? If yes,name of impaired water body/bodies and basis for listing as impaired: ... i.Is the project site in a designated Floodway? ❑Yes[1No j.Is the project site in the 100 year Floodplain? � ❑YesmNo j• P' J Y p WWW... ___. _.._.. ... W..... k.Is the project _.� site in the 500 year Floodplain? []Yes mNo 1.Is the project site located over,or immediately adjoining,a primary,principal or sole source aquifer? Yes ENO If Yes: 9. — m_.-, i•Name of aquifer; Nassau-Suffolk Sole A utter Page 11 of 13 m. Identify the predominant wildlife species that occupy or use the project site: The proposed facility area Is unvegetated(Le.,paved),however,there may be typical suburban specles,such as squirrels,birds,and raccoons, that utilize the overall subject property. n.Does the project site contain a designated significant natural community? ❑YesW]No If Yes: i.Describe the habitat/community(composition,function,and basis for designation):m . ......_ _....__ H. Source(s)of description or evaluation: ill,Extent of community/habitat: • Currently: acres • Following completion of project as proposed acres • Gain or loss(indicate+or-): acres project to contairi any species of plant or animal that is listed by the.federal g .r N o.Does �rcz act si a federal government or NYS as ❑YesONo endangered or threatened,or does it contain any areas identified as habitat for an endangered or threatened species? p. Does the project site contain any species of plant or animal that is listed by NYS as rare,or as a species of _❑Yes®No special concern? q.Is the p project site or'adjoining area currently used for hunting,trapping,fishing or shell fishing? Y...�,.� ..1 g, PP g, ❑ esOl+lo If yes,give a brief description of how the proposed action may affect that use: —.__- .----------__ — E.3. Designated Public Resources On or Near Project Site a.Is the project site,or any portion of it,located in a designatedagricultural� p rs ricult � g ural districc t certified pursuant to DYes❑No Agriculture and Markets Law,Article 25-AA,Section 303 and 3047 If Yes, provide county plus district name/number: .... .y b.Are a_.._ agricuulturltur al]ands consisting of highly productive soils present? ❑Yes[Z]No t If Yes:acreago(s)on project site? .....r. .-.....u..... .... ii. Sotirce(s)of soil rating(s): — ..... .. — _._ project p 't substantial) contiguous to,a registered National Ely..sONo c. Does the ro'ect site contain all or art of or is i y g g es®No Natural Landmark? If Yes: i. Nature of the natural landmark: ❑Biological Community ❑ Geological Feature ii.Provide brief description of landmark,including values behind designation and approximate size/extent: __. d.Is the project site located in or does it adjoin a state listed Critical Environmental Area? CIY'csONo If Yes: i. CEA name: ii.Basis for designation:_ — .W W iii.Designating agency and date: Page 12 of 13 e.Does the project site contain,or is it substantially contiguous logic site, . ..�. p � y g ous to,a building,archaeological site,or district ❑Yes®No which is listed on,or has been nominated by the NYS Board of Historic Preservation for inclusion on,the State or National Register of Historic Places? If Yes; i.Nature of historic/archaeological resource: El Archaeological Site ❑Historic Building or District fl.Name; m.. ..-- mm... ..... M.Brief description of attributes on which listing is....WW W.. ...,.... s based: f.Is the project site,or any portion of it,located in or adjacent to an area designated as sensitive for ®Yes❑No archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory? g.Have additional archaeological or historic sites or resources �g' O � been identified on the project site? ❑Yes®No If Yes: f.Describe possible resource(s): _ if.Basis for identification: h.Is the project site within fives miles of any officially designated and publicly accessible federal, ate,,or Local ®_Ymores ❑No scenic or aesthetic resource? If Yes: i. Identify resource:Willi FutkkTrail Scenic Awat(t�ut�ari_ and 2?l�„Downs;Farm Preserve .... U.Nature of,or basis for aesiguatirt(e.g.,established highway overlook,state or locsilPark,state historic trailorscenic byway, t e.): SceJ3lt:hltorlc,recreattcnl,_trkdar�c, e1tl ,.., _ t n -...- M. Distance between project and resource: o i 5(gte aa) 0.07 tRte 2si i2.o miles. . iIs the project site located within a designated river corridor under the Wild,Scenic an Rivers g d Recreational ❑Yes®No Program 6 NYCRR 666? If Yes: f. Identify the name of the river and its designation;m , .._.......................................�. U. Is the activity consistent with development restrictions contained in 6NYCRR Part 666? ❑Yes❑No F.Additional Information Attach any additional information which may be needed to clarify your project. If you have identified any adverse impacts which could be associated with your proposal,please describe those impacts plus any measures which you propose to avoid or minimize them. G. 'Verification I certify that the information provided is true to the best of my knowledge. VHB Engineering,Surveying and Landscape mm� al Consultant to the Applicant/Sponsor Name Appllc gture P C.as Environment.. -- Date Januatrj� 201b Sigiiiittire _ '' ....,.. ... ....... , Title ProjecteMana er Erin clievEi iii—" 29217.02:projrecflndoc:NYS EAF_Jan 2015 Page 13 of 13 . . . . . ^ �^ I I Site Location Map . . . . . . . . . . . . . . . ; Proposed Communications Facility Upgrade 1000 Pike Street 2« Ma luck Town of Southold @Go/e Eat 2014 »2 � a fIj� Town of Southold-Mµ ��i�lh01d,rowin �'i�lirullio� rsrd LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I, All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list,policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes",then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to malting a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 140 - 03 - 11.1 PROJECT NAME Proposed Communications Facility Upgrade at the Mattituck Fire Department The Application has been submitted to(check appropriate response): Town Board ❑ Planning Dept. © Building Dept. 11 Board of Trustees l_ 1 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital construction,planning activity,agency regulation,land transaction) (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: E i Nature and extent of action: The proposed aciton involves the upgyrado of the Mattituck Fire District's existing communloations faclilly located at 1000 Pike Street,Matlltuck. Specifically,the Fire District Into,nds to reiuove an existing 84,54001-Nall wooden pole with whip antennas lhoreon and auptace it wlth a 120-foot-tall � btu.refgray stealth unlpole and associated equipment. The proposed unipole would support multiple Fire DIstdot vdilp ontennas at various hetghts,the Uppermost orwhtch would roach a top height of 13;x-feet-01-Incites above grade revel(apl),In addillon,a mesa span cabinet and a transfonuerwould be Installed at ground level,proxiiaaato to the base of the propmeol unipote.The proposed stoaltis unlpole would also facilitate future collocation,as It would be ohle to conceal the aantonnws of rnulliple wholes service providers within. Associated rooftop equipment of tuture wlruiess corn munIca wras providers would be situated an two proiaosed steel platfunns rnetirraurinq 33t crud 184 square feel„behind screening endostares designed to match tire building lagade, 'riie proposed scrdenlr'g unraosaaos for future wireless rooftop equipmoaat would extend to a height of 31-feel-2' a-Inctaes aeil„which Is approximlely nine feet higher than Ilan existing building parapet Additionally,a natural gas powered generator(associated with future collocation)could be located upon the bijildino rooftop proximaaate to the proposed equipment platforms. 4 Location of action:_ p ( -140-03-11 1) Mattituck Fire Department,1000 Pike Street,Mattituck SCTM# 0 Site acreage: e cabinets 1.36 -acres subject parcel/0.0021-acre 002 acre ground-level area to contain unlpo a an utility Present land use,Fire District use and communications facility et _...............___ Present zoning classtficatton: am let Business(HB) 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applit:ttltt:Mattituck Fire District (b) Mailing address:Po Box 866 Mattituck,New York 11952 (c) Telephone number:Area Code 031)298-8833 (d) Application number, if ally:-N/A Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No 0 If yes,which state or federal agency?_ DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space,makes efficient use of infrastructure,makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. F7177VN Yes ❑ No [] Not Applicable 'f'he proposed unlpofo Oradassaaolated'accessory equipment cabinets,wiatoh would replace the existing Fire District comrrrunhcalfons facility upon a wooden pole,would be situruted aupon paved area on a portion of the ovaralt Mattttuck Fire Depaufmont property.The overall equipment area would occupy only 0,002±acre(am of the suf)pect parcel),The proposed unipote would be able to conueat antennas of future wireless oomrnunications providers within, promoting collocatlora,and would be blue-gray to bland wilts the sky and surroundlogs, Tlae unipole would be situated in the vicinity of the hamlet canter, rather than along tine shoreline or In an agricultwal area Finally,the presence of a counmunicaifours laaciiity along(or visible froor)GR 48 or the Main Load (Routo 2'6)corridor"would riot be precedent setting,ars the proposed facility upgrade hinvolves the roplacoment of aro exisilrug communications facility on the subject property and as these is a monopole with antennas mounted thereon approArnalely 1,50 rrwlles east of'tho pole location on the Hlljoh's lane, Attach additional sheets if y necessa a Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWWRP Section III—Policies Pages 3 through 6 for evaluation criteria IJ Yes 0 No ❑ Not Applicable t`lae a aNcant intends to consult with both lho Town of or.uthold Planni'n fie arfmarp arutil'Novi!YaA State Office of l' ation and f-ltslorio sair�va�t r ua l<a ristrr tfahaat tta pa�o�uos ti'frua lI(y�irrs eon dosalgnrt ond�.aited et.uc f wouTct wave uafnfun poteratl a rirnpasct au i(I ailc sari fir.__".... -araitaaeoiargtaaal•raaea�s..._.._.-. —_m .-..�-.____�. .�__- -�.�.r..�.A„�,. ., rw ._..-_ -._..__.. .._m 9.. _.. .. _.............-._ _ _......_.... .. e...,, ...... I Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Although the proposed n assoccia associated the Fire District's communications facility upgrade,rade,would be visible from the �. url p p y I fl urrou� din area, i Ns c pat u l at it be o�as�d fr a%r ve m vni maq locatlons Fy'FnTervenlng s rue§ures and vc a a on. -Additionafly,fts-blue= ray color ation,^ lH•afi Atio hi nd-" li- ith•the srtrrou din -smear—finally,-shotifd--coffocation-occvHn-the-ftjttrro,--- lbe.anter.Inas.of tiri�oless cocrtrntrtsisntiot l�,rouade s s�wuCdl a ot�r.e:�l ttisuftl,tin..t9 to pr r rr�,r;to�rr and'_ t trtp.equlpA rortt.would-lar._.._ concealed behind screenin.0 anals. Attach additional i. ._.- heetsif necessary m.. _... ............. � �_. �... NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No© Not Applicable "'t l°�ro.o �fa-cllily wog it] rrat iy Cl�!LnjIIe ff ctnt i t iearest shorclino mofeovor fha or �rtse Igtsl l'I Alorr will N't su ..art:. rninirnal disturbance of only 0.002±-acre of paved area on the overall Fire District property,and would not result any additional v l'bfi�e�%ious'area.�1 ti , e proposed-fe-011it" bltl'i5�FUffff"tfM:— Attach additional sheets ifnecessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III -- Policies Pages 16 through 21 for evaluation criteria El Yes No x Not Al)l)licable +s thr pr'rapr sed f ilw trld e c(jsngrll) r„I wauld nit r etre pct bl_e water nor�rrytrlrJwarlyrc awape or soGid,Grp to��,q�u��rat�u�,_..,_ `thus,there would be no benefits or impacts to water quality or quentily, Attach additional sheets ifnecessary Protect and restore the quality and function of the Town of Southold ecosystems including Policy 6. q y y Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. 0 Yes 0 No® Not Applicable significant Co stat Fish and dlife Habltatsmwandpwetl nds. iFurtherth P rolposed Ifrom nst II ton woe nearest uldshoreline be ori 4t.In emlcsratrsxlrrwity,.raw 9 p sly developed, V d ro 6°and'Would'h�stllt-ln..ary st ifl �1f,-sidvffst It 'puck� gt t"o Y9 _..._ ���... ...._ n previously �... I _e—et ._-_m.__._r, m..._ -. ._... Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III —Policies Pages 32 through 34 for evaluation criteria. Yes No© Not Applicable As the proposed facility would be unmanned and remotely monitored, requiring minimal vehicular trips,there would be no significant advoise impacts to this ah quality iesulting hum autuniribile timistiluns. Muieuvei,the popused action does not involve the cleation of -ap Ind,istrial, so As such, it is not ated at-the-proposed faCilitY WcUld have any adverse impacts to the air quality in the Taun of Southold. Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies;Pages 34 through 38 for evaluation criteria. 1:1 Yes ❑ No ©Not Applicable The proposed action involves the construction of an unmanned communicat6gns fu 1p@y�l�ra� t rr�l waste,hazardous ubs.!ances or other wastes would be generated. PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ YeAr^_7J No❑ Not Applicable As previously indicated,the pro posedmaction involves the construction of 0,n to rad.ed communications faclfitv upon a deyraiopoq portion of Mattituck Fire District this project does not provide public access to,,.and recreational use of coastal u +aatars,p�abitc�lar�d�, mnt�akaficITr ,�orars��.. �. �.. Attach addition_l..s �heets.—ifw nece.�__ _...._. _ w �... .. . ......... a ssary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. I ®Yes ❑ No I Not Applicable - lbw i. tl s Fire District communications In water-dependent resources However,e�aist(rro and future wat�ar-�Joy�eradertt uses would benefit a timer envy —_ . . ..._ ttaoh additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies;Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No©Not Applicable As th ra �a apa f@clllj would be unniannedi C�_iageljlr�rJ tp..prrpw,rna r ou c s_,q[g is Q�,?fij-nG ca'frgrLi the plearest sho�allrbe ik vuo Id...... ,. neither benefit nor impact same. _.._ _.. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. Yes ❑ No® Not Applicable 1.ff?f ful 'r tl ry ca�7lrN tl lvc air faa t prt,acgrYculkuw el lcr kegs kk ti? „l l r«, a _lh impose G 11 .. .pufd.Op,sittrated ons r y� oal�, .,...,. developed,paved area of the Mattituck Fire District. Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ©Yes ❑ No ❑ Not Applicable l Pio alb 2MOd M)JQc—tMMd use n°nir In°Ma,iG okeokric l r s oul u_urirk anr�ed,_t�erefa re 1�a c�ft c t ra a rraar y anel_ ii�c. would be minimal. Created on 512510511:20.AM 29277.621ProjRewrds\Fine[Doos\LNVRP Consislw y Assmmanl Ian 2015 MAI P NING BO DME BERS LING DRESS: P.O. Box 1179 DONALD J.WILCENSKI Southold, NY 11971 Chair "r OFFICE LOCATION: WILLIAM J. CREMERS Town Hall Annex PIERCE RAFFERTY 54375 State Route 25 JAMES H.RICH III �" (car.Main Rd. &Youngs Ave.) MARTIN H.SIDOROUN 1� a) Southold, NY Telephone: 631 765-1938 www.southoldtownny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD MEMORANDUM To: Accounting Department From: Planning Department��+ Date: October 2, 2015 Re: Pay ne�nts Please deposit the attached check into B691: Deferred Revenue. Fee is for an amended Site Plan Application not yet accepted by the Planning Board. Applicant/Project Name & Tax Map #� ...._ � Amount Check Date/No. Type ,, ._,,.. Verizon Wireless at Mattituck Fire 140-3-11.1 $.1..m......_.....m.....m. 000 � 9/28/15 -#5938 District Amato Law Group, PLLC Amended Site Plan Application Fee ,.rrr r1,9„,"off'/J�Irrt/�:J!/�j/✓; Ol oVw r �., w � .., �. �« p e �, f r i✓i ,�, r r /r r ,. 1' ,» 1 rJr l"i „ r �",,,nr ., r ,, f .. „ ,.,. -:r er,,.,I+./r... ,. /.m „1Fr�. I ✓ /. 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New York Avenue Huntington, NY 11743 Please take notice that your application dated August 10, 2015 For permit for a co-location on an existing wireless facility at Location of property: 1000 Pike Street, Mattituck,NY County Tax Map No. 1000 - Section 140 Block 3 Lot 11.1 Is returned herewith and disapproved on the following grounds: oil � 1i a rt ttir c �i �l°°" w t it I; lei�c g a l m the 1[1_ it � 1 i i�ntt ci..,.l qr a __t to eta p a t°ic r i� ,it . a aoe s o Xwhonzed 'i AAM CC: file, planning Note to Applicant: Any change or deviation to the above referenced application, may require further review by the Southold Town Building Department. l FOR INTERNAL USE UNLY Er 1, SITE PLAN USS DETERMINATION AU6 South d Taw atio�� initial betel:r.r�ln ._ Date Sent:_f_� DatV__..: :E e Project-Name: � � project ddress !04 DistFict: � . -�•�Zoning Suffolk County Tax Map N�o.:1�Ogg_ � �._�`_--- - 1egue" �.��....�.�....�. t _. . docun er tation'as to .. lication and su.ppo�ing �. ., lot w ;,:)y of B Hdirtg Permit App proposed use or uses should be submitted.) :� .�termination as to Whether use is Permitted Determination Initial . m�. Initr . -Determination as to whether site p s rriutr d' fan i W _-. . Si ec or . g a of Bull ng n Punning Department (P D.) Referral. . �.. .� �.. .� Date of Commenfi.--Z P.D.. Daae Received:--s—k-9) 1-5 �t CC)rnC'n � t� rY y .. s I' .�.- .m . t. staff Reviewe Signature of Planningff"I F Pal DetP-gT i)1a ate: I____- f -- Decision- W .� Q'. ftirP �f...Riiildina InGnPrt _ - nr TOWN OF SOUTHOLD BUIL. iG PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631)765-1802 Planning Board approval FAX:(631)765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. _ Check Septic Form - — — N.Y.S.D.E.C. `1 Trustees Flood Permit Examined_, _ ,20 � Storm-Water Assessment Form �� Q :- Contact: Attorney for Applicant: Approved_ 2l. Mail to: Re,Nielsen,Huber&Coughlin,LLP Disapproved a/c_ 36 N.New York Ave.,Huntington,NY 11743 �— Phone:,631-425-4100 Expiration — 20_„ APPLICATION FOR BUILDING PERMIT Date ud 4 tr-- t U 20 (S INSTRUCTIONS I a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or Regulations,for the construction of buildings,additions,or alterations.or for removal or demolition as herein described:The applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to admit authorized inspectors on premises and in building for necessary inspections. New York SMSA Limited Partnership d/b/a Verizon Wireless (Signature of applicant or name,if a axpora"a) Limited Partnership 4 Centerock Road,West Nyack,NY 10994 (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Applicant is Lessee Name of owner of premises Mattituck Fire District (As on the tax roll or latest deed) �` Li d,,ds�;cxazershiP If applicant i f`a signature of duly authorized officer New Yo r e ' rtners ip&b/a Verizon Wireless (Name and title J'61am Walden Title: Senior Engineer - Equipment Builders License No. _ Plumbers License No. Electricians License No, Other Trade's License No. 1. Location of land on which proposed work will be done: 1000 Pike Street .-; Martttuck House Number Street Hamlet County Tax Map No. 1000 Section 140 Blore' Lot 11.1 Subdivision Fil6d Map;No ''; Lot State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Fire District/Department use,including communications facility b. Intended use and occupancy Same as above with Public Utility Wireless Telecommunications Facility Nature of work(check which applicable):New Building Addition Alteration Repair —Removal Demolition Other Work Install public utility wireless C a n a Tau e%t 0 1 tailre s te i�5Ima t (To be paid on filing this application) If dwelling,nu If garage, number of cars Fire District Department If business,commercial or mixed occupancy,specify nature and extent of each type of use.,use,.including communications facility Dimensions of existing structures,if any Front f Rear Depth I Height Number of Stories *Approved 120' +/- AGL telecommunications pole Dimensions of same structure with alterations-or additions: Front Rear Depth Height Number of Stories Dimensions of entire new construction:Front Rear Depth Height Number of Stories *Proposed centerline height of antennas: 115' W- 1.3097 acres sq.7 Tc. !equ i pment'platf orm Size of lot:Front Rear —Depth / See attached Deeds Date of Purchase Name of Former Owner 1.Zone or use district in which premises are-situated HB-Harnlet Business 2.Does proposed construction violate any zoning law,ordinance or regulation?YES—NO—X 3.Will lot be re-graded?YES—NOWill excess fill be removed from premises?YES NO X PO Box 666 t.Names of Owner oq remises Mattituck F I ire District Address Mattituck,NY 11 952 Phone No. 631-298-8833 Name of Architect W REF'�Ing—address 5l" MW'181'i, bone No 203-740-7578 Name of Contractor Address lane No. 5 a.Is this property within 100 feet of a tidal wetland or a freshwater.wetland?*YES NO—X IF YES,SOUTHOLD TOWN:TRUSTEES&D.E.C,PERMITS MAY BE REQUIRED. b.Is this property within 300 feet of a tidal wetland?*YES—NO X IF YES,D.E.C.PERMITS MAY BE REQUIRED. 5.Provide survey,to scale,with accurate foundation plan and distances to property lines. 7.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. S.Are there any covenants and restrictions with respect to this property?*YES NO X IF YES,PROVIDE A COPY. TATE OF NEW YORK) SS: OUNTY OF John Walden being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, ;)He is the, Senior Engineer - Equipment of New York SMSA Limited Partnership d/b/a Verizon Wireless,Lessee (Contractor,Agent,Corporate Officer,etc.) "said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; at all statements contained in this application are true to the best of his knowledge and belief;and that the work will be -r-formed in the manner set forth in the application filed therewith. wom to before me this A. of 0A 4t-l+ da 20 :tlewyo ite artnership d/b/a Verizon Wireless % Z- -"No01RI6220645\ �ft QUALIFIED IN Notai Pu%ic '�SUFFOLK coUNTY, Si attire of Applicant S Gomm ame: John Walden wX Title: Senior Engineer - Equipment 0 o N V14 "'s p 11$010� SURVEY FOR MATTITUCK FIRE DISTRICT y AT MATTITUCK g, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. x 1000-140-03-11.1 SCALE1=20' JULY 5, 7994 AUG. 5, 7994(ADDITIONS) „c U MAY 1, 1998(FINAL) JUL76, 2064 a 2014 sEi I 1� VAS 1 I t� d< s x, h �I f/RE rb 1 2—R512 eg 11,✓�� v / / \ '� \�\ L1111.1IL1.1 OING 2]69 sU I C OFF CF 939 a`� ` .✓" h 4/))IJTY RO' ii5 sp.2 s9.R. TOTAL 14361 sq. ft, J, LUT COVERAGE=14361/57052 sq. ft. 252% �vR w DY L'NSKi& 'w ✓^'r .�, Rw. �� "'•\� �" JEAN A 1,711LOw• LaNOSLnvC roVERAGE=]291 sa R. o ® IM�1rNo^ NI0)WPLiFF2 L LAND,S'GAPE COVERAGE= 7291/57052 sy. It. 12.8% 46 PARKING SPACES m �j"%no-w M M KO1NF D(0) MP N/\ /°(D 0� RDAU I f)v/ S Ill N0.4961f1 ,o V,IsWR1a I�o A— Eo���oN E— F-11 tM AREA 1.3097 Acres ,.. s _ le.il 76,,eaea I nx e.37)765-1797 R ]"0 5 RE REF. "C=0 10 NC,VO P.O.BOX 909 ® rvtn/I J '.�K 0 CIO y" 1210 TR,h�ELER STREET .11— oo VLOS "" 501n011),N l.vl 94-211 FOR INTERNAL USE UNL Y E SITE PLAN USE DETERMINATION I;tU(3 �J, 201,P�an* War initial ;L9TTITTati011 Date Se nt: Dat '� mo- Project Name: m_ _ Project Address:- -04,') - . ., . Zoning Ii _�m. Suffolk County Tax Map N • { Request, __ .. _ and .. entatlon'a�to suppotn ocu n of wfdfijgPermit Application utio (Note. proposed ��se or utses sl�o�.t1d be, sul�arrrttted.) o � ��. initial Determination as to whether use is permitted, .�..W- - a1 Deterrn hon is o ination as to whether site p / oe equ red _� uihmm .. Signe Irtg lts ector ent P.D.) Planning Departm ( �_L - 19, pate of P.D. Date Received: Comment Comroent Adlb t L 411 4g" Signature of PlaKning Staff Reviewer Final Deternlil_a iO1 .. - Ru��ldina Ing c-- -,�fi ara of npctnr TOWN OF SOUTHOLD BUILDING I MIT APPLICATION CHECKLIST BUILDING DEPARTMENT �', Do you have or need the following,before applying? TOWN HALL G 2 V6 ` i.? Board of Health SOUTHOLD,NY 11971 -- 4 sets of Building Plans Southow tt�; �lnm tBatdTEL:(631)765-1802 Planning Board approval FAX: (631)765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO._ Check Septic Form N.Y.S.D.E.C. 1 i; -+ Ttvstees � Flood Permit Examined_, 20 k� Storm-Water Assessment Form AUG 10 2015 Contact: Attorney for Applicant: Approved_ _,2l. Mail to: Re,Nielsen,Huber&Coughlin,LLP Disapproved a/c_ 36 N.New York Ave.,Huntington,NY 11743 C Phone:„631-4251100 expiration_ , 20_. APPLICATION FOR BUILDING PERMIT Date 4 ue, Vs l D 20 15- INSTRUCTIONS SINSTRUCTIONS a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 of plans,accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or is,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit all be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector sues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of suance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the Foperty have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an ddition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the building Zone Ordinance of the Town of Southold„Suffolk Cove ty,New York,and other applicable Laws,Ordinances or f'.egulations,for the construction of buildings,additions,or alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laves,ordinances,building code,housing code,and regulations,and to admit authorized inspectors on premises and in building for necessary inspections. New York SMSA Limited Partnership d/b/a Verizon Wireless (Signature of applicant or name,if a mwparatiDn) Limited Partnership 4 Centerock Road,West Nyack,NY 10994 (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Applicant is Lessee Name of owner of premises Mattituck Fire District Li artatc rsbiP (As on the tax roll or latest deed) 1fN�ga,�y� t' a e't rtncrspa��Pae Veridzoln Wuehosized officer (Natxte and title �xp®xat��#"a��x) Name� 3rsteax�dur.eten Title: Senior Engineer - Equipment Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 1000 Pike Street Mattittsck House Number Street Hamlet �. a�au•,t,: County Tax Map No. 1000 Section 140 Btodk ��7� �z Lot 11.1 Subdivision Filed dap Nth, r r: _Lot 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Fire District/Department use,including communications facility b. Intended use and occupancy Facility 3. Nature of work(check which applicable):New Building_ AdditionAlteration Repair Removal Demolition Other Work Install public utility wireless lecommuniFations—antennas inside 12U-0—coommunications in- e ,Mattituck Fire District)�Rfscription) go Used by C)P 'ed equipmenton the roof of an existing building,al) epfcot, in lie plans submitted hereN d install rela AT T EstimatC1jtost-'---$),2��cZb, db — �ee (To be paid on filing this application) 5. If dwelling,number of dwelling units n/a I Numbg%f&611%Aunits on each floor If garage, number of cars Fire District/Department 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use, use,including communications facility 7. Dimensions of existing structures,if any Front Rear Depth I Height Number of Stories *Approved 120' +/ AGL telecommunications pole Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction.Front —R= Depth Height Number of Stories *Rroposed centerline height of antennas: 115Ad- 1.3097 acres - sq., TZ. :equipment:platform 9. Size of lot:�runt —Rear Depth / See attached Deeds 10.Date of Purchase— Name of Former Owner 11.Zone or use district in which premises are situated HB-Hamlet Business 12.Does proposed construction violate any zoning law,ordinance or regulation?YES—NO-X 13.Will lot be re-graded?YES—NO X Will excess fill be removed from premises?YES—NO X PO Box 666 14.Names of Owner o�j remises Mattituck Fire District Address Mattituck,NY 11952 Phone No. 631-298-8833 Name ofAi Addrcss" hone No 203-740-7578 Name of Contractor Address �T�one No. 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO X •IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b.Is this property within 300 feet of a tidal wetland?*YESNOX •IF YES,D.E.C.PERMITS MAY BE REQUIRED. 16.Provide survey,to scale,with accurate foundation plan and distances to property lines. 17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey, 18.Are there any covenants and restrictions with respect to this property?*YES—NO X IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF John Walden being duly sworn,deposes and says that(s)be is the applicant (Name of individual signing contract)above named, (S)He is the Senior Engineer New York SMSA Limited Partnership dib/a Verizon Wil-cless,Lessee lor of (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 knowledge and belief,and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this 2 0 1,r'K A, dEly of ;-r- '10?/ '-New Yoi NjA to artnership d/b/a Verizon Wireless X*Nk 01R1622964 ,;A: LIF JAIED IN ',. --w- Not PiAc �SU�iOLK COUNTY" E, �i�nature of Applicant CO X John Walden �x Title: Senior Engineer - Equipment O ,`S- -'k o' SM ZY FOR MATTITUCK FIRE DISTRICT _ AT MATTITUCK T r TOWN OF SOUTHOLD ti SUFFOLK COUNTY, N.Y. 1000-140-03-11.1 a° x I �{EP � SCALE: 1'=20' p �: Julys, 1994 9 AUG' 5. 7994(ADO(TIONS) MAY 7, 199&(FINAL)NAL) JAN 78, 2004 JUL 7, 2014 'o �S rl nFIRE XOUSE 9811 s9 /t. �. eae ,� Gr urulry Roo namX CRAY ez 39.ft. TOTAL - 14,367 sq 4 L07"COVERAGE= 1436I�57052sq, ft 25.27% d KI JEAN P CAR,[ 1-0—cov CE=7291 sq,fl. WAL7ER LANDSCAPE COVERAGE=72 9 1/5 70 5 2 Aq ft. = 12.87 � 46 PARK/NG SPACES CL /! w'�pw PRY OERpIN •'= M NN NRo"0 RpAO +� N.YS.IIC NO 49618 l' AFY Ac o 1 nils 5lIlYllI 0 fr",01"Loi RYURS PC I-T 1— AREA 1.3097 Acres ° "e Y0s eo'T_ ALL `�- (631)765 5020 FAX(5�1)765-179 --NM ARE REFF—CEO TO NG VO v c�PrFS I_ e 1-0.80X 909 .IA—!0G'ams EA!OF rNF sr��FroR 1230 TRAVELER srREGr 94-211 SOV7NOLD,AY 11971