HomeMy WebLinkAboutSubject File MAILING ADDRESS:
PLANNING BOARD MEMBERS b� Api � � x, P.O. Box 1179
DONALD J.WILCENSKI N0 00 ��r Southold, NY 11971
Chair h� � �„� r�
�� 0001 OFFICE LOCATION:
WILLIAM J.CREMERS j b Town Hall Annex
64 nummummom
PIERCE RAFFERTY N4 4."w 11111111 mP : ��ck4�I 54375 State Route 25
JAMES H.RICH III ur, m " Y (cor. Main Rd. &Youngs Ave.)
MARTIN H.SIDOR ,„,", i0� Southold, NY
i
Telephone: 631 765-1938
www.southoldtownny.gov
PLANNING BOARD OFFICE
TOWN OF SOUTHOLD
May 24, 2016
Mr. Richard L. Edwards
d/b/a CityScape Consultants, Inc.
7050 Palmetto Park Road
Boca Raton, FL 33433
Re: Proposed Co-location for Verizon Wireless at MGH Enterprises
Located at 40200 Route 25, Orient, NY 11957
SCTM#1000-15-9-8.1
Dear Mr. Edwards:
The Planning Department is in receipt of an Amended Site Plan Application for Verizon Wireless
to co-locate on the existing wireless facility referenced above. Pursuant to §280-74(A)(4) of the
Southold Town Code, the Planning Department is seeking your assistance in reviewing and
evaluating the application, including the construction and modification of the site, once
permitted, and any site inspections.
Please provide an estimate for the cost of your consulting services to determine whether the
application meets the General Requirements in the Southold Town Code for maximum
permissible exposure. 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 comments, please contact me.
Best regards,
Brian Cummings
Planner
www.southoldtownny.gov: Weblink located on bottom left of home page, Planning Dept. folder-
Applications; Site Plans— Pending, 1000-15.-9-8.1, Verizon Wireless at MGH Enterprises
AUTHORIZATION AND CONSENT
WHEREAS, New York SMSA Limited Partnership d/b/a Verizon Wireless ("Verizon
Wireless"),with a mailing address of c/o Amato Law Group,PLLC,666 Old Country Road,Suite
901,Garden City,New York 11530,desires to install a public utility wireless communication facility
(the"Communication Facility")on certain real property located at 40200 Main Road,Orient,New
York,known and designated as Suffolk County Tax Map District 1000,Section 15,Block 9,Lot 8.1
(the"Property"),owned by M.G.H.Enterprises,Inc.(the"Owner"),with a mailing address of 40200
Main Road,Orient,New York 11957.
WHEREAS,Verizon Wireless,in order to install and operate the Communication Facility at
the Property,must submit to the Town of Southold(the"Town")certain zoning applications and/or
building permit applications(collectively the"Applications").
WHEREAS,the Owner agrees and consents to Verizon Wireless'submission of all necessary
Applications to the Town,as well as any other application required by any federal,state or local
entity with jurisdiction thereof,such that the required approvals for the proposed Communication
Facility are necessary.
NOW,THEREFORE,the Owner hereby authorizes,consents and agrees to have Verizon
Wireless act as its agent,as follows:
1. The Owner hereby consents to the filing of all Applications by Verizon Wireless with
the Town,and any other necessary federal,state or local agency,with respect to the
installation and operation of the Communication Facility on the Property.
2. Verizon Wireless shall have the authority to act as the limited Agent for the Owner,
thereby permitting Verizon Wireless to execute and complete any necessary
documents on behalf of said Owner as may be required in order to obtain the
necessary approvals and permits to install and operate the Communication Facility.
3. This Authorization shall be limited solely for the purpose of permitting Verizon
Wireless to obtain the necessary approvals and permits to install and operate the
Communication Facility,and for no other purpose.
4. This Authorization shall terminate,and be of no further force and effect,only after
Verizon Wireless receives the necessary Town,federal,state and/or local approvals
and permits required to install and operate the Communication Facility.
M.G.H.ENTERPRISES,INC.
_ -
By: /
Name:Robert Haase
Title:President
Sworn to before me this the
(2 day of 2016
/41
‘4-
Notary Public
FIDO.K1 KEHAN
*err St341 of Wm York
no.OIFE4904531 Sur Carty
Ten Espen Sect
CONSENT TO INSPECTION
Robert Haase, on behalf of
M.G.H. Enterprises,Inc. .the undersigned, do(es) hereby state:
(
Owner s)Name(s) .. ._,
That the undersigned(is) (are)the owner(s) of the premises in the Town of
Route Orient, New York
Southold, located at 40200e 2
0 ......__
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section 15 , Block 91 Lot.............8 ....................................._.
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Building Inspector's Office for the following:
Building Permit Application
That the undersigned do(es) hereby give consent to the Building Inspectors of the
Town of Southold to enter upon the above described property, including any and all
buildings located thereon,to conduct such inspections as they may deem necessary with
respect to the aforesaid application, including inspections to determine that said premises
comply with all of the laws, ordinances,rules and regulations of the Town of Southold.
The undersigned, in consenting to such inspections, do(es) so with the knowledge
and understanding that any information obtained in the conduct of such inspections may
be used in subsequent prosecutions for violations of the laws, ordinances, rules or
regulations of the Town of Southold.
M.G.H. Enterprises, Inc.
Dated: 1 /1 B � , ,. .. ,,.. ...
Dated:
Sign,ture)
_........(Print N
ame) (Print Title)
(Signature)
(Print Name)
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)765-1802 Planning Board approval
FAX:(631)765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C,
Trustees
C.O.Application
Flood Permit
Examined .20 Single&Separate
Storm-Water Assessment Form
Contact: Denise J.Vista,Esq.
Approved .20 Mail to:Amato Law Group,PLLC
Disapproved aic 666 Old Country Road,Suite 901
Gelder]City,New York 11530
Phone:(516)227-6363
Expiation .20
✓'J BYE
( i Building Inspector
`1' — 3 >0'S APPLICATION FOR BUILDING PERMIT
BUILDING D Date April 29 ,2016
TOWN OF SO OLD 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 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 Yp. SM Limi dills Verizon Wireless
By_
,z(Signature of applicant or name,if a corporation)
do Amato Law Group,PLLC
666 Old Country Road,Suite 901
Garden Cies,New York 11530
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Applicant is lessee of property
Name of owner of premises M.G.H.Enterprises,Inc.
(As on the tax roll or latest deed)
If applicant is a corporation,signature of duly authorized officer
(Name and title of corporate officer)
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:
40200 Main Road Orient
House Number Street Hamlet
County Tax Map No.1000 Section 15 Block 9 Lot 6.1
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Marina,restaurant,and wireless communications facility
b. Intended use and occupancy Same,and proposed wireless facility
3. Nature of work(check which applicable):New Building Addition Alteration X
Repair Removal Demolition Other Work public utility wireless communications facility
(Description)
4. Estimated Cost Fee
(To be paid on filing this application)
5. If dwelling,number of dwelling units n/a Number of dwelling units on each floor n/a
If garage,number of cars n/a
Marina/public utility wireless
6. If business,commercial or mixed occupancy,specify nature and extent of each type of use.communications reurn
tower
7. Dimensions of existing saistaliossr if any:Front N/A Rear N/A Depth N/A
Height 69'-0"agl Number of Stories N/A
COWL
Dimensions of same stauettoe with alterations or additions:Front N/A Rear N/A
Depth Height e9'-o"agl Number of Stories N/A
(equipment-cowppatmd) Length. Width
8. Dimensions of entire new construction:Fent[ t3'-to" Bak= 32'-0" Depth
Height i' Number of Stories
9. Size of lot:Front Rear Depth Area:4.7 acres
10.Date of Purchase Name of Former Owner Applicant is lessee of property
11.Zone or use district in which premises are situated Marine II zoning district
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
40200 Main Road
14.Names of Owner of premises M.G.H.Enterprises Address Orient.NY 11957 Phone No.(631)323-2424
Name of Architect WFC Architects Address12-1 Terhnol gyDri`e Phone No (631)669 450
Name of Contractor Address Phone No.
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES X NO
*IF YES,SOUTHOLD TOWN TRUSTEES 8c D.E.C.PERMITS MAY BE REQUIRED.
b.Is this property within 300 feet of a tidal wetland?*YES x NO
*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 tO feet or below,must provide topographical data on survey.
18.Are there any covenants and restrictions with respect to this property?*YES x NO
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF Nassau )
John Walden ,on behalf of
New York SMSA Limited Partnership d/b/a Verizon wireless being duly sworn,deposes and says that lie is the applicant
(Name of individual signing contract)above named,
(S)He is the Senior Engineer-Equipment
(Contractor,Agent,Corporate Officer,etc.)
Mril.18414.100(X.10041(etX,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.
Swornto before me this
^- day of if ti/ i w - New York SrVAkim edpartnership d/b/a Verizon Wireless
svy.v =
T XAN r 3f N 7CCK I f,/
Notary Puolt
°WoMature of Applicant
4sP,rn-tsars -- „erin vc_1 i Tame.
Title: Senior hbgineerequirme c
64. ),CYP
c E C \YJ JE
TOWN OF SOUTHOLD
FORM NO. 3
3 3 3
NOTICE OF DISAPPROVAL Southok:icon
PlannIno Bond I
DATE: May 23, 2016
TO: Amato Law Group, PLLC (Verizon Wireless)
666 Old Country Road, Suite 901
Garden City, NY 11530
Please take notice that your application dated April 29, 2016
For permit for a co-location on an existing wireless facility at
Location of property: 40200 Route 25, Orient, NY
County Tax Map No. 1000 - Section 15 Block 9 Lot 8.1
Is returned herewith and disapproved on the following grounds:
The priowspci coIocation is permitted pursuant to sic plan approval from the Southold Planning
Board.
A ut illre4ed Lire
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.
,
--11
,., ',.;,*,
FOR INTERNAL USE ONLY PC?)\tki,-, il)(1,--
L olA 0' II o r o
SITE PLAN USE DETERMINATION 1 '-----"-----1--------7-
11
MAY 1 6 2016 -:
Initial Determination
cm:7) cz.:„.,.. Date_ silit111'il:f73,ta;r7E--
Date. 5 / Is
. _ _!_ ___ -
(----- ,
Project Name: _....LU , 13
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Project Address. pD --
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M.RPM R1.6.m....m.... M......
Suffolk County Tax Map No.:1 000-A—__.--(milt._71, .\_,Zoning District*
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[8@.. 2 V Le g 0* dilig Permit Application and supporting documentation'a to
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prop.,, !dirt,Pe., % s 'should be subinitted.)
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! 1 !11
s 1 as to Whether use is permitted: ,
,
BM i to , , .
Tow, „, 1 libation as to whether site plan is requirett_Sif.V:ke___
• .OLD
L. ---:------- - - '------
S ktiiii LB..111kti 10 -
Planning Department (P.O.)
P.D.. Date Received: -‹ i 16 i 16 Date of CornMent. • g
I I c-I) i 112
',,:..', t:532 it ),,,,c)n, -0,
,.,_.,__
Signature of Plann6 Dept Staff Reviewer
Final Determination
...,........,......._ ___,,,
Date) /
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Decision: 'A e„ ,, 1 vo c' -L''' ''-77, (y)
,
______________
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c.,,,i-lt-i ire: of Riiildina Insoer.tor
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FOR INTERNAL USE umLyP6% MLA LA-U
SITE PLAN USE DETERMINATION hl r-----
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II 1
_ Initial Determination 'Sroartlial ho—aa
Manning Board
Date: 5 1 Is_,' •
((... . iz.. Date Sent- 6-' t tk,..:s
_ -___ .
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Project Marne- ' i
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Project Address:,- ,1,-.-1-' -)
. _.....
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1,..‹.
Suffolk C-ounty Tax Map No.:1000- '1/4 "."), ___-., ____- ,.L Zoning District:
Request ,/ ' :" t --; - -
------m---------------z-m-------- ..._.
(Note: Copy of Building Permit Application and supporting documentation'a to
proposed use or uses should be submitted.)
Initial DeterMination as to Whether use is permitted:
Initial-Determination as to whether site plan is required: P \. -
-"1, e
..... .
__________.,______ __ ._ ____, ___
,.., os 9 of Qo'
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Planning Department (P.O.) Referral:
P.D. Date Received: / IG / 110 Date of CoMment. . 5- / i q /
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Signature of Plannint Dept-Staff Reviewer
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Mai 1iatq!----.1 1119ati°n
Date: I /
...— .—
Decision:
--- -__ --------:------------
e;,-in aft ire of Rtiildtna Insnector
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)765-1802 Planning Board approval
FAX:(631)765-9502 Survey
Sout oldTown.NorthFork.net PERMIT NO. Check _
Septic Form
N.Y,S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined .20 Single&Separate
Storm-Water Assessment Form
_e.
et: Denise J.Vista,Esq.
Approved .20 4 ail to:Amato Law Group,PLLC
Disapproved at ` 6;6 Old Country Road,Suite 901
_' Phone: 518822r 8363
Expiration ,20 If
741.
44:
44,4 APPLICATION FOR BUIL 1 NG PERMIT
11 ate April 29 ,2016
-41 INSTRUCTIONS
a.This application MUST be completely filled in by typewriter or in ink and submitted to the But 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. I///
.a
New/ Sr 7/yauership 61a Verizon Wireless
6y:
(Sienary of applicant or name,if a corporation)
eta 4/.naw Law Group,PLLC
666 ON Country Road,Suite 901
,r.-n ivN-w York 11 I
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Applicant is lessee of property
Name of owner of premises M.G.H.Enterprises,Inc. ___.........
(As on the tax roll or latest deed)
If applicant is a corporation,signature of duly authorized officer
(Name and title of corporate officer)
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:
40200 Main Road Orient
House Number Street Hamlet
County Tax Map No.1000 Section 15 Block 9 Lot 8.1_
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Marina,restaurant,and wireless communications facility
b. Intended use and occupancy Same,and proposed wireless facility
3. Nature of work(check which applicable):New Building Addition Alteration X
Repair Removal Demolition Other Work public utility wireless communications facility
(Description)
4. Estimated Cost Fee
(To be paid on filing this application)
5. If dwelling,number of dwelling units Na Number of dwelling units on each floor n/a
If garage,number of cars Na
6. If business,commercial or mixed occupancy,specify nature and extent of each type of use.melrirnnsaIniLthiiloici.1.14cii'wivireless
tower
7. Dimensions of existingsatabuktimet,if any:Front N/A Rear NIA Depth N/A
Height 69.-0"agl Number of Stories N/A
tower
Dimensions of same 21f0 with alterations or additions:Front N/A Rear N/A
Depth Height an -u'agl Number of Stories N/A
Width
8. Dimensions of ent(.17-`eqleP7'ctonsTrTc7g:Le'gth 13 -10" li,NOW, 32'-O' Depth
Height 13Number of Stories
9. Size of lot:Front Rear Depth Area:4.7 acres
10.Date of Purchase Name of Former Owner Applicant is lessee of property
11.Zone or use district in which premises are situated Marine II zoning district
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
40200 Main Road
14.Names of Owner of premises M.G.N.Enterprises Address°rent.NY 11957 Phone No.(6311 323-2424
Address12-I Plione-No (631)669-6450
Name of Architect VIFC Architects
Name of Contractor Address- — Phone No.
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES X NO
*IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED.
b.Is this property within 300 feet of a tidal wetland?*YES X NO
*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 x NO
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF Nassau
John Walden ,on behalf of
New York SMSA Limbed Partnership d/b/a Verizon Wireless being duly sworn,deposes and says thatMhe is the applicant
(Name of individual signing contract)above named,
(1)He is the Senior Engineer-Equipment
(Contractor,Agent,Corporate Officer,etc.)
XteNXXXXtlf6XXXXXXINY,.,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
day of 20 16 New York SM77SA .rnite2Ariership d/b/a Verizon Wireless
By;
Notary Public / Signature of Applicant
Name:John Name.
Title:Senior Engineer-Equipment