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1000-96.-1-19.1 (2)
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D �f I m z o z cJ a I I I I L O I mo� Ole I I d Moll, Y qw� o o Q -a.* _- w MG. d e i f t- \ r JF _r 4 z x mJ mw W. ( KI m 5 i 3� 4 O o4 w 5 f- I I m a �I �.� w o C.7 0 o JAL W r W W v x m w E m � w x m w �z i ow as w �o=o Mail „y Jd, rt ��rw s OFFICE LOCATION: 'z' " '�� LING ADDRESS: Town Hall Annex �F S �/ ` P.O. Box 1179 54375 State Route 25 + Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Telephone- 631 765-1938 Southold, NY www.southoldtownny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD MEMORANDUM To: Michael J. Verity, Chief Building Inspector From: Heather M. Lanza, AICP, Planning Director %I Date: November 8, 2019 Re: Planning Department Report Cell Tower Upgrade Modification AT&T @ Junge 21855 County Route 48, Cutchogue SCTM#1000-96.-1-19.1 Zoning District: LI The Planning Board has found that the requirements of the above-referenced AT&T modifications and up-grades have been completed based on the site inspection made October 30, 2019. The improvements are in compliance with the General Requirements of§280-70 and the Planning Department report dated November 20, 2018; therefore, we recommend a Certificate of Occupancy be issued for this application. Thank you for your cooperation. Submissiol? fl/ithout a Cover Letter p?>tPlannin RSender. PQ� C) �vY—e C „ ^ Subject: W ��k d� Iv�� SCTM#: 1000 - — — v - 1, Date: Comments: KTT @ n 2 A-IT @ 6u4- Tectonic � PRACTICAL SOLUTIONS EXCEPTIONAL SERVICE Town of Southold Building Department 54375 Rte 25 Southold, NY September 19, 2019 RE: PERMIT#:43248 AT&T SITE ID: NYCENY1027 \3'Re--" R 1 FA#:10106284 L.� Q 21855 COUNTY ROAD,CUTCHOGUE, NY 11935rpn q ! C) SEC/BLOCK/LOT#96.1-19.1 SIGNOFF LETTER (3C,4C &5C SCOPE) To Whom It May Concern, Tectonic Engineering and Surveying Consultants, P.C. (Tectonic) has performed an inspection from ground of the recent AT&T wireless communication equipment installation at the above referenced site. During this inspection, it was found that the AT&T wireless installation was constructed in accordance with the Construction Drawings dated October 1, 2018, by Tectonic and the Building Code of New York State. Should you have any questions, please do not hesitate to contact us at 845-567-6656. Sincerely, .�F,of NEW, Tectonic y \�"E $c..° rn Craig Buechele, P.E. 097299 Senior Engineer �S�() � Tectonic Engineering&Surveying Consultants P.C. 1279 Route 300 1 Newburgh,NY 12550 dba,Tectonic Engineering&Surveying Consultants P.C. 845.567.6656 Tel 1 845.567.8703 Fax 70 Pleasant Hill Road,PO Box 37 1 Mountainville,NY 10953 tectonicengi neeri ng.com Equal Opportunity Employer From: Pat-Optonline <connoror@optonline.net> Sent: Monday, September 23, 2019 1:28 PM To: Michaelis, Jessica Cc: 'Lorna Mund' Subject: RE: AT&T @ Cutchogue, 21855 CR 48 Cutchogue, NYCENY1027, BP 43248 Attachments: 9410.NYCENY1027 - S&S Sign Off Letter 9-17-19.pdf Jessica, Attached is the PE letter for this site. We are trying to close out i°rn 43244, do you need us to send you the original letter? Is anything else needed to close out this permit? Let me know. Thank you, Ju4r Patrick O'Rourke ����� ��,V.mm� f � Shore 2 Shore Wireless E 5550 Merrick Road, Suite 302 Massapequa, NY 11758 516-263-8817-cell 516-557-2398-office P,�ri�� �tlel l , ,� yi 516-557-2397-fax ��zrii�i� �r i�� From: Pat-Optonline [mailto:connoror@optonline.net] Sent: Monday, November 26, 2018 12:08 PM To: 'Michaelis,Jessica' <jessicam@southoldtownny.gov> Subject: RE: AT&T @ Cutchogue &Orient, 21855 CR 48 Cutchogue &40200 Main Road Orient, AT&T sites NYCENY1059 & NYCENY1027 Jessica, Can you give me Connie's e-mail so I can follow up with her? Thank you, Patrick O'Rourke Shore 2 Shore Wireless 5550 Merrick Road, Suite 302 Massapequa, NY 11758 516-263-8817-cell 516-557-2398-office 516-557-2397-fax From: Michaelis,Jessica [mailto.lessicaariC�Llsout,�iol�dtoyrrwr vI Sent:Tuesday, November 20, 2018 12:40 PM To: 'connoror@optonline.net' <connorQ,ri tont ne net.> Subject: RE: AT&T @ Cutchogue & Orient, 21855 CR 48 Cutchogue &40200 Main Road Orient, AT&T sites NYCENY1059 & NYCENY1027 We did receive these.They went down to the building department today. FYI -Connie, who usually takes care of the applications in the building department is out this week. Thank you, — � Tectonic Town ofSouthold Building Department 54375 Rte 25 Southold, NY September 1T2819 RE: P[RKd|T#:43248 AT&T SITE ID:NY[ENY1U27 FA#-1O1O6284 218SSCOUNTY ROAD, [UTCHOGUE, NY 11935 SEC78LO[K7LOT#96.-1-19.1 S|GNDFFLETTER QC,4[ @5[SCOPE) To Whom It May Concern, Tectonic Engineering and Surveying Consultants, Pl (Tectonic) has performed an inspection from ground of the recent AT&T wireless communication equipment installation at the above referenced site. During this inspection, it was found that the AT&T wireless installation was constructed in accordance with the Construction Drawings dated October 1, 2018, by Tectonic and the Building Code of New York State, Should you have any questions,_please 6onot hesitate 8ocontact usa1B45 567-6656. OF 141 Tectonic Senior Engineer Tectonic Engineering &Surveying Comau|rumtsP.C. 1279Rmnn300 | Newburgh,mv1osso ubo lecmni»Fno|nmioo&,&mwye�xnomnuoummmRo. 845,567,6656R| | o*u�ss7a/ooFox Mo:n|w|nv|||e.wY�0953 /en�on|ceooi:eeonon,m ��� Equmoppo,hAn|0smp|ovo, Town of Southold ckyscape CON s t,l ]. ,r A N T S , 1 N C . Telecommunications Site Review 7050 W.Palmetto Park Road#15-652 Upgrade Application Boca Raton,FL 33433-3483 Tel:877.438.2851 Fax:877.220.4593 October 29, 2018 Mr. Brian Cummings Planner , r Town Hall Annex Building 53095 Route 25 r Southold,New York 11971 �a RE: Town of Southold / SCTM#1000-96-1-19.1 New Cingular Wireless PCS,LLC/NYCENY1027/ Cutchogue Dear Mr. Cummings, At your request, on behalf of the Town of Southold ("Town"), CityScape Consultants, Inc. ("CityScape") in its capacity as telecommunications consultant for the County, has considered the merits of the above referenced application submitted by New Cingular Wireless PCS, LLC d/b/a/ AT&T ("Applicant") to modify and upgrade their equipment on an existing one hundred eight foot, eleven inch (108' 11") monopole tower, owned by Crown Communications. There are antennas mounted at the top of the tower that raise the overall height to one hundred twelve feet, six inches (112' 6"). The tower is located at 21855 Country Road 48, Cutchogue, New York, see Figure 1. Sulitaort Structure & Equi.lLment Currently, the Applicant has nine (9) panel antennas, six (6) RRHs and a (1) surge suppressor at the seventy (70) foot level, see Appendix, Exhibit A. It is proposed to replace all antennas, replace three (3) RRHs, add six (6) RRHs and add a second surge suppressor. One (1) new fiber and two (2) new DC power cables will be added. The new antenna configuration is depicted in Appendix, Exhibit B. All changes to the ground compound will be confined to the existing concrete pad. "Si uctm-,21 Analysis The Applicant submitted a structural analysis, prepared by Black& Veatch, dated July 19, 2018 and based on ANSI/EIA/TIA-222-G, Category C and Class II standards. The report summary indicates that with the upgrades, the tower is still within its design limits, see Appendix, Exhibit C. The report is only a summary and does not provide the new loading percentage. CityScape notes that the previous (2015) analysis indicated the tower was loaded to 83% which Should accommodate the proposed changes. Town of Southold/SCTM#1000-96-1-19.1 citysc�ape New Cingular Wireless PCS,LLC/NYCENY1027 Paget C0NSUu, TAi", irSc . FCC Compliance The Applicant provided documentation stating it will comply with the FCC's Rules regarding interference to other radio services and safeguards to human exposure of radio frequency energy in previous applications. Wireless applications, other than new support structures are governed under the Middle- Class Tax Relief and Job Creation Act of 2012 (Tax Relief Act) and shall be afforded streamlined processing with a qualified application. A qualified application under the Tax Relief Act cannot increase in size of the ground compound, or tower structural changes increasing the height or girth by ten percent (10%) or twenty (20) feet, whichever is greater. Since the Applicant will not be increasing the height or girth of tower, nor the compound, this application is qualified for streamlined processing under the Tax Relief Act. The submitted application conforms to the requirements of Town codes and State of New York wind codes and structural integrity. Therefore, it is CityScape's recommendation that the Town c� the application with the following condition: All new vertical feedlines shall be installed within the monopole structure and all access ports sealed to prevent wildlife intrusion. I certify that to the best of my knowledge all of the information included herein is accurate at the time of this report. CityScape is only employed by local governments and has unbiased opinions. All recommendations are based on technical merits without prejudice,according to prevailing laws and codes. Respectfully submitted, �y, k of Jonathan N. Edwards, P.E. CityScape Consultants, Inc. Town of Southold/SCTM#1000-96-1-19.1 Cftscape New Cingular Wireless PCS,LLC/NYCENY1027 Page 3 C 0 N `' '..: .. ,,,�„m_� _...---............. ...m,. ._.......�.. .._�,..._.�..�._-__. .... ...�..........,DeLormeStreetAtl Atlas ,c. +;x a�w Yg 01 J ,: ' P ro<l pY n.y &�'Wd� �etlYCk+Ce�llPb f" Q baa .... m, ........ I� I Dwa use ubpFu t w license * �r Yml Ix i ne Dp* al i nc Sem R4ths i.J`za' )),001 SpUI� 7 ROO 6N 2d00 IJ260 401011 ,veru, d,dvu"rn, con If„YN Q,P Jtl1 ins+N�,':'d n p 1 1 7 0 Figure 1 — Site Location Town of Southold/SCTM#1000-96-1-19.1 Cftyscape New Cingular Wireless PCS,LLC/NYCENY1027 Page 4 C 0 N S U r., T ,Y111 p" 1 5 , � Nd Appendix Town of Southold/SCTM41000-96-1-19.1 New Cingular Wireless PCS,LLC/NYCENY1027 clitysicape Page 5 C 0 N S 11 L T A A, F S N N Q.. , I/XAJAC = _ l, " CH iR QP.W I i i�f "";n AU -IT W= 221— F'. " .` ISE.. FOX SEL lux 21A0411 �kln If> r � I f 1 d ENV iRCIi,(.PrAr I rX5T AMY % RPM h wlf AWL AW �' a C�,JPVFST PA b V B r ST MEUE R (8C f CAST OWE Exhibit A - Existing Support Structure Town of Southold/SCTM#1000-96-1-19.1 citysicape New Cingular Wireless PCS,LLC NYCENY1027 Page 6 0 N S U IL, T 1, N' � S to f"�J$ ""�' 01,'SOALL PIVVOMf,75 IR$I"q 01", ED"'I"Pl' An hV HS, Calix^^r Op"( FAAA f,"P, dipii,,ri!,ov& il]PE (SCE, DNI'M., I/ADbO F',PC (SCj I 7/*03) RA ANTENNA 014 CWT PIK (TI"? Or ........... 111:11EJJI�i sicwDq) oini,,� wrm z,i1,Aan) XSY H,R %IM4 i","IMN f V fttl R14i4 10 fl,AAN Jl?/HiA QHI't' N4 0,10 PiPt I £i v� � or 3') r'sra.�' ovigia oil, �C14PIA^a s, F"JIVIE ASH ';CTA,p I/A01', V,,STA-L KEIN 8'5 M Ott gV' F)"N" (sk�F' 04 r7P,111�) .........I Y 011i"ItIA'A 1, NCO, 95 Mil'4 �'5ii f"XII;f AW11,14NA fi,1114, (SEC DE"TA )'/),C,5) wub, H'I"fq Oli EX10 M,lj�%NA P4 1V NEW DC6 (SZ� 3�1'A I 4,JA05�, REPIMA LAII0 1,',V ANTY0, hiv'4 iii,EIR CL*Aw.CZM'lL miii l,P 65A 1144 RE'NACI 00 A N'TE1,14A P4 V141110,1110 101, vviii- (11— 11)i3 NICfi c0ilif9ASU IF 10064-01A-F'14 PEIR SEtVAhJ[%!,,A ljra, 11!,T f I[,IE ',It UVAIOR"} DV(Afl. d/AG3) Exhibit B Proposed Antenna Configuration Color Le!"t New Equipment Existing Equipment Replaced Equipment Town of Southold/SCTM#1000-96-1-19.1 CkyScape New Cingular Wireless PCS, LLC/NYCENY1027 Pagel C 0 N S U L A A N T S NC Dale. July 19,2018 BLA,CK&VEATCH 80diriu a world of dillftwonew Amanda Brown O&V Now York LLP Crown Castle 489 Fifth Avenue 8& 12 Floor 3630 Toringdon Way Sulto 300 Now Ywk,NY 10017 Charlotte,NC 20277 (913)458-0145 Subject- structural Analysis Report Carrier Desjlqflfttlon: AT&T Mobility Co-Locate Carrier Site Number: NYCENY1027 Carrier Site Namai CUtChDgUG Crown Castle Designation., Crown Castle IBU Number., 006679 Crown Cattle Site Name, NY CUfCflOGLIF. 0150280 Crown Castle JD15 Job Number: 516670 Crown Castle Work Order Number: 1!A70 s1 Crown Castle Order Number,. 4 10310 Rov,0 15riginaering Firm Designation: B&V New York LLP Project Number-, 191393 Sits Data: 21855 Country Rd,Cutchaque,Suffolk County,NY Latitude 411 1'46.57",Longitude.724 29150.29" 108.25 Foot-Monopole Tower Dear Amanda Bruien. B&V New York LLP Is pleased to submit this"Structural Analysis Report"to determine lho structural inisgrity of the abova mentioned limyer. This analysis has been performed In accordance with the Crown Castle Ellroctural'Stelemeril of Work'end "tonns of Crown CosUB Purchase Order Number 1213902, 161 accordance wldi order 448310,revision 0. The purpose of tho DnOlYSIG Is to determine acceplabililly of the tower sireas level. Based an our anWysis wo have delerminnd the lower shiess,level for the structuro and inundation, under the following load case,to be: LC?;ExIstInWRoserved+Prupasud Eclutpalent auffleldml Capacity lktc Sena Tnbll-I and 1"'44)11 lov no am loadnD, This annlysk, has tenon %wil'o"ned in accarchi rice with ft 2015 Inlornational Builcling Code baried up-jn at) unimatig 3-gricard gra al ward spend at 135 mph convened to a nominnil 3-sacorad aust wInd speed of 105 mph por %irxb-nn "1609,3.1 as roqUlMd for use in ffie TIA-222O Standard per Exception 45 of Section 1609.1.1, E,xposury Cntogory C with a rriaWnurn topogmphle factor, K?I, of 1,0 and Risk Category 11 were used In this analy5is We at D&V Now York LLP appreciate the opportunity Of pt[30dinU our continuing prGleSSIDnO sorvxas to you and Crown CflRgle, 11 you have any questions or nood further assistanco on this car any Othor projects please gwo us a call. Structural analysis prapueod hy,'r,Sindhuri 0i Nfi 1,V 49 V Respectfully submitted by.. P Patrick J.DaAs.P,E, —0 Peofossional Enginoor lmlo-mer Reparl-versim 1A)5,1 Exhibit C — Structural Analysis Summary bud 1�� idd IMIM�M__.I�IIIN 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 23, 2018 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) Dear Ms. Lanza, As per the above referenced Agreement between Town and Consultant, Consultant agrees to provide a review and analysis for an application to modify and/or upgrade equipment at a wireless communications facility located at 21855 CR 48, Cutchogue, SCTM #1000-96-1-19.1 for New Cingular at Junge. 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 OFFICE LOCATION: � a MAILING ADDRESS: P.O. Box 1179 Town Hall Annexe 54375 State Route 25 �41��� �* Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) n Telephone: 631 765-1938 Southold, NY www.southoldtownny.gov � w CPO PLANNING BOARD OFFICE TOWN OF SOUTHOLD October 23, 2018 Mr. Richard L. Edwards d/b/a CityScape Consultants, Inc. 7050 Palmetto Park Road Boca Raton, FL 33433 Re: Wireless Modifications: New Cingular at Junge Located at 21855 CR 48, Cutchogue, NY 11935 SCTM#1000-96-1-19.1 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#32706, $8,500.00, 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. The application materials can be viewed by following these directions: 1. Go to the Town of Southold website ,soutlioldtownn ov; 2. Click on Town Records/Weblink/Laserfiche Icon; 3. Click on the Planning Department folder; 4. Click on Site Plans; 5. Click on Pre-Submission; 6. Click on the SCTM# (tax map#) of the application, 1000-96-1-19.1 If you have any questions, please contact me directly at 631-765-1938 between 8:00 a.m. and 4:00 p.m. Respectfully, Planner Brian Cummings, Encls. TOWN OF SOUTHOLD Purchase Order# .�� 2 70 6 Date _...�.. ccount# U2.(:� G n�.A � ., Deliver and send billingto: Vendor " Department P k ck.. ` ..: .. � .. 8 a Addiress 7 ..� VENDOR "Return this copy and Town of Southold voucher itemized and signed for payment" DESCRIPTIONITEM QUANTITY .M� m �w cf- mµ1 w I I li mmmmmmmw ry "THIS PURCHASE 011:1DIER IS NOT VAI,,,,,ID wI"'I our 11 HE SIGNATUFRES OII: THE DE1131 HEAD RIND THIP.SUPEIRVI OR I CERTIFY THAT THERE ARE SUFFICIENT FUNDS AVAILABLE IN THE ' PRIATION CHARGED ......... ........ ....... ...�.. .... Dept. Head I CERTIFY THIS TO BE A JUST AND TRUE P H.ASE ORDER Supervisor E",,O( LCUU11 Shore 2 Shore Wireless, Inc. 5550 Merrick Road, Suite 302 SoullioGd Town Massapequa, NY 11758 pora�ara (516) 557-2398 office October 4, 2018 Town of Southold 53095 Route 25 Southold, New York 11971 ATTN: Brian Cummings—Town Planner RE: New Cingular Wireless PCS, LLC ("AT&T") Building Permit Application AT&T site NYCENY1027 Premises: 21855 County Road 48 Cutchogue,NY SCTM# Section 96, Block 1, Lot 19.1 Mr. Cummings, Our office represents New Cingular Wireless PCS, LLC (AT&T) with respect to its Application to modify its existing public utility wireless telecommunication facility at the subject premises. The proposed modification is part of AT&T's "LTE Upgrade"project which will allow AT&T to provide better service to the Town of Southold. As shown in the plans submitted to the Town, the upgrade requires only minor modifications to the existing facility. With respect to the Building Permit Application, the following are enclosed in this submittal package; 1) Building Permit Application & Owner's Authorization 2) Four (4) set of signed and sealed construction drawings, prepared by Tectonic Engineering and dated October 1, 2018, including site plans and elevations 3) One (1) Structural Analysis performed by Black& Veatch and dated July 19, 2018 4) Certificates of Insurance from the contractor Ramapo 5) A check for $8,500 (#2379) as a consultant review Escrow fee. Thank you for your time on this matter, let me know how to proceed. / ul04� Patrick O'Rourke Site Acquisition Manager on Behalf of AT&T 516-263-8817 connoror@optonline.net TOWN OF SOUTHOLD BUILDfNG PERMIT API'LlCATION ClIECIKLIST BUILDING DEPARTMENT Do YOU have or need the following,before appiying? TOWN HALL Board of 6 lealth SOUTHOLD,NY 11971 4 sets of Building flans...................... TEL: (631)765-1802 planning Board approval FAX: (631)765-9502 Survey- Southoldtownny.gov PERMIT NO. Check Septic Forni_ N Y.S 1)FIX' FwWes---- ................. C,O,Application ............ ... Flood Permit Exarnhied120 Single&Separate ------------ ................... Truss idendfi,ation Forrn Storrn-W,,ii.crAssessvmvitFoni). OCI 4 2018 Contact:jgja),5AVZ UQ41&1 App roved..................... 20 Mail o: ' O-N NXY(w44? Disapprovedak......................................................................................................- Phone: 9 ................... ..... I'll—----------------.............................-11 11 Expiration 20 BuildingInspector APPLICATION FOR BUILDING PERMIT Date ...................---1 20-__ 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. (Si tu r'e—of applicant or name,if anl) :513-Wd�kl ITT!" (Ntaflinp,address ofappliew-0 Statew, 11-111Q,r appficam is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder 7rai 7 J -- &40� Name of owner of premises ARVOR V. SAE CJI sj6c (As mi the tax roll or latest deed) � i � �lu�....r. t �txw,a° pphq, eogpoi4�' ,signature ofduly authorized officer oi,le off"Icer) ' ar I A C Builders License No. Plumbers License No. Electricians License NO. Other Trade's License No. 1. Location ofland on which yc)posed work will be done: .-2 UTC,4 06 A9 .............................. House&�m—ber Street Hamlet County Tax Map No. 1000 Section Block Lot Subdivision. . e1111111___.__. .. Filed Map No .. ..Lot 2. State existing use and occupancy of prcniisis and intended use and occLip"Incy ofl'topused coru^,9ru. ,!tion: a. Existing use and occupancyHpid _., � — `-- _ . .. ° cy b. Intended use and occupancy N TF,T 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work .. . ..... 4. Estimated Cost o2 d Fee (Description) ....,..... (To be paid on filing this application) 5. If dwelling,number of dwelling units N A Number of dwellingunits on each floor, _ ____ __— If garage, number of cars G. If business,commercial or mixed occupancy,specify nature and extent of type ofta " Pr r" -R7 - ..at..�..t./. ........r. g f _- _mm 7. Dimensions o existing structures, r any: Front_—— _Rear Hei hI. Number of Stories, �" I"'�7J°w"� �� lNePet.� Dimensions of same structure with alterations or additions: Front. fear Depth Height Nunier of Stories ,gym' ' inl"7f r 8. Dimensions of entire new cr:�nstruci.ion. Front. Rear _._—Dcpth ____�. ......._ Height Number of Stories , � ._. rj.��_ 9. Size of lot: From Rear I ppc.lt .. ...... mm 10.Date of Purchase N1 Name of Former Owner _ IWA4/ tA �G� m/y 11.Zone or use district in which premises are situated J—T 4 9T -)WD ojfie f` -I(?r-./Cr _..., 12.Does proposed construction violate any zoning law,ordinance or regulation? SNO /Will excess fill be removed from p�reonises?YES NO 13.Will lot be re-graded?YES NO.... 1 tl� �I hrttte No.....4 14.Names of Owner ofptcttrepscs.: ��t�JrV � t Address "Ur�^��f'Adl- a3- 81 Name of Architect�c 7�f Nrt� dt "�+ r .... trldt t s {r,t" B4trirroc.No e �"p4�c�., �. "I� �CI PISt;aatieNo. � 1 Name ofContraetor a "" '• Add o2a X a sof 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BFxREQUIRED.. b.Is this property within 300 feet of a tidal wetland?*YES NO✓m........_ *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 *IF YES,PROVIDE A COPY. STATE OF NEW Yj ) SS: COUNTY OFc gMa<e- e ,,,,,,,,,,,,,,,,,,,, _ being duly sworn,deposes and says that(s)he is the applicant (Name f individ l si to (N gn g contract)above named, (S)Iie is the, .w �....... � ,f ear tractor,Agent,Corporate __...... ........_ n.. . t � g rp e 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 ar�ce�tlt4t�ar°d,ta�11w best of his knowledge and belief,and that the work will be performed in the manner set forth in the a8�l�a�lgtatkl l.lt al ) cc;tvi'th On Sworn to before me this day of ......... tl .ra _ .0 F z r ' .. NotaryPublic ��� tt�t9 � �5ag�rarataaaar aa�.wpiican.t Date: July 19, 2018 BLACK&VEATCH0, Building I difference? Amanda Brown B&V New York LLP Crown Castle 489 Fifth Avenue 8 & 12 Floor 3530 Toringdon Way Suite 300 New York, NY 10017 Charlotte, NC 28277 (913)458-8145 Subject: Structural Analysis Report Carrier Designation: AT&T Mobility Co-Locate Carrier Site Number: NYCENY1027 Carrier Site Name: Cutchogue Crown Castle Designation: Crown Castle BU Number: 806579 Crown Castle Site Name: NY CUTCHOGUE 958280 Crown Castle JDE Job Number: 516678 Crown Castle Work Order Number: 1597851 Crown Castle Order Number: 448310 Rev. 0 Engineering Firm Designation: B&V New York LLP Project Number: 194393 Site Data: 21855 Country Rd, Cutchogue, Suffolk County, NY Latitude 41° 1'46.57'; Longitude -72'29'50.29" 108.25 Foot- Monopole Tower Dear Amanda Brown, B&V New York LLP is pleased to submit this "Structural Analysis Report" to determine the structural integrity of the above mentioned tower. This analysis has been performed in accordance with the Crown Castle Structural 'Statement of Work' and the terms of Crown Castle Purchase Order Number 1213902, in accordance with order 448310, revision 0. The purpose of the analysis is to determine acceptability of the tower stress level. Based on our analysis we have determined the tower stress level for the structure and foundation, under the following load case, to be: LC7: Existing/Reserved + Proposed Equipment Sufficient Capacity Note:See Table I and Table II for the proposed and existing/reserved loading, respectively. This analysis has been performed in accordance with the 2015 International Building Code based upon an ultimate 3-second gust wind speed of 135 mph converted to a nominal 3-second gust wind speed of 105 mph per section 1609.3.1 as required for use in the TIA-222-G Standard per Exception #5 of Section 1609.1.1. Exposure Category C with a maximum topographic factor, Kzt, of 1.0 and Risk Category II were used in this analysis. We at B&V New York LLP appreciate the opportunity of providing our continuing professional services to you and Crown Castle. If you have any questions or need further assistance on this or any other projects please give us a call. Structural analysis prepared by: T. Sindhuri O Respectfully submitted by: Patrick J. Davis, P.E. i �w Professional Engineerkq 1 "- . `sst " tnxTower Report-version 7.0.5.1 ' 9/17/2016 TOWN OF SOUTHOLD COUNTY OF SUFFOLK: STATE OF NEW YORK In the Matter of the Application of New Cingular Wireless PCS, LLC AUTHORIZATION OF OWNER At the premises: 21855 Cour" Road Cutchogue,New York 11935 Section 96, Block 1, Lot 19.1 ,.----_..___ ------------------..-..---- ---- - ---- -,,----___.--------------x STATE OF NEW YORK ) ) SS.. COUNTY OF SUFFOLK ) Valerie Lasser, being duly sworn, deposes and says: I am the owner in fee of the premises known as Section 96,Block 1,Lot 19.1 (the"Premises" hereafter), and do hereby authorize New Cingular Wireless, PCS, LLC ('AT&T'hereafter), and its representatives to bring such applications for municipal approvals as may be necessary for constructing or installing on the Premises such antennas,support structures,and related equipment as AT&T may require for the establishment of its public utility wireless telecommunication facility. As such, I will fully cooperate with AT&T and its agents in obtaining any required Approvals. By: ,y 019,. Sworn to before me this -- clay cif , 2018 i LISA��' >i ww NOTARY��.. PUBLICS r ub0c,State Now Yotk No.OIV 167 1 Oualffied In Nassau Court Co,mmission Expires June, , Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For crew building or new use: 1. Jijial survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topog,rapliic fcawres,, 2. Final Approval from Health Dept. of water supply and sewerage disposal (S-9 fc)rjll). 3. Approval of clectrical installation from Board of Fire Underwriters. 4. Sworn statement frorn plumber certifying that the solder used, in systerr,contains less than 2/10 of 1% lead. 5. Commercial building, industrial building,multiple resklences and Simi lar bi,i i Idings and installations, a certificate of'Code Compliance from architect or engineer responsible for the bwlding. 6. Subrnit Ilinning Board Appi-oval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Acci irate survey of property showing all property limes,streets,building and unusual natii ral or tollograph i c features. 2. A property completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building- $100-00 3. Copy()f Cer i�f t icate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temponny Cerli ficate or Occupancy-Residential$15.00, Commercial $15.00 Date, New Construction: Old or Pre-existing Building:- (check one) Location of Proi)ertv: 4, House No. 'Street Hamlet Owner or Owners of Property .-.-. Suffolk County Tax Map No 1000, Section BlockLot Subdivision Filed Map. Lot: Permit No. Date of Pen-nit. Applicant:i cant:--,,,-.--.. Health Dept. Approval:u. Underwriters Approval. Planning Board Approval: ............--- Request for: Temporary Certificate.,- Final Certificate: (check one) Fee Submitted: $ Applicant Signature