HomeMy WebLinkAbout43588-Z �p�OgUFFO(,��oG.a Town of Southold 6/24/2019
y� P.O.Box 1179
_T 53095 Main Rd
oy p��h Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 40465 Date: 6/24/2019
THIS CERTIFIES that the building EXHAUST HOOD AND/OR FIRE SUPRESSION SYSTEM
Location of Property: 46455 CR 48, Southold
SCTM#: 473889 Sec/Block/Lot: 55.-2-20
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/22/2019 pursuant to which Building Permit No. 43588 dated 3/27/2019
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:
ansel system in existing bagel store as applied for.
The certificate is issued to Cartselos S LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Aut i ature
�giiFFo�,r. TOWN OF SOUTHOLD
��o caGy� BUILDING DEPARTMENT
a TOWN CLERIC'S OFFICE
o . g SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 43588 Date: 3/27/2019
Permission is hereby granted to:
Cartselos S LLC
300 Second Ave
PO BOX 52
Peconic, NY 11958
To: to install new ansel system in existing bagel store as applied for.
At premises located at:
46455 CR 48, Southold
SCTM # 473889
Sec/Block/Lot# 55.-2-20
Pursuant to application dated 3/22/2019 and approved by the Building Inspector.
To expire on 9/25/2020.
Fees:
NEW COMMERCIAL, ALTERATION OR ADDITIONS $250.00
CO -COMMERCIAL $50.00
Total: $300.00
Building Inspector
OE SO(/l�Olo
1
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [�®] FINAL
[ ] FIREPLACE & CHIMNEY 01 FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
RE KS: ® ��
V&
DATE r ^ J INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
�
FOUNDATION (15T) �A4
....................................
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'FOUNDATION (2ND)
ROUGH FRAMING&
PLUMBING y
INSULATION PER N.Y-, H
STATE ENERGY CODE
FINAL
ADDITIONAL COMMENTS
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applyinep
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL:(631)765-1802 Planning Board approval
FAX:(631)765-9502 S� Survey.
Southoldtownny.gov PERMIT NO. Check
Septic Form
NYSDEC.
Trustees
C.O Application
Flood Permit
Examined 20 Single&Separate
Truss Identification Form
Storm-Water Assessment Foran
Contact:
Approved ,10 20 [ Mail to-
Disapproved a/c
Phone
Expiration 20
(Cl UVE B V ding Inspector
APPLICATION FOR BUILDING PERMIT
MAR 22 2019 Date / / 20 /
INSTRUCTIONS
JjL '�1' gpA[3g be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
. �1r4}f1a`n o 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 thus 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 buildmgs,additions,or alterations or for removal or demolition as herem described.The
applicant agrees to comply with all applicable laws,ordmances,building code,housing code,and regulations,and to admit
authorized inspectors on premises and in building for necessary inspections
(Signature of applicant r name,if a corporation)
(Mailing address of applicant) /l/y
State whether applicant is owner,lessee,agent,architect,enghlee ,ge�conelectrician,plumber or builder ((
C C)r1�-r"-,c,f-Pr 11
Name of owner of premises \f J h Cey 4 Ci (/T Y 9 yl
(As on the tax roll or latest deed)
If applicant is a corporatigiL 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 1 3
1. Location of land on which proposed work will be done: 1 �/
CNT5-/1 (KaflT 07
5avJ�alryj M-I
House Number Street Hamlet
County Tax Map No. 1000 Section Block Lot �(�
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and iltended use and occupancy of proposed construction:
a. Existing use and occupancy Y Ln O-t STT/V e—
b. Intended use and occupancy
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work urs GvA-de A e S 4 ,&ice
n (Description) ��
4. Estimated Cost_ 01000 Fee '
(To be paid on filing this application)
5. If dwelling,number of dwelling units Number of dwelling units on each floor
If garage, number of cars /-
6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. 6T 3 C l S74q✓?
7. Dimensions of existing structures,if any:Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction:Front Rear Depth
Height Number of Stories
9. Size of lot:Front Rear Depth
10.Date of Purchase Name of Former Owner
11.Zone or use district in which premises are situated
12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO
13.Will lot be re-graded?YES NO V Will excess fill be removed from premises?I'FS NO
14.Names of Owner of remises n' i lPeAddressV Circle I)" Aie'iZ e No. x031 C)i -
Name of Architect p e F 4 5 u 5- -n ,'v�ee r� Address `Ifo 1 0 a n IS.*hPhone No / ` S IT Z 3 3
Name of Contractor h P'(54H /--�+c Address +1 e: #< Phone No.
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO lC
*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
*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 YORK)
SS:
COUNTY OFILfotl4o
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the G or) 7Lo�-✓!i/
(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
day of i AANONSEN
Notary Public, State of New York
44�� No.4508710
Notary Public Clualiiled in Suffolk County j Signature of Applicant
Commission Expires 912,312,2-
Of elrompletior
This is to certify that
PlabIck T irra
an employee of
ANDERSON ME EQUPMENT
an Authorized Badger Distributor
has successfully completed a certification training session covering design, installation,
operation and maintenance and has demonstrated a practical knowledge of the following
Badger product:
Range Guard Systems
N D (S issue Date: 4/4/2017
PirJetta Ruokola Expiration Date: 4/4/2020
This certificate is non-transferable.Certificate Is only valid as long as the above named company employs the certified individual.Acceptance of this certificate implies
agreement to abide by the terms of distributor agreement by the above named company and Individual.Any violation or alteration of this certificate will result in the
Immediate voiding of this certificate.
r
SUFFOLK COUNTY
DEPARTMENT OF FIRE, RESCUE AND EMERGENCY SERVICES
PORTABLE FIRE EXTINGUISHER AND AUTOMATIC FIRE EXTINGUISHING SYSTEMS LICENSING
BOARD
CERTIFICATE OF REGISTRATION
REGISTRATION #: 113
EFFECTIVE DATE: 1/17/19 EXPIRATION DATE: 1/31/21
ISSUED TO: NAME: Suffolk Fire Inc.dba Anderson Fire Equipment
ADDRESS: 9 O'Neil Avenue
Bay Shore, NY 11706
ENDORSEMENTS: Portable Fire Extinguishers
High Pressure Hydrostatic Testing
Dry/Wet Chemical Extinguishing Systems
This Certificate of Registration Does Not Exclusively Recommend the Bearer
f'nMMle�inA1FR r_ulpr clog: MAC-Qu81
F
New Fork State Insurance Fund
Workers'Compensation&Disability Benefits Specialists Since 1914
8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED)
AAAA^A 113268460
SUFFOLK FIRE INC T/A
ANDERSON FIRE EQUIPMENT COWNJk-
",
9 ONEIL AVE
BAY SHORE NY 11706 SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
SUFFOLK FIRE INC T/A TOWN OF SOUTHOLD
ANDERSON FIRE EQUIPMENT CO 54375 ROUTE 25A
9 ONEIL AVE PO BOX 1169
BAY SHORE NY 11706 SOUTHOLD NY 11971
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
1723238-2 139863 10/29/2018 TO 10/29/2019 10/15/2018
:]
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 723 238-2, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR
WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL
OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW.
IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS,
OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW
YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS.
THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE
INSURED CORPORATION.
PATRICK TURRO(PRESIDENT)OF A ONE
PERSON CORPORATION
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE
COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER
THE COVERAGE AFFORDED BY THE POLICY.
NEW YORK STATE INSURANCE FUND
S: J/ Q�)Q_e_
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER:449096862
U-26.3
4
SUFFO-3
* DATE(MMIDDNYYY)
CERTIFICATE OF LIABILITY INSURANCE 04126/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
PRODUCER 631-581-7978 c cr Ryan D. Gillies
James F.Sutton Agency Ltd. �Co,N,Exq:631-581-7978 FAX No):639$81-7507
149 E.Main Street
P.O. Box 76d 16SS:
East Islip NY 11730 INSURER(S)AFFORDING COVERAGE NAIC 0
Ryan D.aIllles
INSURER A:AdM iral Insurance
INSURED Suffolk Fire Inc DBA INSURER B:
Anderson Fire Equipment INSURER C:
9 O'Neill Avenue
Bay Shore, NY 11706 INSURER D:
INSURER E.
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO THAT THEIND CATED.CERTIFY NOTWITHSTAND NG ANYIES REQUIREM NTT,TERNS OR CONDITIOOF INSURANCE LISTED BELOWHNV F ANY CONTRACTBEEN ISSUEDO R OTHER DOCUMENT ITH RESPECT TO PERIODTHE INSURED NAMED ABOVE FOR THELICY W ICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR POLICY EFF POLICY EXP
TYPE OF INSURANCE
ADDL SUB POLICY NUMBER LIMITS 1,000,000
A I X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE ® AMA
OCCUR CA000024162-03 04/24/2018 04/2412019 DGE EN
TO RTED $ 100,000
MED EXP An one person) 5,000
PERSONAL&ADV INJURY S 1'000'000
GENERAL AGGREGATE $ 2,000'000
GEN'L AGGREGATE LIMIT APPLIES PER 2,000,000
POLICY r j Qr r LOC PRODUCTS-COMPIOP AGG
$
OTHER COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY Ea acrid-nt $
ANY AUTO BODILY INJURY Per erson $
OWNED SCHEDULED BODILY INJURY Per accident S
AUTOS ONLY AUT�OSSyy PROPER Y AMAGI-
ATOS ONLY AUTOS OND Per aca�ant $
Y $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR HCLAIMS-MADE AGGREGATE $
DED RETENTION$ $
PER OTH
WORKERS COMPENSATION STA LITE
AND EMPLOYERS'LIABILITY Y I N
ANY PROPRIETOR/PARTNERIF�CU nVE E L EACH ACCIDENT $
f�FFICERIM—MW EXCLUDED? N I A
(Mandatorycln ) E L DISEASE-EA EMPLOYEE $
If yes,descnbe under E L DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
Proof of Insurance
G IC ED CAN C L O
TOWN182
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS.
54375 Route 25
PO Box 1169 AUTHORIZED REPRESENTATIVE
Southold,NY 11971 Ryan D.Gillies
ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
COMPLY WITH ALL CODES OF
SEAL TIGHTS (TYP.) Z
NEW YORK STATE & TOWN CODES m 0
a o
Y" TEE AS REQUIRED AND CQNDITIONS OF W � Z
10"x10" DUCT
AP ROVED AS NOTED A
3 4' HOOD ADP VENT PLUG o ��A
DATE: B.P.# 3S T _ T ' NNING BOARD a _E, z
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L� I�TEES W
FEE: D . BY: — — — — — o_
1360_ — CONTROL �..s,_„�., O
NOTIFY BUILDING DEPARTM TAT HEAD IW
765-1802 8 AM TO 4 PM FOR THE N ADP I F-
FOLLOWING INSPECTIONS: L —
1. FOUNDATION - TWA REQUIRED I RG I I W Q
FOR POURED CONCRETE 1 25
2. ROUGH - FRAMING & PLUMBING GAL. I z
3. INSULATION
OCCUPANCY OR
4. FINAL - CONSTRUCTION MUST App I I w
BE COMPLETE FOR C.O. - 6" I i USE IS UNLAWFUL w � a o 0 Q
ALL CONSTRUCTION SHALL MEET THE - I I o o = Z
REQUIREMENTS OF THE CODES OF NEW cn MIN. TO EDGE I PULL WITHOUT CERTIFICA-1 OF HOOD ON Z Y < Z
I
YORK STATE. NOT RESPONSIBLE FOR w STATION Q OF OCCUPANCY �n ;�
DESIGN OR CONSTRUCTION ERRORS. BOTH SIDES App
28"x19" " GAS I �i ;i � TA�v'T��\
FLAT GRIDDLE VALVE
LU
22.5"x20" — J cc
CHEESE MELTER INSPECTION {I 1 'li L '
EU�RE� EEFC� �`�
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FRONT VIEW 'b ENING % , ���<�
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SCALE: %"=1'-0.,
AES MANUFACTURER: COMPONENTS: NOTES: Z w
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'RANGE GUARD: �-RG 1.25 GAL. _RG 2.5 GAL. _RG 4 GAL. RG 6 GAL. RANGE GUARD - RG 1.25 GALLON x Fryers to have High Limit Control to shut off fuel at 425'. 4`E < 8_ U ZZZ&
Ow B.,w� �a
Piping Material BLACK SCH 40 Max Rise 10' MAX. FLOW POINTS = 4 (4 USED) x Detectors shall be located over every piece of equipment. a�w.s NW�wZ- WZ�W
F �aw0 -SO
TOTAL PIPE VOLUME NOT TO EXCEED 72 CUBIC INCHES x The System installed as per manufacturers specs and the AHJ, �Wr.Zv�w
Supply Pipe Size 3/8" Branch Pipe Size 3/8" DROPS 378" MAX. PIPE LENGTH 39 FT. x The System has been installed as per UI-300. 382< �m <i ��W�
0<wN ZW w x^05
Gas Valve Type: MECH Size 3 4" Manufacturer HEISER x The following functions to operate upon system discharge 00,:g, 2Qow�� T=w'
NOOZO d'�Z�03 W1_OW
Detector Temperature Rating: 360' * Supply air damper closes * Gas fuel shuts off in kitchen 0ZHO ww=5N 030=
,S_,0t�,VIS m 5N� O2W
Hood Size. 4' Duct Size: 10"x10" RG-1.25 GAL. CYLINDER #60-120001-001 * Exhaust fan remains on * Electric fuel shut off under hood Nw� �¢w "WSW
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* All systems to activate simultaneously in same hazard area. _ _W5 �M� 0<W0
MOUNTING BRACKET #9197430 2�as ��«aN WNOU
EQUIPMENT SURFACE NOZZLE * Fire Alarm shall activate.
QTY. TIP#/QTY. LOCATIONS CONTROL HEAD 6120099 x Manual Pull Station shall be located a minimum of 10 ft. from --
TYPE AREA HEIGHTS #
DUCT 1 10"x10" ADP 1 0"-6" 0"-6" IN OPENING DISCHARGE ADAPTER KIT #844908 hood & a maximum of 20 ft. from hood and 4 ft from floor.
VENT PLUG #9196984 x All fuel sources are GAS unless otherwise noted. (n
PLENUM 1 4' ADP 1 0"-6" FROM END OF PLENUM a,
MICR)SWITCH KIT SPDT #B120039 .may
FLAT GRIDDLE 1 28"09" ADP 1 13 -48" ON PERIMETER AIM WITHIN 3" CTR ADP NOZZLE 87-120011-001 >:
CHEESE MELTER 1 22.5"x20" ADP 1 - TOP 4" OF COMPARTMENT # z Z o
360' LINK #WK-282664-000 0
LINK HOUSING #804548 m w
MANUAL RELEASE #13875572
%" GAS VALVE #B120071 m
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A: FIRE EXTINGUISHER WITH A MINIMUM RATING LiJ ° co
OF CLASS K MUST BE INSTALLED WITHIN THE
VICINITY OF THE COOKING AREA. a