HomeMy WebLinkAbout44759-Z �g�F OF k
Town of Southold 8/3/2020
P.O.Box 1179
co
C* 53095 Main Rd
a59, Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 41309 Date: 8/3/2020
THIS CERTIFIES that the building HOOD FIRE SUPPRESSION SYSTEM
Location of Property: 51655 Route 25, Southold
SCTM#: 473889 Sec/Block/Lot: 63.-6-1
Subdivision: Filed Map No. • Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
2/27/2020 pursuant to which Building Permit No. 44759 dated 3/3/2020
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:
fire suppression system(hood)in existing building as applied for.
The certificate is issued to Griswold Terry Glover
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Authorized Signature
o�SUFFot�,co TOWN OF SOUTHOLD
BUILDING DEPARTMENT
o-
TOWN CLERK'S OFFICE
o • �^ 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#: 44759 Date: 3/3/2020
Permission is hereby granted to:
Griswold Terry Glover
PO BOX 591
Southold, NY 11971
To: install fire suppression system (hood) in existing building as applied for.
At premises located at:
51655 Route 25, Southold
SCTM # 473889
Sec/Block/Lot# 63.-6-1
Pursuant to application dated 2/27/2020 and approved by the Building Inspector.
To expire on 9/3/2021.
Fees:
NEW COMMERCIAL, ALTERATION OR ADDITIONS $250.00
CO -COMMERCIAL $50.00
Total: $300.00
B ' dinc or
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 new building or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or
topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead.
5. Commercial building, industrial building,multiple residences and similar buildings and installations, a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval 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. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly 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- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00/a�Date. �
New Construction: ,/ Old or Pre-existing Building: (check one)
Location of Property: 'J lbV 5 /-141" 1
House No.yy��WW��p� Street Hamlet
Owner or Owners of Property: ql'�
Suffolk County Tax Map No 1000, Section l!3 Block Lot r
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applicant ignature
Building Department Application
AUTHORIZATION
(Where the Applicant is not the Owner)
C�bvUVII aL-7dev
I, C\AO�V I P-_� J• Sg eV f residing at , 0,j� p
(Print property owner's name) (Mailing Address)
S3 u,A A Oka hereby authorize AvJQY10" ht,V 00 0l u\,)W �-
(Agent)
e qAy to apply on my behalf to the
Southold Building Department.
MIRRC4 &,(D
(Owner's Signature) (Date)
L�CLV 4,j a e So JevS
(Print Owner's Name)
rsf so Lil 51 65'15� MA'A
# TOWN OF SOUTHOLD BUILDING DEPT.
`ycourm,��' 765-1802 AAA(,rl C-AA
INSPECTIONa
-
[ ],-FOUNDATION 1 ST [ ] ROUGH PLBG.
[" ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ]-FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] -FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
[ ] CODE VIOLATION ] PRE C/O 80c[
REMARKS:
lr V A-V _ EA,;U'X c C,¢t.,.,_- Cie
DATE 7y INSPECTOR el
F SOU
�o�ao
# f TOWN OF SOUTHOLD BUILDING DEPT. 4�etr-71m•J
couto, 765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS: Acc
E J<Ut " OFF -
r
DATE INSPECTOR �
ar-
Town Hall Annex , ® Telephone(631)765-1802
n ,.
54375 Main Road � �'�-.; _ -�-, ;-- "' Fax(631)765-9502
P.O.Box 1179 `` = sean.devlin(.3-town.southold.ny.us
Southold,NY 11971-0959
COW
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Griswold Terry Glover
Address: 51655 Route 25 City Southold st: NY zip: 11971
Budding Permit#: 44759 Section. 63 Block- 6 Lot-
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Platinum East Electric License No: 34091 ME
SITE DETAILS
Office Use Only
Residential Indoor X Basement X Service
Commerical X Outdoor X 1st Floor X Pool
New X Renovation 2nd Floor Hot Tub
Addition Survey X Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceiling Fixtures 4 Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt Wall Fixtures 1 Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors
Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO
Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 1 4'LED Exit Fixtures Pump
Other Equipment. Hood w/ Four Vapor Proof Lights, Vent on Roof and Power Ventilator Below
Notes: Commercial Hood Wiring
Inspector Signature: Date: July 14, 2020
S.Devlin-Cert Electrical Compliance Form.xls
FIELD INSPECTION REPORT DATE COMMENTS -4-
J
FOUNDATION(1ST)
------------------------------------
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FOUNDATION(2ND)
O
ROUGH FRAMING& y
PLUMBING
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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 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
Southoldtownny.gov PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined 20—kV Single&Separate
Truss Identification Form
Stone-Water Assessment Form
Contact: 1 I
Appioved ,20� Ma 1 to: 0 I •
VT
Disapproved a/c +'�, ,
0-6
Phone:
Expiration ,20
Bu
F E B 2 7 2020
APPLICATION FOR BUILDING PERMIT
Date o7 LC;7 , 20=ab
;:. 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.
(Signature of applicant or name,if a corporation)
a' Le_ Y ( 1I7c6
(Mailing addr s of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises �ftlur%, 16 h C,r-( 5�J 0 (�'I oAet �
(As on the tax roll or latest deed)
If applicant is a corporation„signature of duly authorized officer
(Name and title ofcorporate_'6'fcer)
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: qq
House Number Street,, - Hamlet
County Tax Map No. 1000 Section �� Block `P Lot
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
b. Intended use and occupancy
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Worktr-t54F^SS lo►,%. hband
(Description)
4. Estimated Cost b, 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.
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 Will excess fill be removed from premises?YES NO
14. Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
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 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 OF )
1 �(Lt& being duly sworn, deposes and says that(s)he is the applicant
(Name of indiv' id& igning contract) above named, CONNIE D.BUNCH
Notary Public,State of New York
(S)He is the l.(Nl No.OIBU6165050
(Contractor,Agent, Corporate Officer, etc.) Quallf lednu o o ra
Commission Expires April 14,2—_
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 before me tl
`tel day of��-CJrI/l� 20a"�,
Notary Public Signature of Applicant
kBUILDING DEPARTMENT- Electri °11js„ Ta-
;FQE
TOWN OF SOUTHOL
C Town Hall Annex - 54375 Main Roa O B �1170 2
o • Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-995022 b
roger.rich ert(a�town.south old.n usBITDING
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: 14-1 TI+- Date:
Company Name: -F4,,, . QC
Name: JCS t 7-14-
License No.: email: 0144,n VIC, eets2Ell w 40 .
Address: 13JO (Cr:�+ `t` So u-FtloC
Phone No.: 63 I - IxS_ ,,,2
JOB SITE INFORMATION: (All Information Required)
Name: /a ti
Address: SI X55 ev
Cross Street:
Phone No.:
Bldg.Permit#: 447 5-1 email: �4 f �,�, � � 6 uc. v
Tax Map District: 1000 Section: 13 Block: Lot: 8
BRIEF DESCRIPTION OF WORK (Please Print Clearly)
clA,&tt,-4tC:A-L 1&010 &V021.41
Circle All That Apply:
Is job ready for inspection?: (.Y�E / NO Rough In Final
Do you need a Temp Certificate?: YES / NO Issued On
Temp Information: (All information required)
Service Size 1 Ph 3 Ph Size: A # Meters Old Meter#
New Service- Fire Reconnect- Flood Reconnect- Service Reconnected - Underground -Overhead
# Underground Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
Zsh Q:�
Request for Inspection FormAs /00 (Z
�
/v'
ea Kate of-
This
�Oi11 t�G'tlG��1
e
This is to certify that
Patrick Turro
an employee of
ANDERSON FIRE EQUMMENT
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
lj_ Issue Date: 4/4/2017
BADGER
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.
SUFFOLK COUNTY
DEPARTMENT OF FIRE, RESCUE AND EMERGENCY SERVICES
PORTABLE SIRE EXTINGUISHER AND AUTOMATIC FIRE JEXTINGUISHING SYSTEMS LICENSING
BOARD
CERTIFICATE OF REGISTRATION
REGISTRATION 0: 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
ENDORS ENT$: Portable Fire,Extinguishers
High Pressure Hydr sostat#c Testing
DrYNVet Chemical Extinguishing Systems _
This CerOcate of Reglaftflon Dow Not Exclusively Recommend the Seaver
3
COMMISSIONER
CHIEF FIR19 !11 AR914AI
L
""'�►, SUFFO-3
CERTIFICATE OF LIABILITY INSURANCE
DATE 05103120/9 ►
05/03/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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 Ileu of such endorsement(s).
PRODUCER 631-581-7978 cT Ryan D. Gillies
James F.Sutton Agency Ltd. PHONE 631-581-7978 FAx 631-581-7507
149 E.Main Street u►Ic,No,Ext): (A1C,No):
P.O. Box 76 Mss-
East Islip NY 11730
Ryan D.dillies INSURSFUSI AFFORDING COVERAGE NAIC d
INSURER A:Admiral Insurance
INSURED DM p INSURER B:
udee�son�IrecE BI
g O'N ill Av qu pment INSURER C:
Bay Soiore, 11706 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTRNSR TYPE OF INSURANCE ADSINSD SUBWVJ POLICY NUMBER POLICY EFF POLICY EXP LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE 7 OCCUR CA000024162-04 04/24/2019 04/2412020 DAMAGETO RENTED $ 100,000
ence)MED EXP(Any oneperson) 5,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
X POLICY❑za- F]LOC PRODUCTS-COMPfOP AGG 21000,000
OTHER $
AUTOMOBILE LIABILITY Ea EIcideDtSINGLE LIMIT $
ANY AUTO BODILY INJURY Perperson)
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY
BODILY INJURY Per accident $
AMS ONLY AUTOS ONLY P�2e0aER��r AMAGE $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED I I RETENTION$
WORKERS COMPENSATION I PER OTH-
AND EMPLOYERS'LIABILITY Y 1 N
TA UTE E
ANY PRRO/PRIIEMTgO�RIPARTNERIE)IECUTIVE E L EACH ACCIDENT $
andatory In NH) CLUDED? El N 1 A
E L DISEASE-EA EMPLOYEE $
If yes describe under
DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached K more space Is required)
Proof of Insurance
CERTIFICATE OD CANCELLATION
TOWN182
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town Of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
54375 Route 25
PO Box 1169 AUTHORIZED REPRESENTATIVE
Southold,NY 11971
a
ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
i
Y � -
m
New York 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)
^A A A A A 113268460
SUFFOLK FIRE INC T/A
ANDERSON FIRE EQUIPMENT CO fir•
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
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER:449096862
U-26.3
U FOLK COUNTY
DEPARTMENT OF FIRE, RESCUE AND EMERGENCY SERVICES
PORTABLE FIRE ExTINGUISHER AND AUTominC FIRE ExTINGUISHING SYSTEms LICENSING
BOARD
CERTIFICATE OF REGISTRATION
REGISTRATION 0: 113
EFFECTIVE ®ATE: 1/17/19 EXPIRATION DATE: 1/31/21
ISSUED TO: NAME: Suffolk Fire Inc,dba Anderson Fire Equipment
ADDRESS: 9 O'Neil Avenue
Say Shore, NY 11706
ENDORSEMENTS:
Portable Fire,Extinguishers
High Pressure Hydrostatic Testing
DryANet Chemical Extinguishing Systems
Tidls Certificate of Registration Does Not Exclusively Recommend the Bearer
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Piping Material BLACK SCH 40 Max Rise 12' MAX FLOW POINTS = 12 (11 USED) o"w��
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TOTAL PIPE VOLUME NOT TO EXCEED 400 CUBIC INCHES x The System Installed as per manufacturers specs and the AHJ
Supply Pipe Size 1 2" Branch Pipe Size 3 8" DROPS 3/8 x The System has been Installed as per UL300.
Gas Valve Type MECH Size 1 1 2" Manufacturer HEISER MAX PIPE LENGHT 132 FT x The following functions to operate upon system discharge- 100<4 LowZ< mo=w'
* Supply air damper closes * Gas fuel shuts off in kitchen oZQNZ ,�Z�o3 ``3"w
Detector Temperature Rating 360° RG-4 0 GAL CYLINDER 60-120003-001 * * �w� ow Nolo
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Exhaust fan remains on Electric fuel shut off under hood =_www wYw,
Hood Size 12'-6" Duct Size. 16"x16" * zo=�� '__�_�� o<=o
CONTROL HEAD #13120099 All systems to activate simultaneously in same hazard area. «a> <M< " QmoU
ADP NOZZLE #87-120011-001 * Fire Alarm shall activate
EQUIPMENT SURFACE NOZZLE LPR NOZZLE 87-120024-001 x Manual Pull Station shall be located a minimum of 10 ft from 2
TYPE QTY AREA TIP#/QTY HEIGHTS LOCATIONS # hood & o maximum of 20 ft from hood and 4 ft from floor.
360° LINK #WK-282664-000 co :3
DUCT 1 16"x16" ADP 2 0"-6" 0"-6" IN OPENING LINK HOUSING #804548 x All fuel sources are GAS unless otherwise noted a
PLENUM 1 12'-6" ADP 2 0"-6" FROM END OF PLENUM MANUAL RELEASE #B875572 O
FLAT GRIDDLE 1 36"x24" ADP 1 13"-48" ON PERIMETER AIM WITHIN 3" CTR 1 Y" GAS VALVE #8120074 .� z z o
6 BURNER RANGE 3 36"x28" LPR 6 16"-20" CENTER o 6 U
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A FIRE EXTINGUISHER WITH. A MINIMUM RATING 0
OF CLASS K MUST BE INSTALLED WITHIN THE
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IT IS A VIOLATION OF LAW FOR ANY PERSON UNLESS THEY Zo
ARE ACTING UNDER THE DIRECTION OF A LICENSED SPACE BEHIND HOOD C\1 36"6 BURNER RANGE
PROFESSIONAL ARCHITECT,TO ALTER AN ITEM IN ANY WAY
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DOCUMENT BEARING THE SEAL OF AN ARCHITECT IS
j, ALTERED THE ALTERING ARCHITECT SHALL AFFIX TO THE
36"FLAT GRIDDLE
041351 DOCUMENT THEIR SEAL AND THE NOTIFICATION "ALTERED
BY" FOLLOWED BY THEIR SIGNATURE AND THE DATE OF
SUCH ALTERATION AND A SPECIFIC DESCRIPTION OF THE
ALTERATION.
AOR SEAL SIGNATURE 16'x16'EXHAUST AR DUCTWORK RISER
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KITCHEN CONSTRUCTION (C) PLAN
-Non Combustible (Masonry) IAII views to be the following scale:j*=1'-0" x Dimensions SCALE:1/4"=V-0"
—Fire rated walls-2 Hrs New Kitchen x Existing Kitchen
11-imited Combustible-(S/rock-metal studs) _Combustible-(S/rock-wood studs)
LExisting I Hr.ok _,Special sprinkler installation-1 Hr.ok
x_Opening Protective(1 1/2 HR)-(Self closing,self latching,fire rated door assembly)
OR
_Ok Without Opening Protectives if all of the following comply
-Draft Curtain 24'H.T.(NULC) -Hds/Aes -Special sprinkler installation
-Exit at grade-OR-Sprinkler heads within 24"of draft curtain 60"apart kitchen safe
LCooking equipment in the Kitchen _Cooking equipment at the Front Counter _Cooking equipment in the Dining Room
_Cooking equipment in the Mobile Unit(d) _Cooking equipment in a Concession Stand(d) —Pizza Oven(d)
HOOD ECONAIR EXHAUST FAN
—Exhaust CFM-Medium Duty(d) x Exhaust CFM-Medium Duty(d) Exhaust CFM-Extra Heavy Duty(d) MODEL#BDU18 Z
(hot top,griddle,fryers,pizza,rotisseries) (range,wok,gas/elect.broilers) (Solid fuel char broilers) 2800 CFM
(Wall-Linear Ft x 300),(S-Island Linear Ft x 500) (Wall-Linear Ft x 400),(S-Island Linear Ft x 600) (Wall-Linear Ft x 550),(S-Island Linear Ft x700)
LLiquid tight external weld x 12"max hood length per exhaust riser(d) ?S_1 8 ga.steel or 20 ga.stainless ch
13upply air 5500 approx.replacement(d) __,Supply air 10 dg difference except for A/C(d) —Supply air hood damper(286 deg.max) ROOF
—Clearance 3"to Combustibles,Including 1'mineral wool (insulate the combustible not the hood) —insulation-Max Flame Spread Rating 25/x 0
jClearance 3'to Limited Combustibles(d) _Clearance 0'to Non Combustibles —Solid Fuel-Under separate hood
LChar Broilers-4'Min to hood _Solid fuel to have spark arrestors(d) 2L24*minimum all sides
LFryer-16'space to flame producing appliance or 16'high steel baffle x Elect.wire In conduit or EMT
x Filters to heat source 18' min x To flue 6'minimum(uprights,rotisseries,ovens,etc.) jClearance(Hood button to app.top)
2cfi"overhang on all sides x 7 ft maximum off floor x Maximum cooking surface temperature
x Listed hood installed in accordance with terms of its listing
x Manufacturer x Exhaust CFM
2LModel x Supply CFM
DUCTS NON TEMPERED MAKEUP AIR UNIT
LAirflow 1500 ft/minute minimum x 16 ga.steel or 18 ga.stainless x Field welds to be Bell or Telescoping(d) 2400 CFM
low
Dimension(LxWxH) Horizontal duct travels less than 75 ft(d) LDuct connections to have flush buttons(d)
jDuct exits bldg directly as possible(d) x-No exhaust dampers used x Duct pitched back to hood to collect grease
•Liquid tight external weld xShall not passs through fire walls INot insulated until inspected
•Ducts not shared by other systems x Sign-Access Panel-Do not obstruct
Clearance 3'minimum to combustibles,including 1'mineral wool,(insulate the combustible not the hood) LAt every direction of change
x_Clearance 3'to Limited Combustibles —Clearance 0'to Non Combustibles(d) LExterior-Weatherproofed
Panels-Unobstructed —Within 3 ft of each side of an inline fan
_20 ft horizontally(d) LDuct secured to the building
__Access door at vertical base
—Enclosures-In bldg.more than 1 floor,from ceiling above hood or through any concealed spaces,ducts shall be enclosed
-Penetrate floors and ceilings -6"duct to enclosure -Vented curb at roof PR
IThrough Penetration Fire Stop System as alternative to Enclosure with 6'airspace shall have a minimum of 3'including airspace,depending on mfr.(d) SECOND LEVEL
FAN
HEAVY DUTY KINDORF
LTerminates-at building exterior up and away from roof x 40 inches from roof FASTENED TO WOOD JOIST
LFan hinges away from duct with hold open retainer and flexible waterproof cables x Grease drains back to trap at fan 16*x 16'EXHAUST AIR DUCTWORK '"THREADED HANGING ROD
x Minimum 10'to air intakes,property lines,windows and doors or 3'vertical 2i_Safe acess area for servicing10'x 26"EXHAUST AIR DUCTWOFK FOR HOOD SUPPORT
Non-Combustible side wall fan termination ok,no opening 10'horizontal,down 32'vertical up,except char-broilers to bepermitted(d)
BAFFLE FILTER 1 FIRE MASTER GREASE DUCT WRAP HEAT SENSOR
------------------- ----
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L__---_- ------------ ECONAIR LISTED HOOD
ALL-ISLAND BLOWER & SHEETMETAL T-6- 12'-6'
1585C SMITHTOWN AVENUE
BOHEMIA, NY 11716 SHEET ROCK WALL ON METAL SIUDS ❑ HEAT SENSOR CONTROL
PANEL
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PHONE:(631)567-7070 CONTACT: MICHAEL HIGGINS
FAX: (631)567-6505 LICENSE#: 01488 36'FLATGRIDDLE
36* 36" 36' 36'
FLAT 6 BURNER 6 BURNER 6 BURNER
RIDDLE RANGE RANGE RANGE
American Legion GROUND
51655 Main Rd, SIDE VIEW FRONT VIEW
Southold, NY 11971 SCALE:1/4'=1'-0' SCALE:1/4'=1'-0"
020-01-21 SCALE:1'=1'-0" DRAWN BY:P.F. I