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Home My WebLink About51832-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT � TOWN CLERK'S OFFICE ` ►� .� 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#: 51832 Date: 04/16/2025 Permission is hereby granted to: Thomas J Mccarthy 46520 CR 48 Southold, NY 11971 To: replacement of an existing fire extinguishing system (Cai Hong Restaurant)as applied for Premises Located at: 46520 CR 48, Southold, NY 11971 SCTM# 55.-5-7 Pursuant to application dated 01/10/2025 and approved by the Building Inspector. To expire on 04/16/2027. Contractors: Required Inspections: Fees: Fire Sprinkler-Commercial $300.00 CO Commercial $100.00 Total $400.00 Building IrIsrector TOWN OF SOUTHOLD—FIRE MARSHAL Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 litt .,//www,� tit�lIL)Idtowiin .v FIRE PROTECTION SYSTEM PERMIT Date Received APPLICATION For Office Use Only tJ ILA PERMIT NO. 6t Building Inspector _ Applications and forms must be filled out in their entiretvincomplete applications'will not be accepted.WORK IS,N07"TO BE STARTED prior to the approval of plans and issuance of a permit. " Has a building permit been obtained for this project? ❑Yes Wo If yes,building permit# Date: cktt PROJECT I KOiAIATiON,, Project Address: Sra Q y SCTM# 1000- - S—# City: N �� Zip: 7 1 CONTACT PERSON INFORMATION: Name: k c t +G &�I l Mailing Address: 1"6 ka�'] ac64 A Phone#: C�CJ Email: ?70r 4Y4, rT Preferred contact method(select one):Ahone ❑Email CONTRACTOR INFORMATION: Name: t ntractor License#: 0�� - t Mailing Address: 5-9 7 Phone#: 6q I d Email: 5. re SCOPE OF WORK: Occupancy Description: ❑Assembly I3tasiness ❑Education ❑Factory/Industrial ❑Institutional ❑Mercantile ❑Residential ❑ Storage Description of Work: JeNew ystcm ❑ Existing System Modification Sprinkler/ Standpipe/Water Supply Fire Alarm/CO Detection Systems Other Fire Protection Systems (Check all that apply) (Check all that apply) (Check all that apply) ❑ NFPA 13,13D or 13R System ❑Manual ❑Automatic ❑ Smoke Control ❑Standpipe ❑ Fire Pump ❑Protected Premises(local) X_Wet or Dry Chemical/Clean ❑Supervising station Agent Number of sprinkler heads: ❑Central Station Kitchen hood/exhaust ❑ Other Floor Area(sq. ft.): 1 .............. i Check BOX After 1�eadiug: 1,the uridersig dire which is herein applied for is based on /C I 1—e C 17,,—o', ned,Understand that the issuance of A permit for the q the agreement to conform to all regulations and requiremerits,I further understand thatrion-compliance of said requirements,by myself or any officer or employee of the firm or individual Usted as the applicant on this form,shall be cause for revocAtional'said pertolt.Vpou revocation of said prrmit the applicant or any employee of the applicant shall be prohibited to conduct such'York for wbith this permit was Isitted,'rhe relasuance of a permit shall be based upon revievv of the circumstances;leading to the revocation.Any foist,statefflebt(s)made heroin are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law Application Submitted By(print name). authorized Agent DOwner AN -4 1 --..................... Company(if applicable): ............ Applicant Signature- I\e ate. I FIRE PR "ECTION SYSTEM PERMIT APPLICATION SUBMITAL INSTRUCTIONS Submit application only after reviewing the requirements for the specific permit for which you are applying(click the applicable link below). • FIRE ALAWN1 /(Al Bolq, MONOXIDE DETECTION WSTENNI ,suimrFrA1c,1.J1Drs1JNLs • F111E SPIZINKIX11 SN'STIKNI_suBmrrm.,c1,11pE1,1NEs • FIXEI,) FIRE Sl,)PPRESSION, 110OD& EXHAI)ST SYSJ'El"t[S SLIB51ITTAI,_(-,RJlDELJNES FEES A$300 permit fee is required for a non-residential permit.A$100 Certificate of Occupancy fee is required if the project is not part of an existing open building permit. All checks should be made payable to the Town of Southold. Permits,once issued,shall at all times be kept on the premises designated thereon with a copy of approved drawings and all related documentation required to obtain said permit. Installations subject to final testing,inspection and approval.Arrangements for testing/inspection shall be made by contacting the Town of Southold Building Department(631)765-1802. FOR OFFICE USE ONLY Amount Paid: I- 0'V Check No.: 157 Permit No.: Date: 4- 1 (0, ZC)Z Exp.Date: q-l� - Znll 2 SUFFOLK COUNTY DEPARTMENT OFTIREI RESCUE AND, EMERGENCY SERVICES ;RE PORTABLE FIRE EXT11'NGUISHER AND AUTOMATIC Ft EXTtNGUISRING SYSTEms LICENSING BOARD CERTIFICATE OF REGISTRATION % REGISTRATION #: 101 ----------------- EFFECTIVE DATE: 02/16/2023) PIRATION DATE: 2/28/2025 --w ISSUED TO: NAME: �b","t Metal & Fire Safety, Inc. Rail ADDRESS $8 road Avenue: 0 470brpok, Ni*1174t- 32 J Ap ENDORSEMENTS: 4 R haiiek Fire bdipgtitshew '77 Dr Xti Fled E ng6is _-ylie t--Chemia4 ffihng,Syste Clean n 4e,nt Extinguishing Systems This Certificate of Registration Does Not Exclusively Recommend the Bearer COMMISSIONER CHIEF FIRE MARSHAL NYSIF New York State Insurance Fund PO BOX 66699 Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 113339671 A'S SHEET METAL&FIRE SAFETY INC 1580 RAIL ROAD AVE HOLBROOK NY 11741 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER A'S SHEET METAL&FIRE SAFETY INC TOWN OF SOUTHOLD 1580 RAIL ROAD AVE 54375 MAIN RD HOLBROOK NY 11741 PO BOX 1179 SOUTHOLD NY 11971-0959 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11247 030-8 617155 02/03/2023 TO 02/03/2024 1/10/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE. FUND UNDER POLICY NO, 1247 030-8, 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, AND, WITH RESPECT" TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. 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.COItiMICERTICERTVAL.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. ALBERT DUSPIVA PRIES OF A'S SHEET METAL&FIRE SAFETY INC ONE PERSON CORP 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 STATYNS7NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 1008768057 U-26.3 /7--0N*N41 NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) 1 µ AAAAAA 113339671 ' A'S SHEET METAL&FIRE SAFETY INC 1580 RAIL ROAD AVE . HOLBROOK NY 11741 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER A'S SHEET METAL&FIRE SAFETY INC TOWN OF SOUTHOLD 1580 RAIL ROAD AVE 54375 MAIN RD HOLBROOK NY 11741 PO BOX 1179 SOUTHOLD NY 11971-0959 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11247 030-8 617164 02/03/2025 TO 02/03/2026 1/10/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1247 030-8, 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, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OIL CANCELLATIONS, OR TO VALIDATE.THIS CERTIFICATE,VISIT OUR WEBSITE AT HITTPS:IfWWW.NYSIF.COIbM/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. ALBERT DUSPIVA PRIES OF A'S SHEET METAL&FIRE SAFETY INC ONE PERSON CORP 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 STAT SUR NOE FUND 4 �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:743615381 U-26.3 CERTIFICATE OF LIABILITY INSURANCE DAT 1/10/2D/YYYY) 1/10/2025 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(ies) 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 endorsements . cow cT PRODUCER - Hometown Insurance Agency of L.I., Inc. PNONE _ 631-589-0100 � n�oy 631.589 0164 5 Orville Dr AIL Ste 400 DD ;fig rlshornr�towN�InsNrf) .com Bohemia, NY 11716 INSURE S nAFFORDING COVERAGE NAIc# Oom Bn ............ ...W__- .........- ........ ILkce�Se 6 INSURER A:Arch Insurance 11150 -- - ...e. ...D ASSHEET'-01 INSURED INSURER B: ...... m,.._....a ........._ A's Sheet Metal and Fire Safety, Inc. INSURILR c 1580 Railroad Ave _ u""' Holbrook, NY11741 INsuRk k: —. INSURER E. ....�. INSURER F r. COVERAGES CERTIFICATE NUMBER.,1062231086 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 REDU CED BY PAID CLAIMS. �_ _ _C ttN.7'N At3DtPOLICY EFF POLICY F.7tP LIMITS TYPE OF INSURANCE POLICYNUMBER. MMIO fYYYY M A X COMMERCIAL GENERAL LIABILITY MFGL10273603 6/20/2024 6/20/2025 EACH 0cCURRENCE $1 OOoxo0 CLAIMS-MADE 1 OCCUR ,PREMNS S Ee a.Is �n l_ $100,000 _.� MED EXP(A one nm PERSONAL B ADV INJURY $1,000,000 GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,OQCi„O S ,,,, .... ❑ PR0. ❑ PAOOUCTS COMP/OP AGG $'2,000,000 X POLICY JECT LOC OTHER: AUTOMOBILE LIABILITY EOa aSINrD SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) '.. $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS OPEIiTY'DAMA "' "� HIRED NON-OWNED $ a AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE. $ EXCESS LIAB CLANKS MADE AGGREGATE $ DI C1 RETE'NTIONS $ WORKERS COMPENSATION STEATUTE. . AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT $ FICER/MEMBEREXCLUDED? OF N/A IlMand#t Mandatory to NH) IT.E.L DISEASE-EA EMPL_OYEE'''.$ w..._.�.... _ NT yys6 de dbe�°Adew E L DISEASE-POLICY LIMIT '$ of aCRIPTIONOF OPERATIONS below LL DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION 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 Main Rd PO BOX 1179 AUTHORIZED REPRESENTATIVE Southold, NY 11971 , emw ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD a y t > e x _....�� ..� i., ra- ..�1 :::. ti 'A T! -i. lx �... ..�I1 ,1-..,.... _... ..._-,...1� E �...z.. I.. ,. r � ._,..r_.,... 1 vl I E ....�..1 t �. t ,'1 c �.1 1 Yi t t._..�... P .1.�en YSI _.. t 1,. ... 1 .... �.- � E.. I �.:.. .t.... � ...i 1i r...rT i f a u`t,..a f. 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