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Home My WebLink About33273-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32905 Date: 02/27/08 THIS CERTIFIES that the building AUTO EXTINGUISHER SYSTEM (STREET) Block 2 GREENPORT (HAMLET) Location of Property: 61560 CR 48 (HOUSE NO.) County Tax Map No. 473889 Section 45 Lot 2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building permit heretofore filed in this office dated JULY 17, 2007 pursuant to which Building Permit No. 33273-Z dated JULY 24, 2007 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 INSTALLATION OF AN AUTOMATIC EXTINGUISHING SYSTEM IN KITCHEN OF EXISTING NURSING HOME AS APPLIED FOR. Tbe certificate is issued to SAN SIMEON BY THE SOUND (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPAR'nmIIT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED Authorized Signature Rev. 1/81 . 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: I. 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 fonn). 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 2/1 0 of I % 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: I. 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 I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwellin Swinuning pool $25.00, Accessory building $25.00, Additions to accessory building $25.0 ,Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - :iiI 00.00 3. Copy ofCertificatc of Occupancy - $.25 4. Updated Celtiflcate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - ReSidential $15.00, Cormnercial $] 5.00 Date. ~l{k New Constmction: _.___._ Old or Pre-existing Building: ~ _ (check one) Location of Property 0/700 I(DUTE '-/8 0ovT;Trx-Q House No. Street /. Hamlet Owner or Owners nf Ptopclty _ San ;;I>1P(J,,-~(J.e s;:t ~ 'y __ _ ______ _ __ ______ . , / # Suffolk Count) Tax ~lap No 10(10, Sect"", ---.!~tfJ._-=-- Block _ _ __ _ __ Lot <.., ____ __ Request for: Temporary Certificate ___ Fee Submitted: $ __~() ~ Final Certificate: __.k_ _ (check one) / / /~~ ~~ {~E Applicant Signature ~f? ~_1~1( CO -l '3dq 0 s FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 24, 2007 PERMIT NO. 33273 Z Date JULY Permission is hereby granted to: SAN SIMEON PO BOX 2122 GREENPORT,NY 11944 for : AUTOMATIC EXTINGUISHING SYSTEM AS APPLIED FOR at premises located at 61560 CR 48 GREEN PORT County Tax Map No. 473889 Section 045 Block 0002 Lot No. 002 pursuant to application dated JULY 17, 2007 and approved by the Building Inspector to expire on JANUARY 24, 2009. Fee $ 250.00 ,Lfu . Authorized Signature ORIGINAL Rev. 5/8/02 r . FIELD INSPECTION REPORT - DATE I COMMENTS \}J - vJ;;j FOUNDATION (1ST) ~~ \Y:i I\J ------------------------------------ r^~ FOUNDATION (2ND) ~~ ~ ./ Z 9 {;' U\~ q-f;; ROUGH FRAMING & O~ PLUMBING ~- --- - ~ _._-_.__.._.~- --._--- IIi c-______ ~ -- trj INSULATION PER N. Y. .., STATE ENERGY CODE - (j::J ':'\ :J <;) ~ FINAL - ADDITIONAL COMMENTS . fI\ !. 1- 2.4- Q? - --r~ ON >'1S~ P-A7 L€1 ~ /h ~ NZ7C).s ~ 0 JH--t::?L- ~T u..o ,~ 21 - (;)g -';:E I ~ f t;;..:>J .ON 5-YS~ P~&Sl . . ~~ <:::::)'L- h/C2-- C-9. ./;:::{ ,'" /L -=s -, 1 . "'-trj ~~ ~~ .., ~ 15 z z..~ :t5 ';j , J trj I "" -Ii IAJP)II.".,..J 2-/27/og /n /11- " r;f\J ;c -1Yll I -FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N.Y. 11971 TEL: 765-1802 Exanined... ........1.lxf ~.~7 Approved...........1..~ ~~'7 Pennit N::l. .J3.~l3.~ Disapproved alc ........... f..................... ......... ..~ .,... II- 4 . 5?i.............. .~..... - ." -', ....../~............. (fuilding Inspector) '-"'j : 7 APPLICATION FOR BUILDING PERMIT 7 BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEy....................... . CHECK ......................... SEPTIC FORM ................... NOTIFY: CALL ki3/.-.!f.? r-. 5: r"?~ MAIL To:1l.4T/::.?~~-t.<i~.'!.F:i1~ ... .?~. (!!~/,!.7??!'.~.. .1.'~7......... .. ?,q<f~ /!1.!I?P.?1?<':>')' N~.'((1ki Date.. .4!~1f?....,~.... I I ---.J a. 'This applicatioo DllSt be COJtlletely filled in by typewriter or in ink and suhnitted to the fuilding Inspector wil 3 sets of plans. accurate plot plan to scale. Fee according to schedule. b. Plot plan showing locatioo of lot and of buildings 00 premises. relationship to adjoining prenises or p.ililic streets or areas. and giving a detailed description of layout of property l1IJSt be drawn on the diagran wich is part of this application. c. The t;Ork covered by this application I'B)I not be C<JlIJEnced before issuance of fuilding Pennit. d. Upon approval of this applicatioo. the fuilding Inspector will issue a fuilding Pennit to the applicant. Such pennit shall be kept 00 the premises available for inspectioo throughoot the work. e. N::l building shall be occupied or used in Wale or in part for any p.rrpose ..t>atever until a Certificate of Occupancy shall have been granted by the fuilding Inspector. INSTRUCTIONS APPLlCATIlll IS IEREIlY MAlE to the fuilding Department for the issuance of a fuilding Pennit plI"suant to the fuilding Zone Ordinance of the Town of Southold, Suffolk Camty. New York. and other applicable Laws. Ordinances or Regulatioos, for the coostructioo of buildings. additioos or alteratioos. or for reDO\1al or dem:>lition. as herein described. The applicant agrees tei ~ly with all applicable laws. ordinances. building code. hwsing code, and regulations, and to adnit authorized inspectors on premises and in building for necessary inspections. ........:~.u . ...~X.Q~~j~:.f.f\~ (Signa~~""6t.applicant. 0 . if a corporation) .~1..t?J.Wr.~".'f-.1!."'!1.1. .. 7.#.~~1-~-m?:?rN.'f (Mailing address of applicant) /I'73Y State whether applicant is owner. lessee. agent, architect, engineer. general contractor, electrician, plwber or builder .. _.... 61!~.. /.7?~7i~.<<7:~N.. .~~r--!I!~.":~1-...................................................................... . 5~ 51H~ B'-l --n-te: 5~ ,~C. Nate of owner of preJUses .................................... ./.......... ............ .....!............... ... ..... .... (as 00 the tax roll or latest deed) ratioo, signature of duly authorized officer. .. .~.~~:>:/0:\.~f.!"i?1.~~ te officer) _ fuilders License N::l. Plwbers License No. -' Electricians License N::l. ..................... Other Trade's License N::l. .................... (,16'0 . . . t. ,-"" IfO"T~ ",;r c;d~AJ/"'ot<.r /IJ'y 1/<7"., Locatloo of land on wlch proposed work W111 be dooe...............................;t.................j........... I. !h1se liuber Street Hanlet Coonty Tax Map N::l. I!xx) Sectioo.... :Si.~....... Block ...?:-........... Lot .... Ari........ Subdivision ...................................... Filed Map N::l. ............... Lot ............... (Nate) 2. State existing use and occupancy of prenises and intended use and occupancy of proposed coostruction: a. Existing use and occupancy .... .~~-<<;~M.....dq~~. .............. ............. ...................... A Jc.~s-., / J _~ -v c;"_v,, I"";,,, /V ,'" ..",4. 1'-'1(}""~ 'lC,\ot.~.I.:''."",' ,,'} ................................................................................. 4.......... .t.i!d:~.~~'~..':'.~~"~.~',!.~"tlr.''''.'''''''''' ~;1i1,""1 Jf..<>.;.' . JS'O'?' III'.'.,..; f!< "kt,;jl.. -) ..~.,_.t ,. t;~~;~''f'i.;;r;"J:.,;<:~d1~la b. Intended use and occupancy ,~. '.. Mature of work (check wlid, applicable): New &ilding .......... Addition.......... Alteration.. "". ..... Repair............ Rmoval ............. Denvlition ............ Other Work ~~f1f!--: /J.~T.;~1r:f~.. ~~:..r:~f!t.Z. ~1'1'&^,e; (Description) 57:;,..,.., 7.v k-r.,.,..-", Estill..ted Cost......................... fee .............................................. (to be paid on filing this application) If a;elling, ruriJer of dwelling ,mits ............ lumer of a;ell ing ,mits on each floor ................ If garage. tulber of cars ...................................... If husiness,ccmnercial or mixed occupancy, specify nature and extent of each type of 1ISe.. /!.JI#-!>.J?:lf.. /jQ":'.4.. Dimensions of existing structures, if any: Front................ Rear ............... Depth ................. l1eight ......................... lUIher of Stories ...................... Dimensions of same structure with alterations or additions: Front ............... Rear ............... Depth.................... lleiWlt .................... lbtber of Stories............... Dl1nensions of entire new construction: Front ................ Rear ............... Depth .............. l1eight ......................... lUIher of Stories ..................... Size of lot: Front.................... Rear .................... Depth .................... 1. Date of Purchase ..................... Nare of Former Oroer ........................................ I. Zone or IISe district in wtich premises are situated .............................................................. ~. DJes proposed constructioo violate any zoning 131) ordinance or regulation: ........................ l. Will lot be regraded .................... Will excess fill be raroved frcm premises: YES NJ ',. Nates of CM1er of prenises Y.A~.~F~f.f1l".~.)'.!':~Y...,::~;.f:fifre8sb.~:f~.1'!'~::.7'"!.t.q;ytf~~:.":T.... Phone 't:b.t~:.-.?'.~~~.7-:~D Nare of Ardlitect .................................... Address .............................. Phone N::>. Nane of Contractor ................................... Address ............................... l110ne N::>. 5. Is tilis property within 300 feet of a tidal wetland? * YES .......... NJ...~... *IF YES, !Ul11DD nm 'IlmSlllE.o; mIMIT MI\Y IlIl 1lI:QJIRED. PLOT DIAGRAM locate clearly and distinctly all buildings, .....,ther existing or proposed, and indicate all set-back dimensions ran property lines. Give street and block lUIber or description according to deed, and show street oanes and indicate hether interior or corner lot. rA1E ex' I>I;W yew, c' ? - SS JlNIY ex' .~.~...f~.\.~....6 ....~~9.~~~t- .~f.9~~~~:l:'6~being duly swom, deposes and says that he is the applicant 'i<m! of individual signing con ract) JOVe named, , is the.... ..... .~~;..... ...................... ...................... ..... ........ ..... (Contractor, agent, corporate oUicer. etc.) ( said owner or OWT'<!rs, and is duly autl10rized to perfonn or have performed tile said work and to ,,",ke and file this pplicatiol1; titat all staterents contained in this application are true to tlte best of his knowledge and l,elief; and Ilat the work will be performed in tIle ""'mter set forth in the application filed therewith. ""m to before Ill? this J . ........l.~~~..\~ay~ ul~ "'i1~.?;~<;O.1 N::>tary Public.. ~= . f,;,,'. rv... IlalIIY No.4 ClIR~~luIW "ff.ll- (Signature f Applicant) AG,o - 6(20011 ~ ~12- CXJI~L G~- 611- 00'-:" (2. I '0 AES MANUFACI1lRER: I<.IDIJE \~W\. - 'IS 12001::' L)O F' Y-::,120022 L 'f' It. - 1':,11- C:O.;(l{ SQ[ 1.o~,,] Piping Hat<rlal ,<;C11';'0 /S.K. Supply Pipe SI1e :/1<.- Gas Valve type: /lJEC:-J-f Size Detector Terrgerature rating: A~ _ 6~,,] Branch -,-, ~ Jt(Jo _ kiax Rise Pipe She s-i;- Hanufacturer l4-~ Quant i ty: Hood Hood size: /...3/_~I;>c 4".><. z" Size: Duct Size: Duct Size: EQ1lIPMENT TYPE DUCT PlENUM QoN:j (. RANGE GRJDDlE WOK FRYER So.lo~ UPRlGHT GAS RAn cl"'U0,,,,it"f ( ElECTIUC RAIl LAVAROCK NATURM/MLS MLSQ1l lIT LOGS QllAN1ITY SURFACE ~ ill # 1:2.' 'i ....:3o~..>c /(, '/ NOZZlE HEIGHTS LOCATIONS / 1 :2/' , ..,,::)0"'.>( /(, I; ADP /:y- '8''1 ADP ::J~4)(Z't" !t7)cZif4 L02: / 110-20 ~-r 10-+1 CENTER 13--18 PERIMEIER /'OtA,-,- S7ATrofIJ 35-56 CENTER 17-{S 2+-t8 2+-t8 1+-t8 2H8 2+-tS X Fryers to haveHigh Limit Control to shut off fuel at 425 deg: X Detectors shall ~ located OYer eVeij piece of equlpnent. X The System installed as per Sf>2f,'.....lfacturers spe~s. and the AHJ_ ~ The System has been instaLLed;,Js per UL300.. X The follo"ing functions to operate upon system discharge: '" Supply air darr.per closes * Gas fuel shuts off in kitchen .. Exhaust tan remains on * Electric fuel shut off under hood '" AU systems to activate slfT'.Jlt'anpously in same hazard <we<L Ill" f-ire Alarm shall activate if one '-5 tnstalled in building. ~ Hanual Pult is 10eMed 10-35 it from hood-and 3-5 ft 'from floor tZ. T01;o.N L~ J-W (, R MlP GRW PIENl1M - /-'\""-P 2- ..3bt"X J'iJ' ADP GRW - At.,o ADP - -- P1l:NUM ADP - %900 ABT Cylind~r;B12COO~ Control Head;B120C10 Pull Sr~tlon:9197463 Link X1t: <11")'70"", Micro 3wi~ch:919722e a.." V"lv,,:B12007-3 Cornar Pull"y;B84"648 Vent Plug:9197430 Di8ch"Xge ^d"pter:€449C8 DESIGN & FIRE PROTECTION. INC. 49 Montauk Hwy Center Moriches. New York 11934 (631) 878-4896' Fax (631) 878.5727 ( z~ 07 LOCATION; x- 403;; C. ISto Rou.,-", 4'"tI SAN 01""5.0'" /57 /he SOU,)" 0/?cEAJf'MT /V'I //<}"7"1 I CI1 If' Jlu;,v ~.E /:;Jt.'o...LE:'; ::3{,O. 11')P If <iA'- /lDr 1A.f'~It::;tfT J5~OXLEI{ 30~ "~x 3'(~' O/-fELP (L) A0P to. t SJ7,ELF ..:;{;o" ..3 t,p" ADr wHELP .L1R. j.PI< fZ../IIJG,e . -3.y".x.z~" :IRE It' ~ ':; ; ~EC" )P" , . ~I""'----' D~,-;.l~-t C. (}SV. - ,.: Lpl< Lf'R., ~ENCH -'-;p R",tJc.c -3~".x:.z'f" ~l .. '.' '73 0 -21.;Zc. " -f<;~~ . .""11 ". " iH: =D ,-,,:....... '_~'. .:)li\ll : MUST ,.0. .","\1.1. MEET THE _ ,.' ;THECODESOFNEW ""Ii S.: ,t :~:J' i~:'[SPO:'JSi8LE FOR .JUGN OR CONSTRUCTION ERRORS. OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY LPR., /lor LtP~::U'fl" ..5 RfIt.eR. .P14~i- 6rirr.rIJN R"'NtJ,~ 17":x.2..~" ..]o"i"X3""" ALL CONSTRUCTION SL!.;. ; MEErTHEREQUJREI'1Pi'" .~"' COG ".. . 0 ,. 'HE 'ES-OFNEWYOF1>\ STATE. UNDERWRITERSCERTIRCATE REQUIRED