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Home My WebLink About35294-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall SouthoId, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34251 Date: 04/02/10 THIS ~K'rIFIES that the building SPRINKLER SYSTEM (#3) Location of Property: 61560 CR 48 GREENPORT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 45 Block 2 Lot 2 Subdivision Filed Map No. LOt No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 4, 2010 pursuant to which Building Permit No. 35294-Z dated JANUARY 13, 2010 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 SPRINKLER SYSTEM (PHASE 3) TO EXISTING BUILDING AS APPLIED FOR. The certificate is issued to SAN SIMEON BY THE SOUND (OWNER) of the aforesaid building. SUFFOLK COUNTY D]{PARTI~NT OF HEALTH APPROVAL E~ECTRICAL c~RTIFICATE NO. PLU~ERS c~KTIFICATION DA'r~u N/A N/A N/A /~~ ~au"t~~' ~ horized Signature Rev. 1/81 TOW BUILD APPLICATION FOR This application must be filled in by typewriter or ink A. For new building or new use: 1. TOWN OF SOUTHOLD and submitted to the Building Department with the following: 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. 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 uatural 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. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupuncy- $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Da~. March 26, 2010 New Construction: Location of Property: Old or Pre-existing Building: xx (check one) 61700 Route 48 House No. Owner or Owners of Property: Suffolk County Tax Map No 1000, Section 4 5 Subdivision Permit No. ~>~5' ~)--0'~ Lt Date of Permit. Health Dept. Approval: .3~e~ Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Street Block 2 Filed Map. Applicant: Underwriters Approval: Lot 2 Hamlet Lot: Final Certificate: XX (check one) Applicant Signature Department: Vendor: Telephone: San Simeon by the Sound 61700 Route 48 P. O. Box 2122 Greenport, N.Y. 11944 PURCHASE RECIUISITION QUANTITY COMPLETE DESCRIPTION UNIT PRICE Shipping & Handling (Estimated __ EXTENDED TOTAL_ :)ATE REQUESTED:Si~ I ~ DATE APPROVED:'~/~//" ~ DATE ORDERED: DATE RECEIVED: REASONS NF~=n;nICOMMENTS: REASON FOR DISAPPROVAL: REQUSTED BY: APPROVED BY: ORDERED BY: RECEIVED BY: (1) DISTRIBUTION ACCOUNT CODE $ /__Cost Center FORM NO. $ 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) PERMIT NO. 35294 Z Date JkNUARY 13, 2010 Permission is hereby granted to: SAN SIMEON BY THE SOUND PO BOX 2122 GREENPORT,NY 11944 for : PHASE 3 SPRINKLER SYSTEM TO EXISTING BUILDING AS APPLIED FOR at premises located at 61560 CR 48 County Tax Map NO. 473889 Section 045 pursuant to application dated JANUARY Building Inspector to expire on JULY GREENPORT Block 0002 Lot No. 002 4, 2010 a_nd approved by the 13, 2011. Fee $ 250.00 Authorized Signature ORIGINAL Rev. 5/8/02 TOWN of SOUTHOLD OFFICE OF BUILDING INSPECTOR - Town Hall Receipt N~, '~-~538 Southold, New York11971 .............................................................. r~.~.~..~...~...~:~: .............. ::::;::::::.~ ........... ~ ....................................... ~ ............................... /1 O0 Dollars Fo~......2.~. ~_~:3.~5~_.......+.__._C..~....~_5._~k5......[ .............................................................................................. Fee for Fee for Fee for . Certificate r-i Sign I-I Flood DevdopmentPmt. n Building Permit ~ofOccupancy ,...._I~:~.~..~_~ .......................................... ~ ............................................................................... Building Department ~, s~,'.n INSPEcTION REPORT DATE COUNTS. . ROUGH ~G & PL~G ~D~ON~ cOUNTS FIRE SPRINKLER ASSOCIATES INC. 41 Mercedes Way, Suite 31 EDGEWOOD, NEW YORK 11717 (631) 254-2800 Fax (631) 254-2805. RE: ARE SENDING YOU ,Z~A~ached [] Under separate cover via [] Shop drawings '~nts [] Plans [] Copy of letter [] Change order [] [] Samples the following items: [] Specifications COPIES DATE NO. DESCRIPTION THESE AR.E TRANS~,~D as checked below: ,g~ For approval [] For your use [] As requested > [] For review and comment [] Approved as submitted [] Approved as noted [] Returned for corrections [] [] Resubmit [] Submit [] Return copies for approval copies for distribution corrected prints ~ FOR BIDS DUE REMARKS ~ ~-~ [] PRINTS RETURNED AFTER LOAN TO US COPY TO 12-02-08;14:57 ; TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN IIALL SOlfrllOLD, NY 11971 TEL: (631) 765-1502 FAX: (6.31) $outholdTown. Nori~Fork~et PERMIT NO. 918312542805 ; # 2/ 3 BUILDING PERMFr APPLICATION CHECKLIST Do you haw or need the ~llowias, before applying? Board of Ho&th 4 se~ of Buildiag Pla~ Survey Septic Form Stona-Watet A~csanent Form Mail to: APPLICATION FOR BUILDING PERMIT / INSTRUCI'IONS Date I r~/~0 a. Tlas application MUST be completely £fllo~ ia by typewriter or in ink and submitted to thc Buildi~ Iaspvetor with 4 sets of plans, a~cutato plot plan to ~e. F~ ac~ng to ~h~e. b. PI~ p~n show~8 l~a~n of Io~ and ofbuil~n~ on p~mis~, ~lations~p to ~jo~8 c. ~e w~ co~ by this applica~ ~y ~t bc ~o~c~ ~fom i~u~ce ofBufld~g P~t. d. U~a ~pmval of ~s ~pli~o~ ~ Bufld~ ~p~tor ~1 iasue a Bu~d~g P~t to ~ a~li~nt, Such a sh~l ~ k~t on ~e ~ a~ble for ~fion ~ou~out ~e wo~ [ e. NO building s~ll be ~i~ or mad in whole or ~ pa~ for any pu~ose what so ever until the Build~ isaes a C~ifl~t; of f. E~ ~g ~t ~11 ~ if thc work au~ofi~ has not co~ed witch 12 mon~s a~ the date of iss~ or ~s not ~ ~mpl~M ~ 18 moues ~m suvh ~, If no ~ning ~dm~ts or o~r m~htio~ aff~i ' BI DG DEP], pmp~ ~ ~ ~ct~ ~ ~e ~, ~c Bufld~g ~or may au~o~, ~ ~, ~e ~n~on efta p~it for TOWN 0~ SOUT~0[~ a~ition six m~. ~fi~, e n~ ~t ~ be ~u~. APPLICA~ON ~ ~Y ~E to t~ Bufld~g ~ for ~ i~ of a Build~g Pc~it pu~ant to Bufld~ ~nc ~n~ of the Town of ~ufltol~ Suffo~ County, N~ York, ~nd ot~r~pli~blc ~ws, O~in~c~ or Re~tiom, for &~ ~c6on Of bufl~, Mdi~o~, ~ alt~lons or for mmov~ or~liti~ a ~in ~d. ~ appoint a~s ~ ~mply M~ ~ a~lica51c laws, ~in~s, butl~ng ~c, ho~d~d ~S ~a~ons, ~d ~ Sta~ ~ ~pli~t is owner, 1~ agar, ~ ~nc~, g~ ~n~or, c1~, pl~b~ ~ b~ld~ (~ on ~¢ ~ mH or l~t d~) It :~limt is: ~o~ :i~:~ of duly :uthod~ o~ (Name and title of corporate officer) Buildam License No. Plumbcrs Lic~se No. Elec~icians Lic~se No. Other'lYade*s Liea~se No. Il Loca6on of land on which pro~s~ work will bc done: ~ ~...~ .,.~ ~1~/'00 ~_,.r~...~,~. ! ~R.~.~f~o~-t e . House Humbcx gtm~ ~ Hamlet County Tax Map No. 1000 So,,ion Subdivision ~r ~ Block, ~ Lot ~ Fil~l Map No. Lot. ~2-02-08;14:57 ; 916312542805 ; # 3/ 3 5. State existing use and occupmacy of pren~ses and intended use ~d occupancy of propesed constraetion: a. Existing use and occupanoy k~O ~..~ I !,~ ~.~ 3. Nature of work (check which applicable): New Building Repair Removal Demolition Addition Alteration Other Work Fee (To be paid on filing this applicaQon) Number of dwelling units on each floor 4. Estimated Cost 5. If dwcllin~ numbe~ of dwelling units If garage, number of cars 6. If business, commercial or mixed occupancy, specify natur~ and ~nt of each type of use, 7. Dimansions of ~xisting stmettues, if any:. From __ Height. Number of Stories __Rear Depth Dimensions of same structure with alterations or ariditions: Front .Rear Depth Height_ Number of Stories 8, Dimansions o f ant/re new construction: Front Rear Depth Height Number of Stodos 9, Size oflot: Front Rear .Depth 10. Date of Purchase Name of Former Owner 11. Zone or usc district in which promis~ ar~ sitvated 12. Does propos~ construction violate any zoning law, ordinance or regulation? YES NO__ 13. Will lot be re-graded? YES__ NO Will excess fill be removed from premise.~? YES 14. Names of Owner of premises Ad~. .Phone No. Name of Architeet Address Phone No Name of Centraetor. Address Phone No. NO 15 a. Is this property within l O0 f~ of a tidal wetland or a freshwater wetland? *YES__NO __ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PF_2.MITS MAY BE REQUIRED. b. ls this property within 300 feet of a tidal wetland? * YES NO__ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide suwey, 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 survcy. 18. Are there any covenants and re~'ictions with respect to this propeW//* YES.__ · IF YES, PROVIDE A COPY. NO STATB OF ~ YORK) SS: COLrNTY OF ) ~e of ~ ~ c~t) ~ ~ (C~or, ~t, Co~mte Offi~, ~.) Sw~to~f~ ~ I / t ~U~WILBE~ ~ Z /~i ~ ~ ~ / N~4375 ~ ~ Si,~ of~ Qualified in Su~oik Commission Expires ~ ~~¢ ~ " ReceiptCopy Page 3 of 3 SUFFOLK COUNTY OFFICE OF CONSUMER AFFAIRS PAYMENT RECEIPT I RECEIPT NO. 223542 I Rec'd From: D/B/A: Date: M MAUSSER FIRE SPRINKLER ASSOCIATES INC 11/9/2009 12:53:00 PM Payment Type: No: Drawn On: CHECK 53520 CHASE Category Service Fee Violation Slip No Remarks 4 - Plumber, Rest. C - Lic. Renew. $200.00 PLUMBER LICENSE MARK MAUSSER This certifies tflat the "~" ~ by the County of Suffolk D~,,~ ~,,~¢~,.,~,.. 43834 - R PI 12/03/2007 co.,~=~ e,~.~.e. ~,~ 1~/01/2011 REC'D BY: _icense# / Registration#: DM ~.3834 TOTAL: Remarks: ;200.00 Customer copy NOTE: PLEASE SIGN SIGNATURE STRIP ON BACK OF ID CARD! Suffolk County Executive's Office of Consumer Affairs This is to certify that MARK MAUSSER Has duly qualified by examination and is, therefore, entitled to receive a RESTRICTED PLUMBER the provisions of the Suffolk Co~ty Occupational Licensing Law. Res~ictions Model G4A Quick Response Concealed Bulletin 154 RevF Automatic Sprinkler The Concealer® UL Quick Response FM Standard Response Concealed Sprinkler With a 1/2" (13mm) or 11/2'' (38mm) Adjustment Features 1. Cover plate attachment with ~" (13mm) assembly adjustment. 2. Smooth aesthetic ceiling profile. 3. Factory installed protective cap. 4. Available in brass, chrome or black plated and white painted finishes. 5. Ordinary temperature rating. 6. Multiple orifices for design flexibility. Approvals & Listings 1. Underwriters Labortories, Inc. (UL)- Quick Response 2. Underwriters Laboratories of Canada (ULC)- Quick Response 3. Factory Mutual Research Corp. (FM)- Standard Response · Light Hazard Occupanicies- No Umitations · Ordinary Hazard Occupancies Groups 1 & 2 Wet Systems Only The Model G4A Concealer~ is designed for use where aesthetic appearance is important. Offices, hospitals, motels and restaurants are but a few of the applications where it can be used. It is available in different odfice sizes albwing the designer to optimize system performance, thereby achieving a very efficient installation. The Model G4A ConcealeP is a UL Listed Quick Response Concealed sprinkler intended for use in accordance with NFPA 13. FM Approves this sprinkler as a standard response concealed sprinkler intended for use in accordance with FM Loss Prevention Data Sheet 2-8N. 4. NYC MEA 258-93-E - Quick Response U.S. Patent number 4,880,063. Application The Reliable Model G4A Concealer® is the most versatile quick response concealed sprin- kler available. It provides the best form of fire protection while offering an attrac'dve appearance and 1/2" (13mm) of cover adjust- ment for ease of installation. The small diameter cover plate as- sembly is easily attached and blends into the ceiling, concealing the most dependable fire protec- tion available, an automatic sprinkler system. Product Description The Reliable Model G4A Concealer~uses a proven quick re- sponse fusible element in a standard style sprinkler frame with a drop-down deflecto~ This assembly is recessed into the ceiling and concealed by a fiat cover plate assembly. The threaded enaaaement provides ~/2" (13mm) of cover adjustment. The flat co~er"plate is attached to the skirt using either 135°F (57~C) or 165°F (74°C) ordinary temperature classification solder. When the ceiling temperature rises, the solder holding the flat cover plate melts, the flat cover plate released thus exposing the sprinkler inside to the rising ambient temperature. The subsequent fusing of the element opens the waterway and causes the deflector to distribute the water. Any secure engagement between the cover plate and cup will assure that the drop-down deflector is propedy located below the ceiling. The Reliable Automatic Sprinkler Co., Inc., 103 Fairview Park Drive, EImsford, New York 10523 Installation Do not install the G4A Concealer® in ceilings which have positive pressure in the space above. · Cut a ~ inch (67mm) diameter hole is cut in the ceiling, the sprinkler is easily installed with the Model G4 Wrench. The wrench has drive tangs which insert into the cup slots. When installing a sprinkler the wrench is first positioned into the sprinkler/cup assembly until the wrench tangs engage the dr'rye slots in the top of the cup (there are two sets of drive slots in the cup). The sprinkler is then tightened into the pipe fitting. When inserting or removing the wrench from the sprinkler/cup assembly, care should be taken to prevent damage to the sprinkler. DO NOT WRENCH ON ANY OTHER PART OF THE SPRINKLER/CUP ASSEMBLY. install the cover plate by hand turning the cover in the clockwise direction until it is tight against the ceiling. A protective cap is provided to protect the drep-down sprinkler deflector from damage which could occur during construction before the cover plate is installed. The cap is factory installed inside the sprinkler cup. Remove cap to install sprinkler, then re-install cap until the cover plate is installed. Maintenance The Model G4A Concealer' should be inspected quarterly and the sprinkler system maintained in accordance with NFPA 25. Do not alean sprinklers with soap and water, ammonia or any other cleaning fluids. Remove any sprinkler that has been painted (other than factory applied) or damaged in any way. A stock of spare sprinklers should be maintained to allow quick replacement of damaged or operated sprinklers. Prior to installation, sprinklers should be maintained in the original cartons and packaging to minimize the potential for damage to sprinklers that would cause improper operation or non-operation. Technical Data Total '" Nominal Sprinkler Inlet Adjustment II Orifice Non Adiustable W' (t3mm) I W' (15mm) Non Adiustable W' (13mm) '! ~." (1lmm) ! Non Adiustable i W'(13mm) ~"(10mm) Adiustable 1V2" (38mm) V2" (15~ ....... Adjus_t~.!e ...... ~W~.~_ .3¢__mm~ ........ ~! (.! ~mm) Adjustable 1W' (38mm) ~ 10mm Ordering Information 1. Sprinkler Model 2. Nominal Orifice 3. Flat Cover Plate Assembly Finish 4. Inlet Type Cover Plate Finishes(q) Standard Finishes Bronze Chrome White Paint Special Application Finishes Bright Brass Black Plating Black Paint Off White Satin C. hrome (]~ Other finishes and colors are available on special order, Consult factory for details Model G4 Sprinkler Wrench UL Listing Category Sprinklers, Automatic and Open Quick Response Sprinkler UL Guide Number VNIV Temperature Rating I Classification Sprinkler Ordinary i 165°F/74'C b ntermediate 212°F/100°C Cover ! Max. Ambient Plate Temp. 135°F/57°C 100°F/38°C 165OF/74oc 150°F/66°C Nora na K Factor _ Sprinkler U~""'"~ M~t'~[~'""l ,,Thread, Appr°vals I Identlfcaflon (SIN) 5.6 / 80 V~ NPT(RF~) t,2,3,4 R5415 42 ] 60 Y2"NPT (RV2) 1,2,4 R5413 2.8 ~ 40 i V2 'NPT (R~/2) 1,2,3,4 [ R5411 5.6 _J_ 80 1" NPT Male or Female 1,2,4 I R5418 ~]-'-- 60 111NPT Male or Female 1,~,~ ] ~.5..~j~ Fig.1 - V~" NPT Non-Adjustable Inlet Fig. 2 - 1" NPT Mare-Adjustable Inlet Fig. 3 - 1" NPT Female-Adjustable Inlet Manufactured b~ Reliable The Reliable Automatic Sprinkler Co., Inc. (800) 431-1588 Sales Offices (800) 848 6051 Sales Fax (914) 829-2042 Corporate Offices www.r e]iables prin kle r cot n Internet Address Revision lines indicate updated or new data EG. Printed in USA 4/~7 P/N 9999970150 NUMBER SYMBOL: OF DESCPIPTION HEADS CONCEALED SPRINKLER HEAD RELIABLE MODEL K FACTOR: 5.62 1/2" -'I¢'~-DEOREE PIPING PROVISIONS FOR FLUSHING AND FLUSHED BEFORE CONNECTION ALL EQUIPTMENT APPROVED/LISTED FOR FIRE PROTECTION SERVICE FIRE DEPT. CONNECTIONS AND HOSE CONNECTION THREADS TO BE COMPATIBLE WITH LOCAL FIRE DEPARTMENT EQUIPTMENT FIRE DEPARTMENT CONNECTION TO BE ON A STREET FRONT OF THE BUILDING ACCESSIBLE FOR FIRE DEPT, AND WITHOUT BEING A POTENTIAL HAZARE ALL NEW SPRINKLER MAIN TO BE SCHEDULE .10 ALL SPRINKLER BRANCH PIPING TO BE SCHEDULE.40 ALL NEW MAIN SPRINKLER PIPING TO BE GROOVED WITH VICTAUUC COUPLINGS ALL BRANCH PiPiNG TO BE THREADED ALL REQUIRED SIGNS CONTRACTORS MATERIAL AND TEST CERTIFICATES FOR ABOVE GROUND AND UNDERGROUND PIPE SHALL BE SUBMITTED TO THE FIRE MARSHAL PRIOR TO THE APPROVAL OF THE INSTALLATION EXIS3NG 4" SPRINKLER~--._...._........~ EAST WING (PHASE 2) I I sINCOMING SERVICE(UNDERGROUND) / ®,URGE /-~---- 10" ELECT. BELL - LOCAT ON OF 2)~x2J~x¢ FO SIAMESE CONNECTION WEST WING (PHASE 1) NORTH ROAD (PT 48) SITE PLAN (NTS) 4 2~ A~4U~ ~e VALV~ 60t P. NATIo P-Xi I'ihI TO SPRINKLFR HD FLOW WIRED TO FA 4," RISER CHECK VALVE W/GAUGES & 2" MAiN DRAIN DRAIN PIPED OUT OF BLDG. ~" OSAY CONTROL VALVE~ 1ST FLOOR BELL (SYSEM SENSOR) MOUNTED OUTSIDE BLDG. & ~RED TO FIRE ALARM PANEL FD CONN. (18"-36" AMY ORADE) CHECK VA.W/ABM GRADE SOURCE RISER DIAGRAM (NTS) SPRINKLER NOTES 1) The installation, components, sizing, spacing, Iocatiod, clearances, position and lype of systems shall conform to NFPA-13. 2) As per NFPA-13, only approved materials will be used. ~) Piping specifications, pipe schedules, system test pipes,,protection against corrosion, damage, t'~ings, valves, hangers, spdnklem, guards and shields shall be in accordance with.NFPA-I 3. 4) Slcok of extra sprinklers will be fumisbed as per' NFPA*t 3 (Required for each temperature rating). B) Sprinkler alarm will be in accordance with NFPA-13. 6) Spacing, location and position o~' sprinldem will be in accordance w~th NFPA-13, 7} Sprinklem shal~ be ap a~pmved type as per NFPA-13. B) Temperature rating shall comply with NFPA-13. 9) All unde~mund plpklg to be installed as per NFPA-24. 10) All electric bells, wate~ew & tamper switches to be interconnected to the Fire Alarm System 11 ) All require~l signs to be installed prior to final inspection. 12) Cont~'actol's Material & Test CerlF~ates for abevegmund & uedergmued pipe shall be submitted to the Fire Mamhal prior th approval of the installation. 13) Fire D~partment Connes~lons & threads ti) be oompafible with local Fire Depedment equlpmenL 14) All p/ping to be flushed thru flushing connections provided In accordance with NFPA-13. FIRE INSPECTION t :OUIRED BEFORE UNDERWFilTER$ CE~IFICATE RfQUIRED REV# DATE DESCRIPTION INIT, ~Fire Sprinkler Associates inc. 4 t ~ercedes Way, Suite 3 ], Ed~ewuod, NY (63 l) ~54-2~00 Fax (631 ) 254-2805 DATE. t'?-./ta' DRAWN BY: SCALE: 1/8" = 1L 0" AUTOMATIC SPRINKLERS THIS SHEET TOTAL CONTRACT NO, SHEET NO ¢1~'/]