HomeMy WebLinkAbout36337-ZTown of Southold Annex
54375 Main Road
Southold, New York 11971
6/2/2011
CERTIFICATE OF OCCUPANCY
No: 34976
Date: 6/2/2011
THIS CERTIFIES that the building
Location of Property:
SCTM #: 473889
Subdivision:
COMMERCIAL ALTERATION
28905 Route 25, Cutchogue, NY,
Sec/Block/Lot: 102.-5-24
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
4/18/2011 pursuant to which Building Permit No. 36337 dated 4/20/2011
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:
Alterations to an Existing Commercial Business;
Storefront Remodeling, as applied for.
The certificate is issued to
Colgate Design Corp
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
ure
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 #: 36337
Permission is hereby granted to:
Colgate Design Corp. (aka, 7-Eleven)
Attn: Southland Corp
PO BOX 711
Dallas, TX 752219867
Date: 4/20/2011
To:
Alterations to an Existing Commercial Business;
Storefront Remodeling, as applied for.
At premises located at:
28905 Main Road (Route 25), Cutchogue, NY
SCTM # 473889
Sec/Block/Lot # 102.-5.24
Pursuant to application dated
To expire on 10/19/2012.
Fees:
4/18/2011
and approved by the Building Inspector.
CO - COMMERCIAL
NEW COMMERCIAL, ALTERATION OR ADDITIONS
Total:
$50.00
$274.80
$324.80
Inspector
Form No. 6
TOWN OF $OUTHOLD
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 su~ey 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
Date.
New Construction: Old or Pre-existing Building:
Location of Property: ~r~c~ C~ ~ ~C_..
House No. Street
Owner or Owners of Property: ~ A,.~ {.,,.~ a:~{~
Suffolk County Tax Map No 1000, Section \ C
Subdivision
Permit No. ~'~ ~-~2~15'7 Date of Permit.
Health Dept. Approval:
Block ~_
Filed Map.
Applicant:
Underwriters Approval:
(check one)
(~-~ Hamlet
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ~ ~ , ~'
Final Certificate:
(check one)
Applicant Signature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLI}, NY 11971
TEL: (631) 765-1802
FAX: (630 765-9502
SontholdTown. NorthFork. net
Examined ¢ ~ ~'0,20 [ I
Approved t~ ~ c~-'O ,20II
Expiration
PERM1TNO. )6~ 7
BUILDING PEKMIT APPLICATION CHECKLIST
Do you have or need the tbllowing, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
Trustees
Flood Permit
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date ~ [ 'of,
INSTRUCTIONS
,20 M
a. This application MUST be completely filled in by typewriter or in ink and submitled to die Building Inspector with 4
sets of plaus, 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 water~vays.
c. The work covered by this application may not be commenced before issuance of Binlding Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to die applicant. Such a permit
shall be kept on the premises available for inspection throughout die work.
e. No building shall be occupied or used in whole or in par[ for any purpose what so ever until die Building Inspector
issues a Certificate of Occapancy.
f. Every building permit shall expire if the work authorized has not commenced widiin 12 mondis after die 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, die Building Inspector may authorize, in writing, the extension oftbe permit for an
addition six months, Thereafter, a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance ora 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 inspection~/~4
t ~ (S]l~ofapplicantorname. ifaco~ration)
(Mailing address of a~ieant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor electrician, plumber or builder
Name ofownerofpremises -'4 ~[gOe..,~ ~3~Coe-s,._q
(As on the tax roll or latest deed
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No. [aox/ k4fi~4'~
PIumbers License No,
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
House Number Street Hamlet
County Tax Map No. 1000 Section ] C~c:~- Block &D--
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 ~'~ I~ - lq
Nature of work (check which applicable): New Building. Addition
Repair Removal Demolition Other Work
Estimated Cost ~l?~ ?00
If dwelling, number of dwelling units
If garage, number of cars
Fee
Alteration
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commemial or mixed oecupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front
Height Number of Stories
Rear
Depth
Dimensions of same structure with alterations or additions: Front
Depth Height. Number of Stories
8. Dimensions of entire new construction: Front Rear
Height Number of Stories
9. Size of lot: Front Rear Depth
Depth
Rear
10. Da~ of Purchase
Name of Former Owner
! 1. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO
Will lot be re-graded? YES NO )~ Will excess fill be removed from premises? YES NO
3.
14. Names of Owner ofpremises~...~Address ZS~,O~s ~'~-~- 6& Phone No.
Name of Architect Address Phone No
Name ofContractorO,~..Wtq t:~-~.& ~,~t~,~.~ ~ Address ~Phone No.
t 5 a. ls 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 X
· IF YES, PROVIDE A COPY.
STATE OF
COUNTY OF Co~:D~::) s)s:
~'~Oi ¢~ ~ ~O,D.-~ being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing co~'act) above named.
(S)He
is
the
L3 (Contractor, Agent, Corporate Officer, etc.)
of smd owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and file tht s~q~l
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will
performed in the manner set forth in the application filed therewith.
Sworn to?efore me thi3s~,
~dayof
t
Notary Public
SIg~loplicant
SCTM# 1000-- I00%~ '-~-- a°'-~t' Subdivision:
Property Address: ~"[r~O'3-- /~'~ /~
Date Submttted: Date Reviewed:
Owner: 7-11
Estimated Cost:
City:
Zone: Conforming?
~ Pre COs?
Building Permits (Open/Expired): BP -Z / C/0 Z- , Info:
BP__-Z / C/0 Z-__, Info: BP __-Z / C/0 Z- , Info:
Single & Separate Search Required? Y ~N~etermination:
1LEQ. Lot Size: ACT. Lot Size:
REQ. Front ACT. Front REQ Side ACT. Side
REQ. Height. ACT. Height
Project D es cription:
Waterfront? Y o(N~)?
If yes, water body.'--
BP__ ~Z / C/O Z- , Info:
BP__ -Z / C/O Z- ., Info: __
REQ. Lot Cov. __ ACT: Lot Cov. __
REQ. Rear PROP. Rear __
ACT
Panel# ~ Flood Zone: ~ Bulkhead/BluffDistance: '
ADDITIONAL APPROVALS REQUIRED
Suffolk County Health: Y o If yes, *Bed#: *Date: / / *Permit#:
- If no, certification required: Y or N Received: Y or N By:
NYS DEC: r~-wcga/Ts Y o~ Date: / / Permit #:
Southold Trustees: Y 0r~~ Date: Permit #:
Southold ZBA: Y o~'.~- Date: / Permit ¢:
Southold Planning: Y o~- Date: Permit ~: - Notes:
Town Landmark C of A: Y /__ *~S CODE Compliance (page 2):(Y}or N
~ / - ,. , ~ ~ , ~ /
Town Septic: Y o~,,~
or NJ Letter - Notes:
or NJ Letter - Notes:
- Notes:
Fee Structure:
Foundation: _ SF
First Floor: ~ ~,, SF
Second Floor: SF
Other: SF
Total: SF
Calculation:
+ Initial Fee: $ ~-.~0 , oO
+ Additional Fee ( ): $
SF X $ =$
+ Initial Fee: $
+ Additional Fee ( ): $
TOTAL: $ °q' 7 t../..., g o
NEW YORK STATE CODE COMPLIANCE CHECKLIST
CLIMATIC/GEOGRAPHIC DESIGN CRITERIA:
· Ground Snow Load: ~0_
Weathering: Severe__ Frost Depth: 36"__
Design Temp: 11 __ 'Ice Shield Underlay: YlgS .
USE/OCCUPANCY CLASSIFICATION:
· HEIGI:tT/FIRE AREA:
TYPE OF CONSTRUCTION:
DESIGN CRITERIA: ENGINEEREDfPRESCRIPTIVB
FULL FRAMING DESIGN ELEMENTS: Y/lq
HEADERS: Y/N WALL STUDS: Y/N
CEILING JOISTS: Y/N FLOOR JOISTS:
LUI~BER SPECIES AND GRADE: Y/N
Wind Speedl 120MPH__ SeismlcDesign Categoryi B .
Termite: M~H Decay: S-M
Flood Hazards:
GLRDERS: YfN
ROOF IL~?TERS: Y/lq
WI[N-DOW AND DOOR SCHEDULE:
· MISSLE TEST REQUIREB{ENTS: Y/N
EGRESS 5.'7 S,F.:
LIGHT 8%: Y/N
~rENT 4%: Y/N
NAILING/CONSTRUCTION SCHEDULE: Y/N
MEANS OF EGRESS: Y/N
PLUMBING RISER DiAG1LAM: Y/N
LOCATION OF FIRE PROTECTION EQUiPMENT: Y/N
TRUSS DESIGN: Y/N
CERTIFICATION: Y/N
ENERGY CALCS: Y/N
TOTAL COMPLIENCEON
(RETURN TO PAGE ONE)
To:
Letter of Transmittal
Permitting, Simplified"
Town of Southoid
Town Hall Annex Building
54375 Route 25
Southold, NY 11971
United States Permit, LLC
Date: Friday, April 15, 2011
From:
United States Permit, LLC
Daniel Savage
117 Hurt Drive SE
Smyrna, GA 30082
(p) 770.433.0169
(f) 1.888.316.0919
danielsavage@ uspermit.net
Hi Bob,
Enclosed please find:
-(1) Building Permit Application
-(1 ) Check ($250.00) to "Town of Southold"
-(4) Sets of Signed and Sealed Construction Drawings
-(1) MSDS Packet
-CI) 0~,' P~~ ~
The enclosed materials are for the 7 Eleven, located:
28905 Main St.
Cutchogue, NY
If you have any questions or need any additional information to review this project, please let me
Thank you,
~niel Sava~
U n~t~J-~s Permit
117 Hurt Drive SE
Smyrna, GA 30082
~t.net
www. uspermit.net
APR 1 8 201/
BLDG. DEPT.
__ TOWN OF SOUTHOLO
Josh Ruple
Powerhouse Retail Servicas
~01 East Main Street
Crowiw, TX 76036
817-676-6957
March 31, 2011
From:
Ed Fuscu
Director, Gasoline and Remodel Construction
7-Eleven, In~
Store Support Center
972-828.6702
Subject:
PermitUag Agent Authorization -Coloniai Update Project
Mr. Ruple,
Per our discussions, 7-Eleven has authorized the Colonial Update Project. As part of this
Initiative, minor project permittln8 may be required throagh the applicable jurisdictional
agencies. By way of this letter, 7*Eleven as Owner authorizes Powerhouse as the Project
Manager to secure such permits as 7-Eleveos agent for this project.
Please give me a call with any questions. We look forward to our joint effort towards updating
the store imagas associated with this project
7~Eleven, Inc.
COLONIAL STORM REMODEL
C~RR~NT STORt~ PHOTO
Cutchogue, NY
Material Safety Data Sheet
Nichiha Fiber Cement Products
Brick, Stone & Block Panels
Manufactured by:
Headquarters Address:
Telephnne:
Importer:
Address:
Telephone:
Emergency Phone:
Nichiha Corporation
18-19 Nishiki 2-Chome, Naka-Ku
Nagoya, Aichi 460-8610 Japan
81-52-220-5111
Nichiha USA, Inc.
6599 Peachtree Industrial Boulevard. Suite AA
Norcross, (iA 30092
770-805-9466
770-805-9466
Date Prepared: 12/01/2009
ACGIH TLV NIOSH REL OSHA PEL Proportion
H~ardous (mg/m~) (mg/m~) (mg/m~)
Components CAS# (resp./total) (resp./total) (resp./total) (weight %)
Calcium Silicate 1344-95-2 NA/10 5/10 5/15 30~55
Natural Organic
Fibers 9004-34~6 NA/10 NA/NA 5/15 10-20
Cry ~alline
Silica(Quartz) 14808-60-7 0.025/NA /)05/NA 10+(%sio2~2)* 3~18
30 + (%sio2 [ 2) **
*Respirable Total ** Tolal Dusl
These PE~. ~s were calculated using 29CFR~¥910 (Code of £~i*deral Regulation. "0S1£4
Boiling Point: ............ N/A Specific Gravity (H20=I): 1.t~:0.2
Vapor Pressure (mm Hg): N/A Melting Point: ........................ N/A
Vapor Density (AIR=l) ... N/A Evaporation Rate (BuO! Acetate-l) N/A
Solubilit). in Water: ..... Nil Reactivity in Water: Nil
Appearance and Odor: .... Sheet - No Odor
Flashing Point: .................... N/A
Flammable Limits: LF.L: N/A
Extinguishing Media: N/A
Special Fire Fighting Procedures: None
Unusual Fire and Explosion Hazard: None
IJEL: N/A
MSDS--Section 1 Page 1
Reactivity Data & Health Hazard Data
Stability.':
Incompatible
(Materials to Avoid): ..... Strong Acids
Hazardous Decomposition
Or Byproduct: None
Hazardnus Polymerization:
Conditions to Avnid: ..... N/A
Conditions to Avoid: ....... N/A
Warning Label Text:
This fiber ccmant product contains lbrms of silica and nataral organic fiber This prtxtuct docs not Ix)se a can-
cer risk in the manufactured state i lowever, dust generated should be controlled, follow the recorrm~endations
on the MSDS. inhalatk)n of crystalline silica dust can cause silicosis and lung cancer.
Route(s) of Entry:
Inhalation? Yes Skin? ...................... No
Ingestion? No Eyes? .................. Yes
Health Hazards (Acute and Chronic):
Acute - Dust may irritate upper respirator~ system and may abrade skin and e3cs Chronic - dust ma5' contain
silica in both respirable and inhalable size fractions: exposure to c~)rstallinc silica causes silicosis, hmg cancer
and pose other .significant health risks.
Carcinogenicity:
]'his product does not have a cancer n~ in the manufactured ~ate CLxstalline silica dust generated during handling
and installation can cause lung cancer.
NTP? ................ Ycs (rcspirablc silica) OSHA Regulated? ......... Yes (silica dust)
LARC Monograph? ....... Group I (silica)
Sign and S.~mptoms of Exposure:
Excessive exposure to product dust may cause upper re~l~iratory irritation
Medical Condition Generally Aggravated by Exposure:
Pre-existing upper respiratoL'y or lung di~ase such as, but not limited to. bronchitis, emph3 sema, and asthma. Smokin
can ag~'avate the effects of cxlx)surc to silica dust
Emergency and First Aid Procedures:
Inhalation - rcnnovc to fresh air Eyes and skin - flush with water, treat akio with moisturizer
MSDS--Sectien 1 Page 2
Precaution For Safe Handling and Use & Control Measures
Steps to be taken in case material is released or spilled:
Vacuum clean dust using vacuum equipped x,,ith [IEPA filter. Place dust in a closable container lbr disposal
or flush with water Do not dLa sweep
Waste Disposal Method:
Dispose in landfill. Comply with all local, state, and federal regulations Waste generated dunng applicalion.
deinolition, breakage or spillage are not classified hazardous wastes
Precautions to be taken in handling and use:
Ventilation - Use sufficient natural or mechanical ventilation to reduce the dust below the PEL for both
able and inhalablc silica
Other Precautions:
Wetu- goggles or fuce shield during cutting or fabricating Foi' pemonal protection measures, see Section VIII
Respirator)' Protection:
Respirator with }IE}~A cartridge as approved by NOISIt/OSItA. Personnel wearing air punlS'ing respirators
should tit-lest respirators in compliance with a written respirato~5' protection program in accordance wilh
OS[tA regulations, ~c 29 CFR§ 1910.134 and 42 Ck R§84. in addition, in circumstances in which the occupa-
titmal exposurc limit ma?,' be exceeded, always usc the ~commended protected device.
Ventilation
Local Exhaust: ....... As Appropriate Special: ............... None
Mechanical: ......... As Appropriate Other: Nonc
(When cutting this product, use a circulm' sm; ;xith du~l collector with }IEPA vacuum)
Protective Gloves: For comfort Eye Protection: ......... Safer; Glasses
Other Protective Clothing or Equipment: ........ None
Work/Hygienic Practices:
Avoid creating aud brcathing dust Practice g(×>d housekeeping to prcvent dust accumulation and propcrl.~
clean up dust spills. Wash m' vacuum clothing which has become dusB'
The forgoi~ it?fi~*?.ation is believed to be accurate as of the date qf this document; however; no wa~*'anO' or rep-
resentatio, with respect to this in~)rmalio, is inlemled or give.. ~Tchiha ~ X4, h~c. accepts no responsibiliO, a.d
disch~ims ali liabilit)' fi~r a.y harmfid ~bcts which mcO, be attrib.ted w erpaxure of silica. Customer users qf our
ptwducts must compl)' with aH applicable health and sq~'(v hm's, tu~tlatio.s and others, inclucting the O,$Tl.l [laz-
ard ('ommunicatio. ,5~anrtarrt
NICHIHA
MSDS--Section 1 Page 3
NICHIHA FIBER CEMENT BUILDING PRODUCT
MATERIAL SAFETY DATA SHEET
ldentit}': NicMha KuraStone
Section I
Manufuctured by: N[i'IIIIL\
T.l.phone No for information
Importer: Nichiha USA, Inc.
Ad.tess: (;659 Peachtree Industrial Boulevard, Suite',L\. Norcross, (lA 30092
Emergency Telephone No.: 770-805-9166
Section II - Hazardous Info.ants ~d E~osure Con,role
A(~(][It TLV NIOSH REL
Hazardous Components CAS~ (mg/m:) (mg/m:~)
(resp./totaD (resp./total)
( Si IA t
(mg/m:~)
(resp./total)
Section ~I - Physical / Chemical Characteristics
Boiling Point: N/A
Vapor Pressure (mm Hg): N/A
Vapor Density (AIR-l): I ',~ ~ {I 1
Solubildtyin Water: Nil
Specific Gravily (H2(t=I):
Molting Point:
Evaporation Rate (Butyl Acetate=l): N/A
Reactivity in Water: Nil
Appearance and Odor: Sheet - No odor.
Section IV - Fire and Explosion Hazard Data
Flashing Point: N/A
Extinguishing Media: N/A
Flammable Limits:
bl~;L: N/A
Special Fire Fighting Procedures: None
Unusual Fire and Explosion Hazard: None
NICHIHA FIBER CEMENT BUILDING PRODUCT
MATERIAL SAFETY DATA SHEET
Section V ' Reactivity Data
Stability: Unstable
Stab e [ X
Incompatible (Materials to Avoid): Stron~ acids
Conditions to Avoid: N/A
Hazardous Decomposition or Byproduct: Nono
Hazardous Polymerization: M'ny oecur [
V~i no! occu X
Conditions to Avoid: N/A
Section VI - Health Hazard Data
Warning Label Text: This fiber cemenl producl contains fbrms of' silica and fibrous glass.
This product does not pose a cancer risk in th(, manufuctured state, llowever, dust
gtmeration should be controled follow the r~ commendalion on the MSD$ Inhalation ofcryshdline silica
dust (:an cause silicosis and lung can(:er
Route(s) of Entry: Inhalation? Ye.__~s Skin?
Ingestion? Nc--) Eyes? Ye__~s
Health Hazards (Acute and Chronic): Acute ' Dust may irritale upper respiralorv svslem mad may
abrade skin and eSes Chronk: ' l)klsl may contain silica in bolh reslfirable and inhalable size fYactions:
exposure t ~ crys Ii le silica cause silicosis, lung (an( er and pose o her s gn fica ~t x a th risk.
--WARNING-- ~
Silica Dust Warning: NICHIHA products contain crystalline silica [a.k.a. sand, silicon dioxide], which is a common Earth's naturally
occurring mineral. Inhalation of crystalline silica into the lungs and repeated exposure to silica, can cause health disorders, such as
silicosis, lung cancer, or a potentially death depending upon various factors. To be conservative, Nichiha recommends that
whenever drilling, cutting, sawing, sanding or abrading the product, users must observe the following safety practices. 11 Use best
work practices to reduce airborne dust concentrations. 21 Use a fiber cement circular saw with a dust collector for cutting (e.g.,
Makita 5057KB). The dust collector must be connected to a HEPA vacuum. 31 Do not use compressed air for cleaning dust. 4]
Work outdoors where feasible, otherwise use mechanical ventilation. 5} Everyone handling Nichiha products or in the vicinity of
others using Nichiha products must wear safety glasses and properly fitted respirators prior to handling Nichiha products. Nichiha
requires that users wear a NIOSH[OSHA approved respirator with a rating of NIO0, 0100, PLO0, or RIO0 in accordance with
applicable government regulations and manufacturer instructions, 6] All employers must comply with the OSHA P£L and ACGIH
TLV-TWA, 71 Warn others in area. These requirements are designed to help minimize exposure to crystalline silica. We also
require that you read all instructions and warnings [including MSDS] prior to using NICHIHA's products, For further information or
questions, please consult the MSDS or your employer. The MSDS for Nichiha products are available at nichiha.com, at your local
dust generated during handling and installalim~ can cause lung cancer.
NTP? [,ARC Monograph? OSHA Regulated?
Y,s (respirable silica) Group ] (silica) Yes (silica (lust)
oxposure to silica dust.
Emergency and First Aid Procedures: Inhalation ' remove lo lYesh air Lyes and skin ' flush ~x~th
,\ ~'~h~ P)bor t Bmont ]~'oduel ](uraSto~o ALSWN (11/08) l~a~o 2 of,?
NICHIHA FIBER CEMENT BUILDING PRODUCT
MATERIAL SAFETY DATE SHEET
Section VI - Precaution For Safe Handlin~ and Use
Steps to be taken in case material is released or spilled: Vacuum clean dust using a vacuum
equipped with a H~PA filter. Place dust in a elosab]~ container for disposal or flush with water.
Do not dry sweep
Waste Disposal Method: Dispose in landfill. Comply with all l(~al, state, and federal reguration.
Waste generated during application, demolition, breakage or spillage are not classified hazardous wastes.
Precautions to bo taken in handling and use: Ventilation ' [;se sufficient natural or mechanical
w, ntilation to reduce the dust below the PI~:L for hot b respirable and inhalable silica.
Other Precautions: Wm)v goggles or f~ce shield during culling or f~bricating. For persona]
protection measurers, see Section ~]Ii.
Section ~,~ · Control measures
Respiratory Protection: t{esipiralor with klEI)A cartridge as apprpved by NOISkI/MSlfA.
Personal wearing air purifS'ing respirators should fit-lest r~spirators m compliam:e with a written
respiratory protection program in ascordance wilh ()SIIA regulations, see 29 CFR§1910.13:I
and 42 C[;R§84. In additionally, in circumstam:es in which the occupational exposure limit
may be exceeded always use t bt, recommen&,d protective devic~.
Ventilation:
Local Exhaust: As Appropriate Special: None
Mechanical: As appropriate ()thor: None
(Cut this product with *~ power saw equipped with vacuum dust catcher.)
Protective gloves: [:or comforl
Eye Protection: Safety Glasses
Other Protective Clothing or Equipment: None
Work/Hygienic Practices: Avoid crcaling anti breathing dust. Practice good heuse-keoping to
prevent dust accumulation and prnperly clean up dust spills. Wash or vacuum clothing which
has become (lusty
The thregoing information is believed to be accurate as t)f the date of this document: however
no warannty or representation with respect to this information is intended or given
Niehiha USA, lac. accepts no responsibility and dis(laim all liability tbr an5' harmful effects
which may be attributed toexposure of silica. Customer users of our products must cmnply with
all applicable health andsafety laws. regulation and others, including the OSHA Hazard
'Communication St adard.
MATERIAL SAFETY DATA SHEET
Material Name: Coronado Stone Veneer
FILE NUMBER: 001
SECTION 1: PRODUCT AND COMPANY IDENTIFICATION
PRODUCT NAME: Precast Stone Veneer
SYNONYMS: N/A
PRODUCT CODES: N/A
MANUFACTURER: Coronado Stone Products
ADDRESS: 1 t 191 Calabash Ave. Fontana~ CA 92337
EMERGENCY PHONE: (9091 357-8295 (7:00am~ 5:00pm PST M FI
FAX PHONE: (909) 357 7362
SECTION 2: COMPOSITION/INFORMATION ON INGREDIENTS
INGREDIENT:
Portland Cement Pumice and Lightweight Aggregate Sand and Aggregate Metal Oxide Pigments
CAS NO. 65 997-15-1 1332-09~8 t 4808-60-7 1309-37-1
OSHA PEL: 15mg/m~
30mg/m3 + (%$i0~+2) 30m~/m3 ? (%SiO~+2) 10mg/m:~
ACGIH TLV: 10mg/m~ N/A N/A 5mg/m3
Component Related Regulatory Information: This material contains crystalline silica and vadous iron oxide pigments.
Component information/Information on Non-Hazardous Components: As provided, this preducl is expected to produce minimal, ii any
hazards. However, if dusts are generated, these components may be present; this product would be considered hazardous under 29 CFR
1910.1200 (Hazard Communication)
SECTION 3: HAZARDS IDENTIFICATION
EMERGENCY OVERVIEW: No unusual conditions are expected from this product. Inhalation of dusts produced during
cutting, sanding or grinding of this product may cause irritation oi the respiratory tract
ROUTES OF ENTRY: Inhalation skin contact, eye contact, ingestion.
Issue Date 12/10/07
POTENTIAL HEALTI-I EFFECTS:
EYES; Dust from this produot may cause slight irritation to the eyes including redness, blurred vision and teariog.
SKIN: Dust from this product may cause itching, rash and short- term irritation.
INGESTION: Ingestion of this product may produce gastroinlestinal irritation and disturbances; however, ingestion of this product is unlikely
INHALATION:
Dusts from this product may cause irritation of the nose, threal and respiratory tract. This product contains crystalline silica. Prolonged and
repeated inhalation of respirabie crystalline silica may cause a chronic lung disease called silicosis. This disease is characterized by fibrosis
and scarring of lhe lung tissue which can result in a decrease in lung function, breathlessness, wheezing, coughing and sputum production.
Short- term overexposure to extremely high concentrations of respirable crystalline silica can produce acute silicosis. Acute silicosis is a
disease that can rapidly progress within months of initial overexposure and reportedly has caused death within 1 to 2 years.
ACUTE HEALTI-I HAZARDS: Irritation, itching, coughing wheezing
CHRONIC HEALTH HAZARDS: Silicosis as a result of exlremely high concentration exposures.
MEDICAL CONDITIONS AGGRAVATED BY EXPOSURE: Chronic respiratory or skin conditions may temporarily worsen from exposure to
dust from this product.
CARCINOGENICITY:
General Product Information
CRYSTALLINE SILICA: The International Agency for Reseamh on Cancer (IARC) recently reviewed existing epidemiological data
and concluded that crystalline silica inhaled in the form of quartz from occupatienal soumes is a known human carcinogen (Group
1 ) In making the assessment, the IARC noted that carcinogenicity was not detected in all industrial cimumatancos studied,
However, IARC reported that a majority of studies indicated an elevated mortality Ior lung cancer among silica-exposed workers
IARC noted that increased rates of lung cancer were reported among some workers in ore mines, quarries, foundries, ceramics,
granite and stone culling industries. The workers in some of these occupational studies were exposed to other potential respiratory
carcinogens such as arsenic, radon, diesel exhaust, polycyctic aromatic hydrccarbons or cadmium. The IARC reviewed animal
studies and concluded that there is sufficient evidence in experimental animals for the carcinogenicity of quartz.
Silica-crystalline quartz has resulted in liver, blood, and lung tumors in rats by inhalation, intrapedtoneal and intravenous injection,
intratracheal and intrapleural administration.
Component Carcinogenicity
ACGIH, IARC, OSHA, and NTP carcinogen lists have been checked for those components with CAS registry numbers
Iron oxide (1309-37-1)
ACGIH: A4 - Not Classifiable as a Human Carcinogen (dust and fume, as Fe)
IARC: Supplement 7, 1987; Monograph 1,1972 (Group 3 (not classifiable))
Quartz (14808-60-7)
ACGIH: A2 Suspected Human Carcinogen
NTP: Known Carcinogen (Select Carcinogen)
IARC: Monograph 68, 1997; (inhaled in the form of quartz or cristobalite from occupational sources)
(Group 1 (carcinogenic to humans))
2 Issue Date 12/10/07
SECTION 4: FIRST AID MEASURES
EYES:
immediately flush eyes with copious amounts of water for at least 15 minutes.
g irritation persists, seek medical attention
SKIN:
Flush skin wilh large amounts of waler.
If irritation persist, seek medical attention
INGESTION:
· Ingestion of this material is unlikely
If ingestion does occur, watch the person for several days to make sure that padial or complete intestinal obstruction does not occur.
Do not induce vomiting unless directed to do so by medical personnel
INHALA~ON:
~' It inhaled, immedialely relocate the abducted person to fresh air
~' If irritation persists, seek medical attention.
SECTION 5: FIRE-FIGHTING MEASURES
FLAMMABLE LIMITS IN AIR, UPPER: N/A
(% BY VOLUME) LOWER: N/A
FLAMMABILITY CLASSIFICATION: Non- Flammable
FLASH POINT: None
AUTOIGNITION TEMPERATURE: N/A
EX'RNGUISHING MEDIA: This product is non-combustible Use any extinguishing media appropriate tot the surrounding fires.
SPECIAL FIRE FIGHTING PROCEDURES: None identified
UNUSUAL FIRE AND EXPLOSION HAZARDS: None identified
SECTION 6: ACCIDENTAL RELEASE MEASURES
ACCIDENTAL RELEASE MEASURES:
CONTAINMENT PROCEDURES: Scoop up materials and put into a suitable container for disposal as a non hazardous waste Dust Irom dry
cotling, sawing, grinding, sanding or drilling of this material will settle out oi the a~r. If concentraled on land. it can be scooped up for dispesa)
as a non-hazardous waste.
CLEAN-UP PROCEDURES: Wear appropriate PPE during cleanup While avoiding generating dust during clean up, gather material and
place it in appropriate containers for disposaJ, Spill area should then be washed thoroughly
3 Issue Date 12/10/07
SECTION 7: HANDLING AND STORAGE
HANDLING PROCEDURES:
No special procedures are required for this material Care should be taken to minimize the generation of dusts and avoid breathing dusts if
they are produced. Contact with eyes and skin should be avoided
STORAGE PROCEDURES: No special procedures are required for this material.
SECTION 8: EXPOSURE CONTROLS/PERSONAL PROTECTION
EXPOSURE GUIDELINES: Permissible exposure levels lor this product mast be detieed in the workplace due to the combination of silica and
other constituents and condition of use. Unless otherwise specified, limits are expressed as eight-hour time-weighted averages (TWA).
VENTILA*RON: General dilution ventilation and/or local exhaust ventilation should be provided as necessary lo maintain exposures below
oesupaticnai exposure limits
RESPIRATORY PROTECTION: A propedy filled NIOSH approved dust respirator or equivalent should be used in any dust environment
and/or when mechanically altering product (sawing, cuiling, ddlling or other similar dust generating process). Use respiratory protection in
accordance with your company's respiratory protection program, local regulations and OSHA regulations under 29 CFR 1910.134.
EYE PROTECTION: Safety glasses with side shields should be wom. Dust goggles should be worn in excessively dusty conditions (See
ANSI Z87.1).
SKIN PROTECTION: Wear leather,' PVC or other appropriate work glove for type of operation.
OTHER PROTECtiVE CLOTHING OR EQUIPMENT: Wear appropriate foot protection that complies with ANSI Z4~ ~ atest edition).
WORK HYGIENIC PRACTICES: Avoid creating and breathing dust. Do no~ eat, drink or smoke in work areas
SECTION 9: PHYSICAL AND CHEMICAL PROPERTIES
APPEARANCE: Cured concrete product of various shapes, sizes and colors
ODOR: Not Applicable
PHYSICAL STATE: Solid
pH AS SUPPLIED: Not Applicable
pH (Other): Not Applicable
BOILING POINT: Not Applicable
MELTING POINT: Not Applicable
FREEZING POINT: Not Applicable
VAPOR PRESSURE (mmHg): Not Applicable
VAPOR DENSITY (AIR = 1): Not Applicable
SPECIFIC GRAVITY (H20 = 1): Not Applicable
4 Issue Date 12/10/07
EVAPORATION RATE: Not Applicable
SOLUBILITY IN WATER: Not Applicable
PERCENT VOLA~LE: Not Applicable
SECTION 10: STABILITY AND REACTIVITY
STABILITY: This is a stable material
CONDITIONS TO AVOID: Avoid dispersion of dust in air
INCOMPATIBILITY: None expected
HAZARDOUS DECOMPOSI~ON OR BY-PRODUCTS: None Identified
HAZARDOUS POLYMERIZATION: Will not occur
SECTION 11: TOXICOLOGICAL INFORMATION
TOXICOLOGICAL INFORMATION:
Dusts from cutting and drilling may cause mechanical irritation to eyes and skin.
Ingestion may cause transient irritation of throat, stomach and gastrointastinal tract,
Inhalation may cause coughing, nose and throat irritation, and sneezing.
· Higher exposures may cause difficulty breathing, congestion, and chest tightness.
COMPONENT ANALYSIS - LD50/LC50
No LDS0/LCS0's are available for this pro0uct's components
CARCINOGENICITY: See section 3 (Hazards identification).
SECTION 12: ECOLOGICAL INFORMATION
ECOLOGICAL INFORMATION: No data available for this product
SECTION 13: DISPOSAL CONSIDERATIONS
WASTE DISPOSAL METHOD: Precast Stone Veneer scrap is ctassiffed as a non-hazardous solid waste disposal Dispose of in accordance
with existing federal, state and local environmental regulations
RCRA HAZARD CLASS: Scrap Precast Stone Veneer as supplied do not meet any of the RCRA characteristics of hazardous waste
(ignitable, corrosive, reaciive or toxic), nor are they liste0 hazardous waste (40 CFR {}261 ].
SECTION 13 NOTES: Dispose of packaging material by either recycling or at an appropriate landfill,
5 Issue Datc 12/10/07
SECTION 14: TRANSPORT INFORMATION
U.S. DEPARTMENT OF TRANSPORTA'I~ON
PROPER SHIPPING NAME: Not regulated lor transport.
HAZARD CLASS: None
ID NUMBER: None
PACKING GROUP: None
LABEL STATEMENT: None
TDG Information
PROPER SHIPPING NAME: Not regulated for transport
HAZARD CLASS: None
ID NUMBER: None
PACKING GROUP: None
LABEL STATEMENTS: None
SECTION 14 NOTES: No additional information available.
SECTION 15: REGULATORY INFORMATION
U.S. FEDERAL REGULATIONS:
General Product Information
NO information available for the product.
Component Analysis
None o! this product's components are listed under SARA Section 302 (40 CFR 355 Appendix At, SARA Section
313 (40 CFR 372.65), or CERCLA (40 CFR 302.4).
SARA 311/312 HAZARD CATEGORIES:
Acute Health [lazm'd:
Chronic t lealth l lazard:
Fire Hazm'd:
Sudden Release of Pressure HaTm'd:
Reactive t lazard:
Yes (If dusts arc generated)
Yes (If dusts ,me generated)
No
No
No
STATE REGULATIONS:
A: General Product Information: No additional infinmation available
B: Component Analysis- State: The following components appear on one or nmre of the following slates hazardous substance lists:
Iron Oxide I~09 37 I Yes Yes Yes Yes Yes Yes
Quarlz 148a8-0} 7 Yes Yt's Yes Yes Yes Yes
6 Issue Date 12/10/07
SECTION 16: OTHER INFORMATION
HMIS and NFPA Category HMIS NFPA
Hazard Rating
Health t* 1
Flammability 0 0
Reactivity 0 0
NFPA Unusual Hazards: None
HMIS Personal Protection: To be supplied by user depending upon use.
DISCLAIMER: Reasonable care has been taken in the preparation of this information. In addition, the
manufacturer makes no warranty of merchantability or any other warranty, expressed or implied, with
respect to this information. The manufacturer makes no representations and assumes no liability for any
direct, incidental or consequential damages resulting from its use.
Key/Legend:
EPA = Environmental Protection Agency; TSCA = Toxic Substance Control Act; ACGIH = American
Conference of Governmental Industrial Hygienists; IARC = International Agency for Research on Cancer;
NIOSH = National Institute for Occupational Safety and Health; NTP = National Toxicology Program;
OSHA = Occupational Safety and Health Administration, NFPA = National Fire Protection Association;
HMIS = Hazardous Material Identification System; CERCLA = Comprehensive Environmental Response,
Compensation and Liability Act; SARA = Supertund Amendments and Reauthorization Act; DSL =
Canadian Domestic Substance List; EINECS = European Inventory of New and Existing Chemical
Substances; WHMIS = Workplace Hazardous Materials Information System; CAA = Clean Air Act
Revision Summary: This is a revised MSDS which replaces all previous Material Safety Data Sheets lbr this product.
Obtain a copy of C,.)ronado Stone Product MSDS sheet by calling (909) 357-8295 or sending a fax requesl to (909) 357 7362.
This is the end of MSDS # 001.
7 Issue Date 12/10/07
APPROVED AS NOTED
COMPLY wr-:'H ALL CODESOFL/--~O-II 8 ~ # -~' ~'~'7
AS REQUIRED AND r',~,,-',~,'-".,"" .'","-
NOTIFY BUILDING DEPARTMENT ,AT
, S~5:~0LDTOV~'NZE~. 765-1802 8 AM TO 4 PM FOR THE
.~~ ',T' ,'r ''~,^~~ F 0 LLOWlNG INSPECTIONS:
s___.~_~ ;BO^RD ~ FOUND^T,O.-'rWO
· //,../,,._...~_ ~~ ~ FOR POURED CONCRE'I~
.¢,..Y.$.~E~] 2 ROUGH- FRAMING, PLUM~ING,
STRAPPING, ELECTRICal. ~1 CAULKING
3 INSULATION
4 FINAL - CONSTRUCTION
MUST BE CO~Pt~ FOR
ALL CONSTRUCTION ~ li~l~
REQUIREMENTS OF ~HE ~.~)O~$ OF
EXISTING SIDING, PAINTED ~ ~ YORK STATE. NOT ~
EXISTING SHINGLE
ROOF
~:ASC,^ SOARD. ---~ .~-~- ~ in /: ........ -'~'~_~
PAINTED TO MATCH
SIERRA HILLS
EXISTING BRICK. ~
PAINTED TO MAT
SIERRA HILLS
' " , . " h- '~- ,. ,~ ::~ ~ ~: ~: ~-F~ ~:a:::~:~-- _m~-_
,3 1/2 X 1 NIOHIH
MATCH ....... ~li : '
10")~IO"SQUARECOLUMN. / EXISTINGSTOREFRONT / / / , -- ,/
PAINTED TO MATCH SIERRA ~ ~ I! 7 '~:-~L:--
fp, ONt ELEVATION
~1'-0" / ' ~"?"~' ~ ~'-'~-' ~ '
STORE7'ELEVEN#16440STORE REMODEL
25 MAIN ROAD
CUTCHOGUE, NY 11935-1217
COLOR MATCH SEALANT TO "OFF
WHITE" QUOINS (BY TITEBOND
WATHERMASTER OR OSI QUAD)
STAINLESS STEEL 2" TRIM
SCREW, RECESS AND FINISH
WITH SEALANT.
3 1/2"X 1" NICHIHA TRIM.
INSTALL AT 30 DEGREE ANGLE.
PAINT TO MATCH QUOINS
EXISTING BRICK VENEER
STAINLESS STEEL 1 5/8" TRIM SCREW.
ALUMINUM "Z" FLASHING
4"x 20 GA. +/- xl0. COLOR TO ; - 2.5 GA. GALVANIZED METAL
MATCH NICHIHA SANDSTONE - ~ LATH, 20" x 8'; CORNER BENT
i
FOR 10" OVERLAP EACH SIDE.
AUTUMN BROWN
MECHANICALLY FASTEN FURRING
STRIPS TO BRICK W/TAPCON
i ;"---'---- TAPCON 3/16" × 1 1/4"
3/16" X 1 3/4" FLATHEAD HEXHEADS W/3/16" WASHERS,
FASTENERS LOCATED ONLY AT
NICHIHA CORRUGATED SHIM BRICK MORTAR JOINTS
(APPROX. 8" C.C.) TYPICAL.
CONSTRUCTION
POLYURETHANE ADHESIVE
NICHIHA SANDSTONE -
AUTUMN BROWN
CONTINUOUS. MINIMUM 1"
ABOVE GROUND SURFACE
SCRATCH COAT, APPLY
MECHANICALLY FASTEN FURRING PER MANUFACTURER'S
STRIPS TO BRICK W/TAPCON
3/16" X 1 3/4" FLATHEAD
SPECIFICATIONS
CONSTRUCTION
POLYURETHANE ADHESIVE .------ TYPE S POLYMER MODIFIED
MORTAR - QUICK DRY
MATCH NICHIHA SANDSTONE -
AUTUMN BROWN, FOLLOW
__ S,DEW^LKELEVAT,ON WALL SECTION
WAINSCOTN.T.8. CAP DETAIL N.T.s.THROUGH QUOINS
7-ELEVEN STORE REMODEL
CONSTRUCTION DETAILS
25 MAIN ROAD
CUTCHOGUE, NY 11935-1217