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HomeMy WebLinkAbout38810-Z Town of Southold Annex 7/29/2014 ."ed OLN P.O.Box 1179 r 54375 Main Road �► fi Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 37047 Date: 7/29/2014 THIS CERTIFIES that the building EXHAUST HOOD AND/OR FIRE SUPRESSION SYSTEM Location of Property: 1950 Breakwater Rd, Mattituck, SCTM#: 473889 Sec/Block/Lot: 106.-9-6.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 4/25/2014 pursuant to which Building Permit No. 38810 dated 4/25/2014 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: hood and ansel system for existing building as applied for. The certificate is issued to North Fork Greek Com Assc (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Authorized igna re 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#: 38810 Date: 4/25/2014 Permission is hereby granted to: North Fork Greek Com Assc PO BOX 1162 Mattituck, NY 11952 To: install hood and ansel system for existing building as applied for. At premises located at: 1950 Breakwater Rd, Mattituck SCTM # 473889 Sec/Block/Lot# 106.-9-6.1 Pursuant to application dated 4/25/2014 and approved by the Building Inspector. To expire on 10/25/2015. Fees: COMMERCIAL ADDITION/ALTERATION $250.00 CO -COMMERCIAL $50.00 Total: $300.00 Building Inspector 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 Date. 10��1,7101 41 New Construction: Old or Pre-existing Building: f (chec one) / Location of Property: y� ��P /���,�ei /`f/� ' //'lam��rw c House No. Street / Hamlet Owner or Owners of Property: �le-e!` /�/' godo y C�c/l4t Suffolk County Tax Map No 1000, Section /Q 6 Block y Lot 6 . 1 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: $ plicant Signat 1 o��OF SO!/ly� SPY • �o TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE A CHIMNEY FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION ( ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLA ION [ ] CAULKING REMARKS: FV L-4- I/-- \ �S -7&rmo ��- -- © I� A v� ®� c N GL-1 OA) - i - ®V DATE INSPECTOR I ho��pF SO(/l TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE A CHIMNEY KFIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: 1 ov 2- DATE -7 - 14 INSPECTOR FIELD MSPS N REPORT DATA COMMENTS • .. W ►d FOUNDATION(IST) 0o FOUNDATION(2ND) • z Cl ROUGH FRAAMgQ& 04 PLUMING INSULATION PER N.Y. y STATE ENERGY CODE FINAL • 1 AD35' V 7—iO --1 �..�C ;10 Z* 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 3� I p Survey SoutholdTown.NorthFork.net PERMIT NO. i Check Scoe Form N.Y.S.D.E.C. Trustees Flood Permit Examined 20 Storm-Water Assessment Form All IS1811d Contact: ' Sheer Metal. Approved 20 156" C"Smitt-h I 4,e Mail to: Disapproved a/c 80hWft NY 1171 b — / -- Phone: 2b 1 1 i Building Inspector APR 2 v APPLICATION FOR BUILDING PERMIT 7 20—� INSTRUCTIONS -" a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets ofplans,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. (Mailing address of applicant) State whether applicant is owner,le see,agent architect,engineer,general contractor,electrician,plumber or udder o1 i,/{ lJ o✓t- Nim c Name of o ner of pr isesya/.ee t ©l 17/i 0 DSC' C � (As on the tax roll-or latest deed) If ant is a co ationjigna a duly authorized officer (Name an of corpo to officer) Builders License No. Plumbers License No. Electricians License No,. Other Trade's License No.:ire 1. Location of land on wJ�jc �osed yvork;11 e done: / / 0 © �'S .�,w yp % f 6 House Number Street Hamlet County Tax.Map.No, 1000 S.cction—i 0 Boca q Lot- Subdivision Filed Map No. Lot 2. State existing use and occupancy of pre 'ses d intended a and 9ccupancy of proposed construction: a. Existing use and occupancy i PK b. Intended use and occupancy 114f,4 ;d " 3. Nature of work(check which applicable):New Building Addition _Alte tion Repair Removal Demolition Other Work Q ��? (Description) 4. Estimated Cost 7 of,C. 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) /� ^� �/rSS: COUNTY OF Ju 11 c 1 91-11(A wt �,(" being duly sworn,deposes and says that(s)he is the applicant (Name of iifn�divi� ign. contract)above named, /� /� I (S)He is the �f! u�....1 l/ow(r Gt-4l�( e /7��/ (Contractor,Agent,Corporate Officer,etc.) 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 tha th work will be performed in the manner set forth in the application filed therewith. Sworn tq before me thi Z" da of f; 2 _ Notary Public Signature o licant Thomas O'Connell Notary Public-State of NewY=k No.01 OC6181625 Qualified in Suffolk County My Commission Expires Feb. L2M6 BADGER Certificate of Completion This is to certify that Patrick Turro An employee of Anderson Fire Equipment, Bay Shore, NY, USA an AUTHORIZED BADGER DISTRIBUTOR has successfully completed a certification training session covering design, installation, operation and maintenance and has demonstrated a practical knowledge of following Badger systems/products: Range Guard Wet Chemical Fire Suppression System Credit: Issue Date: 04/01/2014 Expiration Date: 03/31/2017 Chris M. Hopwood,Technical Training Manager Certificate No: 52909 This certificate is nontransferable. 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 FIRE EXTINGUISHER AND AUTOMATIC FIRE EXTINGUISHING SYSTEMS LICENSING BOARD CERTIFICATE OF REGISTRATION REGISTRATION #: 113 EFFECTIVE DATE: 01/31/13 EXPIRATION DATE: 1/31/15 ISSUED TO: NAME: Suffolk Fire, Inc. db.I,Ariderson Fire Equipment ADDRESS: 9 O'Neil Avenue Bay Shore, NY 11706 ENDORSEMENTS: Portable Fire Extinguishers High Pressure Hydrostatic Testing Dry/Wet Chemical Extinguishing Systems This Certificate of Registration Does Not Exclusively Recommend the Bearer C ISSIONER CHIEF FIRE RSHAL STATE OF NEW,YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Lkensed Insurame Agent of that Caroler la. Legal Name and.Address of Insured(Use street address only) lb.Business Telephone Nu ndw of Instued SUFFOLK FIRE INC (631) 665-6862 dba ANDERSON FIRE EQUIPTMEM' Ic.NYS Unemployment Insurance Employer Registration 9 ONEILL AVE Number of Insured BAY SHORE, NY 11706 Id.Federal Employer Identification Number of Inswed or Social Security Number 113-26-8460 2. Name and Address of the Entity Requesting Proof of 3a.Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) NEW YORK STATE INSURANCE FUND Town of Southold 54375 Route 25 3b.Policy Number of entity listed it box"la": PO Box 1169 DBL 5853 65 - 1 Southold, NY 11971 3c.Policy effective period: 10/02/2013 to 10/02/2014 4,Policy covers: a. All of the employees employees eligible murder the New York Disability Benefits Law b.Q Only the following class or classes of the employer's employees: Under penalty of perjury.I certify that I ani are authorized representative or licensed agent of the irismatice carrier referenced above and that the named instured has NYS Disability Benefits insurance coverage as described above. Date Signed 04/21/2014 g}. Joseph J. Masi (Signature of kwuranca o rder's■uthorbed rropmmmathw of MIS Uosmad insure rce A®arrt of that irmuranca o rrier) TelephoneNtimber (866) 697-4332 Title Director of Disability Benefits Insurance WORTANT: tf box"Aa"is cbecked.and this form is signed by the insurame carrier's authorized retaesentatne or NYS Licensed Insiaaace Agent of due carrier,this cetrificate is COMPLETE. Mail N directly to rbc certificate bolder. If box-41r is checked.this certificate is NOT COMPLETE for proposes of section 220.Subd.8 of the disability Benefits Law. It must be mailed for coarpletion to the Workew Conrpensatiott Board DB Plans Ameptaace Unit.20 Park Simi.Albany.Near York 12207. PART 2.To be cone by NYS WarkeW Compensation Boa (Onlybox"4b" rt 1 has bom chocked) State Of New York Workers'Compensation Board Accordu*to infornietioii n airtamW by the NYS Workers'Con4wi cation Bond.the above-tmnW unplow has complied with the NYS Disability Benefits Law with respect to all of his.-ber employees. Date Sillrmed By (Sipnarure of t\'l'S vtrorken'Compensation Board Employee) Telephone Nurniber Title Please Note:Only insurance carriers licensed to write NYS disability benefits insurance nce policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-124.1. Insurance brokers are NOT authorized to issue this form. DB IMI(5.06) Certificate Number 258585 Additional Illstiuctiolrs for Folm DB-1A20.1 By signing this forni theutstuance carrier identified in box"Y' on this fonn is certifping that it is insulin-the business referenced in box "I a" for disability benefits tinder theNew York State Disability•Benefits Law. The Insirance Carrier or its licensed agent will send this Certificate of Insurance to the entity,listed as the certificate holder ui box "T'. ?leis Certificate is valid for the earlier o one year after this form is approved br the insurance carrier or its licensed agent,or thepolic.v expiration date listed in bar "3c" Please Vote:Upon the cancellation of the disability•benefits policy ntdicated on,his form.if the business continues to be mined on a permit,license or contract issued by a certificate holder.the business must provide that certificate holder:t•itlt a new Certificate of'\-I'S Disability Benefits Coverage or other authorized proof that-he business is complying xith the mandatoreoterage requirements of the Nets York State Disability°Benefits Laic. DISABILITY BENEFITS LAW §220. Subd. 8 (a) The head of a state 0r municipal department, board. Collulllssiorl or Office authorized or required by law t0 issue ally perillit for or ill connection with ally Work inVolviIlc the employment of employees ill employment as defined 1Ii this article. 111(1 not witllstallClillg ally general or special statute requiring or authorizing the issue of sllcll perinits. shall not issue such per'init unless proof Cully subscribed by all insurance carrier is produced 111 a form satisfactory to tile chair. that tile paym1ent of disability benefits for all employees has been secured as provided by this article. Nothing herein. however. $11,111 be construed as creating any liability oil the part of such state or municipal department. board. colinilissi011 of Office to pity any, disability benefits to any, sllcll employee if so employed, (b) Tile head of a state or municipal department, board. colllini$sion 0r office authorized or required by law to eIlter into any contract for of ill connection with any work involving the employIllent of employees iii eillployinent its defined in this article. and 110tNvithstallding filly general or special statute requiring or authorizing any sllcll contract, sllall not enter into any, such contract Mlles` proof drily subscribed by all insurance Carrier is produced in a form satisfactory- to the chair. that the payment of disability benefits for all employees has been secured as provided by this article. DB-1-10.1 (5-06)Rei-erse New_York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 Phone:(631)7564300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^""^ 112195449 SUFFOLK FIRE INC T/A ANDERSON FIRE EQUIPMENT CO 9 ONEIL AVE BAY SHORE NY 11706 POLICYHOLDER CERTIFICATE HOLDER SUFFOLK FIRE INC T/A TOWN OF SOUTHOLD ANDERSON FIRE EQUIPMENT CO 54375 ROUTE 25 9 ONEIL AVE PO BOX 1169 BAY SHORE NY 11706 — SOUTHOLD NY 11971 ---T- [ POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE — 1 72323 107699 -_I 10/29/2013 TO 10/29/2015 4/21/2014_] THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 723 238-2 UNTIL 10/29/2015, 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 SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 10/29/2015 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. 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 jaa Aie, U DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling(888)875-5790 VALIDATION NUMBER:372084864 U-26.3 OP ID: KL CERTIFICATE 4F LIABILITY INSURANCE DA0411 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: N the certificate holder Is an ADDITIONAL INSURED,the pollcy(iss)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain Policies may require an endorsement. A stsbunent on this certlAcsb doss not conlor rights to the cwdit*W holder in Neu of such s. PRODUCER Phone:631-089-01CONTACT Hometown Insurance of U,Inc Weber rvNN Drive Agency Fax:631-589-01 5 OSuits 440 Bohemia,NY{1716 Diane Setter .ANDER-1 AFFOROING COVERAGE NMC I INSURED Suffolk Fir% .DRA eM Inc. W RtER A:AMh I s tuanCe Co. Anderson Fire 9 O'Neil Avenue INSURER° Bay Shore,NY 11706 INS IRER C: INSURER D: INSURER E: 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. Im TYPE OF INSURANCE EMSMIL POLICY NUIMIIER F,v M A OMMMY OY MPI LIMITS GENERAL LIABILITY EACH OCCURRENCE i 1,400, A X COMMERCIa.GENERAL LIABILITY MFPK06312109 04/2 0411114 0U2N'2015PREMISES(FA „,, s 100,004 CLAIMS-MADE DX OCCUR MED EXP(”one Perron) s 5, X BLANKET ADDL INSD PERSONAL a ADV INJURY $ 1.000, 00 ML001900 0806 GENERAL AGGREGATE $ 2,000, GERL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG i 2►00r X1 POLICY PRD` LOCCT i AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i ANY AUTO (Ea accident) eOO&Y NrAW(Par Parson) i ALL ONMED AUTOS — 90DILY INJURY(Par aoddork) i.. SCHEDULED AUTOS PROPERTY DAMAGE i HIRED AUTOS (Por aooidmt) NONAVMED AUTOS i i UMBRELLA LIAB OCCUR EACH OCCURRENCE i EXCESS LIAR CLAIMS-MADE AGGREGATE i — DEDUCTIBLE i RETENTION III i WORKERSCOMPENSATION VtC STATUTH- AND EMPLOYEW LIABEITY Y I N PER ANY PROPMETORJPARTNERIEXECUITIVE OFFICERMEMBER EXCLUDED? F NIA E.L.EACH ACCIDENT f (may M NH) E.L.DISEASE-EA EMPLOYEE i I d"Or be DE RIP V;PERATIONS ba w E.L.DISEASE-POLICY LIT i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Ahad,ACORD 101,Adisdarud Ranw to Schedwe,N more"we In m***M Proof of Insuranoe CERTIFICATEHOLDER CANCELLATION TOWN014 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of SOUtlIOId THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE VIII TH THE POLICY PROVISIONS. 54375 Route 25 P.O.Box 1169 AUTNORIZED rJWItE$BffATM Southold,NY 11971 /4 01968-2009 ACORD CORPORATION. AN rights reserved. ACORD 26(2009/09) The ACORD name and logo are regletsred manes of ACORD System Design 3-4.10 Two Burner Ranges Table 3-14. R Nozzle Coverage Area—Two Burner Range Items Parameters Maximum Hazard Length 28 in.(711 mm) Nozzle Aim Midpoint of hazard area Nozzle Location-Anywhere within the area of a circle 20 in. (508 mm)Min. generated by a 9 in. (229 mm)radius about the midpoint 42 in. (1067 mm)Max. Note: Shape of burner not important. 118 in.(457 mm)DIA. 1 42 in.(1067 mm)MAX. 1 (FROM TOP OF RANGE) I A`R'NOZZLE MAY BE I LOCATED ANYWHERE WITHIN i THE SHADED AREA I I I I I 20 in.(508 mm)MIN. ( AIM POINT.MIDPOINT OF (FROM TOP , OF RANGE) HAZARD AREA 28 in.(711 mm)MAX. HAZARD AREA 14 in.(356 mm)MAX.BURNER LENGTH CENTERLINE TO CENTERLINE Figure 3-11. R Nozzle Coverage for a 2-Burner Range April 2009 3-16 P/N 60-9127100-000 System Design 3-4.9 Four Burner Ranges Table 3-13. R Nozzle Coverage Area—Four Burner Range Items Parameters Maximum Hazard Area 28 in.x 28 in. (711 mm x 711 mm) Nozzle Aim Midpoint of Hazard Area Nozzle Location—Anywhere within the area of a circle 20 in. (508 mm)Min. generated by a 9 in. (229 mm)radius about the midpoint 42 in. (1067 mm)Max. Note: Shape of burner not important. 1 18 in.(457 mm)DIA. 1 42 In.(1067 mm)MAX. 1 (FROM TOP OF RANGE) i I A'R'NOZZLE MAY BE 1 LOCATED ANYWHERE WITHIN THE SHADED AREA I 1 20 in.(508 mm)MIN. _ AIM POINT:MIDPOINT OF (FROM TOP OF HAZARD AREA RANGE) i 28 In.(711 mm) jSURNER ' 14 in.(356 mm)MAX. MAX HAZARD BURNER CENTERLINE AREA LENGTHr TO CENTERLINE mm)MAX. NTERLINE ERLINE MAX.WIDTH Figure 3-10. R Nozzle Coverage for a 4-Burner Range P/N 60-9127100-000 3-15 April 2009 System Design 3-4.2 18-1/2 in. x 24-1/2 in. Deep Fat Fryer With Drip Board Table 3-3. F Nozzle Coverage Area Items Parameters Maximum Hazard Area 18-1/2 in.x 18 in. (470 mm x 457 mm) Maximum Appliance Area(with drip board) 18-1/2 in.x 24-1/2 in. (470 mm x 622 mm) Nozzle Aim Midpoint of module area per nozzle Nozzle Location(at an angle of 450 or more from the horizontal 27-1/2 in. (699 mm)Min. above each module) 45 in. (1143 mm)Max. Module Area(half of hazard area) 18-1/2 in.x 9 in. (470 mm x 229 mm) AN F NOZZLE MAY BE LOCATED 451 45 in, AN F NOZZLE MAY BE LOCATED ANYWHERE WITHIN THE GRID ANYWHERE WITHIN THE GRID (1143 mm) (1143 mm) MAX. MAX. DIAGONAL FROM AIM POINT 45 in. 451n. (1143 mm) (1143 mm) MAX. MAX. 27.112 In. (699 mm) IMAGINARY LINE MIN. DIVIDING MODULES MIDPOINT OF RE MODULE AREA FRONT OF 18.112 In, APPLIANCE (470 mm) + MAX. 91n. �_ 91n. (229 mm) (229 mm) � 24-1/2112. (622 mm) MAX. SIDE VIEW 2 F NOZZLES ARE REQUIRED FOR THIS APPLIANCE AN F NOZZLE MAY BE AN F NOZZLE MAY BE LOCATED ANYWHERE LOCATED ANYWHERE WITHIN THE GRID —� / WITHIN THE GRID NOZZLE LOCATION 45°OR MORE FROM HORIZONTAL(TYP) A ��a AIM POINT. MIDPOINT OF HAZARD AREA HAZARD AREA DRIP BOARD 18.112 In.(470 mm)MAX. 24.1/2 In.(622 mm)MAX. APPLIANCE AREA SIDE VIEW Figure 3-3. 18-1/2 in.x 24-1/2 in. (470 mm x 622 mm) Deep Fat Fryer PM 60-9127100-000 3-7 April 2009 System Design 3-6.1.1.2 Ducts 50 to 100 inches in Perimeter Two ADP nozzles, P/N 87-120011-001, pointing in the same direction are required for protection of ducts with perimeters greater than 50 inches and less than or equal to 100 inches. Ducts can be of unlimited length (refer to Figure 3-30). For other option of ducts up to 75 perimeter inches (See Figure 3-32). Note: All Range Guard systems are listed by UL and ULC for use with the exhaust fan either on or oft'when the system is discharged. DUCT YLZ HOOD � X X 1/4E'/2 ,/4x /zx %d 1/2d MAX.DIAMETER 31.83 In.(809 mm) -�-- 25 In. 635 mT m i NOZZLES TO BE ALONG ONE MAX.SIDE ) Q ♦ F ♦ ♦ CENTERLINE AT THE 114 POINTS. NOZZLES TO BE 0-6 In.(0-152 mm) UP FROM ENTRANCE OF VERTICAL DUCT MAX.DIAGONAL 11.78 In.(300 mm) MAX.DIAGONAL TYP.(2)ADP NOZZLES 11.78 In.(300 mm) SQUARE RECTANGULAR ROUND TL ADP NOZZLE i 0 to 6 In. 152 mm) 1 . DUCT ENTRANCE Cc OF VERTICAL DUCT - IL OF HORIZONTAL DUCT 2-4 In.(51 mm-102 mm) ADP NOZZLE �� AIM POINT NOZZLE TIP TO DUCT HIP VERTICAUHORIZONTAL DUCT Figure 3-30. Duct Protection Using Two ADP Nozzles, P/N 87-120011-001 April 2009 3-36 P/N 60-91271004000 System Design 4 ft. NOZZLE (1.2 m) DUCT 4 ft. DUCT ® 4 ft. NOZZLE 10 ft. 20 ft. (3 m) (6 m) 4 ft. NOZZLE (1.2 m)�/ "V" FILTER BANK COVERAGE "V" FILTER BANK COVERAGE 10 ft.(3 m) PLENUM 20 ft.(6 m) PLENUM NOZZLE 3/4 H H f "V" FILTER BANK COVERAGE(END VIEW) 4 ft. NOZZLE (1.2 m) DUCT �� t. DUCT B 4 ft. B NOZZLE / 10 ft. / 20 ft. (3 m) ® (6 m) 4 ft. NOZZLE SINGLE FILTER BANK COVERAGE SINGLE FILTER BANK COVERAGE 10 ft. (3 m) PLENUM 20 ft.(6 m)PLENUM -*11/31N1♦- 314 H� I♦ W SINGLE BANK FILTER COVERAGE(END VIEW) Figure 3-28. ADP Protection Nozzle, P/N B 120011 April 2009 3-34 P/N 60-91271004000 WON AN Wm to the Nowbg wd1 4�-1'-0" �(D UP-BLAST GREASE EXHAUST Now Mdwn XEAftq Mdm FAN WITH CFM OF 3200 $ RAID NLI�) X United C bIHSjrodc-meld skid) _Die(SjRoat-moodFNKM ) X QVIIfG PR=11 i i HR)-(SW day, adf ming, Are Wft wed ddoor .. InatataHon-1 h do POWER KILL SWITCH Z � _5pedof Sprhlder hata�ion-3j4 tr.ak _ 3600 CFM GREASE TRAP _KkC ttiTitOUT 1aPE7#!ti Protectives H ALL of the folaefig oompfy -Dvft taxtoin 24'HT.(tf.0 Ndajees Sped Sprtnider indd°fion ROOF DECK ROOF DECK HINGE KIT w Ekl of - OR- hood:*ftb 24' of'"draft rartain 6G' WAN safe X QAq Eebmd in EebmW*t:* o f i ter d=400.*�in tinaft RM , HOOD STEEL BRACKETS i � hE*Awd dm- ld {d) X E*owt dm- d) ..ptow dhl- (AS REMU) o>I�ei-aineor 360}.`ulnar t x 50D c" 'of0k• °y {So1d t suet d��t� 1,-x14• DJCT ' (Moelf-itnecr Ft x 400%(S-MW lumar Ff x 60) (1110114 or Fox ESDI(s-fiend throat ft x 706) I*w W 'tat said X IY awx hood per a rises(d) X 18 po.lded or 20 ties doi aL soh 50j50'OX �.(d) err 10�U*AA(� -&Wy*hood dwqw(286 ft ma) t mmm 3'to Cm*mdbles,knft i'miter l noel- poa ww 3•to Com6iatibte(d) _ _taadation-max Boma Sproad 25jx FRESH AIR TN-TAKE 00 BRCiM- 4 mkL to hood. _Said feat to has spark a ndo s( _Soil Fuai-oder hood FRM-16 tech teem to trams producing appWm or - hrgtt aced bdia GRAVRY FEED 10' AW FROM ANY I XtTl.�d asurm lias 18'raitttlaa �(To#us batten 6 treat oxen(uprights,rtrtiawIw averu, 2ND FLOOR 2ND FLOOR RETURN � EXHAUST FM fiUS'M bat"h aocardawe va tome of its��tgmmdnunn off bar: X 2�v�int�t _Nwahchm _ 14'x14" DUCT HEAT SENSOR IN _mom _�PPiy X td�hArsrt otla x m to a �) (REAR OF HOOD) FILTER BANK , DROP CEILING DROP CEILING XW�1)�7MK NN1�wIR1{ �(*xas"LrN Xi6 ga deet or 18 V StdrAm field gelds to bo ltd or T {d) SPAC R I �x�I 04 CLEAN �(�e rtw �as poaebie{d) XX Horfsontal deet irsvd that 75(d)01 WWIQCad coneclims to pitd bond to��gr mei "�\" ��� OUi Dulls not shoed b�yyother systems R=O 36• E& p t ' QFJVRet 3'ttdrtirsen to carabsadbie; irtdudiay flit fw6tetali tint teals ..Nat)lwetiotad ar►fi 5 r _ BAFFLE GREASE FILTERS 42" 3' SPWALL AtR XQEWAICE-r to MW� _Cfwam- 0'to two oombveft X ACM PMnS- � _ib 3 R each dde of an fine tri X ST srAWLFss 16 GUAGE FULLY WELDED KITCHEN r- Sigrpt-eccesa Pout- Do tfot Obstract STM � GREASE EXHAUST HOOD ��CLIP �it 6ar§aaa*t { �r X 6 �Aceese Boar d+�e�ttm ban $ �iearred to DOUBLE�"SHEET ROCK ON _OfCLOS M-is bldg.mos Lha►1 Naar,from cdkq drove hood or any ooacsaied spooes, duets ehoi be atdosed. Hoop OVER in uEf SlAINLESS�WITH '�- PmdnAe foots and a hump -6 in iw duct tod and c m , »Y*id curb at naafi COOKING f D(IEWR WALL CONCREFE X Ttrouah tie Senn as dtanutrvs to 6 EQUIPMENT BY o o fl .,y �.dde�?i shah fwMe o 1 3' d W0M dvwwN an 6" MIN. ON F ALL SIDES �CimmlEs-at Nuall oximes,w ansa MM hm roof X 40 irldtea lam root FLOOR 1 FLOOR Foe Wrqu any from duet v%hold open mtAw dr tori:lraterproaf eebk X am=drains book to at fan X td�I'fie dr+tea,prgxrtr tip,.aha"doors a 88,untied X soda nese,area tar FRONT VIEW CROSS SECTION _too—Cate aides+call fan(amination Ok no apentn o W hcrtwt4 dose 32'reheat up, accept 6w-kdem tc Wadhed SCALE 1/4"=1'-0* SCALE `Vy FN61N� , r - �� Pegasus Englneeiing 6 Nadavorny Lana StoTTy Brook, N.Y. 11790-2100 www.pegasus-englneehng.org CONTRACTOR• ALL-ISLAND BLOWER BLOWER & SHEET METAL 1585—C Smithtown Ave., Ave., Bohemia, N.Y. 11716 LICENSE # HDLO1488 ! CONTACT: Brian Higgins 1-631-567-7070 LOCATION: Transfiguration-Christ Greek Orthodox 1950 Breakwater Rd.Mattituck NY 11706 r DWG BY: CHECKED BY: SCALE: - B.H. AS SHOWN AES MANUFACTURER: RANGE GUARD: RG 1.25 GAL. X RG 2.5 GAL. RG 4 GAL. RG 6 GAL. SEAL TIGHTS (TYP.) Piping Material BLACK SCH 40 Max. Rise 10' Supply Pipe Size 3 8" Branch Pipe Size 3 8" DROPS 3/8" TEE Gas Valve Type: MECH Size 1" Manufacturer ASCO 14"x14" DUCT OUT Detector Temperature Rating: 360' & 450' 9' HOOD BACK OF HOODJCOHEADC VENT PLUG Hood Size: 9' Duct Size: 14"x14" EQUIPMENT SURFACE NOZZLE ®— — — — — �_ — — — — QTY. TIP#/QTY. LOCATIONS 360' ADP !450* ADP 360' NTRL TYPE AREA HEIGHTS o ♦ F- — — — — —ADP I DUCT 1 14"x14" ADP 2 0"-6" 0"-6" IN OPENING �., L J � I PLENUM 1 g' ADP 1 0"-6" FROM END OF PLENUM F_— — T- — — T — — — — — — — — RG i ( 6 BURN. RANGE 1 36"x28" R 2 20"-42" CENTER I 2.5 I I FRYER 1 14"x23.5' F 1 27.5'-45' 45' TO 90' I I I GAL. I I RANGE GUARD - RG 2.5 GALLON - MAX. FLOW POINTS 8 FRYER 6" POINTS USED 7 10 GUARD MIN. TO EDGE I TOTAL PIPE VOLUME NOT TO EXCEED 139 CUBIC INCHES OF HOOD ON BOTH SIDES PULL MAX. PIPE LENGHT o3.4 FT. w STATION RG-2.5 GAL. CYLINDER #60-120002-001 36"x28" L_ m l of Q CONTROL HEAD #13120099 6 BURNER -n q- 40"x29" 1" MECH. GAS <r MOUNTING BRACKET #9197263 CONVECTION OVEN VALVE I f Q RANGE ,.; o ADP NOZZLE #87-120011-001 v_ NO SHELF � 3 — F NOZZLE #87-120012-001 R NOZZLE #87-120014-001 DUAL SPDT #9197228 (�(� VENT PLUG #9196984 v 1 LINK HOUSING #804548 FRONT VIEW A FIRE MINIMUM RATINGSHER OF A CITH A LASS K 360ULINKELEASE NK �WK_282664-000 SCALE: -875572 %8"= 1'-0" MUST BE INSTALLED WITHIN THE 450' LINK #WK-282663-000 VICINITY OF THE COOKING AREA. 1" GAS VALVE #6120072 SUM STAMP NOTES: Anderson Fire x Fryers to have High Limit Control to shut off fuel at 425'. 9 O'Neil Ave., Bay Shore, N.Y. 11706 x Detectors shall be located over every piece of equipment. x The System installed as per manufacturers specs and the AHJ. Tel: 631-435-1002 x The System has been installed as per UL300. x The following functions to operate upon system discharge: Contact: Patrick Turro * Supply air domper closes * Gas fuel shuts off in kitchen s s"crNe�gfti * Exhaust fan remains on * Electric fuel shut off under hood oA * All systems to activate simultaneously in some hazard area. �+ PEGASUS ENGINEERING * Fire Alarm shall activate if one is installed in building. y x Manual Pull iS locoted a maximum 20 ft. from hood and 4 ft. 6 Nodworny Lone, Stony Brook, N.Y. 11790-2100 from floor. PLANNING A BETTER WORLD x All fuel sources are GAS unless otherwise noted. * . 631-751-6600 y v WWW.PEGASUS.ENG.PRO UNAUTHORIZED ALTERATION OF, OR THE ADDITION SEAL - TO PLANS OR DOCUMENTS BEARING THE SEAL JOB SITE: OF A LICENSED PROFESSIONAL ENGINEER IS A VIOLATION OF SEC110N 7209, SUBDIVISION 2 OF THE NEW YORK STATE EDUCATION LAM. - Transfiguration Christ Orthodox Church ANY ALTERATION To THIS DOCUMENT MUST BE DONE BY A PERSON ACTING UNDER THE DIRECT SUPERVISION OF A LICENSED PROFESSIONAL IN - 1950 Breakwater Rd.,Mattituck, N.Y. 11952 ACCORDANCE WITF, THE STATE EDUCATION LAW. COPIES OF THIS DOCUMENT NOT MARKED WITH AN ORIGINAL OF THE PROFESSIONAL ENGINEERS DATE: TSCALE: DWG BY: DWG N0 INKED OR EMBOSSED SEAL SHALL NOT BE 04/16/14 I AS SHOWN A.X.C. 1 CONSIDERED TO BE VALID TRUE COPIES.