HomeMy WebLinkAbout39515-ZNo: 37462
Town of Southold
P.O. Box 1179
53095 Main Rd
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
Date:
3/9/2015
3/6/2015
THIS CERTIFIES that the building EXHAUST HOOD AND/OR FIRE SUPRESSION SYSTEM
Location of Property:
SCTM #: 473889
44780 CR 48, Southold,
Sec/Block/Lot: 63.-1-24
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
1/21/2015 pursuant to which Building Permit No. 39515 dated 1/30/2015
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:
fire suppression system as applied for,
The certificate is issued to Tom's North Fork Prop LLC
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
LV
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AuthoriSignature
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N!pt.
No: 37462
Town of Southold
P.O. Box 1179
53095 Main Rd
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
Date:
3/9/2015
3/6/2015
THIS CERTIFIES that the building EXHAUST HOOD AND/OR FIRE SUPRESSION SYSTEM
Location of Property:
SCTM #: 473889
44780 CR 48, Southold,
Sec/Block/Lot: 63.-1-24
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
1/21/2015 pursuant to which Building Permit No. 39515 dated 1/30/2015
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:
fire suppression system as applied for,
The certificate is issued to Tom's North Fork Prop LLC
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
LV
G
AuthoriSignature
zed
TOWN OF SOUTHOLD
�,�tFFat,r �rr BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
�'r 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 #: 39515 Date: 1/30/2015
Permission is hereby granted to:
North Steak LLC
PO BOX 648
Bridgehampton, NY 11932
To: fire suppression system as applied for
At premises located at:
44780 CR 48, Southold
SCTM # 473889
Sec/Block/Lot # 63.-1-24
Pursuant to application dated 1/21/2015 and approved by the Building Inspector.
To expire on
Fees:
7/31/2016.
COMMERCIAL ADDITION/ALTERATION $250.00
CO - COMMERCIAL $50.00
Total: $300.00
W�'6�2�-
Building Inspector
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
5 d
�0 8ax
119
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.
New Construction:
Location of Property:
Old or Pre-existing Building: (check one)
Ll y -1 1z:d o C4<
House No. Street Hamlet
Owner or Owners of Property: !N 0 r4-�) LL .
Suffolk County Tax Map No 1000, Section CO3 Block Lot
Subdivision C
Permit No,?G S Date of Permit.
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Filed Map.
Applicant:
Underwriters Approval:
Lot:
Final Certificate: (check one)
Fee Submitted: $
Applicant Signature
FQUNDA�ON {1ST} .
FOUNDATION (ZND)
ROUGH FRrOMM &
PLUMBING
IMULATION PEP, N. Y.
STATE ENERGY CiDDB
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TOWN OF SQUTHAJLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTow%NorthFork=net
Examined:! 20
Approved / 20L
Disapproved a/c
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
PERT NO. 3 1 15
Board of Health
4 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Flood Permit
Storm -Water Assessment Form
Contact:
Mail
Phone:
Expiration 20,(A
uilding Inspector
APPLICATION FOR BUILDING PERMIT
Date / _, 20
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, 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 consii�C, ,isu3ifiings, additions; sr ns or for removal or demolition as herein described. The
appucaiu agrees w wuip►y wv i ai►,appiacavi� laws, u,ui i < ;',�i iu►cig wue, c►uusuig cuue, aiiu iebuiauuiw, aiiu w =IUL
authorized inspectors on ptenuses and in building for necesgat pections.
�
j II (Signature of licant or name, if a corporation)
i
x/770
CA4ailing address of appii
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
49 7 ED
P3 NOTED
Name of owner of premises Jl
U (As on the tax roll or latest deed) I
If applicant is a corporation, signature of duly authorized officer s 5
(Name and title of corporate officer)
Builders License No.
Plumbers License No _
Electricians License No._
Other Trade's License No.
1. Location of land on
House Number
proposed work will be done:
B P._
4
FOR POUR LL) 00'i,-; . -T
2. ROUGH - FRAMING, PLWP ,6!%S,
STRAPPING, ELECTRICAL & CAUL'KiNG
3. INSULATION
4. FINAL - CONSTRUCTION & ELECTRICAL
MUST BE COMPLETE FOR C.O.
Stream — z,115F TIQN SHALL MEET THE
/ REQUIREMENTS OF Hamlet THE CODS OF NEW
YORK STAT T RESPONSIBLE FOR
County Tax Map No. 1000 Section Block % IgyN OpTRl1GTI0N ERRORS.
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
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Re21oval Demolition Outer Werk f�Cji�S�-Q��
— 1 (Description)
4. Estimated Cost
5. If dwelling, number of dwelling units.
If garage, number of cars
Fee
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
Dimensions of existing structures, if any: Front Rear
Height Number of Stories
Depth
Dimensions of same structure with alterations or additions: Front Rear
Death Heiaht Number of Stories
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_
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.
NO
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)
SS:
COUNTY11OF )
Mlt%h.AUI I wj being duly swom, deposes and says that (s)he is the applicant
(Name of inndiVi"
r�, +signing
�contract) above named,
(S)He is the llJ�'jovcl«n�
(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;
Thai all siaiemenis coniained in ibis appiicaiion are true to the nest of bus knowiecige and beiiei; ana Uiai Uie work win be
performed in the manner set forth in the application fled therewith.
Sworn to before me this
day of a cw, c 2 5
V
N ary Public
Nd�- � -
Signa of Applicant
FNCootQaiy
Hrt STOPHER M ANGELO
Public - State of New York
NO.01AN5088456
ualified in Suffolk C unt
mission Expires
SUFFOLK COUNTY
DEPARTMENT OF FIRE, RESCUE AND EMERGENCY SERVICES
PORTABLE FIRE EXTINGUISHER AND AUTOMATIC FIRE EXTINGUISHING SYSTEMS LICENSING BOARD
CERTIFICATE CIE REGISTRATION
REGISTRATION #: 113
EFFECTIVE DATE: 01/31/13 EXPIRATION DATE: 1/31/15
ISSUED TO: NAME: Suffolk Fire, Inc.
dba: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 rISSIONER CHIEF FIRE RSHAL
e --
i
has successfully completed training for Applications, Installation, Maintenance
and Service of Protex Series H and Applications, Maintenance and Service of
Protex 2000 and is certified as an authorized Distributor for Restaurant Kitchen
Fire Extinguishing Systems.
Congratulations on a Job Well ''Done. �
_ t
_, racey J. Fuller 9' Vice President - General Manatter Kevin R. Mussack Vice President - Technical Instruction
Addirional Instnictions for Fonn DB -120. 1
By s4ning this form the insurance carver identified in box 'T' on this forth is cerrify* that it is insuring the business referenced in
box -la- for disability berieftts wader the New York State Disability Benefits Law. the Instv=e Carver or its licensed agent will send
this Certificate of Insurance to the entity listed as the cemficate holder in box "?". This Certfcate is valid jor the earlier o one near
after this jornr is approved btu rite insurance carrier or its licensed agent, or the poliq expiration date listed in bar "3c':
Please Vote: Upon the cancellation of the disabihry benefits policy indicated on this form if the business continues to be named on a permit, license or
contract issued bs a certificate holder. the business must provide that certificate holder with a new Certificate of XZ S Disability Benefits Coverage or
other authorized proof that the business is compl -mg with the mandatory coverage requirements of the New York State Disability Benefits Law.
DISABILITY BENEFITS LAW
§220. Subd. 8
(a) The head of a state or municipal department, board. commission or office authorized or required by law to
issue any permit for or in connection with any work involving the employment of employees in employment as
defined in this article. and not withstanding any general or special statute requiring or authorizing the issue of
such permits. shall not issue such permit runless proof duly subscribed by an insurance carrier is produced iln a
form satisfactory to the chair. that the payment of disability benefits for all employees has been secured as
provided by this article. Nothing herein. however, shall be construed as creating any liability on the part of such
state or municipal department, board. commission or office to pay any disability benefits to any such employee
if so employed
(b) The head of a state or municipal department, board, commission or office authorized or required by law to
enter into any contract for or in connection with any work involving the employment of employees in
employment as defined in this article. and notwithstanding any general or special statute requiring or authorizing
any such contract, shall not enter into any such contract unless proof duly subscribed by an 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 -120.1 (5-06) Rye° wse
AES MANUFACTURER:
PROTEX II _ L3000 _ L4600 X L6000
Piping Material BLACK SCH 40 Max. Rise 10'
20"X10" DUCT
20"X10" DUCT
Supply Pipe Size 1 2" Branch Pipe Size 3 8" Drops3 8"
HOOD SEALS (TYP.)
Gas Valve Type: MECH Size 2" Manufacturer HEISER
23' HOOD-\ NL2D
t
NL21)
7¢" SPLIT TEE
Detector Temperature Rating: 360' & 450'
-- - I
—
Hood Size: 23' Duct Size: (2() 220"x10"
®®-------+w--®
---
ca arRa
-----®----®----w------®---- — CONTROL
AD
EQUIPMENT SURFACE NOZZLE
TIP#/QTY. LOCATIONS
QTY.AREA
= 360' 360' 360• 360' 450' 450' 450' 360' 360'
-i C---------- I
Ir-----------------
I
NL1H I
TYPE HEIGHTS
DUCT 2 20"00" NL2D 1 2 0"-6" 0"-6" IN OPENING
N NL1H f NL1H f'
- - - - - - - -
CD
C:) I
PLENUM 1 23 FT. NLIH 3 0"-6" FROM END OF PLENUM
34"x18"
I
9 I
FLAT GRIDDLE 1 60"x24" NL1H 2 24"-48" ABOVE ANY CORNER AIM 12x12
SALAMANDER I i
-
I PROTEX I) I
FRYER 2 14"x23" NL2H 2 24"-48" CENTER
NL1H NL1H
NL2H
NL2H
NL1L NL1H NL1H NL1H
SYSTEM I
I I
SALAMANDER 1 34"x18" NL1L 1 - ABOVE GRATE FRONT EDGE
RAD. CHAR BROILER 1 60"x24" NI-1 H 3 24"-48" CENTER
6" MIN.
I
6 BURN. RANGE 1 36"x28" NL1L 3 13"-23 NZ" CENTER
TO EDGE OF
HOOD ON
NLI NL1 NL1L I +
BOTH SIDES
RPSMPULL
m
m
X
I STATION .
PROTEX II L6000
" 82
60"X24
60"X24"
38"X32" 36"X28" - I o
2 GAS
MAX. FLOW POINTS = 20 (20 USED)
_ M
FLAT GRIDDLE
_ -
o
WORK TABLE RADIANT CONVECTION 6 BURNER I
VALVE
MAX. PIPE VOLUME = 3465
N o
N
CHAR BROILER
OVEN RANGE
MAX. VOLUME BETWEEN FIRST AND
LAST NOZZLE 1313/SIDE
'-
FLOOR
L6000 6.0 GAL. CYLINDER RPSM PULL STATION
MB1 MOUNTING BRACKET 3234 FUSIBLE LINK 360'
MCH2 MECH. CONTROL HEAD 3235 FUSIBLE LINK 450'
FRONT VIEW
A FIRE EXTINGUISHER
MBP2 MOUNTING BRACKET 4200H 2" GAS VALVE
WITH A MINIMUM RATING
NUH NOZZLE MSDPDT2 ELEC. SW. TWO SW. ASSBY.
SCALE: 3/" = 1'-0"
OF 40BC AND CLASS K
NUL NOZZLE CO26 CO2 CARTRIDGE
MUST BE INSTALLED
NL21-1 NOZZLE 90KBS CORNER PULLEY
WITHIN THE VICINITY OF
NL2D NOZZLE
THE COOKING AREA.
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.
A 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 damper closes * Gas fuel shuts off in kitchen
s
* Exhaust fan remains on * Electric fuel shut off under hood
* All systems to activate simultaneously in some hazard area.
PEGASUS ENGINEERING
* Fire Alarm shall activate.
x Manual Pull is located a maximum 20 ft. from hood and 4 ft.
6 Nodwomy Lane, Stony Brook, N.Y. 11790-2100
from floor.
• PLANNING A BETTER WORLD
x All fuel sources are GAS unless otherwise noted.
•
a 631-751-6600
WWW.PEGASUS.ENG.PRO
UNAUTHORIZED ALTERATION OF, OR THE ADDITION
JOB SITE:
TO PLANS OR DOCUMENTS BEARING THE SEAL
OF A LICENSED PROFESSIONAL ENGINEER IS A
VIOLATION OF SECTION 7209, SUBDIVISION 2 OF
THE NEW YORK STATE EDUCATION LAW.
O'Mally'c
ANY ALTERATION TO THIS DOCUMENT MUST BE
DONE BY A PERSON ACTING UNDER THE DIRECT
N
44780 Rt. 48, Southold, N.Y. 11971
SUPERVISION OF A LICENSED PROFESSIONAL IN
ACCORDANCE WITH THE STATE EDUCATION LAW.
COPIES OF THIS DOCUMENT NOT MARKED WITH
AN ORIGINAL OF THE PROFESSIONAL ENGINEERS
INKED OR EMBOSSED SEAL SHALL NOT BE
�
DATE:
0112/15
SCALE:
AS SHOWN
DWG BY:
A.X.C.
DWG NO:
CONSIDERED TO BE VALID TRUE COPIES.
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