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HomeMy WebLinkAbout39998-Z sUFFat�% Town of Southold 8/31/2015 a . cf.„ P.O.Box 1179 ,t 53095 Main Rd ja Southold,New York 11971 CERTIFICATE OF OCCUPANCY • No: 37748 Date: 8/31/2015 THIS CERTIFIES that the building COMMERCIAL Location of Property: 4715 Great Peconic Bay Blvd, Laurel SCTM#: 473889 Sec/Block/Lot: 125.-4-24.23 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8/11/2015 pursuant to which Building Permit No. 39998 dated 8/11/2015 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: fueling station tanks with fire suppression system as applied for. The certificate is issued to Laurel Links Cntry Club of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Authorized Signature TOWN OF SOUTHOLD 4170.F°- % 5 BUILDING DEPARTMENT TOWN CLERK'S OFFICE o '24i, 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#: 39998 Date: 8/11/2015 Permission is hereby granted to: Laurel Links Cntry Club PO BOX 307 Laurel, NY 11948 To: Install fire suppression system for new fueling station tanks as applied for. At premises located at: 4715 Great Peconic Bay Blvd, Laurel SCTM # 47,3889 Sec/Block/Lot# 125.-4-24.23 Pursuant to application dated 8/11/2015 and approved by the Building Inspector. To expire on 2/9/2017. Fees: COMMERCIAL ADDITION/ALTERATION $250.00 CO -COMMERCIAL $50.00 Total: $300.00 BC g 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 $15.00 Date. EJ/oaths New Construction: Old or Pre-existing Building: (check one) Location of Property: 4/7/5r ,efo, //0. House No. Street Hamlet Owner or Owners of Property: / u,-,- ' 1,N,es �� ,� G�A,v .( Suffolk County Tax Map No 1000, Section /V$ Block `� Lot Z Y• Z�j Subdivision l ) Filed Map.. Lot: Permit No. 3 Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: - Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ " 4b Applicant Signature „,,,, 00,,, SOplfolo ��LJJJ ,* _..., * i/7 e 000 C''"X - TOWN OF SOUTHOLD BUILDING. DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING FINAL [ ] FIREPLACE & CHIMNEY IRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMAR . S: / - .14”' i( E ---Tp-7944/r25 Rt 517 — P4--- 5a4/\00.29 / DATE INSPECTOR k't6LD Ill'SncnoN 1.EP ''E DATA ti• CO .E'S .,i. I H. .;"• . . . f+Y � +At�1flri .. •..R+ IS•iY' - 'dam✓ .. .p.+.i..'•'••''.rt+ )' i1 •• +'QUND,Pi ON(1ST) .• a .. - . .: • .. • . • .m•.....1•. • , 31O • , • ROUGH FRAMMO& PLUMBTN'G • • • •. • • INSULATSON PE1�N+Y. 1 _._ -_ _ . . • H STATE ENERGY CODE , • . • .._ . , • FINAL Y - . • • . r - - _ ' . . . t x ' rt` TJ� �reM' . li � - . - • e . E-7 i s- .-6,013,-L, I .:' 6e 4:4;----q,_ - Or- off- . " ....,_......, 2 . r r r. , l . , n �+... ' z ki . w- • 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:A (631)765-18029967q Surve�g Board approval FAX: 631 765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. Check Septic Form NYSDEC Trustees C O Application Flood Permit Examined 20 f_i5 Single&Separate Storm-Waterer� Assessment Form_ _ Contact: PAf r%:A;�' i/OQi?r�'�$.Q Approved I 20 I� Mail to�(ds, 't/T�'+o IN 4164 Disapproved a/c , ' ,2 Z /,y�! M..V. /17/7 -m•� n ,�' // Phone G 3h Lt Ex.iration ' 1 AUG 1 1 2015I Li But g Inspector APPLICATION FOR BUILDING PERMIT ' - Date 20�r 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 zonmg amendments or other regulations affecting the property have been enacted in the mterim,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,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder oN 11 wa;i2 r/e i DA .. Name of owner of premises /�/.0.L.cG Li Ade S (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. Plumbers License No Electricians License No Other Trade's License No /� �j 1. Location ofLend on which prop r'�workiwill be one 14 �z;) Li9vctC. rc! Y //900'. House Number Street Hamlet County Tax Map No 1000 Section '(-2,5"d Block Lot •,! r'• - 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 /-1.02 G;u 4 $LA,v,) b Intended use and occupancy c;,.,4 ii s , 3 Nature of work(check which applicable) New Building Addition Alteration Repair ✓ Removal Demolition Other Work (Description) 4 Estimated Cost` /b 00 o Fee �e.66 (To be paid on filing this application) 5 If dwelling,number of dwelling units N A Number of dwelling units on each floor If garage, number of cars 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use 7. Dimensions of existing structures,if any Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8 Dimensions of entire new construction Front Rear Depth Height Number of Stories 9 Size of lot Front Rear Depth • 10 Date of Purchase Name of Former Owner 11 Zone or use district in which premises are situated _ 12 Does proposed construction violate any zoning law,ordinance or regulation?YES NO 13.Will lot be re-graded?YES NO Will excess fill be removed from premises?YES NO 14 Names of Owner of premises Address Phone No Name of Architect Address Phone No Name of Contractor tag ;,c2 9um.2Ess;on+ Address 824$v fi'ro 1x A Pahone No C.'31-2-73-Zo1 A ' 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) SS ' COUNTY 054 rrOI� T e eO�Qer f t- 14311/10,-6416 being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He,is the (Contractor, gent, orporate 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 that the work will be performed in the manner set forth in the application filed therewith Swornto before me this ` day of 't+t / ir dV Notary Public ature of BARBARA H.TANDY Notary Public, State Of New York No. 01TA6086001 Qualified In Suffolk County Commission Expires 01/13/20 8Z6 SUFFOLK AVENUE 1 BRENTWOOD,NY 11717 Z. FIRE SUPPRESSION&SECURITY SYSTEMS PHONE{631)273.2010 DIV151QN OF EMI LTD, FAX(631)273.2939 NT;, "l\ T FAX 1y (j rt GL Prim: ill (A,c Y1, ComPalip-raiki rd Of Sou t h oi_(iges: Includes Lover Page Foic � 7 � Dt Ism • 0 Urg.nt ❑ For Review [] Please Comment ❑Please Reply Q Reese Ro mrya!, • P • ti 1.1r SIIF New York State Insurance Fund :::.:Workers'Compensation&.Disability Benefits Specialists Since 1914 199 CHURCH STREET,NENYORK,N.Y 10007-1100 - Phone.(8B8)997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 112678152 EMDI LTD,D/B/A BK FRE SUPPRESSION&SECURITY SYSTEMS 826 SUFFOLK AVE BRENTWOOD NY 11717 POLICYHOLDER CERTIFICATE HOLDER EMDI LTD.D/B/A BK FIRE TOWN OF SOUTHOLD SUPPRESSION&SECURITY SYSTEMS 543-75 MAIN ROAD 826 SUFFOLK AVE SOUTHOLD NY 11971 BRENTWOOD NY 11717 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE G1016 071-1 963217 05/01/2015 TO 05/01/2016 8121/2015 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1016 071-1 UNTIL 06/01/2016, 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, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 05/01/2016 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL 8E SUFFICIENT.COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. 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 DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https'//www.nyslf.com/cert/certval.asp or by calling(888)875-5790 VALIDATION NUMBER 78984034 U-26.3 - BKENG-1 OP ID: KF AC-�r tw..---- CERTIFICATE OF LIABILITY INSURANCE DATE IMOD/Mr 08/20/2016 . THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T1119 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OP INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the poiicy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Halve NTACentral Insurance Agency Central Insurance Agency,Inc. PHONE .877-242-9600 AI Na.877.243-8895 93 East Main Street A!C NO Smithtown,NY 11787 ,'' certificatesciainsures.com George Gavaris ADDRESS: /�f INSURERS)AFFORDING COVERAGE NAID# INSURER A:First MercuryInsurance Co. 10657 INSURED EMDI LTD dba BK Fire INSURER e: Suppression&Security Systems INSURER c: Kevin Kamm - 826 Suffolk Ave INSURER DI Brentwood,NY 11717 INSURER E INSURER F; COVERAGES W� 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. INSRi I e ,{rr�]i 1t-1l.•i (M•e Y EFF •6 ' J-Y' LIMITS Jk� Type OF INSURANCE _An - .POLICY NUMBER (MMIDDIYYYYI Mro13(TYYYI _ GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X SE-CGL-0000056548.01 07/27/2016 0712712015 PREM sES(Ea xarrencgi S 100,00 CLAIMS-MACE X OCCUR MED EXP(Any one person) S 5,00 X Contractual Liab PERSONALS ADV INJURY $ 1,000,00 X Errors 8.Omission GENERAL AGGREGATE 3 5,000,000 GEM AGGREGATE LIMIT APPLIES� PER PRODUCTS-COMP/OP Ado $ 6,000,000 I POLICY I7PRI( I LOC COMBINED 61Nt1 ' $ AUTOMOBILE LIABILITY (Ea=Mot) $ ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED —SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS Y DAMAGE $ HIRED AUTOS AUTOS (PER ACCIDENT) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 A - EXCESS LIAB CLAIMS-MADE SE-EX-0000056560-01 0712712015 07/2712015 AGGREGATE $ 5,000,000 DED X I RETENT ION$ 10,000 5 WORKERS COMPENSATION III WC STATU. H- AND EiIPLOYERS'LIABILITY Y J N TORY LIMITS E ANY PROPRIETORIPARTNERIEXECUTIVENIA (Mandatary E L EACH ACCIDENT $ OFFICER/MEMBER EXCWDED7 (Mandatary In NH) E L DISEASE-EA EMPLOYEE $ If yes,ciaecnbe Iatder DESCRIPTION OF OPERATIONS below -- _ _ L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORO 101,AddltIonal Remarks Schedule,If more epace to raqutred) Town of Southold is included as an additional insured under the general liability with respect to the liability created by the negligent acts, errors and omissions of the ziamed insured herein as required by written contract. CERTIFICATE HOLDER • CANCELLATION TOWN OSS ` SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS, 543-75 Main Road Southold,NY 11971 AU-DU:RUED REPRESENTATIVE V ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The A CORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier la. Legal Name and Address of Insured (Use street address only) lb. Business Telephone Number of Insured EMDI LTD. DBA BK FIRE SUPPRESSION & 6312732010 SECURITY SYSTEMS 826 SUFFOLK AVENUE ic. NYS Unemployment Insurance Employer Registration BRENTWOOD, NY 11717 Number of Insured 8480624 1 d. Federal Employer Identification Number of Insured or Social Security Number 11267_8152 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) The Guardian Life Insurance Company of America TOWN OF SOUTHOLD 3b. Policy Number of entity listed in box"la": 543-75 MAIN ROAD 967443 SOUTHOLD, NY 11971 3c. Policy effective period: 411/15 to 4/1/16 4. Policy Covers: a. ® All of the employer's employees eligible under the New York Disability Benefits Law b. El Only the following class or classes of the employer's employees: Under penalty of perjury, I certify that 1 am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. Date Signed: 8/20/15 By: g M • S k'NCUw Stuart J.Shaw, FSA, MMA Telephone Number: 1-888-278.4542 Title: Vice President, Group insurance IMPORTANT: If box"4a"Is checked,and this form Is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If box"4b"is checked,this certificate Is NOT COMPLETE for purposes of Section 220,Subd.8 of the Disability Benefits Law.It must be mailed for completion to the Workers'Compensation Board,DB Plans Acceptance Unit, 20 Park Street,Albany,New York 12207. ' PART 2. To be completed by NYS Workers' Compensation Board(Only if box "4b"_of Part 1 has been checked) State Of New York Workers' Compensation Board According to Information maintained by the NYS Workers' Compensation Board, the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed: By: " (Signature of NYS Workers'Compensation Board Employee) Telephone Number: Title: Please Note;Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insurance aJants of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized-to issue this form. DB-120.1 (5/06) " :+"= r. { : •, -"e' "�, '( '( .:,‘„,i',r?` ' �+) �p �,. T • . . s- i�i-. _ sg :-f•'',�,.,., :,`,7 _ L6� .''. ,,si•g,_,, .isr,�,``,S:YcAC.. ,xy,,-7` ` c-at 9,` ¢ ^..;4<af'`. at ' !tt•c4.-.. ,- _ .m ei-r fir.^• ,-`:_AYt#,,��!. ' -.t .'i".y?•, " r' '°} •. .- yJG; f. ,s '.:}ev+`a?. ` _ a, ,;. Alex:CaVale, , ,' =,VemAloYee of ,,` : ' „ ..'• '�+ ~'tw_'z� !' ”' n5: 'r• p `:; F " ,BK'Fre Suppresion_&SecuritySystem . S ! :gi,_ S y _' '� Ly . ., 't •,,,f,;,1 r : ridI " ' � i • .L' 1.- eV tBrentwooc,; ,.;NY,--. .., >it'; yc' + ,-�»": �r r ` - 1 , re.,..„_..,,,‘:.,...,,y .';'M^tsI ; +.t.:" 1 ;1^: X_ 7' , •} _ ' ' • r',Completed a training course in:;`'a . tsr( 1; .Z s'',t,' „P - ,--,2 ,.-4 a - ,. sy , Es `I_'!I:L'''''', ' _ ,ti Qr `'r'-''' ,•Q ` = i ( „ �a`A T 'Gasoline Station ,, d = f,- 1 _ "L - rr ' ':. .` _ :,y' y _ ,, - ',II', t{- , _ i. ' ;4 .Y,' ,s 5,,,4 :, :T„T ce--.:; _ .' a ,::- , • ” [ a t;• Suppres,-...f` onSystems-Desgn,,Intallaton,: N. , t .r°•rc, ,i . +r . f,--r„ '�. ;, .,,>; ' y .,,.Recharge&.Maintenance' ' '` f ' " :: .,, ,' t '7; z_ ,z '_TrainingDafe: ;November 10,20.14 .” y r ,_ { , • • ' Expiration Date: November 10,2017 : ; , , • , , - • Be.itknown that t „' > Alex-L:aValle• ' :'' „ , - ` , „ While employed by- - ; • ' BK Fire-Suppression &;;SecuritySystemms'. L } - • . • - ,, YBrentwood,;N1(i ,,i: , m , . ,r.,' ` i ir - -•y ' .- i. ,-•aC',. .,@ •-.(-i a,«�.'.-, -�,i:{y.,t;�„'i:• ::.Y'_",j.�,).,.-c_ :'`r?v� -, :.�",„ :t - ' :; .- Completed'^a training,course"iri:;. , ,, ATTENDANTT.78,:II'.Gasoline,Sta-iorn Fir _ j i. �`".,- ._ , at"" ; : e SuppressionfSystei> s- Design;" - '; ' Installation, Recharge._& Maintenance -,-.--,:� ' „ - -,a n 34 y ,_7r, � }..ta,w.:; - w' .. L; ra , ., . ;conducted by a;Factor Authorrized;instructor',•- • .� °•'°`'=~ • This certificate is considered valid Only if`the°above'named individual-is an • V employee of the authorized Pyro-Chem distributor listed at the above location. r.'4 - of`,C�_i'° .,>t"� '.:rt•,'T,,'ryv,}:,': �.*'sS�"•�'_'-„;a,";.”,i p-`a;;','a_.;', n�,$i.,`:;_`�'•r3,.30.'<'e�=:,'J.•- 't • +- '..!•::;,..I!,...„....-*:.: , :• v, _'', .a _ ^v,r' ..mat r-" - r_' __ =,= @. . ; -_ _Training;Date: ';'November10,-2014 :.'1,2.-.::7::::-.i,,,;,::�vk„t< Y ' -- , •9 ''' ' „ ' �' ^ , 4 "f - - s „- ” - ' Y >�cc.. .i' s: t , . 4 � + ? . r�, E� ,` ,,,'._ , ,•;;1.-,...,,,, " ' •`. -.Expiration Date: '�November14,_20,,,,7.,-,.1,1:,-,‘,',,,:1,-.,-',2 �. ;.r."-" r't, -.+ '�, ,; 'tfi('-5;=:'t _ m;rtari .X 1 'x;. r.": ''';'.:-'1-;-":” ! _ - ,' -- „- . >r: -i'.t- ,.-7 ,^°"'tf t, ' °"?.-1 " 4;...MarkE•fFessendn'-j,Director,;, entces-Aecas"., yr Hfi �� ' , ,, , 3i. ft'.--....---_,,,,',:, -- : - %:.2. ��'_' c(` ' `-j - ,T /..,,,,,,„:6;1,-,;-1,-?_-,- -,;,'� �%moit" s°;f _ -"ir_�n!`. k";;, 0.,":4-..,)",,,,,,‘„,---,-, }y.Yati,.`',‘:z ti'-tu9,,r.'_>.-;'�c` te� 't'___^i '.`.sa'':rxt: -' ' }.L i__ _ r' _- • { _1 - � � »srv....,: •,a`v - ?^4- ',,,,,,-0q;,.';' "r !', 'A ;n,. :,:-- ,47:277":"`•;,7.--',7`,".,Z' ,, , ',-±i:,.:',,,,-,,„, - , � ;r,• , af .r•s',�- ~::�}, :w.s..t :�ity.> • . ! , �tC.. 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" ".,{,iN ,t; , I t -'Lt :,4, t " ` ; ' !' +• " a�' "Z ''-?.- :L r, ,„.j:° -,, .+<.V✓• ';:,7"."`7,'-im rz ;µ%.'akm Ji-t, : ,, ,"Ji•r i rv' , ' 1 7::-P'''i ,- nit ' _ • Tyco International Company i :: p,. ffi, w"x ` ,<''1,----p' r r Y { A ' 4.-s: yy ri : t(,,s'.- + " ".1+ ' 1 .,, < • �C' , � . s _r•y. 4t'V'. .. b.sr '. - t . n , "I'-'.. e, , ;s '',-;.,-4''-1 ' ' . 3:,d,Y."'•,' ,.P,C05p1 ' _ `Lie, li ` - '_ .t, ` r _ • - 9 ' • s SUFFOLK COUNTY DEPT CF LABOR, _ 11C$NSINO&CONsuhrER AFFAIRS • - i RESTRICTED PLUMBER LICENSE r i KEVIN KAMM This certifies that the e112"ess"'6 bearer is duty Qnor LTD DBA licensed by the County at Suffolk `�°"`" '° °o"��^ Frltk1 ' rF� 42815-RP 05/23/2007 EXPRATI OCR 05Jitf/2017 Alex LaValle _ ,employee of . BK Fire Suppression &Security Systems _ ' - Brentwood, , ,NY , - . Completed a training course in: , ' - - " ATTENDANT I & II Gasoline Station Fire, Suppression Systems- Design,.Installation, - ' Recharge&Maintenance - . - Training Date: November 10,2014 Expiration Date: November 10,2017 - . ' Be it known that - Alex LaValle , While employed by - BK Fire Suppression & Security Systems - Brentwood',NY ' _ Completed a training course in: - " ; - ` ' 'ATTENDANT" 8 II Gasoline Station Fire Suppression Systeme- Design; - , Installation; Recharge & Maintenance _ - - ' . - conducted by a FactoryAuthonzed Instructor - , This certificate is considered valid only if the above named individual is an ' employee of the authorized Pyro-Chem distributor listed at the above location. Training Date: " .November 10, 2014 ' - X _ Expiration Date: November 10 2017 •- - • " - Mark E-Fessenden-Director, Services-Americas" - • v ��� ' A Tyco International Company • ' , _ voioossa �....,—.." BKENG-1 OP ID:KF A kopcm-,��`�'`� CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDD1YYYY) 08120/20 6 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: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION 18 WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER NAMEAOT Central Insurance Agency Central Insurance Agency,Inc. PHONE 877-242.9600 ar Na_877.243.8995 93 East Main Street AIC No • Smithtown,NY 11787 ADDRESS:CertifICat_-@ George GayerIs INSURER(S)AFFORDING COVERAGE NAlc#10667 INSURED - EMDI LTD dha BK Fire Suppression&Security Systems Kevin Kamm INSUFtER C: 826 Suffolk Ave INSURER' Brentwood,NY 11717 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TI-US IS TO CERTIFY THAT THE POLICIES OP INSURANCE LISTED aELOW 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. ILS TYPE OF INSURANCE INSR iNvr POLICY NUMBER (MMIDDIYYI YI I f.M/DGM'YYI LIMITS GENERALUABILUTY EACH OCCURRENCE $ 1,000,000 A X 1 COMMERCIAL GENERAL LIABILITY X 8E-CGL-0000066548.01 07/27/2016 07/27!2016 Igallt6(Ee ocourVencel E 100,000 CLAIMS MAGE n OCCUR X MED EXP(Any one person) S 5,000 Contractual Lia& PERSONAL 8 ADV INJURY $ 1,000,000 X Errors&Omissior1 GENERAL AGGREGATE $ 5,000,000 OEN'L AGGREGATE�,ATLIMIT APPLIES PER PRODUCTS-COMP/OP ACCO $ 6,000,000 _ POLICY 1 J[ !Tali_ LOC I $ AUTOMOBILE LIABILITY COMBINED I,N"'GLE LIMIT — $ ANY AUTO BODILY INJURY(Per person) $ — ALL OVMIED SCHEDULED BODILY tN IURY(Per accident) $ _ AUTOS AUTOS PROPERTY HIRED AUTOS AUTOS EO ( CCIDE GE $ • $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 6,000,000 A EXCESS UAB CLAIMS-MADE SE-EX-0000056560-01 07/27/2015 07/2712016 AGGREGATE $ 5,000,000 IL DEO I X I RETENTION$ 1%000 — `S - WORKERS COMPENSATION WC LIMITS E$ ANb EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y7 NIA E L EACH ACCIDENT $ , (Mandatary EXQLUDEov l I E L DISEASE-EA EMPLOYEE $ (Mandatary In NH) .. I(vee. lePTI ba Under DESCRIPTION OF OPERATIONS Wow E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(Attach ACORD 101,AddltIonal Remark&Schedule,If more Space la required) Town of Southold is included as an additional insured under the general liability with respect to the liability created by the negligent acts, errors and omissions of the named insured herein as required by written contract. CERTIFICATE HOLDER C.NCELLATION TOWNOSS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 543-75 Matn Road Southold,NY 11971 AUTHORIZED REPRESENTATIVE VAPedyf tet er I Q 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/06) The ACORD name and logo are registered marks of ACORD • MOUNTING BRACKET 10'-0" -�s� MAX. I_ 10'-0" KINDORF rM _ _ IPING W/ NOZZLES � IPING W/ NOZZLES • ---1--, ? i\ / i I NOTES • 0• 1. PYRO-CHEM MODEL ATD SYSTEM IS U.L. LISTED #EX 3437 TO COMPLY WITH UL STANDARD 1254 ( FOR 10 MPH WIND PROTECTION). o 2. INSTALLATION IS TO BE IN ACCORDANCE WITH "PYROCHEM" INSTALLATION MANUAL AND ALL GOVERNING CODES AND ORDINANCES INCLUDING THE NATIONAL ELECTRICAL TANK - I I - TANK I CODE. 3. PIPING IS TO BE SCHEDULE 40 BLACK, GALVANIZED, CHROME PLATED AND/OR DISPENSER GAS D!S•ENSER STAINLESS STEEL. ALL FITTINGS ARE TO BE STANDARD WEIGHT MALLEABLE, GALVANIZED, CHROME PLATED OR STAINLESS STEEL. TUBING IS TO BE Y4" COPPER DISPENSER , = / , USING FLARED FITTINGS AND/OR 1/8" SCHEDULE 40 GALVANIZED PIPE. (ALL IN ACCORDANCE WITH SECTION A-2-8.2 OF NFPA 17). I., / 4. ACTIVATION OF ANY PORT ON THE FIRE CONTROL SYSTEM WILL SHUT-OFF PUMPS, r /1 „ATYPICAL 30„ 1• �� DISPENSERS AND COMPUTER. STORAGE TANK./ 5THIS PIPING IS SHOWN IN SCHEMATIC ONLY. CONTRACTOR MUST COMPLY WITH "PYROCHEM" INSTALLATION MANUAL FOR EXACT LIMITATIONS IN PIPING LENGTH, SIZES, FRONT ELEVATION NTS SIDE ELEVATION ROUTING AND LOCATION OF ALL EQUIPMENT. , NTS /DIESEL NOT 6 INSTALLATION SHALL COMPLY WITH MANUFACTURERS SPECIFICATIONS CONCERNING PROTECTED NUMBER AND HEIGHT OF NOZZLES, AREA OF COVERAGE, TIME OF RELEASE, ETC. b 7 INSTALLATION SHALL INCLUDE ELECTRIC HEAT ACTIVATORS, MANUAL ACTIVATOR CONTROL AND A DEVICE WHICH AUTOMATICALLY DISCONNECTS THE COMPLETE ELECTRICAL SYSTEM TO THE SELF-SERVICE DISPENSING EQUIPMENT WHEN THE DRY / CHEMICAL SUPPRESSION SYSTEM IS ACTIVATED. COVERAGE AREA 8 THE MAINTENANCE AND INSPECTION OF THE SUPPRESSION EQUIPMENT SHALL BE AS PER THE MANUFACTURER'S INSTRUCTIONS AND RECOMMENDATIONS, WITH A SIGNED 7-6' MAX - ") . RECORD OF THE SAME, THAT SHALL BE MADE AVAILABLE FOR EXAMINATION. MAIN ISLAND NOZZLE 225' HEAT DETECTOR -- — — —— — - CLUSTER TYPICAL W/ 15"x15" PAN w '05rA-Ii HAZARD PLA\ 3/4" 3/4" i� J 4 1 �,�y�,,, _ SCALE. „_I'-0" 34" 3/4" - - J 75# 4 x 1 " 1 " 75# DCC 75# END OF ISLAND/ZONE a DCC DCC c of MAI NTI4ANCE Bu,:-cl4G NOZZLE CLUSTER TYPICAL e 3 `° 3 "4 -""1" 1111111 , . 4 - c€�rrc. 1 STORAGE TANK 1 " c --- R" 01 CONC. --- olf, 3/4„ 3/4„ RAW I o MAu^ir !,A>acr_ c`; MAL DING 7 O 1/4" 0.C. COPPER TUBING Mil. T SNS n D-tk'i AL i . i 1\ Fi rump -CO'IC.BLOCK WALL. 'r'€ (L' • • PAC-10 HOME PDA-D2 EtECTRIC DATE `� 1.�k1 lmOt,PROVED AS NOTED.P.# 39M` a- OCCUPANCY OR [ACTUATOR\ METE v 5.o Ai FEE.. g raY: USE IS UNLAWFUL MI w ,�,.4k;4 Nc- }.:I!.D+,aux DEPARTMENT AT WITHOUT CERTIFICATE T'. - 3 AM TO 4 PM FOR THE SITE PLAN 1011 SCALE: NTS FOL, . :' G INSPECTIONS: OF OCCUPANCY 1. F. ' :DATION • TWO REQUIRED FCS, POURED CONCRETE ATID-35 ATD-35 ATID-75 ATD-75 2. f,OGGH - FRAMING & PLUMBING 3. IN ULATION 4. FCOMPLETE CONSTRUCTION FORT 0 .0 MUST FIRE INSPECTION i, ii 'EXISTING AGWAY CONTAINMENT ALL CONSTRUCTION SHALL MEET THE REQUIRED BEFORE. VAULT � ( GALLON REQUIREMENTS OF THE CODES OF NEW OPENING DRY CHEMICAL CYLINDERS � "I (� �"' PAD vORK STATE. NOT RESPONSIBLE FOR CHEMICAL CYLINDERI I / / 'EMAIN ' GASOLINE (TANK N{�. I } AND 500 DESIGN OR CONSTRUCTION ERRORS. ELEVATION MAIN ISLAND END OF ISLAND/ZONE r�µ- GALLON DIESEL (TANK NO. 2) TO NTS NOZZLE CLUSTER NOZZLE CLUSTER -P I E3E REMOVED NTS NTS 0 ,- m - I i ` i COMPLY TH ALL ¢C' �� :1� NEW AREO— OWER 500 GAL NEW YORK STIATE & TOWN CODESCODES OF `,fa I *" I GASOLINE RECTANGULAR. AS REQUIRED AND CONDITIONS OF NEW A�t�- POWER. C�c� SAL � ":3, � �,; xDlEt_ R TANGULAR TANt — , . O ; /TANtiK —ft\17M^7O�DyiEL # 50 —REQ �.L � '� 7. ( "A(°VK NO. V � 11 � � l�I, ., . .,..D MODEL # '5C500D—R.EC (TANK NO. 10) I ,44-4J ' c� ., , 1r,, .1 CONNECTS TO L - EXISTING N BOLLARD TO SO EROID M MONITOR 0 0_ s FF MAIN (TY1 .) RETAIN STORM WATER RUNOFF CIRCUIT 7 -o PURSUANT TO CHAPTER 236 POWER SUPPLY OF THE TOWN CODE.] _ '. PSISM-120 Mill 'ft' BK FIRE SUPPRESSION & ELECLAUREL TANKS SECURITY SYSTEMS SOLEENICAL NOID CONNECTS TO 120 VAC SUPPLY 6 400 MAIN R D MOUNTED IN NORMALLY A DIVISION OF EMDI LTD. CONTROL HEAD CLOSED DISTRIBUTIONLAUREL, NY 11948 826 SUFFOLK AVE. PGS-17 THERMOSTATDEFECTORS CONTACTS BRENTWOOD, N.Y. MUST BE PGS-26A IN PARALLEL POWER PANELTO: PH 631 273-2010 FAX(631 )273-2939 TOTAL- 1 REQ. GASOLINE PUMPS k DISPENSING I— FIRE SUPPRESSION #( ) ISLAND PLAN _ PLAN LICENSE # NCFM 644 SCALE SOLENOID MONITOR CIRCUIT $ ►�"'• ~ NYS 12000259411 AS NOTED DETAIL 0 �,0k SCALE.}•- 1'-O' NO. REVISIONS DATE BY CONTACT PERSON FILE fi&"o ALEX LAVALLE LAUREL LINKS .dwg ./k DRAWN JOB # DWG. # BY RF DATE 08/06/15 ES - 1 II