HomeMy WebLinkAbout40424-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
SoutholdTown.NorthFork.net PERMIT NO, Check
Septic Form_,,,,,,_,,
N.Y.S.D.E.C.___
Trustees
C.O.Applicanon
Flood Permit
Examined 121 '20 14e 6 Single&Separate
JAN 11 2�
contact:
Approved, Storm-Water Assessment Form-
20 Mail-to—
..............
Disapproved a/c 7Z
PhoneL � 'I 'AfiN
Expiration 20
B u i I d*-,4fisl%ic tor
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
a.This application MUSTbe 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.t.Jpon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a pen-nit
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 pen-nit 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)
we �A 4
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Name of owner of premises
(As on the tax roll or la est deed)
If applicafit is a corpora$ion,signature of duly authorized officer
............
(Name aK(le of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No. ]Z&L..............
Other Trade's License No.
1, Locatill) li
p ,which proposed wt .11 bed ne-1
I
House Number Street Hamlet
County Tax Map No. 1000 Section Block Lot
.....................
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 Removal Demolition tier
(Description)
4. Estimated Cost Fee
(17c)be paid on filing this application)
5. If dwelling,number of dwelling units N�unibe'r 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. IT
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__Y_Will excess fill be removed from premises?YES_NO-'X-
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'X
*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 OF 1X
a Y-to R Ub-C—Y--+0f)C— being duly sworn,deposes and says that(s)he is the applicant
(Name W individual signing contract)above named,
(S)He is the ...........
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 that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me this
I J+" _day of 20
—jX TRACEY L.DWYER
VNotary Public NOTARY PUBLIC.STATE O—F--%Wy' Signature of Applicant
NO.01 OW6306900
QUAL.FIED IN SUFFOLK COUNTY
COMMISSION EXPCRES JUNE 30,212a
Z.
it 1-7058/22603549
GARY RUBERTONE ELECTRIC INC.
�w
8 NOTRE DAME ROADl
P.O.BOX 885C,E .. C, �
S RA 119PAYTr
C}IdL7ER�C:lf91f w `T " `
j
s�. I30LLARS
t
J'own Hall Annex
54375-Main 4{mad ALppje Apple Blank" for-Savings
P-0- Box 1.179138 Main Sweet �)
SoutholdNY 1 i97i�} �(�1� S��fP�''arba r, 119631,
�. 2 2 C30 1 x. {
11
1,,.,,�ll°:�Hl„`'-,..,,,
TOVA'q OF SOITIHOLD a
APPLICATION FOR ELECTRICAL INSPECTION
IREQUESTED BY: Date: /� p
Co - �. _.
mpany Name: e—
Name:
License No__
- .. I
Address:
Phone-No..
JOBSITE INFORMATION.- (-Indicates required information)
*Name-.
C _
1
*Addr-ess: J7 C �OA_fn)Q� ,V)00
*Cross Street w
*Phone _:
No--
Tax-Map rstnct® 1000 SectionIc :
! DESCRIPTION FPrintLoi ...�.
`
m
OR (Please .rint lea )
(Please Circle All That ply)
'-Is job ready for inspection= YES"0— Rough In Final P.
*0 o-you need a Temp Certificate.- YESNO
Temp Information(If needed) "
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information- PAYMENT DUE WITH APPLICATION
. 9�_.-3_ 0
_._ 7 .51
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C
Power
Specification sheet CGewrathm
Diesel
Generator set
QS137 series
I
engine
100-200 kW 60 Hz
Description
Cummins Power Generation commercial Controll sysurn -The PowerCommand®1.1
generator sets are fully integrated power electronic control is standard equipment and
generation systems providing optimum provides total genset system integration including
performance,reliability and versatility for automatic remote starting/stopping,precise
stationary standby and prime power frequency and voltage regulation,alarm and status
applications. message display,output metering,auto-shutdown
Features at fault detection and NFPA 110 Level 1
compliance. The optional PowerCommand 2.2
Cummins°hes"-duty engine -Rugged 4- control is UL 508 Listed and provides AmpSentryTo
cycle,industrial diesel delivers reliable power, protection.
low emissions and fast response to load Cooling systom -Standard integral set-mounted
changes. radiator system,designed and tested for rated
Alternator-Several alternator sizes offer ambient temperatures,simplifies facility design
selectable motor starting capability with low requirements for rejected heat.
reactance 2/3 pitch windings, low waveform Enolosures-Optional weather protective and
distortion with non-linear loads and fault sound attenuated enclosures are available.
clearing short-circuit capability-
A-The genset accepts full rated load in a
single step in accordance with NFPA 110 for Level
1 systems.
Warmnty mW mMce-Backed by a
comprehensive warranty and worldwide distributor
network.
d
Stand! n rating Continuous ratina Data 5bects
60 Hz 1 ,50 Hi: 60 NZ 50 Hz 60 NZ 50 Hz
model kW kVA kW A kW ktAr kW kilA kW kY 60 Hz 60 Hz
PSG 100 125 90113 11111FD-3349D$ 125(156 113 141 DSQAC 150 188 135 169 175 218 160 200 200 250 180 2251
cumminspower.com
?3015 Gianmins Power Generation Inc. 1 6-1344n(3/15)
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Generator set speolfications
Governor re ufabon class ISO 8528 Part 11 Class G3
VO4 ere ulation no load to full load *1%
RaqOom volta a varlation t 04%
Freauan2y Logulatioo Isochronous
Random frequency variation x 0.25%
Radio 1rguiengX emissions compliance M r uirernents of most irndustrlal and commercial dncafions
Engine specifications
Bore 107 mm 4.21 in
Stroke 124,0 men 4. in
Vi facement 6.68 L 408 ion
Configuration Cast iron,in-line,6 cylinder
1100 amps minimum at ambient temperature of-1'8°Cto 0°C
Battery capacity -a*F to 32 O
Babe char In altrrlator 100am s
ftrtin Volta e 1 12 volt,negative Sround
Fuel system Direct inj4cV nn:number 2 diesel fuel,fuel fiR®r,autornatic electric
fuel shutoff
Fuel filter Single el t,10 micron filtration,spin-on fuel fiher with water
se arator'
Aircleanerto re iaceable element
Lube oil filter t s Sin-on,full flow
Standard cooling system High ambient radiator
AUternator specifications
Design Srn nshgess,4 le,dei roof,rr3volvin, field
Stator 2/s pitch
Rotor Angle bearing,flexible discs
Insulation s etem Class H
Standard teres rature rise 150•C stand at 40°C amblent
Exciter type. 7orquo match shunt standard PMG optional
Phase rotatton A B(t+",C
Alternator coblimp Direct drive centrifugal bower fan
AC waveform total harmonic distortion a 5%no load to full linear lam,<3%for any single harmonic
12hone influsnoe factor l c 50 per NEMA MGI-22.4'3
`f!de RM harmonic factor(THF) 43
Available voltages
60 Hz Three 1phaae fine-neu f/ilne-Une 80 Hz Single phave Kne-neutmi/Nno4ina
• 110/190 • 115/230 Delta ® 127/220 •240/418 • 110/220 •115/230 • 1240
• 110/220 a 120/208 • 139/240 •255/440
• 115x200 9 120/240 Delta • 220/380 9277/480
• 230/400 9347/600
not available w1th CSGAD or MGA
Note`Consult factory for other voltages-
Generator set options and accessories
Engine Altemuftir Exhaust I] Remote annunciator panel
❑ 120 V 150 W lube oil heater ❑ 105°C rise ❑ Heavy duty exhaust elbow 11 Spring isolators
❑ 120/240 V 1500 W coolant ❑ 125°C rise ❑ Slip on exhaust connection d 2 year prime power warranty
heater ® 120 V 100 W anti- QaneratDr not ❑ 2 year standby power
Fuel syeftm condensation heater ❑ Battery warranty
❑ 24 hour sub-base tank 0 PMG excitation ❑ Battery charger ❑ 5 year basic power warranty
(dual wall) ❑ Single phase 0 Enclosure:aluminum,steel,
weather protective or
sound attenuated
13 Main line circuit breaker
(Vote:Some options may not be available on all models-consult factory for availability.
cumminspower_com
92015 Ounwina Po Ganamllpn Inc. 18-1544n(MS)
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Control system PowerCommand 1.1 Ailternator data
• Line-to-line and line-to-neutral AC volts
•3-phase AC current
• Frequency
-Total kVA
lne data
• DC voltage
" Q • Lube oil pressure
•Coolant temperature
•Engine speed
PowerCommand control is an integrated generator Mer data
set control system providing voltage regulation,engine . Genset model data
protection,operator interface and isochronous .Start attempts,starts,running hours
governing(optional). Major features include: . Fault history
• Battery monitoring and testing features and smart . A8485 ModbuO interface
starting control system. • Data logging and fault simulation(requires InPower
• Standard PCCNet interface to devices such as service tool)
remote annunciator for NFPA 110 applications. Digital governing (optional)
• Control boards potted for environmental protection.
•Control suitable for operation in ambient • Integrated digital electronic isochronous governor
temperatures from-40°C to+70`C(-40 OF to •Temperature dynamic governing
+158°F)and altitudes to 5000 meters(13,000 feet). Digital voiltage regul on
• Prototype tested; UL,CSA,and CE compliant. • Integrated digital electronic voltage regulator
• InPower PC-based service tool available for •2-phase line-to-line sensing
detailed diagnostics. •Configurable torque matching
OperaW/dIsplay p3nef Control functions
• Manual off switch •Time delay start and cooldown
•Alpha-numeric display with pushbutton access for • Cycle cranking
viewing engine and alternator data and providing
• f'CCNet interface
setup,controls and adjustments(English or .(2)Configurable inputs
International symbols) •(2)Configurable outputs
- LED lamps indicating genset running,not in auto, 4. Remote emergency stop
common warning,common shutdown,manual run •Glow plug control(some models)
mode and remote start
.Suitable for operation in ambient temperatures from options
-20°C to+70•C ® Auxiliary output relays(2)
• Bargraph display(optional) ❑ 120/240 V, 100 W anti-condensation heater
AC protection ❑ Remote annunciator with(3)configurable inputs and
•Over current warning and shutdown (4)configurable outputs
•Over and Weider voltage shutdown ❑ PMG alternator excitation
•Over and under frequency shutdown ❑ PowerCommand Watch web server for remote
•Over excitation{loss of sensing)fault monitoring and alarm notification(loose)
• Field overload Q Auxiliary,configurable signal inputs(8)and
configurable relay outputs(8)
Engine protectilon ❑ Digital governing
•Overspeed shutdown ❑ AC output analog meters(bargraph)
• Low oil pressure warning and shutdown - Calor-coded graphical display of:
• High coolant temperature warning and shutdown - 3-phase AC voltage
• Low coolant level warning or shutdown - 3-phase current
• Low coolant temperature warning - Frequency
• 'Hugh, low and weak battery voltage warning - kva
• Fail to start(overcrank)shutdown ❑ Remote operator panel
• Fail to crank shutdown ❑ PowerCommand 2.2 control with Am Sen
• Redundant start disconnect AmpSentry
• Cranking lockout protection
• Sensor failure indication For further detail see document S-1531.
• Low fuel level warning or shutdown
• Fuel-in-rupture-basin warning or shutdown
• cumminspQwer.com
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Ratings definitions
Emergency standby power(ESP): W
Applicable for supplying power to varying electrical
load for the duration of power interruption of a reliable '
utility source. Emergency Standby Power(ESP)is in r ralrm
accordance with ISO 8528. Fuel Stop power in
accordance with ISO 3046,AS 2789,DIN 6271 and
BS 5514.
Limited-time running power(LTP):
Applicable for supplying power to a constant electrical
load for limited hours. limited Time Running Power Tn-0.
(LTP)is in accordance with 180 8528.
Prime power( );
Applicable for supplying power to varying electrical a
load for unlimited hours. Prime Power(PRP)is in V
accordance with ISO 8528.Ten percent overload Dim"A*
capability is available in accordance with ISO 8046,
AS 2789, DIN 6271 and BS 5514.
Base load(continuous)power(COP): This outline drawing Is for reference only. See respective model
Applicable for supplying power continuously to a data Sheet for specific model outline drawing number.
constant electrical load for unlimited hours.Continuous Do not use for hmmalliadon design
Power(COP)in accordance with ISO 8528, ISO 3046,
AS 2789,DIN 6271 and BS 5514.
Dint"A" Dim go" Dim°C" Set W FHS set Welow
*401 stint tr. mrr! n. mm on.) 10361(8000)et kni IM
*S 2656 104.6) 1100 43.3 1549(61 180{N
0 2658 104-f4 1100 43.3 1549 61 225 2700
03 2656(104.6) 1100(43.3) 1549(61) 263 273'4
DMAD2656 104.6 1100(43.3) 1549 61 361 JM
IISC 2656{104.6 1100(43.3) 1549(61)
°Note:Weights represent a set with standard features. See outline drawings for weights of other configurations.
Codes and standards
Codes or standards compliance may not be available with all model configurations—consult factory for availability.
This generator set is designed in facilities
certified to ISO 9001 and manufactured in 200 The ge'n'erator set is available listed to
2200.
facilities certified to ISO 9001 or ISO 9002.
The Prototype Test Support(PTS)program Engine Certified to stationary Emergency U.S.
verifies the performance integrity of the generator EPA New Source Performance Standards,
set design. Cummins PowerGerleration 40 GFR 60 subpart Illi Tier 3 exhaust emission
products bearing the PTS symbol timet the levels. U.S.applications must be applied per
Prototype taut requirert"of NFPA 110 for this EPA regulation.
Lerel 1 s
The generator set package Is available cardfied
All low voltage models are certified to CSA International for seismic application in accordance with the
CSA 022.2 No.100 and CSA 022.2 No.14- Building following lntemational Building Code:
Code 1802WO,ISC200318102006,11302009 and
11302012.
Warning,Back feed to a utility system Can cause electrocution and/or property damage.Do not connect to any Hiding's eleCtrlcal system
except through an approved device or after building main gwiton is open.
North America
1400 73rd Avenue N.E.
Minneapolis,MN 66432
USA
Phone 763 574 5000
Fax 763 574 5298 povirer
C Generation
(2015 Cummins Power Ganerndon Ina.All rights msamod.
Cummins Power GiOnargtbn and Cummins are reglstm®C trademarks W Cummins Inc.PowerComm".Amp Sentry.InPower
and"Our energy wg"g for you."are,traosmarks of Cummins Power Generation.Other company,product,or service names
may be tredarnarke or aeNice marks of others.Specirrcationa are aubject to Changs Without notice. cumminspower.com
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