Fillable OPERATING PERMIT APPLICATION FORM (Incorporated Village of Sag Harbor)

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OPERATING PERMIT APPLICATION FORM (Incorporated Village of Sag Harbor)

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BROWSE INCORPORATED VILLAGE OF SAG HARBOR (NY) FORMS

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VILLAGE OF SAG HARBOR - OFFICE OF CODE ENFORCEMENT/ BUILDING Application #:
FEE $150.00
OPERATING PERMIT APPLICATION FORM
Page 1 of 4
Part I
Applicant/Building Information
Applicant’s Name:
Applicant’s Address:
Contact Person: Telephone:
Address of Premises for which Operating Permit is requested: same as above
Other (specify):
Tax Map Number: Current Occupancy Class:
Part II
Type Operating Permit
An Operating Permit is required to conduct any activity or to use any class of building listed below. Please
indicate the type(s) of Operating Permit(s) requested by checking each applicable box. (If you require
assistance, or would like more information, contact the Office of the Fire Marshal at 631-725-2804.)
Manufacturing, storing or handling hazardous materials in quantities exceeding those listed in Tables
2703.1.1(1), 2703.1.1(2), 2703.1.1(3) or 2703.1.1(4), of the Fire Code of New York State (see 19 NYCRR
Part 1225); (See Appendix A.) Identify the materials and quantities and describe the manner in which the
materials will be manufactured, stored or handled (attach additional sheets if necessary):
Conducting a hazardous process or activity (including but not limited to, any commercial or industrial
operation which produces combustible dust as a byproduct, fruit and crop ripening, and waste handling;
(See Appendix B.) Describe the process(es) or activity(ies) to be conducted (attach additional sheets if
necessary):
Use of pyrotechnic devices in assembly occupancies; (See Appendix C.) Describe the proposed use
(attach additional sheets if necessary):
Use of a building containing one or more areas of public assembly with an occupant load of 100 persons
or more (See Appendix D.) Describe the proposed use (attach additional sheets if necessary):
VILLAGE OF SAG HARBOR - OFFICE OF CODE ENFORCEMENT/ BUILDING Application #:
OPERATING PERMIT APPLICATION FORM
Part II (continued)
Page 2 of 4
Use of a building whose use or occupancy classification has been determined by Village of Sag Harbor Code
Enforcement Officer as posing a substantial potential hazard to public safety. (See Appendix E.) Describe
the proposed use (attach additional sheets if necessary):
Part III
Premises/Building Information
1. Date of last Inspection of Premises?
2. Has a Certificate of Occupancy been issued for the premises?
YES Type: Permanent Temporary Date of Issuance:
NO
3. Date(s) of issuance of previous Certificate(s) of Occupancy? (If any):
4. Has a Certificate of Compliance been issued for these Premises?
YES Type: Permanent Temporary Date of Issuance:
NO
5. Are there currently any open Building Permits associated with the premises? YES NO
If yes, please describe (attach additional sheets if necessary):
6. Have any violations to the Uniform Code been issued in relation to the Premises? YES NO
If yes, please describe (attach additional sheets if necessary):
7. Have any variances to the Uniform Fire Prevention and Building Code been granted in relation to these premises?
YES NO If yes please describe (attach additional sheets if necessary): (Include Variance Decision Number)
VILLAGE OF SAG HARBOR - OFFICE OF CODE ENFORCEMENT/ BUILDING Application #:
OPERATING PERMIT APPLICATION FORM
Part III (continued)
Page 3 of 4
8. Additional Comments:
SIGNATURE OF APPLICANT
I hereby certify that the foregoing information (and all information in attached sheets, if any) is true and complete.
Signature of Applicant or Authorized Representatives Signature Date
Name (and Title, if applicable of person signing Application (Please print)
Part IV
To be completed by this Office
Inspection Required YES NO
Inspections Performed YES Date of Inspection:
NO
Tests or Reports required to verify compliance? YES NO
If YES, have Tests or Reports been received? YES NO
Description:
Application(s) Approved: YES NO
Operating Permit Issued
By:
Date Operating Permit Issued: Date Operating Permit Expires:
Type/Description of Operating Permit:
Conditions of Operating Permit (list conditions here AND in the space provided in the Operating Permit):
Additional Comments:
VILLAGE OF SAG HARBOR - OFFICE OF CODE ENFORCEMENT
OPERATING PERMIT
This Operating Permit must be displayed at Premises
Application #:
Applicant’s Name:
Applicant’s Address:
Contact Person: Telephone:
Address of Premises for which Operating Permit is requested: same as above
Other (specify):
Date of issuance: , 20 Expiration Date: , 20
This Operating Permit is issued to the Applicant named above to conduct the activity(ies) and/or to use the
class(es) of buildings indicated below at the Premises specified above:
Manufacturing, storing or handling hazardous materials in quantities exceeding those listed in Tables
2703.1.1(1), 2703.1.1(2), 2703.1.1(3) or 2703.1.1(4), of the Fire Code of New York State (see 19 NYCRR
Part 1225); as described in the Application.
Conducting a hazardous process or activity; as described in the Application.
Use of pyrotechnic devices in assembly occupancies; as described in the Application.
Use of a building containing one or more areas of public assembly with an occupant load of 100 persons
or more; as described in the Application.
Use of a building whose use or occupancy classification has been determined by Village of Sag Harbor Code
Enforcement Officer as posing a substantial potential hazard to public safety; as described in the Application.
The conditions, surroundings and arrangements for the activity(ies) and/or use(es) subject to this Operating Permit
shall be in accordance with all applicable laws, ordinances, regulations and the conditions (if any) mentioned
below. The Premises shall be subject to periodic inspection by Village Code Enforcement to ensure compliance
with applicable all applicable laws, ordinances, regulations and conditions. The Operating Permit is subject to
revocation for failure to comply with any applicable law, ordinance, regulation or condition. This Operating Permit
shall expire on the earlier of the Expiration Date specified above or on the date of revocation pursuant to the
preceding sentence. CONDITIONS (continue on attached sheets, if necessary):
VILLAGE OF SAG HARBOR - OFFICE OF CODE ENFORCEMENT
By:
Name/Title
VILLAGE OF SAG HARBOR - OFFICE OF CODE ENFORCEMENT/ BUILDING
OPERATING PERMIT APPLICATION
Appendices
(Page 1 of 4)
Appendix A
Hazardous Materials Storage
An Operating Permit is required when (1) any hazardous material included in any category listed in tables
2703.1.1(1), 2703.1.1(2), 2703.1.1(3) or 2703.1.1(4) of the Fire Code of New York State is manufactured, stored or
handled and (2) the quantity of such hazardous material exceeds the quantity listed in the applicable table. This
would include any building that is (whole or in part) a Group H occupancy, is a pre-existing, non-conforming
hazardous occupancy, or has outdoor use manufacture, and/or storage of materials that exceed the tables for
physical and/or health hazard.
This type of Operating Permit will not be issued until an inspection has been performed and establishes to the
satisfaction of Village of Sag Harbor Fire Marshal that the requirements of the Fire Code of New York State are
satisfied. These requirements include the provisions of Chapter 27 of the Fire Code of New York State as well as
any specialized manufacture, use, storage requirements within Chapters 27-42 of the Fire Code of New York State.
A previous fire safety inspection cannot suffice for an Operating Permit application inspection. If necessary, tests
to verify compliance with the Fire Code of New York State must be performed and the reports of such tests must
be provided to the Village of Sag Harbor Fire Marshal. Tests and reports needed to verify compliance with the Fire
Code of New York State vary from product to product. Tests and reports may include:
Verification of inspection of fire protection systems and emergency alarm systems
Verification of inspection of storage cylinders, tanks, or containers
Completing of the Hazardous Materials Reporting Form, as required by General Municipal Law 209-u
(available from OFPC at http://www.dos.state.ny.us/fire/pdfs/forms/hm209u.pdf
)
Presentation of Material Safety Data Sheets for the product(s) requiring permits
Affidavits that the regulated party is in conformance with other State Agencies (Environmental
Conservation, Health, Labor)
VILLAGE OF SAG HARBOR - OFFICE OF THE FIRE MARSHAL
OPERATING PERMIT APPLICATION
Appendices
(Page 2 of 4)
Appendix B
Hazardous processes and activities
Commercial or industrial operations producing combustible dust - An Operating Permit is required when a condition
or process meets the scoping requirements of Chapter 13 of the Fire Code of New York State and is part of a
commercial or industrial operation. Chapter 13 references several different standards, based on the products
producing dust. The reference standards shall be used and compliance with such standards shall be submitted
prior to the issuance of an Operating Permit.
Fruit and Crop Ripening - An Operating Permit is required when a fruit or crop ripening operation meets the
scoping requirements of Chapter 16 of the Fire Code of New York State. The operating permit will not be issued
unless and inspection and/or documented testing demonstrates to the satisfaction of Village of Sag Harbor Fire
Marshal or his assigns that the ethylene generators meet the requirements of Section 1606 of the Fire Code of
New York State and that the appropriate safeguards are in place.
Waste Handling - An Operating Permit is required when waste materials that are considered hazardous are
reclaimed, recycled, collected or otherwise handled at the Premises. Examples of uses that trigger the need for
this Operating Permit include wrecking yards, auto dismantling facilities, junk yards, hazardous materials recycling
facilities, and the like. An inspection must be performed prior to the issuance of this type of Operating Permit; such
inspection must confirm compliance with any applicable sections of the Fire Code of New York State including the
general fire safety practices in Chapter 3 of the Fire Code of New York State.
Other Hazardous Processes and Activities - An Operating Permit is required for any other process or activity
determined by the Village Fire Marshal to be hazardous. Such processes and activities include, but are not
necessarily limited to, the following: [The Authority Having Jurisdiction should determine which processes and
activities are considered hazardous and will trigger the need to obtain an Operating Permit, and those processes
and activities should be listed here. Such hazardous processes and activities should be administered consistent
with local conditions. Processes and activities that commonly trigger the need to obtain an Operating Permit
include use of tents and membrane structures, airports, motor fuel stations, semiconductor facilities, and any other
specialized hazard that specifically regulated in Chapters 11-26 of the Fire Code of New York State.]
VILLAGE OF SAG HARBOR - OFFICE OF THE FIRE MARSHAL
OPERATING PERMIT APPLICATION
Appendices
(Page 3 of 4)
Appendix C
Pyrotechnics in Assembly Occupancies
An Operating Permit is required for use of pyrotechnic devices in any assembly occupancy. [Although Part 1203,
section 1203(g)(1)(iii), requires an operating permit for use of pyrotechnic devices only in assembly occupancies,
section 1203 (g)(1)(v) provides that an operating permit must be required for buildings whose use or occupancy is
determined by the Authority Having Jurisdiction to pose a substantial potential hazard to public safety. See
Appendix E for further information.]
An inspection must be completed prior to the issuance of this type Operating Permit. The inspection must confirm
(1) that all fire protection and life safety features are inspected and have current maintenance within the timeframes
set by Section 901 of the Fire Code of New York State, (2) the existence and adequacy of fire safety plans and
emergency preparedness, and (3) that the means of egress are properly maintained, that interior finishes are
appropriate, and that occupancy calculations are correct. [The required tests and reports should be consistent with
the permit procedures found within NFPA 1126. The section in NFPA 1126 regarding permits and the annex
material provide guidance for the Authority Having Jurisdiction on what to request. An operating permit should be
required for each show or group of shows, and the Premises should be made available for inspection prior to each
event.]
IMPORTANT: Please note that section 280.00 of the Penal Law provides that in the absence of a permit issued by
the “permit authority” under section 405.00 of the Penal Law, it is unlawful to offer or expose for sale, to sell or
furnish, or to possess, use, explode or cause to explode, any “fireworks” or “dangerous fireworks.” Most
pyrotechnic devices fall within the definition of “fireworks” or “dangerous fireworks” under section 270.00
of the Penal Law.
Section 405.00 of the Penal Law provides that the “permit authority” of a state park, county park, city, village or
town may grant a permit for the public display of fireworks by municipalities, fair associations, amusement parks or
organizations of individuals. For a fireworks display within a state park, the term “permit authority” means the state
agency having custody and control of the park. For a fireworks display within a county park, the term “permit
authority” means the county park commission or such other agency as may have jurisdiction, control and/or
operation of the parks or parkways within which any fireworks are to be displayed. For a fireworks display within a
city, the term “permit authority” means the duly constituted licensing agency of such city or, in the absence of such
agency, an officer designated for the purpose by the legislative body of the city. For a fireworks display within a
village, the term “permit authority” means an officer designated for the purpose by the board of trustees of the
village. For a fireworks display within the territory of a town outside of villages, the term “permit authority” means
an officer designated for the purpose by the town board of the town.
AN OPERATING PERMIT FOR THE USE OF PYROTECHNIC DEVICES IN AN ASSEMBLY OCCUPANCY IS
NOT A PENAL LAW SECTION 405.00 PERMIT. OBTAINING AN OPERATING PERMIT FOR THE USE OF
PYROTECHNIC DEVICES IN AN ASSEMBLY OCCUPANCY DOES NOT OBVIATE THE NEED TO OBTAIN A
PENAL LAW SECTION 405.00 PERMIT. AN OPERATING PERMIT FOR USE OF PYROTECHNIC DEVICES IN
AN ASSEMBLY OCCUPANCY DOES NOT MAKE LEGAL ANY ACT PROHIBITED BY PENAL LAW SECTION
270.00.
VILLAGE OF SAG HARBOR - OFFICE OF THE FIRE MARSHAL
OPERATING PERMIT APPLICATION
Appendices
(Page 4 of 4)
Appendix D
Places of Public Assembly with an occupant load of 100 or more persons
An Operating Permit is required for any place of public assembly that has an occupant load of at least 100 persons.
This Operating Permit is required to ensure that life safety and fire protection systems are maintained to the
applicable requirements. [The Authority Having Jurisdiction should determine the appropriate duration of an
operating permit for places of public assembly. Depending on the nature of the occupancy, it may be appropriate
to limit the duration of the operating permit to a relatively short period, and to require the applicant to apply for a
new permit, and to undergo a new inspection, on a relatively frequent basis.]
An inspection must be completed prior to the issuance of this type Operating Permit. The inspection (and any tests
and reports which may be required) must confirm (1) that all fire protection and life safety features are inspected
and have current maintenance within the timeframes set by Section 901 of the Fire Code of New York State, (2)
the existence and adequacy of fire safety plans and emergency preparedness, and (3) that the means of egress
are properly maintained, that interior finishes are appropriate, and that occupancy calculations are correct.
Appendix E
[Optional]
Uses and Occupancy Classifications determined by VILLAGE OF SAG
HARBOR - OFFICE OF THE FIRE MARSHAL to pose a substantial potential
hazard to public safety
[AUTHORITY HAVING JURISDICTION may establish Uses and Occupancy Classifications that pose potential hazard to
public safety. If Authority Having Jurisdiction establishes such uses and occupancy classifications, the Authority Having
Jurisdiction should provide a list, with a brief description, under this appendix E.]
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OPERATING PERMIT APPLICATION FORM (Incorporated Village of Sag Harbor)

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Completed 16 July 2020

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