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HomeMy WebLinkAbout43377-Z ®�OUFE�1'�CpG Town of Southold 3/8/2019 0 P.O.Box 1179 v' fi 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40254 Date: 3/8/2019 THIS CERTIFIES that the building WINDOWS Location of Property: 1325 Factory Ave, Mattituck SCTM#: 473889 Sec/Block/Lot: 122.-2-17 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/3/2019 pursuant to which Building Permit No. 43377 dated 1/8/2019 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: window replacements as applied for. The certificate is issued to Aytulin,Rasim&Judy of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Au 0 d Signature _' TOWN OF SOUTHOLD �o�guFFor,real � BUILDING DEPARTMENT D TOWN CLERK'S OFFICE o . SOUTHOLD, NY y �s4 m 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#: 43377 Date: 1/8/2019 Permission is hereby granted to: Aytulin, Rasim PO BOX 2598 Aquebogue, NY 11931 To: replace windows as applied for. At premises located at: 1325 Factory Ave, Mattituck SCTM # 473889 Sec/Block/Lot# 122.-2-17 Pursuant to application dated 1/3/2019 and approved by the Building Inspector. To expire on 7/9/2020. Fees: SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $200.00 CO -ALTERATION TO DWELLING $50.00 1: $250.00 1 ding 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 I%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: Old or Pre-existing Building: (check one) / Location of Property: /3a �O '"`�'AVS / '�/�n L 9 4 G� House No. // Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section a Block oZ Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: J-1ti n Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ App cant ignature r h� �O TOWN OF SOUTHOLD BUILDING DEPT. `�courm, ' 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATION [ ] FRAMING /STRAPPING [ ] FINAL AhA dO S [. ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION- FIRE NSPECTION- FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: t OUh � ✓ DATE J INSPECTOR? �()0 FIELD TNSPEGfTTON REPORT DATE COMMENTS FOUNDATION (1ST) � H J � -------------------------------------- 'FOUNDATION (2ND) ROUGH FRAMING& PLUMBING INSULATION PER N.Y. STATE ENERGY CODE 9-1 jq Q1�f� FINAL ADDITIONAL COMMENTS t �z a � z° d b H TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUIy,DING 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 appioval FAX:(631)765-95021 ; Survcy SoutholdTown.NorthFork.net PERMIT NO. V Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined 20 Single&Separate Storm-Water Assessment Form Contact: Approved 120 Mail to Disapproved y�— �v n� Phone: ��� a' c�- C I 0 Lt03�U Expiration 20 � ..>L 3 u V. ' y uildin n ctor PLICATION FOR BUILDING T _ JAN 3 2019 Date ^' '20 / ��++ INSTRUCTIONS k Y a.,chis app]ation�VlU T be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 �s&s;of plans,3Co4 to plot+pla 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 slk� (Sig re of applicant or name,if a corpoiation) 'Saa C.nw� (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Name of owner of premises _J t,_Ct�3, ' (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. 1. Location of land on which propose work will be done. 4--c— House Number Street Hamlet County Tax1 Map No. 11000 Section / c� c� Block Lot � n o�- FCti vhaV'� c}-�_ f�-P l°'C� (' (�i hGtyv�►S � S e��i'�2 S�-� mer C�¢-c��`e�r�✓�.� �/�0.'�_ Subdivision Filed Map No. Lot a 2. State existing use and occupancy of premise and intended use and o9 cupancy of proposed construction: a. Existing use and occupancyZS �� b. Intended use and occupancy 3. Nature of work(check which applicable):New Building Addition Alteration Repair X Removal Demolition Other Work ` (Description) 4. Estimated Cost t `/ 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 pre ises?YES_NO JksQ 446 c 0S l -3�1 Y /7 IS- 14.Names of Owner of premises � � Phone No. Name of Architect Address Phone No ca d S / Name of Contractor iz Lr: M Address V— s Phone No. `--e - Q-47- 15 x-47-15 a.Is this property within 100 feet of a tidal wetland or a freshwater wet and?*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 k *IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF 1'"rte being duly swom,deposes and says that(s)he is the applicant (Name of individual signing contract)�ab�o�venamed, (S)He is the a �-4-, (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 that the work will be performed in the manner set forth m the application filed therewith. Sworn before met is TY day f e � 20�1_'/ KATY CARBAJAI. L - Notary Public - State of Colorado- D 20164042272 NotaryPublic Si ature of Applica NIy Commission Expires Nov 4, 2020 A� CERTIFICATE OF LIABILITY INSURANCE Doz�Z;2o;8D' I 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 have ADDITIONAL INSURED provisions or 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 CONTACT MARSH USA,INC. NAME: FAX TWO ALLIANCE CENTER AIC NNo Ext): A/C No): 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS. INSURERS AFFORDING COVERAGE NAIC# CN1 01 642069-HomeD-GAW-1 8-19 INSURER A:Old Republic Insurance Co 24147 INSURED THE HOME DEPOT,INC INSURER B:New Hampshire Ins Co 23641 HOME DEPOT U.S A,INC. INSURER C:HomeRlsk Captive Insurance Company 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 ATLANTA,GA 30339 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER: ATL-004353439.16 REVISION NUMBER: 3 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR N POLICYNUMBER MM/DDIYYYY W MMIDDMl A X COMMERCIAL GENERAL LIABILITY MWZY312717 03/01/2018 03/01/2019 EACH OCCURRENCE $ 9,000,000 CLAIMS-MADE FXI OCCUR -PREMISES Ea occurrence) $ 1,000,000 LIMITS OF POLICY XS MED EXP(Any one person) $ EXCLUDED OF SIR$1M PER OCC PERSONAL a ADV INJURY $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 9,000,000 X POLICY F--]PRO ❑LOC PRODUCTS-COMP/OP AGG $ 9,000,000 JECT OTHER $ A AUTOMOBILE LIABILITY MWTB312718 03101/2018 03/01/2019 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident L 1 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WC 014122577 (AK,NH,NJ,VT) 03 01 2018 0310112019 X I PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B Y/N WC 014122578(WI) 03/01/2018 03101/2019 EL EACH ACCIDENT $ 5,000,000 OFFICE IMEMB R/PARTNER/EXECUTIVE NIA i (Mandatory In EREXCLUDED? 5,000,000 (Mandatory In NH) E L DISEASE-EA EMPLOYEE $ If Yes,describe under Continued on Additional Page E L DISEASE-POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS below C Excess Auto 297-1-10011-00-2018 03/01/2018 03/01/2019 Limit: 4,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc Manashi Mukherjee �Lb�vas+d►.: ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta AC40REP® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA,INC THE HOME DEPOT,INC HOME DEPOT U.S A,INC POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA,GA 30339 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE. Certificate of Liability Insurance Workers Compensation Continued' Camer Indemnity Insurance Company of North America Policy Number WLR C64783191(AL,AR,FL,ID,IA KS,KY,LA,MS,MO,NE,NM,ND,OK,SC,SD,TN,WV,M) Effective Date-0310112018 Expiration Date 0310112019 (EL)Limit$1,000,000 Camer.New Hampshire Insurance Company Policy Number WC 014122576 (DC,DE,HI,IN,MD,MN,MT,NY,RI) Effective Date.03101/2018 Expiration Date*010112019 (EL)Limit$1,000,000 Camer ACE American Insurance Company Policy Number.WCU C64783221(QSI)(AZ,CA,IL,NC,OR,VA,WA) Effective Date.03/01/2018 Expiration Date 0310112019 (EL)Limit$1,000,000 SIR $1,000,000 SIR for the states of AZ,CA,IL,NC,OR,VA,WA Camer National Union Fire Insurance Company Policy Number XWC 4595580(QSI)(CO,CT,GA ME,MI,NV,OH,PA UT) Effechve Date 0310112018 Expiration Date 03/01/2019 (EL)Limit$1,000,000 $1,000,000 SIR for the states of CO,ME,NV,MI,OH,PA,UT $750,000 SIR for the state of GA $350,000 SIR for the state of CT Camer.National Union Fre Insurance Company Policy Number XWC 4595581(QSI)(MA) Effecbve Date,0310112018 Expiration Date.0310112019 (EL)Limit$1,000,000 SIR$500,000 TX Employers XS Indemnity Carnerlllinios Union Insurance Company Policy Number TNS C4916693A(TX) Effective Date.03101/2018 Expiration Date 03101/2019 (EL)Limit$10,000,000 SIR$1,000,000 ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta ACC)RE0® ADDITIONAL REMARKS SCHEDULE Page 3 of ' 3 AGENCY NAMED INSURED MARSH USA,INC. THE HOME DEPOT,INC. HOME DEPOT U S A.,INC. PoucY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA,GA 30339 CARRIER NAIC CODE ' EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance "'HOME DEPOT INSUREDS— The Home Depot,Inc The Home Depot U SA,Inc, Home Depot USA,Inc.dba The Home Depot Home Depot USA,Inc.dba Your Other Warehouse,LLC Home Depot of Puerto Poco,Inc Home Depot Product Authority,LLC Home Depot Store Support,Inc. Red Beacon,LLC Intedine Brands,Inc. Interline Brands,Inc dba' Barrett Copperfield Eagle Maintenance Supply Hardware Express Loran Maintenance USA Renovations Plus Supplyworks US Lock Wilmar CleanSource " JanPak AmSan Sexauer Trayco Zip Technologies 3 , ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD tip' r - 3�' F �3 y�C _ �,'S� � �2�r.... _ r �3• ;�.- __� " } '• 3ry=S• ,�i•. '`a.`' ,sem -..._5 g `�.+,-" Jfy,',s: d�.,t3 �{�;��y''� 3cy-y G"i��, "� i'�,��) f �v. �.{W-."�J�.Y .%Rg`�� ��y}?. rrR�iYr:• �5��(' �Ci+ 4v�• T„ .,. �qr .,a `cx.�3=.--tip• ;tea ,t.- ^�;��^-r�"�' i,�{' >,« '' € -t;. "r -r.+""��,'-+.-,.gam'. •ys€•' ;,�,_rT�,��-�r�'-��'<� ^�F `� •' _ _c'` 'Y A .Y. �.«' y .-'mA^„c-�.'_q' ��'�T«?yT � ` ,y � .[�•'rs-r.."z ,`.� _ •„, _ „r, � „"���-'�� �+r - � <�,r _:, 4 x'✓•' �„�.�_� "'.y-z 'G �rrzk�aP".AY' "§r- � ��"%,', } Cr tl- �"`�{'^R.r � •,."jb�1' �- x �i .- � �cs.•:.^vim'-"�.y '�'� '"'ayiy u/` � � � _ v �., ', - y' s «�""� "�„^'%qf;� F,.�run.�,•� �':^'..'.au53' '{ YJ..,s' �7r"�Zr—. '+'^ .;.�.�''r,'„/,.'�i,•c+.« „� �%->r Jae y.r�-��'rF ✓^ `'� a �`Y�: '�f�d'�`..�,_�.,1 s�.��i y � Cg's p' - ^� • �� :z: y ;fix ;�. '� •�� .�,y�'>; ._.��r�;,,,,,y,��,�[;�'"'�'' �„ - '�J� `� �r m-0� s- � 7 Go Permits, LLC 105 Buttonball Ln. Glastonbury, Ct 06033 e Scoff Doughman a i Phone: 860-952-41 T1 Fax: 860-430-6719 scottdoughman@gopermits.org, "WE UNDERSTAND THAT YOUR TIME IS MONEY" To Whom It May Concern: Enclosed you will find "a building permit application and check. If you have any questions regarding this application, feel free to call me at the number listed below. Please note the following: • Please mail original permit to the owner. • Please fax or e-mail a copy of the permit and receipt to: Fax: 860-430-6719 (attn: Scott Doughman) Email: permits@gopermits.org • If fax or e-mail is not available, please mail a copy of the permit and receipt to:" Go-Permits, LLC 105 Buttonball Ln. Glastonbury, CT 06033 Thank you! D �:,'' _>i�` 1t.�`v.� }� Jennifer Winke, Permit Expediter 'W JAN 3 2019 Go Permits, LLC Phone: 303-946-8685 Fax: 866-697-0768 7 ¢'' " T• jenniferwinke@gopermits.org `' "� +�- = 4°< ;r . . ' *� r Go Permits LLC, 105 Buttonball Ln. Glastonbury'CT 06033, scottdoughman@gopermits.org Home Improvement Agreement: Pagel Home Depot License #'s- For the most current listing www.Homedepot.com/LicenseNumbers NY: Amherst HI-04712, Lockport 2395; Buffalo LT12-10023782, City Tonawanda 33257, East Hampton 4499, Long Beach 4917, N. Tonawanda 368.16, Nassau County H1171050000,- H1771053000, New York City 0900456-DCA, 900457-DCA, 0900458-DCA, 0910621-DCA, 0910622-DCA, 0920734-DCA, 0922474-DCA, 0968605-DCA, 1003822-DCA, 1003823- DCA, 1003825-DCA, 1003828-DCA,1003830-DCA,1003833-DCA, 1026224-DCA, 1075580-DCA, 1129555-DCA,1129556- DCA, 1129557-DCA, 1129562-DCA, 1129564-DCA, 1133444-DCA, 1152032-DCA, 1152034-DCA, 1152035-DCA, 1152036- DCA, 1152038-DCA, 1152039-DCA, 1152040-DCA, 1178447-DCA, 1186042-DCA,1212045-DCA, 1223272-DCA, 1251871- DCA, 1318292-DCA , Niagara Falls 971, Putnam County PC 689, Rockland County H-06464, Southampton L002442, Suffolk County 47874-ME, 55323-ME, 53429-H, 57713-H, 54888-MP, 50222-MP, Town of Tonawanda: 1854, Westchester County WC18484H06, Yonkers 5675, 47874-ME Richard Mirro SalespersonName: Registration No. (if applicable): Home Depot U.S.A., Inc. ("Home Depot") or Service Provider named below will furnish, install and/ or service the equipment listed below at the price, terms and conditions as outlined on this form. hubbard Judy Long Island 1-BD2B24X Customer Last Name ustomer First Name tore / Branch Name Customer Lead/ P # 1325 Factory Avenue MattituckNY 11952 Customer Address ity tate Zip (631) 375-1715 1lh94@yahoo.com Home Phone or on Ce Phone# Customer Email Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 40 Oser Avenue Suite 17 HauppaugeNY 11788 Address City tate Zip Or Email' customercancellationnortheast@homedepot.com . Service Provider Email Address BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW 1N YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME - DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO-CANCEL. PLEASE SIGN-BELOW TO_ACK140-WLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged by: 12/1s/2o18 Customer'NSignMture Date Contract Price and Payment Schedule : Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: $ 17614.00 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 10.00 (If applicable) *Maximum deposit ONLY applicable in MD, MA, ME(3391o), NJ, WI(9991o) Dep. 125.0 % Deposit Amount $ 1903.5 Remaining Balance $ 15710.50 The Home Depot-2455 Paces Ferry Road,N.W.Bldg.5-3,Atlanta,Georgia 30339-Customer Care:1-800466-3337 460 FIDE Customer Agreement(24 Jul.18) v V.7 Home Improvement Agreement: Page2 Finance Charges: *Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which The Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payment(s) made payable to The Home Depot. Insurance proceeds will ' will not be used to pay some or all of the total amount of sale. Description of Work to be Performed: Installation of windows A more detailed description of the work to be performed is inc luded in the section entitled Scope o Work which appears on page 0 of this Agreement. Anticipated Delivery Date/Installation Schedule Approximate Start Date: 02/10/2019 Approximate Finish Date: 03/10/2019 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. Electronic Records Authorization: You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this agreement. By contacting your Service Provider, you may update your email address, withdraw your consent, or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above, you confirm that you have access to a computer that can receive and open emails and PDF documents. By4nitialing this paragraph, I consent to receive only electronic records related to this transaction. Initial Acceptance and Authorization: By signing below, you authorize Home Depot to (a) arrange for Service Provider to perform Installation and/or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's/permitting information may need to be provided to You later.) By signing, you acknowledge that you have read, understand, and accept this Agreement in its entirety, including the General Terms and Conditions and State Supplement, if any. You further acknowledge receiving a co to copy of this Agreement. Keep it to protect your legal rights. X 12/16/2018 The Home Depot ustome 's Signature Date Service Provider Name X 12/16/2018 40 Oser Avenue Suite 17 Co-Signer (if applicable) ate Service Provider Address X 1 12/16/2018 Hauppauge NY 11788 ig ture of Home Depot ate City tate Zip Service Provider Phone Number Service Provider License Number _ The Home Depot-2455 Paces Ferry Road,N.W.Bldg.B-3,Atlanta,Georgia 30339-Customer Care:1-500-466-3337 460 HDE Customer Agreement(24 Jul.18) v 0.1.7 c �Q ED :, , DATE:> ��� B LY CpMPLY WITH ALL CODES OF FEE:d �;. ( AT T BUILD"i,- =` ++ No-I -i To 4 aI M FOR TH= IvFW YORK STATE &TOWN CODE �n2 $ANi AS REQUIRED A 765-1�_ + p CTt'JNS: or"CUR^�i1 �O FOLLO\NINCa Oh tq FC�U"?ED $� id y Y 1. FOU�,DAIl0�L; CON,"- USEBOARD �,��� �� UNLAWFUL �,�L a FOR POUR $ ��iFp eL Z. ROUGH - FRAMING & PL'JNiFsINU �y _ tEES V�"THOUT ��u'�T s. IrIsuLATtoN D���rr��� ;�AUC,{10+V MUST �� 4. FINAL COI" C.0. N.Y. BE CONMPLcI'R ` `' NtEET THE ����ANCY ; ALL CONSTRUCT l0i t SHALL E CODES OF tlpN REQUIRFbnEN T S OF THFOR ESPONSYORK STATE. HOST I CT ON IBLF D`SIGN OR CON L= � WINDOW SPECIFICATION SHEET - Spec Sheet# 1-BD2B24X Sheet: 1 of 2 Customer.Judy hubbard Job#: 1-BD2B24X Consultant- Richard Mirro Date. 12/16/2018 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,RorS Glass Misc Items Hardware Code Screens For doors use v oo Mull "S"=stationary or Z5 E a 5 a `o r r = "X"=operating N Style Wraps t Room Floor Code (Y/N) Style Code Series Code i 5 h-Cr U a > = 9 > =I FULL SCR,STD,White, WRAP, 1 ENTRY 1st DH Y DH 6100 WH WH 31.00 5800 89 F, WH,W C ALL 1 ALL 1 Gla$$Pack:Standard RMW,EXT GBG H C,LSR FULL SCR,STD,White, WRAP,EXT 2 ENTRY 1st DH Y DH 6100 WH WH 3100 5800 89 F, WH,W C ALL 1 ALL 1 GlassPack,Standard C,RMW, GBG H LSR FULL SCR,STD,White, WRAP, 3 BED 1st DH Y DH 6100 WH WH 3100 58.00 89 F, WH,W C ALL 1 ALL 1 GlassPack:Standard RMW,LSR GBG H FULL SCR,STD,White, WRAP, 4 BED 1st DH Y DH 6100 WH WH 31.00 5800 89 F, WH,W C ALL 1 ALL 1 GlassPack,Standard RMW,LSR GBG H FULL SCR,STD,White, WRAP, 5 BED 1st DH Y DH 6100 WH WH 3100 5800 89 F, WH,W C ALL 1 ALL 1 GlassPack:Standard RMW,EXT GBG H C,LSR FULL SCR,STD,White, WRAP, 6 BED 1st DH Y DH 6100 WH WH 31.00 5800 89 F, WH,W C ALL 1 ALL 1 GlassPack:Standard RMW,LSR GBG H FULL SCR,STD,White, WRAP, 7 HALL 2nd DH Y DH 6100 WH WH 31.00 5800 89 F, WH,W C ALL 1 ALL 1 TMP:Full, GlassPack: RMW,EXT GBG H Standard C,LSR FULL SCR,STD,White, EXT C, 8 BED 2nd DH Y DH 6100 WH WH 31.00 5800 89 F, WH,W C ALL 1 ALL 1 GlassPack Standard WRAP, GBG H RMW,LSR SPECIAL CONSIDERATIONS. 1•White,2:White,3.White,4 White,5.White,6.White,7.White,8•White Wrap Calor Interior Casing Type Bay or Bow window. Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(inches) If tied to soffit,color of soffit materiAl I have reviewed and agree with all the job specifications above,and the Construct Roof(Yes or No)', Special Terms and Conditions on the folloVing page ' Garden Window ' Seathoard Material(vinyl only,Whrte Pionite,Buch,or Oak) WINDOW SPECIFICATION SHEET - Spec Sheet#: 1-BD2B24X Sheet: 2 of 2 Customer:Judy hubbard Job#:1-BD2B24X Consultant: Richard MirroDate: 12/16/2018 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,R or S Glass Mlsc Items Hardware Code Screens For doors use LL: E c o o Mull °S"=stationary or Style Wraps d a m 03 Z5 'X" operating t Room Floor Code (Y/N) Style Code Series Code = z vi v a 9 i 9 _� FULL SCR,STD,White, EXT C, 9 BED 2nd DH Y DH 6100 WH WH 31.00 5800 89 F, WH,W c ALL 1 ALL 1 GlassPack•Standard WRAP, GBG H RMW,LSR SPECIAL CONSIDERATIONS. 9•White Wrap Color Interior Casing Type Bay or Bow window eatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,orCsmnt) Top of window to soffit(inches) If tied to soffit,color of soffit material I have reviewed andagree with all the Job spec4flcatlons above and the onstruct Roof(Yes or No)' • • Special Terms and Conditipns on the following page ' ' Garden Window eatboard Maerlal(vinyl only-Witte Pionfte,Birch or Oak) � 1�Y VantagePointe d The Horne Depot 6100 Series by Simonton Double Hung, 0SIMONTON xN f H b 0 w s' With Grids '1 uN> 1Ni'C n, ..,,tw R.: y �w r" t 'K- a�:tts rYs �a Win..:+ y ..• '_' � - +� t» � - e a�:.. >`rfyff �,�������t�,,.r. �� ems } r�c.t,Y✓r�t��f; ='�- � :�< ,�3.� ��','`�'�;�`�"`�-C�.r a�c -n.�'�tfi :. ��� ��2` � `�D[w�� �`'��y�{ � F.. �3�•.�r F S?.•..�a^d»,. M���. _ .,w;, �. .,c Y>:rL, r ���`,rt y 3..:�'` w. _.n ri�a�.e,., �ia�. c�E ,��.'° Toted Un1t Canter of, Toth{pnit Cent®raf Total il�iii Cent�'r of Total t9nit' riYer tmf Ccnt��-oY G1asis Mess aleeg Dias ' Clear/pear Air Intercept Spacer 6,75 0.49 0.49 2.04 2.04 0152 D.81 0.49 O:7S 0,42 Low-E 270/Clear Alr Intercept Spacer 0.75 0,37 D.3 2,7 3.33 0.4S 0.7 0.25 0,37 0.85 Low-E 366/Clear Air Intercept Spacer 0.75 0.37 0.3 2.7 3.33 0.41 0.64 0.18 0.27 0.84 TIAC36/0ear lir intercept Spacer 0.75 0.37 0.3 2.7 3.33 0.44 0.60, 6..24 0.36 0.62 Low-E 270/Clear Argon Intercept Spacer 0.75 0.34 0:26, 2.94 3.85 0.45 O7 0,24 ,0.36' 0.85 Low-E-270(Low E Argon Intercept Spacer 0.75 0.32 0.25 3.13 4 0.39 016 0.23 0.34 0.95 270 Low-E 3(6/Clear Argon Intercept Spacer 0.75 0.33 0.25 3.03 4 0.41 0.64 0.18 0.27 0.84 Low-E 366/Low E Argon Intercept Spacer 0.75 0:32 0,25 113 4 0.33 0.51 0.18 0.26 0.95 366 'nAC36/Clear Argon Intercept Spacer 0.75 0.33 0.26 3.03 3.85 0.44 0.68 0.24, 0.36 0.85 -nAC36/TiAC36 Argon Intercept'Spacer 0.75 0,32 D.25 3.13 4 0.36 0.56 0.22 0.33 0,9 Low-E 270/Clear Krypton IntCrcept Spacer 0.x5 0.32 0.23 3.13 4.35 0,45 0.7 0.24 0.36 6,85 Law-E 270/Low E Krypton Intercept Spacer 0.75 0.31 0.23 3.23 4.35 0.39 0.6 0.23 0.34 0,95 270 Low-E 366/Clear' Krypton, Intercept Spacer 0.75. 0.31 0,23 3.23 4.35 0,42 0.65 0.18 0.27 0.84 I Low-E 366/low E Krypton Intercept Spacer 0.75 0.3 0:22 3.33 4,55 0.33 0.51 0.18 0.26 0.95 3b6 TIAC36/Clear Krypton Intercept Spacer .0.75 0.32 D.23 3.13 4„35 0.44 0.68_ 0.24 0.36 O.BS MAC36/IlAC36 Krypton Intetedpt Spacer 9.75 0.31 0.23 3.Z3 4.35 0.36 0.5.6 0,22, 0.33, 0.9 , Clear/dear Air Super Spacer, 0.75. 0.48 0.49, 2.08 Z,04 0.'52 0.81 0.49 6.75, 0.42 Low-E 270/06ar Afr Super-Spacer 0,75 0.36 0.3 2,78 3.33 0.45 0.7 0.25 0.37 '08 5 Low-E 366/Gear Air Super Spacer 0,75 0.36 0.3 2:78• 3.33 0.41 0.64 0.t8 0.27 1 0.84 TIAC36/Clear Aft Super Spacer 0.75 0.36 0.3 2-,75 3.33 0.44 0.68 p.24 0.36 0.62 Low-E 270/Clear Argon Super5pacer 0,75 0.33 0.26' 3:03. 3.85 0,45 0.7 0.24 0:36 0.85 Low-E 270/1-ow E Argon ' Super Spacer 0.7S 0.32 0.25 3.13 4 0.39 0.6 0.23 0.34 0.95 270 Low-'E 366/Clear Argon Super Soacei 0.75 0.32 0.25 3.13 4 0.41 0.64 0118 0.27• 0.84 Low-E 366/1-ow E Argon Super Spacer 0.75 0131 0,15 3.23 4 0,33 0.31 0.18, 0.26 0.95 366 TIAC36/dear Argon Super Spacer 0.75 0,.33 0.0 3,03 3.85 0,44 0.68 0.24 0.36 0.85 TIAC36/I1AC36 Argon Super Spacer 0.75 0.32 0.25 3.13 4 0.36 0.56 0.22 0.33 0.9 Low-E 270/Clear Krypton Super Spacer 0.75 0.31 0,23• 3.23 4,35 0.45 0.7 0.24 0.36, 0.85 Low-E 270/Low E Krypton Super Spacer 0.75 0.3 D.23 3.33 4,35 0.39 0.6 0.23 0.94 0.95 270 Low-E 366/Clear Krypton Super Spacer 0.75 0.31 0.23 3.23 4.35 0,42 0.65 0.18 0,27 0.84 Low-E 366/Low E Krypton Super Spacer 0.75 0.3 0.22 3.33 4.55 0.33 0.51 0.18 0.26 0.95 366 TIAC36/Clear Krypton Super Spacer 0.75 0.31 0.23 3.23 4.35 0.44 0.68 0.24 0.36 0.85