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HomeMy WebLinkAbout43862-Z �SUFFot'-t" Town of Southold 8/6/2019 G� P.O.Box 1179 • 1 53095 Main Rd yea ap� rti Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40594 Date: 8/6/2019 THIS CERTIFIES that the building HVAC Location of Property: 1000 Village Ln., Orient SCTM#: 473889 Sec/Block/Lot: 25.4-18 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/8/2019 pursuant to which Building Permit No. 43862 dated 6/13/2019 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: HVAC SYSTEM AS APPLIED FOR The certificate is issued to JOTAS Corp of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43862 08-02-2019 PLUMBERS CERTIFICATION DATED � Authorized Signature 'S'aFFn � TOWN OF SOUTHOLD Of-It�C�as BUILDING DEPARTMENT 0 TOWN CLERK'S OFFICE o SOUTHOLD NY SON; 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#: 43862 Date: 6/13/2019 Permission is hereby granted to: JOTAS Corp 25500 Main Rd Orient, NY 11957 To: install a new HVAC system as applied for per HPC approval. At premises located at: 1000 Village Ln., Orient SCTM # 473889 Sec/Block/Lot# 25.-1-18 Pursuant to application dated 5/8/2019 and approved by the Building Inspector. To expire on 12/12/2020. Fees: COMMERCIAL ADDITION/ALTERATION $250.00 CO -COMMERCIAL $50.00 ELECTRIC $125.00 a- Tot $425.00 CRuildinnspe Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWNN'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. 5 - New -New Construction: !000 Old or Pre-existing Building: (check one) Location of Property_ ` I L_ -A-L ` '�-� "T House No. Street Hamlet Owner or Owners of Property: 0 l_S, C_o Suffolk County Tax Map No 1000,Section 1�S Block Lot Subdivision Filed Map. Lot: Permit No. -D/1 ��Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for. Temporary C tificate Final Certificate: (check one) Fee Submitted:SO Appli t gnat re Building Department Amnlication AUTHORIZATION (Where the'Applicant is not the Owner) residing at I, (print.propwW owner's n- e) (Mailing'Address) - Q h• �� f �-. do hereby authorize _ SRA Mechanical (Agent)_ to apply.on my behalf to the Southold Building Department: _ �' "' .(Date) (O er Signature) (print Owner's Name) ; ®��oF so�ly®� Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 117 Southold,NY 11971-0959 ® sean.devlin(a-)town.southold.ny.us •�` � BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To- JOTAS Corp. Address: 1000 Village Ln City Orient st: NY zip: 11957 Building Permit#. 43862 section: 25 Block: 1 Lot: 18 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: SRA Mechanical Inc. License No: 41178-MP SITE DETAILS Office Use Only Residential Indoor X Basement Service Only Commerical X Outdoor X 1st Floor X Pool New Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceding Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser X Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower X Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect X Switches Twist Lock Exit Fixtures TVSS Other Equipment Ameristar AC, Disconnect and a Double pole 25 Amp breaker Notes- Inspector Signature: Date: August 2, 2019 S. Devlin-Cert Electrical Compliance Form.xls oe souryo v # * TOWN OF SOUTHOLD BUILDING DEPT. rycou765-1802 INSPECTION- FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL j. [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION. [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [�ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE C/ INSPECTOR 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 Survey Southoldtownny.gov PERMIT NO. Check Septic Form t� �n ,; N.Y.S.D.E.C. c7® Trustees ` C.O.Application Flood Permit Examined 120A Single&Separate Truss Identification Form Storm-eater Assessment Form B, ontact: �y-- Approved 20 �QtY`()Q, maa.tn; S CC v Disapproved a/c Phon C. Expiration .20 Buidi ector APPLICATION FOR BUILDING PERMIT Date ,20 INSTRUCTIONS a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has-not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or Regulations,for the 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. 14 W V1 (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 l� AI L)Vim\h-LV- Name of owner of premises L- C-0 r5 ar C k ci (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. le Electricians License No. Other Trade's License No. — 1. Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section Block I Lot is Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended`-fuse and occupancy of proposed construction: a. Existing use and occupancy(�I.Pf" l;/ •0 b. Intended use and occupancy 3. Nature of work(check which applicable):New Building on Alteration Repair Removal DemolitionOther Work T,c, .,- s �%,x (Description) Estimated Cost Fee (To be paid on filing this application) 5. If d" ing, number of dwelling units Number of dwelling units on each floor If garag ,,umber of cars — 6. If business, coram . ial or mixed occup cy,specify nature and extent of each type of use. 7. Dimensions of existing stru fres, ' any:Front Rear Depth Height umber of Stories Dimensions of same str ture with a ations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of enti new construction: Front Rear Depth Height Number of Stories /eh nt Rear Dep se Name of Former Owner trict in which premises are situated 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 Naive of Contractor Address Phone No. / 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES ' NO * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C.PERMITS MAY BEEQUIRED. b. Is this property within 300 feet of a tidal wetland? *YES NO VV * 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. 13. Are there any covenants and restrictions with respect to this property?*YES NO * IF YES,PROVIDE A COPY. STATE OF NEW YORK) ` , COUNTY i OAF COT+ A1c R/e_ft being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the (Contracto ,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. Sworntt efore me this day of 20'101 J(iaow Notary Public Signature of Applicant TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2-(),a?- FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL DATE:May 31, 2019 TO: Scott Arnett(JOTAS) 1186 Ocean Avenue Bayshore,NY 11706 Please take notice that your application dated May 8„ 2019: For permit to install a new outdoor AC unit at: Location of property: 1000 Village Lane, Orient,NY County Tax Map No. 1000—Section 25 Block 1 Lot 18 Is returned herewith and disapproved on the following grounds: The proposed installation, on this .25 acre lot in the HB District, is not permitted without review and approval by the Southold Town Landmarks Preservation Commission, because the property is listed on either the Southold Town,New York State and/or the National Registers of Historic places and requires review by the Southold Town Landmarks Preservation Commission. If the requirements of the town code, pertaining to Landmarks (Local Law No.22) are met, a Certificate of Appropriateness (C of A)will be issued. The C of A is required before a Building Permit will be approved. Information about the requirements for applying for a C of A is available at the information counter in the Building Department. Authorize Signa re Note to Applicant: Any change or deviation to the above referenced application may require further review by the Southold Town Building Department. CC: file,Landmark F04,feo� - _ Edward Webb,Chairperson © Town Hall Annex Anne Surchin,Vice Chair �1Q1 �,�© 54375 Route 25 Donald Feiler PO Box 1179 James Grathwohl Southold,NY 11971 Robert Harper Fax(631).765-9502 James Garretson Telephone: (631)765-1802 Joseph McCarthy www.southoldtownny.gov Tracey Dwyer,Administrative Assistant Town of Southold Historic Preservation Commission Tuesday,June 4,2019 RESOLUTION #6.4.19.1 Certificate of Appropriateness RE: 1000 Village Lane,Orient,SCTM# 1000-25.-1-18 Owner: JOTAS Corp. RESOLUTION: WHEREAS, 1000 Village Lane, Orient,NY is on the Town of Southold Registry of Historic Landmarks, and WHEREAS, as set forth in Section 56-7 (b)of the Town Law(Landmarks Preservation Code) of the Town of Southold, all proposals for material change/alteration must be reviewed and granted a Certificate of Appropriateness by the Southold Town Historic Preservation Commission, and, WHEREAS, the applicant is requesting permission to construct a HVAC Unit and Lattice, and, WHEREAS, a public hearing was held on June 4, 2019. NOW THEREFORE BE IT RESOLVED,that the Southold Town Historic Preservation Commission determines that the proposed work detailed in the above referenced application meets the criteria for approval under Section 170-8 (A) of the Southold Town Code and, BE IT FURTHER RESOLVED,that the,Commission approves the request for a Certificate of Appropriateness. MOVER: Commissioner Garretson SECONDER: Commissioner Harper AYES: Chairperson Edward Webb,Vice Chair Surchin, Commissioner Garretson, Commissioner Joseph McCarthy and Commissioner Feiler. OPPOSED: Commissioner Harper RESULT: Passed Please note that any deviation from the approved plans referenced above may require fu they review from the commission. Signed: J4 acw of. A2&j Tracey L Dwyer,Application Coordinate for the Historic Preservation Commission Date: June 5,2019 4 lam' �� � . � • r f f 1 1 S w L - i . � a•.. yr {'_... _. .�-r s`'� � �+d�F3,�'� ,•.5��` Ajn..ey���.;�gl.c ��a;'--•.!,i:� .�3�""'�ir R>:F'r�'i.,e S-r""4' .}.e t..• .... a.. �r1FFa1,C�Q' BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Lwow � � Telephone (631) 765-1802 -FAX (631) 765-9502 roger.richertfttown.southold.ny.us APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: 5 " f\ �N— v �� Date: Company Name: C_ L `— Name: s, C-6y Y License No.: _ -- 411�1� email: � Y � t �ltLd� �-- �� 11• U� Address: �!( ' C 2 Ila S 1d� /✓ ` \ c. Phone No.: Li Lk ct 17S \ JOB SITE INFORMATION: (All Information Required) Name: c 1 e�-i to v �\ o ' Address: Cross Street: �- Phone No.: Bldg.Permit email: Tax Map District: 1000 Section: 2 Block: ILot: ( BRIEF DESCRIPTION OF WORK(Please Print Clearly) Circle All That Apply: Is job ready for inspection?: YES ! NO Rough !n Final Do you need a Temp Certificate?: ,9)1 NO Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A #Meters Old Meter# New Service-Fire Reconnect- Flood Reconnect-Service Reconnected-Underground-Overhead #Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional information: PAYMENT DUE WITH_APPLICATION a�V/ f'� r Suffolk County Dept.of Labor, Licensing&Consumer Affairs MASTER PLUMBING Name SCOTT R.ARNETT Business Name SRA MECHANICAL INC This certifies that the bearer is duly licensed License Number MP-41178 by the County of Suffolk Issued: 08/30/2006 Commissioner Expires: 08/0112020 Lice nse;:Number ;1102 -=Thisinto=certi[y;#hat r �cott.Amd .-: f.; is-D [ILl_!;LICENaED.asa MASTER-SPWIVISthe jp 0373172024: -- - Y Workers' CERTIFICATE OF INSURANCE COVERAGE STATE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a,Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured SRA MECHANICAL INC. 631-495-5164 1186 OCEAN AVENUE BAY SHORE,NY 11706 1c.Federal Employer Identification Number of Insured Work Location Of Insured(Only required if coverage is specifrcallylimited to or Social Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 202023553 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company TOWN OF SOUTHOLD 54375 ROUTE 25 3b.Policy Number of Entity Listed in Box"la" SOUTHOLD, NY 11971 DBL279969 3c.Policy effective period 07/13/2018 to 07/12/2020 4. Policy provides the following benefits: n A.Both disability and paid family leave benefits. Q B.Disability benefits only. C.Paid family leave benefits only: 5. Policy covers: ©•A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or Gasses of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 4/24/2019 By Aw (Signature of insurance carrier's authorized representative or NYS Licensed Insurance'Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are 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 46,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers'Compensation Board,Plans Acceptance Unit,PO Box 5200,Binghamton,NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(Only if Box 4C or 56 of Part i 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 and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note.Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carvers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) • �IpII�If1111111210pI011111(IIliilllllUlillll�I�I A Rv® CERTIFICATE OF LIABILITY INSURANCE DATE D°"'""' 04/244/2011201 9 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(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 Orlonsure,LLC CONTACT T 3500 Bayfield Blvd PHONE •516-784-0234 FAI'C No):516-941-2981 Oceanside,NY 11572 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE MAIC 0 INSURER A: Hamilton Insurance Company INSURED Scott R.Arnett INSURER B: SRA Mechanical Inc. INSURER C: 1186 Ocean Ave INSURER D: Bay Shore,NY 11706 INSURER E: INSURER F: COVERAGES 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. INSR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY NIIOMMO EXP LIMITS LTR COMMERCIAL GENERAL LIABILITY 05/31/2018 05/31/2019 EAcHoccURRENCE $1,000,000 A DTHIBP-07093-01 05/31/2019 05/31/2020 D A-0.1-TURENT CLAMS-MADE �x OCCUR DTHIBP-07093-02 PREMI S Eaoccunence $50,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERALAGGREGATE $2,000,000 POLICY ECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMI $ I,ac idem ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $. EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETE ON$ $ WOR)MRS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE ERH ANYPROPRIETOR/PARTNER/EXECUTIVE I I E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? NIA (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY,LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Certificate Holder is included as Additional Insured. CERTIFICATE HOLDER CANCELLATION Town of Southhoid Town Hall Annex SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 54375 Route 25 " THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Southold,NY 11971 AUTHORIZED REPRESENTATIVE ©1988.2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD New York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Since 1914 199 CHURCH STREET,NEW YORK,N.Y.10007-1100 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE � D ' A A A A'A A 202023553 S R A MECHANICAL INC 1186 OCEAN AVENUE BAY SHORE NY 11706 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ORIENT POINT PO S R A MECHANICAL INC TOWN OF SOUTHOLD 1186 OCEAN AVENUE TOWN HALL ANNEX BAY SHORE NY 11706 54375 RT 25 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G1408179-8 910622 05/01/2019 TO 05/01/2020 5/5/2019 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1408179-8, 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 YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:// WW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE ,DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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 VALIDATION NUMBER:161584323 U-26.3 APPROVED AS INOTED DATE: � B.P.## CCUpANCY OR NOTIF`( BUIL�lG DEPARTMENT AT USE IS UNLAWFUL 765-11 02 8 AM TO 4 PM FOR THE WITHOUT C RTIFICATE FOLLOWING INSPECTIONS. 1 (` 1. FOUNDATION - TWO REQUIRED OF OCCUPANCY FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. TH ALL CODES OF ALL CONSTRUCTION SHALL MEET THE GOMPLY W & W�1 CODES REQUIREMENTS OF THE CODES OF NEW NEW YORK STATE YORK STATE. NOT RESPONSIBLE FOR AS REQUIRED a DESIGN OR CONSTRUCTION ERRORS. SOU%rt8 sop, SBtLttB � J Nunemaker, Amanda From: SRA MECHANICAL INC SCOTT R ARNETT <sramechanical@gmail.com> Sent: Wednesday, May 15, 2019 1:49 PM To: Nunemaker,Amanda Subject: Fwd: Orient Attachments: ATT00001.txt;IMG_0317.JPG;IMG_0316.JPG;IMG_0315.JPG;ATT00002.txt, ATT00003.txt;ATT00004.txt These are pictures of the building the unit is hanging in the air is the out door unit it is going to be lowered to that slab and the covered with lattace the two indoor units get line sets covered in a plastic gutter This is the north side of the building I will call you later today to see if you want me to draw you something but keep in mind I am a plumber not an artist ---------- Forwarded message --------- From: Beasley, Stephanie- Orient, NY<stephanie.a.beasley@@ usps.gov> Date: Wed, May 15, 2019, 1:37 PM Subject: Orient To: sramechanical(cr��gmail.com<sramechanical@ginail.com> ATTENTION: This email came from an external source. 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Z''.S.:Xa't =i-: I'.,k{1; ,.:t r INDOOR.UNIT J-� INDOOR UNIT) { INOOOR UNIT CJ-t INDOOR UNIT) t IND RUNFT—t O r�g ht•tO rCharige design and speciflcations•{iVtf-d- rlot[ce."'- (NVays check t e'U C1it :t nameplate and Wiring diagram`for ttie4ctual'u0etLrequtrOW66ts. ; 5 "JIM, -ltli� ,,S'&rAies__ "M u Iti.,S 1�1 it 1 ,Si 5nes _8` lit Wiririg Piagram,24K Wiring PiAgrAm 36 - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - 8K OWER INAL M 2EN Ll BN -!L T:!u I t! I _', I L. DMUST POWER LI AC-LI AC-L2 AC-L RTI -0 OQTDLQof3 UNIT N Nl N2 L2 12 Ouw tm 10BU TEMP MR u N N2vls El wz NAW I. FILTER ACL _FA RT2 -0 -§LENSOR Rig= w s� N D F Ong FB > Zv stzsoao W4 -x a rf— G w IBN BU WIS Ep" vv FG -BK 20YE 7, 14-9- =mup� • com FD 5 T, t. YEGN -0-Hgset -7 YJ _4 • 40 N t7l —1—Au ovc-comp Ito—ou-— OFAN 2 -,aE WHleda HP amw EFAW� QTAW Bu SAT�-"' TtUf A VALVE VALVE-C P 17WH 4'. 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