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HomeMy WebLinkAbout43868-Z Town of Southold 8/8/2019 ®. P.O.Bog 1179 d' 1► 53095 Main Rd `AAS �' �p��. Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40605 Date: 8/8/2019 THIS CERTIFIES that the building WINDOWS Location of Property: 265 Old Field Ct,Mattituck SCTM#: 473889 Sec/Block/Lot: 120.-3-8.20 Subdivision: Filed Map No. ' Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/6/2019 pursuant to which Building Permit No. 43868 dated 6/14/2019 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 REPLACEMENT TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Beresford,Harry&Barbara of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED �(uthA a Signature TOWN OF SOUTHOLD o�gtlfFO(q�co BUILDING DEPARTMENT z TOWN CLERK'S OFFICE Ca o � ' SOUTHOLD NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 43868 Date: 6/14/2019 Permission is hereby granted to: Beresford, Harry & Barbara 265 Old Field Ct Mattituck, NY 11952 To: install window replacement on existing single-family dwelling as applied for. At premises located at: 265 Old Field Ct, Mattituck SCTM # 473889 Sec/Block/Lot# 120.-3-8.20 Pursuant to application dated 6/6/2019 and approved by the Building Inspector. To expire on 12/13/2020. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO -ALTERATION TO DWELLING $50.00 Total: $250.00 Buildi ector Form No.6 TOWN OF SOUTHOLD BUILDINGDEPARTMENT ENT 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. Swom statement from plumber certifying that the solder used in system contains less than 2110 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 applicanL 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$15.00 Date. 6 Iy3 I.?,gyp(0 New Construction: Old or Pre-existing Building: X (check one) Location of Property: a-41(06 OLD FIELD G M qT r 1;lq CIC NY i I s.5z house No. Street Hamlet Owner or Owners of Property: H AeJZ { G M e$r OQ n Suffolk County Tax Map No 1000,Section 1X0 Block ,3 Lot op..2O Subdivision Filed Map. Lot: _ 1 Permit No. qb�IA Date of Permit Applicant: ELM I STA M 6,N,b X20 tJ Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for. Temporary Certificate Final Certificate: (check one) Fee Submitted:$ J O W r -- Applicant Signature . I��.ialc�iti;� ��c�)=lt•lfiseli$ F1��lf�.atiuri AUTHORIZATION ffhere ilie applicant is not the Owner) residing at. 1� (Print prtipery owner's.natne) (IN44iling address) NY 11135Zdo hereby authorize -__ EL (ET-A M6NDCOA) (Agent) 2)CQ to apply on Yny behalf to the Southold Building Department. (6w' el' s Signature) /D A-0 Iz- (Pri t Owner's Name) 1 - O��OF 50(/lyO 1- * TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION " [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ NSULATION [ ] FRAMING /STRAPPING [ ] FINAL(i(,fnCkt) [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (1ST) CK-1* .................................... 'FOUNDATION (2ND) z �o ROUGH FRAMING PLLM13ING �y � INSULATION PER N. Y; STATE ENERGY CODE y u01) WIAON A AA FINAL ADDITIONAL COMMENTS 1:1truf- L)o d ,H TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUTILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of BmWing Plans TEL-(631)765-1802 Planning Board approval FAX:(631)765-9502 , 7Q�� Survey SoutholdTown.NorthForkmet PERMIT NO. -J U Check Septic Form N Y.SDY-C_ Trustees CO.Application Flood Permit Examined 20A Single&Separate Storm-Water Assessment Form IContact; Approved ! 20 Mail to: SWTi DQUOm MA►d Disapproved a/c IOSBNi'i'O BALL CN LASi'oN$Uey CT 060M Phone:-960— 95,1- 4111 Expiration 1 20 nD 'L� Ij ! ;APPLICATION FOR BUILDING PERIVDT jv� 'I Date ®3 20 Is .JUN - 6 2019 INSTRUCTIONS a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 selk&plan`saccinaie plot jun to scale-Fee according to schedule. V,.- , b;Plot plan showingPlel Don of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Petmit- d.Upon approval of this application,the Build-mg Inspector will issue a Building Permit to the applicant Such a permit shall be kept on the premises available for inspection throughout the wodc e.No building shall be occupied or used in whole or in part for any propose what so ever until the Budding Inspector issues a Certificate of Occupancy- f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition sat months.Thereafter,a new permit shall be required_ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Sui$ulk 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. s (Signature of applicant or name,if a rnrporation) 5913 C-MERSOO It SOHILWIZ ?V. , It. 6olIy (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder A GE W Name of owner of premises A P,9,1 r lC S F n a-D (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 landon which roposed work will be done: ZP5 OL1 Fie er MAT-1111401t NY House Number Street '' ^^ Hamlet Q County Tax Map No.1000 Section )bAAW Block J2Lot 8.40 REMOVE AND tzeoce I wrgwu t 1,11k6 uffii LACE t 00 ST2UCA40,At. CMANG►'F-s. 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 RIES IDE N1 I A t, b. Intended use and occupancy QF_S 1 DE N 110 L 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 ff 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 Dear Depth Height Number of Stories 8. Dimensions of entire new construction:Front Rear Depth Height Number of Stories 9. Size of lot:Front Rear Depth 10.Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situated 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO 13.Will lot be re-graded?YES NO Will excess fill be removed from premises?YES NO 14.Names of Owner ofpremises '4 $�aESFOQ)Address.26S19LD FIELD G' Phone No. 490 y3�r', Name of Architect Address MATT TUCC NY Phone No Name of Contractor HON I&Oi LISA Address Phone No. a4ss paras p6ewt ao t Arl,aark GA 303is 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO *IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b.Is this property within 300 feet of a tidal wetland?*YES NO *IF YES,D.E.C.PERMITS MAY BE REQUIRED. 16.Provide survey,to scale,with accurate foundation plan and distances to property lines. 17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18.Are there any covenants and restrictions with respect to this property?*YES NO *IF YES,PROVIDE A COPY. STANISLAVA ATANASOVA Official Sea! STATE OF NEW YORK) SS: My Public—State of Illinois COUNTY OF (W&L My Comm,svon Exo,res Sep 7,2021 EL281M MEND200 being duly sworn,deposes and says that(s)he is the applicant (Name of individual siguiing contract)above named, (S)He is the ACrEN l (Contractor,Agent,Corporate Officer,etr_) 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. SwornttQ before me this ,j day of � 20 J 9 69-1& Rellt�� 6i"lic Signature of Applicant Go Permits,LLC (�. 105 Buttonball Ln. , , ;��-� g 9 Glastonbury,Ct 06033 LJ Scott Doughman LPA r F=W Jud — 6 2019 Phone:860-952-4112 Fax:860-430-6719 T scottdoughman@gopermits.org "WE UNDERSTAND THAT YOUR TIME IS MONEY" (� 019 To: Town of Southold Building Department Subject: Permit Application for: HARRY BERESFORD 265 OLD FIELD CT MATTITLICK, NY The above listed homeowner has contracted with Sears Home Improvements to replace the windows in his home. The below listed documents are included with this letter. • Notarized permit application • CO Application • Check for$250 payable to Town of Southold • Contract with Home Depot USA detailing scope of work • Home Depot Suffolk County License • Certificate of Insurance • Letter of Authorization from Home Depot USA allowing GoPermits to submit documents on their behalf • Windows specification spec sheet ;lease 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:scottdoughman@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! Ella Mendron, Permit Expediter Go Permits, LLC Phone:847-671-4606 elzbietamendron@gopermits.org Go Permits LLC,105 Buttonball Ln.Glastonbury CT 06033, scottdoughman@gopermits.org q ® �,Etrrmorcryn CERTIFICATE OF LIABILITY INSURANCE 02116P1D19 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 poWies)must have ADDITIONAL INURED provisions or be endorsed. H 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), ER NA EAU PRODUCERMARSH USA,INC. PHONE F TWO ALLIANCE CENTN T10- 3W LENOX ROAD,SUfTE 24M A ATLANTA,GA 30326 WSURERMMWOMMcovauum NATCS CN101642069-HomeD-GAW-19-20 INSURER A:Old Republic Insurance Co 24147 INSURED THE HOME DEPOT,INC. INSURER B:New Ham hire Ins Co 23841 HOME DEPOT U.SA,INC. ulsuRERc:HaneR'sk Captive!maraca Cappany 2455 PACES FERRY ROAD IN5URER D BUILDING C-20 ATLANTA,GA 30339 =F- COVERAGES SICURE- MSURETt F- COVERAGES CERTIFICATE NUMBER: ATL-004353439-26 REVISION NUMBER: 21 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- LTR TVPEOFIKSURANCE �y POLJG1f y FaDIN"ICTEl.EM A X COWAERCULLGENERALUABILRY MWZY 314574 03/0112019 0310112022 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE M OCCUR PREMISES Ea occurmnce $ 1,000,000 X SIR:$1,000,000 MED EXP Qft are I S EXCLUDED PERSONAL&AMfNJURY S 1.000,000 GEPdLAGGREGATE LUHTAPPLIES PEit GENERALA GREGATE S 1.000.000 X POLICY F—I JPERC07r- F-1 LOC PRODUCTS-COMPIOPAGG $ 1,000,000 OTHER: $ A Aurouoen.ELuurlLmr MWTB314573 03101/2019 onl2022 COMBINED SINGLE LIMIT $ 1,000,000 fEaaccideM X ANYAUTO BODILYKAIRYWerper m) S OWNED SCHEDULED SELF INSURED AUTO PHYDMG BODILY[MAIRY(Peraxxidaaq S AUTOS ONLY AUTOS HIRED NON47AIM S AUTOS ONLY AUTOS ONLY S UMBRELLAL.IAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTIONS S B WORKERSCOMPENS4110N WC012717099(AKNH.NJ.VT) 03At12020 X PER OTFL ANDEMPLOYETISLIAT�JTY STAITE ER B ANYPROPRIETOR/PARTNER/E CITDVE YIN WC 012717100(WI) 03111@019 031DIrM' 5,000,000 OFFICERIMEMBEREXCLUDED4 ED NIA E.L.EACH ACCIDENT $ (MandatorylnNH) E.LDISEASE-EAEMPLOYEE $ 5,000,000 If yes,descr be urder Continued on Additional Page 5,000,000 RI DESCPTION OF OPERATIONS below E.L DISEASE-POLICY umrr S C Excess Auto 297110011002019 03101rm9 036 rAw Lir& 4,000,000 A ExcessGersralUabft MWD(3145M 03{01rdD19 0301x= U1* 8,1100.000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 INE EXPIRATION DATE TI(HiEOF. NOTICE WILL BE DEIJVFRED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 Aurrrot+�rlrwTnlE of!Tamm USA hm Manashi Mukherjee �lstualo+.� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016fO3) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CNI 01642069 _ LOC#. Atlanta A�® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA,INC. THE HOME DEPOT,INC. HOME DEPOT U.S-A,INC. POLICY NUMHER 2455 PACES FERRY ROAD BUILDING G20 ATLANTA,GA 30339 CARRIER MAIC CODE TVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORV& FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Wodm CompensaWn C filed: Carder.Indemnity Insurance Company of North America Pollcy Number.WLR 065890549(AI AR FL ID,IA,KS,KY,LAMS,MO,NE,NM,ND,OK,SC,SD,TN,WV,WY) Effective Date:031012019 Expiration Dale:031012020 (EL)Limit$5,000,000 Cartier.New Hampshire Insurance Company Policy Number.WC 012717098(DC,DE,HI,IN,MD,MN,MT,NY,RQ Effective Date:031012019 Expiration Date.031012020 (EL)Limit$5,000,000 Carrier:ACE American Insurance Company Policy Number WCU C65890586(QSQ(AZ,CA,IL NC,OR,VA WA) Effective Date:0310112019 Expiration Date:031012020 (EL)Un&$4.000,000 SIR:$1,000,000 SIR for the stallesefAZ,CA,l1.jdC.CKVA WA Cartier.National Union Fre Insurance Company Policy Number.XWC 5565596(QSQ(CO,CT,GA ME MI,NV,OH,PA,UT) Effective Date:03812019 Exphathn DakK 031012081 (EL)LiDt$4,000,000 $1,000.000SIR6orlhes I ofCOAlFWA .ORPA.Ui $750,000 SIR for the stale of GA $350,000 SIR for the state of CT Camer.National Union Fre Insurance Comperry Poky Number:XWC 5555997(QS9 WA) Effective Dale:031D12019 Expiration Date:03101/2020 (EL)Umit.$4,500,000 SIR.$500,000 TX Employers XS Inderni1Y Carwlftw trust Irrsrsace,Company Policy Number:TNS C65221019(T)) Effective Date.03/01/2019 Expiration Date:03/01/2020 (EL)Limit$10,000,000 SIR:$1,000,000 ACORD 101(2008101) O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACOIiD AGENCY CUSTo11ER 07: CN101642069 LOC#: Atlanta A�v ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY' NAMED INSURED MARSH USA,INC. THE HOME DEPOT,INC. HOME DST USA,INC. PGUCY 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 DEPOr INSUREDS— The Fiume DeA hr- The rThe Home Depot U.SA,Inc. Home Depot USA,Inc.dba The Home Depot Home Depot USA,Inc.dba Your Ogler Warehouse,LLC Home Depot of Puerb Ran,Inc. Hone DepotPmWAuft*LLC Home Depot SbreSWpot,Inc. Red Beacon,LLC Home Depot U.SA,Inc.dba Irterfine Brands Bamett EaWe S** Hardware Express Leran Mah tE ow USA Renoralim MIS SuppVworks US Lock Wdma CleanSource JmPak AmSal Sexaler Trgco Trp Tedmdof- ACORD 101(2008101) O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD j i w t .,r Sslfrolk County Dept,of er y , Labor. Uzmsing&°CQmumer Affairs J Vf i' F .t,C `;- NOME M PROVEMENT LICENSE Name RICE ARDTOLISEY Business Marne HOME DEPOT U-SA INC_ This t.erKer.Vias the bearer's duly"Mmsed LiCense Number H-53429 by the County of Suffopc Issued: 05/1512014 CcTuniss�er Expires: 11101 20 nttpsJlav_prod.county_suf/portiets/feelreceiptVie%v-do?mode=view&autoprint iaise&r 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, 0910621-13CA,0910622-13CA,0920734-DCA,0922474-DCA, 0968605-13CA,1003822-DCA,1003823- DCA,1003825-13CA,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 WC184841-106,Yonkers 5675,47874-ME Vance Comerford Salesperson Name: Registration No.(if applicable): Home Depot U.S.A., Inc. ("Home Depot') or Service Provider named below will fumish, install and/ or service the equipment fisted below at the price,terms and conditions as outlined on this form. BERESFORD HARRY Long Island 1-M3QBSEQ Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 265 Old Field Court I Mattituck NY 11952 Customer Address City State Zip (631)790-5976 usavaluel@yahoo.com Home Phone# Work Phone# Cell 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 1 Hauppauge NY 11788 Address City State 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 IN 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 LAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW T9 ACKNOWLEDGE THAT YOU BEEN GIVEN ORAL AND WRITTEN NOTICE 9F YOUTO CA L. Acknowledged by: 4Z!Z05/13/2019 us er's Signaturd Date Contract Prico lavmpnhedule : 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: $ 707.00 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 10.00 (If applicable) *Maximum deposit ONLY applicable®n MD, MA, IWE(33%6), NJ, loll(9996) Dep. 25 0 % Deposit Amount $ 176.75 Remaining Balance $ 530.25 The Home Depot-2455 Paces Ferry Road,N.W.Bldg.B-3,Atlanta,Georgia 30339-Customer Care:1-8004 66~3337 460F1 HDE Customer Agreement(24 JuL 18) v 0.1.8 Home Improvement Agreement: Paget Finance Chargees: *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 1windows A more detail aescription ol the work to be performed is included in the wection entitled cope o Work which appears on page 0 of this Agreement. Anticipated Delivery Date/Installation Schedule Approximate Start Date: 07/08/2019 Approximate Finish Date: os/o5/tole 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. ff 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 4Atanciel open emails and PDF documents. this paragraph, l consent to receive only electronic records related to this transaction. tial 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 Terrrls and Cop4itions% and Supplement, if any.You further acknowledge receiving a complete co this Ag a ent. Ke it protect your legal rights. X 05/13/2019 The Home Depot ,-,'(;uVtOMetM Sign&tVf-11Yate Service Provider Name X 1 105113/2019 140 Oser Avenue Suite 17 o- igner if pp icab a Date Service Provider Address X 05/13/2019 Hauppauge NY 11788 Si natur epot Date city State i 50061-HS.R-1-128533-13-00262 ervice Per Phone Number Service Provider License Number The Home Depot-2455 Paces Ferry Road,N.W.Bldg.B-3,Atlanta,Georgia 30339-Customer Care:1-800-466-W37 460F1 F®E Customer Agreement(24 J&18) v 0.1.8 DATE: G D3 �Ol ATTN: Town Building Inspector RE: PERMIT AUTHORIZATION LETTER To Whom It May Concern: In accordance with Public Act 91-95, this letter serves as written authorization and notification that Go Permits LLC, and its employees and agents have the authority to represent us in the procurement of permits and pertinent documentation on our behalf. This letter or a photocopy thereof may be regarded by any building official as it's authority to recognize Go Permits LLC as our authorized Agent to sign on our behalf applications for permits and any other related documents that may be required by you, and we agree that, for all purposes,we and not Go Permits LLC or it's employees and agents shall be deemed to be the signer of any such applications and related documents. Scope of work: PX WV F ANIS Me Lla- No 'srw cru 2Ac, ('• 14 Cis. Location: c206 Q L 7 F 19 L n C o 5Z 4 1 1-Z Authorized Agent Go Permits LLC EL 231 PE M M E 0J W/,,) Service Agent Name Best Regards, o Lic ee Signature 'nt WaJWe &License Number NOTE: PLEASE MAIL PERMIT TO: JEFFRE'-'J KUHR NOTARY PU13LIG, 'l`•:C?� 5 1r(:I�iC THD At-Home Services,In Registration: �th��0't��� 40 Oser Avenue- Suite 17-Hauppauge,NY 117 Qualiited in S u; i^Cnurty Phone:631-478-6101-Fax:631-435-4837-Toll Free:877 Won fres Mlareh � Home Improvement Agreement: Scope of Work Scope of Work Job#• Products: Spec. Install Product Total Sheet(s)#: Price: Price: Sales: 1-M3QBSEQ Roofing Siding Windows Insulation 1- 149.00 558.00 Gutters/Covers Entry Door M3QBSEQ Roofing Siding Windows Insulation Gutters/Covers Entry Door Roofing Siding Windows Insulation Gutters/Covers Entry Door Roofing Siding Windows Insulation Gutters/Covers Entry Door Roofing Siding Windows Insulation Gutters/Covers Entry Door Subtotal Sates Tax 0.00 Total Contract Amourd 707.00 Notes: Warranty The warranty on the work identified above is listed in the General Terms and Conditions,or if applicable,specified in the following documents: Warranty Name(s): The Home Depot-2455 Paces Ferry Road,N.W.Bldg.B-3,Atlanta,Georgia 30339-Customer Cam:1-800-466-M37 46OF1 14DE Custmnei Agreement(24 Jd 18) v M.s APPE2011ED AS NOTED �GK DATE: nn B.P.# FEE: (®U BY: ek NOTIFY BUILDING DEPARTMENT AT 765-1802' 8 AM TO 4 PM FOR THE FOLLOWING'INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF WN ZBA �� BOARD SD11�k19�9�8WIV-T�USIE�S OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY VantagePoonte o The dome Depot 6100 Series by Simonton Double dung S 1 MOI`ITON A WIth Grids Glazing Gas Spacer System Se Thickness U-Factor &-Value Visible Transmittance Solar Beat Gain UV Block Coefficient Total Unit Center of Total Unit Center of Total Unit Center of Total Unit _Center of Center of ©lass Glass Glass Glass Glass Clear/Gear Air intercept Spacer 0.75 0.49 0.49 2,04 2.04 0,52 0.81 0149 0,75 0.42 Low-E 270/Gloat Air Intercept Spacer 0.75 0.37 0.3 2,7 3,33 0,45 0,7 0.25 0,37 0185 Low-C-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/Clear Air Intercept Spacer 0.75 0.37 0.3 2.7 3.33 0.44 0.68 0.24 0.36 0.62 Low-E 270/Clear Argon Intercept Spacer 0.75 0.34 0.26 2.94 3,85 0.45 0.7 0.24 0.36 0,85 Low-E 270/1-ow 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 366/Gear 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 Spacer0.75 0.32 0.25 3113 4 0.33 0.51 0.18 0.26 0.95 366 TIAC36/Gear Argon Intercept Spacer 0.75 0.33 0.26 3.03 3.85 0.44 0.68 0,24 0.36 0.85 TIAC36/TIAC36 Argon Intercept Spacer 0.75 0.32 0.25 113 4 0.36 0.56 0,22 0.33 0.9 Low-E 270/Clear Krypton Intercept Spacer 0.75 0,32- 0,23 3.13 4.315 0.45 0.7 0.24 0,36 0.85 Low-E 270/Low EgAltro Intercept Spacer 0.75 0.31 0.23 3,I3 4,35 0.39 0.6 0.23 0.34 0.95 270 Low-E 366/Clear Intercept Spacer 0.75 0.31 0.23 3.23 4.35 0.42 0.65 0.16 0.27 0.84 Low-E 366/Low E Intercept Spacer 0.75 0.3 0.22 3.33 4.55 0.33 0.51 0.18 0.26 0,95 366 TIAC36/dear Intercept Spacer 0.75 0.32 0.23 3.13 4.35 0.44 0.68 0.24 0.36 0.85 TIAC36/TIAC36 Intercept Spacer 0.75 0.31 0.23 3.23 4.35 0.36 0.56 0.22 0.33 0.9 Clear/Clear Super Spacer 0.75 -0.48 0.49 2.08 2.04 0.52 0.81 0.49 0.75 0.42 Low-E 270/Clear Air Super Spacer 0.75 0,36 D.3 2.76 3.33 0.45 0.7 0.25 0.37 0.85 Low-E 366/Clear Air Super Spacer 0.75 0.36 0.3 2.78 3.33 0.41 0.64 0.18 0.27 0.84 TIAC36/Clear Air Super Spacer 0.75 0.36 0.3 2.78 3.33 0.44 0.68 0,24 0.36 0,62 Low-E 270/Clear Argon Super Spacer 0.75 0.33 0.26 3.03 3.85 0.45 0.7 0.24 0.36 0.65 Low-E 270/Low E Argon Super Spacer 0.75 0.32 D.25 3.13 4 0.39 0.6 0,23 0,34 0.95 270 Low-E 366/Clear Argon Super Spacer 0.75 0.32 0.25 3.13 4 0.41 0.64 0.18 0.27 0.84 Low-E 366/Low E Argon Super Spacer 0.75 0.31 0.25 3.23 4 0.33 0.51 0.18 0.26 0.95 366 , TIAC36/Clear Argon Super Spacer 0.75 0.33 0.26 3.03 3.85 0.44 0.68 0.24 0.36 0.85 TIAC36/ iAC36 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 0,23 3.33 4.35 0.39 0.6 0.23 0.34 0.95 270 Low-E 366/Clear Krypton Super Spacer 0.75 0.31 0.23 3.23 1 4.35 1 0.42 0.65 1 0.18 0,27 0.84 Low-E 366/1-ow 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/Gear Krypton Super Spacer 0.75 0.31 0.23 3.23 4.35 0.44 0.68 0.24 0.36 0.85 WINDOW SPECIFICATION SHEET • Spec,Sheet N: 1•M3039E0 Sheet: 1 of 1 r Customer: HARRY SERESFORD Job N;1-MSQSSEQ Consultant: Vance Comerford Date: 05113/2019 Now Window Existing Window Hinge Locations Measurement& Grids Product Options Labor Options From outside, Left to Right says,Bows Location Color Rough Opening 0 of bare N of bare Camnta,1 Pnl, use L,R or S Glass Milo hems Hardware code k Screens For doors use % Style Wraps Mull 5•"atoperangor ory TR-mFI-r Coda "K" ntl (YM) Style Code Swiss Code § 5 F K > 1 BID 2nd DH Y DH 6100 WH WH 32.00 45,00 77 GlasePeolkt Standard WRAP,LBR SPECIAL CONSIDERATIONS: 1:whits Wrap color Interior Casing Type Say or Bow window; Seatboard material(vinyl only-Birch or Oak) Say Pm)ect Angle(30 or 45) y Flanker Type(DH,SH,or Csmnt) op of window to soffit(Inchon) tied,to soffit,color of soffit material I have reviewed and agree with all the Job specifications above and the natruct Roof(Yee or No)• I I Spaclal Terme and Condltians on the folbwing page Garden Window; - atboard Material(vinyl only-White Plonite,Birch or Oak)