Loading...
HomeMy WebLinkAbout43793-Z .221 SVFFOIk app cOG , Town of Southold 8/13/2019 a j P.O.Box 1179 0 co 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40614 Date: 8/13/2019 THIS CERTIMS S that the building WINDOWS Location of Property: 985 Farmveu Rd, Mattituck SCTM#: 473889 See/Block/Lot: 121.-7-7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/17/2019 pursuant to which Building Permit No. 43793 dated 5/24/2019 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 Young,Keith&Stacey of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED s 0, 00, Signature ��u�utK�oTOWN OF SOUTHOLD moo.. ay BUILDING DEPARTMENT to TOWN CLERK'S OFFICE oy . 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#: 43793 Date: 5/24/2019 Permission is hereby granted to: Young, Keith & Stacey 985 Farmveu Rd Mattituck, NY 11952 To: make alterations (window replacement) to an existing single family dwelling as applied for, , At premises located at: 985 Farmveu Rd; Mattituck SCTM # 473889 Sec/Block/Lot# 121.-7-7 Pursuant to application dated 5/17/2019 and approved by the Building Inspector. To expire on 11/22/2020. Fees: SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $200.00 CO -ALTERATION TO DWELLING $50.00 Total: $250.00 Building 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 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. New Construction: Old or Pre-existing Building: V (check one) Location of Property: b rAfm Ve- 9A TI (Gf l�UL�l House No. Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Secti n Block 7 Lot 7 Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ SD A/p plicant Signature E i F r t i i a l;uildin4 Department Application AUTHORIZATION (Whe:e the Applicant i.,not the Owner) (?Tilt roperty o7 e ,5 Name) (MzHL-t�Addre:.sj do ncreby authorize "..Sl- r ( Qrv,&IJ _P1fAI1, a�to app3y an Fav beha)`to the Southold Building Departrticnt. 6 -jq _.. (C)wrc;' SiY� -e} (nate) (print C30 er's acne j SOF so # TOWN OF SOUTHOLD BUILDING DEPT. couff 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ SULATION A0.5 FRAMING /STRAPPING [ ] FINAL Wlln [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: NW" Q �h4 wv 'kph", J DATE - INSPECTOR r� FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (1ST) � y .................................... 'FOUNDATION (2ND) • ROUGH FRAMING& , PLUMBING �3 INSULATION PER N,Y. �y STATE ENERGY-CODE t� I FINAL I ADDITIONAL COMMENTS z rn z • 1 ";t 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 SoutholdTown.NorthFork.net PERMIT NO. ?93Z-- Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined f 20 Single&Separate Storm-Water Assessment Form ' Contact: '+ Approved 20 Mail to: 5co Disapproved a/c d V . IVIQ.sll7/►CV/� �� Expiration —20— Phone: Building Ins ector APPLICATION FOR BUILDING PERMIT L. MAY 1 7 2019 Date 20 INSTRUCTIONS as,y;—a:,ThtS_affljcation MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sefs o£plans,acrtur ie of plan to scale.Fee according to schedule. b.)'lot 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.Sucll 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 pemut 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. PROVED A" NOTEDA... . fis�� . — (Si ature of applicant or name,if a corpo ion) DATE: h—q— B.P.# — �� m1�Q O 9� T� (Mailing address of paf plicant) FEE: �Y. T �—tlt�/3u r igti"whah�� n�lihanils b,�nTPr`Igl A� �P ee gent,architect,engineer,general contractor,electrician,plumber or builder 765-1802 8 AM TO J")P 6R THS FQLLO •ZING INSPEC 1. FOUNDATION - TW REQ1 NrjF�fFT"ei ?! TF �RPS'WNN' FAI�i'iNG & P.LUMBING (A n the tax roll 00%wddy VVII I F1 ALL CODES OF3 corporation,signature of u y authorize officer NEW YORK STATE & TOWN CODES 4. HNAWanmii&jofi o icer) AS REQUIRED ¢SND C—oND J QNS QF BuR9efs'(W&FaTNo - C SOUT01= 7Rp I�zd-QhrcW6-N SHALL MEEr ftq 'i ,0A&*p3SeJVaHE CODES OF NEW Sg 1 t� Ifd660ARD �t T��c�e�S�ier gl r-,pnmsiRi F FOR USTEES YE qN OR QSTRL6 KION ERRORS. cation o on w c nosed osed work will be done: 4S &rm v p L"t/ ► ts DEC House Number Street Hamlet County Tax Map No. 1000 Section Block Lot Pemove q-, nylace 3 cv114aw.5 ;kms W �i e, ho sire c6to6.57. Subdivision Filed Map No. Lot 4 2. State existing use and occupancy of premises�n inte ded a and occupancy of proposed construction: a. Existing use and occupancy E b. Intended use and occupancy r 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work 3 7 a q (Description) 4. Estimated Cost � 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 premises?YES NO 14.Names of Owner of premises S D Address Phone No. Name of Architect Address Phone No Name of Contractor ON, Address Phone No. 2gs61 a s �e�r Rd A I �, &A 10331 15 a.Is this property within 100 feet of a ti al we and or a freshwater wetland?* 1 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-72(— *IF YES,PROVIDE A COPY. STATE OF NEW YORK) COUNTY OF ( pS4O�PfifAL Sq� BRUCE D BARTKO an` 0 D being duly swom,deposes and s pkicant Notary Public (Narnj of individual signing contract)a ve named, In and for the State of Ohio My Commission Expires (S)He is the A rll 05,2021 (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 in the application filed therewith. Sworn to efore me this day of efM 20 Notary ublic Signature of App scant Go Permits, LLC 105 Buttonball Ln. Glastonbury, Ct 06033 MIAM Scoff Doughman ME%= J Phone:860-952-4112 f Fax:860-430-6719 scottdoughman@gopermits.org "WE UNDERSTAND THAT YOUR TIME IS MONEY" May 6, 2019 To: Town of Southold Building Department Subject: Permit Application for: Stacy Young 985 Farmvue Roar! The above listed homeowner has contracted with Home Depot USA to replace the windows in their 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 USA 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 4J U-fac or Ae�+ 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: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! Stephanie Bottomley, Permit Expediter Go Permits, LLC Phone: 513=293-2060 stephaniebottomley@gopermits.org Go Permits LLC, 105 Buttonball Ln. Glastonbury CT 06033, scottdoughman@gopermits.org DATE: 5 4 ATTN: Town Building Inspector RE: - PERMIT AUTHORIZATION LETTER To Mom 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 lettr 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: ?P_rn17)Ue_ &Rj huc 1 , Location .- Fa ny ,e a �c Q Q+ — Authorized Agent Go Permits LLC &n 1'e- O lej� rv"ice Agent Name Best Regards, Lie ee Signature - t N e&License Number NOT-F.-..PLEASE MAIL PERMIT TO: n11 f P JEFFRE•',.KL1J-!R r� pWLia.G:. 1i E:fir F.A:t:ORK THD At-Home Services,in . FRe9isftstio^«:t%�:'.:i 40 Oser Avenue.Suite 17-Hauppauge,NY 117 Duarmad is Phone_631-478-6101-Fax:631-435-4837-Toll Free:877 'r.5i01P BM'�s h g A4CC>RE0® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 02/06/2019 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. TE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRES gwNrPRODUCER,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: TWO ALLIANCE CENTER c No End: NC No): 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS' INSURER(S)AFFORDING COVERAGE NAIC CN101642069-HomeD-GAW-19-20 INSURER A:OW Republic Insurance Co 24147 INSURED INSURER a:New Hampshire Ins Co 23841 THE HOME DEPOT,INC. HOME DEPOT U.SA,INC. INSURER c:HorneRisk Captive Insurance Company 2455 PACES FERRY ROAD BUILDING G-20 INSURER D: ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004353439-28 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 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 Lm TYPE OF INSURANCE INSD SWVD UER POLICY NUMBER fDD EFF POLICNYYYI MID11 EXPnnM LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY314574 03/01/2019 03101/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADEIX] D MAG O RENTED PREMISE OCCUR S Ea occurrence $ 1,000,000 X SIR:$1,000,000 MED EXP(Any one person) $ EXCLUDED PERSONAL&ADV INJURY $ 1,000,01)0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X POLICY❑JEG LOC PRODUCTS-COMPIOPAGG $ 1,000,000 OTHER: $ A Auromomi-ELUIBILITY MWTB314573 03/0112019 03(0112022 COMBINED SINGLE LIMIT Ea actt Tt $ 1,000,000 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 aaadent $ UM13RELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WC 012717099(AK,NH,NJ,VT) 03/01/2019 03/012020 X I PER oTH- B AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETORIPARTNER/ExECUTIVE YIN WC 012717100(Wo 03/012019 03/012020 5,0(10,000 OFFICERIMEMBEREXCLUDED7 -] N!A E L EACH ACCI DENT $ (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 5,000,000 If yes.describe under Continued on Addibonal P 5,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ C Excess Auto 297110011002019 03/012019 03/01/2020 Limit 4,000,000 A Excess General LiabOdy MWZX 314580 03/012019 03/012022 Limit 8,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached FI 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 AUTHOR®REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee �LcLuraor ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 _ LOC#: Atlanta ACC>R"® ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY NAMED INSURED MARSH USA,INC. THE HOME DEPOT,INC. HOME DEPOT U.SA,INC POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA,GA 30339 CARRIER MAIC 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 Horne Depot Home Depot USA,Inc.dba Your Other Warehouse,LLC Home Depot of Puerto Rico,Inc. Home Depot Product Authority,LLC Horne Depot Store Support,Inc. Red Beacon,LLC Home Depot U.SA,Inc dba Inledine Brands Barnett Copperlield Eagle Maintenance Supply Hardware Express Leran Maintenance USA Renovations Plus Supplyworks US Lock Wilmar CleanSource JanPak AmSan Sexauer Trayc:o Zip Technologies ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta AC40R v ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA,INC. THE HOME DEPOT,INC. HOME DEPOT U-SA,INC. POUCY NUMBER 2455 PACES FERRY ROAD BUILDING G20 ATLANTA,GA 30339 CARRIER NAIL CODE EFFECTIVE DATE:- ADDITIONAL ATE:ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensabon ConfimHxt Carrier.Indemnity Insurance Company of North America Policy Number.WLR C65890549(AL,AR,FL,ID,IA,KS,KY,LA,MS,MO,NE,NM ND,OK,SC,SD,TN,WV,WY) Effective[late-0301019 Expiration Date:03107/2020 (EL)Limit$5,000,0D0 Cartier.New Hampshire Insurance Company Policy Number WC 012717098(DC,DE,HI,IN,MD,MN,MT,NY,RI) Effective Date:03/01/2019 Expiration Dale:0310112020 (EL)Limit-$5,000,000 Carrier.ACE American Insurance Company Policy Number.WCU C65890586(QSI)(AZ,CA,IL NC,OR VA WA) Effective Date:03101/2019 Expiration Date:03101/2020 (EL)Limit-$4,000,000 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 5565596(QSI)(CO,CT,GA,ME MI,NV,OH PA UT) Effective Date:0310112019 -- - - - Expiration Date.03101/2D20 (EL)Limit$4,000,000 $1,000,000 SIR for the states of CO,ME,NV,MI,ORPA,UT $750,000 SIR for the state of GA $350,000 SIR for the state of CT Camer.National Union Fire Insurance Company Policy Number.XWC 5565597(QSI)(MA) EfNcbve Date*03101/2019 Expiration Date:0310112020 (EL)Limit$4,500,000 SIR.$5W.000 TX Employers XS Indemnity Carriedilinios Union Insurance Company Policy Number.TNS C65221019(f X) Effective Date 03/0112019 Ex#ra6on Date-03/01/2020 (EL)Limb$10,000,000 SIR:$1,000,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD a Suffolk County Dept of Labor, Licensing Cgns umerAffairs HOME IMPROVEMENT LICENSE Flame f - RICHARD TOUSEY Business Name HOME DEPOT U.S.A,INC. This certifies that the bearer is duly licensed License Number H-53429 by the County of Suffolk issued: 05/15/2014 Commissioner Expires: /110/12020 https://ay.prod.county.suf/portiets/fee/receiptView.do?mode=view&autoPrint=false&rt 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 WC184841106, 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 furnish, install and/ or service the equipment listed below at the price, terms and conditions as outlined on this form. Young Stacy Long Island 1-M13L10J Customer Last Name Customer First Name Store#/Branch Name Customer Lead/ PO# 985 Farmveu Road Mattituck NY 111952 Customer Address City State Zip (631) 235-7346 say985@optonline.net 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 17Hauppauge 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 EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT N CAN Acknowledged by: 05/02/2019 ustom is Signature. Date Contract Price and Payment Schedule : Payment of th ontract Pri s due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: $ 13728.42 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 0.00 (If applicable) - %Azimum dep®sk ONLYapLpftabie 0n WD, RGA, WE(33961), NJ, WRQ(9,9%) Dep. 25.0 % Deposit Amount $ 932.11 Remaining Balance $ 2796.31 The Home Depot-2455 Paces Ferry Road,N.W.Bldg.B-3,Atlanta,Georgia 30339-Customer Care:1-800-466-3337 4609 HDE Customer Agreement(24 Jul.18) v 01.8 Home Improvement Agreement: Paget 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 1windows A more detailed description of the work to be performed is included in the section entitled Scope of Work which appears on page 0 of this Agreement. Anticipated Delivery Date/Installation Schedule Approximate Start Date: 06/27/2019 Approximate Finish Date: 07/25/2019 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. By n' talithis 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 com I o hi ee ent. Keep it o protect your legal rights. XZuy 05/02/2019 The Home Depot Cu omer's Signatur Date Service Provider Name X 05/02/2019 40 Oser Avenue Suite 17 -Signer I ate Service Provider Address X 05/02/2019 Hauppauge NY 11788 Slgnatu n Behal o Home Depot Date City State Zip 50061-HS, R-1-128533-13-00262 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:1-800-466-3337 4601`I HDE Customer Agreement(24 Jul 18) V 0,1 8 Home Improvement Agreement: Scope of Work Scope of Work Job#• Products: Spec. Install Product Total Sheet(s)#: Price: Price: Sales: 1-M131-10J Roofing Siding , Windows Insulation 1- 447.00 3281.42 Gutters/Covers Entry Door M13L10J 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 Sales Tax 0.00 Total Contract Amoun 3728.42 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 Care:1-800466-3337 4601`I HDE Customer Agreement(24 Jul 18) v 01 8 Andersen Wood SPEC SHEET SC: Vence Comerford Measure Tech: INSTALLER: Branch Name Long Island Job#. 1-M13L10J Prepared B P y ISM: Ship To Location` Customer Name: Stacy Young Date: 05/02/2019 Pagel Of 1 SPEC SPR SHEET# REF# ` NEW WINDOW UNIT _ Hung - - Casement LOCK Hardware - - - - - - OPTION! -OPTIONS Screen (Stand - _ ,. (SWH _ olding Ston - • _ '- - Folding Stotre - y ,Is included or White Option FULL DH Frame - _' Included _ _ '," ° - _` _ In BAS -Hung' Included .MISC Existing Window Andersen - - - , FRAM INSE Sash _ _ Glass In Base - _ y Glass unit SASH LIFT in BASE .LABOR type Window TYPE I orlFlnish SCSIZESOLD(Tipto TIP) I MEASURETECHSIZE ONLY ONLY10piloni Casement Harv9ing Options OPTION price) GnlTe Options(PER SASH PRICING) - OPTION pricing) OPTIONSand pncing) OPTIONSI TOTAL MTASM Interio TW SC UI Standard #Bare #Bars #Beds #Bars Patten MISC Location Exisd Series mdo Extern ntni Jam SOnda (WID Size Grid Exton r Interior Vert Honz Vert Hortz & Labor WindType Style Color Color Line Size AW + CODE WALLSILL Sash Hing Temp Screen Type Grid Grid Patten (per (per Lorati (Per (Per Location ObscureFinish Flnls Finish ttem Roo Floc Code CODE CODE CODE COD Colo Cotle WI Height HEIG Wldih Height DEP ANGL Split Venting/Handlrug Style CODE Options CODE Coldr Color CODE sash) sash) CODE Sash) Sesh) CODE CODE CODE Type COD Type CODE CODES 1 KIT 1st TDH 100 Cl WH WH 180 37.00 55 STD TRU, none WH STD WH STD WH JCD, CP CH 0 MULL 2251 2 100 C1 WH WH 11)0 3700 155 STD TRU, none WH STD WH STD WH 0 MULL 3 100 PW WH WH 38.0 37.00 173 STD none 0 :L ,BAY/90W WINDOW _ - _ SGlnetillor Notex gneludeMeo txtwr,NWl atoek Optlom,spotted eondltlon4 Use sem Ito ideaalywmdoWdoar) NANUFncTURER No=gncludemWMOWcaaom - _ naeea4min,U.it..d to identify wtndawldwr) PmodiDn Angle(Bay aa`or 45•) Top OI`Mrday la Bolrit(Nche.) Bay Wadow Flankm(DH/Casement) Wdlfi of OVmlieng es) C—niet Roof t(Yes/No) d ded to Soffi%ecor of Bora material IThele Is roguarantee Met hhh91.10 mot a ng co r NEW DOOR UNR - ., � .•„i= r., '` -^ :. _ ,, _. .,°,. .' , ,�, _ '- _ ,`_ ., ' -. _` - WINDOW&� DOOR ITEM ` Andersen - - - MEASURE FULLFRAME ` Glass Scree Hinge - MULL/STACK Energy Sled AWTnm Wr B Existing Door Type DoorTYPE Color/Finish- SC SIZE SOLD(Tip to TIP) TECH SIZE -ONLY ° Gras Options(PER SASH PRICING) - OPTIO Option Option ' Hinged entl GTithrtg Door Optfore - OPTIONS MISC LABOR OPTIONS Options - Radius Unit PD North in Assembl r ES? Location TOTAL (290, Noteshosun Interlo UI Rol Inswing PD PD Gliding Hinged 400,& Emsting Serle Exterlo Finish Standar (WIDTH TIP Ext Extensio Odd Exterlo Interio #Be #Be Door Door ASer Lock Lock Optiona an other �l� Door Type Style Color Color Size AW + to Jamb Jamb Type Grid Grid Patte ert( dz( bscu Scree IN or # Venting Venting gliding HRDW HRDW Keyed Mulled/ Special r�O1N per? LjFlooiCode COD COD CODE COD Code Width Haig HE[ Wld Heigh TIP Size Location COD Color Color CODE bash Sash CODE CODE OUT Panel Handmg Hand(rg only) Type Finish Lock Stacked Notes MISC Labor Item CODES Y-No Pmaa No Width No AW Coip Wraps #ol loxes No Color Approve] Prim Name Stacy Young This Home Owner ANDERSEN®100 SERIES WINDOW AND DOOR NFRC/ENERGY STAR®INFORMATION This document provides NFRC certified U-Factor,Solar Heat Gain Coefficient(SHGC)and Visible Transmittance(VT)values for Andersen®products along with the corresponding ENERGY STAR®Version 6-0(2015)climate zones in which the product and glass type are certified. 0 These products rated,certified and labeled y National Fenestration Rating Council® (NFRC)-a non-profit organization that provides fair, aaM accurate and credible energy performance ratings for windows and doors. Many of our products meet the stringent energy efficiency certification criteria set by the U.S.Environmental Protection Agency and the U.S.Department of Energy. The certification criteria is based on the heat gain and loss of each product in _ t ? various regions of the country. Check the Andersen product performance available at www.andersenwindows.com for jl units that are ENERGY STAR certified. United States ENERGY STAR@ Canada ENERY STAR@ Climate Zone Criteria Climate Zone Criteria ENERGY STAR® ® Northam ' a��dy`I ❑ ZONE 3 ❑ ZONE 2 3 1t n North-Central ❑ ZONE 1 South-Central Southern Windows Doors Climate 1 U- SH � ", Zone { Fador� GC gann � Level g (U-Factorf SHGC - t`--��;s- 027 Any Press pt"ne z - '017 No Rating 5 �( ® =028 ` 032 ^' 5025 5025 k' . Equivalent — — — =029 x037 Energy Northern 5040 '" North-Central Performance s 0M (effective February 1,2015) - i -0.30 , a 0 42 --W- >;« Southern 5 025 South-CenVal � - hlorih- Air Leakage for Sliding Doors s 0 3 dm4t1 s; - Comfai 5030 5040 Air Leakage for Swing ingDoorss05dm4F ( 5030 5025 -�1 3SOD 25 _ or 1.60 �i 3500 to<6000 (�29 or 140 5 0 40 5 0 25 s r normo 34 or t' t zo At Leakages 0 3 cfmW Blurb ftp F 'soler Heat Garr Coefficient •The ettedwe date for the Northem Zone presmphve and egwvalerd energy performance criteria for wndowc Is Janueryt 2016 For NFRC certified total unit performance for units with capillary breather tubes,please refer to the High Altittude information section for each unit 'U-Factor defines the amount of heat loss through the total unit in BTU/hr-ft 2'•F,metric in W/m2•K.The lower the value,the less the heat is lost through the entire product 'solar Heat Gain coefficient(SHGC defines the fraction of solar radiation admitted through the glass both directly transmitted and absorbed and subsequently released inward The lower the value,the less heat is transmitted through the product 'Visible Transmittance(VT)measures how much light comes through a product(glass and frame) The higher the value,from 0 to 1,the more daylight the product lets in over the product's total unit area Visible Transmittance is measured over the 380 to 760 nanometer portion of the solar spectrum NFRC ratings are based on modeling bya thud party agency as validated by an independent test lab in compliance with NFRC rpogram and procedural requirements This data is accurate as of January 8,2017 Due to ongoing product changes,updated test results or new industry standards or requirements,this data may changeover time Due to variations in dealer and distributor inventory levels,products that were manufactured before January 8,2017 that were designed,tested and labeled with different NFRCvalues may still be available Check the labels on the product packaging to confirm NFRC values Ratings are for sizes specified by NFRC for testing and cerufiwhon Ratings may vary depending on use of tempered glass,different grille options,glass for high altitude,etc All marks where denoted are trademarks of their respective owners 0 2017 Andersen Corporation All rights reserved The Home Depot Thermal ofProductsManufactured by Simonton___ Date& 012018 .vasa. i:...�..a.a.:t/,�:r1�•�: • W_ ith•Grids i` S !e 1a'zin . 'W"7" Y tY, Glass Rajcage A.9;_ iFSpaci'"'�IG: ' �y 'S�f�/ C° SHS"(� y{; .:.c.,e„` sci.w�1„c ...,.f... ,.gid.: 7.. }3 ,�a�i�.4,!•:^'y,D�/L )>£ii . . Ecl� 'Awning 6500 Base PWSOlatSupercept -026 0.21 g @' Casement .,6500 Base ProSola� 5upeiz pt „7t8" ,026 ` '6.24 Transom 6500 Base, ProSoIar SuperC* 1'. "6.27 '0.32 e ® 0:27 a 'd 2 0 Double--HundL 6506 Base ProS6lar ;Supeacept 718" 0.29 l,0.26 v 029 0.24 0 o v Picture Casement (NH), 6500 Base Prosotar Supen�pt 7/0" .'0.26 0.28 m o 0.26 t3:2S a 'a o Q Picture 6500 Base P.rdSolar Supercept 718 027 ' '029 0 o Q.27 ` 026 Q 2°Panel Slider, 6800 Base ProSolar Sipercept 718"' .0.29 1 °026 v 029,'< 0.23 0 © o 3 Pahel Sliders '6500:Base-(s 21.Scfty .- Pro Solar Sumcept, 7%8"3 6:29 1 026 �. 0281 023, a e o 11 a • • ' GatdemD00r.(CH) .6500 Energy Star ProSolarSUN "",Super Spacer 1" 0.30 1 0.24 0 ®. .o o' 0.30 '0.21 Patio'DoorINOVO,_ 650.0-,Base. pro.Solar Super Spacer ¢" '020.1 ,0:26 I a ` 031 0.23 0 o e o • 1 1 Homestotaled everywhere-EXCEPT:Arizona,Calilom)a,Idaho,Nevada;-New Mexlco,Oregon,Utah,and VYashhiglon.,,, ` . Awning(Inc Hopper) 6100 Base' "",Pro<Solair., Interdept 718" 0:27 1 0.24' o -1,6 1 e 0.28 } 0.21 ' ® o •1,,o Casement 6106 BasePro;Solar. Intercept 7Ja -027 0.24 0 9 © v 027 0.22 0 0 0.27 o a Double-Hun 6100;Ene'r" Star. „ Pro Solar Su' rcept 314" 0.30 ' 0:30 0 0.30 ' ® I v A Picture"CBseitjent`(NoKn9e) 610pease t?roSolar_ Intercept 718"; 0.27;1.'028 0 4 0:27 ,Picture 6906 Base Pro Solar Iritenept 31,4", 0.27 - ,031 ?` `a 0:27., ,0.28 o m 2 PanefSlider 610.0-base Pro Solar lhfancept_ 3!4"•, ,0;30 ; 0.28 0 0:30 ' 027 0 3-Panel Sfider, 6100-Base. , - _ Pro Solar` .- _ Intercept.- 3!4"` 036 i 0.29 ,m 0,30 ; 027 a 1 1 0=8 1601es kpaweverywhere,EXCEPT:Arizona,Callibrala,Idaho,Nevada,Hew Mexico,Oregon,Utah,and VYashington. Patio•Door 6100Ener-gy'Star ` _ Pm,sblar SuperSpacer'`.1 0.28 ;" 0,26, o © 0.28` 0.23 0 0 ® v Patio boor NARROW FRAME, ,01Q0(P„DQ5f.Base, ,,., -~Pro Solar _ Intercepl, 3/4"' 028 0:30 a •o ,0.28,l 0:26. ® o M11 1 Homes located an/yiii tollowfng markets:`Dallas,Dever,Detrol;Phfla,.Norrhern NJ,Coag island,NY. Awning 6200 Base.. " ` :P,ro,Solar,SHADE Supercept, 314" '0.27 ; 0.25: o 6 0 'Q 1,0.26, 023 o u o Casement 6200'Base "Pro Solar SHAbE $upercept 314"•` "6-26 ? `0.18` o o 0 .m 0.29 t; 0.17 n o © 0 Pidure'CasementNi-1 6200 Base, Pro Solar,SHADESup sept..,. 314', .025 029 0 ,6 ® 0 0.25 0;19 v c ,Picture Window 6206 Buse Pro Solar;SHADE SuperewtI W, 0;26, ' '024 0 ,o m ® 0.26 - 0.22 o a a o Single Hung 8200 Base Pro Solar SHADE Superc6pt„ W4a -6.28.'1"023 0 'o '® 0.2$' 621 Single Slii ler 6206 Base ;Pro Solar SHADE $upercept 314 ,028 0.23 0 © '0.2 8.' 0:21 3'Panel Slider 6200Base,, : >'Pro Sofar SHADE S6percepf ata 028 Q23 0. o .e. `028 ' 0:21 • " 1 i Nnmes'Iocated'in coastal areas. Awning 86*300 `Energy Star PS SUN/L:ami Supercept 1.e, '026' 1 0.23 -0:21 ©` 0 0 o Casement 'Se+300VL.'Base PSiLami;, Super Spacer 1" 025 0.23 �+ o q. "0 0.25F' 0.21' v o Double Hung SB+300VL Base PSAami_ Super Spacer, 1"• f0.29 0.25. ca. 'o, o 0 0.29 023 Slider 88+'3007;= w "PS/Lain, Intercept, V 0.25 a m o ,® :0.29,1 0.23 '0 a' 0 a Patio Door "Set 300M ETC-366"' ;PS.Shade/Urrii Super,Spacer 1', 3,'i 9 �" v � '.� . • Garden Door(CH) _ ;SB+300VL Base PSILami; Super•Spacer 1" .0'30 ( 028- o- ri 0:30 1 0.25 .fl o o• ca [lots indicate Energy Star cediffied for.that zone _ 4- • - . .. ELWINMiami=