Loading...
HomeMy WebLinkAbout43947-Z 0'== ��O�gUfFO(,�coGy� Town of Southold 8/26/2019 P.O.Box 1179 o ® �� 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40659 Date: 8/26/2019 THIS CERTIFIES that the building WINDOWS Location of Property: 600 Sunset Way, Southold SCTM#: 473889 Sec/Block/Lot: 91.-1-10 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/28/2019 pursuant to which Building Permit No. 43947 dated 7/10/2019 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: REPLACEMENT WINDOWS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Mercier,Carol&Schramm,Peter of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ut oriz d ignature TOWN OF SOUTHOLD BUILDING DEPARTMENT y� TOWN CLERK'S OFFICE o • �i4 SOUTHOLD, NY apt511 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#: 43947 Date: 7/10/2019 Permission is hereby granted to: Mercier, Carol & Schramm, Peter 86 Oakland St Huntington, NY 11743 To: install replacement windows to existing single-family dwelling as applied for with flood permit. At premises located at: 600 Sunset Way, Southold SCTM # 473889 Sec/Block/Lot# 91.-1-10 Pursuant to application dated 6/28/2019 and approved by the Building Inspector. To expire on 1/8/2021. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 Flood Permit $100.00 CO -ALTERATION TO DWELLING $50.00 Total: $350.00 Buil ' for 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: (check one) Location of Property: 4" 6JQj a House No. Stree Hamlet Owner or Owners of Property: 0�`p f �P f`e t io� Suffolk County Tax Map No 1000, Section f Block 1 Lot Subdivision Filed Map. Lot: Permit No. ga /ql Date of Permit. Applicant: 'i4mile R,7+6m" Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $� J�`O O011 tpplicant Signature Building Denar irnent Application AUTHORIZATI.O_N (Where the Applicant is not the Owner) L _ �,f� P (p (� residing at 6106 Suri SP-_ Ljtu (Print property owner's name) (Mailing Address) 7r 1 do hereby authorize P ��C( (A ent) J LL to apply on my behalf to the C Southold Building Department. X U (Owner's Signature) ( a e) (-0 1 Yq (Print Owner's Name) pf SOUI'yo� ` t4 1 # TOWN OF SOUTHOLD BUILDING DEPT. COW, ' 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING FINAL [ ] FIREPLACE & CHIMNEY ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE ZPi INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS r � FOUNDATION (1ST) ..................................... 'FOUNDATION (2ND) ROUGH FRAMING& PLUMBING . y • a INSULATION PER NI Y: y STATE ENERGY CODE FINAL ADDITIONAL COMMENTS °7 /p 2-1S. 0/9 %ola IAPS I yv a v'V TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? A TOWN HALL Board of Health t 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. 45q Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined 20A Single&Separate Storm-Water Assessment Form nContact: C l Approved 20( Mail to: ►6 Disapproved a/c (� U e- 145160 AL WP j 1/� T— Phone:-���-yll 66033 Expiration 201111 r �¢t4_ Building ector r r APPLICATION FOR BUILDING PERMIT JUN 2 8 20 // Date 10 Lz i i 20 �o INSTRUCTIONS - i�P This pphcdt�oon MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 -,-- sets of plan's,acciirate plot�lan 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 pernut 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. IL,L': 99;;�- (SI S gnature of applicant or name,if a c ration) CA D (Mailing address of a hcant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder t Name of owner of premises -0 / N e- (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. Locatio of d on It' h propose wok 'll be done: House Number Street Hamlet County Tax Map No. 1000 Section Block Lot J kernave + ('efIacL ivi oWS, /,'ke 11-ke" ho Aukra� G5. Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises an inten end us and occupancy of proposed construction: a. Existing use and occupancy ----------------- i b. Intended use and occupancy cc 5- 3. Nature of o�rk(check which applicable):New Building Addition Alteration Repair�� Removal Demolition Other Work V (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 r 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 f C tR ddress S Phone No. 3� 1-q y(�-_(u LQ S Name of Architect Address So t Phone No Name of Contractorl4oino, DePofAddress Phone No. As's, es Fffy U, OAA ay &W 3033q ,T 15 a.Is this property within 100 feet of a ta freshwater wetland?*YESX_NO / *IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED.,.9 a� W;Th, r1 i 7,41 ek b.Is this property within 300 feet of a tidal wetland?*YES NO QQd 1/S�ce S y-� orilf� *IF YES,D.E.C.PERMITS MAY BE REQUIRED. b 0-[- j S 1 f 16.Provide survey,to scale,with accurate foundation plan and distances to property lines. / P b._1 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. STATE OF NEW YORK) SS COUNTY OF L�( /lam1,P 40 in LOW being duly sworn,deposes and says that(s)he is the applicant (Name f individual signing contract) bove named, (S)He is the l- Contractor,Agent,Corporate Officer,etc.) of said owner or owners,and is duly authorized(q pbiFlbhii►or,l ave performed the said work and to make and file this application; that all statements contained m this applicatio a5 (4"3Wdst of his knowledge and belief;and that the work will be performed in the manner set forth in the a&bl- e h co Swo to before me this day of J✓'� -`-�� �r = ~ sti rJ ` Not ublic o ;i; r oti - ti � Signature of Applicant S�FXP AUG1���� 0 ;`� .' ^�}, ",� �-G In••n frill. S.ltlUS A•1a�� Jit j"H T. TERRY _ P.O— no, 1 17<I TOWN CLERK" ifz Saulllohl Nc- York- Fax orl Fax US 10i 7(�S•I R�.l REGISCRAP OF VITAJ.STAT1S1lCS �� MARRIAGE OFFICFR - l / b� Tcicphonc S S I6) 7Ct. 1 nCORI)s MANAGEMENTOFFICER ••'/01, y .1 FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of_, the Code of the Town of Southold: "Floodplain Development. Permit ` hpplication" (FDP(93)) , and ',Certificate of Compliance fSr Devellc-pment in Special Flood Hazard Area (C/C(93)) . G_'iv. DEFT TOW.10F:SOUTHOLD X-J--Udith T. Terry Southold Town Clerk August 25, 1993 t JUL 1 6 2019 t APPLICATION iv r PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1 GENERAL PROVISIONS (APPLICANT to read •and sitrrt)- 1. No work may start until a permit is issued. 2 The permit may be revoked if any false statements are made hcrein- 3. If revoked, all work must cease until permit is re-issued. 4. bevelopment shall not be used or occupied until a Certificate of Cornptiance is issued. 5. The permit will expire if no work is commenced within six months cif-issuance. 6- Applicant is hereby informed that other permits may be required to fulfill local,state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator-or his/her representative to make reasonable inspections required to verify compliance. 8. I,THE APPLICANT,CERTIFY THAT ALL STATEMENTS HER AND 1N ATTACHMENTS TO _THIS APPLICATION ARE,TO EST F MY IQ�10� D TRUE AND ACC E. T •. (APPLICANTS SIGNATURE) ` D's'� SECTION PROPOSED DE�rcuo APPLICLJNM NAMEADDRESS TELEPH E APPLI g AD AP s aces e T Q3 n ENGINEER D Q- PROJECT LOCATION: To avoid delay in processing the application, please provide cooug}i information to easily identify thr- firoject location- Provide the street address, lot uumbcr or leo description (attach) anA outside urban areas, the distance to the nearest intersecting road or well-known Giidmark. A sketch attached to this application showing the project locado/nn would be helpful. v- S r U% FDP(93) • APPLICATION PAGE 2OF4 DESCRIPTION OF WORK (Check all appGcabic boxes): A STRUCTURAL DEVELOPMENT ACDVITY STRUCTURE TYPE ❑ New Structure Residential (1-4 Family) ❑ Addition O Residential (More than 4 Family) ❑ Alteration O Non-residential (Floodproof-ing? O Yes) ❑ Relocation O Combined Use (Residential & CommercLd) Cl DemdGtioa- - P ❑ Manufactured (Mobile) Home (In Manu- 0 Replacement factured Home Park?- ❑ Yes) ESTIMATED COST OF PROJECT S 3 7 B. OTHER DEVELOPMENT ACTIVMES. O Fill ❑ Mining O Drilling ❑Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) O Drainage.Improvements (Including Culvert Work) ❑ Itoaai,Street or Bridge Construction 7 ❑ SuFA' vision (New-or Expansion) ❑ fvilividual WaEcr or Sewer Systcm n ❑ Other (Please-Specify) I�a After completing SECTION 2, APPLICANT should submit form to Local Administrator for review- " ,SECTION 3 FLOObPLAW DETERMINATION fTo be completed by LOCAL ADJtiHNISTRATO Q The proposed development is located on FIRM Panel No.• . Dated The Proposed Development: O Is hM located in a Spcdal Flood Hazard Arca (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUrkED). O Is located is a Special Flood Hazard Arca. FIRM zone designation is 100-Year flood elevation at the site is:' Fi. NGVD (MSL) 0 Uoavailablc O The proposed development is Iocatcd in a floodway. FBFM Pancl No. Da(cd O Scc Sccuon 4 for additional iostnictiont SIGNED DATE - Go Permits, LLC 105 Buttonball Ln. Glastonbury, Ct 06033 ��J����(�� ' • Scoff Dovghman l l Phone: 860-952-4112 Fax:860-430-6719 scottdoughman@gopermits.org "WE UNDERSTAND THAT YOUR TIME IS MONEY" June 6, 2019 To: Town of Southold Building Department Subject: Permit Application for: Carol Mercier 600 Sunset Way The above listed homeowner has contracted with The Home Depot to replace the windows in her 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 detailing scope of work • Home Depot Suffolk County License • Certificate of Insurance • Letter of Authorization from The Home Depot allowing GoPermits to submit documents on their behalf • Southold Building Department Letter of Authorization signed by homeowner • LI-factor sheet • Windows specification spec sheet ='rf� Please note the following: JUN 28 2019 • Please mail original permit to the owner. • Please fax or e-mail a copy of the permit and receipt to: vy- T 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 Go Permits, LLC 105 Buttonball Ln. Glastonbury, CT 06033 Scott Doughman Phone: 860-952-4112 Fax: 860-430-6719 scottdoughman@gopermits.org July 10, 2019 To: Town of Southold Enclosed you will find the Floodplain permit and permit fee check for 600 Sunset Way. If you have any questions, feel free to call me at the number listed below. Please note the following: • Please mail original permit to homeowner. • Please fax or e-mail a copy of the permit and receipt to: Fax: 860-430-6719 (attn: Scott Doughman) Email: permits@gopermits.org • If fax or e-mail is not an option, 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 [D I - JUL 1 6 2019 I'TT � o _ V L 1 Go Permits, LLC 105 Buttonball Ln, Glastonbury CT 06033 www.gopermits.org Suffolk County Dept of Labor,,Licensing Consumer Affairs ROME IMPROVEMENT LICENSE `A Name RIGNARD Tdt)SPY Business Name HOME DEPOT ll.SA,INC. This Certifies that the bearer is duly licensed License Number H-53429 by the County®t Suffolk Issued: 05/15/2014 Commissioner Expires: 1110112020 ® DATE(MM/DD/YYY'/) A"h CERTIFICATE OF LIABILITY INSURANCE 02106/2019 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. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH USA,INC. NAME* TWO ALLIANCE CENTER AIC,N xt:ENE ac No): 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS• INSURER(S)AFFORDING COVERAGE NAIC# CN101642069-HomeD-GAW-19-20 INSURER A:Old Republic Insurance Co 24147 INSURED THE HOME DEPOT,INC. INSURER B:New Hampshire Ins Co 23841 HOME DEPOT U.S A.,INC. INSURER C:HomeRlsk Ca five Insurance Company 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY MWZY314574 03/01/2019 03/01/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR DAMAGE (RENTED 1,000,000 PREMISESS Ea occurrence $ X SIR $1,000,000 MED ERCP(Any one person) $ EXCLUDED PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER. GENERAL AGGREGATE $ 1,000,000 X POLICY 1:1ECOT F—]LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ A AUTOMOBILE LIABILITY MWTB314573 03/01/2019 03/01/2022 COMBINED SINGLE LIMrrEa cadent $ 1,000,000 a X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ ,:4 DED I I RETENTION$ $ B WORKERS COMPENSATION WC 012717099(AK,NH,NJ,Vn 03101/2019 03/01/2020 X I PER OTH- B AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N WC 012717100(WI) 03/01/2019 03/01/2020 5,000,000 OFFICER/MEMBEREXCLUDED? ❑N N/A E.L.EACH ACCIDENT $ (Mandatory in NH) EJ-DISEASE-EA EMPLOYEE $ 5,000,000 If yes,describe under Continued on Addlhonal Pae 5,000,000 DESCRIPTION OF OPERATIONS below 9 E L DISEASE-POLICY LIMIT $ C Excess Auto 297110011002019 03/0112019 03/01/2020 Limit 4,000,000 A Excess General Liability MWZX 314580 03/01/2019 03/01/2022 Limit 8,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjeectgwl.a �1+ti.ie�a�ge ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA,INC THE HOME DEPOT,INC HOME DEPOT U.S A,INC. POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA,GA 30339 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continued. i Carrier:Indemnity Insurance Company of North America Policy Number WLR 065890549(AL,AR FL,ID,IA,KS,KY,LA,MS,MO,NE,NM,ND,OK SC,SD,TN,WV,WY) Effective Date.03/01/2019 Expiration Date 03101/2020 (EL)Lima-$5,000,000 Carder.New Hampshire Insurance Company Policy Number.WC 012717098(DC,DE,HI,IN,MD,MN,MT,NY,RI) Effective Date 03/0112019 Expiration Date.03/01/2020 (EL)Limit$5,000,000 Carder.ACE American Insurance Company Policy Number WCU 065890586(QSI) (AZ,CA,IL,NC,OR,VA WA) Effective Date.03/01/2019 Expiration Date 03/01/2020 (EL)Lund:$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(OSI)(CO,CT,GA,ME,MI,NV,OH,PA,UT) Effective Date 0310112019 Expiration Date 03/01/2020 (EL)Limit-$4,000,000 $1,000,000 SIR for the states of CO,ME,NV,MI,OHRA,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) Effective Date 03/01/2019 Expiration Date*03/01/2020 (EL)Limit-$4,500,000 SIR$500,000 TX Employers XS Indemnity Camer.lOmios Union Insurance Company Policy Number.TNS C65221019(TX) Effective Date 03101/2019 Expiration Date 03101/2020 (EL)Limit-$10,000,000 SIR:$1,000,000 ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY NAMED INSURED MARSH USA,INC. THE HOME DEPOT,INC HOME DEPOT U S.A.,INC. POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA,GA 30339 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance HOME DEPOT INSUREDS— The Home Depot,Inc. The Home Depot U SA,Inc Home Depot USA,Inc.dba The Home Depot Home Depot USA,Inc.dba Your Other Warehouse,LLC Home Depot of Puerto Rico,Inc Home Depot Product Authority,LLC Home Depot Store Support,Inc Red Beacon,LLC Home Depot U.SA,Inc.dba Interline Brands Barnett Copperfield Eagle Maintenance Supply Hardware Express Leran Maintenance USA Renovations Plus Supplyworks US Lock Wilmar CleanSource _ JanPak AmSan Sexauer _ Trayco Zip Technologies ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 4� h I'm 1 DATE: (D ATTN: Town Building Inspector RE: PERMIT AUTHORIZATION LETTER To Whom It May Concern: In accordance with Public Act 9I.-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. i Scope of work: Rp--Iylo Ve D Y Location. © S ( ) -1,U _ /, Authorized Agent Go Permits LLC 06L.4 Service Agent Nam Best Regards, Lice see Signature Pint i4ifiK&License Number NOTE: PLEASE MAIL PERMIT TO: JEFFREV J. KLIHR NOTARY PUBLIC, Al F OF NVr YORK THD At-Home Services,In Registration N(I , 1 r 116004581 40®ser Avenue. Suite 17•Hauppauge, NY 117 ission in lfe i �n Cnunly Phone:631-478-6101 •Pax:631-435-4837•Voll free:877 0la fission Ex iresMareh l 3aQ- c�. APPROVED AS NOTED DATE: B.P.# 1-32'17 FEE: BY: 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 NEVA YORK STATE. NOT RESPONSIBLE FOF. DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODE- AS REQUIRED AND CONDITIONS O ZBA 90rrunl n Tf1Wni of eninilNG BOAR' S(�HBL-6i64hIPt�Rk�S�EES N: . . OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICA . OF OCCUPANCY The Home r ' • • Thermal Value of ProductsManufactured bySiMohton Dated: 513012018 _• With Grids L c`_s` - - �.�K, `..�%:'17 -,a;L. '_ - '.:. s,+-::Y'. . -:k: "°rT:'.;'„"�;;t;L�•,er^.;?;^3. - :'�` p -r:�s. :Glafln'/yq sc�.<,'/o.�,-: •:_:: -<,U�<;:�# Y::: �; =.�;aU ��..t�.,,,;���`.� � .,,. �'? '�.' r:..i f'" A�at" -•�=�F;. .si�.-' ���Il-SYl�l1./. ..�... :�}t. �(- ^.r..-r• `t'.' � } _ .£:. ::`..=:r..:.: 65,00 Awning 6500 Base ProSolar Supercept Ire" 0.26 ' 0.23go 0 0.26 ' 0.21 010 0 Casement 6500 Base ProSolar Supercept 7/e" 026 ( 0.24 o 026 j 0.22 0 0 0 0 Transom 6500 Base ProSolar Supercept 1' 0.27 ( 0.32 027 1 029 a 0 Double-Hun 6500 Base roSolar Supercept: Ire" 029 ' 026 029 ( 0.24 0 0Picture Casement (N 6500 Base ProSolar Supercept 718" 0.26 ! 0.28 0.26 i 0.25 0 0 0 0 Picture 6500 Base ProSolar Supercept 7/9" 0.27-1 0.29 0 0 027 j 026 o a 2 Panel Slider 6500 Base ProSolar Supercept 7/8" 0.29 0.26 0 029 j 023 0 0 0 3 Panel Sliders 6500 Base(s 21 sqft) Pro Solar Supemept Ire" 0.29 ; 0.26 0 028 j 023 0 010 -milli 9*0101� Garden Door(CH 8500 Energy Star ProSolar SUN Super Spacer 1" 0.30 1 0.24 0 0 0 0 _007-0--r.. 0 0 0 Patio Door(NOVO 6500 Base Pro Solar Super Spacer 1" 028 L2;211jj 00.31 0.23 v o 0 01 1 s 1 1 Homes located everywhem :Arizona,Mi fonNa,Who,Nevada,Now Mexico,Oregon,Utah,and Wsshingtot Awning(Inc Hopper) 6100 Base Pro Solar Intercept 7/a" 027 0.24 a a o 017-2871- 121 0 v 0 0 Casement 6100 Base Pro Solar Intercept 7/a" 0.27 0.24 0 0 0 0 0.27 0.22 0 0 0 0 Double-Hun 6100 Ene Star Pro Solar sl4" 0.30 0.30 0 0.30 1 0.27 a o a Picture Casement No Hipp) 6100 Base Pro Solar Intercept Ile" 027 1 028 0 0 027 0.25 0 0 0 0 Picture 6100 Base Pro Solar Intercept 314" 027 0.31 0 0 0.27 0.28 a o 2 Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 ! 028 0 0.30 ( 0.27 0 3 Panel Slider 6100 ease Pro Solar intercept 3/4" 0.30 ' 0.28 0 0.30 ( 0.27 0 ® 1 1 r ® • Hamas locatadevetywher® E :Arizona,California,Idaho,Nevada,Now~M Oregon,Utah,and 6Vashington. Patio Door[NOVO 6100 Energy Star Pro Solar Super Spacer 1" 028 026 1 0 1 0 028 0.23 0 0 0 0 Patio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3!4"1 0.28 ( 0.30 1 0 I 0 I 1 0.28 1 028 1 0 0 • 1 1 Homes located only In followfng markets:Dallas,Denver,Detroit,Phlhk Northern NJ,Long Island,NY. Awning 6200 Base Pro Solar SHADE supercept 314" 0.27 0.25 0 0 0 a 028 023 v o v o Casement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 ! 0.18 0 o v o 0.29 0.17 a 0 0 0 Picture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 0.25 0.21 0 0 0 0 025 0.19 0 0 0 0 Picture Window 6200 Base Pro Solar SHADE Supercept 314" 0.26 ! 024 0 0 0 0 0. 6 0,22 0 0 a a Single Hung 6200 Base Pro Solar SHADE 314" 0.28 ' 023 a o 0 0 0.28 0,21 0 0 0 Sin le Slider 6200 ease Pro Solar SHADE Supercept 314" 028 0.23 0 0 0 0.28 ' 0.29 ago a 3 Pane[Slider 6200 Base Pro Solar SHAD te t ala" 0.28 ( 0.23 0 0 0 0.28 021 0 0 0 ® ® ' - NORM-1111 M1 lionres located In coastal areas. Awning SB+300VL Energy Star PS SUWLami Supercept 1• I 026Ini 0 o 0 026 0.21 0 0 o a Casement SB+300VL Base PS/Laml Super Spacer 1" 0.250 0 0025 j 029 0 0 0 0 Double Hung Se+300VL Base PS/ ami Super Spacer i" 029o 0 0 029 023 0 o a 0 Slider Se+300VL Base PS/Lami Intercept i" 0.29a o 0i029 ( 0.23 a a a a Patio Door SB+300VL ETC 366 PS Shade/Lemi SuperSpacer i" 0.300 0 0 Garden Door CH SB+300VL Base PS/Lami Super Spacer 1' 0.30 10 0.30 ( 025 0 0 0 0 •Dots indicate Energy Star certified for that zone .Tl M11 •. • WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-MB17QIH Sheet: 1 of 1 Customer: CAROL MERCIER ,Job#: 1-M617QIH Consultant: Vance Comerford Date: 06/03/2019 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bare #of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use Mull "S"=stationary or W� Style Wraps = 8 "X"=operating C Room Floor Code (Y/N) Style Code Series Code u�S F vi b° > 7 > x° STD,White, WRAP,LSR 1 LIV 1st 2 PNL Y 2 PNL 6500 WH WH 70.00 46.00 116 Glass Pack:Standard S X STD,White, WRAP,LSR 2 BED tat 2 PNL Y 2 PNL 6500 WH WH 5600 46.00 102 GlessPaok•Standard X S STD,White, WRAP,LSR 3 BED 1st TDH Y TDH 6500 WH WH 69.00 46.00 115 Glass Pack:Standard STD,White, WRAP,LSR 4 KITCH 1st DH Y OH 6600 WH WH 3200 3200 64 GlassPack:Standard SPECIAL CONSIDERATIONS: 1.White,2:White,3.White,4:White Wrap Color nterlor Casing Type Bay or Bow window. eatboard material(vinyl only-Birch or Oak) ay Project Angle(30 or 45) ay Flanker Type(DH,SH,or Csmnt) op of window to soffit(Inches) P f tied to soffit,color of soffit material I have reviewed and agree with all the Job specifications above and the onstruct Root(Yes or No)• Special Terms and Conditions on the following page Garden Window: eatboard Material(vinyl only-White Pionite,Birch or Oak)