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HomeMy WebLinkAbout44426-Z °�SilF t�c y Town of Southold 6/19/2020 a P.O.Box 1179 0 o S 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41199 Date: 6/19/2020 THIS CERTIFIES that the building WINDOWS Location of Property: 125 Maiden Ln, Mattituck - SCTM#: 473889 Sec/Block/Lot: 140.4-10 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/7/2019 pursuant to which Building Permit No. 44426 dated 11/19/2019 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 IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Mcdonald,Mark of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Aut ed i ature r, ' T I o�sUFFo �. TOWN OF SOUTHOLD BUILDING DEPARTMENT y, x TOWN CLERK'S OFFICE 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#: 44426 Date: 11/19/2019 i Permission is hereby granted to: Mcdonald, Mark PO BOX 1258 Southold, NY 11971, To: remove and replace windows as applied for. At premises located at: 125 Maiden Ln, Mattituck SCTM # 473889 Sec/Block/Lot# 140.-1-10 Pursuant to application dated 11/7/2019 and approved by the Building Inspector. To expire on 5/20/2021. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO -ALTERATION TO DWELLING $50.00 Total: $250.00 BuiARg 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: (check one) Location of Property: G N\ `t Cit V,_ Lw-, YNA --4 t i-,r,._ac-_ House No. Street Hamlet - Owner or Owners of Property: G"" �— ( /�C ��` hocn. Suffolk County Tax Map No 1000, Section Block ( Lot ( O, Subdivision (t( Filed Map. Lot: Permit No. `1 f f Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ -750 ,cf-V• r AhAic,46t Signature }�� ,5..m •.,ia+'�Pz "'Z: s L'v.:': „ a ,. �, - , .__ ' ( e r . * , -glow .o � ^�;r <;°•.r^S„ ti,s.'... ,,{ a .,-` .. -f)�,- ~ '_, _ + e h ' - , .,. '"EJ 'rn ISO TA .. V 4i �11, ON A a .'.n `':' tM W' '36T - r•,',,�s'! :�}�., H Yt�'V x`3,.<• '',�wx; - ,;r Fw'Fw� yy�,t.('�px�/(•([ o -t I'm •s, � -�..Kr,, );.`"�:, - ,ax' '<_ - r � ,, - gip; _ .✓ , rf li .. ''<� ,,:.:.,' �}.,;, '-A'� , .. �6,yjy'"fiV$}�„>$' �+.M`.'4i/ �3'i•.� ,a <, a ':� L'�.„;: �~ x.:. p'SpFµ "`. ,,may �.'j,, .., •.,y:�a, L J}g3,.3” S -e<.r..-„oa'�. H 3 ” qac ,qT N:;ffi"�r.< K`, �2,,»S'f s•:_: S:�' ��x',::i`< ,f�% _ ,, .__ a ' y i;" =. ,- �" wo ,, r,�'.� .M j; .si torr „ � 'a'S.", � ,, - � - -_ � - -• As ?Y ' ''h i s [{ V'.l,r�`iO.i ,`:t. (<', `. , .. ,. ..Y.. F.• =; f _ �: XY'n9+* .aw.w.,.•.^ ` V " _ r vim qq 's` ,k,for vx. �. .�-} � , ��' ✓ raj'.., _ :•t^. ,Y, .... .tl ' r " s - , " „��<M ,r ^lir .,zr, .3� "1,..< 7;r.t;F` ^ - - rs < ,._", ! _ ,< - _. •- '� .. S.„ ..;f.�. >^„R. . '''�, fir; .: _., < _ r . . ,• ,- e- ' C , !r Sx�✓ _ L- � ., a V -, .t” ',. _ .a txr x. x .. • ,} '. Y .. ;. „•n " _ .. ,x , - - , apF SOUIy * # TOWN OF SOUTHOLD BUILDING DEPT. �ycourm, ' 765-1802 INSPECTION . = [ , ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I ULATION/CAULKING - [ ] FRAMING/STRAPPING [ FINAL Otm)Olt 1S [" ] FIREPLACE-& CHIMNEY- [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION" [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) _ [ ] CODE VIOLATION [ ] PRE C/O REMARKS: A Loy? twe o 1 DATE INSPECTOR f. x FIELD INSPECTION REPORT DATE COMMENTS ►o C� FOUNDATION (IST) ' H ---------------------------------- CIO ' � C FOUNDATION (2ND) - z H ROUGH FRAMING& PLUMBING y 1 INSULATION PER N.Y. y STATE ENERGY CODE L FINAL ADDITIONAL COMMENTS 0 z m Z d t� TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST ¢ BUILDING DEPARTMENT Do you have or need the following,before applymg9 TOWN HALL Board of Health SOUTHOLD;}NY 11971 4 sets of Building Plans TEL'':(631)76561'802 Planning Board approval SAX:(631)765 �11 Survey Southti1, pw .�T t For to t PERMIT NO. -1 v Check 6 d '" "a Septic Form N Y.S.D.E C. r4i �,r�• Trustees �6 c� C.O Application ePa `''4 �J S Flood Permit VEXa�minedl i 20 Single&Separate "•�a �j Storm-Water Assessment Form / Contact: Approved 20 Mail to gC G'� vVw' - Disapproved a/c U� p r� �'O"<< °� 'G Phone Expiration _20 }° Z • AS11O n,EI D Buildi gRInspector SATE:lr' 116E.P X142 a� PPLICATION FOR BUILDING PERMIT FE Date Q 1 ar ,20 NOF?FY EfJILDiNG PEPARTIMENT• AT INSTRUCTIONS 765-1802 8 ASM TO 4 PM FOR THE FOLLOWING IN24IsThisfiapplic�ation MUST be completely filled in by typewritcr or in ink and submitted to the Building Inspector with 4 I• FO(�nI Jsetslo Iplansl accurate.nn�� t 1 n to scale.Fee according to schedule P1ot�ilan��Sho'* gi location of lot and of buildings on premises,relationship to adjoining premises or public streets or F09 Pg.�IRFL�' r n i 'Jy as, d�i+aterwaysTE 2. ROUGHeid��1$r!hus application may not be commenced before issuance of Building Permit. 3. INSULATION d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit 4. FINAL shalUbe�P�tl4QJJn�,t{h�g ,n available available for inspection throughout the work. e 1Vo Du11 ing st}i IF a occupied or used in whole or in part for any purpose what so ever until the Building Inspector EC CC"PI a1 CerftificdatOoflOccupancy. ALL CON STR shpllL-expire if the work authorized has not commenced within 12 months after the date of REQLJIR E�h,i§stlp,Se ghas ptotLe�e��ooiri[p ete�d�✓ti�thin 18 months from such date.If no zoning amendments or other regulations affecting the YORK ST�,pre�er (have�l�eti JeilacW in int"enm,the Building Inspector may authorize,in writing,the extension of the permit for an ddition fix mo�nths.lTher�'%a r,a 9w permit shall be required. DESIGN ON COPE " " , A'ZIChA 1� IL]R: 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-inspeptors•on-premises and in building for necessary inspections. (Signa of applicant or name,if a corporation) NOV - 7 2019 sack 6�►-Li -Cf �c�J�.— C� �°a`�g (Mailing address of applicant) State Whethei ap�pl�i6ihttiis owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Cr�MpLY 1A1ITLI n s i CC) - �qr(C Vve-�0-\.A l�V.,/ YC%RK STATE & TO{�/ �S OF Name of owner of premises CODES (As on the tax roll or la e e ~0 U I R t If applicant is a corporation,signature of duly authorized officer (Name and title of corporate officer) v� Builders License No. ING BOARD Plumbers License No. SuUTHOLD TOWN TRUSTEES Electricians License No. Other Trade's License No. N.Y.5,DEC 1. Location)of oOl ki pCroposle/d�work will be done: House Number Street ff Hamlet CountyTax Map No. 1000 Section d Block l Lot ( 0 Subdivision Filed Map No. Lot t 2. State existing use and occupancy of premises and intended use apd occupancy of proposed construction: a. Existing use and occupancy (—,- b. Intended use and occupancy 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work W •� awp`�zk�"`0^-�. / / (Description) 4. Estimated Cost 1 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 Mr I- 14.Names of Owner of premises P-CA v"\j' Address 1 a S Ing t Ct s Phone No. Name of Architect Address Phone No Name of Contractor�_M1--A—W04 Addreshone No. 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO *IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b.Is this property within 300 feet of a tidal wetland?*YES NOS *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. STATE OF NEW YORK) SS. COUNTY OF t being duly swom,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the N4 (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 w performed in the manner set forth in the application filed therewith. JUSTICE BACHMAN NOTARY PUBLIC Swot befor a STATE OF COLORADO d y of C 201T NOTARY ID 20194025919 MY COMMISSION EXPIRES 0711012023 Notary Public Si ature of Applicant Go Permits, LLC 105 Buttonball Ln. Glastonbury, Ct 06033 r r Scoff'®oughrnan Phone: 860-952-4112 Fax: 860-430-6719 uy scottdoughman@gopermits.org "WE UNDERSTAND THAT YOUR TIME IS MONEY" To Whom It May Concern: Enclosed you will find a building permit application and check. If you have any questions regarding this application, feel free to call me at the number listed below. Please note the following: , • Please mail original permit to the owner. • Please fax or e-mail a copy of the permit and receipt to: Fax: 860-430-6719 (attn: Scott ®oughman) Email: permits@gopermits.org • If fax or e-mail is not available, please mail a copy of the permit and receipt to: Go Permits, LLC 105 Buttonball Ln. Glastonbury, CT 06033 Thank you! Jennifer Winke, Permit Expediter .'t`` ; F` .➢ Go Permits, LLCy_ NOV m 7 20i� Phone: 303-946-8685 'Fax: 866-697-0768 jenniferwinke@gopermits.org Go Permits LLC, 105 Buttonball Ln. Glastonbury CT 06033, scottdoughman@gopermits.org Show Recelpt Detail Page 1 of'2 RECEIPT Suffolk.C.outity Govemmeiit. SUFFOLK COUNTY'LABOR, LICENSING,&CONSUMER AFFAIRS P.O:60X'81.00 HAUPPAUGE,NY 11788 James M.Andrews Applicatlon:H-53429 At�1�iwion*TVPO.ConsumerAffSirs/LicensesMgme Improvement/NA Address: Owner Name: Ownel!Artdress: Applice'ttan'Name, Receipi tio. 1490 6 payiment,Method Raf[vtstjst?etAriioutit'Pald peymantDrate Castdeila Received Commerrfs Cheek 3148046 '$1,8130.00 03012018 CLEMON RENEWAL Nlork s7ies;cdp�ons' , W of P. - i•4\''�tJ w`' li:.,F:i.i �:� Y.. .. } �.'.�4�.�'f,:�.._Z"...:' /.'..•- -. 3iti t"K�n https:,//ay.pro&county.suf/portlets/fee/receiptView.do?Tri.ode=view&autOPrint false&recei... 9/21/20=8 A ® DA /DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE o2106/201os/2o1s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY,AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES,NOT AFFIRMATIVELY OR-NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE,OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the 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: PHOFAX 'TWO ALLIANCE CENTER (A/CNE, Ext): (AC. 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 13:New Hampshire Ins Co 23841 HOME DEPOT U S A,INC. INSURER C-.HomeRisk Captive Insurance Company 2455 PACES FERRY ROAD BUILDING C-20 INSURERD: 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 tPOLICY EXP �TR TYPE OF INSURANCE J=SU D POLICY NUMBER MM DDPOLICY/YYYY MM/DDIYI'YY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY314574 03/01/2019 03/01/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx_]OCCUR DANA E R PREMISES Ea occurrence $ 1,000,000 X SIR:$1,000,000 MED EXP(Any one person) $ EXCLUDED PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 1,000,000 POLICY PRO LOC PRODUCTS-COMP/OPAGG $ 1,000,000 X JECT OTHER $ A AUTOMOBILE LIABILITY MWTB314573 03/01/2019 03/01/2022 COMBINED SINGLE LIMIT Ea accident) $ _ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED F SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIREDNON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION'$ $ B WORKERS COMPENSATION WC 012717099(AK,NH,NJ,VT) 03101/2019 03101/2020X PER - OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANYPROPRIETOR/PARTNER/EXECUTIVE YIN WC 012717100(WI) 0310112019 03/01/2020 5,000,000 OFFICER/MEMBEREXCLUE N NIA EL EACH ACCIDENT $ (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ 5,000,000 If yes,describe under Continued on Additional Page 5,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ C Excess Auto 297110011002019 03/01/2019 03101/2020 Limit. 4,000,000 A Excess General liability MWZX 314580 03/01/2019 03/01/2022 Limit 8,000,000 DESCRIPTION OF OPERATIONS I 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. Manashl Mukherlee ©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 ACO 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 NTA, CARRIER NAIC CODE ATLAGA 30339 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance r - Workers Compensation Continued Carver 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 Date 03101/2019 Expiration Date.03/01/2020 (EL)limit$5,000,000 Carrier,New Hampshire Insurance Company Policy Number.WC 012717098(DC,DE,HI,IN,MD,MN,MT,NY,RI) Effective Date.03101/2019 Expiration Date 03101/2020 (EL)Limit.$5,000,000 Carrier.ACE American Insurance Company Policy Number WCU C65890586(QSI)(AZ,CA,IL,NC,OR VA,WA) Effective Date 03/01/2019 Expiration Date-03/01/2020 (EL)Limit$4,000,000 SIR$1,000,000 SIR for the states of AZ,CA,IL,NC,OR,VA,WA Carrier National Union Fire Insurance Company Policy Number XWC 5565596(QSI)(CO,CT,GA,ME,MI,NV,OH,PA,UT) Effective Date 03101/2019 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 1 $350,000 SIR for the state of CT Carver National Union Fire Insurance Company Policy Number XWC 5565597(QSI)(MA) Effective Date.03101/2019 Expiration Date 03/01/2020 (EL)Limit-$4,500,000 SIR.$500,000 TX Employers XS Indemnity Camerlllmios Union Insurance Company Policy Number.TNS 065221019(TX) Effective Date 03/01/2019 ' Expiration Date 03/01/2020 (EL)Limit$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 AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta ACCM0® 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 CARRIER CODE ATLANTA,GA 30339 NAIC , 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 S.A.,Inc Home Depot USA,Inc.dba The Home Depot Home Depot USA,Inc dba Your Other Warehouse,LLC Home Depot of Puerto Poco,Inc. Home Depot Product Authority,LLC Home Depot Store Support,Inc. Red Beacon,LLC Home Depot USA,Inc dba Intedine Brands Barnett Copperfield Eagle Maintenance Supply Hardware Express Leran Maintenance USA Renovations Plus Supplyworks US Lock Wdmar CleanSource JanPak AmSan Sexauer Trayco Zip Technologies 1 ' ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD With,Grids gir • 0.22 ES; 0.23 r6500 B-­ �m 24 o o o. 'a 026 om .Transom" �66ikq' =77 02_9 0 iJbUtil un - -- Fm$0 Z-UPWP'ept TW 0.291 0.26 0 0291 0.24 A , , _ i * .026 0.28 p 0 0.26 ()25 , 0 0 0 0 Faure 6500 Besse PitiiSritar 3 0.27 0 'D.27 0.29 0 0 26 a 0 Wit.. 718!: 029 '026, 0 0.29 0.23 0 _ At s prosolar tw Jdig 02s 0 0.28 0.23 65%Bqse-i phal'sowl Supe-Spapa JQ 28� 026 1 0-1 0 1 U j 031 1 OM ,,FtHzone,.C.rd6m)�,MMP,HOW^Now AWM Oregon,Lftk and A" We 027 0:24 d b b, 6 10281 0.21 alvid l M W- _7_187JI027 0.24 010 0 0.27 0.22 0 o o .-=-- simpm-, st� MT 0.27 0 027 .5 ...... 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"625 1 6-21 0; -6 6261 0.19, - 0 0 024 0 0 0 0 0261 0.22 0 * * Btngia Flung X200`--$ . 623 0.28 1 021 0.28 0.2� 0.26 1 0.21 .-.�Prds6bfSHADE .s ZAVI 0.28.r A23 d 0,281 0.21 , 0 0 0 hu� Akilk­, 61W.-to bi60t* 7WMWtim &*ibepi -77 026 023 0 0 010 0.26 021 0 cclo 4 i)aber 0-25 0.21 7 0 010 4­ P'S_U n 0 0 40 w.Spaber, .19 0_79_ 1 0.25 0_79 0_23 Sa+'300VL'Sis4 1 17 0291 0-25 0 0 0 0 0.�P_9 0.23 0 0 o o FdHQDoor� , '.-SB+M0VLr ---3.6'1'--" PS'ShadelUffit V wWA*b& 1. 0 025 0.23 "=TC 6 0.19 it - G 30 028 0.30 025 WINDOW SPECIFICATION SHEET - Spec.Sheet#• 1-MSKQV41 Sheet: 1 of 3 CUS1ofTlef' Anne McDonald Job#. 1-MSKOV41 Consultant: Vance Comerford Date: 10/13/2019 New Window Hinge Locations Existing Window Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use _ }g Mull "S"=stationary or `o_ .80L r m y `� H operating W Style Wraps o o 8 t= Room Floor Code (Y/N) Style Code Series Coda 5 STD,White, GlassPack: WRAP,LSR 1 KITCH 1st DH Y DH 6100 WH WH 33 32 65 Standard STD,White, GlassPack: WRAP,LSR 2 KITCH 1st DH Y DH 6500 WH WH 32 45 77 Standard STD,White, GlassPack LSR 3 BATH 1st DH N DH 6100 WH WH 24 29 53 Standard STD,White, GlassPack WRAP,LSR 4 BATH 1st DH Y DH 6100 WH WH 32 57 89 Standard STD,White, GlassPack. WRAP,LSR 5 BATH 1st DH Y DH 6100 WH WH 32 57 89 Standard STD,White,TMP, WRAP,LSR 6 LIV 1st DH Y DH 6100 WH WH 32 73 105 Bottom, GlassPack. Standard \ STD,White,TMP WRAP,LSR 7 LIV 1st DH Y DH 6100 WH WH 32 63 95 Bottom, GlassPack- Standard STD,White, GlassPack WRAP,LSR 8 FIV 1st DH Y DH 6100 WH WH 32 63 95 Standard SPECIAL CONSIDERATIONS 1.White,2 White,4 White,5.White,6.White,7 White,8 White Wrap Color Interior Casing Type Bay or Bow window' Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnl) Top of window to soffit(inches) If tied to soffit,color of soffit material I have reviewed and agree with all the Job specifications above and the Construct Roof(Yes or No) Special Terms and Conditions on the following page Garden Window Seatboard Material(vinyl only-White Pionite,Birch or Oak) WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-MSKQV41 Sheet: 2 of 3 Customer- Anne McDonald Job#:1-MSKQV41 Consultant: Vance Comerford Date, 10/13/2019 New Window Hinge Locations Existing Window Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use c z c 6 Mull "&'=stationary o r Nd g . "X" operating W m ` myo Room Floor Code (YIN) Style Code Series Code S a: 5 vi O a =o > x STD,White, GlassPack. WRAP,LSR 9 LIV 1st DH Y DH 6100 WH WH 32 63 95 Standard STD,White, GlassPack WRAP,LSR 10 LIV 1st DH Y DH 6100 WH WH 32 63 95 Standard STD,White, GlassPack WRAP,LSR 11 FAM 1st DH Y DH 6100 WH WH 28 60 88 Standard STD,White, GlassPack WRAP,LSR 12 FAM 1st DH Y DH 6100 WH WH 28 60 88 Standard STD,White, GlassPack WRAP,LSR 13 BED 1st DH Y DH 6100 WH WH 30 60 90 Standard STD,White, GlassPack- WRAP,LSR 1 BED 1st DH Y DH 6100 WH WH 30 60 90 Standard 4 STD,White, GlassPack. WRAP,LSR 15 BED 1st DH Y DH 6100 WH WH 32 60 92 Standard STD,White, GlassPack. WRAP,LSR 1 BED 1st DH Y DH 6100 WH WH 32 60 92 Standard 6 SPECIAL CONSIDERATIONS. 9 White,10.White,11 White,12.White,13:White,14 White,15•White,16:White Wrap Color Interior Casing Type Bay or Bow window* Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(inches) If tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the Construct Roof(Yes or No)' Special Terms and Conditions on the following page Garden Window Seatboard Material(vinyl only-White Piomte,I or Oak) WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-MSKQV41 Sheet- 3 of 3 Customer, Anne McDonald Job#-1-MSKov41 Consultant: Vance Comerford Date. 10/13/2019 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,RorS Glass Misc Items Hardware Code Screens For doors use tl Mull "S"=stationary or LC O L L m m 6 y W 8 N U N "x"=operating W Style Wraps a, o b $ m `o o ate+ o t= Room Floor Code (Y/N) Style Code Series Code G t _ F vi 0 (L > = > _ STD,white, GlassPack- WRAP,LSR 17 BED 1st DH Y DH 6100 WH WH 32 60 92 Standard STD,White, GlassPack WRAP,LSR 1 DINE 1st DH Y DH 6100 WH WH 50 60 110 Standard 8 STD,White, GlassPack. WRAP,LSR 1 DINE 1st DH Y DH 6100 WH WH 32 60 92 Standard 9 STD,White, GlassPack WRAP,LSR 2 ENTRY list DH Y DH 6100 WH WH 20 48 68 Standard 0 STD,White, GlassPack. WRAP,LSR 21 ENTRY 1st DH Y DH 6100 WH WH 20 48 68 Standard -- SPECIAL CONSIDERATIONS- 17.White,18 White,19 White,20 White,21 White Wrap Color Interior Casing Type Bay or Bow window - Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH.SH,or Csmnt) Top of window to soffit(inches) If tied to soffit,color of soffit material I have reviewed and agree with all the Job specifications above and the Construct Roof(Yes or No)' I I Special Terms and Conditions on the following page Garden Window Seatboard Material(vinyl only-White Pionite,Birch or Oak)