Loading...
HomeMy WebLinkAbout44885-Z FBI&4Qn Town of Southold 8/3/2020 �i P.O.Box 1179 Q F 53095 Main Rd IN �g� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41315 Date: 8/3/2020 THIS CERTIFIES that the building GENERATOR Location of Property: 1475 Lands End Rd., Orient SCTM#: 473889 Sec/Block/Lot: 15.-9-1.20 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/5/2020 pursuant to which Building Permit No. 44885 dated 6/18/2020 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: accessoa generator as applied for. The certificate is issued to Fishstein,Marc&Sweeney,Alexandra of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44885 7/24/2020 PLUMBERS CERTIFICATION DATED Autho ' ed Signature �' TOWN OF SOUTHOLD SUFFn�,�coG moo BUILDING DEPARTMENT y x TOWN CLERK'S OFFICE o SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 44885 Date: 6/18/2020 Permission is hereby granted to: Fishstein, Marc 29 Wayne Ct Northport, NY 11768 To: install generator as applied for. At premises located at: 1475 Lands End Rd., Orient SCTM #473889 Sec/Block/Lot# 15.-9-1.20 Pursuant to application dated 6/5/2020 and approved by the Building Inspector. To expire on 12/18/2021. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CERTIFICATE OF OCCUPANCY $50.00 Total: $235.00 r B64ing 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. 'T�C f o2®o� New Construction: Old or Pre-existing Building: (check one) Location of Property: ke/7s L• fes CMd, JRO,4d 00,1 EN� NY 0,57 House No. r Street Hamlet Owner or Owners of Property: M RC r—(,A jW N Suffolk County Tax Map No 1000, Section Block 041 Lot /- Zo Subdivision Filed Map. d Lot: Permit No. �� Date of Permit. Applicant: 1,ouxi S A- 6E.�At4l/ g' Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ r--^ Ap lic,pAt Signature Building Department Amlication AUTHORIZATION (Where the Applicant is not the Owner) IARC F%1s4p-f N residing at 14175- ..LA4NclS EmJ Ro qJ (Print property owner's name) (Mailing Address) OIZiG��", N �o2K do hereby authorize (Agent) to apply on my behalf to the Southold Building Department. TLA NE s 0202 o (Owner's Signa e) (Date) MARCF�stisf�,� (Print Owner's Name) CONSENT TO INSPECTION I"I/A R. C F 1,S kS7E,I,( _,the undersigned,do(es)hereby state: Owner(s)Name(s) That the undersigned(is) (are)the owner(s) of the premises in the Town of Southold,located at /q7,5" 21414 (s F44 RVA,44 08ikm A/V 117.57 which is shown and designated on the Suffolk County Tax Map as District 1000, Section 6,Block 0�j ,Lot /• Z o That the undersigned(has)(have)filed, or cause to be filed,an application in the Southold Town Building Inspector's Office for the following: r�.�1,S fAI/44i0l-f That the undersigned do(es)hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property,including any and all buildings located thereon,to conduct such inspections as they may deem necessary with respect to the aforesaid application,including inspections to determine that said premises comply with all of the laws,ordinances,rules and regulations of the Town of Southold. The undersigned,in consenting to such inspections,do(es)so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws,ordinances,rules or regulations of the Town of Southold. Dated: s, ( gnature) MARC Ft', hs4-aA (Print Name) (Signature) (Print Name) 4 OF SOUry®� Town Hall Annex ~ ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 • �� sean.devlinCD-town.Southold.ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To. Marc Fishstein Address: 1475 Lands End Rd city,Orient st NY zip: 11957 Building Permit#: 44885 Section: 15 Block: 9 Lot- 1.2 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Shore Power Electric License No: 42536ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Commerical Outdoor X 1 st Floor Pool New X Renovation 2nd Floor Generator X Addition Survey X Attic Garage X INVENTORY Service 1 ph X Heat Duplec Recpt Ceding Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel 200A A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceding Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches 4'LED Exit Fixtures Pump Other Equipment: 22kW Generac Generator and 200A Whole House Transfer Switch Notes: Generator Inspector Signature: �� Date: July 24, 2020 S Devlin-Cert Electrical Compliance Form As g SOUIyO� l V 85 1 H I.Sr LA-M DS t�jD d f TOWN-OF SOUTHOLD BUILDING DEPT. °`ycoutrtv��'' 765-1802 INSPECTION [ ] -FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] `FIREPLACE & CHIMNEY - [ - ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION- [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) -ELECTRICAL (FINAL) [ ] CODE VIOLATION ] PRE C/O � e..+T REMARKS: DATE INSPECTOR FIELD INSPECTION REPORT7 DATE COMMENTS b FOUNDATION (IST) y ------------------------------------ � C FOUNDATION (2ND) �7 H � r ROUGH FRAMING& y PLUMBING MIN INSULATION PER N.Y. y STATE ENERGY CODE �R FINAL ADDITIONAL COMMENTS VN �O z ern O x r� H d t�J �tl �3 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 Suryey Southoldtownny.gov PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined '2096 Single&Separate Truss Identification Form Storm-Water Assessment Form Contact: r 1 r Approved ' 20k Mail to:-.NAw AwER Alref4r M Disapproved a/c CA E[17-A LIS /'h 4.4w t 0A Phone:l0 3/-395-V0 A7 A o Expiration�__A116 202f /68 FAC kWiN /1p0A4-(,(x4-2_ JC C-,N WE464 14 M301 Buil 'ng pector APPLICATION FOR BUILDING PERMIT Date J_Cktil G S7 ,20 ,20 INSTRUCTIONS ,a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector mayauthorize,in writing,the extension of the permit for an addition six months. Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,New York,and other applicable Laws, Ordinances or Regulations,for the construction of buildings,additions,or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulatio ,and to admit authorized inspectors on premises and in building for necessary inspections. (Signa a applicant or name,if a corporation) /r9� r•RaW�tN Rd;l,�►��-a. C'E�t�p �o�cl,�s,�V� (Mailing address of applicant) /1Y3�K State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder Name of owner of premises C F1 Sh slf_;U (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. Lf a 53 6 M E Other-Trade's License No. 1. Location of land on which proposed work will be done: 1 75' 1-,WJs EAId PC)Act ORicH¢ Ale(4VWC 117S7 House Number Street Hamlet g County Tax Map No. 1000 Section / Block 09 Lot P • �Z O Subdivision �J� Filed Map No. Lot 1 - 7-0 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 1 3. Nature of work(check which applicable): New Building , Addition Alteration Repair Removal Demolition Other Work (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 i 10. Date of Purchase Name of Former Owner llI 11. Zone or use district in which premises are situated I 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 Address I Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY 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 properly? * YES NO * IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) Lo"1'5 being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the /1 ew (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 before me this day of 7,,he. 20�? �lFtti�'' J'IN� Notary Public Notary Pub)i omevrYork Si tur of Applicant No.01H06392941;Suffolk 6wtX Commission Expires Jim.3,2623 BUILDING-DEPARTMENT-Electrical Inspector FIR TOWN-OF SOUTHOLD Town Hall Annex54375 Main Road PO Box 1179 Southold, New York 11971=0959 Telephone (631) 765-1802 - FAX (631) 765.9_602 A L-o ggand0southoW�94_9_pv _Q6.rL@southoldtownny.go_v A j PPU V"D. 9N FOR ELECTRICAL INSPECTLCJN ELECTRICIAN INFORMATION (AH'Iriformation Required) bate.; 2_0 Company Name: ------ Name: CIO D 'M License No.: aLgS-34 Mg Address:_&EF 'A0wejm Phone No.: JOB SITE INFORMATION (All Information Required) Name: Address:' OP. N Cross--Street: .4 -1-hlmX Phone Bldg.Rerrnit#: 9-01 load Tax Ma Dis#riirt' 1000_ Block: W-0 BRIEF-DESCRIPTION OF WORK(Ple'-ast<Pflht Clearly) m's .4 004 0--f-e? )!�V_ Circle AH'Thad A#ply: Is job ready for insp6clion?: YESNOR406416 Final Do you heed a T efnpC0tfifJcW1? YES, Issued On , I Temp information:- (All in6rmatiorvrequired) Service Size 1 Ph 3 Ph _Siz' e: -A #Meters Old New Service- Fire Reconnect--Flood Reconnect-Service Reconnected-Underground-Overhead I#Under g round Laterals 1 2 HFr=6 Pole, 'Work done-onService? Y N -Additional 1nf6frnafi6n:"_ PAl -WOTH APPLICATION ATTION Request for lnsoectio6 FormAs i PERMIT# Address: - - - - -- - - - -- - Outlets Surface Sconces HH`s LIC tts bans Fridge HW Exha ust Oven Dryer Smokes, D--W Service Carie®n Micro Cerro for Combo Cooktop Transfer AC AH Mini 47 Comm, ents: Ce P O ----- ---- ---- ---- ----- ----------- - ----------------- - - ---- - - - - - ----------- -- - -- ----------- - -- ------ --- --- --- - UCIlerd Lur imap://imap.secureservernet:993/fetch>UID>/INBOX>10175?he.. SURVEY OF LOT 20 YAP OF LANDS END mg Mr.""nus n.r A+-r. snx,ATA• ORIENT TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-I5-09-7.20 SCALE 7'-20' L A rgA?A ANNL 26. 2017 LANDS END ROAD EKE wrcA.ss.ssa.r. r. -- a,a9 ar. * & r rA'OTtO'■——ApAp• far G ; Ns ., s as•sT•an•• E 1eo.00• . c• O ice � TQ z Z Z ------�' --- p1 4� o . o . . N 88.57.40" W LOlgi A"11 fl�r?t.S Sai.lS] 190.00• ux<.v ncx r L07 1/ h• Nathan Taft Corwin �w � Q Land Surveyor q�witD�N' caeMED TO MOM MARC J. FISHSTEIN ALEXANDRA SWEENEY mu iswusEw.. S� FIDELITY NATIONAL TITLE INSURANCE COMPANY MIT w E .�. I MORGAN STANLEY NOME LOANSE _ UKWm VFW..0 i7W AT WA.M AMR asoR rv mcm F 'us w Aw•�" PC....� un.ra Sam in rm swu.c .-R.Nw lk h na.�wSO -MhR Fi'SI,sIi� Tile �G' --lv`-09-1-2a Pf75 LAmlc PAA Rated, OAI*fJ-Lt 114x7 of 3 S/R/7l17n •.to DitA Nom++ Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE hoard 1 a.Legal Name&Address of Insured(use street address only 1 b.Business Telephone Number of Insured SHORE POWER ELECTRICAL CONTRACTING, INC' 631-395-4029 108 FROWEIN RD-#2 1c.NYS Unemployment Insurance Employer Registration Number of Insured CENTER MORICHES, NY 11934 Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,.a Wrap-Up 1d.Federal Employer Identification Number of Insured or Social Security Policy) Number 20-4999885 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being listed as the Certificate Holder) HARTFORD CASUALTY INSURANCE COMPANY Town of Southold 3b.Policy Number of Entity Listed in Box"1 a" Town Hall Annex 12 WEC AB5PSI Southold, NY 11971 3c.Policy effective period 07/20/2019 to 07/20/2020 3d.The Proprietor,Partners or Executive Officers are Included.(Only check box if all partners/officers included) X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3e',whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note:Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,l certify that I am an authorized representative or licensed agent of the insurance carrier,referenced above and that the named insured has the coverage as depicted on this form. Approved by: Corinne Rooney (Print name of authorized representative or licensed agent of insurance carrier) Approved by: (Signature) (Date) Title:Certificate Coordinator Telephone Number of authorized representative or licensed agent of insurance carrier: 631-567-1011 Ext 352 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www.wcb.ny.gov . f . 4E,I, workers' CERTIFICATE OF INSURANCE COVERAGE YE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a.Legal Name&Address of Insured(use street address only) 1631-395-4029 b.Business Telephone Number of Insured SHORE POWER ELECTRICAL CONTRACTING, INC 108 FROWEIN RD-#2 CENTER MORICHES, NY 11934 Work Location of Insured(Only required if coverage is specifically limited to 1 c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-up Policy) or Social Security Number 20-4999885 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (En)ity Being Listed as the Certificate Halder) Standard Security Life Insurance Company of New York Town of Southold Town Hall Annex 3b.Policy Number of Entity Listed in Box"1a" Southold, NY 11971 79516-00 3c.Policy effective period 1/1/2018 to 10/22/2020 4. Policy provides the folloWing benefits: Mm A.Both disability and paid family leave benefits. ❑ B.Disability benefits only. M C_Paid family leave benefits only. 5. Policy covers: 0 A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as descfflo desk' above. Date Signed 10/24/2019 By �8WA- a-44pt (signature of insurance carrier's authoriz d representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBUPOLICY SERVICES IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If Box 4B,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers'Compensation Board,Plans Acceptance Unit,PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(only if Box 4C or 5B of Part 1 has been checked) State of Now York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law With respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note.Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents Of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB420.1 (10-17) QIDIIP!Qii-1�ei0�i1uiiii10i-i1ii�l� DATE(11lQUDD/YYY1f7 o CERTIFICATE OF LIABILITY INSURANCE 10/24/2019 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 be endorsed. !f SUBROGATION 1S WANED,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 endorseme s. RHONE PRODUCER NAME James Small Hometown insurance of LI,Inc PHONE 631-667-1011 Al No•631-589-4207 (Al, o weber Agency 6 Orville%=Suite 400 ADDRESS: Bohemia,NY 11716 INSURERS AFFORDING COVERAGE NAIC James Small INsuRERA-The Ohio Casualty Ins.Co. INSURED Shore Power Electrical INSURER B: Contracting,Inc. INSURER c: 108 Frowein Road,#2 Center Moriches,NY 11934 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, 'PERM 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 SHAWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ITYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MID A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE 0 OCCUR BKO(20)67918686 07/17!2079 07/17/2020 PREMISES EaEocaurence $ 300,000 MED EXP(Any one person) $ 16,000 PERSONAL&ADV INJURY $ 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY[X]PRO- LOCPRODUCTS-COMPIOP AGG $ 2,000,000 OTHER. AUTOMOBILE LIABILITY CEa aceOMBINident SINGLE LIMIT $ ED ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLAtJAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER 0TH_ AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECIJTIVE ❑ NIA E.L.EACH ACCIDENT $ OFPICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOY $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EKP(RATION DATE THEREOF, NOTICE tMLL BE 13ELWREO IN ACCORDANCE WITH THE POLICY PROVISIONS. Town Hall Annex Southold,NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD F/S s`t'ar N 7,57 ,. &NJ Ro Aj S 4,( a- r7i -Ta J"►0.;,� 3v ff\\ , Psi°, (� C) la" Five Dr;P Lei �� �� CAor S - INSPECT ON R QUIREEGE N E RAC ===11=111_=7F1M APPRO ED AS NOTE GUARDIAN° SERIES - 20L12 - kWDATE: B.P.# � ntial StandbyGenerators FEE:- !� � BY. Air-Cooled Gas Engine NOTIFY BUILDING DEPARTMENT AT 765-1802 SAM TO 4 PM FOR THE 1. FOUNDATION - TWO REQUIRED Standby Power Rating INCLUDES' FOR POURED C0.NCRC TE G007035-3,G007039,3(Aluminum-Bisque)-20 kW 60 Hz • True Power'" Electrical Technology 2. ROUGH - FRAW.',,G & PLUMBING G007042-3,G007043-3(Aluminum-Bisque)-22 kW 60 Hz • Two-line multilingual digital LCD Evolution'" contr;leINSULATION (English/Spanish/French/Portuguese) 4. FINAL - CONSTRUCTION MUST • 200 amp service rated smart switch transfer switch avff fbILOOMPLETE FOR C 0. • Electronic governor ALL CONSTRUCTION SHALL MEET_"THE REQUIREMENTS OF THE CODE • Standard Wi-Fi°connectivity YORK STATE. NOT RESPONS BLE FCS • System status&maintenance Interval LED indicaIDESIGN OR CONSTRUCTIONERRORS • Sound attenuated enclosure • Flexible fuel line connector • Natural gas or LP gas operation I GENERAC` • 5 Year limited warranty —!-I • Listed and labeled by the Southwest Research Institute allowing installation as close as 18 in(457 mm)to a structure t *Must be located away from doors,windows,and fresh air intakes and in accordance with local codes ON haps//assets swri org/Irbrary/DirectoryOfListedProducts/ cus or C U� US QU' N Construcfronlndustryl973_D ����� ®� LISTED V[ Note CETL or CUL certification only applies to unbundled units and units packaged withlimited circuit switches Units packaged with the Smart Switch are ETL or UL USE IS UNLAWFUL certified in the USA only WITHO T CEBIEGATI FEATURES OF OCCUPANCY O INNOVATIVE ENGINE DESIGN & RIGOROUS TESTING are at the heart of Gen- O SOLID-STATE, FREQUENCY COMPENSATED VOLTAGE REGULATION: This erac's success in providing the most reliable generators possible. Generac's G- state-of-the-art power maximizing regulation system is standard on all Generac mod- Force engine lineup offers added peace of mind and reliability for when it's needed els It provides optimized FAST RESPONSE to changing load conditions and MAXI- the most.The G-Force series engines are purpose built and designed to handle the MUM MOTOR STARTING CAPABILITY by electronically torque-matching the surge 1 rigors of extended run times In high temperatures and extreme operating conditions loads to the engine.Digital voltage regulation at±1% O TRUE POWER'"ELECTRICAL TECHNOLOGY:Superior harmonics and sine wave O SINGLE SOURCE SERVICE RESPONSE from Generac's extensive dealer network form produce less than 5%Total Harmonic Distortion for utility quality power This provides parts and service know-how for the entire unit,from the engine to the small- allows confident operation of sensitive electronic equipment and micro-chip based est electronic component. appliances,such as variable speed HVAC systems. O TEST CRITERIA: O GENERAC TRANSFER SWITCHES:Long life and reliability are synonymous with ✓ PROTOTYPE TESTED ✓ NEMA MG1-22 EVALUATION GENERAC POWER SYSTEMS One reason for this confidence is that the GENERAC ✓ SYSTEM TORSIONAL TESTED ✓ MOTOR STARTING ABILITY product line is offered with its own transfer systems and controls for total system compatibility O MOBILE LINK®CONNECTIVITY:FREE with select Guardian Series Home standby COMPLY WITH ALL CODES OF generators, Mobile Link Wi-Fl allows users to monitor generator status from any- NEW YORK STATE & TOWN CODES where in the world using a smartphone,tablet,or PC Easily access information such AS REQUIRED AND CONDITIONS OF as the current operating status and maintenance alerts Users can connect an account to an authorized service dealer for fast,friendly,and proactive service.With Mobile Link,users are taken care of before the next power outage SOUTHOLD TOWN PLANNING BOARD so Hrn n rnw®STEES w GENERAC @ ,.®� � � � i_- PROMISE ­—1— , GENERAC� 20/22 kW Features and Benefits Engine • Generac G-Force design Maximizes engine"breathing"for increased fuel efficiency.Plateau honed cylinder walls and plasma moly rings help the engine run cooler,reducing oil consumption and resulting in longer engine life • "Spiny-lok"cast iron cylinder walls Rigid construction and added durability provide long engine life. • Electronic ignition/spark advance These features combine to assure smooth,quick starting every time • Full pressure lubrication system Pressurized lubrication to all vital bearings means better performance,less maintenance,and longer engine ' life Now featuring up to a 2 year/200 hour oil change interval. • Low oil pressure shutdown system Shutdown protection prevents catastrophic engine damage due to low oil • High temperature shutdown Prevents damage due to overheating Generator • Revolving field Allows fora smaller,lightweight unit that operates 25%more efficiently than a revolving armature generator • Skewed stator Produces a smooth output waveform for compatibility with electronic equipment. • Displaced phase excitation Maximizes motor starting capability • Automatic voltage regulation Regulating outputvoltage to±1%prevents damaging voltage spikes • UL 2200 listed For your safety. Transfer Switch(if applicable) • Fully automatic Transfers vital electrical loads to the energized source of power • NEMA 3R Can be installed inside or outside for maximum flexibility • Remote mounting Mounts near an existing distribution panel for simple,low-cost installation Evolution- Controls • AUTO/MANUAL/OFF illuminated buttons - Selects the operating mode and provides easy,at-a-glance status indication in any condition. • Two-line multilingual LCD display Provides homeowners easily visible logs of history,maintenance,and events up to 50 occurrences • Sealed,raised buttons Smooth,weather-resistant user interface for programming and operations • Utility voltage sensing Constantly monitors utility voltage,setpoints 65%dropout,80%pick-up,of standard voltage. • Generator voltage sensing Constantly monitors generator voltage to verify the cleanest power delivered to the home. • Utility interrupt delay Prevents nuisance start-ups of the engine,adjustable 2-1500 seconds from the factory default setting of 5 seconds by a qualified dealer • Engine warm-up Verifies engine is ready to assume the load,setpoint approximately 5 seconds • Engine cool-down Allows engine to cool prior to shutdown,setpoint approximately 1 minute • Programmable exercise Operates engine to prevent oil seal drying and damage between power outages by running the generator for 5 minutes every other week.Also offers a selectable setting for weekly or monthly operation providing flexibility and potentially lower fuel costs to the owner. • Smart battery charger Delivers charge to the battery only when needed at varying rates depending on outdoor air temperature Compatible with lead acid and AGM-style batteries. • Main line circuit breaker Protects generator from overload. • Electronic governor Maintains constant 60 Hz frequency Unit • SAE weather protective enclosure Sound attenuated enclosures ensure quiet operation and protection against mother nature,withstanding winds up to 150 mph(241 km/h).Hinged key locking roof panel for security.Lift-out front for easy access to all routine maintenance items.Electrostatically applied textured epoxy paint for added durability. • Enclosed critical grade muffler Quiet,critical grade muffler is mounted inside the unit to prevent injuries • Small,compact,attractive Makes for an easy,eye appealing installation,as close as 18 in(457 mm)away from a structure. GENERAC' 20/22 kW Features and Benefits Installation System _ • 14 in(35 6 cm)flexible fuel line connector Listed ANSI Z21 75/CSA 6 27 outdoor appliance connector for the required connection to the gas supply piping. • Integral sediment trap Meets IFGC and NFPA 54 installation requirements. Connectivity(WI-Fi equipped models only) • Ability to view generator status Monitor generator with a smartphone,tablet, or computer at any time via the Mobile Link application for complete peace of mind. • Ability to view generator Exercise/Run and Total Hours Review the generator's complete protection profile for exercise hours and total hours. • Ability to view generator maintenance information Provides maintenance information for the specific model generator when scheduled maintenance is due • Monthly report with previous month's activity Detailed monthly reports provide historical generator information • Ability to view generator battery information Built in battery diagnostics displaying current state of the battery • Weather information Provides detailed local ambient weather conditions for generator location J GENERAC� 20/22 kW Specifications Generator Model G007038-3,G007039-3(20 kW) G007042-3,G007043-3(22 kM i Rated maximumcantmous power capacity-(L'P) w - "--- `__-_____ 20,000 Watts* _" 22,000 Watts' - ' Rated maximum continuous power capacity(NG) 18,000 Watts* 19,500 Watts* _ 240 240 Rated maximum continuous load current-240 volts(LP/NG) - - - - 833/750 ^- --- 917/813 Total HarmonicDistortion - - -- - ---`- ---- --- --------_-"- - Lessthar 5%- - --- Main _ _-__.__ -. --------------- r Mani Ime4 circuit breaker - 4- 90 amp 100 amp rPhase --------------- 1 Number of rotor poles -____ ____ -�__ ___2 --- -- - -------- --- Anted- AC frequency 60 HzPower factor 10 iBatfery requirement(not included) '- _ -- 12 Volts,Gron 26R 540 CCA minimum of Grou 35AGM 650 CCA minimum Unit weight(Ib/kg) 436/198 445 i-202 D�mensions(LxWxH)inlcm _ al loa48x25x29/1219x63.5x737 Sound output in dB(A)at 23 ft(7 m)with generator operating at normd** -� -67 Y -- 67- Sound output m dB(A)of 23 ft(7 m)wdhgenerator m0met-Test'"low-speed exercise mode"_ - `-- - 55 �µ - - __'__57___ Exercise duration 5 min Engine Engine type GENERAL G-Force 1000 Series _._..,___ _ _... __. _a_._- -------_ _ ._- I Number of cylinders -- __ 2 Displacement - --- -- --------999 cc __--_-_--l- 9 Cylinder Block_ li -- - - -- -- - -- - s -- ---- - - -- --- Valve arrangement - � Overhead valve~ -Solid-state w/magneto Governor system - -------` --� `- -_—�______-_ Electronic Compression ratio __-____._-___-._._._-._--__--____.- Starter —'12 VDC Oil ca'acr mcludmgetr - --- A PProxl.9gt(1,8_L Opeabngrpm F--el--consumptio---n---- - --- - ---r----_-...- -- -----_- -- - ------ -- --- - ------, Fid-el 4 Natural gas ft3/hr(m3/hr) 1/2 Load 164(4 64) 203(5 75) Full Load 287(8.13) 306(8.66) II Liquid propane ft3/hr(gaVhr)Mr] 1 1/2 Load 86(2 36)[8 951 92(2 53)[9.57] Full Load' 136(3 74)[14.15] 142(3 90)[14.77] Note Fuel pipe must be sized for full load.Required fuel pressure to generator fuel inlet at all load ranges-3 5-7 in water column(D 87-174 kPa)for NG,10-12 in water column(2 49-2 99 kPa)for LP gas For BTU content,multiply ft3/hr x 2500(LP)or 113/hr x 1000(NG) For Megaloule content,multiply m3/hr x 9315(LP)or m3/hr x 37 26(NG)' Controls Two-line plain text multilingual LCD _ __ __ __ Simple user interface for ease of operation 1 Mode buttons AU-FO----------w +_ _u___..__ ___ ____ _ Autom_atic start on utility failure_Weekly,Bi-weekly,o_Monthly selectable exerciser MANUAL_ Start with starter control,unit stays on-If utility fails,transfer to load takes place Stops unit Power is removed Control and charger still operate. Ready to Run/Maintenance messages - Standard �Engme run hours indication Programmable start delay between 2-1500 seconds Standard(programmable by dealer only) rUhhtiVoltage Loss/Returnto Utility adjustable(brownout ssettmg)" Future Set Capable Exerciser/Exercise Set Error warning Standard 4: Alar_MM_amtenance logs -" _- `"--_-` "-i " - ` - ---`_`" "`-- -`50 events each Engine start sequence- _ ___-__T-______ ---- ------------ Cyclic cranking 16 sec on,7 rest(90 sec maximum duration) (Starter lockout _�__` %a_���^� - y 4 __ ^__ _ - 'Starter c_annot_re-_engage�until 5 sec after engine has stopped. Smart Battery Charger - _ Standard______ _ ___.. ------ ------------- OhargerFaulUMissmgACwarnmg _ -- Standard Low Battery/Battery Problem Protection and Battery Condition indication _ _ _ _ Standard Automatic_VoltageRegulation_wdhOverandllnderVoltageProttechonv" - ry M- -- q- y - .- Standard Under-Frequency/Overload/Stepper Overcurrent Protection _ _ _ _ Standard Safety Fused/Fuse Problem Protection Y- - ��- _ Standard T j -.._ _ Automatic Low Od Pressure/High Od Temperature Shutdown - -- .--. __-_ - "--Standard - ]Overcrank/Overspeed(@ 72 Hz)/rpm Sense Loss Shutdown' - =_ —^ -�_-- w Standard -- --� - -- High Engine Temperature Shutdown - -Standard ___aultw_ __ --__-_tanda_ Common external fcapability Srd Reld upgradable firmware _ Standard *`Sound levels are taken from the front of the generator Sound levels taken from other sides of the generator may be higher depending an installation parameters Rating definitions-Standby Applicable for supplying emergency power for the duration of the utility power outage No overload capability is available for this rating (All ratings in accordance with BS5514,IS03046 and DIN6271) *Maximum kilovolt amps and current are subject to and limited by such factors as fuel BTU/megajoule content,ambient temperature,altitude,engine power and condition,etc Maximum power decreases approximately 3 5%for each 1,000 it(304 8 m)above sea level,and also will decrease approximately 1%for each 10*F(6°C)above 60°F(16°C) GENERAC' 20/22 kW Switch Options Service Rated Smart Switch Features Model G007038.3,6007039-3(20 kW) • Includes digital power management technology(DPM)standard __ 0007042-3,13007043-3(22 W) No of poles • Intelligently manages up to four air conditioner loads with no additional hardware. Current rating(amps) 200 • Up to eight additional large(240 VAC)loads can be managed when used in lVollagesating(VAC) 120/240,10 conjunction with Smart Management Modules(SMMs) Utility voltage monitor(fixed)* • Electrically operated,mechanically-held contacts for fast,clean connections -Pick-up 80% -Dropout 65% • Rated for all classes of load,100%equipment rated,both inductive and resistive Return to Uhhty" �# Approx�13 sec_HP, �%� ' • 2-pole,250 VAC contactors Exercises bi-weekly for 5 minutes`_ Standard ETL or_UL listed Standard--------=_ • Service equipment rated,dual coil design. Enclosure type___�...__w ���...W_.�._-°____._�NEMA/UL 3R _ • Rated for both aluminum and copper conductors Circuit breaker • Main contacts are silver plated or silver alloy to resist welding and sticking Lug range _250 MCM-#6� • NEMA/UL 3R aluminum outdoor enclosure allows for indoor or outdoor mounting *Function of Evolution controller flexibility Exercise can be set to weekly or monthly evi— Dimensions 200 Amps 120/240,1a Open Transition Service Rated Height Width H1 H2 W1 W2 Depth Hz H, in 2675 30.1 10 5 13.5 691 cm 6795 7645 2667 34 29 17.55 Wire Ranges 0 Conductor Lug I Neutral Lug Ground Lug oEPm 400 MCM-#4 1 350 MCM-#6 2/0-#14 GENERAC� 20/22 kW Available Accessories r - Model# Product Description G005819-0 26R Wet Cell Battery Every standby generator requires a battery to start the system.Generac offers the recommended 26R wet cell battery for use with all air-cooled standby product(excluding PowerPacto). G007101-0 Battery Pad Warmer Pad warmer rests under the battery.Recommended for use if temperature regularly falls below 0°F(-18°C)Not necessary for use with AGM-style battenes). G007102-0 M 011 Warmer 011 warmer skips directly over the oil filter.Recommended for use 1f temperature regularly falls below 0°F(18°C) G007103-1 Breather Warmer Breather warmer is for use in extreme cold weather applications For use with Evolution controllers only in climates where heavy Icing occurs. G005621-0 Auxiliary Transfer Switch The auxiliary transfer switch contact kit allows the transfer switch to lock out a single large electrical load that may not i Contact Kit be needed Not compatible with 50 amp pre-wired switches. I G007027-0-Bisque Fascia Base Wrap Kit The fascia base wrap snaps together around the bottom of the new air-cooled generators This offers a sleek,con- ; I(Standard on 22 kW) toured appearance as well as offering protection from rodents and insects by covering the lifting holes located 1n the i base. f G005703 0 Bisque Touch Up Paint Kit If the generator enclosure is scratched or damaged,1t is important to touch up the paint to protect from future corro- sion.The touch-up paint kit includes the necessary paint to correctly maintain or touch up a generator enclosure. G006485-0 Scheduled MaintenanceKit Generac's scheduled maintenance kit provides all the items necessary to perform complete routine maintenance on a Generac automatic standby generator(oil not included). 1 G007005-0 WI Fi LP Tank Fuel Level The Wi-Fi enabled LP tank fuel level monitor provides constant monitonng of the connected LP fuel tank.Monitoring Monitor the LP tank's fuel level is an important step in verifying the generator Is ready to run during an unexpected p owe r fal lu re. Status alerts are available through a free application to notify users when the LP tank is in need of a refill. G007000-0(50 amp) Smart Management Module Smart Management Modules(SMM)are used to optimize the performance of a standby generator It manages large G007006-0(100 electrical loads upon startup and sheds them to aid in recovery when overloaded.In many cases,using SMM's can amp) reduce the overall size and cost of the system. G007169-0 Mobile Link®413 LTE Cellular IThe Mobile Link 413 LTE Cellular Accessory allows users to monitor generator status from anywhere in the world,using I Accessory a smart phone,tablet,or PC Easily access information such as the current operating status and maintenance alerts. Users can connect an account with an authorized service dealer for fast,friendly,and proactive service.With Mobile Link,users are taken care of before the next power outage Dimensions & UPCs Madel UPC 637 6 mm 1218 mm [25,,°, [48 01.1 G007038-3 696471074185 G007039-3 696471074192 G007042-3 696471074208 G007043-3 696471074215 727 2mm [28 6 mI 0 0 646 mm1232 mm [25 Sq In, [48 5 In7 LEFT SIDE VIEW FRONT VIEW Dimensions shown are approximate See Installation manual for exact dimensions.DO NOT USE THESE DIMENSIONS FOR INSTALLATION PURPOSES GENE RAC' Generac Power Systems,Inc. • S45 W29290 HWY.59,Waukesha,WI 53189 • generac.com ©2020 Generac Power Systems,Inc All rights reserved All specifications are subject to change without notice Part No A0000221268 Rev A 02/28/2020