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HomeMy WebLinkAbout45395-Z �o1Oc��FFQ(, cpG� Town of Southold 3/27/2021 P.O.Box 1179 Ca ` 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41917 Date: 3/27/2021 THIS CERTIFIES that the building GENERATOR - Location of Property: 1435 Woodcliff Dr.,Mattituck SCTM#: 473889 Sec/Block/Lot: 107.-6-17.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/20/2020 pursuant to which Building Permit No. 45395 dated 10/29/2020 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: accessory generator as applied for. The certificate is issued to Griffin,Theodore&Maureen of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45395 3/23/2021 PLUMBERS CERTIFICATION DATED c Aut orized Signature sFai �, TOWN OF SOUTHOLD BUILDING DEPARTMENT ' 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#: 45395 Date: 10/29/2020 Permission is hereby granted to: Griffin, Theodore 1435 Woodcliff Dr PO BOX 554 Mattituck, NY 11952 To: install generator as applied for. At premises located at: 1435 Woodcliff Dr., Mattituck SCTM # 473889 Sec/Block/Lot# 107.-6-17.2 Pursuant to application dated 10/20/2020 and approved by the Building Inspector. To expire on 4/30/2022. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CERTIFICATE OF OCCUPANCY $50.00 Total: $235.00 Building Inspector Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines,streets,and unusual natural or . :topographic features. 2. FinalApproval 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. Z L New Construction: Old or Pre-existing Building: (check one) Location of Property: 1!✓� WQ)dc I t't-f- c f rVIP House No. Street Hamlet Owner of Owners of Property: Suffolk County Tax Map No 1000, Section `d Block �j Lot Subdivision Filed Map. Lot:: _ Permit No. Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ '50 Applican Signatu e Building Dc ar ime gt Ap alication s n AUTHO < " ', TION (Where the Applicant is not the Owner) � - m residing at (Print property owner's name (Mailing Address) _do hereby authorize.. (Agent) to apply on my'behalf to the Southold Building TPepartment. (Owner's-Signature) (Date) (Print Owner's Name) AV so Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 sean.devlint')town.southold.ny.us Southold,NY 11971-0959 ® �® ®�ycouff",� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Theodore Griffin Address: 1435 Woodcliff Dr city.Mattituck st: NY zip: 11952 Building Permit# 45395 Section 107 Block: 6 Lot: 17.2 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Universal Electrical Services License No: 54018ME SITE DETAILS Office Use Only Residential X Indoor X Basement X Generator X Commerical Outdoor X 1st Floor Pool New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph X Heat Duplec Recpt Ceiling 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 Ceiling Fan Combo Smoke/CO Transfer Switch 200A UC Lights Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches 4'LED P1 Exit Fixtures Pump Other Equipment 20kW Generator w/ 200A Whole House Transfer Switch Notes Generator Inspector Signature: _ Date: March 23, 2021 S.Devlin-Cert Electrical Compliance Form As o��OF SOOIyo 1 Y b c 1 -In�- # # TOWN OF SOUTHOLD BUILDING DEPT. �`ycoutme�'' 765-1802 .INS=PECTI=ON [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION-2ND - [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY -[ ] FIRE SAFETY INSPECTION ]V FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS:' Or L. AA jjr,'l . C--,Ctr- feX C C,,l C., C (9,A �-o z� L /` J ck -- DATE '� INSPECTOR 0F SoUlyO� H 5 3 q s /� � � V v d�/ r> �(— # # 'TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY- [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] 'CODE VIOLATION [ ] PRE C/O REMARKS: ovvDATE 2 Z INSPECTOR =+ FIELD INSPECTION REPORTDATE ' ` ' FOUNDATION(1ST) ------------------------ FOUNDATION --------------------FOUNDATION(ZND) . CA ROUGH FRAMING& , r• • • �y PLUMBING 77 INSLATION PER N.Y. \ r H STATE ENERGY CODE ` FINAL > �X TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL:(631)765-1802 Planning Board approval FAX:(631)765-9502 Survey Southoldtownny.gov PERMIT NO. Check Septic Form N.Y.S D E.C. Trustees C.O.Application vy y, :, Flood Permit Examined _2a l4i J� Single&Separate ° 3 Truss Identification Form d, Storm-Water Assessment Form Contact: Approved 20 Mail to- Disapproved a/c aU1 � n r Phone. Expiration 2 ,'U) ?i C= Buil ing I s r APPLICATION FOR BUILDING PERMIT Date /D���o ,20 2t1 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 may authorize,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 regulations,and to admit authorized inspectors on premises and in building for necessary inspections. T JJJ(Signature of applic r name,if a corporation) 'y/// �"// (Mailing address of applica State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Name of owner of premises 6-5 (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. 5 aa-I S Electricians License No. M C t5 Ay O ) Other Trade's License No. 1. Location of land on which prop sed work will be do e: 71 House Number Street Hamlet County Tax Map No. 1000 Section U Block Lot f Subdivision Filed Map No. Lot 2. State existing use and occupancy of premi and intended use and occupancy of proposed construction: a. Existing use and occupancy 25)'&Qn C„p b. Intended use and occupancy ('�•p S" SA C 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work Gj-q . � LV (Description) 4. Estimated cos q�� 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 O 13.Will lot be re-graded?YES_NO-Y—Will excess fill be removed from premises?YES_NO,C 14.Names of Owner of premises �l-r77A Address_ARS N/t CI Phone No. K314:24 '15D 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 property?*YES NO� *IF YES,PROVIDE A COPY. STATE OF NEW YORK) COUNTY OF cd J�`cA l �'VJw Ut being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)/above named, (S)He is the J ( o actor,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; lication are true to the best of his knowledge and belief;and that the work will be FRArTigeA forth in t te application filed therewith. NOTARY Mut > T&t(*NW Y01 20 D Re&tr Qualified i o , My Commission Expire<'® otary Public Signature o A p scant 11, f foil BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD } = Town Hall Annex- 54375 Main Road -PO Box 1179 . , Southold, New York 11971-0959 s Telephone (631) 765-1802 - FAX (631) 765-9502 ro err southoIdtownn, ov w seand —@southoldtoVvnny.gov w . APP;LIJOATI,ON FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION {All Information Required) Date; Company Name: , Cary/, Name: 0 044 - �� pm - License No.: L - �y(Z email: i Address: ... Phone No.: JOB SITE INFORMATION (All Information Required) Name: Address: Cross Street: vp Phone No.: -Bldg.Permit#: email: '7-edc��,'FF, Tax Map District 1-000 Section: „/ Del Block: - BRIEF DESCRIPTION OF WORK(Please'Print Clearly) —Cns-}��� Circle All That Apply. Is job ready for inspection?: YES t NO Rough In Final Do you need a Temp Certificate?: YES I NO Issued On, Temp Informatio . (All information required) Service Size 1 Ph 3 Ph Size:, A #Meters _ Old Meter#, New Service- Fire Reconnect-Flood Reconnect- Service Reconnected- Underground -Overhead #Underground Laterals 1 2 H Frame .Pole_ _ -Work done on Service? Y N Additional Wormation;- PAYMENT DUE 1111'ITH APPLICATION Request for Inspection Form As PERMIT# Address: Switches Outlets GFI's Surface Sconces H H's UC Lts., Fans - ,._ ,..._..,.� .. -.".-�-• Fridge � �.. `HW _• , .�... �..�. M1 _._,_ _. _-_ Exhaust Oven Dryer Smokes" DV1/ �S --- ervice�� 7 k Carbon _... . ._..__ _ -,_ _._-• - _Micro,,._, Combo :;, Cooktop ;;. :Transfer- — :x AC -- - , - AH Special,:-,-.. - Comments. pecial: _.. _Comments, .,_,. ..- ,.. . . .,, - tea.,, ., .,, ,.. .,_ ,.. „ ,• ,,, ., .. .,—...,, r , ,. -r. .�, .._ ,,,.-. „_. .r .. -,�. -. ._.... _ .., .,.�,.> •_, OWNER: SUFF. CO. HEALTH DEPT.APPROVAL H.S. NO. M44T 7-1 298-8-16T) AREA: 27,510 :5Q,f=-r DEED: L 72.1-7, 7; 59 Af 73 oi-v ul I ("Ni> 1> / / "v CV z SCALE: S 7' 57.4-,A,,� G 1-4 f, - well -7140- W,Z*Ty Inx Nxv-mArlom OF ---qZ,-PC- M vi*,,- Ifw rG T 71 ovwfs SMYT, 'TIic Lg,o lll.'D sip-CR EMCOSSZD S[AL,S'-iALF-KOr U MZSIDER:10 10 BE A VALID T'Llz COPY OLIARANTErs IN-,!CAlr SHALL RUN ONLY TO IM VE:Sr)�-! TM SWYM 2- wo IS PWAILD, A!,D O,!Q TITLE CCS,%rAN-(, LENDING LIS-,-.D AIND y . INST). CERTIF. lo IM ASS!GNL:S TITLE TulION,GugzA`Q�-S Ajt NOT TRANMEIZASU TO ADDITIONAL tNSTITUTJONS O;t SUBSEQua ovens, STAMP 7-,'v4e 40. SEAL A14T771TUCV- RODERICK VAN TUYL. P. C. -rovviv o6= /Z. - LIC. LAND SURVEYORS-GREENPORT, N.Y. -7, 1 X-�fflolk Co. Tax A4dp Dia,': /000, 5 cap TEST HOLE SUFF. CO. DEPT.OF HEALTH SERVICES STATEMENT OF INTENT 0. FOR APPROVAL OF CONSTRUCTION ONLY o THE WATER SUPPLY AND SEWAGE 10aw DATE, DISPOSAL SYSTEMS FOR THIS RESI. DENCE WILL CONFORM TO THE ?'CYV,- H.S. REF. NO : STANDARDS OF SUFFOLK CO. DEPT. OF HEALTH., SERVICES. APPROVED: od ve APPLICANT 1W vOEaR Woftrsl CERTIFICATE OF INSURANCE COVERAGE sY�aT€_ .Comport atiao 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 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured UNIVERSAL ELECTRICAL SERVICES LLC 516-850-7776 151 1 ST AVENUE MASSAPEQUA PARK,aNY 11762 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location,of Insured(Only required if coverage is specifically limited to certain locations in New York State,i a,Wrap-Up Policy) 471592478 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Southold Building Department 54375 Main Road 3b.Policy Number of-Entity Listed in Box"I a" Southold, NY 11971 DBL537882 3c.Policy effective period 07/09/2019 to 07/08/2021 4. Policy provides the following benefits: A.Both disability and paid family leave benefits. E] B.Disability benefits only. ❑ C.Paid family leave benefits only. 5 Policy covers: © 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 employers 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 described above. I Date Signed 6/17/2020 By �UJ G / (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 - Name and Title Richard White, Chief Executive Officer 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 New 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,carvers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. f DB-120.1 (10-17) (liiiiiiiiiiiiiiiillll�l r a NYS1 F New York State Insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE' ` D D ^^^^^^ 463076153 EASTERN LI GAS-SERVICES LLC PO BOX 1134 }` MATTITUCK NY 11952 ��� SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SMITH DRIVE NORTH EASTERN LI GAS SERVICES LLC TOWN OF SOUTHOLD' PO BOX 1134 53095 RT 25 MATTITUCK NY 11952 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD 'DATE 12344620-6 622886 09/24/2020 TO 09/24/2021 9/25/2020 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER .POLICY NO. 2344620-6, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A' MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON 'THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. BY CAUSING THIS CERTIFICATE TO"BE ISSUED TO THE CERTIFICATE HOLDER, THE POLICYHOLDER UNDERTAKES TO PROVIDE THE 'CERTIFICATE HOLDER 10 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:863999430 U-26.3 N Y S ' F New York State Insurance Fund 8 CORPORATE CENTER DR,2ND FLR,MELVILLE,NEW YORK 11747-3166 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 471592478 UNIVERSAL ELECTRICAL.SERVICES,LLC 151 FIRST AVENUE MASSAPEQUA PARK NY 11762 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER UNIVERSAL ELECTRICAL SERVICES, LLC SOUTHOLD BUILDING DEPARTMENT 151 FIRST AVENUE 54375 MAIN ROAD MASSAPEQUA PARK NY 11762 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2449 563-2 622522 07/16/2020 TO 07/16/2021 9/25/2020 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO 2449563-2, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER' FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND,-WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE-EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 1037062088 U-26.3 Suffolk County Dept.oaf ` Labor,LiCensing&consumoe Affairs x p ter; MASTER ELECTRICAL LICENSE, Name' ANTH(7NY d SEMONELLA, business Name This ceihfies 6bilihe UNIVERSAL ELECTRICAL SERVICES LLC bearer is duty licensed by the Courtly 01 SUff91k 'License Nurnber:ME!54018 Rosalie Drago 'Issued: 0812812014 commissioner Expires: 08101/2022 .4Co CERTIFICATE OF LIABILITY INSURANCE DA CE TE(MMIDD"YYY)09/23/2020 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 Carol Losquadro Roy H Reeve Agency,Inc. H N Etl: (631)298-4700 FAX,No: (631)298 3850 PO Box 54 IAIE-MAIL reeve.comr clos uadro o ADDRESS: q @ y 13400 Mairi"Road • INSURER(S)AFFORDING COVERAGE NAIC# Mattltuck NY 11952 INSURER A: Maxum Ind Co 26743 INSURED INSURERS: Eastern LI Gas Services LLC INSURER C• PO BOX 1134 INSURER D: INSURER E: Mattituck NY 11952 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2092313140 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,TERM OR CONDITION OF ANY CONTRACTOR 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 AL101.SUBRPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER POLIO MOLIC LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE ©OCCUR PRENTED REMISES A AGE ToEa occurrence $ 50,000 MED EXP(Any one person) $ 5,000 A BDG0082594-07 09/18/2020 09/18/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY ECT 7 LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER $ AUTOMOBILE LU161LnY - COMBINED SINGLE LIMIT $ Ea a.d.nt ANY AUTO ' BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETORIPARTNERIEXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ H yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/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 THE EXPIRATION DATE THEREOF,NOTICE'WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS: 53095 Main RD PO BOX 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 r —_1 00 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD t - n C� APPROVED AS NOTED DATE: B.P.# a FEE: m: 6 BY: NOTIFY- BUILDING DEPARTMENT AT 765-1802 ' 8 AM TO 4 PM FOR THE OCCUPANCY O FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED USE IS UNLAWFUL FOR RED 2. R UGHOU FRAMINOGCRETE& PLUMBING WITHOUT CERTIFICATE 3.- INSULATION OF OCCUPANCY 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF ELECTRICAL NEW YORK STATE & TOWN CODES INSPECTION REQUIRED AS REQUIRED AND CONDITIONS OF --7S0tiTH>9tN5Wf4-Z�A-- ARD SOBS Jill •• • P ii V a7�t l It um i®L ;3 r The""_ mart C - ti Introducing our deale(excl isive:line,. ; =Availableatyour�localiggs&Stmt#ct „";�" ate ' Deafer with these gr` a `features.;, , :".x.. ;._` ' `, _ . Parts•'t_aear Tr�a?€ 7 ly `. Limited UL < ' Warranty' g% ' LISTED ;sY Corrosion Resistant Enclosure.& Base Sym phony°II Power 1arlagement Sys m:.,,,: • Rust resistant aluminum and a stainless steel base • Customizable to your home's needs to,protect the generator from the elements, Robust • Automatically balances the power of your home's electrical protection against damage from the elements caused load including high wattage Items like air conditioning units by strong winds,high humidity and salt air and electric ovens ' • Powder-coated paint for years of protection against • Offers whole house power with a more affordable chips and abrasions home generator • Certified to withstand hurricane-force winds up to 175 mph-' Quality Clean Power Un-----ique-Airflow Technology • Ensures your electronics are safely powered --- - --- --- - - -------------------------- ------ • Making these models 50%quieter than most Flexible Placement portable generators • The unique design pushes engine exhaust out the • Approved for installation as close as 18"to a building2 front,directly away from your home Commercial-Grade Vanguard®Engine, Briggs&Stratton°Full Synthetic Generator Oil • Shields the engine from low temperature sludge buildup • Powerful V-Twin OHV engine and high temperature deposits • Easy conversion between natural gas(NG)and liquid • Reduces engine wear,scuffing and abrasion propane gas(LP)during Installation • Enhanced cold weather start-up protection to-20•F Liquid Propane Vapor Natural Gas Limited Warranty' Model Enclosure Voltage Phase' Hz Circuit LPV kW L'PV Amps NG kW NG Amps Parts,Labor,Travel Type Breaker Amps 040547 Galvanneal 120/240 1 60 100 20 1313: 18 75 6 Year 040573 Aluminum 120/240 1 60 100 20 83.3 18 75 6 Year 040592 Aluminum 120/240 1 60 100 20 83.3 18 75 10 Year I This generator is certified in accordance with UL(Underwriters Laboratories)2200(stationary engine generator assemblies)and CSA(Canadian Standards Association)standard , C222-No.100-14(motors and generators). 'The installation manual contains specific instructions related to generator placement in addition to NFPA 37,including the requirement that carbon monoxide detectors be installed and maintained in your home. 'Single phase units are rated at 1.0 power factor and three phase units are rated at 0.8 power factor, ' 'See operator's manual or BRIGGSandSTRATTON.com for complete warranty details. When installed in accordance with the installation manual 20kW' Fortress—Standby Generator -0 �,14 Engine Brand Vanguard® Oil Capacity(oz) 79 Engine Speed(RPM) 3600 Lubrication System Full Pressure Engine Fuel Liquid Propane Vapor(LPV)or Recommended oil 5W30 Full Snthetic Natural Gas(NG) y Engine Cylinder Configuration OHV Low Oil Pressure Sensor Yes R Number of Cylinders 2 6A$t4jrq0or Specs 4 Displacement(cc) 993 Manufacturer Briggs&Stratton Compression Ratio 8.5:1 Type Self-Excited,Rotation Field Governor Type Electronic Voltage Regulator Automatic Frequency Regulation 1% Insulation Class F Valves *` 00,4,V,a'27" CHV with Hardened Seats j -,777 M W -rW, 5" �,;Y,ZYZ"., Ignition System Fixed Timing Magnetron® Hour Meter Yes Starter Motor Rating Voltage 12 Volt LED Digital Display Yes Battery Required 12 Volt,Group 26R,540 CCA Minimum Fault Code Display Yes Weekly Exerciser Yes 1-ow K F37-711-111W1111 \M__SX 4 o 5 5, 7 i�!± Full Load 1/2 Load No Load 64dBA4 BTU/hr NG-260,000 NG-187,000 NG-99,000 LPV-337,500 LPV-207,500 LPV-100,000 ft'/hr NG-260 NG-187 NG-99 LPV-135 LPV-83 LPV-40 M3/hr NG-7,36 NG-5.30 NG-280 LPV-3.82 LPV-2 35 LPV-1.13 Parts - Labor-Travel Unlike other standby generator manufacturers, Limited our warranty covers parts, labor AND travel for the Warranty' full length of the warranty with no start-up costs! i. This generator is certified in accordance with UL(Underwriters Laboratories)2200(stationary engine generator assemblies)and CSA(Canadian Standards Association)standard C22 2 No 100-14(motors and generators). 2 Fuel consumption rates are estimated based on normal operating conditions at 1/2 load.Generator operation may be greatly affected by elevation and the cycling operation of multiple electrical appliances-fuel flow rates may vary depending an these factors 3 See operator's manual or BRIGGSandSTRATTON corn for complete warranty details n Lowest no-load measurement per ISO 3744.Sound level measurement at other locations around generator may be different depending upon installation configuration 2 �✓649i<�RF��raa,.u. RIGG8687Rp1TOP1 20kW' Fortress—Standby Generator a OtM'it Fea1tural 2""t _�.vieCNc3st!.. .,dFk4Y+,�,',._ d.Gda''.�.maBSz✓.aaa< ,„ „ °$ ^"r.��"�wW u , .. �^bsk, .....,.«.,Uu.N^a£°Sv�..�.:'"'£"✓�.YSd��u`za1 s ., Enclosure Material Galvanneal Steel or Aluminum CARB Compliant Yes* with Corrosion Resistant Paint Overcrank Protection Yes NFPA Approved Yes Engine Warm Up(sec) 20 or 50 Automatic Transfer cUL Listed to CSA 22.2 No.100-04 Yes Switch Controlled Engine Cool Down(min) 1 NEMA Compliant Yes Response Time(sec) 26 or 56 Automatic Transfer EPA Certified Fuel System Yes Switch Controlled Basic Wireless Monitor , Monitoring Options ,a^ InfoHub"Monitor Continuous Yes Maintenance Kit 6035 Battery Charging Cold Weather Kit 6404 14— Galvanneal-601/273 Basic Wireless Monitor 6176 Assembled Weight(lbs/kg) Aluminum-440/200 InfoHub 6517 Overall Dimensions(In/mm) 49.2 x 31.7 x 30.6/1250 x 805 x 777 Packaged Weight(lbs/kg) Galvanneal-626/284 Remote Status Monitor 6144 Aluminum-575/261 Packaged Dimensions(in/mm) 68.1 x 41 x 39.5/1730 x 1041 x 1003 49.2 in(1250 mm) 31.7 in(805 mm) f fEI \F ' I 30.6 in I (777 mm) c ZIN E F t O 48.1 in(1222 mm) 29.6 in(752 mm) "CARB does not regulate emergency standby generators outputting less than 50 HP.Only the EPA standards apply. 'This generator is certified in accordance with UL(Underwriters Laboratories)2200(stationary engine generator assemblies)and CSA(Canadian Standards Association)standard C22.2 No.100-14(motors and generators). 3 RlresssiimlU 20kW' Fortress's Standby Generator 1/2"pipe capacity 3/4"pipe capacity 1"pipe capacity 1-1/4"pipe capacity 1-1/2"pipe capacity 2"pipe capacity 20'Length= 118 247 466 957 1,430 2,760 40'Length2 81 170 320 657 985, 1,900 60'Length2 65 137 257 528 791 1,520 80'Length2 56 117 220 452 677 1,300 100'Length2 50 104 195 400 600 1,160 �<<��Rmil". kq&';' �w" ecdti�.;.� -s�.� 1/2"pipe capacity 3/4"pipe capacity 1"pipe capacity 1-1/4"pipe capacity 1-1/2"pipe capacity 2"pipe capacity 20'Length2 200 418 788 1,617 2,423 4,666 40'Length2 137 287 541 1,111 1,665 3,20T 60'Length2 110 231 435 892 1,337 2,575 80'Length2 94 198 372 764 1,144 2,204 100'Length2 84 175 330 677 1,014 1,954 e 'This generator is certified in accordance with UL(Underwriters Laboratories)2200(stationary engine generator assemblies)and CSA(Canadian Standards Association)standard C22,2 No.100-14(motors and generators). , :Total length of piping from outlet of regulator to appliance farthest away., BRIGGS&STRATTON CORPORATION r „ Briggs&Stratton has a policy of continuous product improvement and reserves the right to modify POST OFFICE BOX 702 BRIGGS&STRATr'ON its specifications at any time and without prior notice. Not for Prime Power or use where standby systems are legally required,for serious life safety MILWAUKEE,WI 53201 USA or health hazards,or where lack of power hampers rescue of fire-fighting operations. BS1155-8118 Copyright @2018.All rights reserved YOMP®WERE®.