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HomeMy WebLinkAbout46300-Z �OgUFFOt,f�OG Town of Southold 8/28/2021 y� P.O. Box 1179 0 C" • �� 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42305 Date: 8/28/2021 THIS CERTIFIES that the building, GENERATOR Location of Property: 555 Sound View Rd., Orient SCTM#: 473889 Sec/Block/Lot: 15.-3-7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/7/2021 pursuant to which Building Permit No. 46300 dated 5/24/2021 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 Lavalle,Areti of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 46300 8/11/2021 PLUMBERS CERTIFICATION DATED A rize Si nature FF111/r TOWN OF SOUTHOLD aye BUILDING DEPARTMENT y TOWN CLERK'S OFFICE oy • 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#: 46300 Date: 5/24/2021 Permission is hereby granted to: Lavalle, Areti 27 Sully Dr Manhasset, NY 11030 To: Install generator at existing single family dwelling as applied for. At premises located at: 555 Sound View Rd., Orient SCTM #473689 Sec/Block/Lot# 15.-3-7 Pursuant to application dated 5/7/2021 and approved by the Building Inspector. To expire on 11/23/2022. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CO-ALTERATION TO DWELLING $50.00 Total: $235.00 '-Wk Building Inspector oF soUry®� Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Q sean.devlin a.town.southold.ny.us Southold,NY 11971-0959 ®l�C®UNi'1,� ' BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Areti Lavalle Address: 555 Soundview Rd city.Orient st: NY zip: 11957 Building Permit#: 46300 section 15 Block. 3 Lot- 7 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Universal Electrical License No: 54018ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service 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 Ceding Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches 4'LED Exit Fixtures Pump Other Equipment: 20kW Briggs & Stratton Generator w/ 100A Overcurrent Protection on Generator, 200A Whole House Transfer Switch Notes: Generator Inspector Signature: f- Date: August 11, 2021 S.Devlin-Cert Electrical Compliance Form ` UE SOUT�plo 6 5�57 'SQl A-UJ cr(s'1r' # # TOWN OF SOUTHOLD BUILDING DEPT. Cou765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND , [ ] 'INSULATIOWCAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE-& CHIMNEY ' j ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: DATE �� INSPECTOR r- qf SOOlyo6 # TOWN OF SOUTFIOLD BUILDING DEPT. 765-1802 INSPECTION , [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULA/eTII, �`-OWCA,�U`LKINNG [ ] FRAMING/STRAPPING [ FINAL p ` " [ ]' FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: b 1^, Aaftlojov- JS (2- A- AV, je4tAVO& . - _ Pry- ti-4✓ _ DATE l INSPECTOR Bunch, Connie From: Rita Lavalle <rlavalle@alphainterabstract.com> Sent: Sunday, August 22, 2021 4:58 PM To: Bunch, Connie Subject: Fwd: 555 Soundview Rd. Orient point. #46300 Generator Connie, Following up or conversation please be advised that O'Neil's workers came back to the house last week and installed the venting for regulator. I have attached photos. If Ok please issue sign off. If you need anything else please let me know. r i ^1 'c '. • ',.fit jX4 r. ' ti �� III ♦� • � 4 � Thank ou i :r '. ►��. . rL_�VI- v � �rY `•• to � \ 'RIOXOL N'k" TP Rita Lavalle, Esq. rlavallena,,alphainterabstract.com Alpha Inter Abstract Inc. 36-16 30th Avenue Astoria,NY 11106 (718)545-0661 FIELD INSkCTION REPORT DATE 22.11 EI- Ts FOUNDATION(1ST) ....-.,........L.-...- ,.�. ..r. .. i FOUNDATION (ZND) ROUGH FRAMING,& PLUMBING y INSL-4ATION PER N.Y. y . r • STATE lENERCY CODE INAL , m TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 https:Hwww.southoldtownny. ov Date Received APPLICATION FOR BUILDING PERMITC E-4 For Office Use Only PERMIT N0. Building Inspector. MAY 7 2021 ;. ;Alication's andafci^ s, ° Pp r must,be fill'ed.ciiivin their°entiret appli tia s ri J^nol e a# epted..°�t�ther `Ch zRpplicant4i°noi,"i owner,an,, .�. - C' h {)t+vinei's�Au-Aorizatloii�fair4(Page2)shalt'be£ccirn eted. - z Date:May 5, 2021 Wa5N�k, }„ PERIX: Name:Areti ,�^,:�.,�°r•'=” ;5'�ay-R,�a-b•.°s�^�_;�;d.,-a:�s.s'��. ?i\ w,�a�y�;.. �_.°°a_ .s. : LaValle SCTM#1000-15-3-7 Project Address:555 Soundview Road Orient Point NY 11957 Phone#:917-414-6719 Email:rlavalle @�-�A_ al hainterabstract.com Mailing Address:555_Soundview Road Orient Point NY 11957 .t,rs;° .E^q as�;�`;�n..;...t.� >��c.�a$5" *coNracr'aE�sotu: E, .,.; , :^ :, > > . ==a F ,{. Name:Sean O'Neill Mailing Address:PO Box 64 Jamesport NY 11947 Phone#:631-722-3595 _ Email:oneilloutdoor ower hotmail.com p @ __, , DE4d'N'PRUFE Name: Mailing Address: Phone#: Email: CONTRi4C . O g; •' Name: Mailing Address: Phone#: Email: pES` tttPl It3fVb47 `IROPOSI~D �{1i5i FtUCI`iC1N�.° r ;;_ . ,° x aa. r'L. '4,,.,_ , .^��„f�'ay.�:,.-".a� ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: D CIthergenerator $12000.00 o Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes ®N 1 Existing use of property: Intended use of property: ' Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? E]Yes ®No IF YES, PROVIDE A COPY. N WM_ d1iAjR4heo"" k e", e "' `,». .., csp U!'Ch-§0`8 (Affdfftia fl,'4'Ptractor/disi prism tainage�ind'storMWatet�ISV!MpS'pMVId 'by�,­­­ 'ttillding Permit purstiaritto,,thisui,44029ne, 'thairtir,236 0f'tfiiT6Wrf Codiik�-A0k10T46i 64iWiM E to tfprthwissuaritemf a, 4, S6# 60 ;Qrtfinance°af tfie Tp nnOtSdLithbld, _�'Aj oqs, 4"1 ty ,e or an other I e� ecorittl "b �'is 7- ',ai dItIQhsi-,ajteratI6ns,1oF k. jorrernovaLOP olltio,4�iWei'6piri, escri a ea 116at agrees,to�comp y hoUilhi;code and,ftil�"sandlp�,d thortze ,m n_remises in bulidini(s)Wilecissary inspections.ralsirstatements maae� 6"'&h­---r7�­h11\1 io - - '�711, pmeanorp �s rit io ,I", -, '"'kitate Penal'01W. Fs art it e� 'e d Th Nx premise h N W� Application Submitted By(print name):Sean O'Neill ®Authorized Agent El Owner Signature of Applicant: Date: May 5, 2021 STATE OF NEW YORK) SS: COUNTY OF Suffolk Sean O'Neill being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Agent (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/her knowledge and belief; and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this day of M . 20_Z1 Jacw 0 Notary Public TRACE L. DMER NOTARY PUBLIC,STATE OF NEW YORK NO.0IDW6308900 PROPERTY OWNER AUTHORIZATION QUALIFIED IN SUFFOLK COLIN (Where the applicant is not the owner) COMMISSION EXPIRES JUNE 30,&a Areti LaValle —residing at 555 Soundview Road Orient Point do hereby authorize Sean O'Neill to apply on my behalf to e of So Id Building Department for approval as described herein. May 5, 2021 Owner's Signature Date Areti LaValle Print Owner's Name 2 __j , ff BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 %� Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 raaerr @southoldtownny.gov a seand(�southoldtownny.gov APDL GATI:ON FOR ELECTRICAL INSPECTION, ELECTRICIAN INFO MATION (All Information Required) Date: 2 Company Name: o►�(. ���e •C� l lV-i • ,e . GGC. . Name: - License No.:/77E- 5�I email: _ e b _ c,) 3 � ma.�! - 4frx. Address:... X _. u, . J . _ 76a Phone No.: JOB SITE INFORMATION (All Information Required) Name: eX.1, za" L Address- 60, Cross Street: Phone No.: - Bldg.Permit M ® email: r-1hV /, - a./ /'1 • Tax Map-District:_ 1000 -- - - . _ Section. ! S __-- -- Block: 3 . -- _ ... Lot:_ .. BRIEF DES,041PTION OF WORT CFI ase Print Clearly) -- i Circle All That Apply: Is job ready for inspection?: YES / NO Rough In- Final Do you need a Temp Certificate?: YES / NO Issued On, Temp Information- (All information required) Service Size 1 Ph 3 Ph Size:r A #Meters _ Old Meter# New Service» Fire Reconnect- Flood Reconnect-Service Reconnected- Underground -Overhead #Underground Laterals 1 2 H Frame _P9l0 _ Work done on Service? Y N Additional Information:- "PAYMENT-WE WITH-APPLICATION Request for Inspection Form,xis PERMIT# Address: Switches Outlets GFI's Surface J Sconces H H's UC Lts Fans Fridge HW Exhaust Oven Dryer Smokes DW Service J Carbon Micro Generator Combo Cooktop Transfer AC AH Mini Special: n�Comments• `' kV cc�' U � ' SURVEY OF: PROPERTY LOCATED AT ORIENT LOT No. 49 AS SHOWN ON MAP OF ORIENT BY THE SEA, SECTION 2 FILED: OCTOBER 26. 1961: FILE No. 3444 TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C.T.M. x 1000-15-3-7 AREA = 26.355 SF. SCALE: 1"=40' NOTE: THE EXISTENCE OF RIGHT OF WAYS. WETLANDS AND/OR EASEMENTS OF RECORD IF ANY. NOT SHOWN ARE NOT GUARANTEED. NOTE:WELL AND SEPTIC SYSTEM LOCATION BY OTHERS.B.O.H.REF.Ne. ISL T1 SEPTIC LOCATION 'B' C' -0, O N c A NL S.T. 33.6' 64' L S O U N D L.P.1 51' 61' WELL 56' 57' 79*c)2'331 E 100.00 IY5'� NN�L6 I �OOD "' �•F• •TOPOF DECK .y1�•}}+ BLUFF F ++ 7.F +}+} ta'NON +++ TURF BUFFER :+ t COASTAL EROSION HAZARD AREA '•• Z N N O1 OD 0 LP N O O o G N N LOT 50 .p vt LOT 48 DD vt BRICK = O PATIO LVO OH 1'Yl 1 HOOD pECIC DECK m �. 46.6 'A' 31.5' 20.0' 2 V m FRAAMK E =nom I } RESIDENCE � a m 7.1 M r Ia.B ma 266 n5 •p• p > i( ° Ir m / Nn L rn f W POLE zl H 5 7' O p0. g47.6� EODE DF pAVEMENT SURVEYED BY: FAM; D VIEW R AD PAUL BARYLSKI N LAND SURVEYING S O U PATCHOGUE NY 11772 PHONE 631-294-6985FAX 631-627-3186 PAULBARYLSKIcYAH00.COM NOVEMBER 5. 2016 4-25-2017:PROPOSED NEW RESIDENCE N IV 7-5-2017: ADD NON TURF BUFFER C<1 BAR 7-17-2017: REVISED SURVEY 10-27-2017: STAKE OUT HOUSE I1-21-2017: FOUNDATION LOCATION 6-21-2016• FINAL SURVEY 10 OF secnO W Tm�p Orr 7M M YOR OM STATZ MrATHE TMuN�.A vmuTraN S+ Os07W, J� CMIES OF TNM SRYEY NAP NOT SEARUNS THE LAND anYL7aR8 M M ��LAND 5J� CA EMMEO DEAL Suu.NOT 6E mrsmDED TD BE A MID ME ROPY GU&ROME6 OR COW ATIOO DOICATEO NERECH SHALL R H ONLY TO THE FUW rUR NMR M SWYEY 18 PREPARED AND ON ESS BEHALF TO THE Tr L CONPANT.GOVEA 01rAL A2UCr AND LEIONO OaT TLMON USTEO HEREON ANO 70 THE ASSMNEES OF IHE LENDAC MTITUUON aNRANIEES 011 CDOWCATICM ARE NOT TRMSFMAaE TObMrnInM OR 077 m"R& AOOIfm1UL 2389-FINAL i Suffgtk,County Dept.of Labor,-Licensing&Consumer Affairs ' W s '°` MATER ELECTRICAI_'LICENSE Flame ANTHONY J$EMONELLA Business Name fhiS eerhfies that the 'UNIVERSAL ELECTRICAL'SERVICES LLC bearer is duly ljcensed by the County of Suffolk License Number:ME-54018 Rosalie Drago, Issued: 0$12812014 Coifv iss-toner Expires:, 08101/2022 iy N Y S ' F New York State Insurance Fund 8 CORPORATE CENTER DR,2ND FLR,MELVILLE,NEW YORK 11747-3166 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE D D ^^^^"^ 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. 2449 563-2, 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 Yo workers'STATE Comnsation CERTIFICATE OF INSURANCE COVERAGE pe 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 la.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured UNIVERSAL ELECTRICAL SERVICES LLC 516-850-7776 151 IST AVENUE MASSAPEQUA PARK,NY 11762 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations in New York State,i.e,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"l 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. 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 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 described above. Date Signed 6/17/2020 By 444a�t (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 413,4C 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 carriers are authonzed to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) III III 111 1111111 CONTRACTORS SPECIAL POLICY DECLARATIONS PAGE Renewal Declaration UTICA FIRST INSURANCE COMPANY CONSTITUTED IN OHIO AS UTICA FIRST INSURANCE COMPANY(MUTUAL) Direct Billed- Insured Home Office-5981 Airport Road,Oriskany NY 13424 Mail Address-P.O.Box 851,Utica,NY 13503-0851 Policy Number ART 5057878 06 Renewal of Number: NAMED INSURED AND MAILING ADDRESS NCoun r State',Zip Code try ri P ) Agent 3128000 UNIVERSAL ELECTRICAL NATHAN BUTWIN CO INC SERVICES LLC 60 CUTTER MILL RD STE 414 151 FIRST AVE GREAT NECK, NY 11021 MASSAPEQUA PARK NY 11762 POLICY PERIOD:12:01 A.M.Standard Time at the Location of Designated Premises. 08/20/20 08/20/21 From To Item Prot. Rate Const Description and Location Number Class Group of Property Covered 1 PP 04 F Description: ELECTRIC WORK-NO BUR Location: 151 FIRST AVE MASSAPEQUA PARK, NY 11762 County: NASSAU AGREEMENT In return for your payment of the required premium, we provide the insurance described in this policy. LIABILITY INSURANCE COVERAGE LIMITS ANNUAL PREMIUM Each Occurrence Limit $ 1,000,000 /per occurrence Medical Payment Limit $ 1,000 /per person General Aggregate Limit (other than Products/Completed Work) $ 2, 000,000 Aggregate Limit (Products/Completed Work) $ 2,000,000 Fire Legal Liability $ 50,000 /per occurrence Personal and Advertising Injury $ 1,000,000 /per occurrence Property Damage Deductible $ 1000 Included PROPERTY INSURANCE COVERAGE DEDUCTIBLE LIMIT AUTOMATIC REPLACEMENT ACV PROTECTIVE ANNUAL INCREASE% COST DEVICES PREMIUM Building Business Personal Property Loss of Income Business Personal Property- Off Premises FORMS AND ENDORSEMENTS SEE FORMS INVENTORY PAGE ANNUAL FORM NUMBER DESCRIPTION PREMIUM BAI-1 Blanket Additional Insured (Contractors) Included $150 Minimum Retained Premium ANNUAL Name and Address SUB TOTAL $3,224.00 of Mortgagee: NYS Fire Fee $ 0.00 POLICY TOTAL $3,224.00 Our Authorized Representative Countersignature Date 06/17/20 APDEC(01 18) INSURED COPY ,y DATE(MM/DD/YYYY) ,4coizo® CERTIFICATE OF LIABILITY INSURANCE 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(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 NAME:CONTACT Carol Losquadro Roy H Reeve Agency,Inc. PHONE (631)298 4700 FAX (631)298-3850 (AIC' IC No Ext AIC,No PO Box 54 E-MAIL closquadro@royreeve.com ADDRESS: 13400 Main Road INSURER(S)AFFORDING COVERAGE NAIC# Mattituck NY 11952 INSURERA. Maxum Ind Co 26743 INSURED INSURER B 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 MAYBE 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 ALJUL 51JUR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD-WVD POLICY NUMBER MM/DD MM/DDrrM) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea 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 M'OTHER LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $ 2.000,000 POLICY ❑PRG F—] 1,000,000JECT LOC PRODUCTS-COMP/OPAGG $$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO 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__HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED) ❑ NIA (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Y S ' New York State Insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 463076153 EASTERN LI GAS SERVICES LLC ML;PO BOX 1134 MATTITUCK NY 11952 r 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 2344 620-6, 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 3 APPROVED AS N®T v OCCUPANCY OR DATE: s'� -�- B.P.#, 3� USE IS UNLAWFUL FEE. BY: NOTIFY BUILDING DEP4PTo IT WITHOUT CERTIFICATE 765-1802 BAhA TO , :,M F(-+h -mac OF OCCUPANCY FOLLOWING INSPECTIONS 1. FOIJNDATION - TWO ?CGU r-v FOR POURED CONCRE--E 2. ROUGH - FRAK4ING 3 PLlljl: G 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR 110, COMPLY WITH ALL CODES Or ALL CONSTRUCTION SHALL MEET THE NEW YORK STATE & TOWN CODES REQUIREMENTS OF THE CODES OF NEW AS REQUIRED AND CONDITIONS OF YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. SOUTHOLD TOWN ZBA SOUTHOLD TOWN PLANNING BOARD SOUTHOLD TOWN TRUSTEES N.Y.S.DEC �E��N REQUIRED C"cos ` STANDBY 20kW STANDBY GENERATOR GENERATORS BRIGGS & STRATTON® THE SMART CHOICE For the discerning homeowner that is looking for the smartest, most reliable permanent backup power solution. ETC " y Tom' ° _ = ; ri �'1�.'�� 'v.,a ,'"a°�: f `k-'` M� ° :- r� '�'`toduc� o tl yr e c�ve"s e a t6leai "' . � r' Mill oil !'it Oq t t w 5n6usd9 prf,lanrIlcne we3; b. y. °R •�Ge #=vuei ce�asi9 , ° l' PARTS-LABOR-TRAVEL LIMBED WARR/INTY Unique Airflow Technology Commercial-Grade Briggs&Stratton Vanguard'Engine •Making these models 500/o quieter than most portable generators •Powerful VTwin OW engine •The unique design pushes engine exhaust out the front,directly away •Easy conversion between natural gas(NG)and liquid propane from your home vapor(LP)during installation Flexible Placement Quality Clean Power •Approved for installation as close as 18"to a building2 •Ensures your electronics are safely powered Symphol 11 Power Management System Corrosion Resistant Enclosure&Base r •Customizable to your home's needs • Made with automotive grade galvanneal steel to resist rust •Automatically balances the power of your homes electrical load including • Powder-coated paint for years of protection against chips high wattage items like air conditioning units and electric ovens and abrasions •Offers whole house power with a more affordable home generator C UL US LISTED LIQUID PROPANE I NATURAL GAS L LIMITED WARRANTY' MODEL It, Gil PHASE 'BREAKER ISP JKW -N:^`"SLP AMPS NO kW NO AMPS Fortress ,,YxY ; e 040547 2Q4C1 1 60 100 I� �, 83 18 75 t02,01e8t s w�,z Briggs&Stratton `A� VW lam", # ., ,°. `s ; ., ' 040336 `0 4Q 1 6C7w 100x2} � 83s 18 75 , I This generator Is rated in accordance vnth UL(Underwriters Laboratories)2200(stationary engine generator assemblies) and CSA(Canadian Standards Association)standard C22 2 No 100-04(motors and generators) 2 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 1 3 Warranty details available at www briggsandstratton com t $eae STANDBY GENERATORS 20kW STANDBY GENERATOR ,21 Engine Model Briggs&Stratton Vanguard'" Oil Capacity(oz) 79 Engine Model Type THm Number 613275-0003-E1 Lubrication System Full Pressure Engine Speed(RPM) 3600 Recommended Oil 5W30 Full Synthetic Engine Fuel Liquid Propane(LP)or Low Oil Pressure Sensor Yes Natural Gas(NG) Engine Cylinder Configuration `. 9 CII 9 OHV ,,���`�����%�:azi °%t'.� �'�:�.�A,�� Manufacturer Briggs&Stratton Number of Cylinders 2 Type Self-Excited,Rotation Feld Displacement(cc) 60.6/993 Voltage Regulator Automatic Bore&Stroke[in) 3.37/3.41 Compression Ratio 8.5.1 Insulation Class F Governor Type Electronic Hour Meter Yes Frequency Regulation +/-1 Hz LED Digital Display Yes Valves OHV with Hardened Seats Fault Code Display Yes Ignition System Fixed timing Magnetron® Electric Ignition Weekly Exerciser Yes Starter Motor Rating Voltage 12 Volt Battery 12 Volt I ME �'�:° %��M-K.„x'a'.':�z:,�2_=;`-�� � ex'f�> .,�.,^.�'�' `��$ �,_ '�r;``.sS�3=<�a'�`s�^;. -sM ^f �,.; ��",1 "�.e�` ". r•-"�e«`�e^:'Er y-'�",�"�'•:s: ,kaZ-�`'•"µk" '""�.�� `_°;-'2�� ;- .. 50%Load 100%Load 64 dBA Liquid Propane 83 ft"/hr 2.31 gal/hr 135 W/hr 3.75 gal/hr Lowest measurement of 12 microphones around generator Sound level measurement at other locations around generator Natural Gas 187 ft"/hr — 260 W/hr — may be different depending upon installation configuration Fuel consumption rates are estimated based on normal operating conditions Generator operation may be greatly affected by elevation and the cycling operation of multiple electrical appliances–fuel flow rates may vary depending on these factors 2 + STANDBY GENERATORS 20kW STANDBY GENERATOR � ;i'�\ '.� ¥ fir'r«„^e.;•,.. �� �, �' ,,� � =4 "=��,„�sy+ k"� .� ., i�"i�-,� : �.,.� �� ��` y. �M�s -. �T.,UAES � F`� -�-�. �� '�, ��� � CE�lT1,(C►A,,'�ION�>, - ,�.�F�^ �� �'�,� Enclosure Material Galvanneal Steel with Corrosion CARS Compliant Yes Resistant Paint Overcrank Protection Yes NFPA Approved Yes Engine Warm U ( 20 or 50 Automatic Transfer g Up Switch Controlled cUL Listed to CSA 22.2 NO 100-04 Yes 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 Monitoring Options Monitor InfoHubU'Monitor Continuous Maintenance Kit 6035 Battery Charging Yes Fortress 6404 �" �°'��=k�.:: ���.�'� tfl#7" 2, Cold Weather Kit & ;4 � .,, .� -„,- ,R' Briggs&Stratton 6231 Assembled Weight Jibs) 500 Basic Wireless Monitor 6229 Overall Dimensions(in) 50.5 x 32.9 x 31 InfoHub 6260 Packaged Weight(lbs) 613 Remote Status Monitor 6144 Packaged Dimensions(in) 68.1 x 41 x 39.5 47" 31•' D 31" FORTRESS' 50.5" 32.9" 3 . . STANDBY GENERATORS 2OkW STANDBY GENERATOR NNW 1/2"pipe capacity 9/4"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'Length' 81 170 320 657 985 1,900 60'Length' 65 137 257 528 791 1,520 80'Length' 56 117 220 452 677 1,300 100'Length' 50 104 195 400 600 1,160 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' 200 418 788 1,617 2,423 4,666 40'Length' 137 287 541 1,111 1,665 3,207 60'Length' 110 231 435 892 1,337 2,575 80'Length' 101 212 400 821 1,230 2,370 100'Length' 101 212 400 821 1,230 2,370 *Total length of piping from outlet of regulator to appliance furthest away im Prewired 16 Circuit 100 AMP Model#071076 Standard 16 Circuit 100 AMP Model#071047 Symphony"'11 100 AMP Model#071071 Symphony®11 150 AMP Model#071070 e • • • ■ o- • Symphony®11 200 AMP Model#071066 Symphony®11 Dual 200 Amp 2x200/400 Model#071057 ' ® 6 , , ■ Voltage Rating 120/240 a Number of Protected Circuits Select Circuit 16 Symphony®II•Whole House , UL Approved Yes NEMA 3R Rated Yes Disclaimer:Not for Prime Power or use where standby systems are legally required,for serious life safety or health hazards,or where lack of power hampers rescue of fire-fighting operations BRIGGS&BTRATTON POST OFFICE BOX 702 MILWAUKEE,WI 53201 USA Copyright 02016.All rights reserved BS1007-D—11/16 Briggs 5 Stratton Corp reserves the right to make changes in specifications and features shown herein,or discontinue the product described at any time without notice or obligation 4