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HomeMy WebLinkAbout46465-Z `Og1)Ff0[� .. Town of Southold 11/8/2021 P.O.Box 1179 o • 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42504 Date: 11/8/2021 THIS CERTIFIES that the building GENERATOR Location of Property: 880 Wunneweta Rd, Cutchogue SCTM#: 473889 Sec/Block/Lot: 111.-4-5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/14/2021 pursuant to which Building Permit No. 46465 dated 6/23/2021 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 Callas,William of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 46465 8/20/2021 PLUMBERS CERTIFICATION DATED C\ 0 th ri 0 Signature �SUEF`" zy TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE oy • SOUTHOLD, NY poi � .�a° s• 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#: 46465 Date: 6/23/2021 Permission is hereby granted to: Callas, William 880 Wunneweta Rd Cutchogue, NY 11935 To: install generator as applied for. At premises located at: 880 Wunneweta Rd SCTM # 473889 Sec/Block/Lot# 111.-4-5 Pursuant to application dated 6/14/2021 and approved by the Building Inspector. To expire on 12/23/2022. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CO-RESIDENTIAL $50.00 Total: $235.00 ing Inspector oF sov��� Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 ® sean.deviin(a)-town.southold.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: William Callas Address: 880 Wunneweta Rd city.Cutchogue st: NY zip: 11935 Building Permit#: 46465 section: 1 1 1 Block 4 Lot: 5 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Commander Power License No: SITE DETAILS Office Use Only Residential X Indoor X Basement X Service X Commerical Outdoor X 1 st Floor Pool New X Renovation 2nd Floor Hot Tub Addition Survey Attic Generator 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 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 Fixtures Time Clocks Disconnect Switches 4'LED Exit Fixtures 11 Pump Other Equipment, 20kW Kohler Generator w/200A Whole House Transfer Switch , Emergency Stop - Button Notes: Generator Inspector Signature: Date: August 20, 2021 S.Devlin-Cert Electrical Compliance Form a0FS0(/Ty afii' 1 lY �� - LI W V Aetov 06 y # # TOWN OF SOUTHOLD BUILDING DEPT. `ycou►m ' 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] 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: 9/l DATE INSPECTOR C, ���pf SOUTyO h� �O # # TOWN,OF SOUTHOLD BUILDING DEPT. 765-1802 : 1NrSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I ULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL G [ ] FIREPLACE & CHIMNEY [" ] FIRE SAFETY-INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: DATE �J U2 INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS X1.0 FOUNDATION(IST) -• CS H ------------------------------------ Q FOUNDATION(2ND) z pp o c ROUGH FRAMING& j PLUMBING r INSULATION PER N.Y. STATE ENERGY CODE d 1 FINAL - ADDITIONAL COMMENTS .ate a 1 )F-Le 0 z A Nb ' N W H N z x � x d b H �Q�S FFFF t �d� TOWN OF SOUTHOLD—BUILDING DEPARTMENT y Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.�,yov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector: JUN 1 4 2021 - Applications and forms'lnust,be filled out in:#heit`entirgty:Incomplete "applications will not be accepted.- Where the Applicant is not the owner,an Owners Authoi•iiaiion form(Page 2)`shell be coMpleted.` Date: OWNE_ S)OF ROPERTY: Name:�`� ./ SCTM#1000- Physical Address: 02 14 Q 4 f d Phone#: J'l 6 Email: Z 3-o 1 i,� Mailing Address:" (� f t J CONTACT.--PERSON:' / Name: 141 (1A 74% Mailing Address: - 9 6 ( I 11 A "Osm, , 2-C 116!qa/- Phone#: 69- Email- 6 $ 4 ITT- DESIGN PROFESSIONAL'INFORMATION: .,, _ - Name: 4 04 Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: =- Name:Commander Power Systems Mailing Address: 285 Pulaski Street Riverhead, NY 11901 Phone#: 631-765-6400 Email: ctyndall@commanderpowersystems.com DESCRIPTION'OF PROPOSED CONSTRUCTION' []New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: 20ther Install new Kohler 20 KW emergency standby generator(nat gas) $10,900.00 o Will the lot be re-graded? ❑Yes ONO, Will excess fill be removed from premises? ❑Yes 2N 1 PROPERTY INFORMATION Existing use of property: � .� / Intended use of property: _ Sl �,4�Av / Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes FAb IF YES, PROVIDE A COPY. <I eck Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water Issues as provided by Chapter 236 of the Town Code. 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 0 Regulations,for the construction of buildings, additions,alterations or for iemoval or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing cod_a and regulations and to admit authorized inspectors'on-premises and in buildings)for necessary Inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law. " Application Submitted By(print name): ❑Authorized Agent 06wner Signature of Applicant: Date: 67 a STATE OF NEW YORK) S r. COUNTY OF d l� being duly sworn,deposes and says that(s)he is the applicant ( a-me of individual s' ning contract)above named,, (S)he is the (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 Ung- .20z�L Notary Public DARLENE K BRUSH Notary Public-State of New York PROPERTY OWNER AUTHOR17ATIIONV No.o,BR63,8o5, Qualified in Suffolk County (Where the applicant is not the owner) My Commission Expires Jan 20,2023 6 W W I residing at aox� do hereby authorize to apply on a t ;?ecan S old Building Department for approval asdescr'b7 d herei i/ ,, Owner's Sign ur ate Print Owner's Name 2 LOT, AREA 28,503 SQ. FT. 15—f7 15-21 :18-302 ' LOT NUMBER ,199 -! � � • MON ' gOAD ,MON 40.3water Ai meter 00 MON I I M O� 1 A Idrywell of CC O 1O6? I Ip [V� s n d .�& 42.5'1 00 5t' .� wan o, 3I s C,4 �, : .I 31T41� J O a 9 32.2' ^ 26'. cc'vems. po'h D 3 B.a'"S 34.0' '? 16.0 15.2' P�TrCcNCf% C✓Cti+�- N, 24.8' • GAR I 1 STY FR o FD UNDER1 DiNELL - c`ai NON �Ot'GI� CfnL'l �GLstG1�c'T'�-�, N E 15.0' 14.0' N 16.0' wall- ,;.encl. screen porch N GI�0-Qh�� O.o S 43.3' o drywell M O w GARAGE o 18'x24' O buried propane Z pole 10.5' tank FZ rn drywell O MON LLJ -`t M " L0 ,LO Lo Ir Z. MON" FD 100.,p0 1"-31-20'19 REVISE PROPOSE GARAGE' 32},19�20„W 3p7 12-12-2018-SHOW PROPOSE GARAGE LOT NUMBER , f , 10-7-20,15 'FINAL SURVEY - NOTE: ,CESSPOOL, SEPTIC,TANK"& :WATER • , 'SERVICE LOCATIONS 8Y'OTHERS. 2-11-;2015 FOUNDATION LOCATION THE OFFSETS (OR DIMENSIONS) SHOWN"HEREON .FROM THE STRUCTURES TO THE ' PROPERTY,LINES ARE,FO1k A'SPEa1TcrPURPOSE AND USE AND THEREFORE ARS NOT ' JOB No. "14-60 FILE No. NASSAU POINT ;,INTENDED-TO'GUIDE THE.ERECTION,0F FENCES. RETAKING WALLS, POOLS. PATIOS. ,PLANTING'AREAS, ADDITION TO BUILDINGS OR,ANY OTHER COh3TRUCI10N. SURVEYED FOR -LORRAINE & WILLIAM B. GALLAS uNAUTHoRrzm ALTgwA qN;oR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION LOT NUMBER 300 7209 OF THE NEW YORK STATE EDUCATION LAW. AMENDED MAP;A' OF NASSAU POINT , GUARANTEES_INDICATED HEREON,SHALL RUN ONLY TO THE PERSON FOR WHOM THE S6RV6 ts'PREPARED;'AND'ON HIS BEHALF TO'THE'TmE COMPANY, GOVERNMENTAL SITUATED AT NASSAU POINT ,'AGENCY AND,LENDING INSTITUTION LISTED HEREON.,AND TO THE ASSIGNEES OF THE, LFNDINO)N5TTTUTION.�GUARANTEFS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS TOWN OF SOUTHOLD, SUFFOLK ,COUNTY,N.Y. OR.SUBSEQUENT OWNERS. COPIES OF THIS SURVEY MAP NOT BEARING.THE LAND SURVEYORS INKED SEAL'OR SCALE 1" = 40' DATE 4-14—.2014 EMBOSSER SEAL SHALL''Not BE CONSIDERED TO BE A VALID TRUE COPY. FILED MAP No. 156 'DATE '8-16-1922 -CERTIFIED, ONLY TO: TAX MAP No. (REF ONLY) 1000-111-4-5 DISK 2014, HAROLD F. TRANCHON JR. P.C. LAND SURVEYOR P.O. BOX 616 '1866 WADING RIVER—MANOR RD. WADING RIVER, Oil NEW 'YORK, 11792 N.Y. LIC.-'40.� 048992 631-929-4695 HARQLD F. TRANCHON"JR. PENN. LIC. No. 2115-E YORK Workers' CERTIFICATE OF INSURANCE COVERAGE STATE 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 or that Carrier 1a. Legal Name and Address of Insured(Use street address only) 1b. Business Telephone Number of Insured Standard Electric Corp (516) 819-8684 Calogero Brutto 6500 Jericho Tpke 1c. Federal Employer Identification Number or Social Security Syosset, NY 11791 Number 20-8322723 Work Location of Insured(Only required if specifically limited to certain locations in New York State,i e.a Wrap-up Policy) 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as Certificate Holder) Standard Security Life 3b. Policy Number of entity listed in box"1a": 62310-00 Town of Southold 54375 Main Road 3c. Policy effective period:3/26/2010 to 3126/2021 PO Box 1179 Southold, NY 1197.1 4. Policy provides the following benefits: X A. All for the employer's employees eligible under the New York Disability Law _B. Only the following class or classes of employer's employees: _C. Paid family leave benefits only 5. Policy covers: X 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 Benefits insurance coverage as described above. Date Signed November 23. 2020 By: David N4 Bore (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone No. 631 673 7600 Name and Title: President IMPORTANT: If box 4a is checked, and this form is'signed by the insurance carriers authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If box"4b"is checked,this certificate is NOT COMPLETE for the purposes of Section 220, Sub 8 of the Disability Benefits Law. It must be mailed for completion to the Workers'Compensation Board, DB Plans Acceptance Unit,328 State Street, Schenectady, New York 12305 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-insured employer has complied with the NYS Disability Benefits Law with respect to all or his/her employees. Date Signed By (Signature of NYS Workers'Compensation Board Employee) Telephone No. Title: Please Note: Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS license insurance agents of those Insurance carriers are authorized to issue Form DB-120.1. Insurance Brokers are not authorized to issue this form. DB-120.1 (10-17) Additional instructions for Form DB-120.1 By signing this form, the insurance carrier identified in box"3"on this form is certifying that it is insuring the business referenced in box"la"for disability and/or paid family leave benefits under the New York State Disability and Paid Family Leave Benefits Law.The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in box"T. The insurance carrier must notify the above certificate holder and the Workers Compensation Board within 10 days IF a policy is cancelled 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 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 3c,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 Disability and/or Paid Family Leave Benefits contract of insurance only while the underlying policy is in effect. Please Note:Upon the cancellation of the disability andfor paid family leave benefits 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 NYS Disability and/or Paid Family Leave Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability and Paid Family Leave Benefits Law. DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW 220. Subd. 8 (a)The head of a state or municipal department, board,commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first,two thousand and twenty-one,the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board,commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board,commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract,,shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory.to the chair,that the payment of disability benefits,and after January first,two thousand eighteen,the payment of family leave benefits has been secured as provided be this article. NEW Workers' CERTIFICATE OF YORK STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured (516)819-8684 Standard Electric Corp Calogero Brutto 1c.NYS Unemployment Insurance Employer Registration Number of 500 Jericho Tpke Insured Syosset,NY 11791 1 d Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to 20-8322723 certain locations in New York State,i e,a Wrap-Up Policy) 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) P&C Insurance Co of Hartford Town of Southold 3b.Policy Number of Entity Listed in Box"l a" 54375 Main Road 12WECAC1771 PO Box 1179 3c Policy effective period Southold,NY 11971 12/23/2020 to 12/23/2021 The Proprietor. Partners or Executive Officers are included (Only check box d all partners/officers included)all CI 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"3c",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, I 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: Borg & Borg Inc., David M Borg President (Print name of authorized representative or licensed agent of insurance carrier) Approved by: (Signature) (Date) Title. Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier. 631-673-7600 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 Workers' Compensation Law Section 57.Restrlctlon on Issue of permits and the entering Into contracts unless compensation Is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board,commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. C 105.2(4.17)REVERSE A`�EP CERTIFICATE OF LIABILITY INSURANCE F � `�"'°02"a 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 pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 Borg&Borg Inc. PHONE Full-631-673.7600 iv No:631-351-1700 148 East Main Street Huntington NY 11743 SSS: cefficates0boraborg.com INSURE s AFFORDING COVERAGE HAIC a INSURER A:Merchants Mutual Insurance 23329 INSURED STANELE.ot INsumna:P&C Insurance Co of Hartford 34690 Standard Electric Corp Calogero G Brutto uisullERc:Standard Security Life 6500 Jericho Tpke. INSURERD Syosset NY 11791 INSURER E: INSURER if: COVERAGES CERTIFICATE NUMBER:40014386 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLTYPEOFINSURANCE SU POLICYNUMBER POLICY -i POIDO LIMrS A X COMMERCIALGENERALLIABILRY BOP1063594 2112020 2/111021 FACHOCCURRENCE $1.000,000 DAMAGE TO REMTEff— CLAIMS-MADE ®OCCUR PREMISES En000urrenoe $500.000 MED EXP(Any one person) $15.000 PERSONAL&ADV INJURY SInduded GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S2.000.000 POLICY I JECT F�LOC PRODUCTS-COMPIOPAGG $2.000.000 OTHER: S A AUTCMOBMEL1ABILrY CAP1076068 2112020 2112021 COMBINEDSINI LMIT 51,000,000 Ea ac ddo X ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per wddent) S AUTOS ONLY AUTOS X HIRED X NON-OWNEO PROPERTYD E S IAUTOS ONLY AUTOSONLY Per dent S IUASM LA t i OCCUR EACH OCCURRENCE S EXCESS LIAR HCLAIMS-MADE AGGREGATE S DED RETENTIONS $ a WORKERSCOMPENSAnoN 12WECAC1771 12232019 121232020 X B AND EMPLOYERS'LIABILITY YIN 12WECAC1771 121232020 12123/2021 STATUT EOR ANYPROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT 31.000.0co OFFICERIMEMBER EXCLUDED? MudatmyrnNH) E.L.DISEASE-EAEMPLOYEE $1.000.000 Kyes QesorLeurtdar DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POUCY OMIT S1.000.000 C NYS ISsabmv 62310-00 3262010 3126/2021 NYS DBL Stahory DESCRIPTION Or OPERATIONS I LOCATIONS IVENICLES(ACORD101,Add[danWRomathoSchoWo,mayboanschaditmorosOwkfaqu(md) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Road PO Box 1179 AUTHQRD'EDREPRESENTATIVE Southold NY 11971 lJ h !'l ©1986 2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD W 000"H L E R. Models: 20RCA(L) Multi-Fuel LPG/Natural Gas 09001 Standard Features 4 KOHLER, • RDC2 Controller NATIONALLY REGISTERED o One digital controller manages both the generator set and 44 transfer switch functions (with optional Model RXT). o Electronic speed control responds quickly to varying ® demand. o OnCue®Plus Generator Management System for remote ilkQ monitoring is included with the generator. j�Q' • Kohler Command PRO Engine Features Qo Kohler Command PRO®OHV engine with hydraulic valve �Q lifters for reliable performance without routine valve adjustment or lengthy break-in requirements. • Designed for Easy Installation o Sturdy aluminum base can be mounted on gravel or a concrete mounting pad. o Fuel and electrical connections through the enclosure wall The Kohler® Advantage eliminate the need for stub-ups through the base. o Customer connection terminal block located near the • High Quality Power controller allows easy access for field wiring. Kohler home generators provide advanced voltage and o Designed for outdoor installation only. frequency regulation along with ultra-low levels of • Certifications harmonic distortion for excellent generator power quality to o Meets emission regulations for U.S.Environmental protect your valuable electronics. Protection Agency(EPA)with both natural gas and LPG. • Extraordinary Reliability o UL 2200/cUL listed(60 Hz model). Kohler is known for extraordinary reliability and o CSA certification available(60 Hz model). performance and backs that up with a premium 5-year or o Accepted by the Massachusetts Board of Registration of 2000 hour limited warranty. Plumbers and Gas Fitters. • Powerful Performance o Meets 181 mph wind rating. Exclusive Pow§boost's technology provides excellent starting power. • Approved for stationary standby applications in locations served by a reliable utility source. • Aluminum Enclosure • 20RCAL models packaged with a Model RXT automatic o Attractive aluminum enclosure allows installation as transfer switch are available. See page 4 and the Model close as 18 inches from your home or small'business. RXT ATS specification sheet. o Enclosure panels can be removed without tools to allow easy access for maintenance and service. • Warranty o 5-year/2000 hour limited warranty for on-grid (standby) applications in locations served by a reliable utility source. Generator Ratings Standby Ratings Line Circuit Natural Gas LPG Breaker Alternator Voltage Phase Hz kW/kVA Amps kW/kVA Amps Amps Poles 2F7 120/240 1 60 18/18 75 20/20 83 100 2 120/208 3 60 17/21 58 17/21 58 70 3 2G7 120/240 3 60 17/21 51 17/21 51 60 3 277/480 3 60 17/21 26 17/21 26 30 3 Note: The line circuit breaker is automatically selected based on the generator set model and voltage configuration. RATINGS Standby ratings applytoinstallations served byareliable ublltysource All single-phase units are rated at 1.0powerfactor The standby rating lsappllcabletovariable loads with anaverage load factor of 80%for the duration of the power outage. No overload capacity is specified at this rating. Ratings are In accordance with ISO-3046/1,BS5514,AS2789,and DIN 6271 GENERAL GUIDELINES FOR DERATING-ALTITUDE,Derate4%per 305m(1000ft)elevabonabove 153m(500ft).TEMPERATURE Derate2%per 550C(10°F)temperature increase above 160C(60°F). Availability issublecttochange without notice The generator set manufacturer reserves the right to change the design or specifications without notice and without any obligabon or liability whatsoever Contact your local Kohler Co.generator distributor for availability. § Check the appliance manufacturer's specifications for actual power requirements Consult a Kohler®Power Systems professional to calculate your exact residential power system requirements # Meets NFPA guidelines for 18 Inch clearance to combustible matenals. Check state and local codes for minimum distance required from a structure 134-272 (20RCA) 9/19c Alternator Specifications Alternator Specifications Alternator Features Specifications Alternator • Compliance with NEMA, IEEE,and ANSI standards for Manufacturer Kohler temperature rise. Type 2-Pole,Rotating Feld . Self-ventilated and dripproof construction. Leads,quantity 2F7 4 • Windings are vacuum-impregnated with epoxy varnish for 2G7 4 dependability and long life. Voltage regulator Digital • Superior voltage waveform and minimum harmonic Insulation: NEMA MG1-1.66 distortion from skewed alternator construction. Material Class H • Digital voltage regulator with±1.0%no-load to full-load Temperature rise 130°C Standby RMS regulation. Bearing:quantity,type 1,Sealed • Rotating-field alternator with static exciter for excellent Coupling Direct load response. Amortisseur windings Full • Total harmonic distortion(THD)from no load to full load with Voltage regulation,no-load to full-load RMS ±1.0% a linear load is less than 5%. One-step load acceptance 100%of Rating Peak motor starting kVA* (35%dip for voltages below) 240 V,1 ph 2F7(4 lead) 41 (60 Hz) 240 or 480 V,3 ph 2G7(12 lead) 69(60 Hz) Application Data Engine Exhaust Engine Specifications Exhaust System Manufacturer Kohler Exhaust temperature exiting the Engine:model,type CH1000 4-Cycle enclosure at rated kW,dry,°C(°F) 260(500) Cylinder arrangement V-2 Lubrication Displacement,cm3(cu.in.) 999(61) Bore and stroke,mm(in.) 90 x 78.5(3.54 x 3.1) Lubricating System Type Full Pressure Compression ratio 8,8;1 Main bearings:quantity,type 2,Heavy-Duty Sleeve Oil capacity(with filter),L(qt.)§ 1.9(2.0) Bearings Oil filter:quantity,type§ 1,Cartridge Rated RPM Oil cooler Integral 60 Hz 3600 § Kohler recommends the use of Kohler Genuine oil and filters. Max.engine power at rated rpm,kW(HP) LPG,60 Hz 23.0(30.9) Fuel Pipe Size Natural gas,60 Hz 20.2(27.1) Minimum Gas Pipe Size Recommendation,in.NPT Cylinder head material Aluminum Valve material Steel/Stellite® Pipe Length, Natural Gas LPG m(ft.) 281,000 Btu/hr. 340,000 Btu/hr Piston type and material Aluminum Alloy 8 (25) 1 3/4 Crankshaft material Heat Treated,Ductile Iron Governor:type Electronic 15 (50) 1 1 Frequency regulation,no load to full load Isochronous 30 (100) 1 1/4 1 Frequency regulation,steady state ±0.5% 46 (150) 1 1/4 1 1/4 Air cleaner We Dry 61 (200) 11/4 11/4 Engine Electrical Engine Electrical System Ignition system( Electronic, Capacitive Discharge Starter motor rated voltage(DC) 12 Battery(purchased separately): Ground Negative Volts(DC) 12 Battery quantity 1 Recommended cold cranking amps: (CCA)rating for-18°C(0°F) 500 Group size 51 G4-272 (20RCA) 9/19c Fuel Requirements RDC2 Controller Features, Continued Fuel System • LED indicators for utility power and generator set source Fuel types Natural Gas or LPG availability and ATS position(Model RXT transfer switch Fuel supply inlet 1/2 NPT required) Fuel supply pressure,kPa(in.H2O): • LCD display: Natural gas 0.9-2.7(3.5-11) o Two lines x 16 characters per line LP 1.7-2.7(7-11) o Backlit display with adjustable contrast for excellent Fuel Composition Limits* Nat.Gas LPG visibility in all lighting conditions Methane,%by volume(minimum) 90 min. - • Scrolling system status display:o Generator set status Ethane,%by volume(maximum) 4.0 max. - o Voltage and frequency Propane,%by volume 1.0 max. 85 min. o Engine temperature Propene,%by volume(maximum) 0.1 max. 5.0 max. o Oil pressure C4 and higher,%by volume 0.3 max. 2.5 max. o Battery voltage Sulfur,ppm mass(maximum) 25 max. o Engine runtime hours Lower heating value, MJ/m3(Btu/tt3),(minimum) 33.2(890) 84.2(2260) • Date and time displays * Contact your local distributor for suitability and rating derates based • Smart engine cooldown senses engine temperature on fuel compositions outside these limits. • Digital isochronous governor maintains steady-state speed at all loads Operation Requirements • Digital voltage regulation: ±1.0%RMS no-load to full-load Fuel Consumption,m3/hr.(cfh)@ 60Hz • Automatic start with programmed cranking cycle %Load Natural Gas LPG • Programmable exerciser can be set to start automatically on 100 8.0 (281) 3.9 (136) any future day and time,and run every,week or every two 75 6.9 (243) 3.1 (109) weeks 50 4.6 (161) 2.3 (82) • Exercise modes: 25 3.6 (127) 1.7 (59) o Unloaded weekly exercise with complete system Exercise 2.0 (71) 10 (35) diagnostics Nominal fuel rating: Natural gas: 37 MJ/m3(1000 Btu/ft.3) o Unloaded full-speed exercise LPG: 93 MJ/m3(2500 Btu/ft.3) o Loaded full-speed exercise(Model RXT ATS required) LPG conversion factors: 8.58 ft.3=1 Ib. • Front-access mini USB connector for SiteTech- or USB 0.535 m3=1 kg Utility connection 36.39 ft.3 =1 gal. • Integral Ethernet connector for Kohler®OnCue®Plus Generator Set Sound Data • Built-in 2.5 amp battery charger • Remote two-wire start/stop capability for optional connection Model 20RCA 8 point logarithmic average sound levels are of a Model RDT transfer switch 64 dB(A) during weekly engine exercise and 69 dB(A) during • Diagnostic messages: Displays diagnostic messages for the full-speed generator diagnostics and normal operation.* engine,generator,Model RXT transfer switch,programmable All sound levels are measured at 7 meters with no load. interface module(PIM), and load management device. • Maintenance reminders * Lowest of 8 points measured around the generator. Sound levels at other points around generator may vary depending on installation • System settings: parameters. o System voltage,frequency,and phase o Voltage adjustment RDC2 Controller o Measurement system,English or metric • ATS status(Model RXT ATS required): o Source availability vaneg, 1 240vED o ATS position(normal/utility or emergency/generator) F� eooHz o Source voltage and frequency 0 0 0 0 0 • ATS control (Model RXT ATS required): o Source voltage and frequency settings ® 6F XM "" o Engine start time delay o Transfer time delays o Voltage calibration The RDC2 controller provides integrated control for the o Fixed pickup and dropout settings generator set,Kohler@ Model RXT transfer switch, • Programmable Interface Module(PIM)status displays: programmable interface module(PIM),and load shed kit. o Input status (active/inactive) o Output status(active/inactive) RDC2 Controller Features • Load control menus: • Membrane keypad: o Load status o OFF,AUTO,and RUN pushbuttons o Test function o Select and arrow buttons for access to system configuration and adjustment menus • LED indicators for OFF,AUTO,and RUN modes G4-272 (20RCA) 9/19c i KOHLER, Phone 9 CO.,Kohler,Wisconsin 9-164 USA Phone 920-457-4441,Fax 920-459-1646 For the nearest sales and service outlet In the US and Canada,phone 1-800-544-2444 KOHLERPower.com Generator Set Standard Features Automatic Transfer Switches and Accessories • Battery cables ❑ Model RDT ATS • EPA certified fuel system ❑ Model RXT ATS • Aluminum sound enclosure ❑ Model RXT ATS with combined interface/load management board • Critical silencer ❑ Load shed kit for RXT or RDT • Field-connection terminal block ❑ Power relay modules (use up to 4 relay modules for • Fuel solenoid valve and secondary regulator each load management device) • Line circuit breaker ❑ Other Kohler®ATS • Multi-fuel system,LPG/natural gas,field-convertible 20RCAL Model Packages • Oil drain extension with shutoff valve ❑ 20RCAL with 100 amp RXT with 16-space load center and • OnCue®Plus Generator Management System NEMA 1 steel enclosure for indoor installation • Premium 5-year limited warranty ❑ 20RCAL with 200 amp service entrance-rated Model RXT • RDC2 generator set/ATS controller with combined interface/load management board and • Rodent-resistant construction corrosion-resistant NEMA 311 aluminum enclosure • Sound-deadening,flame-retardant foam per UL 94, Warranty class HF-1 ❑ 5-Year Comprehensive Limited Warranty Available Options ❑ 10-Year Comprehensive Limited Warranty Approvals and Listings ❑ CSA approval Concrete Mounting Pads ❑ Concrete mounting pad,3 in.thick ❑ Concrete mounting pad,4 in.thick (recommended for storm-prone areas) Electrical Accessories ❑ Battery ❑ Battery heater, 120VAC ❑ Battery heater,240VAC ❑ Cold weather package, 120VAC Generator Set Dimensions and Weights ❑ Cold weather package,240VAC Emergency stop kit Generator Set Size,L x W x H: 1193 x 666 x 817 mm ❑ 9 y P (47 x 26.2 x 32.2 in.) ❑ PowerSync®Automatic Paralleling Module(APM) (single phase only;parallel two 20kW residential generator Shipping Weights: sets with the RDC2 controller) 20RCA Generator Set: 252 kg(555 Ib.) Programmable interface module PIM 20RCAL with 100 A RXT ATS w/LC 277 kg(611 lbs.) ❑ 9 (PIM) 20RCAL with 200 A RXT SE ATS: 272 kg(600 Ib.) (provides 2 digital inputs and 6 relay outputs) L Fuel System Accessories ❑ Flexible fuel line(included on GIS models) ❑ Carburetor heater, 120 VAC l� ❑ Carburetor heater,240 VAC H ®® Carburetor heater is recommended for reliable starting at temperatures below O'C(32°F) Literature ❑ General maintenance literature kit W i ❑ Overhaul literature kit NOTE Dimensions are provided for reference only and should not be used for planning ❑ Production literature kit installation Contact your local distributor for more detailed information Maintenance DISTRIBUTED BY: ❑ Maintenance kit(includes air filter,oil,oil filter,and spark plugs) ©2018,2019 by Kohler Co.All rights reserved 134-272 (20RCA) 9/19c