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HomeMy WebLinkAbout47152-Z �p��S�FfDr Town of Southold 1/31/2022 a y� P.O.Box 1179 0 .� 53095 Main Rd o4,� 'Aa Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42724 Date: 1/31/2022 THIS CERTIFIES that the building WINDOWS Location of Property: 1605 Arshamomaque Ave., Southold SCTM#: 473889 Sec/Block/Lot: 66.-3-10 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/29/2021 pursuant to which Building Permit No. 47152 dated 11/29/2021 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: in-kind replacement windows(6)as applied for. The certificate is issued to Nickles,Kathleen of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47152 1/21/2022 PLUMBERS CERTIFICATION DATED o �\ (-\, fi \�-\--\Vf Mk--N Z 16 ut ori d Signature oSUF TOWN OF SOUTHOLD BUILDING DEPARTMENT z TOWN CLERK'S OFFICE SOUTHOLD, NY i 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#: 47152 Date: 11/29/2021 Permission is hereby granted to: Nickles, Kathleen PO BOX 56 Southold, NY 11971 To: In-kind replacement windows (6) as applied for. Replaces BP#39086. At premises located at: 1605 Arshamomague Ave., Southold SCTM #473889 Sec/Block/Lot# 66.-3-10 Pursuant to application dated 11/29/2021 and approved by the Building Inspector. To expire on 5/31/2023. Fees: PERMIT RENEWAL $125.00 Total: $125.00 i _' Building Inspector guFra�t TOWN OF SOUTHOLD BUILDING DEPARTMENT y 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#: 39086 Date: 8/6/2014 Permission is hereby granted to: Nickles, John Arshamaque Ln PO BOX 56 Southold, NY 11971 To: in kind replacement windows (6) as applied for At premises located at: 1605 Arshamomaque Ave, Southold SCTM # 473889 Sec/Block/Lot# 66.-3-10 Pursuant to application dated 7/28/2014 and approved by the Building Inspector. To expire on 2/5/2016. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO -ALTERATION TO DWELLING $50.00 Total: $250.00 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. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I% lead. 5. Commercial building,industrial building,multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9, 1957) non-conforming uses,or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.00 Date. New Construction: Old or Pre-existing Building: (check one) Location of Property: (P()5 k-%'ha Spys#Q�/b House No. l Street Hamlet JV�'(� W Owner or Owners of Property: - jV�Qof Suffolk County Tax Map No 1000, Section (6 Block Lot 0 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: $ L 6t Applicant Signature pF SO(/T�QI 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 sean.devlin(a-town.southold.ny.us Southold,NY 11971-0959 Q�y�0UN1'Y,�c� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Kathleen Nickles Address: 1605 Arshamomaque Ave city:Southold st: NY zip: 11971 Building Permit#: 47152 Section: 66 Block: 3 Lot: 10 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: AS BUILT License No: SITE DETAILS Office Use Only Residential X Indoor X Basement Service Commerical Outdoor X 1 st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser 1 Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower 1 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: Notes: " AS BUILT NO VISUAL DEFECTS " AC Inspector Signature: r Date: January 21, 2022 S.Devlin-Cert Electrical Compliance Form SO �� IS7Z � � �� ��s�lc� �i GIyo� vlo # # TOWN OF SOUTHOLD BUILDING- DEPT. 7654802 INSPECTION [ ]_:FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS:. DATE ANSPECTOR OE SO(/Tho� # # TOWN OF SOUTHOLD BUILDING DEPT. �ycou765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ rSLATIOWCAULKING U FRAMING /STRAPPING [ NAL WI r &lsl [ ] FIREPLACE & CHIMNEY [. ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: �I - 1- �. �Av-iq DATE $ INSPECTOR Allegiance 13 MFR y DATE 1212009 IA7A3Q42AT000BA .C.tS 20W30 95MEW PM 1 "1 60 Mam CIRCUII 41APACIII 25.0 un i.'"WRRFMf PROTICITVt DIVICt USA GNAO.R� r�rr. 110A 1 !c 00 32 09 3.18 tC+311 M l J1 16 b ^u 20812301' 105 IRA � 1 ' 4u 2001230'+ 1/4 HP I 'FANO . �i A2P 48 LU 10 _ ' v Allegiance 13 14FR DATEaA]A;ju 12/7Qpy a2 10006A « 208/230 9513LEF4F '•F�CIRCUIT AMPACFTY ay h� 8O FII;:JHAFg1 I'" If IV f DEVICE 25.0 Apar USA C4k4CA AtAj1 'USE:BRE4rfq�NACp,, NFC a u n a0 00 40 07 dl 3 T 8 ;sn A it Uu 1d.6 AU rs•'� 7.30 tU 206J23 ; nGr20 A2P.1 101 AA 4lL dW 40 M Hv �! IN lII1 M..,, Moo .yl. l�IY �• t t o . • . � . 1 1, PLUAMING 0 1 • • 1 IMPIROe 4 �I� AI 1.la�dl►� ' � 1..1 ���1�'L�I� I � ,� • l a �•�rFff� I e s • RUVUMA i 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) 765-9502Survey SoutholdTown.NorthFork.net PERMIT NO. �0� Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application g Flood Permit Examined U 20 E C Er � W Er Single&Separate I Storm-Water Assessment Form J U L 2 5 2014 �t: - -- - -- - - Power,Home Remodeling Group Approved ,20)T JUL to:_ 2501 Seaport Dr.First Floor Chester,PA 19013 Disapproved a/c BLDG.DEPT. - -- - - TOViN OF SOUTHOLD Phone: ( 8) �3(o-(O33S Expiration 2 ,20A_ YZI39 Building Inspector APPLICATION FOR BUILDING PERMIT Date _3'(A (v a , 20 I L-_ 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. dFea rt,pSA 1F: r a (r;%. tl f e�Ms`�:.j` � �� -y (,/,P�t c `,' fib Lo-ef N r2G E U IN ' �j (Sin re of avMicant or name if a corporation) Power Home Remodeling Group jy --° OT 2501 Seaport Dr.First Floor State whether applicant is owner, lessee, agent, architect, engineer, general contrac�i3P (9,rTCTan*P lu by aiouilder pp g g � g , > > p� p�p�� FEE:- BY 1�� GPi�e`,t^�-1 COj'1+Y'GCC�1- NnTI Y'Rllll DINT DFPARTMFw AT 765-1802 8 AM TO 4 PM FOR THE Name of owner of premises X o&W-'-en t 0-p{ n iV irKI rs FOLLOWING INSPECTIONS: (As on the tax roll or latch&&U--. TIUN- I VV0 REQUIRED FOR POU!'E:r) rr•.iCPET= If applicant is a corporation, signature of duly authorized officerOuc -_. - _1. _- STRAPPING, ELECT FICA. a —� (Name and title of corporate officer) 3. INSULATION Builders License No. H95(08-44 4. FINAL-CONSTRUCTIONI &ELECTRICAL Plumbers License No. MUST BE COMPLETE r'. C 0. Electricians License No. ALL CONSTRUCTION SI IALL MEET THE Other Trade's License No. REQUIREMENTS 0'THE CODES OF NEW YORK STATE. NOT,,r_SPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. 1. Location of land on which proposed work will be done: ( uolZ Arshanowaau-e Ale-nut-, S30U*00 House Number Street Hamlet County Tax Map No. 1000 Section Block Lot ID i Subdivision Filed Map No. Lot i 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy E b. Intended use and occupancy W(()t4AcIj r-eD(TLC-eW iTJ:S 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work 1,2v re0Iz?1CP(Yeof (Description) uUjno(ackC 4. Estimated Cost � 5� 5 3� Fee � POO 5 O (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. 6114 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO_ 13. Will lot be re-graded?YES NO Will excess fill be removed from premises?YES NO 14.Names of Owner of premises Ka{lkwn M� n NiCtd�ddress I 05 A � a2 Y�ione No. L(o3i) 2?6-(a 29q Name of Architect Address-gOu tl��w� iN 1 Phone No r Name of Contractor Po Wf r �t^- T6r Address Power Home Remodeling Group e No. �8 -6 335 2501 Seaport Dr.First Floor y z-3 g l Chester,PA 19013- 15 a. Is this property within 100 feet of a tidal wetland or a fresh vyu�.,,-vv.,«"..0 - _U -- 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) SS: COUNTY OF }� 6 aIn rh*OL'r being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the C ontmcfo F (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 knowledgr� �1 performed in the manner set forth in the application filed therewith. NOTARIAL SEAL STEPHANIE ATKINSON Notary Public Sworn to belore me this CHESTER TWP.,DELAWARE COUNTY a�'^ day of 7t4 20h My Commission Expires Jan 15,2017 No Public Signature of Applicant D ECE " w� ¢f(j BUILDING DEPARTMENT- Electrical s cto TOWN OF SOUTHOLD VAN 1 8 2022 ED Town Hall.Annex- 54375 Main Road - PO 136§40000 � oLD Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(a-).southoldtownny.gov — seand(cbsoutholdtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: ffame owner Electrician's Name: License No.: Elec. email: Elec. Phone No: ❑I request an email copy of Certificate of Compliance Elec. Address.: JOB SITE INFORMATION (All Information Required) Name: Address: ue Cross Street: ft,, � -k Phone No.: BIdg.Permit#: email: Tax Map District: 1000 Section: Block: ' Lot: 10 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): burf If Square Footage: 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: A #•Meters Old Meter# ❑New Service❑Fire Reconnect[:]Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 0 1 n2 H Frame Pole Work done on Service? Y ON Additional Information: PAYMENT DUE WITH APPLICATION Q�c�, S�e,c�S r3QW BUILDING DEPARTMENT- Electrical s ctoVAN 1 8 202 TOWN OF SOUTHOLD eUr 2 Town Hall Annex - 54375 Main Road - PO Bc342 C AG DEP-r �'► OUTH OLD Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9102 rogerr(a southoldtownny.gov — seand(@.southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION 'ELECTRICIAN INFORMATION (Ali Information Required) Date: Company Name: ffam owneiir Electrician's Name: License No.: Elec. email: Elec. Phone No: ❑I request an email copy of Certificate of Compliance Elec. Address.: JOB SITE INFORMATION (Ail Information Required) Name: Address: Cross Street: Phone No.: SGS` - 3 r BIdg.Permit email: �O , Tax Map District: 1000 Section: Up Block: Lot: t Q BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): �s h vt Square Footage: 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 1-11 PhF—]3 Ph Size: A #•Meters .Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals D 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION \ *,e/S � 3$O PERMIT# Address: Switches Outlets G F 1's Surface, Sconces H H's UC Lt's Fans `..._.,:,.. ..... ...:.:. F"rrdge...: ..._ .: ... ._ . HW _. Exhaust Oven W/D Srno.kes DW Mini. {. ,.Carbdn` . _, ....;., 4_ - IVliicro:..... _ : _ Generator Combo.;: ,. . .., . C— ktop _._.r ... . ... .. ..-`Transfer AC AH 'Hood Service Used ; Special:,..: ........ Comments: = APPLICANT: S.0 T Nl. (Property 0—r.Design Prolessiosul,Agent, nttutor Oth.0 *^-- •gym —1000� bpSUE CHAPTER 236 ,/ �1�T�o Stormwater Management Control Plan CHECK LIST NAME: f��� Weimar Sceuon t3lock Lot z S M C P -Plan Requirements: Provide ONE copy of the Building Permit Application. rim Date: * The applicant must provide a Complete Explanation and/or Reason for not providing (6Vv°)7A-6335 7 2,Z all Information that has been Required by the following Checklist! ,� n�r7Mur< I. A Site Plan drawn to scale Not Less that 60'to the inch MUST If You answered No or NA to any Item,Please Provide Justification Here! show all of the following items: YE NO NA If you need additional room for explanations,Please Provide additional Paper. a. Location&Description of Property Boundaries 0 b. Total Site Acreage. c. Existing Natural&Man Made Features within 500 L.F. of the Site Boundary as required by§23&i7(cx2). ' d. Test Hole Data Indicating Soil Characteristics&,Depth to Ground Water. e. Limits of Clearing&Area of Proposed Land Disturbance. 0 f. Existing&Proposed Contours of the Site(Minimum z Intervals) g. Location of all existing&proposed structures,roads, driveways,sidewalks,drainage improvements&utilities. It. Spot Grades&.Finish Floor Elevations for all existing& 0 proposed structures. 1. Location of proposed Swimming Pool and discharge ring. j. Location of proposed Soil Stockpile Area(s). k. Location of proposed Construction Entrance/Staging Area W. I. Location of proposed concrete washout area(s). (� M.Location of all proposed erosion&sediment control measures. 0 2. Stormwater Management Control Plan must include Calculations showing that the Stormwater Improvements are sized to capture,store,and infiltrate on-rile the run-off from all impervious.surfaas generated by a two(21 inch rainfall/storm event. 3, Details&Sectional Drawings for stormwater practices are required for approval. Items requiring details shall include but not be limited to: a. Erosion&Sediment Controls. 0 b. Construction Entrance&Site Access. 0 c. Inlet Drainage Structures(e.g.catch basins,trench drains,etc.) Cl. Leaching Structures(e..Infiltration basins,swales,etc.) ***FOR ENGINEERING DEPARTMENT USE ONLY Additional Information is Required.V � i Reviewed& Stormwater Management Control Plan is Not Complete. `! App-ovedBy: — — — — — — — — — — — — — — — — — — — — — — — — Stormwater Management Control Plan is Complete. E pate SMCP has been approved by the Engineering Department., FORM ° SWCP Check List-TOS MAY-2014 POWER-1 OP ID:AW CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY) 09/11/13 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 be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on thls certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ACT 215-723-4378 NNAOME:. i Lacher&Associates Ins Agency 215.723-8604 PHNNF AIC No Lacher Insurance Group i 632 E Broad St P 0 Box 64398 MAI Souderton,PA 18964 Chad Lacher INSURERS AFFORDING COVERAGE NAIC# INSURERA:Harleysville Worcester Ins Co 26182 INSURED Power Home Remodeling Group, INSURERS:Harleysville Preferred Ins.Co 36696 LLC. Power Home Remodeling Group, INSURERC:NatfonWIde Mutual Ins Company 23787 Inc. INSURER D 2501 Seaport Drive Ste 8110 Chester,PA 19013 MSURERE: 's INSURER j COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,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 TYPE OF INSURANCE D B POLICY NUMBER MMlDD EFF MM/DD P LIMITS LTRGENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 B X COMMERCIAL GENERAL LIABILITY MPA00000089793N4 10/01/13 10101114 pD EM s TO RENTEDmcol $ 100,000 CLAIMS-MADE �OCCUR i MED EXP one person $ 10,00 I PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 lPOLICY X P C- F71 LOC ' NN $ AUTOMOBILE LIABILITY C a aIldentSINGLE LIMIT 1,000,000 A X ANYAUTo BA00000089796N 10/01113 10/01/14 BODILYINJURY(Per person) $ ALLOMED SAGO ULED n. BODILY INJURY(Per=Tdenl) $ AUTSHIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AU`rOSPere da t ' S UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 10,000,000 C X EXCESS LIAB CLAIMS-MADE CMB00000089794N 10/01/13 10/01/14 AGGREGATE $ 10,000,000 DED I I RETENTION $ WORKERS COMPENSATION X I WC S ATU- OTH- AND EMPLOYERS'LIABILITY A ANY PROPRIETORIPARTNERIEXECtmVE Y© NIA WC00000089795 10/01113 10/01/14 E,L.EACHACCIDENr $ 1,000,000 OFF10ER/MEMBER LXCLUD[T17 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 Nyyes,describe under D @SCRIPT'ION OF OPERATIONS below E.LDISEASE-POLICY LIMIT $ 1,000,000 A Mass Auto Policy BAODO00018227P 10/01/13 10/01114 Liability 11000,000 A NY Auto Policy ." SAUDO00074849R 10/01/13 10/01/14 Limit pESCRIPTION OFOPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,AddRlonal Remarks Schedule,Ir more space Is required) CERTIFICATE HOLDER CANCELLATION SOUTNY" ' SHOULD ANY OF THE ABOVE D&CRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE-POLICY PROVISIONS. Town of Southold 53095 Route 25 P.O.Sox 1179 AUTHORIZE/D_REPRESENFATIVE Southold,NY 11971 ©1988-2010 ACORD CORPORATION. All rights"reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD A-0 RR. ...... • m g ....•.. i. f,yk. Vi -H"-"j "30 artment of Lobar, Licensin .... . .. .......... fi Eli c Affairs 4irs* VETERANS MEMORIAL. E . MGHWAY HAUPPAUG �.'NE 8 RK 1178. - : DATEISSUM, 411/2 No. 48569=H x ' -SUFFOLK.COU. NTY in LCen H6' eAt contr SL;l . g ............ W.. This* s,tp,c6rdfy ihdi IYME- EBARRING IN dq.ing"business as , QWRMLINQU LORD GGA hh"d -'Provi§ias'o ih s ti dn, C�q:mg 4yapg.. 6 rp.quire and re&,;qtions ofthe County 4Suffolk,-StAtd-bNe-w(yor -Is'jhereby liicensealidwO ct busirie§saa,HOffi tail gym. ROVEAEN JhAh�'C OUn� .0W t ic*p Citfeg(?ry NOT VALID WITHOUT A'dd.itional B.uPftfdSSeS. DEPARTMENTALSkAt. . r. AN `&kREN— D� Alb CONSUNERAFPAM 'bmw COmrnlssioner -0 J, . .... .. .... .. . )f@Ij'!EW MM10-k AMRM '1�1'6 fib" jpx M.A.—, gg' j T • a. ,A-im t,vsgg M!Qu., W M gog"', g IN lzi.11--W'41zv;lN<-& 0 19,^8 GOES 3461 LITHO.IN U.SA A9 Riots PlesaNed SUFFOLK COUNTY DEPT OF LABOR, LICENSING&CONSUMER AFFAIRS v HOME IMPROVEMENT CONTRACTOR NAME F.YLE E BARRING } F� . Dt191NE5B NAl1E k This cet#ifes that the POWER HOME REMODELING GROUP LLC bearer is duty licensed by the =O�Z/5712011 Countyof Suffolk 48568-H iD.vd,..I.w, •� IEKPMnDIDATE 04/01/2095 -