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HomeMy WebLinkAbout46847-Z L..; ��o�QSpFFOI oy Town of Southold 2/4/2022 P.O.Box 1179 53095 Main Rd Southold,New York 11971 • �pl ����l�r CERTIFICATE OF OCCUPANCY No: 42757 Date: 2/4/2022 THIS CERTIFIES that the building WINDOWS Location of Property: 1605 Pine Tree Rd Ext., Cutchogue SCTM#: 473889 Sec/Block/Lot: 98.-1-7.7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/14/2021 pursuant to which Building Permit No. 46847 dated 9/20/2021 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: window replacements to existing single family dwelling as applied for. The certificate is issued to Kerins,Richard&Stacey of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 0 Au o ized 1 Anature oSOFfo� 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#: 46847 Date: 9/20/2021 Permission is hereby granted to: - Kerins, Richard 41 Butler St Westbury, NY 11590 To: Replace windows at existing single family dwelling as applied for. At premises located at: 1605 Pine Tree Rd Ext., Cutchogue SCTM #473889 Sec/Block/Lot# 98.-1-7.7 Pursuant to application dated 9/14/2021 and approved by the Building Inspector. To expire on 3/22/2023. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO-ALTERATION TO DWELLING $50.00 Total: $250.00 Building Inspector j} ho�aof SOUlyO� * # TOWN OF SOUTHOLD BUILDING DEPT. `ycou►m,��' 765-1802 INSPECTION [ ] FOUNDATION 1ST { ] ROUGH PLBG. [ ] FOUNDATION'2ND [ ] NSULATION/CAULKING [ ] FRAMING/STRAPPING [ FINALWltl -6 S [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: 94t DATE I o-) INSPECTOR FIELD INSPECTION REPORT `DATE COMMENTS oL1 FOUNDATION(IST) y ------------------------------------ C .FOUNDATION(2ND) �O � 1 ROUGH FRAMING: PLUMBING . INSULATION.PER.N.-Y. STATE ENERGY CODE yr vFINAL ADDITIONAL COMMENTS:. ., 'q 5 0. . . 81. Zz0 x .. . . . . . ►ted U G T ° s ` a� +y OF SOIf TN s� ���w��uthYo'ld;�h� �j�9"� VX�'€ Y1V.li«'.f.°'i' 1YIy?3i:�.1--,�,,;�"10� y/Y1:13 . 75 - a x TO P D v V ` curs itsL cony SEP 1 4 2021 i,. . Buildinginspodor. pi1� o G DEPT. , y Ohl� TOWN 1-01 � OF SOUTHOLD t� ► , Aft m _sf��� g� �'+ .� I 35 �a6 '.i" i ,. - - -t 61350.90u. 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Yds ADN 'I .'fES£PROVIDE<A.0 3PY; -L,�' 2 �,�... - ,(a X `: s yx,r�� a `3.,as« - ...n z aSts e � s 't.Aik�stt`sf@3si #.s3. i �.33Tt3'ti;'�' hY#" '°aGq'�s �t E.� ���y�'° s. fasiqt � M! �xa � tsara€ace of t f�a > 't � IS Fa ter Fssti xa t,�s tsps 00 } s S1 YEr�Tt ds g�a F x ppl i a ld n efbmltte� Y: �rfr�rf��e} Gtn n :�- ✓Ulcer Auih ped er�t l�µ r Data: S5; 00VINiTY 05,:qu{Eforo ' ""k$ ' W! ofs epeah says that.{s}he ist e.a?piicantbeir4sworn, es �i�l��:e of r �vadualssoaai :�oc4�ractl abci�e�ra�a-rte�, �5} is t - ems ------------ � ozitrac c r> r t,cornorate Off ce'r;etc. . f,s'gid©Whe or'ownIers,�r1ti is t# ; assthrrr��?d tci p��o car have ppiiforHi6 th said worWirid tea rvaaise and file th S a{s l cattar thea a?#'stat ai Brats t o 'in d in:*his ap'plic�t on,are,' rug�c�`t?�e lae�t of ha�� �r krs ie�lge ti'ki�l'ief;;�j 3` that the work��I I std pe4grrner!a�i the inariner:si f€�0 iri'the appir�atioaa f le:therea:�ith. S of n'bi fdr'e taae:t6 „ di Notary Pub 1L, SPENSER R BULMER NOTARY PUBLIC ( ere thea plicanx is,nox Lhe tsv nen GUILFORD COUNTY,NC My Commission Expires B-24-2022 . ..05 Pin .. _ Jennjf6r s ft do.,her luthoe��a. rrf?'15c .ff 6 tile,?iaat n,af,Q�€tni i i uilctire Cepartrn�p;t cr p 3:ovai as estr:let . c ' E A res gnatur .' ori nt OvA r's" AC®n®® CERTIFICATE OF LIABILITY INSURANCE DATE 21 YYYY) 09107120/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH USA,INC. NAME: TWO ALLIANCE CENTER arc No arc No): 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# CNI01642069-HomeD-GAW:21-22 INSURER A:Old Republic Insurance Co 24147 INSURED THE HOME DEPOT,INC. INSURER B:AIU Insurance Co 19399 HOME DEPOT U.S.A.,INC. INSURER C:HomeRisk Captive Insurance Company 2455 PACES FERRY ROAD INSURER D:NIA N/A BUILDING C-20 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-005314714-01 REVISION NUMBER: 1 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. 1NSR EXP TR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM DDPOLICY EFF MPOMlppYLIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 314574 03/01/2019 03/01/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR DAMAGE TO RENTED 1,000,000 PREMISES Ea occurrence $ X SIR:$1,000,000 MED EXP(Any one person) $ EXCLUDED PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 X POLICY❑PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY MWT8314573 03/0112019 03/01/2022 COEaMBIccid6ent Dnt) GLE LIMIT $ 1,000,000 a X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS ONLYAUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WC 58240269(WI) 03/01/2021 03/01/2022 X PER OTH- --' AND EMPLOYERS'LIABILITY STATUTE ER g Y/N WLR 067818258INC,VA 03101!2021 0310112022 s ANYPROPRIETOR/PARTNER/F�CECUTIVE ( ) 5,000,000 OFFICER/MEMBEREXCLUDED? ❑N N/A E.L.EACH ACCIDENT $ __� (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 5,000,000 If yes,describe under Continued on Additional Pae 5,000,000 DESCRIPTION OF OPERATIONS below 9 E.L.DISEASE-POLICY LIMIT $ C Excess Auto 297110011002021 03/01/2021 03/01/2022 Limit: 4,000,000 A Excess General Liability MWZX 314580 03/01/2019 03/01/2022 Limit: 8,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED IF REQUIRED BY WRITTEN CONTRACT ON THE ABOVE GENERAL LIABILITY POLICY,BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED. 1 CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 ROUTE 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1179 ACCORDANCE WITH THE POLICY PROVISIONS. SOUTHOLD,NY 11971 AUTHORIZED REPRESENTATIVE 7A�ri ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 _ LOC#: Atlanta AC" ADDITIONAL. REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA,INC. THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA,GA 30339 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continued: Carrier:Indemnity Insurance Company of North America Policy Number.WLR C67825287(AL,AR,FL,ID,IA,KS,KY,LA,MS,MO,NE,NM,ND,OK,SC,SD,TN,WV,IM') Effective Date:03101/2021 Expiration Date:03/01/2022 (EL)Limit:$5,000,000 Carrier:AIU Insurance Co. Policy Number:WC 58240268 (AK,DC,DE,HI,IN,MD,MN,MT,NY,NJ,NY,RI,V17 Effective Date:03/0112021 Expiration Date:03101/2022 (EL)Limit:$5,000,000 Carrier:ACE American Insurance Company Policy Number:WCU C67805331(QSI)(CA,IL,OR,WA) Effective Date:03/0112021 Expiration Date:03/0112022 (EL)Limit:$5,000,000 SIR:$1,000,000 Carrier:National Union Fire Insurance Company Policy Number:XWC 1647258(QSI)(CO,CT,GA,ME,MI,NV,OH,PA,UT) Effective Date:03101/2021 Expiration Date:0310112022 (EL)Limit:$4,000,000 SIR:$1,000,000 SIR(CT):$350,000 SIR(GA):$750,000 Carrier:ACE American Insurance Company Policy Number:WLR C67818210(AZ) Effective Date:03101/2021 Expiration Date:03/01/2022 (EL)Limit:$5,000,000 Carrier:National Union Fire Insurance Company Policy Number.XWC 1647259(QSI)(MA) Effective Date:03/01/2021 Expiration Date:03/01/2022 (EL)Limit:$4,500,000 SIR:$500,000 TX Employers XS Indemnity: Carriedllinios Union Insurance Company Policy Number.TNS 066949072(TX) Effective Date:03/0112021 Expiration Date:03/0112022 (EL)Limit:$10,000,000 ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 _ LOC#: Atlanta ACR® ADDITIONAL REMARKS SCHEDULE Page 3 of' 3 AGENCY NAMED INSURED MARSH USA,INC. THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA,GA 30339 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance SIR:$1,000,000 "'HOME DEPOT INSUREDS— The Home Depot,Inc. Home Depot U.S.A.,Inc. Home Depot USA,Inc.dba The Home Depot Home Depot of Puerto Rico,Inc. Home Depot Product Authority,LLC Home Depot Store Support,Inc. Red Beacon,LLC Home Depot U.S.A.,Inc.dba The Home Depot Pro Interline Brands Barnett Hardware Express Leran Maintenance USA Renovations Plus Supplyworks US Lock Wilmer Zip Technologies H.D.W.Holding Company,Inc. Askuity,Inc. ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I i mQI k6r,S? CERTIFICATE OF 101711pe NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a:Legal Name&Address of Insured(use street address only) 1b..Business Telephone Number of Insured Home Depot USA,Inc. 770-433-8211 2455 Paces Ferry Rd.,C-20 Atlanta,GA 30339 1 c.NYS Unemployment Insurance Employer Registration Number of Insured 76011130 Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification.Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 58-1853319 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Town of Southold New Hampshire Insurance Company 53095 Route 25 3b:Policy Number of Entity Listed in Box"1a,, Southold,_NY 11971 WC058240268 3c.Policy effective period 03/01/2021 to 03/01/2022 3d.The Proprietor,Partners or Executive Officers are included.(only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"9"insures the business referenced above in box"l 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"36",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 thatAhe business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that 1 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: Michael Price (Print name of authorized representative or licensed agent of insurance carrier) 02/27/2021 Approved by: (Signature) (Date) Title: CEO North America Telephone Number of authorized representative or licensed agent of insurance carrier: 212-770-7000 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. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or'municipal.depaitment, 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 permif;unle§s proofAuly 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 6' ployees has,heen secured as provided by this chapter. C-105.2 (9-17) REVERSE CERTIFICATE OF INSURANCE COVERAGE DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name&Address of Insured(use.street address only) 1 b.Business Telephone Number of Insured THE HOME DEPOT U.S.A.,INC. 2455 PACES FERRY ROAD NW 770-384-2215 ATLANTA,GA 30339 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage isspecifically' limited to certain locations in New York State,i.e.,Wrap-Up Policy) 501853319 2.Name and Address of Entity Requesting Proof of a Name of Insurance Carrier Coverage(Entity Being Listed as-the Certificate Halder) TOWN OF SOUTHOLD HARTFORD,LIFE AND ACCIDENT - 53096-ROUTE 25 3b Policy Number of Entity Listed in Box"1a" SOUTHOLD, NY 11971 LNY713657 3c Policy effective period 01-01-2021 to 12-31-2021 4.Policy provides the following benefits:. Fd1k Both disability and paid family leave benefits. ❑B.,Disability benefits only: C:Paid family leave benefits only. 5.Policoovers: L✓J A All of the employer's employees el)gible,under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class orlasse s.of employer's employees: Under penalty of perjury,l certify that I•am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date signed 12-07-2020 E re.11� (Signature of insurance carrier's authorized representative or NYS Ucensed Insurance Agent of that insurance carrier) 'telephone Number (212)553-8074 Name and Title:Elizabeth Tello-Assistant Director,Statutory Services IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If Box 413,4C or 513 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 Neuf York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees: Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) If jl °1��a�i ii i�� oil III Additional Instructions for Form D13-120.1 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"1 a"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 2. 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 my 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 and/or 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 anew Certificate of NYS Disability and/or Paid Family Leave Benefits Coverage or other authorized proof that the bpsiness 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 suchemployee 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 for all employees has been secured as provided by this article. DB-120.1(10-1'n Reverse , RECEIPT. SUFFOLK COUNTY GOVERNMENT DEPARTMENT OF LABOR,:C.ICENS.ING;AND CONSUMER AFFAIRS COMMISSIONER ROSALIEDRAGO P.O. BOX 610.0,HAUPPAUGE,NY 11788 (631)853-4600 Today,Date: 1012212020 Apel{cation: H-53429. Application Type; Home Improvement Lfeense. , Receipt No. 414174 Comments Payment.Method Ref.Number Amount Paid payment Date Cashier 1D Renewai+ 14 Additi0r+a1 Check 0003,181507 $1,800,,00_ 1012212020 GAB Locations Contact Info; HOME DEPOT USA iNC(14'SUPPS) RICHARD'T.OUSEY:' PO SOX:105451 ATLANTA,GA:30348 - . Work Description: iI i, 1I l 7 Suffolk County Dept.of ! i Labor; $Licehsing Consumer Affairs ii F{OME.IMPROVEMENT LICENSE [ Name RICHARD TOUSEY til13usaness Name i This certifies that the HOME DEPOT USA INC(14 SUPPS) bearer is duly licensed a by the County of suNatk License Number:H-53429 Rosalie Drago Issued- 05/15/2014 Ei Commissioner Expires: 11/0112022 i 4 ' ^I li it i 11 Vi OCCUPANCY OR USE I5 UNLAWFUL WITHOUT CERTflCAF APPROVED AS NOTED' OF OCCUPANCY DATE: B.p.# FEE:lic?-60.0v BY: NOTIFY, BUILDING DEPARTMENT AT 765-1802, SAM TO 4 PM 1 OR THE FOLLOWING INSPECTIONS.`- 1. FOUNDATION TWO REQUIRED FOR POURED TWO 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CON STRUCTION",MUST BE COMPLETE FOR C.Q. r. ALL CONSTRUCTION SHALL MEET THE �`�'` � L �° - CG:. REQUIREMENTS OF THE CODES OF NEW NEVV YORK S-i l owiJ c". YORK STATE. NOT RESPONSIBLE FOR AS REQUIRED Af'-,` . ")NDITIOh DESIGN OR CONSTRUCTION ERRORS. " SO��T,' NNZBA SOUTHL-__ C+WN PLANNING C_ SOUTHOLL,-"WN TRUSTEES N.Y.S.DEC WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-1WP84MWY Sheet: 1 of 1 i Customer: Stacey kerins Job#:1-1 WP84MWY Consultant: Adam Friedman Date: 09/03/2021 New Window ' Existing Window Hinge Locations 4i .i Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, j use L,R or S Glass Misc Items �aI `o t. - Tm• ` Hardware Code Screens For doors use u Mull "S"=stationary o r o "X" operating 7 N Wraps '.EStyle ide z 3 zRoom Floor Co FULL SCR,STD,White, WRAP,LSR 1 ! LIV 1st SB-DH Y DH 6100 WH WH 32 51. 83, S';, WH,W C ALL 2 1 ALL 2 1 GlassPack:Standard ' GBG H. _ FULL SCR,STD,White, WRAP,LSR 2 j�LIV 1st SB-DH Y DH 6100 WH WH 32, 51 83 S, WH,W C ALL 2 1 ALL 2 1 GlassPack:Standard .. GBG• FULL SCR,STD,White, WRAP,LSR 3 BED 2nd SB-DH Y DH 6100, WH WH. 32 42• 74 S',: WH,W CALL 2 1 ALL 2 1 GlassPack:Standard ... .. GBG H' FULL SCR,STD,White, WRAP,LSR 4 i BED 2nd SS-DH Y DH 6100 WH WH 32 .42 74 S, WH,W C ALL 2 1 ALL 2 1 GlassPack:Standard GBG H i j . , 9 , i t I - i I I SPECIAL CONSIDERATIONS: 1:White,2:White,3:White,4:White High Large Window Access Charge>150U1.Quantity-4.00 j j rap Color I I I j Interior Casing Type Bay or Bow window: i Seatboard material(vinyl only-Birch or Oak) i — Bay Project Angle(30 or 45) j Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(Inches) j If tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the Construct Roof(Yes or No)' Special Terms and Conditions on the following page Garden Window: Seatboard Material(vinyl only-White Pionite,Birch or Oak) i • M h Grids 3 " v <.�.,Ls 3+ 2r ._ +''m'- r;,a'r, r,�" <✓'e.�r,,d°"' z � ` id:Z +k_ .. ' 3 ,�.y rEWE �, Style:, Gt ss�ac�ra _ Spacer ,# G- z � t6C r=SMAC ew...., -.�a-k.4,.:,.._ e'..«. 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