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HomeMy WebLinkAbout47160-Z QSOFFOI/( Town of Southold 3/23/2022 0 P.O.Box 1179 C* _ 53095 Main Rd 4,fjo1oo�, Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42942 Date: 3/23/2022 THIS CERTIFIES that the building WINDOWS Location of Property: 50500 CR 48, Southold SCTM#: 473889 Sec/Block/Lot: 51.-6-1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/12/2021 pursuant to which Building Permit No. 47160 dated 11/30/2021 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 Idarecis,Emilia of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Authorized Signature �o�s�eFot�-pooTOWN OF SOUTHOLD y BUILDING DEPARTMENT y x TOWN CLERK'S OFFICE oy • �� 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#: 47160 Date: 11/30/2021 Permission is hereby granted to: Idarecis, Emilia 167-19 Grand Central Pkwy Jamaica Estates, NY 11432 To: install window replacements to existing single-family dwelling as applied for. At premises located at: 50500 CR 48, Southold SCTM #473889 Sec/Block/Lot# 51.-6-1 Pursuant to application dated 11/12/2021 and approved by the Building Inspector. To expire on 6/1/2023. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO-ALTERATION TO DWELLING $50.00 Total: $250.00 d g Inspector atf so # # TOWN OF SOUTHOLD.BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ SULATIOWCAULKING [ ] FRAMING/STRAPPING [ ] FINAL of Idpf [ ] FIREPLACE & CHIMNEY [ ] FIRE-SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: ot DATE 3h447, INSPECTOR FIELD:INSPPC�'ION. PRT'. TATE:• COMMENTS ,• ►d FOUNDAVON'(1ST): O y ---- --.---------- -- _ .FOUNDATION(2ND).. dye ROUGH FRAMING.H PLUMBING:.• . 77 INSULATION EARN.. '. . . STATE ENERGY CODE l�i+'at -g aK- Alf FINAL DO zb: 2 o Zo ' z f !� b 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://Nvww.sotitholdtownnv.j4ov. Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only C E PERMIT NO. Building Inspector: NOV '12 2021 n" App(i cat'ions,'and 46rms,mustbe filled In applicati ons will riot BUILDING DEPT be atcepte Applicant lliall-6 SOUTHOLD TOWN OF V Date: 11/1/21 U., ,OWNER(S)OF PROPERTY , Name:"E�e," �a Idarecis SCTM#1000- Project Address: 50500 County Rd 48 Phone#: 718-704-622-1 Email:patotatzis(cbaol.com Mailing Address:50500 CountyRd. 48 Southold, NY 11971 Name:Scott Douqhman - Go Permit Mailing Address': 105 Buttonball Ln.Glastonbur _y ,_ qT Q6033 Phone#: 303-946-8685 Email: DESIGN PROFESSIONAL INMATIO Name: Mailing Address: Phone#: Email: CClNTRACTOR RMAi Name:Home Depot Mailing Address:2455 Paces Ferry Rd Atlanta, GA 30339 Phone#: 303-946-8685 Email: permits S. ........................................ ................. ................ ............... ........................ or N 1016h:&PROPOSED CONSTRUCTION EINewStructure OAddition ElAlteration WRepair ElDemolition Estimated Cost of Project: [i]Other Remove and replace 9 windows,same size, no structural change. $ 8594 Willthethe lot be re-graded? E]Yes R No Will excess fill be removed from premises? E]Yes W No S. -.i Fri �' vow�, s -xr r r v pit � x not F��63i )ltta �Sl Fe g A. ekq �M tMa .w ,P c �tIMP"o Sia M gym " y ". ay ,ggry k dF A A € ) f. 'a` y All Y-NOW _�.s r hoc, YM A ' VMS 04 or; of won IP! UM J � t B '� 84azikl $ ��€ii a Nowitt �# h� g1� � E slow AW 1 e : .ft �' & ` ry JUM 1KX 1 3 E F 77 ;4,.s'a�` � -� �.� - , �. F. ° S0 NSERAR'.. LMER V R rF �rpYw�t7R VAA OF NC who ✓d AN a3.5 ,yam gypSyg k � Y y 5. d �iy��',*j, g},}j.:t W '�'T Ct ��,�•LO�� My 777 ,x .v�*ASS �. �..� ,« 7' Plawranv3 <+. z.g$ aka u owl k, �s +* ^,..6. A .,t<°a°x s X a, a raim, e 5 PQ Wf MP .�"�. 'a d�`'�i,R..�._. �'„- `,,.,�.�,... .,.;- y �T:�� ;.fY.,,:,4x,✓��' a' �4a.w,.%s H d� Go Permits, LLC 105 Buttonball Ln. Glastonbury, Ct 06033 "WE UNDERSTAND THAT YOUR TIME IS MONEY" To Whom It May Concern: Enclosed you will find a building permit application and check. If you have any questions regarding this application, feel free to call me at the number listed below. Please note the following: • Please mail original permit to the owner. • Please e-mail a copy of the permit and receipt to: Email: permits@gopermits.org • If fax or e-mail is not available, please mail a copy of the permit and receipt to: Go Permits, LLC 105 Buttonball Ln. Glastonbury, CT 06033 Thank you! Jennifer Winke, Permit Expediter Go Permits, LLC Phone: 303-946-8685 Fax: 866-697-0768 jenniferwinke@gopermits.org Go Permits LLC, 105 Buttonball Ln. Glastonbury CT 06033, scottdoughman@gopermits.org Home Improvement Agreement: Page 1 Home Depot License#'s-For the most current listing visit www.Homedepot.coln/LicenseNumbers Adam Friedman Salesperson Name Registration#(Req.in CA,CT,ME,MD,MI,NJ,DC) Home Depot U.S.A.,Inc.("Home Depot") or Authorized Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Service"Provider'Contact°InformatYon, _ r777-71 The Home Depot The Home Depot �� Service Provider Contact Name Service Provider Company Narne (631) 478-6101 customercancellationnortheast@hom Phone# �cTeTMvider Email Address Service Provider License#(s) Z Customer Infarmatzon �t _ a _ _ 777 m idarecis christina Long Island 1-1X3WBL4C Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 50500 County Road 48 Southold NY 11971 Customer Address City State Zip (718) 704-6227 pagotatzis@aol.com Home Phone# Work Phone# _Cell Phone# Customer Email Address 3 NOTICE OF'RIGHT_TO CANCEL ri ry YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY CONTACTING THE SERVICE PROVIDER OR STORE DIRECTLY; EMAILING SERVICE PROVIDER AT: customercancellationnortheast@homedepot.com OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 40 Oser Avenue Hauppauge 111788 Address City State Zip BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE .BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged by: iol3o/2o2t". C stom ' ignature Date 460Standard Form HJA(21Jul.21)(E) Generated Date 1n/3n/2o21 LeadlPOt? 1-lx3wRI 4C v 0.1.13 Home Improvement Agreement: Page 2 4 D_escriphon of Work to be Performed A detailed description of the work to be performed is included in the paragraph entitled.Scope of Work,Specification Customer Summary Sheet, Quote Form,Estimate,Invoice or Measure which is included in this Agreement. 5.°Anticipated Delivery Date!Installation Schedule _ �_ � ., ;� =f Approximate Start Date: 04/28/2022 Approximate Finish Date: 05/28/2022 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable Electronic R�;Author�zation_ �_ ' �_ You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy,your consent applies to this Agreement and all subsequent documents and written communications related to this Agreement. By contacting your Service Provider,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above,you confirm that you have access to a computer that can receive and open emails and PDF documents 7Contract Price and`Payment Schedule M__.,_.: _ __ . ~ Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: $ 8594.17 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 0.00 (If applicable, total amount of taxes included in Contract Price) *MaWmum deposit ONLY applicable in MD,MA,ME(33%),JV, WY(99%) De osit% 100 De Deposit Amount$ 8594.17 Remainin Balance$ 0.00 ----�-----�,. _. .. -.----�..�' _ gam. Finance Charges Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Sei vice Provider may collect Customer's payments made ayable to Home Depot. _ 9,�Acceptarice`and Authorization � _ _ _ �� _, � fr� �� � By signing below, you authorize Home Depot to:y(a) arrange for Service Provider to perform any Services or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's or permitting information may need to be provided to You later.)By signing,you acknowledge that:(i)You have read,understand, and accept this Agreement in its entirety, including the General Conditions and State Supplement, if any; (ii) You are receiving a complete copy of this Agreement; (iii)all rights and interests under this Agreement are solely vested in the person listed as"Customer"above; and (iv)Electronic signatures will be deemed originals for all purposes. X - r1 /30/2021. ;. Customer's Signature Date X /s/The Home Depot 10/30/2021 The Home Depot Digital Signature Date For questions related to your installation, contact Service Provider at (631) 478-6101 For any other concerns, contact The Home Depot at I-800-466-3337 460 Standard Fomi HIA(21 Jul.21)(E) Genemted Date 1 n.1--A o.1 9 o 9 1 LeadiP09 1-1 X3 W RI ACS V 0.1.12 CERTIFICATE IFICAT E LIINSURANCE0910 20210 YYY) THIS CERTIFICATE IS ISSUED AS A-MATT ER 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: Wthe certificate holder Is an•ADDITIONAL INSURED,.the pollay(les)must haver"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 rices n6t confer ri hts to the certificate.holder in lieu of such endorsement(s): PRODUCERCONTACT MARSH USA,INC. NAM9 PHONE T1�JOALLIAIVCECENTER t��..Ns�..a�iL�w ____3�����1.._.__:_ .... ................._ WO LENOX ROAD,SUITE 2400 MAIL ATLANTA,GA 30326 INSIIrzggCq)AEFg plNdSOV ERAGE l NAICv CN11;'642069•Homeb-GAW:-2122 IN$tIRER A Old Republic Insuram Co 4147 ....�;,,�.._., ��._.. ..._ �19399 INSUREDTHE H04E DWPbT;itdC, IYSURERS AI'J ipsu�anc5 C3 _v._.._W:. HOME DEPOT U.S.A.,INC: iNsuREP c H neRisk CaDiiive insllrancs ComPS? _... 2455 PACES FERRY ROAD INSURER SUILUNG C40 _._.•. _ ..._ _...._ __ _, ATLANTA,GA 3033x• INSURER E; INSURER F COVERAGES CERTIFICATE NUMBER: aATL-005314714-01 REVISION HUMBER: 1 THIS IS TO CERTIFY'THAT THE POLICIES OF INSURA OE,LISTED BELOW HAVE BEENISSUED TO THE INSURED,NAMED ABOVE'FCR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION.OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOWHICH THIS CERTIFICATE MAY BE,ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN is SUBJECT TC)ALL THE TERMS. EXCLUSIONS ANP CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBM i' POLICY EFF. 1 POLICY EXPO L i2; TYPE Op INSURANCE $OLfCYNUR7SEA P11P"DI?fYYYY i 0.il LQ( I Y LIMITS A r{� COMMERCIAL GENERAL LIABILITY i MYJZY 314574 03,'41,2019 10310112022, I EACH 3ceuRRtls S5 10a0 fl0G I i i 7 fSkfAAf,E'�t3�tTfE�'� t CLAWIS-MADE OCCUR €' i, .. 4i'REr.AEvEs,{Eat�u4,ren�e ,5_ .....Y.Y.3i9'�•tlfl"! SIR:$1,000.0-00 MEt3 EXt�(Ise one a'csonS EXCLUDED .._. ...... .. .,_...,... -. PERSONAL:&ADV INJURY 5 1.0CT1,C00- GE,,hl AGG 2ECJ l E LlhdiT APPLIES PER. YGENERAL AGGREGATE xv. poucY.^7 JEC�r 1 LOC i I RODUCTS.COMPIOPAGG __5 2 fl0a cfla. j - - OTHER: { 5 A AUTOMOBILE LIABILITY 11 MVJTB313573 10=1,12019 IrOT011s022. ,COMBINED.SINGtELI I E 5 1;3fl0,0a0 ; aide . :_. .�.._ .. X ANY AUTO I i. 1.SOCl+Y 4 URY(Pfar per,on) :S� OWNED SCHEDULED' i I SELF INSURED AUTO P Y DA'=.C` 1 3 SOCi Y INJURY jPer ex•dentl 3 AUTOS ONLY N AUTOS. ( L ' HIRED X 'NON-OWNED ' i f1 PF2tJPEft7 Y 64N Adm �K AUTOS.ONLY •AUTOS ONLY ? t �'Per aOCIOE ij ... UMBRELLALIAS �OCCJR EACHOCCURRENCE $ EXCESS LIAB" GLAi'vI5 R9ADE AC,aGREGriTE ;5 [ Dl) I:FTENTIGN$ 1 '$ B WORKERS COMPENSATION WC 58240269(1V1) u' J 3 03?012fl22 X I P R TH AND EMPLOYERS'LIABILITY I STIeTUTm ) _R g i X J N • WLR 067818258 INC,VA) 10110111021 103 011'2022 a 00fl 000 1N ti01'RI'tOfLPARThfER D? TIVE .❑ .I tAcm AcctDENT s •OFNCER1MEMBEREXCLUDED7 N NIA i (MsndtEory EL O1S ASF ELP9uLOlE in NH)' It vas,descfe under Continued on Additional Para1 DESCRirION Or OPERATIONS below E.L.03SEASE i ar g000flD,CtnflJflt3 POLICY LIMIT�5 G 1&%oris Atilw 257110011002021 a3rU1,202 E ©3101 1022 Limit 4,000,00-0 A Excess General Liability &9WZX 314580 i 03101/2013 �0310112022 I Limit: � 8,000,000 OESCrPJPTION'OP.OPERATRJNS i LOCA-noNS I VEHICLES,(ACORD 101,Additional Rema iks Sehadule,may be attached 1;mare space is.W 4ulred) CERTIFICATE HOLDER IS,INCLUDED AS ADDITIONAL INSURED IF REQUIRED BY WRITTEN CONTRACT QN-THE ABOVE GENERAL LIABILITY POLICY,BUT O3NLY LxJiTH RESPECT TO LIA61ITY' ARISING OUT OFTTHEORERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION T010 AN OF SOIJTliOLO SHOULD ANY'OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53096 ROUTE-25 THE EXPIRATION DATE, THEREOF., NOTICE -WILL_ BE :DELIVERED IN PO Bdx 1179, ACCORDANCE WITH THE POLICY PROVISIONS. SOUTHoLO,NY 11971 AUTHORIZED REPRESENTATIVE fl 9985-2016 ACORD'CORPORATICIN, All rights reserved: ACORD 25(2010103) The ACORD name and logo are registered marks of ACORD 4G ko CLISTOME tI7 '=CN1Q164 t3 9 LOG91. AGEt CY NAMED INSUkib 'Mk USA;INC ' test-HOME LIEPOTr INC_HOME DEPOT LIISAi,iNC,' _ PO)lZ Y NU3�0 R '. 24.5,PA6ES FERRY,ROAD" BUILDIWC-20` . a ATLANTA,-CA,30339'. CARRIER` NAIC W6r: BFPECTIV&DA75:_.� J �R+WITIt3AIAI:.RMARNi�u - - ., THIS ADDIT'IONAL:REMARKS 'At EWLE w AGORO'I OAM, FL}Rib9 NUMBER: 2 FORM.7ITLE. eitifCate of,l iabil,i ".Insurance �. �'torksrs.ComF�isa!'ionCoi�in��ti::- _ °C�otir,totlontnl,�lnsurat:c�£a°n�any gf�7ortYt Ameri� •` . Odicy Number WLR CUB25237(Al,AF2FL ID LA,KS,KY LkilS;M0,NE,NM,ND,; R SC;SD;TN SWY ',NY) EaipiraUonDatEQ3tOtt2D22� > • �' (E!)Limit X5,010.000 , Cer ar,:AIU lr�umnce C6.' ' -Patky Number6'yC 582fi0268 triY,6C;C�E,H(iN,AddMN,Nff.tvlfNJ,td`l,Rl,rlt'�,� ., , wi-to i)ntai g310t/202-- (ELI timit",UM,000 2022.(ELItimrt,UM,000 - Cnrre�ACE Anercthn insut9�a Compaztiy , , IT�SCy N�m.�:.WCU C87805331(QSI)tCA,IL 131i,i'YA} ° - , EifecUvat3ate.,o3tOtYZ021; `> . : °.. - ._ • -' ' ,. ` 6xpiraiaan DaY��03�'U9�Zfl22:` ' - _ L}Uma S,p S OJfl T , .. .�frie;Nati;dunloriFire'Iisurnv�.CAmpary..' . ° , Pt2�cp Num ;c:SWC ta972 s2 stlSi)(CC,CMi NV H,PA,Y) <.y Et�chvrt E1�ie:�i310112021'• - , •:cx�3�tfOriC�a€e'.03101120'12, �. �• . 's , > _ > {E[;ijmrt.41i3Op0,000,a SiR S1,WO, • Center ACE, yengn'Itssyrancs,Cympsny.'` _.� > Panay vobec WLR G678182,0(AZ) =3 Eft flV Date:03,'011202! Expiratian 00 to 03101,1022' %Cacr7er Nei t Union Eire Insurance Cmmpeny Pr,4iay Numfrer 3fWC W'7259*01MA) ' Ezpirztton Date's0��Q3#2022 � . > t}umt , ' S!R 53iW.01S0<. .TX Emp.16yers XS in'de'mnity.. Cauht iiti unix)nsurarc�Cwm lny ° Pcdicy Numher,TNS 066999072'tTX} < - EXrattao i7>xie,tY3,'Ot12022 {Ct�umd St0 ciQD 060 ', - , �C RDA qj(70013101) - ry 2008 ACO_ RD tCt}E PORATION All fights teserved,,,' Ths.AGCiRD nai»e and lvgrs ire regist6red rtiarl s,of AC6RD , AGENCY CUSTOMER ID: CN 101642069 LOC#: Atlanta ACDORIX ADDITIONAL REMARKS SCHEDULE page s _"Of` 3 AGENCY t4AMED INSURED MARSH USA;INC_ THE HOME-DEPOT,INC. I!f, DEPOT U.S.A:'.INC. POLICY NUMHER -245 PACES FERRY ROAD BUILDING uYF ATLANTA,qA 30339 CARRIER N€aI£Gt70E s EFFEGTIVEI7AYE: - . ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER, 26 FORM TITLE: Cerfificate of Lia�uC�nce SIR:$1,u�0,OD0 •HOMEDEPOT INSUREDS— lbe Hoane Depot,Inc. Home Depot U,S.A:,Inc. Home Depot USA,Inc.dba TN dome Oppet 'Nome Depoldf.Puer c Ric%Im. Marna Depot_rror3u;xA-11mrity;uc Home DEpot:Store"Srppott,tnb. Fad'Nacony LLC Home Cop6t U.SA,bir.dba The Home Depot Pro inter:Ine sends „ Ssnieft Hardware Express: Reran. _ - 'Rdi�=t�na{�c�JSA ReriovagonsPI'S SuPeply�Woft zo Taysn016911e8 H U:V.L Iding Company,Inc Asktiity:Inc. ACORD 141 (20081{01). Q 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo-are registered marks,of ACORD Wbrk,6re CERTIFICATE OF .Compev ' onNYS WORKE'eWCOMPENSAITION,INSURANCE COVERAGE 19,t.egat.Name&Address.of'insured'(use street address only) Ib,B1 lsines'TeieAhpne,Numbprof.insured Horne repot USA,Inc. 770-433-8211 2455 Pads Perry Rd.,C- 0 } . Atlanta CA 30339 1c:NYS Unemployment insurance Eniployar Registration Number of insured 764f'1930 ort Locstlon of Insured(Only required if coverage is specifica;ry fliriiej fe 1d..Federal Employer-Ictenfiiic tion Number of insured or ac ai Sec iri,y certain locaifons in New York state,f,e.;a wrap-Qp Policy) eNumber - 4 58-1853319 2,Name and Address of Zntity Requesting Proof of Coverage 3a:Name of Insurance`Carder #Entity Beira Listed as the Certificate Holder} i Town of Southold ei v H Nampshire'Insurance Company i 53095 Route 25 3t},Pelicy Number of Entity Listed in Box"1 a" Southold,NY 11971 i WC 05824020$ 30,Policy effective period' . 03101/202.1. to. 0310112022 13d.The Pmpri€;tor,Partners or Executive Of5cers are �✓ included,(Only rherk box if all pannam af`t�ers i6duceii) i all excluded or certain partners!aff cern excluded. 1 -This'certifies that the insurance currier Indicated above in box"3"insures the business referenced above in box`'1 a"for woe-ers' compensation under,the,New York State Workers'Cornpensatloo Law.(To use this torch,Newyork( Y)must be'listed under Mrtr.A ort the INFORMATION PAGE of the workers'compensation insurance policy). The insurance Carrier or its licensed argent,will,send this Certificate.of Insurance to the entity listed above as the,certificate holder in box"2" The insurancOlIcarrier,must notify-the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled clue to nonpayment of premiums or within,30 days IF there are reasons other than nonpayment of premiums that cancel the policy;a elim Mate the insured from the coverage indicated on this Certificate. ("hese notices may be sent by regular rn6il.)Otherwise,this Certificate is valid for one:year after this form is approved by f he insurance carrier or its licensed agent,or until the poticy expiration date:listed in,box"3c',whichever is earlier: This,certifi* to 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 an rights or responsibilities-beyond those contained in the referenced policy. This certificate maybe used as;evidence of a,Workers'Compensation.contract of insurance,only+&rhife the underlying policy is"in effect. Please Note; t.Ipon.canceflation of the Workers'compensation policy indicated on this form,if the business continues to be named on a permit,license or contract ssued by;a certificate holder,the business rnust proyide that.certificate holder with a.. ;neer Certificate of Workers'Compensation Coverage or other authorized proof thatthe busiriess-is complying with the; Mandatory coverage requirements of the.New York State Workers'Compensation Lair. Under'perralty of perjury,I certifry+.that i am.an authorized representative or licensed agent of the insurance carrier.re'ferenced above and that the.named insured has the coverage as depicted on this form. Approved by: Michael-Price (Print nana,ot of insurance earrier) 02/2%/2021 e Approved by., (signature) CEO North America Title.- , '+4lephone Number of a6thorized°representative or Boer,sed,agent of insurar ce carriar: 212-770-7000 Please Note:Only Insurance carriers:and their licensed agents are-authorized to Iss€se,Porro C-105.2;Insurance,brokers are tdQT authorized to issu,01t. 0 .2; -9.1j Mww.wcb ny gov Workers' compensation La Section 57. Restriction on'is"sue of permits and the entering into contractsunless compensation is secured. 1. The headof-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 involvitig 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 peirriit 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 provides by this chapter. Nothing herein,. howpver, 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 lava t6 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 authomi irig any such,contract, shall not enter into any such contract uniess proof duly subscribed by an insurance carrier isproduced in a form-satisfactory to,the chair,that compensation for all employees has been secured as provided'by this chapter. C-105.1;(0-17),REVERSE CERTIFICATE COVERAGE DISABILITY ANDPAID 'FAMILY LEAVE BENEFITS LAW PARTY.To be completed by Disability and Paid Family Lieave.Benefits Carrier or Licensed Insurance Agent of that Carrier 7a.Legal Name=&Address of Insured(userstreet address only) b.B siness'telephone ftmber'of Insured THE HOME DEPOT U.S.A.,INC. t N55 PACES FERRY ROAD NW 770-384-2215 ATLANTA,GA 30339 ie.Federal;Employerldentification Number of Insured or Social Security ;Number Work Location of Insured(Only required if coverage,is.specitfosily limited to certain!ovations if,New Yorc State,;.e,,Wrap-Up Policy) 2.Mame and Address of Entity Requesting Proof of Name of Insurance Carrier s Coverage(Entity Being Listed as the Certiffcato,Holder) I TOWN OF SOUTHOLD. HARTFQRD LIFE AND ACCIDENT 53096'Rt U.TE 26 3b Pollcy Number of Entity Listed In Box."Ia" ; I SOUTHOL O, DIY 11971 LNY713657 c Policy effective periost 01-01-2021 trs 12w31=2021 4,Policy provldes.the,foliowing benefits: Q A both'disability and paid family leave benefits. B.,i lsability benefits only. C,Paid family leave benefits only; fi J=folic:y:covaf'S: X All of the empioyees,empioyees eligilile,under theNYS Disability and Paid lFamlly Leave Benefits Low. B.Only the following class or classes of employer's empioyeas: Under penalty of perjury,l:ce Ify that l am an authorized rspresentative or licensed argent of the Insurance:carder referenced above and that the named insured has NY$$Disability And/or Paid.Family Leave Benefits insurance coverage as described above. I ,Dato Signed 12.07-2020 r&oi (signature of an,.uranca carr204'3 authorized ropresentativo or NYS Licensedtnsuranco Agent of that'insuranae;carder) Telephone Number (212)553-8074 Mame and Title:Elizabeth Teito—..'assistant Director,:Statutory Seniices, IMPORTANT, If Boxes dA and SA are,checked,and this ferret Is signed,by the insurance-caidees authorized representative or NYS Licensed Insuirance'Agent of that carrier,this certificate is COMPLETE, Mail it directly to the certificate holder.. If BQxAB;4C or 513 is checked,this certificate is No,r COMiPLETE for purposes of section 220,Subd.ii'cf the N'9`B, Disability and Paid Family Leave.Benefits Law.It roust.be mailed for completion to the Workers'Compensation Board,Plans.Aceeptahce nit,PO Box 6200,l3ingharnton,NY!3902J5260. PART 2:To be,completed by-'tho NYS WcIrkers'C49rr pAnsa ion Board(only if Box ac,or 5B of.Part 1'has beers checked) State of New York Workers'Compensation Board According to,informativn maintained by the NYS/!/Workers"Compensation Board,the above-named employer has,,cgrnptied with I the NYS Disability and Paid Family Leave Benefits Lava with respect toall'of his/her employees. Date Signed B (Sigmture or Authorized MY5:Ydorkers';Campoosarion Board Ernooyee) Telephone Number'.. fume and Title Please Note,Only,insurance carriers licensed towrite NYS disabilify.a d paid faintly leave benefits insurance policies and NYS llceused.lrr�urrance agerffs of those insurance carriers are authorized M71ssue Form DB-120.1.insurance brokers are NOT authorized to issue this form. DBA20,1(10-17) �( I RECEIPT T . SUFFOLK COUNTYGOVERNMENT DEPARTMENT T OF LABOR,LiCENSING,,AND CONSUMER APl4,�li�S COMMISSIONER'ROSALIE DRAGO P,C, S0X.6joo,HAuPPA,3Gl ,W 11788 X631)863-466th • Today Date. 16122120211 Application:. W63429 Application Typet Home improvement License Y LL __•w- Receipt No. 414'174 Comments paymentt�tho Rei.Number Amount Paid t?ay�raerlt Data •CaslileC'1D €t Cheek. eneWal+ 14,At1'ditiOnal, " r. �1;80t7,t}t} 1012212020 GAB �voatioT�s (}pp3181507 Contact ingcr: HOME I SPOT USA 1NG.{14 SUPPS) RlvHARU TOUSEY pts S'oX'i05451 r: ATLANTA,GA,30348 w0th Deacriptlbn. 3 fr suWolk county, lDePt.0� Labor,Licensing Ctansumer Afairs HOME ImpROVE EAT LWENz E t Name RICHARD 'iOU, l Sus;�te�s Nan°ss This.certiii+es that the HOW D'EplT itSA INC(14 SUPPs) bearer•is dWy ti unsed by the COWRY of suf(c t icanse dumber:H-6342a 4 r Rosalie Drago issued: t} 6612 1 Gomraisslon Expires: i9t}4:222 3� N t � as 7107ED AS NOTED DATE: B.P.# FEE: BY: NOTIFY BUILDING DEPARTMENT AT 765-1802: 8 AM TO 4 PN' FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF SQaOLD TOWN ZBA L PI.NG BOARD SVAGW-TNJSTEES N�'3DEr '.)000PANCY OR USE IS UNLAWFUL MTHOUT CERTIFICV OF OCCUPANCY The Home Depot -*Thermal Value of Products Manufactured by Simonton P* g4A M LL ` f ^ ��;,�s�ax"���h!�Vsfrj n„� 21 Awntng�' •` 850�:Base _. ,_. ...< ro5otar_ ... .,,.,,,.�i�etti?BPt.,.,.,�7s, ..,0.26 0,23, � �` a" ,0 2G.,�.%0 2 �� 6' csTf Casement r... 6600,Base [?roSolar= 718" Q2& 624" m e a 026 0 ® Ai o� A ......., ,.-.,ProSStar., r n . o�6�e 9 &500:Bese 0 29,. >fl b > , r PicturetwffiotfuA!l ij... Z i?ane $:oder 8500 Base:.__..... olar,.. . SueicgESt 71 " ,0 290, 029 23 3flanet;uliders ,._.p._., 500ase1slSgft):. . F±roSolar PP.t..._--7Jsafi .x;29`,{ G.artietropr(CI 8500'E e n :afar-" - 1?1nxSalartxUPf .<.-.. r�4�PeIS{��..•, .. , afio MINI, � rS r � b 2� 026 0 1 023 �, �: r i y F QI/!e5 Owe�Bt/BfyW�l�(L*' L'iEP'r; t12Rs, d�l4fIT[t 'IBhGR�IfQi+dfdy l2VY 11{C7C7C,Oi�rEW1ilf8�t811[1 Q ` �"� n 6 s► r 0;25, 0t,, GasetYl; 91Q0;B2se, Pro Sdtaf „ .' 718 'JAW 024.. ' �; 1127.,.,.0 2Z M s+ r �` w .n .. ". .: PctLkesbt!xtertttKPe .. �009ase Fns>Soiag « Pe._ . 718` 07 , 08 . k ? My : y 77, 6Q9:Ss <2r0;;tller: < 374 . . 30 's Nett tnferGe ,_ Q'3D9 06 ;c� _ 's 1 t • f ­11"...elo F!CUAW llrfmna, f�afi�o teYFdo, 4'�Y1 le ,0 9on;� ah,=Ahla r'ft4 Qaor:1lVbtiC x` ner .W F?ai6a D6ot�x. ARptQtJii 1=tN1E at4d;(n�Os)�8ase ., Pr Solar, temep , X14 a 28 E ,34,M ;(f:12 ,._�I ♦ t � Flotri+bslo"cf��cF.oir�,'irt�3'ol!`�►vlrt��na� D�tl'a�,t�+?°1��r3,��i,J�d{ ►,W9„�4r%!`l�jl�t�9. ��„M_1" f, �4Yri1[lg . .»q .Base,<.. ...,. ,.< i�- C-"semen 62dt3 ?ra alaF: HX3 tPcture.vVmdovOQl3ase '�8olartp ._. . A , " _ . _d Vii, LOW 2W,. ,,:,,�s kc.011 in te,�3icte� C2Qf �ase w. auto SS ar§M .. .LQPOrG*Mf. «` 3>Panel,Shisr ,y6209':Bass U,.. .>,..... ... .. <F' i Salary. > SoPp ,,,.: 4" .'U"$_ 0 . �. + . - hi e�f'a •t � s t��`an e�s:� AWnin9-, _ r:..,.., a 300VL Vie, ac 'S SUt`IIL nit' rid t 26 29 �+ + ,•► t3.213 9 + ;_. r ase enl l]oi1l�t Hung; +`300VL;base_._ ... ,..,,.. l mf $II�IQFB+'i?VVVL ,F'attbxCfdbr �v�+�00VL�T{��,>, ,;1?S;Sttade,�t..�►t �'utSeF�r� xK �6 d�49 �r � � ,'�� ,3;' mi S r 1.; 1k0t2a 0 635 : y Garen poor C SBS 300UL -a? Pot�dt eEr�ergySfar esTforfha zone w.•, w, j 'Please Note:Simonton .. . . requirements . order. WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-1X3WBL4C Sheet: 1 of 2 Customer: christina idarecis Job#: 1-1X3WBL4C Consultant:.'Adam'Friedman Date: 10130/2021 New Window - Existing Window Hinge Locations Measurements, Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,R or S Glass 'Hardware Misc Items Screens Code For doors use oLC a w 2> 3c Mull "S"=stationary o r StyleWraps "X"=operating Room FloorCode (Y/N)" Style Code I Series Code S ° .S c > FULL SCR,STD,White, WRAP,LSR 1 KITCH 1st S8-DH Y;� DH 6500 WH WH 28 s0 78 S,, WH,W- PR' TOP 2 2 GlassPack:Standard GBG H FULL SCR,STD,White, WRAP,LSR 2 LIV 1st SS-DH Y DH 6500 WH WH 28 50 78 6, s., WH,W PR TOP 2 2 GlassPack:Standard; .Z.GBG H FULL SCR,STD,White, WRAP,LSR 3 LIV 1st SB-DH Y DH. 6500 WH WH 28 50 7S S ��. WH,W PR TOP 2 2 Gla ssPack:i,Standard ,...GBG H .. . ]FULL SCR,STD,White, WRAP,LSR 4 LIV 1st SB-DH Y DH 6500 WH WH 28 50 78 S, WH,W PR -TOP 2 2 GlassPack:Standard GBG H FULL.SCR,STD,White, WRAP,LSR 5 ENTRY 1st SB-DH Y DH 6500 WH WH 28 50 78 S„ WH,W PR TOP. 2 2 TMP:Full; GlassPack: �., GBG H, Standard FULL SCR,STD;:White, WRAP,LSR 6 HALL 2nd S8-DH v DH 6500. WH WH 24 42 66 S-, •_•~ WH,W PR: TOP 2 2 TMP:Full, GlassPack: GBG. H Standard _ _ FULL SCR,STD,White, WRAP,LSR 7 BATH 2nd SB-DH Y ' DH 6500 WH WH 24 38 62' S., WH,W PR ±TOP22 TMP:Fuil,Obscure GBG H Glass:Full, GlassPack: Standard FULL SCR/STD,White, WRAP,LSR 8 BED1 1st SB-DH Y DH 6500 WH WH 24 42 66 S, WHW PR 2 GlassPack:Standard GBG H SPECIAL CONSIDERATIONS: 1:White,2:White,3:White,4:White,5:White,6:White,7:White,8:White - Wrap Color Interior Casing Type Bay or Bow window: Seatboard material(vinyl only-Birch or Oak) ` Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(inches) 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: T eatboard Material(vinyl only-White Pionite,Birch or Oak) WINDOW SPECIFICATION SHEET - Spec.Sheet#: ?,-1x3WB'L4.c. Sheet: 2 of 2 Customer: christina idarecis Job#:.1-1X3WBL4C Consultaflt:`Adam Friedman. _ Date: 10/30/2021 New Window Existing Window - Hinge Locations Measurements Grids Product Options Labor Options From outside, Leff to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items -Hardware Code Screens For doors use " c c _ m :Mull' "S"=stationa ac o .:vE - c. m c o c N or Style Wraps .c .� r Mn o a�'' "c S •r°r "X"=operating Room Floor Code (Y/N) Style Code Series Code = w 3 = F� of tj a. ' J j _ °� j xc FULL SCR;-STD;White, WRAP,LSR 9 BED2 1st SB-DH Y DH 6500 WH WH 24 42 66 S,, : WH;W PR TOP 2 2 GlassPack:-Standard GBG H - SPECIALCONSIDERATIONS:: 9:White -. ... Wrap Color Interior Casing Type Bay or Bow window: Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) i Top of window to soffit(Inches) 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: eatboard Material(vinyl only-White Pionite,Birch or,Oak)