Loading...
HomeMy WebLinkAbout47084-Z gUFFOL 4-�vG Town of Southold 5/5/2022 a ya4 P.O.Box 1179 0 53095 Main Rd oy�j0� �ao� Southold,New York 11971 y CERTIFICATE OF OCCUPANCY No: 43047 Date: 5/5/2022 THIS CERTIFIES that the building GENERATOR Location of Property: 6660 New Suffolk Rd.,New Suffolk SCTM#: 473889 Sec/Block/Lot: 117.4-32 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/22/2021 pursuant to which Building Permit No. 47084 dated 11/8/2021 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 Collins,Marianne of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47084 4/19/2022 PLUMBERS CERTIFICATION DATED Authorized Signature f ��o�SUFFQt�co TOWN OF SOUTHOLD BUILDING DEPARTMENT C* z 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#: 47084 Date: 11/8/2021 Permission is hereby granted to: Collins, Marianne PO BOX 134 New Suffolk, NY 11956 To: install generator as applied for. At premises located at: 6660 New Suffolk Rd., New Suffolk SCTM #473889 Sec/Block/Lot# 117.-4-32 Pursuant to application dated 10/22/2021 and approved by the Building Inspector. To expire on 5/10/2023. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CERTIFICATE OF OCCUPANCY $50.00 Total: $235.00 uilding Inspector ®��OF SOUTyQI � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.deviin(a-town.southold.ny.us Southold,NY 11971-0959 cOUNT`1,�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Marianne Collins Address: 6660 New Suffolk Rd city:New Suffolk st: NY zip: 11956 Building Permit#: 47084 Section: 117 Block: 4 Lot: 32 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: License No: SITE DETAILS Office Use Only Residential X Indoor X Basement Generator X Commerical Outdoor X 1 st Floor Pool New X Renovation 2nd Floor Hot Tub Addition Survey 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 Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch 200A UC Lights Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches 4'LED Exit Fixtures Pump Other Equipment: 20kW Kohler Generator w/200A Whole House Transfer Switch Notes: Generator Inspector Signature: Date: April 19, 2022 S.Devlin-Cert Electrical Compliance Form m�l g �6fo5 New 5�, r v how Of SOUL plo # # TOWN OF SOUTHOLD -BUILDING DEPT. �o • �o 765-1802 y INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ]. FOUNDATION 2ND' [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY-INSPECTION [ s] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION , [ ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) ] CODE VIOLATION [ ] 'PRE C/O REMARKS: 4(3C78 o n 4- a-v4c 0� en erg¢af--- jA.(-U , tQi10 lit r d r v01) /-QI A r A2,2 S DATE 3 *23 INSPECTOR �o,*pF SOUIyo�O TOWN OF SOUTHOLD BUILDING DEPT. `ycourm?�' 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. 1 [ ] 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: �� Ptihl- 66-c-ngcoz- 66n-r.7 F3cmTc- g6ovr966 L, nF DATE of lc'`z2 INSPECTOR I FIELD:INSPECTION REPORT'. .DATE COMMENTS FOUNDATION(1ST) y FOUNDATION`(2NA). ROUGH FRAMING& . y PLUMBING 1 1 INSULATION.PER N Y. . y STATE ENERGY CODE FINAL .. DITIONAL COMMENTS ` 0 t:�, m ,. O b - r W Z W TOWN OF SOUTHOLID—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P.O.Bax 1179 Southold NY 11971-0959 Telephone(631)765-1802 Fax (631)765-9502 httns://www.southoldtownLiy.gov Date Received APPLICATION FOR BUILDINGT 1 �� For Office Use Only �, f i J PERMIT NO. Building Inspector: `� 0 C T 2 2 2021 I �� �Appficat►ons and farms must,be tilled out ti>their entirety lncom iete KTILD1TG DEEPT. app3icat�az s wii riot lae acceptedN %M1t ie the Applicant Is riot the awn s,art ''t'?F, ,'?;; xClWndvi' AUl#i;arizatroti forte dPag 2j shat!be cpirhpietec Date:10.22.2021 ®1i'iTNER{ LL dF PROPERTY d q,ate N a g Name Marianne ollins SCTM#1000- ............ Project Address 6660 New Suffolk Rd New Suffolk NY 11956 Phone#017)434-1463 Ernarl mariannecollins4@vahoo corn Mailing Address dame Chris Tyndall Mailing Address 285 Pulaski Street Riverhead, NY 11901 Phone# (631)831-8559 Email:Ctyndal!Ccommanderpowersystems corm DES,IosIV PR®FESStQiVAl.liV�f7l1MATt®hi.t` 7 „. p, dame: Mailing Address Phone##: Email: �1YT�2ACrQ1RiNFtdR4Tid� 9 .3 h. (d r� �L '. ,3 � .�f.. k Y s .Y %'',. xe�..0$-i✓ E. Name Standard Electric Corp Mailing Address 6500 .Jericho Tpke, Suite 22E Syosset, NY 11791 Phone#:(516) 499-7354 Email cbruttoCstandardeleetriccorpMCom DI:SCf$iPT , N 6 PRQP®SED CANSTRUCrit?N� � ,�� x ' � � u 4; w �:, .. e da>-,.. .."��5..k t;cs`�'J �;R m*J. '�.n ✓,e, t "F � �i°.K„� S ^<f �',. �L,,; �.vd'f, F-1 New Structure CAddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: Clotherinstall new Kohler 20 KW standby generator(nat gas) $10,500.00 Will the lot be re-graded? ElYes W No Will excess fill be removed from premises? ❑Yes ®No 1 ;;PROPERTY i4FORiWlATiON% Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? OYes No IF YES,PROVIDE A COPY. �. owner/contractorJdes#gri'profess#ona#is responsfb#e dor a##tlrInageandsto#m tivater issues as'pro #ded by ,Chapter 2 S of the Tovun Code;APAUCAT1O1Qi IS HEREBY MAPDC to the Bu(#d#ng Department fouthe Issuance of a Building pertxait plirsbantfo the°'IIuiidittg,Zone Ordinance'o#the Tdwr'o#5outttnid,5u#foitc,County+,iVesuYoikand rinser applicable LaWs;Ordinances or Regotatioits;forthe:;constfrJYcticn a#butldin s, " add#t#rens,a#teisticiris:or#nr rersiovai or derrsohtion as herein`descr14d`The appi#cant"atrees to ccrntply wiih alt apolleabtd,taws,ordinances,l%uifdirfg Co". housing etude and reguiet#ons and to admit authorized inspectoran,premises and"#n buftding(s)''fsr necessary ittspett#ons False stateiisents rriade heretn'are pun#sh bre as a C#ass,A,n#sderneattor`pur`suantto Section 2 �45 q.#fte t�ewYurk,State ettai-Ca�ti Application Submitted By(print name):Marianne Collins CJAuthorized Agent NOWner Signature of'Applicant: gate: 10,22,2021 STATE OF NEIN YORK) SS: COUNTY OFn�) � �(��n-I I I'l� being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the OVA,)Y1 r Q (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 n day of l J� C�YJ�� , 20�I t� Notary Publi TRAC Y L. DWYER NOTARY PUBLIC,STATE OF NEW YORK PROPERTY OWNER THORO O NO.01DW6306900 QUALIFIED IN SUFFOLK COUNTY (Where the applicant is not the owner) COMMISSION EXPIRES JUNE 30,2Q), I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex-54375 Main Road - PO Box 1179 Southold, NewYork-11971-;0959 Telephone (631) 765-1802-,FAX (631) 765-9502 rogerr@southoldtownny.gov N seand@southoldtownny,_gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information'Required) Date: Company Name: Standard Electric Corp ElectriclaWs Name: Calogero Brutto License No.: ME-43098 Elec. email:cbrutto@standardelectriccorp.com Elec. Phone No: (51-6) 499-7354 Oi request'an email copy of Certificate of Compliance Elec. Address.: 6500 Jericho Tpke, Suite 22E Syosset, NY 11791 JOB SITE INFORMATION (Ail Information Required) Name: Marianne Collins Address: 6660 New Suffolk Road New Suffolk, NY 11956 Cross Street: Fannin.Road:New Suffolk, NY 11956 Phone No.: (917)434-1463 'Bldg.Permit#: email:mariannecollins4@yahoo.com Tax Map.District: 1000: Section: Block: Lot: BRIEF DESCRIPTIWOF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Install new Kohler 20 KW standby generator with 200 Amp Automatic Transfer Switch(1201240V, 1 Ph) Square Footage: Circle All That Apply: Is job ready for inspection?: F-] YES Z✓ NO F]Rough In Final Do you need a Temp Certificate?: F] YES❑NO Issued On Temp.information: (All information required) Service SizeQ1 Ph❑3 Ph Size: 200 A #Meters.1 Old Meter# ❑New Service[]Fire ReconnectoFlood Reconnect Oservice Reconnect(Underground ✓[Overhead #Underground Laterals n 1 2 H Frame n Pole Work done on Service? Dy N. Additional Information: PAYMENT DUE WITH APPLICATION 0 1I 2� � a� .� � kW �� l�� 4 corkers' CERT'IRCAT'E OF INSURANC COVE G'E AIT Compensation Burd 'DISAIBILITY AND PAID.FAMILY LEAVE'BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave.Benefits Carrier or Licensed Insurance:Agent 01hat Carrier 1a.Legal Name and Address of Insured'(Use street address only) 1 b.Business Telephone Number of,insured Standard Electric Corp (516)L819-8684 Calogero,Bruno ;6500 Jerlchqtpke 41 c. Federal employer identification Number or Sociat;Security Syosset,'NY"11791 Number 20=8322723 Woik'Locati'on of lnsuied('Only�regirired ifspbatica#i timited(o:ceriain. tocotions in,NOW York Stata,i.e.a Wrap ftp 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'"'la":62310.00 Town of Southold 54375 Main Road 3c.Policy effective period.3/26/2810 to:312612021 PO Box 1179 Southold, NY 11971' 4. Policy provides the following benefits: XA: 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 ei-1ployers,empioyees..eiigible.under the NYS.Disabiiity and Paid Family'Leave`Ben6fits Law _ B.Only the following class;or classes of employer's employees: Under penalty bf 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;.Benef(ts insurance coverage asdescribed.above. Date Signed November 23. 2020 By: David M Borg (Signature of insurance carrier's authorized representative or NYS Licensed insurance Agent or that insurance carrier) Telephone No. 6318131600 Na"me and Title: President IMPORTANT: If box 4a is:checked,and this form is signed'by the insurance carrier's authorized representative or NYS.LicensedInsurance 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,forthe-purooses of Section 220,Sub.8 of the Disability Benefits Law. It must be mailed for completion to the Workers'Compensation Board, DI3 Plans Acceptance Unit,328 State`Street,. Schenectady,New York 12.305 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-i`risured employer has"complied with the NYS Disability.Benefts.Law with respect to all or hisfier employees. Date'Signed `By (Signatura'of NYS Wompre Compensation,Board Employee) 'Telephone No: Title:, Nease.i4ote: Only insurance'ceirriers licensed to write NYS disability°benefits inimaribe.polictes and NYS license insurance agents of those insurance'carriers ate authorized to issue Form DB-120.1. -Insurance Brokers are not authorized to issue this form. DB420.1 (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 7. 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 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 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 Fancily 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 forst,two thousand eighteen,the payment of family leave benefits has been secured as provided be this article. Awa Workers' tEgT FICATE DF STATE CompensAtion •NYS WORKERS' CI�MPENSA y'iOBil 'INSURANCE=COVERAGE Board lata egai Name.&Address of lnsured'(use street address only) 1b.Bwlness'Telept qqp 0 insured, {5i&)819-8684 tandard Electrie'Corp CaloBero Brutto 1c.IVY$Unemploymenttnsurance Emp►oyer.Re9istration Nurnber'of 5insured QQ Jericho;Ap i Syosset,M.11791• 1d Federal Employer ldentificat€an Number,of Insured oitoaal Security Werk Location of Insured rOndy requfied if coverage rs specilrcaily,:/1r;6d Eo Number i 20-832272 csrfain`locatibns In Ne'w•Yor'k St'ate,ke.i a Wrap-up Pakyj 2.IVarrie and Address of,Entbty Requesting Proof`®f Coverage; 36,Narne of.lnsurance;Camer (Entity 8e,ng t fisted as the Certificate Holder) P&C insurance co of'-artfor i Town of Wthold, 3b.Pblicy,'Whiber.'of Entity-Listed in 136X Ia" 54375 Main Road, I2V6'ECAC,1771. PO Box 1179 3c Policy effective period Southold,NY 11971 ;1,Z/23/2020 to 12/23/2021 The Proprietor:Partner's or U6&646 Officers afe�iracluded. ® !Only check b*ff:all O6Onerslctricers lnciuddd)all Ej ekduded:or c6dairi partneWbf9i&a s ekdlUded. 'This certifies that the insurance carrier Indicated above:in box"3"insures the business referenced above in box"1a"for,workers' compensation under,the New York,State Vllorkers'Compensation Law {Tb:use this form,New York(NY)'trust be listed.under.ltem 3`A •,ori the ihV biR mATidN PAGE of the workers'compensation insurance policy).The.;irisurarice'Carrler'otits licenseo agent w ll.send, this Cgttiiicate of Insurance to.the'entity listed 109"as the certificate hoider in box•''2".. The.insurance.carrier`must ,notify the above certificate`holder and,the Wgtkers,Compensation'Board within`10 days IF a policyls canceled due,io nonpayment of premiurns or%vithln 30 days'tF,there are reasons other than nonpayment o€premlt�riis that cancel th'e po'Ii' or eliminate the insured froth the coverage indicated on this Certificate'{These hotices.May be sent by tegular!nail.)Otheiwise,,th s certificate is valid for o" 3ne.year after this•form is approved,by'ttto insurance.tarrier or:its licensed,agent,or:until the`policy ,expiration.date listed in box c",whichever is earlier. This certificate is issued as a matter of information only a4confers no rights upon the certificate holder:This cerEificate`i3oes not'arrtersd, extend oralter the coverage.afforded,by the pohcy`Iisted, nor does'it confer any rights or responsibilities beyond those contained'in the :referenced policy. �•, his certificate rhav,b6 used as evidence of a Workers'Compensation contract of ihsWance-only vrH the underlying policy isl iweiffect. Please Note::Upon,cancellation of the workers'•compensation policy indicated on this form,if the business•continues to'be harried on a.permit;license or contract issued by a'ceriificate'holder`the business must.provide that certificate holder.with:a °new Ce'rtific'ate of Workers'Compensadoh;Cov6rage,orpther authorized proof that:the 6usiness`is complying with tE e mandatory coverage requirements,of the.New York State Workers'•Compensation t-aw. Under of perjury,I certify that I am an authorized representative or licensed a9ent p:f,the,insurance.carrier referenced. abovo and'that the.named insured,has th•e,coverage as depicted,on this form, Approved ;by:,- •Borg°&Barg inc.,`-David'.M Borg President (Print<name of authorized representative or licensed agent;'o#insciraace.carrier) ' 11/2312020 Approved by. '(Signature) (Date) 'Titie:_Authorized Representative Telephone'Numberof:author-ized representative or licensed agent of insurance carrier; 631=673=7600 Please Note:,,Only.insurance carriers;and.:their licensed agents are authorized io issue Forrn C406.2:Insurar ce brokers are HOT. authorited•to t:issue C-A05;2(9-q7) www.Wcb. ny;gov, Workers' Compensation Law Sectlan 37.Restriction 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 thischapter. C-105.2(9.17)REVERSE ACt>a CERTIFICATE OF LIABILITY INSURANCE �►TF MroD1wYrn 11123!2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADD1711ONAL INSURED provisions or be endorsed. It SUBROGATION 18 WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer dlitts to the certificate holder In lieu of such endorsements. PRODUCER Borg&Borg Inc. PHONE 631-673.7600 P"X 631-351.1700 148 East Main Street L- Huntington NY 11743 ADOMIRAM ceMcatej0bMLborg.com U191W AFFORDINOCOVERAOE "moo INSURER A:Merchads Mutual Insurance 23328 INSURED STANELE-01 INSURER a:P&C Insurance Co of Hartford 34690 Standard Electric Corp nasuRFJrc:Standard Secuffly Life Calogero G Brutto 6500 Jericho T ke. wsuRERo: Syosset NY 11791 1NSURERE: IIJBURFR F 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 13Y PAID CLAIMS. R TYPEOFINSURANCE P LIGYNUMBER POLIGYEFF° PO EM Lam A X COUMCIALOENERALLIABILITY ROPIO83694 2IU2020 2/112021 EMNOCCURRENCE $1.000.000 CLAIMS441ADE a OCCUR ISF,SyEa®otuttntroe3 $500.000 UEO EXP lAny one person) $16.000 PERSONAL&ADVIWURY Sladuded GENtACGREGATE LIMITAPPLIES PEM GENERALAGGREGATE $2,000.000 POLICY _-_J1 JECT ❑LOC PRODUCTS-COW10PAGG $2.000.000 OTHER S MO A AUiOBri.ELU18I6RY CAP1075068 2h12020 2/U2021 Ea e T $1.000.000 X ANY AUTO BODILY INJURY(Par pmaar) S CWNEO SCHEDULED BODILY INJURY(Per eoddaer) S - X HIREDOHLY UTOS X NON•OWNED P E g AUTOS ONLY AUTOS ONLY S UNBREI"" H OAR FACHOCCURRENCE s EXCESS LIM CLAIMS-MADE AGGREGATE S OED RETENTIONS $ e WORKERSCOMPENBAMON 12WECAC1771 12/23/2018 1212312020 X I'SMUTE I I RR e ANDEMPLOYERS'LIABILI Y YIN 12WECAC1771 1212312020 1212312021 ANWROPRIETORMARTNER/EXECUnYE ® NIA El.EACH ACCIDENT 51.000A00 0FFICERAIRMBEREXCLUDE07 pudawylnNN) I E1-DISEASE-EAEMPLOYEE $1.000.000 II yea deso dm undo OES ON OP OPERATIONS bd. E.L am-me-POLICY LIMIT S1.000.080 c NYs O;SR 4 62310.00 3126/2010 3I2W2021 NYS DEL. SMUOfY DESCRIPTION OFOPERATIONSILOCATIONS IVOUCLEe(ACORD 101.AddWondRomwMSdvodulo,maybe atw bodHmat*spaeolsmquhod) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELVER® IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Road PO Box 1179 AUTHORul P"RESEWATLVE Southold NY 11971 Cj J) "p /? bl' ©1980.2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD sURVEY OF PROTY NEW S17SlJyVA TE OPER `F' LK TOWN OF SOUTHOLD PJ/BAF SUFFOLK COUNTY, NEW YORK V1M WA CRA,jj0p;,gR 11. P. 'A' Tur mmemloypp,I? S.C. TAX NO. 1000-117-04-32 FRAME GARAGE iSCALE 1"=20' OCTOBER 3I, 2019 5. '1.021 LOCNTF t,4EW sTOCKAM FFNCE S W.4.,--- 14,952 s � ft- AREA q ZD r er 14840- o Ik MAMANNE COL LINS Vt. N Fj�wu Qi 0 swr D4 1"s=Mv mql wA w1lo ox-rcmos aacA"41=_ s"um, M, MCC 14.4* .1mv.1D muz W;Lvmv4�L=_�A 11D TM BP wcur CWVAYSr or MCMD t shV*o ARE 001 A'ff,mn GuAwME10. q I cv4� 0 cowl N jW rs Urttt _ nocovIc Qe OSb, 2 IImy -vxsr 10 T Nathan Tall Corwin Land SurveYOr ath8n T ` "all C" Ld Ve �j - F_ ROAD ..... PSS.W.I$ (FA NN ING ROAD) (CHARL,IE"S LANP) C� APPR VED AS DATE: B.P.# b FEE: _ BY: NOTIFY BUILDING D EPARTM NT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONST;UCTION MUST BE COMPLETE ALL CONSTRUCTI ,Pv S-10,1-1- 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 SOUTH T BOARD SWL�=TOWN TRUSTEES OCCUPANCY OR USE IS UNLAWFUL WITHOUT CER--TIFICV (JF OCCUPANCY ELECTRICAL INSPECTION REQUIRED r � l HLER. iu odeis. 2®RCA(L) Multi-Fuel LPG/Natural Gas 09®®1®1 Standard Features tiY1.I KOHLER. • RDC2 Controller NATIONALLY REGISTERED o One digital controller manages both the generator set and transfer switch functions(with optional Model RXT). = o Electronic speed control responds quickly to varying demand. z ;ri 4 o OnCueo Plus Generator Management System for remote A - monitoring is included with the generator. ; ^ 42 tz :"r • Kohler Command PRO Engine Features o Kohler Command PROe OHV engine with hydraulic valve Z.!"�'I w � �itr ' /3 �,,lu'0 lifters for reliable performance without routine valve rF q !y adjustment or lengthy break-in requirements. pz "" ; � 7 m • 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. g Protection Agency(EPA)with both natural gas and LPG. • Extraordinary Reliability o UL 2200%UL 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 Powerboost" technology provides excellent s Approved for station standby starting power.§ pp y applications in locations served by a reliable utility source. • Aluminum Enclosure __ • 20RCAL models packaged with a Model RXT automatic o lAttractive aluminum enclosure alloyvs itallaton as nsi% 1 transfer switch are available. See pogo 4 and the Model ;close as,18 inches;#rcarn„your home o small business, RXT ATS specification sheet. o Enclosure^panels can be removed without tools to allow • Warrant easy access for maintenance and service, 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 Pales 2F7 120/240 1 60 18/18 75 20/20 83 100 2 120/208 3 60 17/21 58 17121 58 70 3 2G7 120/240 3 60 17/21 51 17/21 51 60 3 277/480 3 60 17121 26 17/21 26 30 3 Note: The line circuit breaker is automatically selected based on the generator set model and voltage configuration. RATINGS:Standbyratings apply to Installations served bya reliable utilftysource.Allstngle-phase units areratedatt.0powerfactor.The standbyratinglsapplicab!etovwiableloads with anaverage load factor of 80%for the duration of the power outage. No overload rapacity is specified at this rating. Ratings are in accordance with ISO-3046/1,BS5514,AS2789,and DIN 6271.GENERAL GUIDELINES FOR DERATING:ALTITUDE:Derate 4%per 305 m(1000 It.)elevation above 153 m(500 Ill.).TEMPERATURE:Derate 2%per 5.5°0(10°F)temperature increase above 18°C(60°F). Availability is subject to change without notice.The generator satmanufacturer reserves the right to Mange the design orspecifications without notice and vhthout any obrigation or liability whatsoever. Contact your lost Kohler Co.generator distributor for availability. § Check the appliance manufacturer's specifications for actual power requirements.Consult a Kohtere Power Systems professional to calculate your exact residential power system requirements. i Meets NFPA guidelines for 18 Inch clearance to combustible materials.Check state and local codes for minimum distance required from a structure. G4-272 (20RCA) 91190 Alternator Specifications t Alternator Specifications Alternator Features Specifications Alternator • Compliance with NEMA, IEEE,and ANSI standards for Manufacturer Kohler temperature rise. Type 2-Pole,Rotating Field a Self-ventilated and dripproof construction. Leads,quantity 2F7 4 * Windings are vacuum-impregnated with epoxy varnish for 2G7 12 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 a Digital voltage regulator with X1.0%no-load to full-load Temperature rise 130°C Standby RMS regulation. Bearing:quantity,type 1,Sealed a Rotating-field alternator with static exciter for excellent Coupling Direct load response. Amortisseur windings Full a 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 fess 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 Compression ratio 8,81 Type Full Pressure 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) Cylinder head material Aluminum Minimum Gas Pipe Size Recommendation,in.NPT Pie Length, Valve material Steel/StelliteG pal Gas LPG Piston type and materia( Aluminum Alloy m(ft.) 281311,,00000 Btu/hr. 340,000 Btu/hr. 8 (25) 1 Crankshaft material Heat Treated,Ductile Iron Governor:type Electronic 15 (50) 1 1 1 Frequency regulation,no load to full load Isochronous 30 {100) 1 1/4 1 Frequency regulation,steady state 10.5% 46(150) 1 1/4 1 1/4 Air cleaner type Dry 61 (200) 1 1/4 1 114 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 i Recommended cold cranking amps: (CCA)rating for-18°C(0°F) 500 Group size 51 G4-272 (20RC/) 9119c P Fuel Requirements R®C2 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.H20): • 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 Backiit display with adjustable contrast for excellent Fuel Composition Limits'° Nat.Gas LPG visibility in all lighting conditions Methane,%by volume(minimum) 90 min. - o 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 Ont pressure C4 and higher,%by volume 0.3 max. 2.5 max. Sulfur,ppm mass(maximum) 25 max, o Battery voltage Lower heating value, o Engine runtime hours MJ/ms(13tu/10),(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 Operation Requirements all loads • Digital voltage regulation: f 1.0%RMS no-toad to full-load Fuel Consumption,m3/hr.(ofh)@ 60Ha • 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 nun every week or every two 75 6.9 (243) 3.1 (109) weeks 50 4.6 (161) 2.3 (82) o Exercise modes: 25 3.6 (127) 1.7 (59) o Unloaded weekly exercise with complete system _Exercise 2.0 (71) 1.0 (35) diagnostics Nominal fuel rating: Natural gas: 37 MJ/rh3(1000 Btulft.3) o Unloaded full-speed exercise LPG: 93 MJ/m3(2500 Btu/11.3) 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 KohierG OnCuee 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. * Lowest of 8 points measured around the generator. Sound levels at • Maintenance reminders other points around generator may vary depending on Installation a System settings: parameters. o System voltage,frequency,and phase Rr o Voltage adjustment v1��Lis Controllero Measurement system,English or metric -- • ATS status(Model RXT ATS required): o Source availability VWgo: 240V o ATS position (normal/utility or emergency/generator) F 60.0 Hz o Source voltage and frequency w Q a� • ATS control (Madel RXT ATS required): o Source voltage and frequency settings 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,Kohlers 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) RDS 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 64.272 (20RQA) 9119c KOHL Phone 9 GO.,Kohler,Wisconsin 9-164 USA NO"HLER8 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 f=eatures Automatic Transfer Switches and Accessories • Battery cables ❑ Model RDT ATS • EPA certified fuel system 0 Model RXT ATS • Aluminum sound enclosure ❑ Model RXT ATS with combined interface/load ® Critical silencer management board❑ 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 Kohlere 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 • OnCuem 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 3R 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 (a CSA approval Concrete Mounting Pads Q 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 Generator Set Size,L x W x H: 1293 x 866 x 817 mm ❑ Emergency stop kit ❑ PowerSyncO Automatic Paralleling Module(APM) (47 x 28.2 x 32.2 in.) (single phase only;parallel two 20kW residential generator Shipping Weights: sets with the RDC2 controller) 20RCA Generator Set: 252 kg(555 Ib.) 20RCAL with 100 A RXT ATS w/LG 277 kg(611 lbs.) ❑ Programmable interface module(PIM) 20RCAL with 200 A RXT SE ATS: 272 kg(600 lb.) (provides 2 digital inputs and 6 relay outputs) L --------__----- � Fuel System Accessories e ❑ Flexible fuel line(included on QS models) ❑ Carburetor heater,120 VAC ❑ Carburetor heater,240 VAC H Carburetor heater is recommended for reliable starting at temperatures below 0°C (32°F) Literature II ❑ General maintenance literature kit W ❑ 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) 0 2018,2019 by Kohler Co.All rights reserved. 64-272 (20RCA) 9/19c