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HomeMy WebLinkAbout47138-Z Town of Southold 6/4/2022 ao Gyp P.O.Box 1179 N 53095 Main Rd oy o� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43120 Date: 6/4/2022 THIS CERTIFIES that the building WINDOWS Location of Property: 1375 Third St.,New Suffolk SCTM#: 473889 Sec/Block/Lot: 117.-7-12 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/9/2021 pursuant to which Building Permit No. 47138 dated 11/23/2021 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: window replacements to existing single-family dwelling as applied for. The certificate is issued to Masone,Karine of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED VU-11 ozu gnature i i �o�seFFoi,r�o TOWN OF SOUTHOLD �y BUILDING DEPARTMENT N TOWN CLERK'S OFFICE o • SOUTHOLD, NY y�ipd* has 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#: 47138 Date: 11/23/2021 Permission is hereby granted to: Masone, Karine 336 32nd St Lindenhurst, NY 11757 To: install window replacements to existing single-family dwelling as applied for. At premises located at: 1375 Third St., New Suffolk SCTM #473889 Sec/Block/Lot# 117.-7-12 Pursuant to application dated 11/9/2021 and approved by the Building Inspector. To expire on 5/25/2023. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO-ALTERATION TO DWELLING $50.00 Total: $250.00 B ' ding nspector OF SO(/l�o TOWN OF SOUTHOLD BUILDING DEPT. �ycou765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [` ] INSULATION/CAULKING [ ] FRAMING /STRAPPING FINAL tom'-50� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION- [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: b Fc� CaF DATE INSPECTOR FIELD:INSPLCTION'REPQRT'. DATE CONN NIS FOUNDATION(IST): y ------ ---------------------- -- C .FOUNDATION:(214A).,. ' H ROUGH FRAMING 8 H 1 PLUMBING. . INSULATION.PtR.N,., . y. STATE ENL+RGY CODE' y-Zz-lZ FINAL ADDITIQNAi,CdM1VIENTS:` �ro . 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://www.southoldtownny.gov- Date Received APPLICATION FOR BUILDING PERMIT 1_0 4 F r Office Use OnlyA E C f PERMIT NO. b C Building Inspector: ® I L'� Nov o 9 201 Applications and formsut be filled cuintir entiretylcorrp[ete applications will not be accepted 6 Where the Applicant i not the owner,an BUILDING DEPT. wner's Aut[sortxat�an€enn�Ra �2j shellbe completed ' u TOWN OF sOUTHOLD Date: 11/1/21 i�WlVti' �QFR1tQPERTY � o ... , . a., 000s Name:Karine Maone SCTM#1 _ _...._.,.._......... _.... _..... _._.__.. _. ..__ .__.._ ___ .•rr...�.. ., _.. _..... Project Address: 1375 Third St. Phone#: 631-4-55-7042 µ _ _ Email karinemasonecounsehng@'mall com Mailing Address 1375 Third St. New Suffolk, NY 11956 CbNi'ACTPERSON Name:Scott Doughman - Go .Permit A mm Mailing Addressuttall .Gury 105 BonbLnlastonbC _ _..... _ .... ......... _..... __...._. ., T 06033_m . _ _.�... ._ .... .__... _.... ........... Phone#:303„-946-8685 Email ermits o ermi#s.or � m_ dslenl sy>lQr ssloluA.loll=tnri� ralv' ti 3 e E Name: Mailing Address: Phone#: Email: ONTiAAC1t�R tNl`ORMATIQN. Name:Home Depot .M_ . Mailing Address:2455 Paces Fer Atlanta, 33 rY Rd ta ta, G 039_.. __. . _ .__ ._.. .... .. _...m._.,.,.._.__. µ :..._...... Phone#: 303-946-8685 _. _ ....e.. _ _.. Email. permits@gopermlts or9.. .. ._._ ..e....__. �__._ iCSCRIPTION Qlr Ply©I,OSED CQNS'f Rll�`rloN, ; ❑New Structure ❑Addition ❑Alteration ©Repair ❑Demolition Estimated Cost of Project: ❑Other $ 2180 Will the lot be re-graded? ❑Yes ©No Will excess fill be removed from premises? ❑Yes ®No 'K4.V'ti fJV si, n,� e� +(�f`aP`o ems. a w�ti0�OwS S a ,ate vAaa" ¢, a.:s *M •sa n$, k ? _9 .; - m , a OPENSER R BULMER p i NOTARY PUBLIC CUP':_FORD COUNTY,NC My Commission Expires 6-24-2022 ..�.� 3715 Third a. F 1 j 1fi�* � "C M e�aaL4 9 DATE:(-AM1DDrNYY) ACC;)ACC;)Re CERTIFICATE OF LIABILITY INSURANCE ost��;a.Q�e THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER..THIS CERTIFICATE'DOES.NOT AFFIRMATIVELY OR NEGATIVELY A E Di EXTEND OR ALTER.'THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE,OF INSURANCE GOES NOT CONSTITUTE -A CONTRACT BETWEEN THE ISSUING INSURER($), AUT14ORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDEN. IMPORTANT: If`the certiflcats holder-is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions.or be endor sats. If SUBROG'ATiONI IS WA,IVED,-sublect10 the terms and conditions.of the policy,certain policies may,require an endorsement. A statement on this certMcafe does'not bonfer ri hts tri the Certificate holder in ko of such endorseTent(S). CONTACT PannuC nA�11r MARSH USA,INC. PtteNa FAX TWO ALLIANCE`CENTER 3560 LENOX ROAD,SUITE 2406EOB%iL ATLANTA,GA'30326 _ i?dsuREWt(s�AFFoftRINGCov_ERAGE MAIC# CN101642069-Hamel)•GAVL-21-22_J _ W INSURER A Old Republic insurance Co 2d14I INSURED19399 "THE HOME DEPOT,INC: �NS{IR i�a AIU lnsuranca Ca HOME DEPOT LLS.A.,INC. INSURER c HnnieRlsk Cao ive insuiance Co R`any_.._..__ I 2455 PACES FERRY ROAD" I NASUIILD!NG w-2l) INSURERD V,4_ w_ .� _ ATLANTA,GA`30339 INSR�E INSURER F4 COVERAGES CERTIFICATE NUMBER: ATL 05314714-01 REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEL40Vi;HAVE BEEN ISSUED TO THE,INSURED.NAMED ABOVE FOR THE`POLICY PERIOCY INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUER OR,MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DSSCRMSED HEREIN IS SUBJECT TO"ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF.SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID.,CLAIMS. SRtAODL SUBRi POLICY EFF I POLICY EXP- Lr` TYPE OF INSURANCE POLICY NUMBER �(-M 'Db�)? hiwo NYYYY LIMITS A j.X'#COMMERCIAL.GENERAL LIABILITY I+At�iZY314574` 1031010122,9?:01i2019 EACH O Ci1RREW E S 1000�u(I t CLAIMIS�7vlADE' �OCCUR 1 X S1R 51000004 MED EXP{Any one pee EXr DED I .,.... _ i _ __::.:.,: (..... PERSONAL&ADV INJURY -1,OC'L1,_O7 GE'J L AGGREGATa.LIMIT APPLIES 'ER: e GENERAL AGGREGATE .� � � 2,000,000 L POLICYaJPRO 'U-Ir-Irjf" C I I PRODUCTS.COMP,OPAGG PRO OTHER: A :AUT06t7HlLELIABILITY Iv1WT631�573' u3,0i112019 03i01J2022 COMBINEDSINGLELIMIT a 1000,000 pled acrldantj. X�A Y AU rO i BODILY INJURY trier perew) OWNED SCHEDULE 3 SELF INSURED AUTO PHY DMc 1 - AUTL7:;:1NLY? AUTOS. I ' 1 rSOOI�Y INJURY(Pa ax-iiI.IM .q - j +�{ }ItIRrl7 �NON-OIJNED ] ' �i PROPERTY TJA'LiAC t_....,. 51 AUTOS ONLY ,AUTOS ONLY y � .. � __._.._.1.__._- _._ ..,..._ ..._.... II II I aced ri 5 I $ s UMBRELLALIAB } EACH Il ESCCEBS LlAe 1-7 CLAIMS MADE A1.GREGATE DCI3 - RETt N ION 9 , 1 1 [3 B" f WORKERS COMPENSATION � i 1fiJG 51320269(WI) 930112021 j 03.0 V2022 - X, I PERAND FMPLOYERS'LIABILITY (3 i B I hNYPRGPRlcTOR'PAR1hER3EXcCUTIVE WLR C6781825£'(NC,VAI 20$10112022 H _R 0001100 1�1'N ', s O'??11i02I 030112022 OrFICEiZMEF1B REXCLUO£D? N NIA fCIDENT S (Mandatory in NH). �; E L DIS ASF I A ?I LC}Y EE 5 000 000 aI ras,describe under 1 i Continued on Ado tonal Pae ___. 6,000,000 r�0 C I DESCRIPTION OF OPERAMO�lS be[.,, E:L.DISEASE-POLICY LIMIT S, A IExcess GerleralLlabiYiy M4'1ZX31458(t Excess Auto 1 ;tli3ti112i121� 03191"2022 �� 0310112010 03101"2022 Limit: 8,000,000 DESCRIPTION OF OPERATIONSi LOCATIONS"!VEHICLES IACORD 191,Additional Remarks Sraraduio,may beattaehed N more space is requ:radl CERTiFICATE`HOLDER IS:INCLUDED AS ADDITIONAL INSURED IF REQUIRED BY WRITTEN CONTRACT ON THE,ABOVE.GENER14 LIABILITY POLICY:BUT ONLY IJITH RESPECT TO LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED, 1 CERTIFICATE,HOLDER CANCELLATION T01'V'N OF'SOUTHOLD. SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53005ROUTE•25'- THE EXPIRATION DATE THPOEOF, NOTICEWILL. BE DELIVERED IN f PO PDX 11779, ACCORDANCE WITK THE POLICY PROVi510NS. � SOUTHOLD,NY 119141 AUTHOM?vDREPRESENTATIVE C 398s.2w6 ACORD,CORPORATION. All rights reserved. AC6RD 25(2016103) 'The.ACORD name and logo are registered(narks"of i,CORD r , `� AGEt�GY,CU5Tt3�llEft"it9: i✓�33;0'16A�2069., < : Atl�ihW + ® � � ICH :.� Page: ,o 3 < MARSH q5A iNG EP INCL THE�fOME D n<.. < • HC'PIEDEPOTU ;Ji,,)M, �oucir�rvu>�aeR• 345$PACES FERs�Y ROAD ATLANTA,CA EFPI C I1VE SATs:. ADDITIONAL REMARKS THIS ADDITIONAL'REMARKS FORM iS 1�SirHEbI3LE'70 AGORCB' C1R@ily 2 Cei�ifi,�ato>ofa ibiC +Insanee:< _ FORM I UMBER ` i tfRmiITLE � = '�orJ<ara Cars)�eif�trmr Cortf#nuer! . .° .. ,> ; Ca�iarl{nSa� l,�yinsur��Cam�aayd(tawthAmerc�a < PolicyNumtgirWLRW825287(AL`,AR;Fr IDtA,.KS,KY,LA,h1S,MO,NE,hN.NQ,OK,SC,SCTN4r1';h'Y,). `< EtFes°'ye Qaik,' 1074021 E.zpiralibn De1�0310113022 ,. .< ' (EQ L.wlt;3.5,OQ0 U40 Pricy Numbea NiC 532 11268 (AK;QC 13E NI W,MD;MN A47AY;NJ NY,Rt,VT).. -. ECtive Da1e;;03101170�1<°, F. pimWn,Qatei.03411'2022:: �< A)Limit .QOM{ Gamer ACE Aliiercan Inst+ranca Gomp�y , P6 icy Ngri am WCU C87805331(QSt)(GA tL,OR 1Yi1) ' Et�glva C1ate:0�,'41rz02i , - _ ^, Evtia-on©ate'03101022: (EL)Umit$5,M0.UOD 5[Ri Ge,{xter,National Union Firelr�urance Ccimpary Pricy Numt r:MYC 1647256(Qi I)(CO;CT GA NE,t�ll,yV,ON,PA,t11) Et�cavaQmf�03t0112t)zs:'. <, �,� • _ . < �. . - (E3:)Limi1:5�;00D,000 =. s ,.• .;.� -SIRS(CT) 35t10{1B � y"st�(aa),�7;�;Dora ` � • ^ .. _ Cerner ACE An dean'f,surarrcv Ubm Pa.n ,y. Pillcy Numi�r:Nh.t7 CJi78i82 0(A2) ^ .EflECttv@ Wat6::D3,'01)2433i° ^ _ E pirakn Qate:03,,=AOb 26 °(EC:j Umit:$5,U�0 0{(0. • < . . < . < C6rrter-Nat ariatUmon Fre Iawanoe Company < Pd4 Numher;)y`JG 1847259{i3S1) E6it 11 ie Qata 03012021 Exp hgon Date!,0310112022+ �E J Umtt4 500,OD0, • S!R'e�il0,Ct90 . . TX)Eanptoyars XS InCemnity. ,, , ' '�� Carrrer!lliraosUnic�ttnstismtCeCompdnyi _ Y Pplcy Numtrer-CN5 686949072(TX) Efface Qar„03J712r321 `J r2iibn Uo :03a0112t122 (El)Umrlu1a,000 < , < V.1008 • AC01 D 40l-{2008I01} •,, ;�' Tlie ACC1R0 name�ns9 Io�o are t�gis�er�c3 ars of;4�C7kDGORD"GORPt3i2ATIt3N AR�rlghfs rEieroesl: , a < AGENCY CUSTOMERI : C 110164206 WC Atlanta ADDITIONAL ULA p of 3 'kqEMCY USA_itC- THEROME DE-POT. ,INC. HWE OEPOT U.S.A.:INC. i}aCICY 3!l 9a R 2455 FALCES R Y ROAC7 ATLANTA,GA 30339 CARRIER' i ;AbbITI€NAL kEMARK'S. THI&ADDITIONAL REMARKS FORM IS A SCHEDULE TO Acmb oRm., ORNUMBER' "VOR'M TITLE: .Cerlificate of Liabsli$�nce .,.:;�� �B;r�i3T tNsi�i�iri�sx•r. ° ; a � u: .A:,Ino. Hom4Uzpot U-8A,ono,ba ha Homer pat < Home MW Of Puettq gpl!ni.' H14 Gepat rm 4AAu9rority,111- Thk Nome Moot Pro . Wx-dine Brads . ftdyMreE West >A�.�harsr+n JCA AR n0vatons Rus u 'ck° - 1 �Ar�itter ° " �p Tethi�o'royeS ` - N;)�Li.Hei�I�cg Gompary,inc,_ _ . As6ty,(no. z ° , < , . ° • . lI8io1t. 02008.,APOWCC)RPt7RATION, All.rl.gt" reeetwd. i` The;ACORD name'and"logo arb registered maks of ACOR ' T 'TE OF � . NYS WORKERS.' COMPENSATION INSURANCE COVE 1 a.I.egal,Name Y Address of Insured(ase,street address only) 1 t3.Business tetephone;Number of Insured I Horne Depot USA;Inc. 770-433-8211 2155 Paces Ferry Rd.,C-20 Atlante,,bA 3033g1c.N'H'S UnempioymentYnsuranc€:ieniployerRegistration Number of I Insured 7&01.1'130 Vkrk Location of insured(On4;required if coverage is specificat;y hmlled o 1 d.Federal Ermloyer Iden ti ication,Number of insured or Social Security certain locations in-Nesv Yo&Stato,Le. a WrwiJp Policy) Number � 5$-1853319 2„Name and Address of Entity Requesting Proof of Coverage y Iia:Name°af'I isisranco carrier , fEntity Being Listed as the Ce°tiflcato;folder} Town of SoutholdNow Hampshire Insurance company 531795 Rbuie 25 j 3b,Policy Number of'Entity Listed`in Box"I a`' Southold,NY 11971 SNC OS 240268 3c.Policy effective period 03101/2021: to, 03/61112022 1,3d.The Proprietor,Partners or Executive dt--kers are included (p ly check box it Bali rsartnt�ts:a Waw-incltci o} i all excluded or certain partnerslofficers•excluded, I 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 Workers'Compgnsation:Lsw.( "o use this form,Now'York,(NY))must be listed strider(tor $A owthe 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-certif~'cate holder In box"2". The'insurange carrier,must notify the above certificate holder and the Workers'Compensation Board within 10 days IF,a policy is canceled due to nonpayment..of pret�iums or within.30 days IF there are reasons othecthan nonpayment of premiums that cancel the polis or elirriinate the insured-from the:coverage indicated on-this Certificate.(These notices tray fie sent.by re0plar Ismail.)Otherwise alis: 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"',whicheverisearlier, This certificate is;issued.as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend nraltar`ihe cbverage afforded by the policy listed;not does it confer any rights or responsibilities'beyond.those contained in Ithe referenced policy. °`i'his'certificate rnay'be used as evidenceof a Workers'Co pensation;contract of insurance only while the underlying policy is in effect. Please(dote: Upon cancellation of the Workers'compensation policy,indicated on this-form,if the business continues tn'be mimed on a permit,license or contract issued by;a certificate holden,the business must.provide that certificate holder with a ,neer Certificate of Yllorkers'',Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements ot`the New.'lrork State Workers -Compensation Law. Under penalty of perjury,JLcertify th'at'f.am an authorized representative or licensed agent of the Insurance carrier'ret'erenoed above.and that the named insured has the coverage as depicted on this form. Approved by: MichaelPrice {Print nam.0 of eafthori7,ei of 04ranse,�agent orinsurance oarriej I , a 02127/2021 {signature} Title; CIrO North America, 212-770-7000 I Telephone,Number ofauthorized,representative or licensed agent of insurance carrier: f lease.Note:Oinly,insurance carriers.and their licensed.agents are authodzeOto issue Form C-405.2 insurance brokers-are. QT— autorized to issue it. 'Mm, vcb:ny,tgov i i CERTIFICATE OF INSURANCE,COVERAG5 DISABILIi"Y AND PAID FAL41LY LEAVE BENEFITS LAW PART I To be completed by 01sabiiity aInd.Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal.Natne,&Address of Insured(use street address only) 1 b.Business Teleptibne Number of Insured THE HOME DEPOT U.S.A.,INC., i 2455 PACES FERRYROA[ NW 770-3$4-2215 ATLANTA,0A 3033.9 1c"Federal Employer identification Nijmber of insured or Social Security Number -Work location of Insured(Only required if coverage,is:specificatiy limited Po curtain locations ln.tvl w Yorc,state,,i.e.,Wrap-up Policy) 681853319 A.Name and Address of Entity Requesting Proof of a Narris of insurance crsrrlor F Coverage(Entity Being Listed as the Certificate;Holder) I TOWN OF SOUTHOLD � HARTFORD LIFE AND,ACCIDENT 53095 ROUTE 26 ib Policy Number of.Entity Listed In Box"la" 1 SOUTHOLD, NY 11971 LNY713657 I 3c Pollcy effective period 01-61-2021 to 12=31-2021 4,Policy provides the followiaig benefits: Q A.13oth disability and paid family leave benefits. ®B.[usability benefits only. C.Paid family leave benefits only. t 5.Poticcovers' IJ A.All of the:omployees`employees eliglble under the,NYS Disability.and.Paid(Family Leave Benefits Law. 13.tfnty the fallowing class or classes of arnplayer`s employees: Under Penalty of perjury,I certify that t am an,authorized representative baa•licensed agent of the Insurance carrier referenced above and that the named insured has NY$Disability an.01d Paid Family Leave Benefits insurance covtrage as described at ove., Date Shined 12-07-20210" (Sign9ture 2-07-2020' (Signature n;Insurance carrlves authorized representative orNYSLicensed;insurance Agent of,that insurance carrier) Telephone Numb€r (212)553-8074 Name and Title Elizabeth Tellb—Assisfani birector,•Statutory,Services impoRTANT: if`Boxes dA and 5A,are checked,andthis forma 18.signedby the insurance carrier's authorized rapresentative or`NYS Licensed lnsurance.Agent of that carrier,this certificate is COMPLETE.Mail it.directly to the certificate holder. 1f Box,4B,4C or 515 is checked,this,certificate is NOT COMPLETE for purposes of Section 220,Subd.'8'of the NYS Disability and Raid Family Leave Benefits Law,it must be mailed for completion to the Workerw Compensation "> Boarri,Pians.Acceptance Unit,PO Box 5200,Binghamton,NY 13902-5200. PART 2.To be completed by the NYS Wdrkbrs'Co ripprisation Board(Only if Box 4;or 5€3 of Parti has been checked) State. f New'York WoekersCompensatlon Board According to-informat(Q»maintained by the NY$Workers'Compensation Board,the above-named employer has..compiled with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. (Sate Signed s i 1 (Signature or Authorized MYS Workers"Compensation Bowd Employee) Telephone Number Name and Title please Nene;Only*insurance carriers licensed to write NYS disability and paid faadly leave.benef(ts 1€surance policies and NY'$ficensedinsurance agents of those insurance carriers:are authorized to issue t=ortri'04-924.1.Insurance brokers are NOT authorised to issue this form. t7B-121);9'(1Q-t7) i �1 1j RECEIPT SUFFOLK CpUNTY'GO ERNM-NT DEPARTMENT OF;LABOR,LICENSING,AND CONSUME AFFAIRS C t9N1SSI0itil R-R®SALIE DRAGQ P.�.S9X WO,HAUPPAUGE,NY 11788 't-oday mate: 10/2212020 Application: H-53429 p pplicatich 1CYpe;,Home IniprOvement Llcenss _....-� Ftt:celpt.Na. 494174Comments Payr ei�t Method Ref..NUMber lkmount Paid l Payrr ent Sete Cashier ID Renewal+ 14 Aldi 011> at Chea 00031815071,600.i3i 161224202 CAS Locaticaits a ct lrtf HOMEt7EPOT USA INC (14 SUPP8) RICHARQ TOUSEY po SOX 105451 AT'LANTA.,GA 30348" : woik CescrlatIlOn: v suftik Qounty Deut of Labor,Licensing consumer-Affa rS J HOME SMPR0VA%fiEr3-i t'_tt i MISE Name RICHARD TOUSEY r , Su�;rs:ss Na:tta Thks<rertifais thatthe n�r Cis tiui iicenset9 HoMe bEPt3T US€t SSlC j9 t St;i�PS} y by tPJts c u my of suffak liconse'Number:H-63429 ! as�lie�irago i$suedc {?vI1sP�J94 , commissSener Expires: 111 ii: n22: ,4 { f _ Home Improvement Agreement; Page 1 Home Depot License#'s-For the most current listing visit-www,,HomedeMt.com/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. 1. Service Provider Contact Information The Home Depot The Home Depot Service Provider Contact Name Service Provider Company Name (631) 478-61 Icustornercancellationnortheas#@hom17 Phone# OffeMvider Email Address Service Provider License#(s) Z. Customer Information masone I Long Island 1-1X190EEM Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 1375 third st New Suffolk INY 11956 Customer Address City State zip (631) 255-7042 karinemasonecounseling@gmaii.com Home Phone# Work Phone# Cell Phone# Customer Email Address 3.NOTICE OF RIGHT TO CANCEL 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 rfiauppauge 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 NO E OUR RIGHT TO CANCEL. Acknowledged by: 10J26/2021 ustomer's Signature Date 460 Standard Form IRA(211p1.21)(E) Generated Date qq� � Lead/POk I—IXI90EEMv 0.1.12 Home Improvement,Agreement: Page 2 4.Description 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 Approximate Start Date: Q4/24/2022 Approximate Finish Date: 05/24/20 221 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. 6.Electronic Records Authorization 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. 7. Contract Price and Payment Schedule 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: $ 12180.00 Includes all applicable taxes.Excludes finance charges.* Sales Tax: $ 10.00 (If applicable,total amount of taxes included in Contract Price) Waximum deposit ONLY applicable in MD, MA,ME(33%),NJ, WI(99116) Deposit% 125.0 Deposit Amount$ 1545 Remaining Balance$ 1635.00 S. 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, Service Provider may collect Customer's payments made payable to Home Depot. 9.Acceptance and Authorization By signing below, you authorize Home Depot to: (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 he person listed as"Customer„above;and(iv)Electronic signatures will be deemed originals for all purposes. X 10/26/2021 Customer's Signature Date X /s/The Home Depot 10/26/2021 The Home Depot Digital Signature.. Date j For questions related to your installation, contact Service Provider at (631) 478-6101 For any other concerns, contact The Home Depot at 1-800-466-3337 I I I I i .. 60 Standard Pon}IIA(21 Jul.21)(E) Generated Date 10/qro✓2021 Laad'POO - v 0.1.12 I 1 mad APPROVED AS NOTED DATE: - a B.P. FEE: BY: NOTIFY BUILDING DEPARTMENT 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 - 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 cnl ITH01 n mWN� S8 N P NNING BOARC USTEES OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICA-' OF OCCUPANCY WINDOW SPECIFICATION SHEET - Spec.Sheet.#: 1-1x190EEM Sheet: 1 of 1 r Customer: karine masone Job#:1-1X19OEEM Consultant: Adam Friedman Data: 10/26/2021 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,RorS Glass Hardware Misc Items Screens Code For doors use g/. _ E o o Mull "S"=stationary or w Style Wraps '0 d. D5 9 Cm7. $ r .m .�. ^0+ "X"=operating t= Room Floor Code 1 (YIN) 'Style Code I Series Code E ', a > z > _ 6500 WH WH 32 61 93 STD,White, Glass Pack: WRAP,LSR 1 LIV 1st SB-DH Y DH, . � � Standard STD,White, GlassPack: WRAP,LSR 2 LIV 1st SB-DH Y, DH 6500 WH WH 32 61 93 Standard J y SPECIAL CONSIDERATIONS: 1:White,2:White Wrap Color Interior Casing Type Bayor 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 materiel 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 Ptonite,.Birch or Oak) Home I! • • • • :•' e• • • • d .60g1gj A mI C D `r s • rI�CalldS M -.. 5,. 6". - �•. u��_`S �� 3� 7; �,� ��rBSS�CI�'a` �+�"� e y�-a-s���Zl � r g a ���� d- r.,-, , -s�,�t n "'•fl *-.# ', .`" r"a' dU` t k v ti .'4e i .r 6500 l&" 0 26 U Easement..:�:: 6500"Base PioSota. SapercePt 7J8 0,26 Transom; .. 6500Basei ProSolar,.. SuPereept !.,. 027 0,32 m. Q 027 029 s DouEif" 650Q.Base ProSolar5L ?/6 PgPQ29 A. Picture Casement,(N[f)`,,, 650ti"'base iroSolar`. 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