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HomeMy WebLinkAbout45699-Z ��o�OSHFfOIR py Town of Southold 7/14/2022 a P.O.Box 1179 W 53095 Main Rd. o y�joo Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43255 Date: 7/14/2022 THIS CERTIFIES that the building GENERATOR Location of Property: 630 Dean Dr, Cutchogue SCTM#: 473889 Sec/Block/Lot: 116.4-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application.for Building Permit heretofore filed in this office dated 1/8/2021 pursuant to which Building Permit No. 45699 dated 1/21/2021 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 Cody,Arthur&Heidi of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45699 7/5/2022 PLUMBERS CERTIFICATION DATED 1 Auth ed gin ature TOWN OF SOUTHOLD BUILDING DEPARTMENT y x . TOWN CLERK'S OFFICE "o • 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#: 45699 Date: 1/21/2021 Permission is hereby granted to: Cody, Arthur& Heidi 630 Dean Dr Cutchogue, NY 11935 To: install an accessory generator as applied for. At premises located at: 630 Dean Dr, Cutchogue SCTM # 473889 Sec/Block/Lot# 116.4-2 Pursuant to application dated 1/8/2021 and approved by the Building Inspector. To expire on 7/23/2022. Fees: ACCESSORY $100.00 CO-ACCESSORY BUILDING $50.00 ELECTRIC $85.00 r Total: $235.00 Building Inspec pF SO!lj�ol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 2 �Q sean.deviin(a-town.Southold.ny.us Southold,NY 11971-0959 Q � onUNT`I,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Arthur Cody Address: 630 Dean Dr city,Cutchogue st: NY zip 11935 Building Permit* 45699 Section: 116 Block: 4 Lot: 2 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Laurel Lighting License No: 4718ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Generator X 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 Transformer UC Lights Dryer Recpt Emergency FixturesTime Clocks Disconnect Switches 4'LED Exit Fixtures Pump Other Equipment: 20kW Briggs & Stratton Generator w/ 200A Whole House Transfer Switch Notes: Generator Inspector Signature:" Date: July 5, 2022 S. Devlin-Cert Electrical Compliance Form ho�aOF SO # * TOWN -OF SOUTHOLD BUILD NOG DEPT. cI^ou ��' 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) LECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: all DATE �L INSPECTOR OF SOUj�°� # # TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL b�i�1 [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ]- RENTAL REMARKS: c•�- DATE INSPECTOR sCOMMENTS FIELD INSPECTION REPORT DATE FOUNDATION(IST) y FOUNDATION(2ND). Z . O c� rA ROUGH FRAMING.& y PLUMBING INSULATION PER N.Y. STATE ENERGY CODE 09 FINAL. . ADDITIONAL COMMENTS -7-lt� -�- � o _ - Z - - m r �i N °z H d b o TOWN OF SOUTHOLD—BUILDING DEPARTMENT s Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southol.d.townny.gov Date Received APPLICATION FOR BUILDINGPERMIT /7, _� r For Office Use Only 1 ' �;4 r_._ `:� Z JLI I ' PERMIT NO. Building Inspect ,J\�j, JAN _ 8 221 � .✓ Applicatiaris and forms.,rriust"be filled oiit in their entirety. Incomplete• �,` applications will not lie accepted. Where the Applicant is not the owner,an 'Owner's Authorization form-,(Page z)shall be`completed. . Date: OWNER(S)Of.PROPERTY: Name:Arthur CodySCTM#1000-116-04-02 Project Address:630 Dean Drive Cutchogue NY 11935_ _ _ ..___..............__.._. ...._,._..... ._. ._.__...,._._. . _ Phone#:516-776-4552 Email:ccod 2166 aho0 Com Mailing Address:630 Dean Drive Cutchogue NY 11935 UPAKY U CONTACT.PERSON: I" Name:Sean O'Neill .i THOUT CERTIFIC I E Mailing Address:PO Box 64 Jamesport„NY 11947 � � _.... ...... ................ ....... - yOCCUPA Phone#:631-722-3595 Email:oneilloutdoor ower hotmall c DESIGN PROFESSIONAL.INFORMATION:..=', Name: _..........__................_. .__....................G . ._.�.. Al L GOOES OF.__.._........... . ._......_ __._._........... ...... Mailing Address: APPROVED AS NOTED _._....._._....__._..... _..._...._.NFW .YORKSRTE & TOWiV CODES Phone#: AS REQUI Email: .DATE: : ......... .Z. B.P.#t _....,w:, ..:... __...:. 'CONTRACTOR INFORMAT19#U.. FEE: .. Name: 11JU11rT _....... _. ......._._._... �.�,_..._._.. _... 765:,1802. 8AMw TO 4 PM .FOR THE Mailing Address: — FOLLOWING IN6FLC I IONS: _.._...._.. ..,m....._:..:...__..,.. ..,._...,.,.. .,. �. ..,,..,..,,1,,.,FOUNDATION...7,...T.WO,..REQUIRED..w....,.m........,.........._ _7T_ Phone#: Email: FOR POURED CONCRETE -DESCRIPTION:OF PROPOSED CONSTRUCTION,.,,,-.- 3.”,INSULATIOW" ❑New Structure ❑Addition ❑Alteration ❑Re air ❑Demolition Y oec p BE COM L ( 6. )$ of Project: DOther generator ALL CONST 60i@A CSHALL MEET THE ................. ..............._.. ..............:. ., ............ ..........._.........__. Will the lot be re-graded? ❑Yes ®No Will excess Ailrgr) dMaTnFli9aBL© Os4 ®No pr=SIG4I OR CONSTRUCTION ERRORS. 1 PROPERTY INFORMATION Existing use of property:Residence .............. Intended use of property:Residence Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes ®No IF YES, PROVIDE A COPY. ❑,Check Box'After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided 6y Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Departmerit:€or the issuance of a Building Permit pursuant to the Building Zone ordinance of the Town of Southold,Suffolk,County,New York and other applicable,Laws;Ordinances or Regulations,for the construction of buildings,. additions,alterations or for removal or demolition as herein described.The appllcant.agrees to comply with all applicable laws,ordinances,building code; housing code and regulatiofs and to admit authorized inspectors on premises and in building(s)for necessary inspections,false statements made herein are punishable as a class A Misdemeanor pursuant to Section 210.45 of the Neter York State Penal Law. Application Submitted By(print name):Sean ®Neill ®Authorized Agent ❑Owner Signature of Applicant: Date: 1-7-2021 STATE OF NEW YORK) SS: COUNTY OF Suffolk ) Sean ®'Neill being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the Agent (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 day of , 20 Notary Public LINDA S. CARLSON Public, State of PROPERTY OWNER AUTHORIZATION Notary No. 01 CA6137178 w York (Where the applicant is not the owner) Qualified in Suffolk County Commission Expires Nov. 14, 20 I, Arthur Cody residing at 630 Dean Drive Cutchogue do hereby authorize Jean O'Neill to apply on i my behalf to the Town of Southold Building Department for approval as described herein. 1 -7-2021 Owner's Sign ure Date Arthur Cody Print Owner's Name 2 BUILDING DEPARTMENT-Electrical Inspector �G TOWN OF SOUTHOLD tia io Town Hall Annex- 54375 Main Road - PO Box 1179 o Southold, New York 11971-0959 Telephone (631) 765-1802- FAX(631) 765-9502 rogerraDsoutholdtownny.gov- seandtcDsoutholdtownny.gov APPLICATION"FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required). Date: r Company Name: //- Name: License No.: 7-� mail: r e le ch7 G 1. Address: 7 7 Ua ct /V Phone No.: # YU JOB SITE INFORMATION (All Information Required) Name: �v/ Address:�6- e ,•%,- v Cross Street: Phone No.: /6 7 6 5'3-a Bldg.Permit#: 01 email: 6C615!4V/G/@ Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK(Please Print Clearly) Circle All That Apply: Is job ready for inspection?: YES/ NO Rough In Final Do you need a Temp Certificate?: YES / NO Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A #Meters Old Meter# . New Service-Fire Reconnect-Flood Reconnect-Service Reconnected-Underground-Overhead #Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION Request for Inspection Form.xis PERMIT# Address: Switches Outlets GFI's Surface Sconces H H's UC Lts Fans Fridge HW Exhaust Oven Dryer Smokes DW Service Carbon Micro, Generator. -.. Combo -- - - --- _. - Cooktktop Transfer AC AH Mini Special: Comments: J ��� RECEF DEC 1-J z015 i' BUFF.CO.HEAL-M SE;ViCES o SURVEY OFPROP.�'_RT u�I RIO-10-0003 . AT CUTC110GU DEC 18 2015 I - SEPTIC MEASUREMENTS a� I A B A^ TOWN OF° ,SO UTHOLD GIC_ I. -- �� SUFFOLK COUNTY, N TOWNF':Ol'TyOLC 19 35 1000 GALLON RECTANGULAR SEPTIG TANK �i�Y - _ 1000-116-04-02 �o: 3o D:P:.#I. SCALz. 1=30, 33 35 D.P. *2 MARCH 25, 2009. � y' NOVEMBER 18, 2009 (B_O.H_) ' DOCEtABER 23, 2009 REVISION) �- oo FEBRUARY 2,•2010(REVISED ELEVATION- NAVD '88) FEBRUARY 16,2010•(ADDITIONS) MARCH 1, 2010-(REVISIONS) APRIL 30, 2010 (ADDITIONS) JUNE'8, 2010 (REVISIONS) N OCTOBER 27, 2010.(REVISIONS). \ c'a,• JANUARY 7, 2011(REVISION§) 3 �.00• - JANUARY 19, 2011 (REVI510N5 - n oo` JANUARY 28, 2011 (REVISIONS - •� a pt/�n V �'- +-�• JUNE 7, 2011 (REVISIONS) '" 7 S N JUULLY 16, 20 5 (FINAL)RUAR�?27, 2014 (FOUNDATION LOCATION) ' 0o' ti \ Na? �-1 AUGUST 3, 2015.flNAL) m 00 w _ , 32• o - c i NOV.20,2015 1Fw U r/ O ®� D ° ! �,.i` •-. \ �� '�'. `�. DEC.11,20(5!SLEEVED WATER LINE a ma aci Du Y��cs�`nR G'�?pp9 1 oma `r `s' \ O `:` .� �v F� ��artn N 1 '/ •�c � � \ a . 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ALL CERNRCA-PONS 631) 765-5020 FAX (631) 765-1797 YS =MONUMENT HEREON ARE VALID FOR THIS MAP AND COPIES 7HEREOF ONLY IF P.O. BOX 909_ AREA=12,661 SQ. FT. E, =WETLANDS FLAG SAID MAP OR COPIES BEAR 771E IMPRESSED SEAL OF 774E SURVEYOR 1230 TRAVELER STREET ®�_ WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N.Y. 11971 11 c7 L!L "'E8Z%.W10b'�t/Stiz6Zona�e�OdOw869�6�ab'tib'JBbOMb'll�dOW3W[NL3Mlz3ZN4L�Zt/.lwZ!Z1t/N+b'4tf�iWDd/P!/Xo4uJ0/1!ew/wo�"an!I-xot au04di Aw WOJJ lu@S i"ts-'vt-"�r*"''�^„•'�"r,,..., _ rt,. �:a:x-<x" -r-'.:,- - "°"" ','p';:;a.: "•;r*:=- _ 'a'T`r:: - - ^:r •a':,,'"',;'?tee":7?''°a:rs , �r r, .. ik'^�`�*',��� .•�< n,; ,-e,- �i'�vr¢�3 , 'r.`9i?�j<:°,.�,s a':>,t,°: sr',•'' 2„•P;'. 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" �� rx. s,: �E%X.=0.".>d:b<!%3 '.lvtC`�f� <...i•W��:"..:",iP:S:..,.:'._:'";^��• R,s� '�i�4n�, ,� '�,9�. evA: '4;"`.r .++Cr J.`, d rrx. ;;•..�'«.sy ,>•.;' k'k � '! ,�S*X,e :,'r" .� '.tu. :rNw aFY!�' _ •.�y�vf<< ;�,,:�:- ��'`-..: ani"<"ti__ _ ...-,.v:se�i;-'' � ,.>= ;', �� Zeno i:n_,`�.w ,. 1 / I X60IInO-MON.O ueaS-USeW DATE(MM/DD/YYYY) ACC)REP CERTIFICATE OF LIABILITY INSURANCE 09/23/2020 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. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lori McBride NAME: Roy H Reeve Agency,Inc. PHONE (631)298 4700 FAX (631)298-3850 AIC No Ext): A/C,No PO Box 54 E-MAIL Imcbride@royreeve.com ADDRESS: 13400 Main Road INSURER(S)AFFORDING COVERAGE NAIC# Mattituck NY 11952 INSURERA: General Casualty Co of Wisconsin(0310761) 24414 INSURED INSURER B: Laurel Lighting Inc&Frank Fenoy INSURER C: 1977 Main Rd INSURER D INSURER E: Laurel NY 11948 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2013011889 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY RRENCE $ 1,000,000 EACH OCCULN I LD CLAIMS-MADE FX OCCUR PREMISES Ea occurrence $ 100,000 X Contractual Liability MED EXP(Any one person) $ 5'000 A CCX0395347 01/30/2020 01/30/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO 2,000,000 JECT LOC PRODUCTS $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y 1 N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVEF-1 N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main Road PO Box 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD -0%*N4- N Y ' F New York state Insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129' nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE R] '`^^^A A 202207186 ROY H REEVE AGENCY INC 13400 MAIN RD PO BOX 54 lam . ffl MATTITUCK NY 11952 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LAUREL LIGHTING INC TOWN OF SOUTHOLD 1977 MAIN ROAD PO BOX 1179 LAUREL NY 11948 53095 MAIN ROAD SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11282068-4 578811 09121/2020 TO 09/21/2021 ' 9/23/2020 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1282 068-4, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. FRANK FENOY(PRES) OF ONE PERSON CORP LAUREL LIGHTING INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. - NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 173203216 N Y S ' F New York state Insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE � D ^^A^^ 463076153 EASTERN LI GAS SERVICES LLC PO BOX 1134 }` MATTITUCK NY 11952 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SMITH DRIVE NORTH EASTERN LI GAS SERVICES LLC TOWN OF SOUTHOLD PO BOX 1134 53095 RT 25 MATTITUCK NY 11952 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12344620-6 622886 09/24/2020 TO 09/24/2021 9/25/2020 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2344620-6, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE-NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER, THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 10 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:863999430 AC R® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 09/23/2020 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: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer_rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Carol Losquadro NAME: Roy H Reeve Agency,Inc. PHONE (631)298-4700 FAX (631)298-3850 AIC No Ext: AIC,No: PO Box 54 E-MAIL ss: closquadro@royreeve.com ADDR 13400 Main Road INSURER(S)AFFORDING COVERAGE NAIC# Mattituck NY 11952 INSURERA: Maxum Ind Co 26743 INSURED INSURER B: Eastern LI Gas Services LLC INSURER C: PO Box 1134 INSURER D: INSURER E: Mattituck NY 11952 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2092313140 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AUDL5UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVO POLICY NUMBER MM/DD MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 3 LN ILL) CLAIMS-MADE F OCCUR PREMISES Ea Occurrence $ 50,000 MED EXP(Any one person) $ 5,000 A BDG0082594-07 09/18/2020 09/18/2021 PERSONAL a ADV INJURY $ 1,000,000 POTHER: LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 POLICY �JET LOC PRODUCTS-COMP/OPAGG $ 1,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE - AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main RD PO BOX 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 801do681S;RA,TU'0 N STANDBY 20kW' STANDBY GENERATOR GENERATORS BRIGGS & TOW THE SMART CHOICE For the discerning homeowner that is looking for the smartest, most reliable permanent backup power solution. FORTRESS Introducing our dealer exclusive line. Available at your local Briggs&Stratton Dealer with these great features: +The industry's longest parts,labor and travel limited warranty +Installed oil warmer for increased starting protection in colder weather PARTS•LA13ON-TRAVEL LaNREO WARIIAMY Unique Airflow Technology Commercial-Grade Briggs&Stratton Vanguard"Engine • Making these models 501/o quieter than most portable generators • Powerful VTwin OHV engine •The unique design pushes engine exhaust out the front,directly away •Easy conversion between natural gas(NG)and liquid propane from your home vapor(LP)during installation Flexible Placement Quality Clean Power • Approved for installation as close as 18"to a building2 • Ensures your electronics are safely powered Symphony®II Power Management System Corrosion Resistant Enclosure&Base • Customizable to your homes needs • Made with automotive grade galvanneal steel to resist rust •Automatically balances the power of your home's electrical load including • Powder-coated paint for years of protection against chips high wattage items like air conditioning units and electric ovens and abrasions • Offers whole house power with a more affordable home generator C UL US LISTED GENERATOR SET RATINGS, LIQUID PROPANE I NATURAL GAS LIMITED WARRANTY3 MODEL VOLfA E PHASE _. HZ ., BREAKER, LP kW' 'LP AMPS NG kW NG AMPS PA pTS;LABQR,°TgAVEL Fortress 920/240 1 60 100 20., 83.3 18 75 6 Year 040547 Briggs&Stratton 920%240 ' 1 •60 100 i 2C} 83,3 040336 18 75 5 Year This generator is rated in accordance with UL(Underwriters Laboratories)2200(stationary engine generator assemblies) and CSA(Canadian Standards Association)standard 022.2 No.100-04(motors and generators). 2 The installation manual contains specific instructions related to generator placement in addition to NFPA 37,including the requirement that carbon monoxide detectors be installed and maintained in your home. 1 s Warranty details available at www.briggsandstratton.com a . STANDBY GENERATORS 20kW STANDBY GENERATOR ENGINE SPECIFICATION$ :ENGINE LUBRICATION Engine Model Briggs&Stratton Vanguard' 'Oil Capacity(oz) 79 Engine Model Type Trim Number 613275-0003-E1 Lubrication System Full Pressure Engine Speed(RPM) 3600 Recommended Oil 5W30 Full Synthetic Engine Fuel Liquid Propane[LP]or Low Oil Pressure Sensor Yes Natural Gas(NG) ... ......... Engine Cylinder Configuration OHV ALTERNATOR SPECS Manufacturer Briggs&Stratton Number of Cylinders 2 Type Self-Excited, Rotation Field Displacement(cc) 60.6/993 Voltage Regulator Automatic Bore&Stroke(in) 3.37/3.41 Compression Ratio 6.5:1 Insulation Glass F CONTROLLER FEATURES Governor Type Electronic ..........: ,r ..'.._..... :...... Hour Meter Yes Frequency Regulation +/-1 Hz LED Digital Display Yes Valves OHV with Hardened Seats Fault Code Display Yes Ignition System Fixed timing Magnetron® Electric Ignition Weekly Exerciser Yes Starter Motor Rating Voltage 12 Volt Battery 12 Volt OPERATIONS FUST.CONSUMPTION" SOUND RATING AT T METERS 50%Load 100%Load 64 dBA Liquid Propane 83 W/hr 2.31 gal/hr 135 ft3/hr 3.75 gal/hr Lowest measurement of 12 microphones around generator. Sound level measurement at other locations around generator Natural Gas 187 ft3/hr — 260 ft3/hr = may be different depending upon installation configuration. Fuel consumption rates are estimated based on normal operating conditions.Generator operation may be greatly affected by elevation and the cycling operation of multiple electrical appliances—fuel flow rates may vary depending on these factors. 2 9ligp '1trAiTiUN STANDBY GENERATORS 20kW STANDBY GENERATOR A. . g ' w OTHERFEATURES CERTIFICATION ; Enclosure Material Galvanneal Steel with Corrosion CARB Compliant Yes Resistant Paint Overcrank Protection Yes NFPA Approved Yes Engine Warm Up(sec) 20 or 50 Automatic Transfer cUL Listed to CSA 22.2 NO 100.04 Yes Switch Controlled Engine Cool Down(min) 1 NEMA Compliant Yes Response Time(sec) 26 or 56 Automatic Transfer EPA Certified Fuel System Yes Switch Controlled Monitoring Options Basic Wireless Monitor . _ AVAILABLE ACCESSORIES InfoHub'"Monitor Continuous Maintenance Kit 6035 Battery Charging Yes _.. ... _;...._.__..._.......,..._..._._._.._....._.� _.............. ...., Fortress 6404 WEIGWT'AflID DIMENSIONS . Cold Weather Kit Briggs&Stratton 6231 Assembled Weight(lbs) 500 Basic Wireless Monitor 6229 Overall Dimensions(in) 50.5 x 32.9 x 31 InfoHub 6260 Packaged Weight(lbs) 613 Remote Status Monitor 6144 Packaged Dimensions(in) 68.1 x 41 x 39.5 47" 31" ae sl 8 O Yd a gig 88° gg * W.�oIp.110 31" �a a °a R 2 a� 8= FopraEss-', 50.5" 32.9" 3 s, raid ag. STANDBY GENERATORS 2OkW STANDBY GENERATOR FUEL PIPE SIZE RECOMMENDATION CHART , . + ■ , ■ OF e ww.�--..vws-.> "r w•.ws^x c-,.._.e+ waw.. ."...x �., -.r.'.. Natural=Gas-1,Inlet Pressure!osis than 2 PSI`/Pressure Drop 1/2"Water Coluimn!Specific Gravity 0.80 1/2"pipe capacity 3/4"pipe capacity 1"pipe capacity 1-1/4"pipe capacity 1-1/2"pipe capacity 2"pipe capacity 20'Length' 118 247 466 957 1,430 2,760 40'Length' 81 170 320 657 985 1,900 60'Length' 65 137 257 528 791 1,520 60'Length' 56 117 220 452 677 1,300 100'Length' 50 104 195 400 600 1,160 I z Liquid Propane/,InletPressure,!!".Water Column/Pressure Qrop 1/11."Water C6lumn'/Specific Gravity 1.50 . a. 1/2"pipe capacity 3/4" pipe capacity 1"pipe capacity 1-1/4"pipe capacity 1-1/2"pipe capacity 2"pipe capacity 20'Length' 200 418 788 1,617 2,423 4,666 40'Length' 137 287 541 1,111 1,665 3,207 60'Length' 110 231 435 892 1,337 2,575 60'Length' 101 212 400 821 1,230 2,370 100'Length' 101 212 400 821 1,230 2,370 *Total length of piping from outlet of regulator to appliance furthest away. ADDITIONAL INF■ ■ .,TRANS, SPSCIFICATION5 Prewired 16 Circuit 100 AMP Model#071076 Standard 16 Circuit 100 AMP Model#071047 SUPPORT EVERY ST ■ OF THE WAY Symphony®II 100 AMP Model#071071 NEED 800-7-59-2744 Symphony"If 150 AMP Model#071070 Our technical supportto answer questions on our generators, Symphony®11 200 AMP Model#071068 and accessories. Symphony®II Dual 200 Amp 2x200/400 Model#071057 Voltage Rating 120/240 CALL TOO AY FOR A FREE Select Circuit:16 119-HOME ESTIMATE!, Number of Protected Circuits Symphony"II:Whole House POO-743-4115 UL Approved Yes NEMA 3R Rated Yes Disclaimer:Not for Prime Power or use where standby systems are legally required,for serious life safety or health hazards,or where lack of power hampers rescue of fire-fighting operations. BRIGGB&BTRATTON POST OFFICE BOX 702 MILWAUKEE,WI 53201 USA Copyright 02016.All rights reserved,BS1007-D—11/16 Briggs&Stratton Corp.reserves the right to make changes in specifications and features shown herein,or discontinue the product described at any time without notice or obligation. 4