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HomeMy WebLinkAbout47204-Z ��o�oSUfF01,f Gam. Town of Southold 7/14/2022 P.O.Box 1179 y .T 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43251 Date: 7/14/2022 THIS CERTIFIES that the building GENERATOR Location of Property: 54800 Route 25, Southold SCTM#: 473889 Sec/Block/Lot: 64.-1-16 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/18/2021 pursuant to which Building Permit No. 47204 dated 12/9/2021 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 Prop Uncommonly Perfect Inc of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47204 7/11/2022 PLUMBERS CERTIFICATION DATED \124v—\�- �'� Aut or zedAi nature ��o�sufFot��o TOWN OF SOUTHOLD BUILDING DEPARTMENT C2 x 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#: 47204 Date: 12/9/2021 Permission is hereby granted to: Prop Uncommonly Perfect Inc 54800 Route 25 PO BOX 606 Southold, NY 11971 To: Install generator at existing single family dwelling as applied for. At premises located at: 54800 Route 25, Southold SCTM #473889 Sec/Block/Lot# 64.-1-16 Pursuant to application dated 11/18/2021 and approved by the Building Inspector. To expire on 6/10/2023. r Fees: ACCESSORY $100.00 ELECTRIC $85.00 CERTIFICATE OF OCCUPANCY $50.00 Total: $235.00 Building Inspector pE SO(/Tyol 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.devlin( -town.southold.ny.us Southold,NY 11971-0959 QIyCOU01 �� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Prop Uncommonly Perfect Inc Address: 54800 Route 25 City:Southold st: NY zip: 11971 Building Permit#: 47204 Section: 64 Block: 1 Lot: 16 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Universal Elec. License No: 54018 ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Commerical Outdoor X 1st Floor Pool New X Renovation 2nd Floor Hot Tub Addition Survey X 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 Fixtures Time 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 11, 2022 S. Devlin-Cert Electrical Compliance Form OE SOUlyolo # * TOWN OF SOUTHOLD BUILDING DEPT. `ycourmN�' 631-765-1802 INSPECTION . [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ]' RENTAL REMARKS: nk, l DATE INSPECTOR OE SO/it, -7 Za Lf S 1 V rV �-t zS # # TOWN OF.SOUTHOLD BUILDING DEPT. 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) `{ A ELECTRICAL (FINAL) [ ] CODE VIOLATION [/ ] PRE C/O [ ] RENTAL REMARKS: It-1 /G r `' DATE 7 12,2t, INSPECTOR ToWt4 OF Gi€d 3C3 \ r 002 V� � � Pll F. \o �rxc= \� ,U I,gill�( t CSE4NC?A'C4CTN 2NO. i €INAL [ 1 €ter tstrsr? -(AAMNU r • C I fiRF SAFETY tVSPE aPGN v�VA v ' N9FfiNCYr kt3EKtAC & t S ,h:ThA2F PIE1v 4t4't'ft!'tT€f3N'"CHEIGYiLti } ELECT RICAL€ f*hL3 vy sm 098357807 ,:�„ � � ���e, ��� y `��' ° � ��- � {lllllllllllllflilllllllillilfllllllilhlllglllll(Illi � , WIP \� f2Xk IAC) \ ...eOkra IS rizoo zaoe 3 60nr Ta 30 LONG ISE ANU POWER AITFlofRITY f1F.fl4$11dad lit 7€kfF1G FIELD:INSgECMNaP'ORT•. ...,A E,:. CO.MIVIENT FOUNDATION:(1ST)' FOUNDATION-(M). Ir RQUGH.FRAIYIIN ; PLUIVIBII�TGy N INSUL,ATId,4._�sRN:, STATE ENI R. CODE: , 4>DDITIONAL:CC .NTS: . .. .. ;z 4OfFfftt �. © TOWN OF SOUTHOLD—BUILDING DEPARTMENT ` Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 �Q a� Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector: ® r c EHE E _ NOV 1 s 2021 Applicaiions,and'#orms.must`kie filled:ciut in their entiretj.Incomplete applications will not be:accepte'd. Where the Applicant,is not the owner,an BUILDING DEPT. 0wnW.s,Authorizatlon form(Page 2)iliall be cornpieted.," TOWN OF SOUTHOLD Date:November 8, 2021 OWN A" OF PR®PERTY Name:Joseph Stadler SCTM#i000- Project Address:54800 Main Road Southold NY Phone#:631-765-0037 Email:Stadle.rioe,@hotmail.com..............._.„___ Mailing Address:54800 Main Road Southold NY CONTACTPf RS N. Name:Sean ONeill Mailing Address:PO Box 64 Jamesport NY 11947„ Phoney#:631-722-3595Email:oneilloutdoorpower@hotmail.com DESIGN PROFESSiONAL:INFt31RIViATIONt Name: .............. ....................._.................._...... .. .. ... ............................._..........._........................................ ............ ..._.._. Mailing Address: Phone#: Email: CONTRACTOR.INFORMATION :: Name:Laurel Lighting Inc. Mailing Address:1977 Main Road Laurel Ny 11948 a Phone#:631-457-3363 Em ail:kfcelectric@ol.com _.. .....__..._...... . . .._ ....,.. . ...................... .,...._.... w_..... ._- .._. .. .. . .. . ._.., .................._...w.. `DESCRIPTION OF PROPOSED,'CONSTRUCTION ;.. ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other Generator $ Will the lot be re-graded? ❑Yes 0N Will excess fill be removed from premises? ❑Yes ®No 1 PROPERTY INFORMATION- ": proper e o Intended u property:use of Existing uproInsf property:_.. ,_.... ._. _. . .. entia TM .. .._ _. ...,...µ._.. _. ._ w.. ..u,_.... Rest,dentia _ ..,. . .,.._..... 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. ri ,Check 94After.Reading: The owner/contractor/design professional.is responsible for,ali drainage and storm water tssuss as provided by,•g Chapter 23&'of the Town Code:'ApPLICATIOIN IS HEREBY MADE to the Building Department for'the issuance of a Building Permit.pursuant to the Buildinji6ne 6rdinant*of the Town of Southold;Suffolk,County,New York and other applicable Laws,ordinances`or.Regulations,for.the•canstruction of buildings, additions;.alterations orfor removal or demolition as,herein described:The applicant agrees to comply With all applicable laws,ordinances,.buildingcode;°ra: ' housing.code and,regulations and,to admit authorized inspectors on premises and'in building(s)for necessary inspections.False'si atements made herein.are .`. punishable as'l Class A misdemeanor pursuant to Section.210.45,of the Nev7 York State Penal Law. Application Submitted:By(pri2n�aL)�:Sean ONeill ❑Authorized Agent El Owner Signature of Applicant: q Date: STATE OF NEW YORK) SS: COUNTY OFSIk�`EOI ) Sean ONeill 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 �p1/em.�Xr 20 Notary Public TRACEY L. DWYER ZAT1 PROPERTY OWNER AIJThI®RIARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 (Where the applicant is not the owner) QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2�o vZ ,, Joseph Stadler residing at 54800 Main Road Southold NY do hereby authorize Sean ONeill to apply on my be o the�own of Southold Building Department for approval as described herein. 11 -8-2021 wner's Signature Date Joseph Stadler Print Owner's Name 2 ` 0tfFpt �{ BUILDING DEPARTMENT- Electrical Inspector f TOWN OF SOUTHOLD o Town Hall Annex- 54375 Main Road - PO Box 1179 W h Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 id s rogerr cDsoutholdtownny.gov -- seand(a southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 1/13/22 Company Name: Universal Electrical Services LLC Electrician's Name: Dennis Gebhard License No.: ME-54018 Elec. email:gebhard73@gmail.com Elec. Phone No: 516-242-9204 ❑I request an email copy of Certificate of Compliance Elec. Address.: 151 First Avenue Massapequa Park NY 11762 JOB SITE INFORMATION (All Information Required) Name: Joe Stadler Address: 54800 Main Road Southold NY 11971 Cross Street: Phone No.: 631-765-0037 Bldg.Permit#: email:stadlerjoe@hotmail.com Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): 20kw generator Square Footage: Circle All That Apply: Is jobxeady for inspection?: 0 YES❑ NO ,rl Rough In 0 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 Reconnect❑Underground❑Overhead # Underground Laterals F 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION . :{ ' •a#v,at srar�;cw.+srs�v -.> SEL"FWAt°720 Yd-77 '=S`G1fflCSTRT6LRtAGt7 iyai°; -. �<•_ � •:' �� y�,,,,,. . � 1#_14.E i'3A4�A�:Ah`.r F�'�E�ld�. ;60- OF-PROPERTY PVE ATZOUTHOLU ra 4c A.i9il E i °! ��'„ T:. N?"d4T'c�t7 R t.terll. _ r g^ s e e i• - {eco. ' ce wily 7" # t14 �• W. �pIECO'MW$V4 DATE(MMIDDNYYY) � o CERTIFICATE OF LIABILITY INSURANCE 11/09/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CNONE CT Carol•Losquadro Roy H Reeve Agency,Inc. H No Ext: (631)298-4700 FAX No): (631)298-3850 PO Boz 54 E-MAJLS: closquadro@royreeve.com ADDRE 13400 Main Road INSURER(S)AFFORDING COVERAGE NAIC# Mattituck NY 11952 INSURER A: Maxum Ind Co 26743 INSURED INSURER B: Eastern LI Gas Services LLC INSURERC: PO Box 1134 INSURERD: INSURER E: Mattituck NY 11952 INSURER F: COVERAGES CERTIFICATE NUMBER: CL219115163 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP MMIDD MMIDD LIMITS X COMMERCIAL GENERALLIABILnY EACH OCCURRENCE $ 1,000,000 RENTED CLAIMS-MADE �OCCUR PREMISES'AMAGE ToEa occurrence $ 50,000 MED EXP(Any one person) $ 5,000 A - BDG0082594-08 09/18/2021 09/18/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2.000,000 POLICY ❑JECT �LOC PRODUCTS-COMPIOPAGG $ 1,000,000 OTHER: - $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $ _ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS I BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNEWEXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I 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 s. Ncw Workers' AITIE Cornpensatiaan CERTIFICATE OF INSURANCE COVERAGE Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured EASTERN LI GAS SERVICES LLC 631-603-5687 1622 MAIN RD JAMESPORT,NY 11947 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations in New York State,i.e.,wrap-up Policy) 463076153 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southhold 53095 Main Road 3b.Policy Number of Entity Listed in Box 1 a" P.O.Box 1179 DBL615307 Southhold,NY 11971 3c.Policy effective period 04/19/2021 to 04/18/2023 4. Policy provides the following benefits: 0 A.Both disability and paid family leave benefits. E] B.Disability benefits only. n C.Paid family leave benefits only. 5. Policy covers: © A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: Under penalty of 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 and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 11/15/2021 By �,�(, �t (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 4B,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board (Only if Box 4c or 58 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 employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) II 111°°°1°°111°11°1°°1°11°11°111°111111 - i�i�CaRD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/23/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY ORL 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. H No Ell): (631)298-4700 IX(AfNc; (631)298-3850 PO Box 54 FMAILss: Imcbride@royreeve.com ADDRE 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 INSURERD: INSURER E: Laurel NY 11948 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2112513854 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 ADUL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE 0 RENTED CLAIMS-MADE �OCCUR � PREMISES Ea occurrence $ 100,000 X Contractual Liability MED EXP(Any one person) $ 5,000 A BBPOO17497-00 01/30/2021 01/30/2022 PERSONAL&ADV INJURY $ 1.000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑JE' F_�LOC PRODUCTS-COMP/OPAGG $ 2,000,000 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 I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ElN/A E.L.EACH ACCIDENT $ (Mandatoryfyes,d be and 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 Road PO BOX 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYS1F New York State Insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 .1 AAAAAA 202207186 ROY H REEVE AGENCY INC 13400 MAIN RD . PO BOX 54 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 09/21/2020 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 SUCHk_,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 U-26.3 s. OCCUPANCY OR APPROVED AS NOTED USE IS UNLAWFUL DATE: d-� B.P. WITHOUT CERTIFICATE FEE: a�5-�gY` OF OCCUPANCY NOTIFY BUILDING DEPARTMENT' AT'- 765-1802 -8 AM TO .4'PM -FOR TAE -OLLOWING INSPECTIONS:., I. FOUNDATION - TWO REQUIR_ED FOR.POURED CONCRETE" ?. ROUGH - FRAMING A-PLUMBING 3. INSULATION 4 FINAL - CONSTRUCTION .MUST tOMPLY WITH ALL COD FS OF BE COMPLETE FOR C.0'I NE;W YORKSTA7 CON, `RU(7101; SHALL MEET THE A REOUIRLD AND ~ �J Wf J CODES, �EGUIREMEW S . - "•AE CODES OF NEW CONDITIONS OF !ORK STATE. NO' •iESPONSIBLE FOR SOUTHOLDTOWNZBA DESIGN OR CONSTRUCTION ERRORS. ' Sr►L)THOLD TOWN PLANNING BOARD SOUTHOLD TOWN TRUSTEES N.Y.S.DEC eLMffd*L 1SPWn0M REQUIRED RETAIN PNRS( STpR,�,a �i!gTER . .. . NT TO ON,gPT R�,r,.JFF, OF THE 'I TOWO,F ER «6 N C S Standby _ , o BRIGGS&STRATTQN, F:O:RTRESS" . Sm.art.Choice s Introddcing our dealer,exclusive:line. AVarlafjle:at your'Iocal Briggs&:Strafiton.-3'. 4 ,��°`' Dealer vOk thesevgrea `features: Parts•L boeTravel t Limited {C U` Warranty @,:.. rus `.` ::`:'.za'``LISTED Corrosion Resistant Enclosure& Base Symphony®II Power'Management.$ystem:. ' • Rust resistant aluminum and a stainless steel base • Customizable to your home's needs _ to protect the generator from the elements. Robust • Automatically balances the power of'your home's electrical protection against damage from the elements caused load including high wattage items like air conditioning units by strong winds,high humidity and salt air and electric ovens • Powder-coated paint for years of protection against . Offers whole house power with a more affordable chips and abrasions home generator • Certified to withstand hurricane-force winds up to 175 mph' Quality Clean Power Unique Airflow Technology • Ensures your electronics are safely powered • Making these models 50%.quieter than most Flexible Placement portable generators • The unique design pushes engine exhaust out the • Approved for installation as close as 18"to a building2 front,directly away from your home I Commercial-Grade Vanguard°Engine Briggs&Stratton"Full Synthetic Generator Oil • Shields the engine from low temperature sludge buildup - Powerful v-Twin OHV engine and high temperature deposits • Easy conversion between natural gas(NG) and liquid • Reduces engine wear,scuffing and rabrasion propane gas(LP) during installation Enhanced cold weather start-up protection to-20•F Generator Set Rafln�gi j Liquid Propane Vapor Natural Gas Limited Warranty° Enclosure Circuit) Model Type Voltage Phase' Hz Breaker Amps LPV kW LPV Amps NG kW1 NG Amps Parts,Labor,Travel 040547 Galvanneal 120/240 1 60 100 1 20 83.3 18 75 6 Year 040573 Aluminum 120/240 1 60 100 1 20 83.3 18 75 6 Year 040592 Aluminum 120/240 1 60 100 20 83.3 18 75 10 Year 'This generator is certified in accordance with UL(Underwriters Laboratories)2200(stationary engine generator assemblies)and CSA(Canadian Standards Association)standard C22,2 No.100.14(motors and generators). '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. 'Single phase units are rated at 1.0 power factor and three phase units are rated at 0.8 power factor. •See operator's manual or BRIGGSandSTRATTON.com for complete warranty details. s When installed in accordance with the installation manual { i ' i BRIGGSsSTRA770N 20M' Fortress—Standby Generator _...,..... ......_........................... m .......................... a Engine.• .;w� 0 1 - ublricatinli Engine Brand Vanguard® Oil Capacity(oz) 79 Engine Speed(RPM) 3600 Lubrication System Full Pressure Engine Fuel Liquid Propane Vapor(LPV)or Recommended Oil 5W30 Full Synthetic Natural Gas(NG) Engine Cylinder Configuration OHV Low Oil Pressure Sensor Yes } Number of Cylinders 2 !(AlternatarSpecs Displacement(cc) 993 Manufacturer Briggs&Stratton Compression Ratio 8.5:1 Type Self-Excited,Rotation Field Governor Type Electronic Voltage Regulator Automatic Frequency Regulation +/ 1% Insulation Class F �..,; Valves OHV with Hardened Seats Controller Features Ignition System Fixed Timing Magnetron® Hour Meter Yes Starter Motor Rating Voltage 12 Volt LED Digital Display Yes Battery Required 12 Volt,Group 26R,540 CCA Minimum Fault Code Display Yes Weekly Exerciser Yes A'Fuel Consamptlana �"Shand hating t 7 M a 0f , A. Full Load 1/2 Load No Load 64 dBA4 BTU/hr NG-260,000 NG-187,000 NG-99,000 LPV-337,500 LPV-207,500 LPV-100,000 ft'/hr NG-260 NG-187 NG-99 LPV-135 LPV-83 LPV-40 M3 NG NG-7.36 NG-5.30 NG-2.80 LPV-3.82 LPV-2.35 LPV-1.13 Parts ® Labor e Travel Unlike other standby generator manufacturers, Limited our warranty covers parts, labor AND travel for the Warranty' full length of the warranty with no start-up costs! 'This generator is certified in accordance with UL(Underwriters Laboratories)2200(stationary engine generator assemblies)and CSA(Canadian Standards Association)standard C22.2 No.100-14(motors and generators). =Fuel consumption rates are estimated based on normal operating conditions at Y2 load.Generator operation maybe greatly affected by elevation and the cycling operation of multiple electrical appliances-fuel Flow rates may vary depending on these factors. 'See operator's manual or BRIGGSandSTRATTON.com for complete warranty details. °Lowest no-load measurement per ISO 3744.Sound level measurement at other locations around generator may be different depending upon installation configuration. 2 t � eplcGS ffii r 20kW' Fortress—Standby Generator r btherrPaatures° .. - . Galvanneal Steel or Aluminum Enclosure Material with Corrosion Resistant Paint CARB Compliant Yes* 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 NEMACompliant Yes Response Time(sec) 26 or 56 Automatic Transfer EPA Certified Fuel System Yes Switch Controlled Monitoring Options Basic Wireless Monitor Available Aceessor)es ' InfoHub'Monitor Continuous Maintenance Kit 6035 Battery Charging Yes Cold Weather Kit 6404 �Weightand Dilli�i�sitins .„- . . __� ,..,.��„ , ....gym..�...... . . :' .. .. ....��....... '” .° . _. Galvanneal-601/273 Basic Wireless Monitor 6176 Assembled Weight(lbs/kg) Aluminum-440/200 InfoHub 6517 Overall Dimensions(in/mm) 49.2 x 31.7 x 30,6/1250 x 805 x 777 Remote Status Monitor 6144 Packaged Weight(lbs/kg) Galvanneal-626/284 Aluminum-575/261 Packaged Dimensions(in/mm) 68.1 x 41 x 39.5/1730 x 1041 x 1003 49.2 in(1250 mm) 31.7 in(805 mm) ___T4 E 30.6 in (777 mm) b W 48.1 in(1222 mm) 29.6 in(752 mm) 'CARB does not regulate emergency standby generators outputting less than 50 HP.Only the EPA standards apply. This generator is certified in accordance with UL(Underwriters Laboratories)2200(stationary engine generator assemblies)and CSA(Canadian Standards Association)standard C22.2 No.100-14(motors and generators). 3 sa1� 16 sthAiON 20M' Fortress-Standby Generator Pope Size Recommendation Ofiiirf apat'ity�k�nThijogandt,ofOTU/HourY ..... ... _,._.mw.._.,.—w_..,_... .... , Natuiral'Gas/inlet Pressure lest than 2 PS11'Pressure Drop VVI Water-alum»/Specific Gravity 0.8b mm , 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'Length2 118 247 466 957 1,430 2,760 40'Length2 81 170 320 657 985 1,900 60'Length2 65. 137 257 528 791 .1,520 80'Length2 56 117 220 452 677 1,300 100'Length2 50 104 195 400 600 1,160 LiquldPrclpaneyapnr/filet Pt'e111ell,Watercalumn/,PreSBurepDrap1/2 V1�atCr.COiulnp/3i10cifllC!wrBYityt,50 '4", : ,. , 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'Length2 200 418 788 1,617 2,423 4,666 40'Length2 .137 287 541 1,111 1,665 3,207 60'Length2 110 231 435 892 1,337 2,575 80'Length2 94 198 372 764 1,144 2,204 100'Length2 84 175 330 677 1,014 1,954 3J' .r • I 'This generator is certified in accordance with UL(Underwriters Laboratories)2200(stationary engine generator assemblies)and CSA(Canadian Standards Association)standard C22.2 No.100-14(motors and generators). s Total length of piping from outlet of regulator to appliance farthest away. BRIGGS G STRATTON CORPORATION - Briggs&Stratton has a policy of continuous product improvement and reserves the right to modify POST OFFICE BOX 702 BRIGGS&STRATTON its specifications at any time and without prior notice. MILWAUKEEWI 53201 USA 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. BS1155-8118 Copyright©2018.All rights reserved. YOU.POWERED'.