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HomeMy WebLinkAbout47909-Z ��O�og11FF0(kcvG: Town of Southold' 8/16/2022 y� P.O.Box 1179 0 co 53095 Main Rd *4 �a Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43340 Date: 8/16/2022 THIS CERTIFIES that the building ' WINDOWS Location of Property: 315 Sutton Pl,Greenport SCTM#: 473889 Sec/Block/Lot: 33.-5-8 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/29/2022 pursuant to which Building Permit No. -47909 dated 6/3/2022 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: windowreplacements to existing single-family dwelling as applied for. The certificate is issued to Rishe,Marc of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED A ize ature p�snf TOWN OF SOUTHOLD BUILDING DEPARTMENT y z 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#: 47909 Date: 6/3/2022 Permission is hereby granted to: Rishe , Marc 130 Tasker Ln Greenport, NY 11944 To: install window replacements to existing single-family dwelling as applied for. At premises located at: 315 Sutton PI SCTM # 473889 Sec/Block/Lot# 33.-5-8 Pursuant to application dated 4/29/2022 and approved by the Building Inspector. To expire on 12/3/2023. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO-ALTERATION TO DWELLING $50.00 Total: $250.00 Bui ing Inspector ho�aOF SO(/TyO� TOWN OF SOUTHOLD BUILDING DEPT. courm, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] NSULATION/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: DATE INSPECTOR FIELD INSPECTION REPORT I DATE COMMENTS � ro FOUNDATION (1ST) -------------------------------------- FOUNDATION (2ND) () O kjxW ROUGH FRAMING& y PLUMBING INSULATION PER N.Y. y STATE ENERGY CODE 0 KVOwV r FINAL ��( . 1 vtpio ADDITIONAL COMMENTS — _0 z rn t� H � O z x H x d b TOWN OF SOUTHOLD—BUILDING DEPARTMENT o � t' Town Hall Annex,54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 https://NvNv�v.southoldtownny.ov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. D Building Inspector: tV/ LC _ APR 7 R 209 Ap<plications arid_forms,rriust be filled-out in their entirety.incomplete' BUILDING DEPT. applications will rtot be accepted:.Vdt ere.tlie Applicant.is not•the owner,an:,.:.. TOWid OF SOUT>1'- Own'er's Authorization form(Page 2j shall be campieted Date: 4/20/22 ®WNER(S)OF PROPERTY. �& NameMarc Rishe SCTM#1000- _ Project Address: 315 Sutton PI Greenport, NY 11944 Phone#:631-433-3123 Email: marcrishe@gmail.com _xx Mailing Address:315_ Sutton PI Greenport, NY 11944 --GQNTA PERSON: . Name:Scott Doughman - Go Permits Mailing Address:105 Buttonball,Ln, Glastonbury, CT_06033 Pnoneµ#:303-946-8685 m _._._.._.. .. ._...... ._.._...........:_...:._............. .Email: permits@9opermits.org_._. _ ......__....._...__.._.__ DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION:< . <. .Y+ Name:HOme �epOt Mailing Address:2455 Paces Ferry Rd. Atlanta, GA 30339 Phone#:303-946-8685 ____.. .. _...._...._.__._._. ...... ...: Email:Permits@goPermits.or9_._ __............. ...._..._... ®ESCRIP.TION,.OE PROPQSED'CONSTRUCTION } , 3. El New Structure ❑Addition ❑Alteration ®Repair ❑Demolition Estimated Cost of Project: ❑Other Remove and replace 8 windows, same size, no structural change. $12,368 Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes ®No 1 „ jfy ;..,,.z ♦ ,:r`'+`i':�'t`'iij, ' ,�' ,yx. .. .. .:,, � '' ^.;Yip'• '�;,"✓l,'>F,, t %EX .. ,.a....i.:X,,,, i.•r;;;”,:...,x..:':�':... ''t,.,5,: ' "PROP �y®pyye gpy�rgpygp ,f .. iWli-' 6Ri!'i,:�nY i-V ��Li 's,.,.e.••= :C/.,rvi'` .`.Y�.."• �«8v9-'s"Y' '¢-- S'eY+•� '<r'S. "^Y' -.5'� �5;.aw: ,4F, i,;! .�;,y:.�wv,ve a.ck,,, .Existing use of property:, Ae ial intended use of property: Zone or use district in which premises is situated: Are there any covenants and'restr ctions with respect to this property? L]Yes i4N6 IF YES;PROVIDE:A COPY. _ _.,... ._ .,_.n__ _-_., _ _, ..._.,__.a� .. _m. ............ eC1C' 3 '. ai 'r: 'arrier uzrtro € 3 tiasi? al#sJis asEi n l:t#r s `.,,.M, ' .. „l,,. . iYt rie SYctSaii at rs s es: b ;G#s� #er? +z� ktov�ii"Crti TPt11tt1##3ISHERi [uIAL► .fothe; iira t faril isu ':863td `f? itTt' aisrtant.ta` Buili�iri"'2�iio'; , Or inniif-itlsfiauan.a' iutri1 ,Gesuii „ 1 ;lakk aii .ts.. appfiwsi€iiisor'.T# atwifoitait�stiticn'cf; u+din ; ani ons; #t�vns or fiaar s nnt�t:iz u#t s ; Piere��+- ak i3. }ler aPl sit:a r s” i;c +riy vvi�a l t° s:1a s,i rdIhan* Moi o W; I.vy.•,- -n esAY.,, ''A i he usir# Gcu4e;and r gul r s>ar+d,to tia t ut�tarix reQ"pe t rx on proms n ;in balwing(o hikessa '10A s:,i~a#s st t or<s;riia <#� reiir>are';, puntsfi #ie s Cla"'—VA.i» eneanor°ursuacrt''io ci#qr. ift 5 of itie.#eevr YtaclrS4at . tial£aHr♦ ' ` yy" -°4f ; :r Application Submitted By(print name)-.Jennifer Wi n a ®Authorized Agent OOwner Signature of Applicant: Gate: f l sTA;TE.OF NfW-VGRK)0-r_-_ SS -COUNTY OFd �'`� ` ) (( __ tt - ��'�` being duly sworn, deposes and says that(s)ho is the applicant (Name of individual signing contract)above named, (S)he`is the, (Contractor,Agent,,Agent,Corporate Officer, etc.) of said owner or owners,and is duly authorizedlo perform or have'performed the:said work and to make and file this . application;that ail,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. C?)5 Y da of 2 �c� .. , tIL ary_40lic SUZANNE S BENTON NOTARY PUBLIC- PROPERTY " ,i�� F� OWNER AUTHORIZATION N �uLFORo COUNTY,-20 �Commission cpires 2-214 - (Where the applicant is not the-owner) I, are as e residing:at 315 Sutton1 do hereby authorize Jennifer mike-Go Permits to apply on my behalf to the Town of Southold Building Departriment for approval as described Herein;, ��.A'AWMI 4/21/22' . Owner's Signature Date Marc Rishe .Print Owner's'Name 2 Home Improvement Agreement: Page I Home Depot License#'s - For the most current listing visit www.Homedepot.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. 77 r-. Service Providers Contaet:Informatiori, -___. .,. . _ __d._ _ . The Home Depot The Home Depot Service Provider Contact Name Service Provider Company Name (631) 478-6101 customercancellationnortheast@hom 1 Phone# V "ceTrovider Email Address Service Provider License#(s) �:".Customer Information RIS_HE MARC Long Island 1-MOBT18 Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 315 Sutton Place Greenport NY 11944 Customer Address City State Zip (631) 433-3123 marcrishe@gmail.com Home Phone# Work Phone# Cell Phone# Customer Email Address NUTICEQF RI�IiT:T4�AN:CEL��= .�."" YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY CONTACTING THE SERVICE PROVIDER OR STORE DIRECTLY; EMAILING SERVICE PROVIDER AT: customercancellationnortheast@homedepot.com OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 40 Oser Avenue Hauppauge -� NY 11788 Address City. State Zip BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIG1jT TO.CANCEL. -Acknowledged by: _.. , .. 0,4/15/2022° Customer's Signa _ e.__._.._...._._....M..,_".. .. ._. Date 460 Standard Foun HIA(21 Jul.21)(E) Generated Date 0411519022 L-dIP04 1-1YJI1BT18 ° 0.1.12 Home Improvement Agreement: Page 2 r-f'--"r..,--2E...........q..Lw.y'.-•--.-,--->•-•-r 4:-Descri tion of Work`tobe`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 ;Anti ipated:Dehvery Date/InstallationFSchedule ,... _....__ _ r_ Hw Approximate Start Date: 10/12/2022 1Approximate Finish Date: 11/11/2022 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. G.'Electronic Records Autfiarization _ _ ' .' 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. :'1 meritSchedule Contract Price"arid a P _ _ 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: $ 112368.61 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 0.00 (If applicable, total amount of taxes included in Contract Price) *Maximum deposit 0NLYapplicable in AID,MA, AIE(33%),NJ, WI(99%) S sit% 100.0 Deposit Amount$ 12368.61 Remaining Balance $ 0.0 Ghair e.;._ .�_�.g,_ 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 De ot. -777777777771= 777.A_cce lance and Authorization "`£ 19,!- By,_. P_.—._.. ' By signing below, you authorize Home Depot to (a)'arrange for Service Provider to perform any 4Services or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's or permitting information may need to be provided to You later.)By signing,you acknowledge that: (i)You have read,understand, and accept this Agreement in its entirety, including the General Conditions and State Supplement, if any; (ii) You are receiving a complete copy of this Agreement; (iii)all rights and interests under this Agreement are solely vested in the person listed as"Customer"above; and(iv) Electronic signatures will be deemed originals for all purposes. ---- X 0'4 Customer's Signature Date X /s/The Home Depot 04/15/2022 The Home Depot Digital Signature Date For questions related to your installation, contact Service Provider at (631) 478-6101 For any other concerns, contact The Home Depot at 1-800-466-3337 460 Standard Fonn HIA(21 Jul.21)(E) Generated Date 04/151909.2 L-`,-P,)" I--1yJ0BT18 ° 0'1'12 ® DATE(MMIDD/YYYY) ACCOREP CERTIFICATE OF LIABILITY INSURANCE 02/24/2022 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 MARSH USA,INC. NAME: PHONE FAX TWO ALLIANCE CENTER AIC No Ext): (AIC, A/C No): 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# CN101642069-HomeD-GAW.22-25 INSURER A: Old Republic Insurance Co 24147 INSURED INSURER B: New Hampshire Ins Co 23841 THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. INSURER C: ACE American Insurance Company22667 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-005314714-02 REVISION NUMBER: 1 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSINSD WVQ POLICY NUMBER MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY316648 03101/2022 03101/2025 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X❑OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 X SIR:$1,000,000 MED FRCP(Any one person) $ EXCLUDED PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRC FLOC PRODUCTS-COMP/OP AGG $ 2,000,000 PRO- OTHER: $ A AUTOMOBILE LIABILITY MWTB316649 03/01/2022 03/0112025 COMBINED SINGLE LIMIT $ Ea accident 1,000,000 X ANY AUTO SELF INSURED AUTO PHY DMG BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A UMBRELLA LIAB X OCCUR MWZX 316647 03/01/2022 03101/2025 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ $ B WORKERS COMPENSATION WC 065886029(WI) 03/0112022 03/0112023 X PER —01H- AND EMPLOYERS'LIABILITY STATUTE ER C Y/N WLR C68916409 AZ,IL 03/01/2022 03101/2023 ANYPROPRIETOR/PARTNER/EXECUTIVE ( ) E.L.EACH ACCIDENT $ 5,000,000 OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) Continued on Additional Page E.L.DISEASE-EA EMPLOYEE $ 5,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED IF REQUIRED BY WRITTEN CONTRACT ON THE ABOVE GENERAL LIABILITY POLICY,BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 ROUTE 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1179 ACCORDANCE WITH THE POLICY PROVISIONS. SOUTHOLD,NY 11971 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. 70la'u�7t_'5'-0 vier ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta Act ADDITIONAL REMARKS SCHEDULE Page 2 Of g AGENCY NAMED INSURED MARSH USA,INC. THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA,GA 30339 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance L ' Workers Compensation Continued: Carrier:Indemnity Insurance Company of North America Policy Number:WLR C68916483(AOS) (AL,AR,FL,ID,IA,KS,KY,LA,MS,MO,NC,NE,NM,ND,OK,SC,SD,TN,VA,WV,WY) Effective Date:03/01/2022 Expiration Date:03/01/2023 (EL)Limit:$5,000,000 Carrier:AIU Insurance Co. Policy Number:WC 065886028(AOS) (AK,CO,DC,DE,HI,IN,MA,MD,ME,MN,MT,NH,NJ,NY,PA,RI,VT) Effective Date:03/01/2022 Expiration Date:03101/2023 (EL)Limit:$5,000,000 Carrier:ACE American Insurance Company Policy Number:WCU C68916446(QSI)(CA,OR,WA) Effective Date:03/01/2022 Expiration Date:03/01/2023 (EL)Limit:$4,000,000 SIR:$1,000,000 Carrier:National Union Fire Insurance Company Policy Number:XWC 1647323(QSI) (CT,GA,MI,NV,OH,UT) Effective Date:03/01/2022 Expiration Date:03/01/2023 (EL)Limit:$4,000,000 SIR:$1,0001000 SIR(CT):$350,000 SIR(GA):$750,000 TX Employers XS Indemnity: Carrier:lllinios Union Insurance Company Policy Number:TNSC68991006 (TX) Effective Date:03/01/2022 Expiration Date:03/01/2023 (EL)Limit:$6,000,000 SIR:$5,000,000 ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta A�RE® ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY NAMED INSURED MARSH USA,INC. THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. POLICY NUMBER 2455 PACES FERRY ROAD _ BUILDING C-20 ATLANTA,GA 30339 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance HOME DEPOT INSUREDS— The Home Depot,Inc. Home Depot U.S.A.,Inc. Home Depot U.S.A.Inc.dba The Home Depot Home Depot of Puerto Rico,Inc. Home Depot Product Authority,LLC Home Depot Store Support,Inc. Red Beacon,LLC H.D.W.Holding Company,Inc. Askuity,Inc. Home Depot Management Company,LLC i �I ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD mlrlreW CERTIFICATE OF sir T ,Camp ns�'ion NYS WORKERS' COMPENSATION INSURANCE COVERAGE Boar 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Home Depot USA,Inc. 770-433-8211 2455 Paces Ferry Rd.,C-20 Atlanta,GA 30339 1c.NYS Unemployment Insurance Employer Registration Number of Insured 76011130 Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,he:,a Wrap-Up Policy) Number 58-1853319 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New Hampshire Insurance Company Town of Southold 3b.Policy Number of Entity Listed in Box"l a" 53095 Route 25 Southold,NY 11971 WC 065886028 3c.Policy effective period 03/01/2022 to 03/01/2023 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled 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 the 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 Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation 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 Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. 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 the coverage as depicted on this form. Approved by: Michael Price (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 02/07/2022 (Signature) (Date) Title: CEO North America Telephone Number of authorized representative or licensed agent of insurance carrier: 212-770-7000 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov Workers' Compensation Law Section 57. 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 inn-a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. C-105.2 (9-17) REVERSE r CERTIFICATE OF INSURANCE COVERAGE 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 Ia.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured HOME DEPOT U.S.A.,INC. 2455 PACES FERRY ROAD NW 446-807-7093 ATLANTA,GA 30339 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,Wrap-Up Policy) 581853319 2.Name and Address of Entity Requesting Proof of 3a Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) TOWN OF SOUTHOLD HARTFORD LIFE AND ACCIDENT 53095 ROUTE 25 3b Policy Number of Entity Listed in Box"I a" SOUTHOLD, NY 11971 LNY713657 3c Policy effective period 01-01-2022 to 12-31-2022 4.Policy provides the following benefits: MV A.Both disability and paid family leave benefits. F1 B.Disability benefits only. Ill F1 C.Paid family leave benefits only. 6.Policeovers: 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 12-29-2021 7clivw- (Signature of Insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (212)553-8074 Name and Title:Elizabeth Tello—Assistant Director,Statutory Services IMPORTANT: If Boxes 4A and SA 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 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 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) A717, IH Additional Instructions for Form D13-120.1 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"1 a"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 2. 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 my 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 Family 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 first, two thousand eighteen, the payment of family leave benefits for all employees has.been secured as provided by this article. DB-120.1(10-17)Reverse RECEIPT SUFFOLK COUNTY GOVERNMENT DEPARTMENT OF LABOR, LICENSING,AND CONSUMER AFFAIRS COMMISSIONER ROSALIE DRAGO P.O. BOX 6100,HAUPPAUGE, NY '11788 (631)853-4600 Today Date: 10/22/2020 Application: H-53429 Application Type: Home Improvement License Receipt No. 414174 Comments Payment Method Ref. Number Amount Paid Payment Date Cashier ID Renewal+ 14 Additional Check 0003181507 $1,800.00 1012212020 GAB Locations Contact Info: RICE REPO US INC(14 SUPPS) PO SOX 105451 ` ATLANTA,GA 30348 Work Description: 1 i Suffolk County Dept.of Labor,Licensing&consumer Affairs i HOME IMPROVEMENT LICENSE Name b RICHARD TOUSEY Business lame I This certifies that the NOME DEPOT USA INC(14 SUPPS) bearer is duly licensed by the County of Suffolk License Number:H-53429 Rosalie Drago Issued: 0511512014 j Commissioner Expires: 11/01/2022 1' 1 ,i oa AT�5,;,,V AS N T D DATB.P.# FEEBY: NOTIFY BUILDING DEPARTMENT AT 765=1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POUREDCONCRETE 2. ROUGH -: FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOP 3.0. 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 UTUOLD ZBA - �ju ._ T OARD STEES nive � JCCUPANCY OR JSE 1,8 UNLAWFUL WITHOUT CERTIFICA- CF OCCUPANCY The Home Depot - Thermal Valhjp of Products Manufactured by Simonton gm .041 With_Grids 4 a`'`r1;'` f-1 1 S lei. r act �,�;�n�g, Awning 6500 Base ProSolar Supercept 718- 0.26 ; 0.23 . - 0 0 00.26 0.21 0 010 0 Casement 6500 Base Pr.oSolar Supercept 7/8' 0.26 0.24 a o 0.26 022 10 01016 Transom 6500 Base ProSolar Supe-pt V 0.27 0.32 0 o 0.27 0.29 0 01-1- Double-Hung 6500 Base ProSolar Supercept 7/8- 0.29 0.26 0 0.29 i 0.24 Picture Casement (NH) 6500 Base ProSolar Supercept 716- 0.26 0.28 0 0 0.26 0.25 Picture 6500 Base ProSolar Supercept 7/8- 0 0.27 029 o o 0.27 31 0.26 0 0 2'Panel Slider 6500 Base ProSolar Supercept 718" 0.0.299 0.26 0 019 1 0-23 3 Panel Sliders 6500 Base(S,21 Sqft) Pro Solar Supercept WS". 0 0.299 0 0.28 1 0.23 I Cole] Garden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer V 0.30 0.24 0 0 0 01 .0.30 j 0.21 101010 Patio Door(NOVO 6500,Base Pro Solar Super Spacer 1" 0.28.1 0.26, 01 01 1 1 7 MHomes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. Awning(Inc Hopper) 6100 Base Pro Solar Intercept 718" 027 P 0.24 0l010100.28 0.21 0 0 0 a Casement 6100 Base Pro Solar Intercept 718" 0,27 0.24 0.27 0.22 o a 0 1 1 Q�- u 6100 Energy Star Pro Solar Supercept 3/4" 0.30 ' 0.30 01 0.30 I 0.27 Picture Casement(No Kinge) 6100 Base Pro Solar Intercept 7/8" 0.27 i 0.28 o 01 1 0.27 j 0.25 T-. -.1-- -0 Picture 6100 Base Pro Solar Intercept V" 0.27 0.31 0 0 0.27 0-28 2 Panel Slider, 6100 Base Pro Solar Intercept 34' 0.30, 1, 0.28 a 0.30 0.27 0 3 Panel Slider 6100 Base Pro Solar Intercept 3W .30 j 029 0 0.30 j 0.27 FfDmes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,Now Mexico,Oregon,Utah,and I Washington. io Door INOVU 6100 Energy Star Pro Solar Super Spacer V 0.2 0.26 1 01 -I 1 1 0.28 1 023 o 0"0 -0 PaM-9o�q.rNARR0VV FRAME 6100(PD05)Base Pro Solar Intercept 3/4'1 0.28 P 0.30 10101 0.28 46mes located only in following markets.Dallas,Denver,Detroit,Phila,Northern NJ,Long Island,MY. Awning 6200 Base Pro Solar SHADE" Supercept 3147 017 0.215 0 0 0 -o 0.26 0.23 0- 0 o a Casement 6200 Base Pro Solar SHADE Supercept X47 0.26 0.1 0 0 " o 0.29 0-17 o e e o 8 o Picture Casement-NH 6200 Base Pro Solar SHADE Supercept 34' 0.25 0.21 0 0 0 0 0,25 0.19 a 0 0 0. Picture Window 6200.Base Pro Solar SHADE Supercept 34' 0.26 0.24 o o o o 0.26 0.22 0 0 o o Single Hung 6200 Base Pro Solar SHADE Supercept 314" 0.28 0.23 - o a a o 0.28 0.21 - -0 0-.Q 3W 0.: f I Single Slider 6200 Base Pro Solar SHADE Supercept 10.28100.21 -1 _ ) 0 0 3 Panel Slider 6200 Base Pro Solar SHADE Supercept 314" 0.28 0.23 0.28 i 0 PIM61111-211-1-P M- 31MM Homes located in coastal areas. Awning SB+300VL Energy Star PS SUN/Lami Supercept V 0.26 i 0.23 o a o 0.26 !, 0.21 o o 0 0 Casement SB+300VL Base PS/Lami Super Spacer V 025 '1 0.23 o o o o 0.25 i 021 0- 0 0 a Double Hung SB+300VL Base PS/Lami Super Spacer V 0.29 1 0.25 6 0 0 0 0.29 0.23 0 0 a 0 Slider . SB+300VL Base PS I Lami Intercept V 0.29 r0.25 o 0 o 0 0.29 0.23 a o 0 o Patio Door SB+300VL ETC 366 PS Shade I Lami Super Spacer 1' 0-30 a o 0 0 - . 0.19 F-- lime Garden Door(CH) SB+300VL Base PS[Lami Super Spacer 1 0.30 0.28 -101 1 •Dots Indicate Energy Star certified for that zone WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-tYJOBTI8 Sheet: 1 of 1 Customer: MARC RISHE .lob#: 1-1YJOBTI8 Consultant: Adam Friedman Date: 04/15/2022 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use u: o Mull "S"=stationary or W Style Wraps R N "X"=operating t_ Room Floor Code (Y/N) Style Code Series Code 5 w _ ~vi U a > i > r FULL SCR,STD,White, WRAP,LSR 1 LIV 1st SH- Y DH 6100 WH WH 36 46 82 Glass Pack:Standard HPS FULL SCR,STD,White, WRAP,LSR 2 LIV 1st SH- Y DH 6100 WH WH 36 46 82 Glass Pack:Standard HPS FULL SCR,STD,White, WRAP,LSR 3 LIV 1st SH- Y DH 6100 WH WH 36 46 82 Glass Pack:Standard HPS STD,White, Glass Pack: METAL,J 4 KITCH 1st PW- Y PW 6100 WH WH 38 39 77 Standard CHAN,FF OPP PGP,F, CASING, HI VIS,HDL PRM CLR, A 5 KITCH 1st PD2- Y 61PD2 6100 WH WH 71.25 81.25 152.5 White,TMP:Full, LSR x S FR-C GlassPack:Standard 6 FAM 1st SH- Y DH 6100 WH WH 42 48 90 FULL SCR,MULL,STD, HPS White, Glass Pack: CASING,NG, Standard WRAP,LSR FULL SCR,MULL,STD, CASING,F, 7 FAM 1st SH- Y DH 6100 WH WH 42 48 90 White, Glass Pack: CD,WRAP, HPS Standard LSR 8 FAM 1st SH- Y DH 6100 WH WH 42 48 90 FULL SCR,STD,White, CASING,F, HPS Glass Pack:Standard CD,WRAP, LSR SPECIAL CONSIDERATIONS: 1:White,2:White,3:White,4:White,5:White,6:White,7:White,8:White Line Level Notes: 1.MISC(4):New frame 2.MISC(5):Misc 3.MISC(6):New frame Wrap Color 4.MISC(7):New frame 5.MISC(8):New frame Interior Casing Type Clamshell Bay or Bow window: Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(inches) If tie;to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the Construct Roof(Yes or No) Special Terms and Conditions on the following page Garden Window: Se. and Material(vinyl only-White Pionite,Birch or Oak)