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HomeMy WebLinkAbout48086-Z �o�Og�FFOL,�CIO Town of Southold 8/24/2022 P.O.Box 1179 0 53095 Main Rd 4,� o� '� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43367 Date: 8/24/2022 THIS CERTIFIES that the building WINDOWS Location of Property: 240 Waterview Dr, Southold SCTM#: 473889 Sec/Block/Lot: 78.-7-31 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/21/2022 pursuant to which Building Permit No. 48086 dated 7/19/2022 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: 8 replacement windows to existing single family dwelling as applied for. The certificate is issued to Romeo ML Asset Mgmt Trt of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Au iorz d g afore TOWN OF SOUTHOLD �o�su�Foi cG y 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#: 48086 Date: 7/19/2022 Permission is hereby granted to: Romeo ML Asset Mgmt Trt 60-04 Little Neck Pkwy Little Neck, NY 11362 To: Replace 8 windows, same size, no structural change to existing single family dwelling as applied for., At premises located at: 240 Waterview Dr, Southold SCTM #473889 Sec/Block/Lot# 78.-7-31 Pursuant to application dated 6/21/2022 and approved by the Building Inspector. To expire on 1/1812024. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO-ALTERATION TO DWELLING $50.00 Total: $250.00 Building Inspector O�In OPSOUIyo`o Y, # TOWN OF SOUTHOLD -BUILDING DEPT. �YOOUMV 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ VfFINAL W(hAdWS [ ] 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 �►o FOUNDATION (1ST) �a ------------------------------------ O FOUNDATION (2ND) �- z 0 H ROUGH FRAMING& PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS O 0. X ►o � O z x H x d b H DocuSign Envelope ID:81 lA7C31-CF44-4C41-9EB6-DDBI78841233 __,i. _, $06 q TOWN OF SOUTHOLD-BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P.O.Box 1179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax(631)765-9502 https://www.sotitholdtownny.v-ov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only D JUN 2 "12922 PERMIT NO. Building Inspector: -Applicationsand forms must be filled out in their-entirety.Incomplete BUILDING DEPT I•applications.will not be accepted. Where theeAppliciani is not the owner,in TOWN OF SOUTHOLD -Owner's Authorlzation form(Page 2)shall be completed. Date: 06/15/2022 OWNER(S)OF PROPERTY: Name: Maria Luisa Romeo SCTM#1000- -7 Project Address: 240 Waterview Dr. Southold, NY 11971 Phone#: 347- 574- 4164 Email: mandjromeo@msn.com Mailing Address: 240 Waterview Dr Southold, NY 11971 'CONTACT PERSON: Name: Scott Doughman - Go Permits Mailing Address: 105 Buttonball Ln Glastonbury, CT 06033 Phone#: 847-671-4606 Email: PERM ITS@GOPERMITS.ORG DESIGN-PROFESSIONAL,INFORIVIATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION." Name: Home Depot USA Mailing Address: 2455 Paces Ferry Rd, Atlanta, GA 30339 Phone#: 847-671-4606 Email: ',DESCRIPTION OF'PROPOSED CONSTRUCTION E]NewStructure DAddition E]Alteration ®Repair ElDemolition Estimated Cost of Project: El Other PA-z-1400S Ar4b*"PLACZ 9 WiriboLig 54PIE So&S, No SMUC;UZAL C4011". $ 7.402 �Will the lot be re-graded? ElYes 15�No Will excess fill be removed from premises? E]Yes ®No DocuSign Envelope ID:81lA7C31-CF44-4C41-9EB6-DDB178841233 PROPERTY INFORMATION Existing use of property: Residential Intended use of property: Residential 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. 1:1 Check Box After Reading:"The.owner /contractor/design professional Is responsible for albdrainageand storm water Issues asprovided by Chapter 236 of the Town Code.APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,Now York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to,admit authorized.inspectors on premises and in buildings),for necessary inspections.False statements made herein are punishable as'a Class A misdemeanor pursuant to Section 210AS of the`New York State Penal Law. Application Submitted By(print name): Elzbieta Mendron ®Authorized Agent 00wner Signature of Applicant: q'k" � Date: �o'l�/Z02Ti STATE OF P SS: COUNTY OF C- O V ) Elzbieta Mendron ' Bing 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 �h j day of —SUy\-L 20 VU NotaryPublic OFFICIAL SEAL PROPERTY OWNER AUTHORIZATION ELIZABETH SALGADO (Where the applicant is not the owner) RY PUBLIC,STATE OF ILLINOIS MY COMMISSION EXPIRES 12/01/2024 (Maria Luisa Romeo residing at 240 Waterview Dr do hereby authorize Elzbieta Mendron to apply on my behalf to the Town of Southold Building Department for approval as described herein. DocuSigned by: x �(gyja �bIMLb X6/16/2022 oecsfg �ia .ignature Date X Maria Romeo Print Owner's Name 2 Go Permits, LLC 105 Buttonball Ln. ® Glastonbury,Ct 06033 J ° Scott Doughman S Phone:860-952-4112 Fax:860-430-6719 scottdoughman@gopermits.org "WE UNDERSTAND THAT YOUR TIME IS MONEY" June 16th, 2022 To: Town of Southold Building Department Subject: Permit Application for: Maria Luisa Romeo The above listed homeowner has contracted with Home Depot to replace the windows in his home. The below listed documents are included with this letter. • Notarized permit application • Check for$250 payable to Town of Southold • Contract with Home Depot detailing scope of work • Home Depot Suffolk County License • Certificate of Insurance • Windows specification spec sheet Please note the following: • Please mail original permit to the owner. • Please fax or e-mail a copy of the permit and receipt to: Fax: 860-430-6719 (attn:Scott Doughman) Email:elzbietamendron@gopermits.org • If fax or e-mail is not available, please mail a copy of the permit and receipt to: Go Permits,LLC 105 Buttonball Ln. Glastonbury,CT 06033 Thank you! Ella Mendron, Permit Expediter Go Permits, LLC Phone: 847-671-4606 elzbietamendron@gopermits.org Go Permits LLC, 105 Buttonball Ln. Glastonbury CT 06033, scottdoughman@gopermits.org 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 lD Renewal+14 Additional Check 0003181507 $1,800.00 1012212020 GAB Locations Contact Info: HOME DEPOT USA INC(14 SUPPS) RICHARD TOUSEY PO BOX 105451 �{ ATLANTA,GA 30348 �3 Work Description: l! li Suffolk County Dept.of Labor,Licensing&Consumer Affairs 1 y HOME IMPROVEMENT LICENSE Name RICHARD TOUSEY Business Name i This certifies that the ricensed HOME byDEPOT USA INC(14 SUPPS) bearer County of suHolt License Number:H-53429 Rosalie Drago issued: 05/1512014 Commissioner Expires: 1110112022 I ' NEW Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 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,i.e.,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"1 a" 53095 Route 25 Southold,NY 11971 WC 065886028 3c.Policy effective period 03101/2022 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,l 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 in 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 %WX Worleers' CERTIFICATE OF INSURANCE COVERAGE sraa[ CQn�jsensatiaan t3oar� 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 HOME DEPOT U.S.A.,INC. 2455 PACES FERRY ROAD NW 446-807-7093 ATLANTA,GA 30339 c.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 Cartier 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"f a" SOUTHOLD, NY 11971 LNY713657 c Policy effective period 01-01-2022 to 12-31-2022 4.Policy provides the following benefits: A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5.Poll c covers: Irl A.All of the employers employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑B.Only the following class or classes of employers employees: Under penalty of perjury,l 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 E- 7-e&40- (Signature of insurance canter'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 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 46,4C or 513 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 513 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 B (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-1201.Insurance brokers are NOT authorized to issue this form. DB-120.1(10-17) 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. M12A.1(1047)Reverse DATE(MMIDDIYYYY) A�V CERTIFICATE OF LIABILITY INSURANCE 02124/2022 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(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 MARSH USA,INC. NAME: PHONE FAX TWO ALLIANCE CENTER A1C N : o 3560 LENOX ROAD,SUITE 2400 E-MAIL ADDRESS: ATLANTA,GA 30326 INSURER(S)AFFORDING COVERAGE NAIC# CN101642069-HomeD-GAW.-22-25 INSURER A: Old RepublicInsurance Co 24147 INSURED INSURER B: Now Hampshire Ins Co 23841 THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. INSURER C: ACE American Insurance Company 22667 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 SUER POLICY NUMBER MMNDY EFF MMILIDD y LIMITS LTR A X COMMERCIAL GENERAL LIABILITY MWZY316648 03/01/2022 0310112025 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RFNTE5-- CLAIMS-MADE �OCCUR PREMISES(Ea occurrence) $ 1,000,000 X SIR:$1,000,000 MED EXP(Any one person) $ EXCLUDED PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ A AUTOMOBILE LIABILITY MWTB316649 0310112022 03/01/2025 COMBINED SINGLE LIMIT $ 1,000,000 Fa accident 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 LIAS X OCCUR MWZX 316647 03/01/2022 03/01/2025 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED I I RETENTION$ 1 $ B WORKERS COMPENSATION WC 065886029(VIII) 03/01/1022 03/0112023 X AND EMPLOYERS'LIABILITY STATUTE ER C ANYPROPRIETORIPARTNERIEXECUTNE YIN NIA WLRC66916409(AZ,IL) 0310112022 03/01/2023 E.L.EACH ACCIDENT $ 5,000,000 OFFICE(Mandatory In EREXCLUDED? � Continued on Additional Pae EL DISEASE-EA EMPLOYEE $ 5,000,000 (Mandatory In NH) 9 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS I 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. �y vvrZL.STs �t2G. ©1888-2016 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 A�® ADDITIONAL REMARKS SCHEDULE Page 2 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 G20 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 Workers Compensation Continued: Cartier.Indemnity Insurance Company of North America Policy Number.WLR C68916483(AOS)(ALAR,FLID,IA,KS,KY,LA MS,MO,NC,NE,NM,ND,OK SC,SD,TN,VA WV,WY) Effective Date:03/0112022 Expiration Date:03101/2023 (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:03/012022 Expiration Date:03/01/1023 (EL)Limit$5,000,000 Cartier.ACE American Insurance Company Policy Number.WCU C68916446(QSI)(CA OR WA) Effective Data:03/0112022 Expiration Date:03101/2023 (EL)Limit$4,000,000 SIR:$1,000,000 Cartier.National Union Fire Insurance Company Policy Number.XWC 1647323(QSI) (CT,GA,MI,NV,OH,UT) Effective Date:031012022 Expiration Data:03101/2023 (EL)Limit$4,000,000 SIR:$1,000,000 SIR(CT):$350,000 SIR(GA):$750,000 TX Employers XS Indemnity. Carderlllinios Union Insurance Company Policy Number.TNSC68991006 (TX) Effective Date:03101/2022 Expiration Date:031012023 (EL)Limit$6,000,000 SIR:$5,000,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CNIO1642069 LOC#: Atlanta A�EP 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 G20 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.,Ina Home Depot U.SA Ina 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 ACORD 101(2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OCCUPANCY OR �� �� ® AS NOT USE IS UNLAWFUL DATE: .p.# �° WITHOUT CERTIFICATE FEE: ! S3- • 7 By: OF OCCUPANCY NOTIFY BUILDING DEPART ENT AT 765.1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I. FOUNDATION - TWO REQUIRED FCR POURED CONCRETE 2. ROUtaH - FRAMING & PLUM13ING 3. INSULATION 4, FINAL - CONSTRUCTION MUST COIAPL`(WITH ALL.CODES OF BE COMPLETE FOR C.O. NEW YORK,STATE,& TOWN CODES ALL CONSTRUCTION SMALL MEET THE REQUIREMENTS OF THE N.Y. AS REQUIRED-AND NDITIONS OF STATE CONSTRUCTION & ENERGY UTNQL�TOWNZBA CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS SOU1HOlDTOWIV-PLANNINGBOARD SOUTM TOWN,TRUSTEES N.Y.S.DEC ,r Rome Improvement Agreement: Page 1 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. 1. Service Provider Contact Information The Home Depot I The Home Depot Service Provider Contact Name Service Provider Company Name (631) 478-6101 customercancellationnortheast@hom Phone# Re ce m ider Email Address Service Provider License#(s) 2.Customer Information romeo maria luisa Long Island 1-1ZUAUYWO Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 240 Waterview Drive I Southold K:= 11971 Customer Address City State Zip (347) 574-4164 mandjromeo@msn.com Home Phone# Work Phone# Cell Phone# Customer Email Address 3.NOTICE OF RIGHT TO CANCEL YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY CONTACTING THE SERVICE PROVIDER OR STORE DIRECTLY; EMAILING SERVICE PROVIDER AT: customercancellationnortheast@homedepot.com OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 40 Oser Avenue Hppauge NY 11788 au 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 NOTIC OF YOUR RIGHT CANCEL. Acknowledged by: 06/11/2022 Cus mer's Signature Date 460 Standard FormHLA(21Jul.21)(E) Generated Date .QrIII 12072 Lead/PO# 1-171'AUYWn v 0.1.12 Home Improvement Agreement: Page 2 4.Description of.Work to be Performed A detailed description of the work to be performed is included in the paragraph entitled Scope of Work,Specification, Customer Summary Sheet, Quote Form, Estimate,Invoice or Measure which is included_ in this Agreement. S.Anticipated Delivery Date/Installation Schedule Approximate Start Date: 12/os/2o22 Approximate Finish Date: 01/07/2023 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. 6.Electronic Records Authorization You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this Agreement. By contacting your Service Provider,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above,you confirm that you have access to a computer that can receive and open emails and PDF documents. 7. Contract Price and Payment Schedule Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: $ 17401.60 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 10.00 (If applicable,total amount of taxes included in Contract Price) *31aximum deposit ONLY applicable in AID, MA, IVE(33%), NJ, WI Deposit% 100.0 Deposit Amount$ 7401.6 Remaining Balance $ o.o 8. Finance Charges Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable.No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payments made payable to Home Depot. 9.Acceptance and Authorization By signing below, you authorize Home Depot to: (a) arrange for Service Provider to perform any Services or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's or permitting information may need to be provided to You later.)By signing,you acknowledge that:(i)You have read,understand, and accept this Agreement in its entirety, including the General Conditions and State Supplement, if any; (ii) You are receiving a complete copy of this Agreement;(iii)all rights and interests under this Agreement are solely vested in the person listed as"Customer"above; and(i ctromc signatures will be deemed originals for all purposes. X ` 06/11/2022 Customer's Signature Date X I/s/The Home Depot 06/11/2022 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 Fotrn HIA(21 Jul.21)(E) Generated Date nglil12099 Lead/PO"- 1-1711A11YWn v 0.1.12 WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-1ZUAUYWo Sheet: 1 of 1 Customer:maria luisa romeo ,lob#:1-1ZUAUYW0 Consultant: Adam Friedman Date: 06/1112022 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Leff to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,RorS Glass Mist Items Hardware Code _ _ Screens For doors use IT m c Mull "S"=stationary or Style Wraps m d Q �0 s m F � ^� '' 'E y "X" operating TR.. FI.r Code (YIN) Style Code Series Code S 5 z 5 FT of U a > x° J > x° STD,White, GlassPack: METAL, 1 KITCH 1st SH-A Y DH 6100 WH WH 36 37 73 Standard WRAP,LSR STD,White, GlassPack: METAL, 2 LIV 1st SH-A Y DH 6100 WH WH 40 65 105 Standard WRAP,LSR STD,White, GlassPack: METAL, 3 LIV 1st SH-A Y DH 6100 WH WH 40 65 105 Standard WRAP,LSR STD,White, GlassPack: METAL, 4 DEN 1st SH-A Y DH 6100 WH WH 40 65 105 Standard WRAP,LSR STD,White, GlassPack: METAL, 5 BED1 1st SH-A Y DH 6100 WH WH 40 65 105 Standard WRAP,LSR STD,White, GlassPack: METAL, 6 BED1 1st SH-A Y DH 6100 WH WH 36 42 78 Standard EXT C, WRAP,LSR STD,White, GlassPack: METAL, 7 MBED 1st SH-A Y DH 6100 WH WH 36 42 78 Standard EXT C, WRAP,LSR STD,White, GlassPack: METAL, 8 MBED 1st SH-A Y DH 6100 WH WH 36 42 78 Standard EXT C, WRAP,LSR SPECIAL CONSIDERATIONS: 1:White,2:White,3:White,4:White,5:White,6:White,7:White,8:White Wrap Color interior Casing Type Bay or Bow window: eatboard material(vinyl only-Birch or Oak) ay Project Angle(30 or 45) ay Ranker Type(DH,SH,or Csmnt) fop of window to soffit(inches) I tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the onstruct Roof(Yes or No)' Special Terms and Conditions on the following page Carden Window: eatboard Material(vinyl only-White Plonite,Birch or Oak) With Gdds ass''Raicir'"a`e�;.. .G �ii`�,:;a"'(. r, 6500, Averting 6500 Base ProSolar Supercept 718" 0.26 . 0.23 -10 0 0.26 ' 0.21 0 0 0 Casement 6500 Base ProSolar Supercept 718" 0.26 i 0.24 © 0 0.26 0.22 o 0 0 o Transom 6500 Base ProSolar Supercept 1' 027 0.32 ®- 0.27 0.29 o o Double-Hung 6500 Base ProSolar Supercept 718" 0.29 ' 0.26 0.29 0.24 0 0 0 Picture Casement (NH) 6500 Base ProSolar Supercept 7/8" 0.26 ; 0.28 0 0 0.26 , 0.25 o 0 o o Picture 6500 Base ProSolar Supercept 7/8" 027 0.29 o 0 0.27 s 0.26 0 2'Panel Slider 6500 Base ProSolar Supercept 718" 0.29 0.26 0 0.29 } 023 0LL 3 Panel Sliders 6500 Base(s 21 Sqft) Pro Solar Supercept 7/8" 0.29 0.26 0 0.28 0.23 0 Garden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 0.30 ? 0.24 1 0 0 0 01 0.30 ; 0.21 1-101010 Patio Door INOVO 6500 Base Pro Solar Super Spacer 1^ 1 0:28 i 0.26 10101 0.31 1 023 10101010 1 1 Homes located everywhere Arizona,California,Idaho,Nevada,New IfJexlco,Oregon,Utah,and Washington. Awning(Inc Hopper) 6100 Base Pro Solar Intercept 718^ 0.27 ; 0.24 11010 0 0 0.28 0.21 0 0 U.-F-. Casement 6100 Base Pro Solar Intercept 7/8" 0.7- 0.24 0 o o o 0.27 0.22 o 0 0 0 Double-Hung 6100 Ene Star Pro Solar Supercept 314" '0.30 ' 0.30 0 0.30 i 0.27 0 0 0 Picture Casement(No Hinge) 6100 Base Pro Solar Intercept 718" 0.27 i 0.28 o 0 0.27 0.25 0 0 0 0 Picture 6100 Base Pro Solar Intercept 314" 0.27 0.31 0 0 0.27 0.28 o o 2 Panel Slider 6100 Base Pro Solar Intercept 314" 0.30 : 0.28 0 0.30 0.27 0 3 Panel Slider 6100 Base Pro Solar Intercept 314" 0.30 0.29 0 0.30 i 0.27 0 c tell]I Il • • Homes Located everywhere t7[CEPT:Arizona,California,Idaho,Nevada,New Mextcq OmWn,titch,and Washington. Patio Door INOVO 6100 Energy Star Pro Solar Super Spacer 1^ 0.28 026 0 0 0.28 0.23 0 0 0 0 Patio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4^10.28 ! 0.30 0 .1 1 1 0.28 1 0.26 01 0 • 1 1 E es Located only in following rmarkets:Dallas,Denver,Detroit;Pfeila,Northern NJ,tong Island,NY. Awning 6200 Base Pro Solar SHADE Supercept 314" 0J..27 0.25 0 0 © 0 0.26 i 023 s 0 0 0 Casement 6200 Base Pro Solar SHADE Supercept 314" 0.26 0.18 o o o o 0.29 i 0.17 0 0 0 0 Picture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 0.25 0.21 o o o o 0.25 0.19 a o 0 0 Picture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 i 0.24 o o o o 026 . 0.22 0 0 0 0 Single Hung, 6200 Base Pro Solar SHADE Supercept 314^ 0.28 0.23 o o o o 028 0.21 0 0 0 Single Slider 6200 Base Pro Solar SHADE Supercept 3W 0.28 It 0.23 0 0 0 0.28 ' 02i 0 0 0 3 Panel Slider 6200 Base Pro Solar SHADE Supercept 314" 028 ` 0.23 1 jolojol028 : 021 p 0 0 • : larkiw1 1 Homes located in coastal areas. Awning SB+300VL Energy Star PS SUN/Lami Supercept 1° 0.26 ' 023 0 0 010 0.26 ,. 0.21 0 0 0 0 Casement SB+300VL Base PSA-ami Super Spacer 1° 0.25 ; 0.23 o a o o 025 '. 031 o 0 0, o Double Hung SB+300VL Base PS/Lami Super Spacer 1° 0.29 0.25 9 o o o 0.29 023 0 0 © 0 Slider SB+300VL Base PS/Lam! Intercept 1" 0.29 . 0.25 o o o 0 0.29 : 0.23 o 0 0 0 Patio Door SB+300VL ETC 366 PS Shade/Larni Super Spacer V 0.30 0.19 0 0 e 0 - Garden Door(CH) SB+300VL Base PS/Lami Super Spacer 1" 0.30 0.28 LE •Dots indicate Energy Star certified for that zone