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45694-Z
r �aO�OS11FfU(r�lpG Town of Southold 11/5/2022 y�E P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43567 Date: 11/5/2022 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 1340 Kimberly Ln, Southold SCTM#: 473889 Sec/Block/Lot: 70.-13-20.12 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/4/2021 pursuant to which Building Permit No. 45694 dated 1/20/2021 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: "as built"deck,pergola and outdoor shower additions to existing single family dwelling as applied for The certificate is issued to Houston,Thomas&Catherine of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45694 10/6/2022 PLUMBERS CERTIFICATION DATED 5/23/2022 Mai ck Pluniting 0 ori e Signature �S11FFDI�o TOWN OF SOUTHOLD ay BUILDING DEPARTMENT a TOWN CLERK'S OFFICE o • �,fi` SOUTHOLD, NY GO Oi 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 #: 45694 Date: 1/20/2021 Permission is hereby granted to: Houston, Thomas & Catherine 1340 Kimberly Ln Southold, NY 11971 To: legalize "as bit" additions and alteration to an existing dwelling (deck and pergola) At premises located at: 1340 Kimberly Ln, Southold nCl aho 0(A-14 0 o r g�koL,) e�- SCTM # 473889 Sec/Block/Lot# 70.-13-20.12 Pursuant to application dated 1/6/2021 and approved by the Building Inspector. To expire on 7/22/2022. Fees: AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $1,014.40 CO-ADDITION TO DWELLING $50.00 Total: $1,064.40 Building Inspector SOUryolo Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.deviina-town.southold.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Thomas Houston Address: 1340 Kimberly Ln city,Southold st: NY zip: 11971 Building Permit* 45694 section: 70 Block: 13 Lot: 20.12 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Platinum East Electric License No: 34091 ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 1 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: Notes: Outside Outlet Inspector Signature: Date: October 6, 2022 Air S.Devlin-Cert Electrical Compliance Form ;N .::N Town F3ali:ilriiiex :' ...... ....... ........ T6.1ep Faxi(63:1):7.65�9502 ne 54375 NTaiit:Road:: 17, ........... ....... ........ .. ........ $qqtbo14,-NY.-1 1�.71--OM: Li JUN 1 5 2022 L BUILDING DEPT BUILDING DEPARTNONT: TOWN OF SOUTH6LD TOWN OFSOUTHOLD u R.- ... JUN vvfv 0 �vIV G D 0077. . Building Permit N:0;.. OvMeft 11j01---,aS �dks�b2) ........... lease prtnt T . ................... .......... ::.::.::.;Plumber: 411 ..................... .... .............. ...... :(Please print.) J certify:that the.so 11der..used.:i.rt::t.hevatersur) - .less:-.less-than:2/1.0.:cif 1% .ply lead; (m i6re*)`.......... * S,womJobe.fo.r.q.:m, e:ffijs, 2-� dayof: ..... C CHALONE Notary Public. State of New York Notary Public, aft t Registration #01CH6287106 Qualified In Suffolk Count Commission Expires Aug. 5.20 i!�; ... .............................. ......... ......... ......... ............... ...... ... . ........... . ` • b� SOF SOUTy * �# TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 1 NSPECT 10 N [ ]. FOUNDATION 1ST [ ] ROUGH PLBG. [ ] -FOUNDATION 2ND. [ ] SULATION/C ULKING [ ] FRAMING/STRAPPING [ FINAL � [ ] FIREPLACE &CHIMNEY [ ] FIRE SAFETY INSP CTION [ ] FIRE RESISTANT CONSTRUCTION [ ],'FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: �V�n�XM C�ilt6l! n �V-i � Dvi DATE q -If INSPECTOR OF SOUI�o� y � TOWN OF SOUTHOLD BUILDING DEPT. �o . �o urm,�� 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IULATAffftAULKING [ ] FRAMING /STRAPPING [ qo`FINAK��) [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] F RESISTANT PENETRATIO [ ] ELECTRICAL (ROUGH) [ ELECTRICAL (FINAL [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL / I� U REMARKS: LOY* DATE0� INSPECTOR � I Y � r e t 1 ` w. 3 j k 1 •s ), i i � � 11 t Fk Ilk ^'-lei jos • Ar y h 16 lr' _47 x�, • Ar / fir• r^ [� . i . f `T 5, s n � a t � x R Sr �' J r /' •. �. �� � .. _r. ,"°".: �. _-�-- � , . �. ��, nr ,;; t � I � * � r:� � � z ' � i � � R W � ��, �► � " � � �~'�� t br _ fit.,��#��*�i � i♦ . ii ilii♦ r � E o- r a Y a tl 406 Ae P14 3Yi f .R t� r -. . �,.� �`, s � � .�� � . � . , ��7, , P M �...� .. �`a+ • ` ��' �$� t w � � t:"t 4 6 I� • � a r. � �, �,, r�: '�.. _ .i .. .., .. �, :, ..+ ».. � ,� .� V ' { 7 4 z 1 _ i���►��� F a a..... �: F' µ r. � � �' ��� i!. `. �} �1. '8� '0.s � v K � r ^ _ ,. t ,+nb. 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V - R r *wrr. • � w DATE FIELD INSPECTION REPORT COMMENTS FOUNDATION(IST) y - �l +, ------------------------------------ - v FOUNDATION(2ND) (~ f z 0 ROUGH FRAMING& PLUMBING ' C t INSULATION PER-N.Y. S ' STATE ENERGY CODE WIND (G CV4 4V. 4, 04.�" 1 l FINAL �6 .Qo1. 4 . ADDITIONAL C MMENTS. a Ira z d H. o�SueFucx�oG TOWN OF SOUTHOLD—BUILDING DEPARTMENT y x Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtoM=.aov Date Received APPLICATION FOR BUILDING PERMIT For Office Use On , r_�' r`" ,i 1" iyM1 I_. S � PERMIT NO. ✓ 7 Building Inspe ,, JAN - 4 2021 Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Z`;, Date: OWNER(S)OF PROPERTY: Name: Thomas Houston SCTM#1000- 70.-13-20.12 473889 Project Address: 1340 Kimberly_Lane,_Southold Phone#: 631-765-5772 Email: rmkb19 o tonline.net Mailing Address: P.O. Box 789, Southold, NY 11971 CONTACT PERSON: Name: Ron Morizzo Mailing Address: P.O. Box 789, Southold, NY 11971__ Phone#: 631-765-5772 Email: rmkb19@optonline.net DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: Ron Morizzo Kitchens & Baths Inc. Mailing Address: P.O._Box 789,_5outhold,NY 11971 Phone# 631^765-5772_ __� _____ Emanrmkbl9@optonline^net DESCRIPTION OF PROPOSED CONSTRUCTION El New Structure XAddition ®AlterationRepair ❑Demolition Estimated Cost of Project: ❑Other $70,000.00 Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes El No 1 N F.0 1100- i respectExisting use of property:w� fan11� ,y:_� Intended-use of property:� farpl�y�-�r�-,��r�.•�e-,�_. Zone or use district in which premises is situated: Are there any covenants and restrictions with to R-40 this property? 11Yes D No IF YES, PROVIDE A COPY. --is*p6fi ib -draihage,an 'Qdesijn'0 A% i 167.f6r:611 ckb r: ea Mg:'jjhe,6Wneqc6rjWd -,id'ftdffiiwater issues as,pi6iddcfd'by',` j�'�Aftb 'M ;dd EBYWA0 isibbiiedWAS IdInk;Permitpursu �'q.,-,t�PPLICATION ISHERI . ....... ,V Application Submitted By(print nam 4:Ron Morizzo ®Authorized Agent DOwner Signature of Applicant- T Date: STATE OF NEWYORK) SS: COUNTY OF*- Ron MbriZZO being duly sworn,deposes and says that(s)he is the'applicant (Nameo: f indi idual signing contract)above named, (S)he is the Contractor int (Contra,ctor,,Agc 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.0eforerpe this 'day of 20 -k 11 Lary Public 21i'r2 Dawn Johnson 'T, Notary Public,State of New York I-NoOIJ`06349053 5*1 IUBLIC ! I PROPERTY OWNER AUTHORIZATION,,* Qualined I n Suffolk County Commission Expires.10/11/2.1-1-1 (Where the applicant is not the owner) ,,-Thomas Houston residing at 1340 Kimberly Lane, Southold NY. Ron Morizzo do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. 12/30/2020 Owner's'Signature Date Thomas Houston Print Owner's Name 2 PROPERTY.INFORMATION Existinguse of property: 1 Tamil Intended use of property: 1 famll Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to -R_40 � this property? ❑Yes ©No IF YES, PROVIDE A COPY. 8 Check-Box After Reading: The owner/contractor/design professional its responsible for all drainage and storm water issues as provided 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,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are, punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print nam ). Ron Morizzo ®Authorized Agent ❑Owner Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF ) Ron Morizzo being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Contractor (Contractor,Agent, Corporate Officer, etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this day of 20 2-f otary Public \tea ZpTE p,�o� Dawn J011nSOn Notary Public,State of New York ensue j =No 01J06349053 PROPERTY OWNER AUTHORIZATION,,roEyY „' Qualified inSuffolk County Commission Expires 10/11/20.X� (Where the applicant is not the owner) Thomas Houston residing at 1340 Kimberly Lane, ;.'_;--_.'Southold NY Ron Morizzo do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. mc� t� 12/30/2020 Owner's Signature . Date Thomas Houston Print Owner's Name 2 q�Cf ,u� l;'' n�7IQILDING DEPARTMENT- Electrical Inspector GDEpT ~ gVILDIN �,�p TOWN OF SOUTHOLD TONNOf-sO� 1 own Hall Annex - 54375 Main Road - PO Box.1179 o Southold, New York 11971-0959 1p� Telephone (631) 765-1802 - FAX (631) 765-9502 roger.riche rtQ-town.southold.ny.us APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Date: `, 2- Company Name: — v -- R6 t .111C. Name: License No.: Air- 3 YO 9 email: a&ivw eq oo. (' Address: 3 - � �- � vv cD 5� Phone No.: &j - JOB SITE..INFORMATION: (All Information Required) Name: S:-(0 A J Address: 1318 jLl� 'Yt C LtJO A \ Cross Street: Phone No.: &V�& fo/0 .alt¢- 5.13- 6;?r7s- BkVermit#: y J� (p email: )A41V)u_-eas1 ' : a oe.� Tax "'District: 1000 .. Section: Block: Lot: BRIEF DESCRIPTION;OF-WORK (Please Print Clearly) C 7' Circle All That Apply: Is job ready for inspection?: YES NO Rough In Final Do you need a-Temp Certificate?: YES PNO- -Issued'Ort•_.. : Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A #Meters Old'Meter# New Service - Fire Reconnect- Flood Reconnect- Service Reconnected - Underground -Overhead # Underground Laterals. 1., 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION 1,6-2-2, A, CDO Request for Inspection Form-As pF SO!/TyOlo Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 • Q Southold,NY 11971-0959 IyCOUNf`I,� BUILDING DEPARTMENT February 8, 2022 TOWN OF SOUTHOLD J Houston, Thomas 1340 Kimberly Ln f1 J ( — Southold, NY 11971 1 RE: CeYtification from anr�ct or engineer for deck framin4 and stapping. TO WHOM IT MAY CONCERN: The items marked below are required to obtain your Certificate of Occupancy Application for Certificate of Occupancy. (Enclosed) X Electrical Underwriters Certificate. A fee of$50.00. Final Survey with Health Department Approval. Plumbers Solder Certificate or Pex Affidavit Trustees Certificate of Compliance. (Town Trustees # 765-1892) Final Planning Board Approval. (Planning # 765-1938) .Final Fire Inspection from Fire Marshall. (631-765-1802) Final Landmark Preservation approval. Final Elevation Certificate required. Final Storm Water Runoff Approval from Town Engineer Spray Foam Insulation certification from a NYS licensed architect or Engineer BUILDING PERMIT: 45694-Z Addition/Alteration — 0035 F?oA® 1 SC-DHS. Ref# RIO— 94 MANN T. %u <� Omoi Q O _ 317• , AND CONSTRUCTION OF SUBSURFACE SEWAGEAL o u DISPOSAL SYSTEMS FOR SINGLE FAMIL Y RESIDENCES . 2p" E and will abide by the conditions set forth therein and on the o_ N 54° 22 - �a permit to construct. 0 gr s:eC-P AREA = 41,617 SO. FT. 1 , 65.72'oy 0 !20"W l l�/• sV C sr ® � w � � � 2.0' •3 iT � kL Z W y /9l2• C N ' 0 SURVEY OF �— 3 PROPERTY cr. o , w' _ " AT SOUTHOLD $toTOWN 'OF SOUTHOLD CERT/F/ED.T� SUFFOLK COUNTY, N. Y ; o ) OVERLOOK ® 4T DEVELOPMENT CORP. 1000 - 70 - 13 - 20.12 ° well S. ARTt L 01S G. LAA4/A SG8le 1" = 401 . 1 VENA ` OT CO � LAIo� T/7ZE _ s y s INSC,If�,4 CiOh-ANY No v. 7, 1988 Mar 24 1994 Dec. 2, 1994 F=und aWn ��• j Oct. Z4, 1996 (Under ConshuctionJ o- NQ9 70 ' PSE OV NEW y 0 FIRM ZONE A4 EL. 8 & ZOME B Y� �� r s� �N t. MFTjc ANY AL 77*�g'RA TION OR ADD17I01V TO THIS SURVEY IS A VIOLA TION NO Fp // OF SECTlIAV 7809 OF THE NEW YORK.STATE EDUCATION LAW ` The locations of wells and cesspools �O fiERE T PER SECTION 7209-s 2. ALL cERTIFICA'TIONs ! VALM FOR THS MAP AND COPES ThEREOF ONL Y IF shown hereon are from field observations 14 SA/A MAP. R COPIES BEAR•THE IMPRESSED SEAL OF THE SURVEYOR A - -' and or from data obtained from others. WHOSE TUBE APPEARS HEREON. ' N. L-lC. NO. 4961'8 ADP1710NML Y TO COMPLY WITH SAID-LAW THE TERM 'ALTERED BY' 06 11 MUST BE ittkED,BY ANY AND ALL SURVEYORS UTILIZING A COPY PECO NO TE, L 0 T.NUMBERS REFER TO 'MAP OF PARADISE B Y THE BAY' OF�!f�!OT SURVEYOR'S MAP. TERM5 SUCH AS 'YNSPECTED"AND (g/61 T 6 - P.C. PtLE'O. NOV_ 4, 1971 FILE N0. 6453 AT THE OFFICE OF THE �R GNT O^DATE'ARE NOT IN COMPLIANCE WITH THE LAW' ( O. BOX SUFrOLK COUNTY. CLERK. ELEVATIONS ARE REFERENCED T4 /k�V.lx I MAIN ROAD SOUTHOLD, N.Y. 11971 1 -88 - 677 ACOO CERTIFICATE OF LIABILITY INSURANCE °ATE`MM,D°"Y„Y' 14..� 12/29/2020 THIS CERTIFICATE IS ISSUED AS'A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE.CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement..A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONT: Automatic Data Processing Insurance Agency,Inc. NAME Automatic Data Processing Insurance Agency,Inc. P HONE1C, Ext: 1-800-524-7024 A/c,No): E-MAIL ADDRESS: 1 Adp Boulevard INSURER(S)AFFORDING COVERAGE NAIC# Roseland NJ 07068 INSURER A: Phoenix Insurance Company 25623 INSURED ;Ron ModzZo Kitchens&Bath INSURER B INSURERC: :22355 Rte 48 INSURER D: INSURER E Cut6hogue NY 11935 INSURER F: COVERAGES. CERTIFICATE NUMBER- 1784217 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. INSSR ADDLISUER TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS INSD WVD POLICY NUMBER MLCD MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADEF-1 OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATELIMITAPPLIES PER: GENERAL AGGREGATE $ POLICY.F PRO- RO LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED S NGL IMIT ., $ 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 UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ r $ WORKERS COMPENSATION R TH- P AND EMPLOYERY/N S'.LIABILITY - STATUTE ER ANY PROPRIETOR /PARTNER/EXECLITIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBEREXCLUDED? N❑ N/A N UB-7N353676-20-42 11/01/2020 11/01/2021 (Mandatory;in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under . 1,000,000 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. 54375 Main Road AUTppHORIZED 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 DATE(MM/DDNYYY) A4CC)R" CERTIFICATE OF LIABILITY INSURANCE 2/29/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND:CONFERS'NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. _ IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Barbara Dammers NAME: . Roy H Reeve Agency,Inc. aCNNo Ext: (631)298-4700 ac No: (631)298-3850 PO Box 54 E-MAIL bdammers@royreeve.com ADDRESS: 13400 Main Road INSURERS)AFFORDING COVERAGE NAIC# Mattituck NY 11952 INSURERA: Utica First lits Co 015326 INSURED INSURER B: NGM Insurance Company 14788 Ron Morizzo Kitchens&Baths Inc INSURER C: 22355 Route 48 INSURER D: INSURER E: Cutchogue NY 11935 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2051812482 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DD MM/DD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 5,000 A ART513046601 06/14/2020 06/14120211-000,000 PERSONAL INJURY $ 1-000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑JECT ❑LOC 2,000,000 PRODUCTS $ POTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _ Ea accident X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED B1U6373Z 06/01/2020 06/01/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident NY Mtr.Veh Law Enforc $ X UMBRELLA LIAROCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS-MADE ULC1441806 01 06/14/2020 06/14/2021 AGGREGATE $ DED I X RETENTION$ 101000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE I ERH ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached'rf,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. P 0 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 . --- - � - ______ � - I 11 . I I",�"l-, �'-., , %'�;���:�,- -�',", ,--", '-,,% ..��I, v I-, ","� "' "'.%""' ,"I'-.�"_'�''�","':�"'>' "..:' '. :' ., "" �','�','.'�'��ll ` I 1� ":� '� '� �' '.: "' ��'%� � > �� - '. --'"',,,,, '.' �' �" �� :� V " �< � , '. 1, " , �� % Y "'I. V'I,I�1� "' , - .: '. 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I r - I I 1� . . � 11 r .� " . , I I , '.1 �' .. " I...1 I ". q � ` . " I I ,� . I I '' �' I � I I I I .�1, - I- ' I .�".�I .: I I 11 � " r e I '. .1 1, ., � :. , , ". , � � I � , � "�. , __1 � I '. I 'r ", , . I '' � I I I. �' r 1'r, , I , . 1� . , � . , :1 :, .r' , � . I �. � . , : ' ' ' ' �- ' I . I / I. r . , . � . , . ' � 3. INSULATION . � I 1, I I �'I..'�.� � .1. .. . . . . � , � - I�� " I :. " 11 . I � I '. � I ", I . .� " " , �� . - -',, , ,.:,,.r,�..�.��'',,� ,*1��'*,'�I r . .,, - . . , ,��- , I I I I . I�' .I. " �' , , � �"' ,,� ,. :,� , " , � � . � �' ','r 1, , ,�.'r, , ,, � ,� . /.I -.r." .' � . .' I I ' : ' r - ' ' ," � '.�, ., ' ' �': ' ' ' '. " - . � I �' , " ", I : ,,,'� , I �` - - " � I I " ,,�_. I �11 I I . -� . � ll'� .1'1. 1� , '� ., , ,''.. . � I, , ", . �, , I " r ,r '� :'I �' . :1 I /�.','�1'�I I �.' . ',r I �'.� r , , , , �' I ,� I � . � I � � I I . I � I , r I . , r "I I- - , " , , . I I I " � . � . - I , , I � I '_ , �� " , � I , � . I , . � � . , � " � , , � '_� , . � �'�', . I . �. " ," '. , �" , � " 1. I I 1. � I ", ." .11 I I . � ..' . rr ,r', , I I 11, 1, I ' .: .I.�, . I . � I I � . . ' � ' "'�' � r �' . I 11 1� .. �' I I . I �� - �-�' .' - , � , . � �" � ,�. ;�, '�. ., I�. � 1 4. FINAL - CONSTRUCTION MiUST �� I � ." I ,". I�' �� . � . . , . � r , " �I I � �' , , � � �' " I ., ,I"I . . 4 " . "I 'r .1 '' , ,. - , ... � 1,, , ,%.. , � I � ,,r , I I I .d � I . I I � I., I .. I I I '' . � � . . , , 1,� .� I. I I I 11,I" , I 1, "I , , ,,r �' , , ', " �' � , ` I � 11 � : ' ,r , ,� , , , I I " , . I I � ,' .� ' I I ,r , , I . I ".,l " . I � . , , 1� . :' . �� � . , � � , , � �. � , r , . . '�' I Ir ,� , , I , L I I I � �' �� , I , I . .' " . - I I "" . , - � I � " � I I � 'r I I r I Ir - I eE COMPLETE FG�--j c.O. ' . .I ,�,�, .'�'�' .',� � � . I - - I . X��: . '' ..,' 1. ,. "� .'�;' I ' I I I .' I , 'r', � , �l ,. - I " I I I , I 1, . .1 1, � . � , I I '�/, , . 1� 1, � � .. I '�� " I � r I . �' .'�" I I . . 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