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HomeMy WebLinkAbout48349-Z Town of Southold 11/3/2022 a y� P.O.Box 1179 o�� 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43555 Date: 11/3/2022 THIS CERTIFIES that the building WINDOWS Location of Property: 75400 Route 25, Greenport SCTM#: 473889 Sec/Block/Lot: 48.-1-48.3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8/16/2022 pursuant to which Building Permit No. 48349 dated 9/29/2022 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: replacement windows to existingsingle family dwelling as applied for. The certificate is issued to Vartholomeos,Anthony&Maria of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED tho iz d Sig ature ,,�SUFfat c TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 48349 Date: 9/29/2022 Permission is hereby granted to: Vartholomeos, Anthony 28-45 42nd St Astoria, NY 11103 To: Install replacement windows to a single family dwelling as applied for. At premises located at: 75400 Route 25, Greenport SCTM # 473889 Sec/Block/Lot#48.-1-48.3 Pursuant to application dated 8/16/2022 and approved by the Building Inspector. To expire on 3/30/2024. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CERTIFICATE OF OCCUPANCY $50.00 Total: $250.00 Buating Inspector OF SOUjyo� TOWN OF SOUTHOLD BUILDING DEPT. cou631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ( ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL V)lndauis [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: o) , D DATEf 0 31— 92— INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS ..� FOUNDATION (1ST) -------------------------------------- FOUNDATION (2ND) � O O y O ROUGH FRAMING& � PLUMBING a N � W � r INSULATION PER N.Y. STATE ENERGY CODE h7571,---// e dW /cam 4 0- FINAL G ADDITIONAL COMMENTS Z m X ►o d y O z x �x d b ao�SUFFoI r�oG: TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11971-0959 N M oy�o oar Telephone(631)765-1802 Fax(631)765-9502 hM2s://www.southoldtomLnny.%zov Date Received, APPLICATION FOR BUILDING PERMIT For Office Use Only o IEC 15 OV DD PERMIT NO. I I Building Inspector: Q U G 1 6 2022 Applications,and forms must be filled'outin their entirety:'Incomplete �.applications,will.not'be accepted::Wli&e the Applicant isnot the owner,an BUILDING DEPT. Owner's Authorisation form(Page,2):shall.be-completed, TOWN OF SOUTH®LD Date: os IO zoz& OWNER(S)OF,PROPERTYc ' Name: — SCTM#1000- _._m-1 HON _I/hl_zrVj0 o.I1.E05_ ..y_....._.._ ._.___._..._.. . _...__._� .._:.__._._..,_._- _. •. _ __ _. ___-. Project Address: ! v --1 (4-L475ypM- Z.5GIo --- Phone#: _ Email: QVeiv�h0�.0�1eDS gD.l.•Coi^'� .. _ Mailing Address: $ii f=2C�n1r 5 � �-- ?�rc '._,..-..N.`/._. _1i-9.�►L4.,.___...._ CONTACT PERSON:. Name: _g COT�_ pUa N A _ l�Q_. .Ei21t'1 Mailing Address: _BuT-ri0. U-_.__LN_..__ Phone#: Email: i7FZr1.13 _DESIGN PROFESSIONALINFORMATION:., Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION:;.' _ Name: �pME.. - �`c�n�__..._USA I►�Cr_.. Mailing Address: o2k 5� DACES Zit 2�._ ,._... -. - a-:. ... _!fin-A N 1-4 G* ._--_3 o;33_ Phone#: ---- DESCRIPTION.OF'PROPOSED CONSTRUCTION El New Structure ❑Addition ❑Alteration Repair ❑Demolition Estimated Cost of Project: ❑Other W 1 r-')Do t P-r—PI,A C1 MEQ►j $ '9. gos Will the lot be re-graded? []Yes E3 No Will excess fill be removed from premises? ❑Yes []No V_EMOdE Ar NJ e0_+-A,ACC 10 dtrJ.DOLJ50 SAME S12� NO Si et-,C714ZA_ CKR(vCF . 1 PROPERTY INFORMATION Existing use of property: S,rOG LE PA M I L_Y intended use of property: S(rj&L c f=A.m I(,,y Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes[]No IF YES;PROVIDE A COPY. ❑Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided 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, housingcode and regulations and to admit authorized inspectorson 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 me): v+i`N�Q.OnI Authoriz/ed Agent ❑Owner Signature of Applicant: Date: //Z/ZDZZ Pl i ndi S 66 (( STATE OF NEW-YOM SS: COUNTY OF ) ;�'L.281 Erpr M 154j.920ei being duly sworn,deposes and says'that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the pra-l`J t (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 JA day of am L o of LtN0TA:RYP1JB:LIC, ic :STATE:OF PROPERTY OWNER AUTHORIZATIONEZ ILLI S (Where the applicant is not the owner) I 1, ANTrtON Y 02 NOLOME05 residing at 81) PaQQc 5MSF do hereby authorize Suofs ts—'A M IWDk t'j to apply on my behalf to the Town of Southold Building Department for approval as described herein. A'At 41hz 08/12/2022 Owner's Signature Date Anthony Vartholomeos Print Owner's Name 2 I ®p DATE(MM/DD/YYYY) �►�® 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 NAME: MARSH USA,INC. FAX PHONE TWO ALLIANCE CENTER No.Ext): (A/C,No): 3560 LENOX ROAD,SUITE 2400 E-MAIL ADDRESS: ATLANTA,GA 30326 INSURER(S)AFFORDING COVERAGE MAIC i! CN101642069-HomeD-GAW.-22-25 INSURER A: OldRe ubi Insurance Co 24147 INSURED INSURER B: New Hampshire Ins Co 23841 THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. INSURER C: ACE Amelican Insurance Campany 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER M/DD MH/DD A X COMMERCIAL GENERAL LIABILITY MWZY316648 03/01/2022 03/01/2025 EACH OCCURRENCE $ 1,000,000 –UA—MAGETO RENTED CLAIMS-MADEX❑OCCUR PREMISES Ea occurrence $ 1,0001000 EXCLUDED MED EXP(Any one person) $ X SIR:$1,000,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY EO- [—]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER A AUTOMOBILE LIABILITY MVVTB316649 03/01/2022 03/01/2025 COMBINED SINGLE LIMIT g 1,000,000 Ea acc dent 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 UAB 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$ _ $ B WORKERS COMPENSATION WC 065886029(WI) 03/01/2022 03/0112023 X STA UTE ER AND EMPLOYERS'UABILnY C ANYPROPRIETOR/PARTNER/EXECUTIVE '/N N 1 A WLR 068916409(AZ IL) 03/0112022 0310112023 E L EACH ACCIDENT $ 5,000,000 (MandatoOFFICER/ry In H)F>CCLUDED9 Confined on Additional Page E-L DISEASE-EA EMPLOYEE $ 5,000,000 (Mandatory In NH) If yes,describe under 5,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 107,Additional Romarks Schedulo,may be attached If more space Is roquired) 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. ©19882016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CNI 01642069 _ LOC#: Atlanta �►`��® ADDITIONAL REMARKS SCHEDULE Page ' 2 Of 3 AGENCY NAMEDINSURED MARSH USA,INC. THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. POUCY 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 Workers Compensation Continued: Carrier.Indemnity Insurance Company of North America Policy Number.WLR C68916483(ADS)(AL,AR,FL,ID,IA KS,KY,LA,MS,MO,NC,NE NM,ND,OK,SC,SD,TN,VA,WV,WY) Effective Date:0310112022 Expiration Date:03/01/2023 (EL)Limit$5,000,000 Cartier.AW Insurance Co. Policy Number.WC 065886028(AOS) (AK,CO,DC,DE HI,IN,MA,MD,ME,MN,MT,NH,NJ,NY,PA RI,Vr) Effective Date:03/0112022 Expiration Date:03/01/2023 (EL)Limit$5,000,000 Carrier.ACE American Insurance Company Policy Number.WCU C68916446(QSI)(CA OR,WA) Effective Date: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:0310112022 Expiration Date: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 (T)) Effective Date:03101/2022 Expiration Date:0310112023 (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: CN101642069 LOC#: Atlanta ACCOR0® 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 MAIC 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.SA 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 r ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Vlorkers' CERTIFICATE OF INSURANCE COVERAGE —z srart Compensation — Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured HOME DEPOT U.S.A.,INC. 446-807-7093 2455 PACES FERRY ROAD NW ATLANTA,GA 30339 1 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 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"1a" SOUTHOLD, NY 11971 LNY713657 c Policy effective period 01-01-2022 to 12-31-2022 4.Policy provides the following benefits: 0 A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5.Poli c overs 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 employers 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 f 7e- &40- (Signature of insurance carriers 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 carriers 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 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 DS-120.1.Insurance brokers are NOT authorized to Issue this form. DB420.1(1047) AI II I 7 7� I'�.I®®Id1l�(1 101�' II'l11 IH YORK Workers' CERTIFICATE OF sTA7E Compensation NYS WORKERS' COM PENSATI®N INSURANCE COVERAGE Board 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 1 c.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 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 PACE 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 RECEIPT SUFFOLK COUNTY GOVERNMENT DEPARTMENT OF'LASOR, LICENSING,AND CONSUMER AFFAIRS COMMISSIONER ROSALIE DRAGO p,0.SOX 6100,HAUPPAUGE.NY 11788 (631)853-4600 Today Date: 10/22/2020 Application: H-53429 Application Type: Home improvement License Receipt No. 414174 Comments Amount Paid Payment Date Cashier ID Renewal+ 14 Additional payment Method Ref.Number $1,800.00 1012212020 GAS Locations Check 0003181507 Contact Info: R CHARD OUSEY INC(14 SUPPS) PO BOX 105451 i' ATLANTA,GA 30348 4! Work Description: J suffoik County Dept of l Labor,Licensing&Consumer Affairs ' HOMEIMPROvEMENTLICENSE i Name RICHARD TOUSEY Business Name This certifies that the HOME DEPOT USA INC(14 SUPPS) beater is duly liransed by the County of suffolk License Number:H-53429 l Rosalie Drago issued: 05/1512014 Commissioner Expires: 11101/2022 Go Permits, LLC j 105 Buttonball Lane Glastonbury, CT 06033 Scott Doughman Phone: 847-671-4606 Fax: 860430-6719 4� scottdoughman@gopermits.org To Whom It May Concern, Please see the attached builiding permit application. If you have any questions or require any further information regarding this building permit application, feel free to call me at your convenience and I would be happy to assist you. Once the permit is ready: 1. Please mail the orlainal permit to the owner 2. Also, please email or fax a copy of the permit and receipt to: ➢ Email: permits@gopermits.org '➢ Fax: 860-430-6719 (Attention: Scott Doughman) ➢ If fax or e-mail is not an option, please mail a copy of the permit and receipt to: Go Permits, LLC 105 Buttonball Lane Glastonbury, CT 06033 Thank you' D [ECzB'V(E Ella Mendron N Permit Expediter DD Go Permits, LLC AUG 1 6 2022 Phone: 847-671-4606 Fax: 860-430-6719 BUILDINGDEPT. elzbietamendron@gopermits.org TOWN OF SOUTHOLD Go Permits, LLC 105 Buttonball Lane, Glastonbury CT 06033 www.gopermits.org V• APPROVED AS NOTED DATE �-°��-aa B.P.# �3 9 FEE: 0 • O BY NOTIFY BUILDING DEPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION-TWO REQUIRED FOR POURED CONCRETE 2. ROUGH-FRAMING,PLUMBING, STRAPPING, ELECTRICAL&CAULKING 3. INSULATION 4. FINAL-CONSTRUCTION&ELECTRICAL MUST BE COMPLETE FOR C.O. 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 ,.,.,..,,...,SOUTHOLD TOWNZU jt r SOUTHOLD TOWNP=IN68= '• SOUTHOLD TOWNTRUSM �L...NXS.DEC .a WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-20LYGJGN Sheet: 1 of 2 Customer:Anthony Varpholomeas ,Job#:1-20LYGJGN Consultant: Adam Friedman Date: 08/04(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 LC E c Mull '&'=stationary or TLE Style Wraps rn cm7 s �p °X°=opera8ng Room Floor Code (YM) Style Code Series Code _ F of cg a. .� > _ _ FULL SCR,STD,White, WRAP,LSR 1 DEN 1st DH- Y DH 6500 WH WH 34 58 92 GlassPack:Standard HITILT FULL SCR,STD,White, WRAP,LSR 2 DINE 1st DH- Y DH 6500 WH WH 34 68 92 GlassPack:Standard HITILT FULL SCR,STD,White, WRAP,LSR 3 DINE 1st DH- Y DH 6500 WH WH 34 58 92 GlassPack:Standard HITILT FULL SCR,STD,White, WRAP,LSR 4 DINE 1st DH- Y DH 6500 WH WH 28 54 82 GlassPack:Standard HITILT FULL SCR,STD,White, WRAP,LSR 5 DINE 1st DH- Y DH 6500 WH WH 28 54 82 GlassPack:Standard HITILT FULL SCR,STD,White, WRAP,LSR 6 BATH tat DH- Y DH 6500 WH WH 28 54 82 TMP!Full Obscure Ij- - HITILT Glass:Full, GlassPaek: Standard FULL SCR,STD,White, WRAP,LSR 7 KITCH 1st DH- Y DH 6500 WH WH 31 54 85 GlassPack:Standard HITILT FULL SCR,STD,White, WRAP,LSR 8 KITCH 1st DH- JY DH 6500 WH WH 31 54 85 GlassPack:Standard HITILT 1 I I I .j SPECIAL CONSIDERATIONS: 1:White,2:White,3:White,4:White,5:White,6:White,7:White,8:White Wrap Color nterlor Casing Type Bay or Bow window: eatboard material(vinyl only-Birch or Oak) y Pro)ect Angle(30 or 45) ay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(inches) If tied to soffit,cola 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: eatboard Material(vinyl only-White Plonite,Birch or Oak) WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-20LYGJGN Sheet: 2 of 2 Customer:Anthony Varpholomeos ,Job#:1-20LYGJGN Consultant: Adam Friedman Date: 08104)2022 New Window Hinge Locations Existing Window Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 PH, use L,R or S Glass Misc Items Hardware Code Screens For doors use a Mull "S"=stationary or ak c ,5 t LL:03 E o o p o "X"=operating gW Style Wraps 'c m .� T c� Ja r Room Floor Code (YM) Style Cade Series Code 3 x 5 1-ui c� a > 11 > _ FULL SCR,STD,White, WRAP,LSR B LAUN 1st DH- Y DH 6500 WH WH 31 50 81 GlassPack:Standard HITILT FULL SCR,STD,White, WRAP,LSR 10 UTIL 1st DH- Y DH 6500 WH WH 34 Be 92 GlassPack:Standard HITILT SPECIAL CONSIDERATIONS: 9:White,10:White Wrap Color Interior Casing Type Bay or Bow window; eatboard 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 tied 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: eatboard Material(vinyl only-White Plonite,Birch or Oak) r:7ti{ _�^^';,'°`iV:':� -may '�11102 . !t T-i Rm' a� '!. .�'y�7,•?�`':. ' ?` lri', t W Krdh Grids Glazin U �j,J-�rljf; U ��11 �•1;. Style Glass Package (allwiahArgon) Spacer IG Fact SHGC`�1f, �I1S!"j Fagf SHGClu �iPL � o B6 Awning 6500 Base ProSolar Supercept 718" 0.26 0.23 0 0 0 0.26 0.21 0 0 0 Casement 6500 Base ProSolar Supercept 718" 0.26 0.24 c o o 0 0.26 0.22 cEFLo Transom 6500 Base ProSolar Supercept 1' 0.27 0.32 0 0 0.27 0.29 o 0 Double-Hung 6500 Base ProSolar Supercept 718" D.29 0.26 0 0.29 0.24 0 0 Picture Casement (NH) 6500 Base ProSolar Supercept 7/8" 0.26 0.28 lo.o. 0.26 0.25 o o o 0 Picture _ 6500 Base ProSolar Supercept 718" 0.27 0.29LO LO-29 LO-23 0 0 21 Panel Slider 6500 Base ProSolar Supercept 7/8" 0.29 0.26 0 0 0 3 Panel Sliders 6500 Base(s 21 sgft) Pro Solar Supercept 718" 0.29 0.26 c 0 0 o GI � • � ' Garden Door(CH) 6500 Energy Star ProSolarSUN Super Spacer 1^ 0.30 0.24 0 0 o a 0.30 0.21 0 0 0 0 Patio Door INOVO 6500 Base Pro Solar Super Spacer 1" 1 0.28 0.26 0 1,0 0.31 0.23 0 U 0 0 c e 1 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washln�cion. Awning(Inc Hopper) 6100 Base Pro Solar Intercept 718" 027 ' 0240 0 0 0 0.26 0.21 0 0 0 0 Casement 6100 Base Pro Solar Intercept 718" 027 0.24 0 0 0 0 0,27 p22 0 0 0 0 Double-Hung 6100 Ene Star Pro Solar Supercept 3/4" 0.30 0.30 0 0.30 0.27 T_ 0 0 0 Picture Casement(No Hinge) 6100 Base Pro Solar Intercept 7/8" 0.27 0.28 0 0 0.27 . 0.25 0 0 0 0 Picture _ 6100 Base Pro Solar intercept 3/4" 0.27 0.31 0 0 0.27 0.28 0 0 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 0.27 0 1 1 P 6 • Homes loeated everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and YYashdngton. _Patio Door(NOVO _ 6100 Energy Star _ Pro Solar _ Super Spacer 1" 0.28 0.26 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 0 028 0.26 10 0 62 : 0. Homes located only in following markets:Dallas,Denver,Detrorx Phila,Northern NJ,Long Island,MY. Awning 6200 Base Pro Solar SHADE Supercept 314" 0.27 0.25 o o 0 [ol 0.26 023 o 0 o 0 Casement 6200 Base ProSolarSHADE Supercept 314" 0.26 0.18 0 o 0 o 0.29 0.17 0 0 0 0 Picture Casement-NH 6200 Base Pro Solar SHADE Supercept 314" 0.25 0.21 0 0 0 0 0.25 0.19 0 0 0 0 Picture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.24 o o o o 0.26 0.22 0 0,0 0 SingleHung 6200 Base Pro Solar SHADE Supercept 314" 0.28 0.23 o o o o 0.28 0.21 0 0 0 Single Slider _ 6200 Base Pro Solar SHADE Supercept 314" 0.28 0.23 _ 0 0 0 0.28 0.21 0 0 0 3 Panel Slider 6200 Base Pro Solar SHADE Supercept 314" 0.28 0.28 . 0.21. 0.23 0 0 0 0 0 0 Lqe "M- T-03RWRIM Homes located in coastal areas. Awning SB+300VL Energy Star PS SUN/Lami Supercept T 0.26 0.23 0 0 0 0 0.26 0.21 0 0 0 0 Casement SB+300VL Base PS/Lami Super Spacer 1" 0.25 0.23 0 0 0 0 0.25 0.21 OF 0 i- Double Hung SB+300VL Base PS/Lami Super Spacer 1" 029 0.25 0 o o o 0,29 0,23 0 0 0 0 Slider _SB+300VL Base _ PS/Lami _ _ Intercept V 0.29_ 0.25 0 o 0 0 0.29 0.23 0 o c o Patio Door SB+300VL ETC 366 �~ PS Shade/Lami Super Spacer 1" 0.30 0.19 0 0 0 0 0 • e - Garden Door(CH) SB+300VL Base PS/Lami _ Super Spacer 1" 0.30 T 0.28_ 0 0 0.30 0.25�L� 0 •Dots indicate Energy Star certified for that zone F 7 . Home 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) 478-61 icustomercancellationnortheast@hom o Phone# der iceWovider Email Address Service Provider License#(s) � ) 2. Customer Information Varpholomeos Anthony Long Island 1-20LYGJGN Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 811 Front Street eenport NY 11944 Gr Customer Address City State Zip (646) 537-5237 avartholomeos@aol.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 STOKE DIRECTLY; EMAII.ING SERVICE PROVIDED AT: customercancellationnortheast@homedepot.com OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 40 Oser Avenue Hauppauge 111788 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 NOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY 1MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT DOME 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 RIGHT TO CANCEL. Acknowledged by: 08/04/2022 Customer's Signature Date 460 Standard Fotm HIA(21 Jul.21)(E) Generated Date nR1�022 Lead/10# 1-7rlI yn 1GN ° 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. 5.Anticipated Delivery Date/Installation Schedule Approximate Start Date: 01/31/2023 Approximate Finish Date: 03/02/2023 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: $ 19809.78 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 10.00 (If applicable,total amount of taxes included in Contract Price) Waxitnuin deposit ONLY applicable in AID, iVIA, AIE(33%), NJ, 111(99%) Deposit% 125.0 Deposit Amount$ 2452.45 Remaining Balance 17357.33 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(iv) Electronic signatures will be deemed originals for all purposes. X 08/04/2022 Customer's Signature Date X I/s/The Home Depot 08/04/2022 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 FormlllA(21Jul.21)(E) Generated Date �R/119./2�22 Lead/POW 1-901YG IGN ° 0.1.12