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HomeMy WebLinkAbout48838-Z TOWN OF SOUTHOLD � BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY „ . �difi 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#: 48838 Date: 2/1/2023 Permission is hereby granted to:. Garcia, Sara 2 Midham ton Ct Quoue, NY 11959 To: Install roof mount solar to existing single family dwelling as applied for. Disconnects must be located on the exterior, labeled and readily accessible. At premises located at: 5275 New Suffolk Ave, Mattituck SCTM # 473889 Sec/Block/Lot# 115.4-30 Pursuant to application dated 1/10/2023 and approved by the Building Inspector.. To expire on 8/2/2024. Fees: SOLAR PANELS $50.00 ELECTRIC $100.00 CO-RESIDENTIAL $50.00 Total: $200.00 �I Building Inspector 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 littps://www.soutlioldtownjiy.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PII PERMIT NO. Building Inspectar: Ubu 0 Q 2 02-25 Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an BUILDING DEPT. TDA OFSOU7HOLD Owners Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name:Sara Garcia SCTM#1000-115-4-30 Project Address:5275 New Suffolk Avenue, Mattituck, NY 11952 Phone#: (631) 241-3930 Email:saragarcia1701 @gmail.com Mailing Address:5275 New Suffolk Avenue, Mattituck, NY 11952 CONTACT PERSON: Name: Tammy Lea/Sunation Solar Systems Mailing Address: 171 Remington Blvd., Ronkonkoma, NY 11779 Phone#: 631-750-9454 Email:permitting@sunation.com DESIGN PROFESSIONAL INFORMATION: Name: William Fisher Mailing Address: 509 Sayville Blvd, Sayville, NY 11782 Phone#: 631-786-4419 Email:bill@fisher-ny.com CONTRACTOR INFORMATION: Name:Scott Maskin/Sunation Solar Systems Mailing Address:171 Remington Blvd., Ronkonkoma, NY 11779 Phone#: 631-750-9454 Email:permitting@sunation.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition RAlteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other Will the lot be re-graded? ❑Yes igNo Will excess fill be removed from premises? ❑Yes RNo t 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 RNo 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, 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 name): Sco Maskin RAuthorized Agent ❑Owner Signature of Applicant: Date: I y f a 3 STATE OF NEW YORK) SS: COUNTY OF Suffolk ) Scott Maskin 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 o '"I day of �Q h I t 61" 20d3 11� ry Public TAMMY LEA Notary Public.State of New York Registration No.01 LE6410842 Qualified In Suffolk County PROPERTYI I Commission Expires November 2,20,1`1 (Where the applicant is not the owner' Sara Garcia residing at 5275 New Suffolk Avenue Mattituck do hereby authorize Scott Maskin to apply on my behalf to the Town of Southold Building Department for approval as described herein. ftl2z Owne s Signature Date Sara Garcia Print Owner's Name 2 BUILDING DEPARTMENT- Electrical Inspector TOWN OFSOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 r Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 ro err southoldtownn ov — seand southoldtownn . ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date; Company Name: SUNation Solar Systems, Inc Name: Scott Maskin License No.: 33412-ME email: germitting@sunation.com Address: 171 Remington Blvd. Ronkonkoma NY 1.1,779 Phone No.: 631-750-9454 JOB SITE INFORMATION (All Information Required) Name: Sara Garcia Address: 6276 New Suffolk Avenue Matti uck NY 11962 Cross Street: Phone No.: (631) 241-3930 Bldg.Permit#: email: saragarcial70l@gmail.com Tax Map District: 1000 Section: 115 Block: 4 Lot: 30 BRIEF DESCRIPTION OF WORK (Please Print Clearly) InsAallation of, sQlauanels - flat on [910f Circle All That Apply: Is job ready for inspection?: YES / NO Rough In Final Do you need a Temp Certificate?: YES / NO Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A #Meters Old Meter# New Service - Fire Reconnect- Flood Reconnect- Service Reconnected - Underground - Overhead Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION. Request for Inspection Fonn.xls AM.NO*N*l YI F PO Box 66699,Albany,NY 12206 New Vork State Insurance Fund I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 753118816 GCG RISK MANAGEMENT INC AN NFP COMPANY 100 CHURCH STREET-SUITE 810 Imm a, . NEW YORK NY 10007 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SUNATION SOLAR SYSTEMS INC TOWN OF SOUTHOLD 171 REMINGTON BOULEVARD 54375 ROUTE 25 RONKONKOMA NY 11779 SOUTHOLD NY 11971 POLICY NUMBER I CERTIFICATE NUMBER POLICY PERIOD DATE 2160 670-2 598021 01/01/2023 TO 01/01/2024 12/08/2022 Z THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2160 670-2, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW,AND,WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK,TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS:/MIWW.NYSIF.COM/CERT/ CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS' COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND (SU±RANCE " �!/1i DIRECTOR,I FUND UNDERWRITING VALIDATION NUMBER: 959308854 p II II1HillBill11111HilmmmmHmnillBilliimmu11111HimIN �II�Iu O II 00000000000110301221 Foran WC-CERT-NOPRMT Version 3(08/29/2019)IWC Policy-216067021 U-263 64 [00000000000110301221][0001-000021606702][##Z][16030-19][Cert_NoP-CERT_1][01-00001] DATE(MM/DD/YYYY) 4 CERTIFICATE OF LIABILITY INSURANCE 2/11/2022 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 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). CONTACT PRODUCER The Horton Group PHONE 10320 Orland Parkway nitr est) 708-845-3000 Orland Park IL 60467 ADtarx s Certlfl We eh an rrawp w,,,,,ww,INSURE.f, S,�„A.FFORDING COVERAGE _ ..........................................NAIC#______._ INSURER A:Evanston Insurance Company-_ 35378 INSURED .. .. ....m.,,.�,,..,. SUNASOL-01 INSURER B:The.... ... ..... Continental. _............„ _ In_surancmw 35289 SUNation Solar System .. _ _....... INSURER C:Axis Surpluslsurance Co 26 620 Remington Blvd Ronkonkoma NY 11779 INsuaERo;Travelers Pro pi-y&Casualty,Co 1payofAmeriica 25674 . R _ m INSURER E; .,,,...... INSURER F; COVERAGES CERTIFICATE NUMBER: 1814587511 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. EXP "(p T k "TYPE OF INSURANCE $ POLICY NUMBEREPrdT1A•4"EN XPACDPYY LIMITS A GENERAL LIABILITY Y Y MKLVlENV103336 2/11/2022 2111/2023 EACH OCCURRENCE_ $1,000,000 X COMMERCIAL GENERAL LIABILITY PRt;�M SES L c,ylrr, CLAIMS-MADE E-1 OCCUR MED EXP(Any one person) $10,000 _______ PERSONAL 8 ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 _ .. _.......................................... ....................................... ..............................................,,...._.. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP POLICY JL X LOC $ B AUTOMOBILE LIABILITY Y Y 7018308202 2/11/2022 2/11/2023ET SsCCent�.,.„ ,.,.. $ �_000 '.. MEIN INGLEIL6'Mtl. 1Q X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ......................IN.............-,......-.-m,..... AUTOS AUTOS BODILY J RY(Per accident) $ HIRED AUTOS AUTOS — �--- NON-OWNED PROP Rd'W'tdi��-AOlal $. rccada(tgd C UMBRELLA LIAB X OCCUR CLAIMSMADE Y Y P-001-000795195-01 2111/2022 2/11/2023 OCCURRENCE $3,000,000 EXCESS LIAB AGGREGATE $3,000,000 DEO I RETENTION$ $ WORKERS COMPENSATION WC STATuOT'H- `AND EMPLOYERS'LIABILITY Y 1 N Y LIM,ITi ....ER,.........m.,.._ __.._............. OFFICER/MEMBER EXCLUDED? NIA ACCIDENT s ry ) EA EMPLOYEE,m . ANY PROPRIETOR/PARTNER/EXECUTIVE _., E OYE $ (Mandato in NH If yes,describe under DESCRIPTION OF OPERATIONS below E..L.DISEASE-POLICY LIMIT $ D Builders Risk Y Y QT-630-2T010874-TIL-22 2/11/2022 2/1112023 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Named Insureds:SUNation Service Inc;SUNation Electric Inc;SUNation Commercial Inc;SUNation Cares Inc Additional Insured on a prim”and non-contributory basis with respect to general liability and auto liability coverage when required by written contract.Waiver of subrogation applies to general liability and auto liabdlity in favor of the stated additional insureds when required by written contract.Excess follows form. Town of Southold is included as an additional insured as required by written contract and the CG 2012(State,Governmental agency,or Political subdivision permits or authorization)is included on the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Southold 54375 Main Road AUTHORIZED REPRESENTATIVE Southold NY 11971 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Workers' CERTIFICATE OF INSURANCE COVERAGE Yore sTTiw Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1 a.Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured SUNATION SOLAR SYSTEMS INC 631-750-9454 171 REMINGTON BOULEVARD RONKONKOMA, NY 11779 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,Wrap-Up Policy) 753118816 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold 54375 Route 25 3b.Policy Number of Entity Listed in Box"I a" PO Box 1179 DBL631187 Southold, NY 11971 3c.Policy effective period 10/01/2021 to 09/30/2023 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. Policy covers: © 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,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 9/16/2022 By WJ o, �f (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked, and this form is signed by the insurance 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 emailed to PAU@wcb.ny.gov or it can 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 sox 413,4C or 56 have 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(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) 11� I I 1111111111111111111111111111111111111imil III I 1�1 DB 120.1 (12-21) ....._..�...W...e. .. .�. _...... ww�. ,.. �.o.u��eor .., Suffolk County Dept.of s Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE 3 Name SCOTT A MASKIN j i Business Name • 3 certifies that the firer is duly licensed SUNATION SOLAR SYSTEMS INC :he County of sulf-olk License Number:H-44104 Rosalie Dra90 Issued: 03/06/2008 Commissioner Expires: 3/1/2024 w 1' i i r M � f of I z. ................... ................ ro Suffolk County Dept.of Labor,Licensing&Consumer Affairs MASTER ELECTRICAL LICENSE Name SCOTT A MASKIN Business Name This Certifies that the SUINATION SOLAR SYSTEMS INC bearer is duly licensed by the County of suffolk License Number:ME-33412 Rosalie Drago Issued: 06/2412003 Commissioner Expires: 06/0112023