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HomeMy WebLinkAbout48786-Z �o�S�Ffot y Town of Southold 3/5/2023 a , P.O.Box 1179 0 .,� 53095 Main Rd X01 �ap�gSouthold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43 899 Date: 3/5/2023 THIS CERTIFIES that the building GENERATOR Location of Property: 895 Highland Rd,Cutchogue SCTM#: 473889 Sec/Block/Lot: 102.-8-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/16/2022 pursuant to which Building Permit No. 48786 dated 1/24/2023 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: accessoty generator as applied for. Maintain 36 inches of clearance from shrubs. The certificate is issued to Burns,William&Patricia of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48786 2/15/2023 PLUMBERS CERTIFICATION DATED Aut ri ed i ature SUFE TOWN OF SOUTHOLD c�ay� BUILDING DEPARTMENT H x TOWN CLERK'S OFFICE "oy . SOUTHOLD, NY �a 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#: 48786 Date: 1/24/2023 Permission is hereby granted to: Burns, William PO BOX 373 Cutchogue, NY 11935 To: Install an accessory generator to an existing single family dwelling as applied for per manufacturers specifications. At premises located at: 895 Highland Rd, Cutchogue SCTM #473889 Sec/Block/Lot# 102.-8-2 Pursuant to application dated 12/16/2022 and approved by the Building Inspector. To expire on 7/25/2024. Fees: ACCESSORY $100.00 CERTIFICATE OF OCCUPANCY $50.00 ELECTRIC $85.00 Total: $235.00 6 Building Inspector pF SO!/jyolo Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.devlin(D-town.Southold.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: William Burns Address: 895 Highland Rd city,Cutchogue st: NY zip: 11935 Building Permit#: 48786 Section: 102 Block: 8 Lot: 2 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Shore Power Electrical Contr. License No: 42536ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Commerical Outdoor X 1st Floor Pool New X Renovation 2nd Floor Hot Tub Addition Survey X Attic Generator X INVENTORY Service 1 ph X Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 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 Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 4'LED Exit Fixtures Sump Pump Other Equipment: 26kW Generac Generator w/200A Whole House Transfer Switch Notes: Generator Inspector Signature: Date: February 15, 2023 S.Devlin-Cert Electrical Compliance Form SOUIyD� -7&-4 V f � •`� ' # TOWN OF SOUTHOLD BUILDINWDEPT. courm, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: ► NAll DATE INSPECTOR '' oF soulyO� --, # TOWN OF SOUTHOLD BUILDING DEPT. courm, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL &ftm4J4vv1 [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: o gz,,�vi\c.... r DATE 3 l yoY INSPECTO GELD INSPECTION REPORT DATE COMMENTS FOUNDATION (IST) ------------------------------------ S_ C FOUNDATION (2ND) cn ROUGH FRAMING & �� d PLUMBING N _ 1 INSULATION PER N. Y. — � STATE ENERGY CODE — FINAL ADDITIONAL COMMENTS e, _ S z5 3 to ZZO �► o�O5�fF0(KQ9 TOWN OF SOUTHOLD—BUILDING DEPARTMENT s� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 N 2 oy�o ao�� Telephone (631) 765-1802 Fax(631)765-9502 https://www.southoldtowmy.gov Date Received APPLICATION FOR BUILDING PERMIT IV/ For Office Use Only (o � EC 16 ZOZZ PERMIT NO. Building Inspector: 70UIL0'1%D E JDj Applications and forms must be filled out in their entirety.Incomplete ®F�p OLD applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date:12/16/2022 OWNER(S)OF PROPERTY: Name:Patricia Burns SCTM#1000- Project Address:895 000-ProjectAddress:895 Highland Road Cutchogue NY 11935 Phone#:631-223-5722 Email:usgs45@gmail.com MailingAddress:895 Highland Road Cutchogue NY 11935 CONTACT PERSON: Name:Nicholas D'Amico - Electrician Mailing Address:108 Frowein Road - Suite 2 Center Moriches NY 11934 Phone#:631-766-7423 _ Email:nick@shorepowerelectric.com DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name:Shore Power Electrical Contracting Inc. Mailing Address:108 Frowein Road - Suite 2 Center Moriches NY 11934 Phone#:631-766-7423 Email:nick@shorepowerelectric.com DESCRIPTION OF PROPOSED CONSTRUCTION BNew Structure n❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $15,300 Will the lot be re-graded? ❑Yes lig No Will excess fill be removed from premises? ❑Yes RNo 1 PROPERTY INFORMATION Existing use of property: Intended use of property:Generator Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes BNo 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):Louis DeSantis IRAuthorized Agent ❑Owner Signature of Applicant: Date: 12/16/2022 STATE OF NEW YORK) SS: . COUNTY OF S JOT-a� ) Louis DeSantis being 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 methis day of 210pt;" &'u— ,20yZ,� Notary Public KERRIANN CHIORANDO Nowt'Public-State of New York PROPERTY OWNER AUTHORIZATION No.01CH6217386 (Where the applicant is not the owner) Qualified in Suffolk County My Commission Exp.02/08/2026 I, Patricia Burns residing at 895 Highland Road (�6 r�h'ereby authorize Louis DeSantis to apply on my behalf to the Town of Southold Building Department for approval as described herein. 12/16/2022 Owner's Signature Date Patricia Burns Print Owner's Name 2 BUILDING DEPARTMENT-Electrical Inspector O`O MCQG TOWN OF SOUTHOLD t Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 L,. rogerr �southoldtownny.dov- sea nd(&-southoldtownny.dov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: /02-/G-Z o z-2- Company Company Name: Shone P-OWE2 V.-C414ic*1 =146. Name: Al j c A o lA S D 'ANi c v License No.: X02�36_ME email: N4cKesAc1ae cwiea Ikcfwc. com Address: log /=/qowLiu NaeieAsx NY //9a* Phone No.: l0 3/- 7G4 - 7,OVa 3 JOB SITE INFORMATION (All Information Required) Name: -hRi'ci,4` uR."-s Address: $ Is- //,, h/ANd Road L'"fc4o u E "Y //93S Cross Street: Phone No.: 3/- ,?,Z 3 - ,5779 2 Bldg.Permit#: email: u s 2 s ef Tax Map District: 1000 Section: /002 Block: $ Lot: 02 BRIEF DESCRIPTION OF WORK (Please Print Clearly) -'N Sf'fl 144-A1 o N of A A 6 k W GEAM"C Ai A C'co fEd Sf.414d-AX QFNER.4fo R Circle All That Apply: Is job ready for inspection?: YES /0 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 Forrn.xls Ilk BUILDING DEPARTMENT- Electrical Inspector �S TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 t rogerr@southoldtownny.gov a seandCcr-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: IA-16-2702-2- - . Company Name: S Aop e (0owc-x 1F1Ec 4te,c r/ Cv V-44Cr14c- Name: /Victi®%s VA/Yrco License No.: 44x25-3 6-Mg email: Nii:Ke sAo/aE owe-2`leeAQ;c-. cc est Address: /og =�owLi�r Phone No.: 6 .3/- 7-C-4 - 7`)a 3 JOB SITE INFORMATION (All Information Required) Name: 'll-Rit'ci.4 uR.NS Address: $9a' /�►� /,aac+� Rc,4o! CufcAo "s IVY //933" Cross Street: Phone No.: (p.3/- g 3 - -57 79;?- Bldg.Permit#: W�510email: cA s s 9r,1-5er,,-.'l• coti Tax Map District: 1000 Section: /OoZ Block: Lot: 2- BRIEF DESCRIPTION OF WORK (Please Print Clearly) -N 5IA/14� o A a.6 k W 6EarOR,+c 1+1'a 60,010d -3-1ANd-ky Q�aE�e.�fo�z Circle All That Apply: Is job ready for inspection?: YES /0 Rough In Final Do you need a Temp Certificate?: YES NO Issued On Ternp 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 Form.xls Z� � � ( D On 6J ani 4- D,e) A- x � �� 5 � a 4•J oy OD tr Jt6 tigD 9�9ss 'Qp Lha`!` •' o� �Q 41-0 'cl �,''• 2 A A • SURVEY FOR APR.20 MARC H.LEVEY 6 BEVERLY LEVEY DEC 091988 LOT 5,"HIGHLAND ESTATES" DAA, ,DULY 1 t Vii. AT CUTCHOGUE TDWN OF SOUTHOLD SCALE+ I"95d SUFFOLK COUNTY,NEW YORK No. 81-412' ■WOUTNOR,[t0 ALT[RATIOK 011 ADDITION TO THIS GUARANTEED 701 SUR11[T A A VIOLATIOII OI7LCT10N 7EOf Ot TNt BANK M� tA TORIC fTATL LAW "Corin Or TNI{wRV[T NOT KARM{ THE LAND EtlYR11T LY LEVEY soAV[TDM9 sIN[O suL oR tMlwaseo srAL sMau IAS C` Norse Coll"0 RED TO I t A VALID TMItE Cotes NaAKUT[[s MIa WED HERE"{MALL Win OKI TD HEALTH DEPARTMENT-DATA FOR APPROPOL TO CONSTRUCT THE of in FOR LP T THE TITLSuRvE T Is rs[/U{o � AND a Nls SOMALI TO TCI[mu CaIs P I Anto - ■M'*W;N \A1N ML:K E��1t TtATM•AIMTt CLIC_ MENIAL A{[NCT AMO L{MDR10 IMSTITYTIMI LIlTID l� N RIII C0.fAK WV OgT�.ILCITOtO�N JQL.OIOCK.�—.LOf NDItOR.AND TO TN[WIH1Q{Of THE LENDING �• NfRq. ARL IRI tTIKLLM{S 1nTNIM 100 KLT 0I 7N1►RO►LMTT MtlTITUTtOM.NIANAMK[{AM[ 1:1gKRA1 /�• !!! OTNM?No THM SNOtN NOKOM. TO ADDITIONAL iNfTITYTtAIl OR lULOwVrCcNwf a TMtWATEN SWMYAM/LTAC OISIOSALST{T[MFON THIS ROID[MQ ONN@f fd /V/f� IML CONFORM.TO TM STANDARDS 0/THE StNI0.1�C0uMfT DVARTM[Nf •DIfTIM[!!NITON lits A KDM iM101LRfT YNl! TURPOSE A l ARE NOT T ML IOR A!RITA&C 0►NdLTN lDIVItX{. IDMIOfr AND ARE MOT TOM OSLO TD L{TASLISN AINLIWIh 1•IbKRT7 LIME OA F011 THE tR[CnON a tLNCLS A0°M/{ fry '400.OSTRANDER AVEMIE YOUNG a YOUNG RIVERHEAD,NEW YORK ..NDNDt{EfiT D..TAMc 9Q 7-.2 o f{l{TIIg10N'MA►/tLLO IN TML O//l0[0/TNL;CLtMK O/SVIIOLK ALOE" D SURVEYOR ENGINEER 3 3 . COUNTT011 AtRIL ES,If17 u ITLL NOgs7 AND LAND SURVEYOR N.Y.S.LICENSE NO,12845 HOWARD W.YOUNG,LAND SURVEYOR .av,nrn.r K rnt t IMA.vNne TANMtMne eemooLsfvT sMarN HTII[ON KY S.LICENSE N0.45093 ' Suffolk County Dept.of n, Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name NICHOLAS D'AMICO Business- uuaneSS Name This certifies that the bearer is duly licensed SHORE POWER ELECTRICAL by the County of suffolk CONTRACTING INC License Number:H-48269 Rosalie Drago. issued: 01/06/2011 Commissioner Expires: 01/01/2023 YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only 1 b.Business Telephone Number of insured Shore Power Electrical Contracting,Inc. 631-395-4029 108 Frowein Road,02 Center Moriches,NY 11934 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required/f coverage is speciffca/ly rmried to certain Dations in New York State,i.e.,a Wrapolp id.Federal Employer Identification Number of Insured or Social Security Poricy) Number 20-1999886 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Hartford Casualty Insumnoe Company Town of Southold 3b.Policy Number of Entity Listed in Box"1 a" 64376 Route 26. 12WECAB5P8l Southold,NY 11971 3c.Policy effective period 07/20/2022 to 07/20/2023 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partnerstoi6cers included) X 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 caller 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 carter referenced above and that the named insured has the coverage as depicted on this form. Approved by: Michael DiPalma (Print name of authorize/fid representative or licensed agent of insurance carrier) Approved by: W k.f PAPM LCv 8/31/2022 (Signature) (Date) Title: Certificate Coordinator Telephone Number of authorized representative or licensed agent of insurance carrier: 631-%7-1011 Ext 317 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 I C406.2(9-17) www.wcb.ny.gov . '4CO�® CERTIFICATE ATE OF LIABILITY INSURANCE e131/2022 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($), 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 certiftoate does not confer rights to tiro certificate holder in lieu of such.endorsem s. PRODUCER Hometown Insurance Agency of L.I.,Inc. PHONE 5 Orville Dr 631-58"100 Fax No 631-5gg.01gq Ste 400 ce horrietowninsuranOe.com Bohemia,NY 11716 INSURERISIAFFORDINGCOVERAGE NAIC0 INSURER A:Ohio Casualty Insurance Cc INSURED SHORPOW41 INSURER B'Hartford Pro and Casually 34690 Shore Power Electrical Contracting, Inc. 108 Frowein Road,Suite#2 INSURERC: Center Moriches,NY 11934 INSURER D: INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER:1617539848 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. INSR LTR TYPE OF INSURANCEam AM POLICY NUYB6t POLICY EFF POLICY EXP LIr11iS A X COrM1ERCIALGEN13tALLUU31L1rY Y BKO(23)57918685 711712022 711712023 EACH OCCURRENCE Fy i 1,000,000 CLAIMS-MADE OCCUR PREMMS Me aoarmenoe $300,000 HIED EXP(Any ane person) $15,000 PERSONAL&ADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2.000.000 POLICY a EC LOC PRODUCTS-COMPIOPAGG $2000,000 OTHER $ AUTOMOSILELIAMU Y acS WGM UMIT $ ANY AUTO N. OWNED SCHEDULED BODILY INJURY(Per per) $ AUTOS ONLY AUTOS BODILY INJURY(Per aoddem) $ HIRED NUTOS N ONLY PROP AMAGE AUTOS ONLY AUTOS ONLY 5 $ UMBRELLALIAB OCCUR EACH OCCURRENCE 5 EXCESS UABCLAIMS MADE AGGREGATE 5 DED RETENTION B WORKERS COMPENSATION $ AND EIPLOYEWLIAt9UTY 12WECAB5PSI 7/20/2022 7120MO23 AFOXCTNEDY!N X OFCERAEMBERELUD ? ED NIA EL EACH ACCIDENT 51.0001000 (Yanda6onrin under uenEL DISEASE-EA EMPLOY $1,000,000 H�s describe r DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000 DESCRIPTtaI OF OPEtAT[ONS/LOCA71pNs!VEJUCLES(ACORD 101,AddWwnW Remarks Schedule,nqy be aUnched U nwm [s required) The Town of Southold is hereby listed as an additional insured,as required by written contract.Subject to policy terms and conditions. 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 Route 25. Southold,NY 11971 AUTHORIZEDREPRESRENTATIVE !1G(�Gl�'Cw'fo► ©1988 2016 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD <NOEW workers• CERTIFfCATE OF INSURANCE COVERAGE a>lr 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 la.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured SHORE POWER ELECTRICAL CONTRACTING, INC 108 FROWEIN RD-#2 6313954029 CENTER MORICHES,NY 11934 Work Location of insured(Only required if coverage Is speufrcalty/imlted to 1c.Federal Employer Identification Number of Insured certain kxstions In New York State,t.e.,Wrap-Up Policy) or Social Security Number 20-4999885 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Bein Listed as the Certificate Holder) Town of Southold Standard Security Life Insurance Company of New York 54375 Route 25. 3b.Policy Number of Entity Listed in Box"1a" Southold, NY 11971 79516-00 3c.Policy effective period 1/1/2018 to 8/30/2023 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: [Xf 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 Disabl)ty and/or Paid Family Leave Benefits insurance coverage as17 above. Date Signed 8/31/2022 By 4Aya-c� (Signature oflnsurance carrier's authodAd representartive or NYS Lkensed Insurance Agent of that insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY 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 413,4C 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 sB of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensadon Board Employee) Telephone Number Name and Title P/erase 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 authadzed to Issue this thorn. DIS-1120.11 (1047) ) III COMPLY WITH ALL CODES OF NEW APPROVED AS NOTED YORK STATE &TOWN CODES AS REQUIRED AN B.P.# D CONDITIONS OF DATE a_=a3 78 SOUTHOLD TOWN1 BY FEE a35.6D ,I NOTIFY BUILDING DEPARTMENT AT SOUTHOLD TIM PUN"M 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: SOUTHOLDTOWN TRIM 1. FOUNDATION-TWO REQUIRED FOR POURED CONCRETE N.Y.S.DEC 2. ROUGH-FRAMING,PLUMBING, ; STRAPPING, ELECTRICAL&CAULKING ' 3. INSULATION 4. FINAL-CONSTRUCTION &ELECTRICAL MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE ELECTRICAL REQUIREMENTS OF THE CODES OF NEW INSPECTION REQUIRED YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. - rlj S. At a4k.MUM ice/.'•' ~ �iR / o� �!Y r� 't-rt'+L�,, ln// �a�-cr Wit, � (038 _ • . a� i12a Was.•� GENERAC® GUARDIAN° SERIES 26 kW Residential Standby Generators Air-Cooled Gas Engine Standby Power Rating ' INCLUDES: X007290-0,G007291-0(Aluminum-Bisque)-26 kW 60 Hz • True Power" Electrical Technology • Two-line multilingual digital LCD Evolution'"controller (English/Spanish/French/Portuguese) • 200 amp service rated transfer switch available • Electronic governor • Standard Wi-Fi°connectivity • System status&maintenance interval LED indicators '>>' • Sound attenuated enclosure • Flexible fuel line connector • Natural gas or LP gas operation GENERAC _ • 5 Year limited warranty • Base fascia 5 • Listed and labeled for installation as close as 18 in(457 mm)to a structure.` `Must be located away from doors,windows,and fresh air intakes and in65usU1 accordance with local codes. cor C LOnLISTED �]C Note:CETL or CUL certification onlyapplies to unbundled units and units packaged with limited circuit switches.Units packaged with the Smart Switch are ETL or UL certified in the USA only. FEATURES O INNOVATIVE ENGINE DESIGN& RIGOROUS TESTING are at the heart of Gen- O SOLID-STATE, FREQUENCY COMPENSATED VOLTAGE REGULATION: This erac's success in providing the most reliable generators possible. Generac's G- state-of-the-art power maximizing regulation system is standard on all Generac mod- Force engine lineup offers added peace of mind and reliability for when its needed els.It provides optimized FAST RESPONSE to changing load conditions and MAXI- the most.The G-Force series engines are purpose built and designed to handle the MUM MOTOR STARTING CAPABILITY by electronically torque-matching the surge rigors of extended run times in high temperatures and extreme operating conditions. loads to the engine.Digital voltage regulation at±1%. O TRUE POWER'"ELECTRICAL TECHNOLOGY:Superior harmonics and sine wave O SINGLE SOURCE SERVICE RESPONSE from Generac's extensive dealer network form produce less than 5%Total Harmonic Distortion for utility quality power.This provides parts and service know-how for the entire unit,from the engine to the small- allows confident operation of sensitive electronic equipment and micro-chip based est electronic component. appliances,such as variable speed HVAC systems. O TEST CRITERIA: O GENERAC TRANSFER SWITCHES:Long life and reliability are synonymous with ✓ PROTOTYPE TESTED ✓ NEMA MG11-22 EVALUATION GENERAC POWER SYSTEMS.One reason for this confidence is that the GENERAC ✓ SYSTEM TORSIONAL TESTED ✓ MOTOR STARTING ABILITY product line is offered with its own transfer systems and controls for total system compatibility. O MOBILE LINK®CONNECTIVITY:FREE with select Guardian Series Home standby generators,Mobile Link Wi-Fi allows users to monitor generator status from any- where in the world using a smartphone,tablet,or PC.Easily access information such _ as the current operating status and maintenance alerts. Users can connect an � account to an authorized service dealer for fast,friendly,and proactive service.With f �.,�� 53 —�-���i� L ; Mobile Link,users are taken care of before the next power outage, f I J DEC 1 5 2022 GENERAQC @1,7% � T , �E.PROMISE �,r1�,�,�;Ii�T a!��;:.: L. T �m� �- GENERAC® 26 kW Features and Benefits Engine • Generac G-Force design Maximizes engine"breathing"for increased fuel efficiency.Plateau honed cylinderwalls and plasma moly rings help the engine run cooler,reducing oil consumption and resulting in longer engine life. • "Spiny-lok"cast iron cylinder walls Rigid construction and added durability provide long engine life. • Electronic ignition/spark advance These features combine to assure smooth,quick starting every time. • Full pressure lubrication system Pressurized lubrication to all vital bearings means better performance,less maintenance,and longer engine ' life.Now featuring up to a 2 year/200 hour oil change interval. • Low oil pressure shutdown system Shutdown protection prevents catastrophic engine damage due to low oil. • EPA Certified for non-emergency applications Allows unit to be used for demand response applications. • High temperature shutdown Prevents damage due to overheating. Generator • Revolving field Allows fora smaller,lightweight unit that operates 25%more efficiently than a revolving armature generator. • Skewed stator Produces a smooth output waveform for compatibility with electronic equipment. • Displaced phase excitation Maximizes motor starting capability. • Automatic voltage regulation Regulating output voltage to±1%prevents damaging voltage spikes. • UL 2200 listed For your safety. Transfer Switch(if applicable) • Fully automatic Transfers vital electrical loads to the energized source of power. • NEMA 3R Can be installed inside or outside for maximum flexibility. • Integrated load management technology Capability to manage additional loads for efficient power management. • Remote mounting Mounts near an existing distribution panel for simple,low-cost installation. Evolution" Controls • AUTO/MANUAL/OFF illuminated buttons Selects the operating mode and provides easy,at-a-glance status indication in any condition. • Two-line multilingual LCD Provides homeowners easily visible logs of history,maintenance,and events up to 50 occurrences. • Sealed,raised buttons Smooth,weather-resistant user interface for programming and operations. • Utility voltage sensing Constantly monitors utility voltage,setpoints 65%dropout,80%pick-up,of standard voltage. • Generator voltage sensing Constantly monitors generator voltage to verify the cleanest power delivered to the home. • Utility interrupt delay Prevents nuisance start-ups of the engine,adjustable 2-1500 seconds from the factory default setting of 5 seconds by a qualified dealer. • Engine warm-up Verifies engine is ready to assume the load,setpoint approximately 5 seconds. • Engine cool-down Allows engine to cool prior to shutdown,setpoint approximately 1 minute. • Programmable exercise Operates engine to prevent oil seal drying and damage between power outages by running the generator for 5 minutes every other week.Also offers a selectable setting for weekly or monthly operation providing flexibility and potentially lower fuel costs to the owner. • Smart battery charger Delivers charge to the battery only when needed at varying rates depending on outdoor air temperature. Compatible with lead acid and AGM-style batteries. • Main line circuit breaker Protects generator from overload. • Electronic governor Maintains constant 60 Hz frequency. Unit • SAE weather protective enclosure Sound attenuated enclosures ensure quiet operation and protection against mother nature, withstanding winds up to 150 mph(241 km/h).Hinged key locking roof panel for security.Lift-out front for easy access to all routine maintenance items.Electrostatically applied textured epoxy paint for added durability. • Enclosed critical grade muffler Quiet,critical grade muffler is mounted inside the unit to prevent injuries. • Small,compact,attractive Makes for an easy,eye appealing installation,as close as 18 in(457 mm)away from a structure. GENERAC® 26 kW Features and Benefits Installation System • 14 in(35.6 cm)flexible fuel line connector Listed ANSI 221.75/CSA 6.27 outdoor appliance connector for the required connection to the gas supply piping. • Integral sediment trap Meets IFGC and NFPA 54 installation requirements. Connectivity(Wi-Fi equipped models only) • Ability to view generator status Monitor generator with a smartphone,tablet,or computer at any time via the Mobile Link application for complete peace of mind. • Ability to view generator Exercise/Run and Total Hours Review the generator's complete protection profile for exercise hours and total hours. • Ability to view generator maintenance information Provides maintenance information for the specific model generator when scheduled maintenance is due. • Monthly report with previous month's activity Detailed monthly reports provide historical generator information. • Ability to view generator battery information Built in battery diagnostics displaying current state of the battery. • Weather information Provides detailed local ambient weather conditions for generator location. GENERAC® 26 kW Specifications Generator Model GW7290-0 GW7291-0 (26 MW) --- - - - -- -- - - - --- - -- -- - - - -- Ratedmaximum continuous power capacity(LP) Rated maximum continuous power capacity(NG) 22,500 Watts' ------------- ---- - ---- ------_ -- _. - - - - ---, Rated voltage '- - _ _ _ '-- 240_- Rated maximum continuous load current-240 volts(LP/NG) _ _-- -- - - -" i 08.3/93.8 Total Harmonic Distodion -- Less than 5% Main line circuit breaker 110 amp Pf>aSe - -- --- - ---- - ___- -- - -- --- 1 -- - - - -- Number of rotor poles -2 Rated AC frequency__ _-- fi0 Hz Power factor 1.0 - - --- - - - -------- - ---- ----- ---- - ------ Battery requirement(not included) --�- 12 Volts,Group 26R 540 CCA minimum or Group 35AGM 650 CCA minimum Unit weight(Ib/kg)-, ---- -�-------------�- --- 518/235-- - - ---- �--- - -_- - Dimensions(L x W x H)in cm- 48 x 25 x 29%121.9 x 63.5 x 73.7__ -- ---- Sound output in dB(A)at 23 it(7 m)with generator operating at normal load" Sound output in d6(A)at 23 it(7 m)with generator in Quiet-Test-low-speed exercise mode_'`��- Exercise duration -�- -- 5min Engine Engine type _ _ GENERAC G-Force 1000 Series - -- Numher of cylinders rt- ----�-----------__---------------------- --- -- _ _-_--- --- ---------_2------ , Displacement _ _ _ 999 cc _ Cylinderbloc'kw - " - 4 -- _T� -- �� � LL- - � Aluminum % staon casleev_e -_ -__.___ ) Valve arrangement Overhead valve Ignition system _ -- - Solid-state w/magneto - Governor system Electronic Compression ratio -" 9.5:1 - �- � • Starter _ 12 VDC Oil capacity Operating rpm 3,600 - ----- -----� FueLconsumption Natural gas ft3/hr(m'/hr) 1/2 Load 188(5.32) Full Load 333(9.43) Liquid propane 0/hr(gal/hr)[L/hr] i 1/2 Load 75(2.06)[7.78] -� _ Full Load _ _ 132(3.63)-[13,73]— Note: 3.63)[13.73]Note:Fuel pipe must he sized for full load.Required fuel pressure to generator fuel inlet at all load ranges-3.5-7 in water column(0.87-1.74 kPa)for NG,10-12 in water column(2.49-2.99 kPa)for LP gas. For BTU content,multiply ft3/hr x 2500(LP)or ft3/hr x 1000(NG).For Megajoule content,multiply m3/hr x 93.15(LP)or m3/hr x 37.26(NG). Controls Two-line plain text multilingual LCD_ _ _ Simple user interface for ease of operation. Mode huttons:AUTO -— r -- - Automatic start an utility failure.Weekly,Bi-weekly,or Monthly selectabie exerciser. LL-1 MANUAL _ Start with starter control,unit stays on.If utility fails,transfer to toad takes place. F OFF__----- -_ - _ Stops unit.Power is removed.Control and charger still ope_ra_te_. Ready to Run/Maintenance messages Standard - Engine run hours indiction �- �-�-' w ,----, ��-Standare-— - - T t - ._-_...__-_ _---- ----- _ -__ Programmable start delay between 2-1500 seconds _ _ __ _ _ Standard(programmable by dealer only) UtilityVolta ge Lo /Return to ghlity adjustable(brownout setting) ____, - - - - -From 140-171 V%190-216 V Future Set Capable Exerciser/6 ercise Set Error waming Standard _ Run/Alarm/Maintenance Iogs�T_ - _` 50 events each _ _ Engine start sequence _ _ _ _ _ Cyclic cranking:16 sec on,7 rest(90 sec maximum duration). Starter lock ord_ Stader cannot re-engage until 5"sec after engine has stopped. y' Smart Battery Charger _ Standard Charger Fault/Missing AC warning i -�-_ -- --i 6--- Standard Low Battery/Battery Problem Protection and Battery Condition indication _ i Standard Automatic Voltage Regulation_withOvcrandUnderyoltageProtecti'on �, Standard!__ __} Under-Frequency/Overload/Stepper Overcurrent Protection -� Standard Safety Fused/Fuse Problem Protection - LL - _ - - -- -- _ _ - Standard -- --- -- - --p------- - ---- ----- - - - -- -- -- --- - -- - - - ' Automatic Low Oil Pressure/High Oil Temperature Shutdown Standard High Engine Temperature Shutdown Standard Internal ka 1-incorrec(Wirin: protection -�- - Standard Common extemal fault capability_ Standard Fiel -_ -- -- ---------- dgradabl upe Trmvrare - - - T' - Standard _- - Rating definitions-Optional Standby:Applicable for supplying backup power forthe duration of the utility power outage with correct maintenance performed. 'No overload capability is available for this rating.(All ratings in accordance with BS5514,ISO3046,UL2200,and DIN6271).Maximum kilovolt amps and current are subject to and limited by such factors as fuel BTU/Megajoule content,ambient temperature,altitude,engine power and condition,etc.Maximum power decreases approximately 3.5%for each 1,000 it(304.8 m)above sea level and approximately 1% for each 10°F(6°C)above 60°F(16°C)."Sound levels are taken from the front of the generator.Sound levels taken from other sides of the generator may be higher depending on installation parameters. U.S.EPA certified for non-emergency applications. GENERAC® 26 kW Switch Options Service Rated Automatic Transfer Switch Features Model _ G007291-0(26 kW)_ _) • Intelligently manages up to four air conditioner loads with no additional hardware. [Lo. of P les v� ? Current rating(amps) 200 • Up to eight additional large(240 VAC)loads can be managed when used in conjunction Voltage ratio (VAC) Y 120%240,10 with Smart Management Modules(SMMs). 9 - Utility voltagee monitor(fixed)* • Electrically operated,mechanically-held contacts for fast,clean connections. -Pick-up 80% -Dropout 65% • Main breakers are rated for 80%continuous load. -- Return to Utility` _ Approx_13 sec • 2-pole,250 VAC contactors. ETL or UL listed A Standard r • Service equipment rated,dual coil design. NEMAN l�Enclosuretytype_ _ _�_ _J_ L 3R • Rated for both aluminum and copper conductors. Circuit breaker protected 22,000 ) Lug range ___—^__ -250 MCM__#_6 • Main contacts are silver plated or silver alloy to resist welding and sticking. *Function of Evolution controller • NEMA/UL 3R aluminum outdoor enclosure allows for indoor or outdoor mounting flexibility. Exercise can be set to weekly,bi-weekly,or monthly —w+ Dimensions 200 Amps 120/240,1e Open Transition Service Rated Height Width H1 H2 W1 W2 Oeptfr H 2 x, in 26.8 30.1 10.5 13.5 6.9 cm 67.95 76.43 26.67 34.18 17.5 i Wire Ranges Conductor Lug Neutral Lug Ground Lug 250 MGM-#6 350 MGM-#6 2/0-#14 L DEPTH= GENERAC® 26 kW Available Accessories Model# Product Description G007101-0 iBattery_ WarPad mer Pad warmer rests under the battery.Recommended for use if temperature regularly falls below 0°F(-18°C).-(Not nec- 1 essary for use with AGM-style batteries).— f G007102-0 10il Warmer Oil warmer slips directly over the oil fitter.Recommended for use if temperature regularly falls below 0°F(-18°C). G007103-1 Breather Warmer Breather warmer is for use in extreme cold weather applications.For use with Evolution controllers only in climates where heavy icing occurs. { ' G005621-0 Auxiliary Transfer Switch The auxiliary transfer switch contact kit allows the transfer switch to lock out a single large electrical load that may not be j Contact Kit ineeded.Not compatible with 50 amp pre-wired switches. I G007027-0-Bisque Fascia Base Wrap Kit 1The fascia base wrap snaps together around the bottom of the new air-cooled generators.This offers a sleek,contoured appearance as as well as offering protection from rodents and insects by covering the lifting holes located in the base. I G005703-0-Bisque Touch Up Paint Kit _ If the generator enclosure is scratched or damaged,it is important to touch up the paint to protect from future corrosion.y T� The touch-up paint kit includes the necessary paint to correctly maintain or touch up a generator enclosure. G006485-0 Scheduled Maintenance KitGenerac's scheduled maintenance kit provides all the items necessary to perform complete routine maintenance on a Generac automatic standby generator(oil not included). G007005-0 Wi-Fi LP Tank Fuel Level The Wi-Fi enabled LP tank fuel level monitor provides constant monitoring of the connected LP fuel tank.Monitonng the Monitor LP tank's fuel level is an important step in verifying the generator is ready to run during an unexpected power failure.Sta- tus alerts are available through a free application to notify users when the LP tank is in need of a refill. G007000-0(50 amp) Smart Management Module jSmart Management Modules(SMM)are used to optimize the performance of a standby generator.It manages large elec- G007006-0 trical loads upon startup and sheds them to aid in recovery when overloaded.In many cases,using SMM's can reduce (100 amp) the overall size and cost of the system. 1 G007169-0-4G LTE{Mobile Link Cellular The Mobile Link family of Cellular Accessories allow users to monitor generator status from anywhere in the world,using G007170-0-Wi-FV !Accessories a smart phone,tablet,or PC.Easily access information such as the current operating status and maintenance alerts.Us- Ethernet ers can connect an account with an authorized service dealer for fast,friendly,and proactive service.With Mobile Link, users are taken care of before the next power outage. G007220-0-Bisque Base Plug Kit Base plugs snap into the lifting holes on the base of air-cooled home standby generators.This offers a sleek,contoured appearance,as well as offers protection from rodents and insects by covering the lifting holes located in the base.Kit contains four plugs,sufficient for use on a single air-cooled home standby generator. —� Dimensions & PCs ModelUPC 637.6 mm 1218 mm [25.1 nI [48.8 In] G007290-0 696471087307 G007291-0 696471087314 727.2 mm [28.8 In] loll O 0 648 mm 1232 mm [25.5 In] 148.5 In7 LEFT SIDE VIEW FRONT VIEW Dimensions shown are approximate.See installation manual for exact dimensions.DD NOT USE THESE DIMENSIONS FOR INSTALLATION PURPOSES. GENERAC® Generac Power Systems,Inc. • S45 W29290 HWY.59,Waukesha,WI 53189 • generac.com ©2022 Generac Power systems,Inc.All rights reserved.All specifications are subject to change without notice.Part No.A0002026894 Rev.0 0 412 6/2 0 2 2