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HomeMy WebLinkAbout48548-Z �o�OSUF t�CpG, Town of Southold 2/12/2023 y� P.O.Box 1179 53095 Main Rd Southold,New York 11971 .CERTIFICATE OF OCCUPANCY No: 43838 Date: 2/12/2023 a .THIS CERTIFIES that the building GENERATOR Location of Property: 805 Capt Kidd Dr.,Mattituck SCTM#: 473889 Sec/Block/Lot: 106.-5-9 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/29/2022 pursuant to which Building Permit No. 48548 dated 12/1/2022 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: accessory generator as applied for. The certificate is issued to Callahan,Taryn&Brendan of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48548 1/19/2023 PLUMBERS CERTIFICATION DATED ut o ' e Signature ' TOWN OF SOUTHOLD ��o�SUFFOIK BUILDING DEPARTMENT TOWN CLERK'S OFFICE o . SOUTHOLD, NY o 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 #: 48548 Date: 12/1/2022 Permission is hereby granted to: Callahan, Taryn 805 Captain Kidd Dr Mattituck, NY 11952 To: Install a 20kw generator to an existing single family dwelling as applied for per manufacturers specifications. A minimum setback of 5 feet is required. At premises located at: 805 Capt Kidd Dr., Mattituck SCTM #473889 Sec/Block/Lot# 106.-5-9 Pursuant to application dated 11/29/2022 and approved by the Building Inspector. To expire on 6/1/2024. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CERTIFICATE OF OCCUPANCY $50.00 Total: $235.00 Building Inspector so�Tyol 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 sean.devlin(a)-town.southold.ny.us . Southold,NY 11971-0959 �QIyCoUffm�`t: BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Taryn Callahan Address: 805 Captain Kidd Dr city:Mattituck st: NY zip: 11952 Building Permit#: 48548 section: 106 Block: 5 Lot: 9 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Wildwood Electric License No: 4836ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Generator X INVENTORY Service 1 ph 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 StrobeHeat Detectors Disconnect Switches 4'LED Exit Fixtures Sump Pump 11 Other Equipment: 20kW Kohler Generator w/200A Transfer Switch Notes: Generator Inspector Signature: Date: January 19, 2023 S.Devlin-Cert Electrical Compliance Form �apF so(/lH° l C ,s—L # # TOWN OF SOUTHOLD BUILDING DEPT. Cour, 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: DATE JAPhA INSPECTOR SOUlyO6 - -- # TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] NSULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL &4&46-N- [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARK t �/ boo, DATE INSPECTOR Lisa Dibenedetto From: Darlene Strehle <darlene@powerprogenerators.com> Sent: Monday, November 28, 2022 6:31 AM To: lisa@powerprogenerators.com Subject: FW: Callahan generator rebate information and letter of hardship Attachments: Callahan generator rebate information.pdf, Untitled attachment 00004.htm Thank you, RLD Darlene Strehle NOV 2 9. .2n92 �a�larsrr��uln��tFi BUILDING tJEPT ®' 1 q�jo' Accounting �IAINl1Fcf*I,1re-lnl.p 64S 9ohnson Ave.Unit 6,Bohemia,NY 11716 IPI(631)S67-2700 IF](631)563-4473 From: Taryn [mailto:tcaIla han923(JIgmail.com] Sent: Sunday, November 27, 2022 6:57 PM To: Fred Raimondo - Power Pro generator; Darlene Strehle; Mom; Brendan Callahan=' Subject: Callahan generator rebate information and letter of hardship Please see the attached letter of hardship that I wanted to forward to you. I am hoping that consideration can be given regarding the expedited permit for a Koehler house generator that is essential to supply electricity to our home for our family members who are medically compromised. We appreciate any assistance that you can provide in expediting the permits. Have a wonderful holiday season. RE: Hardship Letter to be Assigned and Reviewed for the Permit for a Kohler 20kw House Generator at 805 Captain Kidd Drive, Mattituck NY 11952 This letter is a hardship appeal and consideration to expedite the approval for the permit for the house generator at 805 Captain Kidd Drive. This property is owned by us: Taryn and Brendan Callahan and was purchased 6 years ago. Because of the fact that our son, Shane Callahan who was adopted at a month old, has medical issues and special needs, we lived in Hartsdale New York with my parents in order for him to get the medical and academic services he needed. My son has a rare genetic disorder called Behget's disease and has on going medical attention in a temperature controlled environment. He gets immense pain in his joints during cold weather as well as extremely hot weather. I also have medical issues including lupus and Ehlers Danlos Syndrome and undergo infusion treatments on a regular basis which requires electricity for refrigeration of the costly medications and for the infusion pumps which I do at home. Electricity has gone out during my 4 hour Hyqvia IVIG infusions and caused me to lose the medications. My parents live with us and have their own medical issues. My father who had triple by-pass surgery and heart valve replacement is also a disabled Vietnam Vet with severe heart and breathing problems. So naturally, he is very sensitive to temperature changes and cannot be without power, heat or air conditioning depending on the season. Shane has been through so much, as we all have, and we need to avoid any unnecessary medical complications that could arise from being without electricity, heat or a/c or loss of costly medications. We are desperately appealing to you for your approval to expedite the house generator permit before our family has to be confronted by any additional medical or emotional distresses. This hardship appeal is due to all of the above hardship issues that we have had to face over the past couple of years including losing all we owned in hurricane ida in Westchester county a year ago. We strongly appeal to you for consideration, review and approval. Please feel free to contact me at(914)438-8100 if you have any questions. We really need your help and approval. We thank you so much for everything you can do. We currently have an open building permit as well. Sincerely, Taryn and Brendan Callahan 1 jpcwcmonfc� Date. Work Order CUSTOMER INfORMAIION Taryn Callahan CUftOMtR tS11MAi!/ACC04NT NAM[: HUM•ER. CUtIOME. • • ►/IONS LOCATION 805 Captain • • Dr, Mattituck, NY 11952, USA CROSS STREET: WORK TO BE REGULATOR NEEDS TO BE VENTED AWAY N/C PER RICK DONE: TANK & REGULATOR INFORMATION TANK SERIAL#: ' REG FSI: - TANK DATE: DATE TANK SIZE: 1000ouenno r■ MANUFACTURER: �� LOCATION7y�S S/N#: OKT . GAUGE%: WHAT IS GAS ` • USED FOR?: 1 I� � �JL J\��i•v � i �� kRA .11 WORK �i� 11`1�V � . �� :�i ►...�� C�� I DESCRIPTION: S iN�1�Y"" � R 1 _ s � .' � � � ��` ti � �,,�� .`.9 � / 1 t ,�\ •'tf fir, ?*r '7 , iy j/`f ;�:'; l 'al l ,�':; �k �y`4^�•� _ .�� � ?"' ri" �9!Y7A��'' r �g(Tµr^ � s � / � I :I' ��..yJ .' - �� � �� y,��y�y""" f`r �r�,y►, Y y / I, r. - +r. .. — '��. Y�__�L3 l � _ � � �� .�. t ' '!l .t��W r �Yr ,��1� J. 3i��-'�J'�' ��� r �' r�n�!d� r rr '� � •�3+✓� ,,� ,k�4� -�r 'S lj(d p� z „i, _ 3„�'►r r 'k�. 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J b - ' -. 4 >.r ♦r 11k J'�* '.f, ,`•'Lr ' a:' R♦4.� !� �., MaA 4^yY K�"it p� ""Yh t ` ~ - ,�-r '� n 'U � i .��' �.l+b 'fid. ii: ♦ r �rY� W • '��.k�.k` ��.�' d° � ' r r + +� <� ''V�„ �11� ^t e�� � I � 1A� yf}y; •`p� _ � " b ,'t� {� ,mac A �Z.-�� � � � r, .fit ti\ i � t -t.� ,� � j1,:F ,��� �tjJlt + : '�-: _ � t `'.,� *� ,,♦ •�• cf • F � ti �* k Y✓Lyjti - �.� r i •-�; /�/ -''�i• ti., ^'&#.! _ �„-ak '� I Fq',S1 t,.l'lt 1 .-1 Y + ti - FIELD INSPECTION REPORT I DATE COMMENTS FOUTfDATION (1ST) -------------•----------------------- S C FOUNDATION (2ND) z 0 01 G y ROUGH FRAMING& PLUMBING d r INSULATION PER N.Y. STATE ENERGY CODE v FINAL ADDITIONAL,COMMENTS 10z m c� � � r O z x x d r� b SpfFO(k =off C�Gy� TOWN OF SOUTHOLD—BUILDING DEPARTMENT y Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtownny.Rov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only ® t~ LD PERMIT N0. Building Inspector: lb� NOV 2 g 2022 Applications and forms must be filled out in their entirety.Incomplete BUILDING L)Ejol . applications will not be accepted. Where the Applicant is not the owner,an TOWNOFSQtm-64 0 Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: M#1000- CT S .w. _. /.Q._✓'. �1 . �ct-1,/Gt- 1Gt/I- -- - -- -. Project Address: 7-3 a Phone#: _-- _.. Mailing Address:_,., � C' t CONTACT PERSON: Name: Mailing Address: Phone#: 61'j/--5-6 7— 7UU Email: ` e•�e� �s. ��' _._ - �.--- --- - -- -- --..-. DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: - Mailing Address: Phone#: _ 7_ a 700 - Email• DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure E--]Addition ❑Alteration ❑Repair ❑Demolition EstimatedCost ofProject: 5�efher ew e .- $ f y��(o d •C�yd Ci v Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? ❑Yes 2<0 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants a restrictions with respect to this property? ❑Yes o 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): Authorized Agent ❑Owner Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF ) Zf 5— 0 r„1je/7e eT7 being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the / LI e/l (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 thi /j L s d� day of 20 0? Notary Public JANET DAMIANO NOTARY PUBLIC-STATE OF NEW YORK PROPERTY OWNER AUTHORIZATION No. O1 DA5061073 Qualified in Suffolk C,3n� (Where the applicant is not the owner�y Commis5lon Expires � I, residing at -- l Pjl do hereby authorize Z15-1- to apply on my behalf to the Town of Sout old Building Department for approval as described herein. �\)�L6�= r � \�Z- z�z Owner's Signature Date 0- %-I,- V l(PA Print Owner's Name 2 BUILDING DEPARTMENT-Electrical Inspector G� TOWN OF SOUTHOLD a 1 Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerre-southoldtownny.gov - seand ansoutholdtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: JJ-2_3 -22— Company (-Z3 -2ZCompany Name: [k)[L'OLoCc% EL_ . lC I Y.jC Name: PAcD�>}! SSS License No.: E - 4S 3fo email: repo)I UoOC�� -triC •C Address: �C? Q t !` N-F Phone No.: q 0-e-d (o,,5( - 2 �>-2:2-1 JOB SITE INFORMATION (All Information Required) Name: a f .-? Address: Cross Street: Phone No.: / y- 3$ - $/0 0 Bldg.Permit#: 4 Qj j email: fca//Q 44,, a 3eG�a Tax Map District: 1000 Section: /o 6 Block: Lot: 17 BRIEF DESCRIPTION OF WORK(Please Print Clearly) 51-6CI R1CAL �NN�C-r of /4 20 Kw K614e-c CsEn«n_�rae Circle All That Apply: Is job ready for inspection?: YES ! NO Rough In Final Do you need a Temp Certificate?: YES / �O Issued On Temp I rrnati (All in rmation requd) Servi Size 1 P 3 Ph Size: A # eters Old Me r# ew Se 'ce-Fire econnec - Flood Re nnect-Serv' Reconnect e -Undergro d -Overhe #Un ergroun Laterals 1 2 H Frame ole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION Request for Inspection FormAs SURVEY OF PROPERTY �( AT MATTITUCK TOWN OF SOUTF3OLD SUFFOLK COUNTY, N.Y. 1000-106-05-24 SCALE. 1= 20' FEBRUARY 2, 2022 MARCH 7, 2022(SCDHS INFO) DWELLING5 APRIL 25, 2022 PROPOSED) (ON PUBLIG WATERJ Pan CAPTAIN aL ,7 , FY76KIDD DRIVE' Y (PURIO WATER M ROAD) m EL7A7 - CA- FDW �f"J�//Q� R O \� S 86 30" E 694..25' 100.00' �g!� � WATER 1 �r /,.� Qfq a �— HATCHED AREA 9 j -PROPOSED 2nd FLR. ADDITION LYE. 3.s•caRc WAUl m CONC. a SLATE o 1 STORY PAT10 cO LOT 186 FRAMED DWELT TNG x r F >1-76.M7se' t� (PUBLIG WATER) i wooD LOT 188 srorn j DWELLIN& ® M x A B (PUBLIG.WATER) _STOCKAW 3 M OUTDOOR SHOVIER M ( Oq SEPTIC LOCATIONAC T z $ to .a .B. t.0'NTOORE M CP 40' 3Y LOT 187 N CP 56' 49' rn ` "Qt1°p ZONING INFORMATION• R-40 GARAGE aa' DECKING F.F.EL7LBww LOT COVERAGE (EXI5TIN(A .c < SHED NEAR 6• TOTAL AREA • 12A00 5v.FT. n FENCE FF HOU5E. L311 50. FT. 1y� OaS, 5r ED 97 SQIF(Fr. ` rax laE m N 86b013u W STOCKADE FENCE s TOTAL CADVERAG& t751 SOFT, T,S 100.00' , 12000/t75h EXA 0.146 151 - N/O/F AL t'0�' NDRA PAPADOP UL05 N/O/F DIONYSIA K DlMITRI PAPADOPOUL ALOGERA5 STEVEN KALOGERA5 DWELLING DWELLING fPUBLIr- WATER) NOTE NO PRIVATE OR PUBLIC WELLS W ININ 200'OF SUBJECT PARCEL / Q f r,(PUBLIG WATER) /J ELEVATIONS ARE REFERENCED TO NAVD tq'c,,A k/ . t ELEVA77ONS ARE REFERENCED TO NAVD i�� '' MONUMENT l (,' AREA=12,000 sq.fln LOT KAeERS REFER TO 'MM OF CAPTAIN KIDD E5TATEV FILED IN THE 5UFFOL.K COUNTY GLERK'5 CMCF ON JAN. R 1439 A5 FILE NO. 1672 MYS. LIG NO. 49618 ANY ALTERAZION OR ADD1770M TO THIS SURVEY IS A VIOLATION OFY.S UG NO. 057132-01 SECTION 7209OF THE NEN YORK STATE'EDUCATION LAW! EXCEPT AS 1PECIOLN—ICASURVEYMS P.C. PER SW770M 7209—SUBDIVISION 2 ALL CER71FICA77ONS HEREON (631) 765-5020 FAX(631) 765-1797 ARE VAUD FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP P.O. BOX 909 OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE 1230 TRAVELER STREET r� SIGNATURE APPEARS HEREON. SOUTHOLD, MY 11977 21-063 ,Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDYYYY) 10/20/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Borg&Borg Inc. PHONE FAX 148 East Main Street AIc a Ems:631-673-7600 No):631-351-1700______ Huntington NY 11743 ADDRESS: certificates@borgins.com INSURERS AFFORDING COVERAGE _ N_AIC# INSURERA:Ohio Security Irlsu rance CO 24082 INSURED POWESER-01 INSURER B:Ohio Casualty Ins.CO. _ 24074 Power Pro Service Co. Inc. — — - 608 Johnson Ave,Ste 6 INSURERc:_____ Bohemia NY 11716 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1962309390 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. ILTR R ADDLSUBRITYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDYYYY MM/DD YOLICY EFF POLICY YYY LIMITS LT A X COMMERCIAL GENERAL LIABILITY Y BKS59794035 517/2022 ! 5/7/2023 EACH OCCURRENCE $1,000,000 _ I DAMAGE TO RENTED CLAIMS-MADE X OCCUR I PREMISES(Ea occurrence) $300,000 X Contractual Liab MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL_AGGREGATE _ $_2,000,000 POLICY I X�PE F LOC I PRODUCTS_COMPIOP AGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY BKS59794035 517/2022 5/7/2023 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ,ANY AUTO I BODILY INJURY(Per person) $ -OWNED SCHEDULED I I r i i BODILY INJURY(Per accident) $ AUTOS ONLY _;AUTOS - - X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY ;---_-I AUTOS ONLY I !(Per accident) $ � I $ B X UMBRELLA LIAR j X OCCUR I US059794035 5/7/2022 ! 5/7/2023 EACH OCCURRENCE $5,000,000 __ .. _ _ .— EXCESS LIAB I CLAIMS-MADE I AGGREGATE $5,000,000 --r- ---L--''-- DED 1. X RETENTION$ WORKERS COMPENSATION I i PER OTH- 1 AND EMPLOYERS'LIABILITYYSTATUTE_L__i ER____ ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L._EACH ACCIDE_NT _ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA_EMPL_OYE_EI$__ If yes,describe under I DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S I I i i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) certificate holder is added as additional insured 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ,s-- YORK Workers' CERTIFICATE OF , STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE l� Board F608 egal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured werPro Service Co., Inc. Johnson Ave, Ste 6 631-567-2700 emia, NY 11716 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up policy) Number 113430118 xx- 2.Name and Address of Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder) g 3a.Name of Insurance Carrier Town of Southold West American Insurance Compan 54375 Main Road 3b.Policy Number of Entity Listed in Box"1 a" Southold, NY 11971 XWW59794035 3c.Policy effective period 05/07/2022 05/07/2023 3d.The Proprietor,Partners or Executive Officers are included.(Only heck box if all partners/officers included)all excluded or certain partners/officers exclu ti. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,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: Borg& Borg Inc., David M Borg President (Print name of authorized representative or licensed agent of insurance carrier) i'`7/50- . 10/20/2022 Approved by: (Signature) (Date) Title:_Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 631-673-7600 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 YORK I Workers' STATE Compensation CERTIFICATE OF INSURANCE COVERAGE Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by E'lisability and Paid Family Leave Benefits Carrier or Licensed Insurance A ent or that Carrier 1a. Legal Name and Address of Insured(Use street address only) 1b.Business Telephone Number of Insured PowerPro Service Co., Inc. 608 Johnson Ave, Ste 6 631-567-2700 Bohemia, NY 11716 1c. Federal Employer Identification Number or Social Security Work Location of Insured(Only required if specifically limited to Number 113430118 certain locations in New York Slate,i.e.a Wrap-Up Policy) F54375 ame and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier Hartford Life And ntity Being Listed as Certificate Holder)wn of Southold 3b.Policy Number of entity listed inbox"la": LNY811134 Main Road3c. Policy effective period: uthold, NY 11971 01/01/2014 12/3112023 4. Policy provides the following benefits: _A. All for the employer's employees eligible under the New York Disability Law _B. Only the following class or classes of employer's employees: _C. Paid family leave benefits only 5. Policy covers: _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 employer's 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 Benefits insurance coverage as described above. Date Signed 10/20/2022 By: /41 David M Bores (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone No. 631 673 7600 Name and Title: President IMPORTANT: If box 4a is 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"4b"is checked,this certificate is NOT COMPLETE for the purposes of Section 220, Sub. 8 of the Disability Benefits Law. It must be mailed for completion to the Workers'Compensation Board, DB Plans Acceptance Unit, 328 State Street, Schenectady, New York 12305 PART 2.To be completed by the NYS Workers Com ensation 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-insured employer has complied with the NYS Disability Benefits Law with respect to all or his/her employees. Date Signed By: Telephone No. (Signature of NYS Workers'Compensation Board Employee) Title: Please Note: Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS license insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance Brokers are not authorized to issue this form. DB120.1 (10-17) Labor,Licensing&Consumer Affairs A d* `. I-CME IMPROVEMENT LICENSE Name 4: FRANK NAVETTA o Business Name 'n s cerifies:hat the )earer is duly licensed POIvWERPRO SERVICE COMPANY INC �a Ire County of suffolk License Number: H-44193 Rosalie Drago Issued: 02/21/2008 Commissioner Expires: 02/01/2024 - i= / it It�• .:T t w•,.."- _�.v::.;. a' '�-.' --+,.- -r.rr_"�'• ~.� -..rt•c' ..-.�•.•.ti..... a_: .l �w�'J '�� \+,-r--'��_..rc-. M's �M _+- _ 'y � w.r"Ys+-r...'+. u+-� -...,��.w:r•--- 1.-I.�,.{� 1' t � 1i}..1141 r.,�-, _ __.,• _ � - -. - ++ ri ..1 ...--, • '.mit:.,, -e_"_s1.c�sr•as��a•..��. ..'+I2eai'.+s!!"'i.Y�►��. (`�il�lr�l �''� {i 1i�1,J,�1i.+; , -, - •- __' - - ._- _.. _. ._ - �. . 1 °t},'� �'/�;r.lrr``�.1��+� �� srtf!'"i1�1j1•`i`�i��'��i��,+,��in:F.».. -ff 1} '`�`�i. .`'r �ill :i 1 f �1••., ' ,,,, ; �11�1,7/ 1 t�. "tel.l'r I;l�„L„ ��(�r „;tl r'. ` (4 r '�,I�tt a��+,. ,�. fJJ � t f yy�S�I:JA':F�jlt'''��..px...., 1{{;11� I�s�.�„'r.f•..�a' ,� '.rly:;, M,� •�i-tw.,',��i�:f^I ,1 ,+ K`+)n st�' {q- �,, ,(,tr..,c i ,i'. i }::/ •`'�•��','i l•f �.jl,;t `:�►- '; � -`,,'�,� -y7 �:_; RIO f3��'#�1'^�!'h�a - r. ,• 1 , ! '�.f if ,tr , ,� r:•� IL All , ,•�• _ ''` 1 ; .,: � .11,•`!7. ?.,.hs ]� -b: ,rimmm I('�:;�J ,ars' '_• •' ^�i /� . •.1 k 1 i t* �. � `� �, iri= { ;'/'i '}•, `•, ;'J� ' •' i .1 ';Y:1T .2+/ , b�-yt,{'c""1�'�i . .: `, .» • • • • � a • '1 �� / 111'.;, ;',, r. ��'�� 1�f' "1� `v ` .`, „�!'�'a'•M`4`0.'.R�h rt '1� 1 � 1 �•(,A' '� X114: N' }t � ti �...t• ' �. � rrll ,�i.f'(. " t ' `• it i 5, ".' `.+,�.�,� .•-t.�. . ,� t � f IS f• '; =', j11111 'I 15 �•t}� '';r � j11!�'I•r� ', fd,f� t + til\",�' �'� ,` r4, ' 1 •i, J,1. �`) '�,f•'�aL•.. ?•�'-x s�'"`C- 11''�'�' A`'�''f )' '�' `►.. y Y `��=-:`! '�i., 'Yr•rt3`r__c •ir .y' r j:"v _ `a "�,,�' S n •f;' 'li j, 1 ..,, .; , r��i.> r-•� .ltt�:�'J� ) ,,•:`'�f�R�-'���•• . 1:l:: -� ,r(�•tr-11:�; �11Y -< �:,,if�, �`;.f�:1�,rrL->t"�s :`xL' -` ,4,;- t t t ,////'`a* "+t 1wl , ,`1•; Ir') - _ � _ _. - — ... . .. • � Wim,- \_.r .. �\._ t ./� di4 ,. n voaK Workers' CERTIFICATE OF INSURANCE COVERAGE STATE 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 WILDWOOD ELECTRIC, INC. 6319294219 PO Box 373 Rocky Point NY 11778 1 c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,Wrap-Up Policy) or Social Security Number 11-2782074 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Town of Southold Standard Security Life Insurance Company of New York 3b.Policy Number of Entity Listed in Box"l a" L82898-000 53095 Route 25A, P.O. Box 1179 SOUTHOLD, NY 11971 3c.Policy effective period 1/1/2017 to 10/20/2023 4. Policy provides the following benefits: X] A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: XX 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 employer's 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 insuran a coverage as described above. Date Signed 10/21/2022 By (Signature of insurance carrier's aut oiized r rfflletaTivel —NfS—LiEeAed Insurance Agent of that insurance carrier) Telephone Number (212)355-4141 Name and Title Bebi Ishmail,Supervisior-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 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 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 (10.17) II Ili iiiiiiiiiiiiiiiiiiiiiiiiii�iiiiiiiiiiiiiiiiiiilllll l ® DATE(MMIDD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 10/21/2022 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 Jennifer Heiser NAME: Nicholas Devito Agency, Inc. aCNro E.11: (631)509-6388 ac No: (631)509-0099 449 Route 25A ADDRESS: jennifer@devitoagency.com Mount Sinai, NY 11766 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Merchants Mutual Ins. Co. 23329 INSURED INSURER B: Merchants Preferred Ins. Co. 12901 Wildwood Electric Inc. INSURER C: 49A Rocky Point Yaphank Road INSURER D: Rocky Point, NY 11778 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00010319-915110 REVISION NUMBER: 68 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 MMIDD/YYYY MMIDD A X COMMERCIAL GENERAL LIABILITY BOP1099122 04/16/2022 04/16/2023 EACH OCCURRENCE $ 11000,000 DAMAGE CLAIMS-MADE FxIOCCUR PREM SES Ea occurrence) 500 000 X Contractual MED EXP(Any one person) $ 15,000 X Liability PERSONAL&ADV INJURY $ Included GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X )ECT ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY❑PRO OTHER: B AUTOMOBILE LIABILITY CAP1070996 04/16/2022 04/16/2023 Ea acccidentSINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per accident A X UMBRELLA LIAB OCCUR CUP9149680 04/16/2022 04/16/2023 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB Hx CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 53095 Route 25 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 AUTHORIZED REPRESEREPRESENTATIVESouthold, NY 11971 J-H @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by J-H on 10/21/2022 at 03:06PM Workers'YORK CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board ia,Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Wildwood Electric Inc. 631-929-4219 49A Rocky Point Yaphank Road 1c.NYS Unemployment Insurance Employer Registration Number of Rocky Point, NY 11778 Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 11-2782074 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Cedificate Holder) Sentinel Ins. Co. Town of Southold 53095 Route 25 3b.Policy Number of Entity Listed In Box'-1a' PO Box 1179 12WECAC6TZH Southold, NY 11971 3c.Policy effective period 12131/2021 to 12/31/2022 3d.The Proprietor,Partners or Executive Officers are ® included.(Only check box If all partnerslofficers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box°3"insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or Its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form Is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is Issued as a matter of Information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note:Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,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: Nicholas DeVit0 (Print name of authorized representative or lic0sed a.qenL of insurance carrier)r) / Approved by: �d� f -) VA (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier. 631-509-6388 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 r, OOP) � COMPLY WITH ALL CODES OF APPROVED AS NOTED NEW YORK STATE & TOWN CODES _ AS REQUIRED AND CONDITIONS OF DATE-11 •a B.P.# 5 3!50b SOUTHOLD TOWN ZBA h,} FEE BY NOTIFY BUILDING DEPARTMENT AT SOUTHOLD TOWN PLANNING BOARD 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: SOUTHOLD TOWN TRUSTEES 1. FOUNDATION-TWO REQUIRED FOR POURED CONCRETE 2. ROUGH-FRAMING,PLUMBING, N.YS.DEC 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. ELECTRICAL INSPECTION REQUIRED KOHLER. Models: 20RCA(L) Multi-Fuel LPG/Natural Gas 09001 Standard Features 4 KOHLER. • RDC2 Controller NATIONALLY REGISTERED o One digital controller manages both the generator set and transfer switch functions (with optional Model RXT). o Electronic speed control responds quickly to varying - -� °f�• demand. o OnCue@ Plus Generator Management System for remote monitoring is included with the generator. , :k' ,.y;, ! • Kohler Command PRO Engine Features o Kohler Command PROD OHV engine with hydraulic valve ' ?'x lifters for reliable performance without routine valve adjustment or lengthy break-in requirements. • Designed for Easy Installation t[ a; o Sturdy aluminum base can be mounted on gravel or a concrete mounting pad. o Fuel and electrical connections through the enclosure wall The Kohler® Advantage eliminate the need for stub-ups through the base. o Customer connection terminal block located near the • High Quality Power controller allows easy access for field wiring. Kohler home generators provide advanced voltage and o Designed for outdoor installation only. frequency regulation along with ultra-low levels of • Certifications harmonic distortion for excellent generator power quality to o Meets emission regulations for U.S. Environmental protect your valuable electronics. Protection Agency (EPA) with both natural gas and LPG. • Extraordinary Reliability o UL 2200/cUL listed (60 Hz model). Kohler is known for extraordinary reliability and o CSA certification available (60 Hz model). performance and backs that up with a premium 5-year or o Accepted by the Massachusetts Board of Registration of 2000 hour limited warranty. Plumbers and Gas Fitters. • Powerful Performance o Meets 181 mph wind rating. Exclusive Pow§boost"" technology provides excellent • Approved for stationary standby applications in locations starting power. served by a reliable utility source. • Aluminum Enclosure • 20RCAL models packaged with a Model RXT automatic o Attractive aluminum enclosure allows installation as _ transfer switch are available. See page 4 and the Model close as 18 inches from your home or small business. ' RXT ATS specification sheet. o Enclosure panels can be removed without tools to allow easy access for maintenance and service. • Warranty o 5-year/2000 hour limited warranty for on-grid (standby) applications in locations served by a reliable utility source. Generator Ratings Standby Ratings Line Circuit Natural Gas LPG Breaker Alternator Voltage Phase Hz kW/kVA Amps kW/kVA Amps Amps Poles 2F7 120/240 1 60 18/18 75 20/20 83 100 2 120/208 3 60 17/21 58 17/21 58 70 3 2G7 120/240 3 60 17/21 51 17/21 51 60 3 277/480 3 60 17/21 26 17/21 26 30 3 Note: The line circuit breaker is automatically selected based on the generator set model and voltage configuration. RATINGS:Standby ratings apply to installations served by a reliable utility source.All single-phase units are rated at 1.0 power factor.The standby rating is applicable to variable loads with an average load factor of 80%for the duration of the power outage. No overload capacity is specified at this rating. Ratings are in accordance with ISO-3046/1,B35514,AS2789,and DIN 6271.GENERAL GUIDELINES FOR DERATING:ALTITUDE:Derate 4%per 305 m(1000 ft.)elevation above 153 m(500 ft.).TEMPERATURE:Derate 2%per 5.51C(10°F)temperature increase above 16°C(60°F). Availability is subject to change without notice.The generator set manufacturer reserves the right to change the design or specifications without notice and without any obligation or liabilitywhatsoever. Contact your local Kohler Co,generator distributor for availability. § Check the appliance manufacturer's specifications for actual power requirements.Consult a KohlerO Power Systems professional to calculate your exact residential power system requirements. Meets NFPA guidelines for 18 inch clearance to combustible materials. Check state and local codes for minimum distance required from a structure. G4-272 (20RCA) 4/19a Alternator Specifications Alternator Specifications Alternator Features Specifications Alternator • Compliance with NEMA, IEEE, and ANSI standards for Manufacturer Kohler temperature rise. Type 2-Pole,Rotating Field . Self-ventilated and dripproof construction. Leads,quantity 2F7 4 • Windings are vacuum-impregnated with epoxy varnish for 2G7 12 dependability and long life. Voltage regulator Digital • Superior voltage waveform and minimum harmonic Insulation: NEMA MG1-1.66 distortion from skewed alternator construction. Material Class H • Digital voltage regulator with t1.0% no-load to full-load Temperature rise 130°C Standby RMS regulation. Bearing:quantity,type 1,Sealed • Rotating-field alternator with static exciter for excellent Coupling Direct load response. Amortisseur windings Full . Total harmonic distortion (THD)from no load.to full load with Voltage regulation,no-load to full-load RMS t 1.0% a linear load is less than 5%. One-step load acceptance 100%of Rating Peak motor starting kVA: (35%dip for voltages below) 240 V, 1 ph 2F7(4 lead) 41 (60 Hz) 240 or 480 V,3 ph 2G7(12 lead) 69(60 Hz) Application Data Engine Exhaust Engine Specifications Exhaust System Manufacturer Kohler Exhaust temperature exiting the Engine:model,type CH 1000 4-Cycle enclosure at rated kW,dry,°C(°F) 260(500) Cylinder arrangement V-2 Lubrication Displacement,cm3(cu.in.) 999(61) Bore and stroke,mm(in.) 90 x 78.5(3.54 x 3.1) Lubricating System Type Full Pressure Compression ratio 8.81 Main bearings:quantity,type 2,Parent Material Oil capacity(with filter),L(qt.) 1.9(2.0) Rated RPM Oil filter:quantity,type 1,Cartridge 60 Hz 3600 Oil cooler Integral Max.engine power at rated rpm,kW(HP) Kohler recommends the use of Kohler Genuine oil and filters. LPG,60 Hz 23.0(30.9) Natural gas,60 Hz 202(27.1) Fuel Pipe Size Cylinder head material Aluminum Minimum Gas Pipe Size Recommendation,in.NPT Valve material Steel/StelliteD Pipe Length, Natural Gas LPG Piston type and material Aluminum Alloy m(ft.) 281,000 Btu/hr. 340,000 Btu/hr. Crankshaft material Heat Treated,Ductile Iron 8 (25) 1 3/4 Governor:type Electronic 15 (50) 1 1 Frequency regulation,no load to full load Isochronous Frequency regulation,steady state -_0.5% 46 (100) 1 1/4 1 Air cleaner type Dry 46 (150) 1 1/4 1 1/4 61 (200) 1 1/4 1 1/4 Engine Electrical Engine Electrical System Ignition system Electronic, Capacitive Discharge Starter motor rated voltage(DC) 12 Battery(purchased separately): Ground Negative Volts(DC) 12 Battery quantity 1 Recommended cold cranking amps: (CCA)rating for-18°C(0°F) 500 Group size 51 G4-272 (20RCA) 4/19a Fuel Requirements • LED indicators for utility power and generator set source Fuel System availability and ATS position (Model RXT transfer switch required) Fuel types Natural Gas or LPG e LCD display: Fuel supply inlet 1/2 NPT o Two lines x 16 characters per line Fuel supply pressure,kPa(in.H2O): o Backlit display with adjustable contrast for excellent Natural gas 0.9-2.7(3.5-11) LP 1.7-27(7.11) visibility in all lighting conditions • Scrolling system status display: Fuel Composition Limits* Nat.Gas LPG o Generator set status Methane,%by volume(minimum) 90 min. — o Voltage and frequency Ethane,%by volume(maximum) 4.0 max. — o Engine temperature Propane,%by volume 1.0 max. 85 min. o Oil pressure Propene,%by volume(maximum) 0.1 Max. 5.0 max. o Battery voltage C4 and higher,%by volume 0.3 max. 2.5 max. o Engine runtime hours Sulfur,ppm mass(maximum) 25 max. • Date and time displays Lower 3(Btu/g value, • Smart engine cooldown senses engine temperature MJ/m (Btu/ft3), (minimum) 33.2(890) 84.2(2260) * Contact your local distributor for suitability and rating derates based • Digital isochronous governor maintains steady-state speed at on fuel compositions outside these limits. all loads • Digital voltage regulation: ±1.0% RMS no-load to full-load Operation Requirements • Automatic start with programmed cranking cycle Fuel Consumption,m3/hr.(cfh)@ 60Hz • Programmable exerciser can be set to start automatically on %Load Natural Gas LPG any future day and time, and run every week or every two weeks 100 8.0 (281) 3.9 (136) • Exercise modes: 75 6.9 (243) 3.1 (109) o Unloaded weekly exercise with complete system 50 4.6 (161) 2.3 (82) 25 3.6 (127) 1.7 (59) diagnostics o Unloaded full-speed exercise Exercise 2.0 (71) 1.0 (35) o Loaded full-speed exercise (Model RXT ATS required) Nominal fuel rating: Natural gas: 37 MJ/m3(1000 Btu/ft 3) • Front-access mini USB connector for SiteTech- or USB LPG: 93 MJ/m3(2500 Btu/ft3) Utility connection LPG conversion factors: 8.58 ft3=1 Ib. • Integral Ethernet connector for Kohler@ OnCue@ Plus 0.535 m3=1 kg 36.39 ft3 =1 gal. • Built-in 2.5 amp battery charger • Remote two-wire start/stop capability for optional connection Generator Set Sound Data of a Model RDT transfer switch Model 20RCA 8 point logarithmic average sound levels are • Diagnostic messages: Displays diagnostic messages for the 64 dB(A) during weekly engine exercise and 69 dB(A) during engine,generator, Model RXT transfer switch, programmable interface module (PIM), and load management device. full speed generator diagnostics and normal operation.* . Maintenance reminders All sound levels are measured at 7 meters with no load. • System settings: * Lowest of 8 points measured around the generator. Sound levels at o System voltage,frequency, and phase other points around generator may vary depending on installation o Voltage adjustment parameters. c Measurement system, English or metric RDC2 Controller • ATS status (Model RXT ATS required): o Source availability a o ATS position (normal/utility or emergency/generator) o Source voltage and frequency Voltage: 240 V O Freq: 60.0 Hz • ATS control (Model RXT ATS required): a ® o o Source voltage and frequency settings o Engine start time delay all o Transfer time delays o Voltage calibration o Fixed pickup and dropout settings • Programmable Interface Module (PIM) status displays: The RDC2 controller provides integrated control for the o Input status (active/inactive) generator set,Kohler@ Model RXT transfer switch, o Output status (active/inactive) programmable interface module (PIM), and load shed kit. • Load control menus: RDC2 Controller Features o Load status • Membrane keypad: o Test function o OFF,AUTO, and RUN pushbuttons o Select and arrow buttons for access to system configuration and adjustment menus • LED indicators for OFF,AUTO, and RUN modes G4-272 (20RCA) 4/19a r KOHLER® PhoneKOHL9 CO.,Kohler,Wisconsin 9-164 USA Phone 920-457-4441,Fax 920-459-1646 For the nearest sales and service outlet in the US and Canada,phone 1-800-544-2444 KOHLERPower.com Generator Set Standard Features Automatic Transfer Switches and Accessories • Battery cables ❑ Model RDT ATS • EPA certified fuel system ❑ Model RXT ATS • Aluminum sound enclosure ❑ Model RXT ATS with combined interface/load management board • Critical silencer ❑ Load shed kit for RXT or RDT • Field-connection terminal block ❑ Power relay modules (use up to 4 relay modules for • Fuel solenoid valve and secondary regulator each load management device) • Line circuit breaker ❑ Other Kohler@ ATS • Multi-fuel system, LPG/natural gas,field-convertible 20RCAL Model Packages • Oil drain extension with shutoff valve ❑ 20RCAL with 100 amp RXT with 16-space load center and • OnCueD Plus Generator Management System NEMA 1 steel enclosure for indoor installation • Premium 5-year limited warranty ❑ 20RCAL with 200 amp service entrance-rated Model RXT • RDC2 generator set/ATS controller with combined interface/load management board and • corrosion-resistant NEMA3R aluminum enclosure Rodent-resistant construction • Sound-deadening,flame-retardant foam per UL 94, Warranty class HF-1 ❑ 5-Year Comprehensive Limited Warranty ❑ /available Options 10-Year Comprehensive Limited Warranty Approvals and Listings ❑ CSA approval Communication Accessories ❑ OnCue@ Plus Wireless Generator Management System Concrete Mounting Pads ❑ Concrete mounting pad, 3 in.thick ❑ Concrete mounting pad, 4 in.thick (recommended for storm-prone areas) Electrical Accessories ❑ Battery C] Battery heater, 120VAC Generator Set Dimensions and Weights ❑ Battery heater, 240VAC Generator Set Size,L x W x H: 1193 x 666 x 817 mm ❑ Cold weather package, 120VAC (47 x 26.2 x 32.2 in.) ❑ Cold weather package, 240VAC Shipping Weights: ❑ Emergency stop kit 20RCA Generator Set: 252 kg(555 Ib.) ❑ PowerSync@ Automatic Paralleling Module (APM) 20RCAL with 100 A RXT ATS w/LC 277 kg (611 lbs.) (single phase only; parallel two 20kW residential generator 20RCAL with 200 A RXT SE ATS: 272 kg (600 Ib.) sets with the RDC2 controller) L ❑ Programmable interface module (PIM) (provides 2 digital inputs and 6 relay outputs) Fuel System Accessories F ® C] Flexible fuel line(included on QS models) H 8 ❑ Carburetor heater, 120 VAC ® ❑ Carburetor heater, 240 VAC Carburetor heater is recommended for reliable starting M at temperatures below 0°C (32°F) I W Literature NOTE: Dimensions are provided for reference only and should not be used for planning ❑ installation.Contact your local distributor for more detailed information. General maintenance literature kit ❑ Overhaul literature kit DISTRIBUTED BY: ❑ Production literature kit Maintenance ❑ Maintenance kit(includes air filter,oil, oil filter, and spark plugs) ©2018,2019 by Kohler Co. All rights reserved. (34-272 (20RCA) 4/19a