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HomeMy WebLinkAbout48507-Z g G SuFFoc, Town of Southold 3/11/2023 y�tj P.O.Box 1179 53095 Main Rd � Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43915 Date: 3/11/2023 THIS CERTIFIES that the building GENERATOR Location of Property: 240 Old Salt Rd.,Mattituck SCTM#: 473889 Sec/Block/Lot: 144.-5-6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. 9/22/2022 pursuant to which Building Permit No. 48507 dated 11/18/2022 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 Spaeth,Edward of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48507 2/21/2023 PLUMBERS CERTIFICATION DATED t riz d ignature fFal't TOWN OF SOUTHOLD BUILDING DEPARTMENT �s2 TOWN CLERK'S OFFICE Wo • SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 48507 Date: 11/18/2022 Permission is hereby granted to: Spaeth, Edward 31 Marion Ave Stony Brook, NY 11790 To: Install accessory stand-by generator at existing single family dwelling as applied for. At premises located at: 240 Old Salt Rd., Mattituck SCTM #473889 Sec/Block/Lot# 144.-5-6 Pursuant to application dated 9/22/2022 and approved by the Building Inspector. To expire on 5/19/2024. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CO-RESIDENTIAL $50.00 Total: $235.00 Building Inspector ho��pF SO!/TyOlo Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 sean.devlin(-town.southold.ny.us Southold,NY 11971-0959 COU BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Edward Spaeth Address: 240 Old Salt Rd city:Mattituck st: NY zip: 11952 Building Permit* 48507 Section: 144 Block: 5 Lot: 6 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Pumillo Electric License No: 2300ME 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 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 Strobe Heat Detectors Disconnect Switches 4'LED Exit Fixtures Sump Pump Other Equipment: 20kW Briggs & Stratton w/200A Whole Houase Transfer Switch Notes: Generator Inspector Signature: Date: February 21, 2023 S.Devlin-Cert Electrical Compliance Form OF SOUtyO� 5 j v C # # TOWN OF SOUTHOLD BUILDING DEPT. i'ou►m�� 631.765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) JsXFLECTRICAL (FINAL) [ ] CODE VIOLATION ] PRE C/O [ ] RENTAL REMARKS: ol e,6 � n f re IDAe, j oi�- t-r- DATE INSPECTOR - # # TOWN OF SOUTHOLD BUILDING DEPT. to 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: In r G _ DATE In INSPECTOR SOUTyoI — ---- —- - - - h O # # TOWN-OF SOUTHOLD BUILDING DEPT. courm ' 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ],,RfSULATIOWCAULKING [ ] FRAMING /STRAPPING [ FINALb"A4+,e_ll [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: DATE J? ?�Y INSPECTOR FIELD INSPECTION REPORT. DATE COMMENTS FOUNDATION (1ST) a� ------------------------------------- FOUNDATION (2ND) z 0 Q H ROUGH FRAMING& PLUMBING r INSULATION PER N.Y. y STATE ENERGY CODE FINAL ADDITIONAL COMMENTS vJ o z t y O z x x e b H TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.,ov naz:Krrn� Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only I PERMIT NO. Building Inspector: SEP _ 2 2 2022 Applications and forrris�must be filled out in their'entirety:'Incomple.te BUI+ ;- DIiVG®EP-j applications.will not be;accepted. Where the Applicant is riot the owner,an TODUN OF,,�;pUT8 };_D Owners Authorization\form(Page 2)shall be completed', Date:September 9, 2022 OWNER(S)OF PROPERTYt Name:Edward Spaeth_ SCT1. M#1100- Project Address:240 Old Salt Road Mattituek NY 11952 ........... _._ .........................................._ .. ...... ......... ..._... .. .. .. Phone#:516-314-2449 Email:mcspaeth,l@gmail.com Mailing Address:240 Old Salt Road Mattituck NY 11952 CONTACT PERSONi ..- Name:Sean ONeill Mailing Address:PO Box 64„Jamesport NY 11947 Phone#:631.-722-3595 Email:oneilloutdoor ower hotmail.com. DESIGN PROFESSIONAL,INFORMATION: Name: .........._. ... .... _......................................... ........... .. _... ... .................. ... ............................................... .. .......... Mailing Address: Phone#: Email: CONTRACTOR INFORMATION,i' . Name:Universal Electrical Services Mailing Address:151 First Avenue Massapequa Park NY 11762 Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition [--]Alteration ❑Repair El Demolition Estimated Cost of Project: D Other Generator $10,500.00 Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes ®No 1 'PROPERTY INFORMATION Existing use of property`Re$I_d_entl_aIntended use of property:Re$.Idential_„.• •,._.._••._,, Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? Dyes ®No IF YES, PROVIDE A COPY. ® Check Bblk After Reading:`The owner/contractor/design professional is responsible for al(.drainage and.storm water issues as provided 6y., Chapter 236of the Town Code.'APPLICATION IS HEREBY MADE to the Building Department forthe issuance of a Building Permit pursuant to the Building2one . 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 buildingls)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):Sean O'Neill ®Authorized Agent ❑Owner Signature of Applicant: Date: September 9, 2022 STATE OF NEW YORK) SS: COUNTY OF Suffolk ) Sean O'Neill 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 me this day of ,20 Notary Public PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) I, Edward Spaeth residing at 240 Old Salt Road Mattituck NY do hereby authorize Sean O'Neill to apply on my behalf to the Town of Southold Building Department for approval as described herein. 9/9/2022 Owner's WrZature Date Edward Spaeth Print Owner's Name 2 E C � � BUILDING DEPARTMENT- Electric pector i TOWN OF SOUTHOLD ��J 4 �� t o Town Hall Annex - 54375 Main Road - PO B �11i��9�, Pr Southold, New York 11971-0959 ViNI(DPSOII-R,1 j1_ Telephone (631) 765-1802 - FAX (631) 765-9502 �1 rogerr a(�southoldtownny.gov seand(c�southoldtownnV.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 7 '. Company Name: :F,, m ' ILo t eef— Electrician's Name: ��LA j7z, wi; (1,c:::) License No.: 22O O VA L Elec. email: Elec. Phone No: ) L ❑I request an email copyb of Certificate of Compliance Elec. Address.: i,,c6, JOB SITE INFORMATION (All Information Required) t Name: �c �- '�c C11 Address: 2 ' o'b `-s- Cross Street: ��� Phone No.: �. Bldg.Permit #: email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Square Footage: Circle All That Apply: Is job ready for inspection?: F] YES ❑ NO E]Rough In ❑ Final Do you need a Temp Certificate?: ❑ YES ❑ NO Issued On Temp Information: (All information required) Service Size❑1 PhF—]3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals i 2 H Frame Poie Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION 1 't YORK Workers' CERTIFICATE OF INSURANCE COVERAGE sva'rE Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured UNIVERSAL ELECTRICAL SERVICES LLC 516-850-7776 151 1ST AVENUE MASSAPEQUA PARK,NY 11762 1 c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically Ilmited to or Social Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 471592478 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Southold Building Department 3b.Policy Number of Entity Listed in Box"1 a" 54375 Main Road DBL537882 Southold, NY 11971 3c.Policy effective period 07/09/2022 to 07/08/2023 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. B.Disability benefits only. E] C.Paid family leave benefits only. 5. Policy covers: [E A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. E] 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 insurance coverage as described above. Date Signed 7/12/2022 By AW G (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance 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 emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers' Compensation Board (only if Box 4B,4C or 5B have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with,respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-920.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12.21) 11111111] 1°°11111!11°111111111°°°°111111111111 NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) %J9 ^^^^^^ 471592478 UNIVERSAL ELECTRICAL SERVICES,LLC 151 FIRST AVENUE MASSAPEQUA PARK NY 11762 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER UNIVERSAL ELECTRICAL SERVICES, LLC SOUTHOLD BUILDING DEPARTMENT 151 FIRST AVENUE 54375 MAIN ROAD MASSAPEQUA PARK NY 11762 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2449 563-2 291109 07/16/2022 TO 07/16/2023 9/20/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2449 563-2, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SUR NCE FUND 4 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:823317445 U-26.3 i -�� UNIVELE-02 BEGELI ACORO° DATE(MM/DD/YYYY) CERTIFICATE OF-LIABILITY INSURANCE 9/20/2022 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(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 Co MT Ellen Goldman a oldman/�1butWin.com NAME: ( g @ ) Nathan Butwin Company,Inc. PHONE FAX 60 Cutter Mill Rd.Ste.414 (A/C,No,Ext):(516)466-4200 _ (Aro,No):(516)466-4213 Great Neck,NY 11021 E-MAILAD_D_R_ESS: n.com � _ info butwi _ _ _ L INSURER(S)_AFFORDING COVERAGE _—_—____ NAIC#__._ --------____.-_ INSURERA:Utica First Insurance Co. —_ —_ 15326______ INSURED INSURER B ____—_ Universal Electrical Services LLC I INSURER C: 151 First Avenue INSURER D:_ -- --- ---- —--- — — Massapequa Park,NY 11762 1 -- ---- ---- -- INSURER E: -------- --- -------- --- INSURER F COVERAGES CERTIFICATE NUMBER: 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 I NSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP -- D LIMITS A X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 CLAIMS-MADE FX]OCCUR ART3000425430 8/20/2022 8/20/2023 DAMAGE TO RENTED 50,000 _PR0M_I5E,(E_oc�rl aQ $ MED EXP(Any one person) $ 1,000 -- �---- --- PERSONAL&ADV INJURY $ 1,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY[�]jECT [::] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ — �(Ea accident) ANY AUTO I __BODILY INJURY(Per person_i$ OWNED I — AUTOS ONLY SCHEDULEDAUTOS I BODILY INJURY Per accident S j HIRED NON-OWNED PROPRO RPE�T1' AMAGE AUTOS ONLY AUTOS ONLY I eo,. dent _E $ UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESSLIABQ CLAIMS-MADE EACH $ DED RETENTION$ r IS WORKERS COMPENSATION I ' AND EMPLOYERS'LIABILITY �L�TATUIE SRH_- YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMggER EXCLUDED? N/A _ (Mandatory in NH) St ASE-EA EMPLOYE $ If yes,describe under E DESCRIPTION OF OPERATIONS below i^ I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY'OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Southold Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 Main Road ACCORDANCE WITH THE POLICY PROVISIONS. Southold,NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD R. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) .IE5 M4-1 09/20/2022 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 be endorsed. If SUBROGATIONIS 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 USAA INSURANCE AGENCY INC/PHS NAME: 65812845 PHONE (888)242-1430 FAX (ac,No,Ext): (A/c,No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Hartford Insurance Company of the 37478 TRYAD PLUMBING&HEATING INC INSURERA: Midwest 1350 COX NECK RD Property and Casualty Insurance Company 34690 MATTITUCK NY 11952-1450 INSURER B of Hartford INSURER C: Hartford Underwriters Insurance Company 30104 INSURER D: INSURER E: INSURER F: , COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM DDNYYYI (MMIDDtYYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE N OCCUR DAMAGE TO RENTED $300,000 PREMISES Ea occurrence X General Liability MED EXP(Any one person) $10,000 A 65 SBA NE7099 07/19/2022 07/19/2023 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICYPRO- ElLOCPRODUCTS-COMP/OP AGG $2,000,000 EJECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 accident) ANY AUTO BODILY INJURY(Per person) C ALL OWNED SCHEDULED 65 UEC UW5400 07/19/2022 07/19/2023 BODILY INJURY(Per accident) AUTOS AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE DED I RETENTION$ e WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE I ER ANY YIN E.L.EACH ACCIDENT $500,000 B PROPRIETOR/PARTNER/EXECUTIVE NIA 65 WEC GA6886 07/19/2022 07/19/2023 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 (Mandatory In NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION The Town Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 53095 MAIN RD BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED SOUTHOLD NY 11971-4642 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,,_F46 �J of ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD .., w•r+" •., ;... .- -til__ •!. - .. _ Mie, - , I i f ,.. R „ 125 .�L: ..AI ^�• �y -,i �.` N,J'a: /6'9,5 '� f � 0► } � - :�`' �w�,. o © � � •„' ,*.� .'- } _ \ i �/� t terry� C ..... •.� � ?. .70 76 j Ser i - r �—_ _ _ � , � w .. r77G'�J�l�'J•G'/.���t`i '.s � � :.� ' 1 ` * : Cy i wpro i rrfir (� , • � � hlO+rfirt � i 1 a S.C.T.M. N0. DISTRICT: 1000 SECTION: 144 BLOCK: 5 LOT(S): 6 1 1 5Z• - � 4 P fE1y�E cn 1 1370°5��30 M N Ln 1 ; v, °N c 0 i 6 too0' Qj 6 1.3;5 m 4.6 w to tea. N 79°05'„E �� N N w Oq �. FENCEgyp+ ' oD 6 �� W O N i 24.1 19 5' ro ASpNN� DRAY a R GARAGE f 0 32.1 ` A A L' ° 20 26.0' 1 STY FRAME ° 32•� 0 " DWELLING #240 {y16.0' 10' y E 00 t 0' 26. U... V v 0' P 7.fi o N o 0 CEEB 6 0' - O 66.80 16.5' g G L 9F ti f STOOP , OR yAy t�}•7U v m .P C N 1.3's 1 .4's 79°05'OV 8 0.5 W N 1 i THE WATER SUPPLY, WELLS, ORYWELLS AND.CESSPOOL LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. AREA: 20,797.44 SQ.-FT. or 0.48 ACRES ELEVATION DATUM- -------------- UNAUTHORIZED ALTERAT70N OR ADDITION TO THIS SURVEY IS A VIOLA77ON OF SEC77ON 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE ST77UETURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY OF: LOT 4 of: NFA, Y CERTIFIED TO: EDWARD A. SPAETH; MAP OF.-SALT LATE VILLAGE � � M wo- FILED: MAY 10, 1940 No. 1310 SITUATED AT:MATTITUCK r TOWN OF:SOUTHOLD n KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Sys 050882 J� Professional Land Surveying and Design 5 P.O. Box 153 Aquebogue, New York 11931 PHONE (631)298-1588 FAX (631) 298-1588 FILE #222-134 SCALE:J"=30' DATE: 10-14-2022 N.Y.S. LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Aoychuk WI7-H AI.L C:" ,;: APPROVED AS NOT90 _ NIE'Al YORK STATE & T; , ODES fj .P.• ®� AS REQUIRE AND CC,� _MONS OF DATE' FEE BY: SOU-" OLD T01b' NOTIFY BUILDING DEPARTMENT AT SOUTHOLD Inv lr,;;ANNING BOARD 631-765-1802 8AM TO 4PM FOR THE FOLLOWING INSPECTIONS: SOUTHOLD-' ""77i ISTEES 1. FF.00R BRED CONCRETE IRS 11-Y.S.DEC 2. ROUGH-FRAMING&PLUMBING / 3. INSULATION 4. FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHAH MEET THE O C C U PAA,�G Y OR REQUIREMENTS OF THE CODES OF NEW U -UNLAWFUL/�' B YORK STATE. NOT RESPONSIBLE FOR .0 1 n I V A v v U DESIGN OR CONSTRUCTON ERRORS WITHOUT C E RTI F i r,�. OF OCCUPANCY RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 OF THE TOWN CODE. Standby - • BRIGGS&S'�RATTO N ��I FORTRESS" - - The Smart Choice Introducing our dealer'exclusive line. --� Available at your local Briggs& Stratton Dealer with these great'features; Parts•Labor•Travel Limited C UL U$'. Warrant O y, , LISTED 010 New Upgraded Control System Charging System • New AVR optimizes generator performance with tighter voltage control Independent battery charger • LCD display that displays multi-line text and graphics Optimizes battery life with a 3-stage battery charger(bulk, • Default exercise cycle setting of 16 seconds absorption,and float stage) • Low speed exercise available to save fuel and reduce noise Corrosion Resistant Enclosure& Base • Monitors cold temperatures to avoid moisture buildup in engine oil ---- • Cleaner power with improved frequency regulation Made with automotive grade galvanneal steel or aluminum to resist rust Designed for Easy Installation & Maintenance Powder-coated paint for years of protection against chips — ---' ------ -- and abrasions • Approved for installation as close as 18"to a buildingz Certified to withstand hurricane-force winds Lip to 175mpha • Hinged lid with removable side panels for better service access to the engine and alternator Briggs&Stratton'Full Synthetic Generator Oil • Controller,battery charger,and AVR can be replaced separately ---- —— '' ---- — - --- • Cold weather kit included • Shields the engine from low temperature sludge buildup and high temperature deposits • External on/off switch located on back of enclosure • Reduces engine wear,scoring and abrasion Commercial Vanguard"Engine — Compatible with Symphony'II Power • Easy conversion between natural gas(NG)and liquid propane vapor Management System (LPV)during installation • Advanced debris management keeping engine clean and cool for • Customizable to your home's needs enhanced durability and performance • Automatically balances the power of your home's electrical load • Dynamically balanced crankshaft minimized engine noise and vibration including high wattage items like air conditioning units and electric ovens • Compatible transfer switches and modules sold separately Generator Set Rating Liquid Propane Vapor Natural Gas Limited Warranty4 Model Enclosure Voltage Phase' Hz Circuit LPV kW' LPV Amps NG kW NG Amps Parts,Labor,Travel Type Breaker Amps 040587 Steel 120/240 1 60 100 20 83.3 18 75.5 6 Year 040589 Aluminum 120/240 1 60 100 20 83.3 18 75.5 6 Year 040609 Aluminum 120/240 1 60 100 20 83.3 18 75.5 10 Year 'This generator is certified in accordance with UL(Underwriters Laboratories)2200(stationary engine generator assemblies)and CSA(Canadian Standards Association)standard C22.2 No.100-14(motors and generato•s). 'The installation manual contains specific instructions related to generator placement in addition to NFPA 37,including the requirement that carbon monoxide detectors be installed and maintained in your home. 'Single phase units are rated at 1.0 power factor and three phase units are rated at 0.8 power factor. 4 See operator's manual or aRIGGSandSTRATTON.com for complete warranty details. Up to 175 mph,when installed in accordance with the installation manual. A20WFortress—Standby Generator K� BRIGG889TFiATfoN y Engine Specifications L` il i utirscat on I g. Engine Brand Vanguard Oil Capacity(L/qt) 2.3/2.46 Engine Speed(RPM) 3600 Low Pressure Switch Included Engine Fuel Liquid Propane Vapor(LPV)or Lubrication System Full Pressure Natural Gas(NG) Engine Cylinder Configuration OHV Oil Briggs&Stratton 5W30 Full Synthetic Number of Cylinders 2 Low Oil Pressure Sensor Yes Displacement(L/Ci) 0.993 160.60 Alteanator 5peos '{ Compression Ratio 9:7:1 Manufacturer Briggs&Stratton Governor Type Electronic Type Self-Excited,4-Lead Frequency Regulation +/-0.3 Hz(0.50%) Voltage Regulator Automatic Valves \ OHV with Hardened Seats Insulation Class F Ignition System Fixed Timing Magnetron Peak Motor Starting kVA 41 Starter Motor Rating Voltage 12 Volt Controller.F4afures 12 Volt,Group BCI 26 or 51, Battery Required 540 CCA Minimum Generator Sensing Single phase voltage monitoring High Temperature Switch Included LCD Display Displays multi-line text and graphics Dura-Bore Cast Iron Included Fault Display Provides up to 39 detailed fault codes Cylinder Sleeve _ Exercise Cycle Six exercise length options Default:Start and run for 16 seconds; Abort exercise below 40°F(internal temperature) Ckoerations 71_ FueYConsumpti�lix �_ A ~~ -- -- " Souhd Rating A4 7 N9etets� _ Full Load 1/2 Load No Load Low Idle Mode 64 dBA' BTU/hr NO-260,000 NG-187,000 NO-99,000 No Load 67 dBA' LPV-337,500 LPV-207,500 LPV-100,000 its/hr NG-260 NG-187 NG-99 LPV-135 LPV-83 LPV-40 m'/hr NG-7.36 NG-5.30 NG-2.80 LPV-3.82 LPV-2.35 LPV-1.13 g/hr LPV-3.65 LPV-2.24 LPV-1.08 ' Parts•Labor•Travel Unlike some other standby generator manufacturers, our warranty covers parts, Limited labor AND travel for the full length of the warranty with no start-up costs! Warranty' 'This generator is certified in accordance with UL(underwriters Laboratories)2200(stationary engine generator assemblies)and CSA(Canadian Standards Association)standard C222 No.100-14(motors and generators). 'Fuel consumption rates are estimated based on normal operating conditions at i load.Generator operation maybe greatly affected by elevation and the cycling operation of multiple electrical appliances-fuel flow rates may vary depending on these factors. 'See operator's manual or BRIGGSandSTRATTON.com for complete warranty details. 'Lowest no-load measurement per ISO 3744.Sound level measurement at other locations around generator may be different depending upon installation configuration. 2 BR{Gcs a oN 20M' Fortress'"Standby Generator Additional Information �Operatidns Certifications ; Engine Warm Up(sec) 20 seconds after all settable delays CARR Compliant* Engine Cool Down(min) 5 FCC Part 15 Class B/CAN ICES-003(B) Response Time(sec) Immediate after engine warm up NFPA 37 Compliant Wel ht and DitllCttSiOOS M- }t cUL Listed to CSA 22.2 No.100-14 Assembled Weight(Ibs/kg) Steel-489/222 UL2200 Listed Aluminum-440/200 Overall Dimensions(in/mm) 50,5 x 33.8 x 30.6/1283 x 859 x 777 EPA Certified Fuel System Packaged Weight(Ibs/kg) Steel-634/288 Complies with NFPA 37 4.1.4.1.2 Aluminum-580/263 ssories Packaged Dimensions(in/mm) 68,1 x 41 x 39.9/1730 x 1041 x 1013 1Available'Acce_ , Enclosure Material Galvanneal Steel or Aluminum Maintenance Kit 6036 with Corrosion Resistant Paint E-Stop Kit 6491 AvailabLeTransferSviritches. Power Management Low Voltage Module 71052,71053 071100 100 Amp Power Management 71051 071150 150 Amp High Voltage Module Generator Status LED Kit I 6535 071200 200 Amp — — Battery Warmer 6578 071071 Symphony's II 100 Amp InfoHub Universal 6574 071070 Symphony®11 150 Amp 071068 Symphony'11 200 Amp 071057 Symphony'II Dual 200 Amp 50.5 in(1283 mm) 33.8 in(859 mm) 30.61n 1 (777 mm) { i i 48.1 in(1222 mm) 29.6 in(752 mm) •CARB does not regulate emergency standby generators outputting less than 50 HP.Only the EPA standards apply. 'This generator is certified in accordance with UL(Underwriters Laboratories)2200(stationary engine eeneratoi assemblies)and CSA(Canadian Standards Association)standard C22.2 No.100-14(motors and generators). 3 tF rf�« ��>� ;�� ♦�'" ^�r♦, .."e Tri t, ,. � ��.s �,.-\r. +��• 1 �, a �t.t.' � �� ,7�1 �. Ste/i ry �¢+� . fu...,4 ,Nt �C�1��� .�y d'" j•►+.`� ~ t� : .� ',''tea♦,y, �"�I L..�}.�•. Ov 7A41t 140 15 .. . -. - �� ... . �• ~ ty of .>.�' �. a,, .�, ,. . .�.�.. ur.o:e,.re�..cssrt+3.a_�o.•..2�.rti:. Support every step of the way Need help?Visit powernow.com Complete the web form and a local dealer will contact you to answer questions on our generators,transfer switches and accessories. •