Loading...
HomeMy WebLinkAbout49089-Z �o�Qg�fFOt,��oGy�� Town of Southold 5/10/2023 P.O.Box 1179 o _ 53095 Main Rd �4A, �ao��r � Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44083 Date: 5/10/2023 THIS CERTIFIES that the building WINDOWS Location of Property: 940 W Creek Ave,Cutchogue SCTM#: 473889 Sec/Block/Lot: 103.-13-7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/9/2023 pursuant to which Building Permit No. 49089 dated 4/4/2023 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: replacement windows to existing single-family dwelling as applied for. i The certificate is issued to Wipf,Marion of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Auth riz ignatur p�SVFFQI TOWN OF SOUTHOLD �oay BUILDING DEPARTMENT ca a TOWN CLERK'S OFFICE o • � ' 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#: 49089 Date: 4/4/2023 Permission is hereby granted to: Wipf, Marion 940 W Creek Ave Cutchogue, NY 11935 To: install replacement windows to existing single-family dwelling as applied for. At premises located at: 940 W Creek Ave, Cutchogue SCTM #473889 Sec/Block/Lot# 103.-13-7 Pursuant to application dated 3/9/2023 and approved by the Building Inspector. To expire on 10/3/2024. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO-ALTERATION TO DWELLING $50.00 Total: $250.00 Building Inspector OF 50(/l�o� # # TOWN OF SOUTHOLD BUILDING DEPT. �0 • �O `ycourm, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN ULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL ljt�// BSS [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: Av4ovo I I(I-s0 d DATE INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(1ST) O 3 ------------------------------------ S FOUNDATION (2ND) o � z � o aid H W ROUGH FRAMING& PLUMBING T r INSULATION PER N.Y. y STATE ENERGY CODE r-- •S a3 indo� ns�Oc,�l cont, � OL FZ _ FINAL ADDITIONAL COMMENTS $ 2-50 S�.o m O b W y r � z x d b H X15 fel'111 . 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 htt s //,, v.southoldtowmny.gov o� P ( ) ( ) Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only I PERMIT NO. Building Inspector: MAR 0 9 202 , I U/ `Applications and forms;dust befitted aut in their entirety ;Incomplete �- :applications will nat be accepted. Where the Applicant is not the owner,an BUILDING DEPT 701NN OFSOUTHOLD Owner's.Authoriaation'forin.(Page 2)-shall,6e,completed. . - Date: 3/2/23 OWNER(S)OF PROPERTY: Name: Marion..Wi.pf _...... _._.._.... ...._.....__....___.__._...__..JT7M #1000-103001300007000 ._.._.. . ... Project Address: 940W. Creek Ave. Cutchogue,µNY„11935 Phone#: 631-734-6513 7_Email: marionwipf@gmail.com ._.__. _......_..._.._ _...... Mailing Address: 94.0 W. Creek Ave. Cutchogue NY 11935 .CONTACT PERSON:. ” Name: Scott Doughman „ Mailing Address: 105 Buttonball Ln Glastonbury, CT 06033 Phone#: 303-946-8685 _......".._..._. _.. ....,..._........___.__.. ._.._. ,Email:"permits@gopermits.,or9 ...._._...._........ D'ESIGN'PROFESSIONAL INFORMATION;.'' Name: Mailing Address: Phone#: Email: CONTRACTOR'.INFORMATIIONt , Name: Home DepotU.SA __...._......_ .._.__....__.. _.._......__. . ..._.____.._.mm...___... Mailing Address: 2455 Paces Ferry Rd. Atlanta GA30339_ Phone#: 303-946-8685 .. ____......___ Email: .permits@gopermits.,org __._.....__. .._......_. `DESCRIPTION OF PROPOSED CONSTRUCTION, El New Structure ❑Addition ❑Alteration WRepair ❑Demolition Estimated Cost of Project: ❑Other $ 7151 Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes ®No L 1 ` DocuSign Envelope m o043x76C-E` ocmoF110 ` Existing use of property: ,S' lgje�_fa jjy ' Intended use of property: single.fam.i.,ly. Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? OYes ONo IF YES, PROVIDE A COPY. sit&for MI&�iiiige*dstom,WM d inliJ�84ii' S)ter,t4 rpy Application Submitted By(print name): Jennifer Winkle Signature of Applicant: Date: - STATE:OF NEW-YOft) COUNTY OF,Puill0rd Jennifer Winke being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he Js theAgent (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 . 20'17 Notary Public SPENSERRBULMER PROPERTY OWNER AUTHORIZATION Marion. Wipf residing at940 W. Creek Ave. Jennifer Whke do herebv.authorize to apply on behalf the town of Southold,Building Department foe appr'val as described herein, 3/3/2023 uwner'�.Signature Date Marion Wipf Print Owner's Name ISTNEWWorkers' CERTIFICATE OF AT olr�pelnsatiort NYS WORKERS' COMPENSATION INSURANCE COVERAGE S Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured 770-433-8211 Home Depot USA,Inc. 2455 Paces Ferry Rd.,C-20 1c. NYS Unemployment Insurance Employer Registration Number of Atlanta,GA 30339 Insured 76011130 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 58-1853319 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Indemnity Insurance Company of North America 3b.Policy Number of Entity Listed in Box"1 a" Town of Southold WLR C50668058 53095 Route 25 Southold,NY 11971 3c. Policy effective period 03/01/2023 to 03/01/2024 3d.The Proprietor,Partners or Executive Officers are EJ Included.(Only check box if all partners/officers included) Q 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: Eric D.Tonn (Print name of authorized representative or licensed agent of insurance carrier) Approved by: r loelwio {Sign e) (Date) Title: Vice President Telephone Number of authorized representative or licensed agent of insurance carrier: 678-795-4338 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 DATE(MM/DDIYYYY) ACC)RV® CERTIFICATE OF LIABILITY INSURANCE 03/0312023 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 MARSH USA,INC. NAME: TWO ALLIANCE CENTER PHO Ex aC No): 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS, INSURERS AFFORDING COVERAGE NAIC# CN101642069-HomeD-GAW:22-25 INSURER A:Old Republic Insurance Co 24147 INSURED THE HOME DEPOT,INC. INSURER B:Indemnity Ins Co Of North America 43575 HOME DEPOT U.S.A.,INC. INSURER c:ACE American Insurance Company 22667 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-005314714-06 REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR I D POLICY NUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY MWZY316648 03/01/2022 03/0112025 EACH OCCURRENCE $ 1,000,000 DAMAGE TO TED CLAIMS-MADE � OCCUR PREMISES Ea olccurrr nce $ 1,000,000 X SIR:$1,000,000 MED EXP(Any one person) $ EXCLUDED PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: $ A AUTOMOBILE LIABILITY MWTB316649 03/01/2022 03/0112025 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB X OCCUR MWZX 316647 03/0112022 03101/2025 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ $ B WORKERS COMPENSATION SCFC50668198(WI) 03/01/2023 03/0112024 X PER I OTH- AND EMPLOYERS'LIABILITY STATUTE ER C YIN WLRC50668150(MT) 03!0112023 03/0112024 5,000,000 OFFICER/MEMBER EXCLUDED?ANYPROPRIETORIPARTNER/EXECUTIVE � N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 5,000,000 If yes,describe under Continued on Additional Page E.L.DISEASE-POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED IF REQUIRED BY WRITTEN CONTRACT ON THE ABOVE GENERAL LIABILITY POLICY,BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 ROUTE 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1179 ACCORDANCE WITH THE POLICY PROVISIONS. SOUTHOLD,NY 11971 AUTHORIZED REPRESENTATIVE wgravzdGi 22.5' 9rTG. ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta ACC>RO' ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA,INC. THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA,GA 30339 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continued: Carrier:Safety National Casualty Corporation Policy Number:LDS4068089(AL,AR,AZ,FL,ID,IA,IL,KS,KY,LA,MS,MO,NC,NE,NM,ND,OK,SC,SD,TN,VA,WV,WY) Effective Date:03/01/2023 Expiration Date:03/01/2024 (EL)Limit:$5,000,000 Carrier:Safety National Casualty Corporation Policy Number:SP4068090(QSI)(CA,OR,WA) Effective Date:03101/2023 Expiration Date:03/01/2024 (EL)Limit:$5,000,000 SIR:$1,000,000 Carrier:ACE American Insurance Company Policy Number:WCUC50668095(QSI)(GA,MI,NV,OH,UT) Effective Date:03/01/2023 Expiration Date:03/01/2024 (EL)Limit:$4,000,000 SIR:$1,000,000 SIR(GA):$750,000 Carrier:Indemnity Insurance Company of North America Policy Number:WLRC50668058(AK,CO,CT,DC,DE,HI,IN,MA,MD,ME,MN,NH,NJ,NY,PA,RI,VT) Effective Date:03/01/2023 Expiration Date:03/01/2024 (EL)Limit:$5,000,000 TX Employers XS Indemnity: Carder:Zudch American Insurance Company Policy Number:NSL1138319(TX) Effective Date:03/01/2023 Expiration Date:03/01/2024 (EL)Limit:$6,000,000 SIR:$5,000,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta ACO® ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY NAMED INSURED MARSH USA,INC. THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA,GA 30339 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance "'HOME DEPOT INSUREDS— The Home Depot,Inc. Home Depot U.S.A.,Inc. Home Depot U.S.A.,Inc.dba The Home Depot Home Depot of Puerto Rico,Inc. Home Depot Product Authority,LLC Home Depot Store Support,Inc. Red Beacon,LLC H.D.W.Holding Company,Inc. Askuity,Inc. Home Depot Management Company,LLC ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF INSURANCE COVERAGE sad. DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured HOME DEPOT U.S.A.,INC. 2455 PACES FERRY ROAD NW 678-231-8957 ATLANTA,GA 30339 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,Wrap-Up Policy) 581853319 2.Name and Address of Entity Requesting Proof of 3a Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) TOWN OF SOUTHOLD HARTFORD LIFE AND ACCIDENT 53095 ROUTE 25 3b Policy Number of Entity Listed in Box"I a" SOUTHOLD, NY 11971 LNY713657 c Policy effective period 01-01-2023 to 12-31-2023 4.Policy provides the following benefits: ❑V A.Both disability and paid family leave benefits. ❑B.Disability benefits only. E]C.Paid family leave benefits only. 5.Polic covers: IV A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. nB.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that 1 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 11-17-2022 f- L rear7 (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (212)553-8074 Name and Title:Elizabeth Tello—Assistant Director,Statutory Services IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance 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 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. i Date Signed B (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form(. DB-120.1 (10-17) � II � 120-.1«ii��ii�i�I IH Additional Instructions for Form D13-120.1 By signing this form, the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in box"1 a"for disability and/or paid family leave benefits under the New York State Disability and Paid Family Leave Benefits Law. The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed 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 cancelled 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 coverage indicated on this Certificate. (These notices my 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 Disability and/or Paid Family Leave Benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or paid family leave benefits 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 NYS Disability and/or Paid Family Leave Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability and Paid Family Leave Benefits Law. DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first, two thousand and twenty-one, the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b) The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand eighteen,the payment of family leave benefits for all employees has been secured as provided by this article. DB-120.1(10-17)Reverse -Cabor,:Licensing.&ContumerAffairs HOME IMPROVEMENT LICENSE Name.. . .. RICHARD TOUSEY Businesia Name This certifies that the marer is duly licensed, HgME:DePOT USA INC(14 SUPPS)_- �y the County,of;s4ff61k N Montt LI umber:H-53429 . RosalieDra®o aSsut#d," 6511S/2014 .Commissioner EXpiie : 11161t2024 This"licensd3s the,'property.of Suffolk County+. Department of,Labor,kicensin�8 Consumer Affairs. . Possession of this Iicense;doe's not guarantee ifs validity. Additionelluslness Name"': License:Gategbty had AP 1RL V�0 AS NOT DATE: `Z B.P.# FEE: , --.- °.y. NOTIFY BUILDING 'ARTMENT AT 765-1802 8 AM ';C' a M FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TV.0 REQUIRED FOR POURED C ANCrRETE 2. ROUGH - FRAMING X41. PLUMBING 3. INSULATION 4. FINAL - CONSTRLI1--i0!� MUST BE COMPLETE = 0. ALL CONSTRUCTI-;N -.ALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF. NEW YORK STATE & TOWN CODES AS REQLUiREO AND CONDITIONS OF :OU HOLD TOWw ZB,4 ;,LITH!: Andersen Wood SPEC SHEET SC: Adam Friedman Measure Tech: INSTALLER: Branch Name: Long Island Job#: F31746889 Prepared By: ISM: Ship To Location: Customer Name: marion wipf Date: 02/03/2023 Paget Of t SPEC SPRSHEET# REF# NEW WINDOW UNIT" }q)no i" Ca58rk18nt . .. - ."z LOCK '',Haiilware oPMNS :i SOra6tt .. (STAr. '-(1'rattldho4 F0ldhtg StOri9 ;,r - - {Eutuda bfVJt6teOpUDn �FVU.' .OH"Frame � - trxiitdati iri BAS "klung � included• A41SC" . - - "k. ' ;?" Afess '�unh• •'SASH LIFL� -b1 SASE L 40OR .`Hxistin�W)rtdow'• Andtxsen � F �WS Sat Glass .InBase .:Typa-t„`�',.'•: sl LV[tldaw TYPE Odo(1Frrtisfi i SC SIZE SOLD('t'�ta7YP} .MEASURE TECH StPE ONLY'ONLY Opti "Oas"eirmtmt NetlellktB l3pdwts'": OPT }*,.'-p:'- '..--a.:.:,GtiNe"bpttail6't?L7i SASH PR{Cy{ j':< �'.:'• pi(airtg) ,©PTlCtNS', 'anlijxYetngj OPT7t:IP1 TOTAL MT/ISM Interio TW SC UI Standard #Bars #Bars #Bars #Bars Pattern MISC Location Existin Serres Indo Exterio Finish Jam Standar (WIDT Size Grid Exterior Interior Vert Horiz Vert Horiz & Labor Windo Type Style Calor Color Liner Size All + CODE WALL SILL Sash Hing Temp Screen Type Grid Grid Pattern (per (per Lo-'a (Per (Per Location Obsa Finish Finis Finish Item Roo Fioo Code CODE COD CODE COD Cob Code Widt Height HEIG Width Height DEP ANGL Split Venting/Handing Style CODE Options COD Color Color CODE sash) sash) CODE Sash) Sash) CODE CODE CODE -Type COD Type CODE CODES 1 DE 1st DH- 400 DH WH PINE Gray 30 58 88 STD none ST STD ST STD ST METAL, N ALDE WRAP R 2 DE 1st DH- 400 DH WH PINE Gray 30 #88 STD none ST STD ST STD ST METAL, N ALDE WRAP R 3 DE tat DH- 400 DH WH PINE Gray 30 STD none ST ISTD ST STD ST METAL, N ALDE WRAP R 4 DE tst DH- 400 DH WH PINE Gray 30 STD none ST STD ST STD ST METAL, N ALDE WRAP R . .a.,.'�r>�'•�-��_+�""�"^_�. "87rYf8(tWWINDQYi;;�':� ',-Sr/fdato.ZZ��NaE08:Unctrid#lNlat.WM Tdu7f19rabkCPlknf.epcfot�o([dtrlon0.UvoMaMMtd., ".tLiNOFAo?'17RER"tiOTE'S:�nduilamu�liy bcWwta. �,:- ,-x� _ tit- .1deMt(yVvarOowMoci},.��, axwaoHl4.Oa8aultofdtdtlEyedddoWdoor3 Projection Angie:(Bey:30°or 45') Top of WNdow h Solfil Or hes) - Bay Window Flamm am(DH/Casement) :1dlh of o.,h rp(inches) Consatid Roof 1(Yes/No) If bed to Soffit.color of Soffit material 1 Them is no gaarantee that news ing s wi mat e-un mor. a. - - .. NEW DOOR UNIT DOOR ITE Aigleisen. ,> MEASURE FULL FRAME F.• •btasa .,N a <. ;�;.,' °�f: MLiLt.fS7RLK,'-'e "'>z' Eeergyst4 - AWTdmtoi 9 , tloorType ~BornTYPE ,..t &iNFlydatt BO SRE SOLO(TIP to T!P} ...TC-gi SIZE ONLY,. "-GdNe OpSbre tflER SASH PRICING OPTK? L$t7on Optioti ` .''Hinged and OHdktg 15003' `s' OPTIt7NS"' a MfSC.ABbR OPTi4NS Opttods•' Eiadiva tlnk PD Northern Assembl Es? TOTAL (200 Nob: Location Smartsun Interim UI Rol Inswing PD PD Gliding Hinged 400,& meets Existing Series Exterio Finish Stantlar (WIDTH TIP EM Extensio Grid Exterio Inteno #Bar #Be Door Door A-Ser Lock Lock Option all other capllW Door Type Style Cotor Color Size AW + to Jamb Jamb Type Grid Grid Patter ert( riz(P bscur Scree IN or # Venting Venting gliding HRDW HRDW Keyed Mulled I Special rzepgnagal stet ry Roo Floo Code COD COD CODE CODE Cotle Width Heigh HEIGHT Wd Heigh TIP Slze Location COD Color Color CODE Sash Sash CODE CODE OUT Pa Handing Handing only) Type Finish Lock Stacked Notes MISC Labor Item CODES Ymi or No Pronla No Width No `:AW,CtOyw #ot boxes No Color Approval Print Name marion wipf Ttie Home Owner '^•us'f:`"r` a`a:..r"'S�`..:-d•:r7a:M3<F,.�.a"?'`' ,rigor an.. .q:�aa.,r<'m�.keY:':R=% .Fuss _:x• axe.:w.:.,• e;,i'.��<..,x• ;;g:. itt•s ,.-v:,a •,'+n^a+.:.:�� M:.rr�-..-"-%>',.4-; .,:a... ,p,w, ww:r ..5,:,�t'".?:" ..>.�,k. »...F.w..f;a a>+aJi :h,> .xS ii,"m ..a - d ,x.,r•i:.N„ v. .=;vn..o-r..-.«x..x. -..-.R.MrY : r: .••a+.<:r.P x...:.:. .,. No Grilles AND-N-74-00571-00001$siR3U` .1.70 031 0.53 Simulated Divided Lite or Installed Interior Removable' AND-N-74-00571-00002 0.30 1.70 028 OA7 18 40.2 - - - - 3 •o,,d. Flnelight^' (grilles-between-thegiasa) AND-N•74-00577-00001 0.30 1.70 028 0.47 IS <02 K Full Divided Lite AND-N-74-00589-00001 0.31 1.76 028 OA7 17 40.2 - No Grilles AND-N-7400572-00001 0.30 1.70 0.19 0.30 13 <0.2 - - - W e Simulated Divided Lite or Installed Interior Removable AND-W7400572-00002 030 1.70 0.17 026 12 <0.2 - a Finelightm(grilles-between-the-glass) AND4&7400576.00001 0.30 1.70 0.17 026 12 a 0.2 - •:-s Full Divided Lite /W0.N.7400590-00001 0.31 1.76 0.17 026 10 1<0.2 - - No Grilles AND.W7440M.40001 020 1.65 021 OAS 15 <0.2 T1 W � Simulated Divided Lite or Installed Interior Removable AND-N-74-00573-00002 0.29 1.65 0.19 OA3 14 -0.2 - s •off, E Fineligtdm(grilles-between-th"Iass) AND-N-7400579-00001 0.29 1.65 0.19 OAS 14 <0.2 - Yt Full Divided Lite AND-N-7440591-00001 0.30 1.70 0.19 0.43 13 <02 No Grilles AND-N-74-00570-00001 IL30 1.70 0S1 0.59 31 <0.2 c W rn Simulated Divided Lite or Installed interior Removable AND-N-74-005I0-001102 0.30 1.70 OAS 0.52 29 <0.2 - - M Finelight"(gd8es-between-theWass) ANIYtF7400576.00001 030 1.70 OM 042 29 <02 - m e. Full Divided Lite AND-W7400588.00001 0.31 1.76 OAS 0.52 27 <02 - - - ! No Grilles AND-N-7400675400111 026 1.48 0.30 0.52 24 <0.2 - - s y W� Simulated Divided Lite or Installed Interior Removable AND-N-7400675-00002 026 IAS 0.27 OAS 22 <02 s= Finelight"(grilles-betwoon the-glass) AND-W74-00611"DOO1 026 1.48 027 1 OAS 22 <0.2t - - - 3 " Full Divided Lite � AND-N-74-0088401 028 1.59 027 1 0.48 20 <0.2 7n1 d No Grilles AND44.7400676-00001 025 1.42 020 0.47 20 <0.2 ? - - W N S Simulated Divided Lite or Installed Interior Removable AND-W74-0067600002 025 1.42 0.18 0.42 19 <0.2 - - - 400 Series WDodwrighte 9 E= Finelightw(grines-between4he-glass) AND44-74-0067940001 025 1.42 0.18 OA2 19 <a2 N 3 Double-Hung Full Divided Lite AND-N-74006&4-000000001 0.27 1.S3 0.18 OA2 16 <0.2 ' Insert No Grilles AND-N-74-006741 026 1A8 OX 0.57 34 <0.2 e x e W �� Simulated Divided Lite or Interior Removable ANON-74-00674-00002 0.26 1A8 OA2 0.51 31 <0.2 - - 3 i Finelight*v(grilles-0alween-theglass) AND-N•74-00677-0�01 026 1.48 OA2 0.51 31 <0.2 - 6 3 Fan Divided Lite ewD-N-7a-0as63-aoow 026 1.59 OA2 0.51 29 <02 V.w.;"KJ.y° 'L'3=.:Ti':' it'z�S>r-;'.C's,..,P;:"i:.. 'oYs:+«...r.ry,:.5>;C•-.1;;:",.fie. ±�. ..'.a�'vF,»;r, <:.LIN.;�:::r.`_`f,'.;'i; `X1.;,^•,rq:3::(Y<rz .::}'.x.' .:-5:; `4 ai._, I.v .fY. ��:'4ks .::!ry t4s.fin`.-°"�3:�.v'.}r.;,,,y, .(iia. y .r'`k�•`•::.t;i?i>�p=�'%der .30* eaEedo%3_•i'fe!gPen�l;E�'ass..tv7"Gi8)es%}^or"Groater, '�;.-:.^`: .,t.r, a'�<`�,,., <,w, w.;;,���.a�:�;,;;<, •.. ��:',o-^;;1� „,..,s�.,�.,«F...s.r.,n-r��c,::,...�:•a,-vv�„r...:x�,�,�x�:v,vn..,:#.xro^r,v:,•.6:.,}"' L..f"is. •� . ` ..,.'^2�.'_�..._:;f�ei.F :-`>ti� _ Simulated Divided Lite or Installed Interior Removable AND44-7440571.00003 0.30 1.70 025 OA2 16 <0.2 - - • xs; e 3 Finelight^'(grillesbetweeMheglass) AND.N.74-0058340001 0.31 1.76 028 OA7 17 <0.2 - S Full Divided Lite AND-N-74-00595.00001 0.30 1.70 025 OA2 16 <02 - - - Simulated Divided Lite or Installed Interior Removable AND44-7400572-00003 0.30 1.70 0.16 023 11 <a2 - - w 3 N Finelight^'(grilles-between-theglass) AND-N-7400584-00001 0.32 1.82 0.17 026 - 0 Full Divided Ute AN6N174-00596-00001 0.31 1.76 0.16 023 10 - va • ! Simulated Divided Lite or Installed Interior Removable AND-N•74.00513.00003 0.29 1.65 0.17 030 13 LL _ W FlneligM^'(gri0esbetvreen-theylass) AND•N-740058600001 0.31 1.76 0.19 0.43 12 <02 - - - - H Full Divided Lite AND-N-74-00597-00001 0.30 1.70 0.17 038 12 a 02 • Simulated Divided Ute or Installed Interior Removable AND-W74-00570-00DO3 0.30 1.70 0.41 0.46 25 <0.2 - - - - - - e c W 3 i Finelight^'(grilles•hetween-theglass) AND44-74-00562-00001 0.32 1.82 OAS 0.52 26 <0.2 - o. d Full Divided Ute AND41-740059400001 031 1.76 OA1 GAS 24 <a2 - - - - s Simulated Divided Lite or Installed Interior Removable AND-N-7400675-00003 0.26 1.48 025 OAt 21 <02 W c � Flnallght^'(9diles4between•Theglass) /WD•11-74.00681-00001 0.27 1.53 027 OAS 21 <02 iVG - 3 Full Divided Lita AND-N-7440587-00001 028 1.59 025 0.41 19 <0.2 e Simulated Divided Lite or Installed Interior Removable AND-N-74-00676.00003 0.25 1.42 0.17 0.37 18 <0.2 I - ua �3 1 Finelight^'(grilles-between-the-glass) AND-N-74.00682-00001 027 1.53 0.18 0.42 16 <02 rn 3 Full Divided Lite AND•N•74.006M.00001 0.27 1.63 1 0.17 0.37 16 <0.2 - - This information is for reference only. Performance varies b unit size and options selected. Page 78 of 15s Dale s wrtent as of Dece shat 15.2014 end o subject to Wang. y p 9 See page 1 for mare Mfonna0on. For specific unit performance information,please contact your dealer or Andersen Sales Representative.