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TOWN OF SOUTHOLD BUILDING DEPARTMENT °i TOWN CLERK'S OFFICE � 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#: 50117 Date: 12/12/2023 Permission is hereby granted to: Solon, Charles 3189 Lydia Ln Bellmore NY 11710 To: install generator as applied for with flood permit. The generator is located in an AE-8 flood zone and must be installed at a minimum 10' elevation. At premises located at: 4553 Wickham Ave, Mattituck SCTM # 473889 Sec/Block/Lot# 107.4-13 Pursuant to application dated 11/20/2023 and approved by the Building Inspector. To expire on 6/12/2025. Fees: ACCESSORY $125.00 ELECTRIC $100.00 CERTIFICATE OF OCCUPANCY $100.00 Flood Permit $150.00 Total: _ $475.00 B ildirg Inspector TOWN OF SOUTHOL,D- BUIL,DING DEPARTMENT a Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502l tttp //WWWSOL.Ilholt.4.i'o� ,N rnrty,, lk-it Date Received APPLICATION FOR BUILDING II For Office Use Only f'771'� EJ PERMIT N0. Building Inspector _. ... Applications and forms must be filled out in their entirety.Incomplete applications%6111 not be accepted. Where the Applicant is not the owner,an Owner's Authorization farm(Page 2)shall be completed. Date:. 1'✓ 'r XI-3 OWNER(S)OF PROPERTY: Name: C/I &'-les So /oma SCTM# 1000- /o 7.00 - oyoo - 013.0oo Project Address 3 Phone#: Sf6 1S S ' S` yG Email:' , 4 ,� . to ; 'A/I J�0i/ ' hVac✓. Mailing Address: 5'5-3 bJ! C k ~-7i0 e /v Z 11,15--R CONTACT PERSON: Name: / Mailing Address: &/08, � f 6 ��� ,� V 11716 D o `i�Sd/1 flzJe (ten, Phone#: _ Email- DESIGN mailDESIGN PROFESSIONAL INFORMATION. Name: ...... Mailing Addres Phone# E CONTRACTOR INFORMATION: Name: f u 1. r �e Mailing Address: ,�a� �c 8 hof�s�.�, ue ccs, f � 151v/I //7/cam , Phone#: 31— 5-6 7— P-70 U Email°21.> <fed, y DESCRIPTION OF PROPOSED CONSTRUCTION Othery �. ,� p $ Project:. ❑N w Structure Addition ❑Alteration ❑Re air ❑Demolition Estimated 3 ( O G Will the lot be re-graded? ❑Yes FIX10, Will excess fill be removed from premises? ❑Yes Se<o 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes Elo 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): L"56�- Authorized Agent ❑Owner Signature of Applicant: ' c f"' �' G Date: STATE OF NEW YORK) SS: COUNTY OF ) Z, a b,, e -7 being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the .-'7 _71- (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 /0 day of Ck e 20 -23 , Notary Public JANET DAMIANO UIILIC-STATE OF NEW YORK PROPERTY OWNER AUTHORIZhIM No. OIDA5061073 (Where the applicant is not the ownedludllfied In Suffolk Cu y My COMMIsslon Expires _gip - residing at V S-S 3 kbic k ,-7i Au e A-4tly 1Q,j 9 _do hereby authorize G Som ,b,'/-57> -7 ede 74('�c to apply on my behalf to the Town of Southold Building Department for approval as described herein. b�1-� /0 /° 3 Owner i Mature Date ,\,-, ,,.:!�,A') Print Owner's Name 2 LS C E V E NOV 2 2023 BUILDING DEPARTMENT- Electr��� h � 'nae' t R I �r �� bio�d. cr TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 n Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr@southoldtownny.gov- seand@southoldtownnyxio APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: C/ Z- c /'rte. c Name: License No.: email: Address: , , 373 "c ori f ,r�,� l �7 � Phone No.: 6 39 a 9 - 9 Ce 3 6 -- a a l l JOB SITE INFORMATION (All Information Required) Name: 1- S -5 /,0r Address: Cross Street: R Phone No.: Bldg.Permit#: email: 1/1J, 66 /04 5111,15k,4CA VAC- Tax Map District: 1000 Section: %7 .,o o Block: 0 0 Lot: o13 .OC4 I. Ccam`" BRIEF DESCRIPTION OF WORK (Please Print Clearly) -Z-, / C6��e C 7�a�r : k co A rye,- c;,c.-? Circle All That Apply: Is job ready for inspection?: YES /� Rough In Final Do you need a Temp Certificate?: YES Issued On Temp Infcr7matto ( Allon required) Servi i, e 1 Ph A leters Meter# New nervi - Fire Reconnenect- Serva Reconnected - U rground - Overh d#Unde round Laterals 1 le Work done o' Service" Y 7 Additional Information: PAYMENT QUE'WITH APPLICATION Request for Inspection Form.xls ATE A CERTIFICATE OF LIABILITY INSURANCE D139/15I2023Y' 09 152023' 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('jes)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 rf4NTACT M Jennifer Heiser HONE ..... Fax Nicholas Devito Agency, Inc.. c (631)509-6388 tA�c No)R (63 509 0099 449 Route 25A EW )ertrllfejggevitoapn+corn Mount Sinal, NY 11766 _ INSl1RERSIAFFORDINGCOVERAGE _ INSURED Wildwood Electric L ..... INSURERA ljrle�rGhants..,,M,UtUa�Insurance P rripan.)/ 123329 INsuRERs. ,pl(e�rch;�A!te.Preferr...e..d Inm,urA,nce_Company C 12901 nc. INSURER C 49A Rocky Point Yaphank Road Rocky Point, NY 11778 INSURERS INSURER F,: COVERAGES CERTIFICATE NUMBER: 00010319µ1177128 REVISION NUMBER: 71 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. rA .TYPE OF INSURANCE......... �AOr7�.�5'CJfBR� POLICY NUMBER.........,. ..POLICY EFF POLICY EXP I "" ....-_.__ LIMITS,-.�.,.,_.._.---- ....,... IMM CLAIMS-MADE OCCUR BOPI099122 04115/2023 04/1612024 6 sE 0, ff n,E®,j mm„' $___ 1,,,000,000_ COMMERCIAL GENERAL LIABILITYOCCURRENCE an - 500,000_ Contractual PERSONALBADVINJURY $ Included Llat)111ty MED EXP An, onEGATEn) $_ 2 000 000 GEN'LAGGREGATE PRO. LOC PER: ._PRODUCTSGGREG $,. ,�� 6•RO• POLICY❑y�Et•:T ❑ LOC II jl COMP/OP � 2 000 000 ,, OTHER, COMBINED SINGLE LIMIT $ B AUTOMOBILE LIABILITY CAP1070996 04/16/2023 04/16/2024�,.r;, pr,ck�{fupy_ ....... ...�..m_.. �.......... r.,, ANY AUTO BODILY INJURY(Per person) $ AUTO,HIRED NON-OWNED I INJURY(Per accident) $ AUTOS ONLY �„ }_ - q -. OWNED SCHEDULED BODILY IINJ RY(Per $ AUTOS U ... AUTOS ONLY .,tY..Pr 4GF�M�^ .j.— ...qa - ,... I$ 000 EXCESS IABCLAIMS MADE I .AGGREGAT RRENCE $ 1#,000,000 A 1 UMBRELLAAB X� OCCUR CUP9149680 04/16/2023 04/1612024 EACHOCCU _ $ ..... _ AN EMPLOYERS'XJ RETENTION$ 10.000 $ WORKERS COMPENSATION PER 1 ER__ ERS'LIABILITY 'W d N s� I7 .._..__R ....�.- TA-fir. f C — N ANY PROPRIETOR/PARTNER/EXECUTIVE EAC CCIDENT OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) """"""� MPLOYE $ .,•,,,_ E L.DISEASE-EAE _. �....... ....." If yes,describe under OESCRLPTION.OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ i DESCRIPTION OF OPERATIONS/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 Southold, NY 11971 AUTHORIZED REPRESENTATIVE i 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 09/15/2023 at 02:01 PM NEW Workers' YORK CERTIFICATE OF --ATATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1b.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 1'1-2782074 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 Sentinel Insurance Company 53095 Route 25 36,Policy Number of Entity Listed in Box"1a' PO Box 1179 12WECAC6TZH Southold, NY 11971 3c.Policy effective period 12/31/2022 to 12131/2023 3d.The Proprietor,Partners or Executive Officers are © included.(Only check box If all partnersiolficers Included) all excluded or certain partnersiofficers excluded. This certifies that the insurance carrier Indicated above In box"3"insures the business referenced above in box 1 a"for workers' compensation udder the New York State Workers'Compensation Law (To use this form,New York(NY)must be listed under Rem 3 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 mall.)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 DeVito (PAWN name or ul pdzed repres"tairee or llcens agent of i surance catrriie'�'ro 7/ol Approved by: .�" �/ s 2 (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 CA 05.2.Insurance brokers are,NOT authorized to issue It. C-105.2(9-17) www.wrb.ny.gov 'workers• CERTIFICATE OF INSURANCE COVERAGE Z<Y"noir Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW .. ... . ..................._ .. ... .._...... ......... ......�.. . . . ... PART 1.To be completed p ed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name&Address of ���nl ...... Insured Insured(use street address only) 1 b.Business Telephone Number of Insured WILDWOOD ELECTRIC,INC. 631-929-4219 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"1a" L82898-000 53095 Route 25A,P.O Box 1179 SOUTHOLD, NY 11971 3c.Policy effective period 1/11/2017 to 10/29/2024 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: X❑ 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 coverage as described pbove,, Date Signed10/31/2023 By A-211A, 5i nature od ung ante carrier's aut oiiied.m ViNI" NY Lc+!n Insurance A( g + gent of that insurance carrier) Telephone Number (212)355-4141 Name and Title Bebi Ishmail,Supervisior-DBUPolicy 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 com letW`6 the NYS Workers'Comes ....... _.- checked) _.._d p y 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) 1�1�IIIA iiiiiiiiiiiuiiiiiiiiii�iiiiiiiiiiiiiiiiiIII lll Suffolk County Dept.of Labor,Licensing&Consumer Aff; -OVE IMPROVEMENT LICENSE Name FRANK NAVETTA Fn s certifies[hat the Business Name .)earer is duly licersed POWERPRO SERVICE COMPANY IN( )/the County of suffolk License Number: H-44193 Rosalie Drago Issued: 02/21/2008 Comn-;ssiorer Expires: 02/01/2024 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/6/2023 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 1" Ad'T PRODUCER NAMI Fes' 631 351 11I HONE Borg Borg Inc. tPAlf xtl 53 =6tss troor ons.00rn t Npf 148 East Main Street ss_cerllfic E MAIL ,�y�, Huntington NY 11743 ArIPfSf..m.: _.. INstI ERIAFFD3RDItdGOVFCFyn z� 1NsgSRA OhI Casual __ 24Ctl7 t INSURED INsOR� ghIO a,curtty In�surlance Co 24082 PowerPro Service Co. Inc. INSURER G _ 608 Johnson Ave, Ste 6 � ..... Bohemia NY 11716 INsu �R I INSURER F COVERAGES CERTIFICATE NUMBER:1807922580 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, Ad't)17dR S SHO MAY HAVE BE REDUCED BY PAID CLAIMS. B EXCLUSIONS X COMMERCIAL PE F(NSU AL(ABILITY - LIMITS 59794035CY NUMBER � �517/2023F XP Exp CONDITIONS OF SUCH POLICIE 024 r _ RANCE YNSPD M'MIDr//"YYYY � MMP rYY Y LIMITS I gR TYPE OF ... GEN1. Y EACH OC-CIJRFdENCE $1.000 000 00 CLAIMS-MADE XM �OCCUR gia q a-, 0 0 MEXPS $2.0 GEN'L AGGREGATE LIMIT APPLIES PERSONAL B FWOV tNJURYL$1,009,000 PER: G,ENERAL AGGREGATE ... ,00 00'0. IriI V€:Y (PRO- OC PRODUCTS-COMPIOPAGG 52,000000 OIIdR JT L 51712023 5/7/2024 I InILO SINGLE VVT $1,000,000 C] AUTOMOBILE LIABILITY I �BKS59794035 m crldcggly;,. m ._. , X ANY AUTO i BODILY INJURY(Per person) $ i - BODILY INJURY(Per accident),,$ OWNED r 'SCHEDULED ) _ AUTOS ONLY _...-�AUTOS € jNROPPR"q"r' HIRED NON-OWNED $ X A6I I OS�ONLY „mX„AUTOS ONLY .........�. a _. EXCESS LA LIA OCCUR US059794035 51712023 5/712024 EACIt OCCURRENCE 5 5 000 000 GGREGATE 5Q000 OOCk ...... ..,. .. ,. .. A X UMBRELLA LIAB DED X RE.D�Ek�!"rtlON.$'.�y .. MADE A _— iaIln IMS a ANYPROPRIETORIPAR7NER/EXECUTI STA41'U 4;7'rb"9 WORKERS COMPENSATION I_ PER 'IE _, 13 AND EMPLOYERS'LIABILITY YIN �'L EACHAGgDFNT $ VE ���N/A OFFICER/MEMBER EXCLUDE071 E.L DISEASE,EAEMPLO EE' S IMerdd,aler';�Vou NH) f _ �....,... — Il yv describe umlor i I E,L DISEASE-POLICY LlM17 'S �.'..' 47h.'SC:€hVP'rk0"J OI"OPERATIONS Wow i .. '. I DESCRIPTION OF OPERATIONS r LOCATIONS/VEHICLES(AGGRO 701,Additional Remarks Schedule,maybe attached IF more space Is required) Certificate holder is an additional insured to the fullest extent permitted by law when required by a written executed contract. 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 Bldg Dept., P.O. Box 1179 AUT"RIZED,REPRESENTATIVE Southold NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NEWWorkers' CERTIFICATE OF .. ATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board _ ..... 1 a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured PowerPro Service Co. Inc. 631-567-2700 608 Johnson Ave, Ste 6 Bohemia, 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- w. 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) American Fire and Casualtv Co. Town of Southold Bldg Dept., P.O. Box 1179 3b.Policy Number of Entity Listed in Box 1 a" Southold, NY 11971 XWA59794035 3c.Policy effective period 05/07/2023 05/07/2024 3d.The Proprietor,,Partners or Executive Officers are included.(Only beck box if all partnerWolticers Included)all excluded or certain partners/officers xclut-1. 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 then 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 mall.)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 Mote:upon cancellation of the workers'compensation policy Indicated on this form,if the business continues to be narned 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) 9/6/2023 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 ' NOERM CERTIFICATE OF INSURANCE COVERAGE . .. N r� STATE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PAT RT 1.To be com feted by Disabili and Paid Fami'l Leave Benefits Carrier or Licensed Insurance Agent or that Carrier 1-a. Legal Name and Address of Insured(Use street address only) 1b.Business Telephone Number of Insured PowerPro Service Co. Inc. 631-567-2700 608 Johnson Ave, Ste 6 Bohemia, NY 11716 1c. Federal Employer Identification Number or Social Security Number Work Location of Insured(Only required if specifically limited to 113430118 certain locations in New York State,i.e.a Wrap-Up Policy) : . Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier Ohio Securitv (Entity Being Listed as Certificate Holder) 3b.Policy Number of entity listed in box"1a": BKS59794035 Town of Southold 3c.Policy e Bldg Dept., P.O. Box 1179 effective period: Southold, NY 11971 1 05/07/2023 05/07/2024 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: q _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 9/6/2023 By: Valid 1v Borg (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone No. §31673 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,OB Plans Acceptance Unit,328 State Street, Schenectady,New York 12305 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-insured employer has complied with the NYS Disability Benefits Law with respect to all or his/her employees. Date Signed y. (Signature of Ws Workers'CompensaWn Board!Employee) p Tele hone No. 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. u131�u.1 (In-17) p SURVEY OF PROPERTY SITUATED AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-107-04-13- SCALE 1"=36' JUNE 15, 2021 AIL NOVEMBER 16, 2023 ADD PRPROSED GENERATOR AREA = 80,580 sq. ft. a4J1 ST,. �✓ ,P (m m uq 1.850 ac. r 4. ,,." 4 r Os " + °," CERTIFIED TO: c- Charles Solon and Sherry Solon °"`* r�,r�`� •ti a AmTrust Title Insurance Company Aa " «►"✓ w' , c Appellate Land Services LTD 2 no OS: Vi—TE •P,o 1. ANY WETLAND BOUNDARIES SHOWN ARE SUBJECT TO VERIFICATION BY NEW YORK STATE AND/OR OTHER REGULATORY AGENCIES. 1Lf' ki 2. THIS PROPERTY IS IN FLOOD ZONE AE EI. 8 AS SHOWN ON FLOOD INSURANCE RATE MAP Na. 3610300143 H AL atdCt. ^^" k .Y �,� ZONE AE BASE FLOOD ELEVATIONS DETERMINED Z wyM 4E20E Y � H l2 25 "AL AL "' � �•�i `bel; 1 1Wta.. smm r' 4aL VN-e ?A �� �' w ' ✓' E ��� „«� ��^�"rte•+^'""°'"" JL Ilk r, 1, . •°J°pMups Yyiy y sI-A 5 k �+ 1 1 ~ti " �. ""�« rte• �r �" i �,.. t DAVSY ." a TKEDo CoNyoN r OF Y WA ONO- �~ Nathan Taft Corwin II � i ME wa Land Surveyor mEs a T16 san WP xor rsm ,,.y., O�4H 9wi Mat allasaEl� SucrAx Ta 91a kn IS J. A bigy.rro Ls LS. `'✓ ERIf>Gl1lOr6 emICVFD W16DII 9Vll aLx w0.Y ro l,¢Pe]wX mN•lAL TE 9.AfIEY TAb Svvryf-Subdnvio,u- SEe PM1au- aa,M,cNm lyaR e VW6Pd9,AMp fk RatWJ"m'OR 1 ' w`alca" PHONE(631)727-2090^yy Fm, ADDRESS(631)127- 727 �� ro11rt,k�o'' itts o°r l'xcaww � WLLLAG �SSA O„�f�1flCVor6 A�„pr TY16ayP6l£ OFFIflS{DGTm AT i5W Yam R-1 P.O.fi 16 1XE am-ra1¢R mo111 of WAYS ,imm®part,fMr.Yak 11947 C Ne.Yark 11947 ✓�A��,,,6 '"s9 tM'moo:K..... 2184 �(' 2vr [B6.0] � bbb 602 [23.71 980 38.6 CONCRETE PAD cJ _ — OPTIONAL CUSTOMER _ RADIATOR FILL INSTALLED .. — .. — .. . —..— .. _ .. _ .. — .. .. — .. — . — 152 REF. LOCKABLE E-STOP I_ J I TYP A6.0 LL SIDES I I I n ENGINE AND ALTERNATOR • Y cl? AIR INLET CD + �a • m I • + i �'6 GFCI OUTLET(REQUIRES UTILITY POWER INPUT) N 421 100 ONDUIT STUB-UP FOR [16.6] [3.9] LOW VOLTAGE CONTOL • PRIME MOVER LOCKOUT SWITCH 808 110 [31.8] [4.3] ONDUIT STUB-UP FOR GENERATOR LOAD LEADS AND UTILITY POWER (BOTTOM ENTRY) EXHAUST OUTLET IL 836 32.9 731 28.8 943 37.1 DOOR OPENING CONTROLLER AN FUSES FILTER IL DIPSTICK SHOWN W/DOOR REMOVED AIR FILTER REMOVE THIS PANEL TO • • ACCESS COOLANT • • • —_--_-- --- DRAIN —_---- LOAD CIRCUIT--\ zw BREAKER --- z O __--- • w� a w 0 o 00 LLI ^-` 1 N J •• COOLANT =—___ co:)a co 0 o =___= _ ?•:• DRAIN = u)LL m °'ai O • • • • CONNECTION ATTERY LOCATION 4X 016[0.6] 281 OIL DRAIN _ ACCESS PANEL (BATTERY NOT INCLUDED) MOUNTING HOLES [11.1] 1517 1`59. 11 0.4 809 31.91 FUEL INLET FUEL INLET 1880 4.0 1"NPT 1128 44.4 450 17. 980 38.6 100 UNLESS OTHERWISE SPECIFIED: [3•9l NOTE: ALL DIMENSIONS IN MILLIMETERS DO NOT SCALE. DIMENSIONS IN[]ARE ENGLISH STANDARD EQUIVALENTS GENERAL TOLERANCES: THIS ASSEMBLY OR PART MUST a" xxx i i o SURFACE FINISH COMPLY WITH PEP-RML-001. ON COMPOSITE DWGS,SEE PART NO.FOR REVISION LEVEL x i 15 REFERENCE CAD MODEL FOR O CHANGE ANGLES:o•aa MAX. NUMBER DRAWING REVISION Lo M REV DATE D INDICATES PART NUMBERS AFFECTED BY LATEST BY UNSPECIFIED DIMENSIONS. Z25 THIRD ANGLE PROJECTION A 23JUL2021 CT213532 B-2 FUEL INLET 1&2 ADDED RVM � KOHLER.B 29SEP2022 CT221726 SEE SHEET 2 AAS 70 KOHLER,WISCONSIN 53044 C 02NOV2022 CT223403 B-2 "FUEL INLET 2 1"NPT REMOVED' MAJOR o= o [1.0] CRITICAL®= 0 "FUEL INLET 1"NPT'WAS"FUEL INLET 1 1" CHARACTERISTICS COMPLY WITH SCALE:0.050 SHEET SIZE:B SHEET 1 OF 2 NPT B-3 1517 59. WAS 1512 59. • KPs-80022 TITLE: OPTIONAL E-STOP KIT LOCATION DRAWN RVM DATE: DIMENSION PRINT, (A-1.A-5)"40RCL"REMOVED D-3 Al) BY 30RCLA p T 30RCLA/38RCLC 38RCLC APPROVED TAS 22JAN2021 ADV-9759 ADDED-SEE SHEET 2 NCD DWG NO.: OCCUPIED STRUCTURE OCCUPIED STRUCTURE OCCUPIED STRUCTURE OCCUPIED STRUCTURE SEE NOTE 7 SEE NOTE 4 SEE NOTE 4 SERVICEI — -- SIDE DOOR SET SET Ill SEE NOTE 7� F- � O Z SERVICE SIDE DOOR w w SEE NOTE 8 -�— — w ---� �— SEE NOTE 7 SEE NOTE 8 —► t O SET —� SET zi w SEE NOTE 7 SEE NOTE 8 J SEE NOTE 8 SERVICE SIDE SERVICE SIDE L— DOOR DOOR INSTALLATION GUIDELINES N 1)EXHAUST IS AIMED AWAY FROM OR PARALLEL TO THE STRUCTURE. 2)EXHAUST IS NOT DIRECTED AT PLAY AREAS,PATIOS OR OTHER AREAS WHERE PEOPLE CONGREGATE. 3)THE NEAREST WINDOW,VENT,DOOR OR SIMILAR STRUCTURE OPENING IS AT LEAST 5 FEET FROM THE EXHAUST END OF THE GENERATOR. 4)GENERATOR SET MUST BE INSTALLED A MINIMUM OF 18 INCHES FROM STRUCTURE PER NFPA 37,HOWEVER,ACTUAL DISTANCE MAY DIFFER BASED ON STATE AND LOCAL CODES. 5)WINDOWS&DOORS ON ADJACENT WALLS ARE CLOSED. 6)FURNACE AND OTHER SIMILAR INTAKES ARE AT LEAST 10 FEET FROM EXHAUST END OF GENERATOR. UNLESS OTHERWISE SPECIFIED: ALL DIMENSIONS IN MILLIMETERS DO NOT SCALE. GENERALTOLERANCES: THIS ASSEMBLY OR PART MUST T)4"THICK CONCRETE PAD EXTENDING 6-BEYOND GENSET ON ALL SIDES. x�x t i o SURFACE FlNISH COMPLY WITH PEP-RML-001. ®8 NO PLANTS,SHRUBS OR OTHER COMBUSTIBLES ALLOWED IN CHANGE ON COMPOSITE DWGS,SEE PART NO.FOR REVISION LEVEL ANGLES °.� T MAX REFERENCE CAD MODEL FOR ) REV DATE NUMBER �INDICATES PART NUMBERS AFFECTED BY LATEST BY �/ UNSPECIFIED DIMENSIONS. CLEARANCE AREA.(MINIMUM 4 FT.FROM EXHAUST END). DRAWING REVISION • THIRD ANGLE PROJECTION 9)SENSITIVE PLANTS,PATIO FURNITURE,ETC.ARE AT LEAST 8 FEET FROM - 22JAN2021 CT209473 NEW DRAWING RVM EEI KOH L ER. EXHAUST END OF SET. A 23JUL2021 CT213532 SEE SHEET 1 RVM MAJOR O= 0 KOHLER,WISCONSIN 53044 10)REFER TO OWNERS MANUAL FOR OTHER INSTALLATION CONSTRAINTS. B 29SEP2022 CT221726 A- NOTE 8:4FT WAS BFT AAS C 02NOV2022 CT223403 A-8cHARACTERKP�NOTE 11 ADDED•SEE SHEET 1 NCD CRITICALC ° SCALE:0.050 SHEET SIZE:B SHEET 2 OF 2 11)RECOMMENDED SKID ANCHOR-1l2"HILTI KWIK BOLT TZ CARBON STEEL WEDGE ANCHOR WITH STANDARD WASHER. 0022 - WITH TITLE: DRAWN RVM DATE: DIMENSION PRINT, 30RCLA BY 30RCLA/38RCLC 38RCLC APPROVED TAS 22JAN2021DWG No ADV-9759 N 8 I 7 I B I 5 4 I 3 I 2 OCCUPIED STRUCTURE OCCUPIED STRUCTURE N TE: I THE RECOMMENDED DISTANCE FROM A STRUCTURE IS DEPENDENT ON STATE AND LOCAL CODES. PRODUCT HAS BEEN DEMONSTRATED IN ACCORANCE WITH NFPA 37 a a0 a SECTION4 4 BY A THIRD PARTY TEST FACIIIIY TO THE DIMENSIONS SHOWN SERVICE DOOR SET SET MOUNTING AREA MOUNTING AREA SERVICE DOOR ACCEPTABLE 4 FT. CLEARANCE II EXHAUST IS AIMED AWAY OR PARALLEL TO STRUCTURE. L�-T-TEXHAUST END 2) EXHAUST ISNOT DIRECTED AT PLAY AREAS. PATIOS OR OTHER AREAS WHERE PEOPLE-CONGREGATE. z 3) THE NEAREST WINDOW, VF.N7, DOOR OR SIMILAR STRUCTURE OPENING IS AT LEAST 5 FELT FROM.THE EXHAUST END OF iHF SET w� 4) SET HAS PROPER OFFSET FROM STRUCTURE. V% 5) WINDOWS 8 DOORS ON ADJACENT WALLS ARE CLOSED 61 FURNACE AND OTHER SIMILAR INTAKES ARE AT LEAST 10 ILF1 FROM EXHAUST END OF SET, 7) WEED BARRIER AND 3 INCH THICK GRAVEL BASF OR CONCRETE PAD LOCATED TO PREVENT GRASS 8 WEEDS FROM GROWING 100 CIOSE OCCUPIED - TO THE SET. STRUCTURE o a 8] NO PLANTS, SHRUBS OROTHER COMB UST IBLLS ALLOWLD IN CLEARANCE AREA. (MINIMUM 4 FT. FROM E%HAUS1 CNDI 9) REFER TO OWNERS MANUAL FOR OTHER INSTALIAIION CONSTRAINTS IB" MIN Q 101 NO PLANTS, SHRUBS. OR OTHER COMBUSTIBLES AIIOWED WIININ --- 30" OF AIR INTAKE SERVICE DOOR SET MOUNTING AREA z= a R(v DAT[ n coxrosl 11 Dn45 Hr PAY Yo n YIvlslan I[v[1 __ Dv N 9 23 11 NEWDRAWINGICT1793681 ADP x1 �Q A 12 15 17 SEE SHEET 3 Of 5 1[11825]51 r ___ NRM v.1n u110 nx¢1s u. ����� ' NOMEA tN600N61N qDM 8 5-?4-10 IAIIsS.C-7117 30'MIN WAS IB-MIN, IC JI NO][UPDA IED ADP u16P090f1 1,1N 015144 AI Dl Ix 11 15.0x1 IN 1(11811151 [O u xxD uD61 x01 Wf p6lD Iv[gP1 1 _ COxxfC 110x•11u x01x 1Y CO • xll 14u1s [ 19JUN201 t13 31 J0-WAS IB IC-i 6 B 51 PE MOv[0 AWM — 01 O1614x aY 1_Lv110Y 1.11 -78 FROM 30"MIN DIMENSIONS IPRU82381 OE3 DIMENSION PRINT. W/20KW RCA V D 170[1201 IC JI NOIE R[MOVED, VIEWS UPDAI[D IPRO85651 CEN BPPDOVx15 0 11 14/20RCA ADP 9 21 I1 ----- SINGLE UMT --_ " ", 9 11 l i x,x CONFIGURATION -- BA 9 1J n b ADV-8928 D 8 7 6 5 4 3 2 � t 3 AIR CLEANER OIL DIPSTICK HEATER (OPTIONAI ) .n rri J g% „�� so RAIN VALVE AIR OUTLET -f vNEW DRAWING ICT1793681 ND! KOHLER. ®_ i ® ` E3 , _ PflOYALS ADP2_ i� �iYPP BJF 9 ��y kt�� �r� �%' 1 `� � ,J: •.,.rpt ; USET PORI CON I ROLLER LOAD CIRCUIT BREAKER CONNECTION OLOCK �II)AI'IR PAD p r � DRAINOIL -BAT 11 RY,LOCAT�Ofl , D 9 23 11 NEW DRAWING 1011936al HLER. N. CDIMENSION PRINT, 14/20KW RCAOFF ® C3 �� Bir 923 11 ADV-89 26 8 I 7 I 6 I 5 1 4 I 3 I 2 OCCUPIED OCCUPIED OCCUPIED STRUCTURE STRUCTURE STRUCTURE 18" MIN. SERVICE DOOR e/—SERV ICE DOOR f f MOUNTING SET MOUNTING SET AREA 01—A REA oa MOUNTING SERVICE SET i 5 FT AREA DOOR W IQ SET SERVICE m MOUNTING MOUNTING AREA DOOR AREA SERVICE DOOR a4 FT. CLEARANCE ¢ AT EXHAUST END zz 5 FT. iz a Q SET MOUNTING AREA tea' �a OCCUPIED x SERVICE DOOR STRUCTURE w 4 FT. CLEARANCE M a "a 4a AT E%HAUST END 18" MIN V SERVICE DOOR SET OCCUPIED STRUCTURE MOUNTING AREA O vD �a a� � z MOUNTING AREA MOUNTING AREA SERVICE DOOR SET MOUNTING AREA SET SET - NOTE: SERVICE %--SERVICE APPLY NOTES ON SHEET 4 OF 5 DOOR DOOR TO SHEET 5 OF 5. REV DATE ON COMPOSITE DN65.SEE PARI N0.FOR REVISION LEVEL BY DO x01 SC AL[ NLFERENC[1111 YODEL FDR ALL VNSPECI11E0 DIMENSIONS 4 FT, CLEARANCE 4 FT., CLEARANCE 9 23.11 NEW DRAWING ICT1793683 ADP Nx11N1 NIIN.�s15P1a1?o AT EXHAUST END AT EXHAUST END A 12-15-11 SEE SHEET 3 Dr 5 ICTIS25351 NRM �IML:I IDILRuu.N'.S:"""' KOHLER. NOHLERINISIbNDw WW B 524-18 ID-I.D-I.B 21 30-MIN WAS 18' MIN ICT1811351 ADP Txls DRAW Ix4 Ix D[s lcx AxD D[1•It IS Noxt[R INTAKE TO C 19JUN201 SEE SHEET 4 IPRDR2JR1 ANN C0 PROPERTY HD YV51 NO1 8;q1[D IS INTAKE IN [ONNEn1nN 01111 10-LER Co Dx[5 BE 10 F T. D 17OC1201 SEE SHEET 4 IPRO85651 c[n or DESIGN ON I11EN110H ARE RESERVED FROM EXHAUST 14/20RCA APPROVA S DATE DIMENSION PRINT. 14/20KW RCA PARALLEL UNIT ADP9-23-11 CONFIGURATION vPP 823-11 Dir 9.23 11 ADV-8928 D g 7 6 5 4 3 2 I iOH`�OR® Model: 38 R C LC Multi-Fuel Natural Gas/LPG 01 Standard Features 09� • Kohler Co. provides one-source responsibility for the (n�C01'l1•ER- generating system and accessories. - LLY REGISTERED • The generator set and its components are prototype-tested, NATI�NP factory-built,and production-tested. I. 01 • The generator set accepts rated load in one step. • A standard five-year or 2000 hour limited warranty covers all systems and components. • Quick-ship (QS) models with selected features are available. _= See your Kohler distributor for details. • Meets 291 kph (181 mph)wind load rating. • GFCI service outlet installed on the junction box. • RDC2 Controller K� o One digital controller manages both the generator set and transfer switch functions(with optional Model RXT transfer switch). o Designed for today's most sophisticated electronics. o Electronic speed control responds quickly to varying household demand. the Kohler® Advantage o Digital voltage regulation protects your valuable • High Quality Power electronics from harmonic distortion and unstable power Kohler home generators provide advanced voltage and quality. frequency regulation along with ultra-low levels of o Two-line,backlit LCD screen is easy to read in all lighting harmonic distortion for excellent generator power quality to conditions, including direct sunlight and low light. protect your valuable electronics. • Engine Features o Powerful and reliable 2.2 L turbocharged liquid-cooled • Extraordinary Reliability engine Kohler is known for extraordinary reliability and o Electronic engine management system. performance and backs that up with a premium five-year or o Simple field conversion between natural gas and LPG 2000 hour limited warranty. fuels while maintaining emission certification. • Innovative Cooling System • Aluminum Enclosure o Electronically controlled fan speeds minimize generator Attractive aluminum enclosure allows installation as close set sound signature. as 18 inches from your home or small business. • Certifications • Quiet Operation o The 60 Hz generator set engine is certified by the Kohler home generators provide quiet,neighborhood- Environmental Protection Agency(EPA)to conform to the friendly performance. New Source Performance Standard (NSPS)for stationary spark-ignited emissions. o cUL/UL listing, CSA certification standard are available (60 Hz only). o Accepted by the Massachusetts Board of Registration of Plumbers and Gas Fitters. o Meets NFPA 37 requirements for 18 in. offset for installation. • Approved for stationary standby applications in locations Generator Set Ratings served by a reliable utility source. Standby Ratings Natural Gas LPG Alternator Voltage Ph Hz kW/kVA Amps kW/kVA Amps 4E8.3 120/240 1 60 38/38 159 38/38 159 120/240 1 60 34/34 142 34/34 142 120/208 3 60 38/48 132 38/48 132 4D8.3 127/220 3 60 38/48 125 38/48 125 120/240 3 60 38/48 114 38/48 114 277/480 3 60 38/48 57 38/48 57 * 50 Hz options available.Contact your Customer Service representative. RATINGS:All three-phase units are rated at 0.8 power factor.All single-phase units are rated at 1.0 power factor.Due to manufacturing variations,the ratings tolerance is t5%. Standby Ratings:Standby ratings apply to installations served by a reliable utility source.The standby rating is applicable to varying loads with an average load factor of 80%for the duration of a power outage.No overload capacity, is specified for this rating.Ratings are in accordance with ISO-304611,BS 5514,AS 2789,and DIN 6271.GENERAL GUIDELINES FOR DERATING:Altitude:Derate 1.3%per 100 m(328 ft.)elevation above 200 m(656 ft.).Temperature:Derate 3.0%per 10°C(18°F)temperature above 25°C(770F).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 liability whatsoever.Contact your local Kohler generator distributor for availability. G4-305 (38RCLC) 6/21 ;l Alternator Specifications Specifications Alternator • NEMA MG1, IEEE,and ANSI standards compliance for Manufacturer Kohler temperature rise and motor starting. Exciter type Brushless,Wound-Field • Sustained short-circuit current of up to 300%of the rated Leads:quantity,type current for up to 10 seconds. 4E8.3 4,120/240 4138.3 12,Reconnectable • Sustained short-circuit current enabling downstream circuit Voltage regulator Solid State,Volts/Hz breakers to trip without collapsing the alternator field. Material Class H • Self-ventilated and drip-proof construction. Temperature rise 130°C,Standby Bearing:quantity,type 1,Sealed • Windings are vacuum-impregnated with epoxy varnish for Coupling Flexible Disc dependability and long life. Unbalanced load capability 100%of Rated Standby Current • Superior voltage waveform from a two-thirds pitch stator and One-step load acceptance 100%of Rating skewed rotor. Peak motor starting kVA: (35%dip for voltages below) • Total harmonic distortion (THD)from no load to full load with 240 V 4E8.3(4 lead) 74 (60 Hz) a linear load is less than 4%. 480 V,380 V 4D8.3(12 lead) 120(60Hz) 88(50Hz) Application Data Engine Exhaust Engine Specifications 60 Hz 50 Hz Exhaust System 60 Hz 50 Hz Manufacturer Kohler Exhaust manifold type Dry Engine:model,type Residential Powertrain Exhaust temperature at rated kW,dry KG2204T,2.2 L,4-Cycle exhaust,°C(°F) 633(1171) Turbocharged Maximum allowable back pressure, Cylinder arrangement In-line 4 kPa(in.Hg) 7.5(2.2) Displacement,L(cu.in.) 2.2(134.25) Bore and stroke,mm(in.) 91 x 86(3.5 x 3.4) Fuel Compression ratio 10.5:1 Fuel System Piston speed,m/min.(ft./min.) 310(1016) 258(847) Main bearings:quantity,type 5,plain alloy steel Fuel type Natural Gas or LPG Rated rpm 1800 1500 Fuel supply line inlet 1 in.NPT Max.power at rated rpm,kW(HP) Natural gas fuel supply pressure,kPa LPG 47.8(64.1) NA (in.H2O) 1.2-2.7(5-11) Natural Gas 47.6(63.9) NA LPG vapor withdrawal fuel supply Cylinder head material Cast Iron pressure,kPa(in.H2O) 1.2-2.7(5-11) Piston type and material High Silicon Aluminum Fuel Composition Limits* Nat.Gas LP Gas Crankshaft material Nodular Iron Methane,%by volume 90 min. - Valve(exhaust)material Forged Steel Ethane,%by volume 4.0 max. - Governor type Electronic Propane,%by volume 1.0 max. 85 min. Frequency regulation,no-load to Propene,%by volume 0.1 max. 5.0 max. full-load Isochronous C4 and higher,%by volume 0.3 max. 2.5 max. Frequency regulation,steady state ±1.0% Sulfur,ppm mass 25 max. Frequency Fixed Lower heating value, Air cleaner type Dry MJ/m3(Btu/ft ),min. 33.2(890) 84.2(2260) Engine Electrical Fuels with other compositions may be acceptable.If your fuel is outside the listed specifications,contact your local distributor for Engine Electrical System further analysis and advice. Ignition system Electronic Battery charging alternator: Lubrication Ground(negative/positive) Negative Lubricating System Volts(DC) 14 Type Full Pressure Ampere rating 90 Oil pan capacity,L(qt.)§ 4.2(4.4) Starter motor rated voltage(DC) 12 Oil added during oil change(on average), Battery,recommended rating for-18°C(0°F): L(qt.)§ 3.3(3.5) Qty.,cold cranking amps(CCA) One,630 Oil filter:quantity,type§ 1,Cartridge Battery voltage(DC) 12 Oil cooler Remote Battery group size P4 § Kohler recommends the use of Kohler Genuine oil and filters. G4-305 (38RCLC) 6/21 ;t Application Data Cooling RDC2 Controller Radiator System 60 Hz 50 Hz AmbEngine ent jacketwaterc p (ty, 45(113) Engine jacket water capacity,L(gal.) 2.65(0.7) Radiator system capacity,including voltage: 2407 O OFreq: 60.0 Hz O engine,L(gal.) 13.2(3.5) � Water pump type Centrifugal goo o OOO Fan diameter,mm(in.) qty.3 @ 406(16) Fan power requirements(powered by ® auH engine battery charging alternator) 12VDC,18 amps each T_o 0 0 -13 Operation Requirements Air Requirements 60 Hz 50 Hz The RDC2 controller provides integrated control for the Radiator-cooled cooling air, generator set, KohlerS Model RXT transfer switch, m3/min.(scfm)T 51 (1800) 51 (1800) programmable interface module (PIM), and load management. Combustion air,m3/min.(cfm) 2.1 (74) 1.8(64) Air over engine,m3/min.(cfm) 25(900) 25(900) The RDC2 controller's 2-line LCD screen displays status t Air density=1.20 kg/m3(0.075 Ibm/ft3) messages and system settings that are clear and easy to read, Fuel Consumption: even in direct sunlight or low light. Natural Gas,m3/hr.(cfh)at%load 60 Hz 50 Hz RDC2 Controller Features 100% 13.9 (492) 11.6 (409) • Membrane keypad 75% 11.4 (404) 9.5 (335) 50% 9.3 (327) 7.8 (275) o OFF,AUTO,and RUN push buttons 25% 5.8 (205) 4.8 (169) o Select and arrow buttons for access to system Exercise 3.4 (121) 2.8 (99) configuration and adjustment menus LP Gas,m3/hr.(cfh)at%load 60 Hz 50 Hz • LED indicators for OFF,AUTO,and RUN modes 100% 5.6 (197) 4.7 (166) • LED indicators for utility power and generator set source 75% 4.5 (160) 3.8 (134) availability and ATS position (Model RXT transfer switch 50% 3.2 (114) 2.7 (95) required) 25% 2.1 (75) 1.8 (64) - LCD screen Exercise 1.2 (41) 1.0 (35) o Two lines x 16 characters per line s Nominal Fuel Rating: Natural gas,37 MJ/m3(1000 BtuM3) o Backlit display with adjustable contrast for excellent LP Vapor,93 MJ/M3(2500 Btu/ft ) visibility in all lighting conditions LP vapor conversion factors: • Scrolling system status display 8.58 ft.3=1 Ib. 9 Y P Y 0.535 m3=1 kg. o Generator set status 36.39 ft.3=1 gal. o Voltage and frequency o Engine temperature Sound Enclosure Features o Oil pressure • Sound-attenuating enclosure uses acoustic insulation that o Battery voltage meets UL 94 HF1 flammability classification and repels o Engine runtime hours moisture absorption. • Date and time displays • Internally mounted critical silencer. • Smart engine cooldown senses engine temperature • Skid-mounted,aluminum construction with two removable • Digital isochronous governor to maintain steady-state speed access panels. at all loads • Fade-,scratch-,and corrosion-resistant Kohler@ cashmere • Digital voltage regulation: ±1.0%RMS no-load to full-load powder-baked finish. • Automatic start with programmed cranking cycle Sound Data • Programmable exerciser can be set to start automatically on any future day and time,and to run every week or every two Model 38RCLC 8 point logarithmic average sound levels are weeks 53 dB(A)during weekly engine exercise and 61 dB(A) during • Exercise modes full-speed generator diagnostics and normal operation. For o Unloaded exercise with complete system diagnostics comparison to competitor ratings,the lowest point sound levels o Unloaded full-speed exercise are 52 dB(A)and 59 dB(A) respectively* o Loaded full-speed exercise (Model RXT ATS required) All sound levels are measured at 7 meters with no load. • Front-access mini USB connector for SiteTech- connection * Lowest of 8 points measured around the generator.Sound levels at other points • Integral Ethernet connector for Kohler OnCue�Plus around generator may vary depending on installation parameters. g • Built-in 2.5 amp battery charger • Remote two-wire start/stop capability for optional connection of a Model RDT transfer switch See additional controller features on the next page. G4-305 (38RCLC) 6/21 KOHLERS Phone 9 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 Additional RDC2 Controller Features Available Options, Continued • Diagnostic messages Starting Aids§ o Displays diagnostic messages for the engine,generator, ❑ Block Heater,120 V,1 Ph Model RXT transfer switch, programmable interface ❑ Block Heater,240 V,1 Ph module (PIM), and load management device ❑ oil Pan Heater,120 V,1 Ph o Over 70 diagnostic messages can be displayed ❑ oil Pan Heater,240 V,1 Ph • Maintenance reminders § One block heater or oil pan heater is recommended for ambient • System settings temperatures below 0°C(32°F). At temperatures below-18°C(0°F), o System voltage,frequency,and phase installation of both heaters is recommended. o Voltage adjustment Automatic Transfer Switches and Accessories o Measurement system, English or metric ❑ Model RDT Automatic Transfer Switch • ATS status (Model RXT ATS required) ❑ Model RXT Automatic Transfer Switch o Source availability ❑ Model RXT Automatic Transfer Switch with Combined o ATS position (normal/utility or emergency/generator) Interface/Load Management Board o Source voltage and frequency ❑ Load Shed Kit for RDT or RXT • ATS control (Model RXT ATS required) ❑ Power Relay Modules(use up to 4 relay modules for each o Source voltage and frequency settings load management device) o Engine start time delay Maintenance o Transfer time delays ❑ Maintenance kit(includes air filter,oil,oil filter,and spark plugs) o Fixed pickup and dropout settings Miscellaneous o Voltage calibration ❑ Rated Power Factor Testing • Programmable interface module(PIM)status displays Literature o Input status (active/inactive) ❑ General Maintenance Literature Kit o Output status (active/inactive) ❑ Overhaul Literature Kit • Load control menus ❑ Production Literature Kit o Load status Warranty o Test function ❑ Extended 5-Year/2000 Hour Comprehensive Limited Warranty Generator Set Standard Features ❑ Extended 10-Year/2000 Hour Comprehensive Limited Warranty • Aluminum sound enclosure with enclosed silencer • Battery rack and cables Dimensions and Weights • cUL/US listed,CSA certified Overall Size,L x W x H,mm(in.): 1880 x 836 x 1169 • Electronic, isochronous governor (74 x 32.9 x 46.0) • Flexible fuel line Shipping Weight,wet,kg(lb.): 621 (1370) • Gas fuel system (includes fuel mixer,electronic secondary Weight includes generator set with engine fluids, sound enclosure, gas regulator,two gas solenoid valves,and flexible fuel line silencer,and packaging. between the engine and the skid-mounted fuel system components) • GFCI service outlet, 120/240 V for customer connection • Integral vibration isolation • Line circuit breaker H • NEC prime mover shutdown switch • Oil drain extension • OnCueO Plus Generator Management System • Operation and installation literature • RDC2 controller with built-in battery charger NOTE:This drawing is provided for reference only and should not be • Standard five-year or 2000 hour limited warranty used for planning installation.Contact your local distributor for more detailed information. Available Options DISTRIBUTED BY: Controller Accessories ❑ Lockable Emergency Stop(lockout/tagout) ❑ Programmable Interface Module(PIM) (provides 2 digital inputs and 6 relay outputs) Electrical System ❑ Battery ❑ Battery Heater ❑ OnCueg Plus Wireless Radio Kit ©2021 Kohler Co.All rights reserved. G4-305 (38RCLC) 6/21