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HomeMy WebLinkAbout49767-Z �otiOS�FFcoGy Town of Southold 10/27/2023 0 P.O.Box 1179 o _ 53095 Main Rd dao. Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44692 Date: 10/27/2023 THIS CERTIFIES that the building WINDOWS Location of Property: 45 Mathews Ln, Cutchogue SCTM#: 473889 Sec/Block/Lot: 84.4-14 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8/30/2023 pursuant to which Building Permit No. 49767 dated 9/22/2023 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: window replacements"in-kind"to an existing single-family dwelling as applied for. The certificate is issued to Ricci,Carolyn of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Author e S nature TOWN OF SOUTHOLD �o�oSUFFot c s BUILDING DEPARTMENT ca TOWN CLERK'S OFFICE SOUTHOLD, NY dol �a i 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#: 49767 Date: 9/22/2023 Permission is hereby granted to: Ricci, Carolyn 45 Mathews Ln Cutchogue, NY 11935 To: Install window replacements "in-kind" to an existing single-family dwelling as applied for. At premises located at: 45 Mathews Ln, Cutchogue SCTM # 473889 Sec/Block/Lot# 84.-1-14 Pursuant to application dated 8/30/2023 and approved by the Building Inspector. To expire on 3/23/2025. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO-RESIDENTIAL $50.00 Total: $250.00 Building Inspector ho��OE SOGTyo� # TOWN OF SOUTHOLD BUILDING DEPT. 4q 1�, °ycourm 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING `[ ] FRAMING /STRAPPING [ FINAL Gviows [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] . RENTAL REMARKS: DATE /0-23 - --23 INSPECTOR 1 IELD INSPECTION REPORT DATE COMMENTS �v I,OUNDATION (1ST) -- - --- --- ----- — --- - — ---- -- ----------------------------------- — ----- ------- -- FOUNDATION (2ND) -- ----- — --- s z ------ — ROUGH FRAMING& -- -- , PLUMBING — --- -- --- 1 r INSULATION PER N.Y. - - ----------- — "� STATE ENERGY CODE ------ -- 0•�?3-a3 l�in6Ca�—ire S�� L'o- 'rt�Y� Dei � .C�. FINAL ADDITIONAL COMMENTS --— — -- - --- --- o _rn �o O --— -- -- -------- ---- ---- — z 3 DocuSign Envelope ID:F3538473-3E5F-41 F3-B7A7-C8E316249CDC o 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-:,//'Aww.soLitholdtowm.gov Date Received APPLICATION FOR BUILDING PERMIT - � C� C� t� C� � For Office Use Only p PERMIT NO. �'f' ! Building Inspector: AUG 3 0 2023 Applicatiohs'.and forms must be filled out in their.entirety.Incomplete" applications will not be accepted.4here the Applicant is not the owner,an building Department owriees Authorizationform(Page 2)shall be completed. Town of Southold Date:8/21/23 OWNERS)OF PROPERTY:. Name: Carol n Ricci SCTM#1000- Project Address: 45 Matthews Ln Phone :6'31111-1793-1931­9E : Carol r ..__... #_...__.... . . ..d_...... �... .. _ mailn10 __..�.._._..... . _. .. .....,....Y._._ 022@ppl.com Mailing :Address „ „ µ 45 Matthews Ln, Cutchogue,NY 11935 CONTACTPERSON:; := Name: Scott Dou hman Go Permits Mailing Address: 105 Buttonball Ln...,Glastonbury_, ,CT 06033 Phone#: 303-946-8685 Email: ' _..._...�........._. ._._..__ __ _._._. .__.. ..... ._.... _ __. ._._ .._.ail: permrits@gopermlts,org. ....__. . DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: COWfkACTOR INFORMATION: Name: ._. ....___wHome Depot_USA . .. _... Ma�li.ng address: 2455„Paces,Ferry Rd. Atlanta, GA 30339 „ Phone#: 303-946-8685 Email: 11 - _ . Perm itS @gopermlts.org DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ©Repair ❑Demolition Estimated Cost of Project: ❑Other KeDlacment of 14 windows, same size. $ 13.414 Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes ®No 1 DocuSign Envelope ID:F3538473-3E5F-41 F3-B7A7-C8E316249CDC PROPERTY'IN FORMATI ON. Existinglym l y: Si of s ue propertn e family, Intended use le famll ... .,. _. _. single _ _.., .. . endese of property: Sing .._.__.., .._... _.. .__ _......... ._ Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes ❑No IF YES, PROVIDE A COPY. ❑:Check Box-After keading, The owner/contractor/designprofessional is responsible for ail drainage evil stor►n water issues as provided by Chapter 23b of the Town Code.'APPLiC11TION 15 HEAEBI'MADE to the Building Department for the issuance of a Building permit p6irsuant to the Building Zone Ordinance ofthe Town of 5 4thold,Suffolk,°County;Nervi York and other''applicable Laws,Ordinances or Regulatlons;forthe co»structlon,of buildings, additions,alterations or for rern&atm dt6olition as herein described.The applicant agrees to comply with all applicable laws,ordinances,Wilding code, housing code and reMulations and to admit authdr zed'inspectors on,'preniises and.in buildirig(sj for necessary inspections..False`statements made herein are punishable as a Class Amisdemeanor pursuant to Section 210.45 of.the New York State Penal Law. Application Submitted By(print name): Jennifer Winke BAuthorized Agent ❑Owner Signature of Applicant: Date: �'�c)-J G STATE OF NfK) SS: COUNTY OF VUIltord ) Jennifer Winke 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 off I 20'23 Notary Public SPEkW R BULMER NOTARY PUBLIC 13th tclCwMy,NC PROPERTY OWNER AUTHORIZATION y commalon figpM AUOR®T 24,2027 (Where the applicant is not the owner) Carolyn Ricci residing at 45 Matthews Ln. I, do hereby authorize Jennifer Winke - Go Permits to apply on fAgthe Town of Southold Building Department for approval as described herein. 8/24/2023 Owner's Signature Date Carolyn Ricci Print Owner's Name 2 Go Permits, LLC 105 Buttonball Ln. Glastonbury, Ct 06033 s "WE UNDERSTAND THAT YOUR TIME IS MONEY" To Whom It May Concern: Enclosed you will find a building permit application and check. If you have any questions regarding this application, feel free to call me at the number listed below. Please note the following: • Please mail original permit to the owner. • Please e-mail a copy of the permit and receipt to: Email: permits@gopermits.org Thank you! Jennifer Winke, Permit Expediter Go Permits, LLC Phone: 303-946-8685 Fax: 866-697-0768 jenniferwinke@gopermits.org Go Permits LLC, 105 Buttonball Ln. Glastonbury CT 06033, scottdoughmon@gopermits.org Le�anr,Li��rtSirrU C,art�utn�r,4ffliks- z<r,H _: I�IGMARD T6USei a slsr$rdul 110onsad 46ME[9EPCJ1•U$AlhE(9�8UPP�j Y:tliCwenty oP eublk•. Llwn;�P tatttb ra.H-4 3#29 �y� �33�tsgo:" :tii�d;' ._.Ci5116t2t31�i .. g; ;= s • .. ; �ng* olk'Coi�crris�rnc�rA air�r. " We pia, of L e „3 : Posses ori btitil flt rise;hoes no g`grtmt6 its vad6 �itidikignl'�Uslnktss��P��Y H!4OC- zAw= 'CERTIFICATE OF INSURANCE COVERAGE DISABILITY AND PAID FAMILY.LEAVE BENEFITS LAW PART 1.To be completed by Disability and`Paid Family Leave Benefits Carrier or Licensee(Insurance Agent of that Carrier 1a.Legal Marne&'Address of Insured(use street address only) ?1b.Business Telephone Number of Insured HOME DEPOT U.S.A.,INC,, � '67&-231-8167 2455 PACES FERRY ROAD NW ATLANTA,GA 30339 1C,'Federa€Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if average is span ically /united to certain locations In,Vew Y'orl:State,i.e,,Wfal)-up,Policy) 681 853319 2,dame and Address of Entity.Requesting Proof of 3a Name of Insurance Carrier 'Coverage(Entity Being lasted as the Certificate Holder) TOWN OF SOUTHOLDFIARTFC3RD LIFE AND AGLIDENT 63096 ROUTE 25 3b Polley Number of Entity Listed in Box"1a" SQtl{HOLD, NY 99979 LNY713657 ' 13c Policy effective period 01-(11-2ff23 tts 12-3'i-2023 4.Policy provides the following berieiits: A.Both disability and pta€d family leave benefits. S.Disability benefits only. ElC.Paid family leaves benefits only, 5.Policyycovers: ;J A.,All of the employees employeas eilc3ibie under the NYS,Ciisabillty.and Paid Family Leave Sonefito Low. B.Only the following class oietasses of employer's employees: I 3 Under penalty of perjury,,!certify that i am an authorized representative or licensed agent of the Insurance carrier referenced above and that the named insured hes NYS Disability and/or Paid Family Leave Benefits Insurance coverage as described above, { Date.Signed* 11-17-2022 (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that ihmurance carrier) Telephone(dumber (212)55MG74 Name and Title:07abeth Telto—Assistant Director,Statutory Services ! IMPORTANT: If Boxes dA and;SA.are checked,and this form is signed by the Insurance carrier's authorized representative or M Licensed Insurance Agent of.that carrier,this certificate Is COMPLETE.Mail it directly to the certificate holster. If Box 4B,4C or Sia is chocked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 o the NYS Disability and Pain Family Leave Benefits Law.It-must be mailed for completion to the Workers'Compensation Board,Plans Acceptance-Unit,Ptd Box 5260,Binghamton,MY 13802-5200. PART 2:To be completed b .;he NYS Compensation mp ns m(ion Bea (Only if Box 4C or 5B of Part'has been checked} State of New York i Barkers' Compensation Board � According to information maintained by the NYS Workers`Compensation Bogard,the above=narngd,employer has complied with i the NYS,Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. I { j Date Signed BY f 3 (Signature,o7 Authurfzt d NYS Workers',Componsation Board Employce) Telephone Number _. _ ......Name and Title Ploase Nole.Onlyinsurance,carrisrs itoonsed to write NYS disability and paid family l rave benefits insurance poficlos acid NYS licailsod insurance agents or those insuranco'carr/ors are authorized to Issue dorm 179.120.1.Insurance brokers are NOT authorized to Issue this form. Workers' CERTIFICATE OF Compensatlan NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a,legal Flame&Ar;dress of Insured(use street address only) 1b.Business Telephone Number of Insured 77 0-433-8:11 Home E3epot.USA,Inc. 2458 Prices Ferry Rd.,C-20 Atlanta,CSA 36339 '1c.Nyt3 Unemployment Insurance Employer Registration Number of Insured 760/1130 Work Location of Insured f0rtiyrequired ifcdteag'e is spacificaily li€Itited to 1d.Federal Employer.3dentification Number of Insured or Social Security rtain lwmfions in Neta=Yiak State,i.e.,a Wr6p-Up r'blicy} Plurntaer 58-1853x19 2.ware and Address of Entity Requestincg 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 Town of Southold C50663Q5 WLR 05066805853095 Route 25 Southold;NY 11971 3c.Policy effective period t331Q1120?3 to 43f{t112024 3d.The Proprietor,Partners or Executive'Offieprs are included.(Orgy check box ifall lncludod) f excluded or certain partnerslofficers exrla.ided. 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,view York(NY)must be listed under lipp on the INFORMAT11'ON PAGI~ofthe wearkerV comperisatibn 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 ether than nonpayment of,premiums that cancel the policy or eliminate the insured frorn the coverage indicated on this Certificate. (These notices may be sent by regular mail.)otherwise,this Certificate is.valid for one year a€ter.th'is form is approved by the insurance carrier or its licensed agent,or u ntil the policy expiration date lister!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 ektend or alter the coverage afforded bythe policy listed, ncar.dnes.it confer any rights or responsibilities beyond those contained in the referanced policy. This certificate may be used as evidence of a lWorkery Compensation contract of insurance only while the underlying policy is in effect. Please Note: upon cancellation of"the workers'coinperfsation policy Indicated on thislorm,if the business continues to be narned on a permit,license or contract issued by a certificate•holder,the lousiness must provide that certificate hclderwlth a new Certificate of Workers'Compensation Coverage or otherauthorized 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 refbrenced above and that the named Insured has the.coverage as depicted on this form. ,approved by: Eric 0.Tonn (Print name of authorized regresentatave or licensed agent of insurance carrier) Approved by: (cion (mate) Title: Vice President Telephone Number of authorised representative or licerised'agent cf insurance carrier: 678-795.4338 Please Trate: Only insurance carriers and their licensed agents are authorized to issue Farm C-106:2.Insurance brokers are NOT authorized to issue it. C°-'t 0S.2(9-17) w,Amwcb.ny.gov Home Improvement Agreement: Page 1 Home Depot License#'s-For the most current listing visit www.Homedepot.coin/LicenseNumbers Adam Friedman Salesperson Name Registration#(Req.in CA,CT,ME,MD,MI,NJ,DC) Home Depot U.S.A.,Inc.("Home Depot") or Authorized Service Provider named below will furnish, install and/or service the equipment listed below at the price,terms and conditions as outlined on this form. 1.Service Provider CoiitaetInformation The Home Depot The Home Depot Service Provider Contact Name Service Provider Company Name (631) 478-6101 customercancellationnortheast@hom Phone# SM&c Mvider Email Address Service Provider License#(s) �2: Customer Information ,,- _.. .... _,.M „ . RicciCarolyn Long Island I IF35970129 Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 45 MATTHEWS LANE Cutchogue NY 11935 Customer Address City State Zip (631} 734-5484 aarolynrl022@aol.com Home Phone# Work Phone# Cell Phone# Customer Email Address ; YOU,MAY CANCEL THIS AGREEMENT WITHOUT.PENALTY OR OBLIGATION BY CONTACTING THE SERVICE PROVIDER OR STORE DIRECTLY; EMAILING SERVICE PROVIDER AT: customercancellationnortheast@homedepot.com OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 40 Oser Avenue Hauppauge NY 1 111788 Address City State Zip BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU'A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU .HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE YOUR RIGHT CANCEL. Acknowledged by: :.. 07/19)2023. __.._..�_.._.. _ Customer's SigiKature Date 460 Standard Fomt HIA(21 Jul.21)(E) Generated Date 07/19/2029 Lead/P09 1:35970129 ° U'1.12 Home Improvement Agreement: Page 2 1� Descrip........ ..... ....,,...:.. . ....�,.,:_ w.,..... ,. ................: 4.µ tion of Work"tv.be Performed.. . . .e ....... ... ...w... :_.. .. A detailed description of the work to be performed is included in the paragraph entitled Scope of Work,Specification, Customer Summary Sheet, Quote Form,Estimate, Invoiceor Measure which is included in this Agreement. 5:AnticipatedµDeliveryx Date t Installation.Schedule:.:..N _.._ _....__.. M ..: . Approximate Start Date: 01/15/2024 Approximate Finish Date: 02/14/2024 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable 6..Electronic Records Autlibrizatton • : __ __ _� __� You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this Agreement.By contacting your Service Provider,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above,you confirm that you have access to a computer that can receive and open emails and PDF documents. 7. Contract Price and Payment Schedule Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: $ 13474.24 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 10.00 (If applicable, total amount of taxes included in Contract Price) *Alaximum deposit ONL Y applicable in lD,MA, JVE(33%), N9, W(99%) De osit% 25.0 De osit Amount$ 3368.57 Remaining Balance$ 10105.67 1?..._..._............. _.. .....1?_................ _..., g (8,Finance Charges Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable.No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payments made payable to Home Depot. 9.Acceptarice,and Authorization By signing below, you authorize Home Depot to: (a) arrange for Service Provider to perform any Services or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's or permitting information may need to be provided to You later.)By signing,you acknowledge that:(i)You have read,understand, and accept this Agreement in its entirety, including the General Conditions and State Supplement, if any; (ii) You are receiving a complete copy of this Agreement; (iii)all rights and interests under this Agreement are solely vested in the person listed as"Customer"above; and(iv)Electronic signatures will be deemed originals for all purposes. X F _' 7/19J2 Customer's Signature Date X I/s/The Home Depot 07/19/2023 The Home Depot Digital Signature Date For questions related to your installation, contact Service Provider at (631) 478-6101 For any other concerns, contact The Home Depot at 1-800-466-3337 460 Standard Form HIA(21 Jul.21)(E) Generated Date 07/19/2023 Lead,'PO# E35970199 v 0.1.12 CERTIFICATE OF LIABILITY INSURANCE DATE(NIMIDDIYYYY) 03/03,'2023 THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION.ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NQT 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 Bolder Isan ADDITIONAL INSURED,the pollcy(!es)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION I'S WAIVED,subject to,the terms and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does not t con.fer rights to the certificat6 holder,in lieu of such ohdorsernient(s). PRODUCER CONTACT MARSHUSA,INC., NAME: ........... PHONE nNO ALLIANCE CENTER AX 3560 LENOX ROAD,SUITE'2400 E-MAIL ATLANTA,GA.3032$ NAIC4 . ..­.. .......... .......... CN1G4642069-HomeD-GAW-2725 INSURER A Old Remblic InsUrano Co 124147 THE'?iOME DEPOT,ING, Lksyk-g R.R M4 Rhj,Ins Coal NoIt h America HOIAE DEPOT U,SA,INC. INSURER C AGE Air; ra ,9&811 kmo n 22661 2455 PACES FERRY ROAD BUILDING C-20 INSURER D: ATLANTA,GA 30339 COVERAGES CERTIFICATE NUMBER: AT-1-005314714-06 REVISION NUMBER: I THIS IS TO CERTIFY THAT THE POLICIES OF NNSURANCE,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. ................................. ...... 5t1aR POLICY EFF ( POLICY CXP TYPE OF INSURANCE INS01 POLICY NUMBERYY LIMITS A X COMMERCIAL GENERAL LIABILITY 316639 103JO112022 ;03101025 EACH OCCURr!N E ..... 1-000,000 x CLAW&MADE OCCUR. SIR 51.000,000 i ? EXCLUDED I .................... ............. ........... _�2EN LAGGREGATt LIMIT APPLIES PER: GENERAL -ATE 5 2,000.000 X PRO ------------- EJ I-oc 2,000,000 POLICY ODUCT§,�,� ONAJIfT AGG IS OTHER: A AUTOMOBILE LIABILITY i MYffB316649 03101/2022 :03ioj/204- COMBINEI)SINGLE Won S I..,.0..0.0..w.0.. .......... ANY AUTO BODILY INJURY(Per Damon) $ .......... OWNED SCHEDULED SELF INSURED AUTO PHY DMG AUT0S.ONL1 AUTOS BODILY INJURY(Por accicant) S HIRED i MON-OWNED AUTOSONLY AUTOS ONLY ;gd 77-1F_­ UMBRELLAIUAB X I OCCUR MVVZX T 6647 '03MV2022 03'0112025 EACH OCCUARENCE j y 10,000,000 X 1EXCESS LIAR AGG11ECATE 10,000,000 DED RETENTIONS WORKERS COMPENSATION f I SCI=C5066819E(Wl) U310U2023 103/01024 X PER AND EMPLOYERSY LIABILITY STATUTE ER 03,10112023 103/01,'2024 iANYPROPR)rTOPIPARTN,ERI-,XECI)TIVE r—.i �A 5,000,000 TL'EIACH A.C.CIDENT_ w ly'l ...... :O�FFMERIMEMBERrXCLUDEDI INIA11, jMandatory in NH) E.L.DISEASE-EA EMPLOYEE'S 5.000,6xi I describe Una r .................. 5,000,0130 Continued on Additional Page. *--,-- F­­­­­ RIPTION OF OPERATPONStdow EL,"DISEASE-POLICY LIMIT S DESCRIPTION OFOPERATIONS fLOCA-tiONS/VEtliCLES(ACORD 101,Addiflona),RarParks Schedule,Maybe attached 1fm6ra 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 DELIVEREDIN PO BOX 1179 ACCORDANCE WITH THE POLICY PROVISIONS. SOUTHOLD,NY 11971 AUTHORIZED RSPRESENTATIVE 7 uo ZT441 1"1 -_ 0-1988-2,06 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCYCUSTOMER113- CN101642069 LOC*: 'WiGnta ACoSPRD1i ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA,INC. THE HOME DEPOT,INC. POLICY NUMBER 'HOME DEPOT U.S A„INC. 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA,GA 30339 CARRIER ATLANTA, CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A.SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: Certificate of Liability Insurance Poliol Number:LOSA068099(AL,4R.AZ,FL.10,1A,IL,KS.KY,LA,I�S,fiO,NC:,NE,N-�!,NDOK,SC,SDJN,VA,WV,VJY) Fffcorm,Dais:03 u11202' Expiration Cale;0310112024- (EL)Limit$5,000,000 Carrier:Safaty National C..owafty Corpdration. .%4�Wmbor Si40590W(QS1)(CA,ORWA) Effi,dve Date;0310 02023 Expiralion Dato:03101,12024 (EL)Limit S5,0010,000 SIR:$1,000.00 Carrier:ACE.Anlarfc.an.Wurince C91111paly Policy Numbmn WCUCS0666095(QSI)(GA,MI,NV,'OH,UT Efibdive Date:0310112023 Expiration'Oita:03101re024 (EL)Limit$4,L x,000. SfR:51,000,000 SIR(GA):S?60,()00 Carrier IrdmIntly Illsulonw Company of North Amerfca PdtryNornber:WLR M- 68058(AK,C0,6T,DCDF,Hi.[N,MAfAD,A4E,MN,NH,NJ,,NY,PA.Ri,trf) Effective Date:01,10112023 Exolnallbn Data:03"01,024 381.)Limit 85,000,000 TX Empfoya--YS Indemnity CarricrZuric'h Amedcap Imirance Company Policy,Numl;�r.NS013019(TX) Elf.,ctiwl DA6:001/2023 Expiration, Data;0316142024 (EL)Limit 56,0100,000 SIR:$5,000.0un ACORD 101 X2008/01) 02008 ACORD CORIPORATJOJN. All rights reserved. The.ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER 113:, CN101642069 LOC#: Atlanta _ ,fir ' i ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY NAMED INSURED MARSH USA,INC. THE HWIE DEPOT,INC. HOME DEPOT US A.,INC, POLICY NUMBER 2455 PACES FERRY ROAD i OUILDING C-20 ATLANTA,GA 30339 CARRIER. r NACC CODE EFFECTIVE DATE: ADDITIONAL REMARKS •THIS A,DOITIONALL REMARKS FORM ISA SCHI56ULE TO ACbRD FORM, FORM NUMBER: 2b FORM TITLE: Certificate of Liabiliti 1 S!4 ince HOME DEPOT INSUREDS"' Tha Nome Depot,Inc; Nome Depot U.B.A.,Inc. Nome Depot U.S,A:;Is, dba The Name Depot Hama Depot of Puerto Ri ,Im. Home Depot Product Authority,LLC Home Depet Store Support,Inc. Red Baacon.LLC H.D.W.Hewing Company,Inc, ASkuity,Ino. Harm DeW Iti',anagament Company,LLC ACORD 101 (2008101) CQ 2008 ACORD CORPORATION. All rights reserved, The ACORD name End logo are registered marks of ACORO Workers' Compensation Law Section 67. Restriction on issue of permits and the entering into contracts unless.compensation is Secured. 1. The head of a state or municipal department, board, commission oroffice authorized or required by law to issue any permit for or in connection,with any work involving the employment of employees in a hazardous employment deMed by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of suchpermits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all ethployees has been secured as provided.by this. chapter. 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 compensation toany such employee if so employed. .2, The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for orin connection with any work involving the employment of employees in a hazardous employment defined by,this chapter,notwithstanding any general of special statute requiring oradthorizing any such contract, shall not enter into any such contract' ' unless proof'duly subscribed by an insurance carrier produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. C-106.2{9-17)REVERSE Additional Instructions for Form. DB-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"i, 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 ertificate holder and the Workers' Compensation Board within 10days,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 policyoreliminate 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 approve&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 coverqqq afforded by the policy listed,nor does,it,conferarty rights or responsibilities beyond those contained in the referenced 6renced 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 busindss continues'to be named on a permit, license or contract issued by-a certificate-holder,the business must provide that certificate holder With a n6v.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 Toric State Disability and Paid Family Leave Benefits Law. MABI.LITY AND PAID FAivill_Y LE"E-BENEFITS LAW. §220. $ubd. 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 anygeneralor 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 Jarivary 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 astate 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 authodzing.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 pa'yment of disability benefits and after Januaryfirst, two thousand eighteen,the payment,of family leave benefits for all employees has been secured as provided by this article. CB-120.'1(1047)Reverse load APPROVED AS NOTED COMPLY WITH ALL CODES OF DATELIA z B.P # q a 7 NEW YORK STATE&TOWN CODES AS REQUIRED AND CONDITIONS OF J-2-5-0- DD BY: _ SO=TOWN ZBA NOTIFY BUILDING DEPARTMENT AT SOU I OlDTOWN PLANNING BOARD 631-765-1802 8AM TO 4PM FOR THE SOUMLO TOWN TRUSTEES FOLLOWING INSPECTIONS: N.Y.S.DEC FOUNDATION-TWO REQUIRED SOMOID HPC FOR POURED CONCRETE SCHD ROUGH-FRAMING&PLUMBING INSULATION FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS WINDOW SPECIFICATION SHEET - Spec.Sheet#: F35970129 Sheet: 1 of 2 Customer: Carolyn Ricci ,lob#: F35970129 Consultant: Adam Friedman Date: 07/19/2023 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items _ Hardware Code Screens For doors use Mull "S"=stationary or (0 c o m o o o "X"=o eratin Lu Style Wraps '� `m .2 o.Cry o :C r N P 9 t= Room Floor Code (YIN) Style Code Series Code u5 3 x IT ai C) (L > M > M FULL SCR,STD,White, METAL,F, 1 LIV 1st DH- Y DH 6100 WH WH 28 53 81 GlassPack:Standard WRAP,LSR ALDER FULL SCR,STD,White, METAL,F, 2 LIV 1st DH- Y DH 6100 WH WH 28 53 81 GlassPack:Standard WRAP,LSR ALDER FULL SCR,STD,White, METAL,F, 3 LIV 1st DH- Y DH 6100 WH WH 28 53 81 GlassPack:Standard WRAP,LSR ALDER FULL SCR,STD,White, METAL,F, 4 LIV 1st DH- Y DH - 6100 WH WH 28 53 81 GlassPack:Standard WRAP,LSR ALDER - FULL SCR,STD,White, METAL,F, 5 MBED 1st DH- Y DH 6100 WH WH 28 53 81 GlassPack:Standard WRAP,LSR ALDER FULL SCR,STD,White, METAL,F, 6 MBED 1st DH- Y DH 6100 WH WH 28 53 81 GlassPack:Standard WRAP,LSR ALDER FULL SCR,STD,White, METAL,F, 7 MBED 1st DH- Y DH 6100 WH WH 28 53 81 GlassPack:Standard WRAP,LSR ALDER FULL SCR,STD,White, METAL,F, 8 BATH 1st DH- Y DH 6100 WH WH 28 45 73 TMP:Full, GlassPack: WRAP,LSR ALDER Standard SPECIAL CONSIDERATIONS: 1:White,2:White,3:White,4:White,5:White,6:White,7:White,8:White Line Level Notes: 1.MISC(1):(null) 2.New stops 3.MISC(2):(null) Wrap Color 4.New stops 5.MISC(3):(null) 6.New stops 7.MISC(4):(null) 8.Neve stops Interior Casing Type 9.MISC(5):(null) Bay or Bow window: 11.MISC(6):(null) eatboard material(vinyl only-Birch or Oak) 13.='701 Ps null Bay Project Angle(30 or 45) 14.New stops Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(inches) If tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the Construct Roof(Yes or No)' Special Terms and Conditions on the following page Garden Window: Seatboard Material(vinyl only-White Pionite,Birch or Oak) WINDOW SPECIFICATION SHEET - Spec.Sheet#: F35970129 Sheet: 2 of 2 Customer: Carolyn Ricci ,Job#: F35970129 Consultant: Adam Friedman Date: 07/19/2023 New Window Hinge Locations Existing Window Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,RorS Glass Misc Items _ Hardware Code Screens For doors use Mull "S"=stationary or LL at o 4 t t d m mu H g 2 N "X"=operating Style Wraps .� `m v �' o.t7 O 0 >r o 'C v C d L d O O tz Room Floor Code (Y/N) Style Code Series Code p N ti) 3 x r vi v o_ O > x > x FULL SCR,STD,White, METAL,F, 9 BED2 2nd DH- Y DH 6100 WH WH 28 53 81 GlassPack:Standard WRAP,LSR ALDER FULL SCR,STD,White, METAL,F, 10 BED2 2nd DH- Y DH 6100 WH WH 28 53 81 GlassPack:Standard WRAP,LSR ALDER FULL SCR,STD,White, METAL,F, 11 BED2 2nd DH- Y DH 6100 WH WH 28 53 81 GlassPack:Standard WRAP,LSR ALDER FULL SCR,STD,White, METAL,F, 12 BED3 2nd DH- Y DH 6100 WH WH 28 53 81 GlassPack:Standard WRAP,LSR ALDER FULL SCR,STD,White, METAL,F, 13 BED3 2nd DH- Y DH 6100 WH WH 28 53 81 GlassPack:Standard WRAP,LSR ALDER FULL SCR,STD,White, METAL,F, 1 BED3 2nd DH- Y DH 6100 WH WH 28 53 81 GlassPack:Standard WRAP,LSR 4 ALDER SPECIAL CONSIDERATIONS: 9:White,10:White,11:White,12:White,13:White,14:White Line Level Notes: 9.MISC(9):(null) 10.New stops 11.MISC(10):(null) Wrap Color 12.New stops 13.MISC(11):(null) 14.New stops 15.MISC(12):(null) Interior Casing Type 17.M.C(13):(null) Bay or Bow window: 19.WSC(14):(null) Seatboard material(vinyl only-Birch or Oak) 20.New stops Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(Inches) If tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the Construct Roof(Yes or No)' Special Terms and Conditions on the following page Garden Window: Seatboard Material(vinyl only-White Pionite,Birch or Oak) ° c tf7lN7�VifW "!7a".'s"'xr'++,r'y ,;s-r�!{�-.• ^;^t.4`Po»"'?.,m' ...-r:, ;,1,.;',`"IT".•^q:,-�.r��"7.4? -.".�' yr4, �y�.'cv.p((�,/«�/ X`-.rti. �� :•;y>', i,z'e,..yis�.sts¢;: r ,i"'" �•, �� v� ;�:'w "ka; /�,�``,,,{�y.-y. �"•-, s`�8$3J'f <:.%,T.,:yE':. q yea •'�. ..>r r:;�:j •;i�,`k '�t't. 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