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HomeMy WebLinkAbout50520-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT 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#: 50520 Date: 4/8/2024 Permission is hereby granted to: Mor alishvili, Anthon 505 8th Ave Ste 2202 -..............................,,. ..�..............._............___................................ __ _.............................................................................................. ..............................................._.... ..... New ork, NY 10018 To: Install roof mounted solar panels to an existing single-family dwelling as applied for per manufacturers specifications. At premises located at: 2345 Hobart Rd. S uthold . .. ....... ----------------.....�. SCTM # 473889www Sec/Block/Lot# 64.4-10 Pursuant to application dated 3/1/2 024 and approved by the Building Inspector. To expire on 10/8/2025. Fees: SOLAR PANELS $100.00 CO- RESIDENTIAL $100.00 ELECTRIC $125.00 ._...........................________ Total: $325.00 Building Inspector r"'" y ' TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax (631) 765-9502 https://www.sotitlioldto:wpny,gqv Date Received APPLICATION For Office Use Only PERMIT NO.'S 52o Building tA V "" Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. r Date:2-28-24 OWNER(S)OF PROPERTY: Name:Anthony Moralishvili SCTM#1000- vb Ao0-oy- 00 -010. 000 Project Address: 2345 Hobart Rd, Southold, NY, 11971 Phone#:(917) 374-3521 Email:amorali@moraliarchitecture.com Mailing Address:2345 Hobart Rd, Southold, NY, 11971 CONTACT PERSON: Name:Michele Cardon Mailing Address:177 Cantiague Rock Road, Westbury, NY 11590 Phone#:56-318-4035 Email:lipermits@sunrun.com DESIGN PROFESSIONAL INFORMATION: Name:Humphrey K Kariuki Mailing Address:1708 Roxborough Rd, Charlotte, NC 28211 Phone#:980-689-9776 Email:info@mightyengineeringco.com CONTRACTOR INFORMATION: Name:Sunrun Installation Mailing Address:177 Cantiague Rock Road, Westbury, NY 11590 Phone#:516-318-4035 Email:lipermits@sunrun.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition DAlteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $35,550.00 Will the lot be re-graded? ❑Yes ONo Will excess fill be removed from premises? ❑Yes LINO 1 PROPERTY INFORMATION Existing use of property:one family Intended use of property:one family Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes ONo IF YES, PROVIDE A COPY. Check r 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):M i ch e I e Cardon MAuthorized Agent ❑Owner Signature of Applicant: �[� �� `' L Date: 2-28-24 STATE OF NEW YORK) SS: COUNTY OF ) Michele Cardon being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the Agent iv`gent (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 Dtday of 1��11� 20)M— DAVIo i MACKY Nota Public Notary Public, State of New york Reg. No. 01 A53812 5 Qualified in Nassau County PROPERTY OWNER AUTHORIZATION Oas9ion E'xpire .October 01 2025 (Where the applicant is not theowner) I, residing at Anthony Moralishvili 2345 Hobart Road, Southold, NY 11971 . do hereby authorize M ichele Cardon to apply on my behalf to the Town of Southold Building Department for approval as described herein, 2-28-24 Owner's Signature DAVID J MACKEy Date Notary Public, State of News York Anthony Moralishvili Reg, No, 01MA5 51235 Oualied in Nassau County Print Owner's Name Commission Expires October 01 2025 2 d f BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr@southoldtownny.gov— wand outholdtownn . ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 2-28-24 Company Name: Samy Mounas Electrician's Name: Sunrun Installation License No.: ME-33878 Elec. email:lipermits@sunrun.com Elec. Phone No: 631-741-0378 ❑I request an email copy of Certificate of Compliance Elec. Address.: 177 Cantiague Rock Road, Westbury, NY 11590 JOB SITE INFORMATION (All Information Required) Name: Anthony Moralish-,111 Address: 2345 Hobart Road, Southold, NY 11971 Cross Street: Phone No.: (917) 374-3521 Bldg.Permit#: 50520 email:amorali@moraliarchitecture.com Tax Map District: 1000 Section: Block: If Lot: 10 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Installation of roof mounted solar panels. (17) 6.800W Scluare Footage: Circle All That Apply: Is job ready for inspection?: YES ✓ NO Rough In Final Do you need a Temp Certificate?: I YES NO Issued On Temp Information: (All information required) Service SizeF11 Ph 3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect[]Flood Reconnect[]Service Reconnect❑Underground❑Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION � I a- SUNRINC-02 TWANG_ '4`oRo CERTIFICATE OF LIABILITY INSURANCE t EE(MM DDNYYY) 23 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 License#OC36861 coNTAC Fia N;i, E;_,,,,T Walter Tanner ,,, Alliant Insurance Services,Inc. 560 Mission St 6th FI PHONE San Francisco,CA 94105 � 6:Walter.Tannel�allliant C+dm AFFORDING qovERAGEn�,,,,,,,,,,,,,,,,, NAIG# 18m1A-Evansmon Insurance.. ornp ny 35378 _ INSURED ahAmerican Insurance Can _ 35mIsZ Sunrun Installation Services,Inc tNsu6,c Ame,rlcan Zurich Insurance,,,Com an „W, 40,142 775 Fiero Lane,Suite 200 Ph#805-540-7643 INSURER 0; San Luis Obispo,CA 93401 INSURERS; INSURER F; COVERAGES_ CERTIFICATE NUMBER. REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, A XEXCLUSIONScoMMERCIA GENE CONDITIONS POLICIES.LIMITS,,,,,, PoucY NunnBER REDUCED F PAID CLAIMS .... E OF E WVD AL �.. SHOWN MAY HAVE BEEN ,OOO,OOO INSR ADDL SUBR POLICY EFF POLICY EXP LIMBS LTR IT .EACH OCCURRENCE 4 LL .. CLAIMS-MADE ^ OCCUR MKLV5ENV104332 10/1/2023 10/1/2024 O' " ETo'RENIED 1,000,000 M .............................._ 5,000 _ED EXP Anp one rsonJ RSONAL&ADV INJURY_.. . 2,000,000 LO 2,000,000 GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE, 2,000,000 _X. POLICY..Retention: El 'C Per Project A COMP/OP AGG S,OOO,000 P B COMBINED SINGLE LIMIT O AUTOMOBILE LIABILITY w��20�,0�� gg.....��.$ .. 2,000(yd.... X ANY AUTO BAP614287702 10/1/2023 10/1/2024 BgQI�Y IN IURY,,,Per arson J _ ..................................... OWNED U__x SCHEDULED Y Peracclden _ AUTOS ONLY AU TOS „B4ODILYWJURMOS ONLY0O Dbdd.° C�aII.:NatCalrmmsd L obiiDedGE i,000,0X Jy � UMBRELLA LIAB OCCUR „EACHOQCUR,RENCE EXCESS LIAB 4 CLAIMS-MADE AGGREGATE. $... .._.......... DED RETENTION$ TH WORKERS COMPENSATION X Is TE 9 _ AND EMPLOYERS'LIABILITY �. 1,0�0,O ANY PROPRIETOR/PARTNERIEXECUTIVE ( -'q E _ 00 L I N N/A WC614287602 10/1/2023 10/1/2024 E L ACCIDENT 1 000,000 OFFICERIMEMBER EXCLUDED? N (Mandatory in NH) IS _SE EA EMPLOYE _ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E-L.DISEASE-POLICY LIMIT I DESCRIPTION OF OPERATIONS okLOCATIONS U" VEHICLES D $1 000,000.(ACORD eductible: Remarks Schedule,may be attached If more space Is required) Workers'Compensation Poky Evidence of insurance CERTIFICATE 1I LC?E'R CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 4RYT0"4W]Kworkers' T Compensation CERTIFICATE OF INSURANCE COVERAGE Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Sunrun Installation Services Inc. 202 Commerce Dr., Ste. 7 Moorestown, NJ 08057 1 c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 77-0471407 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) The Prudential Insurance Company of America Town of Southold 53095 Route 25 3b.Policy Number of Entity Listed in Box 1a Southold, NY 11971 CG-52830-NY 3c.Policy Effective Period 1/1/2024 To 1213 1120 4 4. Policy provides the following benefits: Q A.Both disability and Paid Family Leave benefits. ❑ B.Disability benefits only. ❑ C.Paid Family Leave benefits only. 5. Policy covers: ■❑ A.All of the employers employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑ B.Only the following class or classes of employers employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS disability and/or Paid Family Leave benefits insurance coverage as described above. Date Signed January 02, 2024 ByOwo of insurance carrier's authorized representative or NYS licensed insurance agent of that insurance carrier) Telephone Number 215-658-7318 Name and Title Carolynn Smith - VP Contracts IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If Box 413,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Com ensation Board,Plans Acceptance Unit,PO Box 5200,Binghamton,NY 13902-5200, PART 2.To be completed by the NYS Workers'Compensation Board(only if Box 4B,4C or 56 have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Numbse 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 (12-21) I II DB°1°°°°1°°1°°°1°°°°1°°IIIIII 120.1 (12-21) NEW Workers' YORK CERTIFICATE OF sTA1w Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Sunrun Installation Services Inc. (415)946-7500 225 Bush Street Suite 1400 1c.NYS Unemployment Insurance Employer Registration Number of San Francisco,CA 94104 Insured 50-86426 4 Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e., 1d.Federal Employer Identification Number of Insured or Social Security a Wrap-Up Policy) Number 77-0471407 2.Name and Address of Entity Requesting Proof of Coverage(Entity 3a.Name of Insurance Carrier Being Listed as the Certificate Holder) AMERICAN ZURICH INSURANCE COMPANY Town of Southold Town Hall Annex Building 3b.Policy Number of Entity Listed in Box"1 a" 54375 Route 25 P.O.Box 1179 WC 6142876-02 Southold,NY 11971 3c.Policy effective period 10/01/2023 to 10/01/2024 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box all partnerslofHcers included) � J� 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"l 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 penury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that thre named insured has the coverage as depicted on this form. Approved by: Mark AN (Print name of aauuthoriized representative or licensed agent of insurance carrier) Approved by: ?14m .rY A 10-01-2023 (Signature) (Date) Title: VP/Underwriter Telephone Number of authorized representative or licensed agent of insurance carrier: (415)946-7500 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 IA stillolk COU'lly L)opt,Of A Connumor Affnif Name oAM I('Y( asisirloss Nanlo fdJh !'U I m'lg ticell,se N tnj)or: lssoll& 000"Wf)14 ruffolk County COW- 01 Alliaw Labor, Licensing & Consumer Affairs jiLMASTER ELECTRICAL LICENSE Name SAMY MOUNAS SUNRUN INSTALLATIONC SERVICES "ti k q . 0 Ih IN (A "�O, lk License Number ME-3387$ Issued 1010112003 r-)w ,0- Expires: 1010112025 (,Ommissioner