HomeMy WebLinkAbout49920-Z �o��gOFFO(X�oGy Town of Southold 2/10/2024
a P.O.Box 1179
0
o _ 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 44984 Date: 2/10/2024
THIS CERTIFIES that the building WINDOWS
Location of Property: 1165 Theresa Dr, Mattituck Mattituck
SCTM#: 473889 Sec/Block/Lot: 115.-15-11
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
10/10/2023 pursuant to which Building Permit No. 49920 dated 10/20/2023
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 to existing single-family dwelling as applied for.
The certificate is issued to Lang,Aurelie
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
u hor z Signature
SUFFnt�c TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y x TOWN CLERK'S OFFICE
"o • SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 49920 Date: 10/20/2023
Permission is hereby granted to,:
Lang, Aurelie
1165 Theresa Dr
Mattituck, NY 11952
To: install window replacements to existing single-family dwelling as applied for.
At premises located at:
1165 Theresa Dr, Mattituck
SCTM #473889
Sec/Block/Lot# 115.-15-11
Pursuant to application dated 10/10/2023 and approved by the Building Inspector.
To expire on 412012025.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $250.00
CO-ALTERATION TO DWELLING $100.00
Total: $350.00
Building Inspector
OF SO(/TyO� - -
# TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] SULATION/CAULKING
[ ] FRAMING /STRAPPING [ FINAL0lfL6(Uk/S
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS:
DATE 1,1410 Iq INSPECTOR
MELD INSPECTION REPORT DATE COMMENTS
FOUNDATION (1ST)
---------------------------------
FOUNDATION (2ND)
ROUGH FRAMING&
PLUMBING
-4zj-
INSULATION PER N. Y.
STATE ENERGY CODE
ftm-U.bk
FINAL
ADDITIONAL COMMENTS
Z;)6
sov 7p0
:�
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
aa0 Gym
H Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 https://www.southoldtomm.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only D Z C RE,, u V f�
PERMIT NO. Building Inspector: t
+J l
O C T 1 0 2023
Applications and forms must be filled out in their entirety.,Incomplete
applications will not be accepted. Where the Applicant is not the,owner,an BUILDING DEPT.
Owner's Authorization form(Page 2)shall be completed. TOIV OF S0TJTn(,1,.0
Date: 10/6/23
OWNER(S)OF PROPERTY:
Name:-Aurelie Lang sCTM#i000
Project Address: 1165 Theresa dr
Phone#: 646-247-7601 _ Email: aurelle.lang50@grppil.com .,,-..-
MallingAddress: 1165 Theresa Dr Mattituck NY 11952
CONTACT PERSON: .
Name: Aurelie Lang
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:N/A
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: Renewal by Andersen Li / LICW
Mailing Address: 2029.New Highway Farmingdale.NY 11735
-Phone#: 877-500-1678 _w- Email. cvalente(a@RBAlongisland.com,_. _
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration WRepair ODemolition Estimated Cost of Project:
❑Other Window replacement Reclace 23 windows $ 65000.
Will the lot be re-graded? MYes @No Will excess fill be removed from premises? ❑Yes @No
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 BNo IF YES, PROVIDE A COPY.
E3 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 ame): Aurelie Lang ❑Authorized Agent BOwner
Signature of Applicant: Date:
STATE OF NEW YORK)
COUNTY OF S SS:QIK
Lano being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing//off� ract)above named,
(S)he is the f—w-P _
(Contractor,Agent,Corporate Officer,etc.)
of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this
application;that all statements contained in this application are true to the best of his/her knowledge and belief;and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
-day of C+6 .2012_�
ary Public
TRACEY L.:DWYER
NOTARY PUBLIC,STATE OF NEW YORK
PROPERTY OWNER AUTHORIZATION NO.01OWsMIX)
ere the applicant 011A�IFIED IN SUFFOLK COUNTY
(Where h pp .cant is not the owner) COMhOSSION EXPIRES JtNIE 30.2p.�(0
I, Aurelie Lang residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Aurelie Lang
Print Owner's Name
2
AP-olk-4\1
NYSIF
New York State Insurance Fund PO Box 66699,Albany,NY 12206
1 nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
a o
^A A A A 364619760
USI INSURANCE SERVICES LLC }
333 WESTCHESTER AVE SUITE 102
WHITE PLAINS NY 10604
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
LONG ISLAND CUSTOM WINDOWS LLC DBA TOWN OF SOUTHHOLD BUILDING DEPT
RENEWAL BY ANDERSEN OF LONG ISLAND 54375 MAIN RD
2029 NEW HIGHWAY PO BOX 1179
FARMINGDALE NY 11735 SOUTHHOLD NY 11971
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
H2403 991-9 1 281705 12/01/2022 TO 12/01/2023 5/4/2023
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2403 991-9, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR
WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL
OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS
OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY.
IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS,
OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW
YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE
COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER
THE COVERAGE AFFORDED BY THE POLICY.
NEW YORK STATrSURANCE FUND
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER:852330502
Client#:1721414 LONGICUS
ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY)
6/29/2023
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(les)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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER N ME: T D J Hardisty
FAX
USI Insurance Services LLC a/c°No Ede:914 459.6200 A/C,No).610 537-4220
333 Westchester Ave,Suite 102 ADDRESS: DJ.Hardisty@usi.com
White Plains,NY 10604 INSURERS AFFORDING COVERAGE NAIC 6
914 459-6200 INSURER A:Selective Insurance Company of New York 13730
INSURED INSURER B
Long Island Custom Windows
INSURER C:
2029 New Highway
INSURER D:
Farmingdale,NY 11735
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER M/D MM/DD LMnS
A X COMMERCIAL GENERAL LIABILITY S200162112 6/20/2023 05/01/2024 EACH OCCURRENCE $1 OOO OOO
CLAIMS-MADE ❑X occuR PflEMISES EaoccTu ence $500 Q00
MED EXP(Any one person) $15 000
PERSONAL&ADV INJURY $1,000 000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s3,000,000
POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $3,000,000
OTHER: $
• AUTOMOBILE LIABILITY S200162112 6/20/2023 05/01/202 Ea acciden SINGLE LIMIT 1,000,000
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
X AUTOS ONLY X NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY Per accident
A X UMBRELLA LIAB X I OCCUR S200162112 6/20/2023 05/OM024 EACH OCCURRENCE $5 00O 000
EXCESS LIAR CLAIMS MADE AGGREGATE $5 00O 000
DED I X RETENTION$10000 $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY
Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
The General Liability policy Includes an automatic Additional Insured endorsement that provides Additional
Insured status to the Certificate Holder only when there Is a written contract that requires such status,
and only with regard to work performed by or on behalf of the named insured.
CERTIFICATE HOLDER CANCELLATION
Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Building Dept ACCORDANCE WITH THE POLICY PROVISIONS.
54375 Main Rd
PO Box 1179 AUTHORIZED REPRESENTATIVE
Southold,NY 11971 Li
@ 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
B_QAAA99a1 onuansa9711 A Q er.T
NE'W
YO K workers CERTIFICATE OF INSURANCE COVERAGE
STATE Compensation
Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW
PART 1.To be completed by NYS Disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier
Ia.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured
LONG ISLAND CUSTOM WINDOWS,LLC DBA RENEWAL BY
ANDERSEN OF L
DBA RENEWAL BY ANDERSEN OF LONG ISLAND 2029 NEW 1c.Federal Employer Identification Number of Insured or Social Security
HIGHWAY Number
FARMINGDALE,NY 11735
Work Location of Insured(Only requited if coverage is specifically 364619760
limited to certain locations In New York State,I.e.,Wrap-Up Policy)
2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY
TOWN OF SOUTHOLD
BUILDING DEPT 3b. Policy Number of Entity Listed In Box 1a
54375 MAIN RD LNY623001
PO BOX 1179
SOUTHOLD,NY 11971 3c.Policy effective period
04-01-2023 to 03-31.2024
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 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 05-01 2023 B
(Signature of Insurance carrier's authortted representative or NYS licensed Insurance agent of that Insurance cagier)
Telephone Number 212 553-8074 Name and Title: ELITJIBETH TELLO—ASSISTANT DIRECTOR STATUTORY SERVICES
IMPORTANT: If Boxes 4A and 5A are checked,and this form Is signed by the Insurance carrier's authorized representative or NYS
Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail It directly to the certificate holder.
If Box 4B,4C or 58 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 emalled to PAU@wcb.ny.gov or It can be mailed for
completion to the Workers'Compensation Board,Plans Acceptance Unit,PO Box 5200,Binghamton,NY 13902-5200.
PART 2.To be completed by the NYS Workers'Compensation Board(Only if Box 4B,4C or 58 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 compiled 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 Authorised NYS workers!Compensation Board Employee)
Telephone Number Name and Title
Please Note:Only Insurance carriers licensed to write NYS disabillly and Paid Family Leave benefits insurance policies and NYS licensed insurance agents of
those insurance carriers are authorized to issue Form DB-120.f.Insurance brokers are NOT authorized to Issue this form.
DB.120.1 (12 21) IIIII'11 I- !I!0 °11°11111111111°IIIII
Additional Instructions for Form 10113-120.1
By signing this form,the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business
referenced in Box 1 a for disability and/or Paid Family Leave benefits under the NYS Disability and Paid Family Leave
Benefits Law.The insurance carrier or its licensed agent will send this Certificate of Insurance Coverage(Certificate)to
the entity listed as the certificate holder in Box 2.
The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a
policy is cancelled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of
premiums that cancel the policy or eliminate the insured from coverage indicated on this Certificate. (These notices 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 NYS disability and/or Paid Family Leave benefits contract of insurance only
while the underlying policy is in effect.
Please Note: Upon the cancellation of the disability and/or Paid Family Leave benefits policy indicated on this
form,if the business continues to be named on a permit, license or contract Issued by a certificate holder,the
business must provide that certificate holder with a new Certificate of Insurance Coverage for NYS disability
and/or Paid Family Leave Benefits or other authorized proof that the business Is complying with the
mandatory coverage requirements of the NYS Disability and Paid Family Leave Benefits Law.
NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW
§220. Subd. S
(a) The head of a state or municipal department, board,commission or office authorized or required by law to issue any
permit for or in connection with any work involving the employment of employees in employment as defined in this article,
and not withstanding any general or special statute requiring or authorizing the issue of such permits,shall not issue
such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the
payment of disability benefits and after January first,two thousand and twenty-one,the payment of family leave benefits
for all employees has been secured as provided by this article. Nothing herein, however,shall be construed as creating
any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to
any such employee if so employed.
(b) The head of a state or municipal department, board,commission or office authorized or required by law to enter into
any contract for or in connection with any work involving the employment of employees in employment as defined in this
article and notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into
any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that
the payment of disability benefits and after January first,two thousand eighteen,the payment of family leave benefits for
all employees has been secured as provided by this article.
DB-120.1 (12-21)Reverse
R P.
Licensing & P
Suffolk County Department of Labor
Consumer Affairs
VETERANS MEMORIAL HIGHWAY HAUPPAUGE, NEW YORK 11788
jj
DATE ISSUED: 1/10/2008 No. 43991-H
SUFFOLK COUNTY
Home Improvement Contractor License
This is to certify that JOHN K HICKS
doing business as
LONG ISLAND CUSTOM WINDOWS LLC DBA
bject to the provisions of applicable laws, rules
having furnished the requirements set forth in accordance with and subject
and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME P
IMPROVEMENT CONTRACTOR, in the County of Suffolk.
License Category t % =
N�
Windows and Siding
NOT VALID WITHOUT Additional Businesses
DEPARTMENTAL SEAL
AND A CURRENT
RENEWAL BY ANDERSEN OF LONG
ISLAND
CONSUMER AFFAIRS
ID CARD
Suffolk County DepL of
Labor,Licensing&Consumer Affairs
HOME IMPROVEMENT LICENSE Commissioner
Name
JOHN K H-CKS
Business Name
LONG ISLAND CUSTOM WINDOWS LLC OBA
bearerisdtdVhconsed t
by the County of sulol,.
License Number.H-43991
I@ Drago Issued: 0111012008
Cammissiorw
Expires; 01/0112024
_0
VN2
Order Summary&w itFMWAL BYANDERSEN OF LONG ISLAND Aurelio Lang
Legal Name:Long Island Custom Windows I License#Suffolk Lic#43991-H 1 1165 Theresa Dr
R E Nassau Lic#H0810150000 I NYC Lic#1307704 Mattituck,NY 11952
brAIVpERSEIY 2029 New Highway I Farmingdale,NY 11735 H:(646)247-7601
Phone:631-843-1713 1 Fax:631-843-1717 1 techs@rbalongisland.com 9 C:(646)247-7601
Measure Tech:Luke LaGrega,
N ROOM SIZE DETAILS
JOB
101 Celia's Room 32" 49" Window: , Double-Hung, 1:1, Flat Sill Insert,Traditional Checkrail, Exterior
31-5/8" 49-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35/ - 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , Grilles Between Glass
(GBG) Grille Pattern: , Sash 1: Colonial 3w x 2h, Sash 2: No Grille Misc:
Interior Stool/Sill, Interior Stool/Sill Construction: , Interior Casing with
Stool & Apron (1), No Bars (1), Pad Opening (1), Replace Rotted Wood (1),
New Construction Vinyl Removal (1) Material: , None
102 Celia's Room 32" 49" Window: , Double-Hung, 1:1, Fiat Sill Insert, Traditional Checkrail, Exterior
31-5/8" 49-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35 / -35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , Grilles Between Glass
(GBG) Grille Pattern: , Sash 1: Colonial 3w x 2h, Sash 2: No Grille Mlsc: ,
Interior Stool/Sill, Interior Stool/Sill Construction: , Interior Casing with
Stool &Apron (1), No Bars (1), Pad Opening (1), Replace Rotted Wood (1),
New Construction Vinyl Removal (1) Material: , None
103 Leonardo's 32 49 Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
Room 31-5/8" 49-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35/ - 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , Grilles Between Glass
APPROVED AS NOTED (GBG) Grille Pattern: , Sash 1: Colonial 3w x 2h, Sash 2: No Grille Misc: ,
L -) None Construction: , No Bars (1), Pad Opening (1), Replace Rotted Wood
SATE' � �.P# (1),_New Construction Vinyl
FEE 3 J,(W BY:
NOTIFY BUILDING DEPARTMENT AT
631-765-1802 8AM TO 4PNI FOR THE COMPLY WITH ALL CODES OF
FOLLOWING INSPECTIONS: NEW YORK STATE$TOWN CODES
1. FOUNDATION-TWO RF-,): > -n AS REQUIRED AND CONDITIONS OF
FOR POURED CC)IgCRF i SOUTHOID WN ZBA
2. ROUGH-FRAMING&I'i..�,:�,;, a
3. INSULATION SOUTNO OWN PLANNING BOARD
4. FINAL-CONSTRUCTION MUST ��SOUTH TOWN TRUSTEES
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE -- N,YS EC OCCUPANCY OR
REQUIREMENTS OF THE CODES OF NEW OLD + USE IS UNLAWFUL
YORK STATE. NOT RESPONSIBLE FOR HD
DESIGN OR CONSTRUCTON ERRORS WITHOUT CE-RT "
09/26/23 OF OCCUPANCrge 2 / 41
Order Summary
dba:RENEWAL WANDEPU%N OF LONG ISLAND Aurelio Lang
Legal Name:Long Island Custom Windows I License#Suffolk Llc#43991-H I 1165 Theresa Dr
RENEWAL Nassau Lic#H0810150000 I NYC Lic#1307704 Mattituck,NY 11952
§ ANDERSEN- 2029 New Highway i Farmingdale,NY 11735 H:(646)247-7601
FWS[VU n M90M Phone:631-843-1713 1 Fax:631-843-17171 techsOrbalon island.com
9 C:(646)247-7601
Measure Tech:Luke LaGrega,
DP ROOM SIZE DETAILS
Removal (1) Material: , None
104 Leonardos 32 49" Window: , Double-Hung, 1:1, Flat Sill Insert,Traditional Checkrail, Exterior
Room 31-5/8" 49-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35/ - 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , Grilles Between Glass
(GBG) Grille Pattern: , Sash 1: Colonial 3w x 2h, Sash 2: No Grille Misc: ,
None Construction: , No Bars (1), Pad Opening (1), Replace Rotted Wood
(1), New Construction Vinyl Removal (1) Material: , None
105 Gregory's 32 42 Window: , Double-Hung, 1:1, Flat Sill Insert,Traditional Checkrail, Exterior
Room 31-5/8" 41-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35/ 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , Grilles Between Glass
(GBG) Grille Pattern: , Sash 1: Colonial 3w x 2h, Sash 2: No Grille Misc: ,
None Construction: , No Bars (1), Pad Opening (1), Replace Rotted Wood
(1), New Construction Vinyl Removal (1) Material: , None
106 Gregory's 32 42° Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
Room 31-5/8" 41-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35 / - 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , Grilles Between Glass
(GBG) Grille Pattern: , Sash 1: Colonial 3w x 2h, Sash 2: No Grille Misc: ,
None Construction: , No Bars (1), Pad Opening (1), Replace Rotted Wood
(1), New Construction Vinyl Removal (1) Material: , None
107 Master 32" 49" Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
Bedroom 31-5/8" 49-1/4" White, Interior White Performance Calculator: , PG Rating:
09/26/23 Page 3 / 41
#EWA
Order Summary
&a:kELNEWAL JW ANDERSEN OF LONG ISLAND Aurelio Lang
Legal Name:Long Island Custom Windows I License#Suffolk Lic#43991-H I 1165 Theresa Dr
R E EW L Nassau Lic#H0810150000 I NYC Lic#1307704 Mattituck,NY 11952
bv_ANDERSEN' 2029 New Highway I Farmingdale,NY 11735 H:(646)247-7601
Phone:631-843-1713 1 Fax:631-843-1717 1 techs@rbalongisland.com g C:(646)247-7601
Measure Tech:Luke LaGrega,
D4 ROOM
25 1 DP Rating: + 35 / 35 Glass: , All Sash: High Performance, No Pattern
Hardware: ,White Screen: , Fiberglass, Full Screen Grille Style: , No Grille
Misc: , Interior Stool/Sill, Interior Stool/Sill Construction: , Interior Casing
with Stool &Apron (1), No Bars (1), Pad Opening (1), Replace Rotted Wood
(1), New Construction Vinyl Removal (1) Material: , None
108 Master 32 49 Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
Bedroom 31-5/8" 49-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35/ - 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , No Grille Misc: , None
Construction: , Interior Casing with Stool & Apron (1), No Bars (1), Pad
Opening (1), Replace Rotted Wood (1), New Construction Vinyl Removal (1)
Material: , None
109 Master 32 49 Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
Bedroom 31-5/8" 49-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35 / - 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , No Grille Misc: , None
Construction: , Interior Casing with Stool & Apron (1), No Bars (1), Pad
Opening (1), Replace Rotted Wood (1), New Construction Vinyl Removal (1)
Material: , None
110 2nd Floor 32 49" Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
Hallway 31-5/8" 49-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35 / - 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , No Grille Misc: , None
Construction: , Interior
09/26/23 Page 4 / 41
WOrder Summary
Am RENEWAL WANDERSEN OF LONG ISLAND Aurelle Lang
Legal Name:Long Island Custom Windows I License#Suffolk Lic#43991-H 1 1165 Theresa Dr
RENEWAL Nassau Lic#H0810150000 I NYC Lic#1307704 Mattituck,NY 11952
byANDERSEN' 2029 New Highway I Farmingdale,NY 11735 H:(646)247-7601
Phone:631-843-1713 1 Fax:631-843-1717 1 techs@rbalongisland.com 9 C:(646)247-7601
Measure Tech:Luke LaGrega,
IUH ROOM SIZE DETAILS
Casing with Stool &Apron (1), No Bars (1), Pad Opening (1), Replace
Rotted Wood (1), New Construction Vinyl Removal (1) Material: , None
111 Hallway 32" 61" Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
31-5/8" 61-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35 / 35 Glass: , Sash 1: High Performance, No Pattern, Sash 2: High
Performance, No Pattern, Tempered Glass Hardware: , White Screen: ,
Fiberglass, Full Screen Grille Style: , Grilles Between Glass (GBG) Grille
Pattern: , Sash 1: Colonial 3w x 2h, Sash 2: No Grille Misc: , None
Construction: , No Bars (1), Pad Opening (1), Replace Rotted Wood (1),
New Construction Vinyl Removal (1) Material: , None
112 Media Room 32" 61" Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
31-5/8" 61-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35 / - 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , Grilles Between Glass
(GBG) Grille Pattern: , Sash 1: Colonial 3w x 2h, Sash 2: No Grille Misc: ,
None Construction: , No Bars (1), Pad Opening (1), Replace Rotted Wood
(1), New Construction Vinyl Removal (1) Material: , None
113 Media Room 32" 61 " Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
31-5/8" 61-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35/ - 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , Grilles Between Glass
(GBG) Grille Pattern: , Sash 1: Colonial 3w x 2h, Sash 2: No Grille Misc: ,
None Construction: , No Bars (1), Pad
09/26/23 Page 5 / 41
W
Order Summary
&w RENEWAL BYANDERSEN OF LONG ISLAND Aurelio tang
Legal Name:Long Island Custom Windows I License#Suffolk Lic#43991-H I 1165 Theresa Dr
RENEWAL Nassau Lic#H0810150000 I NYC Lic#1307704 Mattituck,NY 11952
by_ANDERSEN' 2029 New Highway I Farmingdale,NY 11735 H:(646)247-7601
Phone:631-843-1713 1 Fax:631-843-1717 1 techsOrbalon island.com
9 C:(646)247-7601
Measure Tech:Luke LaGrega,
IN ROOM DETAILS
Opening (1), Replace Rotted Wood (1), New Construction Vinyl Removal (1)
Material: , None
114 Kitchen 32 61" Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
31-5/8" 61-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35 / - 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , No Grille Misc: , None
Construction: , No Bars (1), Pad Opening (1), Replace Rotted Wood (1),
New Construction Vinyl Removal (1) Material: , None
115 Kitchen 32 61" Window: , Double-Hung, 1:1, Flat Sill Insert,Traditional Checkrail, Exterior
31-5/8" 61-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35 / - 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , No Grille Misc: , None
Construction: , No Bars (1), Pad Opening (1), Replace Rotted Wood (1),
New Construction Vinyl Removal (1) Material: , None
116 Kitchen 59 61" Window: , Picture, Insert Frame, Exterior White, Interior White Performance
59-5/8" 61-1/4" Calculator: , PG Rating: 35 1 DP Rating: + 35 / - 35 Glass: , All Sash: High
Performance, No Pattern Grille Style: , No Grille Misc: , None
Construction: , No Bars (1), Pad Opening (1), Replace Rotted Wood (1),
New Construction Vinyl Removal (1) Material: , None
117 Dining Room 71" 57° Window: , Picture, Insert Frame, Exterior White, Interior White Performance
70-1/8" 56-5/8" Calculator: , PG Rating: 35 1 DP Rating: + 35 / -35 Glasses, All Sash: High
Performance, No Pattern Grille Style: , No Grille Misc: , None
Construction: , Mull Removal (2), No Bars (1), Pad Opening (1), Replace
Rotted Wood (1), New Construction Vinyl Removal (1) Material: , None
118 Dining Room 71" 57" Window: , Picture, Insert Frame, Exterior
70-1/8" 56-5/8"
09/26/23 Page 6 / 41
Order Summary
&a:RENEWAL BYANDIMSEN OF LONG ISLAND Aurelie Lang
Legal Name:Long Island Custom Windows I License#Suffolk Lic#43991-H I 1165 Theresa Dr
RENEWAL Nassau Lic#H0810150000 I NYC Lic#1307704 Mattituck,NY 11952
br_ANDER$EN' 2029 New Highway I Farmingdale,NY 11735 H:(646)247-7601
Phone:631-843-1713 1 Fax:631-843-1717 1 techs@rbalongisland.com 9 C:(646)247-7601
Measure Tech:Luke LaGrega,
D• ROOM
White, Interior White Performance Calculator: , PG Rating: 35 1 DP Rating:
+ 35/ - 35 Glass: , All Sash: High Performance, No Pattern Grille Style: ,
No Grille Misc: , None Construction: , Mull Removal (2), No Bars (1), Pad
Opening(1), Replace Rotted Wood (1), New Construction Vinyl Removal (1)
Material: , None
119 Fire Place 32 49 Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
Room 31-5/8" 49-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35 / - 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , No Grille Misc: , None
Construction: , No Bars (1), Pad Opening (1), Replace Rotted Wood (1),
New Construction Vinyl Removal (1) Material: , None
120 Fire Place 32" 49 Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
Room 31-5/8" 49-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35/ - 35 Glass: ,All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , No Grille Misc: , None
Construction: , No Bars (1), Pad Opening (1), Replace Rotted Wood (1),
New Construction Vinyl Removal (1) Material: , None
121 Fire Place 32 49 Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
Room 31-5/8" 49-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35 / - 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , No Grille Mlsc: , None
Construction: , No Bars (1), Pad Opening (1), Replace Rotted Wood (1),
New Construction Vinyl Removal (1) Material: , None
122 Guest Room 31 " 61" Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
31-5/8" 61-1/4" White, Interior
09/26/23 Page 7 / 41
Order Summary
!'N
PWA
dba:RENEWALBYANDERSEN OF LONG ISLAND Aurelle Lang
Legal Name:Long Island Custom Windows I License#Suffolk Lic#43991-H 1 1165 Theresa Dr
L Nassau Lic#H0810150000 1 NYC Lic#1307704 Mattituck,NY 11952
brANDERSEN 2029 New Highway I Farmingdale,NY 11735 H:(646)247-7601
� Phone:631-843-1713 1 Fax:631-843-1717 1 techs@rbalongisland.com 9 C:(646)247-7601
Measure Tech:Luke LaGrega,
.• ROOM
White Performance Calculator: , PG Rating: 25 1 DP Rating: + 35/ -35
Glass: , All Sash: High Performance, No Pattern Hardware: , White Screen: ,
Fiberglass, Full Screen Grille Style: , Grilles Between Glass (GBG) Grille
Pattern: , Sash 1: Colonial 3w x 2h, Sash 2: No Grille Misc: , None
Construction: , No Bars (1), Pad Opening (1), Replace Rotted Wood (1),
New Construction Vinyl Removal (1) Material: , None
123 Guest Room 31 " 61" Window: , Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior
Bathroom 31-5/8" 61-1/4" White, Interior White Performance Calculator: , PG Rating: 25 1 DP Rating:
+ 35 / - 35 Glass: , All Sash: High Performance, No Pattern Hardware: ,
White Screen: , Fiberglass, Full Screen Grille Style: , Grilles Between Glass
(GBG) Grille Pattern: , Sash 1: Colonial 3w x 2h, Sash 2: No Grille Misc: ,
None Construction: , No Bars (1), Pad Opening (1), Replace Rotted Wood
(1), New Construction Vinyl Removal (1) Material: , None
PRODUCTS:23 WINDOWS: 23 PATIO DOORS: 0 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 0 Updated 9126123
Job#03475617
Replace stools in Celia's room, 2nd floor hall &Master
Dining room Andersen triple casement rip, remove mulls, measured in jambs on stool, gets 1-5/8 colonial stops(primed)
Guest room &Guest bath vinyl window rip. Measured behind Us, reverse set pull into Us and caulk
All other windows vinyl window rip. Measured in jambs behind stool, gets 1-5/8 colonial stops(primed)
20 DBs
3 PW
Estimated Duration:3 days
09/26/23 Page 8 / 41