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HomeMy WebLinkAbout50118-Z i �o�s�rtFDlcoG Town of Southold 3/25/2024 a y� P.O.Box 1179 0 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45071 Date: 3/25/2024 THIS CERTIFIES that the building ELECTRICAL Location of Property: 16465 New Suffolk Ave,New Suffolk SCTM#: 473889 . Sec/Block/Lot: 117.-6-32.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/17/2023 pursuant to which Building Permit No. 50118 dated 12/12/2023 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: EV Charger and electric service as applied for. The certificate is issued to Frankel,David of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 50118 3/8/2024 PLUMBERS CERTIFICATION DATED 0 l Aut zed0 nature �suFFoc�.�o TOWN OF SOUTHOLD BUILDING DEPARTMENT y TOWN CLERK'S OFFICE ay • SOUTHOLD, NY 0 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#: 50118 Date: 12/12/2023 Permission is hereby granted to: Frankel, David 68 Bradhurst Ave Ph N New York, NY 10039 To: install EV Charger as applied for. At premises located at: 16465 New Suffolk Ave, New Suffolk SCTM # 473889 Sec/Block/Lot# 117.-6-32.1 Pursuant to application dated 11/17/2023 and approved by the Building Inspector. To expire on 6112/2026. Fees: ACCESSORY $125.00 ELECTRIC $100.00 CERTIFICATE OF OCCUPANCY $100.00 Total: $325.00 Building Inspector I 1 � �o��OF SOUTyO� l # # TOWN OF SOUTHOLD BUILDING DEPT. courm��'' 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [V�FINAL CV Gh"zfGiZ- [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: �G2 ss DATE �� �� a� INSPECTOR hO�*OF SOUTyO� 60/l # # TOWN OF SOUTHOLD BUILDING D T. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATIIO,N [ ] PRE O [ ] RENTAL REMARKS: �( e/ /0/104 e, DATE INSPECTOR oF souryo� # # 'TOWN OF SOUTHOLD BUILDING DEPT. cou 631-765-1802 5- cif 0 1 NSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] SULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL W CO P60---- [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: V2 Pm E iv cp DATE YY INSPECTOR 4444 ifin ILI I- - tl IL w ��. r +~,r- '^ r y� , •• "''l. - Aft Or � i 1 t I M J L k 77, i f i' �r :1 r • I ti f �- � < err �• -a -a �� _ i �- � � --__--__- � � �. � r �e I �� '� f 1 f --'�_! ! _�. __ -. _ a ,.. �� _- -. .��_ - ,_ ,. �. ., �, ,. a., . .� _ - � - } +-�, �. ;; .� `„<< •� •� i _.-"'�"�r7��'e�ra ,. i � """t r ' V IL Y y a J Y:. r i i„ ♦ � J 7 f 1� r t R -• mD no cd v3ueiwuerI adA I 9 t"r�,o`nnimeHija,�q _ • I f s � � I � f _t w . Y.. 1 r' ELD INSPECTION REPORT DATE COMMENTS •v FOUNDATION (1ST) ------------------------------------ C1 � FOUNDATION (2ND) � z cn O ROUGH FRAMING& PLUMBING - � r INSULATION PER N.Y. STATE ENERGY CODE �y FINAL — GI ADDITIONAL COMMENTS a-�( �- SQr�. ICp� l0�O 3a,s i 46 av z �Z rn �o H x x d r� b '''oS$ FOCo 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.southoldtowM.gov Date Received APPLICATION FOR BUILDING PERMIT P-rDD For Office Use Only1 1 U) PERMIT NO. Building Inspector: N 0 U 7 2023 -Applice'tioris.and.forms must be filled out.n their entirety.,l'ncomplete; "applications will'not.be accepted:,Where'the'Applicant is'not the owner;.an=`. 1�1TY� 'r Owner's Autho�izatioti forrin.(Page.2)sfiall be coampleted.' r tg rq� `3.,• I,c . Date: 11/09/2023 OWNERS)OF PROPERTY: Name: David Frankel scrM#sooa Project Address: 16465 New Suffolk Avenue, New Suffolk, NY, 11956 Phone#: 5_1_6-586-3050 1 Email:information@absolutec-d.com Mailing Address:27 Cain Drive Plainview, NY 11803 Name: Absolute Electrical Contracting and Designs Mailing Address: 27 Cain Drive Plainview, NY 11803 Phone#: 516-586-3050 Email: information@absolutec-d.com -b6i PROFES SIONAL INFORMATIONc, N. r Name: Mailing Address: Phone#: Email: CONTRACTORINO 'MATIONc Name: Absolute Electrical Contracting and Designs Mailing Address:27 Cain Drive Plainview, NY 11803 _ Phone#:516-586-3050 Email: information@absolutec-d.com DESCRIPTION,:OF PROPOSEWCONSTRUCTION' ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: DOther EV Charger Installation $1Z000 Will the lot be re-graded? ❑Yes BNo Will excess fill be removed from premises? ❑Yes BNo 1 PROPERTYINFORMATION Existing use of property:Residential Property Intended use of property: Residential Property Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? OYes B No IF YES,PROVIDE A COPY. B Check Box After Reading: The a .-bnn oerammMi:roponsbbforaildmh pandsbx.. wift bmsesprowd.dby owpur 23act de Tam Cade.APM chwm 6 HMW MADE to do ausding Depmtaent fordo lnuence of a BuBding PMA pnaaumntso the Bulm"Zone Ordkmmaf doTam of 5oudmM,sulfak Cow ft New Yak end odor opplunbh Mrs,Ordkmnnm or R@@Wmd ns,fordo aondruelton of buPArak nddMWm dtrradons or for rea m nlor dmnoMdon as heMn dma6ed.The app0co t apses to comply with ell eppUnble krs,onUrmc@96 buldingcode, hour coda and resukdaes and toadmltaudkodrad bapeetas an promkas mid In bun ft(s)for neaenary kopecdom rake ststenenes made herakk M punishable m o dm A mlabawa nor pursuant b Seddon 210AS ofde New Yak State Pond law. Applkation Submitted By(poi ®Authorized Agent OOwner Signature of Applicant: t V i Bate: 11/O9M23 STATE OF NEW YORK) SS, COUNTY OF S II ,, U 6 Wl h l t� C t'LZOVt l t-i being duly swum,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Contractor (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 14 day of �w ,m&M ° M, Notary Public •`''�;OFItWTB '•�d� NOT y0r ', " AXY p� ,a Wfd m S LIC PROPERTY OWNER AUTHORIZATIONo °jMo6?z°4 2 h (Where the applicant is not the owner) tl ( T nnnIlk CK\j 1G 1'YaYlke residing at16Wbs Mewl SulOnbIk AveftRe- NOW S t,t al k.l�(Tr,l l q 5(o do hereby authorize A bsbl wle- HmJ( ,i dCo J,,cL- W do apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 BUILDING DEPARTMENT- Electrical lnspegpr - 0 0024 'G TOWN OF SOUTHOLD Town Hall Annex-54375 Main Road - PO-.Box 1179 Southold, New York 11971-095R, Telephone 631 765-1802 - FAX 631 765-9502 iameshO_southoldtownny.aov - seand0-southoldtownrim v APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Informa ion Required) Date: 1 a Q UC23 Company Name: a P-Slah Electrician's Name: License No.: ��_ (��`�-g� Elec. email: ( �y( Elec. Phone No: tr 10- - ❑1 request an email copy of Certificate of Compliance Elec. Address.: `h - i Q JOB SITE INFORMATION (All Information Required) Name: F(66k Address: umews, 111�1 Cross Street: Phone No.: - Bldg.Permit#: Sb // 9 , email: NY6� h e Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE-SQUARE F OTAGE (Please-Print Clearly): EV 610-f9ec Un"t ifns�oMzhon Square Footage: Circle All That Apply: Is job ready for inspection?: YES ❑NO ❑Rough In ❑ Final Do you need a Temp Certificate?: ❑ YES❑NO Issued On Temp Information: (All information required) Service Size❑1 Ph❑3 Ph Size: a Q #Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead #Underground Laterals 0 1 H Frame M Pole Work done on Service? Y MN Additional Information: PAYMENT DUE WITH APPLICATION I 1-z, f 24, � doe, Ir0-c BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD } .�; Town Hall Annex -54375 Main Road - PO Box 1179 Southold, New York 1 1 971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 iamesh@southoldtownny.Qov seand(a�southoldtownnv.aov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Ail information�Zeq ' ed) Date: 1 a aO gOa Company Name: A6SC> tA e t" h Electrician's Name: m I" %'C, License No.: Hr,, (oe)-gSy Elec. email: G u C- • CO Elec. Phone No: Ib- 5S - 36,50 ❑I request an email copy of Certificate of Compliance Elec. Address.: j d JOB SITE INFORMATION (All Information Required) Name: R,0�)elr- rVi I'YL Address: g 95 'FC,CYY1 Q Cross Street: Phone No.: I(0- 0 - Bldg.Permit#: kL j U I I �'1 email: a covw Tax Map District: 1 00 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): no hew s¢v,); �e g Square Footage: Circle All That Apply: Is job ready for inspection?: YES 0 NO Rough In Final Do you need a Temp Certificate?: YES NO Issued On Temp Information; (All information required) - Service Size❑1 Ph❑3 Ph Size: A #Meters Old Meter# ❑New Service0 Fire Reconnect[]Flood Reconnect QService ReconnectQUnderground[Overhead # Underground Laterals n 1 H Frame Pole Work done on Service? FlY r71N Additional Information: PAYMENT DUE WITH APPLICATION 112 I2 �cuc�t jn+J V,e c I o 4 3 to � 5b11� BUILDING DEPARTMENT- Electrical Insp"r "�24 TOWN OF SOUTHOLD Town Hall Annex-54375 Main Road - PO Box 1179 * Southold, New York 11971-0959 °c Telephone (631) 765-1802 - FAX (631) 765-9502 jameshOa southoldtownnv.gov - seanda-southoldtownnv.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Informs ion Required) Date: Company Name: Yl Electrician's Name: License No.: ME- (2r+9)4 Elec. email: j a Elec. Phone No: - - ❑I request an email copy of Certificate of Compliance Elec. Address.: `h "� ! l 0 i JOB SITE INFORMATION (All Information Required) Name: Fro n Address: u Cross Street: Phone No.: - Bldg.Permit#: 5-0 0 9 email: yj h e Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE F OTAGE (Please Print Clearly): EV diaf ec UInI�' �► -alla-hon �r`'Qf Square Footage: Circle AM That Apply: 1 Is job ready for inspection?: YES ❑NO Rough In Final Do you need a Temp Certificate?: El YES❑NO Issued On Temp Information:. (All information required) Service Size❑1 Ph❑3 Ph Size: 3, 06 A #Meters Old Meter# ❑New Service0 Fire ReconnectE]Flood Reconnect OService ReconnectQUnderground❑Overhead # Underground Laterals R 1 H Frame Pole Work done on Service? FJY _ N Additional Information: PAYMENT DUE WITH APPLICATION 1 Iz 12,F --4>" doe, P �l �' Bunch, Connie From: Absolute Information <information@absolutec-d.com> Sent: Fridav, March 8, 2024 9:57 AM To: Bunch, Connie Subject: [SPAM] - Fwd: Inspection Ticket Attachments: aft a60de-f926-459d-a400-b87cbd8c660f_cdv_photo_002 jpg; c7dd 1 bb9-1 a09-44fl-9701-9a8b876bdeab_cdv_photo_001 jpg; c01 a6b5f-2929-4569- bb52-8834da368bd2_cdv_photo_OOOjpg;a778b369-85c4-4ad2-8b9b-cb8b7a22ae85 _cdv_photo_001jpg;-c2371dd3-4321-4403-8b5b-79e444c02ca0_cdv_photo_002jpg; 8alc552e-5499-4ff2-a6c7-b66e8fa18bc7_cdv_photo_004jpg; 74eb8d52-8ee9-4df5-9eb7-0753fcc2faa2_cdv_photo_OOOjpg; 31112b5e-8bfd-4b20- b6f9-a5e515565696_cdv_photo_003jpg Good morning Connie, Thank you for taking my call. Please review the email below. Thank you, Elisha ----------Forwarded message--------- From:Absolute Information<information@absolutec-d.com> Date:Thu, Feb 29,2024 at 1:51 PM Subject: Re: Inspection Ticket To: Pontino, Susan<susan.pontino@town.southold.nv.us> Hi Susan, We recently just went back to Frankel's home (16465 New Suffolk Avenue, New Suffolk,) to fix the issue that the inspector informed us about. I've attached pictures of the completed work. WE wanted to know if this was sufficient enough to keep the permit process rolling or do we need to set up another inspection appointment? Please let us know.We appreciate all your help with this matter. Thank you, Elisha Absolute Electrical Contracting& Design LLC 27 Cain Drive Plainview, NY 11803 0: 516-586-3050 1 Jesse: 631-872-2291 1 F: 516-586-3145 https://www.absoluteelectricalcontractinganddesign.com information@absolutec-d.com On Tue, Feb 20, 2024 at 11:37 AM Pontino,Susan<susan.pontino@town.southold.ny.us>wrote: 1 Bunch, Connie From: Bunch, Connie Sent: Friday, March 15, 2024 10:16 AM To: 'Absolute Information' Subject: 16465 New Suffolk Avenue Attachments: ###16465 New Suffok Ave_20240315100503.pdf Good Morning, Attached are the electrical certificates for the service and EV charger for 16465 New Suffolk Avenue. The Building Inspector needs to do his inspection. I can schedule that for March 22nd if that's good for you,. Best Regards, Connie Bunch Southold Town Building Dept. Your message is ready to be sent with the following file or link attachments: ###16465 New Suffok Ave_20240315100503.pdf Note: To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. f 1 ' 4_ 799 g9; - YOAF CV IOU qAfA - - 32.•3•• oot '9,00., �:. kd _- �€�;�• . . ' `' -. _ - -ram SIAS 09 M /08:59' N/O/F;JOH.N.&' �`'_ kA 2' . 9 GERTRUDE n, N o HARTUNG 18844 SQ.FT. �:. , 18,319 SQ FT -32 ol IPLii- .� a .�: '09•. '�'�„' ".y' .M.- N/4F AND' ,-f a : k IVEY. °;' - war✓/ `r• ,. 9B 5� b t ", - ','/'%'eeL a-,•, � --"� '=/c.a• - � :N 8 g -00 NE:tN EasEMEMYS ADDED. -12/4191 Suffolk-County:Dept,of = `Labor;licensing CorStriaer-Affairs. MASTER ELECTRICAL LICENSE - DOMINIC 'CHIZZONIII Business Name rhis'cerifies that.the--=, - aearer_is duty.li BSOLUTE ELECTRICAL CONTRACTS S ?y the,County of turialk.:. DESIGN,LLC License Number: ME-U784 Rosalie Drago Issued: 01/21/2020 C6rrtrrissioner Expires: ' 01/0112024 A�® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYWY) 11/13/2023 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(s). PRODUCER CONTA Philip O'Brien NAME: O'Brien Quick Agency PHONE (631)474-7070 FAx AIC No Fart; AIC No): 402 Main Street ALL DDRESS. PhilipO@cquickin$urance.com INSURER(S)AFFORDING COVERAGE NAICS Port Jefferson NY 11777 INSURERA; AmTrust Financial Services,Inc. INSURED INSURERB: Utica Mutual 25976 Absolute Electrical Contracting And Design LLC INSIR FRC: ACE Property and Casualty Insurance Company 20699 27 Cain Drive INSURERD: NYSIF INSURER E: Planview NY 11803 INSURERF: COVERAGES CERTIFICATE NUMBER: CL2351005381 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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 RESPECTTO WHICH THIS CERTIFICATE MAYBE 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. ILTR TYPE OF INSURANCE INSO VWD POLICYNUMBER POLICYF MMIDD YYCY LIMBS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE IF-2 Err-N OCCUR PREMISES aoccurrence $ 100,000 BLANKET AI MED EXP Any one person) $ 6,000 A Y Y WPP1863530 05/09/2023 05109/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATEUMITAPPLIESPER: GENERALAGGREGATE $ 2,000,000 POLICY®jECTEl LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ 1,000,000 Ea acdden ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y Y 5518564 02/12/2023 02112/2024 BODILY INJURY(Peraccident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 C EXCESS UAB HCLAIMS-MADE Y Y CMV-EXL-0026162-02 06/25/2023 06/25I2024 AGGREGATE $ 3,000,000 DED I X RETENTION$ 10,000 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER D ANY PROPRIETORIPARTNERIEXECUTIVE NIA Y H25827957 07/15/2023 07/15/2024 EL EACH ACCIDENT $ 500,000 OFFICER(MEMBER EXCLUDED? El(Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 500,000 I yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarlis Schedule,may be attached if more spate is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 PO Box 1179 GD AUTHOR REPRESENTATIVE Southold NY 11971 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD .Aco® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYIO Ikh.� 11/13/2023 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 WANED,subject to the terns and conditions of the policy,certain policies may rgquire an endorsement A statement on this certificate,does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Philip O'Brien NAME: O'Brien Quick Agency PHONE (631)474-7070 FAX WC No Eut: AtC No 402 Main Street b-MIUL PhilipO@oquicidnsurance.com INSURER(S)AFFORDING COVERAGE NAIC M Port Jefferson NY 11777 IN$URERA. AmTrust Financial Services,Inc. INSURED INSURERS: Utica Mutual 25976 Absolute Electrical Contracting And Design LLC INSURER c: ACE Property and Casualty Insurance Company 20699 27 Cain Drive INSURERD. NYSIF INSURER E: Pianview NY 11803 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2351005381 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 RESPECTTO WHICH THIS CERTIFICATE MAYBE 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. LTR TYPE OF INSURANCE IN SD YVVD POLICY NUMBER POLICYF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR PREMISES occurrence) $ 100,000 BLANKET AI MED EXP(Am one person) $ 5,000 A Y Y WPP1863530 05/09/2023 05/09/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY®JECTT El LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Fa as dent ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y Y 5518564 02/12/2023 02M2/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Peraccident Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 C EXCESSLUIB HCLAIMS-MADE Y Y CMV-EXL-0026162-02 06/25/2023 06/25/2024 AGGREGATE $ 3,000,000 DED I X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER D ANY PROPRIETORIPARTNER/EXECUTNE [EY NIA Y H25827957 07/15/2023 07/15/2024 EL EACHACCIDENT $_500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Ramada;Schedule,may be adached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 PO Box 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 ©1988-2015/ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS'COMPENSATION INSURANCE AAAAAA 461609385 1 C QUICK INSURANCE AGENCY INC 13 W.MAIN ST STE 4 WASHINGTONVILLE NY 10992-1444 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ABSOLUTE ELECTRICAL CONTRACTING AND TOWN OF SOUTHOLD DESIGN NY,CORP. 53095 ROUTE 25 27 CAIN DR PO BOX 1179 PLAINVIEW NY 11803 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2582 795-7 875551 07/15/2023 TO 07/15/2024 11/13/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2582 795-7, 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:/NVWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT JESSE SMELSON ABSOLUTE ELECTRICAL CONTRACTING AND DESIGNS INC-A ONE PERSON CORP 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. BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER, THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 30 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK STAT SU NCE FUND �vY � DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:413539955 U-26.3 _ - ,�:. �ae v+: �:,. (L::,./:'';�;..... r6 '`��--yam •��;- , - '�,r }� k �r e .,.3"�w -�� �Uf�O�k 9:s{��t1�"•�,��Lr,i34 `, i�- "_ •�l:�.�Ory �ocensIng �-Cdnsr�m�r.1 = ' earstful``licer ; {'` ''S ABS,UIUTE-ELECT,RI'CACk.tRAT >'S`,'':'; �aw?ty_,,c;zs<. rlls,;,' : :aDES �,:4 ,:FrF3,> > 3 r License�Number My E- r " �� —chargepoin+ ChargePoint Home Flex Specifications and Ordering Information Ordering Information Model,I Description Station and 16A-50A,NEMA 6-50 plug,7010.4 mm(23') CPH50-NEMA6-50-L23 Cable Model Charging Cable 16A-50A,NEMA 14-50 plug,7010.4 mm CPH50-NEMA14-50-L23 (23')Charging Cable I'Replacement 7010.4 mm(23')Charging Cable CPH50Cable-T1-50A-L23-F 1 i Cable APPR VED AS NOTED Q� DATE. B.P.it l l U FEE ��U BY,NOTIFY BUILDING DEPARTMENT AT OCCUPANCY OR FOLLOWING INSPECOT�IONSFORTHE USE IS UNLAWFUL 1. FOUNDATION-TWO REOU!PFD FOR POURED CONCRETFE WITHOUT CERTIFIC/ 2. ROUGH-FRAMING&PL r,. OF OCCUPANCY 3. INSULATION 4. FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE ChargePointO Home Flex REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTON ERRORS COMPLY WITH ALL CODES OF NEW YORK STATE &TOWN CODES ELECTRICAL AS REQUIRED AND CON TIONS OF INSPECTION REQU!REC SOUTHOLD T N ZBA r� SOUTHOLD OWN PLANNING BOARD c �L us SOUTH O TOWN TRUSTEES LISTED N.YS EC / cO OLD HPC WORKS WITH J of O HD amazon alexa C Charge4oint Home Flex Dimensions weight:6.26kg(13.8lbs) i— 179.4 mm f_179.6 mm (7.06") (7.0711) 132.1 mm (5.20") 284.3 mm Ud 2 chargepoint.com � I —chargepoin+ Specifications Connector and Electrical Input'Cord NEMA 6-50 or NEMA 14-50 AC Power Output Rating Maximum 12 kW(240V AC'50A).Output amperage adjustable via mobile app to 16A,24A,32A,40A, 48A,50A. I AC Power Input Rating 208/240V AC 60Hz single phase @ 16A,24A,32A,40A,48A,50A — - Required Service Panel Breaker Dedicated Dual Pole rated for 125%of maximum load(ex:50A breaker for 40A output) Service Panel GFCI — _ External GFCI may conflict with internal GFCI(CCID).For hardwired installations,use a non-GFCI, circuit breaker. I Power Wiring 3 Wire-L1,L2 plus Earth(no neutral) Charging Cable Length 7010.4 mm(23) , Connector Type SAE J1772' CPower Measurement Accuracy +/-2:0%from 2%to full scale ! Power Report/Store Interval 15 minute aligned to hour Safety and Connectivity Features Ground Fault Detection 20 mA-CCID with auto retry Open Safety Ground Detection Continuously monitors presence of safety(green wire)ground connection Plug-Out Detection Power terminated per SAE J1772 specifications Local Area Network 2.4/5 GHz Wi-Fi(802.11 a/b/g/n) Device storage ~—L _ Local data storage with capacity of up to 90 days of charging session data(100 sessions)in case of interrupted network connection Software Updates Firmware updated over-the-air(OTA) Safety and Operational Ratings Enclosure Ratings Type 3R per UL 50E Safety and Compliance UL and cUL listed product per UL2594,UL2231-1,UL2231-2.NEC Article 625 compliant For Canada CSA C22.2,No.280,281.1,281.2,CEC EMI Compliance FCC Part 15 Class B Storage Temperature -400C to 600C(-40°F to 140°F)ambient Operating Temperature -300C to 500C(-22°F to 122°F)ambient Operating Humidity Up to 95%at 50 C(122 F)non-condensing Non-Operating Humidity — Up to 95%at 500C,(1220F)non-condensing — ENERGY STAR®Certification Yes Indicators 1 WiFi LED Yes ! Fault Indicator per UL Yes '— — j Status LED Yes chargepoint.com 3 Cha`gdboint Home Flex L Installation Install Software Mobile Apo(iOS&Android) Outdoor Installation Hardwired installation or weatherproof NEMA receptacle Note:Required by code to install an outdoor rated GFCI breaker upstream for outdoor plug-in installation ChargePoint,Inc.reserves the right to alter product offerings and specifications at any time without notice,and is not responsible for typographical or graphical errors that may appear in this document. Contact US QVisit chargenoint.com ® Call+1.408.705.1992 AEmail sales(@charaepoint.com -chargepoh* ChargePoint,Inc. Copyright©2019 ChargePoint,Inc.All rights reserved.CHARGEPOINT is a U.S.registered trademark/service mark,and an EU registered logo mark 240 East Hacienda Avenue of ChargePoint,Inc.All other products or services mentioned are the trademarks,service marks,registered trademarks or registered service marks of Campbell,CA 95008-6617 USA their respective owners.DS-HomeFlex-00.September 2019.PN 7 3-0 01318-01-1. +1.408.841.4500 or I101"1 +1.877.370.3802 US and Canada toll-free Listed by Underwriters c �L us chargepoint.com Laboratories Inc, LISTED ll=