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HomeMy WebLinkAbout50119-Z g�FFOd;�- Town of Southold 3/25/2024 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45068 Date: 3/25/2024 THIS CERTIFIES that the building ALTERATION Location of Property: 23 Farmstead Ct Unit 48, Cutchogue SCTM#: 473889 Sec/Block/Lot: 102.1-2-22 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. 50119 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 chargeras applied for. The certificate is issued to Valentine,Lisa&Cammarata,Robert of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 50119 1/22/2024 PLUMBERS CERTIFICATION DATED th riz d ignature i �o�soFFn�Kco TOWN OF SOUTHOLD ay BUILDING DEPARTMENT H a TOWN CLERK'S OFFICE. oy • 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#: 5011.9 Date: 12/12/2023 Permission is hereby granted to: Rimor Development LLC 1721-D North Ocean Ave Medford, NY 11763 To: install EV Charger as applied for. At premises located at: 23 Farmstead Ct Unit 48, Cutchogue SCTM # 473889 Sec/Block/Lot# 102.1-2-22 Pursuant to application dated 11/17/2023 and approved by the Building Inspector. To expire on 6/12/2025. j Fees: 1 ACCESSORY $125.00 ELECTRIC $100.00 CERTIFICATE OF OCCUPANCY $100.00 Total: $325.00 Building Inspector OF SO�j�ol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G Q Southold,NY 11971-0959 �� �o sean.devlinttown.southold.nv.us �y�4UNT`I,�c� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Robert F. Cammarata Address: 23 Farmstead Ct city:Cutchogue st: NY zip: 11935 Building Permit#: 50119 Section: 102.1 Block: 2 Lot: 22 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Absolute Electrical License No: 62784ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Commerical Outdoor 1st Floor Pool New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage X INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect 50A Switches 4'LED Exit Fixtures Sump Pump Other Equipment: 50A Electric Vehicle Charger Notes: E. V. Charger Inspector Signature: Date: January 22, 2024 S.Devlin-Cert Electrical Compliance Form *OE SOUTh°� TOWN OF SOUTHOLD BUILDING DEPT.'-Comm 631.765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ �INAL E✓ 6&Aye f— [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: /1-0 etiezess DATE `g"02 INSPECTOR SOUIyO� /9 r 1/0l # # TOWN OF SOUTHOLD BUILDING DEPT. 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 VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: DATE INSPECTOR SOUTyo� , * # TOWN OF SOUTHOLD BUILDING DEPT. 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 VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: c� DATE INSPECTOR ` GELD INSPECTION REPORT DATE COMMENTS V ,r n ■e FOUNDATION (1ST) ----------------------------------- FOUNDATION (2ND) z O CA y O ROUGH FRAMING& ►� _ PLUMBING INSULATION PER N.Y. STATE ENERGY CODE 241—Qk- FINAL IL— ADDITIONAL COMMENTS (� E � b o �z x - H x d H `g Town Ball Ann=34375_Msin Rind P.O.Box,1179.Southold,NY'11971-0959 Tckphooe(631)76S-18U Fix(631).765-M,bttas://www.souiholdtownny.gov. OM aecwvw APPLICATION 'FO ,�Au L01.N;G PERMIT: r+�a�,euseo.y L5 ' o+ N 0 V 1 7 2023 App ianswo fag n�wrttWfftdoorilnt *mIi* Inoa�npieCe r . '• �■wR� ..�yy��� v���j� u��y 4L''u �t n'X e~S.f� i Q;{i F.Y Name- Rdmn,Cammar,2t a scrM#vooaY-- Pwjw Address: 23 Fan ad COW% CuttW9ue,.'NY 11935 Phonelk 5t6-220-0114 mtomnationCabsoluteo-d.com -Malft 23:Farmstead.Courk CiUX91e, NY 11935 Absolute 1�rical ConbaCtiM and,Designs. h"gms Mfrem 27 Cain Drive Plainview,,NY 1 ims. 51'6-586-3= intomnationgabsolutec-d.com DESM' OMSSOMINFOOM100me. 'Phom #. aoNr crat w�ou►no �aAti�olute Electrical Contracting and.Des�9 e 27 Cain.Drive Mkindiew, NY 11803 Plwne-*516.586--3050 intornnation@absolutec-d.com ap.�al�noer of dows-rraicnoa . 13*w.%uam OM Mon. OARmagoe []Rep& I3DmwRd. E ed Cog atft *t ®ptlier.Ev.a��on $z�oaoo r 1Wdw lot tie regraded? Dyes INW ',M exams fM tie iemoredfi+am.premises? OYes ®No Iso iYi lie R 0 pe Residential:Prop r i ►:'Residdridd property , Zone ar use, 'f p mmjses s Areal me.aW cower an d msuic#ons,vA h resped;to this pnoperij►? OYes®No IF YES,PROVIDE-A COPY. MOO Ok;Oi Aftar Re"41 fs asp ror lip br Oiiptr79iafbe7bwGoie.�fllUGI1i1046iB�1r�MilE�otlie�'�aeNrl�IttorfteY�ealta�uidc�lis�aRpaem�atotbe.puiax. Opdkumwof-mTw=c#ft WWftSWRo%.Qor Nesti a�ifalieraAfg leb ,,.. - r�ioer,�tbeaoer�boc�oaof , ai atararo�isbrfor+ea�ewicrdeaiabonasl�siiea�ieiLiiaa /cnts��eshalra���le6�s„ano�,b�i8�sood� bo aaiear i�r lio-sadoloi i�itareUprtidirgetfwsoA. audiniowhow ess�i�paotiwr;.ratse arsdehneinan /a�taYessa�A iiew�+�orps�ntleSbelfos2'L/�afltieNetirYbeicr�eR�aiia� DOW' Ch[zzoniti ® . UOwner ' �APp� �eju«itsG( eiu�'y' `Dates 11/D920�i STATE-OW INEW YORIQ, (J COUi�tYOF� I _ - w�i✓� i C. 16 r22oyt t A-� benag4* ;deposes andsays t)w(s)he k the appl'Kant '(Name of individual fO ing contract)above named, (S)MIsthe Cor#wbr - tC.otraOor,fi Eorporate oflioe+r.-etd of sak!owner oemer�,ar�d a duly aumed to p have pertaom�ed"the said.work acid to make aad file this appCa�tioa #hat aIi a this ane:Uw to fire best of f es/tier age and-beW and that the wort wM be peKormW in.the n,mnw,setfortb In the apeman fifetherewith: Swain bekm me thawo Op - :°PROPERTY OWN ERIAUTHORIZAT10N the �66 ' alAfiter y � , 062924$ tt - '1� Vs ow EXPIRES ;to:aP.*on my 15b the T of Sor lydd B :O rfine�rtfor appia a-as dew-4--2Y ;herein: Ownwsssknvtwe :Print Owr�s Nana' .` 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 .: '. iamesh(c�southoldtownny.aov seanda-southoldtownnv.aov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Req ' ed) Date: 1 ,9 bol Pog Company Name: SC> C e Np,-�ft q h ' Electrician's Name: m I v1 �'c C_h n I License No.: He- (oa rTS y Elec. email: AISAAeCA- OOYVL Elec. Phone No: 510- 5S - 050 ❑I request an email copy of Certificate of Compliance Elec. Address.: j . a JOB SITE INFORMATION (All Information Required) Name: Robe(+ 0(1MM(2(aAa Address: 9D 'FC,LCYYl Q35 Cross Street: Phone No.: l(0- 0 nil 14 - Bldg.Permit#: 57Z) I I q email: 0A C Tax Map District: 1 00 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): �v b9ar e( u.tn�� 1VI�S�c�`�Gt- ors ►�® he s¢�� �e Square Footage: Circle All That Apply: Is job ready for inspection?: NfYES [:]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: 58 _A #Meters Old Meter# New Service[]Fire Reconnect[]Flood ReconnectOService ReconnectDUnderground DOverhead # Underground Laterals 0 1 H Frame El Pole Work done on Service? Y FIN Additional Information: PAYMENT DUE WITH APPLICATION V'e C*t � 52b11� IIRRVESTPODLTE"HONE OWNERS 3 NOTES ASSOCIATION DESIGNATION b THE C"�MRDME 1710)OOMMM011 FRMTWWWJMMTon! Ip0 TIpN LINE .rAOrDITrlIOARa FOaARKfJ'ICRFOOSe AIDYl AID THUtU lAr9 ma-- NOMFew To O1WemlemeNOF GDWromaOm.1N38SPiSW. 13867 FLANDAD4\AORTO WAGWWACDAN=OTKK RE CLOSURE o. Rio CONCRETE —�,Ai. nu.vlaAnoMvlawraolarAnOwraTiwuwurtaew, ENCLOSURE CO �1 ^uN=T U1^�MMCT0N7�•FaAm ENCLOSURE- TSRiOIL UNl[aa NeaaenR+TADtTl7iewTF.eTDNorATceam I&V IrROP[tRONALDiWSH1 dl LATDDROa'rOR TOALlE11A11RFT1NAM W1T.1 •p CO 17.0" AN mDIteAA.ro UxsFxau+erDIr111 oltuwswYe+aaALnam.n �O11 + ALTIM04MMIM OR LUC WRYEYON WN AFMTOTWMMMSMAN Y�i' nEMYATDN'ALTBWCr F41ON®M°3=ATWNOTIDaIevW O ALTlAAnOAAIDA1r4COIC OFAOI/IgI V MK1N4110R . '�� ' F{ OI ' COFffaMTlalANYETILVNOTRNRRDIIDlAN06URYl1ORe llBIIOD �I 6FAL OR D�O44D 8ULDNLLNOTILCON6DUVD TOA<AM{Dlpla COF/ 40 NOF ScALFAsumEWmONF1lcpmm Ate mTm RE=mrAIDIMI O T.0' UNIT"48 I UNR47 aLDCNrvvAmvun,xmaawuimnorconsm. 1 STY FRAME RESIDENCE A c°rauDxs®Ain.NnuoNo WrNorwrmToran�vDaFrTaeaAem F G.FL634.2 1uj �"y � r oumaeunmNFRcaaou I 21 32 �•----1 eorrDOTrDNTLaaTTaroFaeNONeeARAeowwlcran AURbrta ,; r--- Re1FAv/nNorARrvTwsawwDwrleRVAaarLsorrnDToev�N� 2 3N 1 GARAGE 1 31 2Q am° m srsvir,Lw o'ur a'^umy 2g 1 GARAGE amul rimawmick w In Lu .3 2s 1 1 1 'AFTER a Z a R i) _ § METeR O cliIn N OF' 'D LOmB METER N Tn CEO, N. I+A O. O.H N R W W W' W CONC.WALK 'S CON WAllC. CONGWA{1( J 07 a-0)N 0)N 0:J D)v'v a0 C o e p€]e 3 3 P�Ox®CemL O uT :r L-N� p p •�V_ LV f` �. "LV t`, IV aa nj n e �a- 89.CURB ',(, DROP CURB co D r r co r r co 2. co I a y -� o: m y FARMSTEAD COURT I 1 SUB PAVEMENT `V, GRIFFING STREET "�� tip 1 'HARVEST 4� `T3- o iD iv w$ w w o Tn PO,INTE LANE �� o N €D. €D.� A m tL W N C1 T- �. r CO AV co Z II II o g I^ MILLSTONE LANE S 38°24'18'E� �J M" � � lii 1 456.62' W z w z w I iL o 1� 0 W 2 g o TD Ia 0 1 Op = I ~coI FINAL SURVEY N _ _ �269.77'(ACTUAL) 1oaFaDx+ FOUNDATiDH LOCATION Q2 M S-= SM17ARYASSULT FOR UNITS 47=48^ 837'04'40"E , ouT.ma F ALSURVEY UNIT DESGNATION MAP OF 1144.2022 RDAONANERMW HARVEST POINTE CONDOMINIUM 2 ` QF N Y FILE N0.:490F11 StfbnTs»r20.2020 �P ypp 0 CUTCHOGUE co �aQ. 0 TOWN OF Sou7NOW,BUFFOLKC'OUWTI.HEVYYORK t6TY D{tIR10T 1�lOTTOT 10101.t001 OlAfL LD7t0'A1mO\®AOfI Ir NELSON ; POPE 7 OF &nano•avbam r\aevleym 70 Maass R04MCMile,NY 11747.631A27-"A-M401POPI-om DRAWN Br: NP D NwmMM O SCALE: CHECKED BY' MS FUND- 'sHEETN0.'I OF i DATE 00041a22 PROIECTND: UUU26 T'=3a Suffolk County.pept;.of, Labor,Licensing&Consumer Affairs MASTER ELECTRICAL LICENSE, _ Name DOMINIC CHIZZONITI Businoss Name This certifies that the ,nearer is duly Ilcen�=�rd ' ABSOLUTE ELECTRICAL CONTRAG77NG S ay the County of sudoij, DESIGN LLC License Number:ME-62784 Rosalie Drago issued: 0112112020 . Commissioner Expires: 01101i2024 z a H J k ACCO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 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 CONTACT Philip O'Brien ' NAME: O'Brien Quick Agency PHONnEo (631)474-7070 a No 402 Main Street r-MAIL : PhilipO@cquiddnsurance.com ADDRESS INSURER(S)AFFORDING COVERAGE NAIC B Port Jefferson NY 11777 INSURERA• AmTrust Financial Services,Inc. INSURED INSURERB. Utica Mutual 25976 Absolute Electrical Contracting And Design LLC INsuRER C• ACE Property and Casualty Insurance Company 20699 27 Cain Drive INSURER D: 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. INSR TYPE OF INSURANCEAIJUL POLICY EFF POLICY EXP LTR INSO YV1/D POLICY NUMBER MMID M DMIM, LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ® ISES OCCUR PREM ooeurrence $ 100,000 BLANKET AI MED EXP(Any 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 0 LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y Y 5518564 02/12/2023 02/12(2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Peraccident Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 C EXCESS LIAR Id CLAIMS-MADE Y Y CMV-EXL-0026162-02 06/25/2023 06/25/2024 AGGREGATE $ 3,000,000 DELI I x RETENTION$ 10,000 $ WORKERS COMPENSATION 54 PER OTT+ AND EMPLOYERS'LIABILITY YIN STATUTE ER D ANY PROPRIETORIPARrNERIEXECUTNE NIA Y H25827957 07/15l2023 07/15I2024 ELEACHACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? 500,000 (Mandatory in NH) EL DISEASE-FA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H 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 AUTHORIZED REPRESENTATIVE PO BOX 1179 Southold NY 11971 ©1988-2015AACCORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 1 K Workers' CERTIFICATE OF INSURANCE COVERAGE A Compensation Bgaid, DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured ABSOLUTE ELECTRICAL CONTRACTING&DESIGNS,LLC 27 CAIN DRIVE PLAINVIEW,NY 11803 1 c.Federal Employer Identification Number of Insured Work Location of Insured(only required if coverage is specificallylimited toor Social Security Number certain locations in New York State,i.e.,Wmp•Up Policy) 461609385 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate ShelterPoint Life Insurance Company Town of Southold 3b.Policy Number of Entity Listed in Box 1 a" 53095 Route 25 DBL576825 PO Box 1179 Southold,NY 11971 3c.Policy effective period 01/01/2023 to 12/31/2023 4. Policy provides the following benefits: © 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 employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described otabove. Date Signed 11/13/2023 By 1W, (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If Box 4B,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law.It must be mailed for completion to the Workers'Compensation Board,Plans Acceptance Unit,PO Box 5200,Binghamton,NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(Only if Box 4C or 5B of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-12a 1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) DIOIIPioimiiioiiiiimiiiiiiiiiiiiiii�iiiii�lll voRx workers' CERTIFICATE OF INSURANCE COVERAGE arATE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier la.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured ABSOLUTE ELECTRICAL CONTRACTING&DESIGNS,LLC 27 CAIN DRIVE PLAINVIEW,NY 11803 1c.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) 461609385 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate ShelterPoint Life Insurance Company Town of Southold 3b.Policy Number of Entity Listed in Box"la" 53095 Route 25 DBL576825 PO Box 1179 Southold,NY 11971 3c.Policy effective period 01/01/2023 to 12/31/2023 4. Policy provides the following benefits: © 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 employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 11/13/2023 By CIY/G (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer 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 46,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law.It must be mailed for completion to the Workers'Compensation Board,Plans Acceptance Unit,PO Box 5200,Binghamton,NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(Only if Box 4C or 5B of Part i has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-12a 1_Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) 111111�j1011011101101m1111111111111110111111111111 NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysitcom CERTIFICATE OF WORKERS'COMPENSATION INSURANCE �. . m.� A A A A A A 461609385 I 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 11l13l2023 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://WWW.NYSIF.COMICERTICERTVAL.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 SUR NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:413539955 U-26.3 APP OVED AS NOTED DATE• nn B.P.# 561 FEE U BY: NOTIFY BUILDING DEPARTM T AT 631-765-1802 8AM TO 4PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION-TWO REQUIRED FOR POURED CONCRETE, 2. ROUGH-FRAMING&PLUMBING 3. INSULATION 4. 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 CONSTRUCTON ERRORS COMPLY WITH ALL CODES OF NEW YORK STATE &TOWN CODES AS REQUIRED AND CONDITION SOUTHOLD TOWN ZB SOUTHOLD TO LANNING BOARD ,-SOUTHO WN TRUSTEES - - N,Y,S C OLD HPC SCHD OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICA OF OCCUPANCY ELECTRICAL INSPECTION REO IRED , ..� electrify home L V 2 Charc r -- omn.. Station INSTALLATION AND OPERATION MANUAL Version:1.0.7 Issue Date:August 31, 2021 Contents O Information 04 O Operating Instructions 12 1 Copyright 04 2 Ab-1Th4Dot—nt 04 • Charger Status 14 1 Stotuslndicator 14 3 Intended Use 04 2 Indlcator Defin—n 14 :Ielectrify 4 Clarge,Intended Use 04 3 Understanding Status 15 5 Important Sofety lnstfuctons 04 Indicator Patterns • ' 6 EMCCompl—Statement 05 4 Faults 15 FCC Port 15,Subpart 8,Class B O • Product Overview 06 Troubleshooting 16 1 Included ComponentsUst 07 O Specifications n 2 RecommendedT-ts 07 • Moving,Transportation, 16 and Storage O Installation Instructions o6 • Cleaning is 1 9efore1-11ing 06 2 Installodon Steps 09 ® Warranty 16 3 Instollodon with Hardwiring 10 O Disposal 16 ^�O,^,^^ ^,� O,^ ®Important Safety Instructions(continued) herein Forthem aup-w-dweinfo t*mpleawvisi[elecbifyhomecom. Ir 11 Y If IY 11(�Yi If 11 contact Electrify America.ElectnfyAmencals not mspo sibleforany O EMC Compliance Statement: domogesthatmayoccurre ltKngfromcusmmin[allabonsoropemtions FCC Part 15,Subpart B,Class B that are not described in this document. FCC ID:2AXSSEA2RO40JPAI000 O Copyright Q© Important Safety Instructions R, Personolpro[ec[ionequipment Use of proper personal protection equipment Copyright®2021 EIettrifyAmenta,LLC All rights reserved.Thisdotumen[ READ ALL THE INSTRUCTIONS BEFORE INSTALLING, (Including,but not limited to,eye protection,shock protection,gloves,and 1 Radafrequency(RF)-posurewarning-Thlsequipmen[mustbemstalled Iscopyright protected,It may not be changed,reproduced,or distributed MAINTAINING.OR USING THIS PRODUCT.SAVE THESE other appropriate proteaion)Is recommended when lns[olling orservaing any and operotetlnaceordanCe with the provided mstruCUOne,and lheantenna(s) vnthoutpraragreement iswetl in writing by ElectnfyAmenCa. INSTRUCTIONS.THEY MUST BE PROVIDED TO EACH NEW OWNER electraalegwpment.To reduce the nsk of fire,only connect this equipment to used far this transmitter must be installed to provIdeo separation distance aon—um 50 amperesoverwrrent protectiondewcem accordance with the ofwleost2Ocmfromollperwnsandmustnotbem-kxa[edoropemted ,4\ DANGER.RISK OF ELECTRICAL SHOCK National Eleclraol Code.ANSI/NFPA, in conjunction with any other antenna or[ranss—mm,End users and installers O About This Document INSTRUCTIONS PERTAINING TO A RISK OF FIRE OR ELECTRICAL SHOCK. ®11. Donut use thisequlprnentinonoreowith hatordousorflammoblematenals must be provided-hontennainsrollatioimslruc[Ions and transmitter Theseins varsdescribehowtooperate and care for the charger properly. rvapors.Store hazardous and flammable vapors and materials away from operating conditions for satisfying RE exposure compliance. Addrtanolastructions are dedm the Electrify Amencoa 1. tonotuse any adopters,converters,cable r powecosdr supplor y card, cables o prwl fy pp,antlwe all electrical equipment tluringinstollo[an 2 Federal Communications Cammissan(FCC)In[erference Statement This recommend you viewthe app before using the charger.Far your personal Wlncrease[hle leng[hof[he charging cobleapower supply cord. safety,followtheoperatin bucti nsewd Werecommendthcto 2.Do notmstall this charger on O GFCI circuit breaker. 12 =tArcied om lased,iil contactor:sht dustier n,The cotacta,s—lose thaL en equipmentund to omply for 0ClassB gins y rger tligitaldewce.Wrwon[ro partl5oilheFCC Rules.These ltrnitsaredeslgnistlro opened Orclosed,electrical enclosure, short duration but arc.The concederhr—cored certif tlelee[ridan perform all in-homeins[alla[wns,and this charger prwidereasonablepro[ec[anagainst harmful in[erferencemaresiden[al 3.Suparnse children when device i5 in use.Children under 16 should nIXopero[e i an appropriate elecmcalenclosure,but caution is required if[hisarcoceurs should not be installedin any circumstances without first conwlbngwith Installation.Th,sequ,pmentgenerotee,usesandtonmdsotemd*frequ rRy this tlevice Also,small par[saretlongerous for child—Do no[install m the in the preunteof Flammable vapors—as[hevopor5 could gni[e,[rooting an electricianfamilbrwith your home,itselecttical ponelantlwinng. presence ofchllaren an e loran. energy and,if no[instolled and used inattortlancewith the instructions,may Only qualified,certif d electricians should hardwire this charger. usehormfulnterferen wmdncommunicobons Howew:rrmereano 4 Do not put fingers into the electric vehicle connector. 13 Do not open the charger at any time d-riginstolla[Ion or operation' guarontee that interference will not occurm a porticularnstollotion.If this O Intended Use S.Do not use this produarf the pourer supply core«the elecmc vehicle cable Only varied personnel should open the charger equipment does cause harmfuhriterference to radio or television reception, is frayed,has broken insulation,or shows any other signs of damage 14.Handling live Components—riecdy may cause senousinjuries or death. which can be determined by turning the equipment off and on,the user is These instructions apply to me charger and its use in the USA.Follow all federal, encouraged to try to correct[ne intererence by am or more of the following state,and local laws,regulonom.wtlinonces,codes and safety standards. 6 Do not use this product ifthe enclosure or the electric whale connector is 15,Ifthe electricity service to the chargerls domaged-onediately shut down m¢aswes: broken,cracked,open,or shows any other mdaanon of damage. the power to the charger by switching off the circuit breaker and contact O Charger—Intended Use 7. The ambient operating temperature range for this device ls-22-F(-30-C) hcensedelectr¢an. 1 Rewlent or relocate the rece sung antenna 1. This deviCeaintended forindoorand pur000ruse Do not obscure[he label to+122"F(,,50°C).Do not operate the charger outside this operating range. 16.Turn offarcuit before remounting or replacing the charger. 2.Increase the separation between the equipment and receiver. . an the charger.All persons using the charger must first read and understand 8 Electrify Amencom not responsible far physicalm)ury or damage to property 17 To reduce the risk Of fire,connect only to a circuit provided wth the proper 3 Connect the equipment W an outlet on a circuit different from that to thesemstructlons. or equipment mused by the Installation.usage.repair,cr maintenance of ma.imum branch circuit—rent protection in accordance with the whichtherecelveriscono-ted 2 This device lsintended exclusively for the charging of electric vehicles fitted thlsproduct National Electrical Code and local laves,regulations,codes,and standards. 4 Coosul[[he dealer or an experienced radio/Tv technician for help With a Type l plug(SAE 11772)and charging current control via the pilot signal 9 Theseinstructions describe the usage of the charger in most commonly used 18.Ensure that all components are dry throughout me installation. CAUTION-Argchanes gorinodifi rot cationsexpresslyapprwed (IEC 61851-1.2017).Do not use the charger to charge or 5upplyotherdevaes. imrallabonondmoun[irgscenanos lfsituationsonsea Which lt15 not possible big toe quoromme of this device could void the user's outhonty to operate Follow all federal,stow,and local laws.regulabons,ordinonces,and safety to perform an operation following the procedures provided In this document, 19.Productt elatestChang otan rdwutpnorno[iceoots Ot rocentmgh[ra[ stand ards regarding use of this device mntamthe loteslcnongestoaleproduc['s speOficotansorprocessesdescrbed thleegwpment. Ox I HOMESTAT60N LEVEL 2-ARCER INSTALLATION ANo oRERATION MANUAL I os Product Overview O Included Components List ® Recommended Tools QQ TOOLS FOR PLUG-IN INSTALLATION I.Level O 2.Pencil 3.Electric Drill f i 4.Phillips-Head Screwdriver d III �I n� Q TOOLS FOR HARDWIRED INSTALLATION '� O Charger MOUHNIgbrO ketxl Mounbng[emPlatexl 1.Level �l 2.Pencil O 3.Elects-Dell p4.Phillips-Heotl Screwdriver Cutter 6,Nee .Needle-e-Nose Pliers WRe Stripper Usernwnualxl Holstercosexl HolsterinletxI O 8.Ferrule Cemping Tool NO, ITEM NO. ITEM 1 LED Ring 6 Coble Hdster T20T screw xl a (for nok sembly) 2 Cosmetic Cover 6 Vehicle Connector 3 Plug 7 MOuntitlg Bracket No.8wood S-rewsx4 T20 Torxbltxt (2forbracket.2forhokte0 �`++jj�R�''�/+�✓�C//uu✓✓�✓ + T3OTorxb,txl 4 Middla Cover 8 Body T30Torxsarewsx4 (forbracketassembly) 06 1 NONLSTITION LEVEL 2 cNARG[R INSTILLATION INO OPERATION MANUAL I 0i InstallationInstructions O Installation Steps 5.Once the mounting brocket5instolled,place the charger into thebmcket -m and secure the charger to the bracket using the 4 supplied T3OTom screws. This product must have o proper elecmwl ground connection.Prope r eleca icol grounding reduces the risk of electric shock.This product is equipped with a O Before Installing a power Supply wtile m tht in acludes anegmprt ro Ntgund ducto.ing co The paws , ® We recommend that a certified electrician perform allm-hoe installotiws. 1. Install the holster—measuredfromthe a supplycablomu5tbepluggedinWoa pobbleouhetthotls lns properlytolled #`K^1 Under nocimumstances shouldthechorgerbeinst011ed withoutf-t bot tom Detween315'(BOCm cmc1 ondg—,,ded,nacw co rdance with all locoldesaMordmances. Consulting a certified and qualified electrician.Review these Installation 43.3'(710 car)aIDow theground. —WING.Improper connectionofthepowersupplycoblecon resulon / 1 tt Insbuctions and the directions in your Electrify America Opp carefully elecmc shock.Check with a qualified elecmcan to ensure the product is properly before installation.Failure to ad=to all instructions in this manual and 2.To allow for proper OlrfiGW and working morn.the charger should be placed grounded Do not modify the power supply Cable p—ded with the product ®INSTALL THE HOLSTER the Electrify America Opp Could resultm damage to property,serious at kwst l2'(30.5cm)from any other equipment,walls,or other obstructions Ensure he proper outliamirntolled by a licensed and qualified electrician. The cable hokta5 optional.Install the holster—measured from the bottom injury,or death. 3 Thebrocketmustbemountadw Oflatsurfacesothotitdoesmdeform between 31.5'(80 cm)and 43.3'(110 cm)above the ground.Please select Make Sure to fodww all local codesand regulations for safety and accessibllay, when properly secured. D INSTALL THE MOUNTING BRACKET AND CHARGER the proper mounting hord—for your particular installation. When considenngmstollotlol locations,there are a few things tokeepm mind. 4.Plug-Inln Shallot—Note-Prorto mounting the charger,turn offthe amid[ 1.This productmust be mounted w a wall.The mounting template,lnck,detl PLUG-IN INSTALLATION USING THE ATTACHED SUPPLY POWER PLUG breakerforthedes,mdoutWmclpluglnthechargerThiswillollowfor With the product,shows the proper location to drill pilot holes for the mounting sQ DETERMINE YOUR POWER RATING proper placement of the charger bracket screws. Insert the power plug into the power outlet(NEMA 14-50 receptacle). 1. Prior to astolling your charger,work with your electrician to determine the 2 Usingalevel,place the mounting templatein the locobonwhem you would amperage setting that best fits your home's electricol capacity.This may O ©AMPERAGE CONFIGURATION WITH THE ELECTRIFY AMERICA APR determine which[ X like to mount[hecharger. type of ms[ollotiOn you deed and the best location for 1.Download and iltstoll the Electrify America Opp on your smartphorle the charger. TIv ensure the powermrd has 3.Tope the templotem ploceand measure the height toensure the charger between31.5'(80cm)ond472'(120cm)obovetheground. (avalobleforiOSondAndmid) O agende curve buUsrots[re[ched 2.Ensure that W,-Fi rs turned on.Your does out need to be PICK YOUR LOCATION your phone NOTE.tdeform w[nproust emouMetl on Ofla[surface so that the bracket connected to a Wl-Fl network to connect your charger 1. Install the mounting bracket for the charger—measured from the bottom of the does not deform when properly secured. bracket between 31.5'(80 cm)and 472'(120 cm)abo,the ground. 3 Follow the instruction—the Opp to connect to your charger and configure 4.Installthemountingbrocketsecurelyto thewall, yourompemgesiating 5.When selecting a ocotlon tomsmll the charger,make sure that the charge olgning the holes in the bracket withthosemorketl Configuration Instanatiw Type cable coneasily connetttothe vehalewhen Rio parked.Keepinmindwhere on the wall,and wcure the mounting bracket Len g 16A Hardvnre Only prove the Vehicle's charging portm located(it Canes from vehicle to vehicle)and the tled screws or other fosteners that best /I V/3 how the vehicle will usually be parketl suit your specific insmllatbn needs. 32A Plug-In ar Honiwire B.The bestinstollation locations have enough space to easily store the cable 40A Plug-Ina Fbrtlwire and the charger Itself(or the holster provided with the charger),andwill rot ' interfere with pathways or other items in the garage ordrivewoy. ice I HOMESTAToN LEVEL 2 CHARGER INSTALLATION AND OPERATION RIANUAL I os •Installation with Hardwiring ® Thesemsrolb[ion instruc[ronsareintentled for certified ekettrcions.Only Q REMOVE THE PLUG CABLE 2.Cnmpinsuktedvmefertul¢sanwo hsupplypowerw,m,Includinggrwnd. qualified,certified electricionsshould hardwire the charger.Inoddition Follow the ferrule mainfacturer'sinstructions for crimping theferrules onto 1. Renw.ethemin pkg caWeby Do not loosen ng the screrscreo-rshowier final aril r to the chargerinstalb[bn ms[rucoons,folbw all federal,state,and local laws, PE)in the terminalbbck.Donut loosen the screwssecurlrg the terminal block each wire. I pre regulations,ordinances,codes.and Safety standards, tothe body I' Thmproduct must he properly grounded-either toagiounded,metol, 2.Thisploducthostwomeansofstrainrelief a metal bracket an the,menor permanent wiring systemaan equipment-grounding cantivc[orrun with ofthe body and a black nut on the outside ofthe body. I the supply poWercirouit conductors and connected tothe grounding ■■ tenminclontheproduot. 3.Loosen the left swain relief nuton the outside of the body. i e- Q REATTACH THE COVER CAUTION.To reduce the risk offire.connect only too circuit provided With 50 4.Rerrave the left strain relief snap from the-de of the body. `Y—�J 1. Secure the middle cover with the screws removed in step 1. amperes maaimumbanchcircuitovercurrentprotection(inaccordoncewith 5.Pull the cabledown through the cable gland and remove the swam ■ :,per Electrical Code,ANSIfNFPA 70)- 3.Inserteachferrule terminal mm,n the terminal block.ensun the wires are 2.Attach the cosment toverby placing the top edge ofthe cosmetic cows over relief nut from the plug cable. n9 kcO[ed Properly. the nuddlecoverantl gently pushing the cosmetic corer mro place.Loosen the Q REMOVE THE COSMETIC AND MIDDLE COVERS Q FLIP THE COSMETIC COVER UPWARD TO SEPARATE IT FROM THE BODY left SlNin reliefnut On the 0ut5de Of Me body.Secure the COverwith th¢T20 4.Tgben[ermiral bleak screwsto 33-40m-Ib(l.73-4.S N-M)of torque. TorA screws. 1. Remove thesceNi located at the bottom ofcosumenic cover by using the 1. Insert the new cable through the cable gland nut,men,ma,the body 5.Reinstall and[tighten the stroin relief stra p,p,enwdrg the wines one T20 Tm bit. ofthechdrger. not saained between the shamr 9,f,tmp and the terminal black. Q AMPERAGE CONFIGURATION WITH THE ELECTRIFY AMERICA APP 2.Tilt the cosmetic cover upward and separate it from the middle cover. NOTE:Theconck to si mustbe less Mo,6AWG. 6.Tighten the stroin relief nut tothecoble gland. 1 Download and mstoll the Electrify AmencooppoT your smonphone(Ovaloble 3.Renavethescrewsusing the T20Toni bit for105ond Andrbd). QQ MANUAL AMPERAGE CONFIGURATION(OPTIONAL) 2.Ensure that your phones W,-Fi IS turned on YolrphonedOesnptn¢edlabe 4.Place the mlddlecover on the bodyofthe charger by hanging the TWO hooks on the back ofthe middle cowlto the ledgesat the bottom ofthe body Ar Use this method only if required by locolcotle;O[herwiu,use the Ekctn(y connected tOa Wl-P rle[rAxk toconnect yourchargar. America Opp to set the amperage configuration 3.Follow the'instructions in theapptoconnect to your charger and configure S.Once the cover has been removed open the cable management clip on your omperagesetbng. the rght-hand side of the enclosure to release the LED cable attached to the 1. The amperage of the charger can be monually set by configuring the DIP cover.This will allow the cover to be hung on the bottom of the chorgen switches as shown at right.Ills always preferable to configure the amperage Q WI-FI SETUP(PLVG-IN OR HARDWIRED INSTALLATION) -- r wa the Elecaify Amencoopp. -1 I 1 To connect the charger toa WrFi network,download and Install the Electrify NOTE When mere is o differencebetween the DIP switch settings andthe America appon your smortphone(availoble forlOS and Android). seaingmthe Elecmfy Am,Rncaapp,thechargerwillissuechorgeot the 2,Fol n theinsVu *m,ntheowtosetupwith Wl-Ficonrtectbn. lowest amperage setting. During installation,be wreto use proper personal polecbveequipmen[ NOTE Nthe Wi F signal rs weak inconsistent or unovaibbeatme ins[alboon and do not touch wsmg terminals with your fingers. location,Werecommendmstaling a Wi F repeater tt range exivnde,to _ ... improve th¢Sgmlquality NOTE The C,c itbeakermustbert"dfw125%oftheehosen . operating auaent. Ta 1 101ESTA1101 LEVEL 2 CHARGES InSTALLATiaN All a rcvAnoN MANVA1 1 iI Operating Instructions ® O O Insert the vehicle connector into the charging Once the charger is plugged into the vehicle,the Charging is complete when the charger turns Press the thumb lever on the vehicle connector port on your electric vehicle.The charger will charger will begin flashing blue as it links with green once more. to disconnect from the vehicle. light up green when a connection is detected. the vehicle.When the charger is flashing solid blue, the vehicle is charging. The charger light will dim on the front and remain blue on the bottom for the entire charging session. `l NOTE. m User eM,-i ce yv rydepadingonth,a ti,gsofthe .6 � � vehicle being chargetl.Please conwl[yourvehicle's ovmers malwol ... formoreinformotion. 12 NonEsl�tlOe EEVEF3c11eeGFE —TA—iloxeeooe[vAT—Fle— 1 13 Charger Status © Understanding Status Indicator Patterns O Faults LED COLOR INDICATOR DESCRIPTION LED INDICATOR DESCRIPTION Iftheunitisdi ployingofoult IndICL light Or Hyau Oreexperien<mgdiff-ity charging,please review the Troubleshooting section below. If Me issue persists.pease Contact ElectMy America Customer Support a[ Nocolw O tbWer W Red,11Ia911 f. isHlghalOwlnlwtvoltage detected. (833)532-2778. Blue6green, O Statuslndicator O Indicator Definition OksmatingDM fast Rest" .Daane:Nr-test. Red,2fl.'1— Thechorgerisequipped with onintegroted LED ring to ollow for clear e is e is • e e Ground fault detected, nofthechargersstatus.Onlythebaftomsectonofthe LED Green solid rug Wi rola two llremoin.lI,M—Tscl(for oppnately —tin)since the lost LED PATTERN DErINITION Stoney- Red.3flashes userinteractwn. G—al connection error. e e e on BI-11-king 2secontlsbetweenflashes, Blue,fastflashing EVconrlecce l •e e e e• Red,4flashes Highinpuccurrenr detected. GREEN BLUE •e 1 isStandby Charging B�1°'alO1r Preparing to charge. — Fast flashing Less than l second between Noshes 411111111111,e>• Red.sfloslles OperatRgt yrperaturelimceNceetletl. Blw,sditl e e e e e Disconnecto—i[frompw�er. Charging. I SCcordM Ssetwrdsaff. � lflash •O •O Red,6f1011p installations— �GTee nZ w.flas hing ChorginghnlshedorstoPP d byuser e e e e e e Lneand—trolons—peed. lsecordon.lsecordoff1secoWo Ssecondsoff. RED 2fl.9— yellow.-Id Red,7flashes vehdecanmunlcotion error. Fwk Wi-Fi SI3Wp •O e 0 •O e 0 R Flrstsuccessfulconnectionto Wi-Fi. e e e e e e• I� � no Folb the some flashing portern as Retl said ssR-tilt—DNwralwv uummaDr 3.flashes Red,constant andtor Bashing Foultlndolnw. rMgwrrompewerrwraaMrecdnecta directlyobove. 411111111111 e e e See the Troubleshooting seconn. aRertoaecrcostR powercycNdreaargN. 14 1 NORESTATION LEREL a CIARCER INSTALLATION AND OPLRATIaN NArIUAL I IS Troubleshooting Specifications ISSUE CAUSE ncl.o. Model EA2R040JPA70.00 Com u ication Protocol OCPP7.6.JSONcvnpI.m Ask a certified electrician tocheck that the powerinputis connected correctly Measurements(HXiIi 15.75-x 866-x 6.75"(Opprok) AC Fault Monitw GFCl Integrated(20mA CCID for AC) and the power is within operating range of the unit. Status mdicatordoes Cable Length 24 Feet 50AUnit,C Cud Breaker(rnot provided with not illuminate. Chorgerlsnw receiving power. Disconnectthechoger(ron power soluceond reconnectafter lO selxxWstopower Shor[Circuiy cyclethecharger. Overload Protection local odesffo AGA operbraker s ing) Installation Type Fund Wall mounted bcdcodesfa properbrealut s¢mgJ If the problem persists,contact Customer Support w(833)532-2778. Weight 19.85bs.(approx.) Vehicle Communication Pilot Signd OEC 61851-1:2017) Check the EV battery is fullly charged. Enclosure Rating NEMAType3R UL2594.UL2231-1&2 FCC Pot 15, Indicator does not flash blue after Vehicle lottery isftAg charged. Check if the vehicle connect«isfWl tedto the EV Certifications CIL plugging in the vehicle connector. Plug is not properly connectetl. yinser loss 8 If the problem persists,contact Customer Support at(833)532-2778 Input Power 208V-240V AC Split Phase (3-Wire-L1,LZ Ground) -22°F to.122°F(-30°C to.SO'C) Operating Temperature Full Load Thermal Overload AC Plug-in Cord NEMA14-50 Protection Output power reduced Wait until the temporary enroris esolved and the Charger returns to normal condrtxM, w higher temperatures. typCally less than 10 seconds. Mox.Current Rating 40 Amps,configurable to 32A or 16A Indicator starts[oflash red Chargertwzdetec[etl an emw. Disconnect the charger from the vehicle,wart for the error to Clear,and reconnect the Storage Temperature -40"Fro 176°F(-40^Cto+80-q Chorgertothevehcle, Output Up[o9.6kW(240V AC®40A) while charging. Charger hasencoun[eretlafaWt Humidity 5%-95%(Non-Coclenvng) Ifthe error persists,disconnect the Charger from powersoume and reconnect after Power Metering Accuracy+/-1%ot Full Scale 10 seconds to power cycle the charger iftheenols not resolved,contoct Customer Support at(833)532-2778. Chorge Connector SAEJ1772 Charging Protocol SAEJ1772 Disconnect thecharger from the vehicle,wait fwthe emir toclear,and econnect thechargertothevenx:le. User Im.1f ce/HMI LED Light Ring md,cotortlu mmates red. ChErgerhasdefeUedafauh If the error perusts,Eiscor,"'tthe charger from power source and reconnect offer 10 seconds to power cycle the charger. Wireless WLANwith 24GHz b/g/n with WPA2 If the errwls not resolved,contact Customer Support at(833)5324778. re 1 MOMESTATIOM LEVEL t C MALE. MSTALLATIOM AMD OPE-TIOM MANUAL I Ir Moving, Transportation, Warrantg andStorage Customer Support—pro de more inf—uon on the terms of the Warranty.However,the follow.ng cores are not cov d by the Warranty. WARNING,lffV perrmwngorstorogeofthmdevwemayr ukmhre A_Defects or darnoge caused by any failure to irsstoll,operate,a core for or electnc shock. this product as spenhed,n NIs Install—and Operas—Manual and Do not lift orcony the charger by the cords.Donctall—nemnnector the Electrify Americoapp. mbletodrogmtouchthegroundwhenmovingthechorgm Thistlenoe 8,Costs anal damage mused by repair work which has not been node s hould be stored n a d,y location that's between-40'F and♦176'F by on ElecVdy Amenca-opproved outhon2ed spec ofist or electnoon. Cleaning Disposal The charger may Only be cleaned-h water;the use of lukeWonn raterelec m recommended.Do not use cleaning agents canto n,ng sdvents.Dry the Thecharger is an electrical device Followall federal,state,and trify charger with a clean paper towel or softclath prior to— locol laws,regulobons,ordlnonces,and safety standards regarding Donor—'NWoduct,f the poWe,,card orthe electm veh,clecoble,s frayed, d,sposol of this device. • hosbrokennsulatlm showsonymhervgnsofdonoge DonotusethLs me prmuttlfthe enclosure or the electric v cle connector Is broken,cracked. open,or shows o ng other ndcatgn of damage. Fmfu 0,eros9stance,contaclusat(833)532-2778. 1e 1 101ESTAT101 LEVEL 2 C11"ER A, v electrify home Version: 1.0.7 Issue Date: August 31, 2021