Loading...
HomeMy WebLinkAbout50225-Z g�fFO(�c Town of Southold =off oGy� 5/13/2024 P.O.Box 1179 W ; 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45175 Date: 5/13/2024 THIS CERTIFIES that the building ELECTRICAL Location of Property: 885 Orchard St,New Suffolk SCTM#: 473889 Sec/Block/Lot: 117.-5-41 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/17/2024 pursuant to which Building Permit No. 50225 dated 1/17/2024 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: electric service replaced after fire The certificate is issued'to Gonzalez,Ubaldo of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 50225 04/26/2024 PLUMBERS CERTIFICATION DATED Authorized Signature J fat,(. TOWN OF SOUTHOLD moo a. BUILDING DEPARTMENT TOWN CLERK'S OFFICE oy • o� SOUTHOLD, NY plpl��y� 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#: 60225 Date: 1/17/2024 Permission is hereby granted to: Gonzalez, Ubaldo 885 Orchard St PO BOX 248 New Suffolk, NY 11956 1 To: Electric - 200amp OH Service Reconnect post Fire 1 At premises.located at: 885 Orchard St, New Suffolk SCTM #473889 Sec/Block/Lot# 117.-5-41 Pursuant to application dated 1/17/2024 and approved by the Building Inspector. To expire on 7/18/2025. Fees: ELECTRIC $100.00 Total: $100.00 Building Inspector OF SO(/T�ol Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G Q Southold,NY 11971-0959 .�o • �o sean.devlinl-town.southold.ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Ubaldo Gonzalez - Address: 885 Orchard St city:New Suffolk st: NY zip: 11956 Building Permit#: 50225 Section: 117 Block: 5 Lot: 41 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: All Ways Electric License No: 4062M SITE DETAILS Office Use Only Residential X Indoor X Basement Service X Commerical Outdoor X 1 st Floor Pool New X Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service t ph X Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel 200A A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 4'LED F1 Exit Fixtures Sump Pump Other Equipment: 200A 40 Circuit Panel , New Meter Socket Notes: Service Replaced After Fire Damage Inspector Signature: Date: April 26, 2024 S.Devlin-Cert Electrical Compliance Form �0�2 �atj or pF SO(/l # # TOWN OF SOUTHOLD BUILDING DEPT. "���►�N 631-765-1802 INSPECTION- FOUNDATION 1ST/ REBAR [ ] 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 r Suffolk County Dept.of Licensing censin 9&Consumer Affairs MASTER ELECTRICAL LICENSE ;+ Name RICHARD ESPOSITO This certifies that the Business Name nearer is duly licensed ALL WAYS ELECTRIC CORP 3y the County of Suffolk Rosalie Drago License Number:ME-764 Commissioner Issued: 12/01/1972 Expires: 12/1/2024 roRK Workers' CERTIFICATE OF INSURANCE COVERAGE raroa. Campe�tsation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured ALL WAYS ELECTRIC CORP. 262 ORINOCO DRIVE 6316660477 BRIGHTWATERS, NY 11718 Work Location of Insured(Only required if coverage is specificallylimited to 1c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-Up Policy) or Social Security Number 11-2300137 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier Entity Being Listed as the Certificate Holder) S FFOLK COUNTY DEPT OF LABOR, Standard Security Life Insurance Company of New York LICENSING & CONSUMER AFFAIRS 3b.Policy Number of Entity Listed in Box I P.O. BOX 6100 61621-00 HAUPPAUGE, NY 11788-0099 3c.Policy Effective Period 5/1/2003 to 1/14/2025 4. Policy provides the following benefits: 0 A.Both disability and Paid Family Leave benefits. B. Disability benefits only. C. Paid Family Leave benefits only. 5. Policy covers: 0 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 des d above. Date Signed 1/16/2024 By (Signature of insurance carrier's authorilad representative or NYS licensed Insurance agent of that insurance carrier) Telephone Number (212) 355-4141 NameandTitle SUPERVISOR-DBL/POLICY 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 413,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220, Subd. 8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'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 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(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note: Only insurance carriers licensed to write NYS disability and Paid Family Leave benerrts insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) 11111111 11111111 Additional Instructions for Form D13-120.1 By signing this form, the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in Box I 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 A 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 „2 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 F< 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. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding 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. ypyyl.�'S. �; f• f (, DB-120.1 (12-21)Reverse NYSIF New York state Insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) 0 � NAAAAA 112300137 ALL WAYS ELECTRIC CORP 262 ORINOCO DRIVE BRIGHTWATERS NY 11718 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ALLWAYSELECTRIC1@AOL ALL WAYS ELECTRIC CORP SUFFOLK COUNTY CONSUMER AFFAIR 262 ORINOCO DRIVE PO BOX 6100 BRIGHTWATERS NY 11718 HAUPPAUGE NY 11718 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G 511 578-7 1 780090 11/01/2023 TO 11/01/2024 1/16/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 511578-7, 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:/MWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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 STAT SUR NCE FUND ACl OR®® CERTIMCA►TE ®F LIABILITY INSURANCE DATE3/23/2023 1, hao•� 23/2023 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 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 ICON ACT NAME: DEBBIE L. AARON L. GROBER AGENCY, INC. PHONE (516)872-9500 FAX A/C No Ext: AIC,No; (516)872-2021 ONE SUNRISE PLAZA E-61AIL DLEWIS@GIAINS.COM VALLEY STREAM, NY 11580 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# 1'N-.;"RF:P--MERrHANTS MUTUAL INS. GROUP 23329 INSURED INSURERS:ACCIDENT FUND INS CO OF AMERICA 10166 ALL WAYS ELECTRIC CORP.262 ORINOCO DRIVE INSURER C: INSURER D: BRIGHTWATERS, NY 11718 INSURERE: 631-666-0477 FAX: 631-666-0479 INSURER F: COVERAGES CERTIFICATE NUMBER:o000ORMASTER - ALL COV 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 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 ADDL SUER LTR TYPE OF INSURANCE I POLICY NUMBER I IMM/D POLICY DIYYYY MM/DU/YYYY LIMITS A I X I COMMERCIAL GENERAL LIABILITY CMP9140172 02/08/2023 02/08/2024 EACH OCCURRENCE S 1,000,000 CLAIMS-MADE a OCCUR DAMAGETO PR ES(EaRENTED rence $ 100,000 X XCU, HOSTILE FIRE COV. MED EXP(Any one person) S 15,000 X CONTRACTUAL LIABILITY PERSONAL&ADVINJURY S 1,000,000 GENIAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO ❑ � JECT LOC PRODUCTS-COMPlOPAGG S 2,000,000 JOTHER: S -d AUTOMOBILE LIABILITY CAP9266574 07/17/2022 07/17/2023 COMBINED SINGLE LIMIT $ 1,000,000 Ea accldenl 1xx ANYAUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident)AUTOS S HIRED AUTOS X NON-OWNEDPROPERTY DAMAGE Per accident is $ A X UMBRELLA LIAB X OCCUR CUP9144306 02/08/2023 02/08/2024 EACH OCCURRENCE S 1,000,000 EXCESSIJAB CLAIMS-MADE AGGREGATE S 1,000,000 DIED I X I RETENTION S 10,000 1 1 1 S WORKERS COMPENSATION PER UTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORMARTNEWEXECUTIVE S OFFICER/MEMBER EXCLUDED? ❑N/A E.L.EACH ACCIDENT if yes,(Man In NH) datory E.LDISEASE-EAEMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY UMI7 S A EQUIPMENT INSTALLATION COVERAGE CMP914D172 02/08/2023 02/08/2024 LIMIT: $15,000 B EXCESS UMBRELLA LIABILITY UXLD001985 01 03/01/2023 02/08/2024 OCCVRRENCEIAGGREGATE 4,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) ELECTRICAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SUFFOLK COUNTY DEPT. OF LABOR, LICENSING THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN & CONSUMER AFFAIRS ACCORDANCE WITH THE POLICY PROVISIONS. P. O. BOX 6100 HAUPPAUGE, NY 11788-0099 AUTHORIZED REPRESENTATIVE Aaron Grober/DEBBIE '"—=l ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Lnlengr c�ufF01,{- BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD y z Town Hall Annex- 54375 Main Road - PO Box 1179 *► Southold, New York 11971-0959 wd9,�2 Telephone (631) 765-1802 - FAX (631) 765-9502 jamesh cDsoutholdtownny_•-gov- seand(a-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INF RMATION (All Infoniaation Required) Date: / 7/&7z y Company Name: A I I Y"f N5 I<-4y►C, Electrician's Name: o p Q• License No.: IMG- 40(o2 E- 6-7(e L CS �c Elec. Phone No: (�3) . (Q(� • Oq- 7 ❑I request an email copy,of Certificate of Compliance Elec. Address.: JOB SITE INFORMATION (All Information Required) Name: . Z Address: 4 eW Ja k- Ny 11 9.57 Cross Street: Phone No.: 6 3 f 0 BIdg.Permit#: email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): e yu,p r- 54 G'f'Y lr� 4`r' re—cov,-^e. 4` I�1r VY Square Footage: Circle All That Apply: o VVat aA-" _ r• ewjo Is job ready for inspection?: - VYESF-1 S❑ NO ❑Rough In , ❑ Final Do you need a Temp Certificate?: NO Issued On eal 4. 40to1 ! Temp Information: (All information required) Service Size❑✓�1 Ph❑3 Ph Size: 0200 A #Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect Service Reconnect❑Underground E]d/verhead # Underground Laterals D 1 2 H Frame Pole Work done on Service? N Additional Information: PAYMENT DUE WITH%APPLICATION ' 1 (-7 194 Dual � I Ob% re c* PERMIT p Address Switches Outlets GFI's Surface Sconces H H's UC Lts Fans Fridge HW Exhaust Oven WAD smokes DW Mini Arbon Micro Generator -ombo Cooktop Transfer aC AH Hood Service Amps Have Usec, .pedal: o m m e n t s BUILDING DEPARTMENT-Electrical Inspector H t TOWN OF SOUTHOLD ®� ��✓ Town Hall Annex-54375 Main Road-PO Box 1179-Southol;d, NY 11971-0959 Telephone(631) 765-1802 Temporary Certificate # Date Bch �� zo2�+ Customer Name ¢. Electrician Name 1441 WA �Jec Co Address $$S Oyrjjarj , I Phone (sb I. (,Q(j': 7 e-mail e-mail Phone License# Me Size A Phase 1 Overhead Underground #of Meters Remarks #of Underground Laterals 1 2 New "H" Frame or Pole H P Fire Reconnect Was work done on Service? N Flood Reconnect Old Meter# Service Reconnected Application for electrical service equipment is on file with the town of Southold.On the applicant's notification that this installation is complete,the town will conduct a premises inspection of the service equipment. This verification is val' da the date above. Authorized by U 1 ' 07-30-10; 12:27 6660479 # 1/ 2 pf SO�Tyo ' Town HA Annex / / Tcirphone.(631)765-1502 54,175 Main Road CA x 631)765-g502 P.O.Box 1179 G x rooer.richertt_ o�yn_s0U_tn0Id.nV.Us Soudiold,NY 11971.0959 ���DUNTI,N� BUILDING DEPAICIMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: J CiS&}4 *1,0 l \a, Date: Company Name: `tom 51-1G aov, Name: - License No.: e� — d 6-)— Address: 3- U P-A\NJ DCp Phone No.: � JOBSITE INFORMATION: (`Indicates required information) "Narne: b -Z - ------------------------ - *Address: *Cross Street: *Phone No.: Permit No.: Tax Map District: 1000 Section: '1 Block:�_ Lot: *'BRIEF DESCRIPTION OF WORK(Please Print Clearly) (Please Circle All That Apply) *Is job read for inspection: 1 Y P E / NO &°pf .. Rough In f/ Final *Do you need a Temp Certificate: E / NO �0� 0-� So-Iry LC Temp Information doe J Y l afp -�Y�,• 'Service Size: 1 Phase 3Phase 100 150 20 ) 300 350 40.0 Other *New Service: Re-connect Underground Number of Meters Change of Service Overhe d Additional Information: PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form