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HomeMy WebLinkAbout51566-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 51566 Date: 01/16/2025 Permission is hereby granted to: Perham C L Irry Trt 585 Moores Ln N Greenport, NY 11944 To: install roof-mounted solar panels to existing single-family dwelling as applied for. Premises Located at: 585 Moores Ln N, Greenport, NY 11944 SCTM#33.-2-36 Pursuant to application dated 11/18/2024 and approved by the Building Inspector. To expire on 01/16/2027. Contractors: Required Inspections: Fees: SOLAR PANELS $100.00 ELECTRIC -Residential $125.00 CO- IDENTIAL $100.00 Total $325.00 u lding Inspector�� N TOWN OF SOUTHOLD—BUILDING DEPARTMEN 0� ,w Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 " Telephone (631) 765-1802 Fax (631) 765-9502 htt s://ww .southoldtownn' . owe 'v'0-4 Date Received APPLICATION FORBUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: ,2 V OWNER(S)OF PROPERTY: TM# 1000- Name: Ca ife � nil Project Address: 1J °Ar 1 Phone#: �+� c�J Email: Mailing Address: CONTACT PERSON: Name: ti 1 CC Mailing Address: p- 7�'/ � e S4 Q Phone#: .- Email: DESIGN PROFESSIONAL INFORMATION: Name: . / Mailing Address. _ mai': Phone#: , 6 - E �/CJf�! CONTRACTOR INFORMATION: Name: Mailing Address: !'-7 w �J 2 f Phone#: , ? Email: Z. /�S C�� ,+ DESCRIPTION OF PROPOSED CONSTRUCTION El New Structure ❑Addition eration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other ,- $ Will the lot be re-graded? Dyes ❑No Will excess fill be removed from premises? Dyes ONO 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? Dyes ❑No IF YES, PROVIDE A COPY. Wlfheck Box After : The owner/contractor/design professional Is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and In building(s)for necessary inspections.False statements made herein are punishable as a Gass A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print name):111(ZdI C«C/017 -rued Agent ❑Owner Signature of Applicant Date: 1 STATE OF NEW YORK) SS: COUNTY OF ) l (t being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the (Contractor,Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief; and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this ) day of POVO4 20 "( PROPERTY OWWR AUTHORIZATION (Where the applicant is not the owner) I �" residing at r � ,Le do hereby authoriz _ I k 9 to apply on my behalf to the Town of Southold Building Department for approval as described herein. .+ 4 o Owner's Signature " Date �Gt-7dICe- t�harl Print Owner's Name ' 2 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 amesh@southoldtownny.gov -- seand southoldtownn . ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 11-15-24 Company Name: SUNRUN INSTALLATIONS Electrician's Name: SAMY MOUNAS License No.: ME-33878 Elec. email:LI PERM ITS@SUNRUN.COM Elec. Phone No: 631-741-0378 01 request an email copy of Certificate of Compliance Elec. Address.: 177 CANTIAGUE ROCK ROAD WESTBURY NY 11590 JOB SITE INFORMATION (All Information Required) Name: CANDICE PERHAM Address: 585 Moores Ln N Greenport NY USA 11944 Cross Street: Phone No.: (631) 255-5454 Bldg.Permit#: 6 669 email:culleyclm@yahoo.com Tax Ma District: 1000 Section: 33 Block: 2 Lot: 36 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): INSTALLATION OF ROOF MOUNTED SOLAR PANELS. (14) 5.740KW Square Footage: Circle All That Apply: Is job ready for inspection?: YES ✓ NO Rough In Final Do you need a Temp Certificate?: 1-1 YES NO Issued On Temp Information: (All information required) Service Size1 Ph3 Ph Size: A #Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground Eloverhead # Underground Laterals 1 02 D H Frame Pole Work done on Service? Y N Additional I nformation: PAYMENT DUE WITH APPLICATION Suffolk County Dept. of Labor, Licensing Consum er Affairs HOME IMPROVEMENT LICENSE Name PAUL JOYCE Business Name Sunrun Installation Service Inc This certifies that the bearer is duly licensed License Number H-54140 by the County of suffolk Issued : 09/23/2014 W T. RO-8 e"rk Expires,., 09/01 /2026 uom mission er aajldx iauolssiwwoO SZOZILOIOL 3 -06-VAQ � EOOZ/LML panssl 8t8££-3N jagwnN asuaoi, ypyns jo Alu^oo ayi Fq pasuaail Ainp s jajeaq 'ONI aye tey1 say yao si,; S33IM3S NOI1V-nV1SNl NnaNns aweN ssauisn8 SVNnoN Aimvs aweN 3SN3011 IVOldiO313 i:J31SV" sne.UV jawnsuoo v Bulsueorl'.Ioge3 ;o-;dap iyunoo)glogng ,y f err SUNRINC-02 IWANQ CERTIFICATE OF LIABILITY INSURANCE [�DATE►.. --- 024 " THIS CE RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement s PRODUCER License#OC36861 c2bpcT Walter Tanner Alliant Insurance Services,Inc. PHONE FAX 560 Mission St 6th FI AfC, I o,Est: AIC,N San Francisco,CA 94105 Walter.Tanner e11Ii'ant COM I SURER s AFFORDING COVERAGE NAIc +r I SURER A:EVan stop Inaurancl a'm an 35378 INSURED I..ggRERe,Zurich American Insurance Company 16535 Sunrun Installation Services,Inc INsuRERc:American Zurich Insurance Com an 40142 _w 775 Fiero Lane,Suite 200 Ph#805-540-7643 INSU,RErr.D San Luis Obispo,CA 93401 INSURER.E:. INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL..�SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1 000,000 CLAIMS-MADE �OCCUR MKLV5ENV104843 10/1/2024 10/1/2025 DAMAGE TO RENTED � 000,00'0 M D EXP An, one erson 51000 PERSONAL B ADV INJURY 20000010 GEN"L AGGREGATE LIMIT APP IES PER: GENERAL AGGREGATE 2,000,000 �X POLICY JECT LOC PROD CT COMPIOP A ,000,000 _ Xl�O'TIIEFt,Retention:$200,000 Per Project Agg $ 51000,000 COMOINE3 SINGLE LIMIT 2,000,000 IS AUTOMOBILE LIABILITY IANY AUTO BAP614287703 10/1/2024 10/1/2025 BODILY INJURY Per rson $ OWNED SCHEDULEDAgU��TOS ONLY AUU�TO��S�tW ,�q7 BODILY INJURY(Peraccident $ AU" ONLY AN8%glNf YAMAGdOadCo1I•NrrvtOcrvarad --j L eranCldenC $ ,Wet . Ix iability Ded.: 1,000,0'00 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I J RETENTION$ _ PER OTH- $. C WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY ""' ANY PROPRIETOR/PARTNERIEXECUTIVE P C614287603 10/1/2024 10/1I2025 E.L.EACH ACCIDENT $ 1,000,000 ERtlM'MBEREXCLUDED? 9N N/A 1,000,000 AN L andatpay k'n NH) E,L.DISEASE-EA EMPLOYE If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEMCLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers'Compensation Policy WC614281603 Deductible:$1,000,000. Evidence of insurance CERTI'FICA E HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NEW Workers' CERTIFICATE OF TATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured unrun Installation Services,Inc 415-946-7500 75 Fiero Lane,Suite 200 Ph#805-540-7643 San Luis Obispo,CA 93401 1c.NYS Unemployment Insurance Employer Registration Number of Insured 50-86426 4 ork Location of Insured(Only required if coverage is specifically limited to certain locations in New Yo►ic State,i.e.,aWrap-Up Policy) 1d.Federal Employer Identification Number of Insured or Social Security Number 77-0471407 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) American Zurich Insurance Company Town of Southold 3b.Policy Number of Entity Listed in Box"la" 3095 Route 25 Southold,NY 11971 WC 6142876-03 3c.Policy effective period 10/01/2024 to 10/01/2025 3d.The Proprietor,Partners or Executive Officers are ❑ included.(only check box if all partners/officers included)all ®excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"T'insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Susan B. Kendziora (Print narne of authcri r deep sentativa or licensed agent of insurance carrier) - r C Approved by: (Signature) (Date) Title:Vice President-Operations Services Telephone Number of authorized representative or licensed agent of insurance carrier:800-382-2150 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www.wcb.ny.gov r R workers' YOrrlt CERTIFICATE OF INSURANCE COVERAGE ... 5�4�r Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Sunrun Installation Services Inc. 202 Commerce Dr., Ste. 7 Moorestown, NJ 08057 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) 77-0471407 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) The Prudential Insurance Company of America Town of Southold 53095 Route 25 3b.Policy Number of Entity Listed in Box 1a Southold, NY 11971 1 CG-52830-NY 3c.Policy Effective Period 11112024 To 1,2/31/2024 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 describeda§091ve, - Date Signed January 02, 2024 By (Signature of insurance carrier's arrier's authorized representative or NYS licensed insurance agent of that insurance carrier) Telephone Number 215-658-7318 Name and Title Carolynn Smith -VP Contracts IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If Box 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 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 13,90 -5200. PART 2.To be completed by the NYS Workers'Compensation Board(only if Box 4B,4C or 5113 have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone 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-120.1.insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) I j I111111111111111111111111111111111111111111IIIII DB-120.1 (12-21)