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HomeMy WebLinkAbout51579-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#: 51579 Date: 01/22/2025 Permission is hereby granted to: Wayne Sailor PO BOX 317 Mattituck, NY 11952 To: install additional roof-mounted solar panels to the existing system on the single-family dwelling as applied for. Premises Located at: 2730 Grand Ave, Mattituck, NY 11952 SCTM# 107.-2-8 Pursuant to application dated 11/21/2024 and approved by the Building Inspector. To expire on 01/22/2027. Contractors: Required Inspections: Fees: SOLAR PANELS $100.00 ELECTRIC -Residential $125.00 CO-RESIDENTIAL $100.00 Total S325.00 umldng Inspector yF�l „ TOWN OF SOUTHOLD—BUILDING DEPARTMENT y Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax (631) 765-9502 littps://www.soutlioldtowatM.gov .gate.Received APPLICATION I L I I ; r Office Use Only PERMIT NO. ' Building Inspector: s , n 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: i l I is . OWNER(S)OF PROPERTY: Name:Wayne Sailor SCTM#1000� - mm Project Address:2730 Grand Ave. Mattituck, NY 11952 Phone#:(631) 300-8745 Email:wesailor@hotmail.com Mailing Address:2730 Grand Ave. Mattituck, NY 11952 CONTACT PERSON: Name: Evelyn Polvere/Sunation Solar Systems Mailing Address: 171 Remington Blvd., Ronkonkoma, NY 11779 Phone#: 631-750-9454 ext 346 Email:permitting@sunation.com DESIGN PROFESSIONAL INFORMATION: Name:Michael Dunn, Graham and Associates Inc,. Mailing Address:256A Orinoco Drive, Brightwaters, NY 11718 Phone#:631-665-9120 Email:glenn@grahamassociatesny.com CONTRACTOR INFORMATION: Name:Scott Maskin/Sunation Solar Systems Mailing Address:171 Remington Blvd., Ronkonkoma, NY 11779 Phone#: 631-750-9454 Email:permitting@sunation.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ®Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ 13410&1 V Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes RNo w '' v� PROPERTY INFORMATION Existing use of property:Residential Intended use of property: Residential Zone or use district in which premises is situated; Are there any covenants and restrictions with respect to this property? ❑Yes BNo IF YES, PROVIDE A COPY. Checker Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. APPUCATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law. Application Submitted By(print name): ott Maskln BAuthorized Agent ❑Owner Signature of Applicant: Date: )) g �. � I ) �� STATE OF NEW YORK) SS: COUNTY OF Suffolk Scott Maskl n being duly sworn,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 `Y — ,-:J- / rj day of E Inn L& 204 otary Public LYNN VITA isiotery FublP c, State of Nerw York {"eolstr:'lk',un ?�Gb"6�R"S.5068 99 GuI-ydifi ," irs Suffi.,)lk County ( PROPERTY OWNER AUTHORIZATION fly an ja:,jjission ExpiresOct.28,20 ? (Where the applicant is not the owner) Wayne Sailor residing at 2730 Grand Avenue Mattltu do hereby authorize Scott Maskin to apply on my ehalf the can f Southold Building Department for approval as described herein. I(, II' 1� Ow Sig Lure Date Wayne Sailor Print Owner's Name 2 ' F BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 .q Southold, New York 11971-0959 a, a Telephone (631) 765-1802 - FAX (631) 765-9502 x- roge[r@southoidtow,nny.gov seared southoldtow nn y ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: SUNation Solar Systems, Inc Name: Scott Maskin License No.: 33412-ME email permittin2@sunation.com Address: 171 Remington Blvd. Ronkonkoma NY 11779 Phone No.: 631-750-9454 JOB SITE INFORMATION (All Information Required) Name: Wayne Sailor Address: 2730 Grand Ave. Mattitudk NY 11952 Cross Street: Phone No.: 631 300-8745 Bldg.Permit#: 5 email: wesailor hotmail.com Tax MaE District: 1000 Section: 107 Block: 2 Lot:8 BRIEF DESCRIPTION OF WORK (Please Print Clearly) Ipstg1latigp of solar panels - flat on rQQf- add-on ta exiating $Qlargjystem 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 #Meters Old Meter# New Service - Fire Reconnect- Flood Reconnect-Service Reconnected - Underground - Overhead #Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION Request for Inspection FormAs �_1—N�t workers' CERTIFICATE OF INSURANCE COVERAGE ESTATE 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, la.Legal Name&Address of Insured(use street address only) 1b. Business Telephone Number of Insured SUNATION SOLAR SYSTEMS 631-750-9454 171 REMINGTON BOULEVARD RONKONKOMA, NY 11779 1 c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,Wrap-Up Policy) 753118816 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold 54375 Route 25 3b.Policy Number of Entity Listed in Box"1 a" PO Box 1179 DBL631187 Southold, NY 11971 3c.Policy effective period 10/01/2024 to 09/30/2025 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: RI A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. 0 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. /4343� Date Signed 10/1/2024 By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Leston Welsht 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 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 sox 413,4C or 513 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) 11 111111111111 1111111111111111111111111 1�1 DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 01I25I2024 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 ORALTER 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 COM NTACT Shelby Glerd�al Christensen Group PA (952)653-1dfl xN (95 )653-1100 9855 West 78th Street,Ste 100 guerd'I,INSIC# Eden Prairie MN 55344 James River Insurance Company 203 INSURED Crum&Forster Specialty Insurance Company 44520 SU Nation Solar Systems,Inc, INSURERC: Ascot Insurance Company 23752 171 Remington Blvd INSURER D: INSURER E Ronkonkoma NY 11779 INSURER F: COVERAGES CERTIFICATE NUMBER: 12/01/23-24 SUNation 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. TYPE OF INSURANCE POLICY NUMBER '.MMJO!l YY F MMIDD LIMITS LTR X'COMMERCIAL GENERAL LIABILITY INSO wVD EACH OCCURRENCE $, 1,000,000 "*w DAMAGE TO RENTED b0"O0Id CLAIMS-MADE ❑X OCCUR PRE,MI'SF.,S Eta purx'nt.� $ MED EXP(Any one person) S Excluded. A P0000000282 12/01/2023 12/01/2024 PERSONALBADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY PRO PRODUCTS-COMP/OPAGG $ 2,000,000 PRO LOC OII HER` AUTOMOBILE LIABILITY GOM B1Nl„O SaNG'Le a.IM'VT $ 1,000,000 Ea ac�xdant' . XANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED 133-756069-5 12/14/2023 12/01/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS - A,M'A Paaaccidea�tadent d� HIRED NON-OWNED d ROP c $ AUTOS ONLY AUTOS ONLY X UMBRELLALIAB X:OCCUR EACH OCCURRENCE $ 3,000,000 A IEXCESS LIAB I CLAIMS-MADE P0000000283 12/01/2023 12/01/2024 AGGREGATE s 3,000,000 DED I X RETENTION S U $ WORKERS COMPENSATION PER OTH- 'AND EMPLOYERS'LIABILITY YIN STATUTE '. ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E,L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? El(Mandatory in NH) E.L,DISEASE-EA EMPLOYEE $ _ IF yes,describe under DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT $ Newly BuilUAcqur Bldgs $500,000 Property/Builders Risk C IMMA2310001919-01 12101/2023 12/01/2024 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached 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. 54375 Main Road AUTHORIZED REPRESENTATIVE i Southold NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD N Y S I F PO Box 66699,Albany,NY 12206 New York State Insurance Fund I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A A 753118816 " GCG RISK MANAGEMENT INC AN NFP COMPANY 100 CHURCH STREET-SUITE 810 * NEW YORK NY 10007 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SUNATION SOLAR SYSTEMS INC TOWN OF SOUTHOLD 171 REMINGTON BOULEVARD 54375 ROUTE 25 RONKONKOMA NY 11779 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z 2160 670-2 43689 01/01/2024 TO 01/01/2025 12/11/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2160 670-2, 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:/IVVWW.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 THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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 STATE INSURANCE FUND DIRECTOR,I(SUiRANCE FUND UNDERWRITING VALIDATION NUMBER: 601025760 11111111111 II IIHillIIIIIIIIIHill illHill Hill Hill IIIIIIIIIIIIIIIIIIIIIIIIIIIII I II I�II N 00000000000122055844 Forth WC-CERT-NOMNT Version 3(08/29/2019)[WC Paliry-21606702] U-26.3 64 [00000000000122055844][0001-000021606702][##Z][16282-08][Cert_NoP-CERT 1][01-00001] i+w�j�Yli�,V ',dIB I1" {01yi1'm I Iw Suffolk County Dept. of ,1 Labor, Licensing & Consumer Affairs MASTER ELECTRICAL LICENSE Name SCOTT A MASKIN Business Name SUNATION SOLAR SYSTEMS INC This certifies that the bearer is duly licensed License Number ME-33412 by the County of suffolk Issued: 06/24/2003 R Pr"&. Expires: 06/01/2025 Commissioner Suffolk County Dept. of u r Labor, Licensing & Consumer Affairs HOME IMPROVEMENT LICENSE Name SCOTT MASKIN Business Name SUNation Solar Systems Inc This certifies that the bearer is duly licensed License Number H-44104 by the County of suffolk Issued: 03/06/2008 W�nz, T. Rogeory Expires: 03/01/2026 Commissioner