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HomeMy WebLinkAbout47311-Z o�*of soulyo� Town of Southold * * P.O. Box 1179 53095 Main Rd uxrr. �, Southold, New York 11971 � " CERTIFICATE OF OCCUPANCY No: 45813 Date: 12/10/2024 THIS CERTIFIES that the building GENERATOR Location of Property: 4725 Orchard St Orient, NY 11957 SecBlock/Lot: 27.-2-2.6 Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 12/09/2021 Pursuant to which Building Permit No. 47311 and dated: 01/10/2022 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: accessory generator as applied for. J The certificate is issued to: James Haag Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: 47311 ll/1/2024 PLUMBERS CERTIFICATION: 0 ut o ed Signature 1la-FSO& TOWN OF SOUTHOLD BUILDING DEPARTMENT • TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT RENEWED (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 47311 Date: 01/10/2022 Permission is hereby granted to: Renewal Date: 09/03/2024 James F Haag Jr PO BOX 28 Orient, NY To: Premises Located at: 4725 Orchard St, Orient, NY 11957 SCTM#27:2-2.6 Pursuant to application dated 12/09/2021 and approved by the Building Inspector. To expire on 07/11/2025. Contractors: Required Inspections: Fees: Renewal Fee $117.50 Total S127.50 Building Inspector o�S�FFnt�coG TOWN OF SOUTHOLD BUILDING DEPARTMENT y x 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#: 47311 Date: 1/10/2022 Permission is hereby granted to: Haag Jr, James PO BOX 28 Orient, NY 11957 To: install generator as applied for. At premises located at: 4725 Orchard St., Orient SCTM # 473889 Sec/Block/Lot# 27.-2-2.6 Pursuant to application dated 12/9/2021 and approved by the Building Inspector. To expire on 7/12/2023. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CERTIFICATE OF OCCUPANCY $50.00 Total: $235.00 Building Inspector so�ryol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 sean.deviin(cD-town.southold.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: James Haag Jr Address: 4725 Orchard St city:Orient st: NY zip: 11957 Building Permit#: 47311 Section: 27 Block: 2 Lot: 2.6 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Standard Electric Group License No: 43098ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Commerical Outdoor X 1st Floor Pool New X Renovation 2nd Floor Hot Tub Addition Survey Attic Generator 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 CO Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch In UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 4'LED Exit Fixtures El Sump Pump Other Equipment: 20kW Generator w/200A Transfer Switch Notes: Generator Inspector Signature: Date: November 1, 2024 Copy OF SOUIyo� # TOWN OF SOUTHOLD.BUILDING DEPT. couffm 631-765-1802 INISPECTION [ ] FOUNDATION 1ST/ REBAR. [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL 6 [ ] FIREPLACE & CHIMNEY - [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] -FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL .REMARKS: cp�--lgtoof-& 5W Cbwo, Livit') DATE 9 ANSPECTOR . W # TOWN, OF SOUTHOLD BUILDING DEPT. courm��' 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ]- FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ]. FIREPLACE .& CHIMNEY [ ] FIRE SAFETY INSPECTION [ .] FIRE RESISTANT CONSTRUCTION [ j FIRE RESISTANT PENETRATION [ ] ELECTRICAL"(ROUGH) l }ELECTRICAL (FINAL) [. ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: Ci gam°-�< mcf—k 11G ou- G an 11 ec��1-f 1 J—e Q'�' DATE INSPECTOR i November 1, 2024 Southold Town Building Department Town Hall Annex 54375 Route 25 Southold, NY 11971 �F:tewCa w e leiorn o'f CO for Generator at47r25��Jrc15 a,rcrtree rin�t Dear Building Department, On September 24, 2024, two Southold Town Building Department Inspectors visited our home at 4725 Orchard Street in Orient to inspect our generator-- to complete the CO process for the generator. Their inspection reports requested a couple of minor adjustments. We have made the requested changes, as verified in the provided photos (see attached, 2 pages dated 10/30/24). Please let us know if anything further is needed to complete and issue the CO for our generator. Thankyou, Jame F. Haag 4725 Orchard Street P.O. Box 28 Orient, NY 11957 631-902-6452 Q jamesfhaag@yahoo.comflil NOV 1 2024 �43�iwei r GUi'}iold James Haag 4725 Orchard Street, Orient, NY 11957 10130124 Page 1 of Photo shows fix made in response to 9/24/24 Southold Bldg Dept inspection for Generator CO TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/RESAR [ ] ROUGH PLEIG. [ j FOUNDATION 2ND [ ] INSULATION/CAULKING i [ ] FRAMING/STRAPPING [ ] FINAL I I [ ] FIREPLACE&CHIMNEY [ j FIRE SAFETY INSPECTION -I [ j FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL(ROUGH) J.J--ELECTRICAL(FINAL) , [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL \ REMARKS: f VG C Qr c�n ec Or C'rg�0/ DATE'. INSPECTOR v v 1 r F.« James Haag 4725 Orchard Street, Orient, NY 11957 10130124 Page 2 of Photo showing fix made in response to 9/24/24 Southold Bldg Dept inspection for Generator CO ®*� TOWN OF SOUTHOLD BUILDING DEPT. ` v 631 765 1802 !� •�rgi INSPECTION [ ] FOUNDATION 1ST/REBAR [ ] ROUGH PLBG. 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ROUGH R 0 '.I I.G& t� ' .PLiT1VXNG, 5 r �, y ! : f} 5 i Y . 3 s.99.1 1 Y'.. Y ti. - , j. l ` �" +-mot�:.X,i ,., .. Y . , <r r , . t. . . . . . ,5 , .. .: L. : z INSUI,ATTQN pRF.7f'..:: :, j O H. STATE EIRGY`C0I�E . " . I . .. . � ,,, . . . a 7. . s 2 /j .. / 4 A:: .,`!t fist . FIN - (ID .. '. r ' I t s ' Cf rr a . a m r i(. P • . . ;. • .. s i +, ' .. .,•,..., TM...zI ,t G.,..� ' ' S i L /r I ii /g f '�2 4. r i �1.y� . a: '1L . O '. r .,.. . 0 . . .. . ,. . . . • . . .. . . ►y ... •.1, 4 ro 7 . . :. . . 1 h.t S r.' O _i r 1 �.r!A Y M 1 I . ' 4 a 1 I a �. .. I = t .t S t I( .� e h it rs ro . 4. �r J L'. (.. .d, .'1.n.'. , ! t C! ! . .. Pry i._Y rt '!1,"} Yk 1 . ., ( ) q o. 7s°ry t7(, it}k ;'/ Offal/( ��o caa TOWN OF SO.UTHOLD-B.UILDING DEPARTMENT.'. W Town Hall Annex 54375 Main Road P. O Box'j 179 Southold,NY.1-1971-0959 � col Telephone(631)-765-1802 .'Fax (631)'765-9502 https://www.southoldtownnygov- Date Received . . . . .. .APPL-ICATION'.FOR BUILDING PERMIT For Office Use Only PERMITNO.. L. Building lnsp'ector:. DEC 0. 9 2021 Applications and forms must be filled out in their entirety.Incomplete BUILDING DEPT. applications will not be accepted: Where the Applicant is not the owner,an TOWN OF soLITHOLD . Owner's Authorization form(Pa"' !),shall be completed. Date: OWNER(S)OF PROPERTY: - Na eijames.Haag SCTM #loon Project Address:4725 Orchard St Orient, NY 1..1957 Phone#:631-902=6452 Email:'amesfhaa ahoo.com . 1 9�@Y Mailing Address:4725 Orchard St Orient, NY'1.19.57 '. CONTACT PERSON: z NameChris.Tyndall. Malling Addres8;285'.Pulaski.Street`Riverhead; NY 11901 Phone#: 631)83:1-8569 Emailctyndall@commanderpowersystems.com DESIGN PROFESSIONAL INFORMATION; ' Name: Mailing Address: " Phone#: :. Email: CONTRACTOR INFORMATION•,' Name:Standard•-Electric Corp Mailing Address:6500'Jericho Tpke, .Suite 22E Syosset,.NYA 17.91 P.hone.#:(516) 499=7354.' Emai.I;cbrutto@standardelectriccorp:com`. DESCRIPTION OF-PROPOSED CONSTRUCTION' ❑NewStructure ❑Addition []Alteration- El Repair ❑Demolition. .' Estimated Cost-ofProject:. D Other Install new Kohler 20 KW standby generator'(nat gas) $10,500.00, Will'the lot be.re-graded? '❑Yes ®No WiI[excess fill.be.remoued from premises? ❑Yes: 59No 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? , :Yes []No IF:YES, PROVIDE A.COPY. ❑ Check Box After Reading:,The owner/contractor/design professional is responsible for all-drainage and.storm water issues as provided by Chapter236 of the Town Lode.APPLICATION 15 HEREBY MADE to the Building Department for the issuance of a.Building,Permit,pursuant to the Building2one 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•removial or demolition as'herein described.'The�applicant agrees to comply with alir 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 210.45 of the New York State Penal law. .. Application Submitted By(print ne ):. : r,�t l( Authorized Agent DOwner' "Signature,of Applicant: Date: STATE.OF NEW YOR'K). 'SS: COUNTY OF. being duly sworn,deposes.and says that(s)he' is the-applicant ..(Nam.e'of individual signing contract)above named, (S)he'.is the" .(Contracto.r,Agent;Corporate Officer,-etc.) ' of said owner-or.owners,-and is duly-authorized to,perform-or have performed the said.work.and.to snake 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 20 RIE PIGOT-r t2 fO. y u K- a e o ew or . W1 PI6166611 Qualified in Nassau County.' My Commission Expires May 21;2023 PROPERTY,OWNER AUTHORIZATION' (Where the applicant•is not the owner) residing at YV S_O cz,4w l � Qliem �y llclS7. do hereby authorize-'- /:rT �P� vt1�41 to apply on my.behalf o the Town of Southold Building Department for approval as described herein:. O n r'sSignature . . ' Dat - Print Owner's Name'. - 2 • BUILDING DEPARTMENT-Electrica1. s- cto�E� ,0 9 202j TOWN OF'SOUTHOLD '�`, .., BUILDING DEPT.. ; Town Hall-Annex- 54375 Main Road PO Bd I"70SOUTHOLD "! Southold, New York 1197.1-0959 Telephone (631)�765 1.802.- FAX (631) 765-9502 t 0,� rogerr.0_southoldtownny gov.-seand(&southoldtownny c . . .t �AP,P,:LICATIO•N FOR. ELECTRICAL- INSPECTION: ELECTRICIAN.INFORMATION '(AU Information Required) Date: Company,Name. Name 6 I�. ru+b License No:: - r d i - L�13y4g email: i�c c- t� YAnc_Cc,r ' . . Address: _ oo.._ � �c .. . _T - .._ i. aac h( _I179 c Phone No.: 5 i'(� • g g S JOB SITE INFORMATION (All Information Required) i I .,. Name v _ Address.._ Cross.Street: fr Phone No:: �I Bldg.Permit#.. email.. lw2J�Ga af7�.Co,r✓L yl.. . s Tax Map District 1t)0:0_ k Section----_. ,�.-_�_�_ Block � . - - ,Lot_ . . .BRIEF DESCRIPTION OF WORK:(Please Print Clearly) I►'Zg C _ L� . �;� 1. 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) Old M Service Siz 1,Ph " 3 Ph Size:�: 00-A #.•Meters eter# New Service- Fire:Reconnect Flood Reconnect-Service Reconnected.- Underground'-,Overhead Underground,Laterals 1 2. H Frame Pole Work•done,on.Service? Y N . Addition;al-Information:';-7 - - c PAYMENT DU_E WITH APP_LICATIO_N Request fdr Inspection Form.xis. �U". ,—C� ;c ,Osu¢pp��.0 BUILDING DEPARTMENT-Electrical rispectoP Ec 0 9 202.1 .,.��. OG',. h TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Beitf 7-9 sou-r-o.f o1 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr@southoldtownny.gov southoldtownny.gov- seand&-southoldtownny.gov APPLIGATI;ON FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date;: Company Name: S4CL-VAdCu-C1 Ucc-6^kc Name: OC B rLJ-f+6 License No.: Me - LI3ySg email: brtz(4 j Cac s - .� K d4oc-IncCo co- Address: 00 e-TLC- TPA t c)-G S W 1179 Phone No.: JOB SITE INFORMATION (All Information Required) Name: Address: 417 /1/Y /l57 _ Cross Street: y, /1/y 1IL-7 Phone No.: -1 - Bldg.Permit#: email: 'u� e5 hGu ate, GoM Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) J 44C,_LC C) LU-) ('� P .1, 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 Siz 1 Ph 3 Ph Size: 00 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 Formals �U" r� PERMIT# Address: Switches Outlets GFI's Surface Sconces H H's UC Lts Fridge HW POOL Fans Mini Fr. W/D PanelPump Exhaust Oven Sump Heater Trnsfmr Smokes DW Generator Salt Gen. Carbon Micro GrbDis Water Bond Lights Heat Pucks ERV HOT TUB/SPA Inst Hot DeHum Transfer Disc Combo Cooktop Minisplit Blower AC AH Hood Blower Service Amps Have Used Sub Amps Have Used Comments �— ,r P G� August 27,2024 AUG 3 0 2024 To my friends in the Building Department: Enclosed is my check for$117.50 to extend my permit for my generato %VjDepartrnent "eddc8*eet, Orient.Thank you for your guidance in how to handle this. My contact information to set up the inspection is Mobile:631-902-6452 Email:jamesfha (a) hoo.com Thank you very much for your help and consideration. Best,James Haag 4725 Orchard Street, P.O. Box 28 Orient, NY, 11957 i Mon. Fnd. �25.10` LOT 450.00' N. 40°42'40" E. C-i 7.1 Mon. Fnd. I I � 5 �• -- I � � A ~ip 161 S O 50 g ?S; -7 ouSe . ACCESSORY BUILDING ENVELOPE Nlw Workeirs' ... . PORK P CERTIFICAT:E OF,INSURANCE C.OVERAC;E 57ATi:' Cf9m 'ensatlbn ;Board DISABILITY A O.)iAID::,FAMILY,,LEAVE BENEFITS:.LAW -:PART1':,To,be-edm teted.b -Disa'bili ..arid Paid"Tamil Leave;Benefits`Carrier or.L''tcensed;�Insurance`A' ent.or;tl at.Carrier. •,1a Legal Name and Address oflnsured'{Use.street.address only) `1b:8usmess Telephone,Number of lnsu_red; Standard Electric C_ brp . . (516);;819 86ti4• ¢alogero Brutto '6500 Jericho Tpke 1c.Fetleral Employer Identfcation,Nurnber orSocial Security. ;Syosset,,NY 1:1799, Number. • 20 8322723 w6rk Location of lnsure&tOnly n quir ed if spec�(cally limited:fo cedafn loaatlons rn New lyork Pok f e_a Wrap Up%Polley) 22 N6Me and Address;of Entity Requesting:Proof of Coverage? '-3a :Name of IhsUrance;Carrier (Entity Bemg Listed as Certificate Holder}. Standard Security i06 3b Policy Number of ent listed in box°1 a';62310 00 Town of Southold � •• 54375 Maul Road' 3c,Policy effective period 3/26./2010 to::3/2612021 " 1 0 Box 1179' `Southold, NY 11.97,1.`. ,4 Policy,provitles the foilowing benefits X:A All for the°empioyer's ern ployees:eliglble;under fie,New Ycrk`Disab llty Law; _B Only the following„class,or:classes oA;employer.'s employees;;, . _C P,ad.familpleave t enefifs..orily; '5 Policy covers X.A Atl:of the employers empjoyees:ellgibleundertlie NYS flsabiilty and_Patd family Leave Benefits Law; ! _ B Qniy thefollowm'g ciass;or classes.of,employes employees Under penalty of per`�ury,`f de. , yahat Iram an:authorzed'represenfatlue orlicensed',agent of",he lnsurance;;carrler: ;referenced above;antl that::the tamed.insured has NYS Risablllty Benefits::instarance:coverage,as.descrlbed.'above: Gltllwa ./ Date_,Signed' 'November 23 2020 By. David M Born '. {Signature of l*m a camer5 authorized represeniative-or_NYS Lic©used Insurance A`gent',ofthat insurance,camer}. Telephone 51`.673 7666,, Name andTltle President„ _IMPORTANT. If box 4'a;is checked,and't1.his form issigned by;,tiie insurance cameras authorized repcesentahve"of NY$I icensed Cnsurance; Agent bUtha#carrmer,.this certifica#e is.CQMPLETE Maff:t directly to the certtficafe holder., if box"46'is checked;I is certificate is'NOT COMPLETE<for the purpose$of Section 220,'Sub 8 of the D sability,Benefifs Law It must be mailei for completionto the,INorkers'Compensation Board,DB_ PlansAcceptance lirnC;328 State Street,. . Schenectady,•) ew York=12305; PART 2 To'be com leted b 3the-,NYS;Workers--.Com ensation.Board:OnI if B6icAClor 5B,of,Part'l'has,been•checked State of New York;, Workers Com.pensation oa;:Brd, :According toanformahon maintained by"the NYS Workers'CtimpensaUon Board!the above named msuredfemployer'hascomplied.,with:fEie•NYS: Disability Benefts Law-with respect to all,or hider employees:. ' Dafe`Signed 'BY tS(gnature;ofIYS VGorRts CompertsaLon 8oartl Errsployee):. 1 ease Nate Only insurance carvers licensed to:wnte NYS disability benefits iiisur'ancetipoliciesand NYSlicense;lnsuralnce agents of those insurance,;cariiers`areauho[ized'ta fssuel=orin DB 12Q 1:_. Insuran•ce Brokers are not authorized to issue this form . Additional Instructions for Form DB-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"la"for disability and/or paid family leave benefits under the New York State Disability and Paid Family Leave Benefits Law.The Insurance Carrier or its licensed agent will send this Certificate of Insurance to 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 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 be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carder 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 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 NYS Disability and/or Paid Family Leave Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability and Paid Family Leave Benefits Law. 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 has been secured as provided be this article. von Wdrkert' ,CERTIFICATE bF _ eSTATE Compensation NYS WORKERS' COMPENSATION INSURANCE:C:OVERAGE' Bard 1a 'Legal Namq&Address of Insured(use street address only) 1b.Business Telephone'Number:of Insured tandard Electric Corp (SitSj 819 8684 1 c.NYS Ur�em to men n alogero SrUtto p,,y_,. t;Insurance;;Employe�.Regist�atio Nu.mbe"r,:ot 500:Jencho?pke`. Insured- SyosSet,.NY11791;. 1d Federal Emptoyeeddentification'Numberotinsured arSocial Secugty Work Locq'o6.of Insured(Only.required if coverage►s spec ca!!y llmited'to; Numtier 20 8322723' cerfaln locations!n NeiN Y,o'rk:State,a e,.a.Wrap-Up.PoNcy) 2 Name and Adtlress bf Entity l edueshng Proof l. .f Coveerage', 3a Namb of Insi rence Catner (Entity Bemg:Listed as,the Certrficafe Holder) P&'`C Insurance Co of tiartfor`d:` Town of Southoid 3b` Policy Nurritierof'Eiir _id6i'n 13ox.'1'a" 54375 Matn Road; 12WECAC1771` P;.O`Box 1179. 3o Policy effective period Southold,<NY 11971 T2/23/n 0 to 1z%23/2iw The P�opnetor;Parfners:orExd&fwe Officers,`are`inclutleds ®•.(On�ycheck,tioX,dallpartners/6f(icers ncludedjalls D iexauded.o�'certaMn-partners-loffceis;excluded This,;certtfiesahat the insurance carrier indicated above Irrboz-"3'In"suns the[iusiness referenced above in box 1 a"'forwgrker$' compensation undertheNew;-York State Workers'Compensation Law:(To use.`this..form;New York'(NYf must li"e listed under Item 3A: on'the INFORMATION PAGE of the workers'compensation insurance policy).The'Insurance. arner or it"s.licensed'a ent;will,send� this•Certificate of lrisurance to the:eritty hstetl aboye;as thercerhficate,�holder in box,"2l`_. , • The.insurance carrier must riottfy ttie,_above certificate.holderand;the;Workers'Compensatlon,Boardiuithin 10 days lF.a poltcy'iscanceled tlue to nonpayment°of premiums orwithtn 30'days IF,there are reasons other,than Nonpayment of premiums that cancel the policy or` ehminatdAtie,risure'd,from the coverage indicated on'thls:'Certiticate (These,notices may be sent by regular mall)Otherwise-, C.ertificate,;is:valttl.for one;year after this;form is approved;bythe insurance,cart er or its Ijcensed agent,or until`the.policy explrat' - ate'listed to box"3c",whicheveris ear:Uer.; Thts:•certificate,Is,l}sst ed as a,matterof mfarmatlon only a id.confersno nghis upon the certificate holder This certlfwcafe does not amend;; extend or alter the,eoverage.afforded by the-.pohcyhsted, nor'tlo:, it'c`onfer any rightsor•responsibilities"tieyond.those:contained in.ffie refe�enced.pollcy Ths,eerk�ficate may be used as evidence of a'Workers'Comp'ensatlon'coritract of insurance:'only while`'the,uriderlying poUcy ts:in effect:; Please Note;;Upon:cancellat�on of;the warkers''compensaftonpalicy tndicateri on thts.form,if the business conttnues:to be . named on a.per"mtt,hcense;or contrct issued bya certificate:holder„he'business mustprovide that`certtfcate holder,.wkh,;a new;Certificate of 1Norkers"Compensation',coverage or.other authonzed;'proof.that the:,business is,complying.wlth mandatory coverage requirements„of the New York State Workers'Compensation Law: Under penalty of penury,I certify that I am an auttionzed representattve'or licensed,agent of fheansurance carrier referenced w ...J i0 p above and that tligtnamed. nsured,has the coves a as de toted on this fonri 4pfoved_by Borg'&•Borg IncDavid"M Borg President, (Pnnt-n^^ame of autfioriied tepresentabve:orticensed agent of;insurance,carrie) 1"1/23I2020,� Approved by; (5ignature�, (Date) Ti#Ie:=AUAiprized Reprgseq tWtiva Telephone Nu- t,;4•auihonzed rep esentat ve or licensed,agent of insurance career: 631=ti73=7600; Please Note:Ohiy'insur6nce carriers and their ttcensed agents='a�e autkiorrzed to issue Form:C=105 2.:Insu�arice brokefs ate.NOT; authonzed:to issue it C 10.5 :wwwwcb ny,:gov, TE A`�V CERTIFICATE OF LIABILITY INSURANCE � i23/2o20 n 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(les)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 Ileu of such endorsement(s). PRODUCER Borg&Borg Inc. PHONE 631-673.7600 PAX 0 631-361-1700 148 East Main Street Huntington NY 11743 'DRESS: ceMcales@borgborg.com INSURE S AFFOROINGCOVERAGE HAIL® INSURER A:Merchants Mutual Insurance 23329 INSURED STANELE-01 INSURER B:P&C Insurance Co of Hartford 34690 Standard Electric Corp INSURER C;Standard Secudly Life Calogero G Brutto 6500 Jericho Tppke. INSURERD: Syosset NY 11791 INSURERE: INSURERF• COVERAGES CERTIFICATE NUMBER:40014386 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. ILTR NSR TYPE OF INSURANCE POUCYNUMBER PwoD V . POLICY LOWS A X COMMERCIAL GENERAL LIABILITY BOP1063594 211/2020 2/1/2021 EACHOCCURRENCE $1,000,000 DAMAGETOTIENTIff— CLAIMS-MADE a OCCUR PREMISES IEaoocunence $500.000 MED EXP(Any one parson) $15,000 PERSONAL&ADV INJURY S Included GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 52,000,000 RPOLICY M PRO- LOC PRODUCTS-COMP/OPAOG 52,000.000 OTHER S COMB[NEDSIN T 51,000,000CAP105068 212020 112021 Ea acdanA AUTOMOBILE LIABILITY X ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per acddant) S AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per dorill n S UMBRELLALIAB HOCCUR EACH OCCURRENCE S EXCESS LIASI CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ B WORKERS COMPENSATION 12WECAC1771 12/23/2019 12/23/2020 X STAT OR IS AND EMPLOYERS'LIABILITY YIN 12WECAC1771 12/23/2020 12123/2021 ANYPROPRIETORIPARTNERIEXECUIVE NIA E.L.EACH ACCIDENT S1,000,000 OFFICERMEMSER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yyeess,,desaiba undar OESCRUrrION OF OPERATIONS bdw E.L.DISEASE-POUCY LIMB S 1.000.000 C f1YS DisatT4 62310-00 3126/2010 312612021 NYS DBL statutory DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addltlonal Remarks Schodulo,may bo attached if moro spaco Is raquirod) 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. 64375 Main Road PO Box 1179 AUTHQ RUM REPRESENTATIVE Southold NY 11971 0198112015 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD C�- AP R VED AS NOTED DATE: B.P.# .3 FEE: . � By:��& NOTIFY BUILDING D_PARTMENT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATiON 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOB C.O. ELECTRICAL ALL CONSTRUCTtO!'� Sr-,ALL MEET THE INSPECTION REQUIRED REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF �ONi#6t$-T81A4N-ZBI� OARD LD TOWN T STEES OCCUPANCY OR USE, IS UNLAWFUL WITHOUT CERTIFICA�`" OF OCCUPANCY III DV E C E 0 l''I E Fn KOHLER. DEC 0 9 2021 Models: 20RCA ..L V_ _ H� � ) BUILDING DEPT. Multi-Fuel TOWN OF SOUTHOLD LPG/Natural Gas 09001 standard Features I.KOHLER.-. - . . e, RDC2 Controller NATIONALLY REGISTERED _ 'O One digital controller manages both the generator set and transfer switch functions(with optional Model RXT), o- Electronic speed control responds quickly to varying ��. demand. o OnCue@ Plus Generator Management System for'remote '1 monitoring is.included with the generator. • Kohler Command PRO Engine Features o Kohler Command PROD.OHV. engine with hydraulic valve lifters for reliable performance without routine valve adjustment or lengthy break-in requirements. ..Designed for Easy Installation KO c Sturdy aluminum base can be mounted on.gravel or a concrete mounting pad. o Fuel and electrical connections through the enclosure wall eliminate the need for stub-ups through the base. The Kohler® Advantage Customer connection terminal block located near the • High Quality Power controller allows easy-access for field.wiring. Kohler home generators-provide advanced.voltage and o Designed for outdoor installation only. frequency regulation along with ultra-low levels of •.Certifications harmonic distortion for excellent generator power quality to o Meets emission regulations for U.S.'Environmental protect your valuable electronics. g Protection Agency(EPA)with both natural gas and LPG. • Extraordinary Reliability o UL 2200/cUL listed (60 Hz model). Kohler is known for extraordinary reliability and o CSA certification available (60.Hz model). performance and backs that up with a premium 5-year or o Accepted by the Massachusetts Board of Registration-of 2000 hour limited warranty. Plumbers and Gas Fitters. • Powerful Performance o Meets 181 mph wind rating: Exclusive Powerboost.-. technology provides excellent starting power.§ Approved for stationary standby apPIlc, ations in locations served by a reliable utility source. • Aluminum Enclosure • 20RCAL models packaged with a Model RXT automatic o_Fdl§�sga aluminum enclo�he� llatlonas.. 8 inches from ,ollb`usine`''ss transfer switch are available. See page 4 and the Model RXT ATS specification sheet. o •Enclosure panels can be removed without tools to allow easy access for maintenance and service. .• Warranty 'o 5-year/2000 hour limited warranty for.on-grid (standby) applications in locations served by a reliable utility source. Generator Ratings . Standby Ratings Line Circuit Natural Gas, LPG Breaker Alternator Voltage Phase Hz_ kW/kVA Amps kW/kVA Amps Amps Poles 2F7 120/240 1 60 18/18 75 20/20 .83' .100 2 120/208 3 60 17/21 58 17/21 58 70 3 2G7 120/240 3, 60 17/21 51 . 17/21 5f 60 3 277/480 3 60 17/2i 26 17/21 26 30 3 Note: The line circuit breaker is automatically selected based on.the generator set model and voltage configuration. RATINGS:Standby ratings applito installations served by a reliable utility source.All single-phase units are rated at1.0powerfactor.ThestandbyratingisapplicabletovariableloadsWithanaverage) load factor of 80%for the duration of the power outage. No overload capacity is specified at this rating. Ratings are in accordance with ISO-3046/1,BS5514,AS2789,and DIN 6271.GENERAL GUIDELINES FOR DERATING:.ALTITUDE:berate 4%per 305 in(1000 ft.)elevation above 153 m(500 ft.).TEMPERATURE.Derate 2%per 5.5°C(10°F)temperature Increase above 16°C(60°F). Availability is subjectto change without notice.The generator set manufacturer reserves the rightto change the design or specifications without notice and without any obligation or liability whatsoever. Contact your local Kohler Co.generator distributor for availability. § Check the appliance manufacturer's specifications for actual power requirements.Consult a Kohlerm Power Systems professional to calculate your exact residential power system requirements. t Meets NFPA guidelines for 181nch clearance to combustible materials..Check state and local codes for minimum distance required from a structure. . . G4-.272(20RCA) 9/19c Alternator Specifications Alternator Specifications Alternator Features Specifications Alternator • Compliance with NEMA, IEEE,and ANSI standards for Manufacturer Kohler temperature rise. Type 2-Pole,Rotating Field Leads,quantity a Self-ventilated and dripproof construction. 2F7 4 • Windings are vacuum-impregnated with epoxy varnish for 2G7 12 dependability and long life. Voltage regulator Digital • Superior voltage waveform and minimum harmonic Insulation: NEMA MG1-1.66 distortion from skewed alternator construction. Material Class H a Digital voltage regulator with±1.0%no-load to full-load Temperature rise 130°C Standby RMS regulation. Bearing:quantity,type 1,Sealed • Rotating-field alternator with static exciter for excellent Coupling Direct load response. Amortisseur windings Full • Total harmonic distortion (THD)from no load to full load with Voltage regulation,no-load to full-load RMS ±1.0% a linear load is less than 5%. One-step load acceptance 100%of Rating Peak motor starting kVA: (35%dip for voltages below) 240 V,1 ph 2F7(4 lead) 41 (60 Hz) 240 or 480 V,3 ph 2G7(12 lead) 69(60 Hz) Application Data Engine Exhaust Engine Specifications Exhaust System Manufacturer Kohler Exhaust temperature exiting the Engine:model,type CH1000 4-Cycle enclosure at rated kW,dry,°C(°F) 260(500) Cylinder arrangement V-2 Lubrication Displacement,cm3(cu.in.) 999(61) Bore and stroke,mm(in.) 90 x 78.5(3.54 x 3.1) Lubricating System Compression ratio 8.8:1 Type Full Pressure Main bearings:quantity,type 2,Heavy-Duty Sleeve Oil capacity(with filter),L(qt.)§ 1.9(2.0) Bearings Oil filter:quantity,type§ 1,Cartridge Rated RPM Oil cooler Integral 60 Hz 3600 § Kohler recommends the use of Kohler Genuine oil and filters. Max.engine power at rated rpm,kW(HP) LPG,60 Hz 23.0(30.9) Fuel Pipe Size Natural gas,60 Hz 20.2(27.1) Minimum Gas Pipe Size Recommendation,in.NPT Cylinder head material Aluminum Valve material Steel/Stellite® Pipe Length, Natural Gas LPG Piston type and material Aluminum Alloy m(ft.) 281,000 Btu/hr. 340,000 Btu/hr. Crankshaft material Heat Treated,Ductile Iron 8 (25) 1 3/4 Governor:type Electronic 15 (50) 1 1 Frequency regulation,no load to full load Isochronous 30 (100) 1 1/4 1 Frequency regulation,steady state t0.5% 46 (150) 1 1/4 1 1/4 Air cleaner type Dry 61 (200) 1 1/4 1 1/4 Engine Electrical Engine Electrical System Ignition system Electronic, Capacitive Discharge Starter motor rated voltage(DC) 12 Battery(purchased separately): Ground Negative Volts(DC) 12 Battery quantity 1 Recommended cold cranking amps: (CCA)rating for-18°C(0°F) 500 Group size 51 G4-272 (20RCA) 9/19C Fuel Requirements RDC2 Controller Features, Continued Fuel System • LED indicators for utility power and generator set source Fuel types Natural Gas or LPG availability and ATS position (Model RXT transfer switch Fuel supply inlet 1/2 NPT required) Fuel supply pressure,kPa(in.H20): • LCD display: Natural gas 0.9-2.7(3.5-11) o Two lines x 16 characters per line LP 1.7-2.7(7-11) o Backlit display with adjustable contrast for excellent Fuel Composition Limits* Nat.Gas LPG visibility in all lighting conditions Methane,%by volume(minimum) 90 min. — • Scrolling system status display:o Generator set status Ethane,%by volume(maximum) 4.0 max. — Propane,%by volume 1.0 max. 85 min. o Voltage and frequency Propene,%by volume(maximum) 0.1 max. 5.0 max. o Engine temperature C4 and higher,%by volume 0.3 max. 2.5 max. o Oil pressure Sulfur,ppm mass(maximum) 25 max. o Battery voltage Lower heating value, o Engine runtime hours MJ/m3(Btu/W), (minimum) 33.2(890) 84.2(2260) • Date and time displays * Contact your local distributor for suitability and rating derates based • Smart engine cooldown senses engine temperature on fuel compositions outside these limits. a Digital isochronous governor maintains steady-state speed at Operation Requirements all loads • Digital voltage regulation: ±1.0% RMS no-load to full-load Fuel Consumption,m3/hr.(cfh)@ 60Hz • Automatic start with programmed cranking cycle %Load Natural Gas LPG • Programmable exerciser can be set to start automatically on 100 8.0 (281) 3.9 (136) any future day and time,and run every week or every two 75 6.9 (243) 3.1 (109) weeks 50 4.6 (161) 2.3 (82) • Exercise modes: 25 3.6 (127) 1.7 (59) o Unloaded weekly exercise with complete system Exercise 2.0 (71) 1.0 (35) diagnostics Nominal fuel rating: Natural gas: 37 MJ/m3(1000 Btu/ft.3) o Unloaded full-speed exercise LPG: 93 MJ/m3(2500 Btu/ft 3) o Loaded full-speed exercise(Model RXT ATS required) LPG conversion factors: 8.58 ft.3=1 lb. • Front-access mini USB connector for SiteTech' or USB 0.535 m3=1 kg Utility connection 36.39 ft3 =1 gal. • Integral Ethernet connector for Kohler®OnCue@ Plus Generator Set Sound Data • Built-in 2.5 amp battery charger • Remote two-wire start/stop capability for optional connection Model 20RCA 8 point logarithmic average sound levels are of a Model RDT transfer switch 64 dB(A) during weekly engine exercise and 69 dB(A) during • Diagnostic messages: Displays diagnostic messages for the full-speed generator diagnostics and normal operation.* engine,generator, Model RXT transfer switch,programmable All sound levels are measured at 7 meters with no load. interface module(PIM), and load management device. * Lowest of 8 points measured around the generator. Sound levels at • Maintenance reminders other points around generator may vary depending on installation • System settings: parameters. o System voltage,frequency,and phase o Voltage adjustment RDC2 Controller o Measurement system, English or metric • ATS status(Model RXT ATS required): a o Source availability voltage: 210VJ o ATS position (normal/utility or emergency/generator) Freq: MO Hz o Source voltage and frequency 0 0 • • ATS control (Model RXT ATS required): f © � o Source voltage and frequency settings ® W RUT= "" o Engine start time delay o 0 o—a o Transfer time delays o Voltage calibration The RDC2 controller provides integrated control for the o Fixed pickup and dropout settings generator set, Kohler@ Model RXT transfer switch, • Programmable Interface Module(PIM)status displays: programmable interface module(PIM),and load shed kit. o Input status (active/inactive) o Output status(active/inactive) RDC2 Controller Features • Load control menus: • Membrane keypad: o Load status o OFF,AUTO,and RUN pushbuttons o Test function o Select and arrow buttons for access to system configuration and adjustment menus • LED indicators for OFF,AUTO,and RUN modes G4-272 (20RCA) 9/19C KOHLER CO.,Kohler,Wisconsin 53044 USA Phone KOHLER, For the nea 90-457-4441 est sales andservice o t et6in the US and Canada,phone 1-800-544-2444 KOHLERPower.com Generator Set Standard Features Automatic Transfer Switches and Accessories • Battery cables ❑ Model RDT ATS • EPA certified fuel system ❑ Model RXT ATS • Aluminum sound enclosure ❑ Model RXT ATS with combined interface/load • Critical silencer management board ❑ Load shed kit for RXT or RDT • Field-connection terminal block ❑ Power relay modules(use up to 4 relay modules for • Fuel solenoid valve and secondary regulator each load management device) • Line circuit breaker ❑ Other Kohler@ ATS • Multi-fuel system, LPG/natural gas,field-convertible 20RCAL Model Packages • Oil drain extension with shutoff valve ❑ 20RCAL with 100 amp RXT with 16-space load center and • OnCue8 Plus Generator Management System NEMA 1 steel enclosure for indoor installation • Premium 5-year limited warranty ❑ 20RCAL with 200 amp service entrance-rated Model RXT • RDC2 generator set/ATS controller with combined interface/load management board and • Rodent-resistant construction corrosion-resistant NEMA 3R aluminum enclosure • Sound-deadening,flame-retardant foam per UL 94, Warranty class HF-1 ❑ 5-Year Comprehensive Limited Warranty Available Options ❑ 10-Year Comprehensive Limited Warranty Approvals and Listings ❑ CSA approval Concrete Mounting Pads ❑ Concrete mounting pad,3 in.thick ❑ Concrete mounting pad,4 in.thick (recommended for storm-prone areas) Electrical Accessories ❑ Battery ❑ Battery heater, 120VAC ❑ Battery heater,240VAC ❑ Cold weather package, 120VAC Generator Set Dimensions and Weights ❑ Cold weather package,240VAC L) Emergency stop kit Generator Set Size,L x W x H: 147 x 6.2 x 2.2 mm ❑ PowerSync@ Automatic Paralleling Module(APM) (a7 is 2s.2 x 32.2 in.) (single phase only;parallel two 20kW residential generator Shipping Weights: sets with the RDC2 controller) 20RCA Generator Set: 252 kg(555 lb.) 20RCAL with 100 A RXT ATS w/LC 277 kg(611 lbs.) ❑ Programmable interface module(PIM) 20RCAL with 200 A RXT SE ATS: 272 kg(600 lb.) (provides 2 digital inputs and 6 relay outputs) L �I Fuel System Accessories ❑ Flexible fuel line(included on QS models) ❑ Carburetor heater, 120 VAC ❑ Carburetor heater,240 VAC �'� Carburetor heater is recommended for reliable starting H at temperatures below 01 C(32°F) Literature ❑ General maintenance literature kit w L] Overhaul literature kit NOTE:Dimensions are provided for reference only and should not be used for planning ❑ Production literature kit installation.Contact your local distributor for more detailed information. Maintenance DISTRIBUTED BY- ❑ Maintenance kit(includes air filter,oil,oil filter,and spark plugs) ©2018,2019 by Kohler Co. All rights reserved. 134-272 (20RCA) 9/19c