HomeMy WebLinkAbout50909-Z c4"�Of SOpTyO! Town of Southold
° P.O. Box 1179
�04 53095 Main Rd
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 45810 Date: 12/09/2024
THIS CERTIFIES that the building GENERATOR
Location of Property: 1652 Bridge Ln Cutchogue, NY 11935
Sec/Block/Lot: 118.4-4.1
Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 11/29/2021
Pursuant to which Building Permit No. 50909 and dated: 07/09/2024
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:
accessory generator as applied for,
The certificate is issued to: Danny Fisher ,Barbara Kent , Jack Fisher , Diana Sedenquist
Of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL:
ELECTRICAL CERTIFICATE: 50909 12/5/2024
PLUMBERS CERTIFICATION:
AutLrizeV Signature
FFoi�c TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y TOWN CLERK'S OFFICE
"oy • 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#: 50909 Date: 7/9/2024
Permission is hereby.granted to:
Fisher, Danny
479 13th St
Brooklyn, NY 11215
To: Install accessory generator at existing single family dwelling as applied for, per
Trustees #9904 and with flood permit. Replaces BP#47237
At premises located at:
1652 Bridge Ln, Cutchogue
SCTM #473889
Sec/Block/Lot# 118.-1-4.1
Pursuant to application dated 11/29/2021 and approved by the Building Inspector.
To expire on 1/812026.
Fees:
PERMIT RENEWAL $167.50
Total: $167.50
Building Inspector
o�SOFFot,��o TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
o • SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 47237 Date: 12/16/2021
Permission is hereby granted to:
Fisher, Danny -
479. 13th St
Brooklyn, NY 11215
To: Install accessory generator at existing.single family dwelling as applied for, per
Trustees #9904 and with flood permit.
At premises located at:
1652 Bridge Ln., Cutchogue
SCTM #473889
Sec/Block/Lot# 118.-1-4.1
Pursuant to application dated 11/29/2021 and approved by the Building Inspector.
To expire on 6/17/2023.
Fees:
ACCESSORY $100.00
ELECTRIC $85.00
CO-RESIDENTIAL $50.00
Flood Permit $100.00
Total: $335.00
Building Inspector
OF 50(/Tyo6 ° f - q Q l f ( ) 2�
TOWN OF SOUTHOLD BUILDING 'DEPT.
631-765-1802
INSPECTION . '
[ ] FOUNDATION 1'ST/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:-
r
r" La kt-l'
DATE INSPECTOR .
hoaoq �O�NOF SOUIyo�
# # TOWN OF SOUTHOLD BUILDING.DEPT.
o m,� 631-765-1802
INSPECTION
[ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] NSULATION/CAULKING
[ ] FRAMING /STRAPPING [ FINALle4vx4,e—
] .FIREPLACE & CHIMNEY '[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ =] PRE C/O [ ] RENTAL
REMARKS: &/41.2.. —
rVPA A. 1 I(m-m o v
da-,k" ko Ll doujv� Jvk( L
Py lli MAuAil 0" ril zxJf"ces jp Gox,bysI,(o" .
DATE. INSPECTOR
ho�*oF souryo� 8r1,0�
* # - TOWN OF SOUTHOLD BUILDINVDEPT.
631-765-1802
tNSPECTION
[ ] . FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND' [ ] INSULATIOWCAULKING
[ ] 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: �2K d'CC
eve fkkcLx,5 +u e -�o 4 U 6 S
vh WJ b-p- a - lam+ �- � fro �►�, e4rALt5�-
ex 4- to 6 e 4 -dwiew.-
AAlInd011 ) -5 M(Aff 4ti�k
bye f-r-4- >
I clovi c�,iPM*r o d t e r
ef pate, tL� is I &A I'► %6+ I'd ll:..t 1o9cd
DATE ' INSPECTOR
pF soulyo� 0 C a 1 (05?- / L,6
# * TOWN OF OUTHOLD BUILDI G' DE
couto� 631-765-1802
INSPECTION
[ ] FOUNDATION 1 ST/ 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: Al P LT 6GilV i,�j4f D
DATE INSPECTOR
pE SOUr��l
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O.Box 1179 G Q
Southold,NY 11971-0959 •� • �o sean.devlin(aD-town.southold.ny.us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Danny Fisher
Address: 1652 Bridge Ln city:Cutchogue st: NY zip: 11935
Building Permit#: 50909 section: 118 Block: 1 Lot: 4.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: Electrician: AS BUILT License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service
Commerical Outdoor X 1st Floor Pool
New 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 200A UC Lights Dryer Recpt Emergency Strobe Heat Detectors
Disconnect Switches 4'LED Exit Fixtures 11 Sump Pump
Other Equipment:
Notes: " AS BUILT NO VISUAL DEFECTS " 30kW Kohler Generator
Inspector Signature: Date: December 5, 2024
Copy
marshall paetzel
LANDSCAPE ARCHITECTURE
i2c
r
MoV - 4 2024
November 4, 2024
EvQ,DQiG DEFT.
Town of Southold - Building Department TOWN QF SOT, MOLD
ATTN: Nancy Meyer
53095 Route 25
Southold, NY 11971
Re: Fisher Residence
1652 Bridge Lane, Cutchogue
Generator Installation
To whom it may concern:
I have inspected the generator on the above referenced property and the frame of the generator has been bolted to
the concrete slab at each of the four corners. I believe the generator is adequately anchored to resist hydrostatic and
hydrodynamic loads and stresses during a flood event as required by FEMA and cited in § R322.1.6 of the ICC/New
York State Residential Building Code and of§ 148-16C of the Southold Town Code.
Sincerely,
Stacy Marshall Paetzel , RLA
cc: Danny Fisher
Carrie Blair
NV1D S CAP
»Li„�
OF
5175 Route 48 - Mattituck,New York 11952 - 631.209.2410 ph 631.315.5000 fx - www.mplastudio.com
FIELD:INSPECTI,Q PORT RATE: CO.Ni1V�NTS _ 1
FOUNDATION•(lST).
.FOUNDATION'(2ND);. .
z
O
ROUGH FRA, MINE&'
RLUMBING 'c 1
INSULATION.PER N._ '. . �-3
STATE ENERGY CODE
i n A1004 lZ�l�e
ill r` • . C. AIL6C6 C a ws Ze s-
FINAL
•
OVAL COIVIMENTS
r �0
=ohs°EFoc,rooGy� TOWN OF SOUTHOLD—BUILDING DEPARTMENT
y z Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
�y�o• ��o�� Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldtownngov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only R
V
PERMIT NO. �7ac/ BuildingIr ctor: NOV 2 9
2021
Applications and forms must be filled out in their entirety. Incomplete TO BUILDING LD►NG DEpT
applications will not be accepted. Where the Applicant is not the owner,an OF SOUTHpLD
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name 11��,,
:. ._.. SCTM#10004 _
Project Address:1652 Bridge Lane Cutchogue, NY 11935
Phone#: .Email:
Mailing Address: &0.0
� t
CONTACT PERSON:
Ivame:Chris Tyndall
Mailing Address:285�PulaskivStreet vRiverhead, NY 11901
Phone#_(631)831-8569 _ _ - _- Email:ctyndallCcommanderpowersystems.com
DESIGN PROFESSIONAL INFORMATI
Name:
N
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:Standard Electric Corp
Mailing Address:6500 Jericho Tpke, Suite 22E Syosset,NY 11791
Phone#p(516) 499-7354 v rt.._. _En ail:cbrutto@standardelectriccorp.com.__-.
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
OOther Install new Kohler 30 KW standby generator(LP) $23,600.00
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes ®No
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.
Check Box After Reading: 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 Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By ' It name)_ ,��! /0�,,✓ Ly'Authorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
S •
COUNTY OF
G 6 Im e, �`r^'-f— 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 /
0�( day of /� �/d� ,20
No P lic
JOI ATHAN D. FOGARTY
No ry Public-State of New York
NO.01 F06241421
PROPERTY OWNER AUTHORIZATION Qualifed in Suffolk County
�'
(Where the applicant is not the owner) My Commission Expires May 23,2O
I, /� / ✓�'r�'/ residing at
do hereby authorize �,J�✓�t��12r �° f QA to apply on
my ehalf o t wn of Southold Building Department for approval as described herein.
r ui Lo x/
n� •Agnlaftu�re� � Date
Print Owner's Name
2
��o�gOFFQ[,�co TOWN OF SOUTHOLD
BUILDING DEPARTMENT
H. z TOWN CLERK'S OFFICE
o • SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 47237 Date: 12/16/2021
Permission is-hereby granted to:
Fisher, Danny
479 13th St
Brooklyn, NY 11215
To: Install-accessory generator at existing single family dwelling as applied for, per
Trustees #9904 and with flood permit.
At premises located at:
1652 Bridge Ln., Cutchogue
SCTM #473889
Sec/Block/Lot# 118.-1-4.1
Pursuant to application dated 11/29/2021 and approved by the Building Inspector.
To expire on 6/17/2023.
Fees:
ACCESSORY $100.00
ELECTRIC $85.00
CO-RESIDENTIAL $50.00
Flood Permit $100.00
Total: $335.00
Building Inspector
.•°yP �: - "'QPP ° �:� - ;C�Clb i%•f't ii00°•'1 Irmo
•p'1'p�p:••i1^a• e°t'9`i 0fp')':. - "• `IP9 ri96"I
;.� •,uny�.,y�yqp.n..�.rS.a.Y ^'gl^'NPSWk•uo'yY'Y^44t1'V'Y6�9mrn�yn�rn.nr.".^^�'°'�WSimm�ll'R"�41k!i,s!Q`):'t^Y1t-^•Ft!T^!�sR�rRA'e!!L":t4rn..,�noi.•.din,•u;m,y;.n`.n,.gy.•..tin,nlSL'.�dV!'.^dAYlkrCs>!i57tY� e!��•,,Aa �` �i �•r
°a°Si4 a cc; Q�y'i°
•� k
BOARD OF SOUTHOLD TOWN TRUSTEES
r SOUTHOLD,NEW YORK
�= PERMIT NO.9904 DATE: MAY 19,2021 k ��
.4.. a �QQQ,,• d
ISSUED TO: DANNY FISHER,BARBARA KENT,JACK FISHER&DIANA SEDENOUIST
31
PROPERTY ADDRESS: 1652 BRIDGE LANE,CUTCHOGUE q•°•
SCTM#1000-118-14.1 A .-
AUTHORIZATION
,�tte Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the w Q•.,r' t
Resolution of the Board of Trustees adopted at the meeting held on May 19,2021,and in consideration of application fee in
the sum of$250.00 paid by Danny Fisher, et al and subject to the Terms and Conditions as stated in the Resolution, the
Southold Town Board of Trustees authorizes and permits the following.
.6a Wetland Permit for the existing 41x16.2'fixed wood dock with removable 31x14'wood ramp and two(2)"L"shaped r
floats:61x20'and 6'x10'with a 4'wide access path through the non-disturbance buffer; existing wood pedestrian "
bridge consisting of a 41x15.3'wood ramp to 4102.5'wood bridge to 41x7.8'ramp with 4'wide access path through �w+�
o, the non-disturbance buffer to cross Wunnewetta Pond on applicant's property;for a proposed 16.51x401 in-ground
a swimming pool with 61x9'spa;install drywell for pool backwash;proposed 758sq.ft.patio and turf steps to grade;a ;r i
24"proposed stone wall surrounding pool and patio;along northerly property line 56sq.ft pool equipment with
proposed split rail fence with mesh to pool code;install 258 linear feet x 4'high pool enclosure fencing with 4'self-
r. x latching gate along south side of pool,and proposed 120 linear feet of 4'high wire mesh fence as per N.Y.S.pool
r code;establish and perpetually maintain a proposed 9.448sq.ft.non-disturbance buffer along the landward edge of
{� x wetlands;establish and maintain proposed 3,440sq.ft.non-turf buffer of natural vegetation with 4'wide access path" '
to water to be maintained for a total of 12,888 sq.ft.of vegetative buffers;a portion of existing driveway along
t°%•e property line is to be removed and re-vegetated with evergreens(landscaped);portion of existing driveway to be PA.
P P Y g g ( P )+P g Y
relocated 85'south along Bridge Lane re-paved with pervious material and steel edging;install a proposed 1,000
gallon buried propane tank,andr120/240 V.Kohler generator set on 3''6"x8'elevated wood platfo'rm)next to Pes:t
p. ° dwelling;existing 61x5'outdoor shower modfiedin-kind,`stepping stone-walkway on grade•in-place of existing
r 200sq.ft.of brick walkway,existing 60sq.ft landing resurfaced in-kind;proposed 18sq.ft.masonry landing in place ^�;
of existing 20sq.ft.brick landing;proposed 333sq.ft.on-grade terrace with step in place of existing 22'x10'terrace
with step;existing timber steps(non-treated railroad ties)to be replaced in-kind; proposed stepping stone walkway ''
1! on-grade in place of existing 105sq.ft.brick walkway;proposed 141x4'wide stone step in place of existing 9sq.ft.
°•e stone landing;existing 2411x1416"deck and 18sq.ft.steps to be replaced with wood deck and steps in-kind and in-
place;proposed 48sq.ft.masonry stoop in place of existing 27sq.ft.brick stoop;proposed on-grade steppingstone
P a walkway;and proposed 30 linear feet x 4"wide timber steps;proposed 275sq.ft.masonry walkway in place of
' existing 39sq.ft.brick walkway;and proposed evergreen screening;with the condition that any future repairs of y
r' docks or catwalks must be done using thru-flow decking;and as depicted on the site plan prepared by Marshall
9 Paetzel Landscape Architecture,dated February 17,2021,and stamped approved on May 19,2021.
IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed,and these presents to '
<;y
Ott, s be subscribed by a majority of the said Board as of the 19th day of May,2021 a :
r
LL Zwl
� 'Q`I P 3 OS��S�`� � � 0 ib•
SO
�y • ��� f Wit--
rlI•Snm...h. 007..: '..r:n'ri.».ti..e vaara.�..im:ncrx.n..avn;.+¢.3r...n.:RY,.'n�.rt5:�5...:.R..•.rms.:.va7iw..aaJrsn�..:nr.rtYmTn.mn.2a.:..a:,v.^ass�i:n...r...,natA�ascr,rs.L.,ra..a .xs0.,,......vth �.
:.� .�.� « "ej• a a4 r, -p ;1 o•`^ .1�� �� ••
d,ryry• _ - +� _ �,;::�= �.-...�.. �,..,,�m�^.Y _ .� 3,�
"•'::ii/4 ;5e°i•:• wt,l 4 Q I�e:%_ ':i,°` 1 Ptl„ � i444 1lvi?:•°,• �• Co��� eQQ°�:z a°a,,6�y e�og%'•a �iaY'e Q0�'='
Glenn Goldsmith,President `�ISO � Town Hall Annex
A.Nicholas Krupski,Vice President h®V� ®�® 54375 Route 25
P.O.Box 1179
Eric Sepenoski 1iB Southold,New York 11971
Liz Gillooly G Telephone(631) 765-1892
"Elizabeth Peeples �® Fax(631).765-6641
COU
1 BOARD OF TOWN TRUSTEES
- NOV — 9 2024 � TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
#2161 C Date:July 29,2024
THIS CERTIFIES that the existing 4'x16 2'fixed wood dock with removable 3'x14'wood ramp
and two(2)"L"shaped floats: 6'x20'and 6'x10'with a 4'wide access path through the non-disturbance
buffer,• existing wood pedestrian bridge consisting of a 4'x15 3'wood ramp to 4'02.5'wood bridge to
4'x7 8'ramp with 4'wide access path through the non-disturbance buffer to cross Wunnewetta Pond on
gplicant's property installation of a 16 5'x40'in-ground swimming pool with 6'0'spa:installation of
drvwell for pool backwash,• construction of 758sq ft patio and turf steps to grade,• construction of a 24"
stone wall surrounding pool and patio-, along northerly_property line 56sg ft pool equipment with
proposed split rail fence with mesh to pool code,• installation of 258 linear feet x 4'high pool enclosure
fencing with 4'self-latching gate along south side of pool and 120 linear feet of 4'high wire mesh fence
as per N.Y.S.pool code;establishment and perpetual maintenance of a proposed 9.448sg.ft. non-
disturbance buffer along the landward edge of wetlands,• establishment and maintenance of a 3,440s4.ft.
non-turf buffer of natural vegetation with 4'wide access path to water to be maintained for a total of
12,888 sq ft of vegetative buffers,• removal of aportion of existing driycway along property line and re-
vegetation with evergreens(landscaped),•relocation of a portion of existing driveway 85'south along
Bridge Lane and re-paving with pervious material and steel edging; installation of a 1,000 gallon buried
propane tank and 120/240 V. Kohler generator set on 3'6"x8'elevated wood platform next to dwelling,
existing 6'x5'outdoor shower modified in-kind,• stepping stone walkway on grade in place of existing
200sq ft of brick walkway,existing 60sq ft landing resurfaced in-kind,• proposed 18sg.ft.masonry
landing in place of existing 20sq ft brick landing,• construction of a 333sq.ft.on-grade terrace with step in
place of existing 22'x10'terrace with step;replacement in-kind of existing timber steps(non-treated
railroad ties),• installation of a stepping stone walkway on-grade in place of existing 105sq.ft.brick
walkway, installation of a 14'x4'wide stone step in place of existing 9sq.ft.stone landing;replacement of
existing 24"xl4'6"deck and 18sg ft steps with wood deck and steps in-kind and in-place,• installation of a
48sq ft masonry stoop in place of existing 27sq ft brick stoop-, proposed on-grade steppingstone
walkway and proposed 30 linear feet x 4"wide timber steps• proposed 275sq.ft.masonry walkway in
place of existing 39sq ft brick walkway,and planting of evergreen screening• replacement in-kind of
existing 38sq ft deck,• replacement in-kind of existing 52sq.ft.deck,•with the condition that any future
repairs of docks or catwalks must be done using thru-flow decking,
At 1652 Bridge Lane,Cutchogue
Suffolk County Tax Map#1000-118-1-4.1
Conforms to the application for a Trustees Permit heretofore filed in this
office Dated April 5,2021 pursuant to which Trustees Wetland Permit#9904
Dated May 19,2021,and Amended on March 17. 0022 was issued'and conforms to all of the
r•
Offal* BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
o Town Hall Annex - 54375 Main Road - PO Box 1179
'* Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
ro err southoldtownny_,gov — seandCaD-southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: 4/13/2022
Company Name: LC Electrical Contracting Inc.
Electrician's Name: Lennie Cancellire
License No.: ME-38043 Elec. email:office@ Icelectricalcontracting.com`
Elec. Phone No: 631-874-0485 01 request an email copy of Certificate of Compliance
Elec. Address.: 22 Woodbine Lane East Moriches, NY11940
JOB SITE INFORMATION (All Information Required)
Name: Fisher, Danny
Address: 1652 Bridge Ln, Cutchogue
Cross Street:
Phone No.:
Bldg.Permit#: �j Q�j p a email:
Tax Map District: 1000 Section: I It) Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
(Taut ctra�-o�'
Square Footage:
Circle All That Apply:
Is job ready for inspection?: ❑ YES ❑ NO ❑Rough In ❑ Final
Do you need a Temp Certificate?: ❑ YES 0 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 Reconnect❑Underground❑Overhead
# Underground Laterals R 1 2 H Frame Pole Work done on Service? Y MN
Additional Information:
PAYMENT DUE WITH APPLICATION
`(X O� Q
.4?
PERMIT# Address:
Switches
Outlets
GFI's
Surface
Sconces
H H's
UC Lts Fridge HW POOL
Fans Mini Fr. W/D
Panel
Pump
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
FISHER RESIDENCE
Go m Do
r
-0 O O��❑0 ,nmurl�ux+w Lr wrnrm s
rP[ve D O O❑ il-iu olr+Ymrran, _�'U^ '4 + /
am O O t!
DO O
Dom
Do o o D III, Abe.:wo< .�.. a �'•\�"r ,s 1 14 U&G f8 IE n
D n r-r o❑ �i.� � marshal paetzel
_ ' IPNDSCPVE PRCH:IECTURE
rouavaw"tavoaw.iateOm,al < �� varut a �Y•
NOY„-w,...1
mn,sstu wmun wvn.urta.wa `.dY4 ,,R�t°s�s �!O or,.nw W�wliw�io
-----
��. � .'!.'.'.•'• �w.a�, Lawn laN$W9W
p I�Nm,ROOtl
n•+ ' - "`� _ _ _ b __. __ _. ._.._,� ante l�ixrlron
- /' ..- � �;l ,.•x.mawevuu it u.P...,PPP,aoe
�. r selu..emnlrsou.l
tW.sma:)srn srfa.rfenocsl
- .wt¢u¢ i5• .:a' �� ,emxew t.dhagePoalmabo>edtnv,res
� ulw.wbm.
b.*w nralm��W
� a eaa Y `_+• d �� :.T oemrmatwr,rnro,aa.++R I ,i �/ eF>¢ r�wO��wuv��Oe�.
,mrtatwe amagip (: / -f' NdOHmWaR�nvYm altNlN,pim,ba
LEGEND ROWO ebpvpP,ab o m.
f��� u�mviEE"'P"ssa'ru'�nnrEm�s
` /! / � � � onar.sa oaarewanrs zmMiuvnars
Sz1 rsns°Ofs.iovsv�OFaOY
a¢aNrsPce
/ Psmio"csNuirawms'"
TEST HOSE DATA
ms,,,asswnp� � s..r,or rPrrwPa,.nrass /..;)
aa.be,rt.-.Tev,et.w.asss v
a.sr tl oa .,\ b.mPr .a. PaarscmR �
sRm
''� ,anefae„R,W iwn W smMoldmpONe W
,umiW,a,-nnla,m ..uam,. �
' s SITE PLAN
` a Dm 0
a� Fo
a�
b aamt newersaR nm% (�-� xde l•-zl)._a.
^ snP.,Psun
t'_\.OD � mmin POO rrl PWb�
,� ,wr,.me .WW susss ax SIR
A
Ir
.,,SFIN TIE UNE-��
it S7FP ONyRADE
L ,� PR0. rp
8T�E i� •� EXISTWGEOGE OF CLEARING
wALK1! sow i °k (NPADDmONALCLEARuyG
'• � __ PROW 9TEP8 % .PROPOSED)
4it. pROPOSED278 SP yIASOMRY
WALKWAY Ui p1ACEOF PROPOSED 56SF
_ ! F W.PATH JJ` EXI9TIN6 S9:8F BRICK PROPOSED POOLEGUIPMEtRLjp
y .(t. ••.! . rvemv
ro DOCK WALKWAY S KING �H.WIRE MFSH FFJI�DE.. w-REMWm wa
9L o PROPOSED b AB PEN NY6 POOL —
• / •'� ,•�•• UTILRY a 24'N.STONE WALL
@; 1 Pou, _
Opo + + +
dL
o I
'wk TO BE NREpG uCED PROPOSE[), 8F MASONRY b� '•_7
y STOOPS
1 / IN�KIN STOOP IN PLACE OF EXISTING +575 lWAS
V SF BRICK STOOP 11N 6.5. ♦A5
4 p� E O EXISTING EX,PROPANE O - PROPOSED $b.
�; OO CRAWI:SPACE CAP 5S 788 X'a0'pOOL ♦1.75 �..
D� ENTRANCE / 5.5+ (SEEDETAIL21
QO PROPOSED VW. STONE XB'
/.6•
PLACE.. � �- P(. SELF.CCOSINO, �i PATIO SPA
IIDWG - DAB - SELFdATCHING
STOKE POSTING WOGOPpOLGATE PROP. .i
CE OF RESIDENCEE +.7. OPOSED PROpOSEDB'%4' TURF PAOPOy®r'W
KWAY " .. _NO WORK POOL ORYWELL
ONGRAD:STONE PO _ _ STEPS �',p. SELF4ATCNWF
TEpg r I 7C3" WALKWAY (SEEDETAIL 7I - TEST M 251
41dlD >Ut PROP.- w R W HOLE PC
.. TURF ^= AsvmwYSlr
rnNG ,5o STEPS b
GE+
uD�s a
. PROPOSED
24"H.STONE WALL
1 'r n •'1 �Q � 0
EXISTING
TREE WELL GP DRNEwA`1 .
,�� STEELEDG%G
i
TTING
ER METER
SF O*&U VE "ter- Q- - OQQO DEQK. ' E OF APPROX]AMO SF
PWPLACEOF OOOO OOO +.
-� POSED NATURAL
+ r
STATION TO BE
PROPOSED i P O ABRHED+
AI
iURF BUFFER 4% ,,b ��- 1 AWED AS NON-TURF
I R.
TIE LINE �.F .6_ 1
wI, "r!: ,=' • �`I' � EXISTINGIC£SSPATH r
EXISTING
, � TOPONIO�N DFLAG POLE. \� ,.�,vsa:ererw � /1 / ADJACENT
MEAN HIGH
' h;':. FENCE
WATER LINE �hf
't- 'c WETLANDS BOUNDARY
��►',d 'TIDAL -0ONSUL7ANTS, i ,fi.
` ,-' AS DEUNEATEDBY EN r
INC.ON FEBRUARY 18,2021 �
PROPOSED IS SF MASONRY ym, w _ -,, _ Rai i o
LANDINGIN PLACE OF _ i
gXNTM 20 SF BRICK LANDING PROPOSER TOODGAA
EXISTING OUTDOOR P.. BURIED PROPANETANK �
Epg�G BRICK LANDING PROPOSED STEPPING STONE SHOWER TO BE i
1201240V
WALKWAY'ON.GRADE IN PLACE OF ,MODIFIED IN-KIND PROPOSED
TO BE RESURFACED l"ND EXISTING 200 SF BRICK WALKWAY KpuLER 30 RCL.
GENERATOR SET ON f I
ELEVATEb 4
�� PL^^AT,,FORM l / =r°,Q4
irGiY, .40pRoi'q-TfJ47e:'
i� OTC.hOM / (12.M S D NON-TU
AREA OF NON-TURF BUFFER TO BE .Y
ACTIVELY REVEGETATED WITH: t
PANICUMVIRGATUM 1
AMNIOPHILA BREVILIGULATA
"� ' `SE SOUDAGO SEMPERVIRENS
SCHQACHYROM SCOPARIUM: s
MORELLA PENSYLVANICh
-BACCHARIS HALIMIFOLIA
PER��'19�9 1� '• J�O�
09
T.o��o ��,"`w __ _ __ _ _- %;�,�� =- - -= ` �.�' SCE
IV
1>r.! h1yJ Ir..
�� s` t ► 1 } �� G� , r,,., :r j �, r`� �.a. / / 1 , r� y I
�
Pog o c r HAF
K% r NAF
M
fit 11
N•,s I y � 1 i 1 1 -�;i•r;•,� , _ . •. . ' / �. Er M r �''
�J�/„ Y,_ _ ..`` j 1 �' ;rfY"c_ ,erq, •`',,,. / o
qV
4vco
40
IV
Sil
w 0 ,�9 aF S �°t•5 a� ;� J ( w,n PROPS`
ADDRE
i
OWNER
90 �, a:_,,........,.......,_.P...,..., :,.,..,.....L •'Y� fly
LN
_ \� � S�, „� q•�P`I� MJ P�fP �3 2$ Ir,! 5'7,4�+' ^" /•,r ,
my SITE:
AREA
F -
49
.r-
" a
d + • g�3
�• ^, _Fyn ' ~ "�V Y • � _` �':1'':�' ,I ■ , 4 • `
UA
lI W '� ¢ 'y fy ce Cam"_ •eye r.
a ! t sa ,� moo. • / . " ,b• t�`� to •
f
Z
• . a`
4
O,tea- .�e.— s r��`, �x "BOG � �0��'' ■ • • l�'T ����..../, • �
'` z . ' , o s• .tip I J •
ems" , 11 `, \• 1• �c�} / `�44' D►R
!k �a:l' •
of aW .•- •
`� uaHo tee CmNe N
LR. AIL
t Vs • .r r ,� Ir
AIL OL
ALLAIL
�W crnuO mar ar C14
o?o/a
Y Workers' CERTIFICATE OF 1NSURANCE'COVERAGE.
51'ATi: Compensation
Board .DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW
PART 1.To be completed by.Disabilityand Paid Family Leave Benefits Carrier or Licensed Insurance Agent or that Carrier
1a.Legal Name and Address of Insured(Use street address:only) 1b.Business Telephone-Number:of-Insured
Standard Electric Corp (516)819-8684
Calogero Brutto
6600:Jericho Tpke 1c. Federal.Employ erIdentification Number or Social Security
Syosset,NY 11791
Work Location of Insured(Only required if specifically limited to certain
locations in New York State;i.e..a wrap-Up Policy)
2. Name and Address of Entity Requesting.Proof of Coverage 3a.Name of-insurance Carrier
(Entity-Being.Listed as Certificate Holder) Standard:Security Life
3b.Policy Numberof.'entitylisted in.box 1a":62310-00
Town'of Southold.
54375 Main Road 3c.Policy effective period:3126i2010 to 3126.12021
PO Box 1179
Southold, NY 1.1971
4. Policy provides the following.benefits:
X A. All for the employer's employees eligible.under the New°York Disability Law
B. Only the following classor classes of employer's.employees:.
_C. Paid family leave benefits only
5. Policy covers:
X 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 L am;an:authorized representative or licensed agent of the insurance carrier
referenced above and thaf the named insured has NYS Disability Benefits.insurance coverage'as described above.
Date Signed November212020 By: David M;Bora,
(Signature of insurance earner's authorized representative or NYS Licensed InsuranceAgent of that insurance carrier)
Telephone No. 631673 7600 Name and Title: President;
IMPORTANT: If box 4a is checked,and this form is.signed by the insurance camees-authodzed'representative or NYS Licensed Insurance
Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder.
If box"41)"is checked;this certificate is NOT COMPLETE for the.purposes of Section 220,Sub.8 of the Disability Benefits Law.
It must be mailed for completion to the:Workers'Compensation Board,DB Plans Acceptance Unit,328 State Street,
Schenectady,New York 12305
PART 2.To.be completed by the_NYS Workers Com ensation Board Ont .if Box 4C or 513 of Part 1 has been checked
State of New York
Workers' Compensation Board
According to information maintained by the'NY8 Workers'Compensation Board,the above-named-insured bmptoyer has complied with the NYS
Disability Benefits.Law with respect to all or his1her employees.
Date Signed BY
(Signature of NYS Workers':Conipensation Board Employee)
Telephone,No: Title:
Please Note: Only insurance carriers licensed to write.NYS.disability benefits insurance policies and NYS license insurance agents of those
insurance carriers are authorized to issue Form 1313-1:20:1. Insurance Brokers are,not-authorized Wissue this form.
D13-120.1 (10-17)
Additional Instructions for Form DB-120.1
By signing this form, the insurance carver 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 7.
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 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 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.
YORK Workers' CERTIFICATE OF
STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE
Board
`la.Legal Name.&Address of Insured(use street address only) 1b.Business Telephone Number of Insured
(516)819-8684
tandard Electric Corp
Calogero.Brutto It.NYS Unemployment Insurance.Employer Registration Number-of
�500 Sericho Tpke
certain locations in.New York State,i.e.,a Wrap-Up Policy)
2:Name and Address of Entity Requesting Proof of Coverage 3a,Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) P&C Insurance Co of'Hartford
Town of Southold 3b.Policy Number of Entity.Listed in.Box"1a"
54375 Main Road 12WECAC1771
PO Box 1179 3c.Policy effective period
Southold,NY 11971 12/23/2020 to 12/23/2021
The Proprietor,Partners or Executive:Officers are included.
® (Only check,box if all partnerslofficers:included)all
❑ -excluded or certain partners/officers excluded:
This:certifies that the.:insurance carrier indicated above in box"3"insures the.business referenced above in box"1a".for workers'
compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed'underitem 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
The:insurance carriermust: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#hat cancel the policy or
eliminate the insured from the coverage indicated on Ithis Certificate.(These notices maybe 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 dghts,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 maybe used.as evidence of a Workers'Compensation'contract of insurance.onlywhile the underlying policy is.in effect.
Please Note:Upon cancellation of the workers'compensation.policy indicated on this formi 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,1.certify.that I am an authorized representative or licensed agent ofthe insurance carrier referenced.
above and that the named insured has the coverage as depicted on this forma
Approved by: Borg& Borg Jnc.,.David M Borg:Pres dent
(Print.name of:authorized representative orlicensed.agent.of insurance carrier)
� /iPi+rJ/y 11/23t2020
Approved by: (Signature) (Date)
Title:_Authorized Representative
Telephone Number:of authorized representative.or licensed agent of insurancecarrier: 631-673=7600
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=1052(9-17) www.wcb;ny.gov
Workers' Compensation Law
Section 57.Re dcWn on Issue of permits and the entering Into contracts unless compensation Is secured.
1. 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 a hazardous employment defined by this chapter,and notwithstanding 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 compensation for all employees has been secured as provided by this chapter. 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 compensation to any such employee if so
employed.
2. 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 a hazardous employment defined by this chapter, 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 compensation for all employees has been secured as provided by this chapter.
I
tr105.2(9.17)REVERSE
A`oR� CERTIFICATE OF LIABILITY INSURANCE °A'O"M'DD"0
11/23J2o2
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 pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WANED,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 endorsements.
GWOT
PRODUCER
Borg&Borg Inc. PHONE 831-673.7600 FAX Net.631-351.1700
148 East Main Street E4=L
Huntington NY 11743 A4299M certilicatesdborgborg.com
LOURERISIAFFORDENBCOVERAGE NAIL*
INSUM A:Merchants Mutual Insurance 23329
INSURED STMELE-01 INSURER a:P&C Insurance Co of Hartford 3469D
Standard Electric Corp INsum m c:Standard Secuft Lffe
Calogero G Brutto
6500 Jericho Tpke. OISURER D
Syosset NY 11791 INSURER E:
WSURERF•
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.
LNSR TYPE OF INSURANCE AWL SUB11 POLICY NUMBER POLICY EFF PO LIMITS
LTRA X COMMERCIALOENERALLUL8ILRY BOPIMS94 V112020 211/2021 EACHOCCURRENCE 51.000.000
DAMAGETORENie
CLAIMS•MAOE a OCCUR PREMISES Eaoau noa $500.000
MED EXP one $15.000
PERSONAL 8 ADV INJURY S Included
GEWL AGGREGATE LIMIT APPLIES PER: GENERALAGOREGATE S2,000,000
POLICY PRO- LOC PRODUCTS-COMPIOPAOG $2,000.000
JECT
OTHER $
A AUTOLWBILELIABtUTY CAPI075068 2fl/2020 2/112021 BONED $1,000-000
X ANYAUTO BODILY INJURY(Par Person) $
ONMED SCHEDULED BODILY INJURY(Per ao wwo S
AUTOS ONLY AUTOS
�( H1RE0 X NON-OWNED P iPER 5
AUTOS ONLY AUTOS ONLY
S
UMBRFJ LA LJAB OCCUR EACH OCCURRENCE S
EXCESSLWB CLAIMS-MADE AGGREGATE S
DED I I RETENTIONS S
g WORXERSCOMPENSATION 12WECAC1771 12123/2019 12123MM XSTATUTE OR
e ANDEMPLOYERS LIABILITY YIN 12MCAC1771 12123=20 12J2312021
ANWROPRIETORMARTNERJEXECUINE ❑ MIA E.L.EACH ACCIDENT S 1,000,000
OFFMERIMEMBEREXCLUDEO7
(Mandatory in NH) E.L.DISEASE-EAEMPLO S1,000,Q00
ilveLdesenboundar
DESCRIPTION OPERATIONS below
E.L.DISEASE-POLICY LIMIT $1.000.000
C ws;m3shEQr 62310-00 3/2602010 1 3120/2021 WS DBL Stahftfy
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLIEB(ACORD 101,AddWanal Romarka Seha&do,maybe ottaehad I mars spate Is raqubod)
I
I
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 T HE POLICY PROVISIONS.
54375 Main Road
PG Box 1179 � RnEoa>�'LEeENrATIVE
Southold NY 11971 f7
01988 2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks Of ACORD
�I
• a
OCCUPANCY OR
ED AS NOTED USE IS UNLAWFUL
APPROV ' WITHOUT CERTIFICATE
DATE: .B.P'# OF OCCUPANCY
FEE S-l9.
NOTIFY BUILDING DEPARTMEWT' AT
765-1802 "S Aid TO 4 PM -FOR THE
FOLLOWING``INSPECTIONS:_::._.,
1. FOUNDATION; :TWO REQUIRED
FOR POUR`ED"lCONCRETt
2. ROUGH : FRAMING &. PLUMBING
3. INSULATION
4. FINAL'-'CONSTRUCTION MUST COMPLY WITH All CODES OF
BE COMPLETE FOR C-O: - NEW YORK STATE & TOWN CODES
ALL CONSTRUCTION SHALL MEET THE AS REQUIRED AND CONDITIONS OF
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR SOUTHOLD TOWN ZBA
DESIGN OR CONSTRUCTION ERRORS. SOUTH,OLD TOWN PLANNINGBOARD
SOUTHOLD TOWN TRUSTEES
N:Y;S.DEC
Fi.QQD Z(Mk
COfM y Vffm cK#Jvm j4q
FIDDMAGN.WiDW RETAIN STORM WATER RUNOFF
sovrf 'l)'rn.
` PURSUANT TO CHAPTER 236
OF THE TOWN CODE.
.MCA.INSPECTION REQUIRED
Y �
Model: 30 R C L
KOHLER. Power Systems Multi-Fuel
Natural Gas/LPG
09001 Standard Features
• Kohler Co.provides one-source responsibility for the
NATIONALLY REGISTERED generating system and accessories.
,�
• The generator set and its components are prototype-tested,
factory-built,and production-tested.
• The generator set accepts rated load in one step.
• A standard five-year or 2000 hour limited warranty covers all
systems and components.
• Quick-ship(QS) models with selected features are available.
See your Kohler distributor for details.
• RDC2 Controller
o One digital controller manages both the generator set and
transfer switch functions(with optional Model RXT
transfer switch).
o Designed for today's most sophisticated electronics.
o Electronic speed control responds quickly to varying
household demand.
o Digital voltage.regulation protects your valuable
electronics from harmonic distortion and unstable power
The KOhlef AdVlnta9e
• High Quality Power o Two-line,backlit LCD screen is easy to read in all lighting
Kohler home generators provide advanced voltage and . conditions,including direct sunlight and low light.
frequency regulation along with ultra-low levels of • Engine Features
harmonic distortion for excellent generator power quality to o Powerful and reliable 2.2 L turbocharged liquid-cooled
protect your valuable electronics. engine
o Electronic engine management system.
• Extraordinary Reliability o Simple field conversion between natural.gas and LPG
Kohler is known for_extraordinary reliability and fuels while maintaining emission certification.
performance and backs that up with a premium five-year or • Innovative Cooling System
2000 hour limited warranty. o Electronically controlled fan speeds minimize generator
• All-Aluminum Sound Enclosure set sound signature.
\ • Certifications
• Quiet Operation o The 60 Hz generator set engine is certified,by the
Kohler home generators provide quiet,neighborhood- Environmental Protection Agency(EPA)to conform to the
friendly performance. New Source Performance Standard(NSPS)for stationary
spark-ignited emissions.
o UL 2200/cUL listing is available(60 Hz only).
o CSA certification is available(60 Hz only).
o Accepted by the Massachusetts Board of Registration of
Plumbers and Gas Fitters.
• Approved for stationary standby applications in locations
Served by a reliable utility source.
Generator Set Ratings
Standby Ratings
Natural Gas LPG R
IVr�'
Alternator Voltage Ph Hz kW/kVA, Amps kW/kVA Amps
EHE
4E5.6 120/240 1 60 30/30 125 30/30 125 NOV 2 9 2021
120/208 3 60 30/37 104 30/37 104
Do
127/220 3 60 30/37 98 30/37 98
120/240 3 60 30/37 90 30/37 90 BUILDING DEPT.
4D8.3 277/480 3 60 30/37 45 30/37 45
TOWN OF SOUTHOLD
220/380* 3 50 25/31 47 25/31 47
230/400 3 50 25/31 45 25/31 45
240/416* 3 50 25/31 43 25/31 43
* 50 Hz models are factory-connected as 230/400 volts.Feld-adjustable to 220/380 or 2401416 volts by an authorized service technician.
RATINGS:All three-phase units are rated at 0.8 power facto.AR sin"ase units are rated at 1.0 power factor.Due to manufacturing variallons,the ratings tolerance Is t 6%. Standby Ratlngx Standby
ratings apply to installation salved by a rellable WIRY source.The standby rating Is applicable to varying loads with an average load factor of 80%for the duration of a power outage.No overload capacity
is specified for this rating.Ratings we In acoordance with ISO-Vol,BS 5514,AS 2789,and DIN 0271.GENERAL GUIDELINES FOR DEBATING:AI66de Derate 1.3%per 100 In(328 R)elevation above
20D m(858 8.).Temperature:Derete 3.0%per 10°C(18°F)temperature above 25°C(77"F).Availability is subject to change without notice.The generator set manufacturer reserves the right to change the
design or specifications without notice and without any obligation or liability whatsoever.Contact your local Kohler generator distributor for availability.
G4-229 (30RCy 4/16
Alternator Specifications
Specifications Alternator • NEMA MG1, IEEE,and ANSI standards compliance for
Manufacturer Kohler temperature rise and motor starting.
Exciter type Brushless,Wound-Field • Sustained short-circuit current of up to 300%of the rated
Leads:quantity,type current for up to 10 seconds.
4E5.6 4,120/240
4D8.3 12,Reconnectable a Sustained short-circuit current enabling downstream circuit
Voltage regulator Solid State,Volts/Hz breakers to trip without collapsing the aftemkor field.
Insulation: • Self-ventilated and drip-proof construction.
Material Class H
Temperature rise 1.3010,standby a Windings-are vacuum-impregnated with epoxy varnish for
Bearing:quantity,type 1,Sealed dependability and long fife.
Coupling Flexible Disc
Amortisseur windings Full a Superior voltage waveform from a two-thirds pitch stator and
Voltage regulation,no-load to full-load m1.0%Maximum skewed rotor.
Unbalanced load capability 100%of Rated Standby • Total harmonic distortion (fHD)from no load to full load with
Current 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 4E5.6(4 lead) 44 (60 Hz)
480 V,400 V 4D8.3(12 lead) 120(60 Hz) 88(50 Hz)
Application Data
Engine Exhaust
Engine Specifications 60 Hz 50 Hz Exhaust System 60 Hz 5o Hz
Manufacturer Kohler Exhaust manifold type Dry
Engine:model,type Residential Powertrain Exhaust temperature at rated kW,dry
KG2204T,2.2 L,4-Cycle exhaust,19-F) 633(1171)
Turbocharged Maximum allowable back pressure,
Cylinder arrangement In-line 4 kPa(in.Hg) 7.5(2.2)
Displacement,L(cu.in.) 2.2(134.25)'
Bore and stroke,:mm(in.) 91 x 86(3.5.x 3.4) Fuel
Compression ratio y0.51 Fuel System
Piston speed,to/mm,(tt./min.) 310.(1016) . 258.(847).
Main bearings:quantity;type 5,plain alloy steel Fuel type Natural Gas or LPG
Rated rpm 1800 1500 Fuel supply line,inlet 1 in.NPT
Max.power at rated rpm,kW(HP) Natural gas fuel supply pressure,kPa
LPG 47.8(64.1) ,NA (n.H2O) 1.24-2.74(5-11)
Natural Gas 47.6(63.9) NA LPG vapor withdrawal fuel supply
Cylinder head material" Cast Iron pressure,kPa(in.H20),.. 1:24712.74(5-11)
Piston type and material High Silicon Aluminum. Fuel Composition Limits* Nat.Gas LP Gas
Crankshaft material Nodular Iron Methane,%by volume." 90 min. -
Valve(exhaust)material Forged Steel Ethane,%by volume 4:0 max. -
Governor type Electronic Propane,%"by volume 1.0 max. 85 min.
Frequency regulation,no-load to Propene,%by volume 0.1 max. 5.0 max.
full-load Isochronous 04 and higher,%by volume 0.3 max. 2.5 max.
Frequency regulation,steady state t1.0% Sulfur,ppm mass 25 max.
Frequency Fixed Lower heating value,
Air cleaner type Dry MJ/m3(Btu ),min. 33.2(890) 84.2(2260)
Engine Electrical * Fuels with other compositions may,be acceptable.If your fuel is
outside the listed specifications,contact your local distributor for
Engine Electrical System further analysis and advice.
Ignition system Electronic
Battery charging alternator: Lubrication
Ground(negative/positive) Negative Lubricating System
Volts(DC) 14 -Type Full Pressure
Ampere rating 90 Oil pan capacity,L(qt.) 4.2(4.4)
Starter motor rated voltage(DC) 12 Oil added'during all change(on average),
Battery,recommended rating for-18°C(0'F): L(qt.) 3.3(3.5)
Qty.,cold cranking amps(CCA) One,630 Oil filter:quantity,type 1,Cartridge
Battery voltage(DC) 12 Oil cooler. Remote
Battery group size 24
G4-228 (30RCy 4/10
Application Data
Cooling RDC2 Controller
Radiator System 60 Hz 5o Hz
Ambienttemperature,°C(°F) 45(113)
Engine jacket water capacity,L(gal.) 2.65(0.7)
Radiator system capacity,including voneae: 24ov
Freq: E0.0 HZ
engine,L(gal.) 13.2(3.5)
Water pump type Centrifugal 0
Fan diameter,mm(in.) qty.3 @ 406(16)
Fan power requirements(powered by. ® oR N++o wx
engine battery charging alternator) 12VDC,18 amps each
Operation Requirements
Air Requirements 6o Hz 50 Hz The RD02 controller provides integrated control for the
Radiator-cooled cooling air, generator set; Kohler®Model RXT transfer switch,
m3/min.(scfm)t 51 (1800) 51 (1800) programmable interface module(PIM),and load management.
Combustion air,m3/min.(cfm) 1.6(57) 1.3(45)
Air over engine,m3/mina(cfm) 25(900) 25(900) The RDC2 controller's 2-line LCD screen displays status
# Air density=1.20 kg/m3(0.075 Ibm/ft3) messages and system settings that are clear and easy to read,
even in direct sunlight or low light.
Fuel Consumption*
Natural Gas,m3/hr.(cfh)at%load 60 Hz 50 Hz RDC2 Controller Features
100% 12.0 (424) 10.0 (353) • Membrane keypad
75% 9.8 (345) 8.2 (289) .
50% 7.6 (268) 6.3 (222) o OFF,AUTO,and RUN push buttons
25% 5.5 (196) 4.5 (159) o Select and arrow buttons for access to system
Exercise 3.4 (121) 2.8 (99) configuration and adjustment menus
LP Gas,m3/hr.(cth)at%load 60 Hz 50 Hz • LED indicators for OFF,AUTO,and RUN modes
100% 4.7 (166) 3.9 (138) • LED indicators for utility power and generator set source
75% 3.7 (132) 3.0 (105) availability and ATS position(Model RXT transfer switch
50% 2.8 (100) 2.3 (81) required)
25% 1.9 (69) 1.6 (56) • �LCD screen
Exercise 1.2 . (41) 1.0 (35) o Two lines x 16 characters per line
# Nominal Fuel Rating: Natural gas,37 MJ/3m (1000 Btu/ft3) o Backlit display with adjustable contrast for excellent
LP Vapor,93 MJ/m (2500 Btu/R3) visibility in all lighting conditions
LP vapor conversion-factors:
8.58 ft 3=1 lb: • Scrolling system status display
0.535 m3=1 kg. o Generator set status
36.39 ft.3=1 gal. o Voltage and frequency
o Engine temperature
Sound Enclosure Features o Oil pressure
• Sound-attenuating enclosure uses.acoustic insulation that o Battery voltage
meets UL 94 HF1'-flammability classification and repels o Engine runtime hours
moisture absorption. • Date and time displays
• Internally mounted critical silencer. • Smart engine cooldown senses engine temperature
• Skid-mounted,aluminum construction with two removable • Digital isochronous governor to maintain steady-state speed
access panels. at all loads
• Fade-,scratch-,and corrosion-resistant Kohler®cashmere • Digital voltage regulation: ±1.0%RMS no-load to full-load
powder-baked finish. • Automatic start With
,programmed cranking cycle
Sound Data • Programmable exerciser can be set to start automatically on
any future day and time,and to run every week or every two
Model 30ROL 8 point logarithmic average sound levels are weeks
54_dB(A)during weekly engine exercise and 61 dB(A)during • Exercise modes
lull-speed generator diagnostics and normal operation. For o Unloaded exercise with complete system diagnostics
comparison to competitor ratings,the lowest point sound levels o Unloaded full-speed exercise
are 52 dB(A)and 60 dB(A) respectively.* - o Loaded full-speed exercise(Model RXT ATS required)
All sound levels are measured at.7 meters with no load. • Front-access mini USB connector for SiteTech' connection
* Lowest of 8 points measured around the generator.Sound levels at other points • Integral Ethernet connector for Kohler®OnCue®Plus
around generator may vary depending on installation parameters.
• Built-in 2.5 amp battery charger
• Remote two-wire start/stop capability for optional connection
of a Model RDT transfer switch
See additional controller features on the next page.
G4-228 (30RCy 4/10
KOHLER CO.,Kohler,Wisconsin 53044 USA Kohler Power Systems
Phone 920-457-4441,Fax 920-459-1646 Asia Pacific Headquarters
For the nearest sales and service outlet in the 7 Jurong Pier Road
US and Canada,,phone 1-800544-2444 Singapore 619159
KOHLERPower.com Phone(65)6264-6422,Fax(65)6264-6455
Additional RDC2 Controller Features Available Options, Continued
• Diagnostic messages Starting Aids§
o Displays diagnostic messages for the engine,generator, ❑ Block Heater;120 V,1 Ph
Model RXT transfer switch; programmable interface ❑ Block Heater,240 V,1 Ph .
module(PIM),and load management device ❑ Oil Pan Heater,120 V,1 Ph
o Over 70 diagnostic messages can be-displayed. . ❑ Oil-Pan Heater,240 V,1 Ph
• Maintenance reminders § One block heater or oil pan heater is recommended for ambient
• System settings temperatures below 0°C(32°F). At temperatures below-18°C(0°F),
o System voltage,frequency,and phase installation of both heaters is recommended.
o Voltage adjustment Automatic Transfer Switches and Accessories
o Measurement system, English or metric ❑ Model RDT Automatic Transfer-Switch
• ATS status(Model RXT ATS required) ❑ Model RXT Automatic Transfer Switch
o Source availability ❑ Model RXT Automatic Transfer Switch with Combined
o ATS position (normal/utility or emergency/generator) Interface/Load Management Board
o Source voltage and frequency ❑ Load Shed Kit for RDT or RXT
• ATS control (Model RXT ATS required) ❑ Power Relay Modules(use up to 4 relay modules for each
o Source voltage and frequency settings load management device)
o Engine start time delay Miscellaneous
o Transfer time delays ❑ Rated Power Factor Testing
o Fixed pickup and dropout settings Literature
o Voltage calibration ❑ General Maintenance Literature Kit
• Programmable interface module(PIM)status displays ❑ Overhaul Literature Kit
o Input status (active/inactive) ❑ Production Literature Kit
o Output status(active/inactive) Warranty
• Load control menus ❑ Extended 5-Year/2000 Hour Comprehensive Limited Warranty
o Load status Other Options
o Test function ❑
Generator Set Standard Features ❑
• Aluminum sound enclosure with enclosed silencer
• Battery rack and cables Dimensions and Weights
• Electronic, isochronous governor Overall Size,L x W x H,mm(in.): 1880 x 836 x 1169
• Flexible fuel line (74 x 32.9.x 46.0)
• Gas fuel system(includes fuel mixer,electronic secondary Shipping Weight,wet,kg(lb.): 599(1320)
gas regulator,two gas solenoid valves,*and flexible fuel.line- Weight includes generator set with engine fluids, sound enclosure,
between the engine and the skid-mounted fuel system silencer,and.packaging.
components)
• Integral vibration isolation`
•. Line circuit breaker
• Oil drain extension
• OnCue®Plus Generator Management System H
• Operation and installation literature
. RDC2 controller with built-in battery charger
Standard five-year or 2000 hour limited warranty I*-- W—� L _�
Available Options
Approvals and Listings NOTE:This drawing is provided for reference only and should not be
used for planning installation.Contact your local distributor for more
❑ UL 2200/cUL Listing(60 Hz only) detailed information.
❑ CSA Approval(60 Hz only). DISTRIBUTED BY-
Controller Accessories
❑ Programmable Interface Module(PIM)
(provides 2 digital inputs and 6 relay outputs)
Electrical System
❑ Battery
❑ Battery Heater
®2010 by Kohler Co.Al rights reserved.
G4-229 (30RCL) 4/16