Loading...
HomeMy WebLinkAbout51397-Z %of SOUIyO!° Town of Southold * * P.O. Box 1179 �0 53095 Main Rd Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 45801 Date: 11/26/2024 THIS CERTIFIES that the building ACCESSORY ALTERATION Location of Property: 895 Jasmine Ln Southold, NY 11971 Sec/Block/Lot: 69.-3-24.1 Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 11/20/2024 Pursuant to which Building Permit No. 51397 and dated: 11/20/2024 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: 1 window replacement in existing accessory garage as applied for. The certificate is issued to: Nicoletta Stathakos Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: PLUMBERS CERTIFICATION: QAr IN ut ed ignature tso�ryo! TOWN OF SOUTHOLD BUILDING DEPARTMENT `"o��• �,�¢ 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#: 51397 Date: 11/20/2024 Permission is hereby granted to: Nicoletta Stathakos 1023 79th St Brooklyn, NY 11228 To: 1 window replacement in existing accessory garage as applied for. Premises Located at: 895 Jasmine Ln, Southold, NY 11971 SCTM#69.-3-24.1 Pursuant to application dated 11/20/2024 and approved by the Building Inspector. To expire on 11/20/2026. Contractors: Required Inspections: Fees: Accessory-Alteration $125.00 CO Accessory $100.00 Total $225.00 Building Inspector 5 � OF SOUTyOlo TOWN OF SOUTHOLD BUILDING DEPT. "you 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATION/CAULKING [ ] FRAMING /STRAPPING [V FINAL V)/lp^f> [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: 4/ FWWA W&W DATE 0 v INSPECTOR FIELD INSPECTION REPORT I DATE COMMENTS vl ►a lY FOUNDATION (1ST) ------------------------------------- FOUNDATION (2ND) ' 2 O U'1 cn .9 Ly ROUGH FRAMING& PLUMBING 3 X r t� INSULATION PER N.Y. "3 STATE ENERGY CODE C C7 m Lk FINAL ADDITIONAL COMMENTS �- u9A QJ'( tco rn k b O ,yam x d b y (< .rs:i7P�no TOWN OF S®LiTHOLD—B1<JILD>tRrG DEPARTMENT � ' Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1 R02 Fax (631) 765-9502 httl�s::'�1����rv�. outholdtoGvnnv.�ov Date Received a APPLICATION FOR BUILDING PERMIT y y e © 5 tFor Office Use Only p J � PER PA;T iN0._ � 1] Building Inspector: I ApF7,icalions en.el fauns roust he filled out in their entirety incomplete a p 1111 cai.i co rs will not be:accepted Where the A00licarp;'is mot th#owner, t� Owner's Authorization for!r (P:age2)shall be completed �lziidi�9 f�,ot�t1►�, 0 ::e: 613124 r tll�/.�iER�S�'C3P:PR®PEEtT' 5 i Jn' NiColetta Stathakos SCTM # 1000- ro art Address: _ 895 Jasmine Ln a N C Phone#:a31_371-1243 Email:jzaoutis50@gmail.com 5 g Mailin Address: � 395 Jasmine Ln, Southold NY 11971 e-QN7A.0 7 PERSON! - n Scott Doughman a i Mailino Address:105 Suttonball Ln, Glastonbury CT 06033 t ! Nhone r:303-946-8685 Email: a permits@gopermits org l I DE51aI] PR0rE I Arld]li9 'I , 1 .. i,Jutiie:nfM ' i t'd"a lin-,Address: 1 a Phone#: Email: I C:vilJ s'RAG a OR 1NEqli.9�"f'i�� : !,jarne: Nome Depot USA i y Alailing Address:2455 Paces Ferry. Rd. Atlanta, GA 30339 J a Phone t;: 303-946-8085 Email: permits@go p e rm its.o rg DESC.RIP d ioi�O tzRt?;'LSSED CONSTRUCfibf1! _1PNew Structure OAddition ❑Alteration ❑Repair ❑Demolition V,11 MoVJ Estimated Cost of Project: itP 2r� �P}aGe-2-windwr✓s,same-"-size,-rye s-tr-rretaral-c-hange- 1!1 3665 29I 7 i:i he lot be re-graded? Yes ONO Will excess f9 he removed from premises? L_.IYes _!No a - mcuSign Envelope It):D899U8AU-t59F-4DE0-9707-1 DESt-619tt94 _- I3i4PEGffY(NFf3F3FV9{iTtfy�! single fr" m-fly, 4n*:ndedu5enr?rr�perty:Single family � ` i •;.' cj!sC'ic?:its vd^iC" prerrmises is s;W.,it:ed; Are there any covenants and rests iction5 with respect to this propprt,y;' C,Yei CiNo IF YES,PROVOE,A COPY. � Afte I e C ic9 .'Th r awn�t/cuntt Eta f desi �prutaxstQyal c ms�xansi5l gar ail drafnagc end a[a*rn w�*gr�Ssuex as S�avt ee b1? -v ?,C ar t},`Town crlt;.APPLi ape 9adpire3 0[y it xt far t an#14anE:W ttie.UN47T ZSne . ; :::c-:�:u:r'oP�cu;hu{�,Su�al�:[eirc;,r+l'ezr.Y�t.ud ;hu �,gfrcattf�izsws:0�snanccsa,SRe3'l)et}csd�,fci,ti•�cans:zuctranorEu:lu�,�; n.: , ,s,,:,t•:r.�t"JL�Sor!rrreir�mkilorr3 mct; r ttpn heccl�-drs�r['-twL{1se,;ggtic�ni agrees�.cdmpry twth stl 8ggltca6{e Lbws.G'iiinat)C�.�..hl[{fdltfg.adc, � ..,,n::a•h:c �ioC;on$an:a tah adr:r"s4:tuti+vr;zca inspectces on,pcemisc,�n�tntruiTdPtt$tsj tnt ncc;Yr�tyltis�Ctlatr:;.Fatsg sa,etttep{;,rriade h�cefrt sir+� � ,�•., C o:5 A::;�daxn,a:1ar pucs�3ni Eo Se�tivn 2lE#.aS CF tha Rlecti:Yo�k Stafe r knaG(txv. y ' k c,f1S:e$tr!EttedBY�Ptin.'..M.)iJennifer" Wink FgAt riz dent i'%Vrte, Date, 4 Nc y q to ,._._..__... _.___.•.._.._.. _ _�,. ��-v�_._being duty svrurn,deposes and says that.(s),he is the applicant. i !•�,:r>„ 7; inCi::C;1n'!3ignirig con ract)above named, t contractor, Agr.nt,Corporate Officer; etc:) ii'•J a C::yi't14'a, ),Id is duly authbr:ced to.perform or have.peeformed the said work and to snake dod file this that A!starenients wntairWd In ti�is application are true to the best of his/her knowledge it�d'tzEi;ieP;and ,,Fall be performed in the wanner set forth in the application file therewith. S ILZ ar N ota ' t is SPEND R SULMER NOTARY PUBLIC Guilford Courrty,NC 11 PROPERTY OWNE, R AUTHORIZATION MY Cgmmlesi0h ErRpi"AUGUST24,2027 {Where'*,he applicant is not the owner) 9 Jennifer Winke - Go Permits !_L-C _do hereby authorise to apply on = u -!"e Town � an : e�: b , � � i rt for approval as.iescrihe herein, t iC®ltA �t�S 6/3/2024Ni i --.FJ7(3:87YOP1i3k2C^-..._._____....�._....__.•_......-...•_._......_......_____ ._..___.__.____.-_-_._._ __.�._.�......�__-_... ;S "W riC r-s Date Nicolette Stathaicos Y l Bunch, Connie From: Bunch, Connie Sent: Wednesday, November 20, 2024 10:52 AM To: Jennifer Winke Subject: RE: 895 Jasmine Ln We will just need a check for$225.00 and I can make copies of the paperwork to create a separate building permit. Thank you, Connie From:Jennifer Winke<jenniferwinke@gopermits.org> Sent:Wednesday, November 20, 202410:49 AM To: Bunch,Connie<Connie.Bunch @town.southold.ny.us> Subject:895 Jasmine Ln Hi Connie, You are correct, one of the windows replaced was in the garage.We were not aware that this required a separate permit.You have all the information for this window,as it was submitted with the permit application. Do you just need a check then,or are you able to close this permit and we will make a note for next time to apply for 2 permits when the windows are in separate buildings? Thank you, Jennifer Winke, Team Lead Go Permits, LLC Phone: 303-946-8685 jenniferwinkeCaD-gopermits.org i ATTENTION:This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. 1 6 DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 02r12,12024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. It SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: MARSH USA,LLC. PHONE FAX TWO ALLIANCE CENTER o A); fAtC,No): I 3560 LENOX ROAD,SUITE 240C ADDRESS: i ATLANTA,GA 30326 ----� INSURERS)AFFORDING COVERAGE NAIC 9 ........... -_.-.-.---_.-._ 124147 _.._..---....._.._....._---'._'. CN101G42069-HorneD-GAW.-22-25 INSURER A:Old Republic Insurance Co ....... .. ........._..__......_..--------...._......_..........._._..._...._...__....._.. --._.._.... INSURED THE HOME DEPOT,INC. INSURER B:Indemnity Ins Co Of NoNh America 43575 I HOME DEPOT U S.A.,INC. INSURER C: -- = 2455 PACES FERRY ROAD INSURER D BUILDING C-20 I' ATLANTA,GA 33339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-00531471/4-07 REVISION NUMBER: 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS f CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE,INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, I ( EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _....._........_...................._...--.._...--------....._..-------- ._..........-----------------.....--— -- - -----._....--- -----..._._.._.__._...-------... ---..__.........__......._. !1N5R' ADDL;SUB POLICYEFF ; POLICY EXP --`-7f= TYPE OF INSURANCE I POLICY NUMBER !MM(DDIYYYY i MMIDDIYYYY LIMITS I A I X COP.1MERCIAL GENERAL LIABILITY MWZY 316548 03/0112022 03/01!2025 EACH OCCURRENCE $ 1,000.000 -'-- .._.......___.._.__...___._..__._... DAMAGE TO RENTED 1,000,0 EXCLUDED S I CLAIMS-MADEX i OCCUR I _PREMISESjEa.occurre)icej— � _ i X I SIR $1 000,000 MED EXP(Any one personi $ 0 00 i I PERSONAL&ADV INJURY $ 1, O GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY L J PRO LOC i 2,000.000 JECT I DUCTS $ OTHER. $ MWTB316649 03101/2022 i D3lOt!2025 COMBINED SINGLE LIMrr $ 1,000.000 A I AUTOIdfOBILE LIABILrrY + Ea accidenrl X .ANY AUTO BODILY INJURY(Per person) $ r ^OWNED I l SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AU'IOS ONLY AUTOS i HIRED NON-OWNED PROPERTY DAMAGE $--- — !i AUTOS ONLY AUTOS ONLY Per accident j A I- UMBRELLA LIAB X OCCUR MWZX 316647 0310112022 0310112025 EACH OCCURRENCE $ 107000,000 III ! i „ EXCESS LIAR — CLAIMS-MADE i AGGREGATE $ _ 10,000.0000 f -- iI DED• RETENTION$ $ B ;WORKERS COMPENSATION I SCFC50670533(WI) 03/01204 03/01,2025 X PER i OTH- I i AND EMPLOYERS'LIABILITY Y/N I STATUTE ER iANYPROPRIETOROARTNER/EXECUTIVE ! i E.L.EACH ACCIDENT $ _ _ 5 00,000 OFFICEWMEMBEREXCLUE N NIA' I i(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ S,000,000 II yes.describe under i EE ............................................................ —'bFSCRIPIION OF OPERATIONS below Continued on Ad Page E.L.Of -POLICY LIMIT $ S.00QD00 , i i i I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be aftached If more space Is required) CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED IF REQUIRED BY WRITTEN CONTRACT ON THE ABOVE GENERAL LIABILITY POLICY,BUT ONLY WITH RESPECT TO LIABILITY { ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED. I CERTIFICATE HOLDER CANCELLATION 1 TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 ROUTE 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1179 ACCORDANCE WITH THE POLICY PROVISIONS. SOUTFIOLD,NY 11971 t AUTHORQED REPRESENTATIVE i — 91988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta AC CWrjo ADDITIONAL REMARKS SCHEDULE Page 2 of 3 I ACf FNC'y NAMED INSURED MARSH USA,I.I.C. THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. [POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA,GA 30339 C..3RRiE(i NAIC COpE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ii FORM NUMBER; 25 FORM TITLE: Certificate of Liability Insurance _ __� 1 Wor'rors Compensation Continued: Carrier:Safety National Casualty Corporation Policy Number L DS4068089(AL,AR,A7,FL,ID,IA.IL,KS,KY,LA,MS,MO,NC.NE,NM,ND,OK,SC,SD,TN,VA,WV;WY) Effective Date:Q 12024 Expiration Date-03/0112025 (EL)Um'rf:$5.000,000 f Camer.Safety National Casualty Corpora o i Policy Number.S'40ti8090(CSI)(CA,OR.WA) I Effective Date:03V/2024 Expiration Date:0310112025 (EL-)Limit:$5,000 000 i SIR$5,000,000 i i ( j Carrier ACE American Insurance Company Poicy Numher.6NCUC50G70375(OSI)(GA.MI,NV,OH,UT) Ettectivo Dete TV0112024 Expiration Date.01,31+2025 (EL)Limit:S5,000.000 SIP.:$5.000,000 SIR,GA):S750.000 (EL)lGA).$4,260,000 SIP.51,lw$1.000,000 (EL)(NV):S4,000,000 Ca .r:Indemnity Insurance Company of North America Policy Nwnber:V1,'LRC50670284 (AK.CO,CT,DC,DE,HI,IN.MA.MD,ME,tlN,MT.NH.NJ,NW,PA.RI,VT) Effective Date:03'01/2024 Expiration Date:03131i2025 (EL)Limit:$5,000,000 TX Employers XS Indemnity: Carrier.:arich American Insurance Company Policy Number;NSL1138319-01(TX) Effective Date:03.01/2024 Expiration Date:0 1511 025 {El)Limit:$6,000.000 t SfR•$5,000,000 i i s t {i E 4t! ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta ADDITIONAL REMARKS SCHEDULE Page 3 -of 3 AGENCY NAMED INSURED MARSH USA,LLC. THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA,GA 30339 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER; 25 FORM TITLE: Certificate of Liability Insurance i ""HOME DEPOT INSUREDS— The Home Depot.Inc. Home Depot U.S.A..Inc. Horne Depot U.S.A.Inc.dba The Home Depot Home Depot of Puerto Rico,Inc. I Home Depot Product Authority,LLC Home Depot Store Support,Inc. Rod Boaron,LLC H.D.W.Wiring Company,Inc. I 1 As1wity,Inc.. Home Depot Management Company,t.LC I Horn Depot Solutions,LLC i� S 3 i� f i I r i I I I ACCORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Y�a, Workers' CERTIFICATE OF �Ti Compensation NYS WORKERS'COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured 770-433-8211 Houle Depot USA, Inc. 2455 Paces Ferry Rd., C-20 1c.NYS Unemployment Insurance Employer Registration Numberof Atlanta, GA 30339 Insured � 76011130 V'Vork Location of Insured(Only required if coverage is specifically limited to certain locafions in New York State,i.e.,a Wrap-Up Policy) 1d.Federal Employer Identification Number of Insured or Social Security � Number L 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Indemnity Insurance Company of North America Town of Southold 53095 Route 25 3b.Policy Number of Entity Listed in Box"l a" Southold,NY 11971 WLR C50670284 3c.Policy effective period 0300024 to 03l01,'2025 3d.The Proprietor, Partners or Executive Officers are included.(Only check box if all partnersfofricers included) E Q all excluded or certain partners/officers excluded. I This certifies that the insurance carrier indicated above in box"W insures the business referenced above in box"la"for workers' III compensation under the New York State Workers'Compensation Law.(To use this form,New York(IVY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration elate 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 after the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. "'his certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit,license or contract Issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of penury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named Insured has the coverage as depicted on this form. Approved by: Eric Tonn (Print name of authorized representative or licensed agent of insurance carrier) Approved by: .. 3/1,124 ~ (Signatue) (Date) Title: Vice President Telephone Number of authorized representative or licensed agent of insurance carrier: 678-795-4338 Piaase Note:;only Insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT CERTIFICATE OF INSURANCE COVERAGE Ynr�ir � _�'STArE 1 Compensation Y­ ,Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW I PART 1.To be completed by NYS Disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured HOME DEPOT U.S.A.,INC. 678-384-2193 2455 PACES FERRY ROAD NW ATLANTA,GA 30339 1c.Federal Employer Identification Number of Insured or Social Security Work Location of insured(Only required if coverage is specifically Number limited to certain Iocati(3nS in New York State,i.e., Wrap-Up Policy) 1 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY TOWN OF SOUTHOLD 53095 ROUTE 25 PO BOX 1179 3b. Policy Number of Entity Listed in Sax 1a SOUTHOLD,NY 11971 LNY713657008 1 3c.Policy effective period 01-01-2024 to 12-31-2024 i—•--- 14.Policy provides the following benefits: j A.Both disability and Paid Family Leave benefits. B.Disability benefits only. C.Paid Family Leave benefits only. 5.Policy covers: A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law, B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability andlor Paid Family Leave benefits insurance coverage as described above. Date Signed 11-20-2023 By (Signature of Insurance carrier's authorized representative or NYS licensed Insurance agent of that Insurance carrier) jTelephone dumber (212)553-8074 Name and Title: ELIZABETH TELLO—ASSISTANT DIRECTOR STATUTORY SERVICES I IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or PAYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If Box 4B,4C or 5B Is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law.It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board,Plans Acceptance Unit,PO Box 5200,Binghamton,NY 13902-5200. PART 2.To be completed by the NYS Workers' Compensation Board (Only if Box 413,4C or 5B have been checked) State of New York Workers' Compensation Bard According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their employees. I , i Date Signed By (Signature or Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and Paid Family Leave benefits insurance policies and NYS licensed insurance agents of these insurance carriers are authorized to issue Form DS-120.1.Insurance brokers are NO;authorized to issue this form. P-B-120.1 (12-21) Additional Instructions for Form D13-12001 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 1 a for disability and/or Paid Family Leave benefits under the NYS Disability and Paid Family Leave Benefits Law. The insurance carrier or its licensed agent will send this Certificate of Insurance Coverage(Certificate)to 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 carrier or its licensed agent, or until the policy expiration date listed in Box 3c,whichever is earlier. This Certificate is issued as a matter of information only and confers no rights upon the certificate holder.This Certificate does not amend,extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This Certificate may be used as evidence of a NYS disability and/or Paid Family Leave benefits contract of insurance only while the underlying policy is in effect. Please Bole: Upon the cancellation of the disability and/or Paid Family Leave benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Insurance Coverage for MYS disability andlor Paid Family Leave Benefits or other authorized proof that the business is complying with the mandatM coverage requirements of the NYS Disability and Paid Family Leave Benefits Law. NYS DISABILITY ARID PAID FAMILY LEAVE BENEFITS LAB! (a) The head of a state or municipal department, board,commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first,two thousand and twenty-one, the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b) The head of a state or municipal department, board,commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first,two thousand eighteen,the payment of family leave benefits for all employees has been secured as provided by this article. l D13-120_1 (12--21) Reverse 1 Labor,Licensing 8 Consumer Affairs HOME IMPROVEMENT LICENSE Name RICHARD TOUSEY This certifies that the Business-Name oearor is duly licensed HOME DEPOT USA INC(14 SUPPS) :)y the County of Suffolk License Number:H-53429 Rosalie Drago issued: 05115/2014 Commissioner Expires: 11/01/2024 This license is the property of Suffolk County p Department of Labor,Licensing&Consumer Affairs. r I Possession of this license does not guarantee Its validity. r d' Additional Business Name License Category H1-GC 9 mum t - Visible UV Blcck ( IG Panes of U-Factor A-Value SHOO Transmit Center of Insulated Glass Unit Package Low E .Gas �Spacer5 tern Thick Glass 'total Unit Total Unit Total Unit Total Unit Glass Standard Prosdar Argan intercept 314" 2 0.31 3.23 0.30 0.53 73% Entrgl sear ProSolar Argon Superrept M' r 2 0.29 3.45 0.28 0,46 73% ENERGY STAR NoMem PruSotar Sun Argon Super Sopcer -314" .2 D.30. 3.33 OA9 0.50 71% ENERGY STAR`lord Ccvirtal t ProSalar Argan Superoept _ am" i :2_ _ ti.30 _ 3.33 0.30 I 0.53� 73%_ _ ENF.FGY STAR South Cenral .... PrnSeiar Shade Argon��Supercapt 314. ly~`2 0.29 3A5 .� 021 I 0.49 92% ENERGY STAR Southern ProSotarSf:atlo Argon Suporcept 31d' t 2 0.29 3.45 0.21 0.49 92% With 0 td4 Visible UV Block lG tt Panes of U-Fader R-Value SHGC Transmit Cantor of Insulated Glass Unit Package rl. Lose F Type Gas :spacorSystorn Thick 4 Glass Total Unit Total Unit Total Unit Total Unit I Glass Stinaard I ProSdar .Argon Intercept 374` 2 0:31" 3.23 0.27 O.Z77 73% EneigiSavor _ _ PioSdar .Argon i Supercepi 314' Z_ -0.29. _ 3,45 _� 6.25 6.41 731A ` I FNEFvY STAR 14arnam a �_Prosolar_Sun Argon Super Spacer 314- 2 0:30 3.3F 0.44 0.53 71114. _ ENEkGY STAR Norri cenaal^ ; 'ProSolar Argon Supercept 314' -2 0.30 3.33 0.27 0.47 73% NERGY STAR South Contr.! r .ProSoiar Shade. Argon Supercapt 31d' j 2 fl.29. 3.45 0.19 OAd 92% r�NERCiV STAR 5autrtarn ProSolar5hatle Atgon Supercepl 3!d' { 2O.Zt?: 3.45 0.19 0:d4 J2% APPROVED AS NOTED Zo 2 B P # 5 13_� COMPLY WITH ALL CODES OF DA$��L___�-B.P. AS REQUIRED A�CONDITIEW YORK STATE&TOWN ONS FEE 5- d0 BY: ONS OF MA NOTIFY BUILDING DEPARTMENT AT �OUTII�T 631-765-1802 8AM TO 4PM FOR THE MOM TOM PLOIfdG BM FOLLOWING INSPECTIONS: V SOUNLOTOWNTRUSTEES FOUNDA_hON-TWO REQUIRED kYl DEC FOR POURED CONCRETE SO(�TIIOI� i ROUGH-FRAMING&PLUMBING $CHfl INSULATION FINAL-CONSTRUCTION MUST BE COMPLETE FOR C-0. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS L'd1NDOWSPECIFICATIONSHEET - SpeC Stl-3ei9; F4;357070 SI1c2L' 1 01 1 CUStornec Nicoiolte Statl:a'cos Job k:F433fi7870 Con5ultarl,: Adsm Frmdtnan Date- 05/26,2024 -- -- ---- - — New Window Hinge Locations Existing 4'JrnUO•r.' Measurernents Grids Product Options Labor Oplionsl From outsida, Left to Right t Bays,Bows Location Color Rough Opening R of bars A of bars Csmnls,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doers use Mull "S"=stationary or 1 4 1 C U t LL m C O W N O U N •,X"=operating I w j Style Wraps 2o m c mM `o o m o r I Room Floor Code (Y/N) Style Code Series Gode w 3 x5 vi a > x > _ I STD,White, Glass Pack: WRAP, 1 1LIV 1st Wit Y IDti 6100 WH WH 61 bs 119 1-, �W i'W C ALL 2 2 ALL 2 2 Stanoard METAL, i FF GBG �H STOOL i 1 ! STD,White, GlassPack: METAL, i 2 GAR 1st TDH Y TDH 6100 WH WH 61 58 110 F, iWH,W C ALL 2 2 ALL 2 2 Standard STOOL, i FF GBG IH WRAP I I i I i I 1 I i SPECIAL CONSIDERATIONS: 1:White,2:White Map Color Interior Casing Type Bay or Bow window: eatboard material(vinyl only-Birch or Oak) . Bay Project Angle(30 or 45) Bay Flanker Typs(DK S'H,or Cstitnl) Top of window to soffit(inches) If tied to soffit,color of soffit rnatodai I have reviewed and agree with all the job specifications above and the IConstuci Roof(Yes or No)'_ Special Terms and Conditions on the following page Garden Window: S�eatt;oard Matar'sal(vinyl only-L'df:ite Pionite,Birch or Oak) .. v Dome Improvement Agreement: Page I. Horne Depot License#'s -For the most current listing visit www.Homedepot.com/LicenseNunibers P.dam Friedman Salesperson Flame Registration#(Req.in CA,CT,MEM.D,M:I,NJ,DC) Horne Depot U.S.A.,Inc.("Horne'Depot") or Authorized Service Provider named below will furnish, install and/or service the equipment listed below at the price;terms.and.conditions as outlined on this form. .........._........_._._.- 1. Service Provider Contact Information The Home Depot The.Home Depot Service:Provider Contact Name Service Provider Company Name L631} 478-6101 customercadtellationnortheast@honi Phone 9M eTr"o'- v� ides Email Address Service Provider License#(s) 2. Customer Information E -th g iSta akos i Nicolette Lon Island I F43357870 Customer.Last Name Customer First Name Store#/Branch Naive Customer Lead/.PO# ?895 Jasmine Lane Southold NY 11971 L� Customer Address City State Zip (6.31) 371-124a izaoutis5o@gmail.com Nome.Rhone# Work Phone# Cc11.Phone# Customer Email.Address ... .._ . ..... . .. ....... _.... 3. NOTICE OF RIGHT TO CANCEL. YOU RIAli'CANCEL THIS AGREEMENTWITHOUT PENAL17Y OR OIBLIGATION BY CONTACTING THE SERVICE PROVIDER OR-STORE DIREC:.`TLY;EMAILING SERVICE PROVIDER XF: tcustomercancellationnortheasf@homedepot.com OR DELIVERING WRITTEN NOTICE TO ROME DEPOT talc: 1:1�6 Oser Avenue [Hauppauge- Address City State Zip BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE. SUPPLEMENT CONTAINS A FORM TO USE .I.E ONE IS. SPECIFICALLY PRESCRIBED:BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (I0) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU.MIDST MAKE AVAILABLE FOR PICKUP BY I-ONT IE DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE. SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAR' CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RE,TURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAvV REQUIRES THAT THE ROME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL ,AND WRITTEN NOTICE OF YOUR RIG11T TO CANCEL. Ackt oivledged by: 05J28j2024 Customer's Signature Date 40n SrmWard Fem,111A(21 JuL 21)(E) Generated Date 06129.120941 L-11T114 FA335:Zp70 Rome Improvement Agreement: Page 2 4. Description of Work to be Performed A detailed description of the work to be performed is included in the paragraph entitled Scope of Work,Specification, Customer Summary Sheet, Quote Form,Estimate,Invoice or Measure Which.is included in this Agreement. S.Anticipated.Delivery DateTin'stallatio*n.Schedule -e ate Approximate Start Date: Approximate.Fini�sh Date: F1 0/2512024 All dates are approxi and subject to change based on unforeseen cventsincluding inclement weather, permitting delays, and delays in confirming insurance coverage;of Your claim,for any repair, if applicable. le... 6. Electronic Records Authorization You are entitled to a paper copy of this:Agreement if you choose. If you consent to an e-mailed copy,your consent apphes to this Agreement and all subsequent documents and written communications related to this Agreement.By contacting your Service Provider,you may-updateyour email address,Withdraw your consent,or obtain-a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above,you confirm that you have access to a computer that can receive and open emails and PDF documents. 7. Contract Price :and' Payment Schedii1e Payment of the Contract Price is due upon sigarling unless a different payment schedule is required by law, specified below or in a payment addend-um. Contract Price: $ 136565.20 Includes.all.applicable taxes.Excludes finance charges.* Saves Tax: $ 1.0.60 (if applicable, total amount of taxes included in Contract Price) 'MiLvinu.1111 dePosit ONLYap.plicable V W in MD, VIA, ME(33%),� J, '1(991) Deposit% Deposit Amount 1916-3- Remainii g Balance $ F2744-9 S. Finance Charges ""- y interest payments or other finance charges will be determined by. Customer's -separate cardholder or loaf agreement, to which Horne Depotis NOT a,party, and will be in Addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of-the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payments made payable to Home"Depot. 9.Acceptance and Auth'Grization By-signing below,you autborizeliome Depot to. (a) arrange for Service Provider to perform any Services.or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified.in this Agreement. Do not sign if blank or in complete: (Service Provider's or permitting r') infonnatiortinay need to be provided to You later.)By signing,you acknowledge that:(i),You have read,understand, and accept this Agreement in its entirety, includingthe General. Conditions and State Supplement, if any; (Ji) You are receiving a complete copy of this Agreeriient;.(iii)all rights and.interests under this Agreement are solely vested Electron' signatures will be deemed originals for allpurposes. in the person.listed as "Customer"above; and(iv) 1c; I X Customer's Signature Date X I!!&/The Home Depot V5/28j2024 Tbellome Depot Digital Signature Date For questions related to your installation,contact Service Provider at (631) 478-6101 For eu(v other concerrts, conta,cl The Home Depot at.1-800466-333 7 460.Sundard Pon IFA UI U.2 1.) 05j2819024 L-dT0,' F43-357970 i + 1 o aSwIt e a c Ylsr'10 ' t7VBCacli fG Parea of U Faetar R Valua SflGC Transmit„ Contorot:; �l InsataLeUGlasuUaifPackis a LdivE Gas s oars tom (Thick Glaaa iotalllnCt Tito)Ueit CataMUnit TataiUttit Wain ; �c7 syand ird . ProSdar }man )pteroep): W 2 UUN' 3.23 0.30 9153: 7314 .Ener90aeel Pt6solar Argon Suparcept 314' 2. 0.:20. 3A5 0z :0,46' 7.3U ENERGY STAR 40tiem . ProSotarSua: Argon Su*: peer 314.: z 0.30. 3.33 UA9 0,60 71% ENERGYSTAR.Nort'rQN)ttal Prosoiar :.Argon Supoll(WI: 31.4' 2 0.30 3133 0.30 0.53 ln ENERGY9T—R.South Cemral I ':prnsolar.Shado: Arcjen _ .3i4- r 4 Supeitept 11 ...29: . 3A5 0,21 0.49 92% ' ENERGY$.TAR Southern � Prosolar Shade Argon �Suporcept 314` '.2 �oig8 As ni :04a: 921* with Q.). Viatbla>'. Ulf Black k is Papas of 1t 3 odor 12 Uatue 9HGC Transmit`. Gunter o" Insulator!Glass Unit Packs`a how E Gas :5 acorS tam ':Thick Gfass 7otattinii .Tout Unit Total dnk.. Total Unii Glass'':' Standard PioSdar Argo, intercept. 314`. 2 0.31 3.23 0,27 0.47 73% EnergiSam Piosolar Aigon $upercept 3147' 2 0:2A 3AS 0,2tr 0A4 73`Ya. ENERGY STAR Northem' ( Pro5darsug: :Argon 'Super Spacer 314- :2. 0,30 3,33 0.44 0.53: 713E ^ ENERGY STAR Nortl Central Rrosdar Argon ..Supercept 314' 2 .0.30. 3.33 0.27 0.47 73%. ENERGY.S+'AfZSouttrConfra4 .pfaSglar:Shosie. Argon .Staper000t 314'' 2 r0:2•r+: 3.45 0.)g :0:44 92% g pe..p' 3i4"° 2 U.29i 3.ag 0:@9 0;4Q; `X ENERGY STAR Southern ProSdsr:$haca� Argon Su.an .rta L 92 APPROVED AS NOTED COMPLY WITH ALL CODES OF DAM.B•P# = NEW YORK STATE&TOWN CODES FEE BY: AS REQUIRED AND CONDITIONS OF NOTIFY BUILDING DEPARTMENT AT SMOLDTOMM 631-765-1802 8AM TO 4PM FOR THE SOUfHOLDTMIPLONINGBOARD FOLLOWING INSPECTIONS: SOLOOLDTOWNTRUSTS FOUNDATION-TWO REQUIRED N-Y&DEC FOR POURED CONCRETE SOUMOLDHPG ROUGH-FRAMING&PLUMBING $CHO INSULATION FINAL-CONSTRUCTION MUST BE COMPLETE FOR C-0. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS WINDOW SPECIFICATION SHEET - Spec.Sheet#: F43357670 Street: 1 of 1 Customer: Hicolotte Stathakos Job#: F43357870 Consultant: Adam Friedman Date: 0512812024 u New Window Existing Window �~ W -rvm Hinge Locations Measurements Grids Product Options Labor Options From outside, Leftlo Right Bays,Bows Location Color Rough Opening #of bars #of bars Camels,1 Pnl, use L,R or S ! Glass Misc Items Hardware Code Screens For doors use Mull "S"=stationary or 8 o L m c o L' N „N'=operating w Style Wraps _B g rn m 0 5 r 'r Room Floor I Code (Y/N) I Style Code Series Cod e w $ _ 5 g of I c� a > x° 2 > z° STD,White, GlassPack: WRAP, I 1 LIV 1st IUH Y ID W fi 6100 H WH 61 b8 118 1- '2 Wfi,W C ALL 2 ALL 2 2 Stanaartl METAL, FF Gk IH STOOL i STD,White, GlassPack: METAL, 2 GAR 1st TDH Y TDH 6100 WH WH 61 58 119 F, �WH,W' C All 2 2 ALL 2 2 Standard STOOL, FF GBG 1H WRAP I I i SPECIAL CONSIDERATIONS: 1:White,2:White Wrap Color Interior Casing Type Bay or Bow window: eatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(inches) If tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the Construct Roof(Yes or No)' Special Terms and Conditions on the following page Garden Window: eatboard Material(vinyl only-White Plonke,Birch or Oak) Howe I provemeot Agreement: Ptgei l t3 'Home Depot License#'s-For the most current listing visit NVwNiv Hoinedepot eoiii/LicenseNumbers Adam Friedman aalesper�on Nitme registration.#(lteq.im CA CT ME NJ,DC) Home Depot U.S'A,Inc.("Home Depot") or Authorized Service Provider named below will fum sh, install:and/or service the eguipinent listed below at the puce;ternls.and:conditions:as outlined on this €orm. m. Sea vnee Pro;rider C"' 't �� foir�atto�a - r �.. ., _ ... _. t.... ti... The Home Depot The Home Depot Service Provider Contact Name Service Provider Company Name (631.)478-61 ell ationho heas4hom Phone## 8eRiWOrovider Email Address. Service Provider License# s: . U t,6M Stathakos ILong Island 11 F43357870 Customer.Last:Na .e Customer First Name Store#/Branch.blame Customer Lead/PO4 865 Jasmine Lane Southold NY... 11971 - Customer. City State Zip {631:) 371-1243 azaou#is50@g 1 com Home Phone# Work I'lione# Cell:Phone# Customer Email.Address Q ICF.bF R>tG11T ACEL YOU MAY CANCEL.TfHS AG EE1i�bENT WZTITGTJT PEI�A�.'>fV GIB O>B1LIC ATION BV CONTACTING THE SERVICE.F'RfTVTIER �31t'STOl2E I�TitECTL'Y; E)1�AILI��SiCi#tVIC PRC)ViT➢1�l�A`I' .. . _ _ .. . _. . _ _ _ ... customereancell:ationriortheast@homede.pot.com OR DELIVERING`WR T'FEN NOTICE TO HOME DEPOT AT. 40 Oser Avenue Hauppauge == NY 11788 Address City State Zip BY MIL DNIGH71 ON THE THIRD ZUSINESS DAY AFTER SIG\ING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE: SUPPLEMENT CONTAINS A EORA1 TO USE :IF-ON:E .IS SPECIFICALLY PRESCRIBED BY LAW )IN YOUR STATE. OUR. PAYNIEN I'(S)> WILL BE RETURNED WITHIN TEN (10) ;BUSINESS DAYS AFTER. EMOTE DEi OT'S: RECEIPT OF YOUR NOTICE. YOU.MUST MADE: AVAILABLE. FOR.PICKUP' BY HOME DEPOT O SERVICE PROVIDER AT'Y`OUR.SERVICE ADDRESS AND IN'SUBSTANTIALLY THE SAME CONDITION AS WHEN. DELIVERED,:ANY NIERCHANDISK OR MATERIALS DELIVERED To YOU. OR YOU MAY CONTACT HOME DEPOT FOR, INSTRUCTIONS REGARDING RE'TURN SHIPMENT AT HOME DEPOTS EXPENSE. Tf E LAAV REQUIRES THAT OW DEPOT GIVE YOU A..N�TICE EYPL.AINYNG YOUR RIGHT' TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE.THAT VOU'.HAV.E :BEEN GIVEN ORAL AND WRITTEN NOTICE,OF,YOUR RIGHT TO CANCEL. Acknowledged by: 21324' Customer's Signature Date 460 Stank6rd Fnnn WA(.21 Juk.:�l).i,E)- C3enerited Date �Lekld+l'U� �-:1��� v 0.-J.t2 ;1 Rome bnp.rovemeOt agreement, Page.2 4. Desc iption of F `orR�to 1be Performe�t mm A detailed:description of thewo&to be performed is included in the parag 'hen titled Scope of Work,Spectticarion, Customer Summary Sheet,Quote Farm,Estimate,,Invoice or Measure which is included in this Agreement. tctaetpated lf3elivei�ylatem7 Instdllat►ott Sche+diile µ .. ., . .. .. ..r i .. .,.. ... .. Approximate:Start Date: 0912512024 Approximate.l•itush Date: 10J25J2024� All.dates are approximate and subject to change:based on unforeseen events including'mi ci lernent weather, poi-mitting delays; and delays in confiimiug insurance coverage ofXour claim foi any repair,if applicable —77 .77 6 ) lecti oiiic'Recordsntt➢xora�aion You are entitled:to-a paper copy of this Agreement if.you choose.If you consent to pan.e-rnailed copy Your consent applies to this Agreement and,all subsequent documents and written communications related to this Agreement.By contacting your Service Provider,you may update:your entail address,.withdraw your consent,or obtain;a paper copy of the Agreement or related.documents at:no charge. By providing your coin.sent.an.d verifying,your email address above you confirm that you have access to la.computer that can receive and open emails and PDF documents 7. ontract Price a'd`PaynDent Schedule _ Payment of the Contract Price is due upon signing unless a different payment schedule is required bylaw,specified below or in a payment.addendiun. Contract Price: . 366520 Includes all,applicable taxes_:Excludes finance charges, Sales Tax: $ O:Oo -(If applicable;:total amount:oftaxes included in Contract Price); WiLritu nin eleposit OATYapplicrable in JUP,MA ��E(33YO),AIY W1(99%) Deposit% 25;0 Deposit Amount$ [916.3 Remaining Balance S 2748.9 .A:p W qce 41.iGF 6:LR.s.... 3.....,., Any interest payments or other.finance charges:will be determined by Customer's' separate cardholder: or loan agreement, to which Home.Depot iC NOT a.panty; and will be .in addition to Customer's payriierit 'under this Agreement. Customer is:subject:to the terms and.conditions of the cardholder or loan agreement,as.applicable. No funds should be made payable to.Service Provide;;However, Service'Provider may collect Customer's payments made payable tI.o Home Depot _ � eeptianec and Authairla$iol% 3. v�. . :a�. u ,x By-signing below, you:.autborize Home Depot to (a) arrange for Service:Provider to perform any Services or(b) order and arrange for: the delivery of special order merchandise, including special.order merchandise that.may be custom made,as specified in.this Agreement.Do-not sign.if blank or.incomplete::(Sery ce:Provider's or permitting information may,iieed to be provided to You later.).By si:gning,,you acknowledge:that:(b)You have read;understand, and accept this.Agreement in its entirety including the:General Conditions.and State Supplement, if any; (i ) You are receiving.a complete copy of this Agreement;.(M)all rights and.iritere5ts under this Agreement are.solely vested in the person listed as "Customer"above;and(iv)El:ectronic.signatures will.be deemed onginals.for all.purposes. X €t5J28J2o24 Customer's Signature jute A /s/The Home De .ot. 105j2,81.2024 The Home Depot Dgifial Signature Date For question related to your i�ist�sllatidri;.contact Ser.Ynce Provvider at (631).�478-6101 For.any other concerns, convict The foine D..epot at.10800466 33.3 40 scandArd Form[llA(21 Jut.al).'E) Generated We. Or5 1—. Lcai TGA F43367RM