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HomeMy WebLinkAbout51625-Z TOWN OF SOUTHOLD i BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 51625 Date: 02/11/2025 Permission is hereby granted to: Domeluca II LLC 66 Leonard St 9C New York, NY 10013 To: install roof-mounted solar panels to existing single-family dwelling as applied for. Premises Located at: 14895 Route 25, East Marion, NY 11939 SCTM#23.-1-2.10 Pursuant to application dated 12/02/2024 and approved by the Building Inspector. To expire on 02/11/2027. Contractors: Required Inspections: Fees: SOLAR PANELS $100.00 ELECTRIC -Residential $125.00 CO-RESIDENTIAL $100.00 Total $325.00 Building Inspector „r TOWN OF SOUTHOLD—BUILDING DEPARTMENT � Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502la� ://www. otit oldtowntiv. o) Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector:, Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: 10 131 I ZU-,?q OWNER(S)OF PROPERTY: Name: SCTM #1000- Z , _ _Z. ���1 t�C C6010 Project Address: I Lfli��� l C Z S- MQcp Acd Z. Mao It �� 1 Phone#: Email: Mailing Address: CONTACT PERSON: Name: 1 C+0 V- 'Ck Mailing Address: I-e_CAq I by- cLrS Phone#: �� - 7- 1-7Lf-7 Email: �Vft cL If04 DESIGN PROFESSIONAL INFORMATION: q Name: l' r r ► a2 1 Mailing Address: UCA V` s o Can Phone#: 'i L4 S- U ZQ -0(0 -R Email: I e M te l e-CA-)QA4at :c)” CONTRACTOR INFORMATION:'' . ))oo Name:iud,t LO1AA l l Mailing Address: . ` Phone#: (- Q cj — I ­7 L4--� Em c0 'er, @ 'L-P rr. DESCRIPTION OF PROPOSED CONSTRUCTION ki ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: VOther VQ40 I $ cn� Will the lot be re-graded? ❑Yes 1KNO Will excess fill be removed from premises? ❑Yes No 1 PROPERTY INFORMATION Existing use of property: re Intended use of property: Ires,01tVI1 C k Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? Dyes y No IF YES, PROVIDE A COPY. ❑ Check Box After Read!ing: 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 210AS of the New York State Penal Law. Application Submitted By(print name):W 11Qt"� wet [Authorized Agent ❑Owner Signature of Applicant: ri� n,(,�,�,CI Date: STATE OF NEW YORK) COUNTY OF s"OTC),i- ) <✓ Q l being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the �\ (Contractor,AgIFo , etc.) of said owner or owners, and is duly authorized to per arMWOP av e CW the said work and to make and file this application;that all statements contained in this appli a ia, 41 best of his/her knowledge and belief; and that the work will be performed in the manner set fort `11t1 ��� �rltherewith. Sworn before me this "F'� � 6 [*"'day of k CLR IM.b�e-I11- ,20 Z"l cl,�ZWWUil Notary Public PROPIERIII"Y OWNERT 111111 T111 (Where the applicant is not the owner) I, 1q6Lo S residing at L� f 4S- E do hereby authorize Lo,;, c-P 6 a..� Sel� to apply on jelalf to the Town of Southold Building Department for approval as described herein.: Owner's Signature Date [o S I �- Print Owner's Name 2 � fl BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 v x Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 a . ,. ro err southoldtownn ov - seand southioldtownn ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: - -Z Company Name: e � (oQS Lam... 1 k+ Electrician's Name: K4 CL V,V") License No.: _C_,21 Z Elec. email: tq ft o0 , V" 1r 9 C:CI-4 Elec. Phone No: - (p3-7-4(1uS CED-request an email copy of Certificate of Compliance Elec. Address.: [ .CVvic_,l -E- JOB SITE INFORMATION (All Information Required) Name: a l_l LLC C. tlo to0 , Address: �t� .- (�a."q Cross Street: CAJe f,,J, g Phone No.: - -ILI- (pLf(O- - BIdg.Permit #: '51 email: Tax Map District: 1000 Section: 2 Block: Lot: 2- 10 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Iscivo-Ir _klc� WIE;�N. SAS mac.( - -Ca Z 4kQ a) f Square Footage: Circle All That Apply: Is job ready for inspection?: YES D NO F-1 Rough In F"� Final Do you need a Temp Certificate?: El YES [51 NO Issued On Temp Information: (All information required) Service SizeF11 Ph 3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 2 D H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION CONSENT TO INSPECTION 4 ILC Ct I ( U C ,the undersigned, do(es)hereby state: Owner(s)Name(s) That the undersigned (is) (are)the owner(s) of the premises in the Town of Southold, located at I MC ck;1 Z0( L K-(Q-', C-VI _ which is shown and designated on the Suffolk County Tax Map as District 1000, Section a 3 Block i „ Lot Z- l U That the undersigned (has) (have) filed, or cause to be filed, an application in the Southold Town Building hispector's Office for the following: ZbVc '- __-----__ e, ry a Ck That the undersigned do(es)hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances, rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: 11-11- a egblo S17tai :e (Print Name) (Signature) Pri.... .....-... ( nt Name) N Workers' CERTIFICATE OF INSURANCE COVERAGE Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier la.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured DESPAUX HOLDINGS,LLC DBA GREENLEAF SOLAR 917-544-9306 11 TECHNOLOGY DRIVE EAST SETAUKET, NY 11733 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State,i.e.,wrap-up Policy) 933707839 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold 3b.Policy Number of Entity Listed in Box"1 a" Building Dept DBL706197 54375 Main Rd 3c.Policy effective period Southold, NY 11971 12/01/2023 to 11/30/2025 4. Policy provides the following benefits: A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 9/30/2024 By IAL=t�� (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Leston Welsh Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 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 513 have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board, the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers' Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. D13-120.1 (12-21) I III P111°°1°20°11°1°111°11°2°1°��IIIIII , Additional Instructions for Form D13-120.1 By signing this form, the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in Box 1a 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 cancels 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 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 Insurance Coverage for NYS disability and/ or Paid Family Leave Benefits or other authorized proof that the business is complying with the mandatory coverage requirements of the NYS Disability and Paid Family Leave Benefits Law. NYS 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 for all employees has been secured as provided by this article. DB-120.1 (12-21) Reverse G .4co CERTIFICATE OF LIABILITY INSURANCE DATE(MM/°°'YY"' 09J2312024 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(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer ri hts to the certificate holder in lieu of such endorsements . PRODUCER O NTA T Nicholas Zulkofske Brookhaven Agency,Inc. PHONE 631 941-4113 631 941.U05 100 Oakland Avenue,Ste 1 AppsL gA2, nick brookhavena enc .com Port Jefferson NY 11777 INSU &FEQRDING COVERAGE NAI Maxum Indemni Company INSURED • Utica Mutual Insurance Company Despaux Holdings,LLC dba Greenleaf Solar Continental Indemnity Company 11 Technology Drive .g p,• Hartford Underwriters Insurance Company East Setauket NY 11733 INSURER F,, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE DDL, UBRQn, PO P CY N MBER__ POLICY EFF LICY EXP LIMITS Liu X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1 000,000 � y•, E TO RENTED A CLAIMS-v1ADE A^ i occuR X X BDG-3074482-01 12/01/2023 2/01/2024 pAMAG $100 000 M EXp Am cra arm $5 000 °PERSONAL&ADV INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 POLICY F-1 PE LOC PRODUCTS-COMP/OP AGG 2 000 000 AUTOMOBILE LIABILITY COMB@INFO SCT INGLE LIMIT $1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED X X 5612990 12/01/2023 12/01/2024 BODILY INJURY(Per accident) $ ... AUTOS ONLY AUTOS ^^ X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2 N $ WORKERS COMPENSATION X C?ER OTH AND EMPLOYERS'LIABILITY y I N ANY PROPRIE"fORIPAR`rNERIEXECUTIVE� NIA 46-860739-02-01 12/01/2023 11/16/2024 Ew eACHAccIDENT $1,000,000 C OFFICER/MEMBER EXCLUDED? (Mandatary in NH) E L DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under OOO DESCRIPTIONF P RATIONS b E.L DISEASE POLICY LIMIT $1,OOO, D Installation Floater L I I 12 SBA 13134RUS 12/01/2023 12/01/2024 $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Rd Southold,NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION, All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF STATIE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a. Legal Namem&Address of Insured use street address only) 1 b.Business Telephone Number of Insured g 6 ( Y) P �. 17-644-9306 Despaux Holdings,LLC dba Greenleaf Solar 11 Technology Drive 1c.NYS Unemployment Insurance Employer Registration Number of East Setauket NY 11733 Insured 1 d.Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State, i.e.,a Wrap-Up Policy) 93-3707839 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Continental Indemnity Company Town of Southold 3b.Policy Number of Entity Listed in Box 1a" Building Dept. 6-860739-02-01 54375 Main Rd Southold,NY 11971 3c.Policy effective period 11/16/2024 to 11/16/2025 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Nicholas Zulkofske (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 11/06/2024 (Signature) (Date) Title: Authorized Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 631-941-4113 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov DATE(MM/DD/YYYY) A� CERTIFICATE OF LIABILITY INSURANCE 112/10/2024 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. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRO11 11,DUCER J1CT Nicholas ZulkOfske Brookhaven Agency,Inc. PHONE 1 41-41°l3 (F . 631 941-4405 100 Oakland Avenue,Ste 1 E-�dAIL nick brookhavena enc .com Port Jefferson NY 11777 I SUAFFORDING COVE.. Maxum Indemni Company INSURED I : Utica Mutual Insurance Company Despaux Holdings,LLC dba Greenleaf Solar INSURER • Continental Indemnit Company 11 Technology Drive I : Hartford Underwriters Insurance Company East Setauket NY 11733 IN : IN F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS ITR TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY EACH.OCC RRENCE 1,000,000 RENTED A CLAIMS-MADE Xi]OCCUR DAMA�G£TO.' $100,000 X X BDG-3074482-02 12/01/2024 12/01/2025 MED EXP(Any one arson 5,000 PERSONAL&ADV INJURY §1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2 000,000 PRO- El LOC PRODUCTS-COMP/OP AGG s2,000,000 POLICY JECT AUTOMOBILE LIABILITY (La aWVE I SINGLE LIMITdonfl $1 000 000 B X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED X X 5612990 12/01/2024 12/01/2025 BODILY INJURY(Per accident)'$ PROPERTY x AUTOS ONLY AUTOS ' T'YfJAMAGE X HIRED AUTOS ONLY X $ . NON-OWNED AUTOS ONLY UMBRELLA LIAB OCCUR EACH OC URR. CE. $ '....EXCESS LIAB CLAMS-M AGGREGATE $ R EJE NTJQN I $ AND EMPLOYERS'WORKERS COMPENSATION X PER OTH- ANY PROPRIETOMPAR'TNETM Y N E.L.EACH ACCIDENT 0,000 WE°XECU'�TIVC C OFFICER/MEMBER EXCLUDED? N/A 46-860739-02-02 11/1612024 11116I2025 1,00 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE , 1,000,000 yes,describe under I I I D w E.L.DISEASE-POLICY LIMIT $1,000,OOl1 D Installation Floater 12 SBA BB4RUS 12/01/2024 12/01/2025 $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Rd Southold,NY 11971 AUTHORIZED REPRESENTATIVE <> 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD !R yy Suffolk County Department of Labor, Licensing & Consumer Affairs VETERANS MEMORIAL HIGHWAY HAUPPAUGE,NEW YORK 11788 ak' DATE ISSUED: No.04/12/2024 ME-70212 IV M" SUFFOLK COUNTY W Master Electrician License 01 This is to certify that Eric E Mann doing business as Despaux Holdings LLC DBA having given satisfactory evidence of competency, is hereby licensed as MASTER ELECTRICIAN in accordance with and subject to the provisions of applicable laws, rules and regulations of the County of Suffolk, State of New York. M NOT VALID WITHOUT Additional Businesses V DEPARTMENTAL SEAL HBO& AND A CURRENT Greenleaf Solar CONSUMER AFFAIRS ID CARD kk Wayne T. Rogers r aff, I 6R6 I-IN 0 0115 M 4ift- Al"Iffiffis-4 AM% M 0211�1111' M 5, ljp ME& Suffolk Coun-4- Department of Labor, Licensing & fly Consumer Affairs A VETERANS MEMORIAL HIGHWAY HAUPPAUGE, NEW YORK 11788 1 gq DATE ISSUED: 04/19/2024 No. HI-70178 SUFFOLK COUNTY A J1 Home Improvement Contractor License V This is to certify that William C Wei 10 doing business as Despaux Holdings LLC DBA 41- 1 having furn ished the requirements set forth in accordance with and subject to the provisions of applicable Z -Sol laws, rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct -d business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. kq NOT VALID WITHOUT Restrictions Additional Businesses IMRI DEPARTMENTAL SEAL HI I-Solar Greenleaf Solar A� AND A CURRENT CONSUMER AFFAIRS ID CARD Z-jjgzg Z, W M V9 Wayne T. Rogers Commissioner M OFRIS Y W M r