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HomeMy WebLinkAbout51644-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 51644 Date: 02/13/2025 Permission is hereby granted to: Matthew J Sirico 665 Moose Trl Cutchogue, NY 11935 To: install roof-mounted solar panels to existing single-family dwelling as applied for. Premises Located at: 665 Moose Trail, Cutchogue, NY 11935 SCTM# 103.-4-47 Pursuant to application dated 12/23/2024 and approved by the Building Inspector.. To expire on 02/13/2027. Contractors: Required Inspections: Fees: SOLAR PANELS $100.00 ELECTRIC -Residential $125.00 -RESIDENTIAL $100.00 Total $325.00 Building Inspector a. ' 81 ofTOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax(631) 765-9502 h�ttps:Hwww.sotitholdtownay.gov Date Received APPLICATION FOR BUILDING PERMIT �:. For Office Use Only �-^ �:..�.N �.. a. R �02 ny .m [1 PERMIT NO. S Building Inspector °b 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: �a I 11 LH OWNER(S)OF PROPERTY: Name:Matthew Sirico SCTM#1000-103-4-47 Project Address:665 Moose Trail, Cutchogue, NY 11935 Phone#:631-834-8172 Email:mat.sirico@gmail.com Mailing Address:665 Moose Trail, Cutchogue, NY 11935 CONTACT PERSON: Name: Evelyn Polvere/Sunation Solar Systems Mailing Address: 171 Remington Blvd., Ronkonkoma, NY 11779 Phone#: 631-750-9454 ext 346 Email:permitting@sunation.com DESIGN PROFESSIONAL INFORMATION: Name:Michael Dunn, Graham and Associates Inc. Mailing Address:256A Orinoco Drive, Brightwaters, NY 11718 Phone#:631-665-9120 Email:glenn@grahamassociatesny.com CONTRACTOR INFORMATION: Name:Scott Maskin/Sunation Solar Systems Mailing Address:171 Remington Blvd., Ronkonkoma, NY 11779 Phone#: 631-750-9454 Email:permitting@sunation.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition BAlteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ 33.o I "?. 2L� Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes RNo 1 PROPERTY INFORMATION Existing use of property:Residential Intended use of property: Residential Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes BNo IF YES, PROVIDE A COPY. ❑ 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 demordion 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(print name): of Maskin BAuthorized Agent ❑Owner Signature of Applicant: Date: �a 1 19I a y STATE OF NEW YORK) SS: COUNTY OF Suffolk Scott Maskin being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Contractor (Contractor,Agent,Corporate Officer,etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this day of Ly..0 142 20_2�± Notary Public LYNN VITA idotery NuLlic, State of New York ROc�lstrrl''lic-n #01VI5068399 PROPERTY OWNER I Cival'lli a jr, Suffolk County (Where the applicant is not the owner) icy Commission Expires Oct. 2-8, Matthew Sirico residing at 665 Moose Trail Cutchogue do hereby authorize Scott Maskin to apply on my behalf the=oldDepartment for approval as describe herein. ,3 0 Q Owner's Signature Oa' e Matthew Sirico Print Owner's Name 2 BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 g " o err soutoldtowint . ov -� seand@southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date:: Company Name: SUNation Solar Systems, Inc Name: Scott Maskin License No.: 33412-ME email: germittin sunation.com Address: 171 Remington Blvd. Ronkonkoma, NY 11779 Phone No.: 631-750-9454 JOB SITE INFORMATION (All Information Required) Name: Matthew Sirico Address: 665 Moose Trail Cutcho roe NY 11935 Cross Street: Phone No.: 631-834-8172 Bldg.Permit#: 51 (, email: mat.sirico@gmail.com Tax Map District: 1000 S 'ction: 103 Block: 4 Lot: 47 BRIEF DESCRIPTION OF WORK (Please Print Clearly) Circle All That Apply: Is job ready for inspection?: YES / NO Rough In Final Do you need a Temp Certificate?: YES / NO Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A # Meters Old Meter# New Service - Fire Reconnect- Flood Reconnect-Service Reconnected - Underground - Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION Request for Inspection Formals " DATE(MMIDD/YYYY) 40RV CERTIFICATE OF LIABILITY INSURANCE 11/25/2024 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 be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT The Horton Group PHONE 10320 Orland ParkwayJAIL Na W 7l)8-845-3000 •__ .... E-MAIL Orland Park IL 60467 A0 RE °°°certilicatesQ ehorCongfoup.coorn m INSURER(S)AFFORDING COVERAGE mmmm NAIC,fI INSURER A:James River Insurance Company • 12203 INSURED SUNASOL-01 INSURER B Ascot Insurance Com an 23752 SUNation Solar Systems, Inc. p"'y _ 171 Remington Blvd INSURERC.National Liability&Flre Insurance Company 20052 Ronkonkoma NY 11779 INSURER D:New York State InsuranceFund °°°. INSURER E:PeleuswInsurance Company ITIT m . 34118 INSURER F: Lloyd's of London 15792 COVERAGES CERTIFICATE NUMBER:366712046 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. �.........._ ..... . _ �� _ ....._ ... ........ _........ NSR am FF ILT, TYPE OF INSURANCE POLICY NUMBER MIWDDAYYYY MMIDDIYYYY.. LIMITS LT, A GENERAL L1ABtLITY Y Y P0000000282 12/1/2024 12/112025 EACH OCCURRENCE $1,000„000 X 'COMMERCIAL GENERAL LIABILITY (" gut,)�fStEou¢ren,,., $50,000 ....... -.�. � ---- . CLAIMS-MADE L"' 1 OCCUR MED EXP(Any one person) $Excluded ......... __.............................................................. PERSONAL&ADV INJURY $1 000O 00 •.. GENERAL AGGREGATE $2,000.000 d`aEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OP AGG $2.000.000 ••••••••••••••••••••mm•� • POLICY X. PRO- LOC $ C AUTO MOBILE LIABILITY Y Y 73APBOO8753 6/24/2024 5/24I2025 BiNEC?SGNGLE.L.BM9T F RTSHNOA-01935 9/26/2024 9/26/2025 �� •I•)•• •°°°---•-•-•°-°-'$ o.•A,A4p..-----�----° C X ANY AUTO 72 XAB 010287 5/24/2024 5/24/2025 BODILY INJURY(Per person) $ m..... ALL OWNED •• SCHEDULED ............°.. ......,...... ...................�....�....... ...�... AUTOS _,m,_,°, AUTOS BODILY INJURY(Per accident) $ mmmm NON-OWNED DAI�Ir„4Cz'S e dent $ X HIRED AUTOS X AUTOS .�. --- Hired/Non Owned Limit $1,000,000 A X UMBRELLA LIAB X OCCUR Y Y P0000000283 12/1/2024 12/1/2025 EACH OCCURRENCE $3.000 000 EXCESS LIAB CLAIMS-MADE „AGGREGATE $3,000,000 �... DEO J X I RETENTION$0 $ D WORKERS COMPENSATION Y Z2160670-2 1/1/2025 1/1/2026 X WCST'A'T'U- OTH YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L E4CH.ACCIDENT •• .,5. ._.. $1,000,000 AONDCER/MEM BE EXCLU D? N N/A( A EMPLOY Ed 1,000 000 ) E Mandatory in NH E L DISEASE If yes,describe under DESCRIPTION OF OPERATIONS below E..L„DISEASE-POLICY LIMIT $1„000,000 B Profed'i/auilders Risk IMMA2310001919-01 12/1/2024 12/1/2025 Newly Built/Acqur Bid 500,000 E Professional Liability 121 CTR 0215833-02 4/11/2024 4/11/2025 Limit 1,000.000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule, Additional insured on a primary and non-contributory basis with respect to general liabifl liability if more space required) ty and aunt liability only when required by written contract.Waivers of subrogation applies to the general liability and auto liability in favor of the stated addiflonal insureds only when required by written contract.Umbrella follows form. Town of Southold is included as an additional insured as required by written contract and the CG 2012(State,Governmental agency,or Political subdivision permits or authorization)is included on the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Southold 54375 Main Road Southold NY 11971 AUTHORIZED REPRESENTATIVE ©7988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD N Y S I F PO Box 66699,Albany,NY 12206 New York State Insurance Fund I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A A 763118816 •qr ' GCG RISK MANAGEMENT INC AN NFP COMPANY 100 CHURCH STREET-SUITE 810 � NEW YORK NY 10007 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SUNATION SOLAR SYSTEMS INC TOWN OF SOUTHOLD 171 REMINGTON BOULEVARD 54375 ROUTE 25 RONKONKOMA NY 11779 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NU!!!!� 0110112025 POLICY PERIOD DATE Z 2160 670-2 500704 TO 01/01/2026 12/02/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2160 670-2, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW,AND,WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK,TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/ CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS' COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,I 'SURANCI FUND UNDERWRITING VALIDATION NUMBER: 273292463 IN 1111111111111 1Hi Hill IIIIIIIII Hill Hill Hill IIIIIIIIIIIIIIIIIIIIIIIIIlllll111 IIII II m 00000000000134908764 III Forth WC-CERT-NOPRINT Version 3(08/29/2019)[WC Policy-216067021 U-26.3 62 [00000000000134908764][0001-000021606702][##Z][1652641][Cert—NoP-CERT-1][01-00001] PORK workers'STATE Compensation CERTIFICATE OF INSURANCE COVERAGE 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 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured SUNATION SOLAR SYSTEMS 631-750-9454 171 REMINGTON BOULEVARD RONKONKOMA, NY 11779 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) 753118816 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold 54375 Route 25 3b. Policy Number of Entity Listed in Box"I a" PO Box 1179 DBL631187 Southold, NY 11971 3c.Policy effective period 10/01/2024 to 09/30/2025 4. Policy provides the following benefits: A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: 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 10/1/2024 By /$5t� (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 carriers 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 sox 413,4C or 56 have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) 11 111111111111111111111111111111111111111111111111 1�1 ill Suffolk County Dept. of Labor, Licensing & Consumer Affairs MASTER ELECTRICAL LICENSE IY,VI14 Name �olVi illi��IIIVjIIIIi SCOTT A MASKIN Business Name SUNATION SOLAR SYSTEMS INC This certifies that the bearer is duly licensed License Number ME-33412 by the County of suffolk Issued: 06/24/2003 Wa-y mew T. Rogery Expires: 06/01/2025 Commissioner Suffolk County Dept. of Labor, Licensing & Consumer Affairs J HOME IMPROVEMENT LICENSE Name SCOTT MASKIN Business Name This certifies that the SUNation Solar Systems Inc bearer is duly licensed License Number H-44104 by the County of suffolk Issued: 03/06/2008 W"",& T. Rog�y Expires: 03/01/2026 Commissioner