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Home My WebLink About51308-Z oe soulyo`° Town of Southold * * P.O. Box 1179 N. 53095 Main Rd COUNIN Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 45886 Date: 01/15/2025 THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 480 Grissom Ln Southold,NY 11971 Sec/Block/Lot: 78.4-10.3 Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 09/06/2024 Pursuant to which Building Permit No. 51308 and dated: 10/23/2024 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: "as built" alterations, including HVAC and windows, to existing single family dwelling as applied for. The certificate is issued to: John Ardito,Joseph Ardito Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: 51308 01/13/2025 PLUMBERS CERTIFICATION: uth riz Si ature ��oFso�ry° TOWN OF SOUTHOLD BUILDING DEPARTMENT `� • y� 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#: 51308 Date: 10/23/2024 Permission is hereby granted to: John A Ardito 122 Wilson St Garden City, NY 11530 To: legalize"as built" HVAC condensers and new windows to existing single-family dwelling as applied for. Premises Located at: 480 Grissom Ln, Southold, NY 11971 SCTIVI#78.4-10.3 Pursuant to application dated 09/06/2024 and approved by the Building Inspector. To expire on 10/23/2026. Contractors: Required Inspections: Fees: As Built Addition/Alteration $500.00 ELECTRIC -Residential $200.00 CO Single Family Dwelling-Addition /Alteration $100.00 Total $800.00 -- --------------------- Building Inspector o"�pF SO!/r�Ql � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G • Q Southold,NY 11971-0959 �Q C4UNi`I,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: John A Ardito Address: 480 Grissom Ln City: Southold St: NY Zip: 11971 Building Permit#: 51308 Section: 7$ Block: 1 Lot: 10.3 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: AS BUILT License No: SITE DETAILS Office Use Only Indoor Im—� Basement Pr; Service Wel Solar ' Outdoor (- 1 st Floor Pool 17 Spa L Renovation F, 2nd Floor W Hot Tub Generator [ Survey Iw° Attic I~ Garage Battery Storage INVENTORY Service 1 ph (—v` Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph (` Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors 6 Main Panel 150X2 A/C Condenser 1 Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower 1 Range Recpt Ceiling Fan Combo Smoke/CO 4 Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 1 4'LED Exit Fixtures Other Equipment: 150A Panel 30 Circuit/29 Used, 150A Panel 30 Circuit/ 30 Used Notes: AS BUILT NO VISUAL DEFECTS " Rewired House, Added Smokes and New HVAC Inspector Signature: Date: January 13, 2025 Sean Devlin Electrical inspector sean.devlin(d-)town.southold.ny.us 480Grissom HouseAnd HvacElectric r r ' * ;rt TO�IIVNf�;QF SOUTHULD;;;B �o UILDING DEPT. � �rou►m; 77 , �63f-765-1$02 _ r I,N" Ec—, a ION t [ ] _Fa DATIONf�1STI.REBAR 1 ROUGH PLBG: f K INSULATIQN/CAULtCING µ r : [ FRAMING/STRAPPING FINAL m } i , [ ]: FIREPLACE & CHIMNtY FIRE SAFETY INSPECTION [ FIRE'=RESISP NT CONSTRUCTION ; FIREhRESISTANT PENETRATION e j ECTRICAL (ROUCH ,ELECTRIC'AL t=1NAL [` { ) � . VIC1L' AT[ON [. ] PR �CIQ A.rc 6mrc jr rN m s .n .vq - •.A,� aN., x- a . Y ' � a T ^. A , rNSPcTOR. a� s of SOUlyO # TOWN OF SOUTHOLD BUILDING DEPT., co 631-765-1802 s�o$ 1 NSPECTI 0 N [ ] FOUNDATION 1ST/ REBAR ' [ XROUHPLBG.] 'FOUNDATION 2ND ' [ ATION/CAULKING FRAMING /STRAPPING [ [. ].. FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE.RESISTANT-CONSTRUCTION [ ]- FIRE RESISTANT PENETRATION: [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL(FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ]. RENTAL REMARKS: , z IA— DATE I INSPECTOR laf so # TO_ WN" OF SOUTHOLD BUILDING EP�. 631-765-1802 INSPECTION [ ] -FOUNDATION 1ST/ 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. 4� � Ikc "� 1p1j," t 14 fzg� C_rr DATE 12d AW INSPECTOR . , TO SOUTHOLD BUILDING DP " y � II� 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: ,ter- VZI-/ DATE INSPECTOR MELD INSPECTION REPORT DATE COMMENTS l.)1 b m FOUNDATION (IST) --- a C FOUNDATION (2ND) - �Ar z o cn ROUGH FRAMING& PLUMBING 1 � b _ s � - � r t� INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS �- �5-a5 e\ec,�� Cam• o Z a x � y d b y S . ao�° copy r TOWN OF SOUTHOLD—BUILDING DEPARTMENT r o Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 ;;yow� ti Telephone(631) 765-1802 Fax (631) 765-9502 https://www.southoldtownny.gov ..w Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only ® 0 PERMIT NO. � Building Inspector: S E P - 6 2024 Applications and forms must be filled out in their entirety. Incomplete applications will not.be accepted.;Where the Applicant is not the owner,an Building DepaOrnent Owner's Authoriliatilon.form(Page 2)shall be'completed. Town of Southold Date: 9.5.2024 OWNER(S)OF PROPERTY: Name: Johh A. Ardito SCTM #1000-78.—1 —1 0.3 Project Address: 480 Grissom Lane, SOUTHOLD, NY 11971 Phone#: 51 6.31 7.3923 Email:johnardito@arditolaw.com Mailing Address: 122 Wilson St. , Garden City, NY 11530 CONTACT PERSON: Name: Same as Owner Mailing Address: Phone#: Email: DESIGN PROFESSIONAL INFORMATION: Name: N/A Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: . Name: WithPride Air Conditioning & Heating, Inc. Mailing Address: I Phone#: 51 6.731 .2573 Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ®Other New windows and HVAC condensors $ 7,500.00 Will the lot be re-graded? ❑Yes 51No Will excess fill be removed from premises? ❑Yes 91No 1 I 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 Residential this property? Dyes &No IF YES, PROVIDE A COPY. -12-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 foi removal,or demolition as herein described.The applicant agrees to comply with all applicable Jaws,ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and In building(s)fornecessary 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): John A. Ardito []Authorized Agent Owner Signature of Applicant: Date: Q STATE OF NEW YORK) SS. COUNTY OF I--4/-ASS}e � Tnhn A- Ard i to being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Owner (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 Qday of_mo o ��l�- ,2024 %. C)No4y Public JOSEPH URSO Notary Public, State of New York PROPERTY OWNER AUTHORIZATIONo. 02UR6050061 (Where the applicant is not the ownQVplified.in Nassau County Commission Expires October 30, 20z� I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 UV/ .v- �r h�� t •i l_z NOV 1 g 2024 o�OS%IFFOI,� BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD N : ;Ib� Town Hall Annex- 54375 Main Road - PO Box 1179 o Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 ;i iameshRsoutholdtownny.gov - seand(a)_southoldtownny.gov, APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: i0sla0aLt Company Name: '�{ �� S �LecTrl L Electrician's Name: c-jT —CL Incense No.: Mr- -4 q N4 6 Elec email: e5--re r(Ck yam, Elec: Phone No: (Q 31-60373 1359 E2f request an email copy of Certificate of Compliance Elec. Address.: �,MA -, "ee1l'�ec �hsrllr; JOB SITE INFORMATION (All Information Required) Name: �SOK A- ATErT79 IkcC, I to Address: 1A 9 Cross Street: Phone No.: 5 - .. 3 ct-1 Bldg.Permit#: email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): f T25p�CTioC1eC�seC5 , a A if ruo-njdLLet-�,�L�(;'`1'I C-7- Square Footage: Circle All That Apply: Is job ready for inspection?: YES NO Rough In maV, ,i,'i Do you need a Temp Certificate?: ❑ YES L� O Issued On I' 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 1 F12 D H Frame Pole Work done on Service? Y N, Additional Information: PAYMENT DUE WITH APPLICATION „ii1. NOV�O u��CO i, 02 . 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 jamesh(oD seand(&.south o Idtown ny.gov southoldtownn\f.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: 5(f IS: C_ T(L(- Electrician's Name: c> P-.,, t> -ZK- bt_-ST —17- License No.: f5_ -L4,q qq Elec email: --Me5Te Elec! Phone No: C,31-83-3 133�T[ request an email copy of Certificate ofCompliance Elec. Address.: VC_kgf_-s l.�' SL( JOB SITE INFORMATION (All Information Required) Name: Address: LA 9 Cross Street: 5LCC2 Y40L(f_bu_a, L(a_R_,Q_ Phone No.: !S( (-Q 3 11 92 -5 Bldg.Permit#: email: Tax Map District: j 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): M AS B%,.\C,-r F7Square Footage: Circle All That Apply: Is job ready for inspection?-. E311*,"YES [] NO E]Rough In LLIF fin' a I Do you need a Temp Certificate?: El YES r]A issued On, Temp Information: (All information required) Service SizeF-11 PhF]3 Ph Size: A # Meters Old Meter# EJ New Service[]Fire Recon nectL]Flood ReconnectElservice ReconnectE]Underground FlOverhead # Underground Laterals F]I F]2 F] H Frame F1 Pole' Work done on Service? Y F]N Additional Information: PAYMENT DUE WITH APPLICATION PERMIT# Address: Switches r Outlets GFI's Surface Sconces H H's UC Lts Fridge HW POOL Panel Fans Mini Fr. W/D pump Exhaust Oven Sump Heater Trnsfmr Smokes DW Generator Salt Gen. Water Bond Carbon Micro GrbDis Lights Heat Pucks ERV HOT TUB/SPA Inst Hot DeHum Transfer Disc Combo (fl Cooktop Minisplit Blower AC AH Hood Blower Service Amps Have -2 lased Sub Amps C Have 150 Used Comments I el 0 3` IDA IJ 5� r/ 3r p Suffolk County Dept.of Labor,Licensing&Consumer Affairs 1 r'� HOMEAVROVEMENT LICENSE 'Name MICHAEL DOLAN Business Name WITH PRIDE AIR:CONDITI6NING This oertfies ihst the HEATING INC bearer..is dutyiicense'd by he County ofs0olk License Nurn e(Hl-6016 Wayr,;�T..Rrrgery Issued: 0810812Q98 Commissioner Expires, 08r0V2Q26 r i z t i i i -Suffolk County Dept.of Labor,Licensing&Consumer Affairs RESTRICTED PLUMBING Name MICHAEL DOLAN Business Name This certifies that the With Pride.Air Conditioning&Heating Eric bearer is duty licensed License Number RP-60154 by the County of suffolk issued: OBJ08/201 B W"K'e'T. "erk Expires: 08/01/2026 Commissioner t i This license is the property of Suffolk County .Department of Labor,Licensing&Consumer Affairs.. Possession of this license does not guarantee its validity. Additional Business Name _ d License Category RP1—HVAC Workers' TATE Compensation CERTIFICATE OF Board NYS WORKERS COMPENSATION INSURANCE COVERAGE 1 a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured With Pride Air Conditioning and Heating Inc 516-731-2573 77 Marine St 1c.NYS Unemployment Insurance Employer Registration Number of Farmingdale, NY 11735 Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security 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) Technology Insurance Company, Inc. Suffolk County Department of Labor, Licensing 3b.Policy Number of Entity Listed in Box"la" &Consumer Affairs WWC3698547 P.O Box 6100 Hauppauge, NY 11788-0099 3c.Policy effective period 2/10/2024 to 2/10/2025 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: Owen F Callaghan (Print name of authorized representative or licensed agent of insurance carrier) 6� 05/07/2024 Approved by: (Signature) (Date) EVP Title: Telephone Number of authorized representative or licensed agent of insurance carrier: (781)455-6664 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 A/�� ® DATE(MM/DD/YYYY) ��V//�� CERTIFICATE OF LIABILITY INSURANCE 05/07/2024 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). PRODUCER CONTACT TracyAnziano NAME: AssuredPartners Northeast,LLC. HC a o Exc; (631)465-4000 q/�c No 100 Baylis Road E-MAIL tracy.anziano@assuredpartners.com ADDRESS: Suite 300 INSURER(S)AFFORDING COVERAGE NAIC# Melville NY 11747 INSURER A: Merchants Mutual Insurance Company 23329 INSURED INSURER B: Transverse Specialty Insurance Company 41807 With Pride Air Conditioning&Heating Inc INSURER C: ShelterPoint Life Insurance 81434N INSURER D: 77 Marine Street INSURER E: Farmingdale NY 11735-5604 INSURER F: COVERAGES CERTIFICATE NUMBER: CL244124706 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 MAYBE 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 SUOR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MMIDD MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 100,000 X Contractual Liab MED EXP(Any one person) $ 10,000 A CMP9155979 04/04/2024 04/04/2025 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000.000 POLICY ❑X JET LOC PRODUCTS-COMP/OPAGG $ 2.000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLALIAB M OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAR CWMS-MADE TSCEEX000194-00 04/04/2024 04/04/2025 AGGREGATE $ 5,000,000 DED I X1 RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Statutory C NYS Disability D427069 11/21/2023 11/21/2024 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The following are included as additional insureds if required by written contract,subject to the terms and conditions of stated policies:Suffolk County Department of Labor,Licensing&Consumer Affairs,RO Box 6100,Hauppauge,NY 11788-0099. General Liability and Umbrella Liability apply on a primary and non-contributory basis with a Waiver of subrogation in favor of the Additional Insureds. Duct work&HVAC Unit Installation and service CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Suffolk County Department of Labor,Licensing ACCORDANCE WITH THE POLICY PROVISIONS. &Consumer Affairs AUTHORIZED REPRESENTATIVE P.O Box 6100 Hauppauge NY 11788-0099 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CMP9155979 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations See Addendum See Addendum Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement performed for that additional insured and amount of insurance: included in the "products-completed operations 1. Required by the contract or agreement;or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 NEW IWorker s' CERTIFICATE OF INSURANCE COVERAGE 5°a 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 carrie 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured WITH PRIDE AIR CONDITIONING&HEATING INC. 516-731-2573 ATTN: MICHAEL DOLAN 77 MARINE STREET FARMINGDALE,NY 11735 1 c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations in New York State,i.e.,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) ShelterPoint Life Insurance Company Suffolk County Department of Labor, Licensing &Consumer Affairs 3b.Policy Number of Entity Listed in Box"I a" P.O Box 6100 DBL427069 Hauppauge, NY 11788-0099 3c.Policy effective period 11/21/2023 to 11/20/2024 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. Signed gY Date Si 5/7/2024 46w,4f 9 (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, 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 sox 4B,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. DB-120.1 (12-21) 1111111P1°°°1°°°°1°°1livI11°11°°1°IIIII Additional Instructions for Form 1313-120.1 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 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 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. D13-120.1 (12-21)Reverse od M" ' HANT Policy Number C � CMP9155979 INSURANCE GROUP 04/Poli0 24� 0 04/04/25 . ADDENDUM CG2037 Name of Additional Insured Person(s) or Organization(s) : BLANKET COMPLETED OPERATIONS: 1 . ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE PERFORMING OPERATIONS WHEN YOU AND SUCH PERSON OR ORGANIZATION HAVE AGREED IN WRITING IN A CONTRACT OR AGREEMENT THAT SUCH PERSON OR ORGANIZATION BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY- AND 2. ANY OTHER PERSON OR ORGANIZATION YOU ARE REQUIRED TO ADD AS AN ADDITIONAL INSURED UNDER THE CONTRACT OR AGREEMENT DESCRIBED IN PARAGRAPH 1 . ABOVE. 77 MARINE STREET FARMINGDALE, NY 11735-5604 Location of Completed Operations: AS INDICATED IN THE CONTRACT, AGREEMENT OR PERMIT. Description of Completed Operations: AS INDICATED IN THE CONTRACT, AGREEMENT OR PERMIT. Page 1 Policy Number MIXNS- RCHA1�lTS Policy Period5979 URANCE GR OUP Policy 04/24 TO 04/04/25 MERCHANTS MUTUAL INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NEW YORK - GENERAL LIABILITY COMPLETE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM 1. NAMED INSURED SECTION 11-WHO IS AN INSURED, ITEM 3. is replaced in its entirety with the following: 3. Any organization over which you maintain ownership or majority interest will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and b. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. 2. DUTIES IN THE EVENT OF OCCURRENCE,OFFENSE, CLAIM OR SUIT a. Condition 2.a. of SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS will not apply until after the"occurrence"is actually known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An "executive officer", risk manager or insurance manager, if you are a corporation. b. Condition 2.b. of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS will not apply until after such claim or"suit"is actually known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An "executive officer" or insurance manager, if you are a corporation. 3. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS It is agreed that based on our reliance on your representations as to existing hazards, if unintentionally you should fail to disclose all similar hazards at the inception date of your policy, we shall not deny coverage under this Coverage Part because of such failure. MU 89 58 03 14 Includes copyrighted material from Insurance Services Office.Used with permission Page 1 of 8 Policy Number MIXNS� RCHANTS CMP9155979 Policy Period URANCE GR OUP 04/04/24 TO 04/04/25 4. VOLUNTARY PROPERTY DAMAGE Under SECTION I, COVERAGE D.VOLUNTARY PROPERTY DAMAGE is added: COVERAGE D.VOLUNTARY PROPERTY DAMAGE 1. Insuring Agreement a. We will pay for unintentional"property damage"to property of others: i. Caused by you or while the property is in your possession; and ii. Arising out of the operations described in the Declarations and covered by this policy. b. We will pay the cost to repair or replace the damage to property of others: i. Which is in excess of$500 for each "occurrence".This deductible applies separately to each claim. ii. We will pay any part or all of the deductible amount to effect settlement of any claim or'suit' and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. iii. The most we will pay under this coverage is $10,000 per "occurrence" subject to $25,000 annual aggregate. c. We will make these payments regardless of fault. These payments will not exceed the applicable limit of insurance. 2. Exclusions: a. "Property damage"covered under COVERAGE A. b. "Property damage"due to disappearance, abstraction,theft or loss of use. c. The COVERAGE A. Exclusions apply except for the following: i. 2.j.3. -Property loaned to you. ii. 2.j.4. -Personal property in your care, custody or control. iii. 2.j.5. -That particular part of real property on which you-or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage"arises out of those operations. 3. Conditions If you replace the damaged property, or furnish the labor and materials necessary for repair of the damaged property,we will pay your actual cost exclusive of any prospective profit or overhead . MU 89 58 03 14 Includes copyrighted material from Insurance Services Office.Used with permission Page 2 of 8 MIgNSURANCE Policy Number ERCHANT S CMP9155979 Policy Period GROUP 04/04/24 TO 04/04/25 charges. Repair or replacement of any damaged property is not an admission of liability by either you or us. At our option, any property replaced or paid for by us becomes our property. 5. PROPERTY DAMAGE LIABILITY-ELEVATOR AND SIDETRACK AGREEMENTS Under SECTION I, COVERAGE A., ITEM 2., EXCLUSIONS,the following applies: 1. Paragraphs (3), (4) and (6) of EXCLUSION j. do not apply to "property damage"to property while on or being moved onto or off an elevator. 2. EXCLUSION k. does not apply to: a. "Your product'while on, being moved onto or off an elevator; or b. Liability assumed under a sidetrack agreement. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess, contingent or on any other basis. 6. NON-OWNED WATERCRAFT Paragraph g.(2) of SECTION I,COVERAGE A., ITEM 2., EXCLUSIONS is changed to read: (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry persons or property for a charge. This provision does not apply if the insured has any other insurance for "bodily injury" or"property damage" liability that would also apply to a loss covered under this provision, whether the other insurance is primary, excess, contingent or on any other basis. In that case, this provision does not provide any insurance. 7. FIRE, LIGHTNING OR EXPLOSION DAMAGE The last paragraph of SECTION I, COVERAGE A., ITEM 2., EXCLUSIONS is replaced by the following: EXCLUSIONS c. through In. do not apply to damage by fire, lightning or explosion to premises rented to you or temporarily occupied by you with permission of the owner. A separate Limit of Insurance applies to this coverage as described in SECTION III-LIMITS OF INSURANCE. Paragraph 6. of SECTION III -LIMITS OF INSURANCE is replaced by the following: 6. Subject to Paragraph 5. of SECTION III - LIMITS OF INSURANCE, the most we will pay for damages because of"property damage"to premises rented to you or temporarily occupied by you with permission of the owner resulting from fire, lightning or explosion, or any combination of the three, is the greater of: a. $500,000; or MU 89 58 03 14 Includes copyrighted material from Insurance Services Office.Used with permission Page 3 of 8 Policy Number MIXNS-URANCER CHA 1�lTS CMP9155979 Policy Period GROUP 04/04/24 TO 04/04/25 b. The amount shown next to Damage To Premises Rented To You Limit in the Declarations. This provision does not apply if Damage To Premises Rented To You coverage is not provided by this policy. 8. ADDITIONAL INSUREDS-BY CONTRACT,AGREEMENT OR PERMIT SECTION II -WHO IS AN INSURED is amended to include as an additional insured: 4. a. Any person or organization when you and such person or organization have agreed in writing in a contract, agreement or permit that was executed prior to the"bodily injury", "property damage" or"personal and advertising injury", that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; 2. The acts or omissions of those acting on your behalf in performance of your ongoing operations for the additional insured.A person's or organization's status as an additional insured ends when your operations for that additional insured is completed; or 3. Your acts or omissions or the acts or omissions of those acting on your behalf in connection with premises owned by or rented to you. b. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. A contract, agreement or permit that was executed after the "bodily injury", "property damage" or"personal and advertising injury". 2. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional services. 3. "Bodily injury", "property damage"or"personal and advertising injury" occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than,service, maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (b) That portion of"your work", out of which the injury or damage arises, has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. c. This insurance is primary if that is required by the contract, agreement or permit. MU 89 58 03 14 Includes copyrighted material from Insurance Services Office.Used with permission Page 4 Of 8 Policy Number Al-e�XERCHANTS Policy erioPolicy Period URANCE GROUP 04/04/24 TO 04/04/25 d. This insurance is non-contributory if that is required by the contract, agreement or permit. 9. INCIDENTAL MEDICAL MALPRACTICE LIABILITY a. The definition of "bodily injury" in SECTION V - DEFINITIONS is amended to include injury arising out of the rendering, or failure to render, medical or paramedical services to persons by any nurse, emergency medical technician or paramedic who is employed by you to provide such service. b. Paragraph 2.a.(1)d. of SECTION II - WHO IS AN INSURED does not apply to nurses, emergency medical technicians or paramedics referred to in Paragraph a. above. c. This provision, 9. INCIDENTAL MEDICAL MALPRACTICE LIABILITY, does not apply if you are engaged in the business or occupation of providing any services referred to in Paragraph a. above. 10.INSURED CONTRACT The definition of"Insured Contract"in SECTION V-DEFINITIONS is replaced by the following: 9. 'Insured Contract"means: a. A contract for a lease of premises. However,that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "Insured Contract"; b. A sidetrack agreement; c. An easement or license agreement, except in,connection with construction or demolition operations on or within 50 feet of a railroad; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work performed for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization, provided the "bodily injury" or"property damage" is caused, in whole or in part, by you or by those acting on your behalf. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (i) That indemnifies a railroad for "bodily injury" or "property damage" arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle,tracks, roadbeds,tunnel, underpass or crossing; (ii)That indemnifies an architect, engineer or surveyor for injury or damage arising out of: MU 89 58 03 14 Includes copyrighted material from Insurance Services"Office.Used with permission Page 6 Of 8 Policy Number MIgNSURANCENDCHAB CMP9155979 Policy Period GROUP 04/04/24 TO 04/04/25 (1) Preparing, approving of, failing to prepare or approve maps, shop drawings, opinions, reports, surveys,field orders, change orders or drawings and specifications; or (2) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (Ili).Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering, or failure to render, professional services, including those listed in(ii)above and supervisory,inspection,architectural or engineering activities. 11.MEDICAL PAYMENTS If COVERAGE C. - MEDICAL PAYMENTS COVERAGE is not otherwise excluded from this Coverage Part: 1. The Medical Expense Limit is changed, subject to all the terms of SECTION III - LIMITS OF INSURANCE,to the greater of: a. $15,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage.Part. 2. The requirement, in the Insuring Agreement of COVERAGE C., that expenses must be incurred and reported to us within "one year"of the accident date is changed to"three years". 12.ADDITIONAL INSURED-VENDORS If this policy provides Products Liability Coverage, SECTION II -WHO IS AN INSURED is amended to include as an additional insured any person(s) or organization(s) (referred to below as vendor) you are required by a written contract or written agreement to name as an additional insured, but only with respect to "bodily injury" or"property damage" arising out of"your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed MU 89 58 03 14 Includes copyrighted material from Insurance Services Office.Used with permission Page 6 of 8 Policy Number MERCHANTS CMP9155979 Policy Period INS_URANCE GR OUP 04104/24 TO 04/04/25 to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the product(s); f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Product(s) which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. 'Bodily injury" or"property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees-or anyone else acting on its behalf. However, this exclusion does not apply to: "(1) The exceptions contained in Subparagraphs d. orf.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the product(s). 2. This insurance does not apply to any insured vendor from whom you have acquired such product(s), or any ingredient, part or container, entering into, accompanying or containing such product(s).. 13.NON-OWNED AIRCRAFT a. EXCLUSION g. is changed so that SECTION I-COVERAGE A. applies to an aircraft that is: (1) Hired, chartered or loaned with a paid crew; but (2) Not owned by any insured. b. This provision does not apply if the insured has any other insurance for "bodily injury" or "property damage" liability that would also be covered under this provision, whether the other insurance is primary, excess, contingent or on any other basis. In that case, this provision does not provide any insurance. 14.SUPPLEMENTARY PAYMENTS Paragraphs 1.b. and 1.d. of SECTION I -SUPPLEMENTARY PAYMENTS - COVERAGE A. AND B. are replaced by the following: 1.b.Up to $2,500 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 1.d.All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit", including actual loss of earnings up to $350 a day because of time off from work. MU 89 58 03 14 Includes copyrighted material from Insurance Services Office.Used with permission Page 7 of 8 Policy Number XERCHANTS Policy erioPolcy Period URANCE GROUP 04/04/24 TO 04/04/25 15.LIBERALIZATION If we revise this endorsement to provide more coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. MU 89 58 03 14 Includes copyrighted material from Insurance Services Office.Used with permission Page 8 of 8 MIXNS-URANCERCHANTS Policy Number CMP9155979 Policy Period GROUP 04/04/24 TO 04/04/25 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization, when you have agreed in writing in a contract , Agreement or permit that was executed prior to the "bodily injury" , "property damage" , Or "personal injury and advertising injury" . Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or"your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ V APP 0 ED M NOTED DA R# FEE BY: NOTIFY BUILDING DEPARTMENTAT 631-765-1602 8AM TO 4PM FOR THE FOLLOWING INSPECTIONS: 1 FOUNDATION O IRE FOR POURED CONCRETE OCCUPANCY OR 2. ROUGH-FRAMING&PLUMBING USE IS UNLAWFUL 3. INSULATION 4. FINAL-CONSTRUCTION MUST WITHOUT CERTIFICAT BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE OF OCCUPANCY REQUIREMENTS OFTHE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTON ERRORS COMPLY WITH ALL CODES OF NEW YORK STATE&TOWN CODES AS REQUIRED AND CONDITIONS OF O manN ZBA ELECTRICAL N PLANNING BOARD INSPECTION REQUIRED N TRUSTEES tie/ sou T j W1G44T,� vase ctf jo ed • W,,� d��(� {�uR� ��n�aw1 �— — MINNOW — — — , . �`.;.. r:.Y. _' �>" .::•: b 'FT 55y :.i. -.�,� a.,. '��µ ).-. t �.,'. .FJ _ .... ... �yy�' i k"it r At IPI d«��Y }�'4 t,p��}tl 3Pw.� y 1F,,� t_:'" �"T.'T ' '+ie� a �F.',`� a1 �YI ��,� •j`�„+ ��A• i .E�+b sa 3.�.61•r9%Lc:a...y.'.lsi,�:�.�....•... �kd^ .�.St.."vakw�..a�io^�_rhi.�,r5r,v ss. .�.��4.:'. - _. - . . r .. - �.�" sr--.asp-.•� E _ _ ...� _ _. 3' � �_... -. _. . l y x. Y-4 0 1 r Yam' r y�Xvi /�fr� r�rf �.z'y � � err-�ycq��,�j�'�•-w.s S 1�:,;*• jjy�. ,r i ".>,- f .,:„ r.,-. _ '--✓ .-�....,�.' / rT.,,:�l r :.. ..., � _ � �� t£'�s..f}t�� :+yam . c. r- 3 1 eta i �_ �'+•� . [i ._ THE WI DOWN'- TILT WA'SH' D-OUB'LE=HU G=FULL=FR=CM=E=WI`ND'OWS 3 + Table of Tilt-Wash Double-Hung Window Sizes Scale 1/8"(3)=1'-0"(305)—1:96 Window Dimension 1'-9 5/8" 2'-15/8" 2'-5 5/s" 2'-7 5/8" 2'-9 5/8" 2'-115/8" 3'-15/8" 3'-5 5/8" 3'-9 5/1" (549) (651) (752) (803) (854) (905) (956) (1057) (1159) Minimum 4 �101/e 2 2 L/e 2 6 L/s 2�'Igjk ',40V zj76 L/a 3 21/e" i 3 6 i/s 3 101/Kd a t Rough Opening c s " 7 4(. ) (, • ) a ( .. LL s562). (664) (765) 816) Y (867)M 917 968 4070) Unobstructed Glass 15" 19" 23" 25" 27" 29" 31" 35" 39" (lower sash only) 1(381) 1 1 483)1 1 584) (635)1 1 (686) 1 1 737) 1 (787) (889) (991) i' s CUSTOMVIDTHS 71;5/e t0 45`'/0 ti N 0 B FE3 [Ell FE3 [E] ":7:' Custom-size windows are o Fo available in 1/8"(3)increments. �&,, f � TW18210 7W20210 TW24210 TW26210 TW28210 TW210210 TW30210 TW34210 TW38210 See page 84 for custom sizing. 01101 FE11 FF11 [E�] E I [Ell ❑ Grille patterns shown on page 85. 0! TW1832 TW2032 7W2432 TW2632 TW2832 7W21032 7W3032 TW3432 TW3832 J El Cottage or reverse cottage sash ratio available t OD -It � a�� 0 El E El for heights shown below in all widths. i co '�€ ., � CUSTOM WIDTHS—21'/e"to 45 5/e" i 443 CUSTOM HEIGHTS—48 r/e"to 76 r/r" "• " x s ' 7W1836 TW2036 TW2436 TW2636 TW2836 7W21036 TW3036 TW3436 TW3836 0 El El 11 El B 11 '. TW18310 TW20310 TW24310 TW26310 TW28310 7W210310 TW30310 TW34310 TW38310 Cottage Reverse Cottage f El El El El N t 1 ( TW1842 TW2042 TW2442 TW2642 TW2842 TW21042 TW3042 TW3442 TW3842 rl t 0 El 0. 0 r +`( (} TW1846 1W2046 ip7W244 TW-646 TW2846 TW21046 TW30460 TW34460 TW38460 x Tf7 i t 1' a 1 Fw tr 0 O n ^ lLO 0 - in 4 + N { -{ e� a TW18410 TW20410 TW24410 TW26410 TW28410. IW2104100 7W304100 TW344100 7W384100 v � Iq � � ti •� :; ; j TW1S52 TW2052 TW2452 TW2652 TW28520 TW210520 7W30520 7W34520 TW38520 a 48 `° r�. ltyli; �y-,t ', �+ `��r> �s, r j' 1 � �1�a a�,� � •'� ¢.} r),.y.` `r a X�a •:� x O 00 r- W r NEl t• -, .. F 4 i—6 iW2056 TW2456 TW2656° 7W2856° TW21056° TW3056° TW3456° NV3856° 'i ar . . +, ❑ ❑ ■ ■ ■ Size tables for windows with cottage or p � I reverse cottage sash are available at andersemvindows.com/sizing. co r o�D ^ pp I ' r "d` m t'_ '•3 ••Window Dimension'always refers to outside a I 7W18510 TW20510 TW245100 TW265100 TW285100 7W2105100 7W305100 7W345100 TW385100 -Minimum frame-to-frame j ••Minimum Rough Opening'dimensions � .I may need to be Increased to allow far use s, of building wraps,Hashing,sill panning, i ;o r; brackets,fasteners or other Items.See lm \ L. pages 210-211 for more details. 7 ' �i `s' Dimensions in parentheses are in mlllime[ets m 0 Meet or exceed clear opening area of 5.7 sq.ft.or 0.53 ml,clear opening width of 20"(508)and clear opening height of � 5. TW1862 TW2062 TW24620 TW26620 TW28620 TW210620 TW30620 TW34620 TW38620 24"(610).5ee tables on pages 82-83 continued on next page - -� 'S 78 3 '' i ANDERSEN"' WINDOWS DOORS SOLD BY: SOLD TO: 9/4/2024 t" . MICHAEL FITZGERALD 710B FRANKLIN AVE, FRANKLIN ;LA7Sl1PD'iA'1!' > SQUARE , NY, 11010 9/4/2024 516-872-9690 EXT 31 FITZGERALDM@WINDOWRAMA. COM michael fitzgeraid Abbreviated Quote Report ::.:...................... ................................. .... ............ ............ ......................... Unassigned Quote Unassigned Project 6364431 :. !i":... .. - ;;:,:. : ::Y; :ii:;i...:............ : AT ... .. EL VERY N ES:>:::>:.::.::.:;::..,•::::::: ........::..:..::;;.. ......::.:............... 1� ! T .:.::.:..:.:::.......... ::....:::.:::::.....:::.::::..........:::::::::.::::::::::::::::::I ..........::::::::::::::::::::.::::.:::::.:::::::.::::.:::::::,::::.::.:.:....::::::::::.::::::::::............................................................................................. Item Qtv Operation Location j 100 1 AA None Assigned u ' tirv:A RO Size: 30 1/8"x 56 7/8" Unit Size: 29 5/8"x 56 7/8" " #i TW2446, Unit,-400 Series Double-Hung, Equal Sash, Installation Flange, White Exterior Frame, White Exterior Sash/Panel, Pine . ' .......`.' `� w/Unfinished Interior Frame, Pine w/Unfinished Interior Sash/Panel, AA, Dual Pane Low-E4 Standard Argon Fill Stainless Glass/ Grille Spacer,Traditional, 1 Sash Locks White, WhiteJamb Liner Optional Lock Hardware 1:TW Traditional White PN:9069433 Unit# U-Factor SHGC ENERGY STAR Clear Opening/Unit# Width Height Area (Sq. Ft) Al 0.3 0.31 NO Al 25.8750 24.2500 4.37000 Quote#: 6364431 Print Date: 9/4/2024 4:17:35 PM UTC All Images Viewed from Exterior Page 1 of 2 - Unit Spec Report Large Image TE zo Unassigned Quote Unassigned Project 6364431 . ' - — -- --' Room: None Assigned Item 0tv Operationl 1MD4 1 AA RO Size: 3O1/8"x 567Y8" Unit Size:29 5/8"x 567/8" Comments: 4OO Series Dnub|o'Hung' LmmG4.Standard , Grilles: Nunn Instructions to Manufacturer: � Unit# U`Foctor SH0C ENER8YGTAR ------------------—------------------ ------------'—' Al 0.3 0.31 NO ' Clear Opening/Unit# Width Height Area (Gq.Ft) ------ Al 25.8750 24.2500 4.37000 ' '. . Quote#: 6384431 Print Date: 9/4/20244:17:08 PM UTC All Images Viewed from Exterior Page 2 of 3 ' ' , ` ^ - - AJANDERSENT" WINDOWS & DOORS SOLD BY: SOLD TO: 9/4/2024 MICHAEL FITZGERALD ......••••• ......•••• 710B FRANKLIN AVE, FRANKLIN 104 A7 $fi UPgATI ':.. SQUARE,NY, 11010 9/4/2024 516-872-9690 EXT 31 FITZGERALDM@WINDOWRAMA• COM michael fitzgerald Abbreviated .:b...:.b.....r...e. v iated. Q. u....o....t::.e.:.. Reporto rt ......................................U.......7...i»...':N...l..l...N...A...R....E...i.2...•......:...........................<.:;.>...:.:..:........:<..>.s.::.•.:G....U...S...;T...Q..M....E...R..:.P.....:O....#.i......:............;...:...:....:...........:.;.:.:.::......:.:.<.:...,.,'.:<.T.. ..R...''A...p...l.»...l.i.d..>.>. < ' v<:O:.::: Q .€ .......... Unassigned .................... Quote Unassigned Project 6364431 X. O R 11 ....X::.::.::.:::..: ....:,::,.:::::..:.....:,:.:.:::,.::,..::,.:::.::.,.:::.,:::.::.:.,:,,,,,:.:,,,,:,.:::,,,,.:.,.:::..::,,:.. S ............................:..............................:...:::..,::::.:......:...............:Xe.,..,...::..:..I..:.:.::::,:::,,:.:D.SLIVERY.NOT.E3..................................................... .... ..................... .....:..:,,,.::.,::....,.,....,:.. Nlo Item Qom( Operation Location >-ii :w 100 1 AA-AA-AA None Assigned RO Size: 8 Unit Size: 89 1 8 x 52 7 8``�•�•`�'�' S 9 518 x 52 7 n / ! , i '>€:.:. €1 Mull: Dealer Mulled, Field Ribbon Mull, 1/8 Non Reinforced Material TW2442 -TW2442-TW2442, Unit, 400 Series Double-Hung, Equal Sash, White Exterior Frame, White Exterior Sash/Panel, - ...•�<��::.:`::•:'•y:;�>•:.......•:��f��:::'? Pine w/Unfinished Interior Frame, Pine w/Unfinished Interior Sash/Panel,AA, Dual Pane Low E4 Standard Argon Fill Stainless Glass/Grille Spacer, Traditional, 1 Sash Locks White,WhiteJamb Liner Optional Lock Hardware 1:TW Traditional White PN:9069433 Optional Lock Hardware 1:TW Traditional White PN:9069433 Optional Lock Hardware 1:TW Traditional White PN:9069433 Drip Cap: 120IN White QTY 1 PN:2222546 Join Mull Material: 400 Series TW, 52.875,Vertical 1/8 Non Reinforced White, Pine, Unfinished, PN:1612005 Mull Casing:TW, 52.875,Vertical, 1/8 Non Reinforced, Pine, Unfinished, In Side, PN:1611553 Join Mull Material:400 Series TW, 52.875, Vertical 1/8 Non Reinforced White,-Pine, Unfinished, PN:1612005 Mull Casing: TW, 52.875,Vertical, 1/8 Non Reinforced, Pine, Unfinished, In Side, PN:1611553 Unit# U-Factor SHGC ENERGY STAR Clear Opening/Unit# Width Height Area (Sq. Ft) Al 0.3 0.31 NO Al 25,8750 21.7500 3.92000 61 0.3 0.31 61 25.8750 21.7500 3.92000 C1 0.3 0.31 C1 25.8750 21.7500 3.92000 Quote#: 6364431 Print Date: 9/4/2024 4:37:19 PM UTC All Images Viewed from Exterior Page 1 of 2 l ` - , Unit Spec Report Large Image �_��_��_��......................~�_��_�� Room: None Assigned Item Qtv Operation 100~1 1 AA~AA'Ak RO Size: @S5/8"xS27/W" Unit Size: 801/8"xG27/W" Comments: 4OO Series Double-Hun Lnv�E4 8�ndand.QrU�o: None, Vertical, Dealer Mulled, 10 Non Reinforced Instructions to Manufacturer: � Unit# U'Factor 8HGC ENERGY STAR / ..................................... ---'_----- A1 0.3 0.31 NO ev Bi 0.3 0.31 «v Ci 0.3 0.31 n� Clear Opening/Unit# VV|dNh Height Area(Sq.Ft) .......—..........—......---'-------— ------—'—-------------'—'----- A1 25.8750 21J500 3.92000 B1 25.8750 21.7500 3.92DOO } O1 25.8750 21.7500 3.92000 } Quote 6364431 Print Date: 9/4/20244:37:28 PM UTC All Images Viewed from Exterior Page 2 of 3 TAME. 0 Submittal Split System Cooling 4.0 Ton 4TTR3048N1000A 111 � 1 111 July2022 4TTR3048N-SUB-1A-EN -1 R n N TECHNOLOGIES" TRANE® B SERVICE PANEL C ELECTRICAL AND REFRIGERANT COMPONENT CLEARANCES PER PREVAILING COD9S I � TOP DISCHARGE AREA SHOULD BE UNRESTRICTED FOR AT LEAST 1524(5 FEET) ABOVE UNIT.UNIT SHOULD BE PLACED SO ROOF y RUN-OFF WATER DOES NOT POUR DIRECTLY ON UNIT AND SHOULD BE AT LEAST 305(12")FROM WALL AND ALL SURROUNDING SHRUBBERY ONTWO SIDES. OTHERTWO SIDES UNRESTRICTED i ELECTRICAL SERVICE K PANEL ._ 25 22.2(7/8)DIA.HOLE A LOW VOLTAGE 28.6(1-1/8)DIA.K.O.WITH 22.2(7/8)DIA.HOLE IN CONTROL BOX BOTTOM FOR ELECTRICAL POWER SUPLY I LIQUID LINE SERVICE VALVE, „E„ 1J� I.D.FEMALE BRAZE CONNECTION WITH 1/4"SAE FLARE PRESSURETAP FITTINGS G FIG.1 V�— K.O.FOR ALTERNATE ELECTRICAL ROUTING From Dwg.D152898 GAS LINE 1/4TURN BALL SERVICE VALVE, „D„ I.D.FEMALE BRAZED CONNECTION WITH 1/4"SAE FLARE PRESSURE TAP FITTING.A Model Base A B C D E F G H ] K 4TTR3048N 4 741 946 870 7/8 3/8 143 83 206 70 508 (29-1/8) (37-1/4) (34-1/4) (5-5/8) (3-1/4) (8-1/8) (2-3/4) (20) Sound Power Level A-Weighted Sound Full Octave Sound Power(dB) MODEL Power Level[dB(A)] 63 Hz 125 Hz 250 Hz 500 Hz 1000 Hz 2000 Hz 4000 Hz 8000 Hz 4TTR3048N 71 81 72 69 69 66 60 57 54 Note:Rated in accordance with AHRI Standard 270-2008*For Reference Only 2 4TTR3048N-SUB-1 A-EN TAME' Product Specifications OUTDOOR UNIT(a)(b) 4TTR304SN1000A (a) Certified in accordance with the Air-Source Unitary Air-conditioner POWER CONNS.-V/PH/HZ(�) 208/230/1/60 Equipment certification program,which is based on AHRI standard 210/240. (b) Rated in accordance with AHRI standard 270. MIN.BRCH.CIR.AMPACITY 24 W Calculated in accordance with Natl.Elec.Codes.Use only HACR BR.CIR.PROT.RTG.-MAX.(AMPS) 40 circuit breakers orfuses. (d) This value shown for compressor RLA on the unit nameplate and on COMPRESSOR CLIMATUFFO.7, 'ROLL, this specification sheet is used to compute minimum branch circuit NO.USED-NO.STAGES 1-1 ampacity and max.fuse size.The value shown is the branch circuit selection current. VOLTS/PH/HZ 208/230/1/60 (e) Use start components only when compressor is found to enter locked rotor condition and will not start or when lights dim at compressor R.L.AMPS(d)-L.R.AMPS 18.5-124 start.No means no start components.Yes means quick start kit FACTORY INSTALLED components.PTC means positive temperature coefficient starter. Optional kit shown. START COMPONENTS(e) NO.(Uses BAYKSKT263) M Standard Air-Dry Coil-Outdoor (g) This value approximate.For more precise value see unit nameplate. INSULATION/SOUND BLANKET, NO (h) Max.linear length 60 ft.;Max.lift-Suction 60 ft.;Max.lift-Liquid 60 ft.For greater length consult refrigerant piping software Pub.No. COMPRESSOR HEAT NO 32-3312-0*(*denotes latest revision). OUTDOOR FAN PROPELLER DIA.(IN)`-NO.USED 27.5-1 TYPE DRIVE-NO.SPEEDS DIRECT-1 CFM @ 0.0 IN.W.G.(f) 3970 NO.MOTORS-HP 1-1/5 MOTOR SPEED R.P.M. 835 VOLTS/PH/HZ 208/230/1/60 F.L.AMPS 1.05 OUTDOOR COIL- P—t ._ SP_INE'FIN'TM, > - ROWS-F.P.I. 1-24 FACE AREA(SQ.FT.) 19.07 TUBE SIZE(IN.) 3/8 REFRIGERANT LBS.-R-410A(O.D.UNIT)(9) 5 LBS.,3 OZ FACTORY SUPPLIED YES LINE SIZE-IN.O.D.GAS(h) 7/8 LINE SIZE-IN.O.D.LIQ. 3/8 CHARGING SPECIFICATIONS SUBCOOLING 10°F DIMENSIONS H X W X D . CRATED(IN.) 34.4 x 35.1 x 38.7 WEIGHT_ SHIPPING(LBS.) 221 NET(LBS.) 189 4TTRk48N-SUB-1 A-EN 3 TA WE° Mechanical Specification Options General Compressor The outdoor condensing units are factory charged with The compressor features internal over temperature and the system charge required for the outdoor condensing pressure protection.Other features include:Centrifugal unit,ten (10)feet of tested connecting line,and the oil pump and low vibration and noise. smallest rated indoor evaporative coil match.This unit Condenser Coil is designed to operate at outdoor ambient temperatures as high as 115°F.Cooling capacities are The outdoor coil provides low airflow resistance and matched with a wide selection of air handlers and efficient heat transfer.The coil is protected on all four furnace coils that are AHRI certified.The unit is certified sides by louvered panels. to UL 1995.Exterior is designed for outdoor Low Ambient Cooling application. As manufactured,this system has a cooling capacity to Casing 55°F.The addition of an evaporator defrost control Unit casing is constructed of heavy gauge,galvanized permits operation to 40°F.The addition of an steel and painted with a weather-resistant powder evaporator defrost control with TXV permits low paint finish.The corner panels are prepainted.All ambient cooling to 30°F. panels are subjected to our 1,000 hour salt spray test. The addition of the BAYLOAM107A low ambient kit Refrigerant Controls permits ambient cooling to 20°F. Refrigeration system controls include condenser fan, Thermostats—Cooling only and heat/cooling(manual compressor contactor and low and high pressure and automatic change over).Sub-base to match switches.A factory supplied,field installed liquid line thermostat and locking thermostat cover. drier is standard. 1 q 4TTR3048N-SUB-1 A-EN TRAME® Trane - by Trane Technologies (NYSE: TT), a global innovator - creates comfortable, energy efficient indoor environments for commercial and residential applications. For more information, please visit trane. com or tranetechnologies.com. unitary Small AC' C UL US LISTED The AHRI Certified mark indicates Trane U.S.Inc.participation in the AHRI Certification program.For verification of individual certified products,go to ahridirectory. org. Trane has a policy of continuous data improvement and it reserves the right to change design and specifications without notice.We are committed to using environmentally conscious print practices. 4TTR3048N-SUB-IA-EN 21 Jul2o22 Supersedes(New) ©2022 Trane