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HomeMy WebLinkAbout51901-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#: 51901 Date: 05/07/2025 Permission is hereby granted to: Nikos Theodosopoulos 175 Aldershot Ln Manhasset, NY 11030 To: install roof-mounted solar panels on existing single-family dwelling as applied for. Premises Located at: 595 N Parish Dr, Southold, NY 11971 SCTM#71.4-6 Pursuant to application dated 03/28/2025 and approved by the Building Inspector. To expire on 05/07/2027. Contractors: Required Inspections: Fees: SOLAR PANELS $100.00 ELECTRIC -Residential $125.00 CO-RESIDENTIAL $100.00 Total $325.00 f Building Inspector 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) 765-9502 https://WWW.SOL]tho�idtownny.gov rr �� Date Received APPLICATION FOR BULDING PERMIT I "vi For Office Use Only PERMIT No. Building Inspector: % AppJ�catlonsnci farms musk be fired obit I6 t�tr enIrety a )hplowner,an' „» p(�a tionsQu ill not be accepted Where//ie;ApAlan# ap Owf er's AuthoriZatron form. Page 1 zJ shall P Date: 03/04/2025 OWNERS)OF PROPERTY „ Name: Nikos Theodosopoulos SCTM#1000- 71.-1-6 Physical Address: 595 North Parish Drive, Southold NY 11971 Phone#: 917-359-0825 Email: Nikosl@gmail.com Mailing Address: 595 North.Parish Drive, Southold NY 11971_ CONTACT PERSON: Name:Permit Dept./Long Island Power Solutions Mailing Address:2060 Ocean Ave., Ronkonkoma, NY 11779 Phone#:631-348-0001 1 Email:Permits@GoPowerSolutions.com 'tiEa�IGN f�ROFESS10�1fE1L INFORMATION r/// r rr Name: Michael E. Miele, PE Mailing Address: 33 Quaker Ave. PO BOX 530 Cornwall, NY 12518 Phone#: 845-629-9693 Email: Nypsengineer@gmail.com �o�llrRAC7`OR INFORMATION. ,,,/���ia/o/ /i., % Name:Michael Catizone/Long Island Power Solutions Mailing Address:2060 Ocean Ave., Ronkonkoma, NY 11779 Phone#:631-348-0001 Email:mike@GoPowerSolutions.com , ! / „ dr rrrrr rrr � ❑New Structure ❑Addition BAlteration ❑Repair ❑Demolition Estimated Cost of Project: 8Other Proposed( 41 )panel roof mounted array. (17.425 )kW System $ 50 290.00 [Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes RNo 1 i� I�»�1;11I111�1�,1�1�1J1JJJ1��1 l�111111���11I11 I��1.1�J1J11�J1 � ' 1111 I) ilJ 1, Existing use of property:Single Dwelling Intended use of property Sin le Family Dwelling ® Sing �! . 9 ga ..e_ 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. r f I i Catizone ElectricaVLon,g Island Power Solutions Application Submitted By( I na e): ®Authorized Agent ❑Owner ® _ � .. Signature of Applicant Date �®r, 3 ©� c'� STATE OF NEW YORK) SS: COUNTY OF Suffolk Michael Catizone 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 o day of C_,a- 20 Notary Public ESCAYLM CRISOL RIVERA RODRIGUEZ NOTARY PUBLIC-STATE OF NEW Y No. 01RI6434031 ca t1111 Nlf°IR AUTI-101RIZA l'°'ION Qualified in Suffolk County (Where the applicant is not the owner) My Commission Expires 05-31-2026 I, residing at 595 N Parish Dr Southold 11971 Michael Catizone/Long Island Power Solutions do hereby authorize to apply on my t T wn outhold Building Department for approval as described herein.7J, . :!5?/a,/as Owner' i n ter NICOLE �� .l'T1 NOTARY PUBLIC, ST!`,T OF NEW YORK N0. 01GIOJ0��<.G9 Print Owner's Name QUALIFIED IN SUFFGLK COUNTY Mti,GOi41[o.!SS'C^• LXPIRES,MAR 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 yb ro err sol�tholdtownrl w ov seand southoldtownn ov .. APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Ail Information Required) Date: 03/04/2025 Company Name: Catizone Electrical/Long Island Power Solutions Name: Michael Catizone License No.: ME-53560 email: Permits@GoPowerSolutions.com Address: 2060 Ocean Avenue,Ronkonkoma,NY 11779 Phone No.: 631-348-0001 JOB SITE INFORMATION (AII Information Required) Name: Nikos Theodoso oulos Address: Cross Street: Dayign Rod Phone No.: 917-359-0325 Bidg.Permit#: email: Nikos1pgrnail.corn Tax MaE District: 1000 Section: 71 Block: 1 Lot: 6 BRIEF DESCRIPTION OF WORK(Please Print Clearly) Proposed( 41 )panel roof mounted array.. ( 17.425 )kw System Circle All That Apply: Is job ready for inspection?: YES / NO Rough In Final Do you need a Temp Certificate?: YES / NO Issued On Tamp 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 #Unde round Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: QVQ12-M-US PAYMENT DIE!IIIITH AP'P"LtCTI±IN Request for Inspection FormAs LONG ISLAND MD,OWER 2060 Ocean Ave Ronkonkoma, NY 11779 631348-0001 SOLUTIONS www.longislandpowersolutions.com OWNER AUTHORIZATION This affidavit certifies that Long Island Power Solutions has been granted permission to sign for and obtain permit(s) on behalf of the roperty owner(s).I, 0`0 A1t?5 ,Owner of the property located at: 595 N Parish Dr Southold 11971 Street Town State Zip Tax Map ID :. Do hereby give: Long Island P_ower.Sojuti w-pennission to sign all applications and to have the permit(s) sent directly to: Long Island Power Solutions 2060 Ocean Avenue Ronkonkoma,NY 11779 Attn:Permit Dept. 1170 7 S op O fit`)',,, 'nt Name (Property OwnC Si attire Sworn o Before Me This d 4;, Day 0 eb f cr IaNATURE) N , L,iµ 60°�6: I 0. W 1 6 4 9' QQA;LiFi"Q PN, SQr QL R LINTY � Y O a P J POj'q EXPIRES MAR 30,2027 Notary Stamp Go Green Save Green S,C"T.M" NO DISTRICT: 1000 SECTION:71 BLOCK: I LOT(S):6 EXISTINGDEC LOT COVERAGE (UPLAND AREA.2345D S.Fj DWELLING W/SCREENED PORCH 2156 S.F REAR DECK 1090 S.F. ORNEWAY,WALKWAY @ STOOP 655 S.F. SHED RO S.F. �";A,. ro n, _LA ZEB0 73 S.FS.F. 40 TOTAL5109 S.F or 21.aX � .. NYSDEC � PROPOSED LOT COVERAGE b vhr a (UWUINO AREA:23,450 S.F,) DWELLING W/COVERED PORClk 1995 S.F. "y'G` `,.F• UPPER DECK,REAR PATIO.STEPS*PODA,:. 1946 S.F. SHED:; 96 S.F. GAZEBO: 73 S.F TOTAL'4110 S.F.or 17.5x TOWN OF SOUHOLD 'Y b EXISTING LOT COVERAGE I!,1PLAND ARFA.23,45D S:F'J DWELLING W/SCREENED PORCH 21 S.F. F. 1 k REAR DECK 1020 1020 S.F. .V,L SHEDS.F.BO S. p q� GAZEBO 7-1 SF ap p Earn-.33W Sir or 14,5z °' r TDWN OF 'pFpp pp w.,. PROPOSED LOT COVERAGE DWELLING W/COVERED PORCH: I995 S.F. UPPER DECK.REAR PATIO W/POOL 1894 S.F. SHED: 96 S.F. � T.H./2 GAZEBO: 73 S,F. w., fV w _al.D TOTAL:4058 S.F.or 17.31LkRY 1 Az OL 1'D Da° DWELLINGS r '� MHtl W/PUBLIC WATEYT t R4" NE 6.8' SAND .mm X tll V"R EXISTING 1 STORY o 'tIL W 7 DWELLINGS DECK i., 1'1 Y 4 d 10 M DC+MDd.Y59�dE'D "R EACM.IW.tY TELL T2,2g � n r7: M 4 TR w,y ..e, we near rAP,kL6V'$.� •,•••-�^-21 7.1' oa-zl-zl .° ad!t7d:oPtl �'& fT1pn1!�. K.WOYCHUK IS y ro DWELUNGS 0 121. PROPOSED C flkUN,L AWryhr d & I p* WIPUBMC MAdEPC T.H.If 'N "" ._ y y+'FPrv", 41 dM3.6 IGi 15q EL 12.o ELECTRIC SERAC, s OL 0 avN 2.5' ti,r.. it„wumd Irvld P'3 Pb AgK1 tow _ '�ME wa- ,ryry,, � �" SP a.s" �' &p4 gLldrl.r'pEiril ( .T q,AF 4' "Awc,R000 '043T Rom.Im Tub WuW;K SLEV 1.9 — o ff --7 d$RI k q 'T.appglER rj7ff""" 1 ..WAIFR IN ^^MdiN I4E 4rwN1,M1bTINaARY PALEI"K aU0"j,u SIN 6.0' 1'"+' ' -IELECTWCSERVICE mey w5� ) TO AN 6001 PLC PANEL ,G,'° IuMEp Y O ro r gyp" LC CONTROL PANEL U f 4P WITH HP120 COMPRESSOR ELECTRIC AND AIR 07' o.za:l w ° SUPPLY LINE TO AN-600 x.'M9YCHDK is .,, r a �' m .•� LPCt IP1:' ' yOROACTION " ° Inld-IA"• w H' ' 1EAB'DIAx4'DISTPOOLW3-FDIA T.H./3 WI ..�..t.�. ° * X 4'DEEP LEACHING POOLS W 2-6 DIA 7 a z' N5"p X 4'DEEP EXPANSION POOLS OL T e.wD_ " ' R J `�pg . p TAp5VDT1G)NS AiRAFRYRETAININGWALL StyaropRSE e.e' d"j��+'°1J ., "' ,'. "l LEGEND _ = LP-PRECAST LEACIUNG POOL DWELLINGS, EP-FXAPNSION LEACHING POW EILv o.a W/PUBLIC WATER Cl0-CtEANWT wA1LR HIC116T WEER aLV zo -7.D' 150' AN60-HYDROACTIONANSU)ONiS as-14-z4 -------E)(ISTINGCON'TOUR 4*MCHA is .(xx.x') PROPOSED SPOT FIEVA 12 PROPOSED CONTOUR WM—WATERSER''XE E UIGELECTRICSERJIOE ZONED R-40 PREWSED 02-•20-25 GASLIINE NON-CONFORMING LOT REVISED 01--19-24 THE WATER SUPPLY, RFLLSr OR#TFfLLS AND L"ES,`,TMOL FRONT YARD:40'MIN LOCA DONS SHDIW ARE FROM FIELD 09SiER'VA TR N5M SIDE YARD: 15,MIN(TOTAL 35') REVSED 08-01-23 AND OR DATA OBTAINED FROM OITAI:RS. AREA:25,426 S.F. or 0.58 ACRES REVISED 10-20-22 £LEVA77ON DATUM.- NAVD88 UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE E'DUIC.AIttOV LAW: CDPIES Of EMS SI.NEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID IRUE°COPY GUARANTEES MO CA HT.°RE'ON S NALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 777LE COMPANY;'GOVERNONTAL.AGENCY,AND a',ENDWG 7NSD'IW11ON LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTIIUTION, GUARANIEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADD177ONAL STRUCTURES OR AND 07HER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT OU A,iN,k,,%UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OF: DESCRIBED µ' LLB°1 CERTIFIED TO: NIKOS THEODOSOPOUCwO'S MAP OF; FILED. L ^� SITUATED AT-- SOUTHOLD d� TOWN OF: SOUTHOLD SUFFOLKx COUNTY, NEW YORK A Professional 5)z9B- Surveying P.O. H qi uebogue, New York 11931 PHONE (9 FILE #221-48 SCALE:1"_30 DATE: APRIL 30, 2021 6BB FAX(631)2BB-15BB N.Y.S. LISC VVOC 050882 01�IWVNWN VAR ft*coulft DaPL of Labor.LRca W"I S 6onaumar AIMM N MASTER ELECTRICAL LICENSE Mamie MICMAEL CATIZONE Business Nam LONG ISLAND POWER SOLUTIONS TNa Moles tiral the INC mar'b Aty by dra Gawrll+ Llcenaa Number ME 69580 Msued: p5(pM14 WoyrwT.Rol" Expires: OWM 206 Commistiorler e.oLabor.SLO��fir' HOME IMPROVEMENT LICENSE NAM MIC"ML 4 CATIZONE Business Hum LONG ISLAND POWER SOLL T'DNS Ta9a van sra 04C **b� C wV �`era of Lkarisa Number H Wand: 0006I4014 VApq &T-.R4lr"y E 68iR)1/2646 Conrlissaaer . DATE(MM/DDNYYY) AC0_->R& CERTIFICATE OF LIABILITY INSURANCE 02/20I2025 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 Dorene Wickes Edwards and Company PHONE (631)472-8400 ,No (631)472-8486 140 Greene Avenue I—MARIESs, dwickes@edwardsandco,net ADOINSURERS)AFFORDING COVERAGE NAIC# Sayville NY 11782 INSURERA: James River Insurance Company 12203 INSURED INSURER B: Long Island Power Solutions,Inc.DBA New INSURER C: York Power Solutions INSURER D: 2060 Ocean Avenue INSURER E: Ronkonkoma NY 11779 INSURER F: COVERAGES CERTIFICATE NUMBER: 25-26 Master 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. LTR TYPEOFINSURANCE INSO WVID POLICYNUMBER MM/DDIYYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE Fx]OCCUR PREMISES Me occurrentAoJ $ 100,000 X Contractual Liability MED EXP.(Lny oneperson) $ Excluded A X Ded: $10,000 Y P0000000486 02/28/2025 02/28/2026 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GEN'AL.AGGREGATE $ 4,000,000 POLICY JECT PRO- ❑LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY E COMBINED$ING-LE.LIMIT $ accidan ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY ACE $ AUTOS ONLY AUTOS ONLY r :cdda� $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION P OR' AND EMPLOYERS'LIABILITY TATUTE ER YIN ANY PROPRIETORIPARTNER/EXECUTIVE ❑ N/A E.L...EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L..DISEASE-POLICY LIMIT $ Each Claim $2,000,000 A Professional Liability P0000000486 02/28/2025 02/28/2026 Aggregate $4,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) As respects to General Liability if required by written contract the following are included as additional insured per the policy form FP5201. CERTIFICATE HOLIER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Road AUTHORIZED REPRESENTATIVE Southold NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 02/20/2025 11 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 NAMe Dorene Wickes Edwards and Company PHONED (631)472-8400 FNa y (631)472-8486 10.DI ggj, LAX 140GreeneAvenue E-MAIL s: dwickes@edwardsandco.net ADDRE INSURERS)AFFORDING COVERAGE NAIC# Sayville NY 11782 INSURERA: James River Insurance Company 12203 INSURED INSURER B: Long Island Power Solutions,Inc.DBA New INSURER C: York Power Solutions INSURER D: 2060 Ocean Avenue INSURER E: Ronkonkoma NY 11779 INSURER F: COVERAGES CERTIFICATE NUMBER: 25-26 Master 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. LTR TYPE OF INSURANCE IN SO WVD POLICYNUMBER MMe /Y MMIDDYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 2,000,000 CLAIMS-MADE Fx]OCCUR PREMISES'Eaoceunento $ 100,000111- Contractual Liability MED EXP(Any oneBerson) $ Excluded A X Ded: $10,000 Y P0000000486 02/28/2025 02/28/2026 PERSONAL&ADVINJURY $ 2,000,000 GEN`LAGGREGATELIMI'I'APPLIESPER. GENERALAGGREGATE $ 4,000,000 POLICY�J LOC PRODUCTS-COMPIOPAGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED 54NGLE.LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) ',$ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPEAW DAMAGE $ AUTOS ONLY AUTOS ONLY ' 'acciderM UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PTA AND EMPLOYERS'LIABILITY Y/N TUTE. FOR ANY PROPRIETOR/PARTNER)EXECUTIVE E.L.EACH ACCIDENT $ OFFICER(MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL,DISEASE-POLICY LIMIT $ Each Claim $2,000,000 Professional Liability A P0000000486 02/28/2025 02/28/2026 Aggregate $4,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) As respects to General Liability if required by written contract the following are included as additional insured per the policy form FP5201. Nikos Theodosopoulos and Anna Loukissa If required by written contract the General Liability insurance is primary and non-contributory to the additional insured per the policy form FP4001„ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Nikos Theodosopoulos and Anna Loukissa ACCORDANCE WITH THE POLICY PROVISIONS. 595 N.Parish Dr. AUTHORIZED REPRESENTATIVE Southold NY 11971 �• �rrr ._—., ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Yoe Workers' CERTIFICATE OF INSURANCE COVERAGE tue 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 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured LONG ISLAND POWER SOLUTIONS INC 2060 OCEAN AVE 6313480001 RONKONKOMA,NY 11779 Work Location of Insured(Only required if coverage is specifically limited to 1 c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-Up Policy) or Social Security Number 27-1175107 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Town of Southold Standard Security Life Insurance Company of New York 54375 Main Road 3b.Policy Number of Entity Listed in Box 1a Southold, NY 11971 R97411-000 3c.Policy Effective Period 1/1/2015 to 5/12/2025 4. Policy provides the following benefits: 0 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 Gasses 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 de9;.o ve. Date Signed 5/13/2024 By 1424 (Signature of insurance carriet's authtraf repmsevtittve or NYS licensed insurance agent of that insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY SERVICES IMPORTANT:lf 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 of Part 1 has 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. oB-120.1 (12-21) ll ll"!�!'�' � � iiiii /7-004`\ON� Y ' F PO Box 66699,Albany,NY 12206 New York State Insurance Fund nysif.Com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 271175107 INN ,.w LOVELL SAFETY MGMT CO.,LLC 22 CORTLANDT STREET 33RD FLR NEW YORK NY 10007 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LONG ISLAND POWER SOLUTIONS INC TOWN OF SOUTHOLD 2060 OCEAN AVENUE 53095 ROUTE 25 RONKONKOMA NY 11779 SOUTHOLD NY 11971 POLICY NUMBER I CERTIFICATE NUMBER POLICY PERIOD DATE Z 2467 01 372393 04/01/2024 TO 04/01/2025 03/18/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2467 078-8, 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. 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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT MICHAEL CATIZONE VICE PRESIDENT JOSEPH MILILLO TWO OF TWO OFFICERS LONG ISLAND POWER SOLUTIONS INC 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 'SURANCE FUND UNDERWRITING VALIDATION NUMBER: 97252850 11111'0000000000O012 41 I2511111 Farm WC-CERT-NOPRINT Version 3(0SR92019)[WC Policy-246707891 U-26.3 174 [00000000000125441258][0001-0000246707ee][ssZJ[16348-Q][CerL.NOP-CM1 1][01-00001] /M N Y S F PO Box 66699,Albany,NY 12206 New York State Insurance Fund I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE nnnnnn 271175107 � m LOVELL SAFETY MGMT CO.,LLC M 22 CORTLANDT STREET 33RD FLR NEW YORK NY 10007 ❑M SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LONG ISLAND POWER SOLUTIONS INC TOWN OF SOUTHOLD 2060 OCEAN AVENUE 53095 ROUTE 25 RONKONKOMA NY 11779 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z 2467 078-8 878578 04/01/2025 TO 04/01/2026 02/27/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2467 078-8, 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. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS:/MWWW.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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT MICHAEL CATIZONE VICE PRESIDENT JOSEPH MILILLO TWO OF TWO OFFICERS LONG ISLAND POWER SOLUTIONS INC 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 URANCE FUND UNDERWRITING VALIDATION NUMBER: 906049732 F0000 00 0000001 06T86'71 Form WC-CERT-NOPRINT Version 3(08/29/2019)[WC Policy-24670788] U-26.3 342 DATE(MMIDDNYYY) �+ CERTIFICATE OF LIABILITY INSURANCE 02/20/2025 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 NAME.: Dorene Wickes Edwards and Company PHONE (631)472-8400 � Na:' (631)472-8486 140 Greene Avenue E-MAILss: dWickes@edwardsandco.net ADDINSURERS)AFFORDING COVERAGE NAIC# Sayville NY 11782 INSURERA: James River Insurance Company 12203 INSURED INSURER B: CatlZone Electrical Inc. INSURER C'.'. 2060 Ocean Avenue INSURER D INSURER E Ronkonkoma NY 11779 INSURERF„ COVERAGES CERTIFICATE NUMBER: 25-26 Master 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. LTR TYPE OF INSURANCE P1kN1JSUDLVUV7 POLICYNIUMBER MMIDDNYYY MM/LDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE FRI OCCUR' PREMISES Ea occurrence $ 100 000 w Excluded Contractual LiabilityMED FRCP(Any $one erson) $,,,,, A X Ded.:$10,000 Y P0000000486 02/28/2025 02/28/2026 PERSONAL BADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000 JECT ❑LOC 4,000,000 POLICY [g PRO $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ aeuckierpt ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS - HIRED NON-OWNED '...PR5PMM 67AMAG5 $....... AUTOS ONLY AUTOS ONLY APer kloud. UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ '.., DIED I I RETENTION$ $ WORKERS COMPENSATION' PER OTH- AND EMPLOYERS'LIABILITY Y/N 8T T TE I LER ANY PROPRIETORIPARTNEWEXEC�U'TIVE ❑ NIA E.L.EACH ACCIDENT $....... .... OFFICERIMEMBER EXCLUDED? (Mamtatory in NH) E„L,DISEASE-EA EMPLOYEE $ MIf aa,describe under' — ......,, . D SCRIPTION OF OPERATIONS below EL,DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) As respects to General Liability if required by written contract the following are included ad additional insured per the policy form FP5201. Town of Southold CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Road AUTHORIZED REPRESENTATIVE Southold NY 11971 — ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD rJ712EIK Workers' CERTIFICATE OF sTATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured CATIZONE ELECTRICAL CONTRACTING, INC. (631) 348-0001 2060 OCEAN AVE RONKONKOMA, NY 11779 1c.NYS Unemployment Insurance Employer Registration Number of 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) Number 202241963 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Graphic Arts Mutual Insurance Company Town of Southold 54375 Main Road 3b.Policy Number of Entity Listed in Box"la" Southold, NY 11971 4766763 3c.Policy effective period 07-01-2024 to 07-01-2025 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: Shannon C. Peck (Print name of authod'W representative or licensed agent of insurance carder) Approved by: C Cu J 06-28-2024 (Signature) (Date) Title: Director of Customer Retention and Experience Telephone Number of authorized representative or licensed agent of insurance carrier: (315)734-2000 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 Nall► workers' CERTIFICATE OF INSURANCE COVERAGE ssTATE 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 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured CATIZONE ELECTRICAL CONTRACTING, INC. 2060 OCEAN AVE 631-348-0001 RONKONKOMA, NY 11779 Work Location of Insured(Only required if coverage is specifically limited to 1c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-Up Policy) or Social Security Number 45-5213112 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the certificate Holder) Standard Security Life Insurance Company of New York Town of Southold 54375 Main Road 3b.Policy Number of Entity Listed in Box 1a Southold, NY 11971 R97483-000 ,3c,Policy Effective Period 1/1/2015 to 9/5/2025 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: ❑)c 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 7:;0 ve. Date Signed 9/6/2024 By . ,4q1_U (Signature of insurance carrier's a uthorded representative or NYS licensed insurance agent of that insurance carrier) Telephone Number 212 355-4141 Name and Title SUPERVISOR-DBL/POLICY SERVICES IMPORTANT:lf 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 56 of Part 1 has 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) 111111, 1 i� 0� iiiii�wu � 2 li��