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HomeMy WebLinkAbout37483-Z ',..~s Town of Southold Annex ~„`I`ySFFUt~ z 6/28/2013 P.O. Box 1179 ' 54375 Main Road ~ Southold, New York 11971 :,y~lbl * ~ CERTIFICATE OF OCCUPANCY No: 37483 Date: 6/28/2013 THIS CERTIFIES that the building OTHER Location of Property: 2495 Rocky Point Rd, East Marion, SCTM 473889 Sec/Block/Lot: 30.-3-4 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this ofiiced dated 8/17/2012 pursuant to which Building Permit No. 37483 dated 8/30/2012 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: generator as applied for. The certificate is issued to Koubek, Stanley (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL _ - ELECTRICAL CERTIFICATE NO. 37483 6/27/13 PLUMBERS CERTIFICATION DATED Authorized Signature ,~yiriot~ TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ p TOWN CLERK'S OFFICE "''a • 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 37483 Date: 8/30/2012 Permission is hereby granted to: Koubek, Stanley 2495 Rom Point Rd East Marion, NY 11939 To: install a Generator as applied for At premises located at: 2495 Rock Point Rd, East Marion SCTM # 473889 Sec/Block/Lot # 30.-3-4 Pursuant to application dated 8/17/2012 and approved by the Building Inspector. To expire on 3/1/2014. Fees: ALTERATION OF ACCESSORY BUILDINGS $100.00 CO -ACCESSORY BUILDING $50.00 Total: $150.00 CL t--~-_-- `~-V~.L. _ _ Building Inspector TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need [he following, before applying? 'I~WN HALL Board of Health SUUTHOLD, lYY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey www. oorthfork.uet/Southold/ PERMIT NO. .3 7 7 ~3 Check Septic Fonn N.Y.S.D.E.C. Trustees Examined v /020 ~ 1 Conhch Approved 201 Mail to: Disapproved a/c Phone. Ezpim[ion 20~ i ~cu~(' , Building Inspector APPLICATION FOR BUILDING PERMIT Date S 20~ INSTRUCTIONS a. This applicaion MIDST be completely filled in by typewriter or in ink and submitted [o [he Building Inspector with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may no[ be commenced before issuance of Building Peani[. d. Upon approval of this application, the Building mspector will issue a Building Permit [o [he applicant Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pan for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within I8 months Gom such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, m writing, the extension of the pemu[ for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MAD o the Building Department for the issuance of a Building Pertni[ pursuant to the e (~3~mance Q~f thelTo o Id, Suffolk County, New York and other applicable Laws, Ordinances or „µµ„B„CC„ -~illa--__.. ffior~; fot the cp~strl{cti~ly of~yil ' g , ditions, or alterations or for removal or demolition as herein described. The li ta-co app 1 sn or ' >M~ ilde, housing code, and regulations, and to admit d inspectors on prermses and i for sec a , ~ ?012 ~ i.1NLAVVF~,'~ r~.--~_ _ - (Signature of appli f or name, if a corporation) L -I ~ J~ ~ERT~~I~f~'~,~ , ~d. f~ l~(QYrar?, ~ ~ ~~r~ I ~ ~ (Mailin address ofapplica t) _!t . i~Jid ! t~~i~~l ~ppt7M(~~ r~ aSQ C[n~ Stale whether applicant is owner, lessee, agent, architect, engineer, general contractoq el C~<~ JC Uu?dDt1~l-blTiXdlr b~fl ~S Ql~l1V1D,1~' '?ATE e/ /l~P~BP# 7.83 Name of owner of premises ,5 ~ ~ 1 A h-e E E ~C~J gy ~l~' (As on the tax roll or lat I BUILDING DEPARTMENT qT If applicant is a corporation, signature of duly authorized officer ~E~-1802 8 AM 7G 4 PM FOR THE FOLLOWING INSPECTIONS' (Name and title of corporate officer) 1. FOUNDATION -TWO PEQUIRED til{, 3 e1 FOR POURED CONCRETE rs License No. T' 2 ROUGH -FRAMING, PLUMBING, Plumbers License No. - STRAPPING, ELECTRICAL d CAULKING Electricians License No. ~ 3 INSULATION Other Trade's License No. 4 FINAL - CONSTRUCTION b ELECTRICAL I. Loc ti n of Ian on hich propo d wor will b d e: MUS BE COMPLETE FOR C.O. ~ ~ ~ L MEET Ho s Number Stree CODES OF NEW s~~-y~ sTATE. NoT ~~~E FoR County Tax Map No. 1000 Section Block DE NOR Subdivision Filed Map No. Lot cN~e) ~ICAL 2. State existing use and occupancy of prgmises an Intended use and occupancy of proposed construction: a. Existing use and occupancy a~~~Q f'((l~ * ' b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Addition Alterati9n~ Repair Remo//(vatll//~~ yy~~,, Demolition Other Work yf~/~Qrl/77/(/~~~ICL~c~ 4. Estimated Cost ~ l ~ 1 V Ul/ tF~(,/ Fee J (Description) (To be paid on filing this application) 5: If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Reaz Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 1 I. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO~ 13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES_ NO II Z 4S Ro.,t.H Pt' Rd. 14. Names of Owner of premises ' ~ ~DLr Rkddress f- Yl.fyt Phone No. 3I- y ~9~ Name of Architect Address Phone No NameogContractor'rOWtYC rai - Address~S}.Phone No. (p.3~7S13 LG?1g LSiund 4rx.t-rt~[K[.y ~ lxeirP0./ rµ/ 11?7`~' I S a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO _ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? *YES_ NO_ • IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 fee[ or below, must provide topographical data on survey. STATE OF NEW YORK) COUNTY OFS~(1 / S Vi.(,Q L(. being duly sworn, deposes and says that (s)he is the applicant (Name of i t idual signing contract) above named, (S)He is the ~ U ~ ~Q~ (Contractor, Agent, Corporate Officer, etc.) ofa~ere, and is duly authorized to perform or have performed the said work and to make and file [his application; that all statements contained in this application are true [o the best of his knowledge and belief; and that the work will be performed in the manner set forth N the application filed therewith. Swo to before me this day of - 20_1___ Notary Pub c )OA AOF NEW YORK Signa a Of Applicant NOTARY Np`I~1DA6242175 Qualltled In Suffolk Coslt 2016 MV Cortttnls+lon ExplrN MaY d"av'::n g~FFO(K Town Hall Annex ~~0~ cGGy ~ Telephone (631) 765-1802 54375 Main Road ~ ~ ~ Fax (631) 765-9502 P.O. Box 1179 p • Southold, NY 11971-0959 y~U y0~',t roger.richertCg~town.southold.nv.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Stanley Koubek Address: 2495 Rocky Point Rd City: East Marion St: NY Zip: 11939 Building Permit 37483 Section: 30 Block: 3 Lot: 4 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE contractor: DBA: Towers Electrical Cont Inc License No: 3994-e SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixures Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixtures Time Clacks Disconnect Switches Twist Lock Exit Fixtures TVSS otner Equipment: 17KW stand by generator and transfer switch Notes: Inspector Signature: Date: June 27 2013 Electrical Certificate.xls roar.-r,r+ g~FFO(K Town Hall Annex h~p~ C~G~ Telephone (631) 765-1802 54375 Main Road ~ ~~gg Fax (631) 765-9502 P.O. Box 1179 ~ ~ ~7 Southold, NY 11971-0959 S~0~ ~.50~1~ roger.richert~town.southold.nv.us ,~`~<x~rr lll~. BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Stanley Koubek Address: 2495 Rocky Point Rd City: East Marion St: NY Zip: 11939 Building Permit#: 37483 Section: 30 Block: 3 Lot: 4 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE contractor: DBA: Towers Electrical Cont Inc License No: 3994-e SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot W ater GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent FiMure Pumps Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches Twist Lock Exit Fixtures TVSS other Equipment: 17KW stand by generator and transfer switch Notes: Inspector Signature:~~~ Date: June 27 2013 Electrical Certificate.xls ~o~,~oF souryo6 TOWN OF SOUTFIOLD BUILDING D T. ~ ,~'V ass-1 sot l INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING /STRAPPING [ ]FINAL [ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION [ ]ELECTRICAL (ROUGH) ELECTRICAL (FINAL) REMARKS: DATE Z? INSPECTORS PERMIT # USE NO. STREET AMLET ` OWNER - EXPIRATION HEALTH DEPT. ~ z ~`{~i S d~-~, c~c~ ~C;i~~~- k~~~ Ltiti~(1~L~'~-a4~ ~~~c ~ ~h~.1(,~~~ ~-I'~= I~- N',~ V cn - z •5 0 U . z 0 ~M~yy F91 R A . r ' ~ ~ z.~ ~ ~ s~ ~ c ~ ~ g ~ ~ a. w w~ °a ~F ~o~~OF SO!/lyo~ ~I Town Hall Annez ~ ~ Telephone (63l} 765-1 ~ 54375 Main Road - P.O. Box 1179 ~ ro ef.rich (G3-SOU ` d. ~ 1 - Southold, IdY 11971-0959 ~ ate' "WIMI iv $U[LDING DEl'AR'IMFNI' ~rowrr o~ souz~>~tac.D APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Date: L Company Name: ~ QG'/`,'C4 C on'r/Y•iCT. Name: ~ 4 License No-: 3 9 ~ j ^ g ~ ; y.Q ~"j Address: ! o ~ ~T ~ Phone No.. 6 3 J^ SS 7 S 1 JOBSITE INFORMATION: (*Indicates required information) *Narne: ~q~('~y 'SpJ~tK *Address: ~ H~r y Po ~ n T 2 2 E'~s t' M~ ~ ro,n lei y ! t 9 3 9' *Cross Street: ~ 295 t - `PhoneNo.: x'37-`777- 35i Permit No.: ra Tax Map District: 1000 Section: Block: Lot: *BRIEP DESCRIPTION OF WORK (Please F~rint Cleady) t+ ~ i~w (Please Circle All That Apply) *Is job ready for inspection: YES ! NO Rough In Final *Cb you need a Temp Certificate: YES ! NO Temp Irtfotmatlan (ff needed) *Servioe Size: 1 Phase 3Phase 100 150 200 300 350 400 Other *New Service: Re-~nnecY Underground Number of Meters Change of Service Ovefiead Addftlonal Information: PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form ~+i a - ~~s \ W I ~ ~ J~f Telephone (631) 765-1802 ~ ~ G ~ 11- I b 1,.~- ~ ,g roger.richert aC'~o`wr~i sou~~io9d ~ us `k% ` C' ~ BUILDING DFPA1tTMF1V'Y' S~ 1. L l-~~ ~ i ~ at,~- ~wrr aF sov~rHio><.D ~o ~Dk w i~~ FOR ELECTRICAL. INSPECTION 5or~~ ~ fin) ~ i.~..rvr:o ~ cv o r . Date: Company Name: Name: License No.: Address: Phone No.: JOBSITE INFORMATION: (*Indicates required information) *Name: ~ an~ kOWrJ-P~ *Address: ~ C,~ ~ ~ ~ ~ ~ *Cross Street: *Phone No-- y~1'3~q ~ h ~ Fn ~T ~.rr.Rn~ ~03~5~6-~s~~ Permit No.: Tax Map District: 1000 Section: ~3~ Biock: ~ ~1 Lot: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) ~-~a{~-~~-Z-~1~ (Please Circle AlI That Apply) *1s job ready for inspection: YES ! NO Rough In Final *bo you need a Temp Certificate: YES / NO Temp Information (If needed) *Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other *NeW Service: Re-connect Underground Number of Meters Change of Service Overhead Addftional Information: PAYMENT DUE WITH APPLICATION 82-Request forlnspection Form ~~~y 4c~ ~,C,,O/N/SENT TO INSPECTION J/ G/ ~ I.EC/ ~ ,the undersigned, do(es) hereby state: Owner(s) Name(s) That the under~-s~,i~g~nepd ) ( ) the owne ) of the preq~i es in the Town of Southold, located at ' -E-/ ~~~JGlG(J/ ~DI f. ~Q i'1 G~~, which is shown and designated on~ County Tax Map as District 1000, Section ,Block , Lot That the undersigned (has) (have) filed, or cause to be filed, an applicat{i,on in the Southold Town Building Inspector's Office for the following: =v7 S}r.~ Q I I~VI of D.~C~1VI~~~i2Prtz"~r. That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances, rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: ~ - l Z~ ~Q~_ I (Signature ~aN~c~ KOU~3C~ (Print Name) (Signature) (Print Name) ~ y t~'*+ r. + . i ILL y.. - ? t' ~,1'O: a'J. ,C: ~.t ;7` ;.y ,.'X.: .'.S'c:.+ F +th+P ; r a i _ ~0 ~ et. = - p+ci~ o to a TiL f~ fal0 ~ ~ - F Y= ~O O s Cp ' Z ¢ i ~ ~ . 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L . a. a x} ~ Yt s; ° fir. f vb w r' ~a "S wv: s~ _ SUFFOLK COUNTY DEPARTMENT OF CONSUMER AFFAIRS RESTRICTED PLUMBER MICHAEL S TOWERS J This certifies that the TOWERS ELECTRICAL CONTRACTING INC bearer is duly licensed by the County of Suffolk °`~~°ui0 38814-RP torzarmos i Clit£ord Coleman 01n°°' I E°"'"TONO"'E 10/01/2013 m New York State Insurance Fund Workers' Compensation & Disability Beneftts Specialists Since 1914 199 CHURCH STREET, NEW YORK, N.Y. 10007-1100 Phone: (866)997-3663 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 453913933 TOWERS ELECTRICAL CONTRACTING INC T/A LONG ISLAND EMERGENCY POWER 615 ACORN ST STE G DEER PARK NY 11729 P6 6 ACORNNST 3TE G & FCY POWER, INC. C5 096 ROUTE 25 O D DEER PARK NY 11729 I SOUTHOLD NY 11971-0959 POLICY NUMBER CERTIFICATE NUMBER T PERIOD COVERED BY THIS CERTIFICATE E G 975 462-3 167713 ! 11/01/2012 TO 11/01/2013 L8/14/2012 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 975462-3 UNTIL 11/01/2013, 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, ANO, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 11/01/2013 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. 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 ~m~~~~-- DIRECTOR,INSURANCEFUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif com/cerUcertval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 788660465 U-26.3 STATE OF NEW YORK ' WORKERS' COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be com leted b Disabilit Benefits Carrier or Licensed Insurance A ent of that Carrier 1 a. Legal Name and Address of Insured (Use street address only) I b. Business Telephone Number of Insured 631 586-7513 TOWERS ELECTRICAL CONTRACTING INC Ic. NYS Unemployment Insurance Employer Registration 615 ACORN STREET, SUITE G Number of Insured DEER PARK, NY 11729 2001307 Id. Federal Employer Identification Number of Insured or Social Security Number II 3114864 DBA: LONG ISLAND EMERGENCY POWER 2. Name and Address of the Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Zurich American Insurance Company TOWN OF SOUTHOLD 36. Policy Number of entity listed in box "I a": 53095 ROUTE 25 1554257-002 SOUTHOLD, NV 11971-0959 3c. Policy effective period: 07/ I R/ 12 to 07/ 18/ 13 4. Policy covers: a.®All of the employer's employees eligible under [he New York Disability Benefits Law b.~ Only the following class or classes of the 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 Benefits insurance coverage as described above. Date Signed 8/14/2012 By (Signature of insurance carriers authorized representative or NYS Licensed Insurance Ageut of that insurance carrier) Telephone Number (631) 845-2200 Title Administrative Services Manager IMPORTANT: If box "4a" is 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 [o [he cenifiw[e holder. If box "46" is checked, this certificate is NOT COMPLETE for purposes of Section 220, Subd. e of the Disability Benefits Law. It must be mailed for completion to the Workers' Compensation Board, DB Plans Acceptance Unit, 20 Park Stru-t, Albany, New York 12207. PART 2. To be completed by NYS Workers' Compensation Board (Only if box "4b" 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 Benefits Law with respect to all of his/her employees. Date Signed By (Signature of NYS Workers Compensation Board Employee) Telephone Number Title Please Note: Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB- 120. I . Insurance brokers are NOT authorized to issue this form. DB-120.1 (5-06) ' Additional Instructions for Form DB- 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 inbox " I a" for disability benefits under the New York State Disability Benefits law. The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in box " 2". Tkis Cerificate is valid for the earlier of one year after this form is approved by the insurance carrier or its licensed agent, or the policy expiration date listed in box " 3c Please Note: Upon the cancellation of the disability 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 NYS Disability Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability Benefits Law. DISABILITY 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 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 for all employees has been secured as provided by this article. DB-120.1 (5-06) TOWEELE-01 LAURA ,a~iR° CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DDIYYYY) 8/15/2012 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 holtler is an ADDITIONAL INSURED, the policy(ies) must be entlorsed. If SUBROGATION IS WAIVED, subject to the terms and contlitions of the policy, certain policies may require an endorsement. A statement on this certificate tloes not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LICBnse # BR-670302 CONTACT - ' NAME: Si51 Je Icho ITakee Group, LLC lac°,NNq, EXtI: (516) 496-8004 Fax Ste. 215 P Iac,Ngl:(516)496.7811 E-MAIL Syosset, NY 11791 ADDRESS: INSURERISI AFFORDING COVERAGE NAIC# INSURERA:Merchants Mutuallnsurance Co 23329 INSURED INSURER B Towers Electrical Contracting Inc dba Long Island INSURERC: Emeregency Power 615 Acorn Street Suite G INSURER D Deer Park, NY 11729 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR ~ TYPE OF INSURANCE ADOL SUHiE P04CY EFF POLICY E%P INSR YWD. POLICY NUMBER (MMIDDIYYYY( IMMIDD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 80P9091984 5/12/2012 5/12/2013 DAMAGE TO RENTED PREMISES (Ea oaunence) 8 500,000 CLAIMS-MADE X OCCUR MED EXP (Any one person) $ 15,000 PERSONALSADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMPIOP AGG S 2,000,000 _ POLICY X PRO- _ JECT _ LOC g AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _ - A X ANV AUTO CAP9251412 (Ea accitlent) $ 1,000,000 5112/2012 5112/2013 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accitlenp $ X HIRED AUTOS X NON-OWNEp PROPERTY DAMAGE AUTOS (Per accitlent) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A E%CESS LIAR CLAIMS-MADE CUP9131435 5H 2/2012 5/12/2013 AGGREGATE g 3,000,000 _ DED X RETENTION$ 10,000 $ WORKERS COMPENSATION WC STATU- OTM- - - _ AND EMPLOYERS'LIABILITY YIN .TORY LIMITS ER ANY PROPRIETOR/PARTNERIEXECUTNE E L EACH ACCIDENT 8 OFFIDERIMEMBER EXCLUDED NIA (Mentlatory in NH) E.L. DISEASE-EA EMPLOYEE $ It yes tlescnDe onOer DESCRIPTION OF OPERATIONS DeIOw EL DISEASE-POLICY LIMIT $ DESCRIPTON OF OPERATIONS / LOCATIONS I VEHICLES IAN#ch ACORO 101, AtltlKional Remarka Schetlule, i( more space la requlretll CERTIFICATE HOLDER CANCELLATION SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 53095 ROUIe 25 ACCORDANCE WITH THE POLICY PROVISIONS. Southold, NY 11971 AUTHORIZED REPRESENTATVE Gu~~Q ~.~w ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Long Island Emergency Power 615 Acorn St, Suite G, Deer Park, NY 11729 631-586-7513 /Fax: 631-595-1565 Plumbine Permit Attachment Date: v / S Homeowner: I ~1.I ( ~ S , ~Y~c~YI, I~ I(R3~ Notes: 1. All above ground piping to be galvanized 2. Isolation valves to be installed at meter & at generator 3. Warning tape to be installed 6" below grade 4. Trace wire to be installed with gas pipe 5. Gas risers to be anoidless type 6. Gas piping to be approved plastic 7. Size Generator: K /W~ ! ~ BTU / HR RATING 8. Pipe length: ~V r 9. Pipe Diameter: I~ --f~F4~.A4E~iiif SHUT OFF SHUT OFF EX~ST~h~ VALVE VALVE PROPANE TANK - ~ l_ I GRADE ~ - - 18" ~ - - GENERATOR GAS PIPE ihared documents /Plumbing Permit Attachment GENERAC° GUARDIAN® SERIES STANDBY GENERATORS t 17 kW Air-Cooled Gas Engine Generator Sets ELUDES: Standby Power Rating • TGUe Power® Electrical Technology Model 005885-1 (Steel -Bisque) - 17 kW 60Hz Model 005886-1 (Aluminum -Gray) - 17 kW 60Hz • Two Line. LCD Tri-lingual C~gital Nexus'"' Controller + 1*factronic Governor ~e ro3 a 4> 5 ~y • pcternai Main Circuit Breaker, ~ t~1 , r ~ t~?' ~~'~ystem Sixtus & Maintenance Interval LED ~ 4 .1 t~" ~r++~:~~'~ e; . In~icatorsand GFCI Duplex Outlet _ syrrtr ~ ~ ~ +.~€ai~nd Attenuated Enclosure L ~ ~ r, t ~ ~ - + flexible Ftael Line Connector ~ ~r!"i` r ' 1 + ~bmposlt@Mounting Pad ~~`~~~~y ~ ~~~~~1~~"~~l'~l ~I~ • Natural Cos or LP Gas Operation ~ ~ ~ i~4i a~"~fi' ~':'~2ar i-united Warranty + l~L 220(7 Listed QU~i~~ usYeo FEATURES G INNOVATIVE DESIGN & PROTOTYPE TESTING are key components O SOLID-STATE. FREQUENCY COMPENSATED VOLTAGE REGULATION. of GENERAL'S success in "IMPROVING POWER BY DESIGN." But it This state-of-the-art power maximizing regulation system is standard on doesn't stop there. Total commitment to component testing, reliability all Generac models. It provides optimized FAST RESPONSE to changing testing, environmental testing, destruction and life testing, plus testing load conditions and MAXIMUM MOTOR STARTING CAPABILITY to applicable CSR. NEMA, EGSA, and other standards: allows you to by electronically torque-matching the surge loads to the engine. An choose GENERAC POWER SYSTEMS with the confidence that these unequalled ±1 % voltage regulation. systems will provide superior performance. o TRUE POWER" ELECTRICAL TECHNDLOGY: Superior harmonics and O SINGLE SOURCE SERVICE RESPONSE hom Generac's extensive dealer sine wave form produce less than b% Total Harmonic Distortion for utility network provides parts and service know-how for the entire unit. from the quality power. This allows confident operation of sensitive electronic equipment engine to the smallest electronic component. and micro-chip based appliances, such as variable speed HVAC. O TEST CRITERIA: r,1 GENERAG TRANSFER SWITCHES. Long life and reliability are PROTOTYPE TESTED ~ NEMA MGi-22 EVALUATION synonymous with GENERAC POWER SYSTEMS. One reason for this SYSTEM TORSIONAL TESTED .MOTOR STARTING ABILITY confidence is that the GENERAC product line includes its own transfer systems and controls for total system compatibility. GENERAC" , SPECIFICATIONS GENERAC° 1' rr: II I f{9f9. IIIdIrfItll~ilrr,~1W91'{d3fl~ ~ ° r t Rated Maximum Continuous Power Capacity (NG) 16,000 Watts' Rated Maximum Continuous Load Current- 240 Volts 63.3 LP(75 NG TAI Hsrmrtak ~istoROtt ' _ ik~c~~C.. Main Line Circuit Breaker 100 Amp Rhas~° , i- Nuymbe~r/~ofpAO~t~o~yr Po`,les ~.{2~~ HIfI44IlWh~Y`^~J 69h1z:-, . h Y.I Power Factor 1 l9Yttgty FlgqufrempnCfilut lhalyded} Gmnp 26R`92 Wltsan[Y525 #9nlil~snklgg ,ses bi~N{jan - Unit Weight (Pounds/Kilas) 451/204.6 6lfiriinsings fL'xVJ;X;#(j [rtcheshiim ~ ~xR~`x2~~f7~F8:~~&~X~Y - . , Sound output in dB(A) at 23 It. with generator operating at normal load 66 5ny!~41>f~flmd~fA~a1231tWIth~Rrfetal~JAtN~f~esl~ldAff±~@I~~I~rryal._..,....u v__._...,': ...,.~'.i; ~.~.r....~,.fi.s.-,..,. rr- 11 I Number of Cylinders ~~2 -07$p~Unt` ~ , Cylinder Block Aluminum w/Cast Iron Sleeve Yalue~na09arO8nS . ' . , ` , . = ' Cl~efi ~l., ~ . . - - a , ~ ~ Ignition System Solid-state w/Magneto ~u~syaf: . ~ ~ . ~1epAa~ie „ Co~.yo{ }myp~.p~_ression Ratio 9q.5y:}1~ e s , r.. 4Wr~ , t ~Yyl!tHFi r OII Capaary Including Flter Approx. 1.9 Ots./1 8L Fuel Consumption Natural Gas cu.ft./hr. 1/2 Load Full Loatl 206 Liquid Propane ft3/hr (gal/hr) ~Liter/hr] 284 1/2 Load 69 (1.89) 17.15] FU Loatlk,a i ut ~p.,u~ 106 (2.90) [10.96]ae ha:.; ~~?ra~~~#,h t~~~~f~,~''~7'~'°""3s~2e7~10'1~~~ pp yivta5d 4 : rtnr '_r'' JF II k u :_c"U s . ie. S.m... r t" .,h`,`'*ra„ vt 3, 5.: f Y,W3'"~ ~ y'k s_t~GE¢a3n he ~ r w a.": ~ , ....m wm _ i _._f~ i..... rr ii .`"=n r" r'c-. _ .._,EII xY G...:...k'res Mode Switch -Auto Automatic Start on Utility failure. 7 day exerciser. -Manual/Fest (start) ~ Start with shatter control, unit shays on. If utility fails, t2nsfer to load takes place. Pdf~~817i 42'd~ap71e7W,~Q1i7fPtafl,S$~FhIY§ 2 rs a s, __',x,s a F, n "~2 St~;~~e'_„ Engine Start Sequence Cyclic cranking Y16 sec. on, 7 rest (90 sec. maximum duration). Engine Ccol-Down 1 minute i Stdr36ry'1~4~u'`na1~1e`~`,.-~. Smart Battery Charger Standard ArNcVdlg~Ittm~wllhSi~~hdLhMerVd(legatyanlaellon~ ~ i I, ? . ~~y~d~d`; ~ _ i Automatic Low Oil Pressure Shutdown Skntlartl 1'~hu~g~Nfi:'° High Temperature Shutdown Sandard Qg9~d18Utlp7i... r . '-t Safety Fused SFantlard Law Battery Protection Standard ~'~"v-"9ltf-AbR. i~ ..I~ ~ . ~ttt~rQ E { Future Set Capable Exerciser Standard incuteutWlrlnn~gR`m~uNidn' 1 d~!~.. Internal Fault Protection Standard s z Hirfi.Exl~naC~FS`111C-Ca II ' , . Paling definitlpns-Standby: Applicable for supplying emergency power lot the Ourallgn of the utility power outage. No overload apahillly Is availahle for this rating. (All ratlnAS In accmdanpe with &55514, ISh304fi and DIN6271 ' Madmum wattage and current are suhlecl to and limited by such factors as teal Btu content, ambient temDeralure. altitude, engine power and condition, etc. Matlmum power decreases about 3.5 percent for each 1,nA0leet above sea level. FEATURES Generac ~ Guardian® Series Standby Generator -17 kW •Generac (OHVI) Design Maximizes engine "breathing" for increased fuel efficiency. Plateau honed cylinder walls and plasma moly rings help engine run cooler, reducing oil consumption. Because heat is the primary cause of engine wear, the OHVI has a significantly longer life than competitive engines. • "Spiny-lok" cast iron cylinder walls Rigid construction and added durability provide long engine life. •Electronic ignition/spark advance These features combine to assure smooth, quick starting every time, •Full pressure lubrication system Superior lubrication to all vital bearings means better performance, less maintenance and significantly longer engine life. Now featuring a 2 year/200 hour oil change interval. •Low ail pressure shutdown system Superior shutdown protection prevents catastrophic engine damage due to low oil. • High temperature shutdown Prevents damage due to overheating. •Revolving field Allows for smaller, light weight unit that operates 25% more efficiently than a revolving armature generator. •Skewed stator Produces a smooth output waveform for compatibility with electronic equipment. •Displacetl phase excitation Maximizes motor starting capahility. •Automatic voltage regulation Regulates the output voltage to -_1% prevents damaging voltage spikes. •UL 2200 Listed for your safety. Sold separately •Manual/AutorOff switch Selects the operating mode. •Utility voltage sensing Constantly monitors utility voltage, setpoints 60% dropout, 80% pick-up, of standard voltage. •Generator voltage sensing Constantly monitors generator voltage to ensure the cleanest power delivered to the home. •Utility interrupt delay Prevents nuisance start-ups of the engine, adjustable 10-30 seconds. •Engine warm-up Ensures engine is ready to assume the load, setpoint approximately 5 seconds. •Engine cool-down Allows engine to cool prior to shutdown, setpoint approximately 1 minute. •Programmable seven day exerciser Operates engine to prevent oil seal drying and damage between power outages by running the generator for 12 minutes every week. •Smart battery charger Delivers charge to the battery only when needed at varying rates depending on outdoor air temperature. •Main Line Circuit Breaker Protects generator from overload. •Electronic governor Maintains constant 60 Hz frequency. •Weather protective enclosure Ensures protection against mother nature. Hinged key locking roof panel for security. Lift-out front for easy access to all routine maintenance items. Electrostatically applied teMured epoxy paint for added durability. Model 005886-0 has aluminum enclosure. •Enclosed critical grade muffler Ouiet, critical grade muffler is mounted inside the unit to prevent injuries. •Small: compact, attractive Makes for an easy. eye appealing installation. •SAE Sound attenuated enclosure ensures quiet operation. _ - •1' Flexible Fuel Line Connector •Composite Mounting Pad Easy Installation. Generacra, Guardian® Series Standby Generator - 17 kW AVAILABLE ACCESSORIES Mi+del:# _ ' Pralnei tiiscrip~in~1 5819 26R Wet Cell Battery Every standby generator requires a battery to start the system. Generac offers the !recommended 26R wet cell battery for use with all air-cooled standby product. If the temperature regularly falls below 32° F, install a cold weather kit to maintain 5947 .Cold Weather Kit optimal battery temperature. Kit consists of battery warmer with thermostat built into the wrap. 5621 'Auxiliary Transfer Switch The auxiliary transfer switch contact kit allows the transfer switch to lock out a Contact Kit single large electrical load you may not need. 5839 (Bisque) The fascia base wrap snaps together around the bottom the new air cooled 5666 (Medium Grey)',! Fascia Base Wrap Kit ;generators. This offers a sleek, contoured appearance as well as offering protection ' 'from rodents and insects by covering the lifting holes located in the base. .5703 .Paint Kit 'Bisque Kit 5704 :Paint Kit Medium Grey Kit 5664 'Scheduled Maintenance Kit ' Generac's scheduled maintenance kits provide all the hardware necessary to ' perform complete routine maintenance on a Generac automatic standby generator 5928 Nexus Wireless Remote Completely wireless and battery powered, Generac's Nexus wireless remote monitor provides you with instant status information without ever leaving the house. Advanced Nexus Wireless Remotely control generator tunctions with the advanced model's LCD display. In 5951 i Remote addltan to remote testing of the generator, set the excercise cycle and maintenance interval reminders. Design and sVOalir2li6ns subled to change wilhou!notice. Dimensions shown ale aPPmximate. Conlap yom Geneac Dealer for rertibetl tlrawiogs. 00 NOT USE THESE DIMENSIONS EOF INGTALIA?ON FUPPOSES. 63). [26-1] 1218 19].9] .1M t S 3'^ s,wu',:^ ~ :.mac 1~w x ~ q E~&p~„;P~ A F x L t e G r"'x "~1~~~~ fiRn -T: r ~ ~aa rc 3 ~ i [2667 E T t 3 ~ { ~9 ~ ~ P: 3 r E 4 M' r ` S ~:y .t.a~ N ~ 4 " ~ al.v ``ni ~ .i SEI '.".af S9} A.'F« k.' `"'Vi 12537 PER GRRV~L 1228 MINIMUM Id33] LEFT SIDE VIEW FRONT VIEW GENERAC~ Generac Power systems, Inc. • S45 W2929g HWY. 59, Waukesha, WI 53189 • generac.com K:2011 Generac Power Systems, Inc. All rigMS reserved. All sp¢cilications are su01eN la change wtlAON voice. 6u1kGn 0106100SBY-0 Prinletl in USA. O6RW12