HomeMy WebLinkAbout38320-Z FOL Town of Southold Annex 7/23/2014
P.O.Box 1179
54375 Main Road
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 37038 Date: 7/23/2014
THIS CERTIFIES that the building ACCESSORY
Location of Property: 1430 N Sea.Dr, Southold,
SCTM#: 473889 Sec/Block/Lot: 54.-5-8
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
9/13/2013 pursuant to which Building Permit No. 38320 dated 9/13/2013
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:
accessory pergola as applied for.
The certificate is issued to Conboy, Stephen&Diane
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 38320 7/22/14
PLUMBERS CERTIFICATION DATED
Au 0 ' ed /gnture
's FOL& Town of Southold Annex
f �t,p � 7/23/2014
,a 'A P.O.Box 1179
,r 54375 Main Road
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 37039 Date: 7/23/2014
THIS CERTIFIES that the building ACCESSORY
Location of Property: 1430 N Sea Dr, Southold,
SCTM#: 473889 Sec/Block/Lot: 54.-5-8
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
9/13/2013 pursuant to which Building Permit No. 38320 dated 9/13/2013
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:
accessory outdoor shower as applied for.
The certificate is issued to Conboy, Stephen&Diane
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Au o e ignat re
:rte TOWN OF SOUTHOLD
w BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
1 SOUTHOLD, NY
K f o}
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#: 38320 Date: 9/13/2013
Permission is hereby granted to:
Officina, Stanley & Officina, Shirley
19 Simpson Dr
Old Bethpage, NY 11801
To: construct an accessoryshower & an accessory ry pergola as applied for
At premises located at:
1430 N Sea Dr
SCTM # 473889
Sec/Block/Lot# 54.-5-8
Pursuant to application dated 9/13/2013 and approved by the Building Inspector.
To expire on 3/15/2015.
Fees:
ACCESSORY $176.80
CO -ACCESSORY BUILDING $50.00
ACCESSORY $100.00
CO -ACCESSORY BUILDING $50.00
Total: $376.80
Building Inspector
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings,property lines,streets,and unusual natural or
topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead.
5. Commercial building, industrial building,multiple residences and similar buildings and installations,a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and "pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is
denied,the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00,
Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00.
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of Occupancy - $.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00,Commercial $15.00
Date.
New Construction: ` Old or Pre-existing Building: (check one)^
Location of Property: �L 1 V —4-4f,pS_ �, .-
House No. Street Hamlet
Owner or Owners of Property: 'I�D D\_
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision Filed Map. Lot:
Permit No. �� Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $Q \J0 OR
Applicant Signature
*pF SOUlyolo
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 A roger.riche rt(a-)-town.southoId.ny.us
Southold,NY 11971-0959
C it
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Conboy
Address: 1430 North Sea Drive City: Southold St: NY Zip: 11971
Building Permit#: 38320 Section: S� Jt217 Block: 5 Lot: 8
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: All County Electric License No: 49579-me
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 Water GFCI Recpt 1 Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures 4 CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 1 Twist Lock F1 Exit Fixtures TVSS
Other Equipment: POOL PAVILLION, 1-paddle fan, 1-dimmer
Notes:
Inspector Signature: Date: July 22 2014
81-Cert Electrical Compliance Form.xls
o��pF SOUryO
h �O
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUND ON 1 ST [ ] ROUGH PLUMBING
[ ] FO DATION 2ND [ ] INSULATION
[ FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
7 0 Si
DATE `� INSPECTOR
3
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
] FOUNDATION I ST ROUG LUMBING
I
FOUNDATION 2ND I LAT14ON
FRAMING / STRAPPING FINAL
FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION
FIRE RESISTANT WNSTRUCTION FIRE RESISTANT PENETRATION
ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
CODE VIOLATION CAULKING
REMARKS: 1
DATE —7 /c;� //ZINSPECTOR 2- L
I / /
f
i
SOUryo�
20
G •
T WN OF SOUTHOLD BUILDING DEPT.
t
765-1802
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLUMBING
[ ) FOUNDATION 2ND [ ] INSULATION
[ ]
FRAMING / STRAPPING [ ) FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [�] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
DATE - )/.Z7--/l INSPECTOR
�c
� • 1 r 1
Al
imu",noiq Pim
STATE LTMOY CODE
IMP no • 1 1.
s
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0
0
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. 35'3 -)-g Check
Septic Form _
N.Y.S.D.E.C.
Trustees
Q Flood Permit
Examined I 1200 Storm-Water Assessment Form
Contact:
Approved ,2013 Mail to,�-
Disapproved a/c
Phone:
Expiration ,20 J-..__
Building Inspector
L1
AUG 13 2013 E'` LICATION FOR BUILDING PERMIT
�-- - F Date_ , 20
10[_o INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
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 not be commenced before issuance of Building Permit.
d. Upon approval of this application,the Building Inspector will issue a Building Permit to the 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 part 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 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
addition six months. Thereafter,a new permit shall be required.
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,or alterations or for removal or demolition as herein described. The
applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to admit
authorized inspectors on premises and in building for necessary nispections.
Signatur pplicant r name,if a corporat n)
+-7
N-TRte (Mailing address of applicant)
t-u ,
State whether applicant is owner, lessee, agent, architect, engineer, general contract�, electrician,plumber or builder
Name of owner of premises '
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License Nm2 4 I
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land onwhich roposed work will be done:
til bY- ,C:2 �a - �� Ve_
House Number Street Hamlet
County Tax Map No. 1000 Section, Block 'E) Lot
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and ' tend use and occupancy of proposed construction:
a. Existing use and occupancy II
b. Intended use and occupancy -4-y a•,ue. - -f My l l<
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work Lj'tb��' -� nl 14 It o
(Descr(ption)
4. Estimated Cost—III, Fee
(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 Rear 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 le
9. Size of lot: Front 1 Rear Iu� Depth 2 l
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation?YES N�
13. Will lot be re-graded? YES NOWill excess fill be removed from premises?YES NO
14. Names of Owner of premi es �,1�'v ddress one o.
Name of Architect Address Phone No
Name of Contractor T. i Address t4--IFt,25-A Phone No. (44"fClo'Z
ro,i - ,, . 1toy
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NOt
* IF YES, SOUTHOLD TOWN TRUSTEES&D.E.C. PERMITS MAY BE REQUIE
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 feet or below, must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? * YES N�<D
* IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF )
being duly sworn,deposes and says that(s)he is the applicant
(Name of individuali-gninggccontract)pabov_e n/amed,
(S)He is the CiL7�1'�1 ► �J �-TT V
(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 knowledge and belief,and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before mes
day f _20
Noyny Public Signa of pplic It
l
UC.#01
ir fl6T
MIMI.EV.
i
Town Hal!Annex Telephone(681)765-1802
54875 Main Rood
P.O.Box 1179 • �� u�IN up �
Soudm)K NY 11971-0959 +.
BURDM DEPA)QCI'MM
Town OF SOUMOLD F
APPLICATION FOR ELECTRICAL. INSPECTION
Ldreaw.-
No.:
ESTED BY: f� 1 rit t c �7 Date:
any Name: j�L eO U-J)
U� M i2,4- 7-j -
e No.: ,5 . 14 J
,..
i
I
JOBSITEINFORMATION: (*Indicates required information)
*Name:
*Address: /Lf3 p /1/d 2 "h ! Scam
*Cross Streets
"Phone No.:
Permit No.: 293
0—
Tax-Map District 1000 Section: Block: Lot
*BRIEF DESCRIPTION OF WORK(Please Print Clearly) �GC7zdpp,� ��V/l/�d�✓
(PW"Circle AN That Apply)
Is job ready for inspection: �NO_ Rough In Final
*Do.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-conn 11 of Mets Change of Service Overhead
Additional Informationr1 C DUE WITH APPLICATION
i y
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l' `` E A. RICHTER R.A.
SCOTT A. RUSSELL ,,1 �s ������ JAMES ,
SUPERVISOR I A � MICHAEL M. COLLINS, P.E.
' �
TOWN HALL - 53095 MAIN ROAD r �. # 'TOWN OF souTI'IOLD NEw YORK 11971
Tal. (631)-765-1560 + Fax. (63 1)-X65-9015
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OFFICE OF THE ENGINEER
TOWN OF SOUTHOLD
STORMWATER MANAGEMENT CONTROL PLAN REVIEW COVER SHEET
(To be completed by the applicant)
TO: Engineering Department
PLEASE A.77`ACH: . .
FROM: Building Department t1 A copyDf'the•completed:Applic afion,fbr'
Building''Permit
DATE: �14121j 13
❑ A complete setof'Builuing.Plans
APPLICANT:
❑ A completed Chapter 236 Stormwater
PERMIT#: Review Checklist
s
S,C.T.M
BRIEF PROJECT DESCF IPTION: r /� l6 /� + /,e o
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7/22/2013
Z /I• # � Z6Z8trtrL � �tr�El• �E6-EL-80
DATE:
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CHAPTER 236 APPLICAM: W
-Y 3 7
c� S.C.T.M.ft: w
Stormwater Review Checklist -
PHYSICAL ADDRESS:
! W
Stormwater Management Control Plan Requirements Yes No NA If No or NA,Please Provide Additional Information
1.PIan drawn to scale of not less than 64 feet to the inch showing:
a. location and description of property boundaries
b.total site acreage
c.existing and natural and man-made features on and within 500 feet
of the site boundary as required in 236-17 C 2.
d.test bole data indicating soil characteristics and the depth to water X
e.proposed limits of clearing and the total area of proposed land
disturbance
f.existing and proposed contours of the site(minimum 2' interval)
g. location of all existing and proposed structures,roads,driveways,
sidewalks,drainage' rovements and utilities
h.spot grade and finished floor elevations for existing and proposed
structures
i i.location of the swimming pool discharge ring m
j.location of proposed soil stockpile area(s)
>C ,ter
k.location of the proposed construction entrancdstaging areas
1. location of the proposed coacrete washout area L
in.location of all proposed erosion and sediment control measures c
2.Plan includes calculations showing that the stormwater improvements
are sized to capture,store and infiltrate on-site the runoff from all
!
impervious surfaces paiermd by a two-inch rainfall
3.Detail drawings(required for plan approval)provided far:
a_erosion and sediment controls
ff
b.construction entrance
c.inlet structures(e.g.catch basins,trench drains,etc.)
d.leaching structures(e.g.infiltration basins,swales,etc.)
REVISED 7124!2013
SURVEY OF PROPERTY --
���' - _
SITUATE: SOUTHOLr� - - -.
TONN-- 5OUTHOLD !
SUFFOLK COUNTY NY
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STATE OF NEWYORK
WORKER'S COMPENSATION BOARD
CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW
PART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier
ta.LegalName and Address ofInsured (Use street address only) 1b.Business Telephone Number of Insured
FENCE KING OF ROCKY POINT INC. DBA SWIM KING
POOLS & PATIOS 1c.NYSUnemployment Insuran ce Employer Registration
471 ROUTE 25A Number of Insured
ROCKY POINT, NY 11778 1d.Federal Employer Identification Numberof Insured
or Sod al Security Number
113008276
2 N ame and Address of the Entity requesting Proof of Coverage 3a.N ame of Insurance Carrier
(Entity being listed as the Certificate H older) The First Rehabilitation Life Insurance
Town of Southold Company of America
3b.Policy N umber of Entity listed in box 1a":
53095 Route 25 DBL37154
PO Box 1179 3e.Policy effective period:
Southold, NY 11971 02/01/2013 to 01/31/2014
4 Policy covers:
a. a All of the employer's employees eligible under the N ew York Disability Benefits Law
b. Only the following class or classes of the employer's employees:
U n d er penalty of perjury,I certify th at I am an authorized representative or licensed agent of the i n su ran ce carrier referenced
above and that the named insured has NYS Disability Benefits insurance coverage as described above.
D ate y
Signed 2/11/2013 B �Jjd 4�
(signature of insurance carrier's authorized representad ve or N Y S Li tensed I nsurance A gent of that insurance carrier)
TelephoneNumber 516-829-8100 Title Chief Executive Officer
I M PO R T A N T A f box"4a"i s checked,and this form Is signed by the insurance carrier's authorized rep resentati ve or NYS Licensed Insurance A gen t
of that carrier,this certificate is CO M PL ET E.M ail it directly to the certificate holder.
If box"Alb"i s chocked,this certificate i s NO T COMPLETE for the purposes of Section=Subd.8 of the Disability Benefits Law.
It must be mailed for completion to the Worker's C ompensad on Board,D B Plans Acceptance Unit,20 Park Street,Albany,NY 12207.
PART 2 To be completed by NYS Worker's Compensation Board (Only if box "4b" of Part 1 has been checked)
State of New York
Vlbrker's Compensation Board
According to i nformation mai ntained by the N YS Worker's Compensation Board,the above-named employer has complied with the N YS
Disability Benefits Law with respectto ail of hisAier employees.
D ate Signed By
(Si gnature of NYS Worker's Compensation Board Employee)
TelephoneNumber Title
PI ease N ote:0 nl y i n su ran ce carriers l i cen sed to w ri to N Y S Disability Benefits insurance policies and NYS L i cen sed Insurance A gents of
those insurance carriers are authorized to issue Form D B-120:1.Insurance brokers are NOT authorized to issue this form.
D13-12D1(540E)
STATE OF NEW YORK
WORKERS' COMPENSATION BOARD
CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE
Ia. Legal Name and address of Insured(Use street address only) Ib. Business Telephone Number of Insured
Randy T Rodecker, Inc. 631-744-8100
Dba: Swim King Pools lc. NYS Unemployment Insurance Employer
471 Route 25A Registration Number of Insured
Rocky Point NY 11778 Id. Federal Employer Identification Number of Insured
Additional Named Insureds: or Social Security Number
Fence King of Rocky Point,Inc. 113092960
Work Location of Insured (Only required if coverage is specifically
limited to certain locations in New York State, i.e.a Wrap-Up Policy)
2. Name and Address of the Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder)
Wesco Insurance Company
3b. Policy Number of entity listed in box"Ia":
Town of Southold WWC3044104
53095 Route 25
PO Box 1179 3c. Policy effective period:
Southold, NY 11971
9/1/2012 to 9/1/2013
3d. The Proprietor,Partners or Executive Officers are:
aincluded. (Only check box if all partners/officers included)
Elall excluded or certain partners/officers excluded.
This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"I 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"T'.
The Insurance Carrier will also note the above certificate holder 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.
Please Note:Upon the 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: Henry C. Sibley
(Print name of authorized representative or licensed agent of insurance carrier)
4�Approved by: �� 9/7/2012
(Signature) (Date)
Title: Underwriting Manager
Telephone Number of authorized representative or licensed agent of insurance carrier: 800-438-0160
Please Note:Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance brokers are NOT authorized to
issue it.
C-105.2(9-07)
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