HomeMy WebLinkAbout41485-Z 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
SoutholdTown.NorthFork.net PERMIT NO. Z.—
Septic Form
N.Y.S.D.E C
Trustees–
—
C O.Application
Flood Pernw
Fxanlkncd Single&Separate
Storm-Water Assessment Form
Contact:
Ar,,m:rved
Mail to:
Disapproved ale.
A Phone:........
C6
D
M A 11 2 8 201"7 APPLICATION FOR BUILDING PERMIT
Date March 17 20 17
INSTRUCTIONS
BUMDWGDEMI
,
fbe completely filledinliv iypev,,,rter or in ink andsubmittedto the Building Inspector with4
Ire,u 11",Pscale.Veeacc'ording to sc'he&dc
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 regtit ..s,and to admit
authorized inspectors on premises and in building for necessary inspections.
J
rc
105 Butto ball Ln Glastonbury, CT 06033
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Agent
Name of owner of premises Michael Rebentisch
(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 No. 41506-H Sears Home Improvements
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
--IMD
U,orey-CTeek Lane—Southold
Number
House Nurn er Street Hamlet
County Tax Map No. 1000 Section_78000Block, 4000 Lot 19000
SubdivWon-- ... ...................---Fdcd LoT .................................
2.
a, s 6 1W,a n1 d roua xogry,u:on+ lie ll:::::w uunu IluesudenUa 11
—---------
K Irimmied we wid mmqrncn,SKgh FaNy ResWaWl
.............
3, 1`4ature ofwnirk(clieela: Nmv BOdIg Adlkik Ahamlmi
Repdir — RenmvFfl DemoHfion Other Worl" Mq!Hj jg�p�%& m wtadgzm, Ram sVzpm!nstruc(uirq�dmnge
(DescHpfion)
4, EsAimatcd Co,41 $2 7,339 e
(T ...................................l..iFo nO ....
fln)
5 IFdw(!Hiing,nuinaber addwdling mks Number of WINg WN on W Hoor............
Ifga;age, nunket of cars.............................
6, Khwsin COS, or 11116\ed occuIrmicy.sjjpcc,u(y 111"Ituile and amt of eadh[ype oFusc,
7. Dinn eru,aons of mWWg mn=w Ugun,pQ -- ----
l:ieigliiP: Ni.urflier of!St1obes_-_
Mmmuhns W saria trucluaon Wth altieratbns ai,r add rton s: Il.Arrumt — [Rew
of Sloii i es
8, Dinionsions of cwure nii,!m consn-ucdon: l"ront -R car Depth .......
l:16ght NLurn ber of Stuies
9, SraQ oHW: Frow ...........
0, D:,,ilc,0, of Foi-nier Owncii. ..............
1.I,Zone or u usa distfl cr°nii n wlluua Ila p ii emi&,s are s w ed-- ..................
p2 Does propinsed canon strue6w vhWWwj nmhg law,orAnanceor reguWon?)FES P10-
13, WHI lot be ure graded? Y I S .....WHI excess yIfl be rennuived from promlises,' YES �K)-
4, yl airier of Ownex od'jjrwsnnises—Address—. Plione y,10
tN,jrj,rc any &rchhcO bdrimss Phone No
T,yavne of CoNracroii............... Address....................__Phone Nlo,
5 a. 1s rhis property %0i,hhi 100 1`60 of a Gdal wdpand w a fie,drwawr weflwid?*"V ES 1"40
" 111, f"T,S, mss UTHOLD FOWN VWKQII`RS& D,F-C, PERNUTS MAY' Bl,,[ZEQUIRM
b, Msflhspwjj!iewty wnhhn 300 fa,eLM'afidal wcfland?*
* IF au EY LIEV. PEWMnY MAI(R �REOUTRID,
17. Indevationat any IxAnt on property N al 10 boor bdoM nima pmvWe hToWnWidcA daraorrsurviey,
18,Are diene any covenants mul ruahWons vokh wvMiew to thb puperty?* YES ,,NO
* 1111YES,PROVIIDE A COPY,
S F41�F OF�`T)lv �IORK)
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MHWW V;mareuu+uaay Lwngtg ahfly sii,,mm depose:�and ffiw(s,he is ffic apqaficwnr
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(C'owractm, %gcafl,Corponato Dfficea c1c
ofsald inlMer Of Ukiaxnj mW a d*mWNKmd No puHhnn ow have pohmmW Ac ski v"mk and U)We und the U&jjqkwdmw
dev 0 stwemems M!�owaremxd in ffius applicafion are,Wue Yo the,best of'Ms knuwkAge and hckanid
pea Maar wd m the nNinnicr sek fi�mh an Ahc:,4phca6cqi ffled uhede,Mlh
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III III I IIS II Office ocaQaw n O'NG a an.A11411a
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Puaposall ate 03/1.5/20]7 Nu umaSears 11or e Pli�
� aaaxili �,RIIPa�
us
an ,nouut auwraSea4 IBav 522290
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anAlr�n.. a Nu 4:i�au!I acrisa�u�u 24 If'uUaM'da Ceritrdl Parkway
a(6111.)uu ��.���0~fluuirmr�a�IFgPuayuwn�^ fiwuttuuirirua,U"kuWorkVulluu�uroa� 11"��� @ III�I �°o �'lll� llC� � Longwood,R N:::: 32750'P'-
Flhone(800)469-4,663
are Addiiess S'IIC1RIWAPiii.AND Illwll OU°aOWAR::::. CarouMuaauau ILucerire/R aOsVaa4lloni IPIAHTuW�
11.580 d:aar aau,�.u" .uaa�ulr.uu"
n i .. mm a . ly
NYC Dept of UN � �
lu
� ind
H1809170000"
' auaaail aaua1R0970000uautnauCauatylaCayW RauWsayQnuu�u
_ ... Hy00,Snna alu 4NRyyNR„ Wavka�asR C.aunty=U u I u MuD � Uu13nvstdii�n uthincityluffuuYs�
7UFar .rC-Ny3y1RR0y„Xaukeu 421
routMNafisa uaa,, y W ^
Bilfln,P Addrevs(ff a i fenurit hm above) CRY State .Zip Code Pgyqed:Consuhmft Name&P:keme No,(df a�P^upficaWe)
a°I'Y w a4°#I�flfiaAU 5601 As
seri.. !N amy il�yau n aa)ect and Description of the Say a~auficara Materials to 1m)Used aril Eg�t to be Iiinsla e
I Relrrnaave evuarwfirn
g units to be repiaaanaud (PL.lESSE Iw'RmlE"'IFhaa removed units aauaa tikeRy to be damaged,)
2, V „apaaaaWaauags as aaaassalry to uaauaupWceraut uus.)Wufinish vaW other d. auaauuun.usRaatnaa ^s to be done uaaaothermse fabelow.)
I MauG.i atio n Nlrnaulluudes 9::Ilaa,deaua...0 p of A Job-miated debirNaa aalpPOIIa caalrmpllefiolri of Me job,
v )JIf aalylWNNu aNe)Wftelu the a aaauupietRolru oir t:h( 1project,'tensa cuustorner wRl be Irespo nsiWe f Ir the appfication and uaaavl oval(doirage)of huutWir Ipaalc ei s. in the aa:vem
that the project ay.ures tnaM ” s abt•anof s tauuuP s hun:tauv or egress windows, Seam Horne 4n1alrovaaen Varoducts" iii, ("Sears") RN Pa'Ii °n.ris«U B,i
a aftuuted secu:utfty IWaalrv.
q.°' „„ "event�L"::::.: .s°mw a whatever::r �a:M;s�Irk o R°DN::4'Itain the �aWab"'1�er 'D&"„�q"nit for to the Q�aa111�IN"aN��"Ilul�a�,al"IYII "Irit of any work,deem A V'.a��°fn:nd any
��. )N�aa�a�aRna:� Ik::nNa.)Ilea�.yiu�urva:wuuk,�:aaa�an�"u,.k u::aunaalW::nUa��:.alr aaNr��a�.a.va�u n.��u��aa G. proper� N' y " a
previiauuua;u payment nit mid aNr s coinbaact w dl Ibuu aauAomaatkaaHy calulrnauauNRaad.
Summary of Win'dow Ordeir Addendum(see aRe taafled Wiii,iidow DaReru:"Rde nduuuvu for raraum Rlnf'orrnuaulRuauun)
yW Wil,i of:u.r Quuaun°ht . a.a
y a
R ypaa''. Quaann'fiR.y"
U ype" Quantity:
'ICWI4"ue: QuuaIrnfity ,...
IRyllaaau; Quantity'.
U'hEt Window(NderWadda�'�laurduuaan is uanaad(:::s IaauR of and d 6Puu„aauWaulraa7Na d uu°ntau this au:ulrnNUnaa t by �Pu.uauWauuunaua(a�)nlruR�6aaNna
ra. ucurlm;a.,
dditivaau°naall vaovk to be done”18 W:n:llauuaauWS F' auau
'yWMK NOT to IWe doinc
NO OTHERS
SPECIAL SIU'yS'1FIW.RXIVI'III0RWS' huoN
Ia
TRaama�W kiistanua�"Nio ns ecfio ns have been usvuaowed and a�ual Naalnnl�y�Pto rnvaunRa. to be uRauu°nuu, and C
W NN tht�ua, «�Naaave—(';heck boxes, " oik NOT R
I au n. atom "" _ u��tmiia."P as 6nifi4llar
S'aaaa... Y (Ug.) @'a: v 04/2,'',°/:u1 Page a.of 3
unucrrm,�yay� r..aaaa�aara
FluP .OXIMAI E llf.Ilia TE sand APPR,() Ills FllE'COMPp...p.11(,,)l �Ilr� FI-1�
,.SlA
It he workwwullUtaalYh apulprr� lr�rnatt�:r�nUy u�wl ua ; �..� ( Ippiroximatlrm Start I,)at)
It wwgUN Itre s ubssttaannfiaH corm kited� as a roArunaatt0y n WWI na;r: (/r,pnlalrraaagmmraate Q"grrurrprilebmann Date)
ly �'IP Ip
rhesse dates are asuahrg .„ � a� � � —m Gr ' y Sears �,: � q: Products, inc, ���em ")or, y a:�utheir t�ulme try u�murat.uaarll
aaatt ttma aahnaarna as at hhuaa ttUamua,hpna'm maanunlraaaag u�accepted tta a�msaaraa Ihttrrrmna�Mlrmn ulra"r�r.,ttmnr"Irn `�°'.
�sato
arnttttaln aglc'wrrruanl. Customer understands that the Approximate Shr tt Date is rngy ala msh"umattmadate and ttyIrttasttrrnerwlgbe nrnliaal
att palrNaau°to tthaUrs attantt:as to
wa huedu le the aaaatta M aattaari date.
S ESTOSIBA:1'ttIII U..U,y.g" tthnus Elfini and Proprrnsat WSuaamnmaaa ttlnantt them are no asbestos containing Irnaatteidaalls("AGMs") that wouid Ihraa mgrrshrarttarad lnc the
.: m „ ,.,a .µ a,, t. e Inspection an�° :��a .r ru raa�"or or ohlhnerss Uh is Ileaan°Icned tha��at �:�U' s have to baa;'a�istu.umllred to �.na�aur.�f0lrmra o thna;u.�n
pam,mlmaumrnaaaYla,a„ruff l.gaaa uun,.�tt�nlllaattra.alYn work. Ilg I.apraarn ttuarl.lhu�lr uanw�p�u.,a.,l.umaru pry tthnaa ra.a � �axtt � "
Customer must arrange and payfoir abatement of asbestos by s auaqfrd g irsorn pruarto tire start alr con naatUan of work, qh"CastrrV~Y"hrgw 'ta �
necessary asaary asbestoss aabaaherr entt.wwiittlhnghi tth ktty(30)(Jays:, Sears rl naay a« unclmap this s co nttraact uaymrlr tthuusn orrner(s)IinnUttWs
TrwrrUn notice to Cuas tormner� �:
U " bile yrwa:'nvuul�ntt V 27,339,43 ttContractnnaam;'�a ��r � . 'r°`� r a
Iglhna..gga.gyatt ytiUg�,IC� ulYna,luaa:lurnmg aaUq labor, taxes aauny p g an"r aUUa�«,aa
lrnufi6l gD" 'ylrneint(Irnott to a;xa,:rred 30%of"'ttarW Price rwuaallraws Sttaedirallrs er) � ... State Safes Vaav( 0 00
f UrnaaU q''rmayunnelrh(baiance paayaWe upon cormnlyq ttUttarn of paalhr)y u,ua Y tt'aa7� L cat ttttallrmraav(
a ,
ttRnra gralittUaaq F„ ,/rraerl nal dua(�a pr�"au„tto SeIrra,,arogt.arrry yrramgunrg
hay r�Unra Ihu the//aaasttramer(w) illlll Ic y li s attar�a;r bed olrn a separate Caa«Un ° ttluavhm mer a/ prgpinaal� °
lxaarmg Payment nnnla„ ¢ ” w "'"c" w�"
tt Unaa ttarummn and Irmuaatthuanrtt /tt�rm,aguh
y nl�nl:ysr deirrdUI rn rraade as paaalrtt watt and incorporated rumens tthrinas a:aaarnlraamal Ihp�auraalYnu�ra. � � _
1I10E K) BU.Y Uya YOU, IIIIUIIIIE' BUYER, MAY tt'/ ,I (MIICmg..."'llilll a TRANS ,Ctt"'g N AF ANY yg tt PRIOR '°R MIDNI IfUt' f .FIIlE IFFitIII '.lBUSINESS IlhD y
(ll f7lh'g gfUSlllllyllg"tt'gyIIDAY IN ALASKA, ImlIFr p N'y"g'°g°°U IBUSINESS DAY IN IINy' g'~tt`T'll IlDAKOTA gg': YOU AllIIf:N GE 65 OR OLDER,)ANI.F hg.1`1 IE CiAllOF.g.p"gVltty
.g.'IIR. U'ySACINN'ym SEE.U.Ih'lllE: "Ili"FACHED III'ya1C"Ilia oU:a„'ANCA II'''':U..U.. xi-10N f:QRM FORAN III'''''!,XPU..ANKPII N Oy..Ilf"IhUUs lZIGHlill
ADDITIONAL.PROVISIONS
ft2fa y�g , tt(LlLgjSears offers to furnish the Irruaahr;Iniaahs and aanmaain e for their attaafivery and Iirusah lNagnmarr as specified ori the first page aarry/mar the attached
"rya„ttm,hna„µa anrnrl sspraa'maiitt°iiaaaattUr:alrn,.ahna,awU.s ttarr°tthnar'.p.yy.tt/ylf...g'//.Iltt/Ih::sagnmuwwlY°u”..ttlnflas offeir n.n.uuast be aapapnlc°a:rvrartt by the Ilnn,.al.n.alllaattoarrn gymagaaarhumnraontt.if this is as aaremlGtt ssaaJlra or,as payment
an raraUapuan sats,it ur.mtt be approved ay Uhna rrttuh Sates I....Daralrgnar tt. if this ramprs ar�rrl ararmvemar ttlnarsk^ „,Uan canrah be rrarrin aac I" anae wrtthl
Una«law,tts mpmr w”garwuttnamawn alnmany payments you have made wUUbe r„larled to you.Ainy aratt ri l s Ilett swear afteir tthe insha HattirlrInasbeen aarmrllUd
rare Sears properly and wwNUl lam'''a removed by Sears,
Iywt „l„i,a °o,U,w I understand that Sears wnrfi orattall the .na ttars but wnU arrange for the"rs,h,aUUa ttoanSeam.s not resprrsiuUn ttar,rmatt, s or rnsaHattuan N01
ttaur`vnamor arrangedhay Sears, Sea.a,•msttaUgatt.rn ,rmtturauUaY(a)wwNmalga°n al hr.a”lrg pammnuttS required by focal Uaw. Immlr nrumuaNrattr inhistoric or landriiaru
wm,ulYnurg rgsttr ,s,ttasttmmlraIr wUU r, "rapaasuhUa /ralY rrUarn.ng required aaavalaand aUa lampermits gII”to the crrYrnrrar4mant rg wodon tthngs contract.
authorize,,S.na .a" . ray' c rr n.„a r UUr"aarus' where�re a in stt IIb Ilaaww l:ra I muaalke the UrnsattaaUllaattio nraft rrnaatterpaaUss" y issue as wworu mrlyder
II aau.uttlhuavrura."�a„aar,�ttar. �°G�arrange ttmar�a sa tt.w*ttra � � � aU U y D r � �
hhnr this uraaagaaggaattiionn to as amaaunttraaaattrar„ (3)lrnaapaectt the rrn;ahaagqaattio n, and(y')Ilraay the a aaarnlfraaaatta:ar wwhraalru the UlrnsttaalHaaUNaarn g s axarrnp ilette if q hiave s r grned as cmiftUymaaatte that the
Grrsal:aaflaatttoi n has been conrup petted to ninny a aaaGUsattaarahgramn.
in Umn tty!!Yjiolri aagglree that a"gmranrs is Irmrtt revlparunswulnlle g' Ir attaall ys Uri defivery or lrnaataallllaaGpa:aru due to weather,I ire,sttnNlyaav„war,gaaver nl mnaramntt iec uaUaattNaurlrn(ar any
causes laelyonamtt Seaaraa'maannttrrull.
yIrndl Qt!� lire o ar�' a,m II u.urn e muhaarny that hhuelre arra'no oral a aggrr;eirnaaunhua IIbett�aaanarl Sears amyl r nan”h�.ver, biinag N expecteaurs to do has Ibeero
Ulnlcholed in wwrUttlrngg in this contract,,INothing can be changed UIrN tt:haUsa a:aoirA:raaa:al:uarde sv it is in wwr iittingg on as ssefra:alr tte ttarn.u.nn aaa.cepiU:ed by rmne and Sears,,
wuy age o nu�hgn ay g„q aagglree that any Urutt'aaumm�aa�Uaalr or rneaaaaua�renruaalrntts that II give to Seaare correct and corIrupaiete. g aimresµnoinsaUlUle'for a�alruy sapra�nrMla�aq work
described in this raarrrtt.ra„amatt.
u gs ea � �ava ttricat and/or auarrUrtt ,etpam( )to rnun any rawUy Nw laUUwaR�allnrmarr rhnr giurrhimgs. ttthe
,� U iH rrovfgaattwarattam Uwr
..n :.n” "�.a; . n�,,;a " .w s „ standards o '�� w � w w n�" °�"., and/or.. � " Saar „. . � w .pass I' chna i nl4 m,s
rapm,mPtt.Irua.aaall malnlattdarr pnUuaumnhanrngg,�,aau vurMm���ap alma Icnral.ranm.mah Ik.U°nmr matt hlhnma ualallutty marsrinpamuy aalr a.,Uaaa,l.ruaaaaU anrna.1/au pnlluannulNaurugg codes, II w'wuUN rrnaaUaa.,ttlhnra a ua,aw.,.�,.pary K a ,g�mk at
rany aaw.pems e urin ass Sears has agreed in this maor ttraaaal to rnnaake the mahnaalrnggm,
.f!gyMflj U wwullq pay Sears the cash Ipnn.ce that covers,the price of rlruaattenaaq and UlYnmsttaaHaattio n as shiowin malrn the Pict page.
molt )L!. rprprmupin atte product warrainty dram inrenis Mi be rghfern to rmne by S(:arsr Searrss' 9arr rutty on in'sla q tt:Uaann is:
yUIIhUARS'IU..UIIN UyIg''D WAlZRANIFY ON INS U_LNi"'III U'y
extended w .„ rrr s,.M warranty n am effective w an ....w e r" .,rn e Ila""nrlaattaalUrnrl if the
Illi aaalagnl.uaalcn ttaa any Irruaarnll.apaarnfiu.anaar'warranty a�rattnnrnrttm.rtt Oar you guru U.Una..p.arrrattu.ua,tt�,.p�ua,am.ml�wwhnuuslln ww�armaaunhy haa.,m„arrmna.,,�,ayaarad.wvr ttNnm agaatt.a ttUna.a rrn.,m�lhuaa attuw� � �,
workmanshiparlY'an'r Iliicaattlrar aag any Seaaraa'aarraarnm ed NlrnaattaaNUaal:liaalru Irovess 1'aau�uNl within U one a"aaar./aar Weaattherllbeantter tt/aagraira N...0 ie, lU two eaaraa lair Weaatthua�,beaateir
� Ic Nr � y .g I� y Q D y � � y
Phis,or(iii)three y,am for pattN argrttwu.lyab,and aaGrlaibeattar Sttrr.u„rllaaattrr,thein n upalrrrttae hmaryou Sears w”Gcause su�n hauls to be
corrected arep
a
ir
at no ammttttmracost,to you. tt Sona mlattum"ras that .snrtt :arreuauaUy rrar "„agUaor cannot be tturaly rruaaa,lwan„at Sears”srqe discretion,Sears urpy
6lectt to provide repallaamnaamenntt or ras«paulrual.Serviirp under this,III._grrugulixa d Warrarity is as aaUUaaNhale by caaIIIIIIIIIIrng,'g Sea r's U..0 Ilme Urmmllf maarm,'Ilra ent PrarrIllaalawg^s at 1-8W 22.5030,
r
tty"gives yrurr specific&egra rights,and you Irnaay aalssra have other riggh ttsa that my fm State has State,ytt tt.iiimaulu . /"haUas vnaalYraarn a
SWL... Y (Dig.) Rev 04/23/1.1 F':aa ge 2 of 3
Jobt,ki�iibv� L1827969
N01 ICE TO BUYER
1 U'O11SI IIPI'llHEAG E EMEN T IF ANY 0F I HE SPAOES INTENDED FOR"THE ME:IIE: TEI .II "E'0THIE:IIE'XPIENTOFTHE:AVAILADLEEI10F"" I .II 'TEOII
U11RE: L[FT IIE111E_U111 EGm
E YOU AZEIENTITLJED TO A COPY OF-PHIS AGREEMENT1UF'1E'EUEE"U"'UMEE YOU EUIIIG1111U U1" IIFGJIE.IIE P IT TO PROTECT CT YODUR LEGAL RIGHTS
:1a YOU MAY PAY 01-F F 1"HEE IIF'UUIIE.U_UNPAID BALANCE:DUE.UNDER"U"'WIFE AGREEMENT IIEEM ENT Ar ANY 1UUE1E,AND UUP SO E1G'ANEi YOU SH UL BE ENTITLED D EA O
FULL REBA111 GME`THE UNEARNED FINANCE AND INSUIZANCEE.CEF I EIEE&
YG',11U Il MAY GU1U 'GUIIEIIEm 1FU•EUE1 TRAN'EG GU"EI10 E' NY"'1l1MEE PEGUGUIFE TO E UIIEII UGIEUI"'OF11EhIIIIE:1E'IFUUIIII'.II BUSINESS DA [E"UE°"'TH BUSINESS IIDAY UEU ALASKA,
FIFTEENTH BUSINESS IDAY UU'1 EGG111E11E111 DAKOTA OF YOU ARE:AGE EEE OR OLDER]1111F1 EER THE DXrE.G'1E"THIS'EIIEU'. I IEUlUGm'E'IO .SEE THE.ATTACHED
01'10F OF CANCELLATION FORM FOR AN EXPLANATION GEE THIS EEUG H F. E" EIIL UEEIE. 1E'0 E:EGIIE RG,IE IF. THIS OPTION, HOWEVER, UILL NOT
ml 'UEER.IIFE.EIE111Eµly111FG ANY G1'EIIFEIIEER E1.IIEEII IIIE:IIDIIIIEES AGjAINS1 "U"11EUIIE: IIRETAIL.SELLER YOU IMAY POSSESS. IF YOU WISH, YOU II MAY USE 1IFUIII.EU PAG:GIIEE AS
NOFIFICA111ON IIEBY WR..ITINGUu'III HEREBY IF11FESGUIIIII I[Y' IEU DU1DIII G:YODU'lR NAME AND UEEEE1E111E:1UEUW 11 DUPLICATE 0F. PHIS EEEECEmIIlP11 IS PE"1O1GUIIEIEED IIEE
mU'IIHE SELLER E'G1R YODUR RECORDS
E ITSHALL NOT IIEBE. IILEGAL. FOR 'EIFUE &E:IILLER TO ENIE:JR "YOUR PREMISES UNL.AWFULLY OR COMMI'[' ANY BREACH G'1E' JHE: PEACE "10
REPOSSESS GOODS
IIPUU '.GEEUUII'UEUU UNDER11HIS 11,GIlE1.IlE:IF: II
NO EGE:IG1NESE"UMG1RKEEEESIDEEEES.QNL
Any ° OmEmm Emamme' p goods and services pursuant Eaa yoUlIr'home Iir prrmmrei mllent msm intra ct
UUum a�rmmmEraam°Gumr�.alurUaasanrrm.lraarulaarrr,or rruaaEm�ruamUrnrmaaln mrUmaa urums'i' mmmm rrassrmrurMrmU.�
and was not paid may Ilhave as vafid legal asUaaUrmm against yrnuar EaruapsllrEy known as as mechai*ilcs Ifien,Any rnedhariics fieri filed against your ropei��
y � aad Payment of EUmaa s uru ed—uull maum IIprUamma under the Ilhmuimnw,improvement r ontraau`;m.GmrUor 1ms UUIIIUng as rmumadhaarmUsss UUmarn may iurm aafidaate such
swam lbs aEU.umsEmaallra
Hen "U1lie maamaner,may contact an attorney Gra determine his ri11GGEmts to a U'Usr.Ilhmaarge the rruamchaainl1u,s IHen
In accordance with EluadbmUUl lilssUon Four of Seefiori 71-A of the New York IIE.len Law,Sears has posted aim bond aarUUllhm SAFE(N)IIIVyEUUUIIF'ANCEE.COMPANY GEIF
MEEIIF1UCA,as suarQV mnrisrnpaamry fiiu~"srnuuad by the E1U.s1e of New EUau111mrr guaaraaruEyliiing the IlGalu°oper application by Sews of ainy cashIlGaaayrr eats mar camsllhm aUamposlft
received Urmmrun the c ussEmimumuaar usumdiw this Euamumura iihiipllrovensent contract GmrUuar to the SLIbSt arntiaaU mumimrmmpletUamrm ofthe work,,The surety bond is in Illieu ofthe
escrow requirements of UUlbma New York IIE_liirarm Law E urUEmir:n rmumG.UEGisaamiiimaru of aarly and all claims asserted by the customer undef this Ibond,along with as
(ry-,opy amt'the customer's coi nlUraaurG„shmiaum4d be sent W Sears IIHome Illrrn rmm erumuarnit Products,Inc.,P0m IIBox 52 2290,0,Emmurmgwood,IF'E_3275E-2.290.
At any time durinig the perforiniance ofthis contract,the GUGUUUG.E"EUGUGG1IIr may G ernand and§h all be entitled to receive in f'm,mll from
thie owner advaInce payinent foie any materials that&re necessary to pEEflwthis GmontIrmEGmtm
----
Customer(s)um" „II
' u9'.o�aA��
NOT1T11I � T NEW G,� II �UIII IIF�I�"�I[IIC�ENT �E111L
1-1--
The contractor,agrees E.ma Euurinislhm UUmrn buyer urre'UEllhm as u�umlluliificaate of U qE,iiirkeiirs�'Gwuaurripeii asamEUumrus Insurance IlErmmmur tam corrurmmm,lumm.ummei nt of work pUrsuant to the
contract Pursuant to section EE1(s)(E)of 1F'Me EU um1 the Rules of the Cit of'New York,the contractor[Sears]a ind 111hw ras rnuar[ymaual havedetermined
that as defillrmii1e ruumrnllG lefimmmm date Hiss IIr1OT 1mm be of the essence.
(B,,"a.5 ?mra.i;° i. u
(3U,idnmiiiv:s'nUg na'U'w'mar Customer's is sUginaatuarOalu'te
Accepted
IbSears rans Arrmer nmrU A Iix ca, ('Sears")na
Dy,
A'Uaa as PdannaGlenrk=nt R,,rr se ntaat ve
SWI-NY (Dig.) Rev niK/231:04 Fpage 3 of 3
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mates All advertising for Howne frnprovervient contracting in hall contain t1w ?,iurrnb m f the 140" a m
CER"I 11::::](-#AT1::::! QF- LIABEII....F-TY INSURANCE
. ... ............
THIS CEr(TIII F1CKT'11:-.,, I' IISSUED AS III 011 CONFEIRS NO FUGHTS Ull'0114 TU ClIlNt-TIMCAM HOILDEk III UIS
DOES 14011 AFFIRMAI.Wf..,cjl yr OR N1I:EGATlIVl`.--,1 Y AIMEN11), 1UATETND 011-1 AUTTER' THE COVERAGM AT`11: IIRDED BY TP"iE POLIU11:'S
BELOW. THIS CERTIFICKIM OF INSUTRAIII. 1:)0§.T.S N01" CONSTITUTE A coiq"rl'w,.'r i3i1.1TVVE11�.:N THE $SSLHNGIIIIIMSURII�..,R(S)j, AUTP1011IME11D
ll:klll.'-'.:'F'IRII:.'.r'SIl."114'1'A'1'11(11.":'OR PROIDUCER,AND THE CE1I:;MF11ICA1`11:E 1-4011-DE11k
IMIPOR 111AIPIT:If tho cortifficate holder Is an ADDITIONAl 1111AIS111111:C110,Clio 111pollicy(lies)unust hava A11155ff-1110NA111 III—NS U RE Dp—vovliu I cAli"mis"....
pollIeimmeimlt.A statement on this
St,11111:111it(MAI loi�l�1111SWAIIIVEIIE),sullWfeetto thetaruns and coinditions oftll'ie polfty,cortain cIles limar
y equire aiii,i euldoiis
cerdlicate does not comifuiiuiigliits Is tho cout1ficate holder in How of sucl1w endoimeniierlt�s).
:1. cv�FACT
AM sisk seffice indces ceinual, Lnc. (9,66) 283 7122 FA.x .......
1" (300) 361-0J05
CPRODUCE11hkago o
200 1 4kanifolph EMMAM
Chicago .u[. 60601 usA, ADDRES&
WSURIER(S)Al4:4<)4NOMG COVERAGIlEr NAM#
09ROCIM, 11INSURFR.A� ACF: Amnerkan insurance Cainpany J22667
searTS mlre 11INDiroveillient �,radLlCtS rxw�,, MSUIRIHIR BACIlEr Fire uinrtPir-,'w"iFTteirs—:Iinsura"IK�eco,
1.024 u:]Iorida cE:mtra.1 Fairkway ...........
wwigmiod ril. 32750 IUSA RM REIR Q: ———
WSURER M
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COVERAGII..;S a5li FFICATE NUMBER- 57(306322 7480 REVISION NUIMBER�
-I�S'io ci::RRI:�y 11�Ar PHE POLUES 01F MSU1I1AP4C11::.USTED BELMN HAVE I V3,SUED TO THE U4SURIM 11YAMEDABOVE I ri[iE P011
INIINGAMID 1401W11 111 MAAMYING ANY RM MRE:mE::PU r, rEFUM OR CONIDH]ON OF AIMY CONTRAC� (H:U OTHER DOCUME1114 Ur WVFPo RESPEc r i o im UI I us
CIE1111TTFICAI E IMA(BE MV NEID 4;711""w MX(PERi�KiN,'"II 1 1111E iNSU13AINCE.AFFORDED BY T11 1E 1pouirlIES [XISCRUNED RERUN M SU HUM- rO AlI 1111.THE 11ERMS,
EXCII USIJONS MID C01141C)P1"mONS 011: SU(',i 11:r()LIIUIES I SII KMMi IIMA,W q MIE BEEN IkEIM KIED 13Y I 0.;11 AM& UmHs shown me asii,equested
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AUIDS ...............................
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141 A WII,RC48609247 08/01/2017
A111 mher states $2,000,000
0 Yes,dmym-no undw
011OPIERATIONS below $2,000,000
AAA
Tm r 701,Adtlil(MrTlll::Veiuinav'(s �chod�A�e,inlay1maftached ffirnm*jjmvo0milwpWmd� or.-,,A
:Avideim:e of coverage,
C11:.:HTH9ICATE:11�-i011 I CANCIll'11 11-ArIlION
SHOULD ANY OF THE ABOVI:� DII:SCRIBED I AIME CANCELLED I THE
CEXIIIHARMIOIN I THEREDF,, qoncil:� IMLL DE, IMUNTHRED Rd ACCORDANCE. WITH THE POLKNIPIROMIONS,
Sears wmw roproveiment products AUTHORIZED RIIHIPIRESEMA"VIE
.1624 11oil,Wa centra� P,airkway
A wiigwoud R. 32750 USA
@1988 2015ACOR111)C01H)ORATPON,All rights reseilved.
ACORT)25(20116103) 1 Ill'ie AC011:?l)uIlailne and IlIogo am AaaGUNwamer ulmVnaaQrmas of AC0111RD,
GIE:NC E'EEEEEroT'01II ERE m 5170EEEE0034159
ITS REMARKS SCHEDULE E ge of
. .........
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aMoA ANi:'�' INAMV.iG',9OO,aWr4.Pl"CCM'i.IIA
Aon R'11 Sk services Central, Inc.. Sears Home EI.U1rnpd'"4:b'0.AemeJY't IPII"oduc'ts Inc,
IIi NUMBER
E'Sa^e Cer°N-.m.Emica!t IIqu imiN er. 570063227480
CZ
seas Certificate NuImbeIr°, 57EE06322748EE 1 rFaEC:T FMmE
ADDITIONAL.REMARKS
EENJIIEE IIEEENEIII"'In0NAL. REMAIRKIS FORM IIIS A SCHEDULE"'I'D ACOIIRD IIFm'ORIIIEE,
FORM INEEIEEEEEER- Aa~pEERD 2,15 IE"ORIII "E'E"'FLE:. Cedificate of Uab'uNuN:7 Nnu;:aulr uric
NSURER(S)AFFORDING COVERAGE NAIC
11;ISI,N 1,:u:;1,Nita"..
EEEE:ONAIIL POLICIES Nu W E ,r lxµd" y o a �raNuck unnrinti a�aon ream w Ncoare.aonE�in plin y quthe,
a aNAfid gate Conn fm pohey HnliF;.
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..................... gy rcp% yq q
N/A ',. a wa'.�"c.)486092E➢�,�'� �4'.Y,,�w.Y.A./F�.01.6 08/01/201.7.
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CE ID 101(2N8101) @2008ACORDa'a`OIRIGPa RATI4E R,AH rilglills urmWssir ed.
Pia ACORD na yrm al roma logo airs m&toreaallinai ks,,of'AaaOIRD
S' ea,zmrsI
1024 Florida Central Parkway,Longwoodp FL 32750 PH:407-551-6000
April 2015
LE-MR
L Alfred W. Nyman,Jr.,Assistant Secretary for Sears Home Improvement Products,hic., grant
permission to GO Femiits, LLC associate Scott Doughman to subirdt permits,aril licenses, pick
up permits and licenses, make changestoo rn s„ d lea. n t� chwig made
by tfi building department on behalf of Sears Home Improvement Products,Inc.
I also grant peg°nasion to GO Permits, LLC associate Scott Douglutwn. to purebaseits
and/or licenses with a company ,personal check,person, credit c .or cash'.
1 certifly that the above information n e and correcL
Seats Home Improvement Products,Inc.
STATE of Jlorida
COUNTY of Semirtole
SWORN TO AND SUBSCRIBED BEFORET1 US Aeday of April 2015,b -Alfred W.
Nyman,.Jr.,Assistant Secrebwy for Sears Horne grove t prc ,:n..cm and-who ig X
personally.1mow to nie or lum produced a valid Drivers Ucense.
Seal: �
Print Name. Deborah P. FhiM&0(
�
Notary Public,State of M.n
F.PRH*LILJ MPS
Commission#: EE 090281
°. u .13,2015
JOB NUMBER: 21827969-0001
PROPOSAL DATE: 3/15/2017
WINDOW ORDER " F I .,
ADDENDUM
r➢ m IJ>r,l 1 � r r, ,r � r,.., ///... r/ /�/, r Jl %krr",' r, ,,/ r/,. r,„r/ / 1 / ,. / ;:/.,
R��rr��lMiuuu��(�'7r�1�''vJb,� ill,,,,. �r�I,�INFrr„Fa�i�rrNM�lre,/:.,/i,a,r/ r,,,,„r F.,.,,, r„ r.,,,:;,,,/ r„ ,,,,;,..e i,,,.rf,.,n,//i rr,;;nr1�//'�f����i�+uwr,irr nrr,�,lr,�j�(��������t�rii „r.,r�✓/,,,/ I.,,,.,1,.1�r�i.,,� o u / ./
1 WP-SLIDER 2 46 W X 38 H
WHITE
LOWE/ARGON/LEEP
FULL SCREEN
MAX CLEARANCE DIMENSIONS=[17.5 X
32.75]
2 WP-SLIDER 1 70 W X 38 H 1
WHITE ' f
LOWE/ARGON/LEEP 1
FULL SCREEN
MAX CLEARANCE DIMENSIONS=[29.5 X
32.75]
3 WP-3LITE-BOW-LH/NH/RH 1 86 W X 68 H
WHITE
LOWE/ARGONILEEP
WALL THICKNESS=[WALL=4]
OAK
PROJECTION=[5]
3.1 WP-LEFT HINGE CASEMENT 1 25 7/8 W X 65 1/8 H
WHITE
LOWE/ARGON/LEEP
MAX CLEARANCE DIMENSIONS=[14.376 X
60.3411
3.2 WP-NO HINGE CASEMENT 1 25 7/8 W X 65 1/8 H
WHITE k
LOWE/ARGON/LEEP
r
3.3 WP-RIGHT HINGE CASEMENT 1 25 7/8 W X 65 118 H
WHITE
LOWE/ARGON/LEEP
MAX CLEARANCE DIMENSIONS=[14.376 X
60.341] {
4 WP-PATIO DOOR 1 57 W X 78 H
WHITE
CUSTOM SIZE IT]
RIGHT OPENING
LOWE/ARGON/LEEP
FOOTBOLT
5 WP-DOUBLE HUNG 1 22 W X 69 H
WHITE
LOWE/ARGON/LEEP
FULL SCREEN
MAX CLEARANCE DIMENSIONS=[16.75 X
27.0625]
1 of 3
6 WP-DOUBLE HUNG 4 27 W X 57 H
WHITE
LOWE/ARGON/LEEP
FULL SCREEN
MAX CLEARANCE DIMENSIONS=[21.75 X
21.0625]
7 WP-SLIDER 1 54 W X 57 H
3
WHITE "
LOWE/ARGON/LEEP Q
FULL SCREEN
MAX CLEARANCE DIMENSIONS=[21.5 X
51.75]
8 WP-DOUBLE HUNG 1 22 W X 69 H
WHITE
LOWE/ARGON/LEEP
FULL SCREEN
MAX CLEARANCE DIMENSIONS=[16.75 X
27.0625]
I
9 WP-END VENT 1 96 W X 57 H
WHITE
1/4-1/2-1/4 END VENT
LOWE/ARGON/LEEP
HALF SCREEN
ll f
10 WP-TRAPEZOID 1 23 W X 59 H ,d�
WHITE
LEFT T OID=[LEG=]
LOWE/ARGON/LEEP
11 WP-DOUBLE HUNG 2 55 W X 45
WHITE
LOE/ /LEEP
FULL SCREEN
MAXCLEARANCE I ENSIGNS=[49.75
15.0625]
12 WP-DOUBLE HUNG 1 28 W X 30 H '' J
WHITE
ddM LOWE/ARGON/LEEP IT
FULL SCREEN
MAX CLEARANCE DIMENSIONS=[22.75 X
7.5625]
13 WP—DOUBLE HUNG 1 26 W X 57 H
i
WHITE
LOWEIARGON/LEEP
FULL SCREEN
MAX CLEARANCE DIMENSIONS=[20.75 X
21.0625]
c
14 WP—4LITE—BOW—LH/NH/NH/RH 1 96 W X 60 H
WHITE
LOWE/ARGON/LEEP
WALL THICKNESS=[WALL=4]
OAK
PROJECTION=[ 1/2)
2 of 3
flUii��
w
14.1 WP-LEFT HINGE CASEMENT 1 21 1/4 W X 55 7/5 H
WHITE
LO E/ARGON/LEEP
MAXCLEARANCE 101 ENSIGNS=[9°751 X
51.0911
14.2 WP-NO HINGE CASEMENT 1 21 1/4 X 55 7/8 H
WHITE
LGWE/ARGON/LEEP
14.3 WP-NO HINGE CASEMENT 1 21 1/4 W X 55 7/8 H
WHITE
LGWE/ARGON/LEEP
14A WP-RIGHT HINGE CASEMENT 1 21 1/4 W X 55 7/5 H
WHITE
LO E/ARGON/LEEP
MAX CLEARANCE DI ENSIGNS®[9,751 X
51.091]
I
TOTALS. 19
COMMENT:
03/15/2017 03/15/2017
Customer Signature Cate Customer Signature [late
3of3
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Wincore Window Comparison Sheet
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Wneore Window
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. U-ife tar(U-rap�ua).A Measaare of k9 m rate,of non-cutar hu at teras.or ban'ftough a material or a5sembl y,y'g.is
exprossedanurlo of stu/hr-so ft-OF(W/srs run-"C;,.values are normaNy+given for NM- /,OSS AE w'hriter coed o of 0°
F(IS-Q outdoor temperature,30°F(24°Q indoor temperature,15 mph" wind, solar load. may
be ed for the glass alone orentire witdow, effect of the frame and the spacer
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materials.The lower the LL4=or,the greater a wirtclaw's resisbancei to heat ftw and the better its imouiating value-
,.,.R--arAIM A o..=. scue of the resistance.ot a glazing mate;W or fenestration a5sernW to heat f owl it is the snverss of ..
the 0-factor(R-5/U)and m expressed in units aaf dvr-sag ft•-F/Btu.A high-R-value window ndow has a greater resistance to
.�..heat flejw and!a Ngh+er WnsWad nd raiue than one with a Bow R-value.
Solar heat gain ooefficiaot(-9HGQ.n1e,froaction or sotar radaation admitted dwough a window or skylight,both
drrectte traraswn itteiJ,and abserbed and aaatasequeratdy released nrrward,'Me sotar heat Spin coeuff hent has replaced
'...,
the y„eradarwp,t,p:eWfrcieu-ut as the standard urwdacataa of a.wwndrrwrva's sfnadnng abs+'ta°.It m expressed as a number tiaetrs»aa!n
0 and Y,The Wanwer as window's ssniarr h.Olt aurora ccaffidens,tens de-arc rogar heat it t a nsm&ts„a d the greater its sha+sfi�rW
.�
abfty544GC can be expressed in terms of the gtass Wane or can retea to the entire window assemt4y.
Visible tramanktapme °
The percentage or fradson of the visible spacknen(380 to 720 nanometem)weighted by
the sensitivity of the e,
�. 9.1 (uv).The inviable rags of the ffpadrtxn dwat are outside of short-
wavelength violist end.Ukraviolet rays ar
h -
war a found in everyday sunlight and can cause failing of gaint finishes,
and fabrics.
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