Loading...
HomeMy WebLinkAbout42552-Z gUFFoi�.Co Town of Southold 7/6/2018 G, P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39753 Date: 7/6/2018 THIS CERTIFIES that the building GENERATOR I Location of Property: 2205 Bailie Beach Rd.,Mattituck SCTM#: 473889 Sec/Block/Lot: 99.-3-14 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/4/2018 pursuant to which Building Permit No. 42552 dated 4/10/2018 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 GENERATOR AS APPLIED FOR The certificate is issued to Mattituck Park Dist of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 42552 06-29-2018 PLUMBERS CERTIFICATION DATED Authorized Signature guFFut�- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE may. • ; SOUTHOLD, NY .jj01 � foo 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#: 42552 Date: 4/10/2018 Permission is hereby granted to: Mattituck Park Dist PO BOX 1413 Mattituck, NY 11952 To: install an accessory generator as applied for per manufacturers specifications. At premises located at: 2205 Bailie Beach Rd., Mattituck SCTM # 473889 Sec/Block/Lot# 99.-3-14 Pursuant to application dated 4/4/2018 and approved by the Building Inspector. To expire on 10/10/2019. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CO -ACCESSORY BUILDING $50.00 $235.00 Building In pector 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. :4/_ y'/ New Construction: Old or Pre-existing Building: G /(check one) Location of Property: e&_i (ilQ aCi� `7)(� !� �nkclb_ House No. Street Hamlet Owner or Owners of Property: AALU( A/i bl��J Suffolk County Tax Map No 1000, Section GC[ Block Lot l� Subdivision �j 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: $ 5 Illy pplicant ig ature pF SO�j��®� Town Hall Annex Telephone(631)765-1802 54375 Main Road c� Fax(631)765-9502 P.O.Box 1179 ® �� roger.richertA-town.southoId.ny.us Southold,NY 11971-0959 cuT`I,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Mattituck Park District Address: 2205 Bailie Beach Road city,Mattituck st: New York zip: 11952 Building Permit#: 42552 Section: 99 Block: 3 Lot. 14 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Laurel Electric License No: 4718-ME SITE DETAILS Office Use Only Residential Indoor X Basement Service Only Commerical X Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceding Fixtures HID Fixtures Service 3 ph Hot Water 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 Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches Twist Lock Exit Fixtures TVSS Other Equipment: Standby Generator with 200A Transfer Switch. Notes: Inspector Signature: Date: June 29, 2018 0-Cert Electrical Compliance Form.xls pf SOUIyOIo TOWN OF SOUTHOLD BUILDING DEPT. courm, 765-1802 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) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE INSPECTOR f 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 Southoldtownny.gov PERMIT NO. o� Check Septic Form N.Y.S.D.E.C. Trustees 2 C.O.Application. J Flood Permit J Examined ,20 Single&Separate D Truss Identification Form Storm-Water Assessment Form J APR _ 4 2018 Contact: Approved I , Mail to: Disapproved a/c E r✓�s��i ,�, TOWN OF S OLD Phone: 16 91 `'�9 �S—?S Expiration ,20A�_ Building Inspec or APPLICATION FOR BUILDING PERMIT Date y�y , 20 r?l 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 inspections. (Signature of applicant or name,if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, 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 No. Plumbers License No. Electricians License No. °171 1 Other Trade's License No. 1. Location of land on which proposed work will be do !�bQN l� House Number Street Hamlet County Tax Map No. 1000 Section Block Lot ' Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Oth�Wor C�,MPA(DeR c _ scription) 4. Estimated Cost Q OC) , U 0 Tee J (To be paid on filing this application) 5. If dwelling, number of dwelling units Numbe o dwellirig'units,on.each floor If garage, number of cars t�j iJ 6. If business, commercial or mixed occupancy, specify riatureond e�,tent%bbach type of use. 7. Dimensions of existing structures, if any: Front ,.. Rear Y 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 11. 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 14. Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15 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 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES NO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY OF )CS: L being duly sworn, deposes and says that(s)he is the applicant (game of individual signing contract) above named, (S)He is the i?-cihu-r-e,, (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. Sw rn to before me thi b day of 1 2010 . TRACEY L. DWYER wA' BLIC,STATE O Notary Bubli NO.01 DW6306900 Signature of Ap icant QUALIFIED IN SUFFOL OUNTY COMMISSION EXPIRES AINE 30,2_0Z r - 1 Town Hal!Annex [ Tdcphone(631)7651842 54375 Main Road [�Aer rictmt (m�'�.nY.l� P.O.Box 1179 �' ® S. Smfi oK NY 11971-0959 "Vill1{ti� BUffDING DEPAA71CWr TOWN OF_SOUTs_OLD A0KtOATI04ELECTRICAL INSPECTIQU k8QUESTED BY: Date: Z//,/ s - Ce►mpany Name: Name: Ucense No.: ddress: / Phone No:• JOBSITE INFORMATION: (*indicates requined information) *Nance: f Y)afti+,.+ck Park -f)j j-K i C . *.Address: a r 5 1�i1�'g 12CG(rh *Cross Street: *Phone No.. — aiE Permit No.: Tax-Map District 1400 Seddon: q Block: Lot *BRIEF DESCRIPTION Of=WORK(Please Pft Clearly) (Please Circle All That Apply) *Is job ready for inspection: �NO. Rough In Final *Do-you need a Temp Certificate: YES/ NO Ternp Information(if needed) *S®rvi0e Size: 1 Phase 3Phase 140 150 200 304 354 . 400 O#her *Nw Service: Re-connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION 2 a241equest for Inspection Form CIO-88-015 CYLINDRICAL SEPTIC TANK KEY MAP10 C-) TYPICAL GREASE TRAP O i F TA91 Ippx 1pgN[qnp cove"Ta Fv[snes sx.eL STN LEACHING POOL DETAIL ' enlxn[r TO OR M OE / �` a �� ATTITUCK PARK a / —T Ipon c'+E —ORETE z''qx L ` a � DISTRICTILI 6. Ix nRe esnzlga° T°sERr z n 1 rl�ai/°•ii°p / aaren[nvM[xr a/ vaY,'In oa ecurviEni'r` IxLer— .11 T w $Q / „ D P te, Y OL 1, . 6• r aueL.' ,i 4` Yax z] 120a /['/I' . "Lg9s[•ee r'E FLOW OR EOUIV' YLEHT la• •°e PIF" \ �•; Flrcn[[ ,q ,' 1 I'.T...L II _ s[ETluxs ..II. a' T o's T5 m 4% \ / V S { ; g5 K3, --{• ry F AREA= 22.6 ACRES ± m 1 °nwn°w. ROAD O ESTHER MAP OF FILL ..EE=Le.n J n IE.- .n. / / MA TTITUCK PARK DISTRICT °°° L NI p KE�E �\ AT MATTITUCK \ TOWN OF\ SOOT / a SUFFOLK COUNTYY,, N.N. Y � RIM` EEn 1000 -99- 03- 14 �"(IM` , 0.if O SCALE I"= 100' / \ yLLL May 31,1988 MAY b 1992 �1�� \ \ 0. 21, 1988 Sep t• 25, 1989(revisron) �E Nov. 16, 1989(revisal / \ F MAS /$/992 /F�v) STATE •� SC.DEPT.OF \� / OF NEW YORK •�•� a HEALTH SERVICES • \ c"ry• Try•A u••M ry,LVA„ISEa STATE T T.d ntigF ,/ o°ea ws s"Tn”m.am sErmr,cxr a IULrn arxvlEcs s sg>v ° Jxlr r• H 4 RES'.H4 TOueIETM1N aEP°pT•LqN ISiA+O FELL r..Jr w I.—:T°uac,MTEs G ��ihs auo,� — � sll fl mua+ a m---nn« axon o-a• Ar wr z¢e°w � �� __ m o'>L Twp' .... ti., rn• '2911. IT I4 WIu1J \ / �' � L x TTI•al ra.pde r SUFFOLK COUNTYDEPARTMENT OF HEALTH SERVICES w DROVE WELL TO 6a FEET\� \ / / G V\� ` To 10 FEfT-PULL EO 6ACK spans Twr rv•dbe N/GH CHLOR/DE \ Q I° Iron var•xm BYx[..tr. Approval of C9nstrucled rvnrks PULLED BACK TO 29 FEET.� \'� 'a z[„ n'J.a..9•w..T.a HD Rel No fff-?d-"/S G \ / .��/ TU s—gO mspesal aad,valel supply lanhhes al this 1°e,1lsn \ y�P' n.*.[•,w.".�., .n Lx'J•s.r'em.o.v. have.pr ;al etpn9•Ily ms9Ened b/Ilvs Daµv[Ipent m+dme SANITARY DESIGN Y .I•,HI m mmpfiance mDI Nese as hull plans T �' n°,•s.I m•m.v JUL p 91992 � CAFETERIA (9)- 20' x 20' = 400 SO FT / � r T Fs fiWn•u•I DATE CHIEF DT GENERAL x.[xur Qa S GPD/ PERSON 800 GP.4 TNGINEFRINC SERVICES � muww� KITCHEN SEATS (Or, @J 1 5 gpd = 150 GPD FyEET t `� \ 0'{• 9 50 GPD. nq °vv SEPTIC TANK CAPACITY ten.., ^m°°° exon rnursc sFro ° �+z:°,'"+a Q _ n°f wl..xoa. °jx°e(Axdi oxmck•.'+' 4b \` ne6Fug sucmx Lxc TOT racrwepaex,Ksan. °oy�c'.o cy \ / I.`G� 2 (950 1 = 2000 GAL r, ` Itn`eEa vaL°• Iw - �\ 10' DIA x 4' LIQUID DEPTH _ OOv ww ,•� s-gwN �e GREASE TRAP LEACHING POOLS \ f- ' E..�:,IE T.I.Q.°.w�E..'•F t °I[°L / — = Q •'9aOaa RMYLA YELL[F.RP C°RP 10 w 1 m.nsc srrm 1O F \ l `_ 1000 4000 GAL /DAY 950 GPD / 15 633 3 5 FT .wTmE•• __ _ 31992 II \ _ / = 6' DIA x 5 LIQUID DEPTH 3i 4 = 20 IES V F. k >'I'a i°w:I+ P CON/C SUR r P.C- - l1 633 3/ x n (5I6/765-5020 'Vcav VLFi LWrS ARE TAKEN FROM 2 L P 10' DIA x 10 DEPTH •x,P,'a�n~z u (516) 65 09 111 '�i dSTCRAPNICq,4NP OF FRE FIVE a,Iseo I L L:+ AMWSOl/T ROA ALV. 1197/ TUVJrl UI_ 4'(}+ arF.w° q/4 a,.ss.s OL4 EASTERN iC'NS rad F°'ELL OETal 86- 375 A i New York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A^^^A^ 202207186 ROY H REEVE AGENCY INC 13400 MAIN RD . PO BOX 54 MATTITUCK NY 11952 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LAUREL LIGHTING INC MATTITUCK PARK DISTRICT 1977 MAIN ROAD PO BOX 1413 LAUREL NY 11948 MATTITUCK NY 11952 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11282068-4 564758 09/21/2017 TO 09/21/2018 4/4/2018 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1282 068-4, 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, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. 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. FRANK FENOY(PRES) OF ONE PERSON CORP LAUREL LIGHTING INC 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,INSURANCE FUND UNDERWRITING VALIDATION NUMBER*483951759 U-26.3 ,aco O® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `�../ 04/04/2018 THIS CERTIFICATE IS ISSUED ASA 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 Lori McBride NAME Roy H Reeve Agency,IncAHONE Ext (631)298-4700 A/C,No, (631)298-3850 PO Box 54 E-MAIL Imcbride@royreeve com ADDRESS 13400 Main Road INSURER(S)AFFORDING COVERAGE NAIC# Mattituck NY 11952 INSURER • General Casualty Co of Wisconsin(0310761) 24414 INSURED INSURER B Laurel Lighting Inc&Frank Fenoy INSURER C• 1977 Main Rd INSURER D INSURER E: Laurel NY 11948 INSURER F• COVERAGES CERTIFICATE NUMBER: CL183607878 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR AUUL15Ut3R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MM/DD MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 100,000 X Contractual Liability MED EXP(Any one person) $ 5,000 A CCX0395347 01/30/2018 01/30/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER GENERALAGGREGATE $ 2,000,000 POLICY PRODUCTS-COMP/OPAGG $ JECTPRO F—]LOC 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Pe AUTOS ONLY AUTOS (Per accident) $ HIRED NON-OWNEDPROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per cc I, $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION 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) Certificate Holder is included as Additional Insured with respect to General Liability as required by written contract,per the terms and conditions of form CX00030711-Contractors Policy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Mattituck Park District ACCORDANCE WITH THE POLICY PROVISIONS PO Box 1413 AUTHORIZED REPRESENTATIVE Mattituck NY 11952 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD A-0 �v APER VF Q AS NOTED 4 DATE: B.P. F E E By:- N01IFY 'BUILDING DEPARTMENT AT 765-11802 8A TO 4P FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. CoMpLy WITH ALL CODES OF NEW YORK STATE &TOWN CODES AS REQUIRED So"CWMW pb*H*VARD ffAft:reVMTEES I.T OCCUP Ll L- WITH, ,*ATE OUV C,,Ew OF, -Cy" � . ^ . ~ 1 STANDBY12kWSTAPJDBY GEMERATOR GENERATORS N�N�N������ �� ��^�N���^������ ���°������� �� �� � ����� � ��°� THE ������T F`��Fl|F,� ' ' '`— SMART' `�' '��/��^— Forthadiscerninghonneownorthatia |oohngforthe annarteat, most reliable permanent backup power solution. La LIMFTED Space Saving Design Commercial-Grade Briggs&Stratton Vanguard'Engine " 5O%smaller than our previous 12NNgenerator ° Powerful V-TwnOHVengine 60%Guiotere °Easy conversion between natural gas(NG]and liquid propane ° Re-engineered tobeGO%quieter than our previous 12kW vapor(LP)during installation Designed for Easy Installation &Maintenance Quality Clean Power " Easy tomove into installation location with two-wheel dolly °Ensures your electronics are safely powered °Approved for installation usclose oo18^toabu/|dmCorrosion orrooinn Ros|stautEnclosure&Base " Removable roof and side panels provide better service access " Made with automotive grade gekmnnea|steel toresist rust tothe engine and alternator " Powder-coated paint for years ofprotection against chips SymphnnggUUPower Management System and abrasions " Customizable toyour home's needs C "Automatically balances the power ofyour home's electrical load including high wattage items like air conditioning units and electric ovens LISTED ° Offers whole house power with amore affordable home generator GENERATOR SET RATINGS LIQUID PROPANE NATURAL GAS LIMITED WARRAIUTY4 MODEL VOLTAGE PHASE 142 BREAKER LP' kW LPi AMPS NG kW JvG AMPS PARTS LABOR,TRAVEL.,, Fortress 120/�40'1 1 1, 108 040546 60 60 2 417 YO r Briggs&Stratton .50 108 417 Year 040517 12o�R4b_ 1 ,6o' 60 12 `r^."generator~rated."accordance with uL(Underwriters Laboratories)e2oo(stationary engine generator assemblies) and CSA(Canadian Standards Association)standard co2om" ,00-0^(motors and generators) ^oased on no-load sound power ^The installation manual=*".ns "* w"� related�generator ����*��wn���=mm�m" ------ — ---� 1 ���m�t��°��"m=�^ detectors be installed and maintained inyour home ^Warranty details available=www m`uo=*stratton com GOO e STANDBY GENERATORS 12kW STANDBY GENERATOR ENGINE SPECIFICATIONS' , ENGINE LUBRICATION ( r ,.:..,....__ .._v__.. ° .....>,..H.,...._.....rN:_...»....._�.._..... ._. __.m_....._�.. l., .:...,,_.:..,,—..,,_._.... _ ....,._._,,..�..::.;._.. _ ._._....,..fit:___.µ.._..., ._,�.,,.._,.,,,.._...,. .__..,:....d Engine Model Briggs&Stratton Vanguard" Oil Capacity[oz] 48 Engine Model Type Trim Number 389575-0002E1 Lubrication System Full Pressure Engine Speed(RPM) 3600 Recommended Oil 5W30 Full Synthetic Liquid Propane(LP]or Engine Fuel Natural Gas(NG] Low Oil Pressure Sensor Yes En the C tinder Confi oration OHV :=AI.TERNATOR SPECS ; 9 y g A.. moa . w a d'„': __ - Manufacturer Mecc Alte Number of Cylinders 2 Type Self-Excited, Rotation Field Displacement(cc) 38/627 Voltage Regulator Brushless Bore&Stroke(in) 297/276 Insulation Class H Compression Ratio 8.31 Governor Type Electronic (_.m _. .__ CONTROLLER,FEATURES Hour Meter Yes Frequency Regulation +/-1 Hz LED Digital Display Yes Valves OHV with Hardened Seats Fault Code Display Yes Ignition System Fixed timing Magnetron® Electric Ignition Weekly Exerciser Yes Starter Motor Rating Voltage 12 Volt Battery 12 Volt UPIERATIb A m� FUEL.CONSUMPTION' SOUND RATINGQ,R AT'-7METERS' °' _.... �� 7- 50%Load 100%Load 69 dBA Liquid Propane 621 ft3/hr 17 gal/hr 83 8 ft3/hr 2 3 gal/hr Lowest measurement of 12 microphones around generator Sound level measurement at other locations around generator Natural Gas 117 ft3/hr — 172 ft3/hr — may be different depending upon installation configuration 'Fuel consumption rates are estimated based on normal operating conditions Generator operation may be greatly affected by elevation and the cycling operation of multiple electrical appliances—fuel flow rates may vary depending on these factors 2 i Goa STANDBY GENERATORS 12kW STANDBY GENERATOR ADDITIONAL OTHER FEATURES CERTIFICATION Enclosure Material Galvanneal Steel with Corrosion Resistant Paint CARE Compliant Yes Overcrank Protection Yes NFPA Approved Yes Engine Warm Up(sec) 20 or 50 Automatic Transfer Switch Controlled cUL Listed to CSA 22.2 NO 100-04 Yes Engine Coal Down(min) 1 NEMA Compliant Yes Response Time sec 26 or 56 Automatic Transfer p [see) Switch Controlled EPA Certified Fuel System Yes Monitoring Options Basic Wireless Monitor AVAILABLE ACCESSORIES � InfoHub"Monitor _.__ 1 �.�...,___.__ , Maintenance Kit Continuous 6035 Battery Charging Yes Fortress 6404 WEIGHT AND O)MENSIC)Nty £ Cold Weather Kit Briggs&Stratton 6348 Assembled Weight(lbs) 318 Basic Wireless Monitor 6264 Overall Dimensions(in) 28 x 24.4 x 37.2 InfoHub 6260 Packaged Weight(lbs) 345 Remote Status Monitor 6144 Packaged Dimensions(in) 39 x 35.5 x 45 28" 24.4" D cceasm�no 37.2" G � `4 • FORTRESS 3 26.1" 22.5" 3 m+ STANDBY GENERATORS 12kW STANDBY GENERATOR Natural Gas/Inlet Pressure less than 2 PSI/Pressure trop 1/2"Water Column/Specific Gravity 11.60 1/2"pipe capacity 3/4"pipe capacity 1"pipe capacity 1-1/4"pipe capacity 1-1/2"pipe capacity 2"pipe capacity 20'Length' 118 247 466 957 1,430 2,760 40'Length' 81 170 320 657 985 1,900 60'Length' 65 137 257 528 791 1,520 80'Length' 56 117 220 452 677 1,300 100'Length* 50 104 195 400 600 1,160 Liquid Propane/Inlet Pressure 11"Water Column/Pressuire Drcp 11/2"Water.Column%Spiec-Ilic Gravity 1,50 1/2"pipe capacity 3/4"pipe capacity 1"pipe capacity 1-1/4"pipe capacity 1-1/2"pipe capacity 2"pipe capacity 20'Length* 200 418 788 1,617 2,423 4,666 40'Length* 137 287 541 1,111 1,665 3,207 60'Length' 110 231 435 892 1,337 2,575 80'Length* 101 212 400 821 1,230 2,370 100'Length' 101 212 400 821 1,230 2,370 *Total length of piping from outlet of regulator to appliance furthest away TRANSFER SWITCH SPECIFICATIONS � Prewired 16 Circuit 100 AMP Model#071076 Standard 16 Circuit 100 AMP Model#071047 Symphony®11 100 AMP Model#071071 ■■■ ■ • . Symphony®II 150 AMP Model#071070 • • ■ • a _ . Symphony®Il 200 AMP Model#071068 Voltage Rating 120/240 A ® ■ Select Circuit 16 1 Number of Protected Circuits Symphony'II Whole House UL Approved Yes NEMA 3R Rated Yes ' i Disclaimer.Not for Prime Power or use where standby systems are legally required,for serious life safety or health hazards,or where lack of power hampers rescue of fire-fighting operations BRIGGS&STRATTON POST OFFICE BOX 702 MILWAUKEE,WI 53201 USA Copyright©2016 All rights reserved BS1007-C-11/16 Briggs&Stratton Corp reserves the right to make changes in specifications and features shown herein,or discontinue the product described at any time without notice or obligation 4