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HomeMy WebLinkAbout43101-Z ft= Town of Southold 12/7/2018 P.O.Box 1179 k 53095 Main Rd WSouthold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40090 Date: 12/7/2018 THIS CERTIFIES that the building GENERATOR Location of Property: 250 Paradise Point Rd, Southold SCTM#: 473889 Sec/Block/Lot: 93.-1-5.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/25/2018 pursuant to which Building Permit No. 43101 dated 10/5/2018 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 Bliven Jr,Douglas of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43101 12-05-2018 PLUMBERS CERTIFICATION DATED A thorized Signature TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY ./s,,l �aa4ytiti 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#: 43101 Date: 10/5/2018 Permission is hereby granted to: Bliven Jr, Douglas 250 Paradise Point Rd Southold, NY 11971 To: install generator as applied for. At premises located at: 250 Paradise Point Rd, Southold SCTM #473889 Sec/Block/Lot# 93.-1-5.2 Pursuant to application dated 9/25/2018 and approved by the Building Inspector. To expire on 4/5/2020. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CO -RESIDENTIAL $50.00 Total: $235.00 ing 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 p� Date.' New Construction: Old or Pre-existing Building: (check one) Location of Property: IQ 1 n t Rd House No. Street Hamlet Owner or Owners of Property:��QUlg1Q,Y��1 V Suffolk County Tax Map No 1000, Section 0 q3 Block Lot 5.�-- Subdivision Filed Map. ��'11 Lot: Permit No. 0 Date of Permit. Applicant: C��LiQ6,ki,_ "wl r Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ pplicant Signature oF so�ryolo Town Hall Annex Telephone(631)765-1802 54375 Main Road N Fax(631)765-9502 P.O.Box 1 179 G Q Southold,NY 11971-0959 -gyp • i0 roper.richertl town.southold.ny.us �yCOUNTY,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Bliven Address: 250 Paradise Point Rd City Southold St: New York Zip. 11935 Building Permit#' 43101 Section. 93 Block: 1 Lot: 5.2 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE contractor DBA. Shore Power Electric License No 42536-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1 st 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 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 FixtureTime Clocks Disconnect Switches Twist Lock Exit Fixtures TVSS El Other Equipment: 11 KW standby generator with 200a transfer switch Notes: Inspector Signature: Date: December 5 2018 81-Cert Electrical Compliance Form.xls OF SOUjyo� f # TOWN OF SOUTHOLD BUILDING DEPT. °��ou►m � 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: �/4/ i DATE INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS Wt4 FOUNDATION (IST) Cis ------------------------------------ d 'FOUNDATION (2ND) 1'� Z � O ROUGH FRAMING& H PLUMBING INSULATION PER N.Y: y STATE ENERGY CODE FINAL ADDITIONAL COMMENTS -A rar � z S H z° e b H 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 J� Survey SoutholdTown.NorthFork.net PERMIT NO. U Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application �Q� Flood Permit Examined 20A U Single& Separate �� Storm-Water Assessment Form Contact: Approved 20� Ma110 to:�lf1O� � Disapproved a/c C P_V 1 Ze.�'l1 IM Phone:6031- �9�'�/DoZ4 t10 0 Expiration ,20 6A la D L5.`:,L-:iU`V� Cep-l-r� Moric�,�s I X93`{ i Bu ector �4 t SEP 2 5 2018 APPLICATION FOR BUILDING PERMIT _ TY� Date CDC> , 20J�' INSTRUCTIONS J 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. n Sig ture of applicant or name,if a corporation)s (Mailing address of applicant) /193'1 State whether applicant is owner, lesse , agent, chitect, engineer, general contractor, electrician,plumber or builder Name of owner of premises ` _D0u9k4s__V_!�VkVC^ v (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. CA5-le h Other Trade's License No. 1. Location nd on which p osed work will be done: a?5� ardd ism i ted. c � House Number Street Hamlet �j County Tax Map No. 1000 Section -/3 Block ' Lot 5. �- 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 At ratioiA _ Repair Removal Demolition Other Work#'T_A — (Descriptio 4. Estimated Cost 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 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 NE YORK) DALE KATHRIN IMA 8M Kota�r Public, tsto of Now York 4 S: ROOO$V$00ft 401 WAS340064 COUNTY OF C MIO*d I SYff k Gaunt / EXPIMS APA K2620 Elft, L4WIVAO r being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the (Contra cto Agent orporate 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 me this day of OXt&bCV 20 /9 ej, Notary Public Signature of Applicant ySFFOt fi BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 roger.richertCa)-town.southold.ny.us APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: t ' Date: Company Name: Name: ' License No.: 4,1B 3&1A email: e Address: p a- Phone No.: JOB SITE INFORMATION: (Ali Information Required) Name: Address: b / /97/ Cross Street: Phone No.: BIdg.Permit#: email: Tax Map District: 1000 Section: C1,3 Block: / Lnot: fit... BRIEF DESCRIPTION OF WORK(Please Print Clearly) �� -g��c -inn, d t%yl Circle All That Apply: Is job ready for inspection?: YES NO Rough In Final Do you need a Temp Certificate?: YES NO Issued On Temp Information: (Ail information required) Service Size 1 Ph 3 Ph Size: A # Meters Old Meter# New Service - Fire Reconnect- Flood Reconnect- Service Reconnected - Underground - Overhead #Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION �O�J — �,,t,P1L- �3� 82-Request for Inspection Formals to YORK New workers' CERTIFICATE OF INSURANCE COVERAGE STTA E Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured SHORE POWER ELECTRICAL CONTRACTING, INC 108 FROWEIN RD-#2 631 3954029 CENTER MORICHES, NY 11934 Work Location of Insured(Only required if coverage is specifically limited to 1c.Federal Employer Identification Number of Insured certain locations In New York State,i.e.,Wrap-Up Policy) or Social Security Number 20-4999885 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier TOWN ein O LSOUTHOLID ate Holder) Standard Security Life Insurance Company of New York TOWN HALL ANNEX 3b.Policy Number of Entity Listed in Box"1 a" SOUTHOLD, NY 11971 79516-00 3c.Policy effective period 1/1/2018 to 8/3/2019 4. Policy provides the following benefits: Qi A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: Q A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law n B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as descp1IJlIed above. Date Signed 8/4/2018 By il�- �q.4APt (Signature of insurance carrier's authorizlid representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY SERVICES IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 413,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220, Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton,NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(Only if Box 4C or 513 of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note: Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) 11111111,0°°!111111111111111111111°°111111111111111 NEW Workers' YORK Compensation CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name and address of Insured(use street address only) 1 b. Business Telephone Number of Insured SHORE POWER ELECTRICAL CONTRACTING INC (631)399-4569 108 FROWEIN RD STE 2 CENTER MORICHES NY 11934 1c. NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e. a Wrap-Up Policy) 1d. Federal Employer Identification Number of Insured or Social Security Number 20-4999885 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) The Hartford Casualty Insurance Company Town of Southold 29424 TOWN HALL ANX 3b. Policy Number of Entity Listed in Box"l a": SOUTHOLD NY 11971 12 WEC AB5PSI 3c. Policy effective period: 07/20/2018 to 07/20/2019 3d.The Proprietor, Partners or Executive Officers are ❑ Included.(Only check box if all partners/officers included) ® all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "1a" for workers'compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Worker's Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Danielle Clausen (( (print name of authorized representative or licensed agent of insurance carrier) Approved by: c_.(,a u au rte} 07/19/2018 (Signature) (Date) Title: Operations Manager Telephone Number of authorized representative or licensed agent of insurance carrier 631-589-0100 C-105.2(9-17) Form WC 88 3121 F Printed in U.S.A. www.wcb.ny.gov Page 1 of 2 SHORE-4 OP ID: KL ,d►C'oRO CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD(YYYY) 08/04/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must 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 C NTA NAME: Hometown Insurance of LI,Inc PHONE 631-567-1011 ac No:631-589-4207 Weber Agency c No xt 5 Orville Drive,Suite 400 A DRIESS: Bohemia,NY 11716 James Small INSURERS AFFORDING COVERAGE NAIC 0 INSURER A:The Ohio Casualty Insurance Co INSURED Shore Power Electrical INSURER 8:State Insurance Fund 36102 Contracting,Inc. INSURER c:Standard Security Life Ins.Co 69078 108 Frowein Road,#2 Center Moriches, NY 11934 INSURER D 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 ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0DAMAGETO0 CLAIMS-MADE a OCCUR BKO(19)57918685 07/17/2016 07/17/2019 PREMISES Ea occurrence s 300,00 MED EXP(Any one person) $ 15,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,00 POLICY�JEST 0 LOC PRODUCTS-COMP/OP AGG S 2,000,00 OTHER: $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Per accident S UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DED I I RETENTIONS 1 S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STER ER _ B ANY PROPRIETOR/PARTNERIEXECUTIVE YIN N/A 11329705-6 07/20/2018 07/20/2019 E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandstory In NH) E.L.DISEASE-EA EMPLOYEE S If yes,desuibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S C DISABILITY BENEFIT 79516-00 01/01/2018 08/03/2019 STATUTORY LAW DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION TOWN014 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. Town Hall Annex Southold,NY 11971 AUTHORIZED REPRESENTATIVE W I-IVt'0 ,. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD i�' � �0 �. 31'U J�.�i� * •'f �• ,.i .�1i' ::1,t) �1f•i ! •. •.a:� •4 �I ; ., � , ' •.j . � , 1' 4 ' •f i. r k is/..lit"•, r.;11 •1: '�lO�.� �t � +. .' �t� �,• 1 �s ,� � � �''p�� �. �. 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',,•: '.' • • �i' } (w�'�!:•@'�'�F'ta L�4hJ�tJRYL�'Y+�R!�''• ` ELECTRICAL O—W(W— INSPECTION REQUIRED ENERAC 8 A R VED AS NOT9 DATE:-1015111 B.P.# 4sjili 9,0 )kW FEE: D D By, UARDIAN@ SERIES _ NOTIFY BUILDING DEPAR e,M ential Standby Generators 765-1802 8 AM TO 4 PM FOR THE Air-Cooled Gas Engine FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED ' INCLUDES: 2. ROUGH - FRAMING & PLUMBING Standby Power Rating 3. INSULATION • True Power"" Electrical Technology 4, FINAL - � (� � 7G3o u IA'ununur7 F s.iur:) k4v �o N< • Two Line LCD Multilingual Digital BE ComPLETE�� 3D�, ,,,, i „ r;AI Evolution"" Controller (English/SpanishALL CONSTRUCTION S French/Portuguese) M�Ig7T"Eo ,Alin r;irn r r - �:I;,{,j,-) I i nw Gn 117 REQUIREMENTS OF THE CODES OF NEW • Two Transfer Switch Options AvailableYORK STATE. NOT RESPONSIBLE FOR 100 Amp 16 CircuitSwitch or DESIGN OR CONSTRUCTION ERRORS. 200 Amp Service Rated Switch. See Page 4 for Details. _ • Electronic Governor COMPLY WITH ALL CODES OF • System Status & Maintenance Interval LED Indicators NEW YORK STATE & TOWN ODES == • Sound Attenuated Enclosure AS REQUIRED AND CONDITI N3.'OF GENERAC'-- _ --- ---_ • Flexible Fuel Line Connector • Direct-To-Dirt Composite Pad • Natural Gas or LP Gas Operation • 5 Year Limited Warranty $ • Capability to be installed within 18" (457 mm) of �} a building* Note:CUL certification only applies to unbundled units and units packaged with pre-wired switches.Units packaged with the Smart Switch are UL certified in the USA only OCCUPANCY 0 R*Only if located away from doors,windows and fresh air intakes,and unless otherwise directed by local codes. FEATURES d8Eis/ Cl INNOVATIVE DESIGN&PROTOTYPE TESTRJ6 I k1 Cdrti Ujof E RTF I lQI FREQUENCY COMPENSATED VOLTAGE P,EGULAIION. This state- GENERAC'S success in"IMPROVING POW �F DoQId►� 1A 9"'N "' C T of-the-art power maximizing regulation system is standard on all General;models.It stop there. Total commitment to compone Ing, by i g,r% provides optimized FAST RESPONSE to changing load conditions and MAXIMUM environmental testing,destruction and life testing,plus testing to applicable MOTOR STARTING CAPABILITY by electronically torque-matching the surge CSA,NEMA,EGSA,and other standards,allows you to choose GENERAC loads to the engine.Digital voltage regulation at±1%. POWER SYSTEMS with the confidence that these systems will provide superior SINGLE SOURCE SERVICE RESPONSE from Generac's extensive dealer network performance. provides parts and service know-how for the entire unit, from the engine to the o TRUE POWER ELECTRICAL TECHNOLOGY Superior harmonics and sine wave smallest electronic component. form produce less than 5%Total Harmonic Distortion for utility quality power.This allows c, GENERAC TRANSFER SWITCHES Long life and reliability are confident operation of sensitive electronic equipment and micro-chip based appliances, synonymous with GENERAC POWER SYSTEMS. One reason for this confidence such as variable speed HVAC systems. is that the GENERAC product line includes its own transfer systems and controls for total system compatibility O TEST CRITERIA. PROTOTYPE TESTED NEMA MGI-22 EVALUATION SYSTEM TORSIONAL TESTED MOTOR STARTING ABILITY RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 OF THE TOWN CODE. w GENERAC AQ0@PROMISE ��,+�'"�+r,,,n©o Mobile �y Link �'�NNF — *Budt In the USA using domestic and foinogn parts. GENERAC 9/11 kW features and benefits Engine •Generac(OHVI)design Maximizes engine"breathing"for increasedfueloefficiency. Plateau honed cylinder walls and plasma moly rings helps the engine run 66W,reducing oil consumption resulting in longer engine life. •"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 Pressurized lubrication to all vital bearings means-better performance,less maintenance and longer engine life.Now featuring up to a 2 year/200 hour oil change interval. •Low oil pressure shutdown system Shutdown protection prevents catastrophic engine damage due to low oil. -High temperature shutdown Prevents damage due to overheating. Generator •Revolving field Allows for smaller,light weight unit that operates 25%more efficiently than a revolving armature generator •Skewed stator Producen Wootn 011 tput waiteform for cotMpatibilit*wjth electronic equipment. •Displaced phase excitation Maximizes motor starting capabiliti f Y •Automatic voltage regulation Regulates the output voltage to±1%prevents clAa6Tng voltage spikes. •UL 2200 listed For your safety Transfer Switch -Fully automatic Transfers your vital electrical IoagsTo the energized source of power -NEMA 311 Can be installed inside or oustide for maximum flexibility •Remote mounting Mounts near your existing distribution panel for simple,low-cost installation. Evolution"' Controls •Auto/Manual/Off illuminated buttons Selects the operating mode and provides easy,at-a-glance status indication in any condition. •Two-line LCD multilingual display Provides homeowners easily visible logs of history,maintenance and events up to 50 occurrences. •Sealed,raised buttons Smooth,weather-resistant user interface for programming and operations. •Utility voltage sensing Constantly monitors utility voltage,setpoints 65%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 2-1500 seconds from the factory default setting of 5 seconds by a qualified dealer •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 exerciser Operates engine to prevent oil seal drying and damage between power outages by running the generator for 12 minutes every other week.Also offers a selectable setting for weekly or monthly operation providing flexibilty and lower fuel costs to the owner •Smart battery charger Delivers charge to the battery only when needed at varying rates depending on outdoor air temperature. Compatible with lead acid and AGM-style batteries. •Main line circuit breaker Protects generator from overload. •Electronic governor Maintains constant 60 Hz frequency Unit •SAE weather protective enclosure Sound attenuated enclosures ensure quiet operation and protection against mother nature,withstanding winds up to 150 mph.Hinged key locking roof panel for security Lift-out front for easy access to all routine maintenance items.Electro- statically applied textured epoxy paint for added durability •Enclosed critical grade muffler Quiet,critical grade muffler is mounted inside the unit to prevent injuries. •Small,compact,attractive Makes for an easy,eye appealing installation,as close as 18"away from a building. Installation System •1 ft(305 mm)flexible fuel line connector Absorbs any generator vibration when connected to rigid pipe •Direct-to-dirt composite pad Complex lattice design prevents settling or sinking of the generator system. •Integral sediment trap Prevents particles and moisture from entering the fuel regulator and engine,prolonging engine life GENERAC® 9/11 kW s ecifications Generator Model G007029-0,G007030-0(9 kW) G007031-0,G007032-0,G007033-0(11 kW) Rated Maximum Continuous Power Capacity(LP) 9,000 Watts* 11,000 Watts* Rated Maximum Continuous Power Capacity(NG) 8,000 Watts* 10,000 Watts* Rated Voltage 240 240 Rated Maximum Continuous Load Current—240 Volts(LP/NG) 37.5/33.3 45.8/417 Total Harmonic Distortion Less than 5% Less than 5% Main Line Circuit Breaker 40 Amp 50 Amp Phase 1 1 Number of Rotor Poles 2 2 Rated AC Frequency 60 Hz 60 Hz Power Factor 10 1.0 Battery Requirement(not included) 12 Volts,Group 26R 540 CCA Minimum or Group 35AGM 650 CCA Minimum Unit Weight(Ib/kg) 340/154 348/158 Dimensions(L x W x H)in/mm 48 x 25 x 29/1218 x 638 x 732 Sound output in dB(A)at 23 ft(7 m)with generator operating at normal load** 66 63 Engine Type of Engine GENERAC OHVI GENERAC OHVI V-TWIN Number of Cylinders 1 2 Displacement 426 cc 530 cc Cylinder Block Aluminum w/Cast Iron Sleeve Aluminum w/Cast Iron Sleeve Valve Arrangement Overhead Valve Overhead Valve Ignition System Solid-state w/Magneto Solid-state w/Magneto Governor System Electronic Electronic Compression Ratio 9 0:1 9.5:1 Starter 12 Vdc 12 Vdc Oil Capacity Including Filter Approx.11 qV1 0 L Approx.1.7 gI/1.6 L Operating rpm 3,600 3,600 Fuel Consumption Natural Gas ft3/hr(m3/hr) 1/2 Load 109(mg) 123(3 48) Full Load 133(3 77) 199(5 64) Liquid Propane 0/hr(gal/hr)[I/hr] 1/2 Load 36(1.00)[3 79] 43(1 19)[4 49] Full Load 54(1.50)[5.66] 73(2.01)[7.62] Note:Fuel pipe must be sized for full load. Required fuel pressure to generator fuel inlet at all load ranges-3.5-7"water column(7-13 mm mercury)for natural gas,10-12"water column(19-22 mm mercury)for LP gas.For Btu content,multiply I13/hr x2500(LP)or ft3/hr x 1000(NG).For Megajoule content,multiply m3/hr x 93.15(LP)or m3/hr x 37.26(NG). Controls 2-Line Plain Text Multilingual LCD Display Simple user interface for ease of operation. Mode Buttons: Auto Automatic Start on Utility failure.Programmable exerciser. Manual Start with starter control,unit stays on.If utility fails,transfer to load takes place. Off Stops unit.Power is removed.Control and charger still operate. Ready to Run/Maintenance Messages Standard Engine Run Hours Indication Standard Programmable start delay between 2-1500 seconds Standard(programmable by dealer only) Utility Voltage Loss/Return to Utility Adjustable(Brownout Setting) From 140-171 V/190-216 V Future Set Capable Exerciser/Exercise Set Error Warning Standard Run/Alarm/Maintenance Logs 50 Events Each Engine Start Sequence Cyclic cranking:Engine cranks a maximum of five times at factory set intervals and durations. Starter Lock-out Starter cannot re-engage until 5 sec.after engine has stopped. Smart Battery Charger Standard Charger Fault/Missing AC Warning Standard Low Battery/Battery Problem Protection and Battery Condition Indication Standard Automatic Voltage Regulation with Over and Under Voltage Protection Standard Under-Frequency/Overload/Stepper Overcurrent Protection Standard Safety Fused/Fuse Problem Protection Standard Automatic Low Oil Pressure/High Oil Temperature Shutdown Standard Overcrank/Overspeed(@ 72 Hz)/rpm Sense Loss Shutdown Standard High Engine Temperature Shutdown Standard Internal Fault/Incorrect Wiring Protection Standard Common External Fault Capability Standard Field Upgradable Firmware Standard **Sound levels are taken from the front of the generator Sound levels taken from other sides of the generator may be higher depending on installation parameters.Rating definitions-Standby Applicable for supplying emergency power for the duration of the utility power outage No overload capability is available for this rating. (All ratings in accordance with BS5514,IS03046 and DIN6271). *Maximum wattage and current are subject to and limited by such factors as fuel Btu/megajoule content,ambient temperature,altitude,engine power and condition,etc. Maximum power decreases about 3.5 percent for each 1,000 feet(304 8 meters)above sea level,and also will decrease about 1 percent for each 6°C(10°F)above 16°C(60°F) GENERAC® ° 9/11 kW switch options Limited Circuits Switch Features Model G007030-0(9 kW) G007032-0(11 kW) • 16 circuits. No.of Poles 2 2 Current Rating(Amps) 100 100 • Electrically operated,mechanically-held contacts for fast,positive Voltage Rating(VAC) 250 250 connections. Utility Voltage Monitor(Fixed)` • Rated for all classes of load,100%equipment rated,both inductive and -Pick-up 80% 80% Dropout 65% 65% resistive. Return to Utility' approx.15 sec approx.15 sec • 2 pole,250 VAC Contactors. Exerciser bi-weekly for 12 minutest Standard Standard • 30 millisecond transfer time. UL Listed standard Standard Total of Pre-wired Circuits 16 16 • Single coil design. No.15 A 120 V 5 5 No.20 A 120 V 5 5 • Main contacts are silver plated or silver alloy to resist welding and sticking. No.20 A 240 V 1 1 • NEMA/UL 3R aluminum outdoor enclosure No.30 A 240 V — — No.40 A 240 V 1 1 • Multi listed for use with 1"standard,tandem,GFCI and AFCI breakers No.50 A 240 V 1 1 from Siemens,Murray,Eaton and Square D for the most flexible and cost Tandem Breaker Capabilities 8 Tandems 8 Tandems effective install Circuit Breaker Protected Available RMS Symmetrical Fault Current @ 250 Volts 10,000 10,000 `Function of Evolution Controller t Can be set to weekly or monthly Dimensions —W, 200 Amps 120/240,1e Open Transition Service Rated Height Width Depth H1 H2 W1 W2 in 27.24 30.0 114 13.5 7.09 mm 692 0 762.4 289.0 1 343.0 180.0 H2 H+ Note:The 50 amp switch is flush mountable.H1 and Wt refer to mounting hole spacing. H2 and W2 are cover dimensions.H3 and W3 are the enclosure dimensions without cover. Wire Ranges Conductor Lug J Neutral Lug Ground Lug DEPTH I 1/0-#14 2/0-#14 210-#14 W2 Service Rated Smart Switch Features Model G007033-0(11 kW) available on 11 kW model only No.of Poles 2 • Includes Digital Power Management Technology standard(DPM) Current Rating(Amps) 200 Voltage Rating(VAC) 250 • Intelligently manages up to four air conditioner loads with no Utility Voltage Monitor(Fixed)* additional hardware. -Pick-up 80% • Up to eight more large(240 VAC) loads can be managed when used in -Dropout 65% conjunction with Smart Management Modules(SMMs) Return to Utility* approx.13 sec. Exercise weekly for 12 minutes` Standard • Electrically operated,mechanically-held contacts for fast,clean connections. UL Listed Standard Enclosure Type NEMA/UL 3R • Rated for all classes of load, 100%equipment rated,both inductive and resistive. Withstand Rating(Amps) 22,000 • Service equipment rated,dual coil design. Lug Range 250 MCM-#6 • Rated for both aluminum and copper conductors. `Function of Evolution Controller W+ • Main contacts are silver plated or silver alloy to resist welding and sticking. • NEMA/UL 3R aluminum outdoor enclosure. Dimensions 200 Amps 120/240,ie Open Transition Service Rated M2 Ht Height Width Depth H1 H2 W1 W2 in 27.24 30.0 114 13.5 7.09 mm 692.0 762.4 289.0 343.0 180.0 rMIH J W2--� GENERAC® 9/11 kW available accessories Model# Product Description Generac's Mobile Link allows you to check the status of your generator from anywhere that you G006463-3 Mobile Link'" have access to an Internet connection from a PC or with any smart device. You will even be notified via e-mail or text message when a change in the generator's status occurs. Available in the U.S.only. Every standby generator requires a battery to start the system.Generac offers the recommended 1005819 0 26R Wet Cell Battery 26R wet cell battery for use with all air-cooled standby product excluding PowerPact® G007101-0 Battery Pad Warmer The pad warmer rests under the battery and will warm the battery.Recommended for use if the temperature regularly falls below 0°F (Not necessary for use with AGM-style batteries) G007102-0 Oil Warmer Oil warmer slips directly over the oil filter.Recommended for use if the temperature regularly falls below 0°F. G007103-0 Breather Warmer The breather warmer is for use in extreme cold weather applications. For use with Evolution controllers only in climates where heavy icing occurs. G005621-0 Auxiliary Transfer Switch The auxiliary transfer switch contact kit allows the transfer switch to lock out a single large electri- Contact Kit cal load you may not need.Not compatible with 50 amp pre-wired switches. The fascia base wrap snaps together around the bottom of the new air cooled generators.This G007027-0 Fascia Base Wrap Kit offers a sleek,contoured appearance as well as offering protection from rodents and insects by covering the lifting holes located in the base. If the generator enclosure is scratched or damaged,it is important to touch-up the paint to protect G005703-0 Paint Kit from future corrosion.The paint kit includes the necessary paint to properly maintain or touch-up a generator enclosure. G006482-0-9 kW Generac's scheduled maintenance kits provide all the hardware necessary to perform complete G006483-0-1 1 kW Scheduled Maintenance Kit routine maintenance on a Generac automatic standby generator. Completely wireless and battery powered,Generac's wireless remote monitor provides you with G006664-0 Wireless Remote Monitor instant status information without ever leaving the house.Not compatible with CorePower or EcoGen systems. Smart Management Module Smart Management Modules are used in conjunction with the Automatic Transfer Switch to G006873-0 (50 Amps) increase its power management capabilities.It provides additional power management flexibility not found in any other power management system. dimensions & UPCs Dimensions shown are approximate. Refer to Installation manual for exact dimensions DO NOT USE THESE DIMENSIONS FOR INSTALLATION PURPOSES. - - .8 - [48.0 In] [25In) [zs.t 1.j Model UPC t G007029-0 696471070293 - _ 1007030-0 696471070309 727.2— I` `-- 0007031-0 696471070316 (2&B lnji_- 1I p 1007032-0 696471070323 G007033-0 696471070330 [ - 1232—__ j2s.81nj _ -_ [48.51.1 LEFT SIDE VIEW FRONT VIEW GENERAC® Generac Power Systems,Inc. • S45 W29290 HWY.59, Waukesha,WI 53189 • generac,com 0c2016 Generac Power Systems,Inc. All rights reserved. All specifications are subject 10 change without notice. Bulletin 10000000191-B 5/18/16