HomeMy WebLinkAbout45024-Z Town of Southold 10/3/2020
P.O.Box 1179
w 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 41496 Date: 10/3/2020
THIS CERTIFIES that the building SOLAR PANEL
Location of Property: 360 Cottage Way, Mattituck
SCTM#: 473889 Sec/Block/Lot: 122.-2-23.22
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
7/16/2020 pursuant to which Building Permit No. 45024 dated 7/24/2020
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:
roof mounted solar panels as applied for.
The certificate is issued to Bolling, Crystal
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 45024 9/17/2020
PLUMBERS CERTIFICATION DATED
X�&
th ignature
S Fill
TOWN OF SOUTHOLD
oo�° may BUILDING DEPARTMENT
z TOWN CLERK'S OFFICE
"o o SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 45024 Date: 7/24/2020
Permission is hereby granted to:
Bolling, Crystal
360 Cottage Way
Mattituck, NY 11952
To: install roof mounted solar panels as applied for.
At premises located at:
360 Cottage Way, Mattituck
SCTM #473889
Sec/Block/Lot# 122.-2-23.22
Pursuant to application dated 7/16/2020 and approved by the Building Inspector.
To expire on 1/23/2022.
Fees:
SOLAR PANELS $50.00
CO-ALTERATION TO DWELLING $50.00
1, CT $100.00
Total: $200.00
�.�ilding Inspector
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings,property lines, streets, and unusual natural or
topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead.
5. Commercial building,industrial building,multiple residences and similar buildings and installations, a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings(prior to April 9, 1957)non-conforming uses, or buildings and "pre-existing"land uses:
1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is
denied,the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling $50.00,Alterations to dwelling$50.00,
Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00, Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00
Date. (P (�s 1j
7 GZ 0
New Construction: Old or Pre-existing Building: v"_ (check one)
Location of Property: C) C c c(
House No. S reet Hamlet
Owner or Owners of Property: C
Suffolk County Tax Map No 1000, Section 2 Z Block Z Lot 2-
Subdivision
Subdivision Filed Map. Lot:
Permit No. Z Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applicant Signature
Building Department Application
AUTHORIZATION
(Where the Applicant is not the Owner)
I, 0 L! at 3(0
(Pn t property owner's name) 1 (Mailing Address)
Audc IU Ul do hereby authorize Set UJa L ICQ y/ G
(Agent)
y-e2✓l�-@�-� SCl Gl✓ to apply on my behalf to the
Southold Building Department.
QMM, 4,�-%uw� -- - alm o
(Owne s Signature) 6 1(Dal,-)
U) 6W k),110a
(Print Owner's N e)
®��pE SO(�r�®�
Town Hall Annex ® Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 117 . . .
Southold,NY 119711 seandevlin-0959 �` ® �® @townSoutholdn y'us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Crystal Bolling
Address: 360 Cottage Way city,Mattituck st: NY zip: 11952
Building Permit#: 45024 Section: 122 Block: 2 Lot: 23.22
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Greenleaf Solar License No: 62090ME
SITE DETAILS
Office Use Only
Residential X Indoor X Basement X Solar X
Commerical Outdoor X 1st Floor Pool
New X Renovation 2nd Floor Hot Tub
Addition Survey X Attic Garage
INVENTORY
Service 1 ph X Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel 150A A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors
Sub Panel A/C Blower Range Recpt Ceding Fan Combo Smoke/CO
Transformer UC Lights Dryer Recpt Emergency FixturesTime Clocks
Disconnect 1 Switches 4'LED Exit Fixtures Pump
Other Equipment. TOM Roof Mounted PV Solar Energy Syatem w/ (19) SN72-Cell-SN370M-10
Modules, Enphase IQ Combiner 3, 30 Breaker in Panel
Notes: Solar
September 17, 2020
Inspector Signature: -- 1 Date:
S Devlin-Cert Electrical Compliance Form.xls
�o��,oFsouryolo 1 5621L/ "5(oV cO e ;l
# # TOWN.OF SOUTHOLD BUILDING DEP r
`yrouxn '' 765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] --ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION-
] ' FIRE
NSPECTION-
] ' FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ' ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
DATE INSPECTOR (��
f. [EC
PASSARELLf DD
ENGINEERING , P L L C SEP 2A 2020
September 23, 2020 ]BUMMIG DEPTI•
TOWN c
Attention: Town of Southold Building Department
Subject: Engineer Statement for Solar Roof Installation
Bolling Residence—360 Cottage Way Mattituck, NY 11952
Permit No 45024
Installation Date: 09/01/2020
Town Inspection Date: 09/21/2020
To whom it may concern at the Building Department,
This letter confirms that the roof mounted photovoltaic system at the above referenced
property has been installed as per the design documentation that adheres to requirements of
the 2015 International Residential Code, as well as the 2017 New York State Uniform
Supplement, ASCE 7-10, Long Island Unified Solar Permit Initiative, and the National Electric
Code 2014. This photovoltaic system installation has been inspected and met the
requirements of the building department.
If you have any questions feel free to contact me directly.
��oF NE VV Y0
Sincerely, Q. �SEPH
CO
m w
UJ
Garrett J. Passarelli, P.E. Nt�`� 093600
Principal Ah'OFESS\�NP�'
Passarelli Engineering PLLC
NY PE# 093600
Garrett J.Passarelli,P.E. • 81 Lincoin Avenue Port Jefferson Station,NY (631)708-4575 garrett@passeng.com
FIELD INSPECTION REPORT DATE CORE ENTS-
Vo
FOUNDATION(1ST) �}
--------------------- -------- -
FOUNDATION(2ND)
ROUGH FRAMING&
PLUMBING y
INSULATION PEA N.Y.
STATE ENERGY CODE
T vv
FINAL
.ADD All N ,C�J1N%IMENTs- '
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL:(631)765-1802 Planning Board approval
FAX:(631)765-9502 ]�� Survey
SoutholdTown.NorthFork.net PERMIT NO. (J Check
Septic Form
N.Y.S.D.E C
Trustees
C.O Application
Flood Permit
Examined 20 Single&Separate
Storm-Water Assessment Form
Contact:
Approved 20� Mad to:
Disapproved c
Phone-
Expiration _ 20
g Inspect r
I t APPLICATION FOR BUILDING
D Data,l4Q 20?i-1
INSTRUCTIONS
J U L 1 6 2Q.2fitis 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._EljQLplan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
B�gil� EUPways.
1Dcovered 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.
(Siguature of applicant or name,if a corporation)
I 14:hv><,oa �r- F. Seecr_g+ !
(Mailing address of applicant)
State whether ap licant is rownner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Name of owner of premises (_VI.QC �j l P—�l
— ) (As on the tax roll oil 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.
Other Trade's License No.
1. Locationofland on which p o osed work will a done:21
cip
OLLD
House Number Street Hamlet 'j-�`•f
County Tax Map No. 1000 Section '�Z Block Z Lot ,!��-
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and inten ed use and occupancy of proposed construction:
a. Existing use and occupancy esti GQlL Ck-
b. Intended use and occupancy eS p C.�O 1Ll'l Q
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work Boit/ Ll/t�I
��II
4. Estimated Cost �l ZS',C ). w Fee (Description)
(To be paid on filing this application)
5. If dwelling,number of dwelling units Number of dwelling units on each floor
If garage,number of cars
6. If business,commercial or mixed occupancy,specify nature and extent of each type of use.
7. Dimensions of existing structures,if any:Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stones
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 f
13.Will lot be re-graded?YES_NO Will excess fill be removed from premises?YES_NO
14.Names of Owner of premise 16011 t!n Address 3100 y Phone No. ( Z b 10
Name of Architect 555 i inewepAddressW Llcc.ltrl . Phone No 103( -709-L4 S��
Name of Contracto recol -(—Sc(Q,. Address 1 f /• Phone No. (P G'o 4 l 7(f
£•5 'K&:
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. %e"�
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)
S:
COUNTY O s I ,
_L l ` being duly sworn,deposes and says that(s)he is the applicant
(Nam f individual signing contract))ab a named,
�l
(S)He is the �` Wcacf/ U�— ✓.Q P In 1 C�� �y
(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 to before me this
V_ewx day of 20-2(-)
V"U(A, &h*W
Notary Public Signature of Applicant
- OF SQ(�j�o 1 �
Tam Hall Amex #f Telephone(631)765-1802
54375 Main Road rt _oW111r)7a 0lfl
P.O.Box 1179 ® �� roaer.riche nv us "
Southold,NY 11971-4959
BUIT DING DEPAIt M3M !
TOWN OF SOUTI jOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: ✓ eyi�e - SJla✓ Date:
Company Name: l I
Name:
License No.: U-eU C? c
Address: (e 1Rd
Phone No.: S]QgI-7 c n
JOBSITE INFORMATION: (*Indicates required information)
*Name:
*Address: �V C.Liu -
*Cross Street: _� �d ^-_j
*Phone No.: ( I
Permit No.: V
Tax-Map District: 1000 Section:_L2�,� Block: Z Lot:
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
- 1 Q y-°�/j/ •L rz�21
C_VILO to
(Please Circle All That Apply)
*Is job ready for inspection: ES NO Rough In Final
*Do-you need a Temp Certiffeate: NO
Temp Information(If needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350400 Other
*New Service: Re-connect Underground Number of Meters Change of Seryice Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
824Request for Inspection Form
[ VO
Ic2, Cc.�7zMa� � 2Z� 2 ?"t 0 )5-1
Scott A. Russell ,��0S111 Ir 00, STOWWWA\TIE]CI
SUPERVISOR - WA
SOUTHOLD TOWN HALL-P.O.Box 1179
53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of So u th o l d
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
—
DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING:
' Yes No (CHECK ALL THAT APPLE
❑EfA. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface.
1 ❑ B. Excavation or filling involving more than 200 cubic yards of material
within any parcel or any contiguous area.
❑D"C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
7
❑[2"*D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
�I t
❑['E. Site preparation within the one-hundred-year floodplain as depicted
on FIRM Map of any watercourse.
®0--T. Installation of new or resurfaced impervious surfaces of 1,000 square I,
feet or more, unless prior approval of a Stormwater Management
' Control Plan was received by the Town and the proposal includes
in-kind replacement of impervious surfaces.
If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name,
Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project.
If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan
and a completed Check List Form to the Building Department with your Building Permit Application.
APPLICANT (Property Owner.Design Pi ofessional,Agent,Contractor,Other) S.C.T.M. #: 1000 Date
I p II District
NAME C /` 1)U l '�' ��— Z 23•ZZ
(pint' i Section Block Lot
FOR BUILDING DEPARTMENT USE ONLY***
Contact Information
n'deph.-Numbed
li ` Reviewed By:
— — — — — — — — — — — — — — — — — I
j, Date_
j; Property Address /Location of Construction Work: i � — — — — — — — — — — — — — — — j
�I U �a Approved for processing Building Pei mit. f
Stormwater Management Control Plan Not Required.
❑ Stormwater Management Control Plan is Required.
(Forward to Engineering Depai tment for Review.)
FORM # SMCP-TOS MAY 2014
19'08'00" W 60.01'
23' NON-DISTURBED VEGETATiD BUFFER `
LOT 21 100
AREA=11,135 S.F.
NATURAL—
co
ATURAL(O
O 33.7+
(D f`
pq
y c3 r LOT 22
LOT 20 + 15' t<j 15.1'
+Iq
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FRAME RES.
FFL=34.5
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NOTES: !k e
WATER SERVICE, SANITARY, AND DRAINAGE I►rJ
SYSTEMS LOCATED BY OTHERS.
LOCATION, TYPE, AND SIZE OF UNDERGROUND UTILITIES
SHOWN ON THIS SURVEY MUST BE VERIFIED PRIOR TO
ANY CONSTRUCTION AND/OR EXCAVATION. ADDITIONAL
UNDERGROUND STRUCTURES, IF ANY, OF WHICH THE
SURVEYOR IS NOT AWARE ARE NOT SHOWN.
11-5-07 ADD =RTIFICATION
9-10-07 ADD 'ATER SERV. AND SAN H.C. LOC
6CW DISTRICT 1000 BEC11M 122 BLOCK 2 LOT 23-22
NELSON & POPE , L—L—P
m 'D ENGINEERS • oESIONERS • Sl RVEYORS
572 WALT WHITMAN ROAD, MELVILLE, N (. 11747-2188
Town of Southold
Name: Bolling Residence Address: 360 Cottage Way Mattituck
Included:
• 2 Pre-Compliance Letters ✓
• 4 Sets of Plans
• Building Permit Applicationv
• Stormwater Management ✓/ /
• Application for electrical inspection ✓
• Consent to inspection
• Application for Certificate of Occupancy
• H/O Authorization Form v-"*-
• Survey✓^
• Tax bill
• Electrician License ✓
• Contractor License
• Workers Comp, Liability, and Disability
• Check zOU
D
J U L 1 6 2020
BUU,PTNG DEFT. ._
GREENLEAF SOLAR SOLUTIONS
11 Technology Dr. East Setauket NY 11733
info@gogreenleafsolar.com (631) 509-1747
PASSARELLI
E N G I N E E R I N G P L L C
July 6, 2020
Attention:Town of Southold Building Department
Subject: Engineer Statement for Solar Roof Installation
Bolling Residence-360 Cottage Way Mattituck, NY 11952
To whom it may concern at the Building Department,
This letter confirms that the proposed roof mounting and installation of the solar
photovoltaic system was designed to satisfy the following building standards:
• New York State Residential Code including sections R324, R907 and applicable
requirements of Chapter 23.
• The Long Island Unified Solar Permit Initiative
• ASCE 7-10
• A Standard 70 of the National Electric Code for mounting and installing the
photovoltaic system.
The structural integrity of the existing roof rafters and associated truss components with
targeted joint reinforcement as shown satisfy the structural roof framing design load
requirements for mounting and installation of the photovoltaic system. The installation of
the photovoltaic system has been designed for wind speed criteria of 140 mph and
ground snow load criteria of 30 psf by utilizing specially designed lag screws for secure
mounting. The roof penetrations are designed to be flashed and waterproofed per
manufacturer requirements.
I certify that the manufacturers guidelines and equipment for the roof mounted
photovoltaic system for the address stated above meet the requirements for the wind
and snow load. I certify that the roof rafters are adequate to carry the new imposed
loads by the self-weight of the photovoltaic system.
I hope this letter satisfies the requirements of the Building Department. If you have any
questions feel free to contact me directly.
Sincerely, F NEIN
Y
Q� oSEPN p 0
y �t
arrett J. Passarelli, P.E. C �j
Principal
Passarelli Engineering PLLC �O 0s3soo
NY PE# 093600 AROFESS��NP�
Garrett J.Passarelli,P.E. 9 81 Lincoln Avenue Port Jefferson Station,NY 9 (631) 708-4575 garrett@passeng.com
Suffolk County Dept of
- Labor, Licensing & Consumer Affair
MASTER ELECTRICAL LICENSE
Name
ERIC MANN
Business Name
This certifies that the RUSSELL ELECTRIC INC
bearer is duly licensed
:)y the County of suffolk
License Number: ME-62090
Fc-a N�xd-Q1 Li.
Issued: 04/12/2019
Commissioner Expires: 04/01/2021
Suffolk County Dept.of
Labor,Licensing&Consumer Affairs i
s
HOME IMPROVEMENT LICENSE
Name
SETH A WALKER
Business Name
This certifies that the GREENLEAF SOLAR LLC
bearer is duty licensed j
by the County of suHolk f
License Number:H-56826 }
Rosalie Drago issued: 04/18/2016
Commissioner Expires: 04/01/2022
yYA�• CERTIFICATE OF LIABILITY INSURANCE
11011512019
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 CONTACT
NAMRw
Brookhaven Agency,Inc. PHONE 631 941.4113 FaxNot 631 941.4405
128 Old Town Road,Suite CE-MAILADDRESs.. certificates Brookhaven enc .com
P.O.Box 850 INSURER(s)AFFORDING COVERAGE NAIC a
East Setauket NY 11733 INSURER • Evanston Insurance Company
INSURED -INSURER B:Merchants Preferred Insurance Co.
IN c
GreenLeaf Solar,LLC -INSURER D.
11 Technology Drive INSURER E:
East Setauket,NY 11733 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 TYPE OF INSURANCE DDL USR POLICY NUMBERPOLICY EFF POLICY EXP LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
A CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED $100,000
ranca
x 3EW2155 09/0912019 09/0912020 MEo EXP(Any one n $5,000
PERSONAL 8 ADV INJURY S1,000.000
POTHER.,
L AGGREGATE LIMIT APPLIES PER GENERAL AGGRE TE 2 000 000
POLICY JET LOC PRODUCTS-COMPIOP AGG $1000 000
$
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1 000 000
B X ANY AUTO BODILY INJURY(Per person) $
ALL OSSAUUTTOS
OWNED SCHEDULED CAP1067298 08/05/2019 08/0612020 BODILY INJURY(Per accident) $
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $IAC
AUTOS
$
UMBRELLA UABOCCUR EACH OCCURRENCE
EXCESS LiAB HCLAIMS-MADE AGGREGATE S
DED I I RETENTION$ $
WORKERS COMPENSATION PEROTH-
AND EMPLOYERS'LIABILITY Y I N
ANY O ICERIMEMBERREEXCCLUDE�D?ECUi1VE NIA E.L.EACH ACCIDENT S
(Mandatory In NH) E.L.DISEASE-FA EMPLO
If y88 desaibe hander
DES PTicN OF ERATIONS below E.L DISEASE-POLICY LRAIT I S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space Is required)
CERTIFICATE HOLDER CANCELLATION
Town of Southold SHOULDANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
54375 Main Rd. ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 1179
Southold,NY 11971 AUTHORIZED REPRESENTATRIE T>
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD
Certificate of Attestation of Exemption
from New York State Workers' Compensation and/or
�d Disability and Paid Family Leave Benefits Insurance Coverage
"Thisform cannot be used to waive the workers'compensation rights or obligations of any party.**
The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State
specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant
may NOT use this form to show another business or that business's insurance carrier that such insurance is not required.
Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will
not be accepted by government officials one year after the date printed on the form.
In the Application of Business Applying For:
(Legal Entity Name and Address): Electrical Permit
Russell G Electric Inc From:Town of Southold
15 Beechwood PI
Massapequa Park,NY 11762-1903
PHONE:516-974-8486 FEIN:XXXXX1600 The location of where work will be performed is
360 Cottage Way,Mattituck,NY 11952.
Estimated dates necessary to complete work associated with the building
permit are from June 17,2020 to October 30,2020.
The estimated dollar amount of project is $0-$10,000
Workers'Compensation Exemption Statement:
The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC
WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason:
The business is a one person owned corporation,with that individual owning all of the stock and holding all offices of the corporation.
Other than the corporate owner,there are no employees,day labor,leased employees,borrowed employees,part-time employees,other
stockholders,unpaid volunteers(including family members)or subcontractors.
Disability and Paid Family Leave Benefits Exemption Statement:
The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY
DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason:
The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under
the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning
all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own
at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid
family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in
New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law)
I,Eric Mann,am the President with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,
information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I have not
made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I
understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in
accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the
government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid
family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers'
compensation insurance and/or disability and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved
by the Chair of the Workers'Compensation Board to the goy ment entity listed above.
SIGN
HEREERE �Si ature: Date:
Ea emption,Certificate Number.
`p2z�i� ,,u h, �1:6i 2020.
,NYS Woikers.,.,,Com�Pl�risa�i®n,Board
eX
CE-200 01/2018
� J
APPROVED AS NOTED
)ATE?'c;LYr B.P.#�(�
FE BY w
NOTI Y BUILDIiJO DEPARTMENT AT
765-1802 8 AM i-0 4 PM 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 AND CONDITIONS OF
SO ZBA
SOUTHOLD T NNING BOARD
SO LD TOWN TRUSTEES
.Y.S.DEC
OCCUPANCY O
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
aECMZCAL d1VSPeC,,oN
�tms�
PHOTOVOLTAIC(PV)MODULE STATEMENT. 7,030 W 5YSTEM SIZE ! OF NEW
50LA,PHOTOVOLTAIC MODULE,MOUNTING BRA r.ET5 AND HARDWARE MEET OR EXCEED NYS CODE V y
REQUIREMENTS FOR THE DESIGN CRITERIA FOR THE TOWN OF SOUTHHOLD THE MOUNTING ATTACHMENT TO THE DRIVEWAY BELOW FRONT OF HOUSE FACING STREET MODEL 5-ENERGY .� 0,
ROOF WILL MEET bR EXCEED IRC-2015 AND ASCE 7-1 O REQUIREMENTS 5N72-CELL 5N370M-10 LQ` OSEP A
MODULES AND PANELS PROVIDED SHALL WITHSTAND,WITHOUT EVIDENCE OF STRUCTURAL OR MECHANICAL370 WATT EA, co
FAILURE, 1 5 TIMES THE DE51GN LOAD WHEN TESTED AS SPECIFIED BELOW THE DESIGN LOAD IS TO BE 30 PSF 77 5G"L x 38 98"W x 157"D, (f
DOWNWARD 9POSITIVE)OR UPWARD(NEGATIVE) ALL GLAZING MEMBERS SHALL BE OF SUCH STRENGTH TO i 21 FT2
WITHSTAND THESE LOADS THE MODULES,PANELS AND ANY MOUNTING HARDWARE SHALL BE FACTORY TESTED I - 40 79#/MODULE, IT— _��
LLUJ
UNDER THESE LOADS FOR A PERIOD OF 30 MINUTES (DOWNWARD AND UPWARD FORCES SHALL NOT BE APPLIED HOUSE: U
SIMULTANEOUSLY ' Q � W
�T�/I `� I i SOLAR MODULE ARRAY- m t7 Z
SOLAR FASTENER SPECIFICATIONS/REQUIREMENTS: VGPOUND) �� I 10 MODULES TOTAL �C9
ROOF FASTENING SYSTEM.5NAPNRACK ULTRA RAIL SOLAR PHOTOVOLTAIC RACKING r ACCESS �� 09360 (�
SYSTEM OR EQUAL III� Q`
RAIL SYSTEM:5NAPNRACK 6005-T5G ALUMINUM RAIL OR EQUAL
MOUNT SYSTEM.5NAPNRACK FLASHED L-FOOT MOUNTING SYSTEM OR EQUAL
FASTENERS-5/1 G-INCH DIAMETER 55 LAG SCREWS WITH EFFECTIVE THREAD EMBEDMENT
OF 2.5-INCH INTO DOUGLES FIR ROOF RAFTER,WITHDRAWAL LOAD CAPACITY OF 532
LB/SCREW.
FASTENER SPAN BETWEEN MOUNTING FEET:4'-0"(48-INCHE5)
TOTAL ARRAY AREA= 400 SF
TOTAL RAIL FEET,= 124 RAIL FT/4-0"= 31 MOUNTING FASTENERS
SOLAR SYSTEM STRUCTURAL STATEMENT �� ��� ROOF STRUCTURE ROOF"I"
THE PHOTOVOLTAIC(PV)N SYSTEM HAS BEEN DESIGNED TO MEET THE MINIMUM DESIGN �� I TRUSS RAFTER/ " n " N
� � � 7 2 X 4 /24 O.C. J
STANDARDS FOR BUILDING AND OTHER STRUCTURES OF THE 2017 NYS Uniform Code(2017 �\ `��f SPACING, }- Ln
(NYSUC),2017 NYS Uniform Code Supplement(2017 NYSUCS),2017 NYS Residential Code 7 ROOF PITCH: G:12
(2015 International Residential Code-2015 IRC),ACSE 7-10,ANSI/AWC NDS-2015,National Design �� i
Specifications for Wood Construction,Long Island Unified Solar Permit Initative(LIUSPI),and National ACCESS �� ACTUAL SPAN• _' _
� �
Electnc Code(NEC)2014 ROOF i VP SHEATHING. PLYWOOD ^/ LUEXISTING HOME/BUILDING STRUCTURAL STATEMENT: `� i O LL LU >--
THE EXISTING STRUCTURE 15 ADEQUATE TO SUPPORT THE NEW LOADS IMPOSED BY THE �� TRUSS MEMBERS: 2"X 3"/24"O.C. Q z
PHOTOVOLTAIC MODULE SYSTEM INCLUDING UPLIFT*SHEAR THE EXISTING STRUCTURAL i
ROOF COMPONENTS*DIMENSIONS WERE REVIEWED BY THE DESIGN PROFESSIONAL AND `� TYPE/LAYERS: 3-TA13 A5PHALT/ I
FOUND TO MEET THE LOAD CRITERIA PER IRC-2015, 2015 NATIONAL DESIGN O
SPECIFICATION FOR WOOD CONSTRUCTION,AND ASCE-7-10. UM E z
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WIND AND SNOW LOAD STRUCTURAL STATEMENT. J `---
RAIL MOUNTING SYSTEM 15 DESIGNED AND WARRANTED BY THE MANUFACTURER FOR WIND LOADS UP TO 140
MPH AND GROUND SNOW LOADS OF 30 PSF WHEN INSTALLED AND FASTENED AS REQUIRED BY THE I LEGEND
MANUFACTURER SD :e SD Service Disconnect O ('n Q
INSTALLER NOTE THE MOUNTING FEET MUST BE ATTACHED TO THE BUILDING RAFTERS OR FRAMING(NOT JUST
THE ROOF DECKING) USE MINIMUM 5{I 6'DIAMETERREQUIRED
LAG SCREWS AND DRILL PILOT HOLE TORQUE ALL 5/1 ES 'N MSP Main Service Panel
DIAMETER HARDWARE C 10-I G FT-LBS OR AS REQUIRED BY MANUFACTURER ALL INSTALLATION PROCEDURES �7-Z/EL �VENTILATION j11//// 11�
SHALL BE PER MANUFACTURER'S REQUIREMENTS
SP Sub-panel
GENERAL PHOTOVOLTAIC(PV)INSTALLATION NOTES ® UM Utility Meter
I AN 18-INCH WIDE CLEARING(FREE OF SOLAR EQUIPMENT)WILL BE PROVIDED ALONG AT LEAST ONE SIDE OF ®
THE ROOF ACD RIDGE EITHER ON THE SAME SIDE AS THE SOLAR EQUIPMENT OR ON ANOTHER SIDE OF THE RIDGE A/C Disconnect
THATDOES NOT HAVE SOLAR EQUIPMENT ON IT IN ADDITION,AN 18-INCH WIDE PATHWAY(FREE OF SOLAR C2
EQUIPMENT)WILL BE PROVIDED B
(P
FROM AT AST ONE SAVE OR GUTTER CONNECTING TO THAT I S-INCH ROOF ® Basement Location
RIDGE CLEARING
2.ANY PLUMBING VENTS THROUGH THE ROOF ARE NOT TO BE CUT OR COVERED FOR SOLAR EQUIPMENT
INSTALLATION ANY RELOCATION OR MODIFICATIONS OF VENT REQUIRES A PLUMBING PERMIT AND INSPECTION
3 SOLAR SYSTEM SHALL ONLY BE MOUNTED TO A PERMITTED ROOF STRUCTURE OF A RE51DENTIAL BUILDING OR
A LEGAL ACCESSORY STRUCTURE IF INSTALLED ON A LEGAL ACCESSORY STRUCTURE,A VAUD SURVEY xxxxxxxAx O U
SHOWING SAID STRUCTURE WILL BE PROVIDED [�
4 THE ROOF SHALL HAVE NO MORE THAN A SINGLE LAYER OF ROOF COVERING IN ADDITION TO THE SOLAR —
EQUIPMENT UNLESS OTHERWISE NOTED ON DESIGN PLANS AND ALLOWED PER LOCAL MUNICIPALITY
5 INSTALLATION WILL BE FLUSH-MOUNTED,PARALLEL TO AND NO MORE THAN GANCHES ABOVE ROOF SURFACE J
G WEIGHT OF INSTALLED SYSTEM WILL NOT EXCEED MORE THAN 5LB5 PER SQUARE FOOT FOR PHOTOVOLTAIC5 Q L Z
7 THE SOLAR INSTALLATION CONTRACTOR SHALL COMPLY WITH ALL LICENSING AND OTHER REQUIREMENTS OF _ ^/
THE JURISDICTION AND 15 NAMED ON THE LIPA PRE-SCREENED INSTALLER LISTS (1/ UI
8 PV MODULES AND COMBINER BOXES SHALL BE IDENTIFIED BY THE MANUFACTURER FOR USE IN,GRID-TIED PV LU Q Z W
SYSTEMS
9 THE PROJECT SHALL COMPLY WITH CURRENT NEC REQUIREMENTS INCLUDING ARTICLE G90 SOLAR Z O W (L O
PHOTOVOLTAIC(PV)SYSTEMS
W
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ROOF ACCESS AND PATHWAYS- Q lu
ROOF ACCESS,PATHWAYS,AND SPACING REQUIREMENTS FOR SOLAR PHOTOVOLTAIC SYSTEMS SHALL BE O J J E
PROVIDED IN ACCORDANCE WITH SECTIONS 8324 71 THROUGH P324 7 G OF IPC-2015 J
-NOTE 8324 7 4 SINGLE RIDGE ROOFS•PANELS,MODULES OR ARRAYS INSTALLED ON ROOFS WITH SINGLE RIDGE 0 00 j
SHALL BE EX
LOCATED IN A MANNER THAT PROVIDES TWO(2)3GANCH ACCESS PATHWAYS TENDING FROM THE / C
ROOF ACCESS POINT TO THE RIDGE.ACCESS PATHWAYS ON THE OPPOSING ROOF SLOPES SHALL NOT BE - O O
LOCATED ALONG THE SAME PLANE AS THE TRUSS,RAFTER,OR OTHER SUCH FRAMING MEMBER THAT SUPPORTS
THE PATHWAY ALL ACCESS VALLEYS SHALL HAVE A MINIMUM OF I8-INCHES ON BOTH SIDES OF VALLEY 0 L Z
EXCEPTIONS = Q —
I WHERE AN ALTERNATIVE VENTILATION METHOD HAS BEEN PROVIDED OR WHERE VERTICAL VENTILATION = L (a
METHODS WILL NOT BE EMPLOYED BETWEEN THE UPPER MOST PORTION OF THE SOLAR PHOTOVOLTAIC 3
5Y5TEM AND THE ROOF RIDGE OR PEAK, 2
2 STRUCTURES WHERE AN ACCESS ROOF FRONTS THE STREET,DRIVEWAY,OR OTHER AREAS READILY -
ACCES5LBLETOEMERGENCY RESPONDERS FULL "OUSE ROOF PLAN Date: 07-OG-2020
3 ONE ACCESS PATHWAY SHALL BE REQUIRED WHEN A PANEL CONTAINING ROOF 15 LOCATED NOT MORE THAN S I SCALE NTS
24-INCHES VERTICALLY FROM AN ADJOINING ROOF WHICH CONTAINS AN ACCESS A2 Scale:
NTS
CLIMATIC*GEOGRAPHIC DESIGN CRITERIA-TABLE 8301.2(1)
WIND DESIGN 5UE3JECT TO DAMAGE
eet No.
GROUND in Ice
SF—I Berne SEISMIC Frost NA NT Garner FLOOD AIR MEAN
SNOW Speed opograp Wmd ZZ'. DESIGN eaMenn Une ermi DESIGN nderlayme HAZAP.D FRFE2IN ANNU
LOAD (mph) Effects n Zone TAGo Depth TEMP ftgNred INDEX TEMP
30
_1d
SF I40 B NO 2 G SEVERE 3'-O° to 15 deg NA RAN" 599 51
A- 7
FxAM
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PARTIAL HC)USE ROOF PLAN MODEL S-ENERGY �pfr PIElNy
SCALE +'= I'-O" I 5N72-CELL 5N37OM-10
370 WATT EA, IreQ` p,9
A4 ROOF SECTION — A4 ROOF SECTION 77 5G'L x 38 98"W x 1257Tz P2
32'-3" 40 79#/MODULE,
HOUSE. I rm- W
SOLAR MODULE ARRAY- C 2
13'-4" 18'-11" 1 9 MODULES TOTAL 2 (j
Q 09360
RIDGELINE A.
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POSITIONED OVER ROOF DGE MATERIAL Date: 07-OG-2020
RAFTER MEMBERS BEAM Scale:
rF
PER MFG'S 3/1 G" = I -O"
REQUIREMENTS
NOTE:
-FASTENERS SPACED PER L �"0 5 5
MANUFACTURER RAFTER LAG SCREW
-MOUNTING BRACKET Sheet No.
MATERIALS ARE
NON-COMBUSTIBLE IN Roof Span
NTHACODANCE A—
WITH RM2301 2 2 AND MAX SPAN BETWEEN MOUNTING IN
CONSIST OF ALUMINUM SOLAR PHOTOVOLTAIC MODULE SECTION CONFORMANCE WITH MANUFACTURERS
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R1 ROOF SECTION ROOF SECTION Sheet No.
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7,030 W SYSTEM SIZE
•EL�CT2ICAL ONE LINE DIAGfSAM MODEL: S-ENERGYSN72-CELL' SN370M-10
SCALE: NTS 370 WATT EA;
SOLAR MODULE ARRAY: 19 MODULES TOTAL
STRING INPUT 1 = 10 PANELS
STRING INPUT 2= 9 PANELS
PASS—THROUGH
JUNCTION BOX,
ENGAGE CABLE END
WARNING OR CENTER—FED
(10) 72—CELL PV MODULE, ELEC....1, R°
PAIRED WITH w" 6) #10AWG THWN-2 CU, N
ENPHASE IQ7PLUS-72-2—US MICROINVERTERS LL (1) #8AWG THWN-2 CU EGC IN 1 PVC CONDUIT
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WARNING SYSTEM IS I
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ELECTRICAL NOTES Q W OJ
THE CONTRACTOR SHALL INSURE THE EQUIPMENT O
J AND UNDERWRITERS LABORATORIES INC (UL)1741, U
INSTITUTE OF ELECTRICAL AND ELECTRONIC
ENGAGE CABLE & DROP 240V CABLE. (1) #6AWG TWHN-1 CT ENGINEERS(IEEE)1547,AND THE NYS PUBLIC
SERVICE COMMISSION(PSC)REQUIREMENTS J —
DC GROUNDING REGARDING PV INSTALLATIONS THE CONTRACTOR W
BRANCH TERMINATOR INSTALLED ON ELECTRODE SHALL SPECIFY AND INSTALL FUSED DISCONNECT
ENGAGE CABLE AND GROUND FAULT PROTECTION BASED UPON Q
END OF ENGAGE CABLE #12AWG THWN-2 CU APPLICATION.
BLACK — L1 Date: 07-06-2020
RED — L2 Scale:
WHITE — NEUTRAL NOTE: BRANCH CIRCUIT CONDUCTORS TO BE SIZED BASED ON AMPACITY REQUIREMENTS AND VOLTAGE DROP 3/1 G11 = I'-011
GREEN - GROUND CONSIDERATIONS. PLEASE REFER TO RELEVANT APPLICATIONS NOTES AND DESIGN GUIDES AT
HTTP://ENPHASE.COM/GLOBAL FOR VOLTAGE DROP CALCULATIONS AND CONDUCTOR SIZING ASSISTANCE. EGC Sheet No.
MAX AC OUTPUT ®240VAC, SIZING SUBJECT TO AHJ APPROVAL. ARRAY GROUNDING MAY BE PROVIDED BY UL2703 TESTED BOND BETWEEN
NEC-690.8(A)(B) INVERTER AND CERTAIN RACKING SYSTEMS. SURGE 'PROTECTIVE DEVICE AND LINE COMMUNICATIONS FILTER
RECOMMENDED AND MAY BE NECESSARY IN SOME CASES. CONTACT ENPHASE FOR MORE INFORMATION. E� '
I