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Home My WebLink About45422-Z �o�1c,HFFUt�IpGy� Town of Southold 3/27/2021 P.O.Box 1179 0 o ` 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41913 Date: 3/27/2021 THIS CERTIFIES that the building SOLAR PANEL Location of Property: 1045 Dean Dr., Cutchogue SCTM#: 473889 Sec/Block/Lot: 116.-5-9 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/26/2020 pursuant to which Building Permit No. 45422 dated 11/9/2020 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(expansion to existing panels)as applied for. The certificate is issued to Janusz,Robert&DeBlasio-Janusz,Patricia of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45422 1/5/2021 PLUMBERS CERTIFICATION DATED Au horize Signature o�SUFF TOWN OF SOUTHOLD BUILDING DEPARTMENT y - TOWN CLERK'S OFFICE 4,1 • 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 #: 45422 Date: 11/9/2020 Permission is hereby granted to: Janusz, Robert 1045 Dean Dr Cutchogue, NY 11935 To: install roof-mounted solar panels as applied for. At premises located at: 1045 Dean Dr., Cutchogue SCTM #473889 Sec/Block/Lot# 116.-5-9 Pursuant to application dated 10/26/2020 and approved by the Building Inspector. To expire on 5/11/2022. Fees: SOLAR PANELS $50.00 CO-ALTERATION TO DWELLING $50.00 ELECTRIC $100.00 Tota . $200.00 Building Inspector Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines, streets,and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead. 5. Commercial building,industrial building,multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and"pre-existing"land uses: 1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00 Date. 10/21/2020 New Construction: Old or Pre-existing Building: X (check one) Location of Property: 1045 Dean Drive Cutchogue House No. Street Hamlet Owner or Owners of Property: Robert Janusz Suffolk County Tax Map No 1000, Section 116 Block 5 Lot 9 Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: GreenLoglc LLC Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: X (check one) Fee Submitted: $ 50 Applicant Signature r , Building Department Application AUTHORIZATION Mere'the Applicant is not the Owner) I, Robert Janusz residing at 1045 Nmri I>n Vc, (Print property owner's name) (Mailing Address) do hereby authorize GreenLogic LLC (Agent) to apply on my behalf to the Southold Building Department. (Owner's Signature ) (Date) JCQnLA z (Print Owner's Name) 1 CONSENT TO INSPECTION Robert Janusz ,the undersigned,do(es)hereby state: Owner(s)Name(s) That the undersigned(is)(are)the owner(s)of the premises in the Town of Southold,located at 1045 Dean Drive, Cutchogue, NY 11935 , which is shown and designated on the Suffolk County Talc Map as District 1000, Section 116 1,Block 5 ,Lot 9 That the undersigned(has)(have)filed,or cause to be filed,an application in the Southold Town Building Inspector's Office for the following: Roof mounted solar electric system That the undersigned do(es)hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property,including any and all buildings located thereon,to conduct such inspections as they may deem necessary with respect to the aforesaid application,including inspections to determine that said premises comply with all of the laws,ordinances,rules and regulations of the Town of Southold. The undersigned,in consenting to such-inspections,do(es)so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws,ordinances,rules or regulations of the Town of Southold. Dated: LkLtsiplul�avi Z (Print Name) (Signature) (Print Name) - J rjv so Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 � sean.devlin(ctown.southold.ny.us 1®u 9� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Robert Janusz Address: 1045 Dean Dr city Cutchogue st: NY zip: 11935 Building Permit# 45422 Section 116 Block: 5 Lot- 9 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: GreenLogicLLC License No: 43858ME SITE DETAILS Office Use Only Residential X Indoor X Basement X Service Commerical Outdoor X 1st Floor Pool New X Renovation 2nd Floor Hot Tub Addition X Survey X Roof X 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 A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches 4'LED Exit Fixtures Pump Other Equipment. 2.943kW Roof Mounted PV Solar Energy System, (9) SPR-320-327-E-AC - Modules and Inverters...Expansion of Existing System Notes: Solar Inspector Signature: �.� Date: January 5, 2021 S.Devlin-Cert Electrical Compliance Form.xls Of SOGlyol (/� I 0 - h O # # TOWN OF SOUTHOLD BUILDING DEPT. ��`yromm � 765-1802 INSPECTION , [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING, [ ] FRAMING/STRAPPING [ ] FINAL [ ] 'FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION= [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: DATE INSPECTOR �u J A M E S J. S T 0 U T A R C H I T E C T & .Assoc . 2 G REG L ANE E AST NORTHP0RTN. Y. 631 — 8 58 9388 Post Installation Letter February 24, 2021 RE: Janusz Residence 1045 Dean Drive Cutchogue, NY 11935 To Whom It May Concern: This letter is to confirm that as of this February 24, 20211, James J Stout, NYS license 021633 have personally inspected the placement and installation of the roof top solar panels at the above listed address. The solar panels have been installed as per manufacturer's guidelines and specifications. The racking system design and installation complies with the 2020 NYSRC and 2020 New York State Uniform Code Supplement and all related provisions. The installation was done as per plan. Thank you for your cooperation in this matter. James J. Stout Architect QED ARC J To�T 0 a` 4 '9 1 33 y0Q` F N�`� FIELD INSPECTION REPORT DATE COMMENTS • � b FOUNDATION(1ST) j ------------------------------------ C FOUNDATION(2ND) z a • ROUGH FRAMING& PLUMBING y I INSULATION PER N.Y. STATE ENERGY CODE FINAL a ' ADDITIO p COMMENTS. E� t%-00' Z�* - rn y q� O I z • y Cq d 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 �a Survey Southoldtownny.gov PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O Application Flood Permit Examined ,20 s Single&Separate Truss Identification Form '2_0 >> 0 �•l��(y,,, Storm-Water Assessment Form Q \ �✓ 202Q Contact: Approved ,20 OCA 2� Mail to: GreenLogic LLC Disapproved a/c 97 North Sea Road, Southampton, NY 11968Phone: 631-771-5152 Expiration 120 i ding spector APPLICATION FOR BUILDING PERMIT Date 10La , 2090 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. GreenLogic LLC (Signature of app • ant or name,if a corporatio ) 97 North Sea Road, Southampton, NY 11968 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder Contractor Name of owner of premises Robert Janusz (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer Nesim Albukrek, President (Name and title of corporate officer) Builders License No. ' 40227-H Plumbers License No. N/A Electricians License No. 43858-ME Other Trade's License No. N/A 1. Location of land on which proposed work will be done: 1045 Dean Drive Cutchogue House Number Street Hamlet County Tax Map No. 1000 Section 116 Block 5 Lot 9 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 Single family dwelling b. Intended use and occupancy Single family dwelling 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work Roof mounted solar electric system (Description) 4. Estimated Cost $10,800 Fee $200 (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 S. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase 8/2017 Name of Former Owner Robert Taylor 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation?YES NO X 13. Will lot be re-graded?YE5 NO X Will excess fill be removed from premises?,YES NO X 1045 Dean Drive 14.Names of Owner of premises Robert Janusz Address Cutchogue, NY 11935 Phone No. 631-655-9596 Name of Architect James J Stout Address 2 Greg Ln, E. Northport Phone No 631-858-9388 Name of Contractor GreenLogic LLC Address97 North Sea Road Phone No. 631-771-5152 Southampton, NTM68 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO X * 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 X * 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 X * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF Suffolk ) Nesim Albukrek being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the Contractor (Contractor,Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ,,l Sit- day of 6cy 20,P_0 BARSAWA CASCIOTTA Notary Public Notary Public-State of New York Signature of Appli nt No.01-CA4894969 Qualified in Suffolk County Commission Expires May 11,2023 Scott A. Mussell °5� � S'7C`01R..MWAkIF EIK SUPERVISOR � MANAGEMENT SOUTHOLD TOWN HALL.-P.•O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 `' � Town own D,f Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ANY OF THE FC:I,I1C?WLNU (CHECK ALL 7HAr APPL)r} s Yes No j Q Q A. Clearing, grubbing, grading or,stripping of land which affects more than 5,000 squafe feet of ground surface. as B. Excavation or filling involving mole than 200 cubic yards of material within any parcel or any contiguous area. (� x❑ C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. '? ❑ D. Site preparation within 100 feet of wetlands, beach, bluff or coastal ! ' erosion hazard area. ' { 3 0 E E, Site preparation within the one-hundred-year floodplain as depicted on FIRM Map of.any watercourse. s []E] F. Installation of new ol• resurfaced impervious surfaces of 1,000 square feet or.more, unless prior approval of a Stormwater Management i = Control Plan was received by the Town and the proposal includes in-kind replacemenf'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 O rner.Deatgn Prnies�iniaai,Ag>nt,(".onttaCtor,otltetl S.C.1.�1. 1000 Date. Dwric€ I3APvIE: CreenLo �(N sim-Alb tkr k) i; 116 5 9 10/21/2020 Gam„ T � Section Blork. Lot Ak ' 3 FOR BUILDING DEPAI-UMENT USC ONLY I 3I � 3 Contact Infornianon 631-771-5152 i Reviewed By: i } f - - - i€ Ii Date: , 3 ? _Properly Address/Location of Construction York: I — — — — — — — — — — — — — — — — — , 3 1' [:] Approved for processing Building-Permit. 1 t 1045 Dean Drive j Stormwater Management Control Plan Not Required. � — — — — — — — — — — — — — — — — — ' Cutehogue, NY 11935 1' Stormwater Management Control Plan is Required. ;3 ® (Forward to Engineering Department for Review) F(JRivt �` SMCI'-TC)S MAY 26I4__ �.__ BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 w . Telephone (631) 765-1802 - FAX (631) 765-9502 roc�erra-southoldtownn ..qov — seand,@southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date; 10/21/2020 Company Name: reenLo is LL Name: Robert Skypala License No.: 43858-ME email: Barbara@GreenLogic.com Address: 97 North Sea Road," Southampton, NY 11968 Phone No.: 631-771-5152 JOB SITE INFORMATION (All Information Required) Name: Robert Janusz Address: 1045 Dean Drive, Cutchogue, NY 11935 Cross Street: Phone No.: 631.-655-9596 Bldg.Permit#: email: Tax Map District: . 1000 Section: 116 Block: 5 Lot: 9 BRIEF DESCRIPTION OF WORK (Please Print Clearly) Roof mounted solar electric system (9) SunPower SPR-320-327-E-AC modules, (9) SunPower SPR-320-327-E-AC inverters, System Size: 2.943kW THIS IS AN EXPANSION WE WILL TIE INTO EXISTING COMBIINER BOX AND MONITOR Circle All That Apply: Is job ready for inspection?: YES NO Rough In FFinal Do you need a Temp Certificate?: YES NO Issued On _ Temp Information: (All 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 Iriformatioit' PAYMENT DUE WITH APPLICATION Request for Inspection Form.xis �� oF sov��®� Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 lh • aQ lac®UNT`1,a� March 15, 2021 BUILDING DEPARTMENT TOWN OF SOUTHOLD GreenLogic LLC 97 North Sea Road Southampton, New York 11968 RE: Janusz, 1045 Dean Drive, Cutchogue NOTE: Post installation certification required for expansion of solar panels TO WHOM IT MAY CONCERN: The items marked below are required to obtain your Certificate of Occupancy Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. (631-765-1802) A fee of$50.00. Final Board of Health survey. Plumbers Solder Certificate or Pex Affidavit Trustees Certificate of Compliance. (Town Trustees # 765-1892) Final Planning Board Approval. (Planning # 765-1938) Final Fire Inspection from Fire Marshall. (631-765-1802) Storm Shutters required for all glazing Energy Test Results and Manuals required Final elevation certificate from surveyor. Spray Foam Insulation Certification from a NYS licensed architect or Engineer BUILDING PERMIT: 45422-Z Solar Panels GREENLOGIC "j . ENERGY ! t, MAR 9 2021 March 5, 2021 The Town of Southold Building Department 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Re: Building Permit No.45422 Robert Janusz 1045 Dean Drive, Cutchogue, NY To the Building Inspector: Enclosed please find the Engineer's Certification Letter for the above referenced address. Can you please close the building permit and send the Certificate of Occupancy? Please let me know if you have any questions about the installation. Sincerely, jBwdkma e,a6cki tac Barbara Casciotta Account Manager Barbara@Greenlogic.com 631-771-5152 Ext. 117 GREEN LOGIC LLC © www GreenLogic com Tel- 631.771 5152 Fax. 631 771.5156 SOUTHAMPTON ROSLYN HEIGHTS 97 North Sea Rd., Suite 3 200 S. Service Rd ,#106 Southampton, NY 11968 Rosyln Heights, NY 11577 72JAMES J. S TOUT A RCHITECT & Assoc. G REG L ANE E AST NORTHPORT N. Y.-- 631 - 8 58 9388 Letter of Certification October 8, 2020 Janusz Residence 1045 Dean Drive Cutchogue, NY To Whom it may concern: I,James J.Stout,registered architect NYS license number 021633 would like to submit the following. I have inspected and analyzed the roof structure at the above- mentioned address and have determined the structure and the panel attachment to be adequate to support the new additional load imposed by the proposed solar panel system and complies with the 130-mph wind design load as per 2020 Residential code of NYS(RCNYS),2020 building code of NYS(BCNYS) residential code,2020 Energy conservation construction code of NYS(ECCCNYS)and the 2017 National Electric Code NFPA 7012017 National Electric Code, and the ASCE 7-10. The existing 2°x 8°Q 16"o.c. roof rafters will provide adequate support. Thank you for your understanding in this matter. James J.Stout Architect D ARC , T F� \�.yr02 i X33 roe J Pr� < 0 APPROVED AS NOTED DATEI ; B.P.# - �. C':";ivIRLY WITH ALL CODES OF FEBY NE', YORK STATE & TOWi4 CODES MOT FY BUILDING DEPARTMENT AT AS REOUIRED_TNF 785-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED RD FOR ,POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULA T ION 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. OCCUPANCY O@ tl V MMICAL TNsPECTION REQMRED USE IS UNLAWFUL WT HOOT OEC T IFIL T OF OCCUPANCY LOG ICO GreenLoglc,LLC Approved i Janusz,Robert 1045 Dean Drive Cutchogue,NY 11935 f Total System Size:2.943kW 1 circuit of 9 on a 20A breaker INltIIIAW list FW NYl W UA Q6 Azimuth:155* Monitoring System: SunPower CastAu*uTA,hriirgEla*49adcAlUriRxr�rg 24 Panel/Array Specifications: W'x7/9'13UV6eelirgNLg 24 Panel:SPR-E20-327-E-AC %S565'R*HaadLagS3Ew 24 Racking:SunPower Invisimount Panel:61.39"X 41.18" �Fe�d31/1�g Magic#:Invisimount Legend: ® 9 SunPower 327W Panels SunPower Invisimount Rail • 24 Quick Mount E Lag B 8 2x8"Douglas Fir Rafter 16"O.C. Notes: Number of Roof Layers:1 Y, Height above Roof Surface:4" Materials Used:Quick Mount,SunPower Added Roof load of PV System:3.5psf Engineer/Architect Seal: r BRED ARc C: r � 21 35 OQ TF NE`N'1 Drawn By:MMB Drawing#5 of 5 Date:10/5/2020 REV-A Drawing Scale:1/16"=1.0' ' I 'LOGIC" GreenLogic,LLC Approved Janusz,Robert 1045 Dean Drive Cutchogue,NY 11935 Surface WA Total System Size:2.943kW ; Array Size:2.943kW 1 crcurt of 9 on a 20A breaker Azimuth:245° Pitch: in Monitoring System: �\ SunPower PaneVArray Specifications: Panel:SPR-E20-327-E-AC Racking:SunPower Invisimount Panel:61.39'X 41.18" Array:15'5 518"X 3'5 1/8" Surface:24'7"X 7'7" Magic#:Invisimount Legend: 8 SunPower 327W Panels -- SunPower Invisimount Rail 24 Quick Mount E Lag 8 2x8"Douglas Fir Rafter 16"O.C. Notes: Number of Roof Layers:1 Height above Roof Surface:4" Materials Used:Quick Mount,SunPower Added Roof load of PV System:3.5psf Engineer/Architect Seal: Z' �V�ED ARC 3. w r � 21 3'' yOQ �F NEIN Drawn By:MMB Drawing#1 of 5 Date:10/5/2020 REV:A Drawing Scale:$116"=1.0' F NLOGIC" GreenlAgic,LLC Approved Janusz,Robert 1045 Dean Drive Cutchogue,NY 11935 Surface#A: Total System Size:2.943kW Array Size:2.943kW 1 circuit of 9 on a 20A breaker Azimuth:245° Pitch 36* Monttrin Monitoring System- SunPower PaneUArray Specifications: Panel:SPR-E20-327-E-AC Racking:SunPower Invisimount Panel:61.39'X 41.18" Array:15'5 518"X 75 1/8° Surface:24'7"X T T' Magic#:Invisimount Legend: 8.SunPower 327W Panels SunPower Invisimount Rad 24 Quick Mount E Lag 8 2x8°Douglas Fir Rafter 16'O.C. Notes: Number of Roof Layers:1 Height above Roof Surface:4" Materials Used:Quick Mount,SunPower Added Roof load of PV System:3.5psf Engineer/Architect Seal: e cke ARC / 3. � h 21 33 �pQ' Drawn By:MMB Drawing#2 of 5 Date:10/5/2020 REV:A Drawing Scale:3/16'=1.0' REF h, LOGICS �, -_ . s GreenLogic,LLC Approved Janusz,Robert 1045 Dean Drive Cutchogue,NY 11935 Surface#A: Total System Size:2.943kW Array Size:2.943kW 1 circuit of 9 on a 20A breaker Azimuth:245" Pitch: Monitorinrin g System: SunPower Panel[Array Specifications: Panel:SPR-E20-327-E-AC Racking:SunPower Invisimount 1 Panel:61.39"X 41.18" Array:15'5 5/8"X 3'5 1/8" Surface:24'7"X 7'7" Magic#:Invisimount Legend: 1 ® 8 SunPower 327W Panels SunPower Invisimount Rail 24 Quids Mount E Lag 1 2x8'Douglas Fir Rafter 16"O.C. Notes: Number of Roof Layers:1 Height above Roof Surface:4" Materials Used:Quids Mount,SunPower Added Roof load of PV System:3.5psf Engineer/Architect Seal: f-D ARC 21 3'' yOQ TF NEIN Drawn By:MMB Drawing#3 of 5 Date:10/5/2020 REV:A Drawing Scale:3/16"=1.0' LOGIC* No Vent Pi es Will Be Covered By The Solar Arra LEGEND GreenLogfc,LLC Approved AR Accost loaf Per R.02 dMrctwnf RAP •Root&Cass Gamt-x be e�e+'rom RIP -R.,"r1n W., - Janusz,Robert orernedd obaWaront Boas 1045 Dean Drive —40"a dot's Mncot eMtcePm� GA -Grwna occou ares per R324 7 3-4m AP 'Cross Pem_y 36 mimrrum 5 D •Smaso nm opewoon pe' Ciutchogue,NY 11935 to a servo es AP as—OW40 al od+o nCtr•Per R321 a end R3-e 7 5 R32A 7 7•e rr--from rroge Total System Size:2.943kW 1 circuit of 9 on a 20A breaker 9 SunPower 327W Panels Azimuth:155* Monitoring System: N SunPower PanelfArray 3peciflcations: Panel:SPR-E20-327-E-AC RAP Racking:SunPower Invisimount RAP RAP Panel:61.39"X 41.18" RAP I Magic#:Invisimount GA Legend: D IAPI IAP V-7q, 9 SunPower 327W Panels I I I o SunPower Invisimount Rail I i I ------ --------' 24 Quick Mount ELag IUYI ———— ——— ————— B 2x8'Douglas Fir Rafter 16'O.C. i I Notes: I Number of Roof Layers:1 Height above Roof Surface:4" Materials Used:Quids Mount,SunPower Added Roof load of PV System:3.5psf Engineer/Architect Seal: Aqc ' f. it t � Meter NE Drawn By:MMB Drawing#5 of 5 Date:10/5/2020 REV:A Drawing Scale:1/16"=1.01 GREENLOGIC® ENERGY October 21, 2020 Town of Southold Building Department Town Hall 53095 Route 25 Southold, NY 11971 Dear Building Inspector: Please find attached a building permit application on behalf of the Robert Janusz who has engaged us to install a roof mounted solar photovoltaic(PV) electric system located at 1045.Dean Drive, Cutchogue, NY. This is a system expansion. In connection with this application, please find attached: • Building Permit application • Owner Authorization • Consent to Inspection • A Storm Water Assessment Run-off Form • Certificate of Occupancy Application • Application for Electrical Inspection • 2 Surveys of the Premises • 4 Engineer's Reports • 2 Three Line Electrical Drawings • 2 Spec. sheets of the solar panels • 2 Spec. sheets for Racking System • GreenLogic Suffolk County Home Improvement License • GreenLogic Certificate of Liability Insurance • GreenLogic Certificate of Worker's Compensation Insurance Coverage • Installation Manager's Master Electrician's License • Check for$200($50 Building Permit/$50 CO/$100 Electrical Inspection) Please let us know if you need anything else in connection with this application. Yours truly, `J3avc macea6ciotta Barbara Casciotta Account Manager Barbara@Greenlogic.com 631-771-5152 ext. 117 GREENLOGIC LLC o www.GreenLogic.com Tel. 631 771 5152 Fax: 631.771.5156 SOUTHAMPTON ROSLYN HEIGHTS 97 North Sea Rd , Suite 3 200 S Service Rd ,#106 Southampton, NY 11968 Rosyln Heights, NY 11577 PV–SA-1 — — NEVI EQUIPMENT — — — — EY,IFING SERVICE . . • hC -C 0 M B NEI•? PANEL 120/2,10, 1 PH, 3W • • 2 ; : AC-CMB-i I (PV LOADS ONLY) A 2CCn i KW I i BKR-1 AC-CSC-1 AC DISCONNECT I 4 1 ' MAIN j A B N f FUSED i + E= f N j � � j EGC j Ecc EXISTING AC PANE LEXISTING GEC CEC -6 (;U PROPOSED 3-LINE ELECTRICAL DIAGRAM REVISIONS Janusz, Robert xGREENLOGICO 1045 Dean Drive ._ ENERGY Cutchogue, NY 11935 1.) INITIAL SUBMITTAL WITH APPLICATION ELIMINATING THE COST CSF ENERGY Page 1 of 3 Drawing No: Janusz-3LD1 Revision: 1 Revised: 9/2/20 d EQUIPMENT& COMPONENT SCHEDULE TAG DESCRIPTION SPECIFICATION PV-SA-1 PV SUB-ARRAY SPR-E20-327-E-AC EN PHASE IQ7XS-96-ACM-US, 1-CIRCUIT OF 9-MODULES ELECTRICAL LOAD SUMMARY AC CIRCUITS VOLTAGE MAX.AC TAG POWER,MAX RANGE CURRENT VOLTAGE, NOMINAL PV-SA-1 2943 WATTS 211-264 VAC 11.97 A AC 240 V,AC PROPOSED EQUIPMENT SPECIFICATIONS REVISIONS Janusz, Robert 1045 Dean Drive - � � € ENERGY Cutchogue, NY 11935 ELIMINATING THE COST OF ENERGY 1.) INITIAL SUBMITTAL WITH APPLICATION Page 2 of 3 Drawing No: Janusz-3LD1 Revision: 1 Revised: 9/2/20 EQUIPMENT&COMPONENT SCHEDULE TAG DESCRIPTION SPECIFICATION AC-CMB-1 AC COMBINER PANEL 250V, 100A, NEMA-1, 1-PH, 3-WIRE BKR-1 CIRCUIT BREAKER, PV-SA-1 MATCH AC COMBINER PANEL BRAND, 2-POLE, 20A AC-DSC-1 AC DISCONNECT SWITCH (LINE TAP) 250V, 60A, NEMA-1, FUSED; FUSE RATING: 50 CONDUCTOR SCHEDULE TAG TYPE CONDUIT AWG. / EGC A USE-2/PV/UF 3/4" PVC-40 12 / 6 B THWN-2 1-1/2" PVC-40 4 / 4 C THWN-2 1-1/2" EMT 4 / 4 1.)CONDUCTOR TYPES AND SIZES TO BE ADJUSTED FOR TEMPERATURE, DISTANCE,AND DERATING FACTORS. 2.) ELECTRICAL CONDUIT TO BE MIN. PVC SCHEDULE 40,ADJUST FOR SITE CONDITIONS. 3.) ALL ELECTRICAL MATERIALS AND INSTALLATION METHODS TO COMPLY WITH NEC AND LOCAL CODE REQUIREMENTS. 4.) NOTE: GROUNDING ELECTRODE CONDUCTOR TO BE#6 COPPER MINIMUM. PROPOSED EQUIPMENT SPECIFICATIONS REVISIONS Janusz, Robert ' � LOG IC = 1045 Dean Drive ENERGY Cutchogue, NY 11935 1.) INITIAL SUBMITTAL WITH APPLICATION ELIMINATING THE C'0ST , F,ENER Y Page 3 of 3 Drawing No: Janusz-3LD1 Revision: 1 Revised: 9/2/20 =rte' lJ P ` ER8 ,. Sun erg -Series: E20-327E19-320 e SunPowero Residential AC Module m fF Built specifically for use with the SunPower Equinoxr'�system,the only fully integrated solution designed,engineered,and warranted byone manufacturer, Maximum Power. Minimalist Design. AVAYS industry-lead ng e`fiaency r'eans more power and savings AFAU , � � pc_( available space 4V!tlr tc'•rv..„r rriocules!cq!_!rc.d and h!dcen(1 !cro nverte(s, less is truly mor e Highest Lifetime Energy and Savings. Designed to deliver 603,6 mo,e energy over 25 years in reI-world conditions IlKe partial shade and i,gh temperatures777 " y'..Fdin d4mentAIIy ifferen't'.-:k "'e G p, " r a "= Ahd �ir �e(i";s'y' •,, "'_ ..s i ::,s Up to x'F•'.. eries 1 - , 60% IT more ,, <v. r c .3�,�� %' �,.•r lifetime energy :. �"v'' •�' "' �;: �' x �:r, A T''°� �� <o4;^gz:�.`v;, �•;x�* d> a�„', v>°_ �"„v" � N �,.�, x< ,,._.,,w'<a,,r„", •4°s°: >v„vim ,'»,',`,.,'4",,,�,:.,, �,r�, .s�§�, �r YThe'SunPtiv er"Maxeonw'Solar Cell-: : a `t Years of operation Y.x."'�•,�y�Erlo�le�'ili�lleSi-c''r,CIE'11cy "r't ,IT o:'Utes&Val atilt.a„` Best Reliability. Best Warranty. tr ;` WO,more th2lddeployed d an5 million mot..es oyearoun �. �.1"EtIQPIL%�j�a;a�2 c hif�CU 'JS,�'is ` the*c)rl:%SunPow'er technolo3,is proven to last That's •„ whybVe stand behind our modu e and micro'nverter -_f% u �€ with the!nduslnrs oest 75-rear Combined Power and Product Warranty nclud!ng the highest Power Wa,ranty In Lolai. a\s_§',�" �< :' ` S_a'r S'•�:�Fi , ,.,avYC^iY',R'4,E`,`,._��'='r �, ` i , ±`,.r.,,Factciiy'Iii'tegratecitvlicroih"enter. t,'w';;.`::� a ®°`sl,ll'�Icr;fStP L:,x a 3 r;<•',' � :'<3 C _2% ap.rr f,,;,.>' a -"sem v'ti:.1.,�• I I ;,^"•, rC:tCd,v:ir@,i7haraEC-T:'rC° "=x ` ,.i E ;0�, a ,,• y,,, ,,:d 12% ','raol:�'SizUtdC>N7l„''" a.• :;: us r `y(r x ;more "re' Yi�l(re2re,G B'"l'Cai!lJtated�JN.,., ' ' fr ;, y„ ;power ' , in year [��.Cl:r`er',,t'JrsUfl�'iltNP'..,rIz1G.;lE:s�'z•3k,.n,F Y 3<^�, 2?',,mss„> `.n, .,�,,,,'° �.r,"" £ 'vn+s',:.4 "a,, ^r ,F3 2y� �t�' 'r°•4rv,°v3' ;"''rw fir.. {p',^,v�'e,a s" t>s -o:4"� ,, .ar.,, , '25 _'C z; Years of operation E-Series: E20-327 E19-320 SunPower-9 Residential AC Module Inverter Model:Enphase IQ 7XS(IQ7XS-96-ACM US) @240 VAC @208 VAC O"itou,7'l 320 VA 320 VA Ma/ T 5 VA 315 VA 240,21 -264 208/I 8i-2P) W,< r)'Itinlic"s 0 Irpu, (,") 1 31 151 Ma) t In-,per 20 A,[1)B-and-r mli: '2(s n0e phase) 10(rwo Dole)wye E-n(y 97 5% ---0710% -- --- `Jo-) Fr.-q,-,:,,-,, EO H7 47-'081!7 Short(,rcut,l-,jIjlt(;im-nt rid.r,'ycl,s 3 8 A i Ins 04-Tvo, X po- A---Pu t-3 er, 18 mA tc, ,rt-f 0 1 ILdc / 0 7 ag No 3ccve pilose bell 7riC 11�,fc,-1-1 plase llstai,-t'ans SPR-E20-327-E-AC SPR-E I 9-320-E-AC2S vicaj limited,pov,,er%,vaj rarn/ 2S-yeas limied p,od,!,:wat r,,rzy 14,,rnw -Poer'(Pril i_ -2-20 VV J 1703—- --—-- 1 -1 " FEF-'547 Mocule Eff.c,encv 2 0 9 9% i cc?t,fications Ul 1-'7-11�C-Mndi�,p jyoe 2 fire ra(ed) - ---- --- --- -- - --- --- - - - - I i ar Id -'errIp Coef'Po%re,) -0 35W'),`C U,62109-'..'IEC 32109-2 coinp,ance 7-C Park 1,5 Clpa 3 T ll bypass diodes CES-0003 Cass B - Shade-01 -:r,egra-'ed wodule-'2vei m,mr-ri,im power poirittiaclknl� CAN/C-SA-C22 2 NO 107 i-0' CA Rj!2 21 til-1"41,SA, A L steel P':'Rap d�zli-tciown Enu,nmen-f, Od • OIICILls Voli:(Var and-�cactive Power Prict ity) Offe'ra*'41-M, I i", Onera:i to I emp, -4,)'[ to++8`,'F(-/,0'(to 8-1-'C) E [�,)x Ambier.:Temp -,22-F(50-C) l : -accudFricL with - --------- ----- QFC t:90')(AC mccule) l,'ax _odd Wi-d 62 psf 3000 Pa,3GS kg,/m2 from,&bxk NEC iI,90 12 Rapld Sm,t,��ovjr(i,isidl?arc outside ti-e a,ray) Sr-,)vv 125 ps'COOG Pa,C1 1 Kglml'i ont, NK 690 1 5 A'Connectors,690 35(A)--(E)(1) I,T,oact Resis-arice diameter-ada.,52 rrph i23 mi'q) 11 1111; Wnrn used WEm Invisi!Vlour;rocking enc'Invi-SiMl ac,-1 es Pill,1111`111�1111 1111111111111111 111�11 111i (L,1L 2-703) �',�,c)duc-gr,),indngii-,,,Ir)c)rc'tngthrDLJ9,1-,nvsiMot-n' Solar(ells 96 M-o-Iocrystalline fvlaxecn Gen III Cldss A'li c rate,j Higi transmiss onterrpe,ecl ij�edvoti AC module Q(`.bles and au-,�,ssl(UL 670 and' Frill-Wlel-Live coatin.,, i UL 2238) --riv,ro--lental Rat i-I, Ouidoo, rated 'l�ite,�'or lead break(j,sconnLct =tarnc Clas I Dl.-k ai-01.112:O(hib-ho-.AAMA, li-S) PID--est P,-ter,tal-nd.-ced degracation free i1ht 105 19 b Kg) R-com-itrded N11px 1 3 In 1 (3 3 1 rl,T,) M,)dulc Spacing 1 sunp,,ver 350 v',,'Compared to 3 ccnventioni mul or simc,s zed (26"VVI,I bA, 46 mm offiren,,,,nprox 1,6rr 114 toren-o,gy fbasea on cnird pa,Ly cd.le claim) L J,wL,3iy2Ol7 (4U ill It 2,R) Wth,ab iyln,tat vn for-olarvixiij le:Parts'PvTecf-ovver 201;'ampea,),;?(,tai p3pz:r,20'3 ,1.Fac l CA R Q-2'lefc-lit pro`e-,t donng 393.,. I orrim.;sicmrig Ser,rno E q,iirox installatiun Gim,e JY81 01 fo,morc m(cirmati,n 5 SLaiidarJTesl:Co,,ji,,ons(1 Of,0104,in,r.adia,i,-e ANI-S,2-,'C)NPEt rzinirm-un staricaro ',(-.IMS rurrent I ACCS P ndqMrjg,(,.All fullycontairec within the module 6 pi,oci irt s UL I ister os PVRSE anc,roma,ms wttF rirr:,,,n1 E 3n-N) C 2^ i 1,'?0 12, 437 mm whet nista lcdam)r-irw instolctorl, UL Ger px mur 15,--e vAw, fet jno,e refe,erce irwirrianw), Fl inji.:ol see exter-ed data3heetvil sirpow,,ir PV=M-Mil spenf.c3tlon�;Indtl III 911s data,,il ce,haniewithow noz,e, LISTED E47=0 ,,,20118 Si,,Wowe,Corporation AJ R%litsRe5cived SUNNVVE,oie S lu N POWE Re Mol F,. Type 2 Sillir OWER Icgo zmC are registered tioderrarks&Sil Powl-r Car,,,l ip zh,�U S zmd ozh�r 1,WflUeS 1-8,00-St-NPOW1- pl"w'l-r."ad,tF,-sdey and Ijstll xis lo,Ceml 3 -531948 RevA ors SURVEY OF PROPERTY N DWELLING F<UF7N AT CUTCHOGUE PUBLIC WATER EL QI• ,w TOWN OF SOUTHOLD FE 0 S SUFFOLK COUNTY, N.Y. 1000-116-05-09 EL SO', , N/0/F SCALE. 1'=30' ora ZIMMER DKLUNG APRIL 13, 2018 PUBLIC WATER .� l LEST HOLE DATA MODONALD CE'OSCfENCE --� `�• W/08/2018 EL 81' P / / �'�� AREA OF 7,BROWN LOAM DLNG P�OOLSS BROWN SILTY SAND SM / - ---- 8'-�� UP BROWN SL AIL / \ +, PALE BROWN FINE TO COARSE SAND SW 11 I 1 59' _8• \\ EL.23' as, I11I / x \ I I I I O�R,yE u/c\ \\ 1 I I o x v. III 1 I CONC s�� J'b A• 0.55 `\ I 1 e \ WATER IN PALE BROWN I 11 I 6.5 �.5lx \\ NIO/F FINE SAND I I FR 5°5 e 'S x" DORANN K SHEEHAN LOT 7 OE y FF"5 9,! a,j6,, RE51DEN71AL TRUST VACANT 'p / 1J' l I / DWELLING NOTE WATER ENCOUNTERED as" II I II II -tib' % I PUBLIC WATER BELOW SURFACE Q \III I c A'.51�•u 5se // I 09' II \\ I 2 CMT OVER // 1 KEY Cn x5, ` UNT �" FRO \ DEC i c Q o REEAR \\\ ® m WELL _ i Al -STAKE y .{{ 1 �� 7H IMAffa S = TEST HOLE to i j a \�� B 1 EL 75' • =PIPE ------ `,• \ WAIEIt � f III -MONUMENT 1 1ET°' qb-U77LITY POLE a (�=1 / 110.10• OF P"�WEW EL 77 11l EL 5 ELEVATIONS RETEMVCE NA VD 88 .../ \_ ��r /501, C ` � LOT NUMBERS ARE FXED IN i E SCE Or pEp,N D id S1,r:EEr) 1 MAP�DONNSWEIY f7LED DV THE OFFICE Df EL Ge C WOO? � SUFFOLK COUNTY C U!RK ON AUG 11, 7970 AS AAP �pLJBU Na 5509 , ft- amm. No. 49618 ANY ALTERATION OR ADDITION TO THIS SURVEY IS A WOLATION OF ` s PECOWIC SURVEYORS, P.C. SECTION 7209OF THE NEW YORK STATE EDUCATION LAW.EXCEPT AS PER SECTION 7209-SUMWSON 2.ALC CER70CA17ONS HEREON _�,.�""� ; (631) 765-5010 FAX(631) 765-1797 ARE'VALID FOR TMS MAP AND COPIES THEREOF ONLY ff SAID MAP �' P.O. BOX 909 OR COPIES BEAR 7HETMPRESSED SEAL OF THE SURVEYOR WHOSE �-'� PUBLIC WATER \ AREA= 28,685 SQ F'T. ' 1230 TRAVELER STREET SGNATVRE APPEARS HEREO�L SOUTHOLD, N.Y. 11971 18-112 'PUBLIC WATER 0 -A4 V 4 "'.4 40 Suffolk County Executive's 0 ce of Consumer Affairs .... ............ VETERANS MEMORIAL HIGHWAY HAUPPAUGE,NEWYORK 11788 DATE ISSUED: 5/25/2006 No. 40227-H SUFFOLK COUNTY Home Improvement Contractor License xr This is to certifv that MARC A CLEJAN doing business as GREEN LOGIC LLC having fumished the requirements set forth in accordance with and subject to the provisions of applicable laws,rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME IMPROVEMENT CONTRACTOR,in the County of Suffolk. Additional Bu�m�esses '4 NOT VALED WITHOUT D.EPARTMENTAL SEAL AND A CURRENT CONSUNAEk AFFAIRS ID CARD Director 0:z— t Suffolk County Executive's Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 r DATE ISSUED: 12/10/2007 No. 43858-AN i SUFFOLK COUNTY o Master Electrician License l This is to certify that ROBERT J SKYPALA doing business as GREENLOGIC LLC I having given satisfactory evidence of competency, is hereby licensed as MASTER ELECTRICIAN in accordance with and subject to the provisions of applicable laws,rules and regulations of the County of Suffolk, State of New York. Additional Businesses a � NOT VALID WITHOUT DEPAwrmENTALSEAL AND A CURRENT CONSUMER AFFAIRS 11)CARD Director E IL .eco• CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) u 01/2812020 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 CAN Nicholas Zulkofske Brookhaven Agency,Inc. PHONE 631 941-4113 FA% 631 941-4405 128 Old Town Road,Suite C ArORLE . Certificates@ brookhavena enc .com P.O.Box 850 INSURER(Sl AFFORDING COVERAGE NAIC p East Setauket NY 11733 INSURER A: Southwest Marine&General Insurance Co. INSURED INSURER B: Merchants Preferred Insurance Co. GreenLogic,LLC INSURER c: First Rehab Life Insurance Co. 97 North Sea Rd,Suite 3 INSURER D: National Liability&Fire Insurance Co. Southampton NY 11968 INSURER E: AGCS Marine Insurance Co. 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 ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A CLAIMS-MADE ®OCCUR DAMAGE TO RENTED $100,000 X Contractual Liability X X GL202000012922 01/3112020 01/31/2021 MED EXP(Any oneperson) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 POLICY X❑JECT F LOC PRODUCTS-COMP/OP AGG $2 000 OOO OTHER E&O Liability $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS X X CAP1043565 0811112019 08/1112020 BODILY INJURY(Per accident) $ x HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Par accident) $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ A EXCESS LIAB CLAIMS-MADE X AGGREGATE $ DED I I RETENTION 0 $ WORKERS COMPENSATIONX PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N E L EACH ACCIDENT $1,000,000 D OFFICER/MEMBER EXCLUDED F—] N/A V9WCO23041 06115/2019 06/1512020 (Mandatory in NH) E L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $1,000,000 C NYS Disability D251202 04111119 04/11/20 Statutory Limits E Installation Floater/Property SML93076366 4115119 4115120 $250,000 $1000 Ded DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is also named as Additional Insured. CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 53095 ROUTE 25 SOUTHOLD,NY 11971 AUTHORIZED REPRESENTATIVE <NSZ> @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD HE Workers' CERTIFICATE atm TAT "'.' Flzs 01� YS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Greenlogic LLC 631-771-5152 97 North Sea Rd Suite 3 1c.NYS Unemployment Insurance Employer Registration Number of South Hampton,NY 11968 Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of insured or Social Security certain locations in New Yo*State,ie.,a Wrap-Up Policy) Number 203801194 2.Name and Address of Entity Requesting Proof of Coverage 3a Name of Insurance Carrier (Entity Being Listed as•the Certificate Halder) United Wisconsin Insurance Company Town of Southold Building Department 36.Policy Number of Entity Listed in Box"1 a" 53095 Rte 25 WC532-00243-020-SZ Southold,NY 11971 3c.Policy effective period 712312020 to 7/23/2021 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"l a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of insurance to the entity listed above as the certificate holder in box"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 conifers no'Aghts 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 Workers',Compensation contract of insurance only while the underlying policy is in effect Please Mote: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 busines_s'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. Approve&by: Alicia Christiansen (Printnam f a thonzed representative or licensed agent of insurance tamer) Approved by: (Signature) (Date) Title:Assistant Director of Sales Operations Telephone Number of authorized representative or licensed agent of insurance carrier: 941-306-3077 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form.C-405.2.Insurance brokers are NOT authorized to issue it. C-105.2(947) www.wcb.ny.gov .off> . y,,s„g.c"�+r`�� 1".,- d�.:1 >�'�ti.>a:�' ^">. ��. z'3,g- � v�"'�`^;'�`��ax"a°3.'�« >""Y,� �' �"'�:��- .3SFs°�,s,^ - - <".a�ms�.�-�a,�',_.M.�,�g��"°sc�ry .�,��,;, F`''"�f > r•ai e'm".,4. .�'� 'S"/'�,ore ,p>,-�,. r, ,s 'Ga >,a, y �nfi«"" yid > ;.: k x�'�"�t';�a=,.nJ.y" fir, s�`�,� r" y»�,�, ;,�.��°""> ;y°Aad✓"o '�'„ms�r„� ,, %�' '.- 9"< 6 r� 1, ;>.�; �� r a—MMx e ",F. lF Sirrrp!e 'rid`Fast Installa�ior�,' ��' " �� a�� " Ae > lrregrto medal, q-dM goGnc'n- ', y °i • ��;; " ,; Pre- ,e.m [ed,-id anc'end C iirT1 7s':` �� .. 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I MR Rail Solice 83C win(1)OZIFC) 25-year product waranry 1 War.3rics Gr,01_lfic Lug iO4 staii,less S-year fir-Sr warrancy Ass2moly, IA2-70 bolt,7o-p'ated coaxerlug) End k acetal PONA)ropo'ympr -10 4 g(O 17 oz) U-1-2/03-sied Cert ficaaci W I's Cass A Fire Rased A---- ............ X Compos,tion Sh rig[,?RFfter Anchn-cric Sh Rocif Decxi.rg krichmern rrerr Un vernal Interbue for Oter lR.,).oI-Attacnrnents Wei to roof ataclient harct.am mantjfaczurers doo,mentation, ,sunPmwroiporition All Rig,its Re,,ervPc] SINPOW-R, fw,MJNP(,WrR lor,),t,,-d INVI�,HVOUNI are rn,,Ks o,rc-giste,ed 1, svnpovver um 'peaficatwns,nduaed it znis lata>nect are subjer,to cw.,ngevwIho,iI not,cL Document#509506 RevC