The URL can be used to link to this page

Home My WebLink About47277-Z „ kTOWN OF SOUTHOLD BUILDING DEPARTMENT -< TOWN CLERK'S OFFICE _ 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 #: 47277 Date: 12/29/2021 Permission is hereby granted to: North Fork One LLC c/o Geoffrey Prisco 256 Union St Brooklyn, NY 11231 To: Install new solar roof shingles and Tesla storage packs at existing single family dwelling as applied for. *Disconnects must be located on the exterior, labeled and readily accessible as per code. At premises located at: 290 Windward Rd., Orient SCTM # 473889 Sec/Block/Lot# 19.-1-12.3 Pursuant to application dated 11/8/2021 and approved by the Building Inspector. To expire on 6/30/2023. Fees: SOLAR PANELS $50.00 ELECTRIC $100.00 CO-RESIDENTIAL $50.00 Total: $200.00 Building Inspector 9 TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 . Telephone (631) 765-1802 Fax(631) 765-9502 htt s /www.sciuthcildtownti o titvy Pie Date Received APPLICATIONI V - For Office Use Only s I L ' '10 c � � lug — PERMIT NO. 7 /0127 Building Inspector: Ll Applications and forms must be filled out in their entirety.Incomplete IF DING DEPT applications will not be accepted. Where the Applicant is not the owner,an TOWN r:SOUTHOLD Owner's Authorization form(Page 2)shall be completed. Date:11/4/2021 OWNER(S)OF PROPERTY: Name: Geoffrey Prisco SCTM# 1000- Project 000 Project Address: 290 Windward Rd Orient, NY 11957 Phone#: 718-809-9152 Email: gprisco@brutuspark.com Mailing Address: 256 Union Street Brooklyn, NY 11231 CONTACT PERSON: Name:Tesla Energy Operations,lnc./Anais Fernandez Mailing Address: 15 Grumman Rd West Suite 400 Bethpage, NY 11714 Phone#: 631-406-9567 Email: anafernandez@tesla.com DESIGN PROFESSIONAL INFORMATION: Name:Yurianto Yuianto Mailing Address: 602 N.Atwater Dr Malvern, PA 19355 Phone#: 610-504-4211 Email: yuriy@barun-corp.com CONTRACTOR INFORMATION: Name:Tesla Energy Operations,lnc./Anais Fernandez Mailing Address: 15 Grumman Rd West Suite 400 Bethpage, NY 11714 Phone#: 631-406-9567 Email: anafernandez@tesla.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition OAlteration ❑Repair Demolition Cost of Project: ❑Other tall(281)Tesla Solar Shingles 20.13kw and(5)Tesla Energy Storage System 67.5k-i Will the lot be re-graded? ❑Yes 2No Will excess fill be removed from premises? ❑Yes Z]No 1 j3 ii92395 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? Dyes 14N-o'IF YES, PROVIDE A COPY. U'Eheck Box After a The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. 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,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(s)for necessary inspections.False statements made herein are punishableas a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted Wprint ne): /t�lciiS ,1TAuthorized Agent ❑Owner Signature of Applicant: Date: I /y /Z STATE OF NEW YORK) , SS: COUNTY OF 1 � being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the (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/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this _day of 1\\�VL1'h��r Y , 20 —Etary Public ALEXANDER R. KAPLAN Ai4 RrIo'CR �� $ i � JLDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD own Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 roerroutholtownn��o seandsoutholdtownn - ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 11/4/2021 Company Name: Jason Kane Inc. Name: Jason Kane License No.: ME-37295 email: jkane@tesla.com Phone No: 516-306-0126 ❑I request an email copy of Certificate of Compliance Address.: 127 West Blvd East Rockaway, NY 11518 JOB SITE INFORMATION (All Information Required) Name: Geoffrey Prisco Address: 290 Windward Rd Orient NY 11957 Cross Street: Phone No.: 718-809-9152 BIdg.Permit#: -7- email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) Install (228) Tesla Solar Shingles 16.34kw and (3) Tesla Energy Storage system 40.5 kwh Check 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: (All information required) Service Size ❑1 Ph [J3 Ph Size: A # Meters Old Meter# E]New Service ❑ Service Reconnect ® Underground ❑Overhead Underground Laterals ❑1 ❑2 ❑H Frame❑Pole Work done on Service? Ely ❑N Additional Information: PAYMENT DUE WITH APPLICATION Electrical Inspection Form 2020.xlsx Version#auJ'1 PIL October uo.2oo1 RE CERTIFICATION LETTER KU UU '~' " - -`�� L�� Project/Job#11umn95 u/uo|mooEp- pmjem^d«'«»": pri000nooiuonno !OWN _��04Jmmxm�� znoWindward RU Orient,wY11oo7 AHJ Southold Town SC Office ovmpaoo Design Criteria: ' y/Eucw,mwith ooeoNvSUCS.ASCE 7'1a.and 2o1uNDS "'"°"°=w"',-" -Wind Speed=130 mph(3-s Gust-Vult),Exposure Category C,Partially/Fully Enclosed Method Ground Snow Load~uopnf 7rPMP:Roof oL~napof,Roof LUaL~14po,(Pm'on).Roof LuaL~1*pof(Povt-oa) Note: Per IBC 1o131; Seismic check is not required because Ss=0.182<0.4g and Seismic Design Category(SDC) B<D ToWhom|tMay Concern, 8o|arRoof`° isaroofing system comprised o[both PVand non-PV roofing elements.Please refer to the product data sheets,third-party certifications,and installation documentation for further information. Installation ofSolar Roof"°over asingle layer of composite shingles is acceptable per the manufacturer's installation instructions.If the existing roof has more than one layer of shingles,or any non-comp shingle roofing,a full tear-off is required.The net installed weight of the Solar RoofT11 system is 3.1 psf,is evenly distributed,and no roofing overlays are permitted.Consequently,the net additional loading impact mexisting gravity load resisting elements ioless than s96and nufurther analysis was performed. Where required by the installation manual or conditions above,installer shall perform a full tear-off of all existing layers of roofing material above existing sheathing/decking.Installer shall verify existing roofing,and sheathing/decking satisfy installation instructions.Installer shall verify roof framing ioinsuitable condition that does not exhibit any signs of structural damage which may diminish the capacity of its members o,connections prior mcommencement ofroofing installation. I certify that installation of the Solar RoofTM system on this job,given no presence of existing structural damage at time of installation;meets the criteria outlined inSection nO3of the IEBC/CEBC(afterations to existing structures)and is therefore permitted by code without alterations orstrengthening ofthe existing framing. �^m"� f � ��,,^ ^� "� nf�� ° ` —'m.h-,,* 101990 SSI ovYuri at/o`vo'o*PM,1umumou/ Tesla,Inc. T S S L R Workers' CERTIFICATE OF INSURANCE COVERAGE 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 Tesla Energy Operations, Inc. 901 Page Avenue I Fremont, CA 94538 :1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to I certain locations in New York State,i.e.,Wrap-Up Policy) [ or Social Security Number 02-0781046 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) The Prudential Insurance Company of America Town of Southold 3b.Policy Number of Entity Listed in Box"1 a" 154375 Main Road I Southold, NY 11971-0959 CG-51526-NY i 3c.Policy effective period I 01/01/2021 to 12/31/2022 i 4. Policy provides the following benefits: ❑X A.Both disability and paid family leave benefits. ❑ B.Disability benefits only. ❑ C.Paid family leave benefits only. 5. Policy covers: ❑X A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑ 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 described above. November 25 2020 Date Signed � By (Signature of insurance carrier's authorized representative or NYS Licensed insurance Agent of that insurance carrier) !Telephone Number 215-658-5178 Name and Title H. Richard Brummett-Statutory Disability Coordinator 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 5B 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) [ i Telephone Number Name and Title j 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) 11111FI III II II III -120.- (10-1?) Workers' CERTIFICATE OF ASNon ' NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured i 650-963-5100 Tesla Energy Operations,Inc. Page Avenue Fre 1c.NYS Unemployment Insurance Employer Registration Numberof Fremont,CA 94538 Insured 49-892777 Work Location of Insured(Only required if coverage is specifically limitedto 1d federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) y Number 02-0781046 2.Name and Address of Entity Requesting Proof of Coverage '3a.Name of Insurance Carrier ; (Entity Being Listed as the Certificate Holder) American Zurich Insurance Company Town of Southold 3b.Policy Number of Entity Listed in Box"1a" 437 Main Road WC 1074583-03 Southold, NY 11971 3c.Policy effective period 10/31/2020 to 10/31/2021 l 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"forworkers' 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 tail,)Otherwise,this Certificate is valid for one year after this form is approved by the insurance caner or its licensed agent,or until the policy expiration date listed in bo "3c",whichever isearlier. 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 Workers'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: Susan B. Kendziora (Print name of authorized representative or licensed agent of insurance carrier) Approved by: _14aelr� co, ;/ . rte 10 3112020 (Signature) (Date) Title:Vice President-Enterprise Support Operations Telephone Number of authorized representative or licensed agent of insurance carrier:800-382-2150 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www.wcb.nv.aov INTERNAL USE ONLY 3 Suffolk County Dept.of Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name CHARLES J PICARD Business Name This certifies that the TESLA ENERGY OPERATIONS INC bearer is duly licensed by the County o`su'ok License Number:HI-62558 Fra",k,,Nerd eUr,, Issued: 9112Y2019 Commissioner Expires: 911/2021 ' r Suffolk County Dept.of Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name CHARLES J PICARD Business Name rn-,s cwtfts#ml the marer is Wy kensed TESLA ENERGY OPERATIONS INC 7y the County of suffok License Number:HI-82558 Rosalie Drago Issued: 09/1212019 Commissioner Expires: 09101/2023