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HomeMy WebLinkAbout47879-Z TOWN 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 #: 47879 Date: 5/31/2022 Permission is hereby granted to: Campisi, Matthew ...._.._..............w __. .........................� _....._..�. 26 Evelyn Dr Commack, NY 11725 www_wwwww................__aa...�.._ .... . w.w................_.__........_.........._...—______� To: install (3) energy storage systems outside of the existing single-family dwelling as applied for. At premises located at: 455 Grovem Dr. ,Southold SCTM # 473889 __www_ _. _... ___ ..._...._............ Sec/Block/Lot# 80.4-8 Pursuant to application dated 4/25/2022gq_ and approved by the Building Inspector. To expire on _w11/30/2023. Fees: SOLAR PANELS $50.00 ELECTRIC $100.00 CO-ALTERATION TO DWELLING $50.00 Total: $200.00 Building Inspector '� TOWN OF SOUTHOLD—BUILDING DEPARTMENT T� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 lit e :Hwww. otit,lloldi,owtif1 ,ov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO.—.. .. - Building Insp¢ctor:_._ ....,. Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date:2/8/2022 OWNER(S)OF PROPERTY: Name:Matthew Campisi SCTM #1000- Project Address: 455 Grove Drive Southold, NY 11971 Phone#: 631-988-5334 Email: mcampisi@me.com Mailing Address:455 Grove Dr Southold, NY 11971 CONTACT PERSON: Name:Tesla Energy Operations Inc./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 Yurianto Mailing Address: 905 Chesterfield Drive Lower Gwynedd, PA 19002 Phone#: 972-896-5373 Email: yuriy@barun-corp.com CONTRACTOR INFORMATION: Name:Tesla Energy Operations Inc./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 ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ?Other $21,000 Will the lot be re-graded? ❑Yes 2No Will excess fill be removed from premises? ❑Yes 2No 1 PROPERTY INFORMATION Existing use of property: cS� Intended use of property: �leSi Zone or use district in which premises is situated: Are there any covenants nand restrictions with respect to ❑ ,�. this property? Yes Lr�'N'o IF YES, PROVIDE A COPY. p eck Box After_eadin The owner/contractor desi n professional is responsible for all drainage and storm y gm / g p g rm 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 punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted 13 tint name): Ao61 s1�;� � thorized Agent ❑Owner Signature of Applicant: v Date: STATE OF NEW YORK) l .ems` COUNTY OF � ) being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the —04rn(N,+( (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 120 -21 Nott'Public pATRICIA M: NOTARY rUBLIC-STATE OF NEW yC RK PROPERTY OWNER AUTHORIZATIONNo-017.U6328662 Qualified in Suffolk County (Where the applicant is not the owner) My Commission Expires 08-03-20 3 &(JjI, � yvI residing at 45S Grove brl SO d _ do hereby authorize—AC-16—t—�flewl� �wwwwww to apply on my behalf to t wn of Southold Building Department for approval as described herein. C) I I Owner's Signature Date Print wner's Name 2 SIC"" BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD ° Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 ro err sout�holdtownn ov — seand southoldtownn . ��ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 2/8/2022 Company Name: Jason Kane Inc. Name: Jason Kane License No.: ME-37295 email: `kane tesla.com Phone No: 516-306-0126 DI request an email copy of Certificate of Compliance Address.: 127 West Blvd East Rockaway, NY 11518 JOB SITE INFORMATION (All Information Required) Name: Matthew Campisi Address: 455 Grove Drive Southold, NY 11971 Cross Street: Phone No.: 631-988-5334 BIdg.Permit#: 7 email: mcampisi@me.com Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) Install (3) Tesla Energy Storage System 40.5KWH Check All That Apply: Is job ready for inspection?: DYES ®NO ❑Rough In ❑Final 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 ❑ Service Reconnect ❑ Underground [-x-]Overhead # Underground Laterals D1 2 DH Frame❑Pole Work done on Service? Ely �N Additional Information: PAYMENT DUE WITH APPLICATION Electrical Inspection Form 2020.xlsx YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name""&Address of Insured(use street address only) 1b.Business Telephone Number of Insured 650-963-5100 Tesla Energy Operations,Inc. 901 Page Avenue 1c.NYS Unemployment Insurance Employer Registration Numberof Fremont,CA 94538 Insured 49-892777 Work Location of Insured(Only required if coverage is specifically limitedto 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) 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" 54375 Main Road WC 1074583-04 Southold, NY 11971 3c.Policy effective period 10/31/2021 to 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 inwbox"1 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[hoard 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 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 farm,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: tQ,t col_ 10 31 2021 (Signature) (Date) Title: Vice President-EEntpi _SupportOperatig!s _w_...m 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.gov INTERNAL USE ONLY DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12104/2021 THIS CERTIFICATE IS ISSUED A 11 S 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 have ADDITIONAL INSURED provisions or be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. sIAMeFerrell PRODUCERKayla -, .. MARSH RISK& INSURANCE SERVICES PHONE FAQ FOUR EMBARCADERO CENTER,SUITE 1100 A fRti 415-743-80,25 tC,HaA) CALIFORNIA LICENSE N0.0437153 MAIL Kayla,ferrell@marsh.com SAN FRANCISCO,CA 94111 Attn:SanFrancisco.Certs@marsh.com/FAX 212-948-0398 IfURER( i AFFORo9W{+COVERAGE MAIC CN1 04275261-STND-GAWUE-21- INSURER AuridnAmencan Insurance C",arrnpgly" 16535 INSURED INSURER R Steadfast Insurance C OCrt$Tany -„ 26387 Tesla Energy Operations,Inc. 901 Page Avenue INSURER„ , American Zu th„ ristrranc ¢,zrl;lESray_”" ...- 40142 Fremont,CA 94538 INSURER 0 ANsanzPoPat Nstrs US Insurance QqrTrSa CRy 35306 INSURER F COVERAGES CERTIFICATE NUMBER: SEA-003418109-28 REVISION NUMBER: 9 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, i CLUSIONSAPDCO CONDITIONS OF SUCHLIMITS SHOWN HAVE BEEN REDUCED PAID CLAIMS. F...466L SUBR Pot LIMITS T TYP11 so E OF POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY GLO1074588-04 10/31/2021 10/31/2022 EACH OCCURRENCE $ 2,500,000 __ CiAATAuL CCAtNIV LM . CLAIMS- ...IR:$750,000 MADE �..�.0 OCCUR � ..MED EIXP(Any one IA!'rs"r"aAt_._.$ ........ ... ......... .. . X Includes Host Liquor Liability , 5 2 00 000 X SIR. B X Tort Contras Liab,N 11 o XCU Excl SXS-7426362-02 Excess GL- 10131/2021 10(31(2022 PERSONAL&ADV INJURY $ 11 2500 GEN'LAGGREGATE LIMIT APPLIES PER: -- R. P ENERALAGGREGATE `F „ , Limit;$6,750,000 excess of primary .�.... ...- 20,000,000.. X... POLICY PRO LOC GL limits on right;applies to PRODUCTS...00MFmIL P AGG S 6,000,000 .,,._ 7EC1` TTt:R .(Solar Products Only) � t l.4 .... $ A AUTOMOBILE LIABILITY B1174�5Rt4 0%I'I2C2d 10f3" 722 MBN', IqLLCLILB $ mm_ 10,000,000 .. .. X ANY AUTO BODILY INJURY(Per person) $ OWNED " SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS I CAf FR fY DAM A E HIRED " NON-OWNED $ AUTOS ONLY AUTOS ONLY fPgr"fwwp4 r/en4. occuR EACH OOCCLIRRI NCE, ........... $ 15 ono 000 X UMBRELLALIAB X USL00544221 10131/2021 10(3112022 EACH Excess uA6 CLAr,ME.MADE RETENTIONS:SEE PAGE 2 AGGREGATE - �.... . 15,000,000 DED X RET'ENTtlON$ $ C WORKERS COMPENSATION �1074°58304(AOS) I.I.; P 7�i?1( 2 X t X TfI` LIABILITY YIN 10131/2021 10/31/2022 S 1000,000 i A'TUTa AND ANY� EMPLOYERS p, w WC 1074584-04(MA,WI) E L EACH ACCIDENT 'LROP�ak.PurO Rd$IAK'rNe82!'E?&L:iU4A'T"VE' .. ^Rh„RFRCIu'G CY A RrarcCLt/DC-D N N 1 A CA XSWC EWS 1074585-04 $50M Is XS 10131/2021 10131/2022 (Mandatory in NH) I E.L DISEASE EA EMP rRYFF a 1 000,000 II es, N asrnuNr $10M SIR;$1M EE/EA is XS$10M SIR) E.L DISEASE f'CJ.CY LIMIT $ 1,000,000 O SCRRRTIR"kN r�F ORERATIONS tt6rtiow DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of insurance, CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 54375 Main Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold,NY 11971 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Xmi Ada If 1"Mwe SOMI&ed ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD O workers' CERTIFICATE OF INSURANCE COVERAGE ST ATE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Tesla Energy Operations, Inc. 901 Page Avenue Fremont, CA 94538 1c.Federal Employer Identification Number of Insured Work Location of Insured(only required if coverage is specifically limited to or Social Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 02-0781046 _...w ...................� �. ._..�.. 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"l a" 54375 Main Road CG-51526-NY Southold, NY 11971-0959 3c.Policy effective period 01/01/2021 to 12/31/2022 4. Policy provides the following benefits: ❑R 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 ..www _ �. BY _.., _ ------ ....... (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 215-65$-5178.. Name and Title H. Richard Br mmett-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 4B,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 56 of Part i 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 .�www..w..�_�-...._... ...............wawa_. � ..w�_.... ..� (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title � �w�w_www Please Note:.Onl insurance carriers__.....__.ww w w ...........�..._.................. ......_ry _.__ ,........_...�. ___..wwww..........mm.........insurance p. ..w.... .._._....................._.M,,,,,...... y leave benefits agents of those insurance carriersre authorized to issue Forrm'DB--120 1. Insurance brokers are NOT authorized to policies and NYS licensed insurance gissue this form. D13-120.1 (10-17) Illgll[11111110111111111°1°1°� ° IIII RECEIPT" SUFFOLK COUNTY GOVERNMENT DEPARTMENT OF LABOR, LICENSING,AND CONSUMER AFFAIRS COMMISSIONER ROSALIE DRAGO P.O. BOX 6100, HAUPPAUGE, NY 11788 (631)853-4600 Today Date: 03/22/2021 Application: ME-37295 Application Type: Master Electrical License Receipt No. 421664 Payment Method Ref.Number Amount Paid Payment Date Cashier ID Comments Check 149 $400.00 03/22/2021 CHRISTI Renewal Contact Info: JASON KANE INC JASON KANE 127 WEST BLVD EAST ROCKAWAY, NY 11518 Work Description: Suffolk County Dept.of Labor,Licensing a Consumer Affairs MASTER ELECTRICAL LICENSE r Name JASON KANE Business Name This certifies that the bearer is duly licensed JASON KANE INC by the County of suffolk License Number:ME-37295 Rosalie Drago Issued: 04/2012005 Commissioner Expires: 04/01/2023 Suffolk County Dept.of Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name CHARLES J PICARD Business Name This certifies that the wearer is duly licensed TESLA ENERGY OPERATIONS INC :)y the County of suffotk License Number:HI-62556 Rosalie Drago Issued: 09112/2019 Commissioner Expires: 09/01/2023 1 Poll - ABBREVIATIONS ELECTRICAL NOTES JURISDICTION NOTES A AMPERE AC ALTERNATING CURRENT BLDG `1. THIS SYSTEM IS GRID—INTER11ED VIA A UL—LISTED ALL WORK TO COMPLY WITH SECTION R327 OF THE BUILDING CONIC CONCRETE DC DIRECT CURRENT POWER—CONDITIONING INVERTER. 2020 RESIDENTIAL CODE OF NYS. EGC EQUIPMENT GROUNDING CONDUCTOR (E) 2. A NATIONALLY — RECOGNIZED TESTING EXISTING EMT ELECTRICAL METALLIC TUBING FSB LABORATORY SHALL LIST ALL EQUIPMENT IN FIRE SET—BACK GALV GALVANIZED GEC GROUNDING COMPLIANCE WITH ART. 110.3. ELECTRODE CONDUCTOR." GND GROUND HDG HOT 3. WHERE ALL TERMINALS OF THE DISCONNECTING DIPPED GALVANIZED I CURRENT Imp CURRENT AT MEANS MAY BE ENERGIZED IN THE OPEN POSITION, MAX POWER Isc SHORT CIRCUIT CURRENT kVA A SIGN WILL BE PROVIDED WARNING OF THE KILOVOLT AMPERE kW KILOWATT LBW LOAD HAZARDS PER ART. 690.17. BEARING WALL MIN MINIMUM (N) NEW NEUT 4. EACH UNGROUNDED CONDUCTOR OF THE NEUTRAL NTS NOT TO SCALE OC ON CENTER PL MULTIWIRE BRANCH. CIRCUIT WILL BE IDENTIFIED BY PROPERTY LINE POI POINT OF INTERCONNECTION PHASE AND SYSTEM PER ART. 210.5. PV PHOTOVOLTAIC SCH SCHEDULE S STAINLESS 5. CIRCUITS OVER 250V TO GROUND SHALL COMPLY STEEL STC STANDARD TESTING CONDITIONS TYP WITH ART. 250.97, 250.92(B). TYPICAL UPS UNINTERRUP11BLE POWER SUPPLY V 6. DC CONDUCTORS EITHER DO NOT ENTER BUILDING VOLT Vmp VOLTAGE AT MAX POWER Voc VOLTAGE OR ARE RUN IN METALLIC RACEWAYS OR AT OPEN CIRCUIT W WATT 3R NEMA 3R, RAINTIGHT ENCLOSURES TO THE FIRST ACCESSIBLE DC DISCONNECTING MEANS PER ART. 690.31(E). 7. ALL WIRES SHALL BE PROVIDED WITH STRAIN RELIEF AT ALL ENTRY INTO BOXES AS REQUIRED BY UL LISTING. 8. MODULE FRAMES SHALL BE GROUNDED AT THE UL — LISTED LOCATION PROVIDED BY THE MANUFACTURER USING UL LISTED GROUNDING I� (� HARDWARE. 15 llJr 9. MODULE FRAMES, RAIL, AND POSTS SHALL BE BONDED WITH EQUIPMENT GROUND CONDUCTORS. APR.T-5 2022 5 ' BUILDING DEPT TOWN OF SOUTHOLLD VICINITY MAP INDEX Sheet 1 COVER SHEET Sheet 2 SITE PLAN Sheet 3 THREE LINE DIAGRAM Sheet 4 ESS INSTALLATION LICENSE GENERAL NOTES Sheet 5 POWERWALL MOUNTING DETAIL Cutsheets Attached 1. ALL WORK SHALL COMPLY WITH THE 2020 NYS UNIFORM CODE. 2. ALL ELECTRICAL WORK SHALL COMPLY WITH THE 2017 NATIONAL ELECTRIC CODE. 3. ALL WORK SHALL COMPLY WITH THE 2020 NYS FIRE CODE. MODULE GROUNDING METHOD: WEEB 4. ALL WORK SHALL COMPLY WITH THE 2020 AHJ: Southold Town BUILDING CODE OF NYS. REV BY DATE COMMENTS 5. ALL WORK SHALL COMPLY WITH THE 2020 REV A NAME DATE COMMENTS RESIDENTIAL CODE OF NYS. 6. ALL WORK SHALL COMPLY WITH THE 2020 UTILITY: PSE&G—Long Island EXISTING BUILDING CODE OF NYS. CONFIDENTIAL- THE INFORMATION HEREIN aoe NDMBER: J B-119 2 2 71 CUSTOMER: DWIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THE Matthew Campisi 40.5 KWH ENERGY STORAGE SYSTEM TimothyCamilleri BENEFIT OF ANYONE EXCEPT TESLA INC., NOR MOUNTING SYSTEM: T 5 L n SHALL IT BE DISCLOSED IN WHOLE OR IN 455 Grove Dr PART TO OTHERS OUTSIDE THE RECIPIENTS MODULES Southold, NY 11971 ORGANIZATION, EXCEPT IN CONNECTION WITH THE SALE AND USE OF THE RESPECTIVE TESLA EQUIPMENT, WITHOUT THE WRITTENPAGE NAME SHEET-. REV: DAIS MVERTER PERMISSION OF TESLA INC. 6319885334 COVER SHEET 1 10/12/2021 ESS ��OF NEVI/y NY J�\PDigitally signed by ESS WINDOW * an Yurianto Yurianto J J DN:cn=Yurianto Yurianto c=US :l o=Unaffiliated anto ou=A01410D000OO176B 07CBF250000A7A2 ESSn�2� f �_✓� Reason:I am the author J of this document Loca3 nO 101980 Date:20 Date:20:00 �� 09:35-05:00 FE S1 By Yuri at 9:34:56 AM,4/18/2022 _ MO RE�A Y it I � LEGEND (E) UTILITY METER & WARNING LABEL my INVERTER W/ INTEGRATED DC DISCO & WARNING LABELS R© AUTOMATIC RELAY DC DISCONNECT & WARNING LABELS AC I AC DISCONNECT & WARNING LABELS 10 DC JUNCTION/COMBINER BOX & LABELS Front Of House ENERGY STORAGE SYSTEM FOR STAND Ess ALONE OPERATION 10 DISTRIBUTION PANEL & LABELS Lc LOAD CENTER & WARNING LABELS O DEDICATED PV SYSTEM METER RSD RAPID SHUTDOWN Q STANDOFF LOCATIONS CONDUIT RUN ON EXTERIOR (E) DRIVEWAY 0 --- CONDUIT RUN ON INTERIOR GATE/FENCE Q HEAT PRODUCING VENTS ARE RED LO It I INTERIOR EQUIPMENT IS DASHED L—-J SITE PLAN N Scale: 1/8" = V W E 0 1' 8' 16' S CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER: JB-1 192271 00 CUSTOMER: DESCRIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THE Matthew Campisi 40.5 KWH ENERGY STORAGE SYSTEM Timothy Camilleri T 5 L n BENEFIT OF ANYONE EXCEPT TESLA INC., NOR MOUNTING SYSTEM: SHALL IT BE DISCLOSED IN WHOLE OR IN 455 Grove Dr PART TO OTHERS OUTSIDE THE RECIPIENTS MODULES Southold, NY 11971 ORGANIZATION, EXCEPT IN CONNECTION WITH THE SALE AND USE OF THE RESPECTIVE TESLA EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME SHEET: REV DATE INVERTER: PERMISSION of TESLA INC. 6319885334 SITE PLAN 2 10/12/2021 MAIN PANEL SPECS GENERAL NOTES LICENSE Panel Number;No Label Meter Number.98402108 Overhead Service Entrance E 200A MAIN SERVICE PANEL E 20OA/2P MAIN CIRCUIT BREAKER (E) WRING TESLA (N) 200A INTERNAL TESLA 2 BACKUP GATEWAY LOAD CENTER BACKUP SWITCH Y o0A 2P 30A 2P Z LA 1 L1 20OA/2P a L2 ENERGY X STORAGE l (E) LOADS174 N EGG] SYSTEM — G ----------- ----- — Powerwall 2.0 L--- --- -- I I--- 30A 2P 1 I LZ ENERGY X STORAGE EGc SYSTEM N ————— Powerwall 2.0 30A 2P METER Z z —— EGC——— jEEGC :::] L1— ENERGY STORAGE GEC —— SYSTEM ——— `———— Powerwall 2.0 TO 120/240V SINGLE PHASE I UTILITY SERVICE I I I I Z (1)1624171-00—F (1)AWG#10, THWN-2,Black Backup Switch O (1)AWG#10, THWN-2,Red AC POI (1)Gro Rd Roil (1)AWG#10, THWN-2, White 5r8 x 8, Co per {1 AWG X10, 11iWN-2,,Green,,• ,•,• ,, (1)Conduit,154; 1"EMT —(2)ILSCOy IPC 4 p0-2/Coo 0 (1)AWG p /. / ( �/3, 1HWN-2 Black IflSUIOiIan Pierang Connector, Main 4/0-2, Tap 2/0-6 O �, (1)AWG#3, THWN-2, Red Y (1)Tesla#1232100—OD—G (1)AWG#3, THWN-2, White Back—up Gateway 2.0 NA for AC PW 2.0 THWN-2, Green — 1 Conduit Kit.1'_EMT . .._• ••,, . —(1)Eaton f BW2100 A 100A ain Circuit Breaker, 2—Pole, 24OV, 1akAIC —(3)CUTLER—HAMMER #BR230 Breaker, 30A/2P, 2 Spaces —(1) Panelboard Accessory it for GW 2.0 NA 200A, 6sp/12cir, 12024OV,1PH X (.3)3012170-05—B ASY,AC POWERWALL2.1,5KW,13.5KWH,M48 CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER: JB-1 192271 00 CUSTOMER: DESCRIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THE Matthew Campisi 40.5 KWH ENERGY STORAGE SYSTEM Timothy CamilleriBENEFIT OF ANYONE T 5 L n SHALL TE DISCLOSED IINC., NOR MOUNnNGsrsTEM:EXCEPT N WHOLE OR 455 Grove Dr PART TO OTHERS OUTSIDE THE RECIPIENTS ORGANIZATION, EXCEPT IN CONNECTION WITH MODULES: Southold, NY 11971 THE SALE AND USE OF THE RESPECTIVE TESLA EQUIPMENT, WITHOUTTHE WRITTEN INVI]TTER PAGE NAME SHEET: REV: DATE PERMISSION OF TESLA INC. 6319885334 THREE LINE DIAGRAM 3 10/12/2021 Is 'srs�-. - In !f"'T- `4"�.� rt , ------------- rp :sem„ r tiw +�:• _ r' a i i ti ._e S r ._— c - _ •tee. . Ma - V1C I r , , , — - y r a.. CONFIDENTIAL- THE INFORMATION HEREIN JOB NUMBER: JB-1 192271 00 CUSTOMER: DESCRIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THE Matthew Campisi 40.5 KWH ENERGY STORAGE SYSTEM Timothy Camilleri T S L n BENEFIT OF ANYONE EXCEPT TESLA INC., NOR MOUNTING SYSTEM: SHALL IT BE DISCLOSED IN WHOLE OR IN 455 Grove Dr PART TO OTHERS OUTSIDE THE RECIPIENTS ORGANIZATION, EXCEPT IN CONNECTION WITH MODULES: Southold, NY 11971 THE SALE AND USE OF THE RESPECTIVE TESLA EQUIPMENT, WITHOUT THE WRITTEN INVERTER: PAGE NAME: SHEET' REV: DATE PERMISSION OF TESLA INC. 631 9885334 ESS INSTALLATION 4 10/12/2021 (E) 2x WOOD WALL STUDS I-T (N) POWERWALL BRACKET, POWERWALL UNIT NOT WOOD SCREWS TO STUDS BEYOND. SHOWN FOR CLARITY PROVIDE MIN. (1) SCREW @ EACH STUD IN ANY H POWERWALL INSTALLATION INFORMATION: 1. INSTALL (N) POWERWALL UNIT CENTERED BETWEEN (E) 2x WOOD STUDS WITH MAXIMUM STUD SPACING BASED ON TABLE 1. 2. FASTEN (N) POWERWALL UNIT TO (E) 2x WOOD STUDS W/ (4) (N) 4" WOOD SCREWS W/ MIN. 22" EMBEDMENT. PLACE (N) FASTENERS AT CORNERS OF BRACKET IN ANY HOLE. MAKE SURE THAT THE SCREWS ARE PLACED IN THE NARROW FACE OF THE 2-STUD ATTACHMENT: FRONT VIEW STUD SO THAT LOADS ARE APPLIED TO THE STRONG AXIS. W2 3. MIN. STUD LUMBER GRADE ASSUMED IS "STUD" GRADE. NTS 4. POWERWALL UNITS) MUST BE PLACED PER SPECIFIED LOCATION ON SITE PLAN. DO NOT MOUNT BELOW OR ABOVE WINDOWS. IF LOCATION NEEDS TO BE CHANGED, POWERWALL UNIT PLEASE CONTACT DESIGN TEAM. ANY UNUSUAL FRAMING NEAR THE POWERWALL THAT MAY COMPROMISE THE WALL STRUCTURAL INTEGRITY SHALL BE RELAYED TO POWERWALL UNIT THE DESIGN TEAM PRIOR TO INSTALL. (E)WOOD WALL STUDS (E)WOOD LAG SCREWS TO STUDS BEYOND. WALL STUDS PROVIDE MIN.(1)SCREW TABLE 1: MAXIMUM STUD SPACING ®EACH CORNER IN ANY HOLE LAG SCREWS TO STUDS BEYOND. MIN. PENETRATION PROVIDE MIN. (1)SCREW INTO WALL STUDS ®EACH CORNER IN ANY HOLE 2X4 STUDS 2X6 STUDS MIN. PENE1RA710N IN IENIUR WALL 24 24 POWERWALL INTO WALL STUDS WALL BRACKET LX I ENIUR WALL 16 24 POWERWALL WALL BRACKET •a' WOOD STUD ATTACHMENT: WALL MOUNTED WOOD STUD ATTACHMENT: GROUND MOUNT SIDE VIEW ONE POWERWALL Scale:1/2" =>_'-o" SIDE VIEW TWO POWERWALL Scale:1/2 =1'-0" CONFIDENTIAL-THE INFORMATION HEREIN JOB NUMBER J13-1192271 00 CUSTOMER: DESCRIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THE Matthew Campisi 40.5 KWH ENERGY STORAGE SYSTEM Timothy amCilleri BENEFIT OF ANYONE EXCEPT TESLA INC., NOR MOUNIING SYSTEM: 5 L n SHALL IT BE DISCLOSED IN WHOLE OR IN 455 Grove Dr PART TO OTHERS OUTSIDE THE RECIPIENTS NODULES Southold, NY 11971 ORGANIZATION, EXCEPT IN CONNECTION WITH THE SALE AND USE OF THE RESPECTIVE TESLA EQUIPMENT, WITHOUT THE WRITTEN INVERTER: PAGE NAME SHEEP: REV: DATE: PERMISSION OF TESLA INC. 6319885334 POWERWALL MOUNTING DETAIL 5 10/12/2021 Label ..- LOAD CENT_ER CAUTION: Per ••_ Per Code: NEC 408.4 ,84 SECOND SOURCE IS PHOTOVOLTAIC SYSTEMNEC / THIRD SOURCE IS ENERGY STORAGE SYSTEM Label • • CAUTION DO NOT ADD NEW LOADSPer Code: ,.- • • NEC ' WARNING Per ..- THIS EQWIPMENT FED:BY' NEC 1 •- • , • MULTIPLE SOURCES.TOTAL RATING OF ALL OVER CURRENT CAUTION DEVICES, EXCLUDING MAIN THIS PANEi HAS SPLICED FEED- Per ••" SUPPLY OVERCURRENT DEVICE„ THROUGH CONDUCTORS, NEC 312.8.A(3) SHALL NOT EXCEED AMPACITY OF BUSBAR. LOCATION OF DISCONNECT AT EN-ERGY .STORAGE BACKUP LOAD PANEL - - ----- Label Location: Location:Label NOMINAL ESS UOLTA�G�E_ 12(l�4QV CAUTION MAX AVAILABLE SHORT Per ..- DUAL POWER SOURCE Per ••- CI'RCUIT'FROM ESS: 32APer 706.7(D) .•- • •- marked in field sEcolvD souRCE rs ARC°.FPU'LTCLEAR�I�G. ENERGY STORAGE SYSTEM Label Location: TIME FROM ESS_ 67ms DATE OF GALCULATIO':N:_ ENERGY STORAGE SYSTEM ON SITE LOCATED 1/UIT.HIN LINE OFSIGHT Per •• Label • • ENERGY STORAGE SYSTEM ON SITE LOCATED ON ADJACENT WALLPer Code: .•- • • (MSENERGY STORAGE SYSTEM OfV SITE - LOCATED ON OPPOSITE WALLPer •• Label • • ENERGY STORAGE SYSTEM ON SITE LOCATED INSIDEPer Code: ` AC Disconnect Backup Load Center POWERWALL TYPICAL SYSTEM LAYOUTS Tesla Powerwall is a fully-integrated AC battery system for WHOLE HOME BACKUP residential or light commercial use. Its rechargeable lithium-ion T battery pack provides energy storage for solar self-consumption, Optional; tin-ie-based control, and backup. Powerwall's electrical interface provides a simple connection to Solar any home or building. Its revolutionary compact design achieves market-leading energy density and is easy to install, enabling owners to quickly realize the benefits of reliable,clean power. o o Solar inverter ; ----------------------- Main panel Backup Gateway Utility meter Grid including service disconnect T 3 5 L n PERFORMANCE SPECIFICATIONS MECHANICAL SPECIFICATIONS AC Voltage(Nominal) 120/240 V Dimensions' 1150 mm x 753 mm x 147 mm (45.3 in x 29.6 in x 5.75 in) ^n ---- .- --- -- - - ----- Feed-In Type Split Phase 64 l Weight' 114 kg(251.3 Ibs) Grid Frequency 60 Hz ---- - - -- ---- - ----- - ------ - -------- ---- ---- - - - Mounting options Floor or wall mount Powerwall Whole home Total Energy' 14 kWh - — - - - - -- - backup - - - - Dimensions and weight differ slightly if manufactured before March 2019. Usable Energy' 13.5 kWh Contact Tesla for additional information. 147 mm Real Power,max continuous 5 kW(charge and discharge) 753 mm (29.6 in) (5.75 in) -- -- -------- --- -- -- -------- ---- Real Power,peak(10s,off-grid/backup) 7 kW(charge and discharge) Apparent Power,max continuous 5.8 kVA(charge and discharge) Apparent Power,peak(10s,off-grid/backup)7.2 kVA(charge and discharge) T o M L q --- ---- — --- - - ----- -- - - 1 PARTIAL HOME BACKUP Load Start Capability 106 A LRA for each Powerwall II _ _ Maximum Supply Fault Current 10 kA ------Optional I Maximum Output Fault Current 32 A ` 1150 mm (45.3 in) Overcurrent Protection Device 30 A Imbalance for Split-Phase Loads 100% ;1� Solar Power Factor Output Range +/-1.0 adjustable PowerFactor Range(full-rated power) +/-0,85 50 Internal Battery DC Voltage V I o e ❑ - _-_ _ _ ___ _ Round Trip Efficiency'' i— — 90% -- — ENVIRONMENTAL SPECIFICATIONS Warranty 10 years - - - - - - Solar inverter Operating Temperature -20°C to 50°C(-40F to 1220F) __________________________i Sub panel Backup Gateway Main panel Utility meter Grid 'Values provided for 25°C(770F).3.3 kW charge/discharge power. ---- -- zAC to battery to AC,at beginning of life. Recommended'Temperature - 0°C to 30°C(32°F to 86°F) Operating Humidity(RH) Up to 100%,condensing T=5 L n Storage Conditions -20°C to 30°C(-40F to 860F) COMPLIANCE INFORMATION Up to 95%RH,non-condensing State of Energy(SoE):25%initial Certifications UL 1642,UL 1741,UL 1973, Maximum Elevation 3000 m(9843 ft) I I UL 9540,IEEE 1547,UN 38.3 _ _ Environment Indoor and outdoor rated Grid Connection Worldwide Compatibility ---------- ------- - - --- - - -- -- Powerwall Backup loads Home loads -- --------- - Enclosure Type NEMA 3R Emissions FCC Part 15 Class B,ICES 003 -- - - ---- -------- -- - -_ Ingress Rating IP67(Battery&Power Electronics) Environmental RoHS Directive 2011/65/EU IP56(Wiring Compartment) Seismic AC156,IEEE 693-2005(high) Wet Location Rating Yes Noise Level @ 1m <40 dBA at 30°C(86°F) T - Ei L r3 TESLA.COM/ENERGY T E Ei L n -Bx J,UP-20"1-Q6-01 TESLA.COM/ENERGY POWERWALL Backup Gateway 2 The Backup Gateway 2 for Tesla Powerwall provides energy managementj T a L, Fi and monitoring for solar self-consumption,time-based control,and backup. The Backup Gateway 2 controls connection to the grid,automatically ' detecting outages and providing a seamless transition to backup power. When equipped with a main circuit breaker,the Backup Gateway 2 can be installed at the service entrance.When the optional internal panelboard is installed,the Backup Gateway 2 can also function as a load center. The Backup Gateway 2 communicates directly with Powerwall,allowing you to monitor energy use and manage backup energy reserves from any mobile device with the Tesla app. PERFORMANCE SPECIFICATIONS MECHANICAL SPECIFICATIONS Model Number 1232100-xx-y Dimensions 660 mm x 411 mm x 149 mm AC Voltage(Nominal) 120/240V (26 in x 16 in x 6 in) -- — -- —-- - - -- - - -- - - - - Weight 20.4 kg(45 lb) Feed-In Type Split Phase - Mounting options Wall mount,Semi-flush mount Grid Frequency 60 Hz ------ -------- -- —...----------,..— Current Rating 200 A Maximum Input Short Circuit Current 10 kAl Overcurrent Protection Device 100-200A;Service Entrance Rated' Overvoltage Category Category IV AC Meter Revenue accurate(+/-0.2%) Y s S L N Primary Connectivity Ethernet,Wi-Fi Secondary Connectivity Cellular(3G,LTE/4G)' User Interface Tesla App _ 660 Operating Modes i Support for solar self-consumption, o time-based control,and backup Backup Transition Automatic disconnect for seamless backup Modularity Supports up to 10 AC-coupled Powerwalls Optional Internal Panelboard 200A 6-space/12 circuit Eaton BR Circuit Breakers Warranty 10 years ham— 'When protected by Class J fuses,Backup Gateway 2 is suitable for use in 411 149 circuits capable of delivering not more than 22kA symmetrical amperes. '-The customer is expected to provide internet connectivity for Backup Gateway 2;cellular should not be used as the primary mode of connectivity.Cellular connectivity subject to network operator service coverage and signal strength. COMPLIANCE INFORMATION ENVIRONMENTAL SPECIFICATIONS Certifications UL 67,UL 869A,UL 916,UL 1741 PCS Operating Temperature -20°C to 50°C(-4°F to 122°F) — —CSA 22_2 0.19,CSA 22.2 205_ __ Operating Humidity(RH) Up to 100%,condensing Emissions FCC Part 15,ICES 003 Maximum Elevation 3000 m(9843 ft) Environment Indoor and outdoor rated Enclosure Type NEMA 3R T = S L F, 1,1-.202u-0 6 TESLA.COM/ENERGY BACKUP SWITCH The Tesla Backup Switch controls connection to the grid and " easily installs behind the utility meter, providing whole home backup with Powerwall. The Backup Switch automatically detects grid outages,providing a seamless transition to backup power. It communicates directly 4. iyk with Powerwall, allowing home energy usage monitoring from _ any mobile device with the Tesla app. PERFORMANCE SPECIFICATIONS 176 mm Model Number 1624171-xx-y Continuous Load Rating 200A.120/240V Split phase Short Circuit Current Rating 10 kA with any breaker' 22 kA with minimum 22 kA breaker' 4 Communication CAN u 0 li✓ Product Compatibility Powerwall 2 with Backup Gateway 2, Powerwal I+ Expected Service Life 21 years Warranty 10 years -- - -- -- - -- - - - - 205 mm 'See section 27.12.4 in UL 414. COMPLIANCE INFORMATION Safety Standards USA:UL 414,UL 2735,UL 916 CA Prop 65 Emissions FCC,ICES ENVIRONMENTAL SPECIFICATIONS Operating Temperature -40°C to 50°C(-40°F to 122°F) Storage Temperature -40°C to 85°C(-40°F to 185°F) Enclosure Rating NEMA 3R Pollution Rating PD3 MECHANICAL SPECIFICATIONS Dimensions 176 mm x 205 mm x 74 mm (6.9inx8.1 inx2.9in) Weight ----------- -------2.8Ibs-------- ------------ Meter and Socket Compatibility ANSI Type 2S,ringless or ring type External Service Interface Contactor manual override Reset button -— --— — ----- ------- -- — — - -- 74 mm Conduit Compatibility 1/2-inch NPT 2 Manually overrides the contactor position during a service event. T" = S L n 302'1-U"-OS TESLA.COM/ENERGY