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p�0 �oG Town of Southold 4/4/2023 P.O.Box 1179 53095 Main Rd ,��� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43990 Date: 4/4/2023 THIS,CERTIFIES that the building SOLAR PANEL i Location of Property: 7800 Great Peconic Bay Blvd.,Laurel SCTM#: 473889 Sec/Block/Lot: 126.-11-15 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/11/2022 pursuant to which Building Permit No. 47547 dated 3/15/2022 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 to existing single-family dwelling as applied for. The certificate is issued to Bloom, Steven&Susan of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47547 3/27/2023 PLUMBERS CERTIFICATION DATED tho 'zed i nature o�suffil/r TOWN OF SOUTHOLD �� ay BUILDING DEPARTMENT y x TOWN CLERK'S OFFICE "oy • o�� SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 47547 Date: 3/15/2022 Permission is hereby granted to: Bloom, Steven 7800 Peconic Bay Blvd Laurel, NY 11948 To: install roof-mounted solar panels to existing single-family dwelling as applied for. At premises located at: 7800 Great Peconic Bay Blvd., Laurel SCTM #473889 Sec/Block/Lot# 126.-11-15 Pursuant to application dated 2/11/2022 and approved by the Building Inspector. To expire on 9/14/2023. Fees: SOLAR PANELS $50.00 ELECTRIC $100.00 CO-ALTERATION TO DWELLING $50.00 Total: $200.00 Building Inspector pF SO(/r�,ol 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 sean.devlina-town.southold.ny.us Southold,NY 11971-0959 '� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Steven Bloom Address: 7800 Great Peconic Bay Blvd city:Laurel st: NY zip: 11948 Building Permit#: 47547 Section: 126 Block: 11 Lot: 15 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: GreenLogic LLC License No: 43858ME SITE DETAILS Office Use Only Residential X Indoor X Basement Solar X Commerical Outdoor X 1st Floor Pool New X Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph 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 Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 4'LED Exit Fixtures 11 Sump Pump Other Equipment: 8.4kW Roof Mounted PV Solar Energy System w/ (24) SPR 350W Modules, SunPower Monitor, AC Combiner, AC Disconnect Notes: Solar Inspector Signature: Date: March 27, 2023 S.Devlin-Cert Electrical Compliance Form pF SOGlyO� H -7 5 &f 7 -7 a `i 'Peti0A I Cj 1 -- # TOWN OF SOUTHOLD BUILDING DEPT. courm�� 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) -,,LZ ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: '55� 1/„ DATE Z INSPECTOR SOUTyO - # # TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ eSLATION/C UAU KING FRAMING /STRAPPING [ AL Sof [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: DATE INSPECTOR ,.t :1, I'...": IE . I. :k.'. -y;tJ�,:'�:::;:e.�,`btid?"'p:•. ''r . . . 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J aYtd.:.:.'.... :.,q.�j:s.'7'�A',:it::� ';•.'Ln,...f,` ,. .. ;..:'..,. .,-I. .: . .. :A': •,'l:l.:.:'•r`;f-:l iki-:^:ft1..3L.y i.,;y{.�:.r"i , STATE ENERGY CEDE' ,,<::.�:i.:•.-.�.; :Y'G .j"�!n:ij' , . ;K ;l. :i. :;t> :' y` .'. °;''';` • ir,.!5f Y,�rr '/ �, ;v:; i k°:^'': tta'2.�.',:,Cf.•!�7F'liL.i�":,"A.,F:_�..". ;.tip;oy.1%.c-a,•i: f.i '•f.��i_1.1V 1•:7 Yuki,.`•i':.iv�.: . "r z;f;.:,\:+ ,, ,.:,J�:}.,.;tai..r_ }:,;.,:l.' . . :.; r..:.,:„ ::.;.1;;;,; . :.r.•• . : . ;. . .. t: `'1L„ �..I y ,�,c.,. ,1'.,,n.,�.. .•F,''� I. •''41:9:,C: `//11ww33�1 1.11 .e� �':•, I �.':-'. .f.:is:I,is l"'S:w;!•,A,.,,rl�.flfl:�ri[:i'..`�','.:}r...":;::: '.•...;. - .: :. :, . ...i.:: _ .. .':A:i;�: "�': ti�-" ' 4.i��'v"-�: ,:..�.-t:.. . .. . . . . . . e";a 5 . ..Fr _.•. rr;4 _ '''1: ': „ ti't:' .. ,';: ;: -).i sir,, . ,, .... . . .. .. •.,:.,•7 ys, . .... •I':'.;:....}'moi.'+:;"'..'—'::,........ .-• . . :Z-2 V-3 k 5: . 1. ) �. r..lY7 ,:��,`'•.'A moi:. ,�Yr 5i, 4:w"'j1;L:�}.• , t" ,baa?;yf:.,•4,';,• ' m, ..h' {\ S � raUf#(Tt YQ > TOWN OF SOUTHOLD-BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 F° Telephone (631) 765-1802 Fax (631)765-9502 hM)s://www.southoldtownngov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only ® E C PERMIT NO. Building Inspector: FEB 1 12022 Applications and forms must be filled out in their entiret ''lneom tete BUILDING DEPT. pp . .. Y p ,.. TOWN OF SOUTHOLD applications will riot be,accepted. Where:th6'Apphcant is not the owner,an Owner's Authorizat dq form(Page 2)shall be completed.. Date: a- OWNER(S)OF PROPERTY: Name: Susan Bloom I.ScTM#11 110001-126-11-15 Project Address:7800 Peconic Bay Blvd, Laurel, NY 11948 Phone#:9l7-922-4107 Email:susanilenebioomgmail.com Mailing address:7800.Peconic Bay Blvd, Laurel, NY 11.948 CONTACT PERSON: Name:Barbara..- Green.Lo.gic LLC, Mailing Address:97. North Sea Road, Southampton, NY 11968 Phone#:63l-771-5152 x117EmailABarbaraGroenlogic.com „ . . . "DESIGN PROFESSIONAL INFORMATION: Name:, James.J.—S.tout.Architect Bt..Associates..........----._.... __.___.. _.... .u_.__.,_. . . ...._ __........ ___._ Mailing address: 2 Greg Lane, East Northport, NY 11731 Phone#: 631-858-9388 Email: stouthub@jamesstoutarch.com CONTRACTOR INFORMATIONc Name:GreenLogic._LLC...... .. Mailing Address:97 North Sea Road,.Southampton,.NY 11968 M __ Phone#:631-771-5152 Email:AM@Greenlogic.com __ __.... .__.. 6iSCRIPTI0N:.0F,PRO0OSEO CONSTRUCTION El New Structure ❑Addition ®Alteration ❑Repair ❑Demolition Estimated Cost of Project: [i]Other Solar Panels $37,000 Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes ®No 1 M1 hl PR RTY INFARMATInN � „ , Existing use of property: f� �elltla�,,, • , m Intended use of property: Re,S,Idntla ,". .. Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes. No IF YES, PROVIDE A COPY. ®= ' ck B r%R 1 g--:,,Thn awner/cor traetar/disisrt professional Is responsible for all cirairoge,and storm water issues as prayided by. Cluiptee 236 of the.idri t ade Ap1�1ICATi6N IS HiREBX i 146E to'thiBuiiding Department for.the'issu'ar ca"of a Building Permit pursuaiit"to tiia Building zoiie Airdinanco of ttaa,T ria S uttra �Buf€cl un ;:New York and other applicable LaWs,Ordlr aintes or Regulatlons,for the constiiciM o€bulldings, .. aiddttlonF,al#eration}"o fortemoual or cC® iotition as herein described.The applicant agrees to comply with all applicable laws,ardlnances,baildiirg:cbde, .� a uslog code and guintiar arse tta:.odrrilk uthoriYed inspectors an,premises wind In buildiegls)for neciaisary inspections:False ststementi'mvfa herein are. punishable as a class A,t isdemean r pursuentgtc 5ectlan 230.45 of the,New York State Penal law. Application Submitted By(print name):GreenLogic LLC ®Authorized Agent ❑Owner Signature of Applicant: Date: a 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/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 S day of �rwcq , 20ay Notary Public BARBARA A CASCIOTTA Notary Public-State of New York PROPERTY AUTHORIZATION No. 01-CA4894969 Qualified in Suffolk County (Where the applicant is not the owner) Commission Expires May 11,2023 residing at i/f�c'/ �� ,��� do hereby authorize GreenLogic LLC to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature T— Date Print Owner's Name 2 D E C E W E FFR 1 1 2022 Sff � Bill 4G DEPARTMENT- Electrical Inspector BUILDING DEPT TOWN OF SOUTHOLD TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Aja ��' Telephone (631) 765-1802 - FAX (631) 765-9502 ro err ,south oldtownny.gov -- seand(aD-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: GreenLogic LLC Name: Robert Skypala License No.: 43858-ME email: Barbara@Greenlogic.com Phone No: 631-771-5152 ®krequest an email copy of Certificate of Compliance Address.: 97 North Sea Road Southampton, NY 11968 JOB SITE INFORMATION (All Information Required) Name: Susan Bloom Address: 7800 Peconic Bay Boulevard, Laurel, NY Cross Street: Phone No.: 917-922-4107 Bldg.Permit#: !4-- 15� email:susanilenebloom@gmail.com Tax Map District: 1000 Section: ' 126 Block: 11 Lot: 15 BRIEF DESCRIPTION OF WORK (Please Print Clearly) Roof mounted solar electric system (24) SunPower SPR-X21-350-BLK-E-AC panels Ft (24) Enphase IQ7XS-96-ACM-US micro inverters (1) SunPower PVS6 monitor System Size: 8.400kW Check All That Apply: Is job ready for inspection?: ❑YES ENO ❑Rough In OFinal Do you need a Temp Certificate?: EYES [:]NO . Issued On Temp Information: (All information required) Service Size ❑1 Ph ❑3 Ph Size: A # Meters Old Meter# ❑New Service ❑ Service Reconnect ❑ Underground ❑Overhead # Underground Laterals ❑1 ❑2 ❑H Frame ❑Pole Work done on Service? ❑Y ❑N Additional Information: PAYMENT DUE WITH APPLICATION Electrical Inspection Form 2020.xlsx i A SURVEY OF PROPERTY °' :- / SI T UA TED A T � ••e • QOV LAUREL �G• • • • G•'cam' 4 TOWN OF SOUTHOLD � '' SUFFOLK COUNTY, NEW YORK a .• S.C. TAX No. 1000- 126- 11 - 15 • /C��' SCALE 1 "=20' OCTOBER 2, 2007 SEPTEMBER 9, 2013 UPDATE SURVEY :°:r' �' . \ �ti .0, O� MARCH 21, 2014 STAKE POOL JANUARY 26, 2022 UPDATE SURVEY • e �Q �$�$ \ O A AREA = 53,249 sq. ft. �, d% TO BULKHEAD1.222 � ) ac. O I\ p O �O CERTIFIED T0: a s STEVEN D. BLOOM a \s? k° 90�" SUSAN F. BLOOM • ` ' \ �{ a '0A. • ����" a•,d ., Jy"� 'W C) G . Aa e d' 4 e: 7 V • 3 d" • R/ e • `7. '�• AY 44 ° .. ♦ /w ` \ A d 14 a' a'• e / a •: 1 / nla \mss• \ a ° •: .d. o �fi 1Q. °� �ry�o�• s�.. a Qo°oJ�Q �e ...•.•polo ? . . � „ � F°o�G• J' �' oQ` �� Vol� � Q`p' "d, GP �1KK / o• / s h• •m• O � ti/ N0 u xo y �O�-1 s 5 0 G�' '`°o 'moo � \'g• Q�Pl H ►A 01 cwo,� ti`' O. °• htib FcoQ �� � �•�` y�cP O4-All 61 0 PREPARED IN ACCORDANCE WITH THE MINIMUM q �G 3�° O�� �I/ STANDARDS FOR TITLE SURVEYS AS ESTABLISHED F `b BY THE LI.A.LS. AND APPROVED AND ADOPTED FOR SUCH USE BY THE NEW YORK STATE LAND TITLE ASSOCIATION.- r P o okl-0, � N.Y.S. Uc. No. 50467 ° THE EXISTENCE OF RIGHT OF WAYS ' AND/OR EASEMENTS OF RECORD, IF ANY NO ° Nathan , T SHOWN ARE NOT GUARANTEED. Taft Corwin III s � All, Land Surveyor UNAUTHORIZED ALTERATION OR ADDITION �Q J n� TO THIS SURVEY IS A VIOLATION OF Ff Successor To: Stanley J. Isaksen, Jr. L.S. SECTION 7209 OF THE NEW YORK STATEEDUCATION LAW. Joseph A. Ingegno L.S. o COPIES OF THIS SURVEY MR NOT BERING Title Surveys — Subdivisions — Site Plans — Construction Layout THE LAND SURVEYOR'S INKED SEAL OR ✓ �� EMBOSSED SEAL SHALL NOT BE CONSIDERED O ( ) PHONE (631)727-2090 FaX 727_1727 631 TO BE A VAUD TRUE COPY. �cP 00J� I, INDICATED HEREON SHALL RUN OMCES LOCATED AT MAILING ADDRESS ONLY TO THESPERSON FOR WHOM THE SURVEY 1586 Main Road P.O. BOX 16 IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND Jamesport, New York 11947 James ort, New York 11947 p LENDING INSTITUTION LISTED HEREON, AND E—Mail: NCorwin30aol.com THIONE CERTIFICATIONS RE NOTING N FI�L REENC GFebruary 1, 2022 N ERGY Town of Southold Building Department Town Hall 53095 Route 25 Southold, NY 11971 Project Info: Susan Bloom 7800 Peconic Bay Boulevard Laurel, NY 11948 1000-126-11-15 Dear Building Inspector: Please find attached a building permit application to install a roof mounted solar photovoltaic(PV) electric system for the above referenced property. In connection with this application, please find attached: • Building Permit application with owner authorization • 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 • 2 Spec. sheets for Monitoring 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, Xadtmac C'wdofEcc Barbara Casciotta Account Manager Barbara@Greenlogic.com G R EE§Alggklt�gEi2AQg.GU7iLogic.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 V7'x M W V "50 h" Suffolk County Executive-s Office of Consumer Affairs . ....... .................. VETERANS MEMORIAL HIGHWAY HAUPPAUGE,NEWYORK 11788 DATE ISSUED: 5/25/2006 No. 40227-H SUFFOLK COUNTY Home Improvement Contractor License This is to certifv that MARC A CLEJAN doing business as GREEN LOGIC LLC having ftunished 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 Businesses NOT VALID WITHOUT D)EPARTMENTAL SEAL AND A CURRENT ...... .... CONSUNAER AFFAIRS ........... ID CARD Director K Xx"*1 ,4co CERTIFICATE OF.LIABILITY INSURANCE DATE(MM/DD/YYYY) 0210112022 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 terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Nicholas Zulkofske Brookhaven Agency,Inc. PHONE 631 941-4113 FAX 631 941-4405 100 Oakland Ave,Ste 1 E- L . Certificates@ brookhavena enc .com Port Jefferson,NY 11777 INSURER(Sl AFFORDING COVERAGE NAIL# 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. 1NSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP MMIDONYr LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A CLAIMS-MADE FxI OCCUR DAMAGE TO RENTED $100,000 X Contractual Liability X X GL202200012922' 01/31/2022 01131/2023 MED EXP(Any oneperson) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 POLICY[j] OTHER: E&O Liability $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1000000 B X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED X X CAP1043565 06/11/2021 08/11/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (P,r accident) $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE• E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A see separate certificate (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE $ I(yS,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C NYS Disability 0251202 04/11/2021 04/1112022 Statutory Limits E Installation Floater/Property SML93076366 04/15/2021 04/15/2022 $300,000 $2,500 Ded DESCRIPTION OF OPERATIONS/LOCATIONS I 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 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD VERK lhPorkers' CERTIFICATE OF srATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE B 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Greenlogic LLC 631-771-5152 97 North Sea Rd.,Suite 3 1 c.NYS Unemployment Insurance Employer Registration Number of South Hampton,NY 11968 Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Poricy) Number 203801194 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carder (Entity Being Listed as the Certificate Holder) United Wisconsin Insurance Company Town of Southold 3b.Policy Number of Entity Listed in Box"Id' Building Department 53095 Route 25 WC589-00169-021-SZ Southold,NY 11971 3c.Policy effective period 12/01/2021 to 12/01/2022 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"1 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 Carder.or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form Is approved by the insurance carrier or its licensed agent,or until.the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a'matter of information only and confers no rights upon the certificate.holder.This certificate does not amend, extend or alter the coverage afforded.by the policy listed;nor does it confer any rights or responsibilities beyond those contained in the referenced'policy. This certificate may be used as evidence of a 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: Alicia Christiansen (P'nt name of authorized representative or licensed agent of insurance carrier) Approved by: 2. (Signature) (Date) Title: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-105.2.Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www.wcb.ny.gov ►+ workers' CERTIFICATE OF INSURANCE COVERAGE STATE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name 8 Address of insured(use street address only) 1b.Business Telephone Number of Insured GREENLOGIC,LLC 631-941-4113 97 NORTH SEA ROAD,SUITE 3 SOUTHAMPTON,NY 11968 1c.Federal Employer Identification Number of Insured Work Location of Insured(Onlyrequired if coverage Is specifically limited to or Social Security Number certain locations In New York State,Le.,Wrap-lip Pacy) 203801194 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPolnt Life Insurance Company Town of Southold 53095 Route 25 3b.Policy Number of Entity Listed in Box"Ia" Southold, NY 11971 DBL251202 3c.Policy effective period 04/11/2020 to 04/10/2022 4. Policy provides the following benefits: ® A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. S. Policy covers: ® 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 employers 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. Date signed 4/7/2021 By UJI,fft (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that Insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer 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 56 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 sox 4C or 513 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 (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only Insurance carriers licensed to write NYS disability and paid family leave benefits Insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to Issue this form. DB-120.1(10-17) IlailPiuua1o2i0ai1 (i10ioi17)�i�l� Aam I Suffolk County Executive°s Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 12/10/2007 No. 43858-ME SUFFOLK COUNTY Master Electrician License ' This is to certify that ROBERT 3 SKYPALA doing business as GREENLOGIC LLC 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 NOT VALID WITHOUT j DEPAR'I'MiENTAL SEAL AND,k CURRENT CONSUMER AFFAIRS IV CARD Director -_J �� _ r EXISTING SERVICE 120/240, 1 PH, 3W EMERGENCY AC GENERATOR NEW EQUIPMENT -------- -- -- -- -- -- - KWH PV—SA-1 A AC—COMBINER PANEL AC—CMB-1 B ' 200A MAIN • DISC. n {PV LOADS ONLY) I I e ---- a 85 -- 1 I I PV—SA-2 A I I - y GRID—TIE N 2 BKR-I A e N I LINE TAP a _ e e I I ATS 46 I I BKR-2IAC DISCONNECT I ® IAC—DSC-1 I I IEGC I II I I I II I I II N I I o EGG I I A B N I II I I I I II I I I i II I I i I (TYPICAL SYSTEM SCHEMATIC, I I I I N I FINAL INSTALLATION MAY VARY, I I I I I I REQUIRES LOCAL AHJ II I I i EGC I AND UTILITY APPROVAL) I I I I I I I I I 1 EXISTING AC PANEL I i I I I I i I EXISTINGI _ Ll------------1-------------1—�— EGC #6 CU ----LGEC —� ------------------------------------------- PROPOSED I-LINE ELECTRICAL DIAGRAM REVISIONS Bloom, Susan Aq�. EEL®GIC° pED 7800 Peconic Bay Blvd. G ENERGY Laurel, Laurel, NY 11948 '�;rozj,D=� ELIMINATING THE COST OF ENERGY 1.) INITIAL SUBMITTAL WITH APPLICATION SOF NEN Page 1 of 4 Drawing No: BLOOM-3LD1 Revision: 1 Revised: 2/23/2023 SYSTEM SUMMARY TOTAL KW RATING: (AC POWER) 8.400 kW (PV) TOTAL KW RATING: (DC POWER) 7.560 kW (PV) QTY. COMPONENT SPECIFICATION SUNPOWER BRAND, MODEL: SPR-X21-350-BLK-AC 24 PV MODULE: SPR-X21-350-BLK-AC 350 W DC (NOMINAL), EACH SUNPOWER BRAND, MODEL: SPR-X21-350-BLK-AC 24 PV INVERTER: (INTEGRAL TO MODULE) 315 VA, 1.31 A, 240V AC, EACH NOTE: SUNPOWER MODEL SPR-X21-350-BLK-AC INVERTER SETTINGS COMPLY WITH SECTION 7.5.2 AND 7.5.3 OF THE "PSEG LONG ISLAND'S SMART GRID SMALL GENERATOR INTERCONNECTION TECHNICAL REQUIREMENTS AND SCREENING CRITERIA FOR OPERATING IN PARALLEL WITH LIPA'S DISTRIBUTION SYSTEM" -SEE PAGE-4 REVISIONS Bloom, Susan EOAq A: EENLOGIC® 7800 Peconic Bay Blvd. ey;�`'�Ty'� CGI(_'� ��� �� ENERGY Laurel, NY 11948 `; oo ELIMINATING THE COST OF ENERGY 1.) INITIAL SUBMITTAL WITH APPLICATION 'FocHe Page 2 of 4 Drawing No: BLOOM-3LD1 Revision: 1 Revised: 2/23/2023 EQUIPMENT&COMPONENT SCHEDULE TAG DESCRIPTION SPECIFICATION PV-SA-1 PHOTOVOLTAIC SUB-ARRAY SUN POWER SPR-X21-350-BLK-AC, 1-CIRCUIT OF 12-MODULES PV-SA-2 PHOTOVOLTAIC SUB-ARRAY SUN POWER SPR-X21-350-BLK-AC, 1-CIRCUIT OF 12-MODULES AC-DSC-1 AC DISCONNECT SWITCH (LINE TAP) 25OV, 60A, FUSED, NEMA-311, 1-PH, 3-WIRE, SERVICE RATED AC-CMB-1 AC COMBINER PANEL 250V, 60A, MAIN LUG, NEMA-1, 1-PH, 3-WIRE REVISIONS Bloom, Susan �s��s°STyF= �" �.!� ����L®GIC° 7800 Peconic Bay Blvd. , y ENERGY Laurel, NY 11948, o„ 3� oer ELIMINATING THE COST OF ENERGY 1.) INITIAL SUBMITTAL WITH APPLICATION ''F bFN � Page 3 of 4 Drawing No: BLOOM-3LD1 Revision: 1 Revised: 2/23/2023 ELECTRICAL LOAD SUMMARY,AC CIRCUITS TAG POWER, MAX VOLTAGE MAX.AC VOLTAGE, NOMINAL RANGE CURRENT PV-SA-1 .3,780 WATTS 211-264 VAC 15.72 A AC 240 V,AC PV-SA-2 3,780 WATTS 211-264 VAC 15.72 A AC 240 V,AC CONDUCTOR SCHEDULE TAG TYPE CONDUIT AWG. / EGC A USE-2/PV/UF 3/4" PVC-40 10 / 6 B THWN-2 3/4" PVC-40 6 / 6 C TH W N-2 2" PVC-40 6 / 6 1.)CONDUCTOR TYPES AND SIZES TO BE ADJUSTED FOR TEMPERATURE, DISTANCE,AND DERATING FACTORS. 2.) ELECTRICAL CONDUIT TO BE MINIMUM PVC SCHEDULE 40,ADJUST FOR SITE CONDITIONS. 3.) ALL ELECTRICAL MATERIALS AND INSTALLATION METHODS TO COMPLY WITH NEC AND LOCAL CODE REQUIRMENTS. 4.) NOTE: EQUIPMENT GROUNDING CONDUCTOR TO BE#6 COPPER, MINIMUM Bloom, Susan REVISIONS R ./� 6z SESF, Aft Dxr�'F'' EELOGIC� 7800 Peconic Bay Blvd. ENERGY Laurel, NY 11948 2163 =r ELIMINATING THE COST OF ENERGY 1.) INITIAL SUBMITTAL WITH APPLICATION OF 14 Page 4 of 4 Drawing No: BLOOM-3LD1 Revision: 1 Revised: 2/23/2023 r� AR R VEDAS NOTED DATE: P:# S FEE: l BY:__ NOTIFY BUILDING DEPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE OCCUPANCY OR FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED USE IS UNLAWFUL FOR POURED 2. ROUGH- FRAMINGCTE&EPLUMBING WITHOUT CERTIFICA T 3. ION 4. FINAL - CONSTRUCTION MUST OF OCCUPANCY BE COMPLETE FOR C.O. . ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES ELECTRICAL AS REQUIRED AND CONDITIONS OF INSPECTION REQUIRED gni RNrn T . N 7BA OARD Snl STHQ TOWN TPI-IS EES N.Y.S.DEC rSCar p e�� nnvS4— z Inca �t 4 0 jet /t 6�Oct vt)ble, i AMEs J. S T 0 U T A R C H I T E C T & Assoc . 2 G REG L ANTE E AST N0RTHPORT N. Y. 831 — 8 5a 93 as Letter of Certification C u v January 4, 2022 FEB® 1 12022 Bloom Residence BUILDING DEPT. 7800 Peconic Bay Blvd. -roWN OF S06tHOL® Laurel, NY 11948 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), the Long Island Unified Solar Permit Initiative (LIUSPI)and the 2017 National Electric Code NFPA 7012017 National Electric Code, and the ASCE 7-16. The existing 2"x 6"@ 16"o.c. and the 2"x 8" @ 16"o.c roof rafters will provide adequate support. Thank you for your understanding in this matter. James J. Stout Architect 33 yQ�� 0 NE`N 6GREENLOGICO U�� ENERGY GreenLogic,LLC Approved Bloom,Susan and Steven 7800 Peconic Bay Boulevard Laurel,NY 11948 Surface#A: Total System Size:8.400kW Array Size:2.100kW 1 circuit of 6 on a 20A breaker Azimuth:144° Pitch:15° Monitoring System: SunPower Panef/Artab Specifications: Panel:SPR-X21-350-BLK-E-AC Racking:SunPower Invisimount Panel:61.39"X 41.18" Array:10'5"X 10'3 1/2" Surface:13'11"X 13'2" Magic*:Invisimount Legend: ® 6 SunPower 35OW Panels ® SunPower Invisimount Rail • 12 UniRac 4"Drk Standoffs 24"Douglas Fir Rafter 16"O.C. Notes: Number of Roof Layers:1 Height above Roof Surface:4" AZ Materials Used:UniRac,SunPower Added Roof load of PV System:2.84psf Engineer/Architect Seal: �aED ARC 4 �- � (� � � � � Ar 1 12022 BUILDING DEPT. TOWN OF SOUTHOLD r - Drawn By:MA Drawing#1 of 11 Date:12/30/2021 REV:A Drawing Scale:1/4"=1.0' �4 ENERGY GreenLogic,LLC Approved Bloom,Susan and Steven 7800 Peconic Bay Boulevard Laurel,NY 11948 Surface#A: Total System Size:8.400kW Array Size:2.100kW 1 circuit of 6 on a 20A breaker Azimuth:144° Pitch:15° Monitoring System: SunPower 10 Panel,Array Speciflsations: Panel:SPR-X21-350-BLK-E-AC Racking:SunPower Invisimount Panel:61.39"X 41.18" Array:10'5"X 10'3 1/2" Surface:13'11"X 13'2" Magic#:Invisimount Legend: ® 6 SunPower 350W Panels SunPower Invisimount Rail r • 12 UniRac 4"Drk Standoffs B 0 2x6"Douglas Fir Rafter 16"O.C. Notes: Number of Roof Layers:1 Height above Roof Surface:4" Materials Used:UniRac,SunPower Added Roof load of PV System:2.84psf Engineer/Architect Seal: �<tE� ARC Ar Drawn By:MA Drawing#2 of 11 Date:12/30/2021 REV:A Drawing Scale:1/4"=1.0' 1�a4�9 /;,"SELOGIC' ENERGY GreenLogic,LLC Approved Bloom,Susan and Steven 7800 Peconic Bay Boulevard Laurel,NY 11948 Surface#A: Total System Size:8.400kW Array Size:2.100kW 1 circuit of 6 on a 20A breaker Azimuth:144° Pitch:15" Monitoring System: SunPower 0 Panel/Army Spec! "t ns, Panel:SPR-X21-350-BLK-E-AC Racking:SunPower Invisimount Panel:61.39"X 41.18" 1 Array:10'5"X 10'3 1/2" Surface:13'11"X 13'2" Magic#:Invisimount Legend: ® 6 SunPower 350W Panels SunPower Invisimount Rail • 12 UniRac 4"Drk Standoffs 8 8 2x6"Douglas Fir Rafter 16"O.C. 1 Notes: Number of Roof Layers:1 Height above Roof Surface:4" A"Z- Materials Used:UniRac,SunPower Added Roof load of PV System:2.84psf Enaineer/Architect Seal: EKED ARC . 01yo�` } Drawn By:MA Drawing#3 of 11 Date:12/30/2021 REV:A Drawing Scale:1/4"=1.0' ENERGY Green Logic,LLC Approved Bloom,Susan and Steven 7800 Peconic Bay Boulevard Laurel,NY 11948 Surface#B: Total System Size:8.400kW Array Size:2.100kW 1 circuit of 6 on a 20A breaker Azimuth:144° Pitch:15' Monitoring System: SunPower 10 PaneifArray Specltications: 71\ Panel:SPR-X21-350-BLK-E-AC Racking:SunPower Invisimount Panel:61.39"X 41.18" Array:10'5"X 10'3 112" Surface:14'X 13'2" x - - Magic#:Invisimount Legend: 1Z \1/ ® 6 SunPower 350W Panels' ® SunPower Invisimount Rail • 12 UniRac 4"Drk Standoffs B 2x6"Douglas Fir Rafter 16"O.C. x x x Notes: Number of Roof Layers:I Height above Roof Surface:4" Materials Used:UniRac,SunPower Added Roof load of PV System:2.84psf Engineer/Architect Seal: ES Q Aqc J. 021633 y®� lr' Drawn By:MA Drawing#4 of 11 Date:12/30/2021 REV:A Drawing Scale:1/4"=1.0' \ EL GIC© EINERCY Green Logic,LLC Approved Bloom,Susan and Steven 7800 Peconic Bay Boulevard Laurel,NY 11948 Surface OB: Total System Size:8.400kW Array Size:2.100kW 1 circuit of 6 on a 20A breaker Azimuth:144° Pitch:15' Monitoring System: SunPower Panel/Arrav Seecifications: Panel:SPR-X21-350-BLK-E-AC Racking:SunPower invisimount Panel:61.39"X 41.18" Array:10'5"X 10'3 1/2" Surface:14'X 13'2" Magic#:invisimount Legend: © 6 SunPower 350W Panels SunPower Invisimount Rail • 12 UniRac 4"Drk Standoffs 8 2x6"Douglas Fir Rafter 16"O.C. Notes: Number of Roof Layers:1 Height above Roof Surface:4" Materials Used:UniRac,SunPower Added Roof load of PV System:2.84psf Engineer/Architect Seal: F.D ARC '�'i Sri�T 1021,633 y0Q Drawn By:MA Drawing#5 of 11 Date:12/30/2021 REV:A Drawing Scale:1/4"=1.0' GREENLOGICO ENERGY GreenLogic,LLC Approved Bloom,Susan and Steven 7800 Peconic Bay Boulevard Laurel,NY 11948 Surface 913: Total System Size:8.400kW Array Size:2.100kW 1 circuit of 6 on a 20A breaker Azimuth:144° Pitch:15" Monitoring System: SunPower RaneNArray S�eciiien.ioas: Panel:SPR-X21-350-BLK-E-AC Racking:SunPower Invisimount Panel:61.39"X 41.18" 2 Array:10'5"X 10'31/2" Surface:14'X 13'2" :x Magic#:Invisimount Legend: ® 6 SunPower 35OW Panels nSunPower Invisimount Rail • 12 UniRac 4"Drk Standoffs B B 2x6"Douglas Fir Rafter 16"Q.C. 2 Notes: Number of Roof Layers:1 Height above Roof Surface:4" Materials Used:UniRac,SunPower Added Roof load of PV System:2.84psf Enaineer/Architect Seal: �c' 1. 1ST Xv Q21,633 y0� r' Drawn By:MA Drawing#6 of 11 Date:12/30!2021 REV:A Drawing Scale:1/4"=1.0' S GREENLOGICO ENERGY Green Logic,LLC Approved Bloom,Susan and Steven 7800 Peconic Bay Boulevard Laurel,NY 11948 Surface#C: Total System Size:8.400kW Array Size:4.200kW 1 circuit of 12 on a 20A breaker Azimuth:144° Pitch:34° Monitoring System: y SunPower ° PanelfAmay-Specifications: Panel:SPR-X21-350-BLK-E-AC Racking:SunPower Invisimount Panel:61.39"X 41.18" Array:31'4 11/16""X 20'7 3/4" Surface:41'10"X 23'11" Magic#:Invisimount Legend: ® 12 SunPower 350W Panels ® SunPower Invisimount Rall • 27 UniRac 4"Drk Standoffs 2x8"Douglas Fir Rafter 16"O.C. Notes: Number of Roof Layers:l Height above Roof Surface:4" 47 1 K 7TT Materials Used:UnlRac,SunPower Added Roof load of PV System:2.84psf Engineer/Architect Seal: fLKF-D A&C CD FC TF OF.N � Drawn By:MA Drawing#7 of 11 Date:12/30/2021 REV:A Drawing Scale:1/8"=1.0' Ir.IE-NL0GIC ENERG`Il GreenLogic,LLC Approved Bloom,Susan and Steven 7800 Peconic Bay Boulevard Laurel,NY 11948 Surface#C: Total System Size:8.400kW Array Size:4.200kW 1 circuit of 12 on a 20A breaker Azimuth:144° Pitch:34° Monitoring System: SunPower ° Panel/Array Specifications: Panel:SPR-X21-350-BLK-E-AC Racking:SunPower Invisimount Panel:61.39"X 41.18" Array:31'4 11/16""X 20'7 W Surface:41'10"X 23'11" Magic#:Invisimount Legend: © 12 SunPower 35OW Panels SunPower Invisimount Rail • 27 UniRac 4"Drk Standoffs B 2x8"Douglas Fir Rafter 16"O.C. Notes: Number of Roof Layers:1 Height above Roof Surface:4" Materials Used:UniRac,SunPower Added Roof load of PV System:2.84psf Engineer/Architect Seal: ��kED A& �`, At y0Q Drawn By:MA Drawing#8 of 11 Date:12/30/2021 REV:A Drawing Scale:1/8"=1.0' ENERGY GreenLogic,LLC Approved Bloom,Susan and Steven 7800 Peconic Bay Boulevard Laurel,NY 11948 Surface#C: Total System Size:8.400kW Array Size:4.200kW 1 circuit of 12 on a 20A breaker Azimuth:144° Pitch:34° Monitoring System: SunPower 01 ° Panel/Array Specifications, Panel:SPR-X21-350-BLK-E-AC Racking:SunPower Invisimount 3 Panel:61.39"X 41.18" Array:31'4 11/16""X 20'71/4" Surface:41'10"X 23'11" Magic#:Invisimount 3 Legend: ® 12 SunPower 350W Panels SunPower Invisimount Rail • 27 UniRac 4"Drk Standoffs 3 B 2x8"Douglas Fir Rafter 16"O.C. Notes: Number of Roof Layers:1 3 Height above Roof Surface:4" Materials Used:UniRac,SunPower Added Roof load of PV System:2.84psf Engineer/Architect Seal: BRED ARC F A �.y�, �21.633 yOQ i Drawn By:MA Drawing#9 of 11 Date:12/30/2021 REV:A Drawing Scale:1/8"=1.0' No Vent Pipes Will Be Covered By The Solar Array c' R E E',\,I LOG ICo ENERGY Legend: Greentogic,LLC Approved Bloom,Susan and Steven AR-Access Roof AP-Access pathway,36" minimum width SVO—Setback at ridge 7800 Peconic Bay Boulevard per R202 definitions per R324.6.1 as per R324.6.2.1 Laurel,NY 11948 Total System Size:8.400kW 1 circuit of 6 on a 20A breaker 1 circuit of 6 on a 20A breaker R 1 circuit of 12 on a 20A breaker \Meter Azimuth:144° Monitoring System: SunPower Panel/Array Specifications: Panel:SPR-X21-350-BLK-E-AC Racking:SunPower Invisimount Panel:61.39"X 41.18" Surface:100'3"X 50'6" Magic#:Invisimount Legend: 24 SunPower 35OW Panels I I 1 I SunPower Invisimount Rail 1 i is 63 UniRac 4"Drk Standar SAP APS 09 2x6"Douglas Fir Rafter 16"O.C. I I go 2x8"Douglas Fir Rafter 16"O.C. I I I I I I I I Notes: I I I i 6 SunPower Number of Roof Layers:1 �-——— ——— —————— 350W Panels Height above Roof Surface:4" svo UQ- SV0 —;iVQsVQ Materials Used:UniRac,SunPower Added Roof load of PV System:2.84psf MIX Engineer/Architect Seal: xIxIxIk SRO AAC Ar s���r ,02163, yob O 12 Sun Power i Nl:� 350W Panels 6 SunPower 350W Panels I Drawn By:MA Drawing#10 of 11 Date:12/30/2021 REV:A Drawing Scale:1/16"=1.0' r' 'RE k�L®GI ° ENERGY GreenLogic,LLC Approved Bloom,Susan and Steven 7800 Peconic Bay Boulevard Laurel,NY 11948 Total System Size:8.400kW 1 circuit of 6 on a 20A breaker 1 circuit of 6 on a 20A breaker 1 circuit of 12 on a 20A breaker Azimuth:144° Monitoring System: - - - - - - - --- - - - - - -- -- -- - --- - SunPower 01 - - PanellArsav Specifications- Panel: PecificaLeorrs:ane:SPR-X21-350-BLK-E-AC Material Ust QtY Rail Material Ust Qtv. Racking:SunPower Invisimount Panel:61.39"X 41.18" Surface:100'3"X 50,6" UniRac 4"Drk Standoffs 63 Magic#:Invisimount 5/16"x4.5°SS Lag Bolts 126 Legend: 5/16°Stainless Steel Washers 126 i I 24 SunPower 35OW Panels OTEY Black Flashings 40 SunPower Invisimount Rail OTEYClearJAluminum Flashings 23 63 UniRac 4"Drk Standoffs 8 2x6"Douglas Fir Rafter 16"O.C. 2x8"Douglas Fir Rafter 16"O.C. Notes: Number of Roof Layers-1 Height above Roof Surface:4" - - - --.- Materials Used:UniRac,SunPower _ Added Roof load of PV System 2 84psf Engineer/Architect Seal: FLED ARC 5� S 3. ,$�• i.�� Ar Drawn By:MA Drawing#I 1t:1 Date:12/30/2021 REV:A Drawing Scale:1/16"=1.0' .....—__—__ _.. _w _ EX15TING SERVICE F t F �' � ! 200 p • • • ® A s € F a w u.., . .... AC.—CONIMER PANEL i PV—SA-2 ". I AC—CM3-1 I wr Lca���am `_D AC DISCONNECT 0 2 f I £ @ I I € rV! I I .: 71 E aJ ! I FUSED ll ! € III E 1 r I t?7'cC < iI III I ! ! 9 5 € FI (I I gECC I € I I I EXIT,Tf ING AC PANEL' I E%3ST(NG _ IRREVERSIBLE SPLICE--- ,. -- .,�,��...��,..�.,...�.�.,�,�,. " ¢aC61I �.�_. �GGA 8.400DC kW 7.680AC kW PROPOSED 3-LINE ELECTRICAL DIAGRAM REVISIONS Bloom, Susan y .> E- ���-° ,... 7800 Peconic Bay Boulevard EN Laurel, NY 11948 ELIMINATING THE COST.U1 ENERGY 1.) INITIAL SUBMITTAL WITH APPLICATION Page 1 of 3 Drawing No: Bloom-KD1 Revision: 1 Revised: 11/23/21 EQUIPMENT&COMPONENT SCHEDULE TAG DESCRIPTION SPECIFICATION PV-SA-1 PV SUB-ARRAY SPR-X21-350-E-AC EN PHASE IQ7XS-96-ACM-US, 1-CIRCUIT OF 8-MODULES PV-SA-2 PV SUB-ARRAY SPR-X21-350-E-AC EN PHASE IQ7XS-96-ACM-US, 1-CIRCUIT OF 8-MODULES PV-SA-3 PV SUB-ARRAY SPR-X21-350-E-AC ENPHASE IQ7XS-96-ACM-US, 1-CIRCUIT OF 8-MODULES ELECTRICAL LOAD SUMMARY AC CIRCUITS TAG POWER, MAX VOLTAGE MAX.AC VOLTAGE, NOMINAL RANGE CURRENT PV-SA-1 2800 WATTS 211-264 VAC 11.39 A AC 240 V,AC PV-SA-2 2800 WATTS 211-264 VAC 11.39 A AC 240 V,AC PV-SA-3 2800 WATTS 211-264 VAC 11.39 A AC 240 V,AC PROPOSED EQUIPMENT SPECIFICATIONS REVISIONS Bloom, SusanL, �E;_N E rR G Y 7800 Peconic Bay Boulevard ,t�7'�o Laurel, NY 11948 1.) INITIAL SUBMITTAL WITH APPLICATION ELIMINATING THE COST OF ENERGY Page 2 of'3 Drawing No: Bloom-3LD1 Revision: 1 Revised: 11/23/21 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 BKR-2 CIRCUIT BREAKER, PV-SA-2 MATCH AC COMBINER PANEL BRAND, 2-POLE, 20A BKR-3 - CIRCUIT BREAKER, PV-SA-3 MATCH AC COMBINER PANEL BRAND, 2-POLE, 20A AC-DSC-1_ AC DISCONNECT SWITCH (LINE TAP) 250V, 100A, NEMA-1, FUSED; FUSE RATING: 100A 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 Bloom, Susan 7800 Peconic Bay Boulevard ENERGY Laurel, NY 11948 ELIMINATING TW0ST OF.ENERGY 1.) INITIAL SUBMITTAL WITH APPLICATION Page 3 of 3 Drawing No: Bloom-3LD1 Revision: 1 - Revised: 11/23/21 S U N POWE -0 -Series: X21-350- L X21-335-BLK I X20-327-BLK SunPowero Residential AC Module Built specifically for use with the SunPower Equinox"'system,the only fully integrated solution designed,engineered and warranted by one manufacturer. Maximum Power. Minimalist Design. ��® industry leading efficiency means more power and savings ArAVA-4; per available space.With fewer modules required and hidden microinverters,less is truly more. Highest Lifetime Energy and Savings. Designed to deliver 50%more energy over 25 years in real-world conditions like partial shade and high temperatures." Fundamentally Different. a And Better. v i up to os<. more e enw; i „ lifetime .: .., sS ; 1�tCf ;energy 1 > Eq $ s ,. d Ln µ The SunPower"Maxeont'Solar Cell Years of operation En", es h';hest-effdency mocules avai'abl� = m Urr-rai:�hea r i;a�iiity • Patented solid metal fo-nidation Best Reliability. Best Warranty. pevens t;reakaffe and COrrosson With i more than 25 million modeles-deployed ed around ' the world,SunPower technology is proven to last.Thai's �. why we stand behind our module and microinierter ®. with the industiys best 25-year Combined Power anu i Product Warranty,including the highest Power Warranty ii solar. Factory-integrated Microinverter �I:'71,J1•� ,{JSIer instaiiac'.c� ' . . � y^�: ' � � � i lnret,rated',.vire managerne"t, 67 ra:Sid<:nutdovvrr 3 ,,`iw �. q., Enaineered ar:i c.a;ibrr,ted t; 'more power - f� in year mEl ....-,. 10 15 2C :5 Years of operation fl, X-Series:X21-350-BLK I X21-335-BLK X20-327-BLK SunPowerl Residential AC Module AC Eleccrical, D. Inverter Model:Eniphase IQ 7XS(IQ7XS-96-ACM-US) @240 VAC @208 VAC ...................... .................................................... Peal<Output.Power 320 VA 320 VA ............. lvlay.Corlunuous Ourout POV111112r 316 VA 315 VA Norn.(L.L)Voltage/Range (V! 240/211-264 208/183-229 .1 i .....................................................................- .................................................................................................................................................................................................................................................................................................................................................. . . ..................................... Max,Control-io-is Our.put Current(A) 1,31 1.czl ..................................................... ...... Max.Units per 20 A(11)Branch Circuit' 12(single phase) 10(two pole),Aye ............------ ........................... CEC 10,1eighted Effictericy 97.516 970% Norn Fre,quF_nry 60 Hz Extended Freque,icy Range 47-68 Hz ............. ........................... AC Shor-Circuit I'dUlt Current Over 3 Cycles 5.8 A erns ........................... Overvolvage Class AC.Port AC Port Backfeed Current IS I riA ....I I I..................................------ ............. .................................. ...... ............................................... ..........................--.......... ............. .......................................... Pov.,er SF-,Ring 1.0 ...................................................... ..................................................................................... .......................................................... ................... Pe4jer Factor(adjustab'e) 0.7 lead. 0.7 lag. ........................................ ............................................................... ......................................................... -- ......................... .................... ............ .....................- No acute chase balancin,�for three-phase installar;ons .................................... ......................... .................................... D power Data I WarraMies Certlficadons,�,and Compbri ce, X21-350-BLK-E-AC X21-335-BLK-E-AC X20-327-BLK-E-AC 23-year limited power-warrancy 25-year limited producc warrant,/ Norn.Power�'(Pnorn) 350 W 335 VV 327 VV I .................... ------------.................................................................. .......... -------- - ----............................—d i UI-1703 Power Tol. +5/-0% �51-04b +S--()-% i 1 1-11.'1741!lFFF-1 547 Certifications Module Efficiency 211. 2!.01Y, 204% UL 17-11 Af-Module(Type 2 fire rated) ..................................................... .............-- and Temp.Coef.(Power) -k).29%/'C -0.29',W'C -0.291W'C UIL f�21 09-1/IEC 62109-2 Cornpliance bypass diodes FCC Part 15 Class B 1 three ICES-0003 Class B 1crated ry-ioclue.evel ri,iaxlmurn Shade Tol. 'I ite., ll '/\N/,,-FA.022.2 NO.107.'!-01 ... cower point tracking CA Rule 21(UL'1*74 I SA), ........................... (includes VoltPVar and Reactive Paver Prioriv,/) 1)��Operating Cbrido (includes UL Listed PV Rapid Shutdown Equipment' 1 Operating Temp. -40°F to+185°F(-40°C to SS*C) Enables installation in accordance with: Max.Ambient Temp. NEC 690.6(AC module y`/inti:62 psf,3000 Pal 305 I<g/rI12 front&back Max.Load NEC 69101.12 Rapid Shutdown(inside and-outside the array) Snow:125 psf,6000 Pa,611 1 girn'front, <- NEC 690.1 S AC Connectors,690.33(1'-(E)tf1 1 ............................... ................. .......................................................... Imoact Resistance nch (25 mm)diameter hall at 52 mph(23 m/s) Whentised with InvislMount racking and InvisiMllount accessories Mechai�fc- r. I (UL 2703): Solar Cells 96 Monocrystalline Maxeon Geri Ill Module grounding and bonding thrOUgh invisilviount Class A fire.rated Front Glass tempered glassoi whet:used with AC rnodule 0 Cables and accessories(UIL 6703 and En ant-reflective coating ..................... UL 2238)1: Environmental rating Outdoor rated Raced for load break disconnect ---...................... ............................................................. ........................ Frarne . Class I black anodized(highest AAMA rating)) PID Test Pcientkk :anced degradation free ....................................... ..... . ............................................... ................................ . ...................... .. Weight 42.19 lbs(18.5 kg) .................... ................... Recommended Max. 1.3 in.(33 rnm) Module Spacing 1 Skin Power 360'41 compared to a convei%onal module on same-sized err ys(25U`W,—IG"t efficient,approx.I.[,rn 1,11,fwiore (based On thiril-parrymolule 46mm diara ct,,iriza tion and Mim),,17 51=yr slowerd^grada don(Campe,,-i:1,1 et Si."SunPo',ver M odu I c Pe4radad on Ra t L,"Sun Power white p n per,201 B). 2 Based on search of data sh e.etva I Lips fr,)rri we b si i:e.f;of top 10 manufacturers per I is of 1046 MM January 2017. 3 mmi tylnitiativefcrSr.IarA•todu!es:Fart?`I"IIccF:PoLJeY -1 titin., rviagazine,20 IS,canipeau.Z.etal.'*'Surillower Niodule Dqradai Ion Rate," .........A paper,2013. 4 Facxcrywt to CA Pule2l (111fin- 393 mrn corn m%,sion ing.See r.he Equinox installation Guice 9518101 for more h iformation. standard:SCM,15 curren't,LA.CCs FF:ondvollage.All DC voltage�.,fullycontainedwi'hin the Inodule 6 TS'E module. is Ul.Lister as PvRSE anc.con',orms with NEC 2014 and NEC 20:7 690,12; 437 Pun and IC .i-207:;Rule 64--218 Rapid Shut down of PV SyscemF,for AC and DC conductors; (17.2 in.) when installed to manufacturers instructions. See WWW.5LInP01VeT.,'0!n!faCtS for more reference information. U` ca7UNRY For more details,see axwnc!ed datasheet w,vkv,,.stinnt)wer,.(-.m/dalasheets Speciricationf, included in this dataMhecc are subject to changewithout notic.e. (P2018 Sun ftwerCorporation.Afl Rights Reserved.SUN POWER,the SUN P0',.1-.1ER logo and LISTED S U N P 110' WE K`9 MAXEON are registered Lrademcirls of SLirPcwcr Corporation in the-us.anoother Meddle Fh Pedw.wce:Type 2 counirien-ris well.1.800 TJNP01N,-R, Please rear the Sarety and Installation Instructions for details. 591946 RevA -sunDOW017.120M ... ....... _7t uw, 21 AM 2" NOR N 110:20i jp�:;: Simple and Fast Installation lrregraced module-To-rall;rounding 0 b Pre—ssem-bled mid anderd d2mr)s Levi ating mid clamp for easy placernent Mid clamp wic"-h facililates consistent,even -riodule-.pacfng Simple,pre2rilk.-_�d rail soflire 2 703 Listed�nt.egrated grCU11"'i7:`Ig Flexible Design .............. Addresses nearly all sloped resit end-al rcols Desigh in landscape and por'l-ral!" Rails en--flole easy otistacle,mjnagemienil- Custorner-Preferred Aestiletics n,oaluleand#I n',ount:nclaesthetics Best Jr.-class syscem aesthetics Elegant SimSimplicityity Prerriurn,low-profile design Black anodized components SunPower,�, InvisiMOUntTII is a SiUnPower-designed Hidden rn'd damps and end clampsrail-based -nounting system. he InvisiMouint.systemi and cappec,,T]Usn rails - addresses ?esidential sloped roofs and combines faster Part of Superior System inst.allation time, design flexibility, and superior aesthetics. Bjilt-'(-)r use with SunPower I)r-and AC modules The In.visilViount product was specifically envisioned and Bes-.-ir-dass system reliability acid aesTberics rombine 4uh and engineered to pair,with SunPower modules. The resulting .ropiforiroappsysteryi-level approach will arnplify the aesthetic and installation benefits for both homeowners and installers. sunpower.com 4, Q'I P « TM't'fat"', ri''1,,' ;c>;;, ;tihh;,': ✓'s?.=,,.,;:,,:,�3 r ;.»' , iS4. o'Sv,,.,,'.v,,.,, �W.,.,ti• •�. ,_Tem°� �•w� 8 5,5 ,e w .�.. _.. .._AAAA._... _AAAA• .<�''e,sKr .a .. ® ® ® G3 ® ON. w�. �§�.'t..r .2v � a�a'.� •a't •M`#°AAAA...F c w..i,s;, .�.�� Module*/Mid Clamp and Rail Module*i End Clarnp and Rail 7- Mid Cla;r:n find Clamp Rail K Rail Splice Ground Lug Assembly End Cap s: . Ter7lpefa[Ur'e »C°C to ci0°C(-40'F to 194'r) ComponentIv'aterial Weight --- -----...-_.._.__._......._.................................._._........_..._..--i i...-__- _...__.._._.._....._....................`.....-- Max.Load(I-RFD) )JJ:a uplift Mid Clamp Black oxide stainless steel MSI 304 63 g r7.7 or_) � 6000?a d0wr:fora e_ 1 Enid Clarr:p Back anodized aluminum alloy 61)67,.T6 : 110 g(3.88 0 ) -- : -........_._...._..........:.........................__._ i s Rail Brack anodized aluminum alloy 830 g/m 9 oz/ft) Rail Sulce Aluminum alioV 6005 75 8-C F/n(9 ozift) ° Z5 year prod' uct w_ a 'y War_n`is I Ground Lug 304 stain'ess i 106.1 On(.3.7,oz) I 5-year finish wan anty I i Assembly (A2-70 t;r,it;tii''patea,_opt)er dust) ........... ' .. .. --._._.._...._...........--....._.._..._ _...----......................................................._..........._..__.._._..-- ...._....._...._....—--1 ............ ---. ............... _........ _.._AAAA - , ... Fnd Cap Black,cetal'I OM)ropo;ymer ............................._I 1 n..1 g(0.:_.i r.R.) ---- j UL_'703 Listed Certifiialions _ ss Class A Fire Rated l ....;",,�,�.... � ..�....... - : ...................................__AAAA--------..__.........----- iComoositi'on Shingle Rafter Attachmenc Application Cornposrion Shingle Roof De-c ing A;Cacn11 r 101' C urecd anti slat I Ile Ro if Aitacni ierlf . Un versa)Interface for.Other Roof.Attachments I Refer Co roof attachment hardware manufac;rei's documentation? -----....._..................................... -----....._............................_......................................................................... ... — - - -------.._................_.................................................................-..-..._......_......................... . Moduie frame.!har i,cornpozible with the trn:SNount s},tem requii rd for hardware interoperz,bility. ?.015 SunPovrer rr potation. All Rights Peserved.SUN?Os':SR,the SLIi�PG4JER icgo,a;:d IN`viSldfDU�IT arc,trail^merKs or registered - trademirks of Sunpower Corporation. ki other trxlemarks are.the prrperty or their respect ve cr:r:er;. >Vnpo,•ver.c:om Soec ificatio,�s included in Chis datashec't are Subject to&,.,n2(,,witho!-;notice. Document#509506 RevC i i _ s @� •'^.'.�. w -. _ ,.._ '- - car;:_,• ras � In'iprove Support Reduce maintenance Costs SunPower EnergyLink—Plug-and-Play Installation An intuitive monitoring website enables ydu tcx This cornplete solution for residential and comrner cial monitoO,,P and See a visual map of customer sites , control includes I:)e SunF ;wer PV S:.,:)ery sor a(F\•Sr;.)wl-iich improves 2emctely manage hundreds of saes the instalia_icn process,overall system:reliability,and customer Receive elec ive system reports experience. oCate System issues and r ernotelVdirgnose Compact"ootprint for improved aesthetics Diaonose isaes online RobuSt CiOUd connectivity and comprel-ensive local connectivity )rill{:9cnrrr for the status of ind^:ec.:al c;evrc:es Flexible configuration of devices d:_rring installation Consumption metering =`— .. "r` • "� .r,. ., Revenue-grace production metering(pending) F bleb-based commissirning Remote diagnostics of^V56 and inverters � 9 �� r .I, '• wt¢µ :_.-A Curable JL Type 31,enclosure reduces ma:ntenance costs Easy integration with SunPower eBOS Add Value for Custorners Robust Cloud Connectivity W:rh t G SunPower Monitoring System customers can: f I P,t�..;it:i:rfle o)tions to maintain o:)t.rnai See what the r solar system produces each ` ° -_.v �e� connectivity: day,month,or year i Hardwired Ethernet Optimize dYeir Soi2r ir':VESt(nf'n ar7d"save on wi-Fi I " energy expenses § Cellular backup See their eneq-, use arrd estin;ated bill savings { See their solar system`s performance using the , SunPower rriionicoring,vvelosite or mobile app 1 : ,L � ® r r 1! � • ` w r � ` eR j � !R s SUnPower Monitoring Websites . PVS6 SunPower AC Modules .;... .. ..............ux... Q M 0.�iiu�til� �G��131I1111r' ce..,.� wrt ®� i I M Multiple communication options include AdIll l1113 -t, � Ethernet,W" Fi and cellular. ... ,.� >..t.. I' a Number of SunPawer AC modules 85 Tempersture -22°F to+1 401F(-30°C to+60`Q supported per P'vS6 Humidity(maximum) 9546,nor;-condensing High-speed Internet access via accessible Internet access router or sw tch Power 100-240 VAC(150 a�60 I Iz • 208 VAC(L-L in 3-phase),60 Hz w RS-485 Inverters and meters • One channel of revenue-grade production metering :... integrated Meter b • T ...KKn� vyo channels of consumption metering i Weight 5.5 lbs(2.5 k ----------.-.........-......._........................^............................................................................ ....._.._............................-----._ Ethernet ° LAN(or optional'RAN)port Dimensions 1 1.8x 8.0 x 4.2 in.(30.5 x 2.0.5 x 10.8 cm) PLC PSC for SunPower AC modules Enclosure rating li Type 3R VJi-F 802,11 b/gin 2.4 GHz and 5 GHz Cellular 1.TE Cat-M1 BG t.iNTz 1lcBee IEEE 802.15.4 MAC,2.4GHz ISM band Data Storage 60 days Customer site rr4t:.t1tt?t:_1S5Uj3PQ1KeLS-Qf t --.............d ;lpgracles Arornatic_firmware upgrades Partner site pksmgmt.:;ssunao,.Arer.cam Browsers l:irefax,Safari,and Chrome Mobile de=vices iPhone=',iPadl'and Android161 Customer app 1.Create.account online at:moritor.us.sunpower.com. Wel ' a L"""O 2.On a mobile device,dol the Suni Monitoring Warranty 10 year Limited Warranty app from Apple App Stores clr Google Play'"store. 3.Sign in using account email and password. Certilicatians U4 cli CE,UL 61010-1 and-2,FCC Part 15(Class S) M6. B ill us FCC 1D:YAW529027 E503346