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HomeMy WebLinkAbout46210-Z 'ovaF FBI kcoGy Town of Southold 2/7/2024 o P.O.Box 1179 o • z. 53095 Main Rd Southold,New York 11971 CERTIFICATIE OF OCCUPANCY No: 44945 Date: 2/7/2024 THIS CERTIFIES that the building SOLAR PANEL Location of Property: Wickham Ave,Mattituck SCTM#: 473889 Sec/Block/Lot: 107.40-10.4 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/20/2021 pursuant to which Building Permit No. 46210 dated 5/10/2021 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 panel system to existing barn as applied for. The certificate is issued to MCB 6900 LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 46210 2/6/2024 PLUMBERS CERTIFICATION DATED A or ed i afore 11FfU1KC' TOWN OF SOUTHOLD o� may BUILDING DEPARTMENT y x TOWN CLERK'S OFFICE "o • 4 SOUTHOLD, NY .yam 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#: 46210 Date: 5/10/2021 Permission is hereby granted to: i MCB 6900 LLC 675 Halls Creek Dr Mattituck, NY 11962 To: Install roof mount solar panel system to barn as applied for. At premises located at: Wickham Ave SCTM # 473889 Sec/Block/Lot# 107.-10-10.4 Pursuant to application dated 4/20/2021 and approved by the Building Inspector. To expire on 11/9/2022. Fees: CO-ADDITIONS TO ACCESSORY BUILDINGS $50.00 ELECTRIC $100.00 FARM BUILDING ALTERATIONS $50.00 Total: $200.00 Building Inspector OF SO�j�ol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G Q -�. • �o Jamesh _southoldtownny.gov Southold,NY 11971-0959 �ycouff`I,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: MCB 6900 LLC BED and Boarders address: 6900 Wickham Ave city:Mattituck st: New York zip: 11944 Building Permit#: 46210 Section: 107 Block: 10 Lot: 10.4 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE contractor: Element Energy Electrician: Jamie Minnick License No: ME-52689 SITE DETAILS Office Use Only Residential Indoor X Basement Service Commerical X Outdoor X 1st Floor Pool New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph X Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel 400a 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 Sump Pump Other Equipment: 57.6 kw roof mounted solar energy system with 184 jinko jkm410m-72hl-v 410 watt pi modules with 1 solaredge se43.2k-us inverter, 1 soaredge se14.4k-us inverter, 1 ac disconnect 400ai Notes: 1 solar load center SOLAR ENERGY SYSTEM Inspector Signature: �• Date: February 6, 2024 6900 wickham ave roof laf so TOWN OF SOUTHOLD BUILDING DEPT. �yco 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/C LKIN [ ] FRAMING/STRAPPING [V] FINAL s9 AV f [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFET IN�SPEC ION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: DATE INSPECTOR AA/ jGg (o - G qoa o SOUTyolo # # TOWN OF SOUTHOLD BUILDING DEPT. `ycou 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) [)] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: Sf Ct c2op, DATE ���� INSPECTOR y (`2(!)� q(,,24 o Town of Southold September 16th, 2022 Q GIVE Building Department DD Town Hall Annex Building 54375 Route 25 F E B 8 2023 P.O. Box 1179 Southold, NY 11971 BIJU.DING DEPT. , TOWN Or, SOU 1-HOLD Subject: Roof Mounted Solar Panels at the MCB.6900 LLC 6900 Wickam Ave.,Mattituck.'NY 11952 I To Town of Southold: I have reviewed the solar energy system installation in the subject topic on September 16th, 2022. The units have been installed in accordance with the manufacturer's installation instructions and the construction drawings approved by the Building Department, Town of Southold, New York. The solar panel installation is in compliance with the requirements of the 2020 Building Code of New York State, the 2017 National Electric Code, SEI/ASCE 07-16 "Minimum Design Loads for Buildings and Other Structures", NFPA Standard 70 and current industry standards and practices and based on documentation and data supplied by Element Energy at the time of this report. Markings in accordance with Section 690.53 of the National Electrical Code are provided. To the best of my belief and knowledge, the work in this document is accurate, conforms to the governing codes and standards applicable at the time of submission and conforms with reasonable standards of practice with the view to the safeguarding of life, health, property and public welfare. Sincerel, James Dee i, E V NE ll;Y 260 Deer Drive �: �' )cRoo,�� Mattituck, NY 11952 s. 631-774-7355 S 2 ... . Z�. FIELD:INSPECTION REPORT 'DATE GONIlVL NHS FOUNDATION(1ST) Cy --------=--=--------=----------- FOUI�IDATION(2N)?) ROUGH FRAMING& PLUMBING: �� \ H INSULATION.PER N.Y. STATE'EN'tRGY CODE FINAL'. ADDITIONAL COMMENTS r &- �. �� �- 0 z i 48,5 VF®rk4r, BUILDING DEPARTMENT-Electrical Inspector ell �� +�•' 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 ' rogerr(cDsoutholdtownny.gov- seand(ab-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: Element Energy Name:MCB 6900 LLC - Beds and Borders License No.: email: kevin.cande@gmail.com Phone No: 631 433 5372 El request an email copy of Certificate of Compliance Address.: 6900 Wickham Ave Mattituck NY 11944 JOB SITE INFORMATION (All Information Required) Name: MCB 6900 LLC - Beds and Borders Address: 6900 Wickham Ave Mattituck NY 11944 Cross Street: Phone No.: 631 433 5372 Bldg.Permit#: email: kevin.cande@gmail.com Tax Map District: 1000 Section:0700 f0 7 Block: 0000 /0 Lot: 0004 lO 'ee- BRIEF DESCRIPTION OF WORK (Please Print Clearly) Check All That Apply: Is job ready for inspection?: DYES ❑✓ NO ❑Rough In ❑Final Do you need a Temp Certificate?: DYES ENO 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 02 ❑H Frame ❑Pole Work done on Service? ❑Y ❑N Additional Information: PAYMENT DUE WITH APPLICATION Electrical Inspection Form 2020.xlsx n F0 BUILDING DEPARTMENT- Electrical Inspector Q� `+y 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 rogerr(aD-southoldtownny.clov — seand(cDsoutholdtownny.gov APPLICATION FMELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: Electrician's Name: License No.: Elec. email: Elec. Phone No: ❑I request an email copy of Certificate of Compliance Elec. Address.: JOB SITE INFORMATION (All Information Required) Name: n C13 Ipt-ld© L(� Address: 06 MJ 1' Cross Street: Phone No.: Bldg.Permit#: �--�-C 0 email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Square Footage: Circle All That Apply: Is job ready for inspection?: ❑ YES ❑ NO ❑Rough In ❑ Final Do you need a Temp Certificate?: ❑ YES ❑ NO Issued On Temp Information: (All information required) Service Size❑1 Ph❑3 Ph Size: A # Meters Old Meter# ❑New service[:]Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 FJ2 H Frame D Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION gUFfOt o� °oo TOWN OF SOUTHOLD—BUILDING DEPARTMENT w y= Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtownn .gov Date Received APPLICATION FOR BUILDING PERMIT ' For Office Use Only v , PERMIT NO. �� Building Inspector: / Apr 2-0 2-o2 0. A` licationstand.formssmust.lie'flled;out=in th'ei'r enti�et :'Incom lete Pp.. Y. applicatons'vuill"notsbe"accepted::VlthereztFie:Applicant is:not;the:owner:an; t =c p C'..b.:..- :.,ro... - t.5�i:: i'Y" •.n.r .r. "Owners Autf iatioi5,.form(Page'2)snall:be coiiipleted Date:3/1/21 PETY:tii"...-?i_•.5`-.`°tt: _ _ _ _ ;:;�.c „_r: «aa, r.;<ar - '.�..�r».�,.-.. �,rrr.�. ,.,.:,.,• ....:.., ...,h.�. i OWNER F R '• Name: MCB LLC SCTM# 1000-107001000010004 ProjectAddress:6900 WiCkham Ave MattitUCk NY 11952 o7 .-10 -- I0.'1- Phone#:631- 433 5372 Email:kev_in.cande@gmail.Com Mailing Address: 4 Ai f tF- l ..L4 'CONTACT:PERS - Name:Danielle Rodger-„. Mailing Address:7470 Sound Ave MatttiCuCk NY 11944 Phone#:631 861 5923 Email:danielle.rodger@e2sys.com ,DESLGN=PROFESSIONAL'INF.O .Ki yr Name: Mailing Address: Phone#: Email: iq ae -,- y.`5` itr�' >�•.ti�'u JSs y,: ,},,�"-, p2 r. - Ft NTRACTOR'. NFOR A'I a M_T.ON: - - F: KM ^ Name:Element Energy LLC Mailing Address:7470 Sound Ave Phone#:631 779 7993 Email:permitsC e2sys.com ESC D RIPTION�OF.PR D"_ s,. OPOSE CONSTRIJ:CTION.�- _�;;� ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: DOtherRoof Mounted Solar PV System and Ground Mount $461,576.42- Will the lot be re-graded? ❑Yes ©No Will excess fill be removed from premises? ❑Yes ONo 1 COMPLY ALL CODES OF APPROVED AS NOTED NEW YORK STIATE & TOWN CODES DATE �- B.P.# AS REQUIRED AND CONDITIONS OF ddD 0 BY: SOUTHOLD TOWN ZBA - �OT, 3UILDING DEPARTMENT AT 8 AM TO 4 PM FOR THE SOUTHOLD TOWN PLANNING BOARD F.: . . NING INSPECTIONS: SOUTHOLD TOWN TRUSTEES ;::.%UNDATION --TWO REQUIRED N.Y.S.DEC �� ")URED CONCRETE z ::, .� . - FRAMING & PLUMBING 3. i''jit, . -'ION - 4 �:IJNA� CONSTRUCTION MUST a NAPLETE FOR C.O. ALL CVN'.;TRUCTION SHALL MEET THEREQ NEW OCCUPANCY OR YORKISTATE. NOT RESPONSIBLREMENTS OF THE CODES E OR USE IS UNLAWFUL DESIGN OR CONSTRUCTION ERRORS. WITHOUT CERTIFICATE OF OCCUPANCY Additional certification May Be Required. ��' T Town of Southold April 14th, 2021 Building Department Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Subject:l3oof-mo-un_ted Solar Panels at the MCB 6900 LLC-6900 Wickam•Ave,Mattituck,NY.., 11952 To Whom It May Concern: I hereby state that it is my professional opinion that the subject plans comply with the 2020 Building Code of New York State, the 2017 National Electric Code, ASCE 7-16, and NFPA-70. These code requirements include the fact that the roof framing is adequate to support the additional loads from solar panels as well as roof ridge and peak access to first responders. I have evaluated.the structural framing of the existing roof with the additional loading to account for the proposed solar panel application. Deflection and stresses of the structural components remain within the allowable for the existing roof for wind pressures from 130 mph, 3 second gust, Exposure B with a ground snow load of 20 pounds per square foot. Mounting locations and methods are as indicated in the submitted plans. From the site inspection and analysis, and as evidenced by previous roof loads withstood, it is my professional opinion that the existing building and roof framing is structurally adequate to support the reactions of the solar panels in addition to the existing code required for live and dead loads. Also the wind analysis concluded that the mounting system as shown on the plans is adequate to resist the calculated uplift pressure. The dead load of the heaviest solar panel assembly in this evaluation is approximately 2.8 pounds per square foot. Please contact me if you have any questions or comments about the above. Since , pF NFW y P �y nr O,A O * ��l;• • . ip James Deer s i,'PE m � . 260 Deer Drive 7- Mattituck, NY 11952 631-774-7355 SCOPE OF WORK _ �—----� -- -- --- - - -- - —- Snruami - -.._. .�--.-- DESIGN E DRAFTING BY: ELEMENT ENERGY LLC T� INSTALL A /5.44 KW K00f MOUNT D SOLAR r[!OTOV01_TAIC (PV) YY5TFM A 511E MC6 G900 1_1-G. I REVIEW BY J.M.NABCEPCERTIFIE LOCATED AT 6900 WICKAM AVENUE_. MAFT'TL'CK_ NY 11952 (4 I.00H3F-14, 72.52(;G48), 05 1 1 12-1 20 TIP POWER GtNEKAIED by THE PV.5Y51F.V WILL DF INTFKCONNt(,TED WI1111f1E OTIL11)'GRID TLIKOUGH-tit EXISTING F i-CTRICAL 5LKVICL tOUIPMENT. i _ I REV1510N5 TFlf PV `;Y', _AA [['OL.., f.!_)T I,NCLUDr_ 5TOKAGr BATTFRif:5. Ise' DESCRIPTION DAZE REV SYSTEM RATING 1 I kW DC STC I EQUIPMENT SUMMARY 184 JfNKO JKM4 10M-'i'Gr1l.-V'4 10 WAII IviOJIJLES � ----- 50LAKfDGE SE43.2K-U5 INVERTERS r « 50L AREDGE 5E,4.4K-U5 INVERTER rA 00 MOUNTING SYSTEM k CONTRACTOR SHEET INDEX PV-I COVER 14e•mn..•!r•.m+ Robins isiane ELEMENT ENERGY. LLC. PV-2 SITE PLAN N 7470 SOUND AVE PV-3 ROOF PV LAYOUT 00 MA171TUCK, NY 1 1 95 PV-4 STRUCTURAL/DETAILS 4 SECTIONS LICENSE # 43889-H PV-5 3-LINE ELECTRICAL DIAGRAM 'PV-6 LABELS LICENSE # 52C,89-ME GOVERNING CODES W270 as0° E f 2017 NATIONAL ELECTRICAL CODE. 240° V 120°2020 BUILDING CODE OF NEW YORK STATE. 210° 150° PROJECT NAME 2020 FIRE CODE OF NEW YORK STATE. ASCE 7-1 G AND NFPA-70. 18O° UNDERWRITERS LABORATORIES(UL)STANDARDS S OSHA 29 CFR 1910.2G9 LL-J N GENERAL NOTES PROJECT LOCATION I . CONTRACTOR SHALL CHECK AND VERIFY ALL CONDITIONS AT THE SITE PRIOR TO STARTING TO WORK AND SHALL FAMILIARIZE HIMSELF WITH THE INTENT OF THESE PLANS AND MAKE WORK AGREE THE SAME. �- 2. CONTRACTOR OR OWNER SHALL OBTAIN ALL REQUIRED �L APPROVALS, PERMITS, CERTIFICATES OF OCCUPANCY, • _ U 10. CONTRACTOR TO EFFECT AND MAINTAIN INSURANCE, I.E. '• ' INSPECTION APPROVALS, ETC., FOR WORK PERFORMED FROM .00p / 'r �' CO CONTRACTOR'S LIABILITY, WORKMAN5 COMPENSATION, r AGENCIES HAVING JURISDICTION THEREOF, IF REQUIRED. COMPLETED OPERATION, ETC. ADEQUATE FOR THE PURPOSES 3. ALL WORK SHALL CONFORM TO CONSTRUCTION CODE AND ALL RULES AND REGULATIONS OF THE RESPONSIBLE OF THIS PROJECT AND FURNISH PROOF OF SAME PRIOR TO '� ✓ ''� '� i, O COMMENCING WITH WORK. , • ' JURISDICTION. ", I I . EACH SUBCONTRACTOR SHALL BE RESPONSIBLE FOP, 4. IF IN THE COURSE OF CONSTRUCTION A CONDITION EXISTS WHICH D15AGREE5 WITH THAT AS INDICATED ON THESE PLANS, MAINTAINING SAFETY ON THE JOB 51TE DURING THE �`' ` �,;" ; •ti THE CONTRACTOR SHALL STOP WORK AND NOTIFY THE CONSTRUCTION PHASE TO COMPLY WITH THE REGULATIONS ENGINEER. SHOULD HE FAIL TO FOLLOW THI5 PROCEDURE AND AND REQUIREMENTS OF THE OCCUPATIONAL SAFETY AND ;• _ ,a CONTINUE WITH THE WORK, HE SHALL ASSUME ALL HEALTH ADMINISTRATION. THIS SHALL INCLUDE, BUT ARE NOT yr _ LIMITED TO: PROVIDING FOR ADEQUATE AND PROPER BRACING, t �' ` ' RESPONSIBILITY AND STABILITY THEREFROM SAFETY RAILINGS AND SECURE FOOTINGS FOR ALL TEMPORARY SHEET NAME 5. ALL STRUCTURAL STEEL SHALL BE A-36 AND SHALL BE r •., � ,� FABRICATED AND INSTALLED AS PER LATEST A.I.5.0 SCAFFOLDING, STAIRS, ETC.. AS WELL AS PERMANENT r SPECIFICATIONS. 12. FIGUREDIDIMENSIONS SHALL GOVERN. DO NOT SCALE le 'j s +�' ' COVER G. ALL ELECTRICAL WORK SHALL BE BOARD OF FIRE DRAWINGS, WHERE DIMENSIONS ARE ESTABLISHED BY EXISTING , UNDERWRITERS APPROVED AND IN ACCORDANCE WITH N.E.C. t CONDITIONS. EACH CONTRACTOR SHALL VERIFY EXISTING NYS CODES 4 REGULATIONS c) ,- CONDITIONS PRIOR TO ORDERING MATERIALS AND 7. ANY DEVIATION FROM THESE PLANS WITHOUT THE WRITTEN my CONSENT OF THE ENGINEER WILL NEGATE THE ENGINEER'S COMMENCING WITH WORK. cP DRAWING SCALE CERTIFICATION OF THESE PLANS. 13. CONTRACTOR TO REMOVE ALL DEBRIS CREATED BY THIS s -s T• 5n� . ' ; WORK FROM THE SITE AND DISPOSE OF IN A LEGAL MANNER ON 8. THESE DRAWINGS AS INSTRUCMENTS OF SERVICE ARE AND ,, >.r t ' ,' N .T.S A WEEKLY BASIS OR SOONER IF CONDITIONS WARRANT. �e SHALL REMAIN THE PROPERTY OF THE ENGINEER WHETHER THE ) V , PROJECT FOR WHICH THEY ARE MADE IS EXECUTED OR NOT. 14. AT THE COMPLETION OF WORK, THE SITE TO BE CLEARED OF ALL DEBRIS AND EXCESS MATERIALS. THE FACILITY IS TO BE s ` THEY ARE NOT TO BE USED ON ANY OTHER PROJECTS OR EXTENSIONS TO THIS PROJECT LEFT BROOM CLEAN AND WORK 15 TO BE COMPLETED TO THE TOTAL SATISFACTION OF THE OWNER PRIOR TO RELEASE OF t . - SHEET NUMBER 9. CONTRACTOR SHALL PROTECT, PATCH AND REPAIR ALL FINAL PAYMENT. 1 t PV- I EXISTING WORK ADJACENT TO HIS WORK, OR DAMAGED AS RESULT OF HIS WORK. AERIAL VIEW TAX MAP: 1 000 107001000010003 LE!,-,END Jl TAX MAP: 1 000 1070010000 10003 DE51GN e DRAFTING hY: EXISTING UTILITY METER MAIN SERVICE PANEL EIPMENT ENERGY 11G REVIEW BY NEW PV SUB-PANELS / - i 05 11 N2 CE-125 RTIf c A/C DISCONNECT _ COMBINER INVERTERS -� 0 o GND ELECTRODE REV15ION5 _ PV MODULE DE5CRIPfI0N DATE REV RACKING RAIL 0 ATTACHMENT POINT -- 240° V 0�9 " ---RAFTERS 270o +D '� 0 � -.- FROOF PITCH ANGLE 1800�SQo O -- BSUNRUN METER — _ -- ®VENT G2'-I I' S 0PLUMBING VENT 73'- -- ®SKY LIGHT ®CHIMNEY CONTRACTOR COMPOSITE SHINGLES GOOD CONDITION POTENTIAL SHADING ISSUES TRIM/REMOVE AS NECESSARY ELEMENT ENERGY. I. - 164 18'-I 7470 SOUND AV MATTITUCK, NY I I LICENSE # 43889 LICENSE # 52G89-I PROJECT NAME LU N z � U W > - -, Q — GREENHOUSE U z Q � U U U � � U Q � 5 c SHEET NAME 12' 14 132'-4:' 39'-84 F NEW 51TE PLAN t�EEQ 'A 1a4' Ia4° �'t� ;.�. '10�� W cc DRAWING 5CALE r W NDM N ip r m�, C9 3/ I 2(5 = 1 I-I CONSTRUCTION NOTE5 1 .)ALL EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE WITH THE 5HEET NUMBER MANUFACTURER'S INSTALLATION INSTRUCTIONS. ��— 2.)ALL OUTDOOR EQUIPMENT SHALL BE RAINTIGHT WITH MINIMUM NEMA 3R RATING. 3.)ALL LOCATIONS ARE APPROXIMATE AND REQUIRE FIELD VERIFICATION. LEGEND _-_._.—.___--� DESIGN 4 DRAFTING BY: �E)OSTING UTIUTY METER 'NOTE ELEMENT ENERGY LLC MAIN SERVICE PANEL I). THE PV ARRAYS CAN NOT BE SEEN FROM THE GROUND REVIEW 6YJ.M.05 1 1 1 1 2 cERr�':: ®N�PDISCONNECT m ECNELS i 00 2 129 2). PV ARRAYS ARE NOT GREATER THAN 1 50' PER G05. 1 1 . 1 .3.3 (1) NY5 FIRE CODE EMER INVERTERS ' 3). 4' WIDE FIRE SETBACK/PATHWAY PROVIDED PER G05. 1 1 .3. 1 NY5 FIRE CODE 4). GROUND ACCE55/PATHWAYS PROVIDED PER G05. 1 1 .3.2 NY5 FIRE CODE REVISIONS GND ELECTRODE ?�05 _ 4 PV MODULE DESCRIPTION DATE REV 'JAL —RACKING RAIL ?405 490. C ATTACHMENT POINT 2100 120- F - -- ---RAFTERS 1160.�so- -*—ROOF PITON ANGLE �7 ARRAY#2 ARRAY#I — BSUNRUN METER 50 M.ODULE5 50 MODULES ® 23T A21MVf" 23•PITCH VENT -- 7-AZ OTH 0PLUMBING VENT I ®SKY LIGHT +a ME SMAWAUC5 PATH ,a rust UnGAOtK[tl5 PAT" CONTRACTOR ®CHIMNEY ao•na#crsAouAaaes ar.. +o�rr,;,nnn+:�wcc»rat.I ®COMPOSITE SHINGLES GOOD CONDITION 1 I •rl h 2 r I �POTIIJTiAL SHADING ISSUES j {'s TRIM/REMOVE AS NECESSARY' I- ;- - ' s 1; ._LEMfNT ENERGY, - - ---- — I MH IT 7470 SOUND A\ t' f f: t.. i t( MATTITUCK. NY I I j • 11 f , I i LICENSE # 4385E, I 44 LICENSE # 52689 fill } I t PROJECT NAME I —It IMP I] z Ln LLJ I i Ir V J 56'-6' i 56'-6" ' O L- 10-5 16' 5 66' 51" HE " 13ARN15 lI I • A m I: 14Q F AL 44, 74 5MEET NAME AM i 114 CONSTRUCTION NOTES 00 D ETA 1 .)ALL EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE { pF NE►N y WITH THE MANUFACTURER'S INSTALLATION INSTRUCTIONS. IJV f r,-I 11M. , DEEA,� 0 2.) ALL OUTDOOR EQUIPMENT SHALL BE RA(NTIGHT WITH MINIMUM NEMA 3K RATING. 3.) ALL LOCATIONS ARE APPROXIMATE AND REQUIRE i }` ' "o. a DRAWING 5CALE FIELD VERIFICATION. 7` w ARRAY#4 ARRAY#3 + �� 1� �. {`; '1. i (c` Z LlLu CONSTRUCTION SUMMARY - DETACHED BARN 42 MODULES 42 MODULES (I 84) JINKO JKM4 I OM-72HL-V 4 10 WATT PV MODULES 23rAbmuTM 5 PITCH �•°AZIMUTH+ APA,� 4•.=»:A«IM.PA,r �o 5 (DIMENSIONS: 79. I"x 39.4"x I .G") <_ (1)SOLAREDGE 5E43.2K-U5 INVERTER (1)SOLAREDGE SE 14.4K-US INVERTER 511EET NUMBER (284)ATTACHMENT POINTS @ 72"OC MAX. y �` /_ (I 462) LF IRONRIDGE XR 100 MOUNTING SYSTEM. V ROOF TYPE = ASPHALT SHINGLE (SINGLE LAYER) TAX MAP: 1 000 107001000010003 LOAD CALCULATION ARRAY#142 ARRAY#3t4 ITEM DESCRIPTION ARRAY#I s #2 ARRAY#3 € #4 DESIGN t DRAFTING BY: Rafters ELEMENT ENERGY LLC MODULE WEIGHT(Lb5) 49.6 49.G (D) Deckinq REVIEW BY J.M.NABCEP CERTIFIE (P) Pitch 0511i2-129 #OF MODULES 50 42 (J) Ceilinq Joist TOTAL MODULE WEIGHT(Lb5) 2450.0 2083.2 (RB) a6le Board/Beam REV1510N5 TOTAL LENGTH OF RAIL(Ft) 3987 332.2 IT) Truss Webbinci DESCRIPTION DATE REV (H) Horizontal Span of (R) PAIL WEIGHT PER FOOT(Lb5) 0.68 0.68 - TOTAL RAIL WEIGHT(Lbs) 271.1 225.9 #OF 5TRANDOFF5 82 Go WEIGHT PER 5TRANDOFF(Lb5) 2 2 TOTAL STANDOFF WEIGHT(Lb5) I G4 120 (R15 TOTAL ARRAY WEIGHT(Lbs) 29 15.1 2429.1 POINT LOAD(Lb5) 35.6 40.5 (D (RB CONTRACTOR TOTAL ARRAY AREA(Sal Ft) 971,5 81 G.I (D ARRAY DEAD LOAD(Lb5/5ci Ft) 3.0 3.0 s ELEMENT ENERGY, LLC 7470 SOUND AVE s per A - Method I: i - a e - ( ' MATTITUCK, NY 1 195 net = t ne e - t 5CC I ne a e - 1) -� S) LICENSE # 43883-H CLIMACTIC AND Ground and Spee Live load. Point Max fastener LICENSE # 52689 ME GEOGRAPHIC DESIGN Category Snow Load 3 sec gust pnet30 petpullout loa Fastener Type 5p3Cmg along G' CRITERIA Pg mph ASCE7, ps Ib. rails, in. (t1) _.____. A # 20 130 # 468 5/1 6"x 6"5tainle55 Steel (H) Roof Section 64" (J B # TYP. TYP. # TYP. Lag Bolts � (J) # PROJECT NAME For SI: 1 pound per square foot=0.0479 kPa, 1 mile per hour=0.447 m/s. [ARRAY#1 t 21 [ARRAY#3 t 41 a. Weathering may require a higher strength concrete or grade of masonry than necessary to satisfy the structural U J N requirements of this code.The weathering column shall be filled in with the weathering index,"negligible,""moderate"or"severe"for concrete as determined from Figure R301.2(3).The grade of masonry units shall be determined from ASTM C 34,C 55,C 62,C 73,C 90,C 129,C 145,C 216 or C 652. W b. The frost line depth may require deeper footings than indicated in Figure R403.1(1).The jurisdiction shall fill in the frost line depth column with _J > — the minimum depth of footing below finish grade. FRAMING DETAIL n —1 Q C. The jurisdiction shall fill in this part of the table to indicate the need for protection depending on whether there has been a history of local O subterranean termite damage. O , Z d. The jurisdiction shall fill in this part of the table with the wind speed from the basic wind speed map[Figure R301.2(4)A].Wind exposure 0 category shall be determined on a site-specific basis in accordance with Section R301.2.1.4. e. The outdoor design dry-bulb temperature shall be selected from the columns of 971/2-percent values for winter from Appendix D of the U International Plumbing Code. Deviations from the Appendix D temperatures shall be permitted to reflect local climates or local weather experience as determined by the building official. MODULE MOUNTING CLAMP `� f. The jurisdiction shall fill in this part of the table with the seismic design category determined from Section R301.2.2.1. - C)g. To establish flood hazard areas,each community regulated under Title 19,Part 1203 of the Official Compilation of Codes,Rules and SOLAR MODULE Regulations of the State of New York(NYCRR)shall adopt a flood hazard map and supporting data.The flood hazard map shall include,at a STAINLESS STEEL 3/8" Q minimum,special flood hazard areas as identified by the Federal Emergency Management Agency in the Flood Insurance Study for the community, BOLT AND NUT as amended or revised with: i.The accompanying Flood Insurance Rate Map(FIRM), ii. Flood Boundary and Floodway Map(FBFM),and iii. Related supporting data along with any revisions thereto. IRO uDGE ALUMINUM RAIL The adopted flood hazard map and supporting data are hereby adopted by reference and declared to be part of this section. ALUMINUM 1!BRACKET h. In accordance with Sections R905.1.2,R905.4.3.1,R905.5.3.1,R905.6.3.1,R905.7.3.1 and R905.6.3.1,where there has been a history of 5HEET NAME local damage from the effects of ice damming,the jurisdiction shall fill in this part of the table with"YES."Otherwise,the jurisdiction shall fill in this ALUMINUM FLASHING part of the table with"NO." i. The jurisdiction shall fill in this part of the table with the 100-year return period air freezing index(BF-days)from Figure R403.3(2)or from the O NF W 5T RU CT U RA 100-year(99 percent)value on the National Climatic Data Center data table"Air Freezing Index-USA Method(Base 32°F)." -\ y0 J. The jurisdiction shall fill in this part of the table with the mean annual temperature from the National Climatic Data Center data table"Air ASPHALT SHINGLE ROOF �P E Freezing Index-USA Method(Base 32"F)." 5/1 G"x 6"STAIN R O � k. In accordance with Section R301.2.1.5,where there is local historical data documenting structural damage to buildings due to topographic wind STEEL LAG BOLT r ;Q; W DRAWING SCALE speed-up effects,the jurisdiction shall fill in this part of the table with"YES."Otherwise,the jurisdiction shall indicate"NO"in this part of the table. 2 1/2'MIN THREE — I. In accordance with Figure R301.2(4)A,where there is local historical data documenting unusual wind conditions,the jurisdiction shall fill in this PENETRATION 4 s a part of the table with"YES"and WITH GEOCEL(EQUIVALENT OR 5 y : r j A5 NOTED m. In accordance with Section R301.2.1.2.1,the jurisdiction shall indicate the wind-borne debris wind zone(s).Otherwise,the jurisdiction shall O 07. indicate"NO"in this part of the table. AROSSt NPR' n. The ground snow loads to be used in determining the design snow loads for roofs are given in Figure R301.2(5)for sites at elevations up to 1000 feet.Sites and elevations above 1000 feet shall have their ground snow load increased from the mapped value by 2 Ibs/ft2 for every 100 feet 5HEtT NUMBER above 1000 feet. (") See Figure R301.2(4)B. PV-4 TAX MAP: 1 000 107001000010003 MOUNTING DETAIL n TO UTILITY GRID UTILITY METER DE51GN t DRAFTING BY: 3-FHA5E,208 V ELEMENT ENERGY LLC SdAR 10PD fAACR REVIEW BY J.M.NABCEP CERTIFIED �\ NVERIE■i.D.# - 051 1 1 2-129 O REV1510N5 1 I j DESCRIPTION DATE REV I Y 1 N _. a�� I •�• I i n •••jj I j�ra.wm - --- I ■ -r �. ■. r - - ;ui n..Reu 3R I[1LIti 2aJ 1I;: ORERNAL UTILITY DLSCONNECT-9MTCN 5'In-i Ir[i'E.E[t'V�O r AC D15CONNEU-UTILITY ACCr551B1f • •• ' I �WM JI KVIC[-'rri i-'.I.i�i __.-- . •rx>> L I L I FMATTITUCK. CTOR �I ERGY, LL- n ram_ n I I ND AVE L, NY 114�2 .. •�• 12 »�� I rn-4^T� MAN SERVICE PANEL 4388�l 1 J I I aox�R.x t (} ■ 1 -Y-__�' -__..� I I U Ira xc I LICENSE # 52G89 N 'NOTE _ G ( THI5 3 LINE DIAGRAM 5HOW5 THE WHOLE PV 5Y5TEM INTERCONNECTED WITH +i ■ i l THE PROPERTY.THE ROOF MOUNTED PV 5Y5TEM SHOWN IN TH15 5Y5TEM IS i 1 ONLY FOR 5TRING#I THROUGH#1 1. I EXISTING GROUNDING I ELECTRODE SYsrEM PROJECT NAME I 7 1 PHOTOVOLTAIC ARRAY SUMMARY - 2G2 MODULE w S N D TLn 1 t STRING I.D.# MODULE MODEL STRING LENGTH 5TRING CITY CITY POWER STRNG Z U J I U > 1 I i W r. 3 J 41 1J.-7 H_V 18 3 54 O ---- - 43,2cc w J °l a-8 b s eo f ' 1 u1741,ae(+AaR JKM410M-72HL-V JINKO ■ ■ I �I • • ,�2 •• 1 ,KM4 I M-7 H-v 6 2 32 14,400 W O L _.■• - •w. -- - _..- w ---J G G 11 JrM4I OM 7 H V 18 1 18 NKO - - !2 JrV41 I _7 H-V I8 I I8 © ( (� U JINY. 43,200 W +y FI 3 JKM4 I .-7 li-V 20 3 Go ` p WIRE t CONDUIT SCHEDULE L O C.RCUrr CIRCUIT CIRCUIT CONDUCTOR CONDUCTOR5 CONDUCTOR CONOUIT FILL CONDUCTOR GROUND GROUND GROUND TYPE CONDUIT CONOU,T AMBIENT TEMP E57IMATED Voltage Drop(% /�J�J Q I,D.# ORIGIN OESTINATION 51ZE PER POLE QUANTITY DERATE IN5ULATION 51ZE QUANTITY INSULATION (CU/AL) TYPE 517E TEMP DERATF D15TANCE STRING INVERTER AWG#G 1 16 ' 0.5 U5E-2/rV W;re AWG#8 1 BARE CU FREE AIR 2' 704C 0.67 O.d% OR RMC INVERTER5 COMBINER 1 4 0.8 THWN-2 I THWN-2 CU RMC 087 0.6% LOAD CENTER MAIN PANEL 1 e 0.7 THWw2 I TNWN-2 CU TROUGH 0.87 - - 0.6% ELECTRICAL NOTES CALCULATIONS FOR CURRENT CARRYING CONDUCTORS SHEET NAME ALL EQUlFK,1LN1 10 DE LISTED BY UL OR OTriCR NRTL, AND LABELED FOR ITS APPL ICATfON, 2.)Al.L CONDUCTOR5 SHALL 5E COPPER, RATED FOR G00 V AND 90-C N'ET ENVIRONMENT. " PV Source Circuit Wire Ampaclty Calculation CONFIGURATION 3 )WIRING. CONDUIT, AND RACEWAY5 MOUNTED ON ROOFTOPS SHALL BE ROUTED DIREC7L` [NEC 690.8(5)(1)]: (Isc) '(#of$I nri j )'(I.25) = 20 9 A Modules per String 3-LINE D I A TO, AND LOCATED AS CL05E AS PO1351BLf-TO THE NEAREST R(DGE, 1111",OR VAI L EY. _ -city'Temp Derate'Condult- r i Deratc = 7F-!3 A of EW 3 A > 20.9 A, therefore AC wire Size Is valid. Modules per Inverter ( �' 4 )WJP,YJNG CLEARANCES AROUND ALL PlEIJ AND EXISTING ELECTRICALFOUIf'MEN'SHALLQ•- S OE �� Number of Inverters /� R COMPLY WITH NEC J0.26. k -- inverter Output Wire Ampaclty Calculation � ••� O '� 5.) DRAWfNG5 INDICATE THE GF'NFRAL ARP,ANGEMI-NT OF 5Y51EMS.CONTRACTOR 5!1ALI_ Record low tem tP Inverter Output Circuit OCP Calculation(Inverter Imp)'(1,25) - 1 50 A * Q t FIJRIJl5t1 ALL iJECES�iARY OUTLETS, SUPF'ORT.S, FITTItJGS AND ACESSORIES TO FULFILL 0 AWG, derated ampacity'0emp Ue(ate)'(Condult Fill Derate) _ 5G.(-;A, Voc Temp Coefficient r- } .ap . a DRAWING 5CALL APPI_ICABL E COD175 AND 5`AHDARD5 �G.G A > 150 A, therefore.AC wire 5tre is valid DC SYSTEM SPECIFICATIONS CALCULATIONS Q (I/ C.)WHERE 512E5 OF JUNCTION BOXES, F.ACLWAYS, AND CONDUITS AP.E NOT SPECIf-1ED. O eratin Current Z THE CONTRACTOR`HALL 5l7_F TI1L'M ACCORDINGLY. Combined Inverter Output Wire Ampaclty Calculation O I V . 7,)ALL WIRE TERMINATIO 15:SHALL BE APPROPRIATELY LABELED AND READILY V151BLE, eratm Voltaic Inverter Output Circuit OCP Calculation(Inverter Im )'(I 25) - 350 A f3.) MODULE GROUNDING CAPS TO BE INSTALLED t3L1Wt'f_N MODULE FRAME AND MODLILL p p . Max. System Volta e SUPPORT RAIL, PLR THE GROUNDING CLIP MANUFACTURER'S INSTRUCTIGfJ. 50 MCM,Berated ampacity'(1-emp Derate}'(Condult FIII Derate) - 353.22 /+ Short r 9•)MODULE SUPPORT RAIL TO BE BONDED TO CONTINUOUS COPPER G.E.C. VIA WEEB LUG 353.22 A > 350 A, therefore AC Wire Site is valid- Circuit Current OR ILSCO GBL-4DBT LAY-IN LUG AC SYSTEM SPECIFICATIONS 5HEET NUMBER 10,)THE POLARITY GF THE GROUNDED CONDUCTORS 15(posttive/negativc) Max AC Output Current ��— OR O eratm AC Volta e 240 V 1 0-) THE DC 5 1 D E OF TI1E PV SY5TEIv1 IS UNGROUNDED AIJD 5 H A I L COMPLY WI-1-11 NEC G90.35- TAX MAP: 1 000 107001000010003 DE51GN!DRAFTING BY SERVICE METER I OO I INSTALLATION NOTE ELEMENT ENERGY LLC REVIEW BY J.M.NA5CEP CERTIFIED ® Q SOLAR PV SYSTEM t PHOTOVOLTAIC ; • • • . ( I ) ALL LABEL SHALL BE INSTALLED IN 051 1 12-1 25 EQUIPPED WITH SOLAR BREAKER ` ACCORDANCE WITH THE 2017 NEC RAPID SHUTDOWNOPERATING® REQ U I REM E NTS. �evlsloNs DE5CRIPTION DATE REV OPERATING CURRENT A MAX SYSTEM VOLTAGE VDC (2) ALL LOCATIONS ARE APPROXIMATE AND I ,:_r)202 SOLAR AC LOAD CENTER - OUTSIDE DO NOT RELOCATE THIS SHORT REQUIRE FIELD VERIFICATION. OVERCURRENT ONCE (3) LABELS, WARNING(5) AND MARKING OTURN RAPID SHUTDOWN SWITCH TO Og SHALL BE IN ACCORDANCE WITH NEC THE'OFF'POSITION TO SHUT DOWN PV SYSTEM AND REDUCE 1 10.21 ([3). SHOCK IN ARRAY CAUTION —_ AC DISCONNECT POWER OLLOWINGS4URCESWI (4) THE MATERIAL USED FOR MARKING FROM THE FOLLOWING SOURCES SUPPLIED WITH DISCONNECTS LOC4TE043SHOWN® MUST BE WEATHER RESISTANT IN SOLAR AC LOAD CENTER - IN51DE O �'�'�{Ii■T,I' ry'T„� �E.pA CONTRACTOR '-ill.l I COMPLIANCE WITH NEC 1 10.2 1 (B)(3). 1 WARNING PVM4V (5) THE PV SYSTEM CIRCUIT CONDUCTORS ® 0 ® Q ® OWARNING 'Y" SHALL BE LABELED INSTALLED IN 1v1LNT > NERGY, THIS EQUIPMENT FED BYMULTIPLE DUAL POWER SUPPLY ' SOURCES TOTAL RATING OF ALL COMPLIANCE WITH NEC 6J0.3 17410 SOUND A OVERCURRENTDEVICES.EXCLUDING SOURCES:UTILITY GRID MATTITUCK, NY 1 1 MAIN SUPPLYOVERCURRENT AND PVSOLAR (G) 5HOWN IMAGE FOR LABEL # I G 15 LICENSE # 4388� DEVICE.SHALL NOT EXCEED ELECTRIC SYSTEM CONDUIT - INSIDE BUILDING AMPACITYOFBUS&4R EXEMPLARY AND THE UPDATED IMAGE WILL LICENSE # 52G89 O3 1WARNING BE USED WHEN INSTALLING. ® �� ` !\,WARNING L-. I THIS SERVICE METER WARNING IS ALSO SERVED BY A PROJECT NAME ELEL i R.L,S vG t tiAZAR- I PHOTOVOLTAIC SYSTEM PHOTOVOLTAIC SYSTEM TERMINALS ON THE LINE AND COMBINER PANEL LOAD SIDES MAY BE ENERGIZED DO NOT ADD LOADS CONDUIT - OUTSIDE BUILDING IN THE OPEN POSITION - - W C\J W ® • • • • WARNING .'• • J Q — DUAL POWER SUPPLY O I SOURCES:UTILITY GRID AND O PV SOLAR ELECTRIC SYSTEM _ MAIN SERVICE PANEL - OUTSIDE 5 � O CAUTION SOLAR CIRCUIT _ ACAUTION ® ~ SOLAR ELECTRIC SYSTEM CONNECTED O 3 © PHOTOVOLTAIC SYSTEM u AC DISCONINECti MAIN SERVICE PANEL - INSIDE ILWARNING _j. OPERATING POWER SOURCE OPERATING VOLTAGEVOLTS OUTPUT CONNECTION ® O DO NOT RELOCATE THIS 5HEET NAME OVERCURRENT DEVICE 0 ,1N� t 0 LABELS coos Q AC D15CONNECT/BREAKER _* ' � a r l"o a W m Z DRAWING 5CALE N .T.S. SHEET NUMBER PV-6 TAX MAP: 1 000 107001000010003 YARK TE Compensation workers' CERTIFICATE OF INSURANCE COVERAGE ST 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 ELEMENT ENERGY LLC 7470 SOUND AVE MATTITUCK,NY 11952 1 c.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) 823336604 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company TOWN OF SOUTHOLD 54375 MAIN ROAD 3b.Policy Number of Entity Listed in Box"1 a" SOUTHOLD NY 11971 DBL567527 3c.Policy effective period 01/01/2020 to 12/31/2021 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. ❑ B.Disability benefits only. C.Paid family leave benefits only. 5. 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 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. Date Signed 8/11/2020 By UJI#t (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent ofthat 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 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220, Subd. 8 of the NYS Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board (only if Box 4C or 5B of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family.Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) 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) 11111°°1°°11°111°11°1°°1°11°°°�IIIIIII ® DATE(MM YY) 7/17/ v CERTIFICATE OF LIABILITY INSURANCE 7/17/zozo 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 NAME: ROBERT S.FEDE INSURANCE AGENCY PHONE - - FAX - - 23 GREEN STREET,SUITE 102 E-MAIL E A/C No HUNTINGTON,NY 11743 ADDRESS: ROBERTS.FEDE INSURANCE INSURER(S)AFFORDING COVERAGE NAIC q INSURER A INSURED INSURERB:STATE INSURANCE FUND 523930 Element Energy LLC INSURER C ELEMENT ENERGY SYSTEMS INSURERD: 7470 SOUND AVENUE INSURERE: MATTITUCK, NY 11952 INSURERF: COVERAGES CERTIFICATE NUMBER: 7,788 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DDPOLICY EFF MM/DDPOLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY X CL00275204 7/14/2020 7/14/2021 EACH OCCURRENCE $ 3,000,000 X DAMAGE TO RENTED CLAIMS MADE OCCUR PREMISES Ea occunence $ 100,000 A MED EXP(Any one person) $ 5000 TCF1132060001201 7/14/2020 7/14/2021 PERSONAL 8 ADV INJURY $ 3000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY❑JET LOC PRODUCTS-COMP/OP AGG $ 3000000 OTHER: AUTOMOBILE LIABILITY MBINED S $INGLE LIMIT EaCO accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE FOR AND EMPLOYERS'LIABILITY 124494445 Y/N 7/13/2020 7/13/2021 ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1 000,000 B OFFICER/MEMBER EXCLUDED? IX (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ NY State DBL DBL567527 1/01/2020 1/01/2021 Statutory DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER IS ADDITIONAL INSURED 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 ACCORDANCE WITH THE POLICY PROVISIONS. Southold, NY 11971 AUTHORIZED REPRESENTATIVE RobertS. Fede, Sr. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSI F New York State Insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE • 0 0 A A A A A 823336604 ■ ROBERT S FEDE INSURANCE AGENCY 23 GREEN ST STE 102 HUNTINGTON NY 11743 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ELEMENT ENERGY LLC TOWN OF SOUTHOLD DBA ELEMENT ENERGY SYSTEMS 54375 MAIN ROAD 7470 SOUND AVENUE SOUTHOLD NY 11971 MATTITUCK NY 11952 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12449 444-5 431321 07/13/2020 TO 07/13/2021 8/11/2020 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2449 444-5, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:737801881