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TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 51236 Date: 10/03/2024 Permission is hereby granted to: Kaminski JT Living Trust 805 Bay Haven Ln Southold, NY 11971 To: install roof-mounted solar panels to existing single-family dwelling and to install an energy storage system outside of the dwelling as applied for. Premises Located at: 805 Bay Haven Ln, Southold, NY 11971 SCTM#88.-4-33 Pursuant to application dated 08/14/2024 and approved by the Building Inspector. To expire on 10/04/2026. Contractors: Required Inspections: Fees: SOLAR PANELS $100.00 ELECTRIC -Residential $125.00 CO-RESIDENTIAL $100.00 Total S325.00 Building Inspector TOWN OF SOUTHOLD —BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 his://www.southoldtgMMU.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector %/r r rrr f///% /l��✓!/�rp %ri//� '. r}/ //r rr r � fir rr�/% ,,,: '.,f.. m App�l��Xon�and fvrm mast bk��lled csut►n hr�1r en Ire fn�orn lete i �� / T ➢` �prr�l��tl rn�irlr��r 'I ,. 1 tt / r / / , r /! �r r y tit C1�r�nsr��Ayth�nz�ta��f c�f��P�f����sh�11 bey��r>r>ipl��ed r r/ r, ��j � /i/ rrr i%ji/ii Date..... ���y ., �C?� rrr,„ , /r r r/ r r � r r r / r r r rr / ��%//��/1%�//r//,<i,,,��„/�,,,//,.a/ Name: I t_ SCTM # 1000-- Owe 00 " 04,00 033d Project Address: god 11-97 Phone#: a()3. F)5'- 7SL R Email; JKOM vQ3 7 o)jalottd Mailing Address: . )(Omr . 3 67 R aD 0u Corp r e r /i r .. / 1.r, / r,.. ,., r� / /i � e r r I r // � ///( / r r/ r,.,,,, ,rr� . .ri //,,,///r ../rit%i,�%���i//„r/i, /ir///�ii....✓/Ji >' /! �/ /. r//� ////�i,i�((�,r/.,,��/��//,// ,llff,� /.,,J//�//// ,�, /�f�. lrr,/,/%„/ri✓i,,,,��, /,r��r,/,�Gr/.�rcaf�L��,,,,,ir�%,,,,,,� ,.,,,mow. ,,,,�,,, ,ra„��„/i ,�� ,i�rll��i/r r, /r.../�,� Name: hmof� , n _icesla Mailing Address: /J ru © 7 Phone#:,5/'b c2-73 015 9 Email: 1 P1C ( r % .,,. rr, .✓r., r/ r..r. /, / / r/ / / J r r. //.. r /< i/ rr r, t„ Name: to rI I w (Of Mailing Address: 5760 L-e � Drive- S'cu-k g3--333 ct1)0 TX -Zbuq Phone#: q72' Y94 — J'373 Email: tkrl(zloairun corp-C&A r r / / �+ Name: eS I ... G It Mailing Address: 15 +�►mtl 9d W I Lf06 V 7/ Phone#: s'J(� , �fy� , O r Email:c.jKOW ZD e-S/RColn r ,,, / //Or ////// / / /.:/fir%r /Lary,rr/r%//i / �, / 1;/fr , r r /// /..,//i :J/%/ �/,;/� / /� /./ rr/;.'! /�� r rr%/irr// / //rr/ ///i /r /ir/;/i%r r% ' i/ ESC �PTrOI OF;F'FCIF 5EDO STCICON r /ilr; ,/, r ' //// ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project, ,Wther $ Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? ❑Yes ❑No 1 PROPERTY INFORMATION Existing use of property: Cie, 1-j Intended use of property: Re& dm+a j Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? 0YesX0 IF YES, PROVIDE A COPY. Ll Check Box After Reading. The owner/contractor/design professional is responsible for all drainage and storm water Issues as provided by Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print name): Nuthorized Agent ❑Owner Signature of Applicant: M,�ryL Date: J L A'/ 26 , e'UZ� STATE OF NEW YORK) SS: COUNTYOFSU-44!✓jIK ) I '+"10—t-11 being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, A(S)he is the O r� S (Contractor,Age ,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 pp , 2-l0 day of 1 / 20 - Notary Public PATRICIA M. ZULLO NOTARY PUBLIC-STATE ,OF NEW YORK PROPERTY T I 'Tub No.01 Z00001589 ��-- �(Where the applicant is not the owner) Qualified in Suffolk CountyMy Commission Expires 02-15-2027 I, residing at 30 « I ld � � ��o hereby authorize o , "��- Tc� to apply on TT;�mort-liy my behalf to the Town of Southold Building Department for approval as described herein, Nl�n�o -, I % K RAL 7Q6 Owner's Signature Date Print Owner's Name 2 f BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD - Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 'amesh southoldtownn . ov - seand@southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: -2-0 L/ Company Name: Jason Kane Electrician's Name: 06an K Y License No.: M C 3Zq 95 Elec. email: J lLlar)e_c2D . )a Elec. Phone No: 5 .J06 1, old 4 ❑I request an email copy of Certificate of Compliance Elec. Address.: JOB SITE INFORMATION (All Information Required) Name: UcL e- T Kok minsYN Address: pwoo ' Cross Street: Phone No.: F15 . -1!5L4 Re Bldg.Permit#: ,5 4�5, email: Tax Map District: 1000 Section: Block: Al Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): 9y "ocX oan�td Solctr I,nelS 7.7a PI(Arral 1 .I u3e�wall I�.S Ku.�it Square Footage: Circle All That Apply: Is job ready for inspection?: YES [Z NO Rough In E] Final Do you need a Temp Certificate?: YES �' NO Y p Issued On Temp Information: (All information required) Service SizeF1 Ph 3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect[]Service Reconnect❑UndergroundlgOverhead # Underground Laterals 1 2 M H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION l� Oq r RECEIPT SUFFOLK COUNTY GOVERNMENT DEPARTMENT OF LABOR, LICENSING, AND CONSUMER AFFAIRS COMMISSIONER ROSALIE DRAGO P.O. BOX 6100, HAUPPAUGE, NY 11788 (631) 853-4600 Today Date: 03/01/2023 Application: ME-51331-REN01 ,"License#: ME-51331 Application Type: Master Electrical License Renewal Fee Allocation: Fee Item Description Fee Amount Amount Paid Amount Paid Total Balance Du License Renewal $400.00 $400.00 $400.00 $O.0 Total:...................... ...............................$400. 400 .. .. ..,.. ............ ....,.$ ......I._...... .. Receipt No. 458419 Payment Method Ref. Number Amount Paid Payment Date Cashier ID Comments Check 1171400503 $400.00 03/01/2023 VDEMASI Renewal Total: . otal 400.00 ..............,......,........... ......... ........,.-...__,............. Contact Info: TESLA ENERGY OPERATIONS INC JASON KANE 15 GRUMMAN RD SUITE 400, 3055 CLEARVIEW WAY SAN MATEO CA 94402 BETHPAGE, NY 11714 Work Description: Suffolk County Dept.of Labor,Licensing & Consumer Affairs ' MASTER ELECTRICAL LICENSE 1 Name JASON KANE Business Name This certifies that the nearer is duly licensed TESLA ENERGY OPERATIONS INC �y the County of suffolk License Number: ME-51331 Rosalie Drago Issued: 03/19/2013 Commissioner Expires: 03/01/2025 Rik- �v .a � ��.`� '\.e v.. D��, �_ .a .,i.�a.,.��. .,..2 ::�\-"a n. ,..\:.. .. _� �\�-• :.o��.�i`�.,.O.o �1.�5.�_ �� ,@� ..,. .. ., .� d �. .,...�.,..e Su � _.. _ T � DATE ISSUED: 04A$ C . -mewlwve . Ls TWs Is to ceytlf� a s havi rn t mm ace eoW$*M to the y laws, rules W m y e �, business as a HOME INOW TRA 3_- in dw Comwy o OA. NOT VA4Af)WITM MY f_. i A i�A CVMFN-T S+ [k ► pl. M--f IMMANENT LICENSE s Mc Ucemm a� t as be-f H-Mml lly We f k T° +* NEB Workers' CERTIFICATE OF INSURANCE COVERAGE YYotic Compensation TAE Board under the NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1 T� y illty and Paid Family Leave Benefits Cartier g f that Carrier o be completed b D1sab er or Licensed Insurance Agent o ...... Ia. Legal Name & Address of Insured (use street address only) I b. Business Telephone Number of Insured Tesla Energy Operations,Inc. 901 Page Ave. Fremont,Ca 94538 I c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured (Onl}•required if coverage is specificalh 02-07 8 1 046 limited to certain localioru in New fork Sicae, i,e.. Wrap-Up Policv) 2. Name and Address of Entity as the Certificate Proof of Coverage 3a. Name of Insurance Carrier (Entity g older) New York Life Group Insurance Company of NY Town of Southold 54375 Main Road 3b. Policy Number of Entity Listed in Box "la" Southold,NY 11971-0959 NYD075811 3c. Policy effective period l/l/2024to 1/1/2025 4. Policy provides the following benefits. ® A.Both disability and paid family leave benefits. FIB. 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 December 15, 2023 By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 1-866-761 423 p 6 Name and Title Untl.erwritir a Director 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' Comp+ensaIion 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 1y Signature of Audiorized NYS Workers'Compensation Board Emplovee) 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 urnt DB-120.1 (10-17) 11 __J:DATE(MM/DD/YYYY) ACCY " CERTIFICATE OF LIABILITY INSURANCE 11/0712023 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 endorsemetlt(s). CONTACT PRODUCER NAMEa. .., ,.. MARSH RISK 8 INSURANCE SERVICES PHONE E FAX FOUR EMBARCADERO CENTER SUITE 1100 If4d'C•Np',ip,xfi (AJcNo): CALIFORNIA LICENSE NO,0437153 ADDRESS SAN FRANCISCO,CA 94111 Attn:SariFranclsco.Certs@marsh.com 1 FAX 212-948-0398 kN k1RERl )AFFORDING COVERAGE NAIc u CN102460432-GAWwP-2.5M-23-24 INSURER A:Zurich American Insurance Company 16535 INSURED....._. ...... INSURER B:NIA NIA .... Tesla Energy Operations,Inc. _ - 1 Tesla Road INSURER C American Zurich Insurance Company„ _ 40142 Austin,TX 78725 INSURER D°NBA _ — INSURER E o 6 INSURER'E t COVERAGES CERTIFICATE NUMBER: SEA-003418109-32 REVISION NUMBER: 9 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUBR.... ., _ ,,,,.,,, ,_ „�-�,d POLICY NUMBE9� MMO,A,i'EkDFYYYY MtlOYNI"-�" m LT N'C'M EXP LIMITS R DDdYYYY A X COMMERCIAL GENERAL LIABILITY GLO 1074588-06 10131/2023 10/31/2024 EACH OCCURRENCE "S 2.500.000 ... ........, I�'A Kdt_T0RICrNfIdN OAWW4A4:`vL CLAINIS-MADE X OCCUR Includes Host Liquor Liability'°" �2 500.000 MED EXP An one person) $ E'd ppprag ®- 5,000, (,Any erson) $ ., X SIR 51.000 000 m--- X Tort Contrac Lab,No XCU Excl PERSONAL 8 ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE „$ 5 000 000 X POLICY .,... PRO-JECT LOC PRODUCTS COMP/OPAGG $ 5 000,000 OT}Eq A AUTOMOBILE LIABILITY BAP 107(586.06 1CIB31023 10/31/2024 COMMNED SINGL E LIMIT $ 1 000 000 -- -" X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident AUTOS ONLY ,. AUTOS ..PA60,ATY HIRED NON-OWNED AUTOS ONLY .._... AUTOS ONLY $ UMBRELLALIAB OCCUR .... _,... _.EACH OCCURRENCE _ $ EXCESS LAB CLAIMS-MADE AGGREGATE _. .._.....'$ ._.. _.. DE REnENTISSstCS C WORKERS COMPENSATION r74BC 1074 83-06 AOS) 10,131,023 10t3112024 X PA 071'. _. STAT a,E, ER, AND EMPLOYERS'LIABILITY YIN WC 1074584-06 MA WI 10/31/2023 10/3112024 1,000.000 A ( - ) E L EACH ACCIDENT_ _ $_ ANYPROPRIETOR/PARTNER/EXECUTIVE A oFFICER/ EMBE'EXCLUDED N,W" CA XSWC 1074585-06($50M is XS 1013112023 10/31/2024 E L DISEASE-EA EMPLOYEE $ 1 000,000 (Mandato inNH .. . ........... ,...... Has describe under $10M SIR;$1 M EE/EA is XS$10M SIR) E.L DISEASE POLICY LIMIT $ 1,000 000 SrtRfPTGON B7'F DPE/;A,1'tOPS a dtlw I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101.Additional Remarks Schedule,maybe attached if more space is required) Evidence of insurance. 4 CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 54375 Main Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold,NY 11971 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE x4W4 Red &9g&ndae Seca a ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Workers' RK CERTIFICATE OF TAT Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a Legal Name&Address of Insured (use street address only) 1 b.Business Telephone Number of Insured (650)963-5100 Tesla Energy Operations, Inc. 1 Tesla Rd 1 c. NYS Unemployment Insurance Employer Registration Number of Austin,TX 78725 Insured 49-892777 Work Location of Insured (Only required if coverage is specifically l 1d. Federal Employer Identification Number of Insured or Social Security limited to certain locations in New York State, i.e., a Wrap-Up Policy) Number 02-0781046 2:Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insuran ce Carrier (Entity Being Listed as the Certificate Holder) AMERICAN ZURICH INSURANCE COMPANY Town of Southold 3b. Policy Number of Entity Listed in Box"la" 54375 Main Road Southold, NY 11971 WC 1074583-06 3c. Policy effective period 10/31/2023 to 10/31/2024 3d.The Proprietor, Partners or Executive Officers are �X 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"T'insures the business referenced ' � renced 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 Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c", whichever is earlier. This certificate is issued as a matter of information only and 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 1 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: Cheryl Mamelson (Print name of authorized representative or licensed agent of insurance carrier) Approved by: L%AeYyIMalnelsvva 10/31/2023 (Signature) (Date) Title. Assistant Vice President Telephone Number of authorized representative or licensed agent of insurance carrier: (800)982 2150 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov N Y S' I F New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) ^"^^^ 043790764 ACRISSURE LLC D/B/A ROBERT C MANGI AGENCY INC %. :kg 910 FRANKLIN AVE STE 210 SCAN TO VALIDATE GARDEN CITY NY 11530 AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER JASON KANE INC TOWN OF SOUTHOLD 127 WEST BLVD 54375 MAIN RD. EAST ROCKAWAY NY 11518 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2368 581-1 T 611 08/07/2024 TO 08/07/2025 7/30/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2368 581-1, 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:/MIWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. 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 �/4 4 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 12558072 JASOKAN-01 DATE(MDM oD IivYYY�RI CERTIFICATE OF LIABILITY INSURANCE 12/2024 ...._ ...... ....... ._ 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. If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must IMPORTANT _._ ......_ � 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 _ such endorsement(s this certificate does not confer rights hits to the certificate holder in lieu of s_. _ .�_m). ._�_„ CONTACT PRODUCER -NAME. - RCM Insurance Agency Holdings, Inc. PHONE 516 294»1072 / No).(516) 294-1764 950 Franklin Ave.STE 100 (A/c"IL Service ( )'"" — ( -EDORE @contractor insurance.org— — ------- !Garden City,NY 11530 AC��S'�E55. - --- INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:UTICA FIRST INSURANCE COMPANY _ 15326 INS URED INSURER B Jason Kane Inc., IN"SURERC 127 West Blvd. INSURER D East Rockaway,NY 11518 INSURER,E: _ _._ .,,,_ - w.w. _. _ INS_URER F; .....mm .........._ - TE C_TTHISRIS GT CERTIFY THAT THE POLICIES OFFAINS INSURANCE LLIISTED BELOW HAVE BEEN ISSUED TO THE INSURED REVISION ABOVE "-' R 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. ADDL UR A X COMMERCIAL GENERAL AN50...5 POLICY NUMBER {y 1 POLICY EFF POLICY EXP L gMlDD/t^�Y FARM Od G 1hER8 NC mmLIMITS$ _1,000,000 INT�_w _A DAMAGE C.)RENT 50,000 .�- CLAIMS-MADE X OCCUR X ART3000129980 4/15/2024 4/15/2025 i ReMN$E,S d � ."n EXP gAny Pa lg�atiret r,8 - . rQ00 PERSO9VAY.A A{�r�°INJURY1,000,000. _ $ , 2 OLIO. 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUC,AGG"Rk-flaatT»^ $ X POLICY PRO LOC TS COMPIOP AGG _$ " "��� JECT — e ,,,..e,,.� _ 31HER OC7t9B1NEU SNNGLE LE G'IT AUTOMOBILE LIABILITYANY AUTO --BODILY INJURY tPerperson OWNED SCHEDULED BODILY INJURY Per accident $ ._.. AUTOS ONLY AUTOS - ---�- --- PROPC RIV DAMAGE HIRED Nf,TN60 /^d'N `. _(Per auradld�rr�-- $ ........ .. . AUTOS ONLY ... AV O m. UMBRELLA LIAB OCCUR EACH OCCURRENCE „-,,,,,_S„, _,,, ............. ._. EXCESS LIAB CLAIMS-MADE DED RETENTION$ . _ ..................._ - PER _ O T H- WORKERS COMPENSATION , '/y„h"2aTE .. Eye, AND EMPLOYERS'LIABILITY y/N ANY PROPRIETOR/PARTNER/EXECUTIVE l "fI- hC^'VC------ 9', OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E. 1 11 f__,ASl DESCRIPTION OF Ol�r"RADONS,0010.'11 E L DISEASE-POLICY LINIIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ,Town of Southold INCLUDED AS ADDITIONAL INSURED CERTIFICATE HOLDER, CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Road Southold,NY 11971 AUTHORIZED REPRESENTATIVE _ ©19 ACORD.. 25(2016103) 88-2015 ACORD CORPORATION. All rights reserved„ The ACORD name and logo are registered marks of ACORD NEW Workers' CERTIFICATE OF INSURANCE COVERAGE STA E Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured JASON KANE INC 516-343-0529 127 WEST BOULEVARD EAST ROCKAWAY,NY 11518 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations in New York State,i.e,,Wrap-Up Policy) 043790764 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 DBL470938 3c,Policy effective period 08/07/2023 to 08/06/2025 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: n A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. rl 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 7/25/2024 By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title LeSton Welsh 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 emailed to PAU@wcb.ny.gov or it can 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 46,4C or 5B have 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(Article 9 of the Workers'Compensation Law)with respect to all of their 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 (12-21) I j i III lll DB-120.1 (12-21) _�~ 1 Tesla Road,Austin,TX 78725 f 4 F ��lJ P 650 681 5100 F 650 681 5101 Version#97.9-1 August 13,2024 Certification Letter Project/Job#1193096 Project Address: Kaminski Residence 805 Bay Haven Ln Southold,NY 11971 AHJ Southold Town Tesla Operations Center Bethpage Design Criteria: -Applicable Codes=2020 RCNYS/BCNYS/EBCNYS with 2020 NYSUCS,ASCE 7-16,and 2018 NDS -Risk Category=II -Wind Speed=130 mph(3-s Gust-Vult),Exposure Category C,Directional Procedure for Rooftop Solar Panels -Ground Snow Load=30 psf -MP2:RDL=10 psf,RSL=20.8 psf,PVSL=16.3 psf -MP3:RDL=14 psf, RSL=20.8 psf,PVSL=18.1 psf Note: Per IBC 1.613.1; Seismic check is not required because Ss=0.178<0.4g and Seismic Design Category(SDC)=B<D To Whom It May Concern, Ajobsite survey of the existing framing system of the address indicated above was performed by a site survey team from Tesla.Structural evaluation was based on site observations and the design criteria listed above. Based on this evaluation,I certify that the alteration to the existing structure by installation of the PV system meets the prescriptive compliance requirements of the applicable existing building and/or new building provisions adopted/referenced above. Additionally,I certify that the PV module assembly including all standoffs supporting it have been reviewed to be in accordance with the manufacturer's specifications and to meet and/or exceed all requirements set forth by the referenced codes for loading. The PV assembly hardware specifications are contained in the plans/dots submitted for approval. Ztof NEW L, PAY -tO Y(/,�`q� TDigitally signed by } Yurianto Yurianto `0 DN:cn=Yurianto c— Yurianto c=US 1 ` to o=Texas Reason: I am the 101980 � author of this document Location: Date:2024-08-13 13:59-05:00 By Yuri at 1:59:20 PM,811312024 STRUCTURAL ANALYSIS & HARDWARE DESIGN RESULTS SUMMARY TABLES ' .. e- Design Standard ASCE 7-16 Risk Category' ��II Table 26.9=1 Ultimate Wind Speed V-Ult 130 mph Fig.26.5-1B _�_. _ Exposure Category "�- � � C _ _ Section 26.7 Ground Snow Load �pg 30.0 psf Figure 7.2-1 ecific Qegigm MP Name MP2 MP3 Roofing Comp Roof .Comp Roof , 0 5 ZS Comp V4 with ZS Comp V4 with Standoff Flashing Insert Flashing Insert N d Pitch 23° 18° , SL/RLL:PV 16.3 psf 18.1 psf SLIRLL:Non-PV 20.8 psf Edge Zone Width 5.2 ft 5.2 ft •. MP Name MP2 MP3 Applied Wind Zone WZ1y 2e-' WZ1,2e Wind Pressure -21.5 psf -28.1 psf m XSpacing 64" - 48" , m X-Cantilever 24" 20" YSpacing 41 41" c Y-Cantilever NA NA m J Uplift DCR' ` 79.5%' 79.4% X-Spacing 32" 32" X-Cantilever 15" 11" c Y-Spacing 74" 74" a 'Y-Cantilever NA NA Uplift DCR 71.8% 95.7% Layout Staggered% Staggered 7r' Applied Wind Zone WZ2ri;2r,3e WZ2n;;2i,3e Wind Pressure -30.9 psf -36.6 psf m XSpacing. 48" 32" m X-Cantilever 18" 15" u D .YSpacing 4.1" 41" m Y-Cantilever NA NA J Uplift DCR" 88.1% 70.01/6 X-Spacing 16" 16" X-Cantilever A0" V. r Y-Spacing 74" 74" a° Y-Cantilever NA NA, Uplift DCR 53.1% 63.3% - Layout Staggered Staggered Applied Wind Zone WZ3r W23r Wind Pressure -34.9 psf 43.6 psf u X-Spacing 48" 32" m X-Cantilever 16" 13" u YSpacing .41" 41" m Y-Cantilever NA NA J Uplift DCR '' 99.9% 83.9% X-Spacing 16" X-Cantilever' -'9" ` r Y-Spacing 74" a. Y-Cantilever NA Uplift DCR 60.2% NA Layout Staggered Staggered 1.X and Y are mabmums that are always relative to the structure framing that supports the PV. X is across framing members and Y is along framing members. 2.Where present,the green and red hatching in Applied Wind Zone rows corresponds to hatching on the Site Plan page of the plan set. StrAlification Results, MP Name MP2 MP3 Member Member Impact , ,,Member Impact• Evaluation Check OK . Check OK• ' Results ABBREVIATIONS ELECTRICAL NOTES JURISDICTION NOTES A AMPERE AC ALTERNATING CURRENT BLDG 1. THIS SYSTEM IS GRID-INTERTIED VIA A UL-LISTED ALL WORK TO COMPLY WITH SECTION R327 OF THE 2020 RESIDENTIAL CODE OF NYS. BUILDING CONIC CONCRETE DC DIRECT CURRENT POWER-CONDITIONING INVERTER. EGC EQUIPMENT GROUNDING CONDUCTOR (E) 2. A NATIONALLY - RECOGNIZED TESTING EXISTING EMT ELECTRICAL METALLIC TUBING FSB LABORATORY SHALL LIST ALL EQUIPMENT IN FIRE SET-BACK GALV GALVANIZED GEC GROUNDING COMPLIANCE WITH ART. 110.3. ELECTRODE CONDUCTOR GND GROUND HDG HOT 3. WHERE ALL TERMINALS OF THE DISCONNECTING DIPPED GALVANIZED I CURRENT Imp CURRENT AT MEANS MAY BE ENERGIZED IN THE OPEN POSITION, MAX POWER Isc SHORT CIRCUIT CURRENT kVA A SIGN WILL BE PROVIDED WARNING OF THE KILOVOLT AMPERE kW KILOWATT LBW LOAD HAZARDS PER ART. 690.17. BEARING WALL MIN MINIMUM (N) NEW NEUT 4. EACH UNGROUNDED CONDUCTOR OF THE NEUTRAL NTS NOT TO SCALE OC ON CENTER PL MULTIWIRE BRANCH CIRCUIT WILL BE IDENTIFIED BY PROPERTY LINE POI POINT OF INTERCONNECTION PHASE AND SYSTEM PER ART. 210.5. PV PHOTOVOLTAIC SCH SCHEDULE S STAINLESS 5. CIRCUITS OVER 250V TO GROUND SHALL COMPLY STEEL STC STANDARD TESTING CONDITIONS TYP WITH ART. 250.97, 250.92(B). TYPICAL UPS UNINTERRUPTIBLE POWER SUPPLY V 6. DC CONDUCTORS EITHER DO NOT ENTER BUILDING VOLT Vmp VOLTAGE AT MAX POWER Voc VOLTAGE OR ARE RUN IN METALLIC RACEWAYS OR AT OPEN CIRCUIT W WATT 3R NEMA 3R, RAINTIGHT ENCLOSURES TO THE FIRST ACCESSIBLE DC DISCONNECTING MEANS PER ART. 690.31(E). 7. ALL WIRES SHALL BE PROVIDED WITH STRAIN RELIEF AT ALL ENTRY INTO BOXES AS REQUIRED BY UL LISTING. 8. MODULE FRAMES SHALL BE GROUNDED AT THE UL - LISTED LOCATION PROVIDED BY THE MANUFACTURER USING UL LISTED GROUNDING HARDWARE. 9. MODULE FRAMES, RAIL, AND POSTS SHALL BE BONDED WITH EQUIPMENT GROUND CONDUCTORS. VICINITY MAP INDEX Sheet 1 COVER SHEET ins r ` : Sheet 2 SITE PLAN Sheet 3 STRUCTURAL VIEWS Sheet 4 UPLIFT CALCULATIONS O LICENSE GENERAL NOTES Sheet 5 LOCATION j % Sheet 6 MOUNTING DETAILS 1. ALL WORK SHALL COMPLY WITH THE 2020 NYS Sheet 7 THREE LINE DIAGRAM UNIFORM CODE. Cutsheets Attached 2. ALL ELECTRICAL WORK SHALL COMPLY WITH THE 2017 NATIONAL ELECTRIC CODE. -` 3. ALL WORK SHALL COMPLY WITH THE 2020 NYS FIRE CODE. l MODULE GROUNDING METHOD: ZEP SOLAR 4. ALL WORK SHALL COMPLY WITH THE 2020 BUILDING CODE OF NYS. '"� REV BY DATE COMMENTS AHJ: Southold Town 5. ALL WORK SHALL COMPLY WITH THE 2020 NAME DATE COMMENTS RESIDENTIAL CODE OF NYS. REV A 6. ALL WORK SHALL COMPLY WITH THE 2020 UTILITY: PSE&G-Long Island EXISTING BUILDING CODE OF NYS. CONFIDENTIAL - THE INFORMATION HEREIN JOB NUMBER: J B-1193096 O O CUSTOMER: DESCRIPTION: DESGN: CONTAINED SHALL NOT USED FOR THE James Kaminski 9.72 KW PV ARRAY Priyanka George T 5 L n BENEFIT OF ANYONE EXCEPT TESLA INC., NOR MOUNTINGSYSTEM: 805 Bay Haven Ln 13.5 KWH ENERGY STORAGE SYSTEM SHALL IT BE DISCLOSED IN WHOLE OR IN ZSComp V4 wFlashing-Insert y PART TO OTHERS OUTSIDE THE RECIPIENTS MODULES: Southold NY 11971 ORGANIZATION, EXCEPT IN CONNECTION WITH , THE SALE AND USE OF THE RESPECTIVE (24) Hanwha # Q.PEAK DUO BLK ML-G10+/TS 405 TESLA EQUIPMENT, WITHOUT THE WRITTEN INVERTER: PAGE NAME SHEET: REV: DATE- PERMISSION OF TESLA INC. Tesla POwefwall 3 r240V1 # 1707000-20-G 11.5 kW 13.5 kWh 2038157548 COVER SHEET 1 7/24/2024 .HATCHING INDICATES WIND PRESSURE ryv ,of NEW MP1 PITCH: 230 (5:12) ARRAY PITCH:230 (5:12) AZIMUTH: 114 ARRAY AZIMUTH: 114 ZONES. SEE THE STANDOFF SPACING . '0 MATERIAL:Comp Shingle STORY: 2 Stories AND LAYOUT TABLE FOR MORE .,� It Y��l�;, �'� PITCH: 230 (5:12) ARRAY PITCH:230(5:12) INFORMATION. ,� ,� Q �. MP2 AZIMUTH: 114 ARRAY AZIMUTH: 114 �. s MATERIAL:Comp Shingle STORY: 2 Stories PITCH: 180 (4:12) ARRAY PITCH:181(4:12) MP3 AZIMUTH:204 ARRAY AZIMUTH:204 MATERIAL:Comp Shingle STORY. 2 Stories ROOF /GROUND ACCESS 7/ �/ t( m l ,4J (E)DRIVEWAY a$' h LEGEND ROOF /GROUND ACCESS J (E) UTILITY METER & WARNING LABEL \ 36\\ \ Fse \ INVERTER W/ INTEGRATED DC DISCO Front of House \\ 36„ \ .......... 19 & WARNING LABELS \ ❑RELAY © AUTOMATIC RELAY ❑DC © DC DISCONNECT & WARNING LABELS ...... O © AC DISCONNECT & WARNING LABELS DC JUNCTION/COMBINER BOX & LABELS ••• .O,� O ENERGY STORAGE SYSTEM FOR STAND < ❑ ALONE OPERATION Q DISTRIBUTION PANEL & LABELS LOAD CENTER & WARNING LABELS DEDICATED PV SYSTEM METER S Q RAPID SHUTDOWN / 0 STANDOFF LOCATIONS r;® ......... CONDUIT RUN ON EXTERIOR ' ®© CONDUIT RUN ON INTERIOR EXTERNAL DISCONNECT SWITCH GATE/FENCE 4�'_PLACEID � HEAT PRODUCING VENTS ARE RED ESS + INVERTER UNIT TO BE I/ ,� INTERIOR EQUIPMENT IS DASHED ON A CONCRETE PAD L_�J TOTAL ARRAY AREA (SF): 520 SITE PLAN N TOTAL ROOF AREA (SF):3501 Scale:1/16" = 1' W E TOTAL ARRAY AREA IS a 14.87 01 16' 32' PERCENT OF TOTAL ROOF AREA CONFIDENTIAL— THE INFORMATION HEREIN JOB NUIdBER J B-119 3 0 9 6 0 0 a'STD�' DESCR 719 DESIGN: CONTAINED SHALL NOTE USED FOR THE James Kaminski 9.72 KW PV ARRAY Priyanka George o BENEFIT B ANYONE EXIT MOLE INC., NOR uoS C sr p 805 Bay Haven Ln 13.5 KWH ENERGY STORAGE SYSTEM o SHALL IT BE DIsq.OSED IN WHOLE OR IN ZS Comp V4 w Flashing—Insert Insert Y PART TO OTHERS OUTSIDE THE RECIPIENT'S g ORGANIZATION, EXCEPT IN CONNECTION WITH MODULES: Southold, NY 11971 THE SALE AND USE OF THE RWECnVE (24) Hanwha # Q.PEAK DUO BILK ML—G10+ TS 405 TESLA EQUIPMENT, WITHOUT THE WRITTEN INYERiER PAGE NAME SHEET: REV: DATE PERMISSION OF TESLA INC. Testa Powerwall 3 r240V1 # 1707000-20-0 11.5 kW 13.5 kWh 2038157548 SITE PLAN 1 2 7/24/2024 NY �)f NEWS S1 10198d ��� (N) PV MODULE (E) MOUNTING PLANE (MP) SV TYPICAL rV SIDE VIEW- INITS. PV MODULE 5/16"x1.5" BOLT WITH 5/16" FLAT WASHER INSTALLATION ORDER ZEP ROCKIT OCATE FRAMING MEMBER, MAR ZEP LEVELING FOOT (1) HOLE LOCATION, AND DRILL ZEP ARRAY SKIRT PILOT HOLE. --------- --- -------- ZEP MOUNTING BLOCK (4) ATTACH FLASHING INSERT TO ZEP FLASHING INSERT (3) (2) MOUNTING BLOCK AND ATTACH TO FRAMING MEMBER USING LAG (E) COMP. SHINGLE SCREW. (1) 2�"MIN. (E) ROOF DECKING (2) - ` INJECT SEALANT INTO FLASHING (3) INSERT PORT, WHICH SPREADS 5/16" DIA STAINLESS LOWEST MODULE SUBSEQUENT MODULES SEALANT EVENLY OVER THE STEEL LAG SCREW ROOF PENETRATION. INSTALL LEVELING FOOT ON TOP (E) FRAMING MEMBER STANDOFF [4) OF NTING BLOCK & SECURELY UFASTEN WITH BOLT. CONFIDENTIAL- THE INFORMATION HEREIN JOB NUMBER J B--119 3 0 9 6 0 0 CUSTDMM. DEW"ON: _ DOD: CONTAINED SHALL NOTCE USED FOR THE James Kaminski 9.72 KW PV ARRAY Priyanka George BENEFIT OF ANYONE SHALL T BE DISCLOSED INN WHOLE OR T TESLA INN� �"OS C UNM�` 805 Bay Haven Ln PART TO OTHERS OUTSIDE THE RECIPIENT'S ZS Comp V4 w Flashing—Insert Y 13.5 KWH ENERGY STORAGE SYSTEM FIERSP ¶ViH Southold, NY 11971 THE AM ORGANIZATION, USE OTTHEECE (24) Hanwha # QAAK DUO BLK ML—G10+/TS 405 TESLA EQUIPMENT, WITHOUT THE WRITTEN INVERTER; PAGE NAME SHEET. REV: DATE PERMISSION OF TESLA INC. Tesla Pawerwall 3 r240VI # 1707000-20-G 11.5 kW 13.5 kWh 2038157548 STRUCTURAL VIEWS 3 7/24/2024 NY cam, k. ate sgoa6c Deign wiffle MP*Oft Deign tnlamatton Desir Code ASCU:7-16 MP Name W2 IP3 sm A T"LS-1 Rooting Comp Shwe C=P Shagle 41 Uittrnate Wad Spw V-Ult 130 tlg.1809A ZS Cmv V4 w ZS pomp V4 w _ -` L StaMotf FlahYg-N�rt Floc kig-Moort 1 Eg-re Cabgay C Section 28.7 Ground Srm Loots P9 30 Table 7-1 Pitch 23 18 4 SAL.PV 16.3 1&0 SAL.Non—" 20.E gas A_ Edge Zane Wldlh 5.2 R S2 ft �{JV Axtnuth 114 204 Stories 2 2 Rafter Shs/Spaatig W Or OC 2s10 O16'OC Cd Sftq/**9 2s6 OIV OC Standoff Spaaag and layout LP None LP2 IP3 Applied Wind Zms; 1,2e 1,2e Wind Pressure -21.47 -2a10 Landscape X-Spadn9 64 48 = 24 20 La A-"Y-Spacing 41 41 -Cm0 - Portrait X-Sp* 32 32 Portrait X-CmUever 15 11 Portrait Y-Spacing 74 74 Patrdt Y-Comm - Layout Stoggaed Stewed Applied Wind Zanesr :•:Zt4 2r,Jo •:•:::• ::2n 2r,Js:•:;•. Wind Pressure -30.92 -36.61 Landlps X-Spmfng 46 32 X-CmOiwr 18 15 Lmdoeape Y-**g 41 41 -Cmu - - Portrait X-Spoft 16 16 Portrait X-Cadlm 10 6 Partraft Y-**Q 74 74 Patron Y-Cmtlwa - - Layout Stonored Siopgorsd Applied Wind Zma, 7r 3r Wad Pressure -34.66 -43M Laedseope x—Spadng 48 32 x—cmue� lmdscaps 16 13 L-d-ps Y-Spacing 41 41 Y-Caution. Landscape - - Pa1raR X-Spmdng 16 DO Portrait X-Cmtlwer 9 DO Portrait Y-Spaetp 74 DO Parlra t Y-Cmtlwtr - DO Layout Staggered Staggered Notes 1.X and Y am meftums that am okays rda M to the structure kadag that supports the PV.X Is across rafters and Y is aWq .alters 2. Ng h AMU Wind Zane rows eartespomb to hatchbg an CONFIDENTIAL—THE INFORMATION HEREIN JOB NUII M J B-119 3 0 9 6 0 0 CUSTOMER: DESCRIPTION:' °�": CONTAINED SHALL NOTE USED A INC.,THE James Kaminski 9.72 KW PV ARRAY Priyanka George SHALL T BE DISCLOSED IT OF ANYONE NN WHOLE OR IN NOR MOUNTING C sv p 805 Bay Haven Ln PART TO OTHERS OUTSIDE THE RECIPIENT'S ZS Comp V4 w Flashing—Insert Y 13.5 KWH ENERGY STORAGE SYSTEM ORGANIZATION, NFITE�SP �TM2 ) Southold, NY 11971 THE SALE AND USE OHREEC RESPECTIVE ( 4Hanwha Q.PEAK DUO BLK ML—G10+/TS 405 TESLA EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME SHEET- REV: DATE PERMISSION of TESLA INC. Testa Powerwall 3 r240V1 # 1707000-20-G 11.5 kW 13.5 kWh 2038157548 UPLIFT CALCULATIONS 4 7/24/2024 D ON A DETACHED CONCRETE PAD 3' AWAY r- •, - - --'-��- „- �,f,.;r- ESS TO BE MOUNTED AY FROM NEARBY DOORS/WINDOWS r�A ..!,�':�iT_ ',•, -:-fr'/.- .• y". :'�'�v• �".•�"'e='t-.^`^--,.. :_ _.e•-..- _±.-""'�-� �T �4's _y. ;r�'`"p5. / r�!°r- :•. p = NY 0 k NEW - f = - r �r o ? � Z is< 5 .w^: r._° ,. ,a ' ,- - V rr 1 y�N i r`i 1� a+L• - I >v i• - /s'•tiW - ` a� f " - •k` .a r +'' � .ram_'- -•�{'4._-. ` �y ir?• , 1 /a _ LL. t _ \3 v'i Y U n .r r - �a q rR- _ - J _ :u. 7( 0t _ �••...,av.. -r. ----te,_aaryry'", ...� 't�` �`' i Structural Aspects Only) d - _ •.i .- a..••••---_.._ ^-�. ^��� MEP Dead Weights,seismic in Loads i), '1b" �j:-•s'' �„"x, f. ,�•:_ - - _ ,. _ - � d Et^a-. 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CONTAINED SHALL NOTE USED FOR THE James Kaminski 9.72 KW PV ARRAY Priyanka George ® � SHALLBENEFI T BE DISCLOSED IT OF ANYONE NN WHOLE T TESLAOR IN NOR MOUNiIC SYSTEM. 805 Bay Haven Ln PART TO OTHERS OUTSIDE THE RECIPIENT'S ZS Camp V4 w Flashing—Insert Y 13.5 KWH ENERGY STORAGE SYSTEM THE SALE AND USE OF IN CONNECTION RESPECTiIVE�TM MODULES' Hanwha Q.PEAK DUO BLK ML—G10+ TS 405 Southold, NY 11971 TESLA EQUIPMENT,WITHOUT THE WRITTEN �� PAGE NAME SHEET. REV: DATE: PERMISSION OF TESLA INC. Tesla Powerwall 3 f240VI # 1707000-20-0 11.5 kW 13.5 kWh 2038157548 ESS LOCATION 5 7/24/2024 • u[N[RQL NOTES ISOMETRIC VIEW NTS NY o 40 Y�kfd'f o WITHIN PERIMETER OF THE PAD EXCAVATE AND REMOVE ALL LOOSE AND ORGANIC MATERIAL. COMPACT IN PLACE SOILS TO A LEVEL ' SURFACE. CONCRETE TO BE EMBEDDED INTO SOIL, PER DETAIL. COMPACT & FILL 4" THICK BASE OF CRUSHED, COURSE STONE WHEN 1OPSF OR MORE GROUND SNOW LOAD IS EXPECTED IN SITE SPECIFIC �r_3 11V DESIGN CRITERIA. 7( o CONCRETE USED FOR SLABS SHALL HAVE MINIMUM COMPRESSIVE STRENGTH OF 3,000 PSI AT 28 DAYS. WORK CAN BEGIN 14 DAYS AFTER PAD IS POURED. o CONCRETE REINFORCING SHALL MEET TEMPERATURE AND SHRINKAGE REQUIREMENTS OF ACI 318. — #4 REBARS s 16" O.C. (BOTH WAYS) — ASTM A615 GRADE 60 (FY = 60000 PSI) — 3" COVER MIN FOR CONCRETE FACING SOIL o POSTS SHALL BE 2" SCH 40 STEEL PIPES OR EQUIVALENT TESLA APPROVED POSTS. SIDE VIEW NTS TOP VI EW NTS o EACH POST TO BE ATTACHED TO PAD WITH A HOLLAENDER PIPE FLANGE INSTALLED PER MANUFACTURER SPECIFICATIONS AND (4) 3/8" SIMPSON STRONG—TIE TITEN HD CONCRETE SCREWS (ESR-2713) W/ 2.5" EMBEDMENT MIN. OR EQUIVALENT CONCRETE ANCHOR APPROVED BY TESLA COMPLIANCE LETTER. I o ALL ITEMS TO BE CAST INTO CONCRETE, SUCH AS REINFORCING, SHALL BE SECURELY AND ACCURATELY POSITIONED INTO THE FORMS PRIOR TO PLACING THE CONCRETE. I — I FILL PER o CONCRETE ANCHORS SHALL BE INSTALLED WITH 6" MIN EDGE GENERAL DISTANCE FROM ALL EDGES OF THE PAD. TYPICAL SPACING BETWEEN NOTES POSTS SUPPORTING THE SAME PW IS 20" ON CENTER. POSTS SHALL BE SPACED 12" MIN, ON CENTER FROM POSTS OF OTHER BAYS WHEN z APPLICABLE. N o 1-5/8" STRUTS AND HARDWARE SHALL BE USED TO ATTACH 9 10 ELECTRICAL EQUIPMENT TO POSTS. =>> POWERWALL BRACKET NOT SHOWN FOR CLARITY. ` CONRDENTIAL- THE INFORMATION HEREIN a NUMBER: J 8-119 3 0 9 6 0 0 CUSTOMER: DESq�PM, DESIGN' CONTAINED SHALL NOT BE USED FOR THE James Kaminski 9.72 KW PV ARRAY Priyanka George a SHALLI IT°BE��IN T�OIRN IN NORlillTesla DUNIIC SYSTEIC 805 Bay Haven Ln PART TO OTHERS OUTSIDE THE RECIPIENTS ZS Comp V4 w Flashing—Insert Y 13.5 KWH ENERGY STORAGE SYSTEM THE ORGANIZATION, AND USE OF IN RRENSPPECTIY NTH E 24)Hanwha Q.PEAK DUO BLK ML—G10+ TS 405 SOUtI101d, NY 11971 TESLA EQUIPMENT.WITHOUT THE WRITTEN a7m PAGE NAME' SHEET REV DATE PERMISSION OF TESL"INC' Powerwall 3 r240V 1707000-20—G 11.5 kW 13.5 kWh 2038157548 MOUNTING DETAILS 6 7/24/2024 (N) 200A INTERNAL (E) WIRING BACKUP GATEWAY LOAD CENTER Teslo Powerwoll 3 E-Stop Al12,rive B 200A 2P 60�2P 2 1 Sl u� 1 S2 1 S3 ❑ ❑ RM T TO 120/240V 200A 2P SINGLE PHASE UTILITY SERVICE Ell • (E) LOADS EXTERNAL DISCONNECT SWITCH (E) 200A DISTRIBUTION PANEL r---------------------- -- ------al Emergency Stop Button (E-Stop)Rapid Shutdown Initiation Device per Article 690.12(C) of the NEC2v• Disconnecting Means as defined in Article 100 of the NEC Connection to generation sources with 12V, 1A communication wire L----------------------------------J o e Q e• Ref Qty Description Ref Type Qty Size (AWG, Cu) EGC (AWG, Cu) Conduit Isc (ADC) Imp (ADC) Product String Module per MCI per Voc' Vmp Mounting 1 Breaker, 60A/2P, 2 Spaces 1 PV Wire 2 #10 SBC #06 3/4' EMT 11.17 10.83 Ref Ref String String (VDC) (VDC) Plane A 1 200A Main Circuit Breaker, 2-Pole, 240V, 10kAIC ® ® 0. S1 9 3 452.13 336.51 M131 1 Tesla #1841000-01-C: Back-up Gateway 3.0 NA for PW B S2 7 3 351.66 261.73 MP2 B 1 Tesla Powerwoll 3 [240V]#1707000-20-G 11.5 kW/13.5 kWh Ref Type Qty Size (AWG) Min EGC Conduit Length Imp Vmp S3 8 3 401.89 299.12 MP2 (Cu) (AI) (AWG, Cu) (Cu) (AI) (ft) (AAC) (VAC) C 9 Tesla MCI, 65OV, 12A D 1 UL 508 Emergency Stop Device- NEMA 4X 2 THWN-2 3 #06 #04 #10 PVC Jacketed MC 1' EMT 5ft 48 240 1. GROUND NEUTRAL BOND TO BE COMPLETED IN SERVICE EQUIPMENT (A) 3 THWN-2 3 #2/0 #4/0 #06 2" PVC 2' PVC 2ft - 240 2. CONDUIT RUNS MAY BE CONDENSED DUE TO SITE CONDITIONS AND/OR INSTALLATION EASE. ALL CONDUIT FILL DERATES AND PROPER CALCULATIONS HAVE BEEN COMPLETED PER NEC CHAPTER 9, TABLE 4. 3. SOLAR SHUTDOWN DEVICE TO BE INSTALLED FOR SYSTEM RAPID SHUTDOWN (RSD) IN ACCORDANCE WITH ARTICLE 690 OF THE APPLICABLE NEC. 4. CONDUIT TYPE CAN CHANGE DUE TO SITE CONDITIONS AND WILL FOLLOW THE NEC REQUIREMENTS FOR THAT CONDUIT TYPE. • e 6� e Main Panel Rating (E) 200A Hanwha #Q.PEAK DUO BLK ML-G10+/TS 405: Main Breaker (E) 200A PV Module, 405W, 376.3WPTC, ZEP, Black Rating Frome, MC4, 1000V General Notes DC Ungrounded Qty 24 Inverters Voc 45.34 Panel Number Vmp 37.39 Meter Number 80605322 Isc and Imp are in the DC Conductor Table Service Entrance Overhead J B-119 3 0 9 6 0 0 CUSTOMER: DESCRIPTION: DESIGN: CONTAINED AL- THE INFORMATION HEREIN JOB NUMBER: James Kaminski 9.72 KW PV ARRAY Priyanko George � = 5 L n CONTAINED SHALL NOT BE USED FOR THE BENEFIT B ANYONE EXCEPT TESLAINC., NOR MOUNTING SYSTEM: 805 Bay Haven Ln 13.5 KWH ENERGY STORAGE SYSTEM SHALL IT BE DISCLOSED IN WHOLE OR IN ZS Comp V4 wFlashing—Insert y PART TO OTHERS OUTSIDE THE RECIPIENTS ORGANIZATION, EXCEPT IN CONNECTION WITH MODULES Southold, NY 11971 THE SALE AND USE OF THE RESPECTIVE (24) Hanwha # Q.PEAK DUO BLK ML—G10+/TS 405 PAGE NAME SHEET: REV:TESLA EQUIPMENT, WITHOUT THE WRITTEN INVERTER: DATE- PERMISSION of TESLA INC. Teslo Powerwall 3 [240VI # 1707000-20—G 11.5 kW 13.5 kWh 2038157548 THREE LINE DIAGRAM 7 7/24/2024 Label WARNING:PHOTOVOLTAIC POWER SOURCE Location: LabelLabelLocation: ,_ Code:: `WARNING ,_ ' ' Code: WARNING NEC '•0.31.G.3 NEC ELECTRIC SHOCK HAZARD ELECTRIC SHOCK HAZARD DO NOT TOUCH TERMINALS 13 THE DC CONDUCTORS OF THIS Label Location: TERMINALS ON BOTH LINE AND PHOTOVOLTAIC SYSTEM ARE PHOTOVOLTAIC DC Per Code: LOAD SIDES MAY BE ENERGIZED UNGROUNDED AND IN THE OPEN POSITION MAY BE ENERGIZED NEC DISCONNECT 690.13.13 Label.. Location: PHOTOVOLTAIC POINT OF •• INTERCONNECTION MAXIMUM POWER Per Code POINT CURRENT(Imp) A Per WARNING: ELECTRIC SHOCK •� MAXIMUM POWER- Code: HAZARD. DO NOT TOUCH CEC ' POINT VOLTAGE(Vmp)_VNEC 690.53 TERMINALS.TERMINALS ON MAXIMUM SYSTEM BOTH THE LINE AND LOAD SIDE VOLTAGE(Voc)_V MAY BE ENERGIZED IN THE OPEN SHORT-CIRCUIT POSITION. FOR SERVICE CURRENT(Isc)_A DE-ENERGIZE BOTH SOURCE AND MAIN BREAKER. PV POWER SOURCE MAXIMUM AC _ A OPERATING CURRENT MAXIMUM AC Label Location: OPERATING VOLTAGE V WARNING ' Per ..- ELECTRIC SHOCK HAZARD 690.41.13 IF A GROUND FAULT IS INDICATED NORMALLY GROUNDEDLabel L• • UNGROUDDEDOND ENERGIZED CAUTION • DUAL POWER SOURCE Per ••- NEC 705.12.13.3 SECONDSOURCEIS PHOTOVOLTAIC SYSTEM Label • • WARNING Per Code: Label ELECTRICAL SHOCK HAZARD Location: DO NOT TOUCH TERMINALSCEC '• CAUTION ' '• TERMINALS ON BOTH LINE AND Per Code: LOAD SIDES MAY BE ENERGIZED PHOTOVOLTAIC SYSTEM IN THE OPEN POSITION CIRCUIT IS BACKFEDNEC •' •' DC VOLTAGE IS ALWAYS PRESENT WHEN SOLAR MODULES ARE EXPOSED TO SUNLIGHT Label • • WARNING '• Per Code: Label INVERTER OUTPUT Location: CONNECTIONEC N • PHOTOVOLTAIC AC P• DO NOT RELOCATEDisconnect DISCONNECTPer Code: THIS ODEVICERRENTConduit NEC .•013.13 (CB): Combiner :. Panel(D): Distribution (DC): DC Disconnect (IC): Interior Run Conduit Label AC ' '• OPERATING CURRENT � A •'' Center Per Code MAXIMUM AC (M): Utility Meter OPERATING VOLTAGE VNEC 690.54 •• Point of • • LabelSC LabelLocation: Label BACK Lei P LOAD CENTER CAUTION Per ••. TRI POWER SOURCE Per Code: NEC 408.4SECOND SOURCE IS PHOTOVOLTAIC SYSTEMNEC , THIRD SOURCE IS ENERGY STORAGE SYSTEM Label • • CAUTION DO NOT ADD NEW LOADS Per ••' Label • • NEC ' WARNING ' Per ..- THIS EQUIPMENT FED BYNEC 705.12.B.2.3.c Label • • MULTIPLE SOURCES.TOTAL CAUTION �DEV COES EXCOLUDING MA NNT THIS PANEL HAS SPLICED FEED Per •'" SUPPLY OVERCURRENT DEVICE, THROUGH CONDUCTORS. NEC 312.8.A(3) SHALL NOT EXCEED AMPACITY LOCATION OF DISCONNECT AT ENERGY OF BUSBAR. STORAGE.BACKUP LOAD PANEL Label Locati• Label Location: NOMINAL ESS VOLTAGE 12CV24UV CAUTI 0 N MAX AVAILABLE SHORT Per ..- DUAL POWER SOURCE Per ..- CfRCUIT FROM ESS= 32A Per 1• 7(D) label t• •- marked in field SECOND SOURCE ISNEC 705.12(B)(3) ARC FAULT CLEARING ENERGY STORAGE SYSTEM TIME FROM ESS= G7ms Label Location: (MS QATE OF CALCULATION: ENERGY STORAGE SYSTEM ON SITE ' LOCATED WITHIN LINE OF SIGHT Per ••- Label • • ENERGY STORAGE SYSTEM ON SITE LOCATED ON ADJACENT WALL Per ••" Label • • ENERGY STORAGE SYSTEM ON SITE LOCATED ON OPPOSITE WALL Per ••- Label • • ENERGY STORAGE SYSTEM ON SITE LOCATED INSIDE Per Code (AQ AC Disconnect Backup Load Center (MSP): Main Service Panel •. • Label Gateway 3 Tesla Gateway 3 controls connection to the grid in a Powerwall system, automatically detecting outages and providing seamless transition to backup power. It provides energy monitoring that is used by Powerwall for solar self-consumption.time-based control,and backup operation. Performance Model Number 1841000-01-y AC Meter Revenue accurate(+/-0.5%) ---- — ---- --- - -- - -- -- --- - - - - -- - --- -- - -- ---- ---- - ------ Specifications Nominal Grid Voltage 120/240 V AC Communication CAN Grid Configuration Split phase J User Interface Tesla App Grid Frequency 60 Hz Backup Transition Automatic disconnect for Continuous Current 200 A - seamless backup_ Rating Overcurrent 100-200 A Protection Device Service entrance rated Maximum Supply 22 kA with Square D or Eaton CSR, BWH,or BW,or Short Circuit Current Eaton main breaker Square D QOM breakers 25 kA with Eaton main breaker' Internal Panelboard 200 A IEC Protective Class Class I 8-space/16 circuit breakers ------ ---— - Eaton BR,Siemens QP,or Overvoltage Category Category IV Square D HOM breakers 'Only Eaton CSR or BWH main breakers are 25 kA rated -_- rated to 10_125A Warranty 10 years Environmental Operating Temperature -20°C to 50°C(-4°F to 122°F) Specifications Operating Humidity(RH) Up to 100%,condensing Maximum Elevation 3000 m (9843 ft) Environment Indoor and outdoor rated - - - - - ---Enclosure Type— - NEMA 3R --- - - -- - --- - Compliance Certifications UL 67,UL 869A, UL 916, UL 1741 PCs, Information CSA 22.2 107.1, CSA 22.2 29 - - -- - ------ -- - --------- -- ---------------------- ------ ----- - -- - ------ Emmissions FCC Part 15, ICES 003 Mechanical Dimensions 660 x 411 x 149 mm Specifications ___ -_(26 x 16 x s in) Weight 16.4 kg (36 lb) T g -------------------- -------- ---- -- -- -- - Mounting options Wall mount 660 mm o �411 mm� mm Gateway 3 Datasheet 2023 PV HAZARD CONTROL SYSTEM I BIPV PV HAZARD CONTROL SYSTEM I GENERIC PV ARRAY • UL 3741 REPORT DATE 01-27-23 UL 3741 REPORT DATE 01-27-23 Tesla Inverter Based PVHCS, Consisting of Tesla Inverters,Tesla MCI and other PV RAPID SHUTDOWN ARRAY PV RAPID SHUTDOWN ARRAY listed components to create the system WARNING:To reduce the risk of injury, read all instructions. WARNING:To reduce the risk of injury,read all instructions. PV HAZARD CONTROL EQUIPMENT AND COMPONENTS PV HAZARD CONTROL EQUIPMENT AND COMPONENTS Firmware Versions Certification Standard N d Manufacturer M f nua Model o. Function Manufacturer Model No. Firmware Versions and Checksums Certification Standard Function Ma and Checksums PURSE Mid Circuit Tesla MCI-1,MCI-2 N/A UL 1741 PVRSE Inverter,Powerwall+,or 7.6 kW:15380001 V4,CEA4F802 Interrupter(MCI) Powerwall 3 Tesla 3.8 kW:15340001 V4,FF7BE4E1 UL 1741,UL 1998, 7.6 kW:1538000 V4,CEA4F802 7.6 kW:18500001 V4,CEA41`802 PVRSS/PVRSE Inverter,Powerwall+,or 3.8 kW:15340001 V4,FF7BE4E1 UL 1741,1998 Powerwall 3 Tesla 7.6 kW:18500001 V4,CEA4F802 PVRSS/PVRSE 11.5 kW:17070001 V1,0x3282A1 11.5 kW:17070001 V1,0x3282A1 Mid Circuit Interrupter(MCI) Tesla MCI-1,MCI-2 N/A UL 1741 PVRSE PV Module Tesla SR60T1,SR72T1,SR72T2,SR72T3R PV Modules N/A UL 61730 The PVHC PV modules must be listed by a NRTL to UL 1703 and/or UL 61730-1 and UL 61730-2(excluding Class 0 and Class 1). PVHCS Initiator Dedicated PV system AC circuit breaker or AC disconnect switch,labeled per NEC 690.12 N/A The PV mounting system must comply with one of the following: (PV Inverter) requirements. •PV Mounting System Listed by NRTL to UL 2703 and rated for use with the specific PV modules noted above. PVHCS Initiator Emergency stop device(NISD)-Listed"Emergency Stop Button"or"Emergency Stop UL 508 or UL 60947 The non-certified combinations of mounting and PV modules shall be evaluated for loading,mounting and (Powerwall+,Powerwall 3) Device"or"Emergency Stop Unit". Parts 1,5-1 and 5-5 grounding per the NEC and other applicable installation codes. The following PV connectors may be used to connect to the Tesla MCIs: PVHCS Initiator On/Off Enable switch located on Powerwall 3,when labeled as Rapid Shutdown initiator per UL 1741 Staubli type PV-KST4/611-UR or type PV-KST4-EV02(male), (Powerwall 3) NEC 690.12 requirements PV Connectors Staubli type PV-KBT4/611-UR or PV-KBT4-EV02(female), • Staubli Branch Socket PV-AZB4 and Branch Plug PV-AZS4, Applies to variations of this part number with suffix of two numbers and one letter. Connectors evaluated by an NRTL for intermatability with the connectors above. Note:PVHCS installation requirements may reduce the effective equipment and component ratings below the individual equipment and component PVHCS Initiator Dedicated PV system AC circuit breaker or AC disconnect switch,labeled per NEC N/A PVRSE ratings in order to achieve PVHCS shock hazard reduction requirements. (PV Inverter) 690.12 requirements. PVHCS Initiator Emergency stop device(NISD)-Listed"Emergency Stop Button"or"Emergency Stop UL 508 or UL 60947 Parts PVHCS INSTALLATION REQUIREMENTS (Powerwall+,Powerwall 3) Device"or"Emergency Stop Unit". 1,5-1 and 5-5. PVHCS Initiator On/Off Enable switch located on Powerwall 3,when labeled as Rapid Shutdown initiator UL 1741 Max System Voltage 600 Voc p (Powerwall 3) per NEC 690.12 requirements PVHCS Maximum Circuit Voltage(Array Internal Voltage After Actuation) 165 VDc(cold weather open circuit) 'Applies to variations of this part number with suffix of two numbers and one letter. Max Series-Connected Panels Between MCIs: 10 Note:PVHCS installation requirements may reduce the effective equipment and component ratings below the individual equipment and component PVRSE ratings in order to achieve PVHCS shock hazard reduction requirements. OTHER INSTALLATION INSTRUCTIONS PVHCS INSTALLATION REQUIREMENTS 1.An MCI must be connected to one end of each series string or mounting plane sub-array string. Max System Voltage 600 VDc 2.Verification that MCIs are installed with 10 or fewer modules between MCIs shall be documented for inspection, by voltage PVHCS Maximum Circuit Voltage(Array Internal Voltage AfterActuation) 165 VDc(cold weather open circuit) measurement logs and/or as-built string layout diagrams. OTHER INSTALLATION INSTRUCTIONS 3. For PV Inverter:The PVHCS initiator(AC breaker or switch)shall be sized and installed in accordance with NEC requirements.The 1.An MCI must be connected to one end of each series string or mounting plane sub-array string. specific part shall be identified on the as-built system drawings. 4. For Powerwall+or Powerwall 3:The PVHCS emergency stop initiator shall have the following minimum ratings: Outdoor(Type 3R 2.MCIs shall be installed between series connected module combinations such that the PVHC Maximum Circuit Voltage after actuation is no greater or higher), 12V, 1A,and shall be installed in accordance with NEC requirements.The specific part shall be identified on the as-built than 165V under any circumstances. The installation location coldest anticipated operating ambient temperature shall be used to calculate the PV system drawings. Refer to the Powerwall installation manual for further details. maximum voltage in accordance with NEC 690.7. 3.Verification that the MCIs are installed in accordance with 1)and 2)shall be documented for inspection,by voltage measurement logs and/or as- built string layout diagrams. 4.For PV Inverter:The PVHCS initiator(AC breaker or switch)shall be sized and installed in accordance with NEC requirements. The specific part shall be identified on the as-built system drawings. 5.For Powerwall+and Powerwall 3:The PVHCS emergency stop initiator shall have the following minimum ratings:Outdoor(Type 3R or higher),12V, 1A,and shall be installed in accordance with NEC requirements.The specific part shall be identified on the as-built system drawings.Refer to the Powerwall installation manual for further details. T = S L F, TESR-DS-0451-22 1 T = 5 L n TEPV-DS-0023-22 1 • �Q�pMPgT�el ROOFING SYSTEM SPECIFICATIONS �, GROUND ZEP F-1 LEVELING FOOT • 6`,ocOMPP���v - —--- -- — Listed to UL 2703 Listed to UL 2703 DESCRIPTION PV mounting solution for composition shingle roofs. Part#850-1511 Part#850-1397 Works with all Zep Compatible Modules. Auto bonding UL-listed hardware creates structural and electrical bond. SPECIFICATIONS Designed for pitched roofs. Installs in portrait and landscape orientations. ❑ DC WIRE CLIP HOME RUN CLIP Engineered for spans up to 72"and cantilevers up to 24". Listed to UL 1565 Listed to UL 1565 Part#850-1509 Part#850-1510 ZS Comp has a UL 1703 Class "A" Fire Rating when installed using modules from any manufacturer certified as "Type 1"or"Type 2". _ /C Attachment method UL listed to UL 2582 for Wind Driven Rain. ZS Comp supports 50 psf(2400 Pa)front and up to 72 psf(3450 Pa) rear side design load \ �\ rating for Portrait module orientation per UL 2703. ZS Comp supports 50 psf(2400 Pa)front side and up to 72 psf(3450 Pa) rear side design I I ARRAY SKIRT L 1 END CAP load rating for Landscape module orientation. LL Listed to UL 2703 Listed to UL 2703 Engineered for compliance with ASCE 7-05, 7-10, and 7-16 wind load requirements. Part#s50-lsos Part#850-1586(Left) Part#850-1588(Right) Zep wire management products listed to UL 1565 for wire positioning devices. y. ZS Comp grounding products are listed to UL 2703 and UL 467. y <I ZS Comp bonding products are listed to UL 2703. MOUNTING BLOCK FLASHING INSERT El SKIRT GRIP INTERLOCK Listed to UL 2703 Listed to UL 2703 and UL 2582 for Wind Driven Rain Listed to UL 2703 Listed to UL 2703 Part#850-1633 Part#850-1628 Part#850-1606 Part#850-1613 O / o A CAPTURED WASHER LAG HYBRID INTERLOCK Part#850-1631-002 and#850-1631-004 Listed to UL 2703 Part#850-1281 v T = 5 L ^ ZS COMP DATASHEET 2 T = 5 L n ZS COMP DATASHEET 3 Powerwall 3 Powerwall 3 Technical Specifications Poorer Everything System Technical Model Number Specifications Nominal 1707000-xx-y_ Powerwall 3 is a fully integrated solar and battery system,designed to accelerate the transition to sustainable energy. Customers ----- -Grid-- Voltage(I- ----nput&Output)--- -- -- - --------120/240 VAC----------- --- - - -- ------ ---- --- can receive whole home backup,cost savings,and energy independence by producingand consuming their own energy while Grid Type _ Split-phase- participating in grid services.Once installed,customers can manage their system using the Tesla App to customize system Frequency _ _ _ _ _ 60 Hz behavior to meet their energy goals. Overcurrent Protection Device Powerwall 3 achieves this by supporting up to 20 kWDC of solar and providing 11.5 kW AC of continuous power per unit. It has Solar to Battery to Home/Grid Efficiency 89%1•2- ---------- ------ - - -------- - -the ability to start heavy loads up to 185 A LRA, meaning a single unit can support the power needs of most homes. Powerwall 3 Solar to Home/Grid Efficiency 97.5%3 is designed for mass production,fast and efficient installations,easy system expansion,and simple connection to any electrical Supported Islanding Devices Gateway 3,Backup Switch,Backup Gateway 2 service. Connectivity Wi-Fi(2.4 and 5 GHz),Dual-port switched Ethernet, Cellular(LTE/4G1) Hardware Interface Dry contact relay,Rapid Shutdown(RSD)certified switch and 2-pin connector,RS-485 for meters _ ---• - - AC Metering Revenue Grade(+/-0.5%) Protections Integrated arc fault circuit interrupter(AFCI),Isolation Monitor Interrupter(IMI),PV Rapid Shutdown(RSD)using .?: Tesla Mid-Circuit Interrupters Customer Interface Tesla Mobile App Warranty 10 years ' Solar Technical Maximum Solar STC Input 20 kW E Specifications Withstand Voltage 600 V DC - --- - - - - - -- ------- - -- PV DC Input Voltage Range 60-550 V DC PV DC MPPT Voltage Range 60-480 V DC MPPTs 6 Maximum Current per MPPT(I ) 13 AS — --- — -- ---mp-- ------- --------------- --- Maximum Short Circuit Current per MPPT(Ise) 15 A5 Battery Technical Nominal Battery Energy 13.5 kWh AC' — g Specifications Maximum Continuous Discharge Power 11.5 kW AC Maximum Continuous Charge Power 5 kW AC Output Power Factor Rating 0-1(Grid Code configurable) Maximum Continuous Current 48 A Maximum Output Fault Current 10 kA Load Start Capability(1 s) 185 A LRA Power Scalability Up to 4 Powerwall 3 units supported 'Typical solar shifting use case. 'Values provided for 25°C(77'F),at beginning of life.3.3 kW charge/discharge power. 'Tested using CEC weighted efficiency methodology. °The customer is expected to provide internet connectivity for Powerwall 3;cellular should not be used as the primary mode of connectivity.Cellular connectivity subject to network operator service coverage and signal strength. s Where the DC input current exceeds the MPPT rating,a jumper can be used to combine two MPPTs into a single input to intake DC current up to 26 A IMP/30 A 1ec• 2024 2024 Powerwall 3 Datasheet 2 'Powerwall 3 Technical Specifications Powerwall 3 Example System Configurations Operating Temperature -20°C to 50°C(-4°F to 122°F)6 Powerwall 3 with Gateway 3 Environmental _ y fOptiona!— Specifications Operating Humidity(RH) Up to 100%,condensing Whole Home Backup I I / I Storage Temperature -20oC to 30°C(-4°F to 86°F),up to 95%RH,non- I�� condensing,State of Energy(SOE):25%initial I i�I Maximum Elevation 3000 m(9843 ft) I Solar I - - -- - - -- Environment _ _ Indoor and outdoor rated 9 Enclosure Rating -- Ingress Rating IP67(Battery&Power Electronics) O Meter IP45(Wiring Compartment) _ _ _— Grid Meter socket panel Gateway 3 Load center Pollution Rating PD3 Operating Noise @ 1 m <50 db(A)typical <62 db(A)maximum -``�- e Performance may be de-rated at operating temperatures above 40°C(104T). Backup loads Powerwall 3 Compliance Certifications UL 1642,UL 1699B,UL 1741,UL 1741 SA, UL 1741 SB,UL Information 1741 PCS,UL 3741,UL 1973,UL 1998,UL 9540,IEEE 1547- 2018,IEEE 1547.1,UN 38.3 Powerwall 3 with Backup Switch — —— - r Optional 1 Grid Connection United States Whole Home Backup Emissions - -- ---------- --- ----- --— - - FCC Part 15 Class B ----------- --- - -- --- --- --- I'��I ---- — -- -- - - -- - - -art Environmental RoHS- -Directive- 2011/65/EU Backup Switch ------ - -- -- - - - - - - ------- -- ----- - ------ Seismic _ AC156,IEEE 693-2005(high) I -Solar- Fire Testing Meets the unit level performance criteria of UL 9540A4) ------ -------- ----- ----- --- ---- ------ -- ---- --- ---------- - ------- Meter Grid Meter socket panel Load center Mechanical Dimensions 1099 x 609 x 193 mm(43.25 x-24-x 7.6 in) ----- ------------ ------ - -- ----- ---- -- ------------- --------------- --- - - ---- -- -— - - - ---- Specifications Weight 130 kg(287lb) Mounting Options Floor or wall mount - Backup loads Powerwall 3 0 Oo O Powerwall 3 with Backup Gateway 2 (Optional —1 ! Partial Home Backup I I I�� I 1099 mm Utility Meter I I -F-MainSolar Breaker =_ Grid Meter load center Backup Gateway 2 Load center 609 mm �193 Non-essential loads Backup loads Powerwall 3 2024 Powerwall 3 Datasheet 3 2024 Powerwall 3 Datasheet 8 T = 5Ln r GENERAL NOTES • DRAWING OF STANDARD MCI WIRING DETAIL FOR ANY GIVEN STRING LENGTH • IF INITIATED, RAPID SHUTDOWN OCCURS WITHIN 30 GD SECONDS OF ACTIVATION AND LIMITS VOLTAGE ON THE ROOF TO NO GREATER THAN 165V (690.12.B.2.1) • MID CIRCUIT INTERRUPTER (MCI) IS A UL 1741 PURSE CERTIFIED RAPID SHUTDOWN DEVICE (RSD) DC+ J—BOX J—BOX J—BOX J—Box J—BOX J—BOX MCI MCI RETROFIT PV MODULES DC- 0 MCIS ARE LOCATED AT ROOF LEVEL, JUST UNDER THE PV MODULES IN ACCORDANCE WITH 690.12 REQUIREMENTS 1 • THE QUANTITY OF MCIS PER STRING IS DETERMINED BY STRING LENGTH — NUMBER OF MODULES BETWEEN MCI UNITS = 0-3 — MAXIMUM NUMBER OF MODULES PER MCI UNIT = 3 J—BOX J—BOX J—B0X J—BOX — MINIMUM NUMBER MCI UNITS = MODULE COUNT/3 Mcl *Exception: Tesla (Longi) modules installed in locations where the max Voc for 3 modules at low design temperature exceeds 165V shall be limited to 2 modules between MCIs. PLEASE REFER TO MCI CUTSHEET AND PVRSA INSERT FOR TD-(2)AWG, PV Wire, 600V, Black DC MORE INFORMATION 0, PEAK DUO BLK .PEAK DUO BLK ML--G10+ SERIES in Mechanical Specification 122 a19 3,maoo mm, ea,3v° Format 74.41n x 41.2in x 1.57in(including frame)SERIES Qcells (1890mm x m 1046mm x 40mm) � a•�•�wPo,,,°oxi•i4mml,F„v`m Weight 51.8lbs(23.5kg) " >9]a M1739 rnf 39,R9]mml Front Cover 0.13 in(3.2 min)thermally pre-stressed glass with 385-405 W 1132 Cells anti-reflection technology 4,rpoa,- Back Cover Composite film 20.5% Maximum Module Efficiency Frame Black anodised aluminium szr ws�n Cell 6 x 22 monocrystalline O ANTUM solar half cells Junction box 2.09-3.98 in x 1.26-2.36 in x 0.59-0.71 in (53-101 mm r 32-60 mm x 15-18 mm),IP67,with bypass diodes y -I I-,sr,w-.., osun4 amz Ivy Cable 4 min'Solar cable;(+)a 52.2 in(1325 mm),(-)z 52.2 in(1325 mm) H- osr97- T 4 l o3srnm a MODEL ,Q.PEAK DUO"BLK ML-G10+/TS Connector Staubli MC4;IP68 ■Electrical Characteristics ------_.__-.�._--------- -- -_-_�__ ____.__ _�__�__ _-�_- ---. 4 _,�__.. �_-_-_----- r _- --: POWER CLASS-, 385 390 y 3.95 400?v-�.405 MINIMUM PERFORMANCE AT STANDARD TEST CONDITIONS,STC'(POWER TOLERANCE+5 W/-0 W) Power at li P14,P [W] 385 390 395 400 405 Breaking the 20°/ E efficiency barrier Short Circuit Current' isc,s o [A] 11.04 11.07 11.10 11.14 11.17 =i Open Circuit Voltage' Voc [V] 45.19 45.23 45.27 45.3 45.34 Q.ANTUM DUO Z Technology with zero gap cell layout boosts module efficiency up to 20.5%. _Current at MPP IH P [A] 10.59 10.65 10.71 10.77 10.83 S _ Voltage at MPP V", IV] 36.36 36.62 36.88 37.13 37.39 Efficiency' n [%] >_19.5 _>19.7 2:20.0 >_20.2 220.5 �'� A reliable investment '`v 1 MINIMUM PERFORMANCE AT NORMAL OPERATING CONDITIONS,NMOT2 1I= Inclusive 25-year product warranty and 25-year linear Warranty performance warranty'. Power at MPP P14,P [W] 288.8 292.6 296.3 300.1 303.8 - - - - �m`r E Short Circuit Current Isc [A] - 8.90 8.92 8.95 8.97 9.00 E Open Circuit Voltage V, [V] 42.62 42.65 42.69 42.72 42.76 Enduring high performance _current at MPP __ - - ha,P [A] 8.36 __ &.41 _ 8.46 - 8.91 _ 8.57- Voltage at MPP Vv (VI 34.59 34.81 35.03 35.25 35.46 Long-term yield security with Anti LeTID Technology, 'Measurement tolerances Pv,.,±3%;Isc;Voo±S%at STC:1000 W/m2,25±2°C,AM 1.5 according to IEC 60904-3•'800 W/m',NMOT spectrum AM 15 'cells Anti PID Technology2 and Hot-Spot Protect. Qcells PERFORMANCE WARRANTY. PERFORMANCE AT LOW IRRADIA -- q:C - e= _ _ -_ oo no Innovative all-weather technology At least 98%ot nominal power as re a�,�w,�a..4°, ro• f1[l� w during first year.Thereafter max. r��J{ Optimal yields,whatever the weather with excellent low-light p 9s ------ -- - 0.5%degradation per year At w least 93.5%of nominal power LL +aa --+----- ------- and temperature behaviour. up to 10 years.At least 86%of zo nominal power up to 25 years, wz es LL of All data within measurement w 90 a Zep compatibleTM frame design ww tolerances.Full warranties. o c n accordance with the warcanty g terms of the gcells sales so High-tech black Zep CompatibleTM frame,for improved $ 800 as 1. 15 20 :s organisation of your respective zoo 40o aoo eoo oop aesthetics,easy instal)ation and increased safety. YEARS country. IRRADIANCEIWim'I 'Stantlartl terms of guarantee for the 5 PV companies with the Typical module performance under low nradiance condmmns In Y highest production capanty m 2021(February 2021) companson to STC conditions(25'C.1000 W/m7. The most thorough testing CTEMPERATURE COEFFICIENTS` �ti `-`_ _ - � -�y - -w � � programme in the industry Temperature Coefficient oflsc a [%/K] +0.04 Temperature Coefficientofvpc 0 I [%/K] -0.27 Qcells is the first solar module manufacturer to ass the Tem erature Coefficient of P 109±5.4 �? p p MPP y [%/K] -0.34 Nominal Module Operating Temperature NMOT CF7 (43±3°C) most comprehensive quality programme in the industry:The 2 new"Quality Controlled PV"of the independent certification Is Properties for System Design o institute TUV Rheinland. Maximum System Voltage V_ [V] 1000(IEC)/1000(UL) PV module classification Class II a Maximum Series Fuse Rating [A DC] 20 Fire Rating based on ANSI/UL 61730 TYPE 2 0 'See data sheet on rear for further information Max.Design Load,Push/Pull' [Ibs/ft'] 85(4080 Pa)185(4080 Pa) Permitted Module Temperature -40°F up to+185°F 'APTtest conditions accordingto IEC/TS 6 2 8 0 4-12 015,method A(-1500 V 96h1 [Ibs/ft'] 128(6120 Pa)/128(6120 Pa) on Continuous Duty (-40°C up to+g5°C) Max.Test Load,Push/Pull' 3 See Installation Manual ■Qualifications and Certificates - UL 61730,CE-compliant, _IU Quality Controlled PV- TUV Rheinland;IEC 61215*2016. W o..P4t,. IEC 61730:2016, j S 1•® C U.S.Patent No.9.893,215 C , US ` (solar cells) ~SOW to ii inn - The ideal solution for: -e M ,°F=°••. �oMPAr,8 p p commnoeiv j �zozz' Rooftop arrays on Rooftop arrays on TOyanax.a ¢ 2ou residential buildings commercial/industrialUSA buildings Qcells pursues minimizing paper output in consideration of the global environment. Note.Installation instructions must be followed Contact our technical service for lumber information on approved installation of this product ���I I Hanwha Q CELLS America Inc.400 Spectrum Center Drive,Suite 1400,Iry N wine,CA 92618,USA I TEL 949 748 59 96 1 EMAIL hgc-Inqu,,yttgcells com I WEB gcells.com 'Solar Shutdown Device 1 Technical Specifications The Solar Shutdown Device is a Mid-Circuit Interrupter(MCI) and is part of the PV system rapid shutdown (RSD)function in accordance with Article 690 of the.applicable NEC. When paired with Powerwall+ or Tesla Solar Inverter. solar array shutdown is initiated by any loss of AC power. Electrical Nominal Input DC Current Rating(IMP) 12 A Specifications Maximum Input Short Circuit Current(Isc) 19 A Maximum System Voltage(PVHCS) 600 V DC RSD Module Maximum Number of Devices per String 5 Performance Control Power Line Excitation Passive State Normally Open Maximum Power Consumption 7 W Warranty 25 years Environmental Ambient Temperature -40°C to 50'C (-40°F to 122'F) Specifications Storage Temperature -30°C to 70°C (-22°F to 158'F) Enclosure Rating NEMA 4X/IP65 Compliance Certifications UL 1741 PVRSE, UL 3741, Information PVRSA(Photovoltaic Rapid Shutdown Array) RSD Initiation Method PV System AC Breaker or Switch Compatible Equipment See Compatibility Table below Mechanical Model Number MCI-1 0 Specifications Electrical Connections MC4 Connector 250 mm Housing Plastic M4 Screw Dimensions 125 mm x 150 mm x 22 mm 650 mm 150 mmV M8 Bolt (5inx6inxlin) Weight -350 g (0.77 Ib) Nail/ - - - Wood Screw Mounting Options ZEP Home Run Clip __ __ M4 Screw(#10) -- -- ---- ---- M8 Bolt(5/16") Nail/Wood screw - -------- -- H 22 mm 125 mm UL 3741 PV Hazard Control (and PVRSA) Compatibility Tesla Solar Roof and Tesla/Zep ZS Arrays using the following modules are certified to UL 3741 and UL 1741 PVRSA when installed with Powerwall+or Testa Solar Inverter and Solar Shutdown Devices.See Powerwall+/Tesla Solar Inverter Rapid Shutdown: Module Selection Based on PV Hazard Control System Listing for guidance on installing other modules. Brand Model Required Solar Shutdown Devices Testa Solar Roof V3 1 Solar Shutdown Device per 10 modules Testa Tesla TxxxS (where xxx =405 to 450 W, increments of 5) 1 Solar Shutdown Device per 3 modules' Tesla TxxxH (where xxx =395 to 415 W, increments of 5) Hanwha Q.PEAK DUO BLK-GS or Q.PEAK DUO BLK-G6+ 1 Solar Shutdown Device per 3 modules Exception:Testa solar modules installed in locations where the max Voc for three modules at low design temperatures exceeds 165 V shall be limited to two modules between Solar Shutdown Devices. January 31,2023 Testa Solar Shutdown Device i Datasheet