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HomeMy WebLinkAbout51522-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 51522 Date: 01/07/2025 Permission is hereby granted to: Brian Gebbia 665 Cardinale Dr Mattituck, NY 11952 To: install additional roof-mounted solar panels to existing single-family dwelling as applied for,. Premises Located at: 25 Azalea Rd, Mattituck, NY 11952 SCTM# 115.-6-13 Pursuant to application dated 11/08/2024 and approved by the Building Inspector. To expire on 01/07/2027. Contractors: Required Inspections: Fees: SOLAR PANELS $100.00 ELECTRIC -Residential $125.00 CO-RESIDENTIAL $100.00 Total $325.00 Building Inspector V " TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 1 1 971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 ham .//WWW.SOLlthOldto'wnii y. ,, v Date Received APPLICATION FOR BUILDING PERMIT _ For Office Use Only g _ u oCNOV 2 24 PERMIT N0. Building Inspector:_ Applications and forms must be filled out in their entirety.incomplete',;" applications will not be accepted. Wheed`0e Applicaiit;ls not the ownek,*h :'„'r + • �' '� 1 1 Owner's Authorization form(Page 2)shall=be completed Date:10/23/2024 OWNER(S)OF PROPERTY: Name:Brian Gebbia SCTM# 1000-115.00-06.00-013.000 Project Address:665 Cardinal Drive, Mattituck NY 11952 Phone#:631-740-6006 :IEII.wizardgebbia@aol.com MailingAddress:665 Cardinal Drive, Mattituck NY 11952 CONTACT PERSON: Name:Samuel Magliaro - Trinity Solar Mailing Address:2180 5th Ave Unit 1 , Ronkonkoma NY 11779 Phone#:631-319-7233 Email:Brittany.Gaumer@trinity-solar.com DESIGN PROFESSIONAL INFORMATION: Name:Ayracon V. Almaraz Mailing Address:2211 Allenwood Rd, Wall NJ 07719 Phone#:631-319-7233 Email:Ayracon.Almaraz@trinity-solar.com CONTRACTOR INFORMATION: Name:Samuel Magliaro - Trinity Solar Mailing Address:2180 5th Ave Unit 1 , Ronkonkoma NY 11779 Phone#:631-319-7233 Email:Brittany.Gaumer@trinity-solar.corn DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: [i]OtherSOlar Panels $54,539.92 Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes ®No 1 PROPERTY INFORMATION Existing use of property:1 Family Residential Intended use of property:1 Family Residential Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes ®No IF YES, PROVIDE A COPY. 8 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+Department4or 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:fie applicant ag'rees'to comply with all"applicable laws;ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and=hf buildinils)'for necessary Inspections.,False statements made herein are punishable as a Class A misdemeanor pursuant to Section 310AS of the New York State Penal Law. Application Samuel Magliaro - Trinity Solar pp Submitted B y(priri ame)z BAuthorized Agent ❑Owner Signature of Applicant: Date: 10/23/2024 STATE OF NEW YORK) SS: COUNTY OF SUFFOLK Samuel M ag I la ro being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the Contractor/Agent (Contractor,Agent,Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this _day of ) , 20J_LA___ �. a Public NOTARY PUBLIC, STATE OF NEW YORK NO. 01 SA0013662 OPERTY OWNER AUTHORIZATION QUALIFIED IN SUFFOLK COUNT MY COMMISSION EXPIRES 09/20/2027 Where the applicant is not the owner) Brian Gebbia residing at 665 Cardinal Drive Mattltuck NY 11952 do hereby authorize Samuel Magliar0 - Trinity Solar toapply on my behalf to the Town of Southold Building Department for approval as described herein,. Owner's Signat Date Print Owner's Name 2 u, BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 ro err southoldtownn , ov - seared southoldtownny gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 10/23/2024 Company Name: Trinity solar Name: Richard Guaneri License No.: ME-57843 email: Rich(ivarneri e trnut�-sotar.com Address: 2180 5th Ave Unit 1,Ronkonkoma NY 11779 Phone No.: 631-319-7233 ,JOB SITE INFORMATION (All Information Required) Name: Brian Gebbia Address: 665 Cardinal Drive,Mattituck NY 11952 Cross Street: Phone No.: 631-740-6006 Bldg.Permit#: �5 email: wizardgebbiw'd4iolcom Tax Map District: 1000 Section:115.00 Block:06 00 Lot:013.000 BRIEF DESCRIPTION OF WORK (Please Print Clearly) Installation of a utility approved,grid inter-tied,flush mount,roof mounted,27 Hanwha 410 solar panels,MOM OM photovoltaic electricity generating system, Circle All That Apply: Is job ready for inspection?: YES / NO Rough In Final Do you need a Temp Certificate?: YES / O 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 Reconnected - Underground - Overhead #Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION Request for Inspection FormAs Suffolk County Department of Labor, Licensing & Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 01/29/2014 No. H-52821 SUFFOLK COUNTY E Home Improvement Contractor .license a This is to certify that William F Condit - doing business as Trinity Solar LLC having furnished the requirements set forth in accordance with and subject to the provisions of applicable t= E laws, rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. NOT VALID WITHOUT Restrictions Additional Businesses DEPARTMENTAL SEAL HI-Solar AND A CURRENT CONSUMER AFFAIRS ID CARD Wayne T. Rogers Commissioner Suffolk Counter Dept,of Labor,Lc"rensingp&Consumer Affairs, ' HOME IMPROVEMENT LICENSE Name JILLIAM F CONDIT Busi"ess Name 7tropserCrttes nbax the Trinity Solar LLC bearer rs duty hcensed License Number H-52521 by the county at sutTolNc Issued: 411d29'120 14 n4'T` y Expires, 01/01/2026 Commissioner Suffolk County Dept.of Labor,Licensing&Consumer Affairs ` MASTER ELECTRICAL LICENSE Name RICHARD GUANERI Business Name This cerifies.hat the 3earer is duly licensed Trin-ty Solar Inc. :)y the County of suffolk License Number:ME-57843 Rosalie Drago Issued: 12/15/2016 Comrrissioner Expires: 12/1/2024 0 DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE M 5/28/2024 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. 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 Alexander Glllikin __ Arthur J. Gallagher Risk Management Services, LLC PHON —_— tAz 300 Fellowship Road MAI , xj),856—"482 99±J0 A ,N t 856-482-1888 Suite 200 aDpR ss C.... 61 I U a I AJG com Mount Laurel NJ 08054 .... INSURER(SIAFFORDINGCOVERAGE NAIL# ... ----- ......... .. -_ NsuRE. l?.nX ....... 25569. RA Gotham Insurance Coma _ Y.. r .........19445 1NSURED 2180 Fifth Avenue, Unit 1A TRINHEA-03 inNistuic rvEndurance Amer Fire i annsurance Com an of Pltisbal 41718 Trinit Solar LLC mrv.__ e eclalty Ins Co Underwriters Inc 19917 Ronkonkoma, NY 11779 INsuRERD Lib Insurance Und _ __ �/ ......-- asualtJ/Comoany 31127 INSURER Columbia C„� INSURER F COVERAGES CERTIFICATE NUMBER:364362391 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. .. ...........TYPEOFIN.. ..... ------- ......_. . INSURANCE....................... __ — 1. _ .,w.,.,. -------- ........ ........ _.. INSIR �A DLINSD I��"D POLICY NUMBER�_- WDg.1 Y MMbtlyly tlY„�; LIMITS LIABILITY GL202100013378 6/1/2023 6/1/2025 EACH OCCURRENCE $2,000 000 A X COMMERCIAL GENERAL DAM, F 100 000 CLAIMS-MADE ....]OCCUR ,87ftf 8o9I .S SpoPcasrr rycu�. ..... .... ....-._, — on) $5 000 . 000 ., ....._. ....... PERSONAL I ....1, .., m &ADV INJURY $2,000 000 ny one er GEN%AGGREGA1E LIMIT APPLIES PER: GENERAL AGGREGATE 1 OTuIEiR'.1..X...I PRO- LOC PRODUCTS COMP/OP AGG [$P.000,000......... JECT - 1 COMBINE LE JM17 X I ANY AUTO BODILY INJURY YO(Per person) I$$2 000,000 B AUTOMOBILE LIABILITY CA2960145 6/1/2024 6/1/2025 --- I AUTOS ONLY AUTOS i1OOW 1-1-1.....'4 Ea.. )�...$... ... ,, .. OWNED SCHEDULED ccident $ RTY HIRED � NON-OWNED .,.,,,,.... AUTOS ONLY .... AUTOS ONLY �,.. er accndm:nt)... ,. .......-.. ...- r $ A UMBRELLA LIAB X OCCUR EX202300001871 6/1/2023 6/1/2025 II EACH OCCURRENCE s5000,000 C ELD30006989102 6/1/2024 6/1/2025 E X EXCESS LIAB CLAIMS MADE 1000231834-08 6/1/2024 6/1/2025 AGGREGATE $5 000,000 j" 7039650582 6/1/2024 6/1/2025 DED RETENTION$ Limit of$5,000,000 $19„000,000 B WORKERS COMPENSAT10N WC013588107 6/112124 6/1/2025 'X STATUTE PER OTH OFFIC(Mandatory m NH N E L DISEASE EA EMPLOYEE $ 000 000 ( ry ) I IT 1 000 000 ERIMEEMBBEREXCLUDED?ECUTIVE N/A EL EACH ACCIDENT $1 - If yes,describe under DESCRIPTION under OPERATIONS below E,L DISEASE-POLICY LIMIT ,$1,000,000 B Automobile CA2960145 6/1/2024 6/1/2025 Ail Other Units $250/$500 Comp/Collusion Ded. Truck-Tractors and Semi-Trailers $250/$500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Southold 54375 Route 25 AUTHORIZED RE PRESENTATIVE Southold NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD j, Workers' CERTIFICATE OF INSURANCE COVERAGE 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 1 a.Legal Name&Address of Insured(use street address only) 1 b,Business Telephone Number of Insured TRINITY SOLAR, LLC 2180 FIFTH AVENUE, UNIT 1A 631-319-7233 RONKONKOMA, NY 11779 Work Location of Insured(Only required if coverage is specifically limited to 1 c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-Up Policy) or Social Security Number 22-3292324 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Standard Security Life Insurance Company of New York Town of Southold 54375 Route 25 3b.Policy Number of Entity Listed in Box 1 a Southold, NY 11971 R71757-000 3c.Policy Effective Period 7/1/2013 to 6/1/2025 4. Policy provides the following benefits: ❑X A.Both disability and Paid Family Leave benefits. ❑ B.Disability benefits only. ❑ C.Paid Family Leave benefits only. 5. Policy covers: ❑)c 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 descr" d above. Date Signed 6/2/2024 By W� (Signature of insurance carrier's acuthopi d rLApresentkive or NYS licensed insurance agent of that insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY SERVICES IMPORTANT:lf Boxes 4A and 5A are checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 413,4C or 513 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 413,4C 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(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 ---WW ........ 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. D13-120.1 (12-21) I II IIIIIIIIIIIIIIIIIIIIIIIIIIIII III IIIIIIIIIII III III NEW Workers' CERTIFICATE OF RK STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name&Address of Insured(use street address only) 11 b,Business Telephone Number of Insured "Trinity Solar,LLC 631-319-7233 2180 Fifth Avenue,Unit 1A 1c.NYS Unemployment Insurance Employer Registration Number of Ronkonkoma,NY 11779 Insured 49-230977 Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 22-3292324 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) National Union Fire Insurance Company Town of Southold 3b.Policy Number of Entity Listed in Box"1 a" 54375 Route 25 Southold, NY 11971 WC 013588107 3c.Policy effective period 6/1/2024 to 6/1/2025 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) El all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"T'insures the business referenced above in box 1a"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 I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Michael Price (Print name of authorized representative or licensed agent of insurance carrier) Approved by: �'� _......._ 6/112024 (Signature) (Date) Title: C.E.O.North America Telephone Number of authorized representative or licensed agent of insurance carrier: 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 Lor ArWa`dtS IMF ,a VAS+ } 2 SURVEY OF PROPERTY AT SOUTHOLD TOWN OF soumoL 1000 11 1, 16, 201 0h° . Z vi 00. A\ Try � ,�p�► -We fr UAIItA 111cF INSURANCE CPMPANY V so. w. MCYuuMFNT Y AI tr,A B. PIPE A �"Cfu�n y t t IA IM9 i"}f t ay A WQA lk*V � � M Y S aII., NO $ 1 �1EA"33,218 80.Ff. ' p 1 a� o 1 s IL a s (6il).765-5020 FAY(63l) 765—a 797 €sWp A, Cr lW Box 909 1230 TRAVELER STREET svu rHa ro.r, r 197T 12_267