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HomeMy WebLinkAbout51763-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#: 51763 Date: 03/19/2025 Permission is hereby granted to: Rama B Rao 501 E 87th St Apt 1G New York, NY 10128 To: install roof-mounted solar panels to existing single-family dwelling as applied for. Premises Located at: 1725 King St, Orient, NY 11957 SCTM# 26.-2-43.4 Pursuant to application dated 02/12/2025 and approved by the Building Inspector.. To expire on 03/19/2027. Contractors: Required Inspections: Fees• SOLAR PANELS $100.00 ELECTRIC -Residential $125.00 CO-RESIDENTIAL $100.00 Total $32S.00 Building Inspector +� TOWN OF SOUTHOLD—BUILDING DEPARTMENT �'JTown Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 * `r� Telephone (631) 765-1802 Fax (631) 765-9502 Nitta) I/WWW'Southof tow!111Y.&Y�' ` VAI Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector: 0 Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date:1/14/2025 OWNER(S)OF PROPERTY: Name: Eleanor Thomas SCTM#1000-26-2-43.4 Project Address: 1725 King Street, Orient, NY 11957 Phone#:646-234-4000 Email:ethomas@meteorallc.com Mailing Address:501 East 87St Apt 1 G, New York, NY 10128 CONTACT PERSON: Name:Barbara - GreenLogic LLC Mailing Address:97 North Sea Road, Southampton, NY 11968 Phone#: Email:Barbara@Greenlogic.com 631-771-5152 x117 g DESIGN PROFESSIONAL INFORMATION: Name: Pacifico Engineering PC Mailing Address:700 Lakeland Avenye, Suite 2B, Bohemia, NY 11716 Phone#:631-988-0000 Email:solar@pacificoengineerng.com CONTRACTOR INFORMATION: Name:GreenLogic LLC Mailing Address:97 North Sea Road, Southampton, NY 11968 Phone#:631-771-5152 Email:AM@Greenlogic.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition RAlteration ❑Repair ❑Demolition Estimated Cost of Project: DOther Solar Panels $ 22 000 Will the lot be re-graded? ❑Yes 10No Will excess fill be removed from premises? ❑Yes ®No 1 PROPERTY INFORMATION; Existing use of property:Single family dwelling Intended use of property:Single family dwelling 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. 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 tothe 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):GreenLogic LLC I@Authorized Agent ❑Owner lSignature of Applicant: y Date: STATE OF NEW YORK) SS: COUNTY OF Suffolk Nesim Albukrek being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Contractor (Contractor,Agent,Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this day of jan)LO64 , 20a5 Notary Public BARBARA A CASCIOTTA Notary Public-State of New York PROPER R rY OWNER, Au rHORIZATION No.01 CA4894M applicant is not the owner Oualifledin Suffolk County Where the a p p ) Commission Expires May 11,2w? LC-Ot4Cf(4 I. f oMA.5 resid'ingat ��25 .irJCr S�tg OQI�N I �y do hereby authorize GreenLogic LLC to apply on my behalf to the Town of Southold Building Department for approval as described herein. / XL Ofvner's Signature Date CLI-hM62 L . -11t-0Mft Print Owner's Name 2 BUILDING DEPARTMENT- Electrical Inspector f � TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 s:r Telephone (631) 765-1802 - FAX (631) 765-9502 k. ro err c�utbo9 townn . ov - seared southoldtownn ov APPLICATION I=OR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Ali information Required) Date: 2/7/2025 Company Name: GreenLogic LLC Name: Robert Skypala License No.: 43858-ME email: Barbara@Greenlogic.com Phone No: 631-771-5152 ❑✓ I request an email, copy of Certificate of Compliance Address.; 97 North Sea Road Southampton, NY 11968 JOB SITE INFORMATION (All Information Required) Name: Eleanor Thomas Address: 1725 King Street Orient NY 11957 Cross Street: Phone No.: 646-234-4000 Bldg.Permit#: 45 email: ethomas@meteorallc.com Tax Map District: 1000 Section: 26 Block: 2 Lot: 43.4 BRIEF DESCRIPTION OF WORK (Please Print Clearly) Roof mounted solar electric system **(12 REC460AA PURE-RX panels Et 12 1 En hale IQ78x micro inverters ( p (1) Enphase IQ Gateway ENV2-IQ-AMI System Size: 5.520KW Check All That Apply: Is job ready for inspection?: [:YES Fv-]NO ❑Rough In 'Final Do you need a Temp Certificate?: R✓ YES ENO Issued On Temp Information: (All information required) Service Size ❑1 Ph ❑3 Ph Size; A #Meters Old Meter# ❑New Service ❑ Service Reconnect [:] Underground [—]Overhead # Underground Laterals ❑1 2 H Frame ]Pole Work done on Service? DY EIN Additional Information: PAYMENT DUE WITH APPLICATION Electrical Inspection Form 2020.xlsx DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 101/2912026 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(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER CONTACT NICh101aS ZUIkofSke' Brookhaven Agency,Inc. PHONE 631 941-4113 FAX • 631 941.4405 No (AX 100 Oakland Ave,Ste 1 E'MAIw Ceroates brookhlavena enc .com Port Jefferson,NY 11777 IN U E DINQ MVFRAt;rI JNMrR A• Southwest Marine&General Insurance Co. INSURED lagyM a Merchants Mutual Insurance Co. Greent-ogic,LLC c• First Rehab Life Insurance Co. 97 North Sea Rd,Suite 3 INSURER Q National Liabilit Fire Insurance Co. Southampton NY 11968 IN AGCS Marine insurance Co.. INSURga . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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 IJFtR POLICY E'FF' PO,UCY IEXP LIMITS II R T TYPE OF INSURANCE POLICY N ER X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE. S 1.000*0010' A CLAIMS-MADE X�.OCCUR DAMAGE TO RENTED 100,000.... GE T few NTEDrn X Contractual Liability . X X GL202500012922 01/31/2025 01/3112026 MEOEXP Ao e eMZe 5 000 PERSOGNAL&.ADv aNJURY 1...000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE' 2 000 000 POLICY a]jECT LOC PR..OD'UCT - OMPFOP AG'CaS 2,000,000oIHE . R E&O Llabill!y $1,000 00''0 AUTOMOBILE LIABILITY COMBdNED SI.NGV.E.LIMIT $1 000 000 _. B "1 ANY AUTO BODILY INJURY(Per person;) $ OWNED '..SCHEDULED X X CAP1043565 08/11/2024 08111/2025 BODILY INJURY(Per accldentl� $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY $ UMBRELLA LIAB X OCCUR EACH OCCURR OMVC'E 1,000 000 A X EXCESS LIAB CLAIMS-MADE X EX202500003348 0113112025 01/31/2026 AGGREGATE $1 000 000 R T WORKERS COMPENSATION PER C7TH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E,L EA H ACCIOENT OPFIOERdMEMSER EXCLUDED? N/A see separate certificate (Mandatory in NH) ..DISEA'SE'-E fwIPLOY'EE pI s,describe under F P EL.OdSE E-POLICY LIMIT S C NYS Disability D251202 04/11/2024 04111/2025 Statutory Limits E Installation Floater/Property SML93076366 04/1512024 04115/2025 $300,000 $2,500 Ded DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is also named as Additional Insured as required by written contract. CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 53095 ROUTE 25 SOUTHOLD,NY 11971 AUTHORIZED REPRESENTATIVE <NSZ> ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD f­t'4 E W YORK Workers' CERTIFICATE OF INSURANCE COVERAGE STATE CCITT nsation 4-- 130ard NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW ................. ....... PART 1._.T. . o 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 GREENLOGIG,LLC 631-941-4113 97 NORTH SEA ROAD,SUITE 3 SOUTHAMPTON,NY 11968 SOUTHAMPTON,NY 11966 1 c.Federal Employer Identification Number of Insured ............ 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) SheiterPoint Life Insurance Company Town of Southold Building Department 3b, Policy Number of Entity Listed in Box"la" 53095 Route 25 DBL251202 Southold, NY 11971 3c.Policy effective period 04/11/2023 to --...0..4/10/2025 4. Policy provides the following benefits: 0 A.Both disability and paid family leave benefits. E] B.Disability benefits only. [] C.Paid family leave benefits only. 5. Policy covers: A.All of the employees employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employees employees: ............ ...... ................. ............ -—­-- Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 4/2/2024 By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 5 07829-8100 Name and Title Richard White, ChLqf Executive_0ffIceL._.._ 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 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 513 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. D13-1120.1 (12-21) IIIIII11111111111111111111111 1111111 DB-120.1 (12-21) Docusign Envelope ID:E61 DF324-3482-481 A-B65B-92BB69438483 �O RK Workers' CERTIFICATE OF e STAT lCompT ensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number_ .........�w......... _. ...... .. ... ... .._. of Insured GREENLOGIC LLC 97 N Sea Rd Ste 3 1 c.NYS Unemployment Insurance Employer Registration Number of SOUTHAMPTON,NY 11968 Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) 2.Name and Address of Entity R _�, ..... ....._ equesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Indemnity Insurance Co.of North America TOWN OF SOUTHOLD BUILDING DEPARTMENT 3b.Policy Number of Entity Listed in Box"1 a" 53095 ROUTE 25 C72825767 SOUTHOLD,NY 11971 3c.Policy effective period 12/31/2024 to 01/01/2026 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. ...........-.............................. .............. W ..... This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance 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 holster 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,l 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: Lynne Boone &7racu RFIMO Xrne of authorized representative or licensed agent of insurance carrier) E �,,nQ. 12/19/2024 Approved by: (Signature) (Date) Title: A l5tan Prooram Maria er 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 Acct##:3031516 `. .� �fr tea` tic ;i, :.q+.r', p �.s.��,# s - •`a� ,. y } yu `4,+',`;�;,s 4 fir, <�* -�,, ✓- -.:tom : Ii'> f.�Y. _ a^.+s .r '£''-. ..,y. -fit . " ;,•,•,"`�, �� 'r. .i�I<"�, C % i,.. -a• e' .:,� - .F¢,. a°....+ .., �: .. ,. =p -�t,. =:.t s y � titer k _ 'ta -� �E°� a�� -� �_ �� -� _ °� � � F , f County . . Office Consumer_14 Suffolk of ,� VETERANS •IAL HIGHWAY HAUPPAUGE, ' DATE ISSUED: F 1 • ` - SUFFOLK COUNTY =� z r 1 Home Improvement Contractor ! License l . • This is certifv that IMPROVEMENT CONTRACTOR,in the County of Suffolk. doing business as GREEN LOGIC LLC having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws,rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME F r Additional • VALID DUARTMENTAL SEAL AND A CURRENT }2 ik CONSUNIER AFFAIRS � ? 1 1 ` Director r" ^...,x ^fza,-^.d`, '� � w,r�,"� _«�� , .� �.�.s �.��_,�' •r�:.,� _l�� a ���`- r�_•� c f-j� ..�,.r`- +�, °•�` �°��4 ? . OL Suffolk County Executive's Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 12/10/2007 No. 43858-ME SUFFOLK COUNTY Master Electrician License This is to certify that ROBERT J SIKYPALA doing business as GREENLOGIC LLC having given satisfactory evidence of competency,is hereby licensed as MASTER ELECTRICIAN in accordance with and subject to the provisions of applicable laws,rules and regulations of the County of Suffolk, State of New York. Additional Businesses NOT VALID WITHOUT DEPARTMENTAL SEAL AND A'CURRENT CONSUMER AFFAIRS E IV CARD Director f „ � . o w� .n ;"w�m d „ �.,, ., a �” os�m r, z�r.flA r®:��•... 400 Potrender A—,RNeANaC,New YeNc 11901 TEST HOLE fml.e9iaey ye g 9 y�o�• FUi69T / � oawmr u yea A wwamven,L mwrwr W ,. SITE DATA AREA-40,005 SQ.FT. Q/ lswl Ov i w"'fro VERTICAL DATUM =NAVD(1998) d•RWNFLE � �R 151 lswl i ° 0 E 1Pth°m 4 AodrF%'f .Rvam waunu"a*,„" `'e p (M �' mrcwneduada 0rr3A" r £ 5a1 N 1 r „d Mdtl SURVEYOR'S CERTIFICATION q ',„/� '•%.N "P Adr " PA F1WHAT"THIS('VWFWASP"HIIR L.THOMA6 6 RAMA fd. r>Ndw I+ B� J( OFFOA IT&E'POOLAIA�.'NiMXVwEVS ADOPTS) B rWGY',a�'�REWYONVF W'C�T THE CODE ® " t �s"OY ASSMATcL''r?aOFMO rONALLANOS RYFfORS KsrAs A$50CVA'rxOP9OFp�Rd�E$Slrm2ikL LAND saAzv 'K. aK.Y 1,Wv1-1 A ��w gIr Kn e l DANIEL AW W74 ,AYV . W a bi d},r d.,r✓ ux� pM db 9nP a DANIEL A WEAVER,NVS.LS.NO 50771 •ple" w SURVEY FOR ELEANOR L. THOMAS dl �' TdAN RAMA B. RAO rDR a a at Orient,Town of Southold Suffolk County,New York CERTInED SURVEY K LEGEND . _m / rounry Tw MP oniMl7000 s��b, 2Fi a�w 02 I 43.4 CMF =CONCRETE MONUMENT FOUND K iv�i[-• /" s FIELD SURVEY COMPLETED MAR 16 2024 CMS =CONCRETE MONUMENT SET w \ O �✓'° MAP PREPARED MAR 29:2024 a =CONCRETE PAVEMENT O DW =ORVWELL � Record of Revisions DGE EOP =E OF PAVEMENT ""+. x'" Y1E` $TC*4 DATE OL ON PROPERTY LXNE RO =ROOF OVER WIF =W12E FENCE WSF =WOOD STAID:FOUND ' ---- WSS -WOOD STAKE SET �`/ ry ® vTa POLE 1 rn _.._: • =END OF D10EClIO S MARK-OUT w % 0 x0 � O —c—c— =ELECTRIC MARK-OU'r 40 W 120 —2 TEL ONE MARK-OUT x suarunssE• X€ �,—,.-- =WATER MARK-OUT O Scale:1"-40' ----__--- =SANITARY MARK-OUT roR No.zozaaoz+• 1 OF 1 m"� DWG.2024_W2I.