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Home My WebLink About51766-Z rry TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Kr t. 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#: 51766 Date: 03/20/2025 Permission is hereby granted to: Donald E Schilley 640 Leslie Rd Cutchogue, NY 11935 To: Install roof mounted solar panels to an existing single-family dwelling as applied for. Additional certification may be required. Premises Located at: 640 Leslie Rd, Cutchogue, NY 11935 SCTM#97.-9-5 Pursuant to application dated 02/04/2025 and approved by the Building Inspector. To expire on 03/20/2027. Contractors: Required Inspections: Fees: SOLAR PANELS $100.00 CO-RESIDENTIAL $100.00 ELECTRIC -Residential $125.00 Total S32S.00 Building Inspector rt TOWN OF SOUTHOLD—BUILDING DEPARTMENT t° Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax(631) 765-9502 httL)s://www.soutlioldto nll ov Date ReceW APPLICATION FOR B,U�ILDINGPERMIT For office use only PERMIT N0.51 7 to 0-Building Inspector: Appll6tl6rws and fornris nnust bb filled out In their entirety.Incorpp to applications WlII,'not"be,ac ptedI. Where,the A pllcant;Is not the.ovw Pqr,an 0i OWher",Aothoark0on form(Page 2)s,bali be'cgmplet+ed. lute:213f2028 OWNER(S)OF PROPERTY: Name:Trinity Fleischman scTM#so00- �- 5 Project Address:640 Leslie Road, Cutchogue, New York 11935 Phone#:6312769139 Email:trinity8681 @ieloud.com Mailing Address:640 Leslie Road, Cutchogue, New York 11935 CONTACT PERSON: Name:Alex Yackery - Venture Home Solar LLC Mailing Address:100 Charlotte Ave. Hicksville NY 11801 Phone#:914-214-7108 Email:permittingny@venturesolar.com DESIGN PROFESSIONAL INFORMATION: Name:Patrick Busset Mailing Address:100 Charlotte Ave. Hicksville NY 11801 Phone#:914-214-7049 Email:permittingny@venturesolar.com CONTRACTOR INFORMATION: Name:Venture Home Solar LLC Mailing Address:100 Charlotte Ave. Hicksville NY 11801 Phone#:914-214-7108 Email:permittingny@venturesolar.com DESCRIPTION OF PROPOSED CONSTRUCTION []New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project 20therSOLAR INSTALLATION $$23,082.30 Will the lot be re-graded? ❑Yes El No Will excess fill be removed from premises? ❑Yes ❑No 1 PROPERTY INFORMATION Existing use of property:RES Intended use of property: 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. B 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 Section210.45 of the New York State Penal Law. Application Submitted By(pri e);Alex Y -Venture Home Solar LLC BAuthorized Agent ❑Owner Signature of Applicant: Date: 2/3/2024 STATE OF NEW YORK) SS: COUNTY OF Suffolk Alex Yackery being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)heisthe Contractor- Venture Home Solar LLC (Contractor,Agent, Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work an ra make red de this application;that all statements contained in this application are true to the best of his/her kin edge a b f;and that the work will be performed in the manner set forth in the application file therewit Sworn before me this 3 day of February 2025 reWMAIRY y P li'c EPHEN JU]3N LUISE JR. PUBLIC,STATE OF NEW YORK PROPERTY OW'NER AUTHORIZ ION egistration No.02LU6401287 (Where the applicant is not the oQualified in Su lkCountyon Expires '. jrinity Fleischman residing at 640 Leslie Road Cutchogue, New York 11935 Alex Yackery-Venture Home solar do hereby authorize_ to apply on rr* behalf to the Town of Southold Building Department for approval as described herein. 2/3/2025 O ner's Signature Date Trinity Fleischman Print Owner's Name 2 BUILDING DEPARTMENT-Electrical Inspector �:a w TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 1 1 971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 ro err southoldtownn ov-seand southoldtownn . ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 2/3/2025 Company Name: Venture Home Solar LLC Electrician's Name: Jason P. Sampogna License No.: ME-60556 Elec. email: permittingny@venturesolar.com Elec. Phone No: y-7� $ ❑I request an email copy of Certificate of Compliance " Elec. Address.: #,e-, re• -csvrlf2. N ISO 1 JOB SITE INFORMATION (All Information Required) Fleischman Address: 6401 Leslie Road, Cutcho ue, New York 11935 Cross Street; Phone No.: 6312769139 Bldg.Permit#: email:trinityr8681 @icloud.com Tax Map District: 1000 Section:97 Block: 9 Lot:5 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): PV ROOF MOUNTED SOLAR INSTALLATION - 18 PANELS / 18 MICRO INVERTERS /7.470 kW Square Footage: Circle All That Apply: Is job ready for inspection?: El YES IVI NO DRoughin Final Do you need a Temp Certificate?: 0YES NO Issued On Temp Information: (All information required) Service Size Ell Ph 3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑✓Overhead #Underground Laterals 1 2 M H Frame Pole Work done on Service? Y nN Additional Information: :1 PAYMENT DUE WITH' APPLICATION Building Department Application AUTHORIZATION (Where the Applicant is not the Owner) I, Trinity Fleischman residing at_640 Leslie Read Cat ho ue,New York 11935 (Print property owner's name) (Mailing Address) ....� do hereby authorize Alex 'ate 'denture Home Solar (Agent) to apply on my behalf to the Southold Building Department. 2/3/2025 .............. (Owner's S i ature) (Date) Trinity Fleischman (Print Owner's Name) 8 u/ Or Licen4loo Cqnsum 1, L L71 � ��r r Suffolk County Dept,. Labor,, Licensing & Consumer, ". 11c,irs i'A S E HOME IMPROVEMENT Name ALEXANDER E YACKF. Business Nam( , Venture Home Solar LLC !'-)BA This certifies that the bearer is duly licensed License Number H-59758 by the County of suffolk Issued: 02/15/2018 Expires: 02/01 /2026 Commissioner + workers' aRK vrt Compensation CERTIFICATE OF INSURANCE COVERAGE r. 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 Venture Home Solar, LLC 718-398-2259 100 Charlotte Ave Hicksville, NY 11801 ic.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,Wrap-Up Policy) 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Metropolitan Life Insurance Company Town of Southold 3b.Policy Number of Entity Listed in Box 1a 3095 Route 25 Southold, NY 11971 234439 3c.Policy Effective Period: October 1,2024 to September 30,2025 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: �X 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: February 3,2025 By: P"O" 9"AFM (Signature of insurance carrier's authorized representative or NYS licensed Insurance agent of that insurance carrier) Telephone Number spu_roup contracts@mettife.com Name and Title: Precious Jackson,State Plan Consultant 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 Knit,PO Box 5200,Bin hamlon,NY 13902. 200. PART 2.To be completed by the NYS Workers'Compensation Board(only if Box 4B,4C or 5113 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) ►C 0 2/03/2025 CERTIFICATE OF LIABILITY INSURANCE DATE 103/ 1O 025 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 pojtcy(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 endorssement(s), PRODUCER CONTACT NAME: ttaterina Cole Provident Protection Plus Incorporated PHONE (973)57€t-&776 FAxN (97'3)579-0111 96 US Highway 206 ADDR sa tut 9 na.Cole PmvidenlProtecllonPius.com PO Box 4 WSU R" AFFORDING COVERAGE NAIL 0 Augusta NJ 07822 INSURER A: Southwest Marine&General Ins Cc 12294 INSURED INSURER B: Oxford Insurance Company NC LLC 16817 Venture Home Solar LLC INSURER C: Selective Insurance Company 12572 327 Captain Lewis Drive INSURER D: NJ Manufacturing 12122 INSURER E: Southington CT 06489-1170 INSURERF: COVERAGES CERTIFICATE NUMBER: 2024-2025 REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 MAYBE 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. Foucvw PoLIMITS LTR TYPE OF INSURANCE INSD POLICY NUMBER MMIDD trllyd am COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE ❑X OCCUR Ur-Eaa r $ 100,000 MED EXP(Any oneperson) $ 5,000 A Y Y GL202400012768 11/15/2024 11/15/2025 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LWIT'APPLIESPER: GENERAL AGGREGATE $ 4,000,000 OON POLICY N JPE ElLac -PRODUCTS-COMPIOPAGG $ 4,000,000 OTHER: Per Proj capped agg limit $ 5,000,000 AUTOMOBILE LIABILITY Mt"7fNAgf.S6 LdTP $ 1,000,000 nn ANYAUTO BODILY INJURY(Per person) $ � C OWNED EX SCHEDULED Y Y S2467549 08/22/2024 08/22/2025 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PRPERTe E $ AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS-MADE Y Y 1022-24 11/15/2024 11/15/2025 AGGREGATE $ 1,000,000 DED I I RETENTION$ $ 'WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y r N STATUTE. OR ANY PROPRIETORIPARTNERIEXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I I E,L.DISEASE- LIMIT $ Combined Single Limit $1,000,000 Commercial Auto D Any Auto(Symbol 1) 1104694823 08/22/2024 08/22/2025 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Description of Operations:Solar Panel Installation Certificate holder is Included as an Additional Insured to the above captioned General Liability Policy for tin-going&completed operations on a primary& non-contributory basis and Additional Insured to the Automobile Policy for work the insured Is performing provided a written Contract exists requiring such a status, Per the terms of the policy,coverage for an additional insured is contingent upon an underlying'written contract with the named insured requiring such coverage,. There is a Waiver of Subrogation included in the General Liability,Business Auto,&Umbrella-if required by written contract. Umbrella follows form.30 day notice of cancellation except 10 for non payment of premium. 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. 53095 Route 25 AUTHORIZED REPRESENTATIVE PO Box 1179 Southold NY 11971 y 01988 2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ZTA RK Workers' CERTIFICATE OF Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE board 1 a.Legal Name Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Progressive Employer Management Company III,LLC Labor Contractor,for (718)398-2259 leased workers to: Venture Home Solar,LLC dba:Venture Solar Electric 1c.NYS Unemployment Insurance Employer Registration Number of 100 Charlotte Ave insured Hicksville,NY 11801 1d.Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to certain Number locations in New York State,i.e.,a Wrap-Up Policy) Carrier Listed as the Certificate Holder) American Zurich Insurance Company Town of Southold 3b.Policy Number of Entity Listed in Box"1a" S3095 Route 25 WC 10-18-880-05 Southold,NY 11971 3c.Policy effective period 4/1/2024 to 4/1/2025 3d.The Proprietor,Partners,or Executive Officers are X included.(Only check box if all partners/officers inclued) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3 insures the business referenced above in box"la"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 carder 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,Iicese 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 comptying 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 r;fernced above and that the named insured has the coverage as depicted on this form. Approved by: Douglas Jones (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 4� ,,, ^" ' 2/27/2024 (Signature) (Date) Title: Vice President Telephone number of authorized representative or licensed agent of insurance carrier: (480)951-4177 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) ww.wcb.ny.gov