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TOWN OF SOUTHOLD A. SS-Su�FotK�o� y BUILDING DEPARTMENT i; TOWN CLERK'S OFFICE ca o • SOUTHOLD, NY y o�, 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#: 45327 Date: 10/14/2020 Permission is hereby granted to: 18976 Soundview.Ave LLC 100 W 57th St Apt 6C New York, NY 10019 To: install roof-mounted solar panels as applied for. At premises located at: 18975 Soundview Ave., Southold �f SCTM # 473889 Sec/Block/Lot# 51.-1-16 Pursuant to application dated 10/2/2020 and approved by the Building Inspector. To expire on 4/15/2022. Fees: SOLAR PANELS $50.00 CO-ALTERATION TO DWELLING $50.00 ELECTRIC $100.00 Total: $200.00 1 Building Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1902 APPLICATION FOR-CERTIFICATE OF OCCUPANCY This application must'be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1... Final survey of property with accurate location of all buildings,property lines,streets,-and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical:installation from.Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used.in system contains less.than 2/10 of 1%lead. 5. Commercial building;industrial building,multiple residences and similar buildings and installations,a.certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9,1957)non-conforming uses,or buildings and"pre-existing"land uses: L, Accurate survey of property showing all property lines,streets,building and unusual natural-or topographic features. 2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1._ Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 . Date. 9/24/2020 New Construction: Old or Pre-existing Building: (check one) Location of Property:.18975 Soundview Ave Southold, NY 11971: House No. Street Hamlet Owner or Owners of Property: Christopher Moore Suffolk County Tax Map No 1000, Section Block Lot Subdivision Filed Map. Lot: -C Permit No. Date of Permit. Applicant: ��S ti Mb ' - Health Dept..Approval: Underwriters Approval: . Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ 50.00 Applicant Signat e FIELD;INSPECTION REPQI2T' ' DATE G4 TS FOUNDATION(1ST) FOUNDATION(ZND) ; CA ROUGHRAIVIING y PLUMBING . 77 INSULATION-PER N..Y. ' y. STATE ENERGY CODE. . :. FINAL ', 0. 9 t •• : z' TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631)765-9502 Survey Southoldtownny.gov PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined ,20 Single&Separate Truss Identification Form ann Storm-Water Assessment Form v Contact: T�S�n �(,1 (�j19 Cot Approved 20 Mail to: I� l7rVlkr�yl(1! ka 63 Disapproved a/c Phone: 'I Expiration ,20 ® LL. Building Inspector ICATION FOR BUILDING PERMIT O n T - 2 2020 ,Date September 24, , 2020 1, i ,-.'.1,�C, T'!7PT. INSTRUCTIONS a. This pplic&tion'NIt f ' ' mpletely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations-affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. 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,or 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 for necessary inspections.. Anais Fernandez/Tesla Energy Operation, Int (Signature of applicant or name,if a corporation) 15 Grumman Rd West Suite 400 Bethpage,,NY 11714 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder Contractor Name of owner of premises Christopher Moore (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name;and title of corporate officer) Builders License No.HI-62558 Plumbers License No. Electricians License No.51331-ME ' Other Trade's:License No. 1....L6cation`of land on which proposed work will be done: 18975 Soundview Ave Southold,NY 11971 House,Number Street Hamlet County Tax Map No. 1000 . Section Block Lot Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Residential b. Intended use and occupancy 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work U ul- �,1 1' r V (Description) 4. Estimated Cost 1 _�`1� Fee (To be paid on filing this application) 5. If dwelling,number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing.structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number.of Stories 8. Dimensions of entire new construction: Front Rear i Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10.Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12.Does proposed construction violate'any zoning law, ordinance or regulation?YES NO 13. Will lot be re-graded?YES NO Will excess fill be removed from premises?YES NO `� 14.Names of Owner of premises Christopher Moore Address 75.Soundview Ave SoutholRor"No. 212-729-8051 Name of Architect Chris H. Kim Addr%(N 1T.70ater Drive a ven, hone No 610-504-4211 Name of Contractor Tesla Energy Operations,lnc. AddresjZ Grumman Rd West S.40OPhone No. 631-406-9567 Bethpage, NY 11714 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NOS *IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C.PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? *. YES NO t/ * IF YES,D.E.C. PERMITS MAY BE REQUIRED. 16.Provide survey,to,scale,with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18.Are there any covenants and restrictions with respect to this property? * YES NO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: T COUNTY OF Nassau i Anals Fernandez being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, z (S)He is the Contractor/Agent °_ (Contractor,Agent, Corporate Officer,etc.) o 0 c > of said owner or owners,and is duly authorized to perform or have performed the'said work and to make and file the Aptia; that all statements contained in this application are true to the best of his knowledge and belief;and that,the work Al&a ;5 c! performed in the manner set forth in the application filed therewith. rn m c - v = w14 K O N m N Sworn to before me this N " c day of Z ejm be4- 2090 co c m r- A�-� 14otary Public siglure o plicant w Building Department Application AUTHORIZATION (Where the Applicant is not the Owner) I, C'65L4 w residing at 1891�- �J OV (print property owner's name) (Mailing Address) do hereby authorize Tesla Energy Operations, Inc. (Agent) Anais Fernandez to apply on my behalf to the Southold Building Department. D 7 (s 2O Z.o (Owne s Si ature) (Date) (Print Owner's Name) Christopher sent you printing information about an Amazon.com return (( Please print this return label for me . Thanks ! ,1 This label can be printed until Sep 15,2020 ©2013 Amazon.com,Inc.or its affiliates.All rights reserved.Amazon,Amazon.com,the Amazon.com logo,and 1-Click are re g iste re df trademarks ofAmazon.com,Inc.6r its,affiliates.Amazon.com,410 Terry-Avenue N.,Seattle,WA98,1;0!9-5210_ Please'note't"t this message was sent to the fo`ilowing e-mail address;cmo6re627(.gmail.com. ChnstobherMoor�requested that we send fliis:;e mail.If you,have questions aboutAmazon.com,�pleas,e visit our H6ID Department 7 If you're unable to view the label,contact Christopherso.that they can resend g11CFVnJv: BUILDING DEPARTMENT-Electrical Inspector TOWN OF.SOUTHOLD ` Town Hall Annex - 54375 Main Road - PO Box 1179 o _ Southold, New York 119.71-0959 Telephone (631) 765-1802 - FAX(631).765-9502 roaer:richert0,town s6utl old ny:us APPLICATION FOR.ELECTRICAL INSPECTION, REQUESTED BY: Jason.Kane. __ . _ . Date: 9/24/2020 _ . Company,Name: Tesia"Energy Operations Inc.- Name: Jason Kane License No.: ME-51331 email: jkane@tesia.com Address: 15 Grumman Rd West Suite 400 Beth a e-NY 11714 Phone No.: 51-6-306-0126 JOB SITE INFORMATION: (All information Required) Name: Christopher Moore Address: 18975 Soundview Ave Southold, NY 1197.1 Cross Street: ` Phone No.: 212-729-8051 BIdg.Permit#: Lf� email: .cmoo..re627@gmaii.com Tax Map. District: 10 0 Section: Block: LtSt: i BRIEF DESCRIPTION OF WORK(Please Print Clearly) Install (36) Roof Mount Solar Panels 1 4kw Circle All That Apply: Is jot' ready for inspection?: YES NO Rough In Final Do you need a Temp Certificate?: O/ NO Issued On . Temp Information' (AII 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 WITRAPPLICATION I, 82-Request for Inspection;Fornyft Scott A. Russell , �°SU '� �'7C'�0>]E�.��1 WA TIER. SUPERVISOR z MAN A\G►]EM]EN'7C' SOUTHOLD TO%W HALL-P.O:Box 1179 53095Main'Road-SOUTHOLD,NEW YORK 119710 Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK.SHEET ( TO BE COMPLETED BY THE APPLICANT) DOLES THIS ]PROJECT INVOLVF, ANY OF THE I+OLLONVING: Yes NO (CHECK ALL THAT APPLY) ❑ x❑ A. Clearing, grubbing., grading or stripping of land which affects more than 5,.000 square feet of ground surface. 0 B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. ❑� C. Site preparation on slopes which exceed 1.0 feet vertical rise to 100 feet of horizontal distance. ❑0 D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ❑0 E. Site preparation within the one-hundred-year f loodplain as depicted on FIRM Map of any watercourse. ❑ x❑ F. Installation of'new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval .of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information,Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above,please submit Two copies of a Stormwater Management Control Plan and a completed Check List'Form to the Building Department with your Building Permit Application. APPLICANT: (Proporty Owner,bcsign Professional,Agent,Contractor,Other) S.C.T.M. kt 1000 Date: District 4A%pis Fernandez/Tesla Energy Operation, In t. rrmu Section Block Lot FOR BUILDING DEPARTMENT USE ONLY**** Contact Information: 6.31-406-9567 Reviewed By: Property Address/Location of.Construction Work: — — — — — — — —Date: — — — — — — Approved for processing'Building Permit. 15 Grumman Rd West Suite 400 ❑ Stormwater Management Control Plan Not Required. Bethpage, NY 11714 Stormwater Management Control Plan is Required. ❑ (Forward to Engineering Department for Review.) FORM # SMCP-TOS MAY 2014 3500 Deer Creek Road,Palo Alto CA 94304 P 650 681 5100 F 650 681 5101 1:71 D September 24,2020GV Town of Southold Building Department 0 CT 2 2020 RE: New Roof Mount Solar submission fir.-YT`Tr ..day Dear Sir/Madam: I am submitting a new Roof Mount Solar application for property address:18975 Soundview Ave Southold, NY 11971 I am the applicant Anais Fernandez with Tesla Energy. My phone is 631- 406-9567 or email anafernandez(c)-tesla.com. If you could let me know once review is complete for permit pick-up or mail out. Regards, Anais Fernandez, Permit Coordinator fw� ® DATE(MMIDDNYM �AU CERTIFICATE OF LIABILITY INSURANCE o3/oti2020zozo 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 MARSH RISK& INSURANCE SERVICES NAME: FAX FOUR EMBARCADERO CENTER,SUITE 1100 PHCN o A/C No): CALIFORNIA LICENSE NO.0437153 E-MAIL SAN FRANCISCO,CA 94111 ADDRESS: Attn:SanFranclsco.Certs@marsh.com I FAX 212-948-0398 INSURER(S)AFFORDING COVERAGE NAIC N CN104275261-STND-GAWUE-20- INSURER A:Zurich American Insurance Company 16535 INSURED INSURER B:Steadfast Insurance Company 26387 Tesla Energy Operations,Inc. 45500 Fremont Blvd INSURER C:American Zurich Insurance Company 40142 Fremont,CA 94538 INSURER D:Allianz Global Risks US Insurance Company 35300 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: r SEA-003418109-23 REVISION NUMBER: 8 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. ILTR TYPE OFINSURANCE ADDL SUER POLICY NUMBER POLICY M DIDY� POLICY LIMITS A X COMMERCIAL GENERAL LIABILITY GLO1074588-02 10/31/2019 10/31/2020 EACH OCCURRENCE $ 2,500,000 CLAIMS-MADE I-XI OCCUR Includes Host Liquor Liability DAMAGE RENTED 2,500,000 PREMISES Ea occurrence $ X SIR:$750,000 MED EXP(Any one person) $ 5,000 B X Tort Contrac Liab,No XCU Ezcl SXS-7426362-00(Excess GL- 12/30/2019 10/31/2020 PERSONAL&ADV INJURY $ 2,500,000 GEN'L AGGREGATE LIMIT APPLIES PER: Limit:$6,750,000 excess of primary GENERALAGGREGATE $ 20,000,000 X POLICY❑PRO- ❑ LOC GL limits on right;applies to PRODUCTS-COMP/OP AGG $ 6,000,000 JECT X OTHER: 6M per Pro ect/Loc Agg Solar Products Only) $ A AUTOMOBILE LIABILITY BAP 1074586-02 10/31/2019 10/31/2020 COMBINED SINGLE LIMIT $ 10,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B A 03 ONLY SCHEDULED SXS-7426361-00($5M excess of 12/30/2019 10/31/2020 BODILY INJURY(Per accident) $ AUTOS HIRED NON-OWNED $5M primary Auto Liability) PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLA LIAB X OCCUR USL00544219 12/30/2019 10/31/2020 EACH OCCURRENCE $ 15,000,000 EXCESS LIAB CLAIMS-MADE RETENTIONS:SEE PAGE 2 AGGREGATE $ 15,000,000 DED FX I RETENTION$ $ C WORKERS COMPENSATION WC 1074583-02(AOS) - 1I131110 1 —X PER X OTH- AND EMPLOYERS'LIABILITY STATUTE ER C YIN WC 1074584-02 MA,WI 10/31/2019 10/31/2020 ANYPROPRIETOR/PARTNER/EXECUTIVE ( ) E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUI N N/A CA XSWC:EWS1074585-02 $50M is XS 10/31/2019 10/3112020 (Mandatory In NH) ( E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under $10M SIR;$1M EEIEA is XS$10M SIR) 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) Evidence of insurance. 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 of Marsh Risk&Insurance Services StephanieGuaiumi ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD t Suffolk County Dept.of Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name CHARLES J Pt CARD Business Name i This certifies that the. TESLA ENERGY OPERATIONS INC bearer is duly licensed by Lhe County o`susdt . License•Number:HI-62558. Frc-H.k,Ncrd " issued: 911212019 Commissioner Expires: 9/1/2021 / j 1 A Suffolk.County Dept.of ' Labor,Licenslog&ConsunterAffairs Yu MASTER ELECTRICAL LICENSE " •� Name - JASON KANE Business.Name ' TESLA ENERGY OPERATIONS INC ' This certifies that the bearer isduiy_licensed License Number ME 51331 by the County of Suifoik Issued- 03/1912Q13Cow , n;ss;onef Expires: 0310/12021 a :tt voRI Workers' CERTIFICATE'OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured 650-963-5100 Tesla Energy Operations,Inc. 45500 Fremont Blvd. 1c.NYS Unemployment Insurance,Employer Registration Numberof Fremont,CA94538 Insured 49=892777 Work Location of Insured(Only required if coverage is specifically limitedto 1 d.Federal Employer Identification Number of Insured,or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 02-0781046 2.Name and Address of Entity Requesting Proof ofCoverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) American Zurich Insurance Company 3b.Policy Number of Entity Listed in Box"I a" Town of Southold WC 1074583-02 54375 Main Road 3c.Policy effective period Southold,NY 11971-0959 _ 10/31/2019 to 10/31/2020 3d.The Proprietor,Partners or Executive Officers are ®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"3"insures the business referenced above in box"1a"forworkers' 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 isearlier. 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: Susan B. Kendziora (Print name of authorized representative or licensed agent of insurance carrier) Approved by: ' !,4�� 11/11/2019 (Signature) —� (Date) Title:Vice President-Enterprise Support Operations Telephone Number of authorized representative or licensed agent of insurance carrier:800-382-2150 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.raov INTERNAL USE ONLY Version#86.2-1 PIL NAS September 22,2020 RE: CERTIFICATION LETTER Project/Job#JB-1192108-00 Project Address: Moore Residence 18975 Soundview Ave Southold,NY 11971 AHJ Southold Town SC Office Bethpage Design Criteria: -Applicable Codes=Structure:2018 IESC;PV:2020 Building Code of NYS including 2018 IBC&2020 Residential Code of NYS including 2018 IRC,ASCE 7-16,and 2018 NDS -Risk Category=II Wind Speed=130 mph,Exposure Category C,Partially/Fully Enclosed Method -Ground Snow Load=30 psf -MP1:Roof DL=9 psf,Roof LUSL=20.8 psf(Non-PV),Roof LUSL=18.1 psf(PV) -MP2:Roof DL=9 psf,Roof LUSL=20.8 psf(Non-PV),Roof LUSL=16.3 psf(PV) -MP3:Roof DL=9 psf,Roof LUSL=20.8 psf(Non-PV),Roof LUSL=17 psf(PV) -MP4:Roof DL=9 psf,Roof LUSL=20.8 psf(Non-PV),Roof LUSL=18.1 psf(PV) -MPS:Roof DL=9 psf,Roof LUSL=20.8 psf(Non-PV),Roof LUSL,=16.3 psf(PV) -MP6:Roof DL=9 psf,Roof LUSL=20.8 psf(Non-PV),Roof LUSL=15.6 psf(PV) -MP7:Roof DL=9 psf,Roof LUSL=20.8 psf(Non-PV),Roof LUSL=16.3 psf(PV) Note: Per IBC 1613.1; Seismic check is not required because Ss=0.1.77<0.4g and Seismic Design Category(SDC)=B<D To Whom It May Concern, A structural evaluation of loading was conducted for the above address based on 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/docs submitted for approval. Installer shall verify existing roof framing is in suitable condition and does not exhibit any signs of structural damage which may diminish the capacity of its members or connections prior to commencement of PV installation.Installer verification of the mounting planes noted above is required because some or all of the framing was not observed prior to the structural evaluation performed for this report. OF HE LV 0,p Digitally signed Chris by Chris H Kim Date: _ 20.023H Mykr 21:08.23 -04 00 Tesla,Inc. T E S, L r l '1055 Cls,,arvir Uw V✓ay.Sian Mateo,CA 94402 1 o 6,50 038 1028 (650 638 1029 Version#86.2-1 PIL NAS HARDWARE DESIGN AND STRUCTURAL EVALUATION.RESU,LTS'SUMMARY TABLES' Landscape'.: = Hardware,-Landscape Modules'Standoff Specifications ' Hardware X-X Spacing X-X Cantilever Y Y Spacing Y-Y Cantilever Configuration Uplift DCR MP1 72" 24" 41" NA Staggered 90.6% MP2 72" 24" 41" NA Staggered 74.8% MP3 72" 24" 41" NA Staggered 74.7% MP4 48" 24" 1 41" NA Staggered 67.7% MP5 72" 24" 41". NA Staggered 66.5% MP6 72" 24" 41" NA Staggered 74.9% MP7 72" 24" 41" NA Staggered 74.8% Portrait ',Hardware-P,ortrait,Modules'Standoff,Specifications. Hardware, X-X Spacing X-X Cantilever Y-Y Spacing Y Y Cantilever Configuration Uplift DCR MP1 24" 16" 69" - NA Staggered 51.0% MP2 48" 19" 69" NA Staggered 84.2% MP3 48" 19" 69" NA Staggered 84.1% MP4 24" 14" 69" NA Staggered 57.2% MP5 48',' 20" 69" 'NA Staggered 74.9% MP6 48" 19" 69" NA Staggered 84.3% MP7 48" 19" 69" NA Staggered 84.2% Mounting Plane. Roof Pitch Qualification Results (Degrees) Member Evaluation Results MP1 18° Member Impact Check OK MP2 23° Member Impact Check OK MP3 21° Member Impact Check OK MP4 18° Member Impact Check OK MP5 23° Member Impact Check OK . MP6 25' Member Impact Check OK MP7 23° Member Impact Check OK Testa,Inc. 'T 5 L .ll'7 3055 C� r,rview�Vay.San fvlatao,CF,9A4(li p 650 638 1026 f 650 638 1029 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 NYS 2019 ENERGY BUILDING CONIC CONCRETE DC DIRECT CURRENT POWER—CONDITIONING INVERTER. STORAGE SUPPLEMENT EGC EQUIPMENT GROUNDING CONDUCTOR (E) 2. A NATIONALLY — RECOGNIZED TESTING EXISTING EMT ELECTRICAL METALLIC TUBING FSB LABORATORY SHALL LIST ALL EQUIPMENT IN GC1"PLY WITH ALL CODES OF FIRE SET—BACK GALV GALVANIZED GEC GROUNDING COMPLIANCE WITH ART. 110.3. NEW YORK STATE & TOWN CODES ELECTRODE CONDUCTOR GND GROUND HDG HOT 3. WHERE ALL TERMINALS OF THE DISCONNECTING AS REQUIREDFAOF APPROVE^ �3' N"I';s EJ' 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 DATE/ _ZQ B.P.# KILOVOLT AMPERE kW KILOWATT LBW LOAD HAZARDS PER ART. 690.17. 4. EACH UNGROUNDED CONDUCTOR OF THE OARD FEE:��_._ BEARING WALL MIN MINIMUM (N) NEW NEUT NOTIFY EUILDINu NEUTRAL NTS NOT TO SCALE OC ON CENTER PL MUL11WIRE BRANCH CIRCUIT WILL BE IDENTIFIED BY PROPERTY LINE POI POINT OF INTERCONNECTION PHASE AND SYSTEM PER ART. 210.5. 7651802 8 AM TO 4 rh, FOR T HE: PV PHOTOVOLTAIC SCH SCHEDULE S STAINLESS 5. CIRCUITS OVER 250V TO GROUND SHALL COMPLY r,.. FOLLOWING INS;EC(I� I : STEEL STC STANDARD TESTING CONDITIONS TYP WITH ART. 250.97, 250.92(B). 1. FOUNDATION - 7A`0 REQUIRED TYPICAL UPS UNINTERRUPTIBLE POWER SUPPLY V 6. DC CONDUCTORS EITHER DO NOT ENTER BUILDING FOR POURED CGN0F1ETE VOLT Vmp VOLTAGE AT MAX POWER Voc VOLTAGE OR ARE RUN IN METALLIC RACEWAYS OR � F: CY O 2. ROUGH - FRAMiIVG & PLUMBING AT OPEN CIRCUIT W WATT 3R NEMA 3R, RAINTIGHT ENCLOSURES TO THE FIRST ACCESSIBLE DC s; F, k r�r i it 3. INSULATION DISCONNECTING MEANS PER ART. 690.31(E). USA IS UNLAWFUL 4. FINAL - CONSTRUCTION BUST 7. ALL WIRES SHALL BE PROVIDED WITH STRAIN BE COMPLETE FOR C.O. RELIEF AT ALL ENTRY INTO BOXES AS REQUIRED BY ALL CERTIFICATE ALL CONSTRUCTION SHALL MEET THE UL LISTING. REQUIREMENTS OF THE CODES OF NEW 8. MODULE FRAMES SHALL BE GROUNDED AT THE UL OF OCCUPANCY YORK STATE. NOT RESPONSIBLE FOR — LISTED LOCATION PROVIDED BY THE DESIGN OR CONSTRUCTION ERRORS. MANUFACTURER USING UL LISTED GROUNDING HARDWARE. 9. MODULE FRAMES, RAIL, AND POSTS SHALL BE BONDED WITH EQUIPMENT GROUND CONDUCTORS. r;nIJFF 'w� g�T�VPJPBCnCO I L l 2`3 VICINITY MAP INDEX Sheet 1 COVER SHEET Sheet 2 SITE PLAN Sheet 3 STRUCTURAL VIEWS Sheet 4 UPLIFT CALCULATIONS LICENSE GENERAL NOTES Sheet 5 THREE LINE DIAGRAM Cutsheets Attached 1. ALL WORK SHALL COMPLY WITH THE 2020 NYS UNIFORM CODE. 2. ALL ELECTRICAL WORK SHALL COMPLY WITH THE 2017 NATIONAL ELECTRIC CODE. 3. ALL WORK SHALL COMPLY WITH THE 2020 IFC INTERNATIONAL FIRE CODE. MODULE GROUNDING METHOD: ZEP SOLAR 4. ALL WORK SHALL COMPLY WITH THE 2019 NYS AHJ: Southold Town ESS SUPPLEMENTAL CODE. REV BY DATE COMMENTS 5. ALL WORK SHALL COMPLY WITH THE 2020 REV A NAME DATE PW REMOVAL BUILDING CODE OF NYS. } 6. ALL WORK SHALL COMPLY WITH THE 2020 UTILITY: PSE&G—Long Island RESIDENTIAL CODE OF NYS. 7. ALL WORK SHALL COMPLY WITH THE 2020 — — — — — CONFIDENTIAL — THE INFORMATION HEREIN JOB NUMBER J B-119 2108 00 CUSTOMER: DESCRIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THE Chris Moore 12.24 KW PV ARRAY Olaf Ortega Chavez T 5 L n BENEFIT OF ANYONE EXCEPT TESLA INC., NOR MOUNTING SYSTEM: SHALL IT BE DISCLOSED IN WHOLE OR IN ZS Comp V4 w Flashing—Insert 18975 Soundview Ave 0 KWH ENERGY STORAGE SYSTEM PART TO OTHERS OUTSIDE THE RECIPIENTSORG [MODULES, Southold NY 11971 THE ASALE AND UXSE OF CEPT ITHE RESPECTIVEN CONNECTION (36) Hanwho Q—CELLS # Q.Peak DUO BLK—G6+ 340 TESLA EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME: SHEET: REV DAIS INVERTER' PERMISSION OF TESLA INC. 21 27298051 1 a 9 13 2020 SolarEd e Technologies Ltd. SE11400H—US 240V COVER SHEET � � PITCH: 18 ARRAY PITCH-18 MP1 AZIMUTH: 171 ARRAY AZIMUTH: 1Y,1 MATERIAL:Comp Shingle STORY: 1 Story: pF NEW PITCH:.23 ARRAY PITCH:23 . � MP2 AZIMUTH:261 ARRAY AZIMUTH:261 MATERIAL:Comp Shingle STORY: 2 Stories * * PITCH: 21. ARRAY PITCH:.21 I MP3 AZIMUTH:81 . ARRAY AZIMUTH:81 0 1 . MATERIAL:Comp Shingle STORY: 2 Stories II yPITCH; 18 ARRAY PITCH:,18 �► 0964p'I MP4 AZIMUTH:'171 ARRAY AZIMUTH: 171 MATERIAL:Comp Shingle STORY:2 Stories SV PITCH: 23 ARRAY PITCH:23 1 SV p7 MP5. . AZIMUTH:171 ARRAY AZIMUTH: 171 I I I Digitally signed MATERIAL:Comp Shingle STORY: 1 Story r PITCH: 25 ARRAY PITCH:25 Ch 1 i S by Chris H Kim S� MP6 AZIMUTH:351 ARRAY AZIMUTH:351 1 — MATERIAL:tom Shingle STORY: 2 Stories — 1 Date p g • 2020�0 i. , - : 9.z3 LEGEND H K 21:08:07 -0400 (E) UTILITY METER & WARNING LABEL INVERTER W/ INTEGRATED DC DISCO. 6dVA --- Inv N? -_ & WARNING LABELS ,:FLAY nv , © AUTOMATIC RELAY Unlocked Gated C DC DISCONNECT & WARNING LABELS PIC 1 11 © AC DISCONNECT & WARNING. LABELS CAn DC JUNCTION COMBINER BOX & LABELS , 1 SV �, I (0 1 I �\ , , M 0 / s p1 IV \ �` ,' O. � LADDER ENERGY STORAGE SYSTEM FOR STAND IT' S I . I L . I N ` I I1 M ACCESS OO ALONE OPERA11ON DISTRIBUTION PANEL & LABELS W u'-1 I NI 1u y,,,d Lc LOAD CENTER & WARNING LABELS DEDICATED PV SYSTEM METER RAPID SHUTDOWN STANDOFF LOCATIONS CONDUIT RUN ON EXTERIOR -- CONDUIT RUN ON INTERIOR ��. (E) DRIVEWAY Q GATE/FENCE � ACCESS LADDER � r_, HEAT PRODUCING VENTS ARE RED LADDER ACCESS li INTERIOR EQUIPMENT IS DASHED L='� Front Of House Soundview Ave SITE PLAN N 1897 5 Scale: 1/0" = 1' -. W.. E 0 1' :8' . 16 . . . S QQ CUSTOMER: DESCRIPTION: DMGN: :' .CONFIDENTIAL- THE INFORMATION HEREIN. dOB NUMBER: .J B-1 19 2108 0.O Olaf Ortega Chavez CONTAINED SHALL NOT BE USED FOR THE Chris Moore 12.24 KW PV ARRAY 9 BENEFIT OF ANYONE EXCEPT TESLA INC., NOR MOUNTING SYSTEM: T E S L n SHALL IT BE.DISCLOSED IN WHOLE OR IN. ZS :Comp. V4 W Flashing—Insert 18975 Soundview Ave 0 KWH ENERGY STORAGE SYSTEM PART TO OTHERS OUTSIDE,THE RECIPIENT'S . MODULES Southold, NY .11971 ORGANIZATION, EXCEPT IN CONNECTION.WITH' THE SALE AND USE OF THE RESPECTIVE (36) HanWha Q-CELLS # Q.Peak DUO BLK-G6+ -340 PACE NAME SHEET.- REV DATE TESLA EQUIPMENT, WITHOUT THE WRITTEN INVERTER: PERMISSION OF TESLA INC. SolarEd a Technolo ies.Ltd. SE1140OH-US 24ov 2127298051 SITE PLAN 2 a 9/13/2020 S1 (N) PV MODULE (E) MOUNTING PLANE (MP) TYPICAL PV SIDE VIEW of NEw SV NTS PV MODULE � O 5/16"x1.5' BOLT.WITH A 9640 5/16" FLAT WASHER INSTALLATION ORDER ZEP LEVELING FOOT LOCATE RAFTER, MARK HOLE ZEP ARRAY SKIRT (1) LOCATION, AND DRILL PILOT HOLE. ZEP MOUNTING BLOCK (4) ATTACH FLASHING INSERT TO ZEP FLASHING INSERT (2) .MOUNTING BLOCK .AND ATTACH (3) TO RAFTER USING LAG SCREW. (E) COMP. SHINGLE (1) INJECT SEALANT INTO FLASHING (E) ROOF DECKING (2) (3) INSERT PORT, WHICH SPREADS SEALANT EVENLY OVER THE 5/1:6" DIA STAINLESS ROOF PENETRATION. STEEL LAG SCREW LOWEST MODULE SUBSEQUENT MODULES (2-1/2". EMBED, MIN) INSTALL LEVELING FOOT: ON TOP (4) OF MOUNTING BLOCK & (E) RAFTER . SECURELY.FASTEN WITH BOLT. TAN D FF Scale: l — CONFIDENTIAL— THE INFORMATION.HEREIN JOB NUMBER: ESCRIPTION: DESIGN: CUSTOMER. D JB=1192108 00. CONTAINED SHALL NOT BE USED FOR THE Chris Moore 122.4 .KW PV ARRAY Olaf Ortega.Chavez T 5 L I"1 BENEFIT OF ANYONE EXCEPT TESLA INC., NOR MOUNTING SYSTEM: SHALL,IT BE DISCLOSED IN WHOLE OR IN ZS Comp.V4 w.Ftashing-Insert 18975 Soundview Ave 0. KWH ENERGY STORAGE SYSTEM PRGANIZ TION, E OUTSIDE THE RECIPIENT'S, MODULES SOUtholdy NY 11.971 . ORGANIZATION, EXCEPT IN CONNECTION WITH THE SALE AND USE OF THE RESPECTIVE (36) Hanwha.Q—CELLS # Q.Peak DUO BLK—G6+.340. PACE NAME- SHEET: REV. DATE TESLA EQUIPMENT, WITHOUT THE WRITTEN INVERTER PERMISSION of TESLA INC. SolarEd a Technologies Ltd. # SE1140OH—US F240VI 21 27298051 STRUCTURAL VIEWS 3 a 9/13/2020 Jobsite Specific Design Criteria Design Code ASCE-7 16 Ground Elevation Ke 1" Factor Ultimate,find Speed V—Ult 130 Fig.26.5-1B Exposure Category C Section 26.7 Ground Snow Load P9 30 Tdble 7.2-1 MP Specific Design Information MP Name MPt" M02 MP3 MP4 MP5 MP6 MP7 MP8 Roofing Comp Shingle Comp Shingle, Comp Shingle Comp Shingle Comp Shingle' Comp Shingle Comp Shingle Comp Shingle Standoff ZS Comp V4 w ZS Comp V4 w ZS Comp V4.w ZS Comp.V4 w ZS Camp V4 w ZS Comp V4 w ZS Comp V4 w ZS Comp V4 w ``--of NEW . Flashing—Insert Flashing—Insert Flashing-Insert Flashing—Insert Flashing—Insert Flashing—Insert Flashing—Insert Flashing—Insert 4'�O� Pitch 18 23 21 18 23 25 23 18 A_ SL/RLL PV" 16.0 psi 16.3 psf 17.0 psf 18.0 psf 16.3 psf. 15.6 psf 16.3 psf 18,0.psf y vl SL/RLU Non-PV 20.8 psf 20.8 psf 20.8,psf 20.8 psf 20.8 psf 20.8 pelf 20.8 psf 20.8 psf Standoff Spacing and Layout 0. MP Name MPI MP2 MP3 MP4 MP5 MP6 MP7 MP8 xro�z Landscape X Spacng 7Y 72' 7Y 48' 721 72' 72* 4tY A �9640'l �ti� z c e ew prey 24' . 24' 24' 24' 24' 24' 24' 2, Landscape Y—Spacing 41 41'. 41' 41' 41' 41- 41' 41' Landscape Y—Cantilever.. Portrait X—Spacing 24' Ale 48' 24' 48' 48' 48' 24' Portrait X—Cantilever 16' 19' 19' 14 20' IV 19' Portrait Y—Spacing 69'. 69' 69' 69' 69' 69' 69' 69' Portrait.Y—Cantilever — — — — — — — — Layout Staggered Staggered Sta ered Staggered Staggered Staggered Staggered Sta ered 99 99 99 99 9g Staggered X and Y are maximums that are always relative to the structure framing that supports the PV.X is across rafters and Y is along rafters.' CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER —1 DESCRIPTION: DESIGN: Q OO CUSTOMER: D CONTAINED SHALL NOT BE USED FOR THE ��� O 8. . Chris Moore 1 2:24 KW PV ARRAY . Olaf Ortega Chavez T S L 11 BENEFIT OF ANYONE EXCEPT TESLA INC., NOR MOUNTING Comp NTING SYSTEM: SHALL IT BE DISCLOSED IN WOLF-OR IN IS V4 wFlashing—Insert 18975 . Soundview Ave 0 KWH ENERGY STORAGE SYSTEM PART T0,OTHERS,OUTSIDE THE RECIPIENTS ORGANIZATION, EXCEPT IN CONNECTION.WITH MODULES . Southold, NY 11,971 THE SALE AND USE of THE RESPECTIVE (36) Hanwha'Q—CELLS #. Q.Peak DUO BLK—G6+ 340 TESLA EQUIPMENT, WITHOUT THE WRITTEN r� PAGE NAME SHEET- REV DATE PERMISSION OF TESLA INC. FSoldrEdge VERTER 21 27298051 4 a. 9 13 2020 'Technologies Ltd: SE11400H .=US 240V UPLIFT CALCULATIONS GROUND SPECS : MAIN PANEL SPECS GENERAL.NOTES INVERTER SPECS MODULE SPECS " LICENSE BOND (N) #6 GEC TO (E) GROUND ROD Panel Number.LC404081200 Inv 1: DC Ungrounded INV 1 - (1)SolarEdge Technologies Ltd. #SE1140OH-US(24OV] - (36) Hanwha Q-CELLS#4.Peak DUO BLK—G8+340 AT PANEL-WITH IRREVERSIBLE CRIMP Meter Number.98366859 Tie-In: Supply Side Connection Inverter, 11400W, 240/208V 99r; SetApp HD Wave w/ZB,AFCI _ PV Module; 34OW, 318.PTC, 40MM, Black Fr, MC4, ZEP, 1o00V Underground Service,.Entrance INV 2 Voc: 40.66 Vpmax: 33.94. INV 3 Isc AND Imp ARE SHOWN IN THE DC STRINGS IDENTIFIER �ETesla 200A MAIN SERVICE PANEL . E) 20oA/2P MAIN-;CIRCUIT BREAKER 5 (E) WIRING CUTLER-HAMMER In.Verter 1" Disconnect A" L 6 SolarEdge Technologies Ltd. DC+ - - g�g,Mp 7. - - B 60A - 1x12 -------------- - -- ------ --L - -- SE11400H US.[240V] Dc- EGC J. 24Ov r- -- --------- �----- - 2 3 - A L1. - - - 200A/2P. . s Dc+ i Dc+ 2,3,MR 1: N DG I 4 DO- 1x13 (E) LOADS. . . GND --"=----=----------------------------- —EGC/ --- DC+ DC+ _ cec T 5,6;MP 4: I. (3) • N DG - DG — ---------————— ------ -'----- ---EGC -- ----——— --- --- 1x11 .. .. / I (1)Conduit Kit; 3 4"EMT I N. I o Z Z I ——— — GEC TO 120/240V SINGLE PHASE I _ UTILITY SERVICE I I I I EGC ON ROOF TO BE ROUTED .WHERE NOT SUBJECT.TO PHYSICAL DAMAGE. WHEN ROUTED'SUBJECT TO PHYSICAL DAMAGE THE SIZE MUST BE INCREASED TO #6 SOLID BARE COPPER. Voc* MAX VOC AT MIN TEMP OI (2)ILSCO IPC 4/Q—/6 B " (I)CUTLER—HAMMER #DG222NRB A 0)Tesla 4J; 4 STRING JUNCTION BOX insulAoln Piercing Connector, Main 4/0-4, Tap 6-14 Disconnect; 60A, 240Vgc,Fusible, NEMA 3R " AC UN m, GROUNDED.Block— Diag DIN Rail, DC —(.1)CUTLER— AMMER #DG10ONB `/ 06)SOLAREDGE g P400-5NM4MTM—NM22 SC SUPPLY SIDE CONNECTION. DISCONNECTING MEANS SHALL BE SUITABLE Ground�Weutral it; 60-100A, General Duty:(DG) P V. PowerBox Optimizer, 40OW, MC4, ZEP, Al backplate AS SERVICE EQUIPMENT AND SHALL BE RATED PER NEC.. (1)CUTLER—HAMMER jDS16FK Class:R Fuse Kit —(2)FERRAZ SHAWMUT#TR60R PV BACKFEED OCP Fuse, 60A, 25OV, Class RK5 (1)AWG.#6;THWN-2, Black .1 AWG#6, THWN-2,"Black (1)AWG 18, THWN-2, Black. Voc* =480 VDC Isc =30 ADC 2 AWG#10. PV-Wire, 60DV Black Voc*. 480 VDC Isc =15 ADC 7 cn (1)AWG /6; THWN-2, Red 6. (1)AWG#6, THWN-2, Red 4 (1)AWG 18, THWN-2, Red Vmp 400 VDC Imp=20.14 ADC (1)AWG ,Solid Bore Copper EGC Vmp =400 VDC Im =10.01 ADC O (1)AWG 16. THWN-2, White NEUTRAL Vm =240 VAC Im =47.5 AAC O' '' O .� P— p p, (1)AWG#10, THWN-2;White NEUTRAL Vmp =240 VAC Imp=47.5 AAC . ...,:. (1 .AWG#10,iliHN/TIiWN-2,..Green. EGC.—�1)Conduit,Kit;,3/4`,EMT_.. . . .* ._ 1 #6 PP Solid Bare Co er GEC 1 Conduit Kit 3 4 EMT — 1 AWG 1HWN-2, Green EGC — 1 Conduit Kit 3 4 EMT (1)AWG 110, THWN-2,Black Voc —480 VDC Isc =15 . ADC. (2)AWG#10, PV Wre BODY, Bladc. `Voc .—480 VDC Isc=15 ADC -.0)AWG#6. .... .. .. PP.... ..: . .-(.). .... . .,../ ... .. .. �.). ..#.....7 .. . . . .. .. ...(.). ... .. .. .,../.. . . .. O — — — _ = 0. areCopperV p = VDC = . (1)AWG#10,iHWN 2, Red " Vmp 4a0 VDG Imp 1 07 ADC 2 � '(1)AWG#s,Solid B EGC m 400 Imp 10.9} ADC . . . . .. .. .. ...... ....�. . . . . . . .. . . .. .. .... . .. .. ... . . . _ _ (1)AWG#10 THHN/THWN 2, Green EGC 1)Canduit,Kit 3/4' EMT W Solid P = VDC = . (2}AWG#10, PV Wire,BODY Black Voc* '480 VDC Isc 15 ADC O � (1)AWG#6,S 'd Bare Copper EGC. Vm 400 Imp 9 23 ADC .CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER-- CONTAINEDJ B-11921.08. O 0 DESCRIPTION: DESIGN CUSTOMER. SHALL NOT BE USED FOR THE: Chris Moore 1 Z,.24 KW PV ARRAY Olaf Ortega. Chavez BENEFIT OF ANYONE EXCEPT TESLA INC., NOR MOUNTING SYSTEM: = 5 L n SHALL IT BE.DISCLOSED IN WriOLE'OR IN IS .Comp. V4 wFlashing—Insert 18975 SOundview Ave 0 KWH ENERGY 'STORAGE SYSTEM PART TO OTHERS,OUTSIDE.THE RECIRIENT'S, MODULES-' Southold NY 11971 .ORGANIZATION, EXCEPT.IN CONNECTION.WITH �. THE SALE AND USE OF THE RESPECTIVE (36) Hanwha Q-CELLS # Q.Peak DUO BLK-06+" 340: EQUIPMENT, WITHOUT THE WRITTEN r� r� PAGE NAME-- PERMISSION SHL77 - REV: DATE-- TESLA OF TESLA INC. INVERTER 2127298�51 5. a.. 9 13 2020 SoldrEd a Technologies Ltd. SE1140OH—US 240V THREE LINE DIAGRAM / f L el ab WARNING:PHOTOVOLTAIC POWER SOURCE Location: Label Label Loc� J � - • PHOTOVOLTAIC SYSTEM � yc7JJ"�� L'�,1�1j�.���) Sola _ ••_ EQUIPPED WITH RAPID ••- r'l���1 --� �.• - Pe rod °•1 SHUTDOWN .°1 . [ �JUcr Jar r}Vr_ n .•1 Label • • u PHOTOVOLTAIC DC DISCONNECTPer Code: NECn,•� r r r r I 691 PV •- • •13 SHUT irSYSMAr a r CAUTION (POI) SHOCKHAZAM DUAL POWER SOURCE Per ••- ' SECOND SOURCE IS Label LNEC 1 MAXIMUM VOLTAGE ® PHOTOVOLTAIC SYSTEM MAXIMUM CIRCUIT CURRENT ® Per Code. NEC 69.0.53 MAX RATED OUTPUT CURRENT OF THE CHARGE CONTROLLER ® Label , , OR DC-TO-DC CONVERTER .• (IF INSTALLED) WA R N I N G Per ••- NEC INVERTER OUTPUT CONNECTION 1 • DO NOT RELOCATE Label Location: THIS OVERCURRENT WARNING DEVICE Per ..- ELECTRIC SHOCK HAZARD 690.41.13 IF A GROUND FAULT IS INDICATED NORMALLY GROUNDED CONDUCTORS MAY BELabel L• • UNGROUNDED AND ENERGIZED WARNING ELECTRIC SHOCK HAZARD THE DC CONDUCTORS OF THIS PHOTOVOLTAIC SYSTEM ARE Label Location: UNGROUNDED AND PHOTOVOLTAIC AC •NEC MAY BE ENERGIZED DISCONNECTPer Code- °•1 .13.13 Label SOLAR PV SYSTEM 'BB/Delta cation: livia Inverter Label Location: EQUIPPED WITH RAPIDPer Code: OPERATING CIUR ENT ® A ' Code-' SHUTDOWN ••1 . o Per MAXIMUM AC RAPID NEC OPERATING VOLTAGE ® V 690.54 WN SWITCH r• e 'OFF !t� POSMON TO SH4SOLAR DOWN CONDUCTORSELECTRIC OUTSIDE PV PANELS CONDUCTORS Label • • THE ARRAY REPMN ENERGIZED.IN WARNINGPer Code: LDisconnect. . ELECTRIC SHOCK HAZARD NEC •1 DO NOT TOUCH TERMINALS TERMINALS ON BOTH LINE AND Distribution LOAD SIDES MAY BE ENERGIZEDDisconnect IN THE OPEN POSITION (IC): Inter!or Run Conduit -• -• Disconnect •,• (M): Utility Meter '• Point of - • s solar=@@ so I a r ' • • � .String Optimizer S05000 So5o0o String Optimizer INPUT e.d..Tnput.DC. .Paw. ........... ......... ......................... eel) ........................5000.......................... ..................... W..... .... ..... .. .. . ... . Absolute Maximum Input Voltage (Voc at lowest temperature) 600 Vdc S�+ G ............................................. ........................................................................................................ ........... O 5 00 MPPT Operating Range 120-530 Vdc Maximum Short Circuit Current(Isc)of 12.5 Adc �. connected PV Module .....:......................................... .................................................................................................................... Maximum DC Input Current 13 Adc .................... ........................ .............................................................................................................. .... Maximum Efficien.. o99.1 .-1keig......-M-ci............................. ........................................................................................................ ........... Weighted Efficiency 99 Overvoltage Category II (OUTPUT DURING OPERATION(STRING OPTIMIZER CONNECTED TO OPERATING INVERTER) Maximum Output Current 12.5 Adc ......... ........................... ............................................................................................................ ® f Maximum Output Voltage 500V . Operating Output Voltage range 325-450 Vdc p!. . OUTPUT DURING STANDBY(STRING OPTIMIZER DISCONNECTED FROM INVERTER OR INVERTER OFF) I Safety Output Voltage per String Optimizer 25 Vdc STANDARD COMPLIANCE EMC FCC Part15 Class B,61000-6-2,61000-6-3 ............................................... ..................................................................................................................... Safety . 62109-1(class II safety),UL1741 ............................................... ..................................................................................................................... �+ RoHS. Yes Arc Detection(When Connected to....... ..................................................................................................................... , a R21�gC3tJ UL16998;NEC 690.11 qJ ,�r�g SolarEdge Inverter) yo q Rapid Shutdown(When Connected to NEC 690.12 `!•mlwt� SolarEdge Inverter) INSTALLATION SPECIFICATIONS. Maximum.Allowed. ......System. ...Voltag. .e 600 Vdc ............ .. ..... . ... .......... .................................................................................................................... Dimensions(WxLxH),without bracket 186x200x71/1.32x 7.87x2.8 mm/in ...................................... .................................................................................................................... Weight(including cables) 3.6/8 kg/lb Input and Output Wire Type/Connector... ...........................................Double. . .insulated;4mm2. . (.MC4)............................................. . ... . ........ ........ . ............................................. Input Wire Length 150/6 mm/in Output Wire Length (Female)800/31.5,(Male)900/35.4 mm/in ..............:................................ ................................................................:.................:..........................:...... Operating Temperature Range -40-+85/-40-+185 . C/°F ............................................... .................................................................................................................... Protection Rating NEMA6 .........:..................................... ........................:........................................................................................... Relative Humidity 0-300 ............................................... .................................................................................................................... Reverse current protection - 40 A (0 Rated STC power of the module.Module of up to+5%power tolerance is allowed. (2)Power de-rating from+158eF/+70PC. 1 PV SYSTEM DESIGN HD-WAVE SE3000H= HQ-WAVE SE5000H SESOOOA US SE10000A US-. (' US SE3800H US 'US-SE7600H-US SE7600A-US 'SE31400A US: Input pe Maximum..P.t. ........................ ....... ........... ...... ................ ....................... ......................... - tang Optimizers per0 n ptim¢er r > .......................................................Min#51nverter ..........1 ........ ........................... �........... ........................ ,N Max gString Optimizers per lInverter............ ._....�............ ...... . ..4............. ............4 ........ ........6............. ;'L. �` 'S r ';h4 •..- "3T3 � ';.,, - ...yeti s. .. Cost,Effecti,Ve PVC' ower�o miaatiori at the strrn IeV@� 3 b ,, ' Maximum Power per String Optimizer 5000W;do not exceed inverter Maximum DC Power 11) f �r .... .: ......: . L = ": y� FrvG� � � ? Strings of Different Lengths and Orientations Yes w 'Connects to,astring of.modules;'proylding stnngjMaximwm PowerlPoint,�Trackmg{MPPT)'while mai`ntaimng superior f Refer to inverter dataslieets. efficiency R ,Compatible with SolarEdge single h ase inver ters , .r P —••Fast installation with a single bolt - NeWgeneration maintenance with,optimizer-level mOnitOring ' Safety voltage output(52SV)for installer.and firefighter safety, are trademarks or registered respectiveF 0 SolarEdge Technologies.Inc.All rights reserved.SOLAREDGE.the SolarEdge logo.OPTIMIZED BY SOLARIEDGE owners.Date:SolarEdge� - www.solaredge.us are trademarks of ilieTr SInI e Phase- river er wi HD-Wave TeChr101Og�/ for North America Single Phase- I nverter Z SE3000H-US SE380OH-US SE5000H-US SEOWWUS • SE760OH-US / SE10000H-US / SE11400H.-.US With H�D-Wave Tech nO o .., .... ,,,. .,. for North America ' E S H , APPLICABLE TO INVERTERS WIT - , , PART NUMBER ; I ..O UTPUT PUT SE3000H-US %SE3800H-US / SE5000H-US /SE6000H-US /- . '- Rated AC Power Output 3000 3800 @ 240V 5000 6000 @ 240V 7600 10000 11400@240V' . VA 3300 @ 208V 5000 @ 208V 10000 @ 208V SE7600H-US / SE1000OH-US /SE_11400H=US': .. T 3300@208V 5000@208V 10400@208V Maximum AC Power Output' 3000 5000 7600 10000 VA Min.-Nom. ✓ ✓ ✓ ✓ ✓ ✓ ✓ 3300 @ 208V 5000 @ 208V 10000 @ 208V % • AC Output Voltage Mi Max Vac 12-25 IV Min: . ✓ ✓ • ✓ Vac AC Output Voltage Nom Max. AC3Frequency 2(Nominal) 59.3-60-60.51, Hz LA Maximum Continuous Output 12.5 16 21 25 32 42 47.5 A Current @240V Maximum Contihuous Output _ Current @208V 16 24 - 48.5 A Power Factor 1,adjustable-0.85 to 0.85 O ® GFDI Threshold. 1 A - Utility Monitoring,Islanding Protection,Country Configurable Yes Thresholds INPUT S018Ps. -.-HD., soler �L': Y�{� Power @24 4650 5900 7750 9300 11800 15500 17650 W _ • w OV C Power @208V 5100 7750 - - 15500 W Maximum Maximum D ,. Transformer-less,Ungrounded Yes Maximum Input Voltage 480 Vdc Nominal DC Input Voltage 380 400 Vdc -+ C 3} x 4O✓RI Maximum Input Current @2 8.5 10.5 13.5 16.5 20 27 30.5 Adc r s4 t Maximum Input Current @208Vo 9 - 13.5 27 Adc g ; ;,- , .rA ��+ • ti , • Max.Input Short Circuit Current 45 Adc ". Reverse-Polarity Protection Yes .. .. . , . -. Ground-Fault Isolation Detection 600ka.Sensitivity Maximum Inverter Efficiency 99 99 2 % • C EC Weighted Efficiency 99 Optimized installation with HD-Wave technology Nighttime,Power Consumption <2.5 W m For other regional settings please contact SolarEdge support A higher current source may be used;the inverter will limit its input current to the values stated / Specifically designed to work with / UL1741 .SA certified,for C'PUC Rule 21 grid compliance power optimizers Record-breaking efficiency / Extremely small, / Quick and easy inverter commissioning directly from.a smartphone using the SolarEdge SetApp Built-in module-level monitoring Fixed voltage inverter for longer strings Outdoor and indoor installation I Integrated arc fault protection and rapid shutdown'for NEC 2014 and 2017, per article' / Optional: Revenue grade data,ANSI C12.20 690:11 and 690:12 Class 0.5 (0.5%accuracy) solaredge.com S. Sin Ie ' Phase Inverter wit H D-WaVe .Technology/ for North America SE3000H-US / SE380OH-US / SE5000H=US/ SE6000H-US/ SE760OH—US / SE1.000OH=US /,SE1140OH-US ADDITIONAL FEATURES Supported Communication Interfaces RS485,Ethernet,ZigBee(optional),Cellular(optional) Revenue Grade Data,ANSI C12.20 Optionalr'I Inverter Commissioning with the SetApp mobile application using built-in Wi-Fi station for local connection Rapid Shutdown-NEC 2014 and 2017 690.12 Automatic Rapid Shutdown upon AC Grid Disconnect STANDARD COMPLIANCE" Safety UL1741,UL1741 S4,UL1699B,CSA C22.2,Canadian AFCI according to T.I.L.M-07 Grid Connection Standards IEEE1547,Rule 21,Rule 14(HI) Emissions FCC Part 15 Class B INSTALLATION SPECIFICATIONS ,. AC Output Conduit Size%AWG 3/4'minimum"/14-6 AWG 3/4"minimum/14-4 AWG Range DC Input Conduit Size/#of Strings/AWG Range 3/4'minimum/1-2 strings/14-6 AWG 3/4'minimum/1-3 strings/14-6 AWG Dimensions with Safety Switch 17.7 x 14.6 x 6.8 /450 x 370 x 174 21.3 x 14.6 x 7.3/540 x 370 x 185 TI/ (HxVJxD) mm Weight with Safety Switch 22/10 25.1/11.4 26.2/11.9 38.8/17.6 lb/kg Noise <25 <50 dBA Cooling Natural Convection Operating Temperature Range -40 to+140/-40 to+6014f 'F/'C Protection Rating NEMA 4X(Inverter with Safety Switch) "'.Revenue grade inverter P/N:SE000(H-USOOOBNC4 11)Full power up to at least 50'C/122'F;for power de-rating information refer to:httpsVAvw .solaredge.conVsites/default/files/se-temperature-deradng-note-na.pdf 0 SolarEdge Technologies,Inc All rights mewed.SOLAREDGE,the SolarEdge logo,OPTIMIZED BY SOLAREDGEare trademarks or registered trademarks of SolarEdge Technologies,Inc All "C other trademarks mentioned herein am trademarks of their respective owners.Date:1/2019N01/ENG NAM.Subject to change without notice. Ro HS . Powered Iry i MECHANICAL SPECIFICATION IF ,D U O f Format 68.5 x 40.6 x 1.571n(including frame) (1740 x 1030 x40mm) asam�m ]6.6•r- 6a r)WMT) Weight 474lbs(21.5kg)' ' .. - 6.G,uv4hp°°b�+e 0.1C(GimN ).09•a80mm) •,•+ Front Cover 0.131n(3.2mm)thermally pre-stressed glass x with anti-reflection technology °iDeh epiepv"0 'moo i � n- r Back Cover Compositefilm as.6•rs61mm) Frame Black anodized aluminum a6as•aolommr Cell 6 x 20 monocrystalline Q.ANTUM solar half cells Junction Box 2.09-3.98 x 1.26-2.36 x 0.59-0.71in(53-101 x 32-60 x 15-18 mm), Protection class IP67;with bypass diodes Cable 4mm2 Solar cable;(+)t43.3in(1100mm),(-)a43.31n(1100mm) os°•.arrl.6mm.6mm . a.Pen.wgpdms(oEralni . Connector Staubli MC4:IP68 1 iow•uJP,Pa T'�-I°��•ramm, . • = . ELECTRICAL CHARACTERISTICS j POWER CLASS 330 335 - 340 _ - 345 i MINIMUM PERFORMANCE AT STANDARD TEST CONDITIONS,STC'(POWER TOLERANCE+5W/-0W) Power at MOP" PMPP [w] 330' 335 340 345 . QCELLS t E Short Circuit Current' Imo. [A] 10.41 10.41 10.52 10.58 = Open Circuit Voltage' V°c IV] 40.15 40.41 40.66 40.92 a QGOMPAT/� a - 5 Current at MPP IMPP [A] 9.91 9.97 10.02 10.07 �4 �t11 i,=T.OP_6RAND P.V� Voltage at MPP VMPP IV] 33,29 33.62 33.94 34.25 Product and 1vna6 We a�t� Efficiency' rl 1%1 z18.4 z18.7 t19.0 z19.3 t�,a �v 2019 MINIMUM PERFORMANCE AT NORMAL OPERATING CONDITIONS,NMOT' C�MPA�� C3CELL5 Power at MPP PMPP [w] 247.0 250.7 254.5 258.2 E Short Circuit Current Imo. [A] 8.39 8.43 8.48 .8.52 E Open Circuit Voltage c Voc IV] 37.86 38.10 38.34 38.59 Q.ANTUM TECHNOLOGY:LOW LEVELIZED COST OF ELECTRICITY Current at MPP 1M_ [A] 7.80 7.84 7.89 7.93 Higher yield per surface area,lower BOS costs,higher Voltage at MPP. VMPP IV] 31.66 31.97 32.27 32.57 power classes,and an efficiency rate of up to 19.5%. 'Measurement tolerances P.,±3%;Isc;Va±6%at STC:1000w/m',25±2°C,AM 1.5 according to IEC 60904-3•2800 W/m2,NMOT,spectrum AM 1.5 QCELLS PERFORMANCE WARRANTY PERFORMANCE AT LOW IRRADIANCE INNOVATIVE ALL-WEATHER TECHNOLOGY t_ o° x 10 --T-----r---------------- ' At least 98%of nominal power during Optimal yields,whatever the weather with 2 w _ ___ LL. first year.Thereafter max.0.54% excellent low-light and temperature behavior. g "' degradation per year.At A east 93.1 --- % iaa _-____-______________________ . m o nominalpower up to years. t it '0 . . ---------"---"- least 85%of nominal power up to ENDURING HIGH PERFORMANCE go 25years °° - ----- ---- ----- -----j Z 0` Long-term yield security with Ant[LID and Ant[PID Technology', o All data within measurement toleranc- W 66 Hot-Spot Protect and Traceable Quality Tra.QTm. a e° as.Full warranties in accordance with A00 400 800 1000 g - the warranty terms of the QCELLS16 ' raw+rnaNeetwrn,•I o „ sales organization of your respective ZEP COMPATIBLETM FRAME DESIGN country. Ys:anas Typical module performance under low irradiance conditions in High-tech black Zep Compatible"I frame,for improved aesthetics, comparison toSTC conditions(25°c.l000w/m2) easy installation and increased safety. I TEMPERATURE COEFFICIENTS ' y Temperature Coefficient ofls° a [%/K] +0.04 Temperature Coefficient ofV� 0 [%/K] -0.27 ! \ �g A RELIABLE INVESTMENT m Temperature Coefficient ofPssPP y [%/K] -0.36 Normal Module Operating Temperature NMOT [°F] 109±5.4(43±3°C) c Yeaaa Inclusive 25-year product warranty and 25-year o linear performance warranty2. PROPERTIES FOR SYSTEM DESIGN ° Maximum System Voltage Vsrs IV] 1000(IEC)/1000(UL) Protection Class II o STATE OF THE ART MODULE TECHNOLOGY Maximum Series Fuse Rating [A DC] 20 Fire.Rating based on ANSI/UL 1703 C(IEC)/TYPE 2(UL) Q.ANTUM DUO combines cutting edge cell separation . Max.Design Load,,Push/Puli(UL)' [Ibs/ft°] 50(2400Pa)/50,(240bPa) - Permitted Module Temperature -40°Fvpto+185°FF o and innovative wiring with Q.ANTUM Technology. on continuous Duty (-40°C up to+85°0) oo Max.Test Load,Push/Pull(UL)s [Ibs/fta] 75(3600Pa)/75(3600Pa) 'See Installation Manual 'APT test conditions according to IEC/TS 62804-12015,method B(-1500 V,168 h) - _ 'See data sheet on rear for further inform ation _1. QUALIFICATIONS AND CERTIFICATES UL 1103,CE-compliant,IEC 61215:2016,IEC 61730:2016, - 0 Application Class 11,U.S.Patent No.9,893,215(solar cells) _ �OxJAJ THE IDEAL SOLUTION FOR: OVE- C E o SAus �rorre% „ . . Rooftop arrays on commercial and 'industrial buildings Note:Installation instructions must be followed.See the installation and operating manual or contact our technical service department for further Information on approved Installation and use - - of this product. . OCELLS - 400HanwhaSpectrum CELLS America Inc. EEngineeredIinGGermany400SpectrumCenterDrive,Suite 140b,Irvine,CA92618,USA ITEL+1 949 748 59 961 EMAIL lnquiry@us.q-cells.com I WEB www.q-cells.us '�^5018rClty I . ZepSotar Next-Level PV Mounting Technology �� Next-Level PV Mounting Technology g gY solarQi y ZepSota� 9 9Y Components. ZS Comp for composition shingle roofs '! RIF r . Mounting Block Array Skirt _ Interlock r 3 r 1613 Part No.850=1633 Part No.850-1608 0 500-011 Part No.8501388 0 850- Listed to U1,2703 Listed to UL 2703 Listed to UL 2708 .;y 4•� FlashingGround Insert Grip G d Zep V2 Part No.850-1628 Part No.850-1606 or850-1421 Part No.850-1511 Listed to UL 2703 Listed to UL 2703 Listed to UL 467 and UL 2703 N �F Description . PV mounting solution for composition shingle roofs Works with all Zep Compatible Modules �omPat Auto bonding UL-listed hardware creates structural and electrical bond • ZS Comp has a UL 1.703 Class"A"Fire Rating when installed using modules from any manufacturer certified as`Type V or"Type 2" : Captured Washer Lag End Cap DC Wire Clip U� LISTED Part No.850-1631-001 Part No. Part No.850-1509 Specifications 850-1631-002 (L)850-1586 or 850-1460 Listed to UL 1565 850-1631-003 (R)850-1588 or 850-1467 • Designed for pitched roofs 850-1631-064 Installs in portrait and landscape orientations • ZS Comp supports,module Wind.uplift and snow_load pressures to 50 psf'per UL 2703 Wind tunnel report to ASCE 7-05.and 7-10.standards • ZS Comp grounding products.are UL listed to UL 2703 and UL 467 ZS Comp bonding products are UL listed to UL 2703. • Engineered for spans up to 72"'and cantilevers up to 24" �—0 • Zep wire management products listed to UL 156.5 for wire positioning'devices Leveling Foot Part No.850-1397- zepsolar com zepsolar.com Listed to UL 2703 This document does not create any express warranty by Zap Solar or about its products or services.Zap Solar's sole.warranty is contained in the written product Warranty for This document does not create any,express warranty by Zep Solar or about its products or services.Zep Solar's sole'wartanty is.eontained in the written product warranty for each product.The end-user documentation shipped with Zep Solar's products constitutes the sole specifications referred to in the product warranty.The customer is solely each product.The end-user documentation'shipped with Zep Solar's products constitutes the sole specifications referred to in the pioducl warranty.The customer is solely responsible for verifying the suitability of ZepSolar's products for each use.Specifications are subject to change without notice.Patents and Apps:zspats.com.. responsible for verifying the suitability of ZepSolar's products for each use.Specifications are subject to change without notice.Patents and Apps:zspats:com. Document#800-1839-001 Rev D Date last exported:April 29,2016:11:22 AM Document#800-1839-001 Rev D Dale last exported:April 29,201611:22 AM