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Home My WebLink About33870-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Ro: Z-33179 Date: 07/31/08 THIS CERTIFIES that the building SOLAR PANELS Location of Property: 330 (HOUSE NO.) COunty Tax Map Ro. 473889 Section 120 OLD FIELD CT (STREET) Block 3 MATTITUCK (HAMLET) Lot 8.26 Subdivision Filed Map Ro. Lot Ro. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 21, 2008 pursuant to which Building Permit Ro. 33870-Z dated MAY 6, 2008 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is SOLAR PANELS ON AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ALFRED & MARIE DOMENICI (OWNER) of the aforesaid building. SUFFOLK COUl!lTY DEPARnmRT OF HBALTH APPROVAL N/A BLBCTRICAL CERTIFICATE RO. 3065497 05/15/08 PLUMBERS CERTIFlCATIOlII DATED N/A ~hor!!:!!:::::: Rev. 1/81 . TOWN ~;mS~U~HOLD ~~ \. .IL." \, . BUILDING DEPARTMENT \' : \ TOWN HALL JUl 3 oq 765-1802 I ; . APPLICATION FOR CERTIFICATE OF OCCUP~C~'\~;O . '~1::~ '---- 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: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Depl. 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 2/1 0 of I % 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-confonuing nses, or buildings and "pre-existing" land uses: L Accurate survey of properly sbowing all properly lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. Ifa Cel1ificate of Occupancy is denied, the Building Inspector sball state tbe reasons tberefor in writing to the applicant C. Fees 1. Cel1ificate of Occupancy - Ncw dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swinuuing pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Cer1ificale of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Cer1ificate of Occupancy - Residential $15.00, Conunercial $15.00 New Construction: Old or Pre-existing Building: Date. ~J Dr( SbI4N"''P~~ lIY\.. roaf V (ebeck one) Location of Property: S~O OLo:h"Jc! Lout\r House No. Street Owner or Owners of Property: \--tr1 K'i.P 1 A l t.r~d Suffolk County Tax Map No 1000, Section I -an ~ Hamlet DClWI .QYI i l~ Block DDC?' Lot DD<g. 0'2..(, Subdivision \ Filed Map. Lot: (S6llV'~d~) ~ Permit No. ; ~'X~ Date of Per111it~. 2/, 2CV ttj Applicant: (O~.lII' l:q Ie I,)J. aKl.e b(~tiA.ci. Health Dept Approval: tV It Underwriters Approval: #Vr Planning Board Approval: Request for: Temporary Certificate Final Certificate: ({'~-tU. 'ccJ::a ~ V (check one) m.c.u,y:.'~) ~~~ Applicant Signature Fee Submitted: $ cJo 2- 33179 ee C- '-1'ib c; <; . --, Il/), - !5 - 9. ?, (!J~.(!J ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Located at ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ii!re!ii!re!~(!J BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET - NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by GREENLOGIC LLC. 425 COUNTY RD 39A SOUTH HAMPTON. NY 11988, MARIE DOMENICI 330 OLD FIELD CT. MA TTITUCK, NY 11952 330 OLD FIELD CT. MATTITUCK, NY 11952 Application Number: 3065497 3065497 Certificate Number: Block: Lot: Building Permit: 0 BDC: ns11 Residential :3 3 '6" 10 Described as a occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located inion the premises at: Outside, Section: A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code andlor standard promulgated by the State of New York, Department of State Code Enforcel1J~nt and Admi~strat!~1l or other authority having jurisdiction, and found to be in compliance therewith on the 1St Day of ay, . Name OTY Rate .Rl!!i!!g Circuits IYM Alarm and emergency equipmeut Inverter Unit 1 0 3kw Solar Panel 12 0 200w Wiriug Aud Devices Disconnect 1 0 1-30 amp seal 1 of This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. ~ ~~ ~ ,--- FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 33870 Z Date MAY 6, 2008 permission is hereby granted to: ALFRED & MARIE DOMENICI 330 OLDFIELD COURT MATTITUCK,NY 11952 for : INSTALLATION OF SOLAR PANELS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 330 OLD FIELD CT MATTI TUCK County Tax Map No. 473889 Section 120 Block 0003 Lot No. 008.026 pursuant to application dated APRIL 21, 2008 and approved by the Building Inspector to expire on NOVEMBER 6, 2009. Fee $ 200.00 4.. W~ I (.JA- r Authorized Signature ORIGINAL Rev. 5/8/02 l !>}'l7o 7- TOWN OF SOUTHOlD BUilDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PlBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING I STRAPPING [] FINAL [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRAnON REMARKS: ~ ~ ~~~ ~ ~ ?:e, DATE 7 - r;-; ..- 0 8' INSPECTOR ~~ - FIELD INSPECTION REPORT DATE I FOUNDATION (1ST) ------------------------------------ FOUNDATION (2ND) ROUGH FRAMING & PLUMBING COMMENTS . . e-- . LNSULATlON PERN. Y. -- STATE ENERGY CODE FINAL . . . I "1A'J~ I" ~ .LV " -"" ~ ~j / _-11" .UP.~. . ~..h ,,'~. r-Y/a ~ ~ -~ 7?-'~ V v ~ .~~ ...... - . . ADDmONAL COMMENTS . . . . . . , . ~ \}i \lJ"" I:)(\M . ~~ ..., C. :tl:. ~ -~~ ~~ ~;. v Z IJ.,) 0 \}) o CIl >-I G'i \)~ ~ '>- :!\ ~- '" ~ ~J M >-I b , ~ .- i\: ~/ :? ? 0-~ --z m f"-h^' ~ '-- -M , ~ ~ ~ Q. >-I --" (5 Z [;i ~ .---.:;;: :i>~ ." , >-I H PERMIT NO. 33f70h BUILDING PERMIT APPLICATION CHECKLIST Do you have: or nr:ed. the fo~ before applying? Boord of Health H~ 4 sets ofBoiIdiog P18llS V Planning Boord TvaI JJs1 =.~ Septic Form N.Y.S.D.E.C. Trustees C..llIcI: Mail to: '12.5 l.oll.l\~4 A ,Sl.t.ck /0/ ~I~'r "ql.o~ TOWN OF SOUTHOLD BUILDING DEPARTMENT ..' TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 ....... northrork.net/Soutboldl Examined Approved Disapproved ale ~P's-:20QL I 20-Di Expiratioo 1/ h~ 20...a1 I -t~~~-- IT':\ .c' l'f' .i'. I APR 2 I c' p 'n ;;:" r"" I, I' - " I' \ ,1.. ll,_,,,,::,,-:'} ~J 1,._,. ; r I! , ! I APPUCATlON FOR BUILDING PERMIT Date L/ (Ff 1 o~ .20 oC ~.._ ....~! I INSTRUCTIONS - _ .!:.. '__1.: "'::~~- .' MUST be complelely fi\led in by 1ypeWri..... or in ink and submitted 10 the Bmldiog InspecInr wid> 3 sets ofplans, plan 10 scoIe. Fee ~di..., 10 scbedule. b. Plot plan showing locaIion oflot and of buildings 00 premises, reIatiooship to adjoining premises or public streets or areas, and ..-ways. Co The work covered by lhis application may not be c""...........! belbre issuance ofBuildiug Permit. d. Upon approval oflhis applicolioo, the Building \nspecIor will issue a BuiIdiog Pennit 10 the applicant. Such a pennit shall be kept 00 the premises available Ibr ;.,~ 1hrotJsbout the work. e. No buiJdiog shall be occupied or.-l in whole or in part ror IIIIy purpose what so ever UDIil the Buildiug \nspecIor issues a Cer\ilieale ofOccupan4:y. f. E""'Y buiIdiog pennit shall expiJe if the work authorized bas DOt .......-- wilhin 12 mooths after the dale of issuance or bas DOt been oompIeIed witbIn 18 mooths fiom such dale.1fIlO:rooina -.. or other reguIaIioos affecting the property have been euactecI in the interim, the Buildiog JnspeeIormay ...Abu.iz..., in writing, the e>rtenSi00 of the pennit Ibr an addi1ion six moolhs. T\lemIIl.er, a new pennit shall be mpDred. APPUCATION 18 HEREBY MADE 10 the BuiIdiog ~ fur the issuance of a BuiIdiog Pennit pursuant 10 the BuiIdiog Zooe 0Idi0aDce oftbe Town ofSoofhnLt, Sufti>Ik CeuIIIy, New YOlk. and other applicable Laws, 0edi0aDl:es at R<:gu\aIioos, for the eooslnIdion oCllo.Hdiqp. .."u...." or a11en1ioos or Ibrmuoval or demolilioo as beIeio described. The app~t~ toeomply ~ all ~ ~ onIinances, ~.... housing.... and n:guIations, and 10 admit authorized ~. 00 pmmses and m building ro.:.... y ....." ,0- (s$~ \4'l.!1 (J)u~lil'd ~q.A ,Swk. 101, ~Ou. ~ . iog_ofaPPIicant) /IqltN State whether applicant i. owne<, 1..-., agent, architect, engineer, geoem1_, electricisn, plumber 0< builder (l'M~~ 6"/IIl.nLoq;c. Nameofownet'of".~...;.e. t..la..ri.e U:>VYIe.n ;(..j t" A1~e..tA,: G; (As on the tax roll or latest deed) If is of duly authorized officer (Name and title of officer) Builders License No. Plumbers License No. Electricians License No. L4~ f. OtherTrade'.LicenseN~IIfI.l'f:thiMt il:;ii~"~ 40z,t:f' ~ H 1. '-!bIaDdOO~(!~~bedone: Yn.cdE-lwL House Number Street Hamlet County Tax Map No. 1000 Section , a.O Subdivision Block 3 Filed Map No. Lot ~ ' 2iP Lot (Name) 2. State exist!~ use and occupancy of premises an4 intended ~ and ~pancr of ~ coostruction: a. EXlstmguseandoccupancy ~R..f'\~JL. ~~ b. Intendeduseandoccupancy \t-l.<;,d""",a: ~.~~ 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition OtherWorkl"Wtl rllllf ,"^IIMW6 solcv JXU"4lJ .fH 2"+' (Description) 4. EstimatedCost 10, OOr> Fee 'if> VV . l (To be paid on filing this application) 5. If dwelling, number of dwelling wits Number of dwelling wits on each floor If garage. number of cars 6. Ifbusiness, commercial or mixed occupancy, speeny nature and extent of each type of use. 7. Dimen.ion.ofexistingstructures, if any: Front u.D ' Rear C;S Depth U' Height Number of Stories ;;i Dimensions of same structure with aIIeralIons or additions: Front JltJr Rear DeplIl Heigh\ Number of Stories 8. Dimensions of entire new coostruction: Front lJ Ir Height Number of Stories 9. Size oflot: Front ~S ' Rear 1. tfT) f 10. Dale OfPurch...~Name of Former Owner Rear Depth Depth ~l. r ' ~O P(~VI'oIlc;. 00IY1&" II. Zone or use disttict in which premises are .ituated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO v""" 13. Will lot be ~gtaded? YES_ NO ~II excess fill be removed from premise.? YES_ NO_ 14. Names of Owner of premises Address Phone No. Name of Architect Wit Address Phone No Nsme ofContractor4'" "",I nq.( III Address-:::Itz(. (""'~t/U lUhoneNo. "11" -.:Jll.~IC1... ~~1l4!.t IS a. I. this property within 100 feel of a tidal wetland or a freshwatei wetianJ/ '-YES _NO V . IF YES, SOUTIlOLD TOWN TRUSTEES" D.E.C. PERMITS MAY BE REQUIRED. b.ls this property within 300 feet of a tidal wetland? · YES_ NO_ . IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with lICCI1I1IIe foundation plan and distances to property lines. 17. If elevation at any point on property is stlO feet or below, must provide topographical data on survey. STATE OF NEW YORK) \,sS' COUNTY OFS\J~\ \'--) . ~ At b ~.e It.. being duly sworn, deposes sod says tbat (.)be is !be applicant (Name of individual signing contract) _ named, LmtV6.dnr (CooIrador, Agent, Cot1JO"IlI: Officer, eIc.) (S)Re is !be of said owner or owners, and is doIy authorized 10 perfurm or have perfurmed !be said - and 10 make and file this application; that a11............t. contained in this application are true to !be best ofbis koowledge sod belief; and that !be work will be perfurmed in !be manner set furth in !be application IiIed themNith. Sworn to before me ~ 0' (j;U~l::k]f\L:m , ~~ Andria Schne/der Notary Publle, Stale 01 New Ycllk No.01SC6117259 QualifIed In Nassltf PPJ!'!\}1 ^ _ . Commlli;Ion Explres~~ - ~~ ~ -- lE?DO - \ 20 - 3 - 8, L~ I . TOWN OF SOUTHOLD PROPERTY RECORD CARD TYI,IJJ,i e.- . . STREET :, Q [)ldf'lf Id ct ACR. I,~ TYPE OF BLD. . VILLAGE _.-- DIST. SUB. LOT /1 OWNER 1'10. if;fu c!( REMARKS q .--. I~a YrY7 V{' L ( ~ LAND IMP. TOTAL DATE 30D ,:)0 (:;{) () I bOO 146 FRONTAGE ON WATER TILLABLE -26 (41)5u(:, BULKHEAD HOUSE/LOT FRONTAGE ON ROAD DEPTH TOTAL / '200 Do" (,-{) ., , M:'~ld9 ~5"f"C- ~j!~~on ~l~fon ~~~~1on Patio <?:;';ch ~;c,~r Deck Breezeway . Garage ~""ir....r~ 0.6. Pool :5 5" o~ .:2 cl" ::>::> 9..9- .=~~~ - -~c =c _.~ !. -~'cc .! =-,-=-~ ~ ~:,- ~-=-.~-- ~=~ ~ 120.-3-8.26 4107 F""""'" 'f1J'J.fj== /1 J{tft /0":>)':: 1018 5..$0 5S9'1 Foundation /0,<(3 = 13D "-7S t.tRQ Basement ;,,<(3: nS- 3.5D 083 Ext Walls Itl )(J-:: 82- 1..00 Itd-I Fire Place t:,~'f(o Pl ~ "- .~D 1510 Dormer 4,IC(.,:;" ?:Ic' > 3rZ- 1.3.-ZI:: 483 71-5: Driveway I.~ . 75'lS- "- ~ ~ \\ \ \ ~ ~~ COLOR N91.. ;.,11 1\ Ie, . 7." r.'" , 1 " - '~t I ::1'1 . 1\ I ~ '. I- 1-4 - r.- ".. .'1 I ,!f"'- o.~,z.. (..,u{"^ f-"" f(J"'fe"- " ~ r;. fJ LAvA-lIFJ 'kt>A-rtI TRIM - 6k. 1""; ,f, "60"" " z..t.Afll I . t,. " . . ,- - - . I , . l i'I" 13 -.- " PC pc.. Bath J. '/7- Dinette CS FULL CRAWL Fvl' Floors JI. W~ Kit. SLAB Vlnvl Interior Finish 51/2... L.A. OhJ2- Heat .oU//\ D.A. Woodstove BA. Fin. B. Attic Rooms 1st Floor Rooms 2nd Floor .-"".,,1 A v",1uc 924.' '76'/ - MIW :;.",!./ /M-frohl tRI"- - 1,2.5<1 q/ ~5if lP/ April 5,2008 To: Code Enforcement Division From: James A. Marx, Jr. P.E. Re: Engineer Statement for Domenici Residence, 330 Old Field Ct., Mattituck, NY - Solar Photovoltaic Installation I have verified the adequacy and structural integrity of the existing porch roof rafters for mounting ofKyocera solar panels and their installation will satisfY the structural roof framing design-loading requirements of the New York State Residential Code -2007 For the installation of the Unirac SunFrame solar mounting, the mounting rails will be anchored to the rafters with L-feet supports located on the center of the rafters and will be securely fastened to the rafters with lag screws that have been designed for wind speed criteria of 120 mph Exp. C and snow ground criteria of20 psf. Wind loads will exceed seismic loads. Other climate and goo design criteria are not applicable to this solar installation. The design will meet or exceed Table R301.6 from the NYS Residential Code. The solar system and the mounting assemblies will comply with the applicable sections of the New York State Residential Code-Chapter 23 "Solar Systems" and loading requirements of roof-mounted collectors and roof penetrations. Thereby, I endorse the solar panel installation and certifY this design to be structurally adequate. ~ Sincerely, ^~<c::~ APPROVED AS NOTED (/4' ~./, l,l?!;rf~~~~'}:;,":,t'f,:~~:;\ DATE: 5/c,/~ BP.# 3'q;(70"b <""Y~-'" -'_. ~-Y<l, " , .... , ! n: _ "..... .t:r /h t, L" ., "I FEE: ,..>b<' u BY: ( ~ ~~' f~ J A M J "",,, '" , " ! cii NOTIFY BUILD:"'G CJcc',"TME~'T AT ames . arx, r. <i'\. ~" 't> 765-1802 8 t.M T() cu, FDR THE Professional Engineer {~~t ',j.,1 ,<t FOLLOWL'iG INS'~CT:. "s; NY 56467 N^.'_ . I'-V 'roral3\O~ 1. FOUNDATION - TWO REQU'C1ED ""'- - FOR POURED CC"CRETE 10 High Mountain Road ALL CONSTRUCTION SHALL 2. ROUGH - FRAMiNG & PLUMBING Ringwood NJ 07456 ME"'T THE REQUIPF' ':::NTS OF THE3. INSULATION , ~"DES OF NEWr STATE. 4. FINAL - CON."TRUCT!CN MUST WDERWRITERSCERnFicAfE AL~~g~~:RL~~~ION S~,~~'L MEET THE REQUIRED REQUIREMENTS OF THE WDES OF NEW YORK STATE. NOT iiESPON~;IBLc FOR DESIGN OR CONSTRUCTION ERRORS. OCCUPANCY OR cc:AshleeReinigeT,Gree~ IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY r..... GREENLOGIC ~ ENERGY Michael J. Verity Chief Building Inspector Town of South old 54375 Route 25 P.O. Box 1179 Southold, NY 11971 \0 I \:.' AUG 87p~8 ) I~' -, I t L----;..:;__-..(~~_;---... 11...._ )~ 1 \ U(Qv'!:'.i OF SC:JF~UL) Building Permit Number 33870 [DomeniciJ Dear Michael 1. Verity: f;f1>3&7o I am writing to certify that we, GreenLogic, LLC, have completed the installation of a solar electric system at Marie Domenic's home, 330 Oldfield Court, Mattituck, NY 11952, to the specifications of our Professional Engineer stamped plans and according to Dnirac SunFrame Code-Compliant Installation Manual 809. Please note that GreenLogic, LLC has installed tlj.e solar electric array found on the porch roof only. We do not certify or assume any liabIlity for the installation found on the upper roof of the main house. Thank You, ~~~ AshIee W. Reiniger Project Manager GREEN LOGIC, LLC . www.GreenLogic.com SO UTHAM PTON/COR PORATE 425 County Rd. 39A. #101 Southampton, NY 11968 Tel: 631.771.5152 Fax 631.771.5156 SOUTHOLO 52875 Main Rd., Box 435 Southold, NY 11971 Tel: 631. 765.0404 Fax: 631.771.5156 ...~".- MANORVI LLE 40 Woodland Avenue Manorville. NY 11949 Tel: 631.771.5152 Fax: 631.771.5156 ROSLYN HEIGHTS 200 S. Service Rd.. #108 Rosyln Heights, NY 11577 Tel: 516.625.6880 Fax: 516.625.6881 r.GREENLOGIC ~ ENERGY July 16,2008 m.~II,Il<, "i,,~____ , . vUl' 8 ?n,n,g 7 ,,1 I, i I Town of South old Building Department Town Hall 53095 Route 25 Southold, NY 11971 ')' I_~) L Dear Building Inspector: Please close out the building permit for Marie Domenici, 330 Oldfield Court, Mattituck (Building Permit #: 33870). Enclosed is the electrical certificate. Please schedule a visual inspection of the solar system and contact us with the scheduled date of inspection. Yours truly, ~~ Alexandra McNear Office Manager GreenLogic Energy 0'$/- -:;?-/. r-I r'2-. (QXt. 10:;) GREENLOGIC, LLC . www.GreenLogic.com SOUTHAMPTON/CORPORATE 425 County Rd. 39A, #101 Southampton, NY 11968 Tel, 631.771.5152 Fax 631.771.5156 SOUTHOLD 52875 Main Rd., Box 435 Southold, NY 11971 Tel,631.765.0404 Fax, 631.771.5156 MANORVILLE 40 Woodland Avenue Manorville, NY 11949 Tel,631.771.5152 Fax, 631.771.5156 ROSLYN HEIGHTS 200 S. Service Rd., #108 Rosyln Heights, NY 11577 Tel, 516.625.6880 Fax, 516.625.6881 r.... GREENLOGIC ~ ENERGY ])ate:i\priI18,2008 Town of South old Building ])epartment Town Hall 53095 Route 25 Southold, NY 11971 ])ear Building Inspector: Please find attached a building permit application on behalf of Marie and i\lfred ])omenici who have engaged us to provide a roof-mounted solar photovoltaic (PV) electric system (2400 watts) for their property on 330 Oldfield Court in Mattituck, NY. In connection with this application, please find attached: . i\ building Permit application . i\ Erosion, sedimentation, & storm water run-off assessment form . Survey of Premises . f\n engineers report approving the plan (four copies) . i\ One Line ])iagram of the electrical system . i\ Visio ])iagram of the proposed system . Spec. sheets of the solar panels (Kyocera KC200GT) . Spec. sheets of the inverter (Fronius 3000) . Suffolk Count Home Improvement License . GreenLogic Certificate of Liability Insurance . GreenLogic Certificate of Worker's Compensation Insurance Coverage . Master Electrician's License Please let us know if you need anything else in connection with this application. Yours truly, ~ear~ Office Manager GreenLogic Energy GREENLOGIC, LLC 34 Squires Path East Hampton New York 11937 teL 631.771.5152 fax: 631.771.5156 Bridgehampton I East Hampton I Southold I Hempstead I New York City www.GreenLogic.com 1 GreenLogic, LLC Proposed Domenici 2.4kW (12) Kyocera 200w UnlRac Sunframe Azimuth = 158 degrees Pitch = 20 degrees Scale 3/16" = 1.0' " . I '9; ;"'1 40'-6"\ 12 Kyocera 200w Panels Surface Dimension= 40' 6" x 6' (7' 6" unshaded section) Panel Dimension = 56.2"(563/16") x 39" Array Length = 468" Array Height = 59.2"(593/16") Porch Roof I ames A. Marx Jr. PI.k..la.... ~ 10 HIgh MaunIIIIn RoIId . .........., 07468 "". ,~I '",41' ...... A. .... fessIoD.ii EngiDeer LIceue 56467 Owner: Alfred Domenici 330 Old Field Ct. Mattituck, NY 11952 Lavout Created Bv: PJM Date: 2/5/08 .' GreenLogic. LLC Proposed Domenici 2.4kW (12) Kyocera 200w UniRac Sunframe Azimuth = 158 degrees Pitch = 20 degrees Scale 3/16" = 1.0' . (23) L-Feet (4) Splice Kits (5) 192" Rails ' I ~ ~ ~ ~ ~ ~ ~ ~ Existing Rooting. J "r: r-.' '~ .;. ~. . ;;>>'~<:~;:_-:, {,. - 2"x6" Douglas FU' I Spacing 16" o.c. . I A. ~" .0 ..} * Surface Dimension= 40' 6" x 6' (7' 6" unshaded section) Panel Dimension = 56.2"(563/16") x 39" Array Length = 468" Array Height = 59.2"(593/16") . .. Owner: Alfred Domenici 330 Old Field Ct. Mattituck, NY 11952 Layout Created By: PJM Date: 2/22/08 " Surface Dimension= 40' 6" x 6' (T 6" unshaded section) Panel Dimension = 56.2"(563/16") x 39" Array Length = 468" Array Height = 59.2"(593/16") ~:,l L__ - Unirac SunFrame Rails GreenLogic. LLC Proposed Domenici 2,4kW (12) Kyocera 200w UniRac Sunframe Azimuth = 158 degrees Pitch = 20 degrees Scale 3/16" = 1.0' - (4) Splice Kits (5) 192" Rails - A. u.x.. "'iii- .......... 1J .c. ............. 1<, ~ o/'Y-B ...,.A........ (esslon81 Engineer License 56467, Owner: Alfred Domenici 330 Old Field Ct. Mattituck, NY 11952 Layout Created By: PJM Date: 2122/08 I - 1 Sun Tie XR (2003 Model) Connect the Power of the Sun to Your Utility Meter In yO'W Cz.) ;.:.:.....":~;:._~,'-:'--~"-- ~-- .,...,...._...-~_.;;,"'"_.,,., "",....~-- ~ -I -I -! =1 =i --j ~i~~~.-- == . . Grid-Tie Technology The SIIn lie XR inverter converts DC energy generated by a solar array into utility grade AC power turning any household into a solar power plant. The SIIn Tie XR efficiently sells excess power back to the utility, significantly redudng monthly electric bills. With SUnsweepTM Maximum Power Point Tracking (MPPT) technology. the Sun Tie XR harvests the maximum amount of energy available from the solar array as environmental conditions change. Features ~ Quiet, efficient operation, utilizing high frequency sarro-s1a1e design. ~ Durable construction designed to accommodate """" environmen1s. ~ 1.5 kW and 2.5 kW continuous 0U1pUl models. ~ Standard si:rolling lCD display shows syslem status, power output. AC volts, array input voltage and energy harvest ~ Standard S year warranly (applicable to products manufactured after Fob 03). ~ Incorporates all AC and DC disconnects. PVGFP, combiner board. and the required electrical components for an NEC code compliant sys1em iostaUation. This simplifies syslern complexity and reduces installation time at the site. System Expandibility ~ Nominal 48 volt DC input aUows entry level sys1emS as smaU as four modules. ~ System expansion can be accomplished at a later date by adding additional "strings" of four modules in series. ~ Multiple SIIn lie XR units can be installed at a single site when the PV array exceeds the capacity of a single inverter. options ~ The optional remote meter (STRM) can be easily installed inside the home allowing homeowners to monitor sys1em status and performance. ~ The optional rainshield (STRS) allows the SIIn lie XR to be located in an outdoor location, minimizing DC wire length. xantrex X_ Technology Inc. Headquarters 8999 Nelson Way IIumaIJt British Columbia Canada V5A 485 BOO 670 0707 Toll If.. 604 420 1591 FaIr- 5916195th Northeast Arlington. Washington USA 9B223 360 435 8826 Telephone 360 435 2229 Fax _ V'2nt.DV ,...... . :.un lie AK I' (onnect the Power of the Sun to Your Utility Meter Electrical SpedficatIons - M.lluqooItValtllge ~ M. 0lItput VaItlIge__ c-...IiMaus Power (0 6"'Q EIficioa<y (Peat) M. 0lItput Chor...:b.1oll... Fn...enq (JIoIMIaI) DC ..... VaItlIge (JIoIMIaI) _ MPPrValtllge_ FaII_OlItput. --"'Opee~VaItlIge 51lOI15OD 140VAC 211-164VAC 1500VA 91" Cllmnt source 60Hz 48 voc 4HS voc 52-85 voc 120VOC S1ltIIZ5lIO 140VAC 211-264VAC l500VA 91" Current source 60Hz 48VOC 4HS VOC S2-75VOC 120VOC ..as Hz. -0.7 Hz default per Im929 & UI. 1741 Tjpi<alIy 4 _12 VOC PV _in..... T....__ Sine wave Sine wave Voltage teferenced - current SOWte "'"' _ ~ at ratl!d """"' per IEEE9l9 and UI. 1741 (all models) .."r..._ Ceneral 5pecifications OporatIngT____ -."... -Woigbt SIIippiog Inverter Dim .,.* SllippillgDiT ..4 --. - Wammty Part -.. -38 "flD 113 "I' (-39 "C ID 4S"Q lA fuII__ """'" performan<o aIM! ~ _in1l1e manual) 0uId000; ~0la1Ed........ _ fuIIr......m OptionaI,_....-to<__ 351r1161<g) 401r1181<g) 33'"' H x 13"'Wx S. D (83 an Hx 34anW x 13 an 0) 3r Hx l'.Wx 10. D(94an Hx39 anWx24an D) VerticalwaII.......onIy IS.000" 14.Sn ml SyeaGl""-lDproducts __ffh03) STXR1500. S1XR2SOO - Sun Tie XR InverterS 51115-_ S1RM-__ FeatIns a Options _AiFCooIiog Islanding Ph;~ IRr DbpIay M._ ue DiscoIlMd -- .... ShioId ...__............s,st.- ... eon.ioer""" UgIItIIiDg At'reshtr ACIDC 1\.11.1 tdon RegaIatoIy Approvals UllistedtoUL 1141-1stEcltion cUL Listed to CSA222 No. 101_1-95 _1!IermolIycoo1n>lled....spoed_ran __ACvoItageandlioqueJlq_plusaclM! isIandlng..- MemIEEE929andUl.1741 r&pIinmenIS _ _alphanumeric LCOdisplayfo<_-.sanddaily"""9Yham!st(Wh) S_ dooA>Ie1>oIe IS amp. 240 VAC branch ratl!d -- _singIe1>oIel00amp.OCratl!d__ 5IRM -optianaI.......display unitfo<....... ...........Wh meter; """ .......anddaily_ham!stwith SO' 0lIlIe 5I1I5-optianaI..-roln_""-fo<__ Standan:l (II STXR150D and STXR2500 S_... STlCIl.500 and STlCIll500with 6 fused ........ 20 amps l1lOllimum per..... Standard on aD models --~--- ,;"'.' /';, '~'J4: ""';;:'. ffl V.evW 1 f _.;;-;-';'"~ I I ~ I "",,,.:l!l filii". !!II. ~"' ""'">'.J>"- ." ~"" ~-~ l' , FRONIUS IG GRID-TIED INVERTERS FOR PHOTOVOLTAIC SYSTEMS Light Weight Flexible Lower Cost LCD Display Plug-and-Play Reliable Warranty At 26 Ibs, the FRONIUS IG inverters are the lightest grid-connected inverters making them easy and cost effective to instail. The wide voltage range of 150-500 V allows you to use different types of modules and system configuration possibilities. Integrated UL approved DC & AC disconnects which reduce instailation time and complexity - often eliminating the need for additional disconnects. User-friendly and comes standard with every FRONIUS IG; tracks more than 20 critical system performance parameters, Expansion slots in the inverter allow you to easily upgrade the inverter with data communication options. Fronius has been i? business for over 60 years and has more than 200,000 FRONIUS IG inverters instailed worldwide. 10 year Premium Warranty. POWERING YOUR FUTURE ~( "- '\ DC Input Data FRONIUS IG 2000 FRONIUS IG 3000 FRONIUS IG 25OO-LV Recommended PV power 1500 - 2500 Wp 2500 - 3300 WO / 1800 - 3000 Wp Max. DC input voltage 500 V 500 V / 500 V Operating DC voltage range 150 - 450 V I\. 150 - 450 V/ 150 450 V Max. usable DC input current 13.6A "- 18~ 16.9A AC Output Data FRONIUS IG 2000 FRONIUS IG 3000 FRONIUS IG 2500-LV Maximum output power @40o C 2000 W 2700 W 2350 W Nominal AC output voltage 240V 208V Utility AC voltage range 212 264 V (240 V +10% 1-12%) 183-227V Maximum AC current 8.35 A 11.25 A 11.25 A Maximum utilitv back feed current O.OA I 0.0 A O.OA Operatin freouency range 59.3 - 60.5 Hz (60 Hz nom) Total Harmonic Distortion THO <5% Power Factor (cas phi) 1 General Data FRONIUS IG 2iloo FRONIUS IG 3000 FRONIUS IG 2500-LV Max. efficiency 95.2% I 95.2% I 94.4% Consumption in stand-by < 0.15 W (niaht) Consumption during operation 7W Enclosure NEMA 3R Size (Ixwxh) 18.5 x 16.5 x 8.8 inches 1470 x 418 x 223 mm\ Wei ht 26 Ibs. (11.8 ka) Ambient temperature range -5 to 122 OF (-20 to +50 oc) Cooling controlled forced ventilaton Integrated AC and DC disconnects standard UL approved DC & AC disconnects Protections Ground fault protection Internal GFDI, in accordance with UL 1741 DC reverse polarity protection Internal diode Islanding protection Internal, in accordance with UL 1741, IEEE 1547 Over temperature Output power deratinn Surge protection Internal DC & AC protection, Tested to 6 kV Compliance Safety UL 1741 EMI FCC Part 15; Class A & B Anti.lslanding protection UL 1741, IEEE 1547 Ground fault detector and interrupter Compliant with NEC Art. 690 requirements, UL 1741 Miscellaneous Maximum AC over current protection Two-pole, 15/20 A circuit breaker AC wire sizing Use maximum AWG 6 1940F (90 OC) copper wire DC wire sizina Use maximum AWG 8 1940F (90 oc) cooner wire AC disconnect 16A DC disconnect 25A Warranty 10 year Premium Warranty is Standard '" ~ ~ .. j s j o c o . Distributed by a . . a . . ~~ '8'5 E~ . . ~t 0:: i: -.::= ~ -~ .0 <t . . . a ~ .S: ~~ c~ :5.~ 0-0 - . ~. -g,~ "S~ ~ 1ll ::i! =-E .0 0- B;; ~-~ " B .i:., ~. ~~ ~~ . . ~ ~ .~ ... .!! ~~ Fronius USA LLC Solar Electronic Division 10421 Citation Drive Suite 1100 Brighton, Mi 48116 Phone: 810-220-4414 Fax: 810-220-4424 E-Mail: pv-us@fronius.com www.fronius-usa.com ~ 00 ~ ;:: '" ~ o ~ 30 AMP two pole DC switch from panels to inverter 2 strings of 6 Kyocera 200W panels Array total of 2.4kW, @ @ @ @ Fronius 3000 Inverter 240 VAC 240 VAC from inverter to a 30 Amp switch near utility meter All panels to be grounded as per NEC code 30AMP3R switch near utility meter ...---- ..- .--- ~ K~[][ERa ~~s -.".------~.. ---1 THE NEW VALUE FRONTIER KC125G HIGH EFFICIENCY MULTICRYSTAL PHOTOVOLTAIC MODULE @ LISTED HIGHLIGHTS OF KYOCERA PHOTOVOLTAIC MODULES Kyocera's advanced cell processing technology and automated production facilities produce a highly efficient multicrystal photovollaic module, The conversion efficiency of the Kyocera solar cell is 15% These cells are encapsulated between a tempered glass cover and an EVA pottant with back sheet to provide maximum protection from !he severest environmental conditions. The entire laminate is installed in an anodized aluminum frame to provide structural strength and ease of Installation. Equipped with plug-in connectors. APPLICATIONS KC125G is ideal for grid tie system applications. . Residential roof top systems . Large commercial grid t.e systems . Water Pumping systems . High Voltage stand alone systems QUALIFICATIONS UL1703 certified. PERFORMANCE WARRANTY 25 yea(' limited warranty on power output SPECIFICATIONS . Electrical Specifications MODEL Maximum Powe, Maximum PovMt VOltage Malll.lml.i'l'ft Powot c..nenl Open Citcul1 VonilIge Short-C.rCU-tl Cunen~ _ lElnglh Widlh OePlh Weoghl . Thermal parameters Nominal ~.!.~_~II_T~per<'.ltu'o Ise Currenl tlmlpet'8lute eoet'lcienl (ArC) Voc VoIt39& tempe'-alure~ '(vj.C) KCl25G 125Watts 17.4Vofts 7 _20Amps 21.7Vofts BOOAmps l~~m (56 hn) 652mm (25.7in.t,__ 35.7mmp.4P1,) 12.2kg (26_8tbs) . Physical Specifications - - -----~--_..__.__. i I i (Unit: mm) .'\',' _ .;ii.i .. .;.1, ',1,1 - +L~-',i! "j'i r 1 r I I I ! i "". ~i~ c- , I ~ I 47"C (8,60 x I Cf-3) AI C ____ : (..a.42 x 16-1) vrc ~= ,r , "':-"1':' - .'._ t~ -~-- ...1:: :;... ,-~. --- '::Power DUlput of Ihe module aUer 2S years will nol bo IItSt> Illan 80..... 01 fh minimum power $POOHod In lhe data shee-l. Note- The <<tlecl,ieal $pOCitiealtOfU 3ro undOr le"l conddlcns 01 Irr.ldrarlOO or 1kwlm2. Spectrum of 1 5 air maS5 and cell temperalute 01 25'C Kym::era reserves the rignllo modily these SI>6Ci-healiOR$. wrthoul notic. ~O~~ J-fJD ~ ~s 12. SPECIFICATIONS Typical module production may resutt in a maximum power from 10% higher to 5% lower than Rated Power (Pmax). Under certain conditions, a photovoltaic module may produce more voltage and current than repofIBd at Standard Test Conditions (STC). Refer to Section 690 of the National EIeclrical Code for guidance in series string sizing and choosing overcurrent pr01Bction. Kyocera KC Seriee Module Specification EIectJ1caI CIIalllCt8rilltics:@ STC Model Number KC125GT KC130GT KCl67GT KC170GT KC175GT KC19OGT{ KC200GT Rated Power, Walla (Pmax) 125 130 167 170 175 190 2.00 Open Circuit Voltage (Voc) 21.7 21.9 28.9 29.0 292 32.5 Short Circuit Cunent (lac) 8.00 8.02 8.00 8.03 8.09 8.08 8.21 Voltage at Load (Vpm) 17.4 17.6 23.2 23.4 23.6 26.1 26.3 Current at Load (Ipm) 7.20 7.39 7.20 7.27 7.42 7.28 7.61 Maximum System Voc 600 600 600 600 600 600 600 Factory Installed Diode (QIy) Yes (2) Yes (2) Yes (3) Yes (3) Yes (3) Yes (3) Yes (3) Series F..... Rating (Amps) 12 12 11 11 11 11 11 Thannal CIIaractarlstlca: - Temp. coellicient of Voc (Vre) -8.21 x 10-2 -8.21 x 10-2 -1.09X 10-1 -1.09x1cr1 _1.09X10.1 -1.23X10.1 -1.23X10.1 Temo. coefficient of Isc (Afel 3.18X1o-3 3.16x10-3 3.18x10-3 3.18x10-3 3.18x10-3 3.18 x 10-3 3.18X1o-3 Temp. coefIjcient of Vpm (Vre) -9.31 X 10-2 -9.31 x 10-2 -1.24x10.1 _1.24X10.1 -1.24X10.1 -1.40X10.1 -1.40X10.1 Phyalcal Cllaracta)'latlcs: Model Number KC125GT KC130GT KCl67GT KC170GT KC175GT KC190GT KC200GT Length, Inches (nm) 56.1(1425) 56.1(1425) SO.S (1290) SO.S (1290) SO.S (1290) 56.1(1425) 56.1(1425) Width, Inches (nm) 25.7(652) 25.7(652) 39.0 (990) 39.0 (990) 39.0 (990) 39.0(990) 39.0 (990) Depth, Inches (nm) 1.42(36) 1.42(36) 1.42(36) 1.42 (36) 1.42(36) 1.42(36) 1.42(36) Weighl Pounds (kg) 26.9(12.2) 26.9(12.2) 35.3 (16) 35.3 (16) 35.3 (16) 4O.S (IS.5) 4O.S (IS.5) Mounting Hole Di...-r inches 0.28"(7) 0.26"(7) 0.28" (7) 0.28" (7) 0.28"(7) 0.28"(7) 0.2S"(7) Imml QIy-S QIy-S QIy-4 QIy-4 QIy-4 QIy-4 QIy-4 Gr~ing Hole Dia_ inches 028"(7) 0.28"(7) 0.28" (7) 0.28" (7) 0.28"(7) 028"(7) 0.28"(7) Imm QIy-2 QIy-2 QIy-2 QIy-2 QIy-2 QIy-2 QIy-2 NOTES (1) S1andard Test Conditions of irrediance of 1000 Wfm2, spectn.m of 1.5 air mass, and cell temperalure of 25 deg C. (2) Normal Operational Cell Temperature (NOel) of 800 wfm2, spectn.m of 1.5 air mass, and can temperature of 25 deg C. (3) See module drawing for mo..,ting and grounding hole Iocationa. KYOCERA KC125GT KC130GT KC167GT KC170GT KC175GT KC190GT KC2aOGT MODULE DRAWING ~ KC'2GTKC'3OGT KC.lI ,KC10 K1 " < MODULE DIMENSIONS " DI IN. DI F 1 . 2 "".11.7 '.'4 .. 71 , ."..- .. 7. 71" 28" ~:h. ~~T>< ----.I "r" 11 -J,,- "H" IL ". "~ LEt<GT>< .,. [T'rP,) o i~J If ~o'"_ ~~ ,'0' ........KUl 'i"O' - ,. ,,' .~ LE....TH ". "., lENOTl-l ". "~ ~oorn o o H -". ,," ~. (':2..-___ GROUNOONOHOLE -" -J,,- -H" ~ "'-11 O...7----t t-- 'Ja}. ---I- l--,.'8" """""'-= !:':.L___ < (+) < = =r (-) KC167GT ~ == , H ~ =ruo:r .,. ~. I[ O.47"--t t-- u}' ---I- 1-"'8- """""--"=' II o.oI-7"--t t-- 1:Jj}. --I 1-','8" ~ ." .,. ----'=-II ~. -------4 ',' '0' ~. O,39"---t t- o.;nI'-t t-- 'Ja]. ':j]}. --I t--..18" ---I- +-...11" ~ ~ O.47"-t 1- ~}. ---I- l--',"" """""'-"= .~~Yc?~k S~~~-,:,:~~d. ~Si1rcd'14 8 CORPORATE CEN1ER DR. 3RD FLR.1ELVlUE. NEW VORK 11747-3129 -fII31l--- CE:KII~ICATE OF ~ COMPENSATION INSURANCE . "A"A"A GFlEBI.OGlC LLC 24 SUNRISE AVE PO BOX 38 BRIlGEHAMP10N NY 11932 POLICYHOLDER GREENLOGIC LLC 24 SUNRISE AVE PO BOX 38 BRIDGEHAMPTON Ct:t<1R-ICATE HOLDER THE TOWN OF SOU1HOlD . BUU.DlNGDEPT 53095 ROlJlE.25 SOU1HOlD NY 11911 NY 11932 I~ POUCY NUMBER 11488 061-3 CERTIFICATE NlU3ER 882013 PERIOD COVERED BY 1ltIS CEkIIfICATE lI8I11Tl1J(11 TO lI8I11f.!1lll8 ~ THIS IS TO ~11F'i lHAT THEPOI..ICYI<<1IlE HAloED NJ/CNE IS INSURED WITH. THE NEW YORK STATE INSURANCE FlMI UNDER POUCY NO. 1488061-3 lIiITL 0Iff112OOB, CO\/ER!NG THE ENTIRE OIIlJGATlON OF THIS POLICVHOlDER FOR WORI<EJIS oc.- _.,.TlON UNDER THE NEW YORK ~ oc.- _.,.TlON LAW WITH ~ t:CT TO ALL OPERATIONS .. nESTATE OF NEW YORK. ......-, M NlICAl'B) BELOW, AND, wmt RESPECT TOOPERATlONS 0U1SIDE OF NEW YORK, TO THE POUCYHOLDER'S REGUlAR NEW YORK STATE ENPLOYEES ON..Y. FllAIDPOUCYIS CAI""""R'l,ORat!'...-.oPRlORT00Iff112lJOl1 .. SUCH ~M TO AFFECT THIS CERnFlCATE, .10 DAYS V.~'It:ft NOTICE OF SUCH CANCEU..ATlON WI.L BE GlYel TO THE C1:K.,....;ATE HOI..DER NJ/CNE. . NOTICE BY REGIa ~ MM. SO AIlImt: J . SHALL BE SUFRt:ENI' COMPI.IANCE WITH THIS PRO\/ISION. THE NEW YORK STATEINSURANCEFlMI DOES NOT ASSUME ANYLII\IlIUJY" THE EVENI' OF FAILI.IlE TOGIVE SUCH NOTICE. THIS =>I1......,.iE DOES NOT APPLY TO BUILDING DEMOlJ11QN. THIS =>I..-...ATE IS ISS-lED M A IMnER OF ... OIIM1\.TlON ONLY AND 00_ __ NO RIGKTS NOR INSURANCE CO\/ERAGE UPON THE w:ft.,....;ATE HOLDER. THIS '.."'..,....;ATE DOES NOT AIEN). EXl'END OR ALTER THE CO\/ERAGE AFFORDED BY THE POUCY. NEW YORK STATE INSURANCE FUN)) /~~I- m~ DIRECTOR,JNSURARJND~ 11IIs ~.... be ~"~1b4 on ourWllb 8ilII at hIIps:1lwww.nylllr~ IlI'IJrClllllng (Ma> 87~< lJ-2lI.3 VALJDA.TION NUf~ 914881542 ACORD.,. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDlYYYYI 02/04/2008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LoVul1o Associates. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6460 Transit ReI HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Depew NY 14043 INSURERS AFFORDING COVERAGE NAIC. INSURED Green Logic, LLC INSURER" SCOTTSDALE INSURANCE COMPANY 41297 PO Box 38 INSURER B: Brldgehampton, NY 11832 INSURER C: INSURER D: I INSURER E: COVERAGES THE POlICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDI110N 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY _.... POLICY EFFEC11VE POLICY EllPIRA 110N UMIT1I A ~ENERAL UABlUTY CLSl452918 01/3112008 01/31/2009 iErBa . 1,000,000 ~ 5""RClAI. GENERAL UA8lUTY . 100,000 _ ClAIMS MADE [!] OCCUR MEO EXP (Any on. p8I'1IOfI) . 5,000 -. PERSONAl & ArN INJURY . 1,000,000 GENERAL AGGREGATE . 2,000,000 -il~~nUMfT nSPE~ PROOUCTS. COUPIOP NJG . 1.000,000 X POLICY ~ LOC ~UTOMOBlLE LIABILITY COMBINED SINGLE UMIT . ANY AUTO (Ee8CCkkilnt) - - AlL OWNED AUTOS BOCltLY INJURY (Per penron) . - SCHEDUlED AUTOS - HIRED AUTOS BODILY INJURY (Per8CCld8nl} . - NON-OWNEO AUTOS PROPERTY DAMAGE . (Pw acciMnt) =fae UAWUTY AUTO ONLY ~ EA ACCIDENT . AHYAUTO OTHER THAN EAN;(; . AUTO ONlY: AGG . ~~.BRELlA lL'BUTY EACH OCCURRENCE . OCCUR D Cl.Ali.s MAIlE AGGREGATE . . =i ~0lX:THllE . RETENTION . . WORKERS COIIPENSATJON AND we STATU- 1"oP.'- eMPLOYERS" UABILITY E.L EACH ACCIDENT ANY PROPRIE'TORIPARlNERlEXECUTlVE . OfFlCERlMEMBER EXCLUDED? E.L DISEASE. EA EMPlOYEE $ ~m.1L~~sbeIcrN E.L DISEASE - POUCY LIMIT . OTHER DESCRlPnoN OF OPERATIONS ILOCATIONS I VEHICLES I exClUSIONS ADDED BY ENDORSEMENT I SPECIAL PROvtStON8 CERTIFICATE HOLDER CANCELlATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIE8 BE CANCEU.EO BEFORE lHE EXPIRATlOH Town of Southold DATE THEREOf, lHE ISSUING INSURER WILL ENDEAVOR TO MAl. ~ DAYSWRITTEN 63095 Route 25 N011CE TO lItE CER11FlCAlE HOUJER NAMED TO 1HE LEFT, BUT FAILURE TO DO so SHALL Southold, NY 11971 IMPOSE NO OBLIGATION OR LIA8IUTY OF lIMY KIND UPON THE IN8URER. ITS AGENTS OR REPRESENTA11VES. , ,u_~~lM' ~-L~ ACORD 25 (2001/08) Cl ACORD CORPORATION 1988 r ""': , , , , , , , , , ~ . :,'.: ;',:~~:. :y;. 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(NOTE: ACbeckMak 1,f)loreach ~ ill RequftdforaC!JlnPl8l8Atr,.6.......) Yes .!!2 1 ---------------------------------------------------- 2 3 4 5 6 7 8 9 WIIlhi1 PIlliad RalaIn AI SIonn-W_ Run-OIrGao_db.d by a Two (2") Inch RalnfaIonSIB1 (ThII1lam w111nduda" run-oIf..-ct by ole ~ and/or CCllIIIrucIIQn adMIIas as _as .. SIla I.."""'g'_.....slha ......l8ll8lIlCl'll8llanol~ surfacaI.) Does lha SIB...... and/or Survey ~ AI "''''''- ~ SbucIunls ".......'" SIze & ~ ThIs \lam ahaIlndude" "'.."...ed 0rMe ChIngas....s Slopes c..........,g SUlfacaW....FIo..I WIIlhi1. Pi'ojac:l R8ql.h _lalCI fling. GradIng or EllaMIIIan _lII8I8l1 a dlII1g8 to lha_ ~ _ hwoMng _.... 2OOC\ticV_ofMalarlal__Pan:el? W1111111 AwlItaliao. R8ql.h lalCI DIIIuIIIIng __ e.""".ojC i . III an Area In Excas8 01 FIv8 Thlum1d (5,000) SqIBa Feet of GIaund s..face1 Is _ a NaIIiraI W_ Course R/JmInll '-"'" lhe SIa? Islhil Pi'ojac:l_lha T..-jUI-.ac....._One~ (1llO')_oIa_...Be8ch? WII_ be SIB ",__.on EJcIIUng _Slapes_ ~_(15)_of- RIle'" One Hundred (100') 011.......... DI 1>..ca? WI! DriYaways, PaotcIng _ ..._1......- _ be SIopadto Dlrecta.......v........ Run-Otf Into andlorln lha _ 01 a T..... ~ WIIlhi1 Pi'ojac:lR8ql.hlhal'lbuoo....llofMalarlal. Reo."'" of V.... 11l..and/orlhe~oI _..... WIIhIn lha Town Righl4Way...Ro8d ~ IwIi1 (ThIs 118m wi. NOT _ the "........ of Dm6"8Y Aprona.) WilIhIs Project R8ql.h Sila Pi_...... _lha One HuncInId (100)V_ ~.of __1 ~b] ~ [d [d'-- [d [dl-/ [d [de-- [d~ NOTE: If AIrj Answer to ~ One through...... A;~tJ._..cI wllha Cbeck IIIIrk In'" Box. . ......-1[....... GradIng. 0. . -ga & _ ConInII Plan Is ReqaIIwd _ _lie _..11"'" farR8vWw _to -- aflVrt B....IIIII- __lION: ---------------------------------------------------- !!! No Does lhiI pn>ject _lha _ _.......Ior I -..... -.. AQricIAnI Pi'ojac:l? _ .VouA.___...y....._~.-.......~~&-~PlanIlNOTR8quInIdl V ---------------------------------------------------- srATEOF~~~ ..?~.f~.~.~~._..ss That I. ......._N.1".t...lLb.u...\::ttlk_..................... beio<< duly sworn; ~ and says tbaI: he/she is !he applicant for Permit, \Ifonle..-......-- And that he/she is the . ..................................c.Qr.l.k.u.cln:..:,..Qt.lf..ell.~1.C...u'--- _.OooOacIor.--.~C*or.....' Owner and/or ~ of !he Owner of Owner's, and is duly auIhorized to pedorm or haw pedonned Ihe said work and to make and file this appIiClIrinQ; that all................. CODIained in this appIicaIion are IlUe to Ihe ~ kJlo\v!ed&e and belief; and tbaI: Ihe work will be pedormed in Ihe manner set forth in the application liIed h~ Nola'y Public ~~~':w YcIIlc Sworn to before me Ibis; 1\ " No.Ol'SC6117259 _...._........1~;_....~....._. day ....~r..I.L............_-. <J1l..o <& eorru::~~~F!~ n~ NoIaIyPublic: ~ ...............................................---.-... ._._.~~._._._.- FORM.06lO7 . lOT AREA=: 54.l!O5 sq. ft.' . oPEN SPACE. ro. lION. " , R==~03.4-0 --- R. 50 L... 55 . 00, . ~~. 'Z Vl U1 o VA.i VA,. ~ . ~'..., 01 350 01-800 L===200.00' ---.:. ' ,.\..' , Jl_ ,I . ':J .' , . , "1_ CIJC- ~ l-/O-v . . -llo\ 0, <...ii, O. -n{ "..':' .... " '.' I , ~ \ e ~ .. .... .... ~ FD. lION /' . . .1I",," ,., I' ','. \, vr 'j \ ~ .-- ..- Ei ..... ~ E III !:J B6' '" III 1 LoI ~ I en ClI <:, ~ j LoI ~ C ;;c R= 50.00' ~ l- 78.54' 3ofO.OO' 5 7O'1"'~"N .15.00 OLDFIELD COURT NOlE: CESSPOOL AND SEPTIC TANK 12-13-2001 FINAL SURVEY LOCAllONS BY OTHERS. 7-12-2001 LOCAlm FOUNDAllON _~(III- .alllO__ ___m'IHE 0"_ _" UIIII ". PIlI A .-rID ........ .. .. .. 11 _ ". ..,.. _1IlI1UIl[1ItI_lII'_'" Im.,...__ ........ IlMM. MIDfIION 10 fl. -.. OIl III( 01HIJt ........,..., .-m. .~III_lDTIa_,."~OF__ ~lII''IHE____UII. 0IMIft1J lIMIt INDDIIED ..... -...u. ... -.v 10 'DE ...... FaR .... 1HE ....,'. . __na MD aN .. ...,. 'ftlI _ 1m.I: ....... IV_ bIIH1JL --~__.-._lD1ItI _,,_ ..- ~ ____ ,... _ IGT' 111 J~.......z 10 AElDI'fIOMflL ~ GI' . T-r .... _ OF TItS _ _ _ _ _ LMII ____ _ -. III .. .. .... INIU 111ft' . III ~ 10 .. A WUD .,.. CXPr. CERTIFIED ONLY TO ~o..GJ FT~~ N.Y. LIC. No. 048992 HAROLD F. TRANCHON JR. PENN. LIC. No. 2115-E JOB No. 01-17 FILE No. FARWEU ASSOClAlES SURl/EYED FOR LOT NUMBER 24 MAP OF FARMVEU ASSOCIATES SITUATED AT MATTlTUCK TOWN OF SOUll-lOLD SCAlE 1" = SO' DAlE 1-10-2001 FIlED MAP No. 8808 DATE 9-1-1989 TAX MAP No. (REF ONLY) 1000-120-3-8.26 DISK 500 HAROLD F. TRANCHON JR. P.C. LAND SURVEYOR 1866 WADING RIVER-MANOR RD. WADING RIVER, NEW YORK, 11792 831-929-4695 .?-