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HomeMy WebLinkAbout34262-ZFORM NO. 4 TO,tN OF SOUTHOLD BUILDING DEPD~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33497 I~te: 01/21/09 THIS U~TIFIE$ that the building SOLAR PANELS I~cation of Property: 2305 YENNECOTT DR (HOUSE NO.) (STREET) County T~x Map No. 473889 Section 55 Block 4 subdivision Filed Map NO. __ Lot NO. SOUTHOLD Lot 17 ( HANLE T ) conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 29, 2008 purs,,a~t to which Building Permit No. 34262-Z dated OCTOBER 30, 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. · ~me certificate is issued to MICHAEL F & BONNIE J DOROSKI ( OWNER ) of the aforesaid building. $~)I~K~I)[~ITYDEP~)~tT OF ~THAP~O~-AL N/A E~RICAL u~TIFIC~%TH NO. 4008544 12/16/08 PLUMBERS c~TIFICATION DA'r~3 N/A ~zed~ Rev. 1/81 Jan 13 09 10:57a Michael Doroski (631) 765-6599 TOWN OF SOUTHOLD 765-1802 APPLICATION FOR C~iCA~ OF OCCUpy ~.r ~ ~S appH~l~n must ' · ~ ~ ~ll~ m by i~nter ~ ~ ~d ~b~tted to ~e Bufl~g ~p~t ~ ~e ~ollow~g: A. For n~ buildi~ or n~ topo~ap~c f~. 2.Fin~ ApPW~ ~m Hea~ D~t. ofwat~ ~u~ly ~d ~werage.di~s~ (S_9 fo~) 3.Approval ofel~t~ ins~H~on ~ Bo~ of Fire Unde~ters. 4. Sworn ~tem~t f~ pl~r ~g ~t ~e ~ld~ ~ ~ s~t~ comains l~s ~ ~10 of 1% lead. Commereml ~il~g, ~d~ buil~g, multiple ~nees ~d 6. SubmR Planing Bo~ Ap~ of ~mplet~ ~te p]~ requi~. ~or ~fing b~d~gs ~or ~o April 9, 1~ non-confoming as~, or b~ld~g~ and ~r~existing" ~d 1. Acetate su~eY of p~ s~wing all pro~y lines, ~reets, budding ~d ~u~al na~ or 2. . A ~ly c~plet~ appli~o~ ~d co~ to i~ ~cd by de~ed, ~e Buil~g ~ctor shah sm~e ~e ~ ~refor in w~ting to ~e applic~L C. Fees ' ~ · , m to a~so~ buQd~g $25.~, Bus~ses $50.~. 2. Ce~ific~e ofOccup~ ~ Prc-c~s~ Buil~ng - $100.~ 3. C~y ofC~i~catc ofO~up~cy - $.25 4. Up.ted C~ificate of ~c~ - $50.00 5. Tcmp°~ C~iflcat¢ °f Oc~ - Residential $15.00, Commerci~ $15.00 New Construction: Location of Property: Old or Pm-existing Buildiag: House No. Street Owner or Owners of Property: f; { Suffolk County Tax Map No 1000, S~tioa Subdivision PermitNo...~ t?/,.7._ ~,L-~ ~ Da~eofPermit._ Health Dept. Approval: Planning Board Approval: Request for. Temporary Certificate. Fee Submitted: $ A~ica~t Signature _ Final Certificate: ~ (check one) U~derwriters Approval: ..L$~, ~L0.4,~ ~t'~ bl~){/~ [~.~ 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 425 COUNTY RD 39A SOUTH HAMPTON, NY 1196g, MICHAEL DOROSKI 2305 YENNECO'~' DR SOUTHOLD, NY 11971 Located at 2305 YENNECOTT DR SOUTHOLD, NY 11971 Application Number: 4008544 Section: Block: Lot: Certificate Number: 4008544 Building Permit: * BDC: ns11 Described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: photovoltaic,Attached Garage, Outside, 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 and/or standard promulgated by the State of New York Department of State Code Enforcement and Administratio, o,, or other loth I~ecemoer ~uoo, authority having jurisdiction, and found to be in compliance therewith on the Day of Name QTY Rate Rating Circuits Type AdditionalCharges photovoltaic system Alarm and emergency equipment Inverter Unit I 0 Solar Panel 24 0 Wiring And Devices Disconnect 1 0 Disconnect 1 0 06kw 0 1-30 amp 31-100 amp I of 1 seal 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 DEP~=RTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34262 Z Date OCTOBER 30, 2008 Permission is hereby granted to: MICHAEL F DOROSKI 2305 YENNECOTT DR SOUTHOLD,NY 11971 for : INSTALLATION OF SOLAR PANELS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at SOUTHOLD County Tax Map No. 473889 Section 055 Block 0004 Lot No. 017 pursuant to application dated OCTOBER 29, 2008 and approved by the Building Inspector to expire on APRIL 30, 2010. 2305 YENNECOTT DR Fee $ 200.00 Authorized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. [ ] INSULATION ~J~FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION DATE FOI~DATION (2ND) ROUGH FR_a2Vl]~G & I~S1.L ~TI{. N PER N. Y. STATE ENERGY CODE ~DITION~ COUNTS TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 76~1802 FAX: (631) 765-9502 SoutholdTown. NorthFork. net Approved , Disapproved a/c } ~ [ Expiration t~( ~ , 20 [ ~) BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Build~ng Plans Planthng Board approval Saptie Form ... N.Y.S.D.E.C. ~ TrusU~s }[ i Storm-Water Assessment Form. OCT a 9 2oos {D? g.t¢ . T(~/N OF $OUTHO[ D I ' -' Building Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS eq 20 a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sees of plans, accurate plot plan to scale. Fee aneording 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 Bulldin~ Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building sh,~l be occupied or used in whole or in port for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. £ 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 Dapmlmant for the issuance cfa 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 desedbed. 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 necessmy inspections. ( Signatur~ f applicant or name, ifa corporation) (~ailing address of applicant) State whother applicant is owner, lessee, agent, architect, engineer, general contracto~ electrician, plumber or builder Name of owner of premises k~ (~.0~ (As on the tax roll or latest deed If applicant is a corporation, signature of duly authorized officer (Name and tide of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land qn which propoged2york will be done: t. ,.. , House N~ber Street H~let Co~T~MapNo. 1000 Seaion ~ Block ~ Subdivision Filed Map No. Lot 2. State existing use and occupancy of promises and intended use and occupency of pressed construction: a. Existing use and occupancy Sll/t~[.~ ~l~'O. gt~l~ (~Ltl,) b. Intended use and occupancy ._~ 3. Nature of work (check which applicable): New Building. Repair Removal 4. Estimated Cost 5. If dwelling, number o f dwelling units If gara§e, number of cam 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front ,..~ ~ t Rear ~t[t Depth Height. Number of Stories Dimensions of same structure with alterations or additions: Front )[/fir Rear Depth Height. Number of Stories 8. Dimensions ofentire new construction: Front N'~ Rear .Depth Height Number of Stories 9. Sizeoflot:Fmnt Ibl~~ Rear tq .'~/ Depth [.~'L] ' lO. DateofPurchese f~.U. ~[.O"~t NemeofFormerOwner 1 l. Zone or use district in which premises are situated I~'~[ ~ 0L~'~ ~ 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO 13. Will lot be re-graded? YES__ NO I,~ill excess fill be removed from premises? YES__ NO 14. NemesofOwnerofpremisesM.~J)O(0~[a' AddressZa~J~e~lt~'¢Ol~l'M PhoneNo. 10~l Name of Architect ~tp~ Address Phone No NameofContractor~ Address qY-.~3 t6n~O.~[~- PhoneNo. ~l 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * 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 * IF YES, D.E.C. PERMITS MAY BE REQUIRED. Addition Alteration Demolition Other Work I Igl ~ ~(Description)ll't~-t I~ Fee (To be paid on filing this application) Number of dwelling units on each floor 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 end restrictions with respect to this property? * YES __ NO · IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY OF..(~ ~[0 ~ilrYI ~1~ [ [~UL~-16~ ~ being duly sworn, deposes and says that (s)he is the applicant ~me of ~vidufl sing con~a~) a~ve (Con~ctor, Agent, Co~rme Offi~r, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner s e3,fo~r t~_ in the application filed therewith. s Notary Public ~ Futile, Sta~ of New ~bth N(X 4855659 ? Sign~ o~Applicant ' GREENLOGIC ENERGY October 27, 2008 Town of Southold Building Department Town Hall 53095 Route 25 Southold, NY 11971 Dear Building Inspector: Please find attached a building permit application on behalf of Michael Doroski who has hired us to install a roof-mounted solar photovoltaic (PV) electric system for his home on 2305 Yelmecott Drive, Southold. In connection with this application, please find attached: · A building Permit application Survey of Premises An engineer's report · A One Line Diagram · A Visio Diagram of the proposed system · Spec. sheets of the solar panels (SunPower 225 watt panels) · Spec. sheets of the inverter (SunPower SPR 6000m) · GreenLogic Suffolk County Home Improvement License · GreenLogic Certificate of Liability Insurance · GreenLogic Certificate of Worker's Compensation Insurance Coverage · Installation Manager's Master Electrician's License · Master Electrician's Certificate of Liability Insurance · Master Electrician's of Workers Comp Insurance Please let us know if you need anything else in connection with this application. Yours truly, Alexandra McNear Office Manager GreenLogic Energy GREENLOGIC, LLC · www. GreenLogic.com SOUTHAMPTON/CORPORATE 425 County Rd 39Ar #101 Southampton, NY 11968 Tel: 631,771.5152 Fax 63].771,5156 SOUTHOLD 52875 Main Rd., Box 435 Southold, NY 11971 Teh 631,765.0404 Fax: 631.771,5156 MANORVILLE 40 Woodland Avenue Manorville, NY 11949 Teh 631.771.5152 Fax: 631771.5156 ROSLYN HEIGHTS 200 S Service Rd, #108 Rosyln Heights, NY 11577 Tel: 516.625.6880 Fax: 5166256881 500Om, 6000m & 7000m INVERTERS EXCEPTIONAL RELIABILITY AND PERFORMANCE The SunPower inverters 500Om, 6000m & 7000m provide exceptional reliability and market-leading design flexibility. The SPRm line of Solar Inverters can be easily applied in residential or commercial installations. AIl models come with a 1 O-year warranty. SPR-5OOOm, SPR-6OOOm & SPR-7OOOm www. sunpowercorp.com 500Om, 6000m & 7000m INVERTERS EXCEPTIONAL RELIABILITY AND PERFORMANCE SPR-5OOOm SF~*-6OOOm SF~-7OOOm AC Max O~*~mt ~ r~ 1 I 1 i Slas'~dby / < 7 w / o.25 w INscaene~ SPRm Efficiency Curves 75 Ship,rig D~mmskvns W x H x D i 23.5' x 31.0' x 16.0# UL 1998, FCC Pod 15 A & B SunPower designs, manufactures and delivers high-performance solar electric technology worldwide. Our higbefficiency solar cells generate up to 50 percent more power than conventional solar cells. Our high-performance solar panels, roof tiles and trackers deliver significantly more energy than competing systems. www. sunpowercorp.com 225 SOLAR PANEL EXCEPTIONAL EFFICIENCY AND APPEARANCE The SunPower 225 Solar Panel provides a revolutionary combination of high efficiency and air,active, uniform appearance. Utilizing 72 next generation SunPower all- back contact solar cells and an all-black backsheet, the SunPower 225 elegantly delivers an unprecedented total panel conversion efficiency of 18.1%. The panel's reduced voltage-temperature coefficient and exceptional Iow-light performance attributes provide far higher energy delivery per peak power than conventional panels. SPR-225-BLK SunPower's High Efficiency Advantage - up to 50% More Power Efficiency 12.0% kWs 3.0 225 SOLAR PANEL EXCEPTIONAL EFFICIENCY AND APPEARANCE Peak Power [+/-5%) Pmax 225 W Rated Voltage Vmp 41.0 V Rated Current Imp 5.49 A Open Circuit Voltag __ Vo¢ _--_ 48~.5 V ~ Short Ci~-uit Current Isc 5.87 A Maximum System Voltage IEC, UL 1000 V, 600 V Temperature Coe~ficienls Power -0.38%/°C ........ Vo~t~g_e_?~c].. ~-1..32.5 rnV/~C Current {Isc] 3.5 mA/°C Series Fuse Rating 20 A Peak Power ~er Unit Area 181 W/m2, 16.8 W/f~ CEC PTC Rating 207.1 W 7.0 6.0 5.0 1000w/,~ 4.0 2.0 1.0 0.0 0 10 20 30 40 5O 6O Voltage Temperature -40° C to +90° C [-40°F to +194°F) J impact Resistance Hail -25mrt Jl in) al 23 rn/$ J52 rnph) Solar Cells 72 SunPower all,ack conlact monocr~tolJJP~ Front Glass 3.2 mm (1/8 in) mm~ere~ Junction Box lPg5 rated wilfl 3 bypass diode~ Output Cables 900mm lenglh cable / MultiContact connectors Frame Anodized aluminum ahoy type 6063 V~ight 15 kg, 33 lbs Warronly 25 year limiled power warranty I 0 year lirniled product warranty Certifications I[-C 61215, S~ ~sl~l IEC 61730 UL IislecJ JUL 1703), Class C Fire Rating CAUTION: READ SAFE'I'Y AND INSTALLATION INS'II~UCTIONS BEFORE USING 11'IE PRODUCT. Go to www.sunpowercorp.com/penels for details SunPower designs, manufactures and delivers high-performance solar electric technology worldwide. Our high-efficiency solar cells generate up to 50 percent more power than conventional solar cells. Our high-performance solar panels, roof tiles and trackers deriver slgnifi¢ontly more energy than competing systems. ~ Printed on recycled paper i www. sunpowercorp.com ACORD,. CERTIFICATE OF LIABILITY INSURANCE ,RODUC~ THIS CERTIFICATE IS ISSUED AS A MAI'I'ER OF INFORMATION LoVullo Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6450 Transit Rd HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # I,SUP. ED GreenLogic, LLC iNSURER ~ SCOTrSDALE INSURANCE COMPANY 41297 PO BOX 38 INSURER B: Brtdgehampton, NY t t932 iNSURER C: INSURER D: COVERAGES THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. No'r~NtTHSTANOING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A =~'~E~. Lmmcrry CLS1452918 01131/2008 01/31/2009 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL UABIUTY PREMI .SE~; (Ea =ccur~ce) $ 100,000 CERTIF~ATEHOLDER CANCELLATION Town of Southold 53095 Route 25 Southold, NY 11971 ACORD 25 (2001108) © ACORD CORPORATION 1988 STATE OF NEW YORK WORKERS' COMPI~/~TION BOARD CERTIIqCATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Addrms of Insured (Use street addre~ only) Gr~nohgie LLC County Rd 39A SMte 101 Southmpton NY 11968 wor aou orhsumS (osty 2. Nme and Address of~he Entity Rfques~ng Proof of Coverage (Enfl~r Being Listed as ~he Cerflfl~te HoMer) The Town or SoutboM BIdE l)epL S309S Rle 2S SOUthOM NY 11~71 lb. Business Tdq~one Number of Insured 631-771=~1~2 lc. NYS UnempJoymeut Insurance Employer Rf~b~raflon Number or lusuFed Id. Federtl Employer ldeng~etfion NumlMr of Insured or So,hi Secarf~ Number 203801194 Name of Imurnnee Carrier 3b. Polk? Number of ~ufliy listed in box "la" ~. l~)tJcy effective period 8/11/2009 ~o 8/11/2009 3d. The Proprietor, Psrmers or Executive OfFicers ore X inchded, (Od~ ~ mtr d lurmrsZ~3~.s bdud~ [] HI exchtdal or certnfl jmrmer~fllcers ezchd~. This cgflifi~s that tl~ insuran~ cerr~ indicated abovc in box "3' insuru the bmin~s rc~reuced ~e in box "la' for woflms' COmlMmmfion under the New York State Wed~rs' Compensation Lmv. (Fo use tMs form, New York (NY) mint be ~ ~ ~ 3A on t~ INFORMATION PAGE of th~ work. s' ~ imm'an~ pokey). TT~ lmuran~ Carr~ o~ its lic~s~l agent v~l smd thls Ce~_ _,~__ of Insurance to the u~;~y listed above ns the certificaM holder in box "2". Tb~ lnser~ Carri~r will also notify t~ abow c~e holdw vAthin l O da~ lFa pol~y l~ cancd~d da~ to nonpa~n~t of t~niwn~ ~r v~dn $~ da~ ~F ~h~r~ are re~ns ~th~r t~an n~payment ~f pr~m~zens t~ canc~ t~ p~icy ~ dim~e t~ ~ t~ Please Note: Upon ~he eanedlntion of Ihe workers' eompemah policy indkated on fids foun, if the Imshm m m h named on a ptmlit, lianue or tontra~ issued b~ a tert~kat~ hoid~, th~ Imsim~ must provid~ that eel~Nfltat~ ~ ~ a n~ C~GF. dnt~ of Worl~rs' C~mpmantion Cov~n~ or other authorbml proof that the bus~nen is eomplylng with the mandatory eovemg~ requirements of the New York Stn~ Worlmn' Compensation Law. Under pmmlty of perjury, I e~nfify that I m an authorind r~prta~mmtiv~ or Kuam~l ag~t of tb~ imran~ tarr~r r~ftre~etd above and that h named insured has the coverage as depietM on this form. 631-941-4113 Ple~e NOW.: Only tr,~rance carr~$ and their llcensexl agents are authorlted m ~ Form C-105.2. Imuran~ brolttrs are NOT asaharizedtoi, vmeit C-105.2 (9-07) www.wcb.a~.ny.m Suffolk County Executive's Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 12/10/2007 SUFFOLK COUNTY DATE ISSUED: Master Electrician License No. 43858-ME This is to certify that ROBERT J SKYPALA doing business as GREENLOGIC LLC having given satisfactory evidence of competency, is hereby licensed as MASTER ELECTRICIAN in accordance with and subject to the provisions of applicable laws, rules and regulations of · NOT VALm WITHOUT *DEPARTMENTAL SEAL AND A' CURRENT CONSUMER AFFAIRS m CARD the County of Suffolk, State of New York. Additional Businesses Director 3 strings of 8 SunPower 225 watt panels Total array 5400 All panels to be grounded as per NEC code 1,30 AMP three pole DC switch from panels to inverter SUNPOWER SPR 6000 INVERTER 240 VAC ~ 240 VAC from inverter to a 30 Amp switch near utility meter GreenLogic, LLC Proposed Doroski 5.4 kW 24 Sunpower 225w UniRac Sunframe Azimuth = 160 Pitch = 15 Scale 3/16" = 1.0' 'anel Dimension = 61.39"(61 7/16") x 31.42"(31 7/16") Array Length = 282.78"(282 13/16") Array Height = 188.67"(188 5/8') Magic # = 62.14" (62 1/8") String Configuration String of Panels Inverter Layout Created Bv: PJM Date: 8/18/08 Town 'of Southold Sed_~n'& S--~~ ASSEBSMENT FORM Yes No t 2 3 4 5 6 7 8 9 No~: I~ you Aoswffed Yes to rids Questi°n, a Stmln'Wat~' Gf~ DraInage & Er°~°n Ccn&'A Plan is NOT Requh~d! Yes N_.~o ACORQ. CERTIFICATE OF LIABILITY INSURANCE I PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LoVullo Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6450 Transit Rd HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Depew NY 14043 INSURERS AFFORDING COVERAGE NAIC # ~NSUReD GreenLogic, LLC INSURER~: SCOTTSDALE INSURANCE COMPANY 41297 PO Box 38 INSURER B: BHdgehampton, NY 11932 INSURER C: INSURER C~ COVERAGES THE POLICIES OF INSURANCE USTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIO CLAIMS. EACH OCCURRENCE $ 1,000,000 A G~ERAL MABlUTY CLSt452918 0113112008 0113112009 DAM. AGE TO REN~EU I CLAIMS MA~E ~--] OCCUR ME D E}(P ~ty ~'~e pease-i) $ 9,000 GENERAL AGGREGATE 2,000,000 $ CERTIFICATE HOLDER Town of Southold 53095 Route 25 Southold, NY 11971 ACORD 25 (2001108) CANCELLATION © ACORD CORPORATION 1988 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CF_,RI'IFICATR OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (Use street address only) Greenologic LLC 425 County Rd 39A Suite 101 Southampton NY 11968 Work Location oflnsured 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Lfsted as the Ceflifieate HoMer) The Town of Southold BIdE DepL S309S Rte 2S Southold NY 11971 lb. Business Telephone Number of Insured 631=771-SIS2 le. NYS Unemployment Insurance Employer Registration Number of Insured l& Federal Employer ldentifiention NumlMr of lnfured or Social Security Number 3a. Name of Insurance Carrier National Union Fire Insurance Company 3b. Policy Number of entity listed in box "la~' 992419S 3c. Poliey effeetive period 8/11/2008 to 8/11/2009 3d. The Proprietor, PartneFs or Executive Officcrs are [] all excluded or cemin partners/officers excluded. This ceflific~ tlmt lite insurance cartier illdicaled above in box "3" instlres thc bus,ess rcfcrcnce, d above hi box "la' for workers' compensntion trader the New York State Worke~' Common Law. (To use this form, New York (NY) must be Hsted under Item 3A on the INFORMATION PAGE of the workenJ' compemmtion Insurance policy). The Insurance Carrier or its licensed agent will send this C. erfifica2 of Imu-ance to the e~fity lJ~ed above as ~he certifica2 holder in box "2". The lnsurwnce Carrier will also notffy the above c~rtif w~te holder within 10 days IFa policy is canceled due to nonpayment of premhtms or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the ht~red from the co,er ~ge indicated on tt~ Certific~ ffl~se notices may b~ se~t by regular mail.) O~er~e, flfb ~ is mild for one ye~r q[ter tk~form l~apro~lbytketammaceearrierar~lk~mt~a~, or sm~ t~epa/~y e~p/rafloa date//~e~/n box '$c~, ~k/c~e~e~/~ Please Note: Upon the eaneellntion of the workers' eompeneation poliey indleated on this form, if the business eontinues to be named on a permit, license or contract issued by a e~rtiflcate homer, the business must provide tht ctaii~ate homer with a new Ceriifleste of Workers' Compensation Coverage or other authorized proof that the bneiae~s Js complying with the mandatory coverag~ requiremeuts of the New YoFk State WoFkers' Compeneation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insuranee cartier referenced above and that the nnmed Insured Ires the eoverage as depleted on this form. Approved bT. Approved by: p~te~. Z~lkofske (t~.~ ~-~ ~ AU~. 6. 2008 (sipm~) Title: Telephone Number of au~orized repre~ntafive or licensed a~ent of insm'ance canie~. 631-941-4113 Ptease Note: Only Insurance carriers and their ltcensed agent~ are authorized to tssue Form C-I O5.Z Insurance brokers are NOT authorized to issue it. C-105.2 (9-07) www.w~.sMt~.ny, us Suffolk County Executive's Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 12/10/2007 SUFFOLK COUNTY DATE ISSUED: Master Electrician License No. 43858-ME This is to certify that ROBERT J SKYPALA GREENLOGIC LLC doing business as having given satisfactory evidence of competency, is hereby licensed as MASTER ELECTRICIAN in accordance with and subject to the provisions of applicable laws, rules and regulations of .... the County of Suffolk, State of New York. Additional Businesses NOT VAL}D WITHOUT ~DEPARTMENTAL SEAL AND A' CURRENT CONSUMER AFFAIRS ID CARD Director Michael Drake 20 October 2008 Mr. Michael Doroski 2305 Yennecott Drive Southold, New York 11971 Professional Engineer License #069543 14 Captree Island Box4619 ~, Babylon, NY 11702 ~ 'oA / (Ph) 631 893-9~5c:~-- #~'~' (FX) 631 669-9~. ~'. cap~eeisl~d~aol[¢~?~ FOLL': ": 7 :' ': FOR 2. '3U~':' ' ? ' BE COiv',PLE~ ~ . ~_L.CONSTFA~';7 ;r4 5~ ;..LTTT THE ~: S~c~fl Review of roof for sol~ p~el lns¢2~8~[~po[~k~:Resi~ 2305 Ye~eco~ Drive Southold, New York 11971 x.,c~ ,, ~ DEGIGN OR C~,~,~ ~,:~'N ERRORS, Dear Mr. Doroski, I have verified, by design, the adequacy and structural integrity of the existing roof for mounting solar panels and their installation, with the following recommendations, will satisfy the structural design-loading requirements of the New York State Residential Code-2007. The roof section in question should be supported with and additional 2x8 #2 D.F. mounted ~ the north(west) end roof rafter mounting position and the second from the south(east) end roof rafter mounting position-see attached drawing, then this roof assembly will be in conformance to the present N.Y.S. building codes, including the 120 m.p.h, loading requirement. Thank you for your consideration. If you have any_g_u, es, t, io~s concerning this matter, or ifI can be of asmstance ~n othe~,~rfffitf~C,'~e"~d~'~o ~ot hesitate to co. ntact me at 631-893- 9213. ~ ALL CON' MEETTHE RE~ -~.,, ~ i:~:, OF THE CODES OF t,,u¢,¢ ~U, ,,,. ol'ATE. OCCU?ANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OFOCC - · CERTIFICATION OF NAILING & CONNECTIONS REQUIRED. 14 Capiree Island, Babylon NY 11702, 631-893-9213, f631-669-9404 captreeisland ~/l OL. COM DORO3KI RESIDENCE 2305 YENNECOTT DRIVE SOUTHOLD~NY 11971 GreenLogic, LLC Proposed Doroski 5.4 kW (24) Sunpower 225w UniRac Sunframe Azimuth = 160 Pitch = 15 Scale 3/16" = 1.0' MICHAEL J, DRAKE JR, P,E, 4619 CAPTREE ISLAND BABYLON,NY 11702 631-893-9213 ADD 2X8 R,R, APPROX, 12' LONG THESE LOCATIONS Panel Dimension = 61.39"(61 7/16") x 31.42"(31 7/16") Array Length = 282.78"(282 13/16") Array Height = 188.67"(188 5/8') Magic # = 62.14" (62 1/8") 2" x 6" Douglas Fir 16" on center Collar ties every 32" o UniRac Lfeet String Configuration 3 Strings of 8 Inverter Layout Created By: PJM Date: 8/18/08 EDITED By: MD Date: 10/28/08 TOWN OF SOUTHOLD PROPERTY RECORD CARD _FORMER OWNERM, Vqr~ ~olc~r(.n~ R 40 LAND / ~oo /7--66 1 7~oo AGE NEW FARM SEAS. IMP. NORMAL Ac re STREET TOTAL /~ I-/"b VILLAGE W BUILDING CONDITION FARM CO'MM. DATE ~//? ~ BELOW ABOVE CB. MICS. REMARKS Value Per Vclue Acre TYPE OF BUILDING Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowla~d DEPTH House Plot BULKHEAD DOCK 55.-4-17 3/06 ~nsion Foundation Bath ~ ~ Dinette ~ Fire Plac~ ~ He~t D~. Breez~wo~ ~,~ Og2LzWO ~ T~eR~f RoOms lstFIoor ~ ~I~,~ P~Z ~00 Recreation__. R~m Rooms2ndFIoor FIN. B O, B. Dormer Driveway Total j J