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HomeMy WebLinkAboutTR-7213AJill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hail Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0545C Date June 1, 2010 THIS CERTIFIES that the roof mounted solar photovoltaic system on the existing dwelling At 100 MacDonald's Crossing, Laurel Suffolk County Tax Map //145-4-15 Conforms to the application for a Trustees Permit heretofore filed in this office dated 11/20/09 pursuant to which Trustees Wetland Permit #7213A dated 12/16/09 was issued and conforms to all of the requirements and Conditions of the applicable provisions of law. The project for which this certificate is being issued is for a roof mounted solar photovoltaic system on the existing dwelling. The certificate is issued to INA HASDAY owner of the aforesaid property. Jill M. Doherty, President Jamc~ F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (631 ) 765- ! 892 Fax (631 ) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: ~"~Ch. 275 Ch. 111 INSPECTION SCHEDULE INSPECTED BY: COMMENTS: __ Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction ~ constructed Project complete, compliance inspection. ,/, CERTIFICATE OF COMPLIANCE: James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghos±o, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE __ Pre-construction, hay bale line __ 1st day of construction ¼ constructed __ Project complete, compliance inspection. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7213A Date of Receipt of Application: November 20, 2009 Applicant: Ina Hasday SCTM#: 145-4-15 Project Location: 100 MacDonald's Crossing, Laurel Date of Resolution/Issuance: December 16, 2009 Date Of Expiration: December 16, 2011 Reviewed by: Board of Trustees Project Description: To install a roof mounted solar photovoltaic system onto the existing dwelling. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the application prepared by GreenLogic, LLC, received on November 20, 2009. Special Conditions: None. Inspections: Final inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Jam~es F. Kin~'g, ~ent Board of Trustees JFK:eac SURVEY OF P/O LOT 12 & LOTS 13 & 14 ~ OF EDGEMERE PARK LAUREL Nathan Taft Corwln III Land Surveyor /~ ??ROVED ~,~": BOARD OF TRUSTEES TOWN OF $OUTHOLD James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD / Please be advised that your application dated /~~~--~'has _ ,~, been reviewed by this Board at the regular meeting of ~(,"]~./-/~,. ~ and your application has been approved pending the completion of the following items checked off below. __ Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ~ Constructed ($50.00) t//"Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: BY: James F. King, President Board of Trustees James F. King. President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. P,O. Box 1179 Southold, NY 11971 Telephone ( 631 ) 765 - 1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report Date/Time: GreenLogic, LLC on behalf of INA HASDAY requests an Administrative Permit to install a roof mounted solar photovoltaic system onto the existing dwelling. Located: 100 MacDonald's Crossing, Laurel. SCTM#145-4-15 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 .Chapt.~3/ other Type of Application: ~-'Wetland Coastal Erosion __Administrative__Emergency Pre-Submission __ __Amendment Violation Info needed: Modifications: Conditions: Present Were: __&King __d. Doherty __P.Dickerson __ D. Dzenkowski other Form filled out in the field by D. Bergen~.B.Ghosio, Mailed/Faxed to: Date: Pacifico Engineering PC PO Box 1448 Sayville, NY 11782 www.pacificoengineering.com November 15, 2009 Town of Southold Building Department 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Subject: Solar Energy Installation for Craig Hasday 100 MacDonald Crossing Laurel, NY 11948 Engineering Consulting Ph: 631-988-0000 Fax: 631-382-8236 engineer@pacificoengineering.com I have reviewed the roofing structure at the subject address. The structure can support the additional weight of the roof mounted system. The units are to be installed in accordance with the manufacturer's installation instructions. I have determined that the installation will meet the requirements of the 2007 NYS Building Code, and ASCE7-05 when installed in accordance with the manufacturer's instructions. Roof Section A mean roof height 14 ft pitch 51/2 in/12 roof rafter 2x6 rafter spacing 16 in OC Reflected roof rafter span 13.4 ft Table R802.5.1(1) max 13.3 ft CRITERIA Roof Section A The climactic and load information is below: Wind CMMAC'FIC AND Speed, 3 GEOGRAPHIC DESIGN Category sec gust, mph C 120 Ralph Pacifico, PE Professional Engineer Live load, pnet30 per ASCE 7, psf 58 point pullout load, lo 304 Fastener type 5/16" dia screw, 4-1/2" length, 2 per 9.225 kW 41 SunPower 225w UniRac Sunframe Azimuth = 125° Pitch = 25° Scale 1/8" = 1.0' Panel Dimension = 61.39 x 31.42" Array Length -- 736.68" Array Height = 163.1" Magic # = 32.17" SunPower 225w I I 2x6"DouglasFirRafter 6" on center UniRac SunFrame Rail UniRac L-Foot Layout Created By: BCA Date: 11/12/2009 9.225 kW 41 SunPower 225w UniRac Sunframe Azimuth = 125° Pitch = 25° Scale 1/8" = 1,0' Panel Dimension = 61.39 x 31.42" Array Length = 736.68" Array Height = 163,1" Magic # = 32,17" SunPower 225w I I 2x6"DouglasFirRafter 16" on center · . 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SunPower's High Efficiency Advantage - up to 50% Mom Power Convenlional Watts / Panel 165 Efficiency 12.0% kWs 3.0 225 SOLAR PANEL EXCEPTIONAL EFFICIENCY AND APPEARANCE Peak Power (+/-5%) Pmax 225 W Ratad Voltage Vmp 41.0 V Rated Current Imp 5.49 A O~n Circuit Voltage V~c 48.5 V Short Circuit Currenl Isc 5.87 A Maximum System Voltage IEC, UL 1000 V. 600 V Temperature Coefficients Power -0.38% Voltage ivac] -132.5 mV/°C Current (IscJ 3.5 mA/°C Series Fuse Rating 20 A Peak Power per Unit Are~ 181 W/m2, 16.8 W/fl2 CEC KrC Rating 207.1 W Solar Cells Front Glass Junction Box Outaut Cables Weight 3.2 mn' 11/8 in) tempered lPg5 rated wi~n 3 bypass diode~ 900mm length cable / MultiContact connectors Anodized aluminum alloy lype 6063 15 kg, 33 lbs 7.0 5.0 t0eow/,., 4.0 800 W/m~ 3.o 2.0 1.0 0 10 CAUTION: READ SAFETY AND INSTALLATION INSTRUCTIONS BEFORE USING THE PRODUCT. ©o to www. sunpowercorp com/paneJs For details SunPower designs, manufactures and delivers high-performance solar electric technology worldwide. 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SPR-3OOOm and SPR..4OOOm ww~v. sunpowercorp.com 3000m & 4000m INVERTERS EXCEPTIONAL RELIABILITY AND PERFORMANCE SPR-3000m SPR-40OOm AC Maximum Output Curmnt I$A, 12.5A 17A, 16.6A (O 208% 2~0V) AC Naminal Voltage / Range l~-2~ve~evA¢ 1~-2~ve20eVA¢ 2H -26ave2aovAc 211-26~ve~aovAc AC Frequency / Range 6o.$ Hz 60.`5 Hz POV,~r Faclor I ~ Peak Inverter Efficiency 96.6% 96.8% CEC Weighted ER~iciency 9`5.0 % · 208 v 9,5.5 % e 208 v Recammended Array Input 36o0 w Pow~ [Dc o STC) DC Input Vdfage Range 200 -5oo v · 2o8v Peak Power Tracking Vohage DC Max. Input Current DC vataee supde No. o~ Fused Sttlng Inputs Power Consumplion: Slandby / Nighflime Fused DC Disconnett 48O0 W SPRm Efficiency Curves % of Rated Output Power Shipping Dimensions W x H x D indus 23.5" x 18.`5" x ~6.0' Unff Dimensions W x H x D indus 17.8" x 13.8" x 9.3# Inv.'er Weight 88 lbs Shipping Weight 94 Ib~ Foxed Air / Soaled ,&.m J)Jell! 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SPR-5OOOm, SPR-6OOOm & SPR-7OOOm www. sunpowercorp.com AC Max Oul~t ~ (~ ~0~V, 24A, 20.8A, 18A v.l~. / n.,~ ~-~v*~,~: SPR-6000m SFR-7000m 60Hz/59.3Hz- 60Hz/59.3Hz- 60 Hz / 59.3 Hz- AC Freq / Range 60,5 Hz 60.5 Hz 60.5 Hz Peak Inverla' 96,8% 97,O% 97.1% 95,5 %~208 V 95,5 % ~' 208 V 96.O % ~J 208 V cee WeJghl~J 95,5 % ~ 240 V 95.5 % ~* 240 V 96.0 % ~ 240 v J~JrlcJe~ 95,5 % ~ 277 v 96.0 % @ 277 v 96.0 % ~* 240v Anay Inpet Pm~ar 5300 w 6400 w 7500 w loc e STC) 2,50 - 600 V 250 - 600 V 250 - 600 V Peak Paw~ 250 - 480 V 250 - 480 V 250 - 480 V EX:Max. 2lA 25A 30A DC Vel~g. <5% 4 Standby/ <TW/0.2SW 5000m, 6000m & 7000m INVERTERS EXCEPTIONAL RELIABILI'FY AND PERFORMANCE SPRm Efficiency Curves 75 Shil~ng Dimemlam W x H x D inches 23.$' x 3 I.O' x 16.O' Shipping Weight 154 lbs Cen'ificalbm UL 1998, FCC Part 15 A & B [ SunPower designs, manufactures and delivers high-performance solar electric technology worldwide. Our high-efficiency solar cells generate up to 50 percent more power lhan convenlional ~olar cells. Our high-performance solar panels, roof tiles and trackers deliver significantly more energy than competing systems. www.$unpowercorp.com ACORD. CERTIFIC.t E OF LIABILIT INSUR I ~N-7 01[19/09 ~ ~IS ~F~ ~ I~EQ ~ A ~R OF INFO~ON ONLY ~D CONFE~ NO ~G~S U~N ~E ~ATE ~cess ~al ~, Inc. (CL) ~LDE~ 365 ~OS~S P~ DR~ ~R ~E ~E ~ BY ~E ~ BELOW. ~DB~Y ~ 11797 Phone: 516-799-8222 INSU~ ~FO~ING CO~E ~C Gr~l~ic ~C 425 Co~ ~. 39A Sui~ 101 Sou~ ~ton ~ 11968 ~AL UA~U~ EAC~ OCCLRRENCE $1,000,000 A X ~ ~ME~~ ~P1681L 01/31/09 01/31/10 ~(~)~'u~="~ S 50,000 ~&~ si,000,000 GENE~A~E~ s 2,000,000 ~L A~ UM~;S ~R: ~S-~P~ S 1,000,000 CERTIfiCATE HOLD-~ CANCELLATION TORNSOH TOWN OF SOUTHOLD 53095 ROuT~ 25 SOUTHOLD NY 11971 ACORD 25 (2001/08) © ACORD CORPORATION STATE OF NEW YORK CERTIFICATE O~Y~ WORKERS' COMPENSATION BO~ ~ WORKERS' COMPENSATION'INSURANCE COVERAGE la. Legal Name & Address of'Insured (Use street address only) Greenlogic, LLC 425 County Road 39A, Suite 101 .Southampton, NY 11968 Work Location of Insured (OHO, ~qu/red 0~eoverage is spec/fl~,~t~ limited to certain locations in New York ~tate, i.~, a Wrap-Up Potlcy) 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder) Town of Southold Building Dept. 53095 Route 25 Southold, NYl1971 lb. Business Telephone Number of Insured 631-771-5152 lc. NYS Unemployment Insurance Employer Registration Number of Insured Id. Federal Employer Identification Number of Insured or Social Seeurity Number 3a. Name of Insurance Carrier National Union Fire Insurance . 3b. Policy Number of entity listed in box "la" 3c. Policy effective period 08/11/2009 to 08/11/2010 3d. The Proprietor, Partners or Executive Officers are [] included. (Only cheek box if an partners/omcers included) [] aH excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Itm 3A on the INFORMATION PAGE of the workerst compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of insmance to the entity listed above as the certificate holder in box "2". The Insurance Carrier will also notify the above certOqcate holder 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 premiurns that cancel the policy or eliminate the insared from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certifi, v,,, is valid for one year after this form is approved by the Insurance carrier or its licensed agent, or until the policy ~piration date listed in box ~$c", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, ffthe business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certfficate 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 1 am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage ns depicted on this form. Approved by: Approved by: Thomas P. Terry (Print name of aulhorized n:tnesentat~ or licensed agent of insmancc carrie0 (Sig~m~) ~ (D~) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier:. __631-283-8000 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 (9-07) www.wcb.state.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, roles and regulations of the County of Suffolk, State of New York. , , Additional Businesses NOT VALID WITHOUT DEPARTMENTAL SEAL AND A' CURRENT CONSUMER AFFAIRS ' ID CARD Director 9.225 kW 41 SunPower 225w UniRac Sunframe Azimuth = 125° Pitch = 25° Scale 1/8" = 1.0' Panel Dimension: 61.39 x 31.42" Array Length: 736.68" Array Height = 163.1" Magic # = 32.17" SunPower 225w I I 2x6"DouglasFirRafter 16" on center · . UniRac SunFrame Rail O UniRac L-Foot Layout Created By: BCA Date: 11/12/2009 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MA/LIN(; ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: December 10, 2009 ~ Re: Proposed Wetland Permit for INA HASDAY'~-'~' SCTM#1000-145-4-15 GreenLogic, LLC on behalf of INA HA, SDAY requests an Administrative Permit to install a roof mounted solar photovoltaic system onto the existing dwelling. Located: 100 MacDonald's Crossing, Laurel. SCTM#145-4-15 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "A" which states: A. Maintenance or repair involving no substantial changes in an existing structure or facility; Cc: Lori Hulse, Assistant Town Attorney Office Use Only __Coastal Erosion Permit Application//' Wetland Permit Application ~ Administrative Permit ~ __Amendment/Transfer/Extension Received Application: fl IXO ~7~Receivad Fee:$ ~Jompletad Application __Incomplete __SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) ~L'V-VRP Consistency Assessment Form I~ ~"CAC Referral Sent: fi[ ~:~ ' ' Bate o f Inspection: }~}~_ ~Receipt of CAC Report: _._Lead Agency Determination: ~______~chnical Review: blic Hearing Held: ~ ~-~1 ~ ,/~Resolutlon: Phone Number:( 000- (provide LILCO Pole #, distance to cross streets, and location) (If applicable) ~oar~ of Trustees Applicatio~ Land Area (in square feet): Area Zoning:. GENERAL DATA Previoususeofproperty:Q-'-'~(:~ ~ff~L~.(~t Ik~ ~'~]A_~ I/~'~9 Intended use ofproperty: C~I"~:~ '~_X.("lffhl_~._~ ~__,11 )'l°~J t l('xl9 Covenants and Restrictions: Yes No If "Yes", please provide copy. Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspen/ded by ~ No If yes, provide explanation: a governmental agency? Yes Project Description (use attachments if necessary): _xc 04cO.\\ oov° ~oard of Trustees Applicl WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~'-l~-b~ Area of wetlands on lot: .square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: t'-~\ ('~ feet Does the project involve excavation or filling? xY No Yes If yes, how much material will be excavated? How much material will be filled? Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: cubic yards cubic yards feet Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): .rd of Trustees Appli¢ COASTAL EROSION APPLICATION DATA Purposes of proposed activity:i~-~ ~[ ~r-OC) ~ ~Ch(~/(~d .e wetl~sen~ f~et of the proposed activiW. No Yes Does ~e project involve excavation or filling? No Yes If Yes, how much material will be excavated? .(cubic yards) How much material will be filled? (cubic y~ds) M~er in which material will ~ removed or de.sited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) PROJECT In NUMBER PART 1 - PROJECT INFORMATION 617.20 ~PENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNMSTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) SEQR .~__~_j.~PPLICANTISPONSOR 2. PROJECT NAME 3.P~CT L~TION: ~ ~' ~ 4. P~CI~ LOCA~ON: ~t ~s e~ RMd Ink.ns. Pmmbent I~dm~ e~ -~ ~ map DESCRIBE PROJECT BRIEFLY: oo-,-c 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately a~res 8.r~...~J~ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Ivlyss [] No if rm, desc~bebrtelly: RONIS PRESENT LAND USE IN VICINITY OF PROJECT? (Choo~e as many as spply.) (tentia, [~,n~lusetal []Commercial I--]Agriculture [~Pa~/Fore,t/OpenSpace [~]Other (de=.) t0. DOES ACTION INVOLVE A PERMrT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal. Steteor Local) r-}YSS ~ if yes, list agency name and permit I approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ]Yes ~ If yes, list agency name and permit / approval: I~,So~A ~ OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDEn ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date: if the action la a Costal Area, and you are I state agency, complete the Coastal Assessment Form before proceedlttg with this as~,esamnnt Z PART II - IMPACT A~F.~SMENT ~1'o be completed by Lead A~enc¥) l: DOEs ACTIO~ED ANY TYPE . THRESHOLD IN 6 NYcRR' PART 617'47 if yes' c°°rdinat® the review pr°ceos and u~a Iha FULL EAF'[~1 Yea ~'No WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If NO. a negative Ideclaration may be a~upemeded by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS. ASSOCIATED WITH THE FOLLOWING: (Answers may be handwrlUen, Cl. Exbtlng ab' quality, aur['ace or groundwater quality or quantity, nor'e levela, exJstlng traffic pattern, solid waste production or disp43sal, potanl]al for aroeion, dm!nage ol'aoodlng pmbimr~? Exp~k~ bdelt~/: Ir onc. I C3. Vegeta~on or fauna, I'mh, Wnellf!sh ~ wlMl~e ~pecte~, ~gnllk~nt ha~ltat~, o~ threatened or endangered species? Expla n bdefly: I CA. A commu~y'l exlltlng plln~ of golll al M~Jal~ Idopted, ~ · chlnge ~ uti or Intena~/of use of land"or oth~ n~ure] relourca·? Ex.in txilfly: C5. Orowth, .ubsequer4 development, or ml~ted acll~tie~ likely to be induced by ~ pro.ed a~--lion? Explain briefly: C7. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARA~ISff'ICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL / --']Yea E. t8 THERE, OR 18 THF,~IE UKELY TO BE CONTROVlE~Y RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ~ e3~aln: PART III - DETERMINATION OF 81GNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadv®r~eeffe~ident~d~t~we~detmm~newhether~t~ssubstantia~arge~imp~rta~r~i~e$~n~nt. Each effect shoald be messed In connection with ~ (a) setting (i.e. urban or rural); (b) probability of occurring; (c} duration; (d) in'eversbility~ (e) geographic scope; and (f) magnitude, tf neMssafy, add attachments or reference suppo~ng materials. Erisum that explanations contain suffioient detail Io show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checle~ yes, the cleterminatJon of signifK~mce must evatuate the potential impact of the proposed action on the environmental characteristics o(the CEA. Check this box if you have iden6fled one ~ mom potentially large (x significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a posifi~ declaration. Check tfll~ box If y(~J have determined, baled on the Information and m~alysls above and any supporting documentation, that 1he propped a~or WILL NOT result In any significant adverse environmental impacts AND provide, on attachments as nece$$a~/, the reasons ~Jppo/~Jng thil determination. Name of Lead Agency Date T[I~ c/Responsible Officer Signature 7~pon~)m om(er In LeaCl .~, ency .rd of Trustees Applicat County of Suffolk State of New York DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REpRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. SWORN TO BEFORE ME THIS Notary Publi4' ll/19/2009 14:48 i 5i 65~813 HASDAY PAGE 01/0i ACT]GORIZATION (where the applica~ is not the ownK) Southold Boa~ of Town Tmstee~ on my behalf. APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the oart of town officers and emolovees. The vuroose of this form is to orovide infonnatinn which can alert the town of oossible conflicts of interest and allow it to take whatever action is necessary to avoid same. ~' (L~as~name, first name, middle initial, unless you are~uplymg in the~name of ~ ' someone else or other entity, such as a company, lfso, indicate the other person's or company's name.) NAME OF APPLICATION: (Check ali that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other", name the activity.) Do you personally (.or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO t,~ If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); __C) an officer, director, partner, or employee of the applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submitted this~ _day of A/~/' 200 O q Signature /L/I/'L ~:~ J'~.,.-'C~ ,4 Print Name / h,~"~ ~'~ Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION The Application has been submitted to (check appropriate response): Town Board ~-~ Planning Dept. ~-~ Building Dept. [] Board of Trustees ~ Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital [-~ construction, planning activity, agency regulation, land transaction) ~ (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: ~ Nature and extent of action: Location of action: Site acreage: Present land use: Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (c) Telephone number: Area Code ( )_ (d) Application number, if any:_ Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ~] No [] If yes, which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. Yes [] No otApplicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section IH - Po~cies Pages 3 through 6 for evaluation criteria [] Yes [] No~t--V2 Not Applicable Attach additional sheets if necessa~ Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Pol~ies Pages 6 through 7 for evaluation criteria [-~ Yes [] No ~ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minlmize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pag,,es 8 through 16 for evaluation criteria [] Yes ~'~ No~2a Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southoid. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria ~'~ Yes [] No ~NNot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section HI - Policies; Pages 22 through 32 for evaluation criteria. [] Yes ~-~ No ~/~ot Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section Ill - Policies Pages 32 through 34 for evaluation criteria. ~ Yes [] No ~Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section HI - Policies; Pages 34 through 38 for evaluation criteria. ~-~ Yes [~ No ~Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LVOIP Section III - Policies; Pages 38 through 46 for evaluation criteria. N~ot Ap [] Ye~ No plicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See ~WRP Section III - Policies; Pages 47 through 56 for evaluation criteria. ~ Yes ~] Nor~Jl ~[ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. [] Yes [] No~'/t-~ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for eva~lation criteria. ~-~ Yes ~ No[U-M'LE3 Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; P~ges 65 through 68 for evaluation criteria. [] Yes [] No~1.~ Not Applicable Created on 5/25/05 11:20 AM November 19, 2009 Town of Southold Town Trustees Town Hall 53095 Route 25 Southold, NY 11971 Dear Trustees: Please find attached a building permit application on behalf of Ina Hasday who has engaged us to install a roof-mounted (flat to the roof) solar photovoltaic (PV) electric system for her home on 100 Macdonalds Crossing, Laurel, NY 11948. In connection with this application, please find attached: An application · A Transactional Disclosure Form · A Short Environmental Assessment Form · A LWRP Consistency Assessment Form · 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 SPR 225 BLK) · Spec sheets of the inverter (Sunpower SPR6000m) · 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 Please let us know if you kneed anything else in connection with this application. 631-771-5152 ext 113 GREENLOGIC, LLC · www Greerfl. ogm corn SOUTHAMPTON/CORPORATE: 425 County Rd. 39A Southampton. NY 11968 Tel: 6317715152 CUTCHOGUE: 1070 Depot Lane Cutchogue, NY 11935 ~1:631.765.0404 MANORVILLE: 40 Woodland Avenue Manorville. NY 11949 Tel: 631 830.0102 FIRE ISLAND: 125 Duneway Seaview, NY 11770 Tel: 631.741.6400 ROSLYN HEIGHTS: 200 S Service Rd., #108 Rosyh/ Heights, NY 11577 Tel: 516.625.6880