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HomeMy WebLinkAboutTR-7393A Jill M.Doherty, President so yo Town Hall Annex Bob Ghosio,Jr.,Vice-President 54375 Main Road P.O. Box 1179 James F.King 4 Southold,New York 11971-0959 Dave Bergen G Q • �O Telephone(631) 765-1892 John Bredemeyer OI�r�U a Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #0630C Date: April 7, 2011 THIS CERTIFIES that the installation of solar panels onto the existing roof of the dwelling At 275 Watersedge Way, Southold,New York Suffolk County Tax Map # 88-5-58 Conforms to the application for a Trustees Permit heretofore filed in this office Dated September 1, 2010 pursuant to which Trustees Administrative Permit#7393A Dated September 22, 2010 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 the installation of solar panels onto the existing roof of the dwellin>i The certificate is issued to PETER&ANNETTE CORBIN owner of the aforesaid property. uthorized Signatui 0 0 gyFFO( Jill M. Doherty,President G Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President P.O. Box 1179 James F. King Southold,NY 11971 Dave Bergen ,.. Telephone(631)765-1892 John Bredemeyer �,j. Fax(631)765-6641 poi � Sao' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 4 —� Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction % constructed Project complete, compliance inspection. INSPECTED BY: V COMMENTS: I CERTIFICATE OF COMPLIANCE: Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghesio, Jr. John Bredemey~r Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (63 I) 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 ½ constructed Project complete, compliance inspection. Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town H~lAnnex 54375MainRoad P.O. Box 1179 Southold, New York 11971-0959 Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Permit No.: 7393A Date of Receipt of Application: September 1, 2010 Applicant: Peter & Annette Corbin SCTM#: 88-5-58 Project Location: 275 Watersedge Way, Southold Date of Resolution/Issuance: September 22, 2010 Date of Expiration: September 22, 2012 Reviewed by: Trustee Bob Ghosio Project Description: To install solar panels onto the existing roof of the 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 received on 9/1/10 and plans stamped approved on 9122110. Conditions: 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. Jill M. Doherty, President James 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 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated C~ / i ! / 0 has been reviewed by this Board at the regular meeting of Q },,;I ~/10 and your application has been approved pending the completion c'f 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) __ ¼ Constructed ($50.00) v// 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: Jill M. Doherty, President Board of Trustees Jill M. Doherty. President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: GreenLogic, LLC on behalf of PETER & ANNETTE CORBIN requests an Administrative Permit to install solar panels onto the existing roof of the dwelling. Located: 275 Watersedge Way, Southold. SCTM#88-5-58 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. 111 other Type of Application: __ Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission __Violation Info needed: Modifications: Conditions: Present Were: __&King __J.Doherty __J. Bredemeyer B.Ghosio, D. Dzenkowski other Form filled out in the field by ~ Mailed/Faxed to: Date: D. Bergen__ CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CER'nFICATE IS ISSUED AS A MATrER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Brookhaven Agency, inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 850 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 150 Main Street East Setauket NY 11733 INSURERS AFFORDING COVERAGE NAIC # ~NSU~D Greenlogic, LLC INSURERA: NGM INSURANCE COMPANY 425 County Road 39A Suite 101 ~NSURERe: MERCHANTS PREFERRED INS CO Southampton NY 11968 INSURER C: INSURER D: I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSU ED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED. NOTVVlTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN iS SUBJECTTOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Gl;NEPAL UABIUTY EACH O¢CURRERCE 1,000,000 A X X COMMERCIALG~NERALL~,BILI~' ~IPP1681L 01/31/10 01/31111 PR~MI~F~DAMAGETOREN~DI~n'~,mr~I 50,000 I CLAJMS MADE [] OCCUR MEDEXP(Anyonepe~o~) , 5,000 X XCU PERSONAL & ADV INJURY i 1,000,000 X CONTRACTUAL LIAB GENERALAG(~EGA~ $ 2,000,000 B A X ^NYA~O CAPI043565 0611212009 0611212010 (Eaaccicient) EXCESS I UIV~RELLA LIABIU1Y EACH OCCURRENCE $ 2,000,000 A X ~ OCCUR [] CLAIMSMADE CUPI681L 01/31110 01131111 AC~REC~tE S 2,000,000 RETENTION ~ 10,000 $ wo.~E.~COM.~.~o. I ...... ~ I I°;~- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE~I~ESCRIBEDPC~:.;C;~ BE GANCELLEDBEEQRE '~'JE~rXPI PATTON TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 Phone: I Fax: ACORD 25 (2009/01) © 1988-2009 ACORD C~g hfs reserved. The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS 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 (Only required if coverage is specifically limited to certain locations in New York State, Le., a Wrap-Up Policy) 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 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, NY 11971 or Social Security Number 20-3801194 3a. Name of Insurance Carrier New Hampshire Insurance Co 3b. Policy Number of entity listed in box "la" WC1602420 3c. Policy effective period 08/11/2010 -8/11/2011 3d. The Proprietor, Partners or Executive Officers are [] included. (Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box "2". The Insurance Carrier will also notify the above certificate 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 premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail..) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c'; whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, 1 certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Thomas P. Terry, CPCU /-'~-'~57,~TS- (Pnnt name of authorized representative or licensed agent of insurance c~e/~ Approved by: ~-q 08/03/2010 L[ (S~gna~e) (Date), Title: Authorized Representative t Telephone Number of authorized representative or licensed agent of insmance cagier: (631) 28328000 ' 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, rules and regulations of the County of Suffolk, State of New York. Additional Businesses NOT VALID WITHOUT DEPARTMENTAL SEAL AND K CURRENT CONSUMER AFFAIRS ~ ID CARD Director mm~ ~ m~]m ml]l l11 m []~m~ i ....... mfllflmmlrm~l ......... mmm'lm To:{} Pagelofl 2010-09-01 18:10:52 (GMT) 16317314531 From: ,Nex McNear Town of Southold Board of Trustees Application Office Use Only ~Coestal Erosion Permit Applicafiory~ __Wetland Permit Application Amendmcnt/Tr -~ sfer/Ext ension ~c~ivod F~e;$ ~'"O°'~' ~ ' j~_Complete~ ^pplication C~ ~[ ~ lC) __Incomplete._ __SEORA Classification: Type I Type H_.~Unlisted __ ~0~ rdi~,tion:(dete .~nt) ~--~CAC Referral _.~rete of I.specfion: ~lJ I ~ !l 0 __Receipt of CAe R~ort: ._Le~ A~ancy Detetm|natlon: Tec. hMca] Review: __Resolution; Phone Number:~r0l) ~,,~-~5{ ~e (provide LILCO Pole #, distance to cross strc~s, and location) AOENT: (I f ~plieable) Town of Southold Board of Trustees Application Office Use Only ~Coastal Erosion Permit Application __Wetland Permit Application Administrative Permit Amendment/Transfer/Extension __Received Application: __Received Fee:$ __Completed Application __Incomplete __SEQRA Classification: Type I Type II Unlisted __Coordination:(date sent) __LWRP Consistency Assessment Form __CAC Referral Sent: __Date of Inspection: __Receipt of CAC Report: __Lead Agency Determination: __Technical Review: __Public Hearing Held: __Resolution: South~old ~row~ Bo~rd of Trustees I Name of Applicant Address Phone Number:~a:3t =?=:~ [ ~S IS ~- Suffolk County Tax Map Number: 1000 - Property Location: ~ '~'-% I~=:~--~c~ ~--4,t:::~-- ~X// (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Boaxd of ~z'ust~$ &ppiS.aarP. on Land Area (in square feet):. Area Zoning: Previous use of property: Intended use of property:. Covenants and Restrictions: If"Yes", please provide copy. GENERAL DATA Yes ~ No Does this project require a variance from the Zoning Board of Appeals If"Yes", please provide copy of decision. Yes E No Prior permits/approvals for site improvements: Agency Date ~016 __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? tO No Yes lfyes, provide explanation: Project Description (use attachments if necessary): Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: Irlf~C~.[ VD(irap /'~0ttrt~c~ Area of wetlands on lot: square feet Pement 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: feet Does the project involve excavation or filling? v/' 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): Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity:_ ~Fx~L~:3 ~ ~ lr~otlrx'~:~ Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? v/ No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? IX}f/0t (cubic yards) Manner in which material will be removed or deposited: /x) It4 Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation &the project as proposed. (Use attachments if necessary) PROJECT ID NUMBER PART 1 · PROJECT INFORMATION 1. APPLICANT I SPONSOR 3,PROJECT LOCATION: Municipality I 617.20 APPENDIX C STATE ENVIRONMENTAL QIJALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2, PROJECT NAME ~_0~_f~1 ~-J County SEQR 4. PRECISE LOCATION: Street Addesa and Road Intersections. Prominent landmarks etc -or provide mad 6.,B ROPOSE ACT,ON: [] New 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WIL~. PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? I'Vl Yes LJ No I1 no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many aa apply.) [:~Real~entJal ~'llndust~a, r~lcommerclal DAgriculture ~"'~ParklForest/OpenSpace i-]Other (desc~be) 10. DOES AC'RON INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) I--'~Yes I--~No ff list agency name and permti / approval; yea, 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~]Yes F-"~No If yes, iisi agency name and permit / approval: 1 . AS A RE LT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date: i ,,,,nat,,,, ,S [ O(lO If the action Is a Costal Area, and you are s state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT AS~8$MENT {'rD be completed by Lead Agency) A. DOES ACTIO~CEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review process ar~ use the FULL EAF. [] Yes [].o B. ~~LLAcT~~NRECE~VECO~RD~NATEDREV~EVVASPR~V~DEDF~RUNL~STEDACT~~NS~N6NYCRR~PART617~6? IfNo, anngetiva declaration may be aupempoed by another involved agency. [] Yea [] No C. COULD ACTION RESULT iN AN~ ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwrittan, if legible) C1. Existing air quality, surface or g~oundwatar quality or quanfliy, noise levels, existing Iraffic pattern, solid waste prOducfico or disposal, potential for erosion, drainage or ifcoifing problems? Explain briefly: C2. Aestheric, egrlcuifurel, srchaeofogical, historic, or other natarel ¢x cultural resources; or community or neighborhood character? Explain b~efly: C3. Vegetagon ~'-~al ~:~1~: shellflsh~or WIMIIfe sPe~ea, signlifCa'nt'habita~s, or thmata~ced or endangered species? Explain briefly: C4, A~mmu~ify~sesi~ingp~ns~rg~sasctttcietiyad~ted~orachengeinuse~r~nten~y~use~ and or other na ural resources . Ex~a~nbnefly~ C~. Long ten~, shoat term, c~mulatlve, or other effects not Iden6fled in CI-C57 F_xp~ain bC~y: C7. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABMSHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEAI? ~lf year espiain b~: E, I$ THERE, OR IS.THERE LIKELY TO BE~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If },es explain: r-ives I No PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) IN STRUCTION$: For each adverse effect identlfl ed above, determine whether it Is substantial, large, imixxta nt or otba~wise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanationo contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potentiatim pact of the proposed action on the environmental characte~iatics of the CEA, Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then preceed direcSy to the FULl EAF and/or prepare a positive declaration. Cheek this box if you have determined, based on the information end analysis above and any supporting documentation, that the proposed actie~ WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons suppo~ng Name of Lead Agency gnature of R'e~o n sibl~Office r in Lead Agency Title of Resbonsible Officer SIgrlsture of Preparer (if different from responslJ)le officer) Bo&~:d o£ ~'x'ust:~ims Application (print owner of property) AUTHORIZATION (where the applicant is not the owner) (mailing address) (Agent) /J~L~.~ ~., ~O~.~apply for permit(s)from the Southold Bi/~f Town Trustees on my behalf. (Owner% signature) Board of Trustees Application County of Suffolk State of New York N'~t~"~ A [~C~t~t~'~:~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE 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. ' U Si~naiure SWORN TO BEFORE ME THIS. ~ O DAY OFfs, $ '~ · ,.J 20 /0 Notary Public / APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees. The ~uroose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: I~C[ ~ [..L K~'~' ~--..I ~ I~ .~}1 ~ (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Cbeck all 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 oftbe 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 ~ 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 applicanl/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% oftbe 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 ,,~ Signature Print Nme ' 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 SCTM# I000 '8 g g The Application has been submitted to (check appropriate response): TownBoard ~ Planning Dept. [] Building Dept. ~ BoardofTrustees 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 &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) Nameofapplicant: ~___~O-x/-X~tC_~ LL.c~ (b) Mailing address: t'[~s COtXr¥~ I~ ~q ~4 (c) Telephone number: Area Code t1~. ~'~"~ ' ~' ! S 2.. (d) Application number, if any:. Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [] No [~f 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 ~ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria [] Yes ~ No [~Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria [] Yes [] No [~/Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria [] Yes [-~ No [~/'Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria Yes [] No ~Not Applicable Attach additional sheets if necessa~ 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 III - 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 III - 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 III - 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 LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. [] Ye~ No ~Not Applicable 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 LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. ~ Yes ~-~ No [--~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 [~Not Applicable Attach additional sheets if necessa~ Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. [] Yes [] No ~Not Applicable Attach additional sheets if necessa~ Policy 13. Promote appropriate use and development of energ~ and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. [] Yes [] No [~ Not Applicable Created on 5/25/05 11.'20 AM August30,2010 Town of Southold Town Trustees Town Hall 53095 Route 25 5outhold, NY 11971 Dear Trustees: Please find attached a building permit application on behalf of Peter and Annette Corbin who have engaged us to install a roof-mounted (flat to the roof) solar photovoltaic (PV) electric system for their home on 275 WatersEdge Way, Southold. In connection with this application, please find attached: · 2 applications · 2 Transactional disclosure Forms · 2 Short environmentalAssessment Forms · 2 LWRP Consistency Assessment Forms · 2 Surveyor Premises · 2 Engineer's Reports · 2 One Line Diagrams · 2 Visio Diagrams of the proposed system · 2 Spec. sheets of the solar panels (SunPower SPR-215WHT) · 2 Spec. sheets of the inverters (SunPower SPR40OOm) · GreenLogic Suffolk County Home Improvement License · GreenLogicCertificate of Liability Insurance · GreenLogic Certificate of Worker's Compensation Insurance Coverage · Installation Manager's Master Electrician's License Please let us know if you need anything else in connection with this application. Yours truly, Barbara Casciotta Account Manager GreenLogic LLC {}RE~NLOG[C, ILC, ~wG ee ogccom SOUTHAMPTON/CORPORATE: 425 County Rd 39A SoLJ~harT-pton, NY 11968 Tel: 631 771.5152 ti7 CUTCHOGUE: 1070 Depot Lane Cutchogue, NY 11935 RI: 631.765.0404 MANORVILLE: 40 Woodland Avonue Manorville NY 11949 Tel: 631.8300102 FIRE ISLAND: 125 Duneway Seaview, NY 11770 Tel: 631.741~6400 ROSLYN HEIGHTS: 200 S. Service Rd. #108 Rosyln Heights, NY ] 1577 Tel: 5166256880 2 Strings of 9 SunPower 215 watt panels. Each sting has 1,935 watts Army total of 3,870 watts All panels to be grounded as per NEC code 30 AMP two pole DC switch fTom panels to inverter j ~ :~ SUNI'OV~ER SPR 4000 INVERTER '~ ~ [" ....... i 30 AMP 3R i.'~~ switch near i 9 / C~)' IlO . --'! utility meter  .~'"'"'/ 240 VAC from invetter to a 30 Amp switch near utility meter 2 Strings of 9 SunPower 215 watt panels. Each sting has 1,935 watts Array total of 3,870 watts All panels to be grounded as per NEC code 30 AMP two pole DC switch from panels to inverter 240 VAC 240 VAC from inverter to a 30 Amp switch near utility meter 30 AMP 3R switch near utility meter 215 SOLAR PANEL EXCEPTIONAL EFFICIENCY AND PERFORMANCE The SunPower 215 Solar Panel provides indush'y leading efficiency and performance. Utilizing 72 next generation SunPower all-back contact solar cells and an optimized panel design, the SunPower 215 delivers an unprecedented total panel conversion efficiency of 17.3%. The 215 panel's reduced voltage-temperature coefficienl and exceptional Iow-light performance attributes provide far higher energy delivery per peak power than conventional panels. SunPower's High Efficiency Advantage - Up to Twice Ibe Power Thin Film Watts / Pane~ 65 Efficiency 9.O% kWs 90 Conventional 165 12.0% 120 SPR-215-WHT Peak Power (+/-5%) Pmax 215 W Rated Voltage Vm~p ..... 39.8 V_ Ratad Current Imp 5.40 A Open Circuit Voltage Vec 48.3 V Short Circuit Current Isc 5.80 A Maximum Sysl~m Voltage IEC, UL 1000 V, 600 V Temperalure Coefficients Power -0.38%/°C Voltage (Voc) -136.8 mV/°C Current (lsc) 3.5 mA/°C Series Fuse Rallng 15 A Peak Power per Unit Area 173 W/m2, i 6.1 W/~ CEC PTC Rating 198.5 W 215 SOLAR PANEL EXCEPTIONAL EFFICIENCY AND PERFORMANCE 7.0 6.0 5.0 1~0 W/m~ ~mSO ~~C 4.0 ~oo w /,,~ 2.0 50o W/m~ 1.0 0.0 l~W/.~ 0 I0 ~ 30 ~ ~ ~ Current/vd~ge charo~Jsfi~ wi~ de~nden~ on i~adJo~e and m~ule ~m~ra~re T~mperat~re - 40° C ia +85° C {-40° F to +185° F) Max load 50 pst (2400 PascalsI front end back Impact Resistance Hail - 25mm (1 in) at 23 rn/s (52 mph) Solar Cells 72 SunPower allback conlad monocrystalline Junction Box IPSo5 rated with 3 bypass diodes Warranly 25 y~ar limiled power wamanty OIJt~Uf CabJes 900mm Jength c~ b~ _/~M~u_ '_J~. ~ oonned~_ _s 10 year limited product v~rronly Frame Anodized olumJnv .m_.~l_ _k~. I~- 6~53 CertiFicafions IEC 61215, Safely tesled IEC 61730; Weight 15kg, 33lbs UL listed JUL ! 703), Cla~ C Fire Raling ;:,,*11- z ,,o,L i CAUTION: READ SAFEI~t' AND INSTALLATION INStrUCTIONS BEFORE USING THE PRODUCT. Go ia www.sunpowercorp.com/panels for details SunPower designs, manufactures and delivers high-performance solar electric technology worldwide. Our high-efficiency solar cells generat~ up to 50 p~rcent more power than conventional solar cells. Our hig~performance solar panels, roof tiles and h'ackers deliver significantly more energy then competing systems. Prinled on recycled paper www. sunpowercorp.com SPR-3OOOm and SPR-4OOOm 3000m & 4000m INVERTERS EXCEPTIONAL RELIABILITY AND PERFORMANCE The SunPower inverters 3000m and 4000m provide exceptional reliability combined wilh superior performance. Innovative design and advanced testing have been brought together to create a durable inverter that enables optimal system performance over the long term. Both models come with a standard lO-year warranty. w~n,v.su npowercorp.com 3000m & 4000m INVERTERS EXCEPTIONAL RELIABILITY AND PERFORMANCE SPR-3000m SPR-4000m AC Power 3000w 3500w e 208 v / 4000 w ~* 240 v AC Maximum Oul~t Curreflt 15A, 12,5A 17A, 16.6A le 2o8v, 24ov) AC Nominal Vdtage / Range 183 - 229 Ve 208 V~: t83 -229 Ve 2~ VAC 211-264V~240VAC 211-264V~240VAC AC Fmquee~'y / Range 60 Hz / 59.3 Hz- 60Hz/59.3Hz- 60.5,~Hz 60.5 Hz Power Fooler Peak Inverter Efficiency 96.6% 96.8% CEC Weighted Efficiency 95.0 % e 208 v 95,5 % e 208 v 95.5 %Q 240V 96.0%Q 240V Recammended Array Input 36oo w 4500 w Power (DC Q STq DC Input Vohage Range 200 -500 v ~ 208v 250 - 600 v e 208 VAC 200 -500 V g 240V 250 - 600 V ~, 240 VAC Peak Power Tracking Voltage No. of Fused SiTing Inpuls DC Max. Input Current 17A 18A DC Vohage Ripple < 5% Power Consumption: · 7 W / 0,1 W Slandby / Nighttime Fused DC DJscoflnect Standard; Complies w NEC Standards Grounding Posifl~ C~ound SPRm Efficiency Curves 100 ~ ~O 3~0V~ ~' 480 v~ 75 % of Rated Oulput Power Shipping Dimensiens W x H x D inches 23.5" x 18.5- x 16.0' Unit D|meflsJons W x H x D ~nches 1 ?~8' x 13.8" x 9.3~ InverflH' Weight 88 lbs Sh~pplng Weight 94 I~ Cacding Forced Air / Sealed Electronics Enclosure Enclosure NEtW 3R Mo~lllJllg Wall Mount Bracket Standard Ambient Temperature Range - 13 to + 113 'F Wclrrglll~ 10 year limiled warranty SunPower designs, manufactures and delivers high-performance solar electric technology worldwide. Our high-efficiency solar cells genera~ up to 50 percent more power than conventional mlar cells. Our high-performance solar panels, roof tiles and trackers deliver significantly more energy than competing systems. www. sunpower¢orp.com Pacifico Engineering PC PO Box 1448 Sayville, NY 11782 www. pacificoengineering.com August 28, 2010 Town of Southold Building Department 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Subject: Solar Energy Installation for Annette Corbin 275 Waters Edge Way Southold, NY 11971 Engineering Consulting Ph: 631-988-0000 Fax: 631-382-8236 engineer@pacificoengineering.com .--~ Bo~r~ of Trus*ees 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 16 ft pitch 3 in/12 roof rafter 2x10 rafter spacing 16 in OC Reflected roof rafter span 19.3 ft Table R802.5.1(1) max 20.6 ft The climactic and load information is below: CLIMACTIC AND Wind Speed, 3 GEOGRAPHIC DESIGN Category sec gust, CRITERIA rnph Roof Section A C 120 Ralph Pacifico, PE Professional Engineer Live load, point pnet30 per pullout ASCE 7, load, lb psf 59 604 ? Fastener type 5/16" dia screw, 4" length LOGIC Paciflco Engineering PC PO Box 1448, Sayville, NY 11782 Ralph Paciflco, PE NYS License 066182 Chimney HT: 5' GreenLogic, LLC Proposed 7.74 kW Panel Dimension = 31.42" x 61.39" ~ SunPower 21 5w Corbin, Annette 36 SunPower 215 Array Length = 408.46~ · UniRac L-Foot 275 Waters Edge Way UniRac Sunframe Array Height = 188.67 , UniRac SunFrame Rail Southold, NY 11971 Azimuth = 186° Surface Dimensions = 507" x 263" 631,765.2829 Pitch = 13° Magic # = 62.14" t I 2x10" Douglas Fir acorbin@madisoncg.com Scale 3/16" = 1.0' Rafters 16" On Center Layout Created By: BCA Date: 8.27,2010 LOGIC Pacifico Engineering PC PO Box 1448, Sayville, NY 11782 Ralph Pacifico, PE NYS License 066182 Chimney HT: 5' GreenLogic, LLC Proposed Corbin, Annette 275 Waters Edge Way Southold, NY 11971 631.765.2829 acorbin@madisoncg.com 7.74 kW 36 SunPower 215 UniRac Sunframe Azimuth = 186° Pitch = 13° Scale 3/16" = 1.0' Panel Dimension = 31.42" x 61.39" Array Length = 408.46 Array Height = 188.67 Surface Dimensions = 507" x 263" Magic # = 62.14" SunPower 215w · UniRac L-Foot , , UniRac SunFrame Rail I I 2xl0"DouglasFir Rafters 16" On Center .~-.~ Layout Created By: BCA Date: 8.27.2010 SUP-,.VE"r' Ot= LOT ,.5 HAP OF TERRY' I/dATERS AT BA'r'VIFI/',I FILED I:~O. 2q, Iq5¢, FILE No. 2qOI SITUATE: BA"Cv'I EIAI TOI~IN: 542UTHOLI~ .SUFFOLK OOUNT'r', NY .SiJ~VE"f'ED, E~E6. 18,, 200q PET]BE CO~ CIH~CAC~ 'MI'L~ ~fSUEANC~., COMPA.'~4Y ITr'LE N©. 380~-80643 SouthhCd ]own Board of Trustees NOTES: · I"IONUMENT FOUN~ o PIPE FOUND Area = 0.45.50 Acres ®P-,APHIC 5~.,ALE I"=.~O'