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Home My WebLink About35832-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34763 Date: 12/28/10 THIS CERTIFIES that the building SOLAR PANELS Location of Property: 360 SOUTH HARBOR RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Nap No. 473889 Section 75 Block 3 Lot 7 Subdivision Filed Nap No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 19, 2010 pursuant to which Building Permit No. 35832-Z dated SEPTEMBER 7, 2010 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 SOL/MR PANELS ON AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. · he certificate is issued to WALTER N & PAULINE C PHARR, (OWNER) of the aforesaid building. JR SUFFOLK COIIlF~YDEPAR~q~OFH~J%LTHAPPROVAL N/A ELRL-£~ICAL C~d(TIFICATE NO. 35832 12/03/10 I~LU~ERS CERTIFICATION DA'£~d3 N/A Authorized Signature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 35832 Z Date SEPTEMBER 7, 2010 Permission is hereby granted to: PO BOX 958 SOUTHOLD, NY 11971 for : INSTALLATION OF SOLAR PANELS TO AN EXISTING DWELLING AS APPLIED FOR at premises located at 360 County Tax Map No. 473889 Section 075 pursuant to application dated AUGUST Building Inspector to expire on MARCH SOUTH HARBOR RD SOUTH/B~G~ Block 0003 Lot No. 007 19, 2010 and approved by the 7, 2012. Fee $ 200.00 Authorized Signature ORIGINAL Rev. 5/8/02 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUP/ This application must be filled in by typewriter or ink and submitted to the Building E A. For new building or new use: 1. IOWN OF SOUIHOLD Final survey of property with accurate location of all buildings, p.roperty lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dapt. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2~10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Pl.amng Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of prOperty showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. New Construction: Location of ProPerty: Old or Pre-existing Building: House No. Street Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Subdivision (check one) Hamlet Permit No. Health Dept. Approval: Planning Board Approval: Date ofPermit. Block Lot Filed Map. Lot: Applicant: Underwriters Approval: Request for: Temporary Certificate Fee Submitted: $ ~'~D .OP~ Final Certificate: (check one) Applicant Signature Tov, n 1 tall Almex 54375 Main Road 1'.(). 1½ox 117!) Southold, N Y 11971-0959 Tclellh(me ((;31) 765-1802 Fax ((;31) 765-9,502 ro.qer, richert~town.southold.ny, us 1½[ IILI)ING 1)EPARq'MENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: W & P Pharr Address: 360 Harbor Rd City: Southold St: NY Zip: 11971 Building Permit #: 35832 Section: 75 Block: 3 Lot: WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: License No: SITE DETAILS Office Use Only Residential ~ Indoor ~ Basement ~ Service Only ~ Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage Service 1 ph Service 3 ph Main Panel Sub Panel Transformer Disconnect Other Equipment: INVENTORY Hot Water GFCI Recpt A/C Condenser Single Recpt NC Blower Range Recpt Appliances Dryer Recpt Switches Twist Lock Ceiling Fixtures [~ HID Fixtures Wall Fixtures ~ Smoke Detectors Recessed Fixtures ~.~ CO Detectors Fluorescent Fixture ~.~ Pumps Emergency Fixtures~ Time Clocks Exit Fixtures ~ TVSS Photovoltaic system to include 16 Sunpower Spr 215 wht modules, I Sun Power Spt 4000 inverter, total watts 3440, 1 ac disconnect, 1 dc disconnect Notes: Inspector Signature: Date: Dec 3 2010 81-Cert Electrical Compliance Form Pacifico Engineering PC PO Box 1448 Sayville, NY 11782 www. pacificoengineering.com Engineering Consulting Ph: 631-988-0000 Fax: 631-382-8236 engineer@pacificoengineering.com November 16, 2010 Town of Southold Building Department 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Su~e~: Solar Energy Installation for Pauline Pharr 360 South Harbor Rd Southold, NY 11971 I have reviewed the solar energy system installation at the subject address. The units have been installed in accordance with the manufacturer's installation instructions and the approved construction drawing. I have determined that the installation meets the requirements of the 2007 NYS Building Code, and ASCE7-05, specific to the fastening of panels to the roof, to comply with the NYS code re: 120 mph winds. To my best belief and knowledge, the work in this document is accurate, conforms with the governing codes applicable at the time of submission, conforms with reasonable standards of practice, with the view to the safeguarding of life, health, property and public welfare Regards, Ralph Pacifico, PE Professional Engineer BLDG. DEPT. TOWN OF SOUTHOLD TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING/STRAPPING J~FINAL [ ] FIREPLACE&CHIMNEY [ ] FIRE SAr,. ~ ,( INSFECTION DATE //'''''' ~ "- / ~ INSPECTOR ~OUND~.~ON OSm3 FOUNDATION (~ND) · ROUOH IU~2~O & I~ U'i,ATION ~ N. Y, STATE ~GY CODE ADDITIONAL COMMENT8 Ol "V · . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 1'1971 TEL: (631) 765-1802 FAX: (631) 76~9502 SoutholdTown. NorthFork. net Examined ¢/~. 20 ]O Approved .t~ 20 ~ 0 Disapproved a/c BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form. N.Y.S.D E C Trustees Flood Permit Storm-Water Assessment Form Contact: to:q-,aS 5q A Phone: f~'~{' "4~ · ~i~(~ST be com~etely filled in by typewriter or in i~ ~d submitted to the Building lns~ctor ~th 4 ~owing~m ~u~ ~ ~ ~.~h../~location of lots~ ° ~~7;[;:i~i:~;;X;;:mises, relationship to adjoining premises or public st~eeB or ~e~, and wate~ays. c. The work covered by ~is application may not be mmmenced before issumce of Building Pemit. d. Upon approval of this application, the Building Inspector will issue a Building Pemit to the applicant. Such a pemit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pm for ~y pu~ose what so ever until the Building Inspector issues a Ce~ificate of Occup~cy. [ Eve~ build~g pe~it sh~l expke if the work authorized h~ not commenced wi~in 12 monks after the date of issumce or h~ not ~en completed within 18 monks f~om such date. lfno zoning mendments or o~er regulations affecting the prope~ have ~en enacted in the interim, ~e Building Inspector may authori~, in ~iting, the extension of the pemit for m addition six months. ~ema~er, a new pe~it sh~l be required. APPLICATION IS HE.BY MADE to the Building Dep~ment for ~e issu~ ora Building Pe~it pmu~t to the Building Zone Ordinan~ of the Tom of Southold, Suffolk County, New York, and other applicable Laws, Ordin~ces or Regulations, for the construction of buildings, additions, or ~temtions or for removal or demolition ~ herein described. ~e applicant agrees m comply with all applicable laws, ordinmces, building rode, housing code, and regulmions, ~d to Mmit authorized ins~ctors on premises ~d in building for necessa~ inspections. ~ (Signature of applic~t or ~e, ifa ~ration) (Ma~ing address of applm~t) State whether applicant is owner, lesa~li, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises [,k.~,,lt4~r '[- "~aoJ. t,~e "~h.~,' ~ (As on the t~ roll or latest deed) If applic~t is ~co~omtion, sign~ure of duly authorized o~cer (Natured title of co.orate off'er) Buildem License No. ~D ~ Plumbers License No. Electrici~s License No. ~ ~ ~ Other Tmde's License No. 1. Location of land on which oroposed work will be done: ~(~0 G. H-.~,.~:o,,- House Number Street County Tax Map No, 1000 Section Subdivision Hamlet Block ~ Lot Filed Map No, Lot -/5 --4- 2. State existing use and occupancy of premises and intended use and occupancy 9f proposed construction: a. Existing hse and occupancy .~'~ rx~l~.- 't~,=~r~f~{ r'~t~-r~c ~- b. Intended use and occupancy %1 ~ ~ -'~'xt t,/ r~, 4 er~: ~_, 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work ~1,oo~' rval::~xJ~ ~, [ (~ (Description) 4. Estimated Cost t'~OO Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. 1 f business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimansions of existing structures, if any: Front Rear J)epth Height. Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimansions of antire new construction: Front. Rear _Depth Height Number of Stories 9. Size of lot: Front Rear .Depth 10. Date of Purehane [q'~. C[ Name of Former Owner ~1~ tl. her 1 I. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO Y/ 13. Will lot be re-graded? YES NO ~/'Will excess fill be removed from premises? YES__ 14. Names o f~.E.n..e r o.L~ r e m i_s e s'l:> '~:~}~ r v'Address <~cn,a.q-tn= t~ Phone No. Nameof~q~"t'~ ~~ Address ;l:~l~0~,~'ll~PhoneNo ~l.qg*g-0ooO Name of Contractor ~ ¢~t~CC~tc- Address q...~ e-~-~a~ ~ Phone No. ~l '-'~ I. ~'1 ~ a- l 5 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. 16. Provide sur~ey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES__ NO w/~ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY OF ]~L°~ t 1~ d~ [ ~'1~ ~ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (Contractor, Agent. Corporate Officer, 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 tree to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Public, State of New Yo~ No. 0~A48~969 ~lifi~ in 6uffolk Coun~ ~n E~im~ May 11, ~ t I Town Hall Annex $4~75 Main Road P.O. Box 1179 Somhold, NY 11971-0959 Telephone (631) 765-1802 ro~er r~ert('~oo ~wn~.~s~o~u~f~.n¥.u~ BUrg .r~ING DEPARTMENT TOWN OF SOUT~OLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Company Name: Name: License No.: Mdress: Phone No.: Da~e: R-Z 0'! 0 JOBSITE INFORMATION: (*Indicates required information) *Name: *Address: ~0 ~. ~a,~o~ ~ ~O~ol~ . *Cm~ Street: *Phone No.: Permit No.: Tax Map District: 1000 Section: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) ~ Iq-~Jt-~ ( I F:)ho~o t ~ i.~_-- (Please Circle All That Apply) *Is. job ready for inspection: ~Do you need a Temp Certificate: Temp Information (If needed] · · Service Size: 1 Phase ' 3Phase 100 · New Service: Re-connect Underground Additional Information: Rough In Final 150 200 300 350 400 Number of Metem Change of Service PAYMENT DUE WITH APPLICATION Other Overhead 82-Request for Inspection Fonm '~ ~'~ O' 'l'o~m }tail Amlcx 51375 Main Road P.(). P, ox 1179 Soul]lo]d, NY 11971-09.59 Telephone (631) 765-1802 Fax (631) 76,5-9502 BI IILI)ING DEPAI/TMENT TOWN OF SOUTHOLD November 16, 2010 Walter & Pauline Pharr PO Box 958 Southold, NY 11971 RE: 360 South Harbor Road, Southold ~-~ NOTE: See the inspector's ticket dated 11/9110 ~ ~ · TO WHOM IT MAY CONCERN: The Following Items Are Needed To Complete Your Certificate of Occupancy Application of Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. A fee of $50.00 Final Health Department approval. Plumbers Solder Certificate. (All permits involving plumbing after 4./1/84) __ Trustees Certificate of Compliance. (Town Trustees #765-1892) __ Final Planning Board approval. __ Final Fire Inspection from Fire Marshal. __ Final Inspection from the Building Dept. __ Final Landmark Preservation approval. Building Permit: 35832-Z solar panels Q. Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROFER;W LOCA~O~ ~.C.T.M.~_.. . ~_ ~O~NO A~ONS ~Y ~UIRE THE SUB~ ~N OF A Z~ ~ ~ ~ ~ ~ .6,~ATER~G~ING~D~I~E~D~ION~OLP~ Ob~ S~n B(~ ~ kKK ~ arg~ BY A D~IGN P~Of~EO~ IN ~B ~ATE OF N~ Y~ Item Number: (NOTE: A Check Mank (qr) for ea0h Queetten Is Requked fer a Complete Ap~cetion) Yes No Will this Project Retain All Storm-Water Ran.Off Generated by a Two (2") Inch Ralnfall aq Site? V/ (This item will include all mn-off created by site clearing and/or ~onslmctian a~,~tlce an weti as all SI~ Improvements and the perrramant ~cetian of imperious surfaces.) D°es the Site Plan and/or Survey Show AIl Propeeed Drainage 81ructums Indicating Size & LeeaUan? / r'~ This Item sh~ include all Prepeeed Grade Cha~gee and Slopes Controlling Surface Wet anClowt Will this Project R~quim any Land Filling, Grading ~r Excavatian where them is a ~hange to the Naturol ' r~ Existing Grade Involving more than 200 Cubic Yards of MatedaI within any Parcer? -L/' Will this Application Require Land Disturbing A~lJvittes Encompassing an Area In Excess of r~ ,// F-we Thousand (5,000) Square Feet of Ground Sudace? Is there a Natural Water Coume R~nnlng through the eke? Is this Project within the Trustees ~dsd~§o~ or within One Hundred (100') feet of a Wetland or Beach? -- Will there be Site preparation On F_.xisitng Grade Stepes which Exceed Flitann (15) fsi[ of Vedical Rise to One Hundred (100') of HorizonteJ Distance? . intoWil( and/or DrivewayS,in thePeddngdirectionAreaSof a Town°r other right-of-way?lmpe;vteus Surfaces be Sloped to Direct Storm-Water Run-Off Will this Project Require the Piacarnant of MMedal Removal of Vegelatfon and/or the Canstn.'otio~ of r'~ any item within the Town Right-of-Way or Road Shoulder Area? (This Item will NOT Inolude the InstallaUon of Driveway Aprons.) Wili this Pro,oct Require Site Prepare,on within the One Hundred (100) Year Floodplain of 8ny Watercourse? r~ NOTE: If Any Answer to Questtone One through Nine te Answered with a Check Mark In the Box, a Stoml-Watar, 6redtoE, Drainage & Erosion Control Plan Is Reclulred and Mu~t be 6ubmltted for Revlaw Prior to luuan~e of Any Building Permltl EXEMPTION: Does this project meet the minimum standards for classification as. an Agficulte~ Project? Here: If You Answered ¥e$ to this Question, a Storm-Water, eroding, Drainage & Erosion Conlrol Plan is NOT Requlredl Yes No STATE OF NEW YORK, ~, _ , ............ ss That [, .....l~, _ ~..**v~......**.~...~ ~ ***v~, ...[~, _ ................ ~ d~y ~m, de~.s ~d ~d ~at he/she ~ ~e 0 0~4~/ · Owner ~or ~p~bdvc of ~c ~n~ ol O~cr's, ~ i6 duly aulo~d Lo pcdorm or ha~ pedo~ed m~e ~d file ~s ~pl/c~on; ~ ~] s~men~ ~n~ncd in ~is app6~on a~ ~t ~e wo~ w~l ~ ~onned in ~e ~er set fo~ in ~c app6~fion fled Sworn to ~[om me ~s; o~ Pub 'c .......................................... ~.~ .... TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREet ~> L~ C") W'~,GE D~ST. SUB. LOT "FORMER OWNER N ~. ACR. RES. ~/O S~S. VL FARM CO~. CB. MICS. Mkt. Valu~ ~ND iMP, TOTAL DATE RE~RKS I ' ~ ' AGE BUILDING CONDITION N ~ NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable FRONTAGE ON WATER )3 '/~¢. W~land FRONTAGE ON ROAD ~, ~/ ~ ~ ~-~ % ~ ~ Meodowl~d DEPTH ~ / ~ Hous~ BULKH~D Total D~K TRIM . ~.~H ,7'Z M. Bldg. Extension Extension Porch Breezeway , xZ-/ ~- Garage !Patio Foundation Basement Ext. Wails Fire Place Type Roof Bath Floors Interior Finish Heat Rooms 1st Floor l,/ Recreation Room Rooms 2nd Floor Dormer Driveway / - Total / Dinette LR. DR. BR. FIN. B C. GREENLOGIC® ENERGY December 1, 2010 The Town of Southold Building Department 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Re: Building Permit No. 35832 Pauline Pharr 360 South Harbor Rd, Southold To the Building Inspector: Enclosed please find the Engineer's Certification Letter for the post installation for Pauline Pharr's photovoltaic solar system, which we installed at 360 South Harbor Rd, Southold. Please arrange to send her the certificate of compliance and close out the building permit. Please let me know if you have any questions about the installation. Sincerely, Barbara Casciotta Account Manager GreenLogic LLC 631-771-5152 ext. 117 GREENLOGIC, LLC · www GreenLog~c corn Tel: 877771.4330 Fax: 877.771.4320 SOUTHAMPTON/CORPORATE: 425 County Rd. 39A Southampton, NY 11968 CUTCHOGUE: 1070 Depot Lane Cutchogue, NY 11935 MANORVILLE: 40 Woodlar/d Avenue Manorville. NY 11949 FIRE ISLAND: 125 Duneway Seaview, NY 11770 ROSLYN HEIGHTS: 200 S Service Rd, #}08 Rosyh~ Heights, NY 11577 CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERllFICATE IS ISSUED AS A MATrER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TI-IL 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 # ~NSUaED GreenIogic, LLC ~NSURE~A: NGM INSURANCE COMPANY 425 County Road 39A Suite 101 ~NSURE"B: MERCHANTS PREFERRED INS CO Southampton NY 11968 INSURER C: INSURER D: COVERAGES THE POLICIES O FINSU RANCE LISTED BELOW HAVE BEEN I SSU ED TO TH E INSURED NAM EDABOVE F ORTHE POLICY PERI ODIN D ICATED. N OTWITHSTAN DING 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. EXCLUSlONSAND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. G.~ENERAL LIABIUI'( EACH OCCURRENCE ; 1,000,000 A X X CO~MERCIALGENERALL~.BILITY MPP1681L 01131110 01131111 DAMAGETORENTED3R~MiRF~ IF~ nc~,r~nc~l ;80,000 I CLAIMS MADE [~ OCCUR ' MED EXP (Any one person) X ACM PERSONAL & ADV INJURY ~ 1,000,000 X CONTRACTUAL LIAB GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PROOUCTS - COMP~)P AGG ; 1 ~000~000 ~POLICY[~PRO~,IFC,T ~-~LCC AUTOMO~LE MABlUTY COMBINED SINGLE LIMIT ; 1,000~000 B A X ^.YAUTO CAPI043565 06/12/2009 06/12/2010 EXCESS I UMBRELLA MABIM3Y EACH OCCURRB-~CE ~ 2,000,000 A X ~OCCGR ~CL~MSMA~E CUPI68iL 01131110 01131111 AC~REGATE $ 2,000~000 RETENTION $ 10,000 $ CERTIFICATE HOLDER TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 Phone: I Fax: ACORD 25 (2009/0t) CANCELLATION SHOULD AHY OF THE ABOVE DESCRIBEDPOCICIES BE CANCELLED BEFORE THE EXPIRATION The ACORD name and logo am registered marka 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 carder 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, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Approved by: Thomas P. Terry, CPCU (Print name of authorized representative or licensed agent of insurance cartier) 08/03/2010 (Signature) (Date) 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 * HAUPPAE GE, NEW YORK 11788 DATE ISSUED: 12/10/2007 SUFFOLK COUNTY Master Electrician License This is to certify that No. 43858-ME 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. 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I W Slandby / Nighltime SPRm Efficiency Curves 100 ~a0va~ 8o 75 % of Rated Oulput Power 8O% 9O% 100% Shipping Dimensions W x H x D inches ~3.5' × 18.5" x t6.o' Unit Dimensions W x H x D inches 17~e' x 13.8' x 9.~~ Inveder Weight 88 Ib~ Shipping Weight 94 lbs Cooling Forced Air / Sealed Ambient Temperature Range -13 to .113 oF Certifications SunPower deslgns, 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 deliver significantly more energy than competing systems. www. sunpowercorp.com SPR-215-WHT 215 SOLAR PANEL EXCEPTIONAL EFFICIENCY AND PERFORMANCE The SunPower 215 Solar Panel provides industry 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 totaJ panel conversion efficiency of 17.3%. The 215 panel's reduced voltage-temperature coefficient 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 Ihe Power Thin Film Conventional Waits / Pand 65 165 Efficiency 9.0% 12.0% kWs 90 120 r Peak Power (+/~%) Rated Vo~ge Rated Current Oger~ Circuit VoJlage Short Circuit Current Pmax 215 W Vmp 39.8 V Imp 5.40 A Voc 48.3 V Isc 5.80 A Maximum System Voltage IEC, UL 1000 V, 600 V Temperalure Ccefficients Power -0.38%/~C Voltage (Voc) -136.8 mV/~C Current (Isc) 3.5 rnA/~C Series Fuse Rating 15 A Peak Power per Unit Area 173 W/m2, 16.1 W/~' CEC PTC Rating 198.5 W 215 SOLAR PANEL EXCEPTIONAL EFFICIENCY AND PERFORMANCE 7.0 6.0 5.0 4.0 ~.o 1.o o.o 10e0 W/r~ 500 W/m~ 0 10 20 30 40 Solar Cells 72 SunPow~r all~ck conlacl monoa-/stolline Front Glass 3.2mm Jl/8 in.) tempered Junction Box lpg5 raled wilh 3 bypass diodes Ou~out Cables 90Omm lenglh cable / Mutii~ontocl connectors Frame Anodized aluminum alloy type 6063 Weight 15kg, 33lbs Temperature - 40° C to +85° C (-40° F Io +185° F) Max load 50 psf (2400 Pascals) front and back Impact Resistance Hail- 25mm (1 in) al 23 m/s (52 mph) 10 year limiled product wananiy Certifications IEC 61215, Sa,~ety tested IEC 61730; UL lis/ed IUL 1703), Class C Fire Raling Dimensions CAUTION: READ SAFE'P( AND INSTAUA11ON INSI~LICTIONS BEFORE USING 11'1E PRODUCT. Go te www.sunpowercorp.com/panels 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 lrackers deliver significantly more energy than competing systems. ~ Printed on paper www. sunpowercorp.com 2 Strings of 8 SunPower 215 W pane;s First String total 1720 Array total 3440 I I I I I I All panels to be grounded as per NEC code II SunPower S~R 400d '~ 3verter 2, 30 AMP two pole DC switches from panels to inverter 240 VAC 1 240 VAC from inverter to a 30 ^mo switch near utility meter Pacif'mo Engineering PC PO Box 1448 Sayville, NY 11782 www. pacificoengineering.com August 8, 20t0 Town cf Southold Building Department 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Subject: Solar Energy Installation for Pauline Pharr 360 South Harbor Rd Southold, NY 11971 Engineering Consulting Ph: 631-988..0000 Fax: 631-382-8236 engineer~pacificoengineedng.com APPROVEDASNOTEO // DATE' FEE: ~. BY NOTIFY BUILDING DEPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION- TWO REQUIRED FOR POURED CONCRETE 2 ROUGH . FRAMING, PLUMDNG, STRAPPING, ELECTRICAL & CAULKING 3~ INSU~TION 4 FINAL. CONSTRUCTION & ELECTRICAL MUST BE COMPLETE FOR CO. ALL CONSTRUCTION SHALL MEET THE I have reviewed the roofing structure at the subject address. The structure can R~l~L~l~l~qt~L~ OF NEW the roof mounted system. The units are to be installed in accordance with the n~llq~q~a~Sl~){~l~l~i~ti~9~SiBLE FOR instructions. I have determined that the installation will meet the requirements o~[;I,~I[~)~ and ASCE7-05 when installed in accordance with the manufacturer's instructions. Roof Section A B mean roof height 14 ft 14 ft pitch 5 in/12 5 in/12 roof rafter 2x10 2x6 rafter spacing 16 in OC 24 in OC Reflected roof rafter span 13.6 ff 10.6 ff Table R802.5.1(1) max 20.6 ft 10.8 ff collar tie 2x4 collar fie spacing 16 in OC The climactic and Icad information is below: CEMACTIC AND GEOGRAPHIC DESIGN CRITERIA Roof Section A B Category C Wind Speed, 3 seC gust, mph 120 Ralph Pacifico, PE Professional Engineer Live Icad, point pnet30 per pullout ASCE 7, toad, lb psf 58 304 58 304 ,¥iTHOiJ i CERTIFICATE Ui- uGu,, Fastener type 5/16" dia screw, 4" length, 2 per 5116" dia screw, 4" length, 2 per LOGIC I ELIMINATING THE COST OF ENERGY Pacifico Engineering PC Ralph Paciflco, PE NYS I_ice~se 066182 GreenLogic, LLC Proposed Pharr, Pauline 3.44kW PV 360 South Harbor Road Southold, NY 11971 (631.765.8138 ppharrin(~aol.com 1.72 kW 8 SunPower 215w UniRac Sunf~ame Azimuth = 160° Pitch = 22° Scale 3/16" = 1.0' Panel Dimension = 61.39" x 31.42" Array Length = 245.44" Array Height = 98.76" Magic # = 32.17" SunPower 215w t UniRac 4" Standoff UniRac SunFrame Rail I~2x6" Douglas Fir Rafter I 16" on center Layout Created By: BCA Date: 8.5.2010 LOGIC i ~ Paciflco Engineering PC (:[IMINATING THE COST OF ENERGY $31-9~8~0oo wwwp.ac_, ~_o~_ um_e~ ~cu Ralph Pacifico, PE NYS License 066182 GreenLogic, LLC Proposed Pharr, Pauline 3.44kW PV 360 South Harbor Road Southold, NY 11971 (631.765.8138 ppharrin~aol.com 1.72 kW 8 SunPower 215w Panel Dimension = 61.39" x 31.42" UniRac Sunframe Azimuth = 160° Pitch = 22° Scale 3/16" = 1.0' Layout Created By: BCA Date: 8.5.2010 Array Length = 245.44" Array Height = 98.76" Magic# = 32.17" SunPower 215w · UniRac 4" Standoff UniRac SunFrame Rail I12x6" Douglas Fir Rafter ~ 16" on center - LOGIC Pacifico Engineering PC PO Box 1448, Say~e, NY 11752 ELIMINATING THE COST OF ENERGY Ralph Pacifico, PE NYS Liceflse 066182 GreenLogic, LLC Proposed Pharr, Pauline 3.44kW PV 360 South Harbor Road Southold, NY 11971 (631.765.8138 ppharrin~aol.com 1.72 kW 8 SunPower 215w UniRac Sunfl'ame Azimuth = 160' Pitch = 22° Scale 114" = 1.0' Panel Dimension = 61.39" x 31.42" Array Length = 245.44" Array Height = 98.76" Magic # = 32,17" SunPower 215w · UniRac 4" Standoff _ UniRac SunFrame Rail I 12x6" Douglas Fir Rafter 16" on center Layout Created By: BCA Date: 8.5.2010 £1tMINATING LOGIC THE COST OF ENERGY : Pacifico Engineering PC PO Bo]( 1448, S~, NY 11782 Ralph Pacifico, PE NYS License 066182 GreenLogic, LLC Proposed Pharr, Pauline 3.44kW PV 360 South Harbor Road Southold, NY 11971 (631.765.8138 pphardn@aol.com 1.72 kW 8 SunPower 215w UniRac Sunfl'ame Azimuth = 160° Pitch = 22° Scale 1/4" = 1.0' Panel Dimension = 61.39" x 31.42" Array Length = 245.44" Arrey Height = 98.76" Magic # = 32.17" Layout Created By: BCA Date: 8.5.2010 SunPower 215w -" · UniRac 4" Standoff UniRac SunFrame Rail J2x6" Douglas Fir Rafter 16" on center