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HomeMy WebLinkAbout36099-ZTown of Southold Annex 54375 Main Road Southold, New York 11971 3/15/2011 CERTIFICATE OF OCCUPANCY No: 34865 Date: 3/15/2011 THIS CERTIFIES that the building Solar Panels Location of Property: 240 WILLOW DR GREENPORT, SCTM #: 473889 Sec/Block/Lot: 33.-6-6 Subdivision: Filed Map No. Lot No. conforms substamially to the Application for Building Permit hercto£ore filed in this officed dated 12/10/2010 pursuant to which Building Permit No. 36099 dated 12/17/2010 was issued, and conforms to all o£the requirements o£the applicable provisions of the law. The occupancy for which this certificate is issued is: Roof mounted electric solar panels on an existing one family dwelling as applied £or. The certificate is issued to Haaspcr, Carl & Haaspcr, Jorga (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 36099 1/24/11 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. 36099 Z Date DECEMBER 17, 2010 Permission is hereby granted to: CARL HAASPER PO BOX 522 GREENPORT,NY 11944 for : CONSTRUCTION OF ROOF MOUNTED ELECTRIC SOLAR PANELS AS APPLIED FOR at premises located at 240 WILLOW DR County Tax Map No. 473889 Section 033 pursuant to application dated DECEMBER Building Inspector to expire on JUNE GREENPORT Block 0006 Lot No. 006 10, 2010 and approved by the 17, 2012. Fee $ 200.00 ~ Signature ORIGINAL Rev. 5/8/02 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Depaxtment with the following: A. For new building or new use: 1. Final survey °f property with accurate location of all buildings, pyoperty lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (8-9 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.a~ing Board Approval of completed site plan requirements. 1~. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: I. 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 $ t5.00, Commercial $15.00 New Construction: Location of Pmpert"y.k ~ -4 House No. Owner or Owners 0f Property:'y~ · Suffolk County Tax Map No 1000, Section Subdivision Health Dept. Approval: Date.x/ _ Old or Pre--existing Building: Street ~ '3 Block (check one) ~ Hamlet Planning Board Approval: Date of Permit. Filed Map. Applicant: Underwriters Approval: Request for: Temporary Certificate Fee Submitted: $ %'-~. Final Certificate: (check one) (.~ ~lJlic~ant Signature .5137.5 Main Road P.O. Box 117!} Soulh~fld, NY I 1!171-0q39 Telephone (631) 763-181)2 F~LX (631) 76.5-q302 ro.qer, richert~town southo d ny us BUIIJ)IN(; I)EI~AI/TMI~;NT TOWN OF $OUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Carl Haasper Address: 240 Willow Dr City: Greenport St: NY Zip: 11944 Building Permit #: 36099 Section: 33 Block: 6 Lot: WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Go-Solar Inc LicenseUo: 35972-me 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 INVENTORY Service 3 ph Hot Water GFCI Recpt Main Panel NC Condenser Single Recpt Sub Panel NC Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: Ceiling Fixtures [~ HID Fixtures Wall Fixtures ~.~ Smoke Detectors Recessed Fixtures ~.~ CO Detectors Fluorescent Fixture J.~ Pumps Emergency Fixturel~ Time Clocks Exit Fixtures L~] TVSS photovoltaic system-consisting of 44 kd210 and 6 kd135 panels, 2 SMA 4000 inverters, total watts10,080, I combiner box Notes: Inspector Signature: Date: Jan 24 2011 81-Cert Electrical Compliance Form TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] ROUGH PLBG. [ ] I~LATION [ ~ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SA~c, ( INSPECTION [ ] FIRE RESISTANT C(XlS1RUCTI~ [ ] FIRE RESISTANT I~NLqllATION REMARKS: ~ ~ ~ DATE Fisher Engineering Services, P.C. PO Box 30 · Oakdale · New York 1171 -- - -- Phone: (631) 563-9028 ~ C [~ ~ ~ February 22, 2011 Building Department Subject: Engineer Statement for Solar Roof Installation Haasper Residence- 240 Willow Drive, Greenport, New York I have verified the adequacy and structural integrity of the existing roof rafters for mounting the solar collector panels and their installation satisfies the structural roof framing design load requirements of the Residential Code of New York State. I have reviewed and certify that the manufacturer's guidelines and equipment for the photovoltaic equipment for the above residence meet the requirements for wind and snow load and that the roof structure is adequate to carry the new loads imposed by the System. For the installation of the solar mounting, the rails are securely anchored to the rafters utilizing lag screws that have been designed for wind speed criteria of 120 mph Exposure C and snow ground criteria of 20 psf. Wind loads will exceed seismic loads. Other climate and geo design criteria are not applicable to this solar installation. The solar collector system and the mounting assemblies comply with the applicable sections of the Residential Code of New York State- "Solar Systems" and loading requirements of roof-mounted collectors. This system has been installed properly at the above referenced residence. The installation is in accordance with the minimum requirements certified by this letter. I hope that this letter serves and meets with the approval of the Building Department. Sincerely, Licensed Professional Engineer Architectural Design · Residential · Light Commercial Additions Extensions Conversions Construction Estimates/Oversight · Expediting · Inspections ~.,.~'n~s~,c~. 0Nmn~o~T DiS ]. 9om'~s.. FOUNDATION (lST) _ "'~ · ' -- -A PL~G ' ' ~8~ON P~ N.Y. ,' STA~ ~R~ CODE , ~ - ~/~~ ~D~ON~ cOUNTS '-'.. ' ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined /~- ~,20 /0 Approved ,/eg- --//fi'", 20 /O D'Aa.pprewd a/c Expiration PERMIT NO. BI DG OE?l. TOWN OF SO[~IHOLO Building Inspector i PERMIT APPLICATION CHECKLIST 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 Stom~-Water Assessment Form Contact: pbone: ¢ ' APPLICATION FOR BUILDING PERMIT Date /~/' ,~¢ ,20/0 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. L Every building permit shall expire if the work authorized has not commenced within 12 months after the date of' issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting thc property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of appl}.~ or na~t~if a c~rporation) (Mailing addresgof applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name ufowner o~ premises (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. County Tax Map No. 1000 Section Subdivision Location of land 2n which ~roposed work will be done: 0,90 i,O, [J.o o , q. at.,.a?o,er-, a;.y. House Number Street 'q ill~l~:lOUl~_~ amlet I1~'~'~~ a ,. ,,~ Lot /3 2. State existing use and occupancy of premi~ies and intended pse. and occupagcy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building. Addition Alteration Repair Removal Demolition __Other Wort~/..~/..~//,o~ ~ ,~t~r~ ~ '~ ~ ~ 5)/-%Ce~ (t~escription) 4. Estimated Cost Fee 5. If dwelling, number of dwelling units J If garage, number of cars // (To be paid on filing this application) Number of dwelling units on each floor / 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front ~, f Rear ~t9-~/ Depth Height. Number of Stories / Dimensions of same structure with alterations or additions: Front S ~ Depth Height ....- ..... Number of Stories Dimensions of entire new construction: Front S'/~ e.- · Rear Depth Height Number of Stories 9. Size of lot: Front CP/~! Rear q/2.-~" Depth 10. Date of Purchase Name of Former Owner .~-- ~**,/t~.; 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO JI-A 13. Will lot be re-graded? YES N~,~'Y~ill excess fill be removed from premises9 YES 14. Names of Owner of premises ~.d. /]~.~/Oe2 Name of Architect Name of Contractor ~0 .So/.A-t,~-~vc Address,,~ ~ p/F'Phone No. ~;'¢/~' Address Phone No Address ~7-x t}hu~ ~t/t ~',~q. JkqPhone No. b 15 a. Is this property within 100 feet ora tidal wetland or a freshwater wetland? *YES * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE RE~.J. JIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO ~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. NO W/ 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. l 8. Are there any covenants and restrictions with respect to this property? * YES__ · IF YES, PROVIDE A COPY. NO W/ STATE OF NEW YORK) SS: COUNTY OF ) /;k.-~.~ ~ ~ being duly sworn, deposes and says that (s)he is the applicant (Nam-e of individua~sig"~ih~ ~'drac~ above named, (S)He is the'// t"~k~rk~ '1 (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 ail statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Town H~dl Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 ....F,~ (63l) 765-,95q2 ro,qer.richert(~,town.soutno~l ny us BUILDING DEPARTMENT TOWN OF SOUTI-IOI.~ APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Company Name: Name: License No.: Date: /~//-// Address: Phone No.: JOBSITE INFORMATION: *Name: *Address: *Cross Street: *Phone No.: Permit No.: Tax Map District: (*Indicates required information) 1000 Section: :~3 Block: ~ Lot: *BRIEF DESCRIPTION OF WORK (Please Print ~oo~+1,t °~s-f~. -~o~ I~r.s ~o,o~o (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  / NO Rough In ~ / NO 100 150 200 300 350 400 Other *New Service: Additional Information: Re-connect Underground Number of Meters Change of Service Overhead PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form BUILDING PERMIT EXAMINER CHECKLIST Applicant: 6xchite~ sc'r t# t000- Property Address: Subdivision: ;f~:~P/3 *Date Submitted: Owner: ~ ~'~Q-~ Sutldlng Permits (Open/Expired): B?gOT/~-Z/C/0 Z.~5-?aTg, info: /V ~ ~/'__-Z / C/0 Z- , Info: BP__ -Z / C/0 Z- , Info: ~ingle & Separate Search Required? Y or~ Determination: ~EQ. Lot Size: ACT. LOt Size: (~_~, ~ o~-~-o~"~ IIIQ. Front ACT. Front REQ Side ACT. Side IBQ. Height. ACT. Height. R~t~. tt~,,. SI~ ?roject Description: ;Vaterfront? Y o~N~ yes, water body.':" Estimated Cost: Zone: Conforming? City: ~ Pre COs? BP T 'Z / C/0 Z' ' , Info: - -- BP__ -Z / C/0 7.- , Info: _. REQ. Lot Cov. __ ACT: Lot Coy. REQ. Rear PROP. Rear ./let Panel#__ Flood Zone: __ Bulkhead/Bluff Distance: kDDITIONAL APPROVALS REQUIRED lnffolk County Health: Yo If yes, *Bed#: *Date: / / *Permit#~ - If no, certification required: Y or N Received: Y or N By: qYS DEC: Pn~-~zc~ar~$ Y o~- Date: __/__ _ louthold Trustees: y or~- Date: / louthold ZBA: Y or~ ~ Date: / /__ louthold Planning: Y o~..~- Date: ~/ ['own Landmark C of A: Y o~DTE: __ {otes: / Permit #: Pernfit #: Permit #: Permit #: / Town Septic: Y o~] or NJ Letter - Notes: or NJ Letter - Notes: - Notes: - Notes: Compliance (page 2)~or N CODE ~ee Structure: :oundation: SF :irst Floor: SF ',~cond Floor: SF )ther: SF ?oral: SF Calculation: /,~ ,~ ~_~ SF X $ __ =$ + Initial Fee: $ + Addition{ti Fee ( ): $ SF X $ =$ + Initial Fee: $ + Additional Fee ( ): $ ~7~ o, oc9 · Ground Snow Load: 20__ Weathering: Severe__ Design Temp: ! 1. · Ice Shield Underlay: YES. USE/OCCUPANCy CLASSIFICATION: · HEIGt:IT/FIRE AREA: TYPE OF CONSTRUCTION: NEW YORK STATE CODE COMPLIANCE CHECKLIST CLIMATIC/GEOGRAPHIC DESIGN CRITERIA: Wind Speed; 120MPH. Seismic Design Category." B ..', · Frost Depth: 36" __ Termite: M-H i Decay: S-M .. - Flood Hazai'ds: DESIGN CRITERIA: ENGINEBRED/pREsc1LI?TiVE FULL F1LAMING DESIGN ELEMENTS: y/N HEADERS: YfN WALL STUDS: Y/N CEILING JOISTS: YfN FLOOR JOISTS: Y/N LUI~BER SPECIES AND GRADE: Y/N GLR_D ERS: Y/N ROOF RAJ~ERS: Y/N WII',IDOW AND DOOR SCHEDULE! NIISSLE TEST REQUIREMENTS: EGRESS 5.7 S.F.: Y/N LIGHT 8% :y/N 5rENT 4 %: Y/N NAILING/CONSTRUCTION scHEDuLE: Y/N MEANS OF EGRESS: Y/N PLUMBING P,-[SER D[AGICAM: Y/N LOCATION OF FI1LE PROTECTION EQUEPMENT: Y/N · TRUSS DESIGN: Y/N CERTIFICATION: Y/N ENERGY CALCS: Y/N TOTAL COMPLIENCE? Y/N (RETURN TO PAGE ONE) Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M~a: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A l^  ,~.~ STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. DisUtot Sectton Lot SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT [ Yes No a. What is the Total Area of the Project Parcels? i Will this Project Retain AIl Starm. Water Run,Off' (Include Total Area of all Parcels located within ~ ~ ~ Generated by a Two (2") Inch Rainfall on Site? · b. What is the TotalArea of Land Clearingthe Scope of Work for Proposed Construction) ~,(S'F~cms) (This item will include all run-off created bY site cleadng and/or construction activities as well as all and/or Ground Disturbance for the proposed ~ Site Improvements and the permanent creation of impervious surfaces.) construction activity? / (S.F. / Acres) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCRIPTION (pro,,'~ Addit~o.N Pages ss Needed) Drainage Structures indicating Size & Location? This ' / Item shall include all Proposed Grade Changes and (J~[/Jg.,'~ ~ ~0¢ ~0~,~ S0t~ ?~ Slopes Controlling Surface WatsrFIow. SV~vt, C0/~/~, Z ~5/ '](/V0~.~4~,4-]~.~1~ 3 Does the Site Plan and/or Survey Ooscribe the erosion and sediment control practices that will be used to '~ do [P~S '~ --Ig I]~y ~ ~.~.4~ ~) [ -~,~' ~"t~ j% Construction/rem must be Period.maintained throughout the Entire iby , 4 Will this Project Require any Land Fitling, Gradingor (~ 0 b~ ~/i~ ~,~ .~.~ Excavation where there is a change to {~he Natural · Existing Grade Involving more than 200 Cubic Yards __ of Matedal within any Parcel? 5 Will this Application Require Land Disturbing Activi0es D /,~ Encompassing an Area in Excess of Five Thousand (5,000 S.F.) Square Feet of Ground Surface? -- 6 Is there a Natural Water Course Running through the O j Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or -- Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one (1)or mere acres; including disturbances of less than one acre thct 7 Will there be Site preparation on Existing Grade Slopes r~ ~,~ are pad of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen (15) feet of Vertical Rise to including Construction activities involving soil disturbances of less than one (1) acre where One Hundred {100') of Horizontal Distance? the DEC has determined that a SPDES permit ts required for storm water discharges. SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways, Parking Areas or other Impervious r~ tor Sllom~ Water Discharges from Construction activity * Permit No. GP.~.t0-00t .) Surfaces be Sloped to Direct Storm-Water Run-Oft 1. The SWPPP shall be prepared prior to the submittal of the NOI. The NOI shall be into and/or in the direction of a Town right-of-way? -- submitted lo the Department prior to the commencement of construction activity. 2. The SWPPP shall descdbe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material,~ required, post-construction storm water management practices that will be used and/or Remova~ of Vegetation and/or the Construction of any V constructed to reduce the pollutants in storm water discharges and to assure item Within the Town Right-of-Way or Road Shoulder~ STATE OF NEW YORK, q~,,c~ ;,/ That I, ..~....~_/....~....~: ................... being duly sworn, deposes and says that be/sbe is the applicant £or Permit, And that he/she is the ~-/..[.~./...~.. Owner and/or representative of tt~e Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statement~ contathed in this application are true to the best of bis lmowledge and belief; ~md that the work will be performed in the manner set forth in the appfication filed berewith. Sworn to before me this; FORM - 06/10 ~ Falll~0t} / Town I lall AImcx 51S75 Main Road P.O. Box 1179 Southold, N Y 11971-09.59 Tclclihonc (6:41) 76,5-1802 Fax (631) 7{i,3-9,~02 BI ;II,I)IN(; I)I']PARTMI']NT TOWN OF SOUTHOLD March 2,2011 Go Solar Inc 272 Main Road Riverhead, NY 11901 RE: Haasper, 240 Willow Drive, Greenport. Please provide the information the Building Inspector requested on 2/17/11 (copy of his ticket attached) TWO WHOM IT MAY CONCERN: The Following Items Are Needed To Complete Your Certificate of Occupancy: __ Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. __ A fee of $50.00. __ Final Health Department Approval. Plumbers Solder Certificate. (mi permits involving plumbing after 4/1/84) Trustees Certificate of Compliance. (Town Trustees #765-1892) Final Planning Board Approval. Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. Building Permit: 36099-Z solar panels SOUND DRIVE THE LOCATION OF WELLS, WATER SERVICE LINES, SEPTIC TANKS AND CESSPOOLS SHOWN HEREON ARE FIELD OBSERVA- TIONS AND OR DATA OBTAINED FROM OTHERS. LOT 15 NB 7"42 '50" W 201.01 ' LOT 12 J6J. 5 1' INLET POND R OA D C) C) DESIIN G. GRAF N.Y.S. LIC No. 5006 lAX I.D, No. 1000-33-6-6 SURVEY OF: LOT 15 MAP OF HOMESTEAD ACRES DATE: ~t~:' SCALE: f' = 60' SEP ] 0 STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier la. Legal Name and Address of insured (Use street address only) GO SOLAR INC 272 MAIN ROAD RIVERHEAD, NY 11901 2. Name and Address of the Entity requesting Proof of Coverage (Entity being listed as the Certificate Holder) lb. Business Telephone Number of Insured 631-727-2224 lc. NYS Unemployment Insurance Employer Registration Number of Insured 4629719 ld. Federal Employer Identification Number of Insured or Social Security Number 300144659 3a. Name of Insurance Carrier The First Rehabilitation Life Insurance Town of Southold Building Department Town Hall Southold, NY 11971 Company of America 3b. Policy Number of Entity listed in box "la": DBL176989 3c. Policy effective period: 02/05/2010 m 02/04/2011 4. Policy covers: a. [] All of the employer's employees eligible under the New York Disability Benefits Law b. [] Only the followingclassorclassesoftheempIoyer'sempIoyees: Date Signed Telephone Number Under penalty of per. jury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. (Signature of insurance carrier's authorized representative or~YS ~ Insurance Agent of that insurance carrier) 516-829-8100 Title Sr. Vice President IMPORTANT: If box "4a" is checked, and this form is signed by the insurance carrieds authorized representative or NYS Licensed Insurance Agent of that carrier, this certificate is COMPLETE. Mail it directly to the certificate holder. If box "4b" is checked, this certificate is NOT COMPLETE for the purposes of Section 220, Subd. 8 of the Disability Benefits Law. It must be mailed for completion to the Worker's Compensation Board, DB Plans Acceptance Unit, 20 Park Street, Albany, NY 12207. PART 2. To be completed by NYS Worker's Compensation Board (Only if box "4b" of Part 1 has been checked) State of New York Worker's Compensation Board According to information maintained by the NYS Wm'ker's Compensation Board, the aBove-named employer has complied with the NYS Disability Benefits Law with respect to all of hislher employees. Date Signed By Telephone Number Title (Signature of NYS WorkeCs Compensation Board Employee) Please Note: Only insurance carriers licensed to write NYS Disability Benefits insurance policies and NYS Licensed Insurance Agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (5-06) Additional Instructions for Form DB-120.1 By signing this form, the insurance carrier identified in Box "3" on this form is certifying that it is insuring the business referenced in Box "la" for disability benefits under the New York State Disability Benefits Law. The insurance carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in Box "2", This certificate is valid for the earlier of one year after this form is approved by the insurance carrier or its licensed agent, or the policy expiration date listed in Box "3c", Please Note: Upon the cancellation of the disability benefits 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 NYS Disability Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability Benefits Law. DISABILITY BENEFITS LAW Section 220. Subd. 8 (a) The head of state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b) The head of state or municipal department, board, commission, or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article, and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. DB-120.1 (5-06) Reverse New York State Insurance Fund ~Forkers' Compensation & Disabilit~ Benefits Specialists Since 1914 8 CORPORATE CENTER DR, 3RD FLR, MELVILLE, NEW YORK 11747-3129 Phone: (631) 756~300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE GO SOLAR INC 272 MAIN RD RIVERHEAD NY 11901 POLICYHOLDER CERTIFICATE HOLDER GO SOLAR INC TOWN OF SOUTHOLD 272 MAIN RD BUILDING DEPARTMENT RIVERHEAD NY 11901 TOWN HALL SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE 11346 970-5 995019 02/09/2010 TO 02/09/2011 3/8/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1346970-5 UNTIL 02/09/2011, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 02/09/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYANDCONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY, U-26.3 NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www, nysif.com/certJcertval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 306965270 Certifiedto the new UL1741/IEEE 1547 lOyr. standard warranty Improved CEC effidency · Integrafed f~sed series sh-ing combiner > Sealed electronics enclosure & Opticool > Comprehemive SMA communications and data cdledion options > Ideal for reddentid or light commercial applications · Rugged ca~ ~duminum outdoor rated enclosure of inverters updated with our W~dh ov~ ,has Max. Recommended Array Input Power (DC · ~Tc) Max. DC Voltage Peak Power Tracking Voltage DC Max. Input Current DC Vollage Ripple N¥~ber of ~used Siring Inputs AC Nominal Power AC Maximum Output Power AC Maximum Ou!put Current AC Nominal Voltage / Range AC Frequency/Range Peak Inverter Efficiency CEC weighted Efficiency Dimensions W x H x D in inches Weight / Shippin Weight Ambient tern Topology Cooling Concept Location Indoor / Outdoor {NEMA 3R) SB 30OOUS Lid Color: aluminum / red / Blue / yellow Communication: RS485 ~n]p!ion~:~:' !EEE-929, !EEE-i547, UL 1741, UL 1998, FCC Part i5 A & B Specifications for nominal conditions Efficiency Curves 3750 W 500V 180- 400V·208V 200 - 400 V · 240 V 17A <5% 4 228 V 250 - 480 V · 240 V 18A <5% 3500W·208V/4000W·240V 17 A @ 208 V, 16.6 A · 240V 183 - 229V·208 V 211 - 264V·240V 60 Hz / 59.3 Hz - 60.5 95.5 % · 208 V 96.0 % @ 240 V 3000 W 3000 W 15 A · 208 V, 12.5 A@ 240V 183 - 229 V· 208 V 211~264V·240V 60 Hz / 59.3 Hz - 60.5 Hz 1 96.6 % 95.0%@ 208 V 95.5 % · 240 V 1Z8 x13,8 x9.3 lZ8 x13.8 x9.3 88 lbs / 94 lbs 88 lbs / 94 lbs < 7W/0.1W < 7W/0.1W PWM, true sinewave, PWM, true sinewave, Convection, regulated fan cooling Convection, regulated fan cooling e/e e/e e/o/o/o e/o/o/o o/o o/o · · · · · Included O Option - Not available ~v. sma-america.com Phone 530-273-4895 Toll Free 888-4SMAUSA SMA America, Inc. PV MODULE FRAMING AND MOUNTING SYSTEM FOR PITCHED ROOFS PV MODULE FRAMING AND MOUNTING SYSTEM FOR PITCHED ROOFS Module Compatibility Use SunFrame with PV modules from these major manufacturers: BP Solar, GE Energy, Isofoton, Kyocera, Mitsubishi, ?botowatt, RWE Schott, Sanyo, Sharp. Call UniRac or your ?V dealer for manufacturers not listed. Code Compliance SunFrame is designed to comply with the Uniform and Califomia building codes when installed according to SunFrame installation instructions. Call UniRac concerning status of International Building Code compliance. Components O Inter-Module Rails support modules as little as 2.125 inches above the roof. O Full Length Cap Strips secure modules and finish the array topside forming a gap-free frame. Self- tapping screws at 16-inch intervals provide the holding power. O Push-Fit End Caps neatly finish the rail ends. O L-Feet attach directly to asphalt shingle roofs and support the rails one-half to three-quarters of an inch above the roof surface to provide convective ventilation. O Splices safely extend rails. O Aluminum or Steel Standoffs (optional) in a range of heights sup- port L-feet above tile or shake roofs. UniRac offers appropriate flashings. Clear or dark finishes on all visible above-roof components, from L-feet to screw heads, match the frames of your PV modules. Component Specifications Rails, cap strips, two-piece standoffs, splices, and L-feet: 6105-T5 alnminum extrusion. End caps: UV resistant plastic. One-piece standoffs: Service Condition 4 (very severe) zinc-plated welded steel. Fasteners: 304 stainless steel. xArw~N. Ulllrac. colyf See our SunFrarne page for complete in/ormation: pricing, installation instructions appropriate to your build- lng code, and minimum requirements for the number and type of modules you plan to mount. UniRae, Inc. 3201 University Boulevard SE, Suite 110 info@unirac.com Albuquerque NM 87106-5635 USA 505.242.6411 505.242.6412 Fax practices specified by AAMA 609 & 610-02 - "Cleaning and Maintenance lot Architecturally Finished Aluminum" (m.aamanet.mg) are not followed by pucchaser This WIn, anty does nor cover damage to the Product that occors during its shipment, storage, or installanon This Warranty shall be VOID if installation ol the Product is not perfumed in accordance with UniRac's wmten installation instxucuons, or if the Product has been modified, repaired, or reworked in a manner not ptewously authorized by UniRac IN WRIIING, or if the Product is installed ill an environment /or which it was not designed Un/Rat shall not be liable for consequential cx)nfingent or incidental damages aristng out of Pub 050206.1ds · February 2005 © 2005 UniRac, Inc. All tights reserved. and discharge all of UniRac's liability unth lespect to this limited THE NEW VALUE FRONTIER KYOCERa KD135GX-LP HIGH EFFICIENCY MULTICRYSTAL PHOTOVOLTAIC MODULE I,,ISTED HIGHLIGHTS OF KYOCERA PHOTOVOLTAIC MODULES Kyocera's advanced cell processing technology and automated production facilities produce a highly efficient multicrystal photovoltaic module. The conversion efficiency of the Kyocera solar cell is over 16%. These cells are encapsulated between a tempered glass cover and a pottant with back sheet to provide efficient pmteetion from the severest environmental conditions. The entire laminate is installed in an anodized aluminum frame to provide structural strength and ease of installation. Equipped with plug-in connectors. APPLICATIONS KD135GX-LP Is Ideal for grid tie system applications. · Residential roof top systems · Water Pumping systems · Large commemial grid tie systems · High Voltage stand alone systems · etc. QUALIFICATIONS · MODULE: UL1703 certified · FACTORY: ISO9001 and ISO 14001 QUALITY ASSURANCE Kyocera multlcrystal photovoltaic modules have passed the following tests. · Thermal cycling test · Thermal shock test · Thermal / Freezing and high humidi[y cycling test · Elect rical isolation test · Hail impact test · Mechanical, wind and twist loading test · Salt mist test · bght and water-exposure test · Field exposure test LIMITED WARRANTY year limited warranty on material and workmanship 20 years limited warranty on power output: For de~l, p~ase refer to 'category IV" in Warranty issued by I{yocem ELECTRICAL CHARACTERISTICS Current-Voltage characteristics of Photovoltaic Module KD135GX-LP at various cell temperatures Current-Voltage characteristics of Photovoltaic Module KD135GX-LP at various irradiance levels SPECIFICATIONS KD135GX-LP · Physical Specifications ~68 (26.3in,) :i 35.7 '-~17+~--- Unit; mm (in.) · Specifications · Elect Heal Pe~enaance un,er Standard Test ~ {'STC) Maximum Power (Pmax) 135W (+S%/-5°/o) Maximum Power Voltage (Vmp¢ 17.7V Maximum Power Current (Impp} 7.63A Open Circuit Voltage {Vet) 22.1V Short Cimuit Current (Isc) 8.37A Max System Voltage Temperature Coefficient of Voc Temperature Coefficient of Isc 600V -0.80x104 V/'C 5.02x10'3 A/'C · Electflc~l Pe~'formarme at ~W~w~, *NOCT, &M1 .S Maximum Power (Pmsx) 95W Maximum Power Voltage {Vmpp) 15.6V Maximum Power Current (Impp) 6.10A Open Circuit Voltage (voc) 19.9V Short Circuit Current (Isc) 6.82A · Cells Number per Module I 36 I~ModuleCharaeterlatics Length X Width X Depth Weight Cable 15~nm~.lin)x~nvn~.ltn}x36~mll.~) 13.0kg(28.71bs.) (+)760mm(29.gin).(-)184~nm(72.4h} · Junetlofl Be~ Chmaele~latlc~ Length X Width X Depth IP Code 18~m(3~m)×1~r~n(4,3in)x fffnm(O.6~l P65 · Othem *Operating Temperature -40~C ~90=C Maximum Fuse 1 SA *This ternperalure is based on cell temperature, Please contact our office for furlher information K IDEERa KYOCERA Corporation · KYOCERA Corporation Headquarters CORPORATE SOLAR ENERGY DIVISION 6 Takeda Tobadono-cho Fushimi-ku, Kyoto · KYOCERA Solar, Inc. · KYOCERA Solar do Brasil Ltda. · KYOCERA Solar Pty Ltd. · KYOCERA Fineceramics GmbH · KYOCERA Asia Pacific Pte. Ltd. 298 Tiong Bahru Road, #13-03/05 Central Plaza, Singapore 168730 TEL:(65)6271-0500 FAX;(65)6271 °0600 a Kyocera Asia Pacific Ltd. Room 801-802, Tower 1, South Seas Centre, 75 Mealy Road, Tsimshatsul East, Kowloon, Hong Kong TEL:(852)2723-7183 FAX:(852}2724..4501 · KYOCERA Asia Pacific Pte. Ltd., Taipei Office 10F* NO. 66, Nanking West Road, Taipei, Taiwan TEL:(8$6) 2-25~-3609 FAX:(886)2.3559.-4131 · KYOCERA (Tianjin) Sales & Trading Corp. tBetjtng Office)Room 2107, Belling Huabin Inter n~Uonal Building, No.8 Yong An Dong LI, Jlan Cue Men Wai Road, Chao Yang District, Belling, 100022, China TEL:tS0) lC~8528-8838 FAX:{86)10-8528.8839 htr p.//www.kyocera,co m.c n/ · KYOCERA Korea Co., Ltd. Oiplomatlc Center Roon~ #406. 137~-1, Saccho-2Dong, SeOCho-Ku,Seoul, 137-072, Korea TEL:(82)2-3463-3535 FAX:(82)2*3463-3539 http://www, kyocera,co.kr/ Kyccera reserves the right to modify these specifications without notice LIE/Il 0D0711-SAGM KD210 KD; KD210 KD; KD210 KD~ KD135 KD210 KD210 KDZI0 KD210 KD135 KD135 KD135 KD135 44 Kyocera KD210 6 Kyocera KD135 2 SMA 5000 Unirac SunFrame South THE NEW VALUE FRONTIER KD210GX-LP HIGH EFFICIENCY MULTICRYSTAL PHOTOVOLTAIC MODULE KBOCEREI LISTED HIGHLIGHTS OF KYOCERA PHOTOVOLTAIC MODULES Kyocera's advanced cell processing technology and automated production facilities produce a highly efficient muiticrystal photovoltaic module. The convemion efficiency of the Kyocera solar cell is over 16%. These cells am encapsulated between a tempered glass cover and a pottant with back sheet to provide efficient protection from the severest environmental conditions. 'Hie entire laminate is installed in an anodized aluminum frame to provide structural strength and ease of installation. Equipped with plug-in connectors. APPLICATIONS KD210GX-LP is ideal for grid tie system applications. · Residential roof top systems · Water Pumping systems · Large commercial grid tie systems · High Voltage stand alone systems · etc. QUALIFICATIONS · MODULE: UL1703 listed · FACTORY: ISO9001 and ISO 14001 QUALITY ASSURANCE Kyocera multlcrystal photovoltelc modules have passed the following tests. · Thermal cycling test · Thermal shock lest · Thermal / Freezing and high humidity cycling test · Electrical isolstion test · Hail impact test · Mechanical, wind and twist loading test · Salt mist test · Light and water-exposure test · Field exposure test LIMITED WARRANTY · ~ 1 year limited warranty on material and workmanship -~20 years limited warranty on power output: For detail, please refer to 'category IV"' in Warranty issued by Kyccera (Long term output warranty shall warrant if PV Module{s) exhibits power output of less than 90% of the original minimum rated power specified at the time of sale w~hin ELECTRICAL CHARACTERISTICS Current-Voltage characteristics of Photovoltaic Module KD210GX-LP at various cell tern ~eratures Current-Voltage characteristics of Photovoltaic Module KD210GX-LP at various irradiance levels SPECIFICATIONS KD210GX-LP · Physical Specifications Unit:mm(in.) · Specifications I~ Eleea~el ~ an~e~ StandaM Te~t Cendttle~s (*STC) Maximum Power (Pmax) 210W (+5%/-5%) 26.6V Maximum Power Voltage (Vmpp) Maximum Power Current (Impp) Open Circuit Voltage (Vcc) 7.90A 33.2V Short Circuit Current (isc) 8.58A Max System Voltage 600V Temperature Coefficient of Voc --0.120 V/'C Temperature Coefficient of Isc 5.15x 10.3 A/=C m Cells Number per Module I 54 Length x Width X Depth Weight Cable 18.5kg(40.81bs.) {+)760mm(29.9in},(-)t 840mrn(72,4in) Length × Width × Depth IP Code l~mm{3.lt ~)x108mm{4.:~n)×lSmm{0,~n) P65 · Others *Operating Temperature Maximum Fuse _40"C ~90~C 15A Please contact our office for further information K BEERa KYOCERA Corporation · KYOCERA Corporation Headquarters CORPORATE SOl. AR ENERGY DIVISION 6 Takeda Tobadon(>.c ho Fushimi-ku, Kyoto 612-8501. Japan TEL:(81 )?$-604-3476 FAX:(81 )75-604-3475 htr p://~NWw, kyoce ~a. CO m/ · KYOCERA Solar, Inc. 7812 East Acoma Drive · KYOCERA Solar do Brasil Ltda. · KYOCERA Solar Pty Ltd. · KYOCERA Fineceramics GmbH · KYOCERA Asia Pacific Pte. Ltd. 298 Tiong Bahru Road, #13-03/05 TEL:(65)6271-0500 FAX:{65)6271-0600 · Kyocera Asia Pacific Ltd. Room 801-802, Tower 1, South Seas Centre, 75 Mealy Read. Tslmshatsui East, Kowloon, Hong Kong · KYOCERA Asia Pacific Pte. Ltd., Taipei Office 1 OF, NO. 66, Nanking West Road. Taipel, Taiwan TEL:(886) 2-2555-3609 FAX:(886)2-2559-4131 · KYOCERA (Tianjin) Sales & Trading Corp. (Belling Office) RCOm 2107, Belling Huabin International Building, No.8 Yong An Dong El, Jian Cue Men Wai Road, Chao Yang District, Belling, 100022, China TEL:(86) 10-8528-8838 FAX:(86)1 O-8528-8839 · KYOCERA Korea Co., Ltd. Diplomatic Center Room #406, 1376-I, SeOChO-2Dong, Seocho-Ku,Seoul, 137~)72, Korea TEL:($2)2-3463-3538 FAX:(82)2-3463-3539 h t t p://www, kyocer a.co,kr/ Kyccera reserves the right to modify these specifications without notice LIE/Il 0A0711 -SAGM SB ~O00US SB 4000US Max. Recommended Arra]' ~p. ul Power DC · STC 3750 W Max. DC Voltage e 500 V Peak Power Tracking Voltage ~ 180 - 400 V · 208 ~ 200 - ~g~ V · 240V 17A DC Vollage Ripple ~ < 5% Number of Fused Slrin~ In~ .... ~ 4 228 V 5000 W 600 V 250 - 480 V · 240 V 18A < 5% 4 285 V AC Nominal Power AC Maximum Oulput Power AC Maximum Oulput Current AC Nominal Vofiage / Range 3000W 3000W 3500 W · 208 V./~4000 W · 240 V 4000 W 17 A@ 208 V, 16.6A· 240V 183 - 229V· 208V 211 - ,2~4¥@ 240V 183 - 229V·208 V 211 - CEC weighted Efficiency 96.6 % 96.8 % 95.0%· 208 V 95.5 %@ 240V 95.5 % · 208 V 96.0 % · 24OV Dimensions W x H x D in inches 1Z8 x 13.8 x 9.3 88 lbs / 94 lbs Power Consumption: stand.by/nighttime ~ ' ~';~W / 0.1 W Topology ~ P~VM, true sinewove, .-- ...................................... pp~rent sours? .... ConYection, regulated fan cooling Mounlin Location Indoor / Outdoor (NEMA 3R) 1Z8 x 13.8 x9.3 88 lbs < 7W/0.1W PWM, true sinewave, current source Convection, regulated fan cooling Lid Color: aluminum / red Communication: RS485 ~, IEEE-1547, UL 1741, UL 1998, FCC Port 15 A & B Specifications ~or nominal conditions · included OOption -Nofavailable Efficiency Curves P~cIWI ~n~v. sma-a merica.com Phone 530-273-4895 Toll Free 888-4SMAUSA SMA America, Inc. Certified to the new UL1741/IEEE 1547 10yr. warranty standard CEC efficiency rated load-break rated DC disconnect switch Integrated fused series string combiner Sealed electronics enclosure & Opticool Comprehensive SMA communications and data collection options Ideal for residential or · light commercial applications Rugged cast aluminum outdoor rated enclosure SJvtA is proud to introduce our new line of inverters updated with our latest technology and designed specifically to meet the new IEEE 1547 requirements. Compact design makes them ideal for residential use and the integrated DC disconnect makes installation more cost effective. They are field-configu- rable for positive ground systems making them more versatile than ever. Increased efficiency means better performance and Shorter payback periods. With over 500,000 fielded units, Sunny Boy has become the benchmark for PV inverter performance and reliabilih/throughout the world. AGENCY Walter P Geoghan Agency Inc CPS1222661 AGENCY CUSTOMER ID: 923791 LOC #: ADDITIONAL REMARKS SCHEDULE 41297 Go Solar, Inc. cio Gary Mlnnick 272 Main Road Riverhead, NY 11901 EFFECTIVE eATE: 10120/2010 ADDITIONAL REMARKS Page 2 of 2 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25(20t0105) FORM TITLE: Certificate of Liability Insurance This Page Intentionally Left Blank ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE · ~ 10/1,4/2010 THIS CERTIFICATE IS ISSUED AS A MATrER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATWE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(e). PRODUCER CQNTACT NAME: Walter P Geoghan Agency Inc LoVullo Associates, Inc. IA~c.PHONENo. ;,~: (631) 472'5000 I(Nc,F~X No}: (631) 472'5611 6450 Transit Road E-MAIL ADDRESS: Depew, NY 14043 INSURER(S} AFFORDING COVERAGE NAIC # ~NSURERA: SCOTTSDALE INSURANCE COMPANY 41297 INSURED INSURER B: Go Solar, Inc. cio Gary Minnick INSURER C: 272 Main Road INSURER D: Rlverhead, NY 11901 INSURER S: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT~VITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ~,DDL 3UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR ~ POLICY NUMBER (MM)DD~(YYY) CMM)OD/YYYY~ LIMITS A GENERAL LIABILITY CPS1222661 10/2012010 1012012011 EACH OCCURRENCE $ t,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES (Ea cccurr~ce) $ 1001000 I CLAIMS-MADE [] OCCUR MEDEXP(Anyonep~-son) $ 5,{)00 PERSONAL & ADV INJURY $ 11000,000 DED I I RETENTION * $ A Business Personal Pro=ertv CPSI22266t 10120120t0 f0120/2011 $t10,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DEgCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 ACORD 25 (2010105) AUTHORIZED REPRESENTATIVE ~~ © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PV MODULE FRAMING AND MOUNTING SYSTEM FOR PITCHED ROOFS . odule Compatibility Components ~se SunFrnme with PV modules om these major manufacturers: P Solar, GE Energy, Isofoton, Kyocera, ~itsubishi, Photowatt, RWE Schott, anyo, Sharp. :all UniRac or your PV dealer for ,anufacturers not listed. :ode Compliance unFrame is designed to comply with Le Uniform and California building odes when installed according to unFrnme installation insu'uctions. :all UniRac concerning status of ~tematonal Building Code compliance. Inter-Module Railg support modules as little as 2.125 inches above the roof. Full Length Cap Strips secure modules and finish the array topside forming a gap-free frame. Self- tapping screws at 16-inch intervals provide the holding power. Push-Fit End Gaps neatly finish the rail ends. L-Feet attach directly to asphalt shingle roofs and support the rails one-half to three-quarters of an inch above the roof surface to provide convective ventilation. ~ Splices safely extend rails. O Aluminum or Steel Standoffs (optional) in a range of heights sup- port L-feet above tile or shake roofs. UniRac offers appropriate flashings. Clear or dark finishes on all visible above-roof components, from L-feet to screw heads, match the frames of your PV modules. Component Spedfications Rails, cap sU'ips, two-piece standoffs, splices, and L-feet: 6105-T5 aluminum extrusion. End caps: UV resistant plastc. One-piece standoffs: Service Condition 4 (very severn) zinc-plated welded steel. Fasteners: 304 stainless steel. www. unirac.com See our SunFrame page for complete information: pricing, installation instxuctions appropriate to your build- ing code, and minimum requirements for the number and type of modules you plan to mount. ~niRae, Inc. 3201 University Boulevard SE, Suite 110 ~fo@unirac.com Albuquerque NM 87106-5635 USA $05.242.fi411 505.242.6412 Fax Pub 050206.1ds · February 2005 © 2005 UniRac, Inc. All rights reserved. PV MODULE FRAMING AND MOUNTING SYSTEM FOR PITCHED ROOFS KD210 KD KD210 KD KO210 KD; KD135 44 Kyocera KD210 6 Kyocera KD135 2 SMA 5000 Unirac SunFrame KD210 KD210 KD210 KD210 South K£ !10 KD210 Z10 KD210 KD135 KD210 K[ ~D210 K[ KD210 K[ KD135 210 KD210 Zl0KD210 210I~ KD135 KD210 KD210 KD210 KD210 KD210 KD210 KD135 I GRAPHIC SCALE LM: TAX LOT 27.1 VIEW: TAX LOT 27.1 100 ., ~O~-of - Surveyed by: Drafted by: A.V.R. [ Checked by: A.M. ,. ! ~,~ I/' Barrett , ,Bonacci & / lI [] \/ Van Weele, PC Civil Engineers 175A Commerce Dr. Hauppauge, NY 11788 .,urv~;,orsT 631.435.1 I I 1 Planners F 631.435.1022 w~w.bbvpc,com Tax Map No.: DISTRICT 1000 SECTION 98 BLOCK 1 LOT 27.1 ~,~,.,~.~ ....... ~.,. INDIAN NECK °~"°' ~'"~"°"'"'~' ~"'"'°"*~ PECONIC o.a .,~.o,~1o ~ *ddl,or~ p. .... TOWN OF SOUTHOLD SUFFOLK COUNY, N.Y. Dat~ ScaleProject No. Sheet No. ~,c.,~,~oo. ,,._-,oo, ^o8oo~ 1 or 1 1. TOTAL LOT AREA OF 1000--98--1--27.1 ---- 77.661g ACRES LOT AREA OF W~TLANDS = 4.111 ACRES 2, PROPERTY IS ZONED A--C, AGRICULTURAL--CONSERVATION. 3. SI3EISURFACE AND ENVIRONMENTAL CONDITIONS WERE NOT EXAMINED OR CONSIDERED AS PART OF THIS SURVEY. 4. ROOF DRAIN LOCATIONS PROVIDED BY BUILDER. 5. ALL WELLS TO BE ABANDONED OR U33L~ZED FOR NON-POTABLE USE ONLY. PUMP HOUSE TO BE UTflJZED FOR NO-POTABLE USE ONLY. SEE I~GEND ~ ~]~ DRAINAGE INLET / STRUCTURE Ot=51~N C,~ITERIA HIND ~JBJECT TO PAHA®E FP~3M P~INTER ICE E~IIEL~ UB~ ~ND 6~ED ~P~U~ DEDI~N UND~AYMT. LIVE DEAD ~F UPLIFT LO~ ~LL ~A~ING ~CUPANGY HEIGHT Pl~ A~ D~H DE~I~N LINE ~ODE~ ~LICHT TO II ~¢ 40 pe¢ 20 pe~ IN~IOR ZONE = 2~,~ p5¢ IN~RIOR ZONE = 24~ pel (¢~1~ NON HABITABLE HOPPER EAVE ~. / P~AK 6AP COLOR 6ODE RED lb ~Ab~,E (.043) COLOR CO~ 0~ COLOR HOPPER ~ (6 / BAY) 12 CALVE IIEIDE 6RO55 BRAGf BOLTED TO LEG H/(I) B/g' 6RAGE ~ BOLT H/I~5IER5 BOTH ~. F~TORY ~ TO pbATE (I/4' EYEAg ALL I I/4" X 1.q45' X 5,1~" eALVANIZEIg F~A~ HITH II) P HOLE FOR B/H*' ANCHOR BOLT. EPlt~EDD HITH ~IHP~ON' ~ET HIC:,H EPOXY' TO 12" HI\. ER=. DEPTH. I~OVIOE ~IHPBOfl 'EP '1/~'-2' ,NO N~T AT EACH ANCHOR BOLT. 5LAB t'7.426 _'L~----~ (&) I0 GAUGE (,BO) 'BFT' HOPPER r~ ~ ~ LEGS, FACTORY NELDED TO BABE ~ d~ PLATE 0/4" BEAD ALL AROUND). I0 GAUGE (.BO) BFT LEG PROFILE 7 cH5 ~ (&) I/4~ X 7.q45" X 3.1~5II GALVANIZED '~ ' ~ BABE PLATE FILTH (I) I" HOLE FOR 3/4'~ Y~I~~ ANCItO~ BOLT. EMBEDD NITN 'BIMPBONi ~~ SET NIGH BTRENGTI~ EPOXY TO 12~' MIN, ~ EFF. OEPTI< PROVIDE SIMPSON BABE PLATE AND NUT AT EACH ANCHOR BOLT. SCALE: I I/2"=1'-O" O 6" I'-O" e 12C215/16' SCALE: I/,4"= I '-0" 0 2 4 & lie OF FOJHOATIOfl ENTER LINE OF ANCHOR E~OLT5 ~) IO GAI~E (,1~O) 1~Fr' ~R bECk. FACTORY ~ELPEO TO BA~ pLATE (I/4' ~EAD ALL ABOUi~). / '-. HITE #5 (~ KSI) BAR · / k 12' OL. HEAVE TOP AND / ~N ~OM OF ~, / / / X / / X / / ~ / ~ ~E (2 OF ~ / k / k / / HOPPER (I OF 2) SCALE: 114 =1-0 ~ ~ APPROVEDASNOTED ~.~ ~ =~ WJT~!, , x~_~- < ~O~, _ z~ $- PAGE.. I oF I ROOF AREA -- PHOTOVOLTAIC MODULE (TYP) RIDGE SHED ROOF PITCH 4:12 SPAN: I 5' RAFTERS 2"x8" @ I g" O.C. (TYP) RAPTEP-.5 2"xlO" @ lc" D.C. (TYP) UNIRAC 50LARMOUNT SYSTEM (TYPICAL RAIL ACROSS EACH ROW OF ENTIRE ARRAY) (Only Two Shown for Clarity) ROOF PITCH G:I 2 SPAN: I 3'-8" W/ SUPPORT WALL AT 5'-5" AP-..TIAL HOU._ E P-..C)OI= PLAN FASTENER REQUIREMENTS: TOTAL ARRAY AREA = 7G8 SF WIND LOAD: ASCE 7 (SEE CALCULATIONS THIS SHEET) 41.5 PSF TOTAL UPLIFT = 41.5 PSF x 768 5F = 3 I ,872 LBS FASTENER: 50LARMOUNT LAG SCREW SPEC 203.2, 8/04: (FLAT WASHERS REQ TO BE USED WITH LAG BOLTS) LAG BOLT WITHDRAWAL VALUE; 5/IQ" DIA., 2GQ LB/IN X 2-IN THREAD DEPTH= 532 LB. CAP. EACH MIN. NUMBER OF LAG BOLTS REG. = 3 I ,872 LBS / 532 LBS/LAG BOLT = GO TOTAL RAIL FEET, 230 FT = 230 PAIL FT/GO DOLT5 = MAXIMUM 5PAN BETWEEN MOUNTING FEET DOLTS: 3'- I 0" MAX. .I=ULL HOU._ E I OOF PLAN Wind Load Calculation: ASCE 7-02: Partially Enclosed Bulldln~l Design (Assume Worst Case) Low R~se Bulld~n,~; h<=GOf~: Mean Height; h=3Of~ I. Dmecklonahty Factor: Kd per Section G.5.4.4, (Table G-G): Kd=0.85 2. Importance Factor: per 5¢c~on ~.5.5, ¢able G-I) Ca~a~ory II; I= 1.0 3. Vdoci~y Pressur~ Coefficient: Kh p~r 5~C~lOn ~.5.~.4 (Exposure Category C per G.5.G fable g-3); Kh=O.98 4. Topographic Factor: ~ per 5ecbon 6.5.7 (Long 151and); ~= I 5, Gu5~ Fac$or: G per G.5.8.1, G=0.85 G. Exposure Classification: per 5ecbon G.5.9 = II 7. Internal Pressure Coefflc~enb: GCpI per 5ecbon G.5. I I. I, Table G-5; GCp~=0.55 8. External Pressure Coefflc~enb GCpf per 5ecbon G.5. I I .2. I, F~ure G- I O; I0. GCpf=O.80 Velocity Pressure: qh per Secbon G.5. I O: qh = (0.0025 G)(Kh)(l~t)(Kd)(V ^ 2)(I) qh=(O.OO25G)(O.98)( I )(0.85)( 120 ^ 2)(I) qb=30.7 Desitin Wind Load per Section G.5. I 2 p=qh(GCpf-GCp) p=30.7(+0.80+0.55) ?=30.7( I .35) p=4 1.5 psf MOUNTING FOOT W/ BUTYL RUDDER MEMBRANE BETWEEN FOOT ¢ ROOF DMINGLE OR NO CALK FLASNIING 3" STANDOFF MOUN'TING FEET PER RESIDENTIAL CODE OF NEW YORK STATE ROOF PENETRATIONS CHAPTER 9 (TYP) >,.,.,EET TOTAL ROOF DEAD LOAD I O#/SF (ROOF) + 2.5#/5F (MODULE) = I 2.5#/DF TOTAL UNIRAC RAIL INSTALLATION GUIDELINES PER MANUFACTURE'S REQUIREMENTS MOUNTING FEET POSITIONED OVER' ROOF RAFTER MEMBER5 PER MEG'S REQUIREMENT5 / PHOTOVOLTAIC MODULE / "X" (MAX 5PAN) MAX, SPAN BETWEEN PHOTOVOLTAIC MODULE SECTION SCALE: NTB NOTE: FASTENERS SMALL NEVER EXCEED 48" BETWEEN RAIL FEET PER MANUFACTURER MOUNTING BRACKET MATERIAL5 ARE NON-COMBUSTIBLE IN ACORDANCE WITH RM2301.2.2 AND CONSIST OF ALUMINUM L BRACKETS UNIRAC RAIL 15 DESIGNED AND WARRANTED BY THE MANUFACTURER FOR LOAD5 UP TO 50 LBS/SQ. FT. (APPROX. I 2D MPH WIND) WHEN INSTALLED AS REQUIRED DY THE MAUNUFACTURER. NOTE: THE MOUNTING FEET' MUST BE ATTACHED TO THE BUILDING RAFTEP-.5 OR FRAMING (NOT JUST THE ROOF DECKING). USE 5/I G" OR 3/8" DIAMETER LAG DOLTS AND DRILL PILOT HOLE. FINAL TIGHTENING SHALL BE BY HAND. ALL INSTALLATION PROCEDURE5 SHALL BE PER MANUFACTURER'S REQUIREMENTS. NOTE: Modules and panels and any mounting hardware provided shall w~thstand, w~thout ewd~nc~ of sbructural or mechanical failure, 1.5 times the deslOn load when tested as spec~hed below. The deslcj~ load m to be 30 psf downward(posltwe) or upward (negative). All members shall be of such 5~reng~h fo w~fhefand loads. The modules, panel5 and any mounbng hardware shall be facfory f¢5~ed udder ~h¢se loads for a 30 mmuf¢5. (Downward ¢ upward forces 5hall no~ b~ apphed ¢~mulfan¢ously. I 0,050 W SYSTEM SIZE 44- MODEL KD2 I 0 KYOCERA 210 WATT EA., 40.8#/MODULE, 5¢. I"L x 3D"W x I .4"D G- MODEL KO 135 KYOCERA 135 WATT EA., 27.5#/MODULE, 59. I"L x 2G.3"W x I .8"D (2.5#/5F) HOUSE: 50LAR MODULE ARRAY- 46 MODULES TOTAL 24 MODULE ARRAY: 24 MODULE ARRAY: SO~R DISCONNECT INVERTER (I) 5MA 5000 / ',...¢ × 'y .J ! Exterior PVC Condu~t b_~ SOLAR DISCONNECT b~ INVERTER (I) SMA 5000 INV INV AC DISCONNECTLEI Groundln~j Electrode AC DIDCONNEcTL~-~ Groundln~ Electrode EXIST. POWER PANEL EXIST. METER M APPROVED AS NOTED NOTIFY BUILDING DEPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1 FOUNDATION- ~ REQUIRED FOR POURED CONCRETE ROUGH - F~MING, PLUMBING, STRAPPING, ELECTRICAL & CAULKING 3 INSU~TION 4 FINAL- CONSTRUCTION & ELECTRICAL MUST BE COMPLETE FOR C,O, ALL CONSTRUCTION SHALL ME~ THE REQUIREMENTS OF THE CODES OF NEW YORK STATE NOT RES~NSIBLE FOR DESIGN OR CONSTRUCTION ERRORS, ,DY,STEM ONE LINE DIAGRAM (TYP) SCALE: NT5 BUILDING P-.~VII~W NOT~ COMPLY VVITH ALL CODES OF NEW YORK STATE & TOWN OODES AS REQUIRED ~' A~ .... DI~, ,o OF~ ., ~ SOU~i'I~,Z~TOWN ZBA ~ SOUTHOLD~OARD , ....... N~DEC TOWN BUILDING pLANB E~AMINEiR HA~ R~VIEWED THE ENCLOSED DOCUMENT [=OR MINIMUM ACCEETABLE PLAN BUBMITTALI(EQUIRJ~MENT5 OF THE TOWN AB SPECIFIED IN THE BUILDING AND/OB RESIDENTIAL CODE OF THE STATE OF NEW yOI~K`. THIS I~EVIEW DOE5 NOT GUARANTEE COMPUANCE WITH THAT CODE. THAT I~ZSPONDIBIU~( lB GUARANTEED UNDEff. THE SEAL AND 51GNATURE OF THE STATE OF NEW YORK` LICENBED DEBIGN PP. OFESBIONAL OF RECORD, THAT SEAL AND 51GNATUR~ HA5 BEEN INTERPRETED A5 AN A1TESTATION THAT, TO THE BEST OF THE LICENSEE'5 BELIEF AND INFQRMATION THE WORK, IN THE DOCUMENT 'ACCURATE °CONFORMS WITH GOVERNING CODE5 APPLICABLE AT THE TIME OF THE 5UDMI5510N 'CONFO&M5 WITH REASONABLE STANDARD5 OF PRACTICE AND WITH VIEW TO THE SAFEGUARDING OF LIFE, HEALTH. PROPERTY AND PUBLIC W~LFARE 15 THE P. ES?ONSlBILITY OF THE LICENBEE ELECTRICAL 5TIRUCTUP-,AL 5TATI~MENT INSPECTION REQUIRED THE EXISTING 5TR. U~i'URE 15 ADEQUATE TO ~UPPORT THE NEW' LOAD5 IMPOSED BY THE PHOTOVOLTAIC MODULE B~TEM INCLUDING UFLIET ~ 5HEA&. TH[ EXIBTING P-AETER. 51ZED ~ DIMENSlONB CONEORM TO R. CNY5 TABLE R¢02.5. I ( I ) - RAFi'ER. 5PANB q Date: I 2-5- I 0 Scale: AB SHOWN No.