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HomeMy WebLinkAbout36309-ZTown of Southold Annex 54375 Main Road Southold, New York 11971 6/20/2011 CERTIFICATE OF OCCUPANCY No: 35003 Date: 6/20/2011 THIS CERTIFIES that the building SOLAR PANEL Location of Property: 370 Munn Ln, Orient, SCTM #: 473889 Sec/Block/Lot: 17.-4-1 Subdivision: Filed Map No. conforms substantially to the Application for Building Permit heretofore 3/30/2011 pursuant to which Building Permit No. Lot No. filed in this ofliced dated 36309 dated 4/8/2011 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: install electric solar panels to an existing dwelling as applied for The certificate is issued to Peyton, Elizabeth (OWNER) of the aforesaid builcYmg. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 36309 6/8/11 ~A )~S~gnature TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 36309 Date: 4/8/2011 Permission is hereby granted to: ~eyton, Elizabeth 41 Commerce St New York, NY 10014 To: install electric solar panels to an existing dwelling as applied for At premises located at: 370 Munn Ln SCTM # 473889 Sec/Block/Lot # 17.-4-1 Pursuant to application dated To expire on 101712012. Fees: 3/30/2011 and approved by the Building Inspector. CO - ALTERATION TO DWELLING SINGLE FAMILY DWELLING - ADDITION OR ALTERATION Building Inspector $50.00 $200.00 $250.00 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCI JUN 17 2011 BI DG ?ANCY 10\,'~?I OF SO[IV!OlD This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 lbrm). 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. Commemial 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 Planning Board Approval of completed site plan requirements. Bo 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 New Construction: Location of Property: ~ '7t9 House No. Owner or Owners of Property: 5'~ Suffolk County Tax Map No 1000, Section Date. Old or Pre-existing Building: (check one) Street Hamlet Block /-'/ Lot /t Subdivision Pernfit No. C) ~o ~ C3 Health Dept. Approval: Date of Permit. Filed Map. Lot: 5/ - 5f '// Applicant: a~ ' Offo,.OT.,,t-,'~ Underwriters Approval: Planning Board Approval: Request lbr: Temporary Certificate Fee Submitted: $ ~"~ ' ~ Final Certificate: (check one) )z~) A~l~ant Siguature Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631 ) 765-1802 Fax (631 ) 765 9502 rofler, dchert~,town southo d ny us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Elizabeth Peyton Address: 370 Munn Ln City: Orient St: NY Zip: 11957 Building Permit #: 36309 Section: 17 Block: 4 Lot: WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Green Logic 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 INVENTORY Se~icelph ~ Heat ~ Duplec Recpt ~ Ceiling Fixtures ~ HID Fixturesr~l~ Wall Fixtures Smoke Detectors Service 3 ph Hot Water GFC~ Recpt Main Panel NC Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture M Pumps Transformer Appliances Dryer Recpt Emergency Fixtures~ I Time Clocks Disconnect Switches Twist Lock Exit Fixtures [~ TVSS Other Equipment: photovoltaic system to include, 24 Sun Power 215 panels, I ac disconnect I Sun Power 5000 inverter Notes: Inspector Signature: Date: June 8 2011 81-Ced( Electrical Compliance Form TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION DATE f/~///~ INSPECTOR~~~ [ ] FOUNDATION 1ST [ ] ROUGH~BG. [ ]FOUNDATION 2ND [ ]IN~SOLATION [ ] FRAMING / STRAPPING [//~ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS~.' ~/~-~ ~/~-'" ~-~-~~ f~/ INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONS]RUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ~ELE~,mICAL (FINAL) REMARKS: 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 May 24, 2011 Town of Southold Building Department 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Subject: Solar Energy Installation for Elizabeth Peyton 370 Munn Lane Orient, NY 11957 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 TO~¥N OF SOUIHOLD DATE I COM~VI~NT$ FOUNDATION (lST) FOUNDATION (2ND) . ROUGH FRAM~G & PLUMBING STA~ ~-~R~ cODa ~D~IO~ CO~T8 , , ,~. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork. net ^pp o,*d / [ Disapproved a/c MAR 20/1 B/DG DEPT. PEm,T No. 3 o ? /~etor APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS BUILDFNG 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 Flood Pcrrnit ~ .2. ~ ,20(I ..... t-~, ................ )mpletely filled in bY typewriter or in ink and submitted to the Building inspector with 4 sets of plaas, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location elint and 0f hoildings on premises, r~latinnship to adjoining premises or public s~'ee~s or areas, and waterways. c. Thc work covered by this application may not be commenced before issuance of Buildlng 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 par~ for any purpose what so ever until the Building inspector issues a Certificate of Occupancy. f. 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 wahin lg months from such date. If no zoning amendments or other regulctions affecting thc property have been enacted in the intorhn, 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 Builthng Depertmant for the issuance of a Building Permit pursuant to thc Building Zone Ordinance of tho Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regalauans, for the conslract~on of braidings, 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 neccesa~ inspections. .c tc bcc-- . ~ ~(Sig~2ture of'tl~heant or name, ifa corporation) (IVfailing address of ap~lican0 State whether applicant is owner, lessee, _agent, architect, engineer, general contractor, electrician, plumber or builder (As on the ~ roll or la[~t d~d) ~ ~d title of~te o~) Builde~ Licen~ No. ~O~ Plum~ Lieen~ No. El~trici~s Li~nse No. ~ ~ ~ ~ ~ber Tmde's Li~nse No. 1. Location of land on which~p,~oposed work v~ill bc done: Hou~ Numar Street H~let County T~ Map No. 1~ ~ction [~ Bilk ~ Lot SuMivision Filed Map No. Lot 2. State existing nse and oeeupancy of premises and intenc~d use and occppancy of proposed construction: a. Existing use and occupancy ~ Ir'lt~l~ .j b. Intended use and occupancy "~ 3. Nature of work (obeck which applicable): New Building_ Addition Alteration Repair ' Removal Demolition Other Work 4. Estlmated Cost ~Zt~2~ Fee ~.~-0 0 (Te be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwalling anita on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of ese. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear De~h Dimensions of same structure with alterations or additions: Front Depth. ,Height. Number of Stories 8. Dimeusious of entire new constructlon: Front Rear Height Number of Stories 9. Size of lot: Front Rear .Depth 10. Date of Pumhase Name of Former Owner .Rear I I. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES I NO 13. Will lot be re-graded? YES NO v/Will excess fill be removed from premises? YES__ NO 14. Names of Owner of_premises~ · Pc~''Otx Addres~ Phone No. Name of Arehiteet Name of Contractor~a~ tO.- LC-e-- Addresst4~-% 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO · IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet ora tidal wetland? * YES__ NO · 1F YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YESI · IF YES, PROVIDE A COPY. NO STATE OF NEW YORK) coumv OFStd-f t s: ~,[l'~ ~ ,~r t ~ t~ ~ing duly swo~ ~s~ ~d rays *at (s)~ is ~ ~pli~t ~ ofindi~du~ sipi~ ~n~a~) a~ve n~ (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 w/Il be performed in the manner set forth in the application filed therewith. Sworn to before me this _~~day of /~_/{A.E-.Ja-_ 20 ! t Notary l~blic Town of Southold Erosion, Sedimentation & Storm-Water Run-off A=~-$_~_~-~MENT FOR" SCOPEOFWORK . PROPOSED CONSTRUCTION ITEM# / WORKA,q.q~.q.qhirF~j[,* a. (IncJude To~lAran o~ all Parcels i0cetm] wllhin t ~ ibis ~ RelaJn All ~to~atar Run*Off b. Whal is the Tolal Aran of Land (~mtng (S.F./~,~e~) Crh~ item v,~l ~cJude all run-off cma~ad by si~e ar~or Gn~nd D~stumance fox*lira pmpceed ~'J I A clead"g and/or con~mction activities an vmll a~ a, ~lte Imp~ovemanls and the permanent croatian of canU~Jc~m ac~v~ IS~F. / ~) impervious su#aces.) PRO~,qDE BRIEF PROJECT DESCR~IION ~,~mm~g,,.,Ne,d.~ 2 Daes~e$iteplanand/(~SurveyShowAIIPmpceed Drainage $1mctums ,ndlm~ Slze& Loce~o~? Thb ----~ r~ item shall include all Pm~sed Grade Changes and and sediment con,at prances that vAI be u~d to Item must be mainlained throughout the Entire Constmc~n Period, 4 W"I thts P~ Require any Land Fling, C~ or F.~stlng Grade Involving mom than 2~0 Cut~c Yards of Metedal ~ any Pan:M? 5 ~ this Appice~an Requi~ Land Dl,~u~aln~ ~ ~J~unq;~sm~ an Ama In Exce,~ of Flve Thousand (5,000 $.F.) Square Feet of Ground Surface? 6 Is there a Natural Water ~ Runn~g 8Yough the Site? Is this ProJeM with~rl ~e Tmstean judsdic~,ian aeneral D~C SWP P ulmmats: orwilhinOneHundmd(100')feetofaWetlandor tm=k"~ng Comlmaaon aM~#aa law4vlr~ aMI ~lsturbmce. ~ lass ,mn one (i) acm Mmm which Exceed Flftean (15) feet of '~erlk;al Rise to Ih" [~C hM detam~ed I~M · SP[~c~ pem~ Is M~Jlred ~x stem) water d~s~. One Hundred (100') of Horizontal Distance? SW~'P~ Sawll me~ S',e IMMwim RMiuf~menm of ~e 8~E~ MMM pmmlt 8 Wll~ Driveways, Paddng Ames or other Impewfoce ~n/~d b I~e Depmtmen~ prim ~ the oommencemem a/mr~u~on a~V~y, into and/o~ In the dkectlon of a To~l fight.of, way? r~r~ ~ms~u~m -- -- mmaga~m --ms t~at. be used ax~r Removal of VegetaOon and/or the Ccmstructlon of any r~_.. STATE OF NEW YORK, ~_~ ,_/~.. ~ ~. COUN'I~I' OF .~..~..L.~.....~....~_..~... ........ SS ~'~'~{//~~ ............... , epos 'andsay~flmthe/sl~is~ue~pplio~u~forPcu-rait, ......... ~ ~'~'~:~ ............................................................... Owner ~l/or represea~i~ of the Ovmer or Owners, m~d is duly ~uthom=d ~o p~rform or lucre performed ~he saki work znd make ~md file this application; ahat all st~men~ con~ued in th~ appl~c~ion are true ~o ~he best ofhh lu~ow[ed~ and bd{ef; aad that ~he work ~.11 be performed ia ~e manner ~et fo~ h~ fl~e applk~ioa filed herewifll. S~om to b~£ore me ~s; ....................... No~r~ Public:' ' '" FORM - nl~/4fl ~'4~'h~'4':J."'?[°J:~:'JJ:.."v'::d< (" ~-~' ~ .................. No. 01-CA4894969 Qualified in Suffolk Count~y~o [/ Commission Expires May 11, Telephone (631) 765-1802 rofler, richertdt~w(~n ~s) guC~'~.n¥.us BU~.DING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Company Name: Name: License No.: Address: Phone No.: Date: *Name: *Address: *Cross Street: *Phone No.: Permit No.: Tax Map District: JOBSITE INFORMATION: (*Indicates required information) 100o Section: / '"/ Block: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) Lot: I (Please Circle Ali That Apply) *Is job ready for inspection: *Do you need a Temp Certificate: Temp Information (If needed] ' *Service Size: I Phase · 3Phase  NO Rough In ~ NO 100 150 200 300 350 400 Other *New Service: Re-connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form E Irrno Toth Hv"~ei - ~ oF Town Hall Annex 54375 Main Road P.O. Box 1179 Southold. New York 11971-0959 Telephone (631 ) 765-1802 Fax (631 ) 765-9502 BUILDING DEPARTMENT TOWN O1* 8OUTHOLD June 16, 2011 Green Logic LLC 425 CR 39A Southampton, NY 11968 370 Munn Lane, Orient NRg~I'E: See enclosed copy of Building Inspector's(~dated 5/27111 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. (All permits involving plumbing after 4/1184) __ Trustees Certificate of Compliance. (Town Trustees#765-1892) Final Planning Board Approval. Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. BUILDING PERMIT: 36309-Z solar panels C ,GREENLOGIC® June 14,2011 dUN 17 2011 BtDG DEPI, TOWN OF SOUINOtD The Town of Southold Building Department 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Re: Building Permit No. 36309 Elizabeth Peyton 370 Munn Lane, Orient To the Building Inspector: Enclosed please find the Engineer's Certification Letter and the Application for Certificate of Occupany for Elizabeth Peyton's solar electric system, which we installed at 370 Munn Lane, Orient. Please arrange to send her the Certificate of Occupancy 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 i ,, (i{ ;i ,,,, ,, Tel: 8777714330 Fax:8777714320 SOUTHAMPTON/CORPORATE: CUTCHOGUE: MANORVILLE: FIRE ISLAND: ROSLYN HEIGHTS: 125 0oLmty Rd. 39A 1070 Depot Lane 40Woodlarld AvenLe 125 Duneway 2005 S(rwc* Rd ~108 Soiti/a~/pion NY 11968 Cutchogue, NY 11935 Manc)rwlle NY 11949 Seaview, NY 11770 Rosvl Heights NY J]}TY CERTIFICATE OF LIABILITY INSURANCE 0112712010 pfu~uc~ THIS CERllFICATE IS ISSUED AS A MATTER OF INFORMATION BrookhavenAgency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 890 ALTER .THE COVERAGE AFFORDED BY THE POLICIES BELOW. 150 Main Street East Setauket NY 11733 INSURERS AFFORDING COVERAGE NAIC # ~SUm~D Greenlogic, LLC ,NSU~ER)~ NGM INSURANCE COMPANY 425 County Road 39A Suite 101 ~NSU~a~B: MERCHANTS PREFERRED INS CO Southampton NY 11968 INSURER C: INSURER D: COVERAGES THE POUCIES OFINSURANCE LISI~D BELOWHAVE BEEN ISSUEDTOTHEINSURED NAMEDABOVE FORTHE POUCY PERIODINDICATED. NOTWI'IHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUSJECTTO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LT~ m ~ ~ ~L~=~NCE FOUCY NUMB;~ ~PO~[C~Y ~!~ uuns ~r~ER~ u~w E~C~ OC~JRR~C~ t 1,000,000 A X X COUMERC~.~N~_____~a~TY MPP1681L 01/31/10 01131111 DAMA~ETORENTED ,~50,000 X__ XCU .ERSOW~&~DV~U~Y , ~ 1,000,000 ~ CONTRACTUAL UAB GENERALAGGEEGA~ $ 2,000,000 I--I 1,0oo,00o -- COMBNEOSI~e.E UM~ , $1,000,000 B A ~ ~r(~o CAPI043565 06112/2009 06112/2010 Ex~*~ ~ UMa~B.L~ UAW. nY ;~CN ~CCURR~CE $ 2,000,000 A X ~ occu; [] c~s~uc~ CUP1681L 01/31/10 01/31/11 AGGREGATE $ 2,000,000 .~,u~no~ ; 10,000 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 Phone: I Fax: ACORD 25 (2009/01) C=e[ ~ ~P;CATE HOLDER CANCI~.LATION SHOULD ANY OF I~IE ABOVE DESCRIBEDPOUCIES BE CANC;~ ~ ;r~ BEFORE THE EXPiRATiON © t988-2009 ACORO cOR~ghts resm'ved. The ACORD name and logo am registered marks of ACORD Suffolk County Executive's Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 12/10/2007 SUFFOLK COUNTY This is to certify that Master Electrician License ROBERT J SKYPALA GREENLOGIC LLC No. 43858-ME doing business as having given satisfactory evidence of competency, is hereby licensed as MASTER ELECTRICIAN in accordance with and subject to the provisions of applicable laws, roles and regulations of the County of Suffolk, State of New York. Additional Businesses NOT VALID WITHOUT DEPARTMENTAL SEAL AND A CURRENT CONSUMER AFFAIRS ' ID CARD Director 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, £e., a Wrap-Up Policy) lb. Business Telephone Number of Insured (631)771-5152 lc. N¥S 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 ofentitylisted in box"la" WC1602420 3c. Policy effective period 08/11/2010-8/11/2011 3d. The Proprietor, Partners or Executive Officers are [;~'l 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 notiJ~ 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 1 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 (Pdnt name of authorized representative or licensed agent of insurance carrier) 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 Town of Southold Annex 54375 Main Road Southold, New York 11971 FEES PAID 4/11/2011 17.-4-1 Peyton, Elizabeth 370 Munn Ln Permit #: Legal Address: 370 Munn Ln 36309 Date Fee Check Number SINGLE FAMILY DWELLING - ADDITION OR ALTERATION CO - ALTERATION TO DWELLING 4/8/2011 4/8/2011 Receipt No 511 512 Amount $200.00 $50.00 Total: $250.00 This is a receipt for payment of fees. This is not a building permit. Date Printed: 4/11/2011 Page 1 of 1 Pacifico Engineering PC PO Box 1448 Sayville, NY 11782 www.pacificoengineering.com December 13, 2010 Engineering Consulting Ph: 631-988-0000 Fax: 631-382-8236 engineer~pacificoengineering.com Town of Southold Building Department 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Subject: Solar Energy Installation for Elizabeth Peyton 370 Munn Lane Orient, NY 11957 APPROVED AS NOTED NOTIFY E~U!LDIN~ 765-180z FOLLOWIN~' %~PF CTK',N~ FOR r~ RED 2 ROUG~ 3 ~ vv .~ ~'~" ~ ~, :-:CTRICAL I have reviewed the roofing structure at the subject address. The structuref~!~ah'sEIJpii:~r4hE[adl;litio, r~l weight of the roof mounted system. The units am to be installed in accordance instructions. I have determined that the installation will meet the requi~t~{B~t7~)O? and ASCE7~05 when installed in accordance with the manufacturer's irk~J:~l~E NOT RESPONSIBLE FOR UE$1GN OR'CONSTRUCTiON ERRORS. Roof Section A B mean roof height 14 ft 14 ft pitch 5 1/2 in112 5 1/2 in/12 roof rafter 2x6 2x6 rafter spacing 24 in OC 24 in OC Reflected roof rafter span 10.8 ff 10.8 ff Table R802.5.1(1) max 10.8 ft 10.8 ft The climactic and load information is below: Wind Catego~ Speed, 3 sec gust, mph C 120 CLIMACTIC AND GEOGRAPHIC DESIGN CRITERIA Roof Section A B Ralph Pacifico, PE Professional Engineer . 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The SPRm line of Solar Inverters can be easily applied in residential or commercial installations. All models come with a 1 O-year warranty. SPR-5OOOm, SPR-6OOOm & SPR-7OOOm www. sunpowercorp.com 500Om, 6000m & 7000m INVERTERS EXCEPTIONAL RELIABILITY AND PERFORMANCE AC Power AC Max Output Current (@ 208V, 240V, 277V): Electrical Data SPR-5OOOm SPR-6OOOm SPR-7OOOm 5000 W 6000 W 7000 W 24A, 20 BA, 18A 29A, 25A, 216A 34A, 29A, 25.3A 100 95 SPRm Efficiency Curves AC Nominal Voltage / Range AC Freq/Range 183 229V@208VAC 183 229V@208VAC 183 229V@208VAC 211 264V@240VAC 211-264V@240VAC 211 264V@24DVAC 60Hz/59 3 Hz- 60Hz/59 S Hz- 60 Hz/593 Hz- 605 Hz 605 Hz 605 Hz 75 ~0% 20% ~o% 40% so% 6o% 70% 80% eo% ~oo~ % of Rated Output Power Power Factor 1 1 1 Efficiency Recommended (DC @ STC) Voltage Range Tracking Voltage Mechanical Data Shipping Dimensions W x H x D inches 23 5 z' x 31 0" x 16 0r' Unit Dimensions W x H x D inches 18 4' x 24 I" x 9S' Inverter Weight 143 lbs Shipping Weight 154 lbs Cooling Forced Air / Sealed EbctronJcs Enclosure Warranty and Certifications DC Max. 2iA Input Current Compliance: IEEE 929, IEEE-1547, UL 1741 2005, UL 1998, FCC Part 15 A & B Ripple No. of Fused Nighttime About SunPower SunPower designs, manufactures and delivers high-performance solar electric technology worldwide. Our high-efficiency solar cells generate up to 50 percent more power than conventional solar cells. Our high-performance solar panels, roof tiles and trackers deliver significantly more energy than competing systems. www. sunpowercorp.com BENEFITS Highest Efficiency SunPowerTM Solar Panels are the most efficient photovoltaic panels on the market today. More Power Our panels produce more power in the same amount of spoco up to 50% more than conventional designs and 100% more than thin film solar panels. Reduced Inslallafion Cost More power per panel means fewer panels per install. This saves both time and money. Reliable and Robust Design Proven materials, tempered front glass, and a sturdy anodized frame allow panel to operate reliably in multiple mounting configurations. The SunPowerTM 2 ! 5 Solar Panel provides today's highest efficiency and performance. Utilizing 72 back-contact solar cells, the SunPower 215 delivers a total panel conversion efficiency of 173%. The panel's reduced voltage-temperature coefficient and exceptional Iow-light performance attributes provide outstanding energy delivery per peak power watt. SunPower's High Efficiency Advantage - Up to Twice file Power Thin Film Conventional SunPower Peak Watts / Panel 65 170 215 Efficiency 9.0% 130% 17.3% Peak Watts / ~ (m2) 8 190) 12 (130) 16 (173) About SunPower SunPower designs, manufactures and delivers high-performance solar electric technology worldwide. Our high-efficiency solar cells generate up to 50% more power than conventional solar cells. Our high-performance solar panels, roof tiles and trackers deliver significantly more energy than competing systems. SPR-21 5-WHT-U Electrical Data Peak Power {+/~5%) Pmax 215 W Rated Voltage Vmpp 39.8 V Rated Current Impp 5 40 A Open Circuit Vollage Voc 483 V Shorl Circuit Currenl Isc 5.80 A Maximum System Voltage UL 600 V Temperature Coefficients NOCT Series Fuse Raling Solar Cells Front Glass Junction Box Output Cables Frame Weight Power -0 38% / K Voltage (Voc) -136.8mV / K Current (Isc} 35mA / K 45°C +/2°C 15A Mechanical Data 72 SunPower all-back contact monocrystalline High transmission tempered glass IP-65 rated with 3 bypass diodes Dimensions: 32 x 155 x 128 (mm) 1000mm length cables / MultiConlact (MC4) connectors Anodized aluminum alloy type 6063 (black) 33.1 lbs. (]50 kg) I-V Curve 7,0 6,0 5,0 lOOOW/n~ ~ 4,0 N, 3,0 ~ 2,0 ~l 1,0 0 10 20 30 40 50 Voltage (V) 6O Current/voltage characleristJcs with dependence on Jrradiance and module temper alure Tested Operating Conditions Temperature -40° F to +185° F (-40° C to + 85° C] Max load 113 psf 550kg/m2 (5400 Pa) front eg. snow; 50 psf 245kg/m: (2400 Pa) front and back eg wind Impact Resistance Hall 1 in (25 mm) at 52mph (23 m/s) Warranties Certifications Warranties and Certifications 25 year limited power warranty lO year limited product warranty Tested to UL 1703. Class C Fire Rating Dirnensions (IN) Pacifico Engineering PC PO BOX 1448, BayvilJe~ NY 11782 Ralph Paciflco, PE NYS License 066182 GreenLogic, LLC Proposed Peyton, Elizabeth 370 Munn Lane Orient, NY 11957 15.16 kW 24 SunPower 215 UniRac Sunframe Azimuth = 170° Pitch = 20° ~Scale 3/16" = 1,0' Panel Dimension = 61.39" × 31,42" Surface Dimensions = 509" x 201" SunPower 215w UniRac L-Foot UniRac SunFrame Rail t il 2x6" Douglas Fir Rafters 16" On Center Layout Created By: VDC Date: 9.10.10 II Pacifico Engineering PC ~J31-98s-o0OO Ralph Pacifico, PE NYS License 066182 CHIMNEY HT: GreenLogic, LLC Proposed Peyton, Elizabeth 370 Munn Lane Orient, NY 11957 Rafters with 2x6" collarties on either side 6' 6" down from the ridge See Framing Detail #1 Rafters with 2x6" Collar Ties/Ceiling Joists at the eve See Framing Detail #2 Rafters with no Collar ties i5. 6kW i24 SunPower 215 Panel Dimension = 61.39" x 31.42" UniRac Sunframe ;iAzimuth = 170° Surface Dimensions = 509" x 201" PitCh = 24° Scale 3/16"= 1.0' ~ SunPower 215w UniRac L-Foot UniRac SunFrame Rail 2x6" Douglas Fir Rafters 16" On Center Layout Created By: VDC Date: 9.10.10 3 Strings 0~ 8 S~ewer 215 EaCh ~tring i 720 wa~ts Array total of 5160 waEs II SUNPOWER SPR 5000 INVERTER 240 VAC from inverse;~ to a 30 Amp switch near utility meter BENEFITS Highest Efficiency SunPowerTM Solar Panels are the most efficient photovoltaic panels on the market today. More Power Our panels produce more power in the same amount of space up to 50% more than conventional designs and 100% more than thin film solar panels. Reduced Installation Cost More power per panel means fewer panels per install. This saves both time and money. Reliable and Robust Design Proven materials, tempered front glass, and a sturdy anodized frame allow panel to operate reliably in multiple mounting configurations. The SunPowerTM 215 Solar Panel provides today's highest efficiency and performance. Utilizing 72 back-contact solar cells, the SunPower 215 delivers a total panel conversion efficiency of 173% The panel's reduced voltage-temperature coefficient and exceptional Iow-light performance attributes provide outstanding energy delivery per peak power watt~ SunPower's High Efficiency Advantage - Up to Twice the Power Thin Film Conventional SunPower Peak Wa~'s / Panel 65 170 215 Efficiency 9.0% 13.0% 17.3% Peak Watts / ~ (m2) 8 (90) 12 (130) 16 (173) About SunPower SunPower designs, manufactures and delivers high-performance soler electric technology worldwide. Our high-efficiency solar cells generate up to 50% more power than conventional solar cells. Our high-performance solar panels, roof tiles and trackers deliver significantly more energy than competing systems. SPR-215-WHT-U c(~us Electrical Data Peak Power (+/-5%) Pmax 215 W Rated Voltage Vmpp 39,8 V Rated Current Impp 5.40 A Open Circuit Voltage Voc 48.3 V Short Circuit Current Isc 5.80 A Maximum Syslem Voltage UL 600 V Temperature Coefficients NOCT Series Fuse Rating Solar Cells Front Glass Junction Box Output Cables Frame Weight Power ~.38% / K Voltage (Vcc) -136.8mV / K Current (Isc} 3.5mA / K 45°C+/-2°C 15A Mechanical Data 72 SunPower all-back contact monocrystalline High transmission tempered glass lPg5 rated with 3 bypass diodes Dimensions: 32 x 155 x 128 (mm) lO00mm length cables / MultiContact )MC4) conr~ectars Anodized aluminum alloy type 6063 (black) 33.1 lbs. (15.0 kg) I-V Curve 7,0 6,0 i 3,0 1,0 0 10 20 30 40 50 60 vo~aee Current/voltage characteri$~¢$ with dependence on irradiance and module temperature Tested Operating Conditions Temperature -40° F to + 185° F (-40° C to + 85° C) 113 psf 550kg/m2 (5400 Pa) front - e.g. snow; Max load 50 psf 245kg/m~ (2400 Pa) front and back - e.g. wind Impact Resistance Hail 1 in (25 mm) at 52mph )23 m/s) Warranties Certifications Warranties and Certifications 25 year limited power warranty 10 year limited product warranty Tested to UL 1703. Class C Fire Rating Dimensions 2× 577 [~] 4× L [z,vl [2909