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HomeMy WebLinkAbout35640-ZTown ofSoutholdAnnex 54375Main Road Southold, New York l1971 8/26/2011 CERTIFICATE OF OCCUPANCY No: 35173 Date: 8/26/2011 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: SOLAR PANEL 5896 SOUND AVE MATTITUCK, Sec/Block/Lot: 121.-4-27.1 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 5/27/2010 pursuant to which Building Permit No. 35640 dated 6/14/2010 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: solar panels on an existing one family dwelling as applied for. The certificate is issued to Olsen, Randall&Olsen, Laural (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 35640 6/25/10 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 35640 Z Date JUNE 14, 2010 Permission is hereby granted to: R3kNDALL OLSEN PO BOX 73 MATTITUCK,NY 11952 for : INSTALLATION OF (ELECTRIC) SOLAR PANELS TO AN EXISTING DWELLING AS APPLIED FOR at premises located at 5896 SOUND AVE County Tax Map No. 473889 Section 121 Block pursuant to application dated MAY 27, 2010 Building Inspector to expire on DECEMBER MATTITUCK 0004 Lot NO. 027.001 and approved by the 14, 2011. 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 OCCUPANCY 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 form). 3. Approval of electrical instalIation 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 Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" laud 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: House No. Owner or Owners of Preperty: ~'~L~\~ Suffolk County Tax Map No 1000, Section Subdivision Old or Pre-existing Building: Street ~ ~'i Block (check one) Hamlet Filed Map. Lot: Applicant: Underwriters Approval: PermitNo. '2'o~:J'{{)- -~- DateofPermit. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Foe Submitted: $ Final Certificate: a/ (check one) Applicant Signature 17!t Tclcl~honc (6BI) 763-1802 Fax (t;31 ) ro.qer, richert~,town southo d ny.us BI ;ILl)IN(; DEPAI/TMI';NT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRIClAL COMPLIANCE SITE LOCATION Issued To: Randall Olsen Address: 5896 Sound Ave. City: Mattituck St: NY Zip: 11952 Building Permit#: 35640 Section: 121 Block: 4 Lot: 27.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: GO Solar Inc. LicenseNo: 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 Service 3 ph Hot Water Main Panel NC Condenser Sub Panel NC Blower Transformer Appliances Disconnect Switches Other Equipment: photovoltaic system INVENTORY Duplec Recpt [~ Ceiling Fixtures GFCI Recpt ~ Wall Fixtures Single Recpt Recessed Fixtures Range Recpt Fluorescent Fixture Dryer Recpt Emergency Fixture,, Twist Lock Exit Fixtures HID Fixtures Smoke Detectors CO Detectors Pumps Time Clocks TVSS Notes: consists of, 48 kd210 modules, 2 Xantrex GT 5.0 inverters, I ac disconnect. Inspector Signature: Date: June 25 2010 81-Cert Electrical Compliance Form TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ~ELECTRICAL (FINAL) REMARKS: DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION ¶ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ] FIRERESI~A#TCONSTRUCTI0. REMARKS: ~ [ ] ROUGH PLBG. [ ] INSULATION [~.~FINAL [ ] FIRE SA~-.', 1~ INSPECTION [ ] FIRE RESISTANT PENETRATION DATE INSPECTOR 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 June 21, 2011 Town of Southold Building Department 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Subject: Solar Ene~ylnstallationfor Randy Olsen 5898 Sound Ave Mattituck, NY 11948 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 2010 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 FOUNDATION (IST) FOUNDATION (~ND) · ROUGH FIIAM~G & PLUMBING INSULATION PERN. Y. , , , . ADDITIONAL COMIVlENTS . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net Examined Approved Disapproved a/c Expiration 'J /1¢, 2o / o /~//¢.20/t Building Inspector 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 Storu~-Water Assessment Form Contact: Mail to: Phone: APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ~'/:2.-{o ,20 /O 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 Pemfit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a pem~it 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. 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 within 18 months from such date. If no zoning amendments or other regulations affecting the 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 of a 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. (SignO of applicant or name, ifa corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owne~ of premises ~t~r/M) ~) IOf[[ O {~g~K5 (As on the tax roll or latest deed) If a~t is a cocoon, sig~Iure of d~ authori~officer ~a~e'and t~le 6f coCbrate officer5 G ' Builders License No. Plumbers License No. ~q~ - ~ O Electricians License No. ~ ~ - ~ Other Trade's License No. Location of land on which proposed work will be done: 59,qlo Coo tto0 House Number Street Hamlet County Tax Map No. 1000 Section !~} Block · ~:~l~~Lot_ c~ '7. / Subdivision F~Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost 5. If dwelling, number of dwelling units If garage, number of cars Fee Addition Alteration OtherWork ~"3{OA .~/ ~61~ lP-©C_~· (}qO.,~t(Des ~ ion)' (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 Height. Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth. Height Number of Stories Rear Dimensions of entire new construction: Front Height Number of Stories Rear _Depth 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES NO V/Will excess fill be removed from premises? YES 14. Names of Owner of premises Name of Architect Name of Contractor 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 REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO "-" * IF YES, D.E.C. PERMITS MAY BE REQUIRED. NO Address ~":~/(t 5 ov~,oq ~ Phone No. ~'0{- ~- 3 5'- t40 / ~ Address Phone No Address ~'701- t3'~l trO EO~ Phone No. NO ~ 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? * YES__ · IF YES, PROVIDE A COPY. NO / 1'~ -~-K.x.~~ ~-'~'~'-~t''x ~X~,~~'~_~ being duly sworn, deposes and says that (s)he is the applicant [[Narr~of individual signing, contract) above nmr~e~l, (S)Heisthe ~,(~ ~ 5)~) % [CL~, F_[/~[fx ~ (G(o3tractor, Agent,'C6'orporate Officer, etc.) ' of said owner or owners, and is duly authorized to peri:bm or have performed the said work and to make and file this application; that all 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 therewitb. Sworn to before me this q day of. ~/~f- 20 (_///~- Notary . Tow___ n o_ f Southold Erosion, Sed,mentaflon & Storm-Water Run-off A$$-~-SSMENT FOR;" PROPERTY LOCATION: S.C.T.M. R THE FOLLOWING ACTIONS MAY REQUIRE THE SI. Invade=ION OF A District C~'~ ~ ~r~o BY A DESIGN PROFESSIONAL IN 'i'HE STATE OF NEW YORK. Item Number: (NOTE: A Check Mark (~) for each Question is Required for a Complete Application) Yes No 3 4 5 6 7 8 9 1 2 Will this Project Retain All Storm-Water Run-Off Generated by a Two (2") inch Rainfall co Site? (This item will In0iude ail run-off oreaisd by site c~eating and/or construction activities as well as all Site Improvements and the permanent creaflcm of Imparvious surfaces.) Does the Site Plan and/or Sur~ey Show Ail Proposed Drainage Structures IndicaUng Size & Location? This Item shall include all Pmpoeed Grade Changes and Slopes Controlflng Surface WaisrFIowi Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural Existing Grade InVolving more than 200 Cubic Yards of Matedai within any Parcel? Will this Application Require Land Dislurbthg Aoflvitiee Encompassing an Area in Excess of Five Thousand (5,000) Square Feet of Ground Surfaco? Is there a Natural Water Course Running threugh the Site? Is this Project within the Trustees judsdictian ar within One Handmd (100') feet of a Wetland or Beach? Will there be Site preeparelico on Existing Grade Slopes which Exceed Ftlteen (15) feet of Vedical Rise to One Hundred (100') of Horizantel Distance? Will Driveways, Parking Areas or other Impe~zious Surfaces be Sloped to Oirect Storm-Water Run-O~f into and/or in the direction cfa Town right-of-way? Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of any Item Within the Town Right-of-Way or Ro;~d Shoulder Area? (This Item will NOT Include the Installation of Driveway Aprons.) Witl this Project Require Site Preparatian within the One Hundred (100) Year Fleedplain of any Watercourse? E~ NOTE: If Any Answer to QUestions One through Nine IS Answered with a Check Mark In the Box, a Storm-Water, Grading, Drainage, & Erosion Control Plan Is Required and Must be Submitted for Review Pr or to Issuance of Any Building Permltl EXEMPTION: Yes No Does this project meet the minimum standards for ctesslflcatlou as an Agricultural Project? Note: If You Answered Yes to this Question, a Storm-Water, Greding, Drainage & Erosion Control Plan is NOT Requiped! __ ~ STATE OF NEW YORK, coumw OF .....~..~..~..~/~ ......... SS That I ........ ~,~.~...¢......,....~....(........./~..!...~.. ,~.. .................. being duly sworn, deposes and says that he/she is the applicant for Permit, (Name of k;dMdual sigrflflg Oocurnent) And mat he/she is the ................... ~..IM...~Q.J~,,..: ................................ Owner and/or representative of the Owner of Owner's, and is duly authorized to perform or have performed the said work and to n~ke 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 herewith. Sworn to before me this; .................. ~.. .................... day of........~......~. .......................... ,20.t.0 /~ ................. Town Hall Ammx &f,375 Mare Road P.O. Box 1179 $outhold, NY 11971-0959 Tclcphone (631) 765-1802 · . _~l;ax (63l) 765-9502 ro.qer r cnert(o4,town.soutfiold.n¥.us BUILDING DEPARTMENT TOI~N' OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION Company Name: __ ~ ~O~-/~-.., .../.'~r_. License No.: Address: ~7:~ ~ ~.;' ~iV~he~. N~. Phone No.: JOBSITE INFORMATION: (*Indicates required information) *Cross Street: *Phone No.: ~/_ Permit No.: Tax Map District: 1000 Section: *BRIEF DESCRIPTION OF WQRK (Please Print Clearly) Date: (Please Circle All That Apply) *Is job ready for inspection: *Do you need a Temp Certificate: Temp Information~_lf en~..ded] *Service Size' 1 Phase' *New Service: Re-connect Additional Information: 3Phase (/~...EE~s~) NO Rough In 100 150 ~ 300 350 400 Other Change of Service Underground Number of Meters PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form Town Hall Aimex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 76,5-1802 · ._.F. ax (631) 765-,95(}2 ro.qer.nchertC, town.soutno~d.ny.us BUILDING DEPARTMENT TOWN OF $OUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Company Name: Name: License No.: &ddress: Phone No.: oLc. cr, Date: JOBSITE INFORMATION: *Name: *Address: *Cross Street: *Phone No.: Permit No.: (*Indicates required information) Tax Map District: 1000 Section: Block: Lot: 'BRIEF DESCRIPTION OF WORK (Please Print Clearly) Iix~ Qe-3L-¢{, (( (x(~h 67,}r') C)- (Please Circle All That Apply) *Is job ready for inspection: *Do you need a Temp Certificate: Temp Information (If needed} *Service Size: ~_~hase 5 3Phase *New Service: Re-connect Additional Information: 100 Underground ~S / NO Rough In (Final '~S~ NO 150 200 300 350 400 Other Number of Meters Change of Service Overhead PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York I 1971-0959 Telephone (631 ) 765- 1802 Fax (631 ) 765-9502 BUILDING DEPARTMENT TOWN OF' SOUTHOLD May 13, 2011 Go Solar Inc 272 Main Road Riverhead, NY 11901 RE: Olsen, 5896 Sound Avenue, Mattituck See enclosed ticket from Building Inspector dated 5/13/11 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 4/1/84) __ Trustees Certificate of Compliance. (Town Trustees#765-1892) __ Final Planning Board Approval. __ Final Fire Inspection from Fire Marshall. __ Final Landmark Preservation approval. BUILDING PERMIT: 35640-Z solar panels BOBS,,,,,c CERTIFIED TO: FIRST AMERICAI' AQUEBOGUf" AB NORTH FORK B, RANDALL OLSEI' LAURAL A. OLS CERTIFICATE OF LIABILITY INSURANCE I DATEI"" Y',99,O , 009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MA'FI*ER OF INFORMATION LoVulloAssociates, lnc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6450 Transit Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Depew, NY 14043 INSURERS AFFORDING COVERAGE NAIC # INSURED GO Solar, Inc. ~r~$URER ~ SCOTTSDALE INSU RAN CE COMPANY 41297 cio Gary Minnick INSURER B; SCOTTSDALE INSU RAN CE COMPANY 41297 272 Main Road iNSURER C. Riverhead, NY '1 '190'1 INSURER D; COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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 ~RMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. A GENERAL LIABILn~I CPS1056624 1012012009 '10/20/2010 EACH OCCURRENCE $ 2,000,000 I CLAIMS MADE [~ OCCUR MED EXP (Any one persr~} $ 5,000 GENERAL AGGREGATE EXCE~ I UMBRELI,.A LIABILITY EACH OCCURRE~ CE $ $ A OTHER Business Personal Property CPS1056624 10120/2009 10/20/2010 $110,000 Deductible $1,000 CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 1'1971 SHOULD ANY OFTHE ABOVE DESCRIBED pOCICIES BE CANCELLED BEFORE THE EXF~RATION ACORD 25 (2009101) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD For more Information contact: Walter P Geoghan Agency Inc at 631-472-5000. IMPORTANT It the cedificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the cedificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement oo this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contracl between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 {2009/01) New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR, 3RD FLR, MELVILLE, NEW YORK 11747-3129 Phone: (631) 756-4300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE GO SOLAR INC 272 MAIN RD RIVERHEAD NY 11901 POLICYHOLDER GO SOLAR INC 272 MAIN RD RIVERHEAD NY 11901 CERTIFICATE HOLDER TOWN Of SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD NY 11971 POLICY NUMBER 11346 970-5 CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE 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. 1346 970-5 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 THESTATE 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 ONLY ANDCONFERS 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/cert/certvaLasp or by calling (888) 875-5790 VALIDATION NUMBER: 306965270 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 to 02/04/2011 4. Policy covers: a. [] All of the employer's employees eligible under the New York Disability Benefits Law b. ~ Only the foUowingclassorclassesoftheemployer'semployees: Under penalty of perjury, I certify thM 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 Li~ Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Title St, Vice President IMPORTANT: If box "4a" is checked, and this form is signed by the insurance carrier's autho¢ized 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 2ZO, 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 WOrker's Compensation Board, the above-named employer has cOmplied with the NYS Date Signed By Telephone Number Title (Signature of NYS Worker's 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 a~icle, 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 PV MODULE FRAMING AND MOUNTING SYSTEM FOR PITCHED ROOFS PV MODULE FRAMING AND MOUNTING SYSTEM FOR PITCHED ROOFS Module Compatibility Use SunPtame with PV modules from these major manufacturers: BP Solar, GE Energy, Isofoton, Kyocera, Mitsubishi, Photuwatt, RWE Schott, Sanyo, Sharp. Call UniRac or your PV dealer for manufacturers not listed. Code Compliance SunFrame is designed to comply with the Uniform and California building codes when installed according to SunFrame installation instructions. Call UniRac concerning status of International Building Code compliance. Components Inter-Module Rails suppmt 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 Caps 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. 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 Spedfieations Rails, cap strips, two-piece standoffs, splices, and L-feet: 6105-T5 aluminum extrusion. End caps: UV resistant plastic. One-piece standoffs: Service Condition 4 (very severe) zinc-plated welded steel. Fasteners: 304 stainless steel. www. unirac.com See our SunFrmne page for complete information: pricing, installation insa'uctions appropriate to your build- Lng code, and minimum requirements for the number and type of modules you plan to mount. UnlRae, Inc. in~@uniruc.com 3201 University Boulevard SE, Suite 110 Albuquerque NM 87106-5635 USA 505.242.6411 505.242.6412 Fax Pub 050206.1ds · February 2005 © 2005 UniRac, Inc. All rights reserved. THE NEW VALUE FRONTIER KYOCERa KD210GX-LP HIGH EFFICIENCY MULTIORYSTAL PHOTOVOLTAIC MODULE US~EB HIGHLIGHTS OF KYOCERA PHOTOVOLTAIC MODULES Kyocera's edvenced cell processing technology and automated production facilities produce a highly efficient multicrystal photovoltaic module. The conversion efficiency of the Kyoeera solar cell is over 16°/o. These cells are encapsulated between a tempered glass cover and a pottant with back sheet to provide efficient protection 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 KD210GX-LP is Ideal for grid fie 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 Kyocere multlcry~al photovoltalc modules have pae~ed the following tests. · Thermal cycling test · Thermal shock test · Thermal / Freezing and high humidity cycling test · Electrical isolation test · Hail impact test · Mechanical, wind and twist loading test · Salt mist test · Light and water-exposure test · Field exposure test LIMITED WARRANTY year limited warranty on material and workmanship 20 years limited warranty on power output: For detail, please refer to "catago~ IV' in Warranty issued by Kyocers ELECTRICAL CHARACTERISTICS Current-Voltage characteristics of Photovoltaic Module KD210GX-LP at various cell tern reratures Current-Voltage characteristics of Photovoltaic Module KD210GX-LP at various irradiance levels SPECIFICATIONS KD210GX-LP · Physical Specifications 3s(1.an.) 946 (37.2in.) (-) Unit: mm [in.) · Specifications · ~ Fer~n~nee under ~and~d Te~ Cond~or4 (*STC) Maximum Power (Pmax) 210W {+5%/-5%) Maximum Power Voltage (Vrnpp) Maximum Power Current (Impp) Open Circuit Voltage (voc) Short Circuit Current itsc) Max System Voltage Temperature Ceefficient of Voc Temperature Coefficient of Isc 26.6V 7.90A 33.2V 8.58A 600V -0.120 V/'C 5.15x1~3A/~ B BectHcll W ~t ~OOW/m~, *NOGT, AMI.5 Maximum Power (Pmax) Maximum Power Voltage (Vmpp) Maximum Power Current (Impp) 148W 23.5v 6.32A 29.9V 6.98A Open Circuit Voltage Shod Circuit Current Number ~er Module I 54 · Module Chametm~tk~ Length x Width x Depth Weight 18.5kg(40.81bs.) Cable (+)760mm(29~i~),(-}1840mm{72~in) Length x Width x Depth I 100mm(3.~in)x108mm(4.3i~]x15~m(O.~in} IP Code I IP65 *Operatin~l Temperature I -40°C --90~C Maximum Fuse I 15A KSlOEERa KYOCERA Corporation · KYOCERA Corporation Headquarters CORPORATE SOLAR ENERGY DlVlelON 6 Takeda Tobadono-cho Fushlml-ku, Kyoto 612-8501, Japan TEL: 81 )75-804-3476 FAX:(81 )75-604-3475 ht tp://www, kyOCera.co m · KYOCERA Solar, Inc. 7812 East Ac. Oma Drive TEL:(1 )480-948-8003 Or (800)223-9580 FAX:(1)480-483-8431 · KYOCERA Solar do Brasil Ltda. Ay. Gulgnard 661, LoJa A TEL:(55)21-2437-8525 FAX:($$)21-2437-2338 htr p://ww'*v, kyoce rasolar, com.br! · KYOCERA Solar Pty Ltd. Level 31 6'10 Talavera Road, Nor~ Ryde TEL:(61 )2-8870-3948 FAX:(61 )2-9888-9588 htr p://www, kyoce r asolar.com.au/ · KYOCERA Fineceramics GmbH Fritz-Muller-Strasse 107, 73730 E$$1ingen Germany TEL:(49)711-93934-989 FAX:(49)711-93934*950 · KYOCERA Asia Pacific Pte. Ltd. 298 Tlong eahru Road, #13-03/05 Central Plaza, elngapore 168730 TEL:(66)6271-0500 FAX:(85)6271-0600 · Kyocera Asia Pacific Ltd. Room 801-802, Tower 1, South Seas Centre, · KYOCERA Asia Pacific Pte. Ltd., Taipei Office · KYOCERA (Tianjin) Sales & Trading Corp. · KYOCERA Korea Co., Ltd. > Certified to the new UL 1741/IEEE 1547 > 10 yr. standard warranty · Highest CEC efficiency in its dass · Integrated load.break rated ACand DC disconnect switch · Seoled ~ endesure & Opticool · Co~ SMA · Ideall or , and designed :md S~7OOOU are also compat- efficiency mean, beret performance and shorter ~rabl. for positive ground *y~ems ~g them , Sunny Boy has become the benchmark for SB 5@@@US SB 600@US Max. Recommended Array Input Power (DC @ STC) Max. DC Voltage Peak Power Tracking Voltage DC Max. Input Current DC Voltage Ripple Number of Fused String Inputs AC Nominal Power AC Maximum Output Power AC Maximum Output Current (@ 208, 240, 277 V) AC Nominal Voltage / Range AC Frequency / Range Power Factor peak Inverter Efficiency CEC weighted Efficiency Dimensions W x H x D in inches Ambient ~mpe~[a~e range Power Consumption: standby / nighttime Topology Cooling Concept SB 7000US I~oc~ii~n indoor Ud Color: aluminum / red/blue / yellow Communication! RS~185 / Wireless Warranl~ ]~ar IEEE-1547, UL 1741, UL 1998, FCC Part 15 A & B Specifications for nominal conditions Efficiency Curves 6250 W 7500 W 8750 W 600 V 600 V 600 V 250 - 480 V 250 - 480 V 250 - 4.80 v 21 A 25A 30A <5% <5% <5% 4 4 4 300 V 300 V 300 V 5000 W 6000 W 7000 W 5000 W 6000 W 7000 W 24 A, 20.8 A, 18A 29 A, 25 A, 21.6 A 34 A, 29 A, 25.3 A 183- 229V@208V 183- 229V@208V 183- 229V@208V 211 - 264V@ 240V 211 - 264V@240V 211 - 264V@240V 244 - 305V@ 277V 2.~- 305 V@277V 244 - 305VO277V 60Hz/59.3Hz-60.SHz 60Hz/59.3Hz-60.SHz 60Hz/59.3Hz-60.SHz 96.8 % 9Z0 % 9Z1% 95.5 % @ 208 V 95.5 % @ 208 V 95.5 % @ 208 V 95.5 % @ 240 V 95.5 % @ 240 V 96.0 % @ 24.0 V 95~5 % @ 277 V 96.0 % @ 277 V 96.0 % @ 277 V 18.4 x2~.1 x9~5 18.4 x24.1 x95 18,4 x24.1 x9~ 14.3 lbs~ 154 lbs 143 lbs/154 lbs 143 lbs~ 154 lbs <TW/O.25W <7W/O.25W <7W/O.25W PWM, h'ue sin@wave, PWM, ~rue sinewave, PWM, true sin@wave, current source current source current source Convection wi~ Conve~ion w~n Convection with regulated fan coding regulated fan cooling regulated fan cooling · · · ®/o/o/o el@l@~@ el@l@/@ o/o o/o · · · · · · · Included O O~ion - Nd available www. sma-amerlca.com Phone 530-273-4895 Toll Free 888-4SMAUSA SMA America, Inc. ' ENERAL NOTES Roof SectionA mean roof height 24 ft pitch 7 1/2 in/12 1. CONTRACTOR SHALL CHECK AND VERIFY ALL CONDITIONS Al THE 11. THE OWNER SHALL SELECT ALL FINISH MATERIALS AND COLORS roof rafter 2xl 0 HIMSELF WtTH THE INTENT OF THESE P~NS AND MAKE W~K RE~IN THE PROPER~ OF THE ENGINEER WHETHER THE PROJECT rafter spacing 16 in CC ' '?' ~ SHALL Z CON--ACTOR OR OWNER SHALL OBTAIN ALL REQUIRED APPROVALS. NOT TO BE USEO ~ ANY OTHER PROJECTS OR EXTENSIONS TO Reflected roof rafter span 16.9 ff ~RMITS'CERTIFICATESOF~CUPANCY'INSPECTI~ THISPROJECT~XCEPTBYAGREEM~NTINWRITINGANDWITH Table R802.5.1(1) max allowable 20.6 fl M~?' ~-~: REQiJ[~ ;'; -~"' OF THE THE TOTAL ~TISFACnON ~ THE O~ER PRIOR TO REL~SE OF Fm~ PAYMENT, ~ . CONDUIT APP-? ) AS huTED ' , iNVERTER INVERTE~ NOTIFY BUILDING DEPARTMENT , ~ 765-1802 8 ~ TO 4 PM FOR THE ME~R ~ WI"lNG GUTTER [ DC ~ FOLLO~NG INSPECTIONS: ~ ~ 1. FOUNDATION- ~O REQUIRED ': O % ~ DISC~NECT FOR POURED CONCRETE SERVICE 2 ROUGH- FRAMING. PLUMBING.  ~ STRAPPING ELECTRICAL & CAULKING PANEL ~ AC AC DC 3 INSU~TION ~ ~ ~ 4 FINAL-CONSTRUCT~ON & ~LECTRtCAL Mio Clomp ~..~/. MUST ' ~. ..- REQUIReMeNtS OF 7~E Cr-}DES OF NEW L4~I , ~ E~ CIc~ N.T.S. YORK STATE NOT RESPONS~SLE FOR DESIGN OR CONSTRUCTION ERRORS, ~'~ ~'~ RISER PlA~ SHOW~ FO~ ~EFERENCE '~ S~o~n, ~oa 1o my best belief and information the work in this document is accurate, conforms with the ~overnin~ codes applicablo at the time of submission, conforms w~th reasonable standards ~PICAL CONNEXION P~A/L · ALL ROOF PENE~ONS ARE TO BE SEALED of practice, with the view to the safeguarding of life, health, prope~ and public welfare, Revision 2 PV PANEL WITH 5I~FLEX OR E~UIVALENT SEA~NT and is the responsibiliW of the licensee. Revisi~ 1 P ,et = A Km I p,etgo (eq 6-2) Ka (sec 6.5.7) 1 Pnet3o (fig 6-3) -25.9 ~~ PO BOX ~44~, 5AWILLE, NY ~ 7~2 CLIMACTIC AND Wind Speed, Live load, point pullout bstener ~"~¢~r~ 6EO6~PHIC DESIGN Categow 3 sec gust, pnet30 per Fastener type CRITERIA mph ASCE 7, psf load, lb s~cing along ~ O~ ~ENE~L NO~S, ROOF SE~ON, PATA, PETAILS ANP SPECS REQUIRER , i ROOF LAYOUT "~'*~'~ ....~!~,~ PA¢IFI¢O EN~INEERIN~ PC PV Panel ~A~-~ ~ PO Box ~g, SAWILLE, NY ~782 //, kyocera ~9 0l~e~ PANEL: KD210 I~ OtY: 48 ~sqg ~ou~d Ave~ Ma~ituck, NY ~q4* LENGTH: 591 in PROPOSED SO~R ENERGY INSTAL~TION I have review~ the r~fing structure at the subject address The st~cture ~n suppoA the additional weight ,,~,~ v,,.,,m,- ofthe r~f mounted system The units are to beinslalledinac~rdan~with the manufactureCsins~llation WIDTH: 39 i~ ~EN~L NO~S, ROOF ~E~ION, DATA, p~TAILS AND SPECS instru~ions I have determined that the installation will meet the requirements of the 2007 NYS Building ,.~ ~s~t, Code, and ASCET-05 ~en installed in a~rdan~ with the manu~cturer's instru~ions. WA~S: 10080 0~/~/~0 AS NOTED