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HomeMy WebLinkAbout36511-ZTown of Southold Annex 54375 Main Road Southold, New York 11971 11/14/2011 CERTIFICATE OF OCCUPANCY No: 35286 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: Date: 11/10/2011 SOLAR PANEL 460Paddock Way, Mattituck, Sec/Block/Lot: 107.-4-2.11 Filed Map No. LotNo. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 6/17/2011 pursuant to which Building Permit No. 36511 dated 6/22/2011 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for winch this certificate is issued is: solar panel system on an existing one family dwelling as applied for. The certificate is issued to Dickerson, Allan & Dickerson, Charlotte (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 36511 7/29/11 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 #: 36511 Date: 6/22/2011 Permission is hereby granted to: Dickerson, Allan & Dickerson~ Charlotte 460 Paddock Way Mattituck, NY 11952 To: install an electric Solar Panel system at am existing dwelling as applied for At premises located at: 460 Paddock Way, Mattituck SCTM # 473889 Sec/Block/Lot # 107.-4-2.11 Pursuant to application dated To expire on 12/21/2012. Fees: 6/1712011 and approved by the Building Inspector. SINGLE FAMILY DWELLING - ADDITION OR ALTERATION CO - ADDITION TO DWELLING Total: $200.00 $50.00 $250.00 Building Inspector ~orm No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-180Z APPLICATION FOR CERTIFICATE OF occUPANcy · Thiz applleation 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 0f 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 sewemge_dispnsal (S_9 form). 3. APProval of electrieal inatallation from Board 0f Fire Underwriters. 4. Sworn statement from plumber eeatifying that the ~older used in system eontaius less than 2/10 of l%'lead. ~ 5. Commercial building, industrial building, maltiPle nmidenees and similar buildings and installations, a ~ertifleate of Code Compliance from arohiteet or engineer responsible for the build~g. 6, Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming usa, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all properly lines,'strects, building and:unusual naturaj 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 I. Certi~ca!e ~f ~cupancy - New dwe~ing $$~.~ Additi~ns t~ dw~ling $5~.~ A~terati~ns t~ dweHing $$~.~ · Swimming po01 $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 Ccrtificat~ of OccupanCy - $$0.00 ' 5. Temporary Certificate 0fOecupancy - Residential $15.00, Commercial $15.00 New Construction: . /Old or Preexisting Buil~g: ~ Ho~e No. S~ of V po.y:. C.. (check one) Hamlet Lot Subdivisisn P~mit No. ~(o~} .Date of Permit. lCIoalth Dept. Approval: Plalming Board Approval: Request for: Temporary Certificate AO.? Filed Map. Lot: / · ' Underwriter~ Approval: Final Certificate: ~ (check one) A~licant Siena~tnre- ' Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631 ) 765-1802 Fax (631) 765-9502 ro.qer, richert~town.southold.ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION ssued To: Allan Dickerson ~,ddress: 460 Paddock Way City: Southold St: NY Zip: 11971 ~uilding Permit #: 36511 Section: 1 07 Block: 4 Lot: 2.11 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE 3ontractor: DBA: Go Solar Inc License No: 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 Servicelph ~ Heat ~ DuplecRecpt ~ Service 3 ph Hot Water GFCl Recpt Main Panel NC Condenser Single Recpt Sub Panel NC Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: PHOTOVOLTAIC SYSTEM, to include, 28 Kyocera panels Ceiling Fixtures [~ HID Fixtures Wall Fixtures ~.~ Smoke Detectors Recessed Fixtures ~.~ CO Detectors Fluorescent Fixture [~ Pumps Emergency Fixtures~ Time Clocks Exit Fixtures ~ TVSS I Xantrex 5.0 inverter, 1 AC disconnect, (this is an addition to an existing PV system) Notes: Inspector Signature: Date: July 29 2011 81-Cert Electrical Compliance Form TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] ELECTRICAL (ROUG~H~,~ ,~ _ ] ~LE~CTRICAL (FINAL) REMARKS:__ __ _ ~ DATE ~( INSPECTOR~ ~/~ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTIO# [ ] FIRE RESISTANT PENETRATION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ] I/N,.~J~TION [ ]FRAMING/STRAPPING [,,'"J FINAL Fisher Engineering Services, P.C. PO Box 30 · Oakdale · New York 11769 Phone: (631) 563-9028 September 28, 2011 Building Department Subject: Engineer Statement for Solar Roof Installation Dickerson Residence- 460 Paddock Way, Mattituck Permit No. J il NOV 9 2011 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 and the minimum requirements for buildings and structures of ASCE 7-05. 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, William G. Fisher,~Y.E. Licensed Professional Engineer Architectural I~sign · Residential · Light Commercial Additions · Extensions · Conversions Construction Estimates / Oversight · Expediting · Inspections TOWN OF SOUTHOL BUILDING DEPART5 TOWN HALL SOUTHOLD, NY 1197 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFo JUN 2 0 2011 Examthed ~/ ,,~,-"'~20 // Approved ~ / Z 2'~, 20 I/ Disapproved a/c Expiration BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey. Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Mail to: g0 ..~ [,/~o,.. ~c..-. Building Inspector APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date 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. 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (~ ~][fX/ ~gnature ofta~licant or name,-if a corporation) (Mailing a~l'dress of applicant) //[~19~_ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises /~./,ff~ g b,"~t.g.~ ~,r¥/ (As on the tax roll or latest deed) If applicant is a corporation, signaturc of duly authorized officer (Name and title of corporate ofricer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. Locatign of lanClon which pr_opos ,ed work will be ,dpge: House Number Street / 7 Hamlet County Tax Map No. 1000~,Sectio,la ~f~7 Block 0 Subdivision [,0RL~ fit7-- ~')~D'/[ ~'5~/~/4_S,FiledMapNo. Lot ,,h,.. / / Lot 2. State existing use and occupancy ofl~remis~s ag,d ir~tended use and occupancy of proposed construction: a. Existing use and occupancy ReS }~d{e-4'~i*~°' - .... ,,l, , b. Intended use and occupancy ~ 3. Nature of work (check which applicable): New Building Addition ...... Alteratign~ Rep.air , ReTnovalo , Demolitigp .- .Oth~r 4. Estimated Cost tx-,*~rot~ ~}'ta r, t4~t? ~,~t-.~ Fee (To be paid on filing this application) 5. If dwelling, number~uT-dwelling units // Number of dwelling units on each floor If garage, number of cars .// 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front / Rear Height. Number of Sto~es Dimensions of same structure with alterations or additions: Front Depth. Height 8. Dimensions of entire new construction: Front 5'~,~e Height Number of Stories 9. Size of lot: Front ~ ~ ~' Rear [ z¢ ,T t Num6er of Stories Depth Rear .Re.q~''~ Depth_ Depth t 0. 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-k:' 13. Will lot be re-graded? YES NO YWill excess fill be removed from premises? Y~S~/,~,~?~ NO 14. Names of Owner ofpremises~ O~(~6~l~ Address ~ ~ ~ ~ne No~ ~- ~. Name of Architect Address Phone No NameofContractor f~ ~0~e Address~7~ ~ PhoneNo.~/~Tg7~¢' 15 a. Is this prope~y within 100 feet of a tidal wetl~d 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 * IF 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? * YES · IF YES, PROVIDE A COPY. NO-' STATE OF NEW YORK) SS: COUNTY OF ) (Name of individual signing contract) above named, duly sworm deposes and says that (s)he is the applicant ~)neisthe O~J~C~L (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 applicatioa; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be perfbrmed in the manner set forth in the application filed therewith. Sworn to before me this ~ ( day of ~Ct~ 20 Il ~'~O~~L MARK 1'. GAG£N Notary Public ~ ~ PUSUC, ~te of ~w York No. ~95650 Qualifi~ in Su~lk ~un~ Fisher Engineering Services, P.C. PO Box 30 · Oakdale · New York 11769 Phone: (631) 563-9028 June 12, 2011 Attention: Building Department Subject: Engineer Statement for Solar Roof Installation Dickerson Residence- 460 Paddock Way, Southold, New York I have verified the adequacy and structural integrity of the existing mol 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 shall be 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. The installation shall be in accordance with the minimum requirements certified by this letter. I hope that this letter serves and meets with the approval of the Building Departxnent. Sincerely, William G. Fisher,tP,~E. Licensed Professional Engineer Architectural Design · Residential · Light Commercial Additions · Extensions · Conversions Construction Estimates / Oversight · Expediting · Inspections Town Hall Annex 54375 Main Road P.O. Box 1179 Southold. NY 11971-0959 Telephone (631 ) 765-1802 Fax (63 I) 765-9502 BUILDING DEPARTMENT TOWN OF SOUTHOLD September 13, 2011 Allan Dickerson 460 Paddock Way Mattituck, NY 11952 TO WHOM IT MAY CONCERN: The Following Item(s) Are Needed To Complete Your Certificate of Occupancy: *NOTE: Certification required from an Engineer or Art~ f~/e fastening of the Solar Panels to the roof structure. __ Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. A fee of $50.06. 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. - Bob Fisher Final Landmark Preservation approval. BUILDING PERMIT: 36511 - Solar Panels ACO tD CERTIFICATE OF LIABILITY INSURANCEI THIS CERTIFICATE iS ISSUED AS A MATTER 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 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the celtiflcale holder is an ADDITIONAL INSURED, the polley(les) 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 tights to the certificate holder in lieu of such endorsement(s). LoVullo Associates, Inc. 6450 Transit Road Depew, NY 14043 i.su~Eo Go Solar, inc. c/o Gary Minnlck 272 Main Road Riverhead, NY 11901 COVERAGES I NC~:~cT Walter P Ge~ghan A~ency Inc ~ ,ac No E~t~. (631) 472~000 ~ ,0' (631) 472-6611 CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIO~ OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED EY THE IK)CJCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSION.?~ AND CONDIT!?NS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED SY PA~D CLAIMS CPS1222661 100,000 5~000 1,000~000 _2,000~000 _1,000,000 CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 ~ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are reglste'ed marks of ACORD AGENCY CUSTOMER ID: 923791 LOC #: ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of 2 GPS1222661 41297 Go Solar, Inc. rJo Oa~y Mtnnick 272 Main Road Rlve~ea.t, NY 11901 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 2~2010/05) FORM TITLE: Certificate ofLlabilit~ Insurar~e This Page Intentionally Left Blank ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are mgistere<[ marks of ACORD 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 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 2. Name and Address of the Entity requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity being listed as the Certificate Holder) Town Of Southold - Building DepL P,O. Box 1179 Southold, NY 11971 The First Rehabilitation Life Insurance Company of America 3b. Policy Number of Entity listed in box "la": DBL176989 3c. Policy effective period: 02/05/2011 to 02/04/2012 4. Policy covers: a. [] All of the employer's employees eligible under the New York Disability Benefits Law b. [] Only the followingclassorclassesoftheernployer'semployees: 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. Date Signed 2/28/201 1 By (Signature of insurance carrier's authorized representative ~ NYS Licensed Insurance Agent or that insurance carrier Telephone Number 516-829-81 00 Tit e. Chief Executive Officer IMPORTANT:If box "4a" is choked, and this form is signed by the insurance carrier's autho¢ized r~oresentatlve 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 puq~es of Section 220, Subd. B of the Disabili~ B~tefits Law. It must be mailed for completion to the Worker's Compensation Board. DB Plans Acceptance Unit, 20 Park Streat, Albany, NY 12207. PART 2. To be completed by NYS Worker's Compensation Board (Only if box "4b" of Part I has been checked) State of New York Worker's Compensation Board According to Information maintained by the NYS WOrker's Compensation Board, the abOUe-named employer has complied with the NYS DiSability Benefits Law with respect to all of his/her employee~. Date Signed By Telephone Number Title (Signature of NYS Worker's Compensation Board Employee) Please Note: Only insuranee carriers licensed to write NYS Disability Benefits insurance policies and NYS Licensed Insurance Agents of those insurance carriers are authorized to issue Form DB-1Z0.1o 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 Cer[ificate of Insurance to the entity listed as the certificate holder in Box "2". This certificate ia 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 NY$ 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 ir 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 & 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 ^ ^ ^ ^ ^ ^ 300144659 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 P.O. BOX 1179 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE I 1346 970-5 436834 02/09/2011 TO 02/09/2012 2/28/2011 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1346970-5 UNTIL 02/09/2012, 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 02/09/2012 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 AND CONFERS 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 vatidated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 1050215290 Lot 9 ~.~,.. Lo~ 12 r ~. : 5.0544 Ac. ~% AreO n/~ Louis 'I'. Herr · {EALTH DEPARTMENT C~TA FOR APPF~OVAL TQCONSTRUCT F IVISION MAP FILED INTHE OFFICEOF~ECLERK~ FOLK C~Y ON JUNE 21,1990 AS FILE N0.8963. nov~ or tormert¥ Deon F. Tuth~%% Lot SEPT. 14,1994 OCT. 4 1994 SEPT. 8,995 I0 YOUNG ,& YOUNG SURVEY FOR: ALLAN DICKERSON 8~ CHARLOTTE DICKERSON LOT NO. 12, ' WOLF PIT POND ESTATES" AT MATTITUCK TOWN OF SUFFOLK CO, N.Y. I~^~'AUG. 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Cable + 76~m129.gin, - 1840mm 72.4in · Junction Box Characteristics Length X Width x Depth 100mm(3.gir~}×108mm(4.3in}×15mm(0.6in) IP Code P65 www. kyocerasolar, com 800-223-9580 toll free 800-523-232g fax *Operatin~ Temperature -40"C,-90~C Maximum Fuse 15A K JDEERa The Xantrex GT 5.0 offers value and reliability in a package you're already comfortable with Xantrex takes our proven GT Series design to the next level with a five kilowatt inverter. Our high performance photovoltaic string inverter offers high efficiency, clean aesthetics, high reliability as well as lower installed cost through time saving installation and included features. The GT 5.0 also offers best-in-class efficiency and the best price- to-performance ratio in the industry. The result is a high performance inverter that makes utility interactive installations easier and more cost effective. Technology: Proven high frequency design in a compact enclosure Integrated DC/AC disconnect that is NEC compliant to eliminate the need for external DC (PV) Large heat sink offers extraordinary heat dispersion without the need for a cooling fan Backlit, two-line, 16-characte~ liquid crystal display (LCD) indicates instantaneous power, daily and lifetime energy production, photovoltaic array voltage and current, utility voltage and frequency, time online "selling" today, fault messages. Installer customizable screens LCD vibration sensor allows the tap of a finger to turn backlight on and display screen cycling Bright LED indicators provide system status at a glance Integrated RS232 and Xanbus R J45 communication ports Free PC software for remote monitoring and system troubleshooting available online Installation: Module selection and sizing are extremely flexible due to wide PV input MPPT tracking voltage range A lightweight and versatile mounting bracket simplifies installation The modular design allows inverters to be mounted side-by-side, using each wiring box as a wiring raceway Easy access DC (photovoltaic) and AC (utility) terminal block simplifies wiring Integrated Iockable AC/DC disconnect saves installation time and balance of system component cost Rugged N EMA 3 R inverter enclosure allows reliable outdoor and indoor installations Performance: ' 95.5% (CEC listed) 94% peak efficiency maximizes investment and energy harvest Fast M PPT tracking algorithm ensures maximum energy harvest from the array under any conditions Excellent thermal performance FCC Part B compliance means less potential interference with communication, radio, and consumer electronics Serviceability: 5-year standard warranty (1 O-year extended warranty available) Sealed inverter enclosure can be separated from the wiring box allowing DC/AC connections to remain intact in the unlikely event that the inverter needs to be serviced For more information about the GT Series, access to the Xantrex string sizing tool, and free download of GT View, please visit: www.xantrex.com/gridtie PHOTOVOLTAIC POWER INVERTER www. xantrex.com Xantrex Grid Tie Solar Inverter Series Electrical Specifications Models GT 5.0-NA-DS-240 Maximum AC power output 5000 W AC output voltage (nominal) 240 Vac AC output voltage range 211 - 264 Vac AC ~requency (nominal) 60 Hz AC frequency range 59.3 - 60.5 Hz Maximum continuous output current 23A Current THD < 2% Power factor > 0.9 DC input voltage range 235 - 600 Vd¢ Peak power tracking voltage range 235-550 Vdt Peak inverter efficiency 96.5% CEC efficiency 55.5% Night-time power consumption 1 W Output ove~current protection 15 A Mechanical Specifications Operating temperature range -13F to +149F (-25°C to +65°O Enclosure type NEMA 3R Unit weight 57.0 lbs (25.8 kg) Shipping weight 60.0 lbs (27.2 kg) Shipping dimensions (H x W x D) 34.1 x 20.4 x 102 ' (86.6 x 51 .$ x 26,2 cm) inverter dimensions (H x W x D) 28.5 x 15.9 x 5.7' (75.5 x 40.3 x 14,6 cra) Mounting Wall mount (mounting bracket included) Features PVlUtility disconnect Eliminates need for e~emal PV (DC) disconnect, Complies with NEC requirements. Cooling Convection cooled, no fan required. Display Backlit, 24ine, 16-character liguLd c~,stal display indicates instantaneous p~wer, daily and lifetime energy production, PV array voltage and current, utility voltage and fredueno/, time online ~selling~ today, fault messages. Installer customizable screens. Communications RS 232 and ~vo Xanbus R J45 por~s Wiring box PV, utility, ground, and communications connections. Wiring box can be separated from the inverter. Warranty 5-year parts (10*year extended warranty available) Options PV MODULE FRAMING AND MOUNTING SYSTEM FOR PITCHED ROOFS PV MODULE FRAMING AND MOUNTING SYSTEM FOR PITCHED ROOFS Module Compatibility Use Sunl~rame with PV modules from these major manufacturers: BP Solar, GE Energy,, Isofoton, Kyoo-~ra, Mitsubishi, Photowatt, RWE Schott, Sanyo, Sharp. Call UniRac or your PV dealer for manufactorers 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 Intemational Building Code complia~ace. Components O Inter-Module Rails 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 Caps neatly finish the rail ends. O L-Feet attach directly to asphalt shingle mofs 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 mofs. 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 SpecLfications Rails, cap strips, two-piece standoffs, splices, and L-feet: 6105-T5 aluminum extrusion. End caps: UV resistant p]LaStlC. One-piece standoffs: Service Condition 4 (very severe,.) zinc-plated welded steel. Fasteners: 304 stainless steel. See our SunPcame page for complete information: pricing, installation instructions appropriate to your build- ing code, and minimum requirements for the number and type of modules you plan to mount. UniRae, Inc. i~fo@unirac.com 3201 UniversiVy Boulevard SE, Suite 110 Albuquerque NM 87106-5635 USA 505.242,6411 505.242.6412 Fax Pub OS0206.1ds · February 2005 © 2005 UniRac, Inc. All rights reserved. Ridge Existing Photovoltaic System KD185 KD185 KD185 KD185 KD185 KD185 KD185 KD185 KD185 KD185 KD185 KD185 KD185 KD185 KD185 KD185 Kl3185 KD185 KD185 KD185 KD185 KD185 KD185 KD185 KD185I KD185 KD185 KD185 not to scale Allan Dickerson Garage 28 Kyocera KD185 1 Xantrex GT5.0 UniRac SunFrame tv