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HomeMy WebLinkAbout37037-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 4/30/2012 CERTIFICATE OF OCCUPANCY No: 35569 Date: 4/30/2012 THIS CERTIFIES that the building SOLAR PANEL Location of Property: 965 Leeward Dr, Southold, SCTM #: 473889 Sec/Block/Lot: 79.-%24 Subdivision: Filed Map No. conforms substantially to the Application for Building Permit heretofore Lot No. filed in this offlced dated 2/24/2012 pursuant to which Building Permit No. 37037 dated 3/5/2012 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: roof mounted electric Solar Panel system on an existing one family dwelling as applied for. The certificate is issued to Rumpler IV, John (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 37037 4/4/12 - Autl~rized Signature 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 #: 37037 Date: 315/2012 Permission is hereby granted to: Rumpler IV, John 965 Leeward Dr Southold, NY 11971 moz install a roof mounted electric Solar Panel system as applied for At premises located at: 965 Leeward Dr, Southold SCTM # 473889 Sec/Block/Lot # 79.-7-24 Pursuant to application dated To expire on 9/4/2013. Fees: 2124/2012 and approved by the Building Inspector. SINGLE FAMILY DWELLING - ADDITION OR ALTERATION $200.00 CO - ADDITION TO DWELLING $50.00 Total: $250.00 Building Inspector 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 installation from Board 0f 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 resideaees 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" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2_ A properly c~mpleted 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: Old or Pre-existing Building: House No. Owner or Owners of Property: Suffolk County Tax Map No 1000, Section 8ubdivisi0n (check one) Permit No. 57 0~ ~7 DateofPermit. ~' Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Foe Submitted: $ SC>- ~ Street Hamlet Slo k -7 2 qL Filed Map. Lot: Applicant: G ~-~w-t ~ tC.~ Undemniters Approval: Final Certificate: ~/' (check one) ~licant Signature Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971 0959 Telephone (631) 765-1802 Fax (63 I) 765-9502 ro.qer, dchert~town.southold, ny. us BUILDING DEPARTMENT TOWN OF SOUTItOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: John Rumpler IV ~,ddress: 965 Leeward Ddve City: Southold St: NY Zip: 11971 3uilding Permit #: 37037 Section: 79 Block: 7 Lot: 2z WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Sontractor: DBA: License No: SITE DETAILS Office Use Only Residential ~ Indoor ~ Basement ~ Service Only ~ Commedcal 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 A/C Condenser Single Recpt Sub Panel NC Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: Ceiling Fixtures ~[E~[~ HID Fixtures Wall Fixtures I I Smoke Detectors Recessed Fixtures CO Detectors Fluorescent Fixtur~ Pumps Emergency Fixture Time Clocks Exit Fixtures I I TVSS roof mounted photovoltaic system To include, 36 Sun Power panels 1 Sun Power 8000 inverter. (8280 watts) Notes: inspector Signature: Date: April 4 2012 81-Cert Electrical Compliance Form.xls INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING / STRAPPING FIREPLACE & CHIMNEY ] ROUGH PLBG. INSULATION ~FINAL FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT-- .... [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (Fi~L~LTTION REMARKS: _ INSPECTOR ~-~, ~ 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ~ELECTRICAL (FINAL) REMARKS: DATE INSPECTO~ Pacifico Engineering PC PO Box 1448 Sayville, NY 11782 www. paciflcoengineering.com Engineering Consulting Ph: 631-988-0000 Fax: 631-382-8236 engineer@pacificoengineering.com March 26, 2012 Town of Southold Building Department 54375 Route 25, P.O. Box 1179 Southotd, NY 11971 Subject: Solar Energy Installation for John Rumpler IV 965 Leeward Drive Southold, NY 11971 I have reviewed the solar energy system installation at the subject address. The units have been installed in accordance with the manufacturer's installation instructions and the approved construction drawing. I have determined that the installation meets the requirements of the 2010 NYS Building Code, and ASCE7-05. 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 Ralph P~ei~l Engineer FOUNDATION (IST) -~ FOUNDATION (2ND) ~ . ~OU~H m~u~ & ~ ~ PL~G ~ STA~ ~ cODE ~D~ION~ COUNTS ~ , ., ~ 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 (f2o 12 Expiration PERMIT NO. BUILDING PERMlT 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: Phone: {0~1' , Building Inspector APPLICATION FOR BUILDING PERMIT Date ~C'e4~ 2~:, ,20 I ~. INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. 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. ._~~Signature~of applicant or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises ~--~O[xn ~¢Lr'~[~r~ I,~/ (As on the tax roll or latest deed) If applicant is a c, orporation, signature of duly authorized officer (Na~ne ~td title of corporate officer) Builders License No. t._( 02_27 - tq Plumbers License No. Electricians License No. q-~> 8 ~ ~ - ~ ~ Other Trade's License No. 1. Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section -'/e:~ Block -'{ Lot 2 4 Subdivision Filed Map No. Lot State existing use and occupancy of premises and intende.4 use and occ, upancy of proposed construction: a. Existing use and occupancy _~lr~[~__ '4~rrx~l~ b. Intended use and occupancy .~::,(r~[~' --~r~ [~' 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost ~g t~ 2., q ~'--% Fee 5. If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work 11~oO¢ ~(e'ea%-~ c ~}'5'le['l~scription) (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 8. Dimensions of entire new construction: Front Height Number of Stories Rear .Depth 9. Sizeoflot: Front 10. Date of Purchase Rear Depth Name or Former Owner ~ h ¢~ b 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. NamesofOwnerof~remises~Oh~ ~ ~ Address 5o~o~ PhoneNo. Name of Architect ~ ~~ ~ Xddress ~t~& un~Phone No Name ofContractor~r~tc CC~ Address~ Phone No. ~.q~ 15 a. Is this propeay within 100 feet ora tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE ~QUIRED. b. Is this propeffy within 300 feet of a 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__ NO ,/ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY OF '-~ I-~('OI ~_: R/'~ -~t me'x A ~ ~[F-.- '~--~ [~.- being duly sworn, deposes and says that ts)he is the applicant (Name of individual signing contract) above named, tS)He is the ~C)t~c~¢ 10V/ (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 true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this day of '~-e~ct.~'~4 20 ~ ~ Nota~ Public ~ /~'gnature of Applicant To~n Hill ~x 54375 NL~n Road P.O. Box 1179 Sout~old, NY 11971-0959 REQUESTED BY: Company Name: Name: License No.: ~,ddres$: :)hone No.: BUR,D~G D]~ TOWN OF SOUTHOLD ..APPLICATION FOR ELECTRICAL INSPECTION Date: 2. -ZE>- I;2. JOBSITE iNFORMATION: (*Indicates required information) *Name: J cK,,',, t V *Address: *Cross Street: *Phone No.: Pe~it No.: Tax.Map DistriCt: 1000 *BRIEF DESCRIPTION OF WORK (Please Print Clearly) Block: (Please Circle All That Apply) *Is job ready for inspection: *Do.you need a Temp Certificate: Temp Information (if. needed) *Service Size: 1 Phase 3Phase *New Service: Re-connect Addlt!enal Information: YES / NO Rough In Final YES / NO 100 150 200 300 350 .400 Other Underground Number of Meters Change of Service Overhead .,PAYMENT DUE WITH APPLICATION 82~Request for Inspection Form Town of Southold Erosion, Sedimentation & Sta~.i-Water Run-off ASSESSMENT FORM P~OPERTY LOCATIOH: $.C.T.M. ~ 'THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A nq O,.,,.O.A.O.R.,O. OO.','.OI,.LA,, o~m¢! 6Kaon ~ CERTIFIED BY A DESIGN PROFESSIONAl. IN THE STATE OF NEW YORK, SCOPEOFWORK - PROPOSED CONSTRU~'I'ION ITl!flY[# / WORKM$~SMENT' ] Yes No :a. What is ihe Total Ama of lhe Project Parceis? '[ WRHhlsPmjectRetalnAIIStom'~WaterRun-Off (Include Total ~ of all Parcels located within Generated by a Two (2") inch Rainfafl ~ Site? the Scope of Work for Proposed Coustm~ion) ls.s./~cr~) ('rh~s item will Include all mn-off created bi site b. What is the Tote[ Area of Land C~earing clearing and/or construction actJvffies as well as all and/or Ground Disturbance for Ihe proposed Site Improvements and the pa~manent cmatio~ of con$~on activity? impervious surfaces.) (~$.,~,.) 2 Does the 8ita Plan and/or 8uwey Show All Propcee~ PROVIDE BRIF.~ PROJECT DESCRIPTION o'~,~*~.~P~,..~ Drainage Stmc~ms Indicating S~za & Loce~o~? This '1_1 Item shall Include all Proposed Grade Changes and ~ mOUlet-~c~ ~O[,~,,V" SIopasContmlllng$or~aceWaterFlow. 'and sediment control Ixa~ces that will be used th control site erosion and ston~ water discharges. This (~ ~)~ ~'O ~,,~a ~ Ito. m~t be maintained throughout the En~m Construction Period. 4 Wi" this Project Require any Land Riling, Grading or Excevefion where there is a change to the Natural ~ V Exis~g Grade Invo~ng mom than 200 Cu~c YardsL~ -- of Material within any Parcel? ~ Will Ihis ,~ppiication Require Lan(/Dlstud3ing Activities N Encompassing an Area in F. xces~ of Five Thousand (5.000 S.F.) Square Feet of Ground Surface?I~1 G Is there a Natural Water Course Running thmngh the Site? Is this ProJectv/dhin the Tmsteesjufledlction aeaeml DEC SWPPP Reflulremeats: or wffhin One Hundred (100') feet of a Wetland orL~ Stlbr~sslo~ 13{ a ~NPPP Is ~equlred for ell ConslmcBon activities Involvir~g soil Beach? d~tu~ban~one(1)ormcmaczes; includi~gdlstorban~esoflassthaaoneacmlhat ! 7 W311tberebeSiteprepamtlononEx!stingGradeSIopas am p~l of a larger common plan that will ~thl~tely disturb one or more acres ~ ~; which Exceed Fifteen (t5) feet of Verlical Rise to rnch~ng Co~tm(~lon ~dfies Involving s~ dist~ces of less than one (t) ~ where One Hundred (100') of Hoflzontal Distance? Itm DEC ha~ dstem~ln~d ~a~ a SPDE$ pem~t is required ~or s~orm water di~har~es. ~NPPP~ Shall Iaea{ the Minimum R~flul~ments of Ihe 8PDE$ General Permit 8 Will Driveways. parking Areas or other Impewioue COUbrrY OF ........................................... SS '].'hat ! .............................................................................. being duty mom, &poses and says that he/she is the applicam for ?crmit, (Name of Inc~vidua, ~nlng Document) And d~a he/she is ~c .................................. ; ................................................................................................................................. Owner and/or representative of the Owner or Owners, a~d is duly aufl)ofized to perform or lmve performed the said '~ork and to make and file this application; that all statemen~ contained in this applicaiou are true to the be.st of his l~xowledge and belief; and that the work ~411 be performed in the manner set forth in file application filed here~4th. Sworn to before me this; ....................... ................. ) ............ ..... ........ FORM - 06/10 No. 01-CA4894969 Oualified In Suffolk County Commission Expires May 11, 2-0 Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631 ) 765-1802 Fax (63 I) 765-9502 April 5, 2012 BUILDING DEPARTMENT TOWN OF SOUTHOLD John Rumpler IV 965 Leeward Dr Southold, NY 11971 TO WHOM IT MAY CONCERN: The Following Items Are Needed To Complete Your Certificate of Occupancy: Note: Please have an Architect or Engineer certify that the panels were installed according to New York State code. Application for Certificate of Occupancy. (Enclosed) ('~Electrical Underwriters Certificate. (contact your electrician} 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. (Planning # 765-1938) __ Final Fire Inspection from Fire Marshall. __ Final Landmark Preservation approval. BUILDING PERMIT: 37037 - Solar Panels ' t GREENLOGiCR April 25, 2012 The Town of Southold Building Department 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Re: Building Permit No. :37037 John Rumpler IV 965 Leeward Drive, Southold To the Building Inspector: Enclosed please find the Engineer's Certification Letter for John Rumpler's solar electric system, which we installed at 965 Leeward Drive, Southold. Please arrange to send him 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 6:31-771-5152 ext. 117 ~ , !~ .~,,*,~',~,!~:~1~:.,,< ~ u Tel: 877 771 4330 Fax: 877.7714320 SOUTHAMPTON, CORPORATE: 425 Cnmty Rd 39A So~tnampton NY ~1968 CUTCHOGUE: 1070 Depot Lane Cutchogue, NY 11935 MANORVILLE: 40 Woo,~land Avenue Manorvi!le NY L1949 NEW YORK CITY: 241 6th Avenue #3B New York, NY 10014 ROSLYN HEIGHTS: 200 S Service Rd #I08 Rosyln Heights NY 11577 Suffolk County Executive's Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 12/10/2007 SUFFOLK COUNTY DATE ISSUED: Master Electrician License No. 43858-ME This is to certify that ROBERT J SKYPALA GREENLOGIC LLC doing business as having given satisfactory evidence of competency, is hereby licensed as MASTER ELECTRICIAN in accordance with and subject to the provisions of applicable laws, roles and regulations of the County of Suffolk, Slate of New York. Additio lB in es NOT VALID WITHOUT DEPARTMENTAL SEAL AND K CURRENT CONSUMER AFFAIRS ID CARD Di~tor CERTIFICATE OF LIABILITY INSURANCE 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 BEI~/VEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsament. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTNAME: Brookhaven Agency, Inc. Brookhaven Agency, Inc. ,A,~PHONE.^ ;~.(631) 941-4113 I ?~c .o~: (631) 941-4405 P.O. Box 850&D~)RFSS~i:'MAJL brookhaven.agency~verizon.net 150 Main Street PRODUCEn East Setauket NY 11733 INSURERI$~ AFFORDING COVERAGE NAIC INSURED INSURER A: Torus Specialty Insurance Co. Greenlogic, LLC INSURER S: Merchants Preferred Insurance Co. 425 County Road 39A, Suite 101 INaURER C: Commerce & Industry Insurance Co. Southampton, NY 11968 INaURER S: INaURER E: INaURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS ~S 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 CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR e, DDLSUBR POLICY EFF POUCY EXP GENERAL LIABILITY EACH CCCURRENCE } 11000~000 A ~- CObiMERCiALGENERALLiABiLiTY X 50817A121B 01131112 01/31113 pr~.U;~;~DAMAGETORENTEDi;=~.~..~n.~i ~501000 X I CLAIMS-MADE [] OCCUR MEDEXP(Any~le~ersor~I ~X XCU PERSONAL & AOV INJURY ~ 1,000,000 X CONTRACTUAL LIAB GENEP.~^OGREO^TE S2,000,000 B X ANYAUTO CAPI043565 06112111 06112112 (E,~a~..~) $1,000,000 X~ UMBRELLALlAB X~ OCCUR EACHOCCURRENCE $510001000 A EXCESSLIABI Ii I CLAIMS-MADE X 50817AI21A 01/31/12 01/31/13 AGGREGATE $5,000~000 X RETENTION $10,000 $ AND EMPLOYERS' UAalUTY Y I N C ANyPROPRIETOR/PAR~NEPJEXECUTIV~ WC001602420 08111111 08/11/12 E.L. EACHACClDENT ~1,000,000 (MamJato~y In NH) E.L. DISEASE - EA EMPLOYE~ $1,000,000 C INSTALLATION FLOATER CPP4182553 01/30/11 01/20/12 $105,400 DED $1000 CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD BUILDING DEPARTMENT 53095 ROUTE 25 SOUTHOLD, NY 11971 Phone: I Fax: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR~ENTATIVE ~ ~ <NSZ> © 1988-2009 ACORD CORPORATION. All rights reserved, ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (Use street address only) Greenlogic, LLC 425 County Road 39A Suite 101 Southampton, NY 11968 Work Location of Insured (Only required if coverage is specifically limited to certain locations In New York State, I.e., a Wrap-Up Policy) 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holderl TOWN OF SOUTHOLD BUILDING DEPARTMENT 53095 ROUTE 25 SOUTHOLD, NY 11971 I b. Business Telephone Number of Insured 631-771-5152 I c. NYS Unemployment Insurance Employer Registration Number of Insured Id. Federal Employer Identification Number of Insured or Social Security Number 20-3801194 3a. Name of Insurance Carrier New Hampshire Insurance Co 3b. Policy Number of entity listed in box "la" WC001602420 3c. Policy effective period 8/11/2011 to 8/11/2012 3d. The Proprietor, Partners or Executive Officers are X included. (Only check box if all partners/officers included) [] all excluded or certnin partners/officers excluded. This certifies that the insurance carrier indicated above in box "Y' 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/nsurance Carrier will aiso notify the above certificate holder within l 0 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 tMs form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c ", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Peter Zalkofske Approved by: (Date) Title: Authorized Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 631-941-4113 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 Pacifico Engineenng PC PO Box 1448 Sayville, NY 11782 www. pacificoengineering.com Februa~ 17, 2012 Town of Southold Building Department 54375 Route 25, P.O, Box 1179 Southold, NY 11971 Subject: Solar Energy Installation for John Rumpler IV 965 Leeward Drive Southold, NY 11971 OC;i Engineenng Consulting Ph: 631-988-0000 Fax: 631-382-8236 engineer@pacificoengineed ng ,com APPROVED NOTED NOTIFY BUILDING DEPrARTMEN 765-1802 8 ~ TO 4 PM FOP FOLLO~NG INSPECTIONS. 1. FOUNDATION - TWO R: 2UIRED FOR POURED CONCRL rE STRAPPtNG ELECTRiCaL 3 NSULATION 4 FIN;L. CONSTRUCT MUST ~E C')~.~PLET[ ALL CONSTRUCT~UN S~k ~,~' ' REOb ~;[MSNTS OP ' ~E ,,: CLIMACTIC AND Ground Wind Live load, poim GEOGRAPHIC DESIGN Category Snow Lot( Speed, 3 pnet30 per CRITERIA pg sec gust, ASCE 7, pullout Fastener type mph psf load, lb Roof Section A C 20 120 57 1167 5/16" dia screw, 4-1/2" length, 2 per Ralph Pacifico, PE i-_ I ,~L~t~J, i ~ Professional Engineer ~ ~ / ,~4~'~/'7 II ~ /~ · ? YORK STATE '~0 DESIGN OR CONSTRdC?ION I have mvi~ed ~e ~fing structure at the subj~ address. The stm~ure ~n sup~ ~ ~d~onal ~ight of the r~f mount~ system. The uni~ are to ~ ins~ll~ in a~o~a~ ~th the manu~umds ins~lla~on instructions· I have dete~in~ that the ins~llation will m~t the r~uiremen~ of ~e 2010 NYS BuiMing C~e, and ASCE7-05 ~en ins~ll~ in ac~rdan~ wi~ the manu~rer's instru~ons. R~f S~tion A mean r~f height 13 ff pitch 4 ~4 in/12 ELECTRICAL r~f ra~r 2~ wi~ 2x4 puHins INSPECTION REQUIP ~r spacing 16 in DC Refl~t~ r~f rafter s~n 10.2 ff Table R802.5.1 (1) max 13.3 ff The clim~c and load info~n is ~1~: LOGIC' EtlMINAT~N6 THE COS! OF ENERGY J Pactflco Englneedng PC *Always double check measurements GreenLogic, LLC - Approved 8.28kW Layout 36 Sunpower 230w Panel Dirr~nsion = 61.39"x31.42" UniRac Sunframe Array Length = 502.72" John Rumpler Azimuth = 176° Array Height = 188.67" 965 Leeward Drive Pitch = 22° Surface Dimensions =585"x239" Southold, NY Scale 3/16" = 1.0' Magic # = 62.14" ISSUES I SPECIAL INSTRUCTIONS ~yL i.~,,; PROJECT COMPONENT COUNT iX Sunpower 230w A) Attachment type and count: · Attachment Point B) Rail lype and count: UniRac Sunframe . == UniRac Sunframe "~'=": ~ I 2x6' Douglas Fir Ratters 16" On Ralph Paciflco Professional : Center m's L~;~i 0~6182 NJ I~ 249E047443~0 Layout Created By: MVP Data: 11-11-11 LOGIC' Th.se s ra,.rs ~.i, be sist. r~. others will have purlins Pac/flco Er~lineering PC *A~ays double check measurements NY L~I~ NJ ~c 2~7~ GreenLogic, LLC - Approved 8.28kW Layout 36 Sunpower 23~ UniRac Sunframe A~ay He~ht = 188.67" 965 Leeward Drive Pitch = 22" Su~a~ Dimensions =585"x239" //~/~ Southold, NY Sca~ 3/16" = 1.0' Magic ~ = 62.14" ISSUES/SPEC~INSTRUC~ONS ,~o ~/ ,~[,~ ~ (~/, A) Affachment ~ and count: 39 Standoffs . B) Rail ~pe and count: UniRac SunEame ~- UniRac Sunfmme _ ~ 2x6" Douglas Fir Ra~m 16" On Professional Ralph Pac~ Engineer Layout Created By: ~ Date: 11-11-11 LOGIC' ELIMINATING THE COST OF I:NERGY Pac~§ce Engirteer~ng FC 4x9 on SPRS000m *A~ays double check measuremen~ GreenLogi~, LLG - Approv~ 8.28kW Layout ~ Sunpower 23~ Panel Dimension = 61.39"x31.42" UniRac Sunframe Array Length = 502.72" John Rump~r ~imuth = 176° Array Height = 188.67- 965 Leeward Drive Pitch = 22° Su~a~ Dimensions =585"x239" ~O~CT COMPONENT COUNT ~ Sunp~r 23~ ~ " O ' A) A~chment ~pe and count: e Affachmnt Point ./~ Rail ~pe and count: UniRac SunEame - ~ UniRac Sunframe ' ' ~ 2~" Do~l~ Fir Raffem 16" On Fnnin~r R~ph P~co Pr~sional Layout Created By: MVP Date: 11-11-11 LOGIC ELIMINATING THE COST OF ENERGY 2x4 Douglas Fir Purlins to be added from top [---~ ~ plate of bearing wall to roof rafter at 16" on "~i~ - .~ center. ~ "~_ - 8 Rafters to the west of chimney will be ~//~k. ' ~ ' i~.. -. sistered with 2x6 Douglas Fir full span. ,2'/ ~ 45.0' ' -' I Framing: , i 2x8 Douglas Fir ridge. / 2x6 Douglas Fir rafters, spanning 19'11", spaced 16" on q~nter. ~2x6 Douglas Fir ceiling joists spaced 16' on center~ I 2x4 Douglas F r exter or wall. !' L %" Plywood sheathing. Padfico Enginee~ng PC *Always double check measurements GreenLogic, LLC - ~prov~ 8.28kW Layout 36 Sunpower 230w Panel Dimension = 61.39"x31.42" UniRac Sunframe Array Length = 502.72" John Rumpler ~imuth = 176~ ArraYsuda~Height = 188,67"Di~nsions =585"x239" 965 Leewa~ Dr~e Pitch = 22" Southold, NY Scale 3/16"= 1.0' Magic ~ = 62.14" PR~ECT COM~NENT COUNT ~ A) A~chment ~pe and count: ",':, e A~chment Point :.' B) Rail ~pe and count: UniRac Sunframe UniRac Sunfmme ' ~ ~' Dougl~ Fir Ra~m 16" On Ralph Pac~o Professional Engin~r Layo~ Crated By: MVP Date: 11-11-11 LOGIC' ELIMINATING THE COST OF £N£RGY Material List UniRac 4" Drk Standoffs 5/16"x4.5" SS Lag Bolts 5/16" Stainless Steel Washers 39 78 78 Rail Material List GreenLogic, LLC - Approved 8.28 kW_,~.?"'×::..~ Sunpower 230w Layout 36 Sunpower 230w Panel Dimension = 61.39"x3'1.42" UniRac Sunframe Array Length -- · Attachment Point John Rumpler Azimuth = 276° Array Height = -- UniRac Sunframe 965 Leeward Drive Pitch -- 22° Surface Dimensions = "~ I Southold, NY Scale 3116" = 1.0' Magic # = ~ i 2x6" Douglas Fir Rafter 16" On Center PROJECT COMPONENT COUNT ISSUES / SPECIAL INSTRUCTIONS A) Attachment type and count: B) Rail type and count: UniRac Sunframe Layout Created By: MVP Date: 11-11-11 Lot OCT* 19,1972 YOUNG & YOUNG 400 OSTRANDER AVENUE, R~VERHEAD, NEW YORK SURVEY FOR: RICHARD E.ODDON LOT 33," LEEWARD ACRES AT BAY~ AT ECUR [ CO. .ow.o.~ou~,o,~ 1~.~"~~~ SUFFOLK CO., N.Y.