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HomeMy WebLinkAbout36819-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY 5/24/2012 No: 35712 Date: 5/24/2012 THIS CERTIFIES that the building Location of Property: SCTM#: 473889 Subdivision: SOLAR PANEL 40 Oriole Dr, Southold, Sec/Block/Lot: 55.-6-15.15 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore fded in this officed dated 11/4/2011 pursuant to which Building Permit No. 36819 dated 11/17/2011 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: Roof mounted electric Solar Panel System on an existing one family dwelling as applied for. The certificate is issued to Roslak, Maureen & Roslak, John (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 36819 5/23/12 ed ~gl~atJl(e 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 #: 36819 Date: 11/17/2011 Permission is hereby granted to: Roslak, Maureen & Roslak, John 40 Oriole Dr Southold, NY 11971 To: Roof mounted electric Solar Panel System as applied for At premises located at: 40 Oriole Dr, Southold SCTM # 473889 Sec/Block/Lot # 55.-6-15.15 Pursuant to application dated To expire on 511812013. Fees: 11/4/2011 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 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: For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual naturat or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (8-9 form). 3. Approval of electrical installation from Board 0fFire Underwriters. 4. 8w. orn 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 amhitect 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, streats, building and unusual natural or topographic features. 2. A properly ¢~mpleted app}ication 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, Swimmi~ig 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 Certificat~ of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Location of Property: House No. Owner or Owners of Property: -~O~ Suffolk Co}~nty Tax Map No 1000, Section Subdivision Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~0, OD Old or Pre-existing Building: Date of Permit. Date. (check one) Street Hamlet Filed Map. Lot: Applier: Undemrriters Approval: L_LC Final Certificate: / (check one) ~f~pplicant Signature Town Hall Annex 54375 Main Road P.O. Box 1179 South(fid, NY 11971 0959 Telephone (631) 765-1802 Fax (631) 765 9502 roqer, dchert~town.southold.ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: John Roslak Address: 40 Oriole Drive City: Southold St: NY Zip: 11971 Building Permit #: 36819 Section: 55 Block: 6 Lot: 15.15 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Greenlogic LicenseNo: 43858-me SITE DETAILS Office Use Only Residential [~ Ind°°r l~ Basement ~] Service Only t~ Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 3 ph Hot Water GFCI Recpt Main Panel NC Condenser Single Recpt Sub Panel NC Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: Ceiling Fixtures r~l~[~ HID Fixtures Wall Fixtures II Smoke Detectors Recessed Fixtures II co Detectors Fluorescent Fixtur( ~J~ Pumps Emergency Fixture Time Clocks Exit Fixtures ~ TVSS roof mounted PHOTOVOLTAIC SYSTEM, to include 45 Sun Power 230 modules 1-SPR-4000, and 1 SPR-6000 inverters,all required combiner boxes and disconnects and "signs" Notes: Inspector Signature: Date: May 23 2012 81-Cert Electrical Compliance Form.xls TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ]~JI. ATION [/1~FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REM,~RKS: DATE INSPECTOR~ TOWN OF SOUTHOLD765.1802BUILDING DEPT. INSPECTION [ ] FOUNDATION ¶ST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FUUREmSTANTCONS1'RUCllm~ ] ROUGH PLBG. ] INSULATION ] FINAL ] FIRE SAi-,'; '( INSPECTION ] fiRE RESISTANT PENETRATION REMARKS: 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 Janua~ 24,2012 Town of Southold Building Department 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Subject: Solar Energy Installation for John Roslak 40 Oriole 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 R Engineer 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 BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Boaypproval Survey Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Mail to~_~_ (_.~ Phone: ~o~ l "-1~'l l ' ~"l--.,~2 l t Building Inspector 'LICATION FOR BUILDING PERMIT Date ~(~4-OIo~' ~l ,2011 INSTRUCTIONS ...... ~T be coT etely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate Ip ot plaice 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 I2 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 ora Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name, if a corporation) (Maifing addri:ss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. q-O 2 2, '-/ Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which propost~d work will be done: House Number Street Hamlet County Tax Map No. 1000 Section ~ ~ Block Subdivision Filed Map No. Lot / ,~, 1% Lot Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM l~O ~ ~ [~, ~ STO~-WAT~ G~ING~ D~INAGE AND EROSION CO~ROL a. Whalis~eTo~l~eaof~ePr0]~P~? I ~]l~sPmj~Re~tn~-WaterRu~ b. What ~ the To~l Ar~ ~ Land Cleadng is.p, ;~) ~ls ~em ~11 ~ude all m~ff cma~ by s~ ~ns~ion ac~vi~? impewious suda~s.) (s.F.,~,) 2 ~s~eSite Pianand/or Su~yS~w~lPro~s~ PRO~E BR~ PRO~ D~C~ON {~r~ ~.a ~.~..~ Dmin~e S~ms Ind~ S~e & L~fi~? ~ls Item shall include all P~d Grade Chang~ and [n~all ~ mo~ So~ S[opes~llJngSu~a~WaterFl~. and s~im~t ~1 prances that will be us~ ~nt~l ~te e~on and sto~ ~t~ disch~es, Item mu~ be ~in~ined ~ughout ~e En~ G~s~ Pedod. Ex.va,on where ~em is a change to ~e ~1 Exls~g G~de In~Mng ~m ~an 2~ Cu~c Ya~s of Material ~in any ~? S ~1 this ~p]i~fio~ Requ[~ Land Di~u~ng A~i~ En~mpa~ing an ~a In Ex.ss of Rve ~nd (5.~ S.F,) Square Feet of G~nd Su~a~? 6 Is ~ a Natural Water Cou~ Running ~mugh SEe? Is ~is ~je~ ~n ~e T~s juH~[~ e~eml DEC S~PP R~ulre~: or ~in O~ Hundred (1~') feet of a We~ ~Pp~s ~all meet ~ Minimum Requlr~n~ of t~ SP~ ~1 ~E 8 Will DHve~ys, P~ing ~s or o~er Im~s ................................................................................. ~eing duly swoni, de.scs ~d sad ~ hdsh¢ is ~e apphc~[ for P~ ~d ~at he/she is ~e O~er ~or represenadve of ~e Oa~er or O~)ers, m~d b d~y auflm~cd to pc~o~ or have pcffo~ m&c m~d ~lc ~is application; ~at ~1 s~temen~ con~ed in ~is applic~on ~e ~e [o die best of his ~owle~e a~d ~d; ~d fl~at ~e work ~11 be ~o~ed in ~e m~ncr act ford~ in d~c apph~doa fii~ he~4d~. Sworn to before me FORM - 06/10 No. 01-CA4894969 Qualified in Suffolk Count~ E3/.~_~_ Commission ExpirEs May 11, Town Hall Annex 5~75 Yah Road P.O. Box 1179 Sou~old, NY 11971-0959 T~lcphone (631) 765-1802 m-er fiche ' ~ (6~t) 7c:4-95~ H · rt~o~,[own.sou[no~(L ny. us BUU .r~INC, DEPARTMENT TOWN OF $OUTHOLD APPL~CAT[ON FOP, ELECTRICAl. INSPECTION REQUESTED BY: Name: Name: No.: Date: I 0 - 2~I- J J *Name: *Address: *Cross Street: *Phone No.: Permit No.: TaxMap District: JOBSITE INFORMATION: (*Indicates required information) 1000 Section: S ~:) Block: ~, Lot: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) I J~ ~ ~n ~ ~ ~ e ~~ (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 Additienal Information: YES/(~ Rough In Final 100 150 200 300 350 .400 Other Underground Number of Meters Change of Service Overhead PAYMENT DUE WITH APPLICATION l l q Td l 82=Request for Inspection Form October 31, 2011 Town of Southold Building Department Town Hall 53095 Route 25 Southold, NY 11971 Dear Building Inspector: Please find attached a building permit application on behalf of John Roslak who has engaged us to install a roof-mounted (flat to the roof) solar photovoltaic (PV) electric system for his home at 40 Oriole Drive, Southold. In connection with this application, please find attached: · A building Permit application · AStorm Water Assessment Run-off Form · A Certificate of Occupancy Application · 2 Surveys of Premises · Four Engineer's Reports (2 originals and 2 copies) · FourVisio Diagrams ofthe proposed system · Two spec. sheets of the solar panels (SunPower SPR-230WHT) · Two Spec. sheets of the inverter (SunPower SPR4OOOm and SPR6OOOm) · GreenLogic Suffolk County Home Improvement License · GreenLogic Certificate of Liability Insurance · GreenLogic Certificate of Worker's Compensation Insurance Coverage · Installation Manager's Master Electrician's License Check for $250 ($200 building permit/S50 CO) · Application for Electrical Inspection with a check for $100 Please let us know if you need anything else in connection with this application. Yours truly, Barbara Casciotta Account Manager GreenLogic LLC 631-771-5152 ext. 117 SOUTHAMPTON/CORPORATE: d2$ County Rd 39A SodLha,~:)ton NY 1]968 ¥(}1:877 77I 4330 Fax: 877.7714320 CUTCHOGUE: 1070 Depot Lane Cutchogue, NY 11935 MANORVILLE: 40 Woodland Ave~iue Manorvilk NY ]1949 NEW YORK CITY: 241 6th Avenue #3B New York, NY 10014 ROSLYN HEIGHTS: 200 S Si!rvi(e Rd #108 R{~syln Heights, NY 1L577 Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631 ) 765-1802 Fax (631 ) 765 9502 Janua~27 2012 BUILDING DEPARTMENT TOWN OFSOUTHOLD John & Maureen Roslak 40 Oriole Dr Southold, NY 11971 TO WHOM IT MAY CONCERN: X-En_.~eer to certify the faste~ing/e'f t~'lar Panels to the needs ' ' Lcza'd. The Following Item(s) Are Needed To Complete Your Certificate of Occupancy: Application for Certificate of Occupancy. (Enclosed) L-~.~ Electrical Underwriters Certificate. A fee of $50.00 __ Final Health Department Approval. __ Plumbers Solder Certificate. (All permits involving plumbing after 4/1184) __ Trustees Certificate of Compliance. (Town Trustees #765-1892) __ Final Planning Board Approval. __ Final Fire Inspection from Fire Marshall. - Bob Fisher __ Final Landmark Preservation approval. BUILDING PERMIT: 36819- Solar Panels GREEN OGIC January 27, 2012 The Town of Southold Building Department 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Re: Building Permit No. 368192 John Roslak 40 Oriole Drive, Southold, NY To the Building Inspector: Enclosed please find the ng~neer s Cerhflcat~on Letter for John Roslak's solar electric system, which we installed at 40 Oriole 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 631-771-5152 ext. 117 Tel: 877.7714330 Fax: 8777714320 SOUTHAMPTON/CORPORATE: 4:25 'S:~,mty Rd 39A S),,t/I /p,ol , NY 11968 CUTCHOGUE: 1070 Depot Lane Cutchogue, NY ]]935 MANORVILLE: 40 Woodland Av(~u~ Manor,'ille NY 11949 NEW YORK CITY: 241 6th Avenue #3B New York, NY 10014 ROSLYN HEIGHTS: 200 S Sorvice Rd. ~i108 Rosyln Heights NY lib// CERTIFICATE OF LIABILITY INSURANCED vY) 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 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 endorsement. A statement on this cer[ificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Brookhaven Agency, Inc. PRODUCER NAME: !A~c .. F.?(631) 941-4113 Brookhaven Agency, Inc. PHONE I ~F~. Uol: (631) 941-4405 E-MAIL brookhaven.agency~verizon.net P.O. BOX 850 ADORESS: PRODUCER 150 Main Street C.~TnUFR ~o ~: East Seta uket NY 11733 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Torus Specialty Insurance Co. Greenlogic, LLC tNSLIRER 8: Merchants Preferred Ins. Co. 425 County Road 39A, Suite 101 ~NSURERC: Utica National Southampton, NY 11968 INSURER D: INSURER E: INSURER F: COVERAGES 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 CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ~DDL~UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN.~R WVD POLICY NUMBER IMMIDD/YYYYiIMM/DD/YYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COUMERC~^LGENERALUAB~L~T¥ X 50817A110B 01/31/11 01/31/12 DAMAGETORENTED $50,000 I CLAIMS MADE r~ occur MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 ~ CONTRACTUAL LIAB GENERALAGGREGATE ~2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2~000,000 -- (Ea accident) $1,000,000 B X~ ANYAUTO X CAPI043565 06/12/201( 06/12/201 BODILY INJURY (Per person) X~ HIRED AUTOS (Per accident) X~ UMBRELLALIAB ~ OCCUR EACH OCCURRENCE $2,000,000 A EXCESSLIAB~ CLAIMSMADE X 50817Al10A 01/31/11 01/31/12 AGGREGATE $2,000,000 $ X RETENTION~ 10,000 i C Installation Floater CPP 4182553 1/30/10 1/30/11 $105,400 Ded $1,000 CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD BUILDING DEPARTMENT 53095 ROUTE 25 SOUTHOLD, NY 11971 Phone; Fax: ACORD 25 (2009/09) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. © 1088-2000 ACORD CORPORATION. All rights m~orved. The ACORB name and lobe are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name & Address of Insured (Use street address only) Greenlogic, LLC 425 County Road 39A Suite 101 Southampton, NY 11968 Work Location of Insu red (Only requiredifcoverageis specifically limited to certain locations in New Yor,~ State, l.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 lb. Business Telephone Number of Insured 631-771-5152 1 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 "I a' 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 certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this fo tm, New York (NY) must be listed under Item 3A on the I N FORMATION 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 also notify lhe above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this CertiJicate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its' licensed agent, or until the policy expiration date listed in box "3c", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, liccnse 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 Zulkofske Approved by: (Prim name of authorized representative or licensed agent of insurance carrier) (Signatffre) -- (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 il. C- 105.2 (9-07) www.wcb.state.ny.us Suffolk County Executive's Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 12/10/2007 No. 43858-ME SUFFOLK COUNTY This is to certify that Master Electrician License ROBERT J SKYPALA GREENLOGIC LLC doing business as having given satisfactory evidence of competency, is hereby licensed as MASTER ELECTKICIAN in accordance with and subject to the provisions of applicable laws, roles and regulafious of the County of Stfffolk, State of New York. Additional Businesses NOT VALID WITHOUT DEPARTMENTAL SEAL AND A' CURRENT CONSUMER AFFAIRS "ID CARD Director OCCUPANCY OR USE I$ UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY Pacifico Engineering PC PO Box 1448 Sayville, NY 11782 www. pacificoengineering.com October 28,2011 Engineering Consulting Ph: 631-988-0000 Fax: 631-382-8236 engineer~pacificoengineering.com Town of Southold Building Department 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Subject: Solar Energy Installation for John Roslak 40 Oriole Drive Southold, NY 11971 OCCUPANu APPROVED AS NOTED NOTIFY BUILDING DEPARTMEN' 765-1802 8 AM TO 4 PM FOR FOLLOWING INSPECTIONS 1. FOUNDATION - TWO OE~JUIRED FOR POURED CONE~b :- 2 ROUGH- FR;MtNG ~LU',~E STPApplNG ELE~'RIC~L &,'.Aj -iiN!~ USEIS UNLAWFUL 3 ,NS.LAT,ON WITHOUT CERTIF!CA- OF OCCUPANCY ,~, CONSTPiJCTION SHALL M~:-THE REQUIREMENTS OF THE CCD,~ ~ Of k,;. YORK STATE NOT RESPONSIBLE FOR I have reviewed the roofing structure at the subject address. The struct~~~t of the roof mounted system. The uni~ are to ~ ins~ll~ in a~rdan~ with the manufacture¢s ins~llation instructions. I have determin~ that the ins~llation will meet the requiremen~ of the 2010 NYS Building C~e, and ASCET-05 when installed in a~rdance with the manufacturer's instructions. Roof S~tion A mean roof height 18" ELECTRICAL pitch ~2 in/12 roof rafter 2~ INSPECTION REGUIRED rafter spacing 16 in OC Refitted roof rafter span 4.9 ff Table R802.5.1(1) max 13.3 ff The climac~c and I~d information is below: CLI~OTIC A~D Ground Wind Live load, point 6EO6BPHIC DESIGH Cat~o~ Snow Load, Sp~, 3 pnet~ ~r CRITERIA pg ~c gust, ASCE 7. pullout Fastener type mph psf load, lb Roof Section A C 20 120 33 676 5116" alia screw, 4-1/2" length Ralph Pacifico, PE /'~' ~/'~,,~/¢ Professional Engineer LOGIC 7' Chimney Off of roof. *Always double check measurements Pac~fico E~i~ng PC J j Po aex '~4,~. se~le, m' 'n ~ J GreenLogic, LLC - Approved Layout John Roslak 40 Oriole Drive Southold, NY PROJECT COMPONENT COUNT 10.35 kW 45 Sunpower 230w UniRac Sunframe Azimuth = 160° P~tch = 45° Scale 3/16" = 1.0' A) Attachment type and count: 45 Standoffs. B) Rail type and count: UniRac Sunframe Panel Dimension = 61.39"x31.42" Array Length =471.3" Army Height = 188.67" Surface Dimensions =495"x237.5" Magic # = 62.14" ISSUES / SPECIAL INSTRUCTIONS Sunpower 230w Attachment Point UniRac Sunframe 2x4"/2x6' Douglas Fir Truss 16" On Center Ralph Pacifico Professional Engineer .Ys L~ 0~182 NJ L~ 24~047~ Layout Created By: MVP Date: 10-11-11 LOGIC 7' Chimney Off of roof. *Always double check measurements GreenLogic, LLC - Approved Layout John Roslak 40 Oriole Drive Southold, NY 10.35 kW 45 Sunpower 230w UniRac Sunframe Azimuth = 160° Pitch = 45° Scale 3/16" = 1.0' PROJECT COMPONENT COUNT Panel Dimension = 61.39"x31.42" Array Length =471.3" Array Height = 188.67" Surface Dimensions =495"x237.5" Magic # = 62.14" iSSUES / SPECIAL INSTRUCTIONS A) Attachment type and count: 45 Standoffs. B) Rail type and count: UniRac Sunframe ~<1 Sur~power 230w · Attachment Point · UniRac Sunframe I 2x4"/2x6" Douglas Fir Truss 16" ~ On Center Ralph Pacifico Professional Engineer NYS L~ 066182 NJ L~c~ 249E04744300 Layout Created By: MVP Date: 10-1 1-1 1 LOGIC 7' Chimney Off of roof. 2x9 on SPR4000m 3x9 on SPR6000m GreenLogic, LLC - Approved Layout John Roslak 40 Oriole Drive Southold, NY PROJECT COMPONENT COUNT *Always double check measurements A) Attachment type and count: 10.35 kW 45 Sunpower 230w UniRac Sunframe Azimuth = 160° Pitch = 45° Scale 3/16" = 1.0' B) Rail type and count: UniRac Sunframe Panel Dimension = 61.39"x31.42" Array Length =471.3" Array Height = 188.67" Surface Dimensions =495"x237.5" Magic # = 62.14" ISSUES / SPECIAL INSTRUCTIONS ~ ~. Sunpower 230w · Attachment Point UniRac Sunframe I t 2x4"/2x6" Douglas Fir Truss 16" On Center J P m::tf~o Englrmering I:~ J PO Box 'm44~, 6J,p~Je. NY il 17~2 J Ralph Pacifico Professional Engineer Layout Created By: MVP Date: 10-11-11 LOGIC Framing: Double 2x8 Douglas Fir ridge. 2x4 Douglas Fir rafter spanning 5' from ridge, nailed to a 2x4 Douglas fir plate. Then a 2x6 Douglas Fir plate nailed to a 2x6 Douglas Fir rafter spanning 6' to the 2x4 Douglas Fir knee wall, with a total span 14'9", spaced 16" on center. 2x8 Douglas Fir ceiling joists spaced 16" on center. 2x4 Douglas Fir exterior wall. %" Plywood sheathing. Pacifico Engbme~ng PC *Always double check measurements GreenLogic, LLC -Approved 10.35 kW Layout 45 Sunpower 230w Panel Dimension = 61.39"x31.42" UniRac Sunframe Array Length =471.3" John Roslak ~.imuth = 160° Array Height = 188.67" 40 Oriole Drive Pitch = 45° Surface Dimensions =495"x237.5" Southold, NY Scale 3/16" = 1.0' Magic # = 62.14" ISSUES / SPECIAL INS'I~UCTIONS PROJECT COMPONENT COUNT Ii~:-~ ,! Sunpower 230w A) Attachment htpe and count: e Attachment Point B) Rail type and count: UniRac Sunframe OniRac Sunframe [I I 2x4"/2x6" Douglas Fir Truss 16" Ralph Pacifico Professional E ngineer On Center Layout Created By: MVP Date: 10-11-11 3 Strings of 9 SunPower 230 W panels, Each string 2070 watts Array total of 6210 Watts All panels to be grounded as per NEC code 2, 30 AMP two pole DC switches from panels to inverter SUNPOWER SPR 6000 INVERTER 240 VAC ~ 240 VAC from inverter to a 30 Amp switch near utility meter 2 Strings of 9 SunPower 230 W panels, Each string 2070 watts Array total of 4140 Watts II II I I II All panels to be grounded as per NEC code 2, 30 AMP two pole DC switches from panels to inverter SUNPOWER SPR 4000 INVERTER 240 VAC 240 VAC from inverter to a 30 Amp switch near utility meter BENEFffS Highest Efficiency SunPowerTM Solar Panels are the most efficient phof0voltaie panels on the market today. More Power Our panels produce more power in the same amount of space---up to 50% more than conventional designs and 100% more than thin film solar panels. Reduced !ns~!!ation ~t More p°wer P~r P~ne~:me~wer panels per install This SaV~ both time and money. Reliable and Robust Design Proven materials, tempered front glass, and a sturdy anOdiZed frame allow panel to operate reii~blY in multiple mounting configurationsl The SunPowerTM 230 Solar Panel provides today's highest efficiency and performance. Utilizing 72 all back-contact solar cells, the SunPower 230 delivers a total panel conversion efficiency of 18.5%. The panel's reduced voltage-temperature coefficient and exceptional Iow-light performance attributes provide outstanding energy delivery per peak power watt. 20%; 15% ' 10% 5% 0% SunPower's High Efficiency Advantage 18% 19% 10% Thin Film 14% Conventional SunPower SunPower E18 Series E19 Series SPR-230E-WHT-D EleclHcal Data Peak Power 1+5/~%1 Prnax 230 W Rated Voltage Vmpp 40.,5 V Rated Current Impp 5.68 A Open Circuit Voltage Voc 48.2 V Short Circuit Current Isc 6.0,5 A Maximum System Voltage UI. 600 V Temperature Coefficients Power (P) -0.38% / K Voltage {Vc~) -132.5mV / K Current (Isc) 3.SMA / K NOCT 45° C +/-2° C Series Fuse Rating 20 A Solar Cells Front Glass Junction Box Output Cables Frame Weight Mechanical Data 72 SunPower all-k~ck conlact monocrystalline High transmission tempered glass IP~55 rated with 3 bypass diodes Dimensions: 32 x 155 x 128 (mm} lO00mm length cables / MultiContacl (MC4) connectors Anodized aluminum allay type 6063 Iblack) 33.1 lbs. (15.0 kg) I-V Curve 7,0 6,0 4,0 ~:~'' ..................... 2,0 0 10 20 30 40 50 Voltage {V) 6O Current/vollage chara¢leristlcs wilh dependence on ir radiance and module temperature. Tested Operating Conditions Temperature -40° F to +185° F (40° C to + 85° CI Max load 113 psf 55Okg/m2 (5400 Pa) front - e.g. snow; 50 psf 245kg/m~ (2400 Pa) front and back - e.g. wind Impact Resistance Hail 1 in (25 mm) at 52mph (23 m/s) Warranties Certifications Warranties and Certifications 25 year limited power warranty 10 year limited product warranty Tested to UL 1703. Class C Fire Rating Dimensions sunpowercorp.com BENEFITS Reliable and Robust Design Proven track record for durability and bngevity High Efficiency Weighted CEC efficiency over 95% and peak efficiency over 96% Reduced Installation Cost Integrated DC disconnect with fuses lowers material costs and labor requirements Altractive Aesthetics Integrated disconnect eliminates need for visible conduits to inverter Ideal Output Ideal for residential applications SunPowerTM 3000m and 4000m Inverters offer exceptional reliability and superior performance. Innovative design and advanced testing are combined to create a durable inverter for optimal system performance over the long term. Both models are backed by a standard 1 O-year warranty. SPR-3OOOm and SPR-4OOOm sunpowercorp.com 1-800-SUNPOWER SPR-3000m SPR.-4000m AC Power 3500W@ 208 V/ 3000W 4000W@ 240 V AC Maximum Oulput Current (@ 208V, 2-~OV) AC Nominal Vohage / Range 183 - 229 V@ 208 VAC 183 - 229 V @ 208 VAC 211-264V@ 240VAC 211-264V@240VAC r~J ~'l='A-uen-'//'~ yaan-e 60 Hz / 59 3 Hz 60 Hz / 59.3 Hz - AC 60.5 Hz 605 Hz Power Faclor i i CEC Weighted Efficiency 95 0 % @ 208 v 95 5 To @ 208 v Recommended Army Input Power (DC @ STC) DC Input Voltage Range 375OW 4375W@ 208 V 500OW@ 240 V 200-800 V @ 208V 250-60OV@208VAC 200 5COV @ 240V 250-6(X)V @ 240VAC IOO 95 250 Vdt 75 SPRm Efficiency Curves % of Rated Oulput Power Mechanical Data Shipping Dimensions W x H x D (inches) 23.5' x 18.5' x 16.0' Unit Dimensions W x H x D (inches) 17.8' x 13.8' x 9.3' Inverter Weight 88 Jbs Shipping Weight 94 lbs Forced Air / Sealed Cooling Electronlc$ Enclosure Enclosure NEMA 3R Ambient Temperature Range -13 ~o +113 ~F IO0% Peak Power Tracking Voltage DC Max. Input Current DC Voltage Ripple No. of Fused String Inputs Power Consumption: Standby / Nighttime Fused DC Disconnect Electrical Grounding 175 - 400 V @ 208 VAC 220 - 480 V @ 208 VAX; 203 - 4C~ V @ 240 VAC 250 - 480 V @ 240 VAC Warranty A 18 A Certifications < 5% 4 Standard; Complies w NEC Standards Warranty and Certifications About SunPower Founded in 1985, SunPower Corp. (Nasdaq: SPWRA, SPWRB) designs, manufactures and delivers the planet's most powerful solar technology broadly available today. Residential, business, government and utilily customers rely on the company's experience and proven results to maximize return on investment. BENEFITS Reliable and Robust Design Proven track record for durability and longevity Effective Power Range Enables most systems to use a single inverter rather than muttiple units Commercial Use Flexible AC voltage output and, scalable building blocks create an easy solution for commercial applications High Efficiency Weighted CEC efficiency of at least 95.5% and peak efficiency of at least 96.5% Reduced Installation Cost ~tegrated DC disconnect with fuses owers material costs and labor requirements Attractive Aesthetics ntegrated disconnect eliminates need for visible conduits to inverter SunPower SPR-5OOOm, -600Om, -7000m and -8000m inverters offer superior reliability and performance and can be easily integrated into residential or commercial installations. All models are backed by a 1 O-year warranty. SPR-5OOOm, -6000m, -7000m and ~m sunpowercorp.com 1-800-SUNPOWER String Inverters SPR-5000m AC Nominal Power 5000 W AC Max Output Current (@ 208V, 24 A, 21A, 18A 29A, 25A, 22A 240V, 277V): AC Nominal 183 - 229 V @ 208 V 183 - 229 V @ 208 V Voltage / Range 211 - 264 V @ 240 V 211 - 264 V @ 240 V 244-305V @ 277V 244 305 V @277V AC Freq / Range 60 Hz/59.3 Hz- 60 Hz/59.3 Hz- 60.5 Hz 60.5 Hz Power Factor (Nominal) 0.99 099 Peak In~erler 96.8% 97,0% Efficiency CEC Weighled 955% @ 208 V 955% @ 208 V Recommended (Module @ STC) Peak Power No. of Fused 4 4 Power Consumption: <7W/0.1 W Operafion/Nighltime SPRm EFFICIENCY CURVES '0 85 ~_- ~O 75 Electrical Data SPR-6OOOm SPR-7000m SPR-8000m 7680W @ 240 V 6000 W 7000 W 8000 W @ 277 V Mechanical Data SPR-5000m, SPR-6000m, SPR-7000m and SPR-8000m 34A, 29A, 25A N/A, 32A, 29A 183-229 V @ 208V N/A@ 208 V 211-264V@240V 211 264V@240V 244- 305V@277V 244-305V@277V 60 Hz/59.3 Hz - 60 Hz/59.3 Hz - 60.5 Hz 60.5 Hz 099 099 97.1% 96,5% N/A @ 208 V 960% @ 240 V 96.0% @ 277 V Shipping Dimensians 23.5" x 31.0' x 16.0' W x H x D ({nches) Unit Dimensions 18,4' x 24.1 ' x 9.5" W x H x D (inches) 141 lbs for SPR-5OOOm, InYertar Weight -6000m and -70OOm / 148 lbs tar SPR-8000m 148 ~bs far SPR-5000m, Shipping Weight -6000m and -7000m /152 lbs for SPR-8OO0m 8750W 250- 600 V 250- 480 V 30A 4% 10000W 300- 600 V 300- 480 V 30A 4% Forced Air / Sealed Cooling Electronics Enclosure Enclosure NEMA 3R Wall Mouni Mounting Bracket Standard Ambient -13 1o +113 °F Temperature Range 4 4 ~o~ 4o~ so% ~ ?o~ eo~ ,~o~ loo~ % of rated output power About SunPower Warranty and Certifications Warranty 10 year limited warranty Compliance: IEEE-929, IEEE-1547, UL 1741, Certifications UL 1998, FCC Part 15 A&B Founded in 1985 SunPower Corp. Nasdaq: SPWRA, SPWRB designs manufactures ,and delivers the planel s most powerful sola technology. Residential, business, government and uti ity customers re y on the company s experience and proven resu ts to max rn ze return or, investment.