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HomeMy WebLinkAbout37215-ZTown of Southoid Annex P.O. Box 1179 54375 Main Road Southoid, New York 11971 CERTIFICATE OF OCCUPANCY 8/3/2012 No: 35856 Date: 8/3/2012 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: SOLAR PANEL 1065 Leeward Dr, Southold, Sec/Block/Lot: 79.-7-23 Filed Map No. conforms substantially to the Application for Building Permit heretofore 5/10/2012 pursuant to which Building Permit No. 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: Lot No. filed in this officed dated 37215 dated 5/14/2012 roof mounted electric solar panel system as applied for. The certificate is issued to Metz, Michelle (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 37215 7/12/12 ~orizdi Signdture 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 #: 37215 Permission is hereby granted to: Metz, Michelle 1065 Leeward Dr Southold, NY 11971 Date: 5/14/2012 To: construct a roof mounted electric solar panel system as applied for At premises located at: 1065 Leeward Dr, Southold SCTM # 473889 Sec/Block/Lot # 79.-7-23 Pursuant to application dated To expire on 11/13/2013. Fees: 5/10/2012 and approved bythe Building Inspector. SINGLE FAMILY DWELL1NG - ADDITION OR ALTERATION CO - ALTERATION TO DWELLING Total: $50.00 $50.00 $100.00 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 of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. ,_~- '7. I ~- New Construction: Old or Pre-existing Building: Location of Property: IO~o~ L~'c--n,,,.-~ ~'. (cheek one) House No. Street OwnerorOwuersofProp¢ : r ,c tle S. r e42_ Suffolk County Tax Map No 1000, Section "'1 ~ Subdivision Permit No. Date of Permit. Hamlet Block '-~ Filed Map. Applicant: Lot '~ ~ Lot: Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ '~d'~ Underwriters Approval: Final Certificate: (check one) Town Hall Annex 54375 Main Road P.O. Box I 179 Southold, NY 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 Issued To: Michelle Metz Address: 1065 Leeward Dr City: Southold St: NY Zip: 11971 Building Permit #: 37215 Section: 79 Block: 7 Lot: 2~ WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Green Logic LicenseNo: 43858-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 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 [~ HID Fixtures Wall Fixtures I I Smoke Detectors Recessed Fixtures[E~ CO Detectors Fluorescent Fixture ~.~ Pumps Emergency Fixtures~ Time Clocks Exit Fixtures [__~ TVSS PHOTOVOLTAIC SYSTEM to include, 32 SunPower Spr327 panels and 2-SunPower Spr5000 inverters (10,464 watts) Notes: Inspector Signature: Date: July 12 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. [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) q~] ELECTRICAL (FINAL) REMARKS: INSPECTOR DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IHJSULATION [ ] FRAMING / STRAPPING [V~INA~~ ( ) FIREPLACE & CHIMNEY [ ) FIRE SAFETY INSPECTION ( ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ~ [ ] ELECTRICAL (FINAL) REMARKS: /~/-~/~,-'-'~ ~,-- ~'--/~- ~/~-.~ ~,,..,.~r ,~- DATE INSPECTOR Pacifico Engineering PC 700 Lakeland Ave, Suite 2B Bohemia, NY 11716 www. pacificoengineering.com Engineering Consulting Ph: 631-988-0000 Fax: 631-382-8236 engineer@pacificoengineering.com July 18, 2012 Town of Southold Building Department 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Subject: Solar Energy Installation for William Metz 1065 Leeward Drive Southold, NY 11791 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 NY 0 TOWN'OF ~0UTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined ~y~/, 20/.2- Approved Disapproved a/c Expiration sets of PERMIT NO. 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. Tmstees Flood Permit Storm-Water Assessment Form Contact: -~t ~.e~l Coc::~ t c- Mail to: q~ Phone: ¢3[- Building Inspector PLICATION FOR BUILDING PERMIT Date INSTRUCTIONS BLDG DEPF. a. Th~s_ ~al~e/~ufifiq~9~T he. ,-,,~ iletely filled in by typewriter or in ink and submitted to the Building Inspector with 4 dans, 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 applicalat or name, ifa co~pqration) ¢ou.c-bJ 5oueich,'- mi l' , l (Mailin~ address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises ~tc~e:[[e~ ~ ~g-[' -~. (As on the tax roll or latest deed) If applicant ~O~e of duly authorized officer ~ame ~d title of co.orate officer) Builders License No. ~0~. ~ Plmbers License No. Elec~icians License No. ~ ~ - ~ff 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 "lq Block ~ Lot ~ "~ Subdivision Filed Map No. Lot State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Sl~l[~' -~r~tt~ ~,loOo__~[[tr~ b. Intended use and occupancy St~:~[~ cl o ttn9 Nature of work (check which applicable): New Building. Repair Removal Demolition Estimated Cost ~7 5~t -] -"/~- If dwelling, number of dwelling units If garage, number of cars Fee Addition Alteration Other Work Roof ~O.,m{~ ~ 0 ~ (Description) (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 Rear Depth Height Number of Stories 9. 10. Date of Purchase Dimensions of same structure with alterations or additions: Front Rear Depth Height. Number of Stories Dimensions of entire new construction: Front Rear Depth Height Number of Stories Size oflot: Front 6~ ~, al2._~ Rear °~'2'cg- '~+ Depth o°-(o~ .al I ~C+ Name of Former Owner I 1. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO v/ 13. Will lot be re-graded? YES __ NO ~/ Will excess fill be removed from premises? YES NO ~/ 14. Names of Owner of.(premises/~ ~dae~l~, $ tYl~..Address Io~,a l-~=~,d I:,,- NameofArchitect-r. aea,-q~o :F:::v~,~,,-,,,~ Addre; ~:o~t-4~l~t PhoneNo. /o~1.16, t,,~-t~q- ss~Phone No ~'~'1 -q'a'8~ -OOoo Name ofContractorC::i,-~,~Lo~: Uc.~ Addresl ~Phone No. b~,l. 'r'~ I. ~ ~-~. 15 a. ls this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO ,/ *IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MNAoY V REQUIRED.' b. Is this property within 300 feet ora tidal wetland? * YES * 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 t// · IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY OF -~t,l'-~E~S: being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the ~vx'{-v'~c~l ~ v~' (Contractor, AgenL Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~, No(aw Public BARBARA A. CASCIOTTA #otaty Public, State of Ne~Ye~ No. 01-CA4894969 Oltalifled in Suffolk CoualF . ....--- ~mmls~ion Expires May It, ~::9/,,~ ~Jgnature of Applicant Town ~ Annex $4~75 Main Road P.O. Box I Southold, NY 11971-09,59 Telephone (631) 765-180~ rooar rich ' ~ (~) ?C~OQ~ BUII,r~ING DEPAEI'MENT TOWN OF $OUTHOLD APPLICATION FOR ELECTRICAL INSPECTION ' Name: Name: License No.: Date: 5- '7 · l ~_- JOBSITE INFORMATION: (*Indicates required information) *Name: *Address: *Cross Street: *Phone No.: Permit No.: Tax,Map District: 1000 Section: '~ ~ Block: 7 Lot: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) (Please Circle All That Apply) *Is job ready for inspection: *Do you need a Temp Certificate: Temp Information (If needed) *Service Size: 1 Phase 3Phase *New Service: Re-connect Additional Information: Rough In Final 100 150 200 300 350 .400 Other Underground Number of Meters Change of Service Overhead PAYMENT DUE WITH APPLICATION 82;Request for Inspection Form ' 13 Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOr.,ATIOH: S.C.t'JK a: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A !0~) "~ U"7~ ,=~ STORM-WATr:R~GRADINGFORAINAGEANDEROSIONCONTROLPLAN Olemet ~KUon LO~ CERTIFIED BY A DESIGN PROFE881ONAL IN THE ~I'ATE OF NEW YORK, 8COPEOI*WORK - PROPOSEJ) CONSTRU{JrlON ITI~I# / WORKA~$E~SMENT Ye~ No a. Whal is the Total Area of the Project paresis? '1 Will this Project Retain All Storm-Wafer Rur~Off (Include Total Area of all Parcels located wilt, in Generated by a Two (2') Inch Rainfall [m Site? the Scope of Werk fix Proposed CoflelnJCtion) V' b. What is the Total Area of Land Clearing (S.F./.~=~) (This item will Include all ion-off cmatad by sito clearing andJor constr~ction a~viites as we]l as all and/er Ground Disturbance for the proposed ~ Site Improvements and the permanent creatimt of conabuct~on activibj? impervious surfaces.) 2 Does the Sita Plan andlor Survey Show Att Pmpocad PROVIDE BRIEF PROJECT DESCI~t'I'ION r~,,~.~,~gKu~) Dminnge S(nictores Indicating Size & Lecatkxt?This Item shall include all Proposed Grade Changes and I oc,C Sispe. ,of,ngSu,a .WetsrFi . e[ec~[~.- ~ *'.i~-~-J~~ 3 DoastbeSiteP[anand/orSuryeydascllbethaeroslon / r~ and sediment control practices ~hat wtil be used to control site erosion and stom~ water discharges. ~is item must be maintained throughout the Entire C~astruc~on Period. 4 Wilt this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural r'~ Exist~g Grade Invch~ing more than 200 Cubic Yards--L~ of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area In Excas~ of Five ~cand (5,000 S.F.) Square Feat of Ground Surface? -- 6 IsthereaNaturalWatarCourseRunrdngthroughthe r-] site? is this Project within the Trustees jur~sd/ction General DEC SWPPP Requirements: Or w~thin One Hundred (100') feet of a Wetland or~ -- Su~mlsdion o~ a SWPPp Is requi~ed f~' si] Con~tmclion aclJvltlee InvoNIng soil Bead:t? dbturbannes of one (1) or more ac~es; including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes are pa~t of a larger common plan II~t will ultimately disturb one or mere ac~e~ o/lend; which Exceed Fif~nen (15) feet of V~'itcel Rise to r-'] 5"1'ATE O1; NEW YORK, ~,~ ~ .~_.~_~ i k/ COUNTY O~' ,....,.......'~"~-...,..,....' ' ~...'..,.....' "-'. ....... SS ................................................................................ r~e ng duly sworn, deposes and says that he/she is the applic-aat for Permit, And that he/she is the ~-' ~lrTl ~'~"~ ~ i~ ~ ............................................ 1'~7~5~i~'~;:X~'~ij~'~'r'.'~i ............................................................... Owner an~or repre*entafive of the O~a~aer or O'~a~er~, and i~s duly authorized to perfoma or have performed the said work and to make and file this application; that ail ~tateme~ coutah~ed in thi~ applicatio~ are tree to the be.st of his h~owledge and beli~; and that the w~rk will be performed in the mm~ner ~et forth in the applica~on filed herewith. Sworn to before me this; .................. , .... :. ' ....... .......................... FORM - 06/10 Notary Public, StEle of New No. 01-CA4894969 Qualified in Suffolk Couni~ Commission ExpireE May 11, . GREENLOGIC" EN ERQY May 9, 2012 Town of 5outhold Building Department Town Hall 53095 Route 25 Southold, NY 11971 Dear Building Inspector: Please find attached a building permit application on behalf of Michelle Metz who has engaged us to install a roof-mounted (flat to the roof) solar photovoltaic (PV) electric system for her home at 1065 Leeward Drive, Southold. In connection with this application, please find attached: · Building Permit application · AStorm Water Assessment Run-off Form · Certificate of Occupancy Application · 2Surveysofthe Premises · Four Engineer's Reports (2 originals and 2 copies) · FourVisio Diagrams of the proposed system · Four One Line Electrical Diagrams · Two spec. sheets ofthe solar panels (SunPower SPR-327WHT) · Two Spec. sheets of the inverter (5unPower 5PR5000m) · 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 $100 ($50 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 Tel: 8777714330 Fax: 877.77].4320 SOUTHAMPTON/CORPORATE: 425 County Rd. 39A Southar/~pton, NY 11968 CUTCHOGUE: 1070 Depot Lane Cutchogue, NY 11935 MANORVILLE: 40 Woodlarld Avenue Manorville NY ]1949 NEW YORK CITY: 241 6th Avenue #3B New York, NY 10014 ROSLYN HEIGHTS: 2005 Service Rd, #108 Rosyln Heights NY 115// Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631 ) 765-1802 Fax (631) 765-9502 July 20, 2012 Michelle Metz 1065 Leeward Dr Southold, NY 11971 BUILDING DEPARTMENT TOWN OF SOUTI-IOLD TO WHOM IT MAY CONCERN: The Following Items Are Needed To Complete Your Certificate of Occupancy: **Note: An Architec~L~ee~As required to certify the fastening of the Solar Panels to the roof structure. __ Application for Certificate of Occupancy. (Enclosed) __ Electrical Underwriters Certificate. (contact your electrician) __ A fee of $50.00. __ Final Health Department Approval. __ Plumbers Solder Certificate. (All permits involving plumbing after 4/1/84) __ Trustees Certificate of Compliance. (Town Trustees # 765-1892) __ Final Planning Board Approval. (Planning # 765-1938) __ Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. BUILDING PERMIT: 37215 - Solar Panels C GREENLOGIC® ENERGY July 25, 2012 The Town of Southold Building Department 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Re: Building Permit No. 372].5 Michelle Metz 1065 Leeward Drive, Southold, NY BIi)G D£P[. ?OWN Ol SOUFHO[D To the Building Inspector: Enclosed please find the Engineer's Certification Letter and the Town of Southold Certificate of Compliance for Michelle Metz's solar electric system, which we installed at 1065 Leeward Drive, Southold. Please arrange to send her the Certificate of Occupancy and close out the building permit. Please let me know if you have any questions about the installation. Sincerely, Alex McNear Senior Account Manager GreenLogic LLC 63].-771-5152 ext. 107 Tel: 877771.4330 Fax: 877.771 4320 SOUTHAMPTON/CORPORATE: 425 County Rd 39A ,Sruth~r/xston NY 1}968 CUTCHOGUE: 1070 Depot Lane Cutchogue, NY 11935 MANORVILLE: 40 Woodland Avenue Marx/rvillr NY 1}949 NEW YORK CITY: 241 6th Avenue #3B New York, NY 10014 ROSLYN HEIGHTS: 20DS Service Rd. #108 Rosyln Heighls NY }}577 J iSUFFOLK CO. HEALTH DEPT. APPROVAL t STATEME.NT OF INTENT 'THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF TH/ SUFFOLK CO. DEPT, OF HEALTH SERVICES. APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: SUFFOLK CO. TAX MAP DESIGNATION: ' DIST. SECT BL~K PCL owNERS A~RE$S: DEED: L. ~ A P. 'TEST HOL~ STA~ '- - F,, 5E AL Suffolk County Executive's Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 12/10/2007 SUFFOLK COUNTY Master Electrician License DATE ISSUED: This is to certify that No. 43858-ME 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 &Suffolk, State of New York. Additional Bu~iness¢~ NOT VALID WITHOUT DEPARTMENTAL SEAL AND K CURRENT CONSUMER AFFAIRS ID CARD Director Suffolk County Executive's Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 5/25/2006 No. SUFFOLK COUNTY Home Improvement Contractor License This is to certify that MARC A CLEJAN 40227-H doing business as GREEN LOGIC LLC having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws, rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME NOT VALID WITIIOuT DEPARTMENTAL SEAL AND A CURRENT CONSUIVJtER AFl'AIRS ID CARD IMPROVEMENT CONTRACTOR, in the County of Suffolk. Additional Businesses Director STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (Use street address only) Greenlogic, LLC 425 County Road 39A Suite 101 Southampton, NY 11968 Work Location of Insured (Only requiredifcoverageisspecifically limited to certain locations in New Yorl~ 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 lc. 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 certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures thc business referenced above in box "la" for workers' compeusation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Rem 3A on the IN FORMATION PAGE of the workers' corn pensation insurance policy}. The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box "2". The Insurance Carrier will also notif~ the above certificate holder within I0 days IF a policy is canceled due to nonp~, ment of premiums or within 30 days IF Ihere 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 Certi~cate 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 conlinucs 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 Zulkofske Approved by: August 15, 2011 (S~gnatirrc) (Date) Title: Authorized A~ent 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) wv~v.wcb.state.ny.us CERTIFICATE OF LIABILITY INSURANCE I I 0111912012 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 BE'I~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 endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTNAM;~ Brookhaven A~lenc¥, Inc. Brookhaven Agency, Inc.I~.IcPHONE.. ;...(631) 941-4113 I r~A~. No~. (631). 941-4405 P,O, BOX 550 ADDRI=s~:E'MAIL brookhaven.agency~.verizon.net 150 Main Street PRODUCER East Setauket NY 11733 INSURER(E} AFFORDING COVERAGE NAIC # INSURED INSURER A: Torus Spec a ty Insurance Co. Greenlogic, EEC INSURER a: Merchants Preferred Insurance Co. 425 County Road 39A, Suite 101 INSURERC: Commerce & ndustr~ Insurance Co. Southampton, NY 11968 ~NSURER D: 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, NOTVVITHSTANDING 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. NEE t~DDL SUBR POLICY EFF POLICY EXP O~ENERAL MABIUTY EACH OCCURRENCE $1,000,000 A X COMMERCIALGENERALLIABILITY X 50817A121B 01131112 01131113 DAMAGE TO RENTED X I CLAIMS'MADE [] OCCUR UEDEXP(An¥oneperson) $5,000 X XCU PERSONAL & ADV INJURY $1,000,000 X CONTRACTUAL LIAB GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/DP AGO $ 2,000,000 IPOLCY~ iFFT ~ILoc (Ea accidenl) B x ANYAUTO CAPI043565 06112111 06112/12 $~,uuu,uuu ~X NON~)WNED AUTOS $ $ ~ UMBRELLA L[AB X~ OCCUR EACH OCCURRENCE $5,000,000 A EXCESSUAB ~ I CLAIMS-MADE X 50817A121A 01/31/12 01/31/13 AGGREGATE $5,000,000 __ DEDUCTIELE $ X RETENTION $101000 C ANY PROPRIETOR/PARTNERIEXECUTIV WC001602420 08/11111 08111/12 E.L. EACH ACCIDENT S ~,000,000 (Mandato~ In NH) E.L. DISEASE -EA EMPLOYEE $ f ~000~000 D~SCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $1,000,000 C INSTALLATION FLOATER CPP4182553 01130111 01120112 $105,400 DED $1000 CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD BUILDING DEPARTMENT 53095 ROUTE 25 $OUTHOLD, NY 1197'1 Phone: Fax: SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ~ ~ <NSZ> © '1988-2009 ACORD CORPORATION. All dghte reservec ACORD 25 (2009~09) The ACORD name and logo are registered marks of ACORD 2 Strings of 8 SunPower 327 W panels, Each string 2616 watts Array total of 5232 Watts All panels to be grounded as per NEC code SUNPOVVER SPR 5000 INVERTER 2, 30 AMP two pole DC switches from panels to inverter 240 VAC ~ 240 VAC from inverter to a 30 Amp switch near utility meter Pacifico Engineering PC 700 Lakeland Ave, Suite 2B Bohemia, NY 11716 www. pacificoengineering corn April 27, 2012 Town of Southoid Building Department 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Subject: Solar Energy Installation for William Metz 1065 Leeward Drive Southold, NY 11791 Engineering Consulting Ph: 631-988-0000 Fax: 631-382-8236 engineer@pacificoengineering.com APPROVED AS NOTED FEE ~-BYE~ NOTIFY BUILDING D 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION- ~ REQUIRED FOR POURED CONCRETE 2 ROUGH - FRYING, PLUMBING, STRAPPING, ELECTRICAL & CAULKING 3. INSU~TION 4 FINAL.CONSTRUCTION & E~CTRICAL MUST BE C~E~ F~ C.O. ALL CONSTR~ ~ ~ ~ REQUIREMENTS OF ~E CODES OF NEW YORK STATE. ~T RE~NSI~ FOR DESIGN OR CO~ E~RS. I have reviewed the roofing structure at the subject address. The structure can support the additional weight of the roof mounted system. The units are to be installed in accordance with the manufacturer's installation instructions. I have determined that the installation will meet the requirements of the 2010 NYS Building Code, and ASCET-05 when installed in accordance with the manufacturer's instructions. Roof Section A B mean roof height 12 ft 24 ft pitch 5 3/4 in/12 5 3/4 in/12 roof rafter 2x8 2x8 rafter spacing 16 in DC 16 in DC Reflected roof rafter span 7.8 ff 5.4 ff Table R802.5.1(1) max 16.8 ft 16.8 ft The climactic and load information is below: CLIMACTIC AND GEOGRAPHIC DESIGN CRITERIA Roof Section A B Category C Ground Snow Load Pg 20 Wind Live load, Speed, 3 pnet30 per sec gust, ASCE 7, mph psf 120 56 56 point pullout load, lb 1146 1146 Fastenertype 5/16" dia screw, 4-1/2" length, 2 per 5/16" dia screw, 4-1/2" length, 2 per LOGIC ELIMINATING THE COST OF ENERGY DRAWING NUMBER: Pacifico Engineelng PC I OF 9 SURFACE I LAYOUT *Always double check measurements ~,~ Pa~f~co, Pmfessienal Er~ine~' GreenLogic, LLC - Approved 10.46kW Layout 32 Sunpower 327w Panel Dimension =61.39"x41.18 UniRac Sunframe Array Length = 329.44" William Metz Azimuth = 195° Array Height = 126.53"_~ Surface 1065 Leeward Drive Pitch = 26° Dimensions =36'5"x14'4" Southold, NY Scale 3/16" = 1.0' Magic # =62.14" .S..E$, S C ,NSTRUCT,ONS PROJECT COMPONENT COUNT.~/~ Sunpower 327w . A) Attachment type and count: 24 Standoffs. · Attachment Point ' '' ' ~ ~ r B) Rail type and count: UniRac Sunframe UniRac Sunframe j ~ 2x8' Douglas Fir Rafters 16" On Ralph Pacifico Professional Engineer Layout Created By: MVP Date: 4-10-12 LOGIC E£1M;NATING THE COST OF ENERGY DRAWING NUMBER: Pacifico Engineering PC 2 OF 9 ~URFACE I A3q'ACHMENTS *Always double check measurements .~ Lic ~182 NJ Lic 24GE04744300 GreenLogic, LLC - Approved 10.46kW Layout 32 Sunpower 327w Panel Dimension =61.39"x41.18" · - . · UniRac Sunframe Array Length = 329.44" William Metz Azimuth = 195° Array Height = 126.53" 1065 Leeward Drive Pitch = 26° Surface Dimensions =36'5"x14'4" Southold, NY Scale 3/16" = 1.0' Magic # =62.14" r: PROJECT COUNT ~ Sunpower 327w A~.., Attachment type and count: 24 Standoffs. · Attachment Point UniRac B) Rail type and count: UniRac Sunframe Sunframe ~~ 2x8" Douglas Fir Rafters 16" OnRalph Pacifico Professional Layout Created By: MVP Date: 4-10-12 LOGIC' THE COST OF ENERGY XXX xxxxx 2x8 on SPR5000m DRAWING NUMBER: Pacifico Engbeeling PC 3 OF 9 ~.~.~ SURFACE 1 STRINGING *Always double check measurements GreenLogic, LLC - Approved 10.46kW ,-y ,~a"ou* 32 o p°un-ower 327w Panel Dimension =61.39"x41.18 UniRac Sunffame Array Length = 329.~" ~lliam Me~ ~imuth = 195° Array Height = 126.53" 1065 Leeward Drive Pitch = 26° Suda~ Dimensions =36'5"x14'4" Southold, NY Scale 3/16" = 1.0' Magic~ =62.14" ~, ~F'~'-.~/ I -..~ PROJECT COMPONENT COUNT ~ Sun~wer 327w AEachment and count: A) ~pe · A~achment Point B) Rail ~pe and count: UniRac Sunframe UniRac Sunframe ~ ~ 2x8" Douglas Fir Rafters 16" On Fnnineer Ralph Pacifi~ P~essional Layout Creat~ By: MVP Date: 4-1~12 LOG lC® L ELIMINATING THE COST OF ENERGY DRAWING NUMBER: Pacifico Engineering PC 4 OF 9 SURFACE 2 LAYOUT *Always double check measurements GreenLogic. LLC - Approved 10.46kW Layout 32 Sunpower 327w Panel Dimension =61.39"x41.18 UniRac Sunframe Array Length = 370.62" ,. ~-/~ , ~/~. ~?.,, ~lliam Me~ ~imuth = 110~ Array Height = 126.53" 1065 Leeward Drive Pitch = 26° Sudace Dimensions =36'5"x14'4" PROJECT COM~NENT COUNT ~ Sunp~er 327w ' A) A~achment ~pe and count: 25 Standoffs. ~ ' ~ · A~achment Point B) Rail ~pe and count: UniRac Sunframe ~ UniRac Sunfmme ~ ~ 2x8" Douglas Fir Raflem 16" On Ralph Pacifico Professional Engineer Layout CreWed By: M~ Date: 4-10-12 LOGIC ELIMINATING THE COST OF ENERGY Pacifico Engineering PC DRAWING NUMBER: POl~x 1448, sa?vie, NY 11782 5 OF 9 ;URFACE 2 ATTACHMENTS *Always double check measurements GreenLogic, LLC - Approved 10.46kW ,, Layout 32 Sunpower 327w Panel Dimension =61.39 x41.18 UniRac Sunframe Array Length = 370.62" Metz ~imuth = 110° Array Height = 126.53" ~lliam Suda~ Dimensions 1065 Leeward Drive Pitch = 26° Southold, NY Scale 3/16" = 1.0' Magic ~ =62.14" I~UES I SPECI~ INSTRUCTIONS A) A~achment type and count: 25 Standoffs. · A~achment Point ~-~ B) Rail ~pe and count: UniRac Sunframe ~ UniRac Sunframe  ~ 2x8" Douglas Fir Rafters 16" On Pa~fi~ Professional Ralph Engineer Layout Created By: MVP Date: 4-10-12 2x8 on SPR5000m DRAWING NUMBER: Pacifico Engineenng PC 6 OF 9 SURFACE 2 STRINGING *Always double check measurements NY L[c~6182 NJ L~ 24GE~7~ GreenLogic, LLC - Approved 10.46kW Layout 32 Sunpower 327w Panel Dimension =61.39"x41.18 UniRac Sunfmme Array Length: 370.62" William Me~ ~imuth = 110° Array Height = 126.53" 1065 Leeward Drive Pitch = 26° Surface Dimensions =36'5"x14'4 .... Southold, NY Scale 3/16" = 1.0' Magic ~ =62.14" ISSUES / SPECIAL INSTRUCTI~S PROJECT COMPONENT COUNT ~[ ' Sunpo~r 327w '~.~ A) A~achment ~pe and count: ~'~ oc,~s~";~:~ · A~achment Point ' B) Rail ~pe and count: UniRac Sunframe ~ UniRac Sunfmme ~ ~ 2x8" Douglas Fir Rafters 16" On Ralph Pacifico Professional Engineer Layout Created By: ~P Date: 4-10-12 LOGIC® JOB MATERIAL LIST Material List UniRac 4" Drk Standoffs S/:16"x4.5" SS Lag Bolts 5/:16" Stainless Steel Washers Oatey :12920 Flashin§ Rail Material List Qty. Pacifico Engineering PC DRAWING NUMBER: Po Box 1448, Sa/vile, NY 11782 7 OF 9 MATERIAL LIST *Always double check measurements. NY LJC (~182 NJ Lic 2.4C~E047443~ GreenLogic, LLC - Approved 10.46kW Layout !32 Sunpower 327w Panel Dimension = 61.39"x41.18" · i UniRac Sunframe Array Length = William Metz Azimuth = -° Array Height = : ~:::~-'/.~' 1065 Leeward Drive Pitch = -° Surface Dimensions = = -' PRO~EcT$OUthoId'coMPONENTNY COUNT S~le 3/16" = 1.0' Magic ~ Sunpower 327w ~ ~, A) A~achment ~pe and count: · A~chment Point ~ UniRac SunEame S) Rail ~pe and count: UniRac Sun~ame I I 2x8" Douglas Fir Rafters 16" On Center Ralph Pacifico Professional Engineer Layo~ CreWed By: MVP Date: 4-10-12 NVS ~I~NJ Li~249E~7~ LOGIC / EL M~NATING THE COST OF ENERGY South Surface Framing: 2x10 Douglas Fir ddge. 2x8 Douglas Fir rafters spaced 16" on center, spanning 19'8". 2x4 Douglas Fir collar ties spaced 48" on center, 3' down from ddge. 2x8 Douglas Fir ceiling joists spaced 16" on center. 2x4 Douglas Fir extedor wall, ~ Plywood sheathing. East Surface Framing: 2xl 0 Douglas Fir ddge. 2x8 Douglas Fir rafters spaced 16" on center, spanning 14'4". 2x4 Douglas Fir collar ties spaced 48" on center, 3' down from ridge. 2x6 Douglas Fir ceiling joists spaced 16" on center. 2x4 Douglas Fir exterior wall. %" Plywood sheathing. Pacifico Engineering PC DRAWING NUMBER: ~0 Box 1448, Sayville, NY 11782 8 OF 9 ROOF FRAMING *Always double check measurements GreenLogic, LLC - Approved 10.46kW Panel Dimension =61.39"x41.18 --~-. Layout 32 Sunpower 327w UniRac Sunframe Array Length = William Me~ ~imuth = o Array Height = 1065 Leeward Drive Pitch= Su,a~Magic,=Dimensions Southold, NY Scale 3/16" = 1.0' PROJECT COMPONENT COUNT ~ Sunpower 327w ~; "~ 7/' ¢~ / ~',? A) A~achment ~pe and count: · A~achment Point B) Rail ~pe and count: UniRac Sunframe ~ UniRac Sunframe ~ ~ 2x8" Douglas Fir Raflem 16" On Pac~co Professional Ralph Engin~r Center NYS g~ Layout Created By: MVP Date: 4-1~12 LOGIC 18" Walkway 2 SMA Inverters located ~ adjacent to main electrical adjacent to Electric Meter 18" Walkway Pacilico Engineering DRAWING NUMBER: Po ~ox 9 OF 9 ~-~o~ ~,~.,~,,.~.~ FAST TRACK PERMIT *Always double check measurements GreenLogic, LLC - Approved 10.46kW Layout 32 Sunpower 327w Panel Dimension = 61.39"x41.18 .... UniRac Sunframe Array Length = William Metz Azimuth = Array Height = 1065 Leeward Drive Pitch = ° Surface Dimensions = ~] Southold, NY Scale 1/16" = 1.0' Magic # = PROJECT COMPONENT COUNT~ Sunpower 327w :' A) Number of Roof Layers: 1 B) Height above Roof Sudace: 4" ~ AEachment Point ~ UniRac Sunfmme C) Mate~als Used: Eco-Fasten, UniRac, Sunpower D) Added Roof Load of PV System: 3.5 PSF ~ ~ ~8~ Douglas Fir Rafters 16" On Ralph Pac~co Professional Layout Created By: MVP Date: 4-10-12