HomeMy WebLinkAbout38036-Z Town of Southold Annex 9/21/2013
A P.O. Box 1179
fir 54375 Main Road
tF Southold, New York 11971
,a1~
CERTIFICATE OF OCCUPANCY
No: 36521 Date: 9/21 /2013
THIS CERTIFIES that the building SOLAR PANEL
Location of Property: 995 Bray Ave, Laurel,
SCTM 473889 Sec/Block/I.ot: 126.-8-1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed iu this ofilced dated
5/14/2013 pursuant to which Building Permit No. 38036 dated 5/21/2013
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 solar panels on an existin¢ sin¢le family dwellin¢ as applied for.
The certificate is issued to Smith, Robert & Smith, Barbara
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 38036 8/19/13
PLUMBERS CERTIFICATION DATED
ut otiza Signat e
TOWN OF SOUTHOLD
A BUILDING DEPARTMENT
~ TOWN CLERK'S OFFICE
~fi~ SOUTHOLD, NY
,n
°'~~='~;r.~°'~~
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 38036 Date: 5/21/2013
Permission is hereby granted to:
Smith, Robert & Smith, Barbara
995 Bray Ave
Laurel, NY 11948
TO' Installation of roof-mounted solar panels on an existing single family dwelling as
applied for.
At premises located at:
995 Bray Ave, Laurel
SCTM #_473889 _
Sec/Block/Lot # 126: 8-1
Pursuant to application dated 5/14/2013 and approved by the Building Inspector.
To expire on 11/20/2014.
Fees:
SOLAR PANELS $50.00
CO -ALTERATION TO DWELLING $50.00
Total: $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 ar 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 similaz buildings and installations, a certificate
of Code Compliance from azchitect 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 completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy -New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00,
Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy -Residential $15.00, Commercial $15.00
Date.
New Construction: °Ol~d or Pre-existing Building: (check one)
Location of Property: ~CJJr J?^(xV ~r=Nu~
House No. Street Hamlet
Owner or Owners of Property: ~GtY' I7Gt~(A ~ l~
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision Filed Map. Lot:
Permit No. ~~iJ 3 (p Date of Permit. Applicant:
Health Dept. Approval ff ''Underwriters Approval:
Planning Boazd Approval:
Request for: Temporary Certificate Final Certificate: ~ (check one)
Fee Submitted: $ ~ 00
A licant Signature
gFIFF01,~
Town Hall Annex C4~ Telephone (631) 765-1802
54375 Main Road ~ ? Fax (631) 765-9502
P.O. Box 1179 ~ •
Southold, NY 11971-0959 'y~jo! ~ ,lsdr' rooer.richertla~town.southold.nv.us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Smith
Address: 995 Bray Ave City: Laurel St: NY Zip: 11948
Building Permit 38036 Section: 126 Block: 8 Lot: 1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: SUnatlOn SOlar Systems License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement X Service Only
Commerical Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceiling Fixures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches Twisl Lock Exit Fixtures TVSS
Other Equipment: $,120 watt roof mounted photovoltaic system to include 22 solar panels 1-solarec
SE5000, and 1-Solaredge se3000 inverters
Notes:
Inspector Signature: g~`~~~~,~ Date: Aug 19 2013
Electrical Cert'rficale.bs
_ _
hO~,F,OF SW/l~6
a/ TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
e~ 1 NSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING /STRAPPING [ ]FINAL
[ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH) ~ ELECTRICAL (FINAL)
REMARKS:
DATE l3 INSPECTOR Y-`
3 3 ~ ~ ~0~.~,OF SM/l~G
TOWN OF SOUTNOLD BUILDING DEPT.
765.1802
1 NSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] INSU ON
[ ]FRAMING /STRAPPING [ INAL
[ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH) [ ]ELECTRICAL (FINAL)
REMARKS:
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DATE ~ INSPECTOR
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' TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following, before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 4 sets of Building Plare Yes
TEL: (631) 76518112 Planning Board approval
FAX: (631) 7659502 /18.x?, survey
SoutholdTowa.NorthFork.net PERMFF NO. .7 Check Yes
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined ~ t-~ 20~ Storm-Water Assessment FOrm
_ Conbct:
Approved d 12 ~ , 20 13 Mail [o: SUNatkm Solar Systems, Inc.
Disapproved arc 121]MOnWak Hwy., Oakdale, NV 11]89
Phone:631-750-9454
Expim[ion ZV , 20~
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date May 10, , 2013
INSTRUCTIONS
a. This application MUST be completely filled m by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scale. Fee according [o schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or
azeas, and waterways.
c. The work wvered by this application may not be commenced before issuance of Building Permit
d. Upon approval of this applicatioq the Building Inspector wdl issue a Building Petmit to the applicant. Such a permit
shall be kept on the premises available for inspection throughout the work.
e. No budding 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 expve if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within ] 8 months fmm such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim, the Building Inspector may authorize, m 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 Budding Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk Comty, New York, and other applicable Laws, Ordinances or
Regulations, for the wnstmction 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
General Contractor
Name of owner of premises Barbara Smith, 995 Bray Avenue, Laurel, NY 11948
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
Scott Maskin, President SUNation Solar Systems
(Name and title of corporate officer)
Builders License No. 44104-H
Plumbers License No. N/A
Electricians License No.33412-ME
Other Trade's License No. N/A
1. Location of land on which proposed work will be done:
995 Bray Avenue Laurel
House Number Street / Hamlet
County Tax Map No. 1000 Section ~ a y Block ~ Lot
Subdivision Filed Map No. Lot
,
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Residential
b. Intended use and occupancy Residential
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work Solar Panels flat on roof
(Description)
4. Estimated Cost $35,690 Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner
I ] . Zone or use district in which premises are situated
12. Does proposed constmction violate any zoning law, ordinance or regulation? YES_ NO~?
13. Will lot be re-graded? YES_ NO~WiII excess fill be removed from premises? YES_ NO??
14. Names of Owner of premises Barba2 smin Address 9s5 Bray ave., Laurei, rlv phone No. ~t-ZSe-4a4t
Name of Architect wiiiam c. Fisher Address Po eox 30, oakdaie t t7elphone No satass~ata
Name of ContractorsUNation soar systems, inc Address [217 Montauk Hwy, Oaicdphone No. sat-~~~
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY~REQUIRED.
b. Is this property within 300 feet of a tidal wetland? *YES NO
* IF YES, D.E.C. PERMITS MAYBE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
l7. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
18. Are [here any covenants and restrictions with respect to this property? *YES NO~
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk ~
Scott Maskin, SUNation Solar being daly sworn, deposes and says [fret (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the Contractor
(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 [hat the work will be
performed m the manner set forth in the application filed therewith.
Sworn W before me this
_~~Z~
Notary Public Signa of Applicant
i
hO~~OF Styjryo{o
Town Hall Annex ~ # Telephone (63&~U
7~6,555pp.1~~802
54375 Main Road ~ ,~,~yc (631) 7UIrW10.
P.O. Box 1179 roS]er.nChe OYVft.&0 nV.UB
Southold, MY l 1971-0959 .1
~MINi'1,'~
BUILDING DEPARTMENT'
TOWN OP l30UTH0][.D
APPLICATION FOR ELECTRICAL INSPECTION ~
REQUESTED BY: C--sla~F-- Date: ~ j
Company Name:
Name: ~ s
License No.:
Address:
~2t'1 O ~ ~
Phone No.: _ -~j
JOBSITE INFORMATION: {*Indicates required information)
*Name: S F
*Address: S ~ r`a ~ >~vpvn.~e..~ l-•~.U,r.O,f . N ~f ~ ~q I!
*Cross Street:
*Phone No.: ~~_~GI~-~p~l
Permit No.: `1S
Tax Map District: 1000 Section: BIOCk: Lot: y
'~T ~ I
*BRIEF DESCRIPTION OF WORK (Please Print Clearly) S I
InSd-atln~4S~p~T~, 12-r~ I.t,a# i~V SuS-}gym T Sola,rcds¢. 5~-soooq~-uS
invthd-t1' !_-~SnlarEd~- S~3c~n~~US ltiuel-rP.r-
(Please Circle All That Applyj
*Is job ready for inspection: Y ~ Rough In Final
*Do you need a Temp Certificate: ES ! NO
Temp Information (If eeded) `
*SeMce Size: 1 Phas 3Phase 100 150 ~ 300 350 .400 Other
*New Service: e-connecC Underground Number of Meters Change of Servi Overhead
Additions! Information: PAYMENT DUE WITH APPLICATION
Pd S~a3-13
p~ c
b2=Request far Inspection Form ~ ~ ~ f `
Fisher Engineering Services, P.C.
PO Box 30 • Oakdale • New York 11769 _
Phone: (631)563-9028 ~ 1 !
August 15, 2013 ~ ~
Building Department
_ ~~~D
l~~i SEP 62013 i~
Subject: Engineer Statement for Solar Roof Installation ~l'
Smith Residence: 99 Bray Avenue
Laurel, New York 11948 Permit: 38036
I have verified the adequacy and structural integrity of the existing roof rafters for
mounting the solar collector panels and their installation satisfies the structural roof
framing design load requirements of the Residential Code of New York State.
I have reviewed and certify that the manufacturer's guidelines and equipment for the
photovoltaic equipment for the above residence meet the requirements for wind and snow
load and that the roof structure is adequate to carry the new loads imposed by the System.
For the installation of the solar mounting, the rails are securely anchored to the rafers
utilizing lag screws that have been designed for wind speed criteria of 120 mph Exposure
C and snow ground criteria of 20 psf. Wind loads will exceed seismic loads. Other
climate and geo design criteria are not applicable to this solar installation.
The solar collector system and the mounting assemblies comply with the applicable
sections of the Residential Code of New York State- "Solar Systems" and loading
requirements ofroof-mounted collectors.
This system has been installed properly at the above referenced residence. The
installation is in accordance with the minimum requirements certified by this letter.
I hope that this letter serves and meets with the approval of the Building Departrnent.
~\~~\PM G, F~ tG
Sincerely, 1 ~ sy~
`r'~ A :
William Fisher, P.E. ~A o>a 6Z~
Licensed Professional Engineer c^^^ 659 ~d
,..nw~ Q4
Architectural Design • Residential • Light Commercial
Additions • Extensions • Conversions
Constmction Estimates /Oversight • Expediting • Inspections
~o~~pF SO~lyolo
Town Hall Anncx yy Telephone (631) 765-1802
54375 Main Road ~ T Fax (631)765-9502
P.O. Box 1179 G ~
Southold, NY 11971-0959 ~ ~
~~~OOUNT'1 N~
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
September 13, 2013
Robert & Barbara Smith
995 Bray Ave
Laurel NY 11948
TO WHOM IT MAY CONCERN:
The Following Items (if Checked) Are Needed To Complete Your Certificate of Occupancy:
i/ 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. (rows trustees a ass-iasz)
Final Planning Board Approval. (Planning # 7s5-1938)
Final Fire Inspection from Fire Marshall.
Final Landmark Preservation approval.
Final inspection by Building Dept
BUILDING PERMIT: 38036 -Solar Panels
STATE OF NEW YORK
WORKER'S COMPENSATION BOARD
CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW
PART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier
1a. Legal Name and Address of Insured (Use street address only) 1b. Business Telephone Number of Insured
SUNATION SOLAR SYSTEMS INC 631-737-9404
ie. NVS Unemployment Insuranze Employer Registration
1217 MONTAUK HIGHWAY Number of Insured
OAKDALE, NY 11769
1d. Federal Employer Identification Number of Insured
or Social Security Number
753118816
2. Name and Address of the Entity requesting Proof of Coverage 3a. Name of Inwrance Carrier
(Entity being listed as the Certificate Holder) The First Rehabilitation Life Insurance
TOWn Of SOUthOld Company of America
3b. Policy Number of Entity listed in boz "1a":
54375 Route 25 DBL243442
Southold, NY 11971 x. Policy effective period:
11/28/2012 ~ 11/27/2013
4. Policy covers:
a. ~ All of the employer's employees eligible under the New York Disability Benefits Law
b. ~ Only the following class or classes of the employer's employees:
Under penalty of perjury, I certify that I am an authorized represerttative or I icensed agent of the irtwrance carrier referenced
above and that the named inwred has NVS Disability Benefits insurance coverage as described ab/ove.
Date Signed 5/13/2013 By
(Signature of insurance artier's authorizetl represenmiw or NYS Licensetl Imurance Agent of shat inwrana artier)
Telephone Number 516-829-8100 Title Chief Executive Officer
IMPORTANT: If box'H" is checked, antl Ihis form is signetl by me insurance carrier's authorized representative or NVS Licensed Insurance Agent
of shat arrier, Mis ceniFare is COMPLETE. Mail it direnly to sla ardficere holdw.
If box'Ib" is clacked, mis certifiate is NOT COMPLETE far tla purposes of Settion 220, Subd. a of the Disability Betafiu Law.
It muss be mailed for cemplelion to the Worker's Compensation Board, DB Plam Accepnna Unit, 20 Park Street, Albany, NV 12207.
PART 2. To be completed by NYS Worker's Compensation Board (Only if box "ab" of Part 1 has been checked)
State of New York
Worker's Compensation Board
Aaortling to information maintainetl by the NYS Worker's Compensation Boartl, the above-named employer has complietl with the NVS
Disability Benefits Law wim respan to all of hisBter employces.
Date Signed By
(Signature of NYS Worker's Compensation Bard Employee)
Telephone Number Title
Please Note: Only Insurance cerriers licensed to write NVS Disability Benefits insurance policies and NVS Licensed Insurartce Agents of
those irtwrence carriers are authorized to issue Form DB•120.1. Insurance brokers are NOT suthorizetl to issue this form.
DB-120.1 (6-06)
• «
Additional Instructions for Form DB-120.1
By signing [his form, the insurance carrier identified in Box "3" on this form is certifying that it is insuring the
business referenced in Box "1 a" for disability benefits under the New York State Disability Benefits Law. The
insurance carrier or its licensed agent will send this Certificate of Insurance to the entity listed as [he certificate
holder in Box "2". This certificate is valid for the earlier of one year after this form is approved by the insurance
carrier or its licensed agent, or the policy expiration date listed in Box "3e".
Please Note: Upon [he cancellation of [he disability benefits policy indicated on [his form, iF [he business continues [o be named
on a permit, license or contract issued by a certificate holder, the business must provide [ha[ certificate holder with a new
Certificate of NYS Disability Benefits Coverage or other authorized proof [ha[ the business is complying with the mandatory
coverage requirements of the New York State Disability Benefits Law.
DISABILITY BENEFITS LAW
Section 220. Subd. 8
(a) The head of state or municipal department, board, commission or office authorized or required by
law to issue any permit for or in connection with any work involving the employment of employees in
employment as defined in this article, and notwithstanding any general or special statute requiring or
authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an
insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits
for all employees has been secured as provided by this article. Nothing herein, however, shall be
construed as creating any liability on the part of such state or municipal department, board, commission
or office to pay any disability benefits to any such employee if so employed.
(b) The head of state or municipal department, board, commission, or office authorized or required by
law to enter into any contract for or in connection with any work involving the employment of employees
in employment as defined in this article, and notwithstanding any general or special statute requiring or
authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an
insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for
all employees has been secured as provided by this article.
DB-120.1 (5-06) Reverse
_New York State Insurance Fund
Workers' Compensadott & Disabilit}~ Benefrls Specialists Since 1914
199 CHURCH STREET, NEW VORK, N.Y. 10007-1100
Phone: (888)997-3863
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
753118816
SUNATION ROOFING SERVICES INC
1217 MONTAUK HIGHWAY
OAKDALE NY tt769
r
POLICYHOLDER CERTIFICATE HOLDER i
SUNATION SOLAR SYSTEMS INC TOWN OF SOUTHOLD
1217 MONTAUK HIGHWAY 54375 ROUTE 25
OAKDALE NY 11769 SOUTHOLD NY 11971
I
_ _ _
POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE ~ DATE
J Z 2160 670.2 _ 775751 09/O6I2071 TO Ot/0U2015 ~ 11/26!2012.1
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY N0.2160 670.2 UNTIL 01/01/2015, COVERING 7HE ENTIRE OBLIGATION OF THIS POLICYHOLDER
FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATIOPJ LAW WITH RESPECT TO ALL
OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS
OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY.
IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 01(01/2015 1N SUCH MANNER AS TO AFFECT THIS CERTIFICATE,
70 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE.
NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW
YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE
COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER
THE COVERAGE AFFORDED BY THE POLICY.
NEW YORK STATE INSURANCE FUND
DIRECTOR,INBURANCE FUND UNDERWRITING
This certificate can be validated on our web site ai https:flwww.nysif.comlcerUceMal.asp or by calling (888) 875-5790
VALIDATION NUMBER: 587674295
u-26.3 4841CD45944-20/1198
SolarMount Beam Connection Hardware
SolarMount L-Foot
?art No.304000C.304000D
_ L-FOOt material: One of the following extruded aluminum alloys: 6005-
- T5, 6105-T5,6061-T6
• Uhimate tensile: 38ksi, Yeld: 35 ksi
_ - Finish: Clear or Dark Anodized
• L-Foot weight: varies based on height: -0.215 Ibs (98g)
~ Allowable and design loads are valid when components are
Bea ? assembled with SolarMOUnt seder beams according to authorized
~ Bolt UNIRAC documents
i L-Foot For the beam to L-Foot connection:
• Assemble wi8t one ASTM F593'/:
-16 hex head screw and one
mated ASTM F594 ~"serrated flange nut
Flange N • Use anti-seize and tighten to 30 fl-Ibs of torque
Resistance factors and safety factors are determined according to part
1 section 9 of the 2005 Aluminum Design Manual and third-party test
y results from an IAS accred'Red laboretory
~ NOTE: Loads are given for the Lfoot to beam connection only; be
~ X sure to chsclc load limits for standoff, lag screw, or other
r attachment method
Applied Load Average Safety Design Resistance
i,or ron Direction Ultimate Allowable Load Factor, Load Factor,
~`n1°""~ Ibs (N) Ibs (N) FS Ibs (N) m
_ Sliding, Zt 1766 (7856) 755 (3356) 2.34 1141 (5077) 0.646
Tension, Y+ 1859 (8269) 707 (3144) 2.63 1069 (4755) 0.575
Dimensions specfied in inches unless noted Compression, Y- 3258 (14492) 1325 (5893) 2.46 2004 (8913) 0.615
Traverse, X3 486 (2162) 213 (949y 2.28 323 (1436) 0.664
s._...
. ::=UNI~AC
SoiarMount Beams
Part No. 31013X, 310132C-B, 310168C, 310168C-B, 31O168D
310208C,310208C-8.310240C,310240C•B,310240D,
410144 M, 410168M, 410204M, 410240M
Properties Units SolarMount SolarMount HD
Beam Height in 2.5 3.0
Approximate Weight (per linear ft) plf 0.811 1.271
Total Cross Sectional Area in' 0.676 1.059
Section Modulus (X-Axis) in' 0.353 0.898
Section Modulus (Y-Axis) in' 0.113 0.221
Moment of Inertia (X-Axis) in° 0.464 1.450
Moment of Inertia (Y-Axis) in' 0.044 0.267
Radius of GyreBon (X-Axis) in 0.289 1.170
Radius of Gyration (Y--Axis) in 0.254 0.502
SLOT FOR T-BOLT OR 1.728
1 SLOT FOR T-BOLT OR
HEX HFJiD SCREW 1/" HIX HEAD SCREW
2X SLOT r-0R SLOT FOR
BOTTOM CLIP 2.500 BOTTOM CLIP
T 3.000
1.316 ~I
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750
1.207
1.875
1 ~
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SolarMount Beam SolarMount HD Beam
Dimensions specified in inches unless noted
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The only inverters specially designed for distributed DC architecture
• Superior efficiency (97.5%)
a Small, lightweight and easy to install on provided bracket -
Built-in motlulelevel monitoring 12~ -
~ Communication to Internet via Ethernet or Wireless i
- Outdoor and Indoor installation
Integral AC/DC Switch
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All our irnerters are part of SolarEdge's innovative system -over 97% efficiency and best-irtclass reliability. Our fixed
designed to provide superior performance at a competitive voltage technology ensures the inverter is always working at its
pdce. The SdarEdge inverter combines a sophisticated, optimal input vohage, regardless of the number of modules or
digital control technology and a one stage, ultrdefficient power environmental conditions.
conversion architecture to achieve superior pertormance
TECHNICAL DATA
SE3000A-US SE3800AUS SESOOOA-US SE6000A41S SE7000A11S
5200@208V 5200@208V
Rated AC Pourer Output 3000 3800 5000 6000@240V 6000@240V W
6000@277V 7000@277V
5200@208V 5200@208V
Max. AC Power Output 3000 3800 5000 6000@240V 15000@240V W
6000@277V 7000®277V
AC Output Vokage MIn.i4arl.JAaz. 183 -208. 229 / 211- 240 - 264 183 - 208 -229 /211- 24x284 / 244 277 - 294 Vac
AC Flequenq MIn.1JOm:
Max. 59.3 - 60 -80.5 (HI verslon 57 - 60 - 60.5) Hz
Maz. CoMirxaws Orttfxxt Current @208V 14.5 ]BS 24 25 25 A
Maz. Czmtinuous Output Current @240V 12.5 i6 21 25 25 A
Max. CExdinuous Ouput Curren[ @277V - - 16S 22 25 A
GFDI 1 A
Utilky Monitadng, Islanding Protection, Country Conflgumble Thresholds Ybs
Recommmtled Max. DC Power • (STC) 3750 ~ 4750 6250 7500 I 8750 W
Transformer-less, Ungrounded Yes
Maz. Input Voltage 500 Vdc
Nam. OC Input Voltage 325 @ 208V / 350 @ 240V /400 @ 277V Vdc
Max. Input Curtent 10 12.5 16 18 18.5 Adc
Reverse-POladry Protection Yes
Ground-Fault Isolalbn De[ecUOn 600NS1 Sensitivity
Maximum Inverter Efficiency 97.8 97.7 98.3 98.3 98.3 %
CEC Weigh[etl Efficiency 97.5 97 @ 208V / 97.5@ 208V, 240V 97 @ 208V / 97.5@ 240V / %
97.5@ 240V / 98 @ 277V 98 @ 277V
Ni~lttime Power Consumptan < 2.5 W
Y x
Supportetl Commurvcation interlaces RS485. RS232. Ethernet, Zigbee (optionap
r ,
SaferyY UL1741. IEC-62103 (EN50178), IECb2109
Grid Connection Standards Utility-Interactive. VDE 01261-1. AS4777. RD1663 . D1f 5940, IEEE1547
Emissions FCC part15 class B, IEC6100QFs2, IEC61000b3, IEC6100P}ll, IEC61000}12
RoHS Yes
AC Output 3/4- Contluit
DC Input 3/4' Conduit
Dimensions (HxWxD) 21 x 12.5 x 7 / 21 x 12.5 z 7.5 / 540 x 335 x 191 n / mm i
540z315x 172
j Dimensions with AC/DC Switch (HxWzDI 30.5 x 12.5 x 7 / 30-5 x 12.5 x 7.5 / 775 x 315 x 191 ul / mm
775z315z172
Weight I 44.7 / 20.2 47.7 / 21.7 Ib / xg
Weight with AC/OC Switch 51.2 / 23.2 54.7 / 24.7 Ib / xg
I CEaling Nature) Correction
i Noise < 50 dBA
Min.JNax. Opereting Temperature Range -13 / -25 (CAN version -40 / -40) to +140 / +fi0 'F / 'C
' Protection Rating NEMA 3R
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' AUTHORIZATION TO MARK
This authorizes [he application of the Certification Mark(s) shown below to the models described in the Product(s)
Covered section when made in accordance with the conditions set forth in the Certification Agreement and Listing
Report. This authorization also applies to multiple listee model(s) identified on the correlation page of the Listing
Report.
This document is the property of Intertek Testing Services and is not transferable. The certification mark(s) may be
applied only at the location of the Party Authorized To Apply Mark.
Applicant: SolarEdge Technologies Ltd Manufacturer: Flextronics
Address: 6 Ha'Harash Street Address: Hataasia 1
Hod Hasharon Ramat Gavriel 23108, Migdal Haemek
Country: Israel Country: Israel
Contact: Mr. Meir Adest Contact: Mr. Zafrir Gabay
Phone: +972 9 957 6620 Phone: +g72 4 6448 200
FAX: +972 9 957 6591 FAX: N/A
Email: MEIR.A@SOLAREDGE.COM Email: zafrir.gabay@il.flextronics.com
Party Authorized To Apply Mark: Same as Manufacturer
Report Issuing Office: Lake Forest, CA
Control Number: 4000525 Authorized by: J~l~fIC.41i~
William .Starr, Certification Manager
E1~ ~S
Intertek
This document supersedes all previous Authorizations to Mark for the noted Report Number.
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Intertek Testing Services NA Inc
155 Main S4eef Cortland Nv 13n45
Telephone B00-346-3851 or 607-753-6711 Fax 607-756-6699
UL 1741 Standard for Satety for Inverters, Converters. Controllers and Interconnection System Equipmen
Standard(s); for Use Nlith Distributed Energy Resources, Second Edition Dated: January 28, 2010
CSA C22.2 107.1 Issue2001'09~01 Ed~.3 General Use Power Supplies - (R2006)
Product: Utility Interactive Inverter
Brand Name: SolarEdge
Models: 6 models. SE3000, SE3300. SE3800. SE5000 SE6000 SE7000 (Option. followed by A to indicate
Interface board, etc.)
ATP:1 for Report 3188027CRT-001a page 1 of 2 AT~1 Issued; 22-Feb-2012
AUTHORIZATION TO MARK
This authorizes the application of the Certification Mark(s) shown below to the models described in the Product(s)
Covered section when made in accordance with the conditions set forth in the Certification Agreement and Listing
Report. This authorization also applies to multiple listee model(s) identifed on the correlation page of the Listing
Report.
This document is the property of Intertek Testing Services and is not transferable. The certification mark(s) may be
applied only at the location of the Party Authorized To Apply Mark.
Applicant: SolarEdge Technologies Ltd Manufacturer: Flextronics
6 Ha'Harash Street 213 Harry Walker Parkway
Address: Hod Hasharon Address: South Newmarket Ontario, L3Y 8T3
Country: Israel Country: Canada
Contact: Mr. Meir Adest Contact: Mr. Marko Skocic
Phone: +972 9 957 6620 Phone: (905 952-1110
FAX: +972 9 957 6591 FAX: N/A
Email: MEIR.A@SOLAREDGE.COM Email: marko.skocic@ca.Flextronics.com
Party Authorized To Apply Mark: Same as Manufacturer
Report Issuing Office: Lake Forest, CA `QT~7-__--
Control Number: 4002875 Authorized by: ~,~C/C,4Lsl~E
William T. tart, Certification Manager
ETA ~S
Intertek
This document supersedes atl previous Authorizations to Mark for the noted Report Number.
,
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Intertek Testing Services NA Inc
165 Main Street, Cortland. NV 13045
Telephone 800-345-3851 or 607-753-6711 Fax 607-756-6699
UL 1741 Standard for Safety for Inverters, Converters. Controllers and Interconnection System Equipmen
for Use With Distributed Energy Resources. Second Edition Dated: January 28, 2010
Standard(s):
CSA C22.2 107.1 Issue2001%09101 Ed:3 General Use Power Supplies - (R2006)
Product: Unlit Interactive Inverter
Brand Name: SolarEd e
Models: 6 models. SE3000 SE3300. SE3800. SE5000. SE6000. SE7000 (Option: followed by A to indicate
Interface board, etc-j
ATM for Report 3188027CRT-001 a Page 2 of 2 ATM Issued. 22-Feb-201'2
® LG
Life's Good
•
LG Electronics, Inc. (Korea Exchange: 06657K5) is
one of the globally leading companies and
technology innovator for electronics, information
and communication products. The LG Electronics
currently employs more than 91,000 people
worldwide in 117 companies. In fiscal year 2011,
45.97 billion USD of revenue was achieved.
LG is one of the world's largest manufacturers of
mobile phones, flat screen Ns, air conditioners,
washing machines and refrigerators. As a future-
oriented company, LG enables others to use
technology consisting of renewable energies.
LG's high quality solar products are being
manufactured in LG's leading prod ucticn facility
in South Korea.
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0 Mechanical Properties 0 Electrical Properties (STC')
Cells 6 x 10 300 W 295 W 290 W 285 W 280 W
Cell vendor LG MPPvoltage (Vmpp) 320 319 318 31.6 31.5
Cell type Mono<rystalline MPP current Im 9.42 9.30 919 909 8.97
( PP)
Cell dimensions 1562156 mma/6x6m' _
#of busbar g - Open crcwt voltage (Voc) 395 39.3 392 390 389
Dimensions (L z W x H) 1640 x 1000 x 35 mm Shod arcuit current (Isc) 100 991 980 968 956
6457x 39372138 in Module efficiency 18.3 18.0 177 174 171
Static snow load 5400 Pa / 113 psf Operating temperature ('C) -40 - t90
State wind load 2400 Pa / 50 psf Maximum system voltage (V) 600(UL), 1000(IEC)
Weight... 16.8 + O 5 kg / 36 96 + 11 Ib Maximum series fuse rafing (A) 15
Connector type MC4 connector lP 67 _ Powertolerance O-+3
Junction box IP 67 with 3 bypass diodes
- - ' STC (Sbndartl Tes, Cmaronl: Irradance 1000 W/mr module remperame 25'C AM LS
length of cables 2 x 1000 mm / 2 x 39 37 n • The namapmre power ompm : mea:„red ana aerarm nee W LG elaarmn<s ar to agile and as:ewre aa~reunn.
Glass High transmission tempered glass
Froma Anodized aluminum O Electrical Properties (NOCT')
0 Certifications and Warranty
300 W 295 W 290 W 285 W 280 W
Codifications IEC 61215, IEC 6173 0-1/-2, UL 1703, Maximum power (Pmpp) 220 216 213 210 206
I50 9001 IEC 61701(In progress) MPPvoltage (Vmpp) 293 292 291 289 28.8
DLG-Fokus Test "Ammon a Res stance, MPP current (Impp) 751 Z42 733 725 715
(In progress)
Produc}warrant' 10 years Open circuit voltage (VOC) 365 36.3 362 360 359
Output warranty Of Pmax - Shadcircudturrenf (Isc) 808 798 789 780 770
(m.aa„om.nrroierana. z 3%1 Linear warranty.
Efficiency reduction < 4.5 %
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LG Eledm its U S.A Inc "LG Lila s Goad" Is mgsrraretl rratlemark of LG Carp. yr
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SolarMount Technical Datasheet
Pub 110818-ltd V1.0 August 2011
SolarMount Module Connection Hardware 1
Bottom Up Module Clip .................................................................................................1
Mid Ctamp ....................................................................................................................2
End Clamp ....................................................................................................................2
SolarMount Beam Connection Hardware ......................................................................3
L-Foot 3
SolarMount Beams ..........................................................................................................4
SolarMount Module Connec#ion Hardware
SolarMount Bottom Up Module Clip
Part No.302000C
Washer Bottom Up Clip material: One of the following extruded aluminum
Bottom Nut (hidden..see alloys: 6005-T5, 6105-T5, 6061-T6
Up Clrp n~~J' ~ Ultimate tens(le: 38ksi, veld: 35 ksi
Finish: Clear Anodized
• Bottom Up Clip weight; -0.031 Ibs (14g)
~ Allowable and design loads are valid when components are
Beam ~;y 8o/t assembled with SolarMount series beams according to authorized
UNIRAC documents
Assemble with one'/."-20 ASTM F593 bolt, one'/."-20 ASTM F594
serrated flange nut, and one'h° flat washer
~ Use anti-seize and tighten to 10 ft-Ibs of torque
~ ~ \ Resistance factors and safety factors are determined according to
. - _ part 1 seMion 9 of the 2005 Aluminum Design Manual and third-
party fast results from an IAS accredited laboratory
• Module edge must be fully supported by the beam
* NOTE ON WASHER: Install washer on bolt head side of assembly.
DO NOT install washer under serrated flange nut
Applied Load Average Allowable Safety Design Resistance
Direction Ukimata load Factor, Load Factor,
_ ~ Ibs (N) Ibs (N) FS Ibs (N) m
Tension, Y+ 1566 (6967) 686 (3052) 2.28 1038 (4615) 0.662
Y Transverse, Xi: 1128 (5019} 329 (1463) 3.43 497 (2213) 0.441
• - -
~ x Sliding, Z: 66 (292) 27 (119) 2.44 41 (181) 0.619
Dimensions specified in inches unless rested
s.
. - :.~UNIRAC
SolarMount Mid Clamp
Part No. 302101 G, 3021010, 3021030, 302104D,
3021050, 302106D
ma Bolt Mid clamp material: One of the following exWded aluminum
Mid `Fla Nu alloys: 6005-T5, 6105-T5, 6061-T6
Clamp Ultimate tensile: 38ksi, Yield: 35 ksi
• Finish: Clear or Dark Anodized
• Mid clamp weigh: 0.050 Ibs (23g)
- ~ Allowable and design loads are valid when components are
assembled according to authorized UNIRAC documents
• Values represent the allowable and design load capacity of a single
mid clamp assembly when used with a SolarMOUnt series beam to
~ retain a module in the direction indicated
Assemble mid clamp with one Unirec Y."-20 T-bolt and one'/.°-20
ASTM F594 serrated flange nut
Use anti-seize and tighten to 10 ft-Ibs of torque
Beam ~ Resistance factors and safety factors are determined according to
~ part 1 section 9 of the 2005 Aluminum Design Manual and third-
party test results from an IAS accredited laboratory
Applied Load Average Allowable Safety Design Resistance
,m~z.a„rt - Direction Ultimate Load Factor, Load Factor,
~~i5`"'"""15` _ Ibs (N) Ibs (N) FS Ibs (N) m
Tension, Y+ 2020(8987) 891(3963) 2.27 1348(5994) 0.667
Transverse,Zf 520(2313) 229(1017) 2.27 346(1539) 0.665
Y Sliding, Xt 1194(5312) 490(2179) 2.44 741(3295) 0.620
?X
Dimensions specified In inches unless noted
SolarMount End Clamp
Part No. 3020610, 30200X, 302002D, 3020030;
302003D, 30200AC, 302004D, 3020050, 302005D,
3020060, 302006D, 302007D, 3020080, 302068D,
3020090, 302009D, 3020100, 302011 C, 3020120 End clamp material: One of the following extruded aluminum
_ allays: 6005-T5, 6105-T5.6061-T6
~ ~ ` ott Ultimate tensile: 38ksi, Yield: 35 ksi
• Finish: Clear or Dark Anodized
• End clamp weight: varies based on height: -0.058 Ibs (26g)
Enid Clamp Allowable and design bads are valid when components are
Serrated ti. assembled according to authorized UNIRAC documents
Flange Nut .1 Values represent the allowable and design load capacity of a single
end clamp assembly when used with a SolarMount series beam to
retain a module in the direction indicated
• Assemble with one Unirac Y."-20 T-bolt and one'/."-20 ASTM F594
' ~ sertated flange nut
eea J Use anti-seize and tighten to 10 ft-Ibs of torque
' Resistance factors and safety factors are determined aceording to
~ part 1 section 9 of the 2005 Aluminum Design Manual and third-
Y party test results from an IAS accredited laboratory
~ ~ Modules must be installed at least 1.5 in from either end of a beam
.x
_ _ Applied Load Average Allowable Safety Design Resistance
Direction Ultimate Load Factor, Loads Factor,
_ _ Ibs (N) Ibs (N) FS Ibs (N) rD
'"""L' Tension, Y+ 1321 (5876) 529 (2352) 2.50 800 (3557) 0.605
~•:1rr
++x~.,e
Transverse, Zx 63 (279) 14 (61) 4.58 21 (92) 0.330
• Sliding, Xt 142 (630) 52 (231) 2.72 79 (349) 0.555
Dimensions specified +n inches unless noted