HomeMy WebLinkAbout38266-Z
fgpi0~ Town of Southold Annex 1/9/2014
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g P.O. Box 1179
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54375 Main Road
Southold, Southold, New York 11971
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CERTIFICATE OF OCCUPANCY
No: 36703 Date: 1/9/2014
THIS CERTIFIES that the building SOLAR PANEL
Location of Property: 550 Mt Beulah Ave, Southold,
SCTM 473889 Sec/Block/Lot: 51.-3-2.6
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
8/12/2013 pursuant to which Building Permit No. 38266 dated 8/20/2013
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 MOUNT SOLAR PANELS TO A ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to Ingarra, Frank & Ingarra, Carmela
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 38266 10-30-2013
PLUMBERS CERTIFICATION DATED
Authorized Signature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
g~ 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 38266 Date: 8/20/2013
Permission is hereby granted to:
Ingarra, Frank & Ingarra, Carmela
550 Mt Beulah Ave
Southold, NY 11971
To: Installation of roof-mounted solar panels as applied for.
At premises located at:
550 Mt Beulah Ave, Southold
SCTM # 473889
Sec/Block/Lot # 51.-3-2.6
Pursuant to application dated 8/12/2013 and approved by the Building Inspector.
To expire on 2/19/2015.
Fees:
SOLAR PANELS $50.00
CO - ALTERATION TO DWELLING $50.00
Total: $100.00
uilding nspe
Jan 141401:39p innovated energy 5163909779 p.3
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01-14-14;13:5; 15169-73421 f 1/ 2
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i
Form Nc4
TOWN OF SO L
BUILDING DEPA E T
TOWN HAL
765-1802
APPLICATION FORCERTtFIC i,IE (I FOMP ICY
This application must be filled in by typewriter or ink and submit to tbe Buildirt~ p partm at with the following:
A. For new building or new use:
I. Final survey of property with accurate location ofall buildil 9s, p rty lines, and unusual natural or
topographic features.
2. Final Approval from Health Dept. of waater supply and se posal (9-9 ortr).
3. Approval of electrical installation from Bard of Fire Und&
4. Sworn statement from plumber certifying that the solder us d ~t s m contains less V [0 of I% lead.
5. Commercial building, industrial building, multiple resider and s1m]Iar build Jigs and installations, a certificate
of Code Compliance from mehitect or engineer responsible th building.
6. Submit Planning Board Approval o€compieted site plan re( itm ts.
B. For existing buildings (prior to April 9,1957) non-conformi g If s , err buildin and "pre-exislirg" land uses:
1. Accurate survey of property showing all property lines, bu Iding arit un uFd I or topographic
features.
2. A properly completed application and consent to inspect si b the appfice Ifs ificate of Occupancy is
denied, the Building Inspector shall state the reasons ther.a i -ting to the lice t
C. Fees
1. Certificate of Oocupaiuy - New dwelling $50.00, Additions fling $50M, Alters dons to dwelling $50.00,
Swimming pool $50.00, Accessory building $50.00, Addid is to i ry but ding $ .00, Businesses $50.00.
2_ Certificate of Occupancy on Pm-existing Building - $100.
3. Copy ofCertificate of Occupancy - $15
4. Updated Certificate of Obctrpancy - 350.00
5. Temporary Certificate of Occupancy - Residential $15.00, cial S 15.00
te. i -A O 0.4
New Construction: Oki or Pre-existing Building: (chickone)
Location of Property: 5 O N i , h . Sc u~ho1C~
House No. Street Hamlet
Owner or Owners of Property: ~h r~ 1+ R (Z I+ -l 0q iC. ct l4 V/ I C-4.0-
Suffelk County Tax Map14o [000, Section 5 t lock 3 Lot ~c ~ tD
subdivision it ad Lot:
Permit No. 3 $ Z 1P 1;' Date of Permipit ilia
Health Dept Approval: Underw ' rs p nova]:
Planning Hoard Approval:
Request for. Temporary Certificate Final Certif at : J check one)
FeeSubmitted: 3 ?0NV\
l
All
AppIt 't r a
SOpTy~~o
Town Hall Annex Telephone (631) 765-1802
54375 Main Road T Fax (631) 765-9502
P.O. Box 117 Q roger. richert(C7town.southold.ny.us
Southold, NY 11971 1-0959
~1~00UNTy N~
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Ingarra
Address: 550 Ml Beulah Ave City: Southold St: NY Zip: 11952
Building Permit#: 38266 Section: 51 Block: 3 Lot: 2.6
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Home Star Energy License No: 50010-h
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service Only
Commerical Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey X Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceiling Fixtures 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 Fixture Time Clocks
Disconnect Switches Twist Lock Exit Fixtures TVSS
Other Equipment: 9560kw photovoltaic system to include, 35 Ben Q 260 Watt panels with Enphase
m215-60 micro inverters, sub panel and 60a ac disconnect
Notes:
Inspector Signature: Date: Oct 30 2013
i~r
81-Cert Electrical Compliance Form.xls
I Lill: III III I Jill Jill Jill Jill III III III III III III Jill III! III III III
J A M E S J. S T O U T A R C H I T E C T P. L. L. C.
2 G R E G LANE EAST NORTHPORT N.Y. 631 - 8 58 9388
January 3, 2014
Re:
~cS/yl
To Whom It May Concern:
This letter is to confirm that as of this date, I, James J Stout, NYS license 0121633
have personally inspected the placement and installation of the roof top solar
panels. All of the solar panels have been installed as per manufacturers guide
lines and specifications. The racking system design and installation complies with
the 2010 building code of NYS section 1609 and all related provisions.
Thank you for your cooperation in this matter.
ncerely,
`~~A~~ERED qR";
es J. Stout =
Architect ° oz,s3 .
JAN-9 2014
J L'
FIELD REM= R84Mlr DATE CObIIdAm
FOUNDATION (1ST) v~
FOUNDATION (2ND)
~ O
O
ROUGH FRAhflNQ &
PLUMBING
rn
C
• C H
INOULATION PERN. Y. m
STATE ENERGY CODE
FINAL
O ADDITIONAL COMMENTS
C ~-ZO-
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TOW-N,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 Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthForLnet PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined I2A ,20 13 Storm-Water Assessment Form
Contact:
Approved 20 20 13 Mail to:
Disapproved a/c
Phone:
Expiration , 20
E Building Inspector
D IJ PLICATION FOR BUILDING PERMIT
12 2M Date -'20 13
INSTRUCTIONS
BLDG-DEPT.
T ;gin 01 SOUTPOLO
e completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and waterways.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The
applicant agrees to comply with all applicable laws, ordinances, building code, ousing code, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
(Signa e f ppti nam o ation)
t4 vT
Y (?3/
(Mailing address f applic t)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
k~l kct
Name of owner of premises f(ka K A ~ ?~Gl
(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.
Plumbers License No.
Electricians License No. J6 3 - M
Other Trade's License No.
1. Location of land on whi h proposed 6 ork 11 don :
55~ p aan-~ t u e. vu`f fn o I I I l
House Number Street Hamlet
nc
County Tax Map No. 1000 Section 5 Block sar ^x-s Lot a - w
ret, . .
Subdivision Filed Map N, i _ 40, i of
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy JZES / t?FCKm taL
b. Intended use and occupancy Rsro trT) A1~
3. Nature of work (check which applicable): New Building Addition Al ion
Repair Removal Demolition Other Work l_eDftr) a?IQAe (ins fzt()
(Description)
4. Estimated Cost (S 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 -2-
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
i
Dimensions of same structure with alterations or additions: Front 75,3' Rear 75, 8
Depth 2-q 18 Height Zr3 Number of Stories Z _
)l . t WA
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front ZZl.o, Rear 274,04 Depth Zo ZS
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO_
13. Will lot be re-graded? YES- NO Will excess fill be removed from premises? YES_ NO_
14. Names of Owner of remises nk~-1: Arta Address.~So/ufaGnf(&,k h rw~ Phone No. 3/ - 7.5-6
Name of Architect R e-s J .S F4-&V Address RPi l Phone No le3/ - f Acrg
Name of Contractor 6Li --Address / p ~ t. Asia ' a - Phone No. 889- -231 -60"
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 BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? * YES NO
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF )
Ims being duly swom, deposes and says that (s)he is the applicant
( ame of individual signing contract) above named,
(S)He is the t7/VI'T
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me this
,52 O day of fU qeQ 20 /3
OTARY tatlKlC,shY 01 N.Y. a
N tary blip 9ulkYc couniv ture of Applicant
Commb@bn ftPkft Oct 26,2011
i
' i
~o~~OF St1/jj~6 ~I
T~ HA Am"
54375 Main Road ? Telephone (631) 765-1802
& 5 P -
s3
P.O. Box 1179 roster n (6307
wn. nV us i
SadhoW, NY 11971-0959
ii
OCT 28 2 3
BUILDING DEPAUMENT
TOWN OF SOUTHOLD (
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Date: J I O
Company Name: ?
Name:
License No.: os-
Address: 1
Phone No.: ~g
I
JOBSITE INFORMATION: (*Indicates required information)
*Name: - 10. 1 p._
*Address: a Y~ '(~Ue ~ ~-ho 1
*Cross Street:
*Phone No.:
Permit No.: !
Tax Map District: 1000 Section: Block:- Lot: ,
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
~n5+alla ail o-f(Please Circle All That Apply)
*Is job ready for inspection: (YES / NO Rough In Final
*Do you need a Temp Certificate: YES / NO
Temp Information (if needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
1~la1 ~~G 11~°j .
'>~~hFY
orm
New York State Insurance Fund
Workers' Compensation & Disability Benefits Specialists Since 1914
8 CORPORATE CENTER DR, 2ND FLR, MELVILLE, NEW YORK 11747-3166
Phone: (631) 7564000
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
271560717
HOME STAR ENERGY SERVICES INC
32 LINCOLN AVENUE
MASSAPEQUA NY 11758
POLICYHOLDER CERTIFICATE HOLDER
HOME STAR ENERGY SERVICES INC TOWN OF SOUTHOLD
32 LINCOLN AVENUE 53095 ROUTE 25
MASSAPEQUA NY 11758 PO BOX 1179
SOUTHOLD NY 11971
POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE
H 2219 323-9 687536 07/0412013 TO 07/04/2014 7/29/2013
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2219 323-9 UNTIL 07/04/2014, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER
FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL
OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS
OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY.
IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 07/04/2014 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE,
10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE.
NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW
YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE.
THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE
INSURED CORPORATION.
DENNIS MYERS -PRES
JOHN ZATOR - V PRIES
HOME STAR ENERGY SERVICES INC
TWO PERSON CORP
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
DIRECTORJNSURANCE FUND UNDERWRITING
This certificate can be validated on our web site at https://www.nysif.conVcerUcertval.asp or by calling (888) 875-5790
VALIDATION NUMBER: 1071563706
U-26.3
STATE OF NEW YORK
WORKERS' 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
I a. Legal Name and Address of Insured (Use street address only) 1 b. Business Telephone Number of Insured
HOME STAR ENERGY SERVICES INC. 516-816-6127
ATTN: DENNIS MYERS Ic. NYS Unemployment Insurance Employer
32 LINCOLN AVENUE Registration Number of Insured
MASSAPEQUA, NY 11758
Id. Federal Employer Identification Number of
Insured or Social Security Number
271560717
2. Name and Address of the Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) Zurich American Insurance Company
Town of Southold 58 South Service Road, Melville, NY 11747
53095 Route 25
PO Box 1 179 3b. Policy Number of entity listed in box "la":
Southold, NY 11971 6973452 - 001
3c. Policy effective period:
10/15/2012 To 10/15/2013
4. Policy covers:
a. ?X All of the employees 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 1 am an authorized representative or licensed agent of the insurance carrier referenced above
and that the named insured has NYS Disability Benefits insurance coverage as described above.
Date Signed 7/29/2013 By
(Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier)
Telephone Number (631) 845-2200 Title Operations Manager
IMPORTANT: If box "4a" is checked. and this form is signed M' the insurance carrier's authorized representative or NYS Licensed Insurance Agent of
that carrier, this certificate is COMPLETE. Mail it dwectk to the certificate holder.
If box "4b" is checked. this certificate is NOT COMPLETE for purposes of Section '_20. Subd. S of the DisabiIit} Benefts Law. It must be
mailed for completion to the Workers' Compensation Board_ DB Plans Acceptance Unit. 20 Park Street. Alban)'. New York 12207.
PART 2. To be completed b NYS Workers' Compensation Board (Only if box "4b" of Part 1 has been checked
State Of New York
Workers' Compensation Board
According to information maintained by the NYS Workers' Compensation Board, the above-named employer has complied with
the NYS Disability Benefits Law with respect to all of his/her employees.
Date Signed By
(Signature of NYS Workers' Compensation Board Emplocee)
Telephone Number Title
Please Note: Onlr insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insurance agents
of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form.
DB-120.1 (5-06)
SCFI`OLN CO'J : V DEPT C.='_A®OR
LICENSING A CONSUMER _Alr AIRS
-ASTER
LLLU RICIAN
BRIAN LOPICCOLO
i
+_x.•...
Thls CeNlGeS that the
hearer Is Wy x `+Nl Gl[CtRIC MC
ncen; d by the
County of Suffolk
48307-ME ~ofrorzon
PI rl12015
v
SUFFOLK COUNTY DEPARTMENT
OF CONSUMER AFFAIRS
H E IM ENT
CONTRACTOR
LICENSE
' DENNIS E MYERS
This CerNm Met the
bearer k4 duly NOME STAN ENERGY SERVICE INC
IleecIsed by the
county of SuRolk
50010-H 0411812012
c..u... ° I enu~cxwn 0410112014
ho~~pF SOplyolo
Town Hall Annex yy Telephone (631) 765-1802
54375 Main Road T Fax (631) 765-9502
P.O. Box 1179
Southold, NY 1 1 971-0959 com
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
November 1, 2013
James J. Stout
2 Greg Lane
East Northport, New York 11751
RE: Frank Ingarra, 550 Mount Beulah Avenue, Southold, 1000-51-3-2.6
NOTE: certification from architect required that solar panel installation meets NY State Code.
TO WHOM IT MAY CONCERN:
The Following Items (if Checked) Are Needed To Complete Your Certificate of Occupancy:
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 411184)
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.
Final inspection by Building Dept.
BUILDING PERMIT - 38266 solar panels
SUFFOLK COUNTY DEPARTMENT
OF CONSUMER AFFAIRS
HOMEIMPROVEMENT
CONTRACTOR
LICENSE
DENNIS E MYERS
This certifies that the
bearer is duly NOME STAR ENERGY SERVICE INC
licensed by the
County of Suffolk
50010-H o4/taaol2
.P..L,sR 7/1
C....... " I FFMU1p.WlE 04/01/2014
New York State Insurance Fund
- _
Workers' Compensation & Disabiiity Benefits Specialists Since 1914
8 CORPORATE CENTER DR, 2ND FLR, MELVILLE, NEW YORK 11747-3166
Pho : (631) 7564000
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
AAAAAA 271560717
HOME STAR ENERGY SERVICES INC
32 LINCOLN AVENUE
MASSAPEQUA NY 11758
POLICYHOLDER . CERTIFICATE HOLDER
HOME STAR ENERGY SERVICES INC TOWN OF SOUTHOLD
32 LINCOLN AVENUE 53095 ROUTE 25
MASSAPEQUA NY 11758 PO BOX 1179
SOUTHOLD NY 11971
POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE
H 2219 323-9 687536 07104/2013 TO 07/04/2014 7129!2013
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2219 323-9 UNTIL 07/04/2014, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER
FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL
OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. AND, WITH RESPECT TO OPERATIONS
OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY.
IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 07/04/2014 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE,
10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE.
NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW
YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE.
THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE
INSURED CORPORATION.
DENNIS MYERS -PRES
JOHN ZATOR - V PRIES
HOME STAR ENERGY SERVICES INC
TWO PERSON CORP
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,INSURANCE FUND UNDERWRITING
This certificate can be validated on our web site at https://www.nysif.com/cerUcertval.asp or by calling (888) 875-5790
VALIDATION NUMBER: 1071563706
U-26.3
STATE OF NEW YORK
WORKERS' 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
I a. Legal Name and Address of Insured (Use street address only) 1 b. Business Telephone Number of Insured
HOME STAR ENERGY SERVICES INC. 516-816-6127
ATTN: DENNIS MYERS 1 c. NYS Unemployment Insurance Employer
32 LINCOLN AVENUE Registration Number of Insured
MASSAPEQUA, NY 11758
1d. Federal Employer Identification Number of
Insured or Social Security Number
271560717
2. Name and Address of the Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) Zurich American Insurance Company
Town of Southold 58 South Service Road, Melville, NY 11747
53095 Route 25
PO Box 1179 3b. Policy Number of entity listed in box "1 a":
Southold, NY 11971 6973452 - 001
3c. Policy effective period:
10/15/2012 To 10/15/2013
4. Polic covers:
a. hX All of the employer's employees eligible under the New York Disability Benefits Law
b. E] Only the following class or classes of the employer's employees:
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 NYS/Disability Benefits insurance coverage as described above.
Date Signed 7129/2013 By ~w J
(Signature of insurance carriers authorized representative or NYS Licensed Insurance Agent of that insurance carrier)
Telephone Number (631) 845-2200 Title Operations Manager
IMPORTANT: If box "4a" is checked, and this form is signed by the insurance carriers authorized representative or NYS Licensed Insurance Agent of
that carrier, this certificate is COMPLETE. Mail it directly to the certificate holder.
If box "4b" is checked, this certificate is NOT COMPLETE for Purposes of Section 220, Subd. 8 of the Disability Benefits Law. It mutt be
mailed for completion to the WorkersCompensation Board. DB Plans Acceptance Unit, 20 Park Street Albany, New York 12207.
PART 2. To be completed b NYS Workers' Compensation Board (Only H box "4b" of Part 1 has been checked
State Of New York
Workers' Compensation Board
According to information maintained by the NYS Workers' Compensation Board, the above-named employer has complied with
the NYS Disability Benefits Law with respect to all of his/her employees.
Date Signed By
(Signature of NYS Workers' Compensation Board Employee)
Telephone Number Title
Please Note: Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insurance agents
of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this jorniL
DB-120.1 (5-06)
SUFFOLK COUNTY DEPT OF LABOR
LICENSING d CONSUMER AFFAIRS
MASTER
ELECTRICIAN
BRIAN LOPICCOLO
This certifies that the °10Af
Heater is duty SNL eLECfRic Rtc
licensed by the
County of Suffolk
48307-ME 012012011
c
VACANT
COSDEN COURr i
(NOT OPEN)
N.BB°P4~soT.. 201.28'
r9L29 ! a r rQ
°ox p
orraN ~rW l .
0
FIRE WELL
W I r•
MAP OF
W r LQT 3
4r
~t
i A p MOUNT BEULAH ACRES
I
Q rs lot it Ar SOUMCILD
v TOWN CF SOUTHOLD
: -4 SUFFOLK Ca., N.Y.
s m 0. AA*i/tr priiesMl . LEI raev AW eq W! is M4
NEW
W 2 Of 1
1 $
0 47
ILA 0 ' I r -
of $0
P h ~y/t %e CGC+OMM B F#04 /Ui/"
100.40 -ror
s, .2&004'50 W. i9r. ab donack associates
VACANT 313 west mom street
Lor 2 rlverheod,new York 11901
(516) 369-1717
a = srAX9 SEr Mar. 27,1W Job N.C. 64-461
04D N047H ROAD ELEVAr/oNS ARE REFERENCED rO AN 1000-051-032.6 Scale f I" =40'
ASSUMED DArum.
Survey No. 05010,000
TJAP 0 f A P OF PROPERTY
OF
GEORGE C. 4 E C. & M1 ARGARET A.
STAl STANKEVICH
TNDTCATTNG A P07 NG A PORTION OF PROPERTY TO RE
~ I ACQU RED BY T ZED BY THE TOWN OF SOUTHOLD
ST SITUATE AT
I N/F N/F sot S OUTHOL,D
ACADEMY PRINTING SERVICES, INC, TOWN OF SOUTHOLD
TOWN TOWN OF SOUTHOLD
STTFFOLK 0 ~OLT~ COUNT`:', NEW YORK
ASPHALT DRIVEWAY rAr JANUARY H, 2005
---_J m N
W N 315, 52' _ - C, R GRAPHIC SCALE
155,52' 0 m 21 is zc m Go
_ N 58013'30' E
107.6' - - - ]SSA'" 241, 22.3 5W - - 60;00' 6, M
j I I STOCKADE ~w IN FEET )
1 STORY P[NC I 1 1 inch = 20 ft.
i STDME DRIVEWAY I N FRAME SHED ti I 24.E
~ W 1 1/2 I FR* 1 1/2 STORY FRAME BARN
22.4• J 1' RODE OVERHANG
QYPfCFlU co
o N/F AREA OF TOTAL PARCEL PARCEL = 41,204± SQ. FT. OR 0.946 ACRES
L'i OVERHANG ti TOWN OF SOUTrInLD AREA OF PARCEL TO BE ACQU BE ACQUIRED = 20,514± SQ.FT. OR 0.471 ACRES
AREA OF REMAINING PAPCEI NG PARCEL = 20,690± SQ. FT. OR 0.475 ACRES
1' RDGF OVERHANG M PROPERTY TO BE ACQUIRED a a
SS' 33.3' w BY THE
WOOD ® CESSPOOL I Z ?RICK SIDEWALK PORCH w ti I ? TUWN OF S[7UTH17LD CONC MrIN ~ W
4 5' H J 33.3' STORY J OJ' E
FRAM ME BUILDING
I n n I y y
Iti -
I I r ~ !a ~ W 14.5' I O
Y L - . - - 9.2' A I 1. AOnasnremnnfs are in
til ~ ~ 0 V momenta err in accordance wish US Standards,
2, Ronr V' nnonshnma t alts olio ihrrge-~ gt,r,tfon or addition to a survey map bearing a
OVERHANG IM 2 (TYPICAL) Z CC Spb-Ee Lanq Sur a (T Sl~hecNon clwn of lho i ssie"al t and Scrveyor's Snails a violation of Section 7209, 'echon 2, of the New York Star. Education Law.
N 3. The ('ned for the euhp feed for the subject parcel is rrcorded in the office of the
i i ~ BRICK SIDEWALK I ch,rlf of Suffolk Corral) nrSunnik Cnonty as Lfher 11918 Page 133.
4. Guarantees or cedlfic iomc.s or cadlficatfons Indicatrd hereon signify that this
d a ~ Y ~ survey was prepared y was prepared in accordance with the existing "Code of
4 ~ N p W ~ ~ p L Practice" for Land Association of Profess ice" Por Land Surveys adopted by the 'New York natlon of Professional Land Surveyors'. Said guarantees
~W W y or certlflcata+ns shill ri hflcahnns shall run only to the person for whom the survey
j~ is papered, and o npared, and on his beheff to the title company,
' E PIPE U 0.2' E 150,87 caNC MnN governmental agency, and the ass,gnnra cf 'nmentol agency, and the lending institution listed hereon he ass,pnnrs of the lending institution. Guaranraes or
cations err not transferable to additional institutions or
S 60'22'20' W urcrrr 4 ,914,13' urrurr vaiE certifications nro not vCa sidsnguent ewnera intent owners
'ho' or~ vAVEMCNT 5. Copies from she "p RI( •s from hie "ORIGINAL' of this survey map, not bearing an
EDGE OF PAVEMENT "PRICINAL'offha Las p anal shall nor he cons ,INAL'of flip Land Surveyor's "INKED" or "EMBOSSED" shall not he considered to be a true and valid copy.
s-of-wav not shown, are not certified.
6 Rights-of-wav not sho
ASPHALT PAVEMENT P,O, n' 7. The s rvay "closes"ff urvay "closes"m ethem etically.
EDGE DF PAVEMENT P. U
ILr)
N N/F Sid'fr'k Cnim Sn(/r T, County Real Property Tax Map
RI TOWN OF SOUTHOLD IUTHOLD Dislict 1000
SnahOn 061.00
~ Rlnok 01.00
Lot 003.000
Certified to: 1 to:
1. Town of Southoi Town of Southold
MAIN STREET
I herehy certify that this maqqq was made from an attn. I mirvey comp}etPd
by me on J' n.. 6 2Qn4 LOUIS LOUIS K. McLEAN ASSOCIATES, P.C.
MADE BY: KG/JL DATE: 111512005 C011SULTING ENGINEERS
CHECKED BY: FFL DATE: 111812005 437 SD. COUNTRY RIIAD
TRACED BY: MA DATE: 111812005 Roy R. }.lk so, L.S BRIIOKHAVEN, NEW YDRK
COMPARED BY: RRF DATE: 111812005 NVSPLS o.4 500
Jul 26, 2006 - 08i33on n P,\05010,00 (Stankevlch Property Survey 6 Phase D\dwg\Acqulstlon Survey.dwg Loyou4w La outl ,
S I T E M A P
0
ALUMINUM ALLOY VS SOLAR PANEL MODULES STRING 1 ( CONNECTED TO PV MODULES )
MID CLAMP Z31 W' S O 11150- E
STRING 2 ( CONNECTED TO PV MODULES )
APP APPROVED AS NOTEDrn1
T-BOLT ALUMINUM VS RAIL BY UNIRAC DATE: e-Q DATE: a0 13 0 P. It 3g~ 66 R Y
ALUMINUM ALLOY ALUMINUM ALLOY STANDOFF FEE NOT Y BU FEE B
L-FOOT 15A 15A 7651802 8 NOT FY BUILDING DEPARTMENT AT 765.1802 8 AM TO 4 PM FOR THE bO
QUICK MOUNT PV FLASHING BREAKER BREAKER ASPHALT FOLLOWINC FOLLOWING INSPECTIONS. POOH
ROOF SHINGLE 1. FOUNDA' 1. FOUNDATION - TWO REQUIRED
FOR POE 2. ROUGH FOR POURED CONCRETE
2, ROUGH - FRAMING & PLUMBING
3. NSULATI 3. INSULATION
EXISTING ROOF 4. FINAL - BE COMI 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.Q. ELECTRICAL E
SHEATHING G ENO ALL CONST XISTI IN METER YORK STAI ALL CONSTRUCTION SHALL MEET THE 8
5/16" X 3 1/2" ZINC PLATED LAG LPANE C CoGen P 200 AMP EXISTING REQUIREMENTS OF THE CODES OF NEW IkhlMi'I~~E§9TI~iI4I'IP'^~~P,I~'R~I,S
O CENTER OF ROOF A EXISTING ROOF RAFTER BOLTS INT RAFTER DICONNECIN PANEL REOUIREME YORK STATE. NOT RESPONSIBLE FOR
HOUSE DESIGN OF DESIGN OR CONSTRUCTION ERRORS. s Q
vo 341, O
LOCATION OF SOLAR PANELS
i COMPLY Y COMPLY W; H ALL CODES OF z STOAT f ME GMGE
NEW YORK E NEW YORK STATE & TOWN CODES HOUSE k I =
AS REQUIRE[ kS REQUIRED App- MON3_G'F
?I ROOF PLAN / PANEL LOCATION r D I IO
PANEL ATTACHEMENT DETAIL ONE LINE DIAGRAM
SCALE 3"=1'-0" SCALE SCALE N.T.S. SCALE 1/81'-0" ~~cTEES ~ z
J
O
]31.U] x ol's5'lo' w
M O U N T B E U L A H A V E N U E
I Z ON I N G IN F O
AUO 265"' SOLAR MODULES
STREET ADDRESS: 550 MOUNT BEULAH AVE SOUTHOLD, NY 11971
SECTION: BLOCK : LOT ( S 3
f 2" X B" ROOF RAFTER ® 16" O.C.
2'X4" COLLAR TIES ® 16" O.C. G E G E N E R A L N O T E S
ALUMINUM SUPPOkl RAIL BY UNIRAC
12 12 1. SOLAR F SOLAR PANELS WILL BE AUO 265 WATT PV MODULE.
\1 THESE DRAWING HAVE BEEN 2. PROVIDE PROVIDE A.C. DISCONNECT: CUTLER HAMMER DG221VRB-30A GENERAL
ALUMINUM STANDOFF AND L-FOOT ~1 DESIGNED IN ACCORDANCE WITH DUTY SAFET I IUTY SAFETY SWITCH, NON FUSIBLE, 240VAC, NEMA 3R.
CLIP LAG BOLTED TO RAFTER THE (AF & PA) WOOD FRAME 3. THE AC THE AC DISCONNECT WILL BE LABELED AS "UTILITY DISCONNECT AND
CONST. MANUAL FOR ONE AND PHOTOVOLTF
EXISTING ASPHALT ROOF SHINGLES--I TWO FAMILY DWELLINGS. UTILITY MET 'HOTOVOLTAIC SYSTEM LOCK-OUT" LOCATED WITHIN VIEW OF THE ELECTRIC
/-v 7 i Avr Dc\ nni 114 Ai in nlw ITILITY METER.
PAPER ON 1/2" PLYWOOD SHEATHING 4. IF IT IS IF IT IS NOT PRACTICAL TO LOCATE THE AC DISCONNECT WITHIN VIEW
OF THE UTI lF THE UTILITY METER, THEN A WEATHERPROOF PLAQUE SHOWING THE
LOCATION C OCATION OF THE SWITCH MUST BE INSTALLED WITHIN VIEW OF THE
ELECTRIC U :LECTRIC UTILITY METER.
THESE DRAWING COMPLY WITH 5. ALL WIRI i. ALL WIRING TO MEET THE NATIONAL ELECTRICAL CODE.
THE 2010 NEW YORK STATE THE RAFTERS AS INDICATED HAVE BEEN ANALYZED AND DEEMED
RESIDENTIAL BUILDING CODE. 6. THE RAF SUFFICIENT SUFFICIENT TO SUPPORT THE ADDED LOAD OF THE SOLAR PANELS AND
CONNECTOR ;ONNECTORS.
7. THE SOL THE SOLAR PANELS MAY NOT BE INSTALLED ON AN EXISTING ROOF
THAT HAS I HAT HAS MORE THAN 1 LAYERS OF ASPHALT ROOF SHINGLES, UNLESS
ADEQUATE kDEQUATE MEANS OF SUPPORT ARE PROVIDED AS PER THESE DRAWINGS.
8. THE MA) S. THE MAXIMUM SPACING BETWEEN THE STANDOFFS SHALL BE 66" O.C.
9. THE SOL I. THE SOLAR PANEL MOUNTING SYSTEM WILL BE BY IRON RIDGE WITH
\ 2 1/2" ALUMINUM "I" BEAM.
i A 2 1/2"
TABLE R301.2(1)
CLIMATE AND GEOGRAPHIC DESIGN CRITERIA
i Wlntl SUBJECT TO DAMAGE FROM 1. Ice sheild
GROUND' SNOW ROUNDS SEISMIC SNOW DESIGN underla- Flood
I LOAD SPEE LOAD SPEED •(mph) CATEGDRY v Weathering ° Frost line Termite ° ment Hozzardsh depth required
20 Ib9. 11 !0 be. 110 mph C SEVERE dG•. Moderate to YES NO Heavy
i TEE?
JA JAMES J. STOUT ARCHITECT
2 GR1 2 GREG LANE EAST NORTHPORT, NEW YORK (631) 858 9388
- I d
WOOD CONST. 1OOD CONST. BRICK CONST. CONCRETTE CONC. BLOCK STONE CONST. EXISTING TO BE REMOVED
I
ROOF SECTION
SCALE 112"=1'-0" `gyp......
tnnt11rr4rp~ DRAWN BY S.R.D. DATE :6/11/13 REVISION NO. .a`tEaEU I~
PROPOSED SOLAR PANEL INSTALL. V)
For: INGARRA RESIDENCE
_ c-
Of; 550 MOUNT BEULAH AVE p
N SOUTHOLD, N.Y. 11971
q*0.020''h"- *0 2`1 q...
'A4y 10F1 NE1'N~1 ,zArzjN,DF1 NPAGE NO. m SITE MAP, ROOF PLAN, DETAILS
LAYOUT PLAN, AND ROOF SECTION A-1 OF 2 °
- - _
ALUMINUM STANDOFF
LAG BOLTED TO RAFTER
-
m
AUO 265W SOLAR
MODULES
~_____-----a 2 1/2" ALUMINUM
SUPPORT BEAM
m
rr-
5'-4" 4'-0" 4'-0"
4'-0°
NOTE: THIS PROJECT WILL HAVE ( 30 ) AUO 265 WATT F WATT PV MODULE PANELS WITH A
;E M215 MICRO INVERTERS
KW OUTPUT OF ( 7950 KW ) AND ( 30 ) ENPHASE M21
)~E ROOF
SOLAR PANEL LAYOUT WEST GARAGE R
SCALE 3/8"=1'-0"
4'-0" 4'-0" 5'-14" 5'-4 5'-4" 4'-0" 4'-]"
N
L ALUMINUM STANDOFF J-F2 1/2" ALUMINUP ' ALUMINUM AUO 265W SOLAR
LAG BOLTED TO RAFTER SUPPORT BEAM RT BEAM MODULES
JA- JAMES J. STOUT ARCHITECT
2 GREi 2 GREG LANE EAST NORTHPORT, NEW YORK (631) 858 9388
DO CONST. BRICK CONST. CONCRETTE CONC. BLOCK STONE CONST. EXISTING TO BE REMOVED
NOTE: THIS PROJECT WILL HAVE ( 5 ) AUO 265 0 265 WATT PV MODULE PANELS WITH A Wood CoNSr. B L---J
ENPHASE M215 MICRO INVERTERS
KW OUTPUT OF ( 1325 KW ) AND ( 5 ) ENPHA`. ```aaQEDuuuy aumuu,py~ DRAWN BY : S.R.D. DATE 6/11 /13 REVISION NO.
~`\S,~EpEU iii I~
PROPOSED SOLAR PANEL INSTALL.
For: INGARRA RESIDENCE
E ROOF
SOLAR PANEL LAYOUT WEST HOUSE R( Of; 550 MOUNT BEULAH AVE 0
SCALE 3/8"=1'-0" H 33. SOUTHOLD, N.Y. 11971 0
p.021 'yF OFi NE nad 47TF OF NE'N~~``
LAYOUT PLANS PAGE NO. m
A-20F 2