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HomeMy WebLinkAbout38792-Z yaFFOL �� Town of Southold Annex 7/10/2014 A' P.O.Box 1179 54375 Main Road r, Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 37013 Date: 7/10/2014 THIS CERTIFIES that the building SOLAR PANEL Location of Property: 3645 Mill Rd, Peconic, SCTM#: 473889 Sec/Block/Lot: 67.-2-11 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 4/10/2014 pursuant to which Building Permit No. 38792 dated 4/18/2014 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 TO A SINGLE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Dunn,Robert&Dunn,Irene (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 38792 07-02-2014 PLUMBERS CERTIFICATION DATED Authorized Signature TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 38792 Date: 4/18/2014 Permission is hereby granted to: Dunn, Robert & Dunn, Irene PO BOX 185 Peconic, NY 11958 To: construct a roof mounted electric Solar Panel system as applied for At premises located at: 3645 Mill Rd, Peconic SCTM # 473889 Sec/Block/Lot# 67.-2-11 Pursuant to application dated 4/10/2014 and approved by the Building Inspector. To expire on 10/18/2015. Fees: SOLAR PANELS $50.00 ELECTRIC $100.00 CO -ALTERATION TO DWELLING $50.00 Total: $200.00 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. 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. 03-20-2014 New Construction: Old or Pre-existing Building: X (check one) Location of Property: 3645 Mill Lane Peconic House No. Street Hamlet Owner or Owners of Property: Robert and Irene Dunn Suffolk County Tax Map No 1000, Section 6700 Block 200 Lot 11000 Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Lorne Brousseau. Horizon Solar Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Applicant Signature o�*OF SOUTyoI � o Town Hall Annex Telephone(631)765-1802 54375 Main Road N Fax(631)765-9502 P.O.Box 1179 iQ roper.richert(aD-town.southold.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Irene&Robert Dunn Address: 3645 Mill Rd City: Peconic St: NY Zip: 11958 Building Permit#: 38792 Section: 67 Block: 2 Lot: 11 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Horizon Solar LLC License No: 46976-me SITE DETAILS Office Use Only Residential X Indoor X Basement 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 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 F1 Exit Fixtures �] TVSS Other Equipment: 4.56 KW photovoltaic system to include, 16-KG 285N1 K panels with 16-Enphase M250-60 micro inverters,AC disconnect Notes: Inspector Signature: Date: July 2 2014 81-Cert Electrical Compliance Form.xls i Of SOpj�o� coulm TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: r - r DATE v - INSPECTO�Z� Thomas A Reilly P.E. Consulting Engineers "For every house is built by someone,but the builder of all things is God" Hebrews 3:4 4 Bezel Lane Smithtown,N.Y.11787 Tel:(631)724-7888 Fax:(631)724-5740 June 30, 2014 � �_ , Mr. Lome Brousseau i Horizon Solar LLC JUL 10 2014 1087 Fort Salonga Rd Northport, NY 11768 Re: Post Installation Inspection—Dunn Residence 3645 Mill Road, Peconic Dear Mr. Brousseau, The office of Thomas D. Reilly PE, Consulting Engineers has inspected the installation of the solar panels on the roof of the above-referenced residence. This letter is to certify that the solar panel assembly has been installed in accordance with the manufacturer's specifications. As installed, the roof remains structurally sound, and is capable of supporting the solar array configuration in accordance with the 2010 Residential Code of New York State and the minimum design requirements of ASCE 7-05 (specifically, based on a 120 mile per hour wind speed and 20 psf ground snow load). If you have any questions concerning the above, please do not hesitate to call me at the number above or(631) 525-8947. Very truly yours, Orr Nf:(� William P. Keenan, P.E. �Q��QhTRIc �,9 C.3 ti LU cc: Thomas D. Reilly s Fp 088701' N. AgOFESSIO�� NTS I FIELD INSPE •N RE�O1�T DATE COMMENTS �ro FOUNDAMN(1ST) FOUNDATION(ZND) � W O ROUGH FR TQ& PLUMBING ,t. INSULATION PER N.Y. y STATE ENERGY CODE • ' Y I 1 FINAL i ADDZ'TIONAL C6MMF4TS ' o • z � � 1. _ C � . ! v` 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 Plans TEL:(631)765-1802 Planning Board approval FAX:(631)765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO._ 7 q_ �- Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Examined 20 = _ , I+ii Storm-Water Assessment Form Contact,. Approved / 20MAR y � Mail to: 31 Disapproved a/c 6U1 Phone: Expiration Building Inspector APPLICATION FOR BUILDING PERMIT Date March 2 0 2014 INSTRUCTIONS a This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or Regulations,for the construction of buildings,additions,or alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to admit authorized inspectors on premises and in building for necessary inspections. ` (JACnature of applicant or name,if a corporation) 1087 Fort Salonga Road, Northport NY 11768 (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder applicant is general contractor (Horizon Solar LLC) Name of owner of premises Robert and Irene Dunn (As on the tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer Lorne Brousseau, Owner (Name and title of corporate officer) Builders License No. 48916-H Plumbers License No. Electricians License No. 46976-ME Other Trade's License No. 1. Location of land on which proposed work will be done: 3645 Mill Lane Peconic House Number Street HamletAS NOTE[) ��++ �p County Tax Map No. 1000 Section 6700 Block 200 Lot 11o0� Subdivision Filed Map No. "t- E: BY PLEEY LEE LVE" d `3" sa rm. ��� IvOG V /'11VI I V 4 r-mrVf\ I FiC FOR PO'. r1.;= 2. ROUGH-FRA%9,U. STRAPPING, ELECTRICAL & CAULK;,%G a 3. INSULATION 4. FINAL-CONSTRUCTION & ELECTRICAL ". MUST BE COMPLETE FOR C 0. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 OF THE TOWN CODE. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy single family residential b. Intended use and occupancy single family residential 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work solar panel installation (Description) 4. Estimated Cost $19,048.00 Fee $50 permit; $50 CO; $100 elec. insp. (To be paid on filing this application) 5. If dwelling,number of dwelling units 1 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 21 Rear 21 Depth 4 0 Height 25 Number of Stories 2 Dimensions of same structure with alterations or additions: Front 21 Rear 21 Depth 4o Height_ 25 Number of Stories-2 8. Dimensions of entire new construction:Front Rear Depth Height Number of Stories 9. Size of lot:Front 52' Rear 51' Depth 131' 10.Date of Purchase 11101101 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 X 13.Will lot be re-graded?YES NO X Will excess fill be removed from premises?YES NO­ RAO r 1wM (� �� 3 W 5 Mru t wr 14.Names of Owner of premises Address " 1195>? Phone No. Name of Architect k%k 1lunar Address zt LC4W, "honeNo 31--114 1 17r NameofContractor "r,( ArAAuwiSAddress 1111 r Sake 1h Phone No. `11-iaU-4914 Nuw NY liq 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES X 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 X 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 X *IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF S+- N Lorne Brousseau being duly swom,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)Heisthe Contractor; Horizon Solar LLC (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 Z day of 20 1 Nota blic Signature of Applicant ANfi�NN t U6:Ai01 0�lIM.OIP. � o��afjyo 01 Town Hall Annex Telephone(631)765-1802 54375 Main Road �t (631)7 P.O.sox 1179 • roger.richedo-tOWn.SO_tl[1101f1.ny.us Southold,NY 1197I-0959 j Wa DING DEPARTMENT ! TOWN OF SOVTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Lorne Brousseau Date: 03-20-2014 Company Name: Horizon Solar LLC ;,. Name: License No.: 46976-ME c Address: 1087 Fort Salonga Road, Northport NY 11768 Phone No.: 631-683-4898 ! I I JOBSITE INFORMATION: (*Indicates required information) *Name: Robert and Irene Dunn *Address: 3645 Mill Lane, Peconic .11958 *Cross Street: Route 48 *Phone No.: 718-644-5590 j Permit No.: Tax-Map District: 1000 Section: —6700 Block: 200 Lot_ 110 *BRIEF DESCRIPTION OF WORK(Please Print Clearly) -olar oanel installation on roof of main residence panels will be flush mounted (Please Circle All That Apply) *Is job ready for inspection: j I *Do you need a Temp Certificate: YES 4:n� Rough In FinalYES kfU) Temp Information(If needed) *Service Size: 1 Phase 3Phase 100 150 ® 300 350 400 Other *New Service: Re-connect Underground Number of Meters Change of Service ea Additional Information: PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form f I Scott A. RU SSel1 6PSuFFQk James A. Richter, R.A. SUPERVISOR Michael M . Collins P.E. SOUTHOLD TOWN HALL-P.O.Box 1179 16 SWEAMAD N EW YORK1971 Telephone#: (631)-765-1560 46 #F(6 ' j651. 01 MICHAEL.COLLINSia rOWN.SOUTHOLD.NY.US �'� > N107 1� S Office of the Engineer APR 15 2014 Town of Southold STORM WATER M ANAGEM ENT CONTROL PLAN r ( TO BE COMPLETED BY THE APPLICANT ) PLEASE NOTE: All Contact&Project Information Requested by this FORM is Nessary for a Complete Application. APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) PROPERTY OWNER: (If Different from Applicant) NAME: Lorne Brousseau, Horizon Solar NAME: Robert and Irene Dunn ADDRESS: 1087 Fort Salonga Rd ADDRESS: 3645 Mill Lane Northport NY 11768 Peconic 11958 Telephone Number: 631-683-4898 Telephone Number: 718-644-5590 Completed Applications can be picked up at the Engineering Department after being notified by the Department, or; it can be Mailed to the Applicant with the submission of a Self Addressed 8.5 x 11"Envelope& Appropriate Postage. DATE: 04-01-2014 Property Address / Location of Construction Work: 3645 Mill Lane S C T M #: 1000 6700 200 11000 Peconic 11958 District Section Block Lot Required Documents for Stormwater Review: Copy of Complete Building Permit Application. Stormwater Management Control Plan. (2 Sets) Note: SKFs are required whenever Cracng or Excavations exceed 5,000 S.F,when New Impervious Surfaoes are aeated,and(or when emsting Rod Systerns,Dnvevyays,Patios or other Impervious Surfaces are Re-Sxfaced. De Minimis Projects will NOT be Subject to the Submission of a SMCP During the Stormwater Review! Note. These Prqec s would be l imted to Interior Dations,Palolaowant of exterior Doors&Wndm AA Deck Construction with Loose Fit Deddng,Installation arxVor Mxfficaaltion of Mechanical 9ysler s or other similar Wxk A Complete Description of the Scope of Work Proposed under the Building Permit Application. A Completed Stormwater Review Checklist. If No or NA are Indicated, Justification is Required. ** FOR ING DEPARTMENT USE ONLY **** Reviewed By: Date: l Appr ed: Additional Information Required: �osuR:q,r CHAPTER 236 STORMWATER MANAGEMENT CONTROL PLAN CHECK LIST DATE: 04-01-2014 APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) . O NAME: Lorne Brousseau S C T M #: 1000 6700 200 1100 Telephone Number: 631-683-4898 District Section Block Lot S M C P -Plan Requirements: The applicant must provide a Complete Explanation and/or validation of all Information Required by this Checklist if it has not been provided! 1. A Site Plan drawn to scale Not Less that 60'to the inch MUSTYE NO NA If You answered No or NA to any Item, Please Provide Justification Here! show all of the following items: If you need additional room for explanations, Please Provide additional Paper. a. Location& Description of Property Boundaries b. Total Site Acreage. X c. Existing-Natural & Man Made Features within 500 L.F. NA - The proposed building permit is for of the Site Boundary as required by§236-17(C)(2). the installation of solar modules only d. Test Hole Data Indicating Soil Characteristics&Depth to Ground Water. 00 X e. Limits of Clearing& Area of Proposed Land Disturbance. (photeveltaics) . The modules will he f. Existing& Proposed Contours of the Site (Minimum 2'intervals) ins a e on e existing roo e g. Location of all existing & proposed structures, roads, O� roof itself is not being resurfaced as driveways,sidewalks, drainage improvements& utilities. h. Spot Grades& Finish Floor Elevations for all existing& �� X proposed structures. 1. Location of proposed Swimming Pool and discharge ring. 00 j. Location of proposed Soil Stockpile Area(s). —==F—X- I ' — k. Location of proposed Construction Entrance/Staging Area W. O X 1. Location of proposed concrete washout area(s). X m. Location of all proposed erosion&sediment control measures. 0� X 2. Stormwater Management Control Plan must include Calculations showing that the stormwater improvements are sized to capture,store,and infiltrate on-site the run-off from all impervious surfaces generated by a two V)inch rainfall/storm event. 3. Details&Sectional Drawings for stormwater practices are required for approval. Items requiring details shall include but not be limited to: a. Erosion &Sediment Controls. 00 X b. Construction Entrance &Site Access. 0= c. Inlet Drainage Structures (e.g.catch basins,trench drains,etc.) 77— d. d. Leaching Structures (e.g.infiltration basins,swales,etc.) X FORM # SWCP Check List -TOS JAN 2014 CONSENT TO INSPECTION y � IN4 ,the undersigned,do(es)hereby state: Owner(s)Name(s) / That the undersigned s are)the owner( �ofth�e Pre=mises in the Town of Southold,located at AAA I LA, which is shown and designated on the Suffolk County Tax Map as District 1000, Section _,Block Z 'Lot That the undersigned(has)(have)filed,or cause to be filed,an application in the Southold Town Building Inspector's Office for the following: SO%.@g4L �7b+�3LA That the undersigned do(es)hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property,including any and all buildings located thereon,to conduct such inspections as they may deem necessary with rest to the aforesaid application,including inspections to determine that said premises comply with all of the laws,ordinances,rules and regulations of the Town of Southold. The undersigned,in consenting to such inspections,do(es)so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws,ordinances,rules or regulations of the Town of Southold. Dated: U?hnt Name (Signature) 10 E'ilC '04W -1 (Print Name) Thomas D. Reilly P.E. Consulting Engineers "For every house is built by someone,but the builder of all things is God" Hebrews 3:4 4 Bezel Lane Smithtown,N.Y.11787 Tel:(631)724-7888 Fax:(631)724-5740 March 22, 2014 Mr. Lome Brousseau Horizon Solar LLC 1087 Fort Salonga Rd Northport, NY 11768 Re: Roof Framing Evaluation—Dunn Residence 3645 Mill Road, Peconic Dear Mr. Brousseau, In accordance with your request, I have inspected the roof structure at the above-referenced residence. The purpose of the inspection was to evaluate the e)asdng roof structure to determine its suitability to support a proposed solar panel array system. Based on my evaluation of the existing roof structure and review of the manufacture specifications for the solar assembly including the panels and supporting roof mounting system, I have determined that the exisdng roof structure is capable of supporting the solar array configuration in accordance with the 2010 Residential Code of New York State and the minimum design requirements of ASCE 7-05. Specifically, the calculations are based on a 120 mile per hour wind speed and 20 psf ground snow load. If you have any questions concerning the above, please do not hesitate to call me at the number above or(631) 525-8947. Very truly yours, William P. Keenan, P.E. cc: Thomas D. Reilly '' 4 �f hO��pF SO(/r�Ol Town Hall Annex O Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G Q Southold,NY 11971-0959 • �� of onit July 8, 2014 BUILDING DEPARTMENT TOWN OF SOUTHOLD Horizon Solar 1087 Fort Salonga Rd Northport, NY 11768 Re: Dunn, 3645 Mill Lane, Peconic TO WHOM IT MAY CONCERN: The Following Items(if Checked)Are Needed To Complete Your Certificate of Occupancy: ***Note: Need Certification from an Engineer stating the panels were installed on the roof per NYS Building Code Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. 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. Final inspection by Building Dept. Final Storm Water Runoff Approval from Town Engineer BUILDING PERMIT — 38792 — Solar Panels � UE � p�EN SOUND o� Sp LOT 23 2 '�� �► ' d � �4i ✓ o_ y�'30, " wood Frr►e `" N �5 Residence Sao / oi• e i C 24, A*ho/t Driveway \�-, Fd CM a4' 0, � u Fr fy 4 ame 142'1 .a Gff9e .. t^-- 1.4 o f.9•� 0 LOT 25 M {; r z s54. 0 Fd /P MAY d��tA S ReQuxe New C� Amoveo �P-- VNIly FM#: 117 SURVEYED: 31 August, 1998 Filed: 5 AUGUST, 1924 SCALE' 1=20' Tld,f. 1000-067-02-11 SURVEY OF AREA= 6,798.029 SF or LOT 24 0.156 Acres IN IM 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 ocensed Insurance Agent of that Carrier la.Legal Name and Address of Insured(Use street address only) 1b.Business Telephone Number of Insured HORIZON SOLAR LLC 631-871-1250 1c.NYS Unemployment Insurance Employer Registration Number of Insured 1087 FORT SALONGA RO AD NORTHPORT, NY 11768 1d.Federal Employer Identification Number of Insured or Social Security Number 263420621 2.Name and Address of the Entity requesting Proof of Coverage 3a.Name of Insurance 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 box"1a": 53095 Route 25 DBL427406 Southold, NY 11971 3c.Policy effective period: 01/01/2014 to 12/31/2014 4.PoI icy covers: a. ❑1 All of the employer's employees eligible under the New York Disability Benefits Law b.FJ 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 thatthe named insured has NYS Disability Benefits insurance coverage as described above. 3/24/2014 ' Date Signed By t � (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurancecarrier) Telephone Number 516-829-8100 Title Chief Executive Officer IMPORTANT:if bar"4a"is checked,and this form is signed by the insurance carrier's 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 the purposes of Section 220,Subd.9 of the Disability Benefits Law. It must be mailed for completion to the Worker's Compensation Board,DB Plans Acceptance Unit,20 Park Street,Albany,NY 12207. PART 2. To be completed by NYS Worker's Compensation Board (Only if box"4b" of Part 1 has been checked) State of New York Worker's Compensation Board According to information maintained by the NYS Worker's Compensation Board,the above-named employer has complied with the NYS Disability Benefits Lew with respect to all of his/her employees. Date Signed By (Signature of NYS Worker's 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 form. DB-120.1(5-06) Additional Instructions for Form 1313-120.1 By signing this form,the insurance carrier identified in Box"T'on this form is certifying that it is insuring the business referenced in Box"la"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 the certificate holder in Box"2".This certificate isvalid 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"W'. Please Note:Upon the cancellation of the disability benefits policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of NYS Disability Benefits Coverage or other authorized proof that 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,shal I 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'Compensadon&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 Phone:(631)756.4300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^AAA^ 263420621 HORIZON SOLAR LLC 1087 FORT SALONGA ROAD NORTHPORT NY 11768 POLICYHOLDER CERTIFICATE HOLDER HORIZON SOLAR LLC TOWN OF SOUTHOLD 1087 FORT SALONGA ROAD 53095 ROUTE 25 NORTHPORT NY 11768 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE 12232489-1 53042 09/08/2013 TO 09/08/2014 3/24/2014 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO.2232489-1 UNTIL 09/08/2014, 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 09/08/2014 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 THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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/cert/certva1.asp or by calling(888)8752790 VALIDATION NUMBER:717734828 U-26.3 HORIZA OP ID: RM CERTIFICATE OF LIABILITY INSURANCE DATE 0124/2014 ) 03124!2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SJ AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)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 Phone:516-681-4343 SECT Schizzano Insurance Agency Inc Fax:516 681-5938 PHONE FAX 40 Commerce Place STE 204 C No Ext): AIC,No): Hicksville,NY 11801-5210 NEU ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC f INSURER A.Arch Specialty Ins Company INSURED Horizon Solar LLC INSURER 13: 1087 Fort Salonga Road INSURER C: Northport, NY 11768 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. HN-SR TYPE OF INSURANCE U POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DDIYYYY MMIDDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY AGL000711600 12116/2013 12116/2014 PREMISES(Ea occurrence $ 100,00 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 1,000,00 POLICY p PR 0i LOC AIfrOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS AOT OWNED PROPERTY DAMAGE $ OS Per accident $ JEDMBRELLALIABOCCUR EACH OCCURRENCE $ CESS LIAR CLAIMS-MADE AGGREGATE $ RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN Y SI TS1I ER ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? N 1 A E.L.EACH ACCIDENT $ (Mandatory In If yesCdescribe under E.L.DISEASE-EA EMPLOYEE $ , nd DESRIPTION OF OPERATIONS below F.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION TOWNSOH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Route 25 PO Box 1179 AUTHORIZED RE PRESENTATIVE Southold, NY 11971 �f � O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD SUFFOLK COUNTY DEPT OF LABOR, LICENSING h CONSUMER AFFAIRS HOMEIMPROVEMENT CONTRACTOR LICENSE LORNE J BROUSSEAU This ceff*s that the bearer is duly HORIZON SOLAR LLC Iicensed by the County of Suffolk 48916-H 06/1612011 06/01/2015 ... ... . ...... .... ...... .. . SUFFOLK COUNTY DEPARTMENT OF CONSUMER AFFAIRS MASTER ELECTRICIAN NAME KEVIN NONE This certifies that the gUStNE33 NAME bearer is duly HORIZON SOLAR LLC licensed by the License Number DateIssuedof Suffolk Clifford Coleman 46976-ME 01 /12/2010 01,.da � ex14w►noN oA-rE 01 /01 /2014 �QL Residential Photovoltaic(PV,) Design and Installation SCLAR 03-25-2014 -- Town of Southold Building Department l 54375 Route 25 j,l �' " !" } t:I �1� PO Box 1179 Southold, NY 11971 --- I To whom it may concern, Please find enclosed a building permit application for solar panels. This application is for 3645 Mill Lane, Peconic NY 11958. It is for a roof mounted system (flush to the roof). Since the house is within 100 feet of water I contacted the Town Trustees to inquire about getting a permit with them as well. I was told (Amanda)that solar panel roof installations are waived so no Trustee permit is required. Thank you, let me know if any material is missing from the application. Sincerely, //G L G Lorne Brousseau Horizon Solar LLC HORIZON SOLAR, LLC 1087 Fort Salonga Road, Northport, NY 11768 Phone:(631)683-4898 1 Fax:(631)683-4899 1 www.Horizon-Solar.com ! 1 Cover Sheet Solar Energy System Fast Track Permit Application Owner's Name: Robert and Irene Dunn Address: 3645 Mill Lane, Peconic NY 11958 Phone Number: 718-644-5590 Property Map Section: 6700 Block: 200 Lot: 11000 Plan Preparer Name: Lorne Brousseau, Horizon Solar Address: 1087 Fort Salonga Road, Northport NY 11768 Phone Number: 631-683-4898 1 Contents CoverSheet...................................................................................................................................................1 RoofDiagram.................................................................................................................................................3 EquipmentLocation Diagram.......................................................................................................................4 OneLine Electric Diagram.............................................................................................................................5 2 Roof Diagram NOTES: -Installation will be flush-mounted,parallel to and no more than 6"above the roof surface" -Weight of the installed system will not exceed more than 5 lb/ft2 Note: 3.5" Stainless steel lag on bolts will be used. Mounting hardware will be less than 6"above roof surface. v c n m 0 1 inch=7.3 feet 18" clearances!!!! 3 ■ ■ ■ , ■ ■ . • , # � 2 , m%mbvAe& under individual solar panels : . , . :.. . . AC disconnect ^,WUUH ��� ^ ^° Main electrical « « w w . m ! , service Ln Irene Dunn 3645 Mill Road AC Disconnect A Peconic NY 11935 V i� Main AC Panel V Modules: 16* LG 285N1K-A3 w Inverters: 16* Enphase M250-60 CU To Grid a a� O LC Life's Good Mono - • C[ 11 LG Electronics, Inc. (Korea Exchange:06657.KS) 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, 48.97 billion USD of revenue was achieved. LG is one of the world's largest manufacturers of mobile phones,flat screen TVs,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 production facility in South Korea. 4PPHOVk0 PH-ODUC1 ; C �LusCE NM 564573 BS EN 61215 Photo Raic Modules "i ® LG's High Efficient Cell Technology O ,�O Convenient Installation Driv1 hy DC �r�; c�ir�.iil5 hr,>�r�ahoui l i C�irry,nU,grounu:ny,,mi con!r�ctiny '16skg Light and Robust 100% EL Test Completed qtr "e rpt SII l rrlodl ss Il ct lu r r F �cez r,� up tr �IJJ P.1. ��li r l`F,er .,�,iOr hy`he rink we_ Reliable Warranties Positive Power Tolerance rthri ',. rp #" :1 04 - )d�. Mono...... m NeoN 00 • •• S 80 0 Mechanical Properties 0 Electrical Properties(STC") Cells 6 x 10 300 W 295 W 290 W 285W 280 W Cell vendor LG MPP voltage(Vmpp) 32.0 31.9 31.8 31.6 31.5 Cell type Monocrystalline __..... __..._ MPP current(Impp) 9.42 9.30 9.19 9.09 8.97 Cell dimensions 156 x 156 mm'/6 x 6 in -- -- - - -- Open circuit voltage(Voc) 39.5 39.3 39.2 39.0 38.9 #of busbar 3 .......... Dimensions(L x W x H) 1640 x 1000 x 35 mm Short circuit current(Isc) 10.0 9.91 9.80 9.68 9.56 64.57 x 39.37 x 1.38 In Module efficiency(%) 18.3 18.0 177 174 17.1 Static snow load 5400 Pa/113 psf Operating temperature(°C) -40-+90 Static wind load 2400 Pa/50 lost Maximum system voltage(V) 600(UL),1000(1 EC) Weight 16.8±0.5 kg/36.96+1.1 Ib Maximum series fuse rating A 15 Connector type MC4 connector IP 67 Power tolerance(%) 0-3 +3 Junction box IP 67 with 3 bypass diodes - - - - - 111_1-1-`--1- '---" _-- 'STC(Standard Test Condition):Irradiance 1000 W/m'module temperature 25'C,AM 1.5 Length of cables 2 x 1000 mm/2 x 39.37 in 'The nameplate power output is measured and determined by LG Electron-at its sole and absolute discretion. ..............__.._ ___ ...._ .._..__... .._._...... _... Glass High transmission tempered glass Frame Anodized aluminum - -- 0 Electrical Properties(NOCT") O Certifications and Warranty 300 W 295 W 290W 285 W 280W Certifications IEC 61215,IEC 61730-1/-2,UL 1703, Maximum power(Pmpp) 220 216 213 210 206 ISO 9001 IEC 61701(In progress), MPP voltage(Vmpp) 29.3 29.2 29.1 28.9 28.8 ...... DLG-Fokus Test"Ammonia Resistance', MPP current(Impp) 7.51 742 733 725 715 (In progress) - - - Open circuit voltage(Voc) 36.5 36.3 36.2 36.0 35.9 Product warranty 10 years Output warranty ofPmax Short circuit current(Isc) 8.08 798 789 780 7.70 _.. ....__...._ _._.. ._......_. ___ _...,. . ____. (measurement Tolerance a 3%) Linear warranty* Efficiency reduction <4.5% 1)list year.97%,2)After 2nd year:0.7%annual degradation,3)802%for 25 years (from 1000 W/m'to 200 W/ri NOCT(Nominal Operating Cell Temperature):Irradiance 800 W/-,ambient temperature 20'C' IS Temperature Coefficients wind speed 1 mis NOCT 45±2'C 10/0.4° 10/040 Pmpp -0.42%/K 10 Dimensions(mm/in) Voc 0.31%/K m M Isc 0.03%/K w w 0 Characteristic Curves 1000/39.37 Drain holx(4a (&-0 ahorf rd.) Lon de frame Short side frame a) g a� Q 10 1000 w 4.0'7.5(Y Hew) 960/37.80 9 Drain nelea(4aa) (Oi.farKe e.r...n meunerq Mlee) 18/0n `c v j 8 PI 800 W U 48/189 7 JUMfion bon 12-64.3 6 (>OO W Growdln9-.(12..) 1-1 fel 5 - 8.08o(Z-.) 1 400 W Meunen9 lwiea(a.al 3 200w 5.5/0.2z 2 Cable 1°00/39.37 Ian9M 71_JI-.Y1 5 10 15 20 25 30 35 40/oltage IV) -51-6 140 2e [ e -ir~ P 4.0/0.16 120 • • x O • O a Ori 0 a 100 _. ISC m o L 3 O Vo 15 DafailY ur 80 Voc Y T -- 9-/37.17 I 08/0.31 eo Pmax 40 n G � m o 20 0 35/38 -a0 -25 O 25 50 75 90 Temperature CC) 'The distance between the center of the mountin0/grounding holes LG North America Solar Business Team Products Good is a r are subject change w G Co nonce LG Electronics U.S.A.Inc "LG Life's Good"Is a registrated trademark of LG Corp. 61 1000 Sylvan Ave,Englewood Cliffs, All other trademarks are the property of their respective owners. JJ 07632 0 , Contact:) Ig.solar@lge.corn Copyright @ 2013 LG Electronics.All rights reserved. ;ife s Good www.lgsolarusa.com 03/01/2013 ----i Enphase®Microinverters Enphase@M250 y1% The Enphase' M250 Microinverter delivers increased energy harvest and reduces design and installation complexity with its all-AC approach. With the M250, the DC circuit is isolated and insulated from ground, so no Ground Electrode Conductor(GEC) is required for the microinverter. This further simplifies installation, enhances safety, and saves on labor and materials costs. The Enphase M250 integrates seamlessly with the Engage® Cable, the Envoy Communications Gateway", and Enlighten®, Enphase's monitoring and analysis software. PRODUCTIVE SIMPLE RELIABLE -Optimized for higher-power - No GEC needed for microinverter -4th-generation product modules - No DC design or string calculation - More than 1 million hours of testing - Maximizes energy production required and 3 million units shipped - Minimizes impact of shading, - Easy installation with Engage - Industry-leading warranty, up to 25 dust, and debris Cable years [ei enphase® sA® E N E R G Y C US Enphase®M250 Microinverter//DATA INPUT DATA(DC) M250-60-2LL-S22/S23/S24 Recommended input power(STC) 210-300 W Maximum input DC voltage 48 V Peak power tracking voltage 27 V-39 V Operating range 16 V-48 V Min/Max start voltage 22 V/48 V Max DC short circuit current 15 A Max input current 9.8 A OUTPUT DATA(AC) @208 VAC @240 VAC Peak output power 250 W 250 W Rated(continuous)output power 240 W 240 W Nominal output current 1.15 A(A rms at nominal duration) 1.0 A(A rms at nominal duration) Nominal voltage/range 208 V/183-229 V 240 V/211-264 V Nominal frequency/range 60.0/57-61 Hz 60.0/57-61 Hz Extended frequency range' 57-62.5 Hz 57-62.5 Hz Power factor >0.95 >0.95 Maximum units per 20 A branch circuit 24(three phase) 16(single phase) Maximum output fault current 850 mA rms for 6 cycles 850 mA rms for 6 cycles EFFICIENCY CEC weighted efficiency,240 VAC 96.5% CEC weighted efficiency,208 VAC 96.0% Peak inverter efficiency 96.5% Static MPPT efficiency(weighted,reference EN50530) 99.4% Night time power consumption 65 mW max MECHANICAL DATA Ambient temperature range -40°C to+65°C Operating temperature range(internal) -40°C to+85°C Dimensions(WxHxD) 171 mm x 173 mm x 30 mm(without mounting bracket) Weight 2.0 kg Cooling Natural convection-No fans Enclosure environmental rating Outdoor-NEMA 6 FEATURES Compatibility Compatible with 60-cell PV modules. Communication Power line Integrated ground The DC circuit meets the requirements for ungrounded PV arrays in NEC 690.35.Equipment ground is provided in the Engage Cable.No additional GEC or ground is required. Monitoring Free lifetime monitoring via Enlighten software Compliance UL1741/IEEE1547,FCC Part 15 Class B,CAN/CSA-C22.2 NO.0-M91, 0.4-04,and 107.1-01 Frequency ranges can be extended beyond nominal if required by the utility To learn more about Enphase Microinverter technology, [e] enphase® visit enphase.com E N E R G Y 0 2013 Enphase Energy.Al rights reserved.All trademarks or brands in this document are registered by their respective owner.