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HomeMy WebLinkAbout39137-Z Town of Southold Annex 10/15/2014 P.O.Box 1179 7e 54375 Main Road ' ► �, mil Southold,New York 11971 w CERTIFICATE OF OCCUPANCY No: 37212 Date: 10/15/2014 THIS CERTIFIES that the building SOLAR PANEL Location of Property: 2810 Westphalia Rd,Mattituck, SCTM#: 473889 Sec/Block/Lot: 114.-7-5.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 8/19/2014 pursuant to which Building Permit No. 39137 dated 8/27/2014 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 AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Penny,Domenica (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 39137 10-07-2014 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#: 39137 Date: 8/27/2014 Permission is hereby granted to: Penny, Domenica 2810 Westphalia Rd Mattituck, NY 11952 To: Installation of roof-mounted solar panels as applied for. At premises located at: 2810 Westphalia Rd SCTM # 473889 Sec/Block/Lot# 114.-7-5.2 Pursuant to application dated 8/19/2014 and approved by the Building Inspector. To expire on 2/26/2016. Fees: SOLAR PANELS $50.00 CO -ALTERATION TO DWELLING $50.00 7 $100.00 T $200.00 ns .ector 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 New Construction: Old or Pre-existing Building: (check one) Location ofProper\1 /O Wks-f-,phal'ia_kc House ,No. Street Hamlet Owner or Owners of Property' Suffolk County Tax Map No 1000, Section Block Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: A (chec one) Fee Submitted: $ A licant Si n ur o�*OF SOUryol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road N Fax(631)765-9502 P.O.Box 1179 �o roger.riche rt(a)-town.southoId.ny.us Southold,NY 11971-0959 Q ly00UNTY,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Domenica Penny Address: 2810 Westphalia Rd City: Mattituck St: NY Zip: 11952 Building Permit#: 39137 Section: 114 Block: 7 Lot: 5.2 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Grid City Electric Corp License No: 53710-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 Exit Fixtures TVSS Other Equipment: g KW roof mounted PHOTO VOLTAIC SYSTEM to include, 36 CS 250 panels, 1-Solar Edge 760OTL inverter, 1-60a AC disconnect Notes: Inspector Signature: ZDate: Oct 7 2014 81-Cert Electrical Compliance Form.xls OF SOUI,yo� 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) ICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE - INSPECTOR J A M E S J. S TOUT A R C H I T E C T & Assoc. 2 GREG LANE EAST NORTHPORT N. Y. 831 - 8 58 9388 October 8, 2014 Re: Domenica Penny 2810 Westphalia Road Mattituck, NY 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 at the above listed address. All of the solar panels have been installed as per manufacturer's guidelines and specifications. The racking system design and installation complies with the 2010 building code -of-NYS section 1609 and all related provisions.The installation of the solar panels were as per plan. Thank you for your cooperation in this matter. Sincerely, Ja J. Stou Ar ect o'er :. U OCT 14 2014 s_ , prPT. FIELD INSPEOT011 REFOR+T DATA COMMENTS FOUNDATION(1ST) � ......q...ww.;.ww..w.......U.. FOUNDATION(3ND) � rA ROUGH FICF PLUMBING INSULATION PEA N.Y. '�H STATE ENERGY CODE r MAL , w .r 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) 765-9502G I Survey. SoutholdTown.NorthFork.net PERMIT NO. ( l Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined '20 Single&Separate Storm-Water Assessment Form Contact: Approved ,20 Mail to: Disapproved a/c Phone: Expiration _,20_L.._ `'1 E 1 ng Inspe for PPLICATION FOR BUILDING PERMIT AUG 19 2014 `tom I� Date%J � , 2014 BHT,, Di PT. INSTRUCTIONS T(�!rJr;pr�O�Ililn!D app ication 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. 0K)", (Signator of plicant or name,if a corporation) �f' CA 64 11 (Mailing address of applic t) State whether applicant is owner,lessee, agent, architect,engineer, general contractor, electrician,plumber or builder UUP( �cc 1 -DjName of owner of premises 0 me 1 C �eyvi (As on the tax roll 6r 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. 3714 N-(� Other Trade's License No. 1. Location of land on wich proposed work will Oe done:P1, �;O—&(A Ck J House Number qtreet Mttet County Tax Map No. 1000 Section I �1 c -+ x+�++ad� �M► � Lot 5• r w Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intend use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 7 3. Nature of work(check which applicable):New Building Addition _ Alteration Repair Removal Demolition Other Work 1A✓Pic he 1 k (Description) 4. Estimated Cost 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 DepthHeight Number of Stories II I- , "`t � 8. Dimensions of entire new construction: Front Rear ) Height Number of Stories 9. Size of lot:Front Rear Depth 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 d�'emises ^(A Addresso�S�DweS p Fc� Phone No.R-los-96" Name of Architect JGI,IIKC63 SVW\)k Address Phone No �D 3l x$58'—g38Sc Name of Contractor t ✓ Address Phone No.St(Q 5 we -?7Y5 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�tEQUIRED. 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) S: COUNTY OF&( being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the A (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 "rim WRLY ooFFEY I 5`W' day of 10 IV 201 q.N.Y. o li 010i of Applicant �s °5"> � S�F O�IE�.I��l[WA FIEIR, Scott A. Russell ,� SUPERVISOR MA NAGIE LENT SOUTHOLD TOWN HALL-P.O.Box 1179 Town of)So u tho l d 53095 Main Road-SOUTHOLD,NEW YORK 11971 CHAPTER 236 - STORMWATER MANAGEMENT-'WORK SHEET ( TO BE COMPLETED BY THE APPLICANT) —DOES THIS PROJECT ; : (CHECK ALL THAT APPLY) • Yes No []UA. Clearing, grubbing, grading or.-,tripping of land which affects more t• than 5,000 square feet of ground surface. t ' El VB. Excavation or f illing involving more than 200 cubic yards-of material ; within any parcel or any contiguous area. E]QC. Site preparation on slopes which exceed 10 feet vertical rise to . 10.0 feet of horizontal distance. ❑[ D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. { El[�(E. Site preparation within the .one-hundred year floodplain as depicted on FIRM Map of any watercourse. [} F. Installation of new -or resurfaced impervious surfaces of 1,000 square . ` feet or more, unless prior approval of a Stormwater Management t Control Plan was received by the Town and the proposal includes ' in-kind replacement of impervious surfaces. - ------ ----- If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. _- —----=— --- —=-- - ---- --- -- - Date: APPLICANT: (Property Owner,Desi n Professional,Agent,Contractor,Other) S.C.T.M. : 100 pe y g District pp S ti1_11. -� NAME L S �-t : Block Lot FOR BUIL-DING DEPARTNIENT USE ONLY"' Contact Information: l(l / f�s nckpnnr Num Reviewed By: w ` — — — — — — — — — — — — — — — — — — Date_ PropertyPropei-ty Address/ Location of Construction Work: — — — — — — — — — — — — — — — — — ` Y7 Gt Approved for processing Building Permit. — — o Gt/ 1� _ Stormwater Management Control Plan Not Required. �Zcr, Stormwater Management Control Plan is Required. (Forward to Engineering Department for Review.) FORM - SMCP-TOS MAY 2014 Sep. 17. 2014 9: 50AM No. 0706 P. 2 �0L Si)Ulyo <o Town Hall Amex Telephone(631)78965.g11802 54375 Mait►Road �c rouenrichert iOt rI1�0U rIplq.liV.us 1 P.O.Sox 1179 Southold,NX 11971.4959 � rQVi�l'1,1� i" BUILDING DF.PA,RTWNT TOWN OF SOUTHOLD i APPLICATION FOR ELECTRICAL INSPECTION li REQUESTED BY: � � Date; Company Name: •--� i_ Name: License No.: S F Address: Phone No.: JOBSITE INFORMATION: (*Indicates required information) 'Name: veon "Address: r291 "Cross Street: i "Phone No.: Permit No.: ( 3-7 T i Tax-Map District: 1000 Section: Block: Lot: *BRIEF DESCRIPTION OF WORK(Please Print Clearly) (Please Circle All That APPLY) ; *Is job read for inspection: J Y YE / NO Rough In Final } *Do-you need a Temp Certificate: YES NO It i . Temp Information Of-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 DUI; WITHAPPLICATION .82=Request for Inspection Form I TOWN OF SOUTHOLD PROPERTY REO ) CARD OWNER STREET VILLAGE DIST. ' SUB. LOT 01 cA F Pe vi n"H FORMER 0= N 54--ke,1 i E ACR. . S W TYPE OF BUILDING RES. :fat EAS. VL. """ FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS t o a 5 t tt m i c1 cuc 111 Q (, 1 % c t�2ttx - 7 t la - 6r37 7 a e f Tillable FRONTAGE ON WATER Woodland F ONTAGE ON ROAD Meadowland DEPTH 177, House Plot BULKHEAD Total i� IEEE7 ' ■■■■■■■■■■■�■■■�■■■■■■■■■■■■■ 4 4 ■■■■■■■■■■■I ■fir'■ iii1 ■■■■ ■■■■■■■■■■■Z"ME ■ot■�.■■■■■■■■■ ON ■■■■■■■■■■ ®■ ■■ice■■■■■■ ■■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■ ■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Foundation Basement i • aa - •_ rs• Rooms I st Floor : • f r. •• ` -• • r•s Rooms 2nd Floor : Driveway o��oF so�ryol. � o Town Hall Annex Telephone(631)765-1802 54375 Main Road cn Fax(631)765-9502 P.O.Box 1179 G • Q Southold,NY 11971-0959 'Q COUNTY, BUILDING DEPARTMENT TOWN OF SOUTHOLD August 6, 2014 James Stout, Arch. 2 Greg Lane East Marion, New York 11731 RE: Domenica Penny 2810 Westphalia Road Mattituck, New York 11952 Dear Mr. Stout: We received the Building Permit application for the above property. I've enclosed 2 forms that need to be completed and returned to us as part of our application process. One is a Certificate of Occupancy application and the other is the Stormwater Management Form. If you have any questions, please contact our office 631-765-1802. Respectfully, Southold Town Building Dept. R n,zl Connie Bunch O�*Of SO(/jyQl � o Town Hall Annex Telephone(631)765-1802 54375 Main Road cn Fax(631)765-9502 P.O.Box 1179 G • Southold,NY 11971-0959 'Q �yC'4UNV,N ' October 10, 2014 BUILDING DEPARTMENT TOWN OF SOUTHOLD James J. Stout 2 Greg Lane E. Northport NY 11731 Re: Penny,2810 Westphalia Rd,Mattituck TO WHOM IT MAY CONCERN: The Following Items(if Checked)Are Needed To Complete Your Certificate of Occupancy. "NOTE: Need certification that the panels were installed to 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. (AII 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 — 39137 — Solar Panels y ' tk" 6VA44y1Et'S,lfa'A►CC HC/,T Y, $HAL(„aif! cft r fJ ME Orpso', ,q MIIOM - '".. ,S aREPARfL. A.NL1 Y.his of J,11E i7rMAN r, 60 �,:.... .�. .Y LfiiDtM,:.Mv5 " TFSC!4/f3E0 P/?op-E T;/ +r+►. ► k►s SITUATE rr rH,S MATTI TUCK, TOIvN OF SC,UTHOLD s:.",•E+•,S ASAIA nwr x 5F,;nnaJ(AA►,,nes c SUFFOLK COUNT), N. r E•WitY:IOh'Sr_f0;,.'n :Y '' t:lEs 7 NIS StAvEr MAP 40F MM” LAIJO S&Rfl'f+s Cv&"M MAL 0#41 eca of ec+vsnfoEv ro a A v.L S the r SURVEYED FOR DANA FOX SURVEYED 17 AUu(,,ST «, , SCALE 1"—JO' AREA= 16,731.256 SF JR a 430 A.fR[S C0.4'rJVR LINES r.•: +929 ;;,,:. BENCH USED wa55 16:11. L) o N 350730"E 100.0 N N/F SCHELIN -W RIV L�lE BLEND — -- _` rc�0 r' N 35' 07' 30" 45 l0.. S4""?P4c` "t O. I11{110d V MA"'T t. N O ! V QL. tf 20.6' 14.4' v ' 60 2.11" a � �64 3 J c) 11) , M � 2.Ll N v tJ.4' 2L' l/� Z ro ar S 39" 42' Op" w cn �s 179.85;F. 8 h w r~ ,f t^rk' NOIR Tl l f?OA[_) , C,?4R41J1FE1.+ T. SURVEYED 8 f UAMA rL!X F10EU I"NA rIONAL r!rL£Mrs CJ. Ctr Pl r S -ANI E r J. ,'p v NEN $ 'IT L!: Nr 6,51-7 4-5 -55 4. 1.5 SEP 7003 FINAL SLrRVEY. L ENSED•J%ri L!r. r'/�' ' ! VNE .'J11< L 4'1,:A rE POURED CL1NCRETE FOUNDA/k7N «%3 APRIL 2000 SNOry R/ta OA rA J MAP TO MA rATUCf' CREEr 1 E.,9 APRIL 20,72 SQUARE Of'F HOUSE. ADD CCWrOUR LINES IN DATUM, CORRECT TEST If,-XE STATE OFNEW YORK VVOR&ERS' COMPENSATION 8QARD CERT|F|CATE0FINSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW -SI A'1`1`1 OFNl-'%VYORK \k0RKFRS* ('01MI)ENSANONBOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAtGE I a. L,cgal Name and address of Insured(Use street address only) I h, Business Telephone Number of insured 718-785-9243 Grid City Electric,Corp. 2047 Nameoke Ave -1c, NYS I lneniploLtnent Insurance Finplo\er Registration Far Rockaway, NY 11691 Number of Insured Work 1-ocation of Insured Only required if coverage is spccificallv flillited to certain locations ill New ),Ork State. i.e. a Wrap-1*p Id. Federal Fniplover Identification Number cat Insured or Polio.) Social Secttrit\ Number 46-0689064 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) The Hartford Insurance Company Town of Southold 3b. Policy Number of entity listed in box-la": Town Hall Annex Building 0IWECEL,13125 54375 Route 25 Southold. NY 11971 3c. Policy effective period: 8/6/2013 to 8/L6/2015 3d. The Proprietor. Partners or Executive Officers are: El included. ((hit% check ho\il'all vartnev,,!officert incliitic(i) all excluded or certain partners/officers excluded. I'llis certifies that the insurance carrier indicated above in box "Y' insures the business referenced above it) box "I a- lor %%orkcr,' compensation under the New York State Workers* Compensation T.avv. i I" u,c lhl� 1'ofm, York I\Y I mu,i 1%, 3A on the 1.\'l ()R11,\ I1()\. of,111c The Insurance arrier or its: licensed agcnt—\tiill send this Certificate of Insurance to the entity listed above as the certificate holder in box The insurance It,i/I tjit.vo ncrNfi the chore certificate holder Itililin 11) dav� lb a po/ici, is CCURTIC(I (1111' 10 nrutlrittrrter;I r; 1wenliums 1w within 30 dais lb'diere are reasons other'thao nonlrqj ment of lwenfif0o.v that Cillic"Cl tilt!poliel.or eliminate=the' in urcd fi-01), tile coverage indicated on this Certificate. t 7hese notices mov he sen I t by regular nl(lij.) this Certificate iv ralid.lor one year after this forin is approved Ay the insurance carrier or its licensed agent, or until the policy expiration date fisted ill bo-v-3c", whichever is earlier. Please Note: Vpon the cancellation of the workers'compensation pollicv indicated on this form,if the business continues to he named on to permit.license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New Ylwk State Workers'Compensation 1,9w. Under penalty of perjury.I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: --Mitch Qi NOt rt luame fauthori7ed reWesentafive,)t licensed agent of oi,urankx carrier) Approved by: 7 '01,,20141 tyienanarr) (!)stet "title: .��ent of Record I clephone Number of authorized representative or licensed agent of insurance carrier _016)338-2700 Please Note. 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Canadian Solar is committed to providing high quality solar products,solar system solutions and services to customers around the world. a �a .v _r CanadlanSolar Make The Difference ELECTRICAL DATA I STC MODULE i ENGINEERING DRAWING Electrical Data CS6P-250P CS6P-255P Nominal Maximum Power(Pmax) 250W 255W Rear View Frame Cross Section Optimum Operating Voltage(Vmp) 30.1V 30.2V Optimum Operating Current(Imp) 8.30A 8.43A Open Circuit Voltage(Voc) 37.2V 37.4V Sect on A-A Short Circuit Current(Isc) 8.87A 9.00A Module Efficiency 15.54% 15.85% 35 0 Operating Temperature -40eC-+8S°C Maximum System Voltage SOOOV(IEC)/3000V(UL)/600V(UL) Maximum Series Fuse Rating 15A W Application Classification Class A o Power Tolerance 0-+5W s 'Under Standard Test Conditions(STC)of Irradiance of 1000W/m',spectrum AM 1.5 and cell I temperature of 25'C. I4 Its J j ELECTRICAL DATA I NOCT Electrical Data CS6P-2SOP CS6P-25SP i Nominal Maximum Power(Pmax) 181W 185W Optimum Operating Voltage(Vmp) 27.SV 27.SV Optimum Operating Current(Imp) 6.60A 6.71A Open Circuit Voltage(Voc) 34.2V 34.4V CS6P-255P I-V CURVES Short Circuit Current(Isc) 7.19A 7.29A *Under Nominal Operating Cell Temperature(NOCT),irradiance of 800 W/m',spectrum AM 1.5, 10 10 ambient temperature 20'C,wind speed 1 m/s. MODULE I MECHANICAL DATA 5 5 Specification 7 T Data Cell Type Poly-crystalline,61nch 6 5 Cell Arrangement60(6 x 30) Dimensions 1638 x 982 x 40mm(64.5 x 38.7 x 1.571n) �5 �5 Weight 18.Skg(40.8 lbs) 4 4 ` Front Cover 3.2mm tempered glass 3 3 1 ` Frame Material Anodized aluminium alloy --1000w/m2 —5T 1-BOX IP67,3diodes 2 800w/m2 2 --25C Cable 4mm'(IEC)/4mm'&12AWG 1000V(UL1000V)/ 600w/m2 4 1 51C _._._..400w/m2 11t,, 1 ---85C 12AWG(UL60OV),1000mm 0 Connectors MC4 or MC4 comparable 0 5 10 15 20 25 30 35 40 0 5 10 15 20 26 30 35 40 45 Standard Packaging 24pcs,504kg(quantity and weight per pallet) voltage(v) vonage(v) Module Pieces Per Container 672pcs(40'HQ) TEMPERATURE CHARACTERISTICS Specification Data Partner Section Temperature Coefficient(Pmax) -0.43%/aC Temperature Coefficient(Voc) -0.34%/-C Temperature Coefficient(Isc) 0.065%/'C Nominal Operating Cell Temperature 45t2"C PERFORMANCE AT LOW IRRADIANCE Industry leading performance at low irradiation environment, +96.5% module efficiency from an irradiance of 3000w/m'to 200w/m'(AM 1.5,25 C) 'The spec!)Icotlons made herein may deviate slightly and are not guaranteed.Due to ongoing Innovation,research and product enhancement we reserve the right to make Ony a0ustments to the Information contained herein at any time wlthout notice..P/ease always obtain the most recent revision of datasheet which shall be duly incorporated into the binding contract mode by the parties governing all transactions related to the purchase andsole of the products described herein, solar=ee . SolarEdge Single Phase Inverters For North America SE3000A-US / SE380OA-US / SE5000A-US / SE6000A-US / SE760OA-US / SE10000A-US / SE1140OA-US • • USA-GERMANY ITALY FRANCE JAPAN CHINA AUSTRALIA THE: NETHERLANDS ISRAEL WWW.solarP_dge.US solar�,=eeSingle Phase Inverters for North America solar SE3000A-US/SE380OA-US/SE5000A-US/SE6000A-US/ SE760OA-US/SE10000A-US/SE1140OA-US SE3000A-US SE380OA-US SE5000A-US SE6000A-US ' SE760OA-US SE10000A-US SE1140OA-US OUTPUT Nominal AC Power Output 3000 3800 5000 6000 7600 9980 @ 208V 11400 VA 10000 @240V Max.AC Power Output 3300 4150 5400 @ 208V 6000 8350 10800 @ 208V 12000 VA 5450 @240V 10950 @240V AC Output Voltage Min.-Nom.-Max.* ✓ ✓ 183-208-229 Vac AC Output Voltage Min.-Nom.-Max. ✓ ✓ ✓ ✓ ✓ 211-240-264 Vac AC Frequency Min,-Nom.-Max.* 59.3-60-60.5(with HI country setting 57-60-60.5) Hz Max.Continuous Output Current 12.5 16 24 @ 208V 25 42 48 @ 208V 47.5 A 21 @240V 42 @ 240V GFDI 1 A Utility Monitoring,Islanding Protection,Country Configurable Yes Thresholds INPUT Recommended Max.DC Power** (STC) 3750 4750 6250 7500 9500 12400 14250 W Transformer-less,Ungrounded Yes Max.Input Voltage 500 Vdc Nom.DC Input Voltage 325 @ 208V/350 @ 240V Vdc Max.Input Current*** 9.5 13 16.5 @ 208V 18 23 33 @ 208V 34.5 Adc 15.5 @ 240V 30.5 @ 240V Max.Input Short Circuit Current 30 45 Adc Reverse-Polarity Protection Yes Ground-Fault Isolation Detection 6006 Sensitivity Maximum Inverter Efficiency 97.7 98.2 98.3 98.3 98 98 98 oda CEC Weighted Efficiency 97.5 98 97.5 @ 208V 975 97.5 97 @ 208V 97.5 % 98 @ 240V 97.5 @ 240V Nighttime Power Consumption <2.5 <4 W ADDITIONAL FEATURES Supported Communication Interfaces RS485,RS232,Ethernet,ZigBee(optional) Revenue Grade Data,ANSI C12.1 Optional STANDARD COMPLIANCE Safety UI-1741,UL1699B,UL1998,CSA 22.2 Grid Connection Standards IEEE1547 Emissions FCC partly class B INSTALLATION SPECIFICATIONS AC output conduit size/AWG range 3/4"minimum/24-6 AWG 3/4"minimum/8-3 AWG DC input conduit size/#of strings/ AWG range 3/4"minimum/1-2 strings/24-6 AWG 3/4"minimum/1-2 strings/14-6 AWG Dimensions with AC/DC Safety 30.5 x 12.5 x 7/ 30.5 x 12.S x 7.5/ in Switch(HxWxD) 775 x 315 x 172 775 x 315 x 191 30.5 x 12.5 x 10.5/775 x 315 x 260 mm Weight with AC/DC Safety Switch 51.2/23.2 54.7/24.7 88.4/40.1 Ib/kg Cooling Natural Convection Fans(user replaceable) Noise <25 <50 dBA Min.-Max.Operating Temperature -13 to+140/-25 to+60(CAN version****-40 to+60 Range ) 'F/'C Protection Rating NEMA 3R 'For other regional settings please contact SolarEdge support. "Limited to 125%for locations where the yearly average high temperature is above 77'F/25°C and to 13S%for locations where it is below 77"F/25'C. For detailed information,refer to htip'//www solaredee us/files/pdfs/inverter do ovgrsizinz euide udf **'A higher current source may be used;the Inverter will limit its input current to the values stated. CAN P/Ns are eligible for the Ontario FIT and microFIT(microFiT exc.SE11400A-US-CAN). I -' '---r " k 0 bQ cu �-- 0.75--I 000 00 u SolarMount ©2008 UNIRAC, INC. 1411 BROADWAY BLVD NE Standard Rail ALBUQUERQUE, NM 87102 USA PHONE 505.242.6411 UNIRAC.COM UNIRAC-300001 JOB Na 2014—SO336 ,'I- i o W I c a cc J 4'-0" 5'-4" 5'-4" 4'-0" V N Z p W Q OUTLINE OF ROOF J 0 i--� rliF I W W N o Qc) Q � — x ALUMINUM "L" FOOT _ — — LAG BOLTED TO RAFTER IL W J G — —� — — — — — — �— — a, CANDAIAN SOLAR 250W SOLAR MODULES p 0 w (f) i� 2 1/2" ALUMINUM (n W z 0 SUPPORT BEAM Op >' 3�: >- Ld LdzpU a, m 0- ONO f-- W o z C/1 frQ O 4- o 0- o m 5'-4" C/1 w NOTE: THIS PROJECT WILL HAVE ( 14 ) CANADIA SOLAR 250 WATT PV MODULE PANELS WITH A KW OUTPUT OF 3.5 KW �'� "•••.� ''�. SOLAR PANEL LAYOUT SOUTH EAST ROOF `°r.UAZ • cZ� SCALE 3/16"=1'-0" �W•N •�� '''''ffffllillllll+�� im No. SITE MAP GENERAL NOTES 2014--SO336 1. SOLAR PANELS WILL BE (36) CANADIAN SOLAR 250 WATT PV MODULES AND (1) SAMIL POWER SolarRiver 760OTL-US INVERTER. 2. PROVIDE A.C. DISCONNECT: CUTLER HAMMER DG221VRB-3OA GENERAL DUTY SAFETY SWITCH, NON FUSIBLE, 24OVAC. NEMA 3R. 0 t� 3. THE AC DISCONNECT WILL BE LABELED AS "UTILITY DISCONNECT AND Z Q PHOTOVOLTAIC SYSTEM LOCK-OUT" LOCATED WITHIN VIEW OF THE ELECTRIC z Z UTILITY METER. 0I 4. IF IT IS NOT PRACTICAL TO LOCATE THE AC DISCONNECT WITHIN VIEW OF s (5 THE UTILITY METER, THEN A WEATHERPROOF PLAQUE SHOWING THE LOCATION Lu Q OF THE SWITCH MUST BE INSTALLED WITHIN VIEW OF THE ELECTRIC UTILITY � a METER. F U) 5. ALL WIRING TO MEET THE NATIONAL ELECTRICAL CODE. m TO SUP. PPORRTT THE RS AS ADIDEDCLOAD OFVTHE SOLAR PANELS AND CONNECTORS.BEEN ANALYZED AND DEEMED CIENT \ J Q _j 7. THE SOLAR PANELS MAY NOT BE INSTALLED ON AN EXISTING ROOF THAT C R 4 8 N 0 R T H R 0 A D HAS MORE THAN 1 LAYERS OF SUPPORT ARE PROM SPHALT ROOFER SHINGLES DRAWINGS.NL SS ADEQUATE (� z QMEANS OF Q w 8. THE MAXIMUM SPACING BETWEEN THE STANDOFFS SHALL BE 66" O.C. .-..I w 9. THE SOLAR PANEL MOUNTING SYSTEM WILL BE BY UNIRAC WITH A 2 1/2" W W W N Q I•••r ALUMINUM "I" BEAM. Q Z U Q Lo 179.85 z xy ZONING INFORMATION ° CL JQ < FRAME �r -�942'00" W WQ = � SHED SHED Lu STREET ADDRESS: 2810 WESTPHALIA ROAD � C) 2 C)O MATTITUCK, NY 1 1952 W (n L i Q SECTION: 114 BLOCK: 7 LOT ( S ): 5.2Q O W Z Z ,� LINE DIAGRAM ct -J I 0 Uj aZoY p_ r- 90 40.0' Lo STRING 1 ( CONNECTED TO PV MODULES ) (n W 0 < O IOCCUPANCY OR n N13.4 A� z STRING 2 ( CONNECTED TO PV MODULES ) a Q- N UNLAWFUL RESIDENCE I J 3 O ui �JSEISU � wo ,� Q _ WITHOUT CERTIFICATE °: . 0 16.6' Q � �'`" O 4 I OF OCCUPANCY w. S°LAR y° EXISTING 760OTL-US EXISTING 200 AMP INVERTER a N ~ METER PANEL IN DCW A PR NOTED cn HOUSE DISCONNECT N 82 8 2 INTEGRATED DATE: . � B.P.# W FE gY: 48.4S.t0h E ATTACHMENT DETAIL �� ;.,, ►� 100.00' N 35'07 30" E NOTI Y BUILDING DEPARTMENT AT �; '•.d'p'i., MIO ALUMINUM+P ALLOY VS SOLAR PANEL MODULES • �� 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: COI, L`T' �'a'!=H ;ALL CODES OF m:u' 1. FOUNDATION - TWO REQUIREDNEW YORK STATE & TOWN CODES a;u' FOR POURED CONCRETEAS REQUIRED A F T-BCLT ALUMINUM VS RAIL BY UNIRAC 2. ROUGH - FRAMING & PLUMBING LF00T ALUMINUM ALLOY ALUMINUM ALLOY STA14DOFF ''�.,�(��•.^ •`P``�`` 3. INSULATION SB n ASPHALT QJICK MOUNT PV FLASHING '���,���••••••• ``��`` 4. FINAL - CONSTRUCTION MUST ROOF SHINGLE ARD BE COMPLETE FOR C.O. - � ALL CONSTRUCTION SHALL MEET THE �� SGLM = TEES EXISTING ROOF REQUIREMENTS OF THE CODES OF NEW �y��� SHEATHING i ,'- --' EXISTING ROOF RAFTER 1 BOLTS INTO ENTERZINC OFPLATED LAG YORK STATE. NOT RESPONSIBLE FOR —"` " `� `- RAFTER DESIGN OR CONSTRUCTION ERRORS. JOB NO. 2014-SO336 OJTLINE OF ROOF LCCATION OF SOLAR PANELS-----,,,, THESE DRAWING HAVE BEEN DESIGNED IN NOTE: ALL ROOF MOUNTING 18" MINIMUM ACCESS PATH ACCORDANCE WITH THE (AF & PA) WOOD BRACKETS SHALL BE PROPERLY PROVIDED ON ADJACENT ROOF /; / y Z FRAME CONST. MANUAL FOR ONE AND TWO SECURED TO A ROOF RAFTER. j Lu FAMILY DWELLINGS. `- - - - - - - - - - - - - - - a Q J a' THESE DRAWING COMPLY WITH THE THE ACTUAL IN-FIELD ATTACHMENT TO Q 2010 NEW YORK STATE RESIDENTIAL THE ROOF WILL MEET OR EXCEED NYS � BUILDING CODE. RESIDENTIAL CODE REQUIREMENTS z N Z Q w N _j 0 O ROOF PLAN/PANEL LOCATION z w N of � x SCALE 1/16"=i'-0" Z J 0) W Q o1:CANADIAN SOLAR 250W SOLAR MODULES �: 9 2" X 4" COLLAR TIES @ 48" O.C.—I LLJ 2" X 8" ROOF RAFTER' @ 16" O.C. (j 0 cr W Z U V) ALUMINUM STANDOFF AND L-FOOT CLIP LAG BOLTED TO RAFTER 27 v z O U ALUMINUM SUPPORT (n LIJ r- :D C 0 RAIL BY UNIRAC >-m o N EXISTING ASPHALT ROOF SHINGLES Z � �a 0 (MAX 1 LAYERS) ON 15 BUILDING 0� PAPER ON 1/2" PLYWOOD SHEATHING ----- --- - p (L LL 0 �2 0_ w ----- ����luulu►rgr�� �•ZJ.L • m•WS • , • .' N.Z� d•N v ''lf,-o rr►►IIlls% ROOF CROSS SECTION SCALE 3/8"=V-0" Joe No. 2014-SO336 o 0) V) 4'-0" 5'-4" 10'-8" 4'-0" 4'-0" 4'-0" (N Z 0 < 0 Lu W 7 Ld (N c) < Lo �4- OF ROOF :z,—O(-ITLINE CL Z :] (3) Lj < ALUMINUM "L" FOOT <, LAG BOLTED TO RAFTER -i ALL.) r 0 V) V) Ld 0 CANDAIAN SOLAR 250W SOLAR MODULES vi Q z y w :D z 0 Q) 2 1/2" ALUMINUM Y) Lj T-- 0 _---SLPPORT BEAM 0 CL co f- -j 04 Ld o z 0 i: < < C/) 0- C/1 NOTE: THIS PROJECT WILL HAVE 22 CANADIA SOLAR 250 WATT PV MODULE PANELS WTH A KW OUTPUT OF 5.5 KW ) AND ( 1 ) SAMIL POWER SolarRiver 7/ 600TL—US INVERTER ;011 .0 SOLAR PANEL LAYOUT SOUTH EAST ROOF SCALE 3/16"=1'-0" Eq:—, C-4:Z uls