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HomeMy WebLinkAbout38396-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 37362 Date: THIS CERTIFIES that the building SOLAR PANEL Location of Property: 875 Ackerly Pd Ln, Southold, 1/8/2015 1/8/2015 SCTM #: 473889 Sec/Block/Lot: 69.-5-13.3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/16/2013 pursuant to which Building Permit No. 38396 dated 10/9/2013 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: ROOF MOUNTED SOLAR PANELS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Young, Randy (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 38396 12-10-2013 PLUMBERS CERTIFICATION DATED Authorized Signature Permit-#: 38396 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) Permission. is hereby granted to: Young, Randy 875 Ackerly Pond Rd Southold. NY 11971 Date: 10/9/2013 To: install a roof mounted electric Solar Panel system as applied for At premises located at: 875 Ackerly Pd Ln, Southold SCTM # 473889 Sec/Block/Lot # 69.-5-13.3 Pursuant to application dated 9/16/2013 and approved by the Building Inspector. To expire on 4/10/2015. Fees: SOLAR PANELS $50.00 CO - ALTERATION TO DWELLING $50.00 ELECTRIC $100.00 Total: $200.00 Building In*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: V Old or Pre-existing Building: (check one) Location of Property: 515 A CIS J c. 'RCGIi17 t.QN s SQdf H9(, D House No. Street Hamlet Owner or Owners of Property: jNN9-(-,0L11JG Suffolk County Tax Map No 1000, Section -e' 0590 Block 01000 Lot DA GM Subdivision Permit No. �5S� Date of Permit. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Filed Map. Lot: Applicant: -At-L 4Rof,4 re Underwriters Approval: Final Certificate: V1 (check one) p ican Signatur Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 roper. richertp_town.so uthold. riy. us BUILDING DEPARTMENT - TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To:_ Randy Young Address: 875 Ackerly Pond Lane -...City: Southold St: NY Zip: - 11971 Building Permit#: 38396 Section: 69 Block: 5 Lot: 13.3 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Tri -Tech Electric East Inc License No: 44137.me Residential X Commerical New: Addition INVENTORY Service Only Pool Hot Tub Garage Service 1 ph 51TE DETAIL5 Duplec Recpt Office Use Only Indoor Basement Outdoor X 1st Floor Renovation 2nd Floor ... Survey Attic INVENTORY Service Only Pool Hot Tub Garage 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 Fixtures.. Time. Clocks Disconnect Switches El Twist Lock Exit Fixtures TVSS .. .other Equipment: 6KW PHOTOVOLTAIC SYSTEM to _include, 24-25OW. Trina panels with micro inverters, 1-100a 4 space subpanel, and PV meter Notes: Inspector Signature: Date: Dec 10 2013 81 -Cert Electrical Compliance Form.xls Optimize Engineering Co., LLC P.O. Box 264•Farmville•VA 23901 Ph: 434.574.6138.E -mail: grichardpe@aol.com Richard B. Gordon, P.E. President December 22, 2014 Town of Southold Building Department Office of Building Inspector Town Hall Annex Southold, NY 11971 CE �I JAN 9 2015 BLDG. DEPT. TONIN Of SOUTHOLD Subject: Solar Panels at Young Residence, 875 Ackerly Pond Road, Southold, NY 11971 SCTM number: 473889 Sec/Block/Lot: 69.-5-13.3 Permit number: 38396 To Whom It May Concern: I certify that the installation of the subject solar panels is in compliance with the current Building Code of New York State, the current Residential Code of New York State, the manufacturer's specifications, and all other relevant codes and standards'. Please contact me if there are any questions or comments about the above. Yours truly, Optimize Engineering Co. LLC -- --- , - -- -------------- Richard - rdon' P New Yo r r.'- P.E. Lic n e o. 079309-1 OF Nei 8.00 y0 r Z # Z ` ' 4U 0�9309'� ?FES S IONS 3g3% �ooq SOUl,�o� � TOWN OF SOUTHOLD BUILDING DEPT: 7e5ne02 QJ/ INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) REMARKS: DATE INSPECTORS TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING D66.RTMENT Do you have or need the following, before applying? TOWN HALL Board of Health SOUTHOLD, NY 1 � 971_ 4' sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.D.'E.C. Trustees ' Flood Permit Examined l 20 !� Storm -Water Assessment Form Contact: Approved %C7 C',20 Mail.to: Disapproved aJc � 1 11V11\r. Expiration Building Inspector ggp 16 2013 PPLICATION FOR BUILDING PERMIT BLDG. DEPT.. Date C(— 1 i 20 TOw�I OF mITHOLD INSTRUCTIONS a. This application MUST be completely filled in by typewfiter�br 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 premise's; relationship to. adjoi 'mg.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, an writing, the extension of the -permit for an addition six months; :Thereafter,.a new permit shall be required. APPLICATION IS HERBllY MADE, to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Orc}irIance of the Town of Soy h6ld;=Suffolk County, New York, -and -othet' applicablelaws„Ordinances or Regulations; -for the'`construction'of build ng' §!;additions, or alterations or _for_remdVaL,or demolition: ae- herein described. The ' applicant agrees to comply with all applicable caws; ordinances; building code, housing code, and regulations, and to' admit authorized inspectors on premises and, in building for necessary inspections. .a 4(SjAnatuFe or name, if a corporation) FUL ¢ I I yy i ('��, I I T I� �'I(�� pip �1p 1 �� c-�_ (Mailing ddress of applicant) State whether applicant is owner -,lessee gen architect, engineer, general contras i� or builder z' A-�� ^mac o/� 3 g P # �' 39-1 Name of owner of premises (As on the tax roll or lat AWd)3UILDING DEPA TMENT AT ' If applicant is a corporation, signature of duly authorized officer 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION -TWO REQUIRED (Name and title of corporate officer) FOR POURED CONCRETE 2. ROUGH - FRAMING, PLUMBING.. '/,'N Builders. License No. �����' STRAPPING, ELECTRIC”; CA ' Plumbers License No. '�" _ — i. INSULATION Electricians License No. 4. FINAL - CONSTRUCTION & ELEC i ;,CAL Other Trade's License No. MUST.BE COMPLETE FOR C 0. ALL'CONSTRUCTIONSHALL _MEET THE " 1. Location of land on which proposed work will be done: REQUIREMENTS OF THE CSDES FOR NOT RESPONSIBLE FOR 815 � .� 3DAi meq' R Tq�E. � �- AIAG �t"iaQtSISTRI-jSTION ERRORS .Street House Numberer Ham,.7. County Tax Map No. 1000 Section Block (' Lot Subdivision Filed Map No. Lot &11drrm i ..I YOM" N'"PC-CTI, bN jZ.0-Czg] 2. State existing use and,occupancy.,of premises and intended use and occupancy of proposed construction; . a. Existing use and.occupancy OrAS 5�`JL% D &Y- 4 b. Intended use and occupancy 3. Nature of -work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work 152LAP . -4?4ti!-U" (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 r--- 6. If business, commercial or mixed occupancy, specify nature and extent of each type -of use. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories' Dimensions of same structure with alterations`or additions: Front _ Rear Depth Height — Number of Stories 8:- Dimensions of entire new construction: Front Rear Depth ^ Height, Number.of Stories. '77 Size.of lot: Front 164. RSRear, 1 `j4..4 0, Depth, JC S G5 10. Date of Purchase y' Name tof Former Owner 11. Zone,or.use.district in which premises are situated, -p 12. Does proposed,construction violate any zoning law, .ordinance,or regulation? YES:::. ;NO ,✓. ; 13. Will lot hie re -graded? YES " NO t/Will excess fill be'removed-from 'premise`s? YES" NO ,/ .;t 14. Names of Owner remises �a1Ji Address �i5 P ne No. �kS—tea Name of .Address ' B& ,%4 T.A"1LJ ne No 5'!4jS 1 AS Name of Contractor �a4 :. Address 16_90_4NpO CZ - Phone.No 15 a. Is this property. within 100 feet of a tidal wetland or a freshwater wetland? *YES NO ✓ * IF YES, SOUTHOLD TOWN TRUSTEES::&-1RPERMITS MAY BE REQUIRED. b. Is thus 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'aiid 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. d STATE OF NEW YORK) SS: COUNTY OF �. � � ,'� being duly sworn; deposes aiid`says that (s)he is the'applicant (Name of individual signing contract) above named, (S)He is the (Contractor, ge t, Corporate Officer, etc.); ofsaid owner or owners, and is. duly authorizW to perform or have peifoinied the said "work? and. to 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. Swopo before -met / day of �. 20/� NAMY L :. Notary PublicN w�g2jaw 81 ignature f App ' t &alffiad In Nassau Cotr*v Town Hatt Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 i C 10 Telephone (531) 765-1802 rogerricheritwn 1) 7V Bua DING DEPAWMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION QUESTED BY. _,QAC, IF - Date: npany Name: ` oiAP. DDD jt ne: mse No.: 1G6 (-l-I- Iress: t CC t ane No.: JOBSITE INFORMATION: (*Indicates required information) *Name: *Address: *Cross Street: *Phone No.: Permit No.: Tax -Map District: —1 1--115 1000 _ Section: Block: -0ji2Q� Lot:gjd *BRIEF DESCRIPTION OF WORK (Please Print Clearly) _ tn4�fAct�. SCL ?Ar,11�aA . api (Please Circle All That APpiy) 'is job ready for inspection: YES/ NO. Rough In Fina 'Do -you need a Temp Certificate:YES! NO rernp 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 kdditional Information: PAYMENT DUE WITH APPLICATION BMequest for Inspection Form Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 December 19, 2013 Randy Young 875 Ackerly Pond Rd Southold, NY 11971 BUILDING DEPARTMENT TOWN OF SOUTHOLD TO WHOM IT MAY CONCERN: Telephone (631) 765-1802 Fax(631)765-9502 The Following Items (if Checked) Are Needed To Complete Your Certificate of Occupancy: "Note: Certification required from an Architect or Engineer certifying the panels were installed per NYS Code 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: BP 38396 — Solar Panels Optimize Engineering Co., LLC P.O. Box 264•Farmville•VA 23901 Ph: 434.574.6138•E -mail: grichardpe@aol.com Richard B. Gordon, P.E. President September 27, 2013 Southold Building Department Southold, NY Re: Solar Electric Panels Roof Structural Framing Support To Whom It May Concern: I hereby certify that I am a Licensed Professional Engineer in the State of New York. Please note the following conclusions regarding framing structure, roof loading, and photovoltaic system size and proposed site location of installation: 1. Existinq roof framing: Conventional framing 2x6 16" o.c. 11'-11" span (horizontal rafter projection). This existing structure is definitely capable to support all of the loads that are indicated below for this photovoltaic project. 2. Roof Loadinq • 4.33 psf dead load (modules plus all mounting hardware) • 17.5 psf snow live load (25 psf ground snow live load reference) • 1.5 psf roof materials • Exposure Category B, 120 mph wind uplift live load of 21.34 psf (wind resistance) 3. Solar Photovoltaic System size: 6 kw and 24 Trina 250 Watt Modules 4. Address of proposed installation: Residence of Randy Young, 875 Ackerly Pond Lane, Southold, NY 11971 This installation design will be in general conformance to the manufacturer's specifications, and is in compliance with all applicable laws, codes, and ordinances, and specifically, International Residential Code/ IRC 2009, 2010 Building Code of NY, 2011 NEC, and 2009 ICC Energy Code. The spacing of the UniRac mounting brackets ANCHORAGE/FASTENING of the brackets is at a maximum of 64" o.c. along the rail and using 5/16" x 3 %" length lag bolts, min. 2 per rafter & min. 2" penetration, which is adequate to resist all 115 mph wind live loads including wind shear, to mount rails to rafters while alternating mounting feet between adjacent rafters between rail rows for better distribution of roof load. Rails may be attached to either of two mounting holes in the L -feet. Mounting in the lower hole for a low profile, more aesthetically pleasing installation or mount in the upper hole for a higher profile to maximize airflow under the modules to cool them more. Slide the 3/8 -inch mounting bolts into the footing bolt slots. The rails will be attached to the footings with the flange nuts. Please also note the following: A. The Design Criteria for the Town of Southold is in conformance with the RC301.1 or ASCE 7, as per referenced standards. Wind speed design is 120 mph. B. The mounting brackets and hardware meet or exceed NYS Code requirements for the design criteria for the Town of Southold. C. The actual in -field attachment to the roof will meet or exceed NYS Residential Code requirements. D. The installation must comply with RM2301.2.1 through RM2301.2.9. Very truly yours, E OF NF �. Q\G,rPRD B O O nO M / Z Z U),. / 0 9 ,9309-1 O�FS810 C � U E OCT - 7 2013 BLDG. DEPT. TOWN Of SOUTHOLD -bearer is duly licensed by the T_Countyof Suffolk Cliffordd-Coleman D1—wr SUFFOLK COUNTY DEPARTMENT_ n;: r-6mRIIIRAPR flFFAN?C HOME IMPROVEMENT CONTRACTOR LICENSE NAME KENNETH SANGER - GU81NE98 NAME SOLAR DAD AND SONS INC Lfanna Number Dato laauatl 47061-H O7J04/2010 EVIRA'RDN DATE 02101/2014 ° NW YORK STATE,-' Colrlot of Molor Vohlcl a _ _... - ... - ; IM ``60 377 9721 -'_CLASS DM' . . BANGER ' y' ` _ •, 4CENNETH,A1 r ; { 3 iB.BELINDA CT` zITHTOWN; NY 11767 DOB'. 1121=,68 ' stn_ ,SEX. M EYES Hsi HT B=00 E: NONE R:- NONE I -17 ISSUED 11 09-09' EXPIRES 1 t-21 •,ZMTNMW1 , New York State Insurance Fund Workers' Compensation & Disability Benef cts Specialists Since 1914 8 CORPORATE CENTER DR, 3RD FLR, MELVILLE, NEW YORK 11747-3129 Phone: (631) 756-4300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A ^AAA ^ 262772072 SOLAR DAD AND SONS INC 16 BELINDA CT SMITHTOWN NY 11787 POLICYHOLDER SOLAR DAD AND SONS INC 16 BELINDA CT SMITHTOWN NY 11787 CERTIFICATE HOLDER TOWN OF SOUTHOLD TOWN HALL ANNEX BUILDING 54375 ROUTE 25 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE 12186126-5 480926 01/31/2013 TO 01/31/2014 3/28/2013 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2186126-5 UNTIL 01/31/2014, 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 01/31/2014 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. KENNETH SANGER (PRESIDENT) AND DEBBIE SANGER (VICE PRESIDENT) OF A TWO PERSON CORPORATION 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.nysitcom/cerYcertval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 1036884417 U-26.3 ACORO® CERTIFICATE OF LIABILITY INSURANCE `, /DD/Y 3/28/ D/28/ 20133 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(S), 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 tpe 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 Integrated Brokerage Services, Inc. 255 Grand Blvd P.O. Box 958 Westbury NY 11590 CONTACT Mary Ostaseski . (516) 997-2900 FAX No: (516)997-2910 E-MAILRESS• � ma oibsinsurance.com ADD INSURERS) AFFORDING COVERAGE NAIC # INSURERA:The Burlington Insurance Co. 23620 INSURED Solar Dad And Sons Inc. 16 Belinda Ct Smithtown NY 11787-5155 INSURERB:State Insurance Fund INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:I2GLCOI 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. INSR LTR TYPE OF INSURANCE ADD SUER POLICY NUMBER MMIDDY EFF MMIDD EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEFx OCCUR 54375 Route 25 AUTHORIZED REPRESENTATIVE RGL0032448 0/4/2012 0/4/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 2, 000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COJECT MBINED SINGLE LIMIT Ea .cadent $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Peracadent UMBRELLA LIAB EXCESS LIAR —d OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE 0 OFFICERIMEMBER EXCWDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 1861265 /31/2012 /31/2013 WC STATU- 10TH TOR LIMITER L EACH ACCIDENT $ 100,000 EL DISEASE -EA EMPLOnq $ 100,000 EL DISEASE -POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The Certificate Holder is included as -in Additional Insured ATIMA. CFRTIFICOTF FInU nFR CANCELLATION ACORD 25 (2010/05) INS025 (2oloos).o1 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Southold Town Sall Annex Building 54375 Route 25 AUTHORIZED REPRESENTATIVE P.O. Box 1179 Southold, NY 11971 - Mary Ostaseski/MO ACORD 25 (2010/05) INS025 (2oloos).o1 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier 1a. Legal Name and Address of Insured (Use street address only) 1b. Business Telephone Number of Insured SOLAR DAD AND SONS INC 631-265-9489 1c. NYS Unemployment Insurance Employer Registration 16 BELINDA COURT Number of Insured SMITHTOWN, NY 11787 1d. Federal Employer Identification Number of Insured or Social Security Number 262772072 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": Town Hall Annex Building DBL341839 54375 Route 25 3c. Policy effective period: P.O. Box 1179 06/30/2012 to 06/29/2014 Southold, NY 11971 4. PoI icy covers: a. LJ Al I of the employer's employees eligible under the New York Disability Benefits Law b. r] Only the following class or classes of the employer's employees: Under penalty of pe jury, 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. 3/28/2013 wid B By Date Signed s (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Title Chief Executive Officer IMPORTANT: If box "4a" is checked, and this form is signed bythe 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. 8 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 Law 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) IT FROM -GROUND LEVEL TO PEAK: OF ROOF .1 - SMA 6000 INVERTER LOCATED INSIDE. PRODUCTION METER LOCATED NEXT TO EXISTING METER METER LOCATION ,ELECT..PANEL LOCATION (INSIDE:.13ASEMEN71) ROOF I BUILDING ORIENTATION = 209* ROOF PITCH (PANEL AREA) =20* A - RELOCATE SATELLITE DISH (A m BACK SITE LOCATION Project Title: RANDY YOUNG 67.5,ACI<ERLY POND LANE SOUTHOLD, NY 11971 PROPOSEDB.OkW I SOLAR SYSTEM Dfdvving Date, 8/26/2013 Drawn. By: ¢ MLH Checked By. GAP Revised By. ,Scale. KT.S IDON LL 0 m 0 cc — CV) CO Total Panel 05unt: 24 4- C5 Panels Used: TRINA.260w 11\ Pape] Spec TSIA-250,PCIPAOS.08 Utility Cqmpany: LIPA NS Ac6ount,Ntimber. X9634319901 Rev. No. Sheet 0- 2211 Allenwood Road Wall, New Jersey 07719 u OLAR " 877-797-2978 www1rinity-Sular.com �O,aa 03 6W-5�0 /, p�owro 9�=N-A M y \0 Qp O�O NO *` d i � 'C3 Cn .-� 9.3 N� M <OrnM A0m N CD to cQ. 40 `Q n ® ( o z �- CD n Cn Modules to be mounted flat on roof 24 - 25OW Trina Modules PA05.08 2 strings of 12 modules - 544.32V Max 11.12 ADC Max per string 1 Array Existing 200A 120/240V 10 Main Breaker Loadeenter Install 2p40A Solar Breaker NEG 690.64 (B) 1 EMT 2- #8 THWN-2 2'- #10 THWN-2 Trina 25OW modules "—I 8.2A �VmP 30,5V __.�. 8.9A Inverters to be located inside #8 AWG Bare Copper Bond to rails and Modules 1" EMT 2- #8 THWN-2 2- #10 THWN-2 1" EMT 4 - #10 THWN-2 1 - #8 THWN-2 f 110> 2211 Allenwood Rd. SMATeChnologles 6.0 KW Solar System sunny W ��y Wall, 1V) 077.19 SOLAR TEL. 732-780-3779 6000W inverter ZSOW Trina modules 2 strings -of 12 modules FAX. 732-780-6671 Southold, NY 11971 PA05.n Date:8/26/13 Infernal Ground Faun Protetttan IMP =16.4A sash DC LIMP - 366V Dlxa i VOC - 544.32V - ISC - 22.25A f 110> 2211 Allenwood Rd. CUSTOMER: Randy Young 6.0 KW Solar System Electrical One Line Diagram ��y Wall, 1V) 077.19 SOLAR TEL. 732-780-3779 875 Ackeriy Pond Lane24- ZSOW Trina modules Revision No. 00 FAX. 732-780-6671 Southold, NY 11971 PA05.n Date:8/26/13 Account# 2013-23736 Drawn By: Ml_H jE1'(4j1T FROM GROUND LEVEL TO PEAK OF ROOF rIONIMETER t EXISTING ME LOCATION PANEL -1-0 tE BASIEME1 SITE LOCATION SITE issued !' i�ew�isioras No. Descrlpfiofl Date Orientation - j 4, Rev. No: Sheet A SOLAR 2211 Allemwootl Road 377-797-2.9718 Wall, Nom? jer6ev 07719 PLoLmt Title:: RANDY YOUNG Project Address: 875 A, CKERLY POND LANE SOUTHOLD,34Y-11971 Drawinq Title; 77 PROPOSED 6.0,kW SOLAR SYSTEM Drawing Iriformation bravving bate: .91101.2013 Drawn By: klLH ChocKed By: GAP Revisor! By. GAP O�A N.T.S 0 System Information:cq a CY) 0 U)U) Total System Size- 6kW 0 n 0) Total Panel Count: 24 ds o 0 Panels Used TRINA 250w yi7j Q' Panel Spec, TS 1%I - 2- 5p, p CIPP Ac 5.0 Utility Cxmpany? LIPA LICENS Account Number, 963431%01 Rev. No: Sheet A SOLAR 2211 Allemwootl Road 377-797-2.9718 Wall, Nom? jer6ev 07719 n I qq ModulesAo be=.mounted flat on roof 24 - 250WisiTrina Modules TSM -250 PC/PA05.08 I Array Q) C CO Qp 0 0 0 :3 -0 Cn =t -n 3 CD M M - E7 = CO (a 0 =3 CD X N) CD CD CD ra % M C) C/) 0 CD - r 0 r - CD C-) Cn .2A 37 SV ijj Existing 2COA 1ZOIZ40V 10 Main Breaker it Loaftenter Install 2p3OA Solar Breaker NEC 690.64(8) Inverters to be locaLed an roof under solar modules V EMT 4 - `10 THWN-2 Enphase M-215 Micro inverters M215-60-2LL-S22IS23 - - - — - - - - - - - - R6V trf iffikg #8 Bare C000er Bonding Conductor Factory Installed wires to be connected to junction box ----------------------------------------------------------------------- ------------- - — --------- — ----------------------------- — _- — --- -- --__- 1,OOA, Main 4 -space SQMain Lug Subpane! SOLAR 2 - 2p15A Breakers PRC quitTm V EP IT METER 6- J 10 TWHN I - #8 THWN-2 V E11T 4 - #'10 THNNN-2 I I" EMT 6-#IOTWHN I - #8 THWN-2 A- 6 THWN-2 GEC To Existing Grounding electrode CUSTOMER: Electrical One Line Diagram 2-211 Allenwood Rd. Randy Young 6 KW Solar System Revision No. 01 Wall, NJ 07719 875 Ackerly Pond Lane 24- 25OW Trina modules Date- 9/1.0/13 SGLA TEL. 732-780-3779 Southold, NY 11971 TSM-2.50PC/PA05.08 FA:<. 732-780-6671 Account -re : 2013-28736 GAP I 5PI, am - - - — - - - - - - - - R6V trf iffikg #8 Bare C000er Bonding Conductor Factory Installed wires to be connected to junction box ----------------------------------------------------------------------- ------------- - — --------- — ----------------------------- — _- — --- -- --__- 1,OOA, Main 4 -space SQMain Lug Subpane! SOLAR 2 - 2p15A Breakers PRC quitTm V EP IT METER 6- J 10 TWHN I - #8 THWN-2 V E11T 4 - #'10 THNNN-2 I I" EMT 6-#IOTWHN I - #8 THWN-2 A- 6 THWN-2 GEC To Existing Grounding electrode CUSTOMER: Electrical One Line Diagram 2-211 Allenwood Rd. Randy Young 6 KW Solar System Revision No. 01 Wall, NJ 07719 875 Ackerly Pond Lane 24- 25OW Trina modules Date- 9/1.0/13 SGLA TEL. 732-780-3779 Southold, NY 11971 TSM-2.50PC/PA05.08 FA:<. 732-780-6671 Account -re : 2013-28736 GAP I a Module can bear snow loads up to 540OPa and wind loads up to 240OPa Guaranteed power output 0-+3% High performance under low light conditions Cloudy nays, mornings and evenings Independently certified by international certification bodies Manufactured according to International Quality and Environment Management System Standards IS09001, IS014001 TSM-PC05A / TSM-PA05A THE Honey MODULE T40 iin-asolar The power behind The pr -A ELECTRICAL DATA @STC i TSM445 ` TSM -250 TSTA -255 i TSM -260 PC/PQ05A PC/PQOSR (PCjPA05A PCJPA05A Values at Standard Test Conditions STC (Air Mass AM1.5, Irrodiance 1000W/m=, Cell Temperature 25°C). ELECTRICAL DATA @ PIOCi I TSM -245 TSM -250 1 TSTA -255 TSM -260 i PC/PAOSA PC/PA05R PCjPA05A PCjPA05A NOCT: Irradiance, at 800W/m2, Ambient Temperature 20-C, Wind Speed I M/s. TEMPERATURE RATINGS WARRANTY (Please refer to product warranty for details) PACKAGING CONFIGURATIOW MAXIMUM RATINGS CAUTION: READ SAFETY AND IPISIALLATION INSTRUCTIONS BEFORE USING T HE PRODUCT. 0201 Trina Solar Umited. All rights reserved. Specifications included in this dotasheet are subject to change Without notice. H n t a i Coxa' •�S w F., N".'25 � y �jP �' y4'gs 'f -� �^ ^ !�' ,� `rte h�i � rr� p �'� y.. }� f` t a raT i x 1 } t Y7 : i, g J � �.) wJ "x n' r�'•,r ` rte 00uerj 8•sem i ,:,rlS SUNNY BOY 500®US/600®US/700®US / 800®US The best in their class Our US series inverters utilize our proven technology and are designed specifically to meet IEEE -1547 requirements. Sunny Boy 6000US, Sunny Boy 7000US and Sunny Boy 8000US are also compatible with the Sunny Tower. Increased efficiency means better performance and shorter payback periods. All four models are field -configurable for positive ground systems making them more versatile than ever. Throughout the world, Sunny Boy is the benchmark for PV inverter performance and reliability. Technical Data Fierenry Uw 250 V DC u' -310V0 ! ,.V UN 680 V DC- 8. 1,Doq%}``.'i'`<�7;]a➢0`�S.i :::::: �3IJ3U'4'<' .'iU00;F::' :3rrUu¢:i "> c6i7W%r ' �20Q7?. Tel. +1 916 625 0870 Toll Free +1 888 4 SMA► USA www.SMA-America.com SMA America, LLC The Enphase Energy Microinverter System improves energy harvest, increases reliability, and dramatically simplifies design, installation and management of solar power systems. The Enphase System includes the microinverter, the Envoy Communications Gateway, and Enlighten, Enphase's monitoring and analysis software. pjJ �; SEP 2 0 2013 11 - Maximum energy production P R O DU C T I V E - Resilient to dust, debris and shading - Performance monitoring per module - System availability greater RELiABL; than 99.8% - No single point of system failure - Quick and simple design, installation SMART and management - 24/7 monitoring and analysis S A F E _ Low voltage DC Reduced fire risk M215 MICROINVERTER TECHNICAL DATA IWA Owfi, - Recommended input power (STC) 190 - 26OW Maximum input DC voltage 45V Peak power tracking voltage 22V -36V Operating range 16V - 36V Min./Max. start voltage 22V/45V Max. DC short circuit current 15A Max. input current 10.5A �1-40 M" Maximum output power 215W 215W Nominal output current 1.OA (arms at nominal duration) 0.9A (arms at nominal duration) Nominal voltage/range 208W183 -229V 24OV/211-264V Extended voltage/range 208W179 -232V 24OV/206-269V Nominal frequency/range 60.0/59.3-60.5 Hz 60.0159.3-60.5 Hz Extended frequency range 60.0/59.2-60.6 Hz 60.0/59.2-60.6 Hz Power Factor >0.95 >0.95 Maximum units per 20A branch circuit 25 (three phase) 17 (single phase) Maximum output fault current 1.05 Arms, over 3 cycles; 25.2 Apeak, 1 74m duration 01 N 15. IN - 0, "VE Ow FIND— a -, 711 - ON" I NO b. CEC weighted efficiency 96.0% Peak inverter efficiency 96.3% Static MPPT efficiency (weighted, reference EN50530) 99.6% Dynamic MPPT efficiency (fast irradiation changes, reference EN50530) 99.3% Nighttime power consumption 46mW TMV I ME Ambient temperature range -40°C to + 650C Operating temperature range (internal) -40°C to + 850C Dimensions (WxHxD) 17.3 cm x 16.4 cm x 2.5 cm (6.8" x 6.45" x 1.0")* Weight 1.6 kg (3.5 lbs) Cooling Natural convection - No fans Enclosure environmental rating Outdoor - N EMA 6 without mounting bracket 0 I A � i KOW WIN a - +'-- WE, Compatibility Pairs with most 60 -cell PV modules Communication Power line Warranty 25 -year limited warranty 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 Enphase Energy, Inc. 201 1 st Street Petaluma, CA 94952 Phone: 877-797-4743 Fax: 707-763-0784 142-00010 Rev 03