application „---00-00k
Office Use Only
•
Permit#: Q.-. A 6 . 242
Fee:
742 Bay Road,Queensbury, NY 12804 Invoice#: 0(31QA
P:518-761-8256 www.queensbury.net CEOWEI
SOL 1103E RMIT LIGATION
SEP272018
• Property Owner(s): I TOWN OF QUEENSBURY
BUILDING&CODES
Name(s): Michael Marsh
Mailing Address, C/S/Z: 39 Meadow Drive Queensbury. NY 12804
Cell Phone: _( ) 765 418 7026 Land Line: _( )
Email: mhm@purdue.edu
Project Address: 39 Meadow Drive Queensbury, NY 12804
Section Block Lot: 297.17-1-28
Existing Use: ® Single Family ❑ 2-4 Family ❑ Commercial ❑ Other:
• Solar Contractor:
Business Name: Solar Liberty Energy Systems, Inc.
Contact Name: Kelli Wilson
Mailing Address, C/S/Z: 6500 Sheridan Drive Suite 120 Buffalo, NY 14221
Cell Phone: _( ) Land Line: _( ) 716 634 3780
Email: kelli.wilson@solarliberty.com
• Electrical Contractor:
Business Name:
Contact Name:
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
Contact Person for Building & Code Compliance: Kelli Wilson
Cell Phone: ( ) „ Land Line: { ) 716 634 3780
Email: kelli.wilson@solarliberty.com
Solar Panel Application Revised December 2017
Estimated cost of construction: $ 1-kt,00
Total System Capacity Rating (sum of all panels):
Solar PV System: 2 . I b kW DC
Select System Configuration:
ICI Supply side connection with micro inverters
O Supply side connection with DC optimizers
O Supply side connection with string inverter
O Load side connection with DC optimizers
O Load side connection with micro inverters
O Load side connection with string inverter
Please sign below to affirm that all answers are correct and that you have met all the
conditions and requirements to submit a unified solar permit.
michael marsh(Sep 21,2018) Sep 21,2018
Homeowner's Signature Date
¶2I ( 3
-
41 ( 3
Solar Co. Repr:sentative Signature Date
Solar Panel Application Revised December 2017