application Office Use Only
Permit#: `�l.� ?,QA,c)
Fee: $ /VJ
742 Bay Road, Queensbury, NY 12804 Invoice #:
P:518-761-8256 www.queensbury.net
SOLAR PANEL PERMIT APPLICATION
• Property Owner(s):
Name(s): Elaine Sharp
Mailing Address, C/S/Z: 141 Montray Road Queensbury, NY 12804
Cell Phone: _( ) 518 256 9966 Land Line: _(
Email: elaine sharp ny( gmail cnm
Project Address: 141 Montray Road Queensbury, NY 12804
Section Block Lot: 296.13-1-52
Existing Use: l I 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: D E C EE 0 V E
Contact Name: JAN 14 2019
Mailing Address, C/S/Z:
Cell Phone: _( ) Landrb Q QUEEN.SBURY
Email: BUILDING&CODES
Contact Person for Building & Code Compliance:
Cell Phone: ( ) Land Line: (
Email:
Solar Panel Application Revised December 2017
Estimated cost of construction: $ 10,791
Total System Capacity Rating (sum of all panels):
Solar PV System: 3.924 kW DC
Select System Configuration:
❑ Supply side connection with micro inverters
❑ Supply side connection with DC optimizers
❑ Supply side connection with string inverter
❑ Load side connection with DC optimizers
® Load side connection with micro inverters
❑ 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.
OGa/fie Sat, Jan 3 2019
Elaine Sharp(Jan 3,201
Homeowner's Signature Date
I/9 I
Solar C entative Signature Date
Solar Panel Application Revised December 2017