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TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 128 or: IL DING&CODES
P:518-761-8256 wwwu
.aeen _..._,. Invoice#: �Z22-
SOLAR PANEL PERMIT APPLICATION
• Property Owner(s):
Name(s): RusseV '\ct1\ 4 e
Mailing Address, C/S/Z: J I Avx-W CO N
Cell Phone: _ISM ) 7O S �� Q�e�6�c?ry i N� tZ$Oy
w\ Land Line: ( )
Email:
Project Address: t iv\kmH,y C,cU1A t (.. V S + NN ', O�
Section Block Lot: '� .\\ —'— , O Y
Existing Use: GA-Single Family 0 2-4 Family 0 Commercial 0 Other:
• Solar Contractor:
Business Name: oy‘ C,6y/v ivN
Contact Name: ;ec 5. l
Mailing Address, C/S/Z: 13 �` Q n
Cell Phone:_(2�(S ) 372.-3��� t�Land �� n�� '2,�7Z,
Line:
Email: tee • ��;', d a ( {Jb ) 't,
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• Electrical Contractor:
Business Name: cuv\ C.ohAn1,c).,,
Contact Name:CALLS U:ItiyS ), I O p "Lam- u
Mailing Address, C/S/Z: ( U lz. . , ? b JQ`u/ "
Cell P one:_($4s 7Z
) � .- �- � � ` Z-S�Z-
2utf' $g Land Line: (1/46 ) (CSZ- ?,6 51, 3C it(
Email:
Contact Person for Building & Code Compliance: Le-a_ epic 161.-ccA.
Cell Phone: ( ) Land Line:
Email:
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Solar Panel Application
Revised December 2017
January 24, 2019
Russell Flansburg
1 Anthony Court
Queensbury NY 12804
Dear SunCommon,
I hereby authorize you to apply for a building permit on my behalf,for the purpose of
installing a solar electric system at my property located at:
1 Anthony Court Queensbury NY 12804
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Russell=lansburg(Jan 25,2019)
Russell Flansburg
Property Owner(s)
Estimated cost of construction: $ U $ UCH • 00
Total System Capacity Rating (sum of all panels):
Solar PV System: \•3o3 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
dLoad 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.
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Homeowner's Signature Date
2C1 IS
Solar Co. Rep _n a ve Signature Date
Solar Panel Application Revised December 2017