application TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: SOLAR-0316-2019
Tax Map No: 302.14-3-6
Permission is hereby granted to: MICHAEL HOFFMAN
For property located at: 27 LINDEN AVE
In the Town of Queensbury,to construct or place at the above location in accordance with application together
with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
Type of Construction
Owner Name: MICHAEL HOFFMAN Solar Panel-Residential $111000.00
Owner Address: 27 Linden AVE Total Value $111000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Solar Liberty Energy Systems Inc
6500 Sheridan DR, Suite 120
Buffalo,NY 14221
Plans&Specifications
Roof-mounted solar panel installation(3.924 kW DC)
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday, May 20, 2020
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury; Tuesday, May 21, 2019
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
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Office Use Only
Permit#: —O 51
-t..; Fee:$
742 Bay Road,Queensbury,NY 12804 Invoice#: k
P:518-761-8256 www.queensbury.net
SOLAR PANEL PERMIT APPLICATION
• Property Owner(s):
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Name(s): Michael Hoffman III w1TT.,
Mailing Address, C/S/Z: 27 Linden Ave. Queensbur NY 12804f y r Ulf J j
Cell Phone: ( ) 518 793 0345 Land Line:_( TeVvro oF m ,�-c1`1
Email: hoffmk@roadrunner.com �_� BUILDING � r"'Y 1
Project Address: 27 Linden Ave. Queensbury, NY 12804
Section Block Lot:
Existing Use: Ll Single Family ❑ 2-4 Family ❑ Commercial ❑ Other:
• Solar Contractor:
Workers' Comp documentation must be submitted with this application
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:
Workers' Comp documentation must be submitted with this application
Business Name:
Contact Name:
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line:_(
Email:
Contact Person for Building & Code Compliance: _
Cell Phone: ( ) Land Line: (
Email:
Solar Panel Application Revised February 2019
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Estimated cost of construction: $ 11,000
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.
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Michael D Hoffman(May 14.2019) May 14,2019
Homeowner's Signature Date
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Solar Co. Rep esentative Signature Date
Solar Panel Application Revised February 2019