application t -
Office Use Only
1114,
Permit#: c�OLAQ, pAZ.9t• 7at�
Fee: $ 2Oa
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.queensbury.net
SOLAR PANEL PERMIT APPLICATION
• Property Owner(s):
Name(s): John DeCola
Mailing Address, C/S/Z: 1875 Bay Road Lake George, NY 12845
Cell Phone: _( ) Land Line: ( )
Email:
Project Address: 1875 Bay Road Lake George, NY 12845
Section Block Lot: 252.-1-47
Existing Use: 8 Single Family ❑ 2-4 Family ❑ Commercial ❑ Ott JUN 21 2019 sJ
• Solar Contractor: T OWN OF OUEENSBURY
BUILDING&CODES
Business Name: Kasselman Solar —
Contact Name: Scott Stevens
Mailing Address, C/S/Z: 20 Walker Way, Albany, NY 12205
Cell Phone: (518 )703-0976 Land Line: _(
Email:scott.stevens@kasselmansolar.com
• Electrical Contractor:
Business Name: Kasselman Solar
Contact Name: Gino Cimmino
Mailing Address, C/S/Z: 20 Walker Way, Albany, NY 12205
Cell Phone: _(518 )368-3196 Land Line: _(
Email:
Contact Person for Building & Code Compliance: Scott Stevens
Cell Phone: ( 518 ) 703-0976 Land Line: (
Email: scott.stevens@kasselmansolar.com
Solar Panel Application Revised December 2017
bocuSign`Envelope ID:37C7333E-A5B1-4ADD-B79C-84716F1BDE69
20 Walker Way
'��• kasselmansoLAR Colonie, NY 12205
(518)-478-8365
This letter herebyauthorizes Kasselman Solar LLC,to act as John Deco1 a
(customer) agent
&contractor. I further authorize Kasselman Solar LLC,to submit my building permit application to the
necessary town building department.
Customer Name(print) John Decol a
Customer Signature gi Oyt
1875 Bay Rd, Lake George, NY 12845
Customer Address
Queensbury
Town
Kasselman Solar Employee Signature �, y�