application E C IE 0 V E Office Use Only
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.. f{ SEP 17 2020 Permit#: 501A-11, o
42=b Fee: $ 6:0
TOWN OF QUEENSBURY 2q
742 Bay Road,Queensbury,NY 12804 BUILDING&CODES Invoice#: - /
P:518-761-8256 www.oueensbury.net
SOLAR PANEL PERMIT APPLICATIO.4
• Property Owner(s):
Name(s): ) )\(-- -k "SejkloPirMailing Address, C/S/Z: \ ` jO 2 Yt M_LS 7�2 Qt16605 , AJ 'f 12_0'-(
Cell Phone: (31-( q-) 2 - Land Line: ( )_Email: c_Gi_v C_Ctru.,
Project Address:
Section Block Lot: 3OW " t — ar.) —
Existing Use: .Single Family ❑ 2-4 Family ❑ Commercial ❑ Oth. .r: __
® Solar Contractor:
Workers' Comp documentation must be submitted with this 3pplicatior
Business Name: ?\LA J (PV,
Contact Name: Q , s ��U
Mailing Address, C/S/Z: pzOwiow 5t I 11:2-0R
Cell Phone:_( t ,�(c-( ) QL-17- (p Land Line:_(3( ) `3-7,- -Q(qa X/G'-
Email: 7 LOGO A LSkrl t9L.0 er crkl. CCAAA
• Electrical Contractor: ✓
Workers' Comp documentation must be submitted with this ,ipp,'ication
Business Name: (PV. LL.C, _-- _
A n
Contact Name: -\ck2 \t' �e,
Mailing Address, C/S/Z: `top� � ,br�c V1k,
Cell Phone: _(51 Y ) L(4l -C� '5� 1 I Lana Line: _( ' _
Email: irYl C_ArYla @C kit_9 ptz.CGW\. - _ —
Contact Person for Building & Code Compliance: 00 "cv✓
Cell Phone: ( ) Land Line:
Email:
Solar Panel Application Re%.i:ed March 2 )19
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Estimated cost of construction: $ t S Ls . CO
Are the solar panels? % Purchased ❑ Leased
Total System Capacity Rating (sum of all panels):
Solar PV System: 10. kW DC
Select System Configuration:
❑ Supply side connection with micro inverters _
XiSupply 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.
a ,
- : 5 {
Homeowner's Signature Cate
Solar C epresenta ive Signature Date
Solar Panel Application "'` Revised March:c 019
DocuSign Envelope ID:F11FF6D5-FB1E-493B-9089-44DO4
(518)948 5316 l
��-yy //^^�� SEP 17 2020 HELLO@PLUGPV.COM
�U`7 P V HTTPS://WWW.PLUGPV.COM
r 33 riRDBORO AVENUE ALBANY, NY 12205 8
TOWN OF QUEENSBURY
BUILDING&CODES
LETTER OF AUTHORIZATION FOR ZONING AND PERMIT APPLICATION
To Whom It May Concern: •
I, Erika Miller as owner(s)of the property located at
71 Burnt Hills Dr Lot 36, Queensbury, NY 12804
•
Hereby designate PlugPV, LLC. as my contractor and registered agent for the purposes of the applying
for Permits and Zoning Board representation regarding my solar installation project.
Print Erika Miller
1.n.a3
ignedby.
Sign I`-
b89w6s8CAu44/h...
Date 8/26/2020