Application Office Use Onlv
Permit#:
Permit Fee: $ 85 l
742 Bay Road,Queensbury, NY 12804
P:518-761-8256 www.gueensbury.net Invoice#: ✓ l
Flood Zone? Y N Reviewed By:
SOLAR PANEL PERMIT APPLICATION
SITE INFORMATION:
Project Location: 20 Ridgewood Ct Lot 4
Tax Map ID#: 266.3-1.73.4 Subdivision Name:
PROJECT INFORMATION:
Residential: Commercial Other:
Single Family x
Multi-Family
Are the solar panels? X Purchased _ Leased
Estimated cost of construction: $15,055.00
Total System Capacity Rating (sum of all panels):
Solar PV System: 12.24 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
X Load side connection with string inverter
Solar Panel Application Revised January 2021
DECLARATION:
1. 1 acknowledge that no construction shall be commenced prior to the issuance of a valid permit and will be
completed within a 12 month period.Any changes to the approved plans prior to/during construction will
require the submittal of amended plans,additional reviews and re-approval.
2. If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of
Queensbury.After 1 year from the initial application date, 1005"o of the fee is retained.
3. Ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
4. 1 certify that the application, plans and supporting materials are a true and a complete statement and/or
description of the work proposed,that all work will be performed in accordance with the NYS Building Codes,local
building laws and ordinances, and in conformance with local zoning regulations.
5. A third-party electrical inspection will be completed at which time the Town of Queensbury's Building and Codes
Enforcement department will be contacted to complete an inspection of the final installation of the solar panels.
Please sign below to affirm that all answers are correct and that you have met all of the conditions and
requirements to submit a unified solar permit.
I have read and agree to the abovi4:
Homeowner' Signature Date
Solar Co epresent ive Signature Date
Solar Panel Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Property Owner(s):
Name(s): Chris Patten
Mailing Address, C/S/Z: 20 Ridgewood Ct Lot 4
Cell Phone: _(518 )796-4654 Land Line: _( ) _
Email: patten84@gamil.com
• Solar Contractor:
Workers' Comp documentation must be submitted with this application
Business Name: Tesla Energy Operations
Contact Name: Amy Keyser
Mailing Address, C/S/Z: 326 Old Niskayuna Rd, Latham NY 12110
Cell Phone: _( 518-)390-5527 Land Line: _( )
Email:
• Electrical Contractor:
Workers' Comp documentation must be submitted with this application
Business Name: Tesla Energy Operations
Contact Name: Kenneth Tiffany
Mailing Address, C/S/Z: 326 Old Niskayuna Rd, Latham NY 12110
Cell Phone: _( 518�.764-886 Land Line: _(__)
Email:
Contact Person for Compliance in regards to this project: Amy Keyser
Cell Phone: ( ) 518-390-5527 Land Line: �)
Email: akeyser@tesla.com
Solar Panel Application Revised January 2021
PLEASE INCLUDE WITH YOUR SUBMITTAL:
1. Completed Solar Panel Installation permit application
THREE (3) COPIES OF THE FOLLOWING:
2. Signed and stamped architect or engineer solar plans, which include:
a. Design/snow load
b. Letter indicating rafters can handle additional load of solar panels and snow
c. Proper setbacks from ridgeline for Fire Department access
d. Rapid Shutdown
3. Plot plan indicating proposed structure to hold solar panels
ADDITIONAL IMPORTANT INFORMATION:
1. Any changes to the approved plans prior to or during construction will require the submittal of
amended plans, additional reviews and re-approval.
2. If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the
Town of Queensbury. After 1 year from the initial application date, 100% of the fee is retained.
Solar Panel Application Revised January 2021
OWNER AUTHORIZATION
Job#: F"A 086 80�I 1
Property Address: i� t� L dq eu(XX� C , Gw Oet �b wy, nr 9 10t 6 4
I PATTE&1 as Owner of the subject
property hereby authorize 1E— ENERGY OPERATIONS INC.to act on my
behalf,in all matters relative to work authorized by this building permit application.
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Signature of Owner: late:
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