SOLAR-0080-2022 ni
Office Use Only
4 f'• Permit#: �-' ODSfl
? n '
_ Permit Fee:$
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.oueensbury.net Invoice#:
Flood Zone? Y N Reviewed By:
SOLAR PANEL PERMIT APPLICATION
SITE INFORMATION:
Project Location: 11 Linette Lane
Tax Map ID#: 308.10-1 -33 Subdivision Name:
PROJECT INFORMATION:
Re ' ntial:Q Commercial Other:
L_v_ISingle Family
Multi-Family
Are the solar panels? 0✓ Purchased Leased
Estimated cost of construction: $37,540.00
Total System Capacitv Rating (sum of all panels):
Solar PV System: 13,6 kW DC
Select System Configuration:
Supply side connection with micro inverters E f E WJ cam,
X
Supply side connection with DC optimizers
�� 07
� �
Supply side connection with string inverter
X TOWN OF QUEENSBURY
Load side connection with DC optimizers BUILDING&CODES
Load side connection with micro inverters
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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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,100%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 above:
See attached
Homeowner's Signature --� �;�� Date
3/2/2022
Solar Co. Representative Signature Date
Solar Panel Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Property Owner(s):
Name(s): Christina Gow
Mailing Address, C/S/Z: 11 Linette Lane,Queensbury,, NY 12804
Cell Phone:_(518 ) 221-3396 Land Line:_( )
Email:
• Solar Contractor:
Workers' Comp documentation must be submitted with this application
Business Name: Kasselman Solar,LLC
Contact Name: Loreen Harvey
Mailing Address, C/S/Z: 279 Broadway bldg 2,Menands,NY 12204
Cell Phone:_(518 )478-3906 Land Line:_( )
Email:LHarvey@kasselmansolar.com
• Electrical Contractor:
Workers' Comp documentation must be submitted with this application
Business Name: Kasselman Solar,LLC
Contact Name: Ernesto(Gino)Cimmino
Mailing Address, C/S/Z: 279 Broadway bldg 2,Menands,NY 12204
Cell Phone:_( 518 )368-3196 Land Line:_( )
Email:ginoc@kasselmansolar.com
Contact Person for Compliance in regards to this project: Loreen Harvey
Cell Phone: ( 518 )478-3906 Land Line: J )
Email:LHarvey@kasselmansolar.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
DocuSign Envelope ID:F2B3468A-AD4E-4E76-99F1-F8FAA4423966
279 Broadway
-.
.. Building#2
�.k+�`SS.eI��:nL Menands,NY12204
(518)-478-8365
(518)-953-1095 Fax
Christina Gow (Customer)hereby authorize Kasselman Solar LLC,to act
as customer,agent&contractor,and to submit all necessary permit applications and supporting
documents to the Town Building Department on my behalf.
Christina Gow
Customer Name(Print)
C DocuSigned by:
ustori'i"YSiVffi'ture
11 Linette Lane Queensbury NY 12804
Customer Address
Queensbury
Municipality that issues your Building Permit
DItf,11ti��1led fly:
Ka IfflRf ISt5lbffmployee Signature