SOLAR-0023-2024 Office Use Only
Permit#: �L cQ- - OOZS- 2024).
Permit Fee:$ �� — 1
742 Bay Road,Queensbury, NY 12804
P:518-761-8256 www.queensbury.net Invoice#:
Flood Zone? Y Reviewed BY 2_4." J
SOLAR PANEL PERMIT APPLICATION
SITE INFORMATION:
Project Location: 17 Oaktree Circle, Queensbury, NY, 12804
Tax Map ID#: 302.17-2-35 Subdivision Name:
PROJECT INFORMATION:
JZJ.Residential: ❑ Commercial n Other:
()Single Family
°Multi-Family
Are the solar panels? @` Purchased ❑ Leased
nRoof-mounted n Ground-mounted
Estimated cost of construction: $ 29,700.00
Total System Capacity Rating (sum of all panels):
Solar PV System: 9.03 kW DC
Select System Configuration:
Supply side connection with micro inverters
nSupply side connection with DC optimizers
�allos2_ o
Supply side connection with string inverter _
TOWN O llE.ENSBURY
❑ Load side connection with DC optimizers BUIP!?INN Ct
e�. `-' �s +.ems..":DES
nLoad side connection with micro inverters
Load side connection with string inverter
Solar Panel Application Revised March 2022
f
DECLARATION:
1. I 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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. If the work is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
4. I 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 Act as Agent Form
Homeowner's Signature Date
/d� 12-27-23
Solar Co. Representative Signature Date
Solar Panel Application Revised March 2022
r
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Property Owner(s):
Name(s): Russell Pittenger
Mailing Address, C/S/Z: 17 Oaktree Circle,Queensbury, NY, 12804
Cell Phone: (518 )320-2898 Land Line: _(
Email:russpittenger@gmail.com
• Solar Contractor:
Workers' Comp documentation must be submitted with this application
Business Name: Apex Energy Tek LLC
Contact Name: Richard Christine
Mailing Address, C/S/Z: 64 Main St.Queensbury NY 12804
Cell Phone: (518 )415-55-11 Land Line:_(
Email:permitting@apexsolarpower.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.Compliance in regards to this project: Richard Christine
Cell Phone: ( ) Land Line: ( )
Email:permitting@apexsolarpower.com
Solar Panel Application Revised March 2022
• � •
11
..•.•:••••:•... apexenergytek
AUTHORIZATION
FORM
"TO ACT AS AGENT FOR"
I, Russell Pittenger owner of the premises located
at: 17 Oaktree Circle Town ofQueensbury
Tax Parcel #302-17-2-35
hereby designate: Apex Solar Power
as my AGENT regarding my Permit Application
for: installation of residential PV system
Dec 20 2023 09:26 EST Pussell 'riRenger Sger gag HER
Date Signature