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RC-000507-2016 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 — Community Development-Building&Codes (518)761-8256 CERTIFICATE OF COMPLIANCE Permit Number: RC-000507-2016 Date Issued: Friday, September 16,2016 This is to certify that work requested to be done as shown by Permit Number RC-000507-2016 has been completed. Tax Map Number: 301.13-1-6 Location: 605 WEST MOUNTAIN RD Owner: DENNIS DALY Applicant: PosiGen Solar This structure may be occupied as a: Solar Panel System No Rafter Upgrades By Order of Town Board TOWN OF QUEENSSBUR/YY Issuance of this Certificate of Compliance DOES NOT relieve the �J �,dproperty owner of the responsibility for compliance with Site Plan, ���� Y Variance,or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY x 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building& Codes (518)761-8256 BUILDING PERMIT Permit Number: RC-000507-2016 Tax Map No: 301.13-1-6 Permission is hereby granted to: PosiGen Solar,DENNIS DALY For property located at: 605 WEST MOUNTAIN RD In the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance Tvne of Construction Owner Name: DENNIS DALY Single Family-Alteration $12,480.00 Owner Address: 605 W Mountain RD Total Value $12,480.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical inspection Agency PosiGen Solar I IA Solar DR Halfmoon,NY 12065 Plans&Specifications Solar Panel System No Rafter Upgrades $30,00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,July 31,2017 (if a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town of Q ensbu day, gu SIGNED BY: j 277the Town of Queensbury. Director of Building&Code Enforcement PRINCIPAL STRUCTURE APPLICATION office Use Only Received Date: �1//1�� L) _ Tax Map ID Tax Map ID _ Permit No. `50-+- z p L(P Permit Fee EX2) Zone Rec Fee rlvm i ts3 . 8!1$_ Historic Site Yes No Site Plan# Subdivision Name Lot# Subdivision# Project Locations S yj Ak .a-, TOWN BD. RESOLUT10N 86-2013: $850 recreation fee for new dwelling units—single family, duplexes/two-family, multiple family,apartments,condominiums,townhouses,and/or manufactured&modular homes, but not mobile homes. This Is in addition to the permit fee(s). Applicant p I Owner Address Address f `1 Phone/E-mail �' l ' i 4 Phone/E-mail 4.tu'139 tic( 01'1 t Contact Person for Building&Codes Compliance: ha�,r� L v\5 s: t r Phone L56) 77::x-1 .�L 1 TYPE OF CONSTRUCTION *'Check all that apply Nein Addition Alteration 1 a floor sf 20d floor sf Total sf Height Single Family Two-Family Multi-Family (#of units _} Townhouse ; 11 Business office Retail-Mercantile Factory-Industrial Attached Garage (1, 2, 3, 4+) Other PIQ7, ' P� L� 1 c. If commercial or industrial please indicate of business Town of Queensbury Building&Codes Principal Structure Application Revised September 2015 Proposed use of building or addition (Dp .o V 5u, Source of Heat(circle one) Gas OR Propane Solar Other Fireplace: Complete a separate application for Fuel Burning Appliances&Chimneys Are there structures not shown on plot plan? Are there easements on the property? Site Information a. Dimensions or acreage of lot b. Is this a corner lot? c. Will the grade be changed as a result of construction Yes No d. Public water or Private well e. Sewer or Private Septic System Value of all work to be performed(labor or materials) $ �I ,DECU"7 M 1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12 month period. 2. If work is not complete by the 1 year expiration date the permit may be renewed, subject to fees and . department approval. 3. I certify that the application,plans and supporting materials are a true and complete statement/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 4. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of occupancy. 5. I also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance of a certificate of occupancy. I have read and agree to the above: PRINT NAME: _ v ;�, t-- w�S ' fir' DATE: ! SIGNATURE: DATE: i For office use only Operating Permit Issued: Yes No Occupancy Type Construction Classification Assembly Occupancy Limit Special Conditions Town of Queensbury Building&Codes Principal Structure Application Revised September 2015 DocuSign Envelope ID:3272D3B2-12B8-4DE6-AC19-CBBD6B39OOA3 301.13-1-6 RC-000507.2016 Daly, Dennis Pos i G e n 605 West Mountain Road 14 =�r.,�: , f3:;i��, Solar Panel System AUTHORIZATION FORM TOWN OF CUEENSSURY BUILDING DEPARTMENT Based on our limited examination,Compliance with our comments sl;iii xot he construed as indicaVog the dans and %P-Cifitcations are in full compli3nCe with the wilding Godes of New York State. "T© ACT AS AGENT F. O " Ro BUILDING �UEENSgt}RY RevieWe CCPD S PT. Y� Date: Dennis K Daly ? owner of the premises located at: 605 W Mountain Rd Queensbury WAR �y Caunty,IVY , NY 12804 ,Tax Parcel #, 101.13-1-6 hereby designate PosiGen New York, LLC and/or its subcontractors as my AGENT regarding my Permit Application for PV Solar System Install D" afgnedby; Signature: "/t,l AAI S � Va� AUG 0 3 2% Ev0748801E43F9424... Date: 6/29/2016 111:06:13 AM CDT C N N01 to U1 0 ON ` L) R (Ljj J] rn -c m Ch .� Gi ryl 00 0 10 7 cq C 4 nein _ tU eo w C co � "u ; T- r CO O T- N 0. Q } ro n �0 ` m z -2 _0 Y � ii 7 fu rt) ffl O co ZN ltl 5 Q 0, cj (xZ W 46'6 0.6 ctrl 46'6t, WOL LO cci �Z'i�Z cc�i o � ut7Z 331VIO 06 Ir- h��6y Z 3s r o 00 Cb 0 o QL't7Z U {Sly X ryD iI w �J rl n `� U7 N N � ftp. N f1 C7 >— Ch r � f7D Ln ": E Sll M U) N fV W V ! ` CL I d o 20 ) © vl 5 sfC N CO MO U Lo �° ° - - ❑ sn t. d m 4 an 00 co P ov r0. P sn c M ` m a o © toz ra � LE aQ i OE > z 1p ILI i f y, Lf t i •�.r�� a f' t I . UTAH OFFICES SanyTCTC Lc�yt��,yto n n G n E E R s St. George Project Number: U 1900-0626-161 July 25,2016 PosiGen 997 Central Avenue Albany,NY 12205 A`1717ENTION: Madlin Rivera REFERENCE: Dennis Daley Residence:605 West Mountain Road,Queenshury,NV 12804 Solar Panel Installation Dear]vis"Rivera: Per your request, we have reviewed the attached layout and photos relating to the installation of solar panels at the above-referenced site.The following materials and components are proposed in the installation ofthe solar panels, Roofstructurc supporting,the proposed panels:2x6 Manufactured trusses a 24 in o.c. Root`material•Composite shingles Recommended attachment spacing:48 in o.c. Based upon our review,it is our conclusion that the installation of solar panels on this existing roof will not adversely affect the structure of this house.The design of solar panel supporting members and connections is by the manufacturer and/or installer. The adopted building code in this jurisdiction is the 2010 Building Code of New York State and ASCE 7-05. Appropriate design parameters which must be used in the design of the supporting members and connections are listed below. Please verify these parameters with the local building department. Ground snow load:50 psf Design wind speed:90 mph(3-sec gust) Wind exposure:Category C Our conclusion regarding the adequacy ofthe existing roof is based on the fact that the additional weight ofthe solar panels is less than 3 pounds per square toot,In the area ofthe solar panels,no 20 psf live loads will be present per Section 1607,12.5.3 ofthe International Building Code.2015 Edition.Regarding snow loads,it is our conclusion that since the panels are slippery and dark,effective snow loads will likely be reduced in the areas ofthe panels. Solar panels will be flush-mounted,parallel to and no more than 6"above the roof surface.Thus,it is our conclusion that any additional wind or seismic loading related to the addition of solar panels is negligible. Luring design and installation,particular attention must be paid to the maximum allowable spacing of attachments and die location of solar panels relative to roof edges. The use of solar panel support span tables provided by the manufacturer is allowed only where the building type, site conditions, and solar panel configuration match the description of the span tables. Attachments to existing roof trusses or rafters are designed by others and must be staggered so as not to overload any existing structural member. Waterproofing around the roof penetrations is the responsibility of others. Electrical engineering is beyond our scope. All work performed must be in accordance with accepted industry-wide methods and applicable safety standards. Vector Structural Engineering assumes no responsibility for improper installation ofthe solar panels. Please note that a representative of Vector Structural Engineering has not physically observed the rool"lfuming. Our conclusions are based upon the assumption that all structural roof components and other supporting elements are in good condition, fiee of damage and deterioration,and are sized and spaced such that they can resist standard roof loads. Very truly yours, VECTOR STRUCTURAL ENGINEERING.LLC �Q� NEy.C9 New York COA:0012807 / eye, V. H04� W f/ to z J � Wells i..Holmes.P.E. �FQ 0901161 tc,= Project Engineer pROFESSN07/25/2016 WLH/dgd 9138 S. State St.. 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O O 7xl4 r-I Z .--I r-I 0 co It w Yt 2t J r 00) Q co r � r �• STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS'COMPENSATION INSURANCE COVERAGE Is.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured PosiGen New York 997 Central Avenue {504) 835-2510 Albany, NY 12205 lc.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only requiredifcoverageisspeciJlcally Id.Federal Employer Identification Number of Insured limlted to certain locations in New York State, ie., a Wrap-Up or Social Security Number Policy) 901030545 2.Name and Address of the Entity Requesting Proof of 3a. Name of insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) New York Marine & General Insurance Compari 3b.Policy Number of entity listed In box uta" WC201500009680 Town of Queensbury 742 Bay Road 3c. Policy effective period 9/4/2015 9/4/2016 Queensbury, NY 12804 to 1 3d. The Proprietor,Partners or Executive Officers are Included. (Only check box If all partnersloMeers Inctuded) X all excluded or certay kparMerAlOffit�ded. This certifies that the insurance carrier indicated above in box"3" insures lite business referenced above in box"la" for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)mustbe fisted under Item 3 on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"211. i 7lre Insurance Carrier will also notify the above certiflcate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premlums that cancel the policy or eliminate the insured from the coverage indkated on this Cert ylcate. (These notices may besent by regular mall.) Otherwise,this Certificate is valid far ane year after this form Is approved by the Insurance carrier or Its Ucensed agent,or until the policy expiration date listed In boat 113c",whichever Is earlier. Please Note:Upon the cancellation of the workers' compensation policy Indicated on this form,if the business continues to be named an a porm%license or contract Issued by a certificate holder,the business must provide that certificate holder with a now Certificate of Workers'Compensation Coverage or other authorized proof that the business Is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certifythat I am an authorized representative or licensed agent of the Insurance carrier referenced above and that the named Insured h`ass theCcoverage as de icted on this fo nu. Approved by: h t' 1 JN a LAe --� (Print name ofu horirxd rap agnl orliccnsc E bcmorimuu�m cc carrior) Approved by: /�4CJA�J-r � 5 � (sig�natlure) Title: _� ' C�+��w -�r -- Telephone Number of authorized representative or licensed agent of insurance carrier: "J �3 5 3 L j 7�\/ Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. insurance brokers are NOT authorized to issue it. C-105.2(9-07) www.wcb.state.ny.us STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disabili Benefits Carrier or Licensed Insurance Agent of that Carrier Ia. Legal Name and Address of Insured(Use street address only) Ib.Business Telephone Number of Insured 504-293-5469 POSIGEN NEW YORK,LLC DBA POSIGEN SOLAR 1 c.NYS Unemployment Insurance Employer Registration SOLUTIONS 997 CENTRAL AVE. Number of Insured ALBANY,NY 12205 5123979 Id.Federal Employer Identification Number of Insured or Social Security Number 901030545 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) HARTFORD LIFE AND ACCIDENT Town of Queensbury 3b.Policy Number of entity listed In box"I a": 742 Bay Road Queensbury, NY 12804 LNY818030 3c. Policy effective period: 01-01-2016 to 12.31-2016 4.Policy covers: a.m All of the employer's employees eligible under the New York Disability Benefits Law b.QOnly the following class or classes of the employer's employees: Under penalty of penury,I certify that l am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. 01-05-2016 e.1A -r.,e.0 Date Signed By (Signature of insurance carrier's authorized representative or NYS Licensed Insunmot Agent ofthat insuranoe carrier) Telephone Number (800)454-7020 Tide_Mmmr- IMPORTANT: If box"40 Is checked,and this form is signed by the Insurance carrier's authorind representative or NYS Licensed Insurance Agent or that carrier,this certificate Is COMPLETE. Mail It directly to the certificate holder. If box"4b"is checked,this certificate is NOT COMPLETE thr purposes ofSecdon 220,Subd.8 orthe Disability Benefits Law.It most be mailed Por completion to the Workers'Compensation board,DB Plains Acceptance bait,20 Park Street,Albany,New York 12207. PART 2. To be completed by NYS Workers'Compensation Board(Only if box"4b"of Part 1 has been checked State Of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed By (Signature ofNYS Workers'Compensation Board Employee) Telephone Number Tide Please Note:Only Insurance carriers licensed to write NNS duabillty henef is insurance policies and NYS licensed Insurance agents of those insurance carriers are authorized to issue Form D8-120.1. Insumnce brokers are NOT artthodzed to tone this fortis: DB-120.1(5-06) -� POSIG-1 OP 10:SP �-RL7► CERTIFICATE OF LIABILITY INSURANCE FDATE TE(MMI2 6) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: M the certificate holder Is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endomemen s. aaoDUcai CONTACT Certificate Department Legacy Risk 8,Insurance Svcs PHONE .926-4824000 aC No;928-4824001 CA Liconse#OH66768 1860 Mt.Diablo Blvd,Ste#400 ADDRESS:Walnut Creek,CA 84696 ;certificates !e ac risk.net Chris Lang,CPCU,ARM INSURER(S)AFFORDING COVERAGE _ _NAIC b INSURER A:Lloyd's of London INSURED POSIGen,Inc INSURERS: _ &Related Entities —_-- 2424 Edenbom Ave#660 INSURER C: — Metairie,LA 70001 INSURER D; INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR POLICY am TYPE OF INSURANCE POLICY NUMBER 0AM1001YIrm LIMITS A X cOMMERc1AL GENERAL untuTY EACH OCCURRENCE 5 16,000,00 CLAIMS-MADE a OCCUR X 01641$1301 0aM112016 0611112017 PREMISES(Ea ocarca ce 5 1,000,00 X $26.000 DedtOee MED EXP(Any one person) S 10,00 PERSONAL&ADV INJURY S 16,000,00 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 16,000,00 X POLICY D JEICT M LOC PRODUCTS-GOMPIOPAGO S 16,000,00 OTHER S NED SINGLE COMatLIMIT S AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ AAL ED SSCHrEEDDULED BODILY INJURY(Per aoddent) S WNED HIREDAUTOS AAUUTOS Persocidett 5 S UMBRELLA LIAS OCCUR EACH OCCURRENCE $ -- MICESS LIAB CLAIMS-MADE AGGREGATE DEC) I I RETENTION S S WORKERS COMPENSATION I STATUTE ER AND EMPLOYERS'LIABILITY `- ANY PROPRIETORIPARTNERIEXECUTiVE YIN NIA E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (VAndatory In NH) E.L.DISEASE-EA EMPLOYE S _ U yyaaae describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES(ACORO ia1,Additional Remarks Schedule,may be a tached it more space Is required) Subject to all policy terms limitations and conditions. Certificate Holder is Additional Insured when required by written contract CERTIFICATE HOLDER CANCELLATION TOWNOFQ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Queensbury 742 Bay Road AUTHORIZED REPRESENTATIVE Queensbury,NY 12804 4'1 @ 1888-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD