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HomeMy WebLinkAboutBP22-183PERMIT #o8ZDc— /Q DATE: 9 3o` 4 IXP: *3 SECTION BLOCK / LOT OTHER APPROVALS TYPE OF WOR �l JOB LOCATION o /PAloa ARB�/h OWNER P� 0Q/ QscA) ZMV7VUS -e .60 j Lr i4 )1 v%may �rrus1/ 017lig-,el;l BOT CONTRACT OF� O) ,�� {:��7�71,� t /t���[.� (QLI%�' G33 �US�PQS ZBA EST. COST ;� i FEE �' c� ,,�tt '�' J `� 3g Q � OTHER ✓�O # FEE4� DATE 4 # FEE DATE INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING CI RGH PLUMBING GAS O SPRINKLER ELECTRIC LOW -VOLT 0 ALARM m AS BUILT CI FINAL •�/ne�o�'t:o d5 /�1.�nlObN%P���O✓ �GZT7o/1 SyS> S DRn'1. t` W uJJ v G GSA VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE April 22,2025 The Jody D Rasch Living Trust The Ann Parkin Living Trust Jody D Rasch&Ann Parkin as Trustees 25 Hillandale Road Rye Brook,New York 10573 Re: 25 Hillandale Road, Rye Brook,New York 10573 Parcel ID#: 135.28-1-32 Building Permit#22-183 issued on 9/30/2022 for a Rooftop Solar Array This certifies that the rooftop solar array,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to —a Ire r•_ D D -� Rom' For office us onl p? BUILD EPARTMENT PERMIT MAR — 6 2025 VIL OF RYE B OK ISSUED: — ct-c�a- 938 KING STRE YE BROOK,> uv YORK 10573 DATE: VILLAGE OF RYE BROOK 939-0668 J/ FEE: ��� Q r PAIDAt BUILDING DEPARTMENT w ---o kyy-gov APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION ##tt4###t########i################iii#ii4##ii######iirtrtrt###rt#rt#rt##rt#####rt##rt#########ii#####i#######ii######iii■#i###i#t##### Address: Occupancy/Use: Parcel ID#: 3 J, Zone: Owner: IN A) P19J, i AJ Address: 06 &Q O' P.E./R.A. or Contractor: 4 0,AJ POI&uj� GofiZ Address: Person in responsible charge: Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: /1/�l ��/U� being duly sworn,deposes and says that he/she resides at ,.gfjl (Print Name of Applicant) (No.and Street) in F,!Z �jR�b�f L_ ,in the County of _ VJ-F,:�Te—JtF:�,j�_ in the State of ,that (Cityrrown/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fie s,and including the monetary value of any materials and labor which may have been donated gratis was:$ 2 for the construction or alteration of: .C F'—r0 ' <.5c1'� Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this t7 Sworn to before me this day of G�S'�%� , 20,�E day of , 20 Signature of Property Owner yjQ�,� 1 Signature of Applicant ��>� p!r. &-M m ame of Property Owner L\ Print Name of Applicant Notary Public SHARI MEULLO Notary Public Notary Public,State of New York No.01ME6160063 Qualified In Westchester Coun��jj'� 6/I ao2a Commission Expires January 29,20- �yE BRC�v� 1982 BUILDING DEPARTMENT AS VILDING INSPECTOR SISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET - RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : 2.S H/ C Z DATE: 7- 2 0 ZS PERMIT# �J� 2 Z ISSUED:�' l?_SECT: 13X, , BLOCK: / LOT:-3Z- LOCATION: ^ m OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 0 ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER --:'p ❑ FINAL PLUMBING / C ` ❑ CROSS CONNECTION FINAL 0 OTHER ZI . oN a S oaw C% QI y �-7 ��' ca ' a" y 1••1 W A. N ) 11 M ! a v y � Np L� q o p �{ 4,0 [ ° 0 Or , w o W � z Z M A o o � v s w � Q O a o q UOzv2. � � xo � V = a � v 1) W vUi � P" oC a. can ,v 3 o p . CY h+l P-i p 0" a N CA a b v w O y Ln UU Q � w W z o A `� � v o q r 14 CU ,� O o g n a u w p; F p wo � N � U W W � p � c x CA u C uz � � o � a rr� a C7 A z O tin Z a O W w : BUILDING DEPARTMENT VILLAGE OF RYE BROOK -D 938 KING STREET RYE BROOK,NY 10573 (9 4)&9-0668 LJUL 1 2022 W roo c.or `- —f VILLAGE OF RYE= BRC FOR OFFICE USE ONLY: (y� Approval Date: SEP 2 2 201 rmit# �� 3 Application# 5 7& a Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: Case# : Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# � Other: Application Fee: Permit Fees: Z APPLICATION TO INSTALL PHOTOVOLTAIC SOLAR ARRAY Application dated: / 'r�1 ' _is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the installation of a Photovoltaic Solar Array as per detailed statement described below. l. Job Address: E till�c�ne�.E�o (ZA. SBL: 115• aw— LL 3�'z �Q5 (Zone: 2 Type,kW&Location of Array, (use additional sheets if necessary): � U a, Q . (J 1 S a la,r - I , �'l 3.Property Owner:�rfz�GY 1 Address:c�� C q{05 Phone#M 14' II -_M'5' Cell# e-mail , 4.Applicant:1,pal4U Y()G- Address: 3 fod 1/1os;� Phone# Cell 11#����� 'p3(Q U e-mai]Mi L,qV I nA Dv�?,i Orr 5. Design Engi neer: �](Wn Address• .ID .J f �n� i 5UQ (A W.Phone# �� I�� T Cell # a-mail j(�T(1(��A VI Qi 1Q 1(I Q QfS.CO►Y7 6. Solar Contractor: f a_- I Address:WEW„)hVZ!?�`[ 1�S(ab' Phone#M)Lpj` -n(P D Cell# e-mail P11'1�llu.61II'Q 7. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: Post-construction: 8. If building is located on a corner lot,which street does it front on: ► �. �� r 9. N.Y.State Construction Classification: od N.Y. State Use Classification: - 10. Construction Type&Location: O Typical Western Lumber Frame;O Timber Frame[TC];O Wood Truss[TT]; O Pre-engineered wood[PW];Located;O Floor Framing[F];O Roof Framing[R];O Floor&Roof Framing[FR]; ther: eoo-� sbti� /`` 11. Number of stories:.- Roof Style: (hip,shed,mansard,etc...) 12. Will a New Roof Be Installed: NoX Yes ❑ (a separate roofing permit is required to re-roof an existing building) 13. Roofing Material&Number of Layers: �S D ►� 8/12/2021 14. Will the proposed project disturb 400 sq.ft. or more of land,or create 400 sq. or more of impervious coverage requiting a Stormwater Management Control Permit as per§217 of Village Code? No: Yes: ❑ Area: 15. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? No: Yes: ❑ (If yes,applicant must submit a Site Plan Application,&provide detailed drawings) 16. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?No: Yes: ❑ (If yes,applicant must submit a Tree Removal Permit Application) �$ 17. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? No: Yes: ❑ Indicate:TIER 1: TIER lI:_TIER III: if yes a IIomc Occupation Pe nit Application is required) 18. What is the total estimated cost of construction: $ 14,6's R • (Note:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be d/onra�ted ratis.If the final cost exceeds the estimated cost,an additional fee will beJrequired prior to issuance of the CIO). 19. Start Date: -�/ dui pZ p2 Completion Date: I d La.> This application must bear the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are nonrefundable. STATE PF NEW YORK,JQPUNTY OF WESTCHESTER ) as: 1, ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of indAridual signing as the applicant) and further star s that(s)he the legal owner of the property to which this application pertains,or that(s)he is the, for the legal owner and is duly authorized to make and file this application, (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention& Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this 110 Sworn to before me this I day of A Od 20 day of Notary Public Notary Public 6�i� Igna%e—of Property Owner Signature of Applicant Print Najak of Property Owner Print Name of Ap licant N*Ury Public-state of Nsw York Melissa Ann Mitchell 2 NO.01OU6350827 NOTARY PUBLIC,STATE OF NEW YORK Qualified In Bronx County Registration No.01MI6420346 MY commission Expires 1112ff4" Qualified in Westchester County Commission Expires August 2,2025 8/12/2021 a ` �������������ii�i��i�i�wEi�. � �r�w� �� �i�#�i�w������i�i� ,•�iT �i��� S` �Es E � 1 O 40 44 4; rA " t °0 Z 61 ena ON x N LL ► ' +r r CA a E `LI C L4r, � o o O e z G x a ►� w �+I00 > z V w cn w � V) C O w A O o tL O c� u z all W Z M ~ x "' o w a < O a H p 5 ;0- w A me A00 � V A N ° z o A u p H " �, a x A w 0. W A N o ° a ,.a � ` p o U w z In z o 2 z o ; � 4 . p CC ENPE dR_nc�: BUILDING iiE RTMENT NOV 2 2 2022 VILLAGE OF RYE BROOK 938 KING STREET RYE BROoX,NY 10573 , VILLAGE OF RYc BROOK (914)939-0668 BUILDING DEPARTMENT www ouk.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: Approval Date: NOV 2 ?�ZZ Permit Fee: $ Approval Signature: Other: Application dated, is hereby m e to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. ZS R 1.Address: (t 1 l e SBL: 'J •2�—1 —3 2- Zone: 2.Property Owner: ` d c f,�1 Address: 25 kii« los-l� Phone#: l q�'T �`� Cell#: email: pm 3.Master Electrician: Address: Lic.#: Phone#: Cell#: V email: Company Name: A(ptr :� QJVQJJ UrnAddress:*0 [�(eL Vl 161%t4 STe iaj 61 1 4.Proposed Electrical Work/Fixture Count: n , n 5.31 Party Electrical Inspection Agency: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Gam_,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of ind idu signning as the applicant)state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the k�, , o 1, for the legal owner and is duly authorized to make and file this application. (indicate architect4ontractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,theO0CA of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this U Sworn Walks day o NtW b t r ,20 12 day of 20 7 Z__ EMILY GUIROA atur of Property Owner otary Public-State of Now York ature of Appli t Nied In Bronx 21 - Q, Qualified in Bronx Count O er Commission Expires 1112 nva'i Print N e licant Notary Pu he � Notary Publ Melissa Ann Mitchell / NOTARY PUBLIC,STATE OF NEW YORK Registration No.01 MI6420346 6/23/2022 Qualified in Westchester County Commission Expires August 2,2025 STATE WIDE INSPECTION SERVICES, INC. Service With Integrity i•• • • SWIS . : APPLICATION •2.7224 1 fax 914.219.1062 1 SWISNYcoml SWISTRAINING.COM Office Use Elect. Permit# C '_ \ Date y c� Bldg Permit# >�> / ` Sq R Plumbing Permit# v Final Certificate# City/Village ' 1 zip 11"z- 1—) Building Dept. County <a Address 1 ) , Cross Street Section Block ' [Lot 3 2 Owner Name/Address(If different than above) C� �( 1 Contact Number ((� ) ❑Basement ❑ Ist FI. ❑2nd Fl. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside 1 tyResidential ❑/Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters #Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect )unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization r ❑ safety Inspection 1,1 ❑Consultation I'�SI (A �'Gl�l l ► l 1 C rV� ��� �C3 r� ie C, o +-IS- (� - iv Nil US � i t w►I lvf 14-e r 2LI G> I U0 P, �Ac, r L 6o,6 Gc AU IE C E �W `LrF-':. ( � 1 G C A ZP b, lc(kKf r R NOV 2 2 2022 > Z Z P-r VILLAGE OF RYE BROOK l � Z 0 i Y C" BUILDING BUILDING DEPARTMENT �f �\J This application is valid for one(1)year from the date received by sWIS.This applicaln is intended to cover the above listed items to be inspected,if at anytime of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address Name License# ( Date Signature Address f l `) ' City/State Zip Code / Y Company ) Phone# 'r! I t 11t `~D State Wide Inspection Services CAC) DEC 13 20223 1080 Main Street Fishkill, NY 12524 aT VILLAGE OF RYE BROOK 845 202-7224 Phone Tb I MuffBUILDING DEPARTMENT 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: SunPower Corporation Systems Jody Rasch Darren Handler 25 Hillandale Road 1414 Harbour Way,Suite 1901 Rye Brook, NY 10573 Richmond,CA 94804 Located at: 25 Hillandale Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 22-284 135.28 32 Certificate Number: 2022-7896 Building Permit Number: BP 22-183 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 25 Hillandale Road, Rye Brook, NY 10573 The Photovoltaic System was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation,as set forth below,was found to be in compliance on the 30th day of November 2022. Name Quantity Rating Circuit Type PV Modules 33 Micro Inverters 33 Load Center 01 100AMP Breaker 01 60AMP Breakers 02 20AM P Breaker 01 15AMP Monitor 01 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. Building Permit Check List&Zoning Analysis tddresg. 1.l.1'''` C_��� - SBL• Zone:t Z-� Use: Z I/S' Const.Type: Other. Submittal Date Z—?—Revisions Submittal Dates: Applicant izA SG t4 Nature of Work t 2-, 2)—? r�? A ke, Reviews:ZBA: PB• BOT• Other. OK ( ( ) FEES:Filing: BP: 7— — C/O: Flood Plane: Legalization ( ) (,"P: Dated: ✓ Notarized: ✓SBL: ✓truss I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review Street Opening. ( ) ( ) ENVIRO: Long. Short Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan Other ( ) ( ) SURVEY:Dated: Current Archival: Sealed. Unacceptable: ( ) ( PLANS:Date Stamped: --,' Sealed: ✓ Copies: � Flectroni� Other. Li( ) ( . cense: Workers Comp: Liability --f—Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated; N/A; (t� ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Pernut N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H W.I.C.:_Battery _Other ( ) ( ) PLUMBING Plans: Permit Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit N/A Other. ( ) ( ) FUEL TANK Plans: Permit Fuel Type: Other ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other: ( ) ( ) BP DENIAL C/O DENIAL LETTER: Other. ( ) ( ) Other. z Zz— (�ARB mtg.date: approval;- %I Z2 notes: ( )ZBA mtg.date: approval:- notes: ( )PB mtg.date: approval;- notes: REQUIRED EXISTING PROPOSED NO APPROVED Am of SEP 2 2 2011 Cirrlr —• F� l Mein C A,cm Cos Ft H/Sb: Sd.H/Sb: spa : &IMP. Hight/Stories: notes: BUILDING DEPARTMENT D � VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 J U L 2 1 2022 1 ID (914)939-0668 VILLAGE OF RYE BROOK w_ w-y ok.oLg BUILDING DEPARTMENT *********************************************************************************************************** ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to 'submit a copy of this check list will be removed from the ARB agenda. Job Address: 0�5 `'�"{`�n3oje' Date of ub ission: Parcel ID#: �j''J, _Zone: �— Proposed Improvement(Describe`in detail):_, lnSfial�O.�l� �� & I a• O�kV`i �1'1('+ t I � APPLICANT CHECK LIST: 1 ,� I � ��� �nSJ_„III MUST BE COMPLETED BY THE APPLICANT R)b� 1"LOV kwe SO L�l l� , U� 3b l The following items must be submitted to the Building 0 io 7)1 S Department by the applicant-no exceptions. Property Owner: JIij kk&h 1. l lT Completed Application _ 1 nn-++ 2. Two(2) sets of sealed plans. (one full size (maximum Address: KO. R 0 k I allowable plan size=36"x 42"1 and one 11"x 17") r Phone# ( j� 3. ( Two(2)copies of the property survey. l `'� �� i 4. ( Two(2) copies of the proposed site plan. Applicant ap eanng before the Board: 5. ( One electronic/disc copy of the complete application materials. 6. (p Filing Fee. Address: &W Ve A48 SJE(S� fIYY�3 7• ( )Any supporting documentation. Phone# C�Iy'��j� b l p S• ( )HOA approval letter. (if applicable) 9. ( �Photographs. Architect/Engineer:!' myl SL dy-n Laq 10.( ) Samples of fmishes/color chart. (a sample board or model may be presented the night of the meeting) Phone#(1`��) ��1— Sa��S By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions&Procedures, and that their application is complete in all respects. The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. 441 Sworn to before me this 11 Sworn to be re me this day of , 20 41a day of J 4 20 Z 2- gatrof Property Owner Sigatur of ApplicantuasK C—I-O Print Nam Property Owner Print Name of licant Notary Public No ublr EMILY QUIROA Melissa Ann Mitchell Notary Public-State of New York NOTARY PUBLIC,STATE OF NEW YORK No.01QU83SOt27 Qualified in Bronx County Registration No.01MI6420346 My Commission Expires 111211"14 �joaj Qualified in Westchester County Commission Expires August 2,2025 PAYMON ESKANDANIAN P.E. Project: Rye BrookNYResidence � Location: Rye Brook,NY Calc.by: PE 28202 CABOT ROAD,SUITE 300 Date: 7/5/2022 LAGUNA NIGUEL,CA 92677 STRUCTURAL CERTIFICATION LETTER D E-E 1v/ FL July 5,2022 pF NEW yO JUL 21 2022 ILSK�N� ,p To: Sunpower Corporation .44 7y 1414 Harbour Way * � : * VILLAGE OF RYE BROOK South Richmond,CA94804 r' BUILDING DEPARTMENT Project: Rasch Residence 481 25 Hillandale Rd SbNP� Rye Brook,NY 10573 To Whom It May Concern: A structural evaluation of the existing roof structure to support a new roof-mounted Photovoltaic(PV)system and its attachment to the underlying structure was performed based on the Design Criteria noted below. The structural review only applies to the section of the roof that is directly supporting the solar PV system and its supporting elements. Contractor shall verify the framing sizes,spacings,and spans noted in the stamped plans and accompanying calculations and notify the Engineer of Record of any discrepancies prior to starting construction. DESIGN CRITERIA: Applicable Codes:2020 New York State Building/Residential Code,ASCE 7-16 Risk/Occupancy Category: II Roof Dead Load(s):14 psf,Comp Shingles(ROOF 1) Roof Live Load(s):20 psf, 0 psf Under PV Ground Snow Load:30 psf,Roof Snow Load:21 psf(ROOF 1) Basic Wind Speed:120 mph, Exposure Category:C DESCRIPTION OF EXISTING ROOF STRUCTURE: ROOF 1:2x8 Rafters @ 16"o.c.with a maximum unsupported horizontal span of 15'-0"and a slope of 30 degrees CONCLUSIONS: ROOF 1:Adequate to support the imposed loading-No structural upgrades required Max PV mount spacing-Landscape config:48",Portrait config:48", Pattern:Staggered(ROOF 1) Attachment to Framing: 1-5/16"Lag Screw(s)w/2.5"min embed @ above spacing(ROOF 1) This review relies on the roofs structural system having been originally designed and constructed in accordance with the building code requirements and having been maintained to be in good condition.The design of racking,rails,panels and all other hardware is outside of the scope of this report.All components and waterproofing shall be installed per manufacturer specifications.Laguna Pacific Group assumes no responsibility for improper installation of solar PV panels,racking,or waterproofing. Please do not hesitate to contact me should you have any questions or comments. Sincerely, Paymon Eskandanian,SE,PE Laguna Consulting Engineers/Laguna Pacific Group Page 1 PAYMON ESKANDANIAN P.E. Project: Rye BrookNYResidence � Location: Rye Brook, NY Calc.by: PE 28202 CABOT ROAD,SUITE 300 Date: 7/5/2022 LAGUNA NIGUEL,CA 92677 GRAVITY LOADS (ROOF 1) 1.NEW PV SYSTEM ITEM LOAD DEAD LOAD (N)PV SYSTEM DEAD LOAD, DLrv-N= 3 psf Note:PV System Weight Provided by Client/Manuf. ITEM LOAD ASCE Ch-3 Comp Shingles 4 psf 1 x Decking 3 psf 2AGQF-DEAQ.1 0-AQ 2x8 Rafters @ 16"O.C. 2.27 psf Vaulted Ceiling 4 psf Miscellaneous 0.73 psf ROOF DEAD LOAD, DLRaoF= 14 psf ITEM VALUE ASCE Ch 4 Roof Live Load,Lc 20 psf Tributary Area Supported By Member,AT= s 200 sq.ft 3.ROOF LIVE LOAD Tributary Area Reduction Factor, R, = 1 Roof Slope= 7/12 (30 Deg.) Slope Reduction Factor,Rz= 1.00 ROOF LIVE LOAD, LLRooF=Lo.R1.R1= 20 psf Note:Live Load Under PV Arrays=0 PSF. ITEM VALUE ASCECh-7 Ground Snow Load,pg= 30 psf Exposure Factor(Fully Exposed),Ce= 1 Table 7.3 Thermal Factor(Cold Roof),C,= 1 Table 7.3 Snow Importance Factor,IS= 1 Minimum Low-Slope Roof Snow Load,pLs min= N/A psf Minimum Flat Roof Snow Load(AHJ),pf minAHJ= N/A psf 4.ROOF SNOW LOAD Flat Roof Snow Load, pf=0.7C,C,Ispg+Pf sur;Pf?Pf-min AHJ _, Pf= 21.0 psf Roof Slope= 7/12 (30 Deg.) Surface Type= All Other Surfaces Slope Factor,C,= 1.00 ROOF SNOW LOAD,ps= Cs .pf= 21.0 psf Eqn 7.4 Page 2 Project: Rasch Residence PAYMON ESKANDANIAN, P.E. Location: Rye Brook, NY Calc. by: PE 28202 CABOT ROAD,SUITE 300 Date: 7/5/2022 LAGUNA NIGUEL,CA 92677 WIND LOADS (ROOF 1) Wind loads on standoffs and their attachment to the underlying structure are determined as per the requirements for rooftop solar panels parallel to the roof surface(ASCE 7-16,Section 29.4.4). Risk Category = II Basic Wind Speed,V(ULT) = 120 mph Wind Directionality Factor,Kc = 0.85 Table 26.6-1 Exposure Category = C Topographic Factor,Kzt = 1.0 Table 26.8 Ground Elevation Factor,Ke = 1.0 Table26.9-1 Mean Roof Height,h = 25 ft(Max) Velocity Pressure Exposure Coefficient,KZ = 0.95 Table26.10 1 Velocity Pressure,qh=0.00256K,K7tKdKe\r = 29.64 psf(ULT) Eq.26.10-1 qh-ASD=0.6 x gr_ULT = 17.79 psf Roof Type = Gabled Roof Slope = 30 Degrees YE = 1.0 29.4-4 Effective Wind Area,AeH = See Table Below 26.2 Design Wind Pressures(ASD),PUpuFr IASDI = qh(ASD)•(GCp).YE•Ya:Paso MIN=10 psf Eq.29.4-7 Standoff Net Uplift Forces,PUpli t(ASD)(Ibs) = PWIND ASD x Atfb-0.6PDL(See Table Below) PRESSURES UPLIFT DOWNWARD Panel Configuration PORTRAIT LANDSCAPE ALL ZONE ZONE1 ZONE2 ZONE3 ZONE1 ZONE2 ZONE3 ALL ZONES Interior Ede Corner Interior Ede (Corner) YA 0.76 0.76 0.80 0.80 0.80 0.80 0.80 GC„ -1_69 -1.92 -2.56 -1.80 -2.00 -2.86 000 Design Wind Pressures(ASD), -22.7 -25.8 -36.4 -25.6 -28-5 -40.7 12.8 PUPLIFT(ASD) (PSO StandoffX-Spacing(m) 48.00 48.00 32.00 48.00 48.00 32.00 48.00 Trib.Width(ft) 3.22 3.22 3.22 1.63 1.63 1.63 3.22 Trib.Area,AT-(ft) 12.87 12.87 8.58 6.52 6.52 4.34 12.87 Pupnn;ASDI(Ibs) -269 -308 -297 -155 -174 -169 188 ROOF ATTACHMENT CHECKS Max Standoff Uplift(ASD)= 308 Ibs Mount Allowable Uplift= 450 Ibs(Per Manuf.) Standoff Demand/Capacity Ratio,DCR= 69% <100%, Therefore O.K. Fastener Size and Type= 5/16" Lag Screw(s) No.of Fasteners per Standoff,N= 1 Min Fastener Embed Into Framing,T= 2.5 in Fastener Allowable Pullout Per Inch,W= 246 lb/in Additional Factor of Safety,F.S= 1.5 Fastener Group Allowable Pullout Capacity, TALL=(N x W x T x LDF=1.6)/(F.S.)= 656 Ibs Fastener Demand/Capacity Ratio,DCR= 47% <100%, Therefore O.K. Page 3 Project: Rasch Residence PAYMON ESKANDANIAN, P.E. Location: Rye Brook,NY Calc. by: PE 28202 CABOT ROAD,SUITE 300 Date: 7/5/2022 LAGUNA NIGUEL,CA92677 MEMBER CHECKS (ROOF 1) PASS 1.(E)WOOD ROOF CONSTRUCTION: ROOF SLOPE = 30" FRAMING TYPE = Rafters WOOD SPECIES&GRADE = DF#2 RAFTER OR TRUSS TOP CHORD SIZE = 2x8 (S=13.14 inA3 ; I =47.63 inA4) RAFTER OR TRUSS SPACING = 16"o.c. MEMBER HORIZONTALSPAN,L = 151.0" Z.NILMBlK LUAUINb: LOAD TYPE 11.1114.11FORM U.I. ROJ PS OVER HOItiz PSF UKD ROOF DEAD LOAD 14.0 16.2 21.6 PV DEAD LOAD 3.0 3.5 4.6 ROOF LIVE LOAD` 0.0 0.0 0.0 ROOF SNOW LOAD 21.0 21.0 28.0 'RILL=0 PSF UNDER PV 1GOVERNING LOAD CASE = DL+PV+SL TOTAL LOAD,WTi = 54 plf J.BtNUIN(i(:Ht(:KS: REFERENCE DESIGN BENDING STRESS,F. = 900 psi LOAD DURATION FACTOR,Cd = 1.15 SIZE FACTOR,CF = 1.20 REPETITIVE MEMBER FACTOR,C, = 1.15 ALLOWABLE BENDING STRESS,F',=F,x Cd x Cr X C. = 1,428 psi MEMBER BENDING STRESS,t,=M,,,a,/S = 1,391 psi BENDING DEMAND-LAPACITY KATIU=tb/F', = 97% <100% BENDING O.K. 4.SHLAK LMLLKS: REFERENCE DESIGN SHEAR STRESS,F, = 180 psi LOAD DURATION FACTOR,Cd = 1.15 ALLOWABLE SHEAR STRESS,F' =F x Cd = 207 psi MAX SHEAR,Vm =WTJ/2 = 406 Ibs MEMBER AREA,A = 10.88 in MEMBER SHEAR STRESS,t =V_/A = 37.4 psi SHEAR DEMAND-CAPACITY RATIO=t /F' = 18% <100% SHEAR O.K. S.DEFLECTION CHECKS: ALLOWABLE DEFLECTION(TOTAL LOAD),AALL I = (L/180) E=1,600,000 psi 1.000 in SPAN TYPE=Simple Span MAX DEFLECTION(TOTAL LOAD),AMAX n = 5 WLA4/384E1 0.810 in (L/222) AMAX•TL < AALL•LL TOTAL LOAD DEFLECTION O.K. ALLOWABLE DEFLECTION(LIVE/SNOW),AALL LOL = (L/240) = 0.750 in MAX DEFLECTION(LIVE/SNOW LOAD),AMAX LUSL = 5 WLA4/384EI = 0.418 in (L/430) OMAX•LL < aALL•LL LIVE LOAD DEFLECTION O.K. Page 4 BR(�V� Village of Rye Brook Agend U 60 ' y Architectural Review Board Meeting 06L4.�LiJ.j v t �, Wednesday, September 21,2022 at 7:30 PM Village Hall, 938 King Street VJ 1. ITEMS: 1.1. #5741 (Consent Agenda) Re-Appearance Marilyn Ullman&Lena Vladsky 51 Greenway Lane&52 Greenway Lane New Arbors standard design fencing. 1.2. #5753 (Consent Agenda) Srikanth Ambati&Pranitha Mantrala 7 Talcott Road Rooftop solar array. 1.3. #5754 (Consent Agenda) Marc Abramson&Erika Abramson 47 Hillandale Road 6'-0"high white vinyl fence in rear yard. 1.4. #5755 (Consent Agenda) Matthew Byrnes&Helene Byrnes 7 Deer Run New windows to facilitate interior bathroom renovation. 1.5. #5756 (Consent Agenda) Philippe Ledesma&Tonella Ledesma 7 Bell Place 6'-0" high white vinyl privacy fence along rear yard. 1.6. #5757 (Consent Agenda) Benjamin Tapper&Erica Tapper 4 Deer Run Rooftop solar array. 1.7. #5767 (Consent Agenda) Pawling Holdings LLC 261 North Ridge Street New stone and clapboard siding. 1.8. #5768 (Consent Agenda) Ann Parkin&Jody Rasch 25 Hillandale Road Rooftop solar array. Page 1 of 4 1.9. #5769 (Consent Agenda) Michael Rosenfeld&Afton Rosenfeld 56 Lincoln Avenue 4'-0" high aluminum fence along bridge. 1.10. #5771 (Consent Agenda) Blake Silverman&Alexa Silverman 18 Milestone Road 4'-0"high fence in rear yard along BelleFair Boulevard and 4'-0"high fence in side yards. Consent Agenda Approvals: Motion PSe— Second ,�Abstention Aye; Nay; Adjournment; Notes 1.11. #5758 Blake Jacoby&Paula Jacoby 16 Elm Hill Drive Rear deck and hot tub. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.12. #5759 Michael Seidenfeld&Daniella Schneider 5 Jacqueline Lane Rear patio&retaining wall. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.13. #5760 Daniel Debari&Catherine Debari 11 Elm Hill Drive One-story addition. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 2 of 4 1.14. #5761 Brian Lerch&Stacy Kapner-Lerch 7 Reunion Road Expand existing deck and add deck stairs. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.15. #5762 Michael Scheffler&Carol Scheffler 3 Meeting House Lane New rear deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.16. #5763 Win Ridge Realty LLC 166 South Ridge Street Replace store front. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.17. #5764 Win Ridge Realty LLC 166 South Ridge Street New tenant sign"Amazing Lash Studio" Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.18. #5765 Steven Santiago&Amy Swift 3 Woodland Drive Reconfigure front entry roof,window modification and interior alterations. Approvals: Motion Second Abstention Page 3 of 4 • • Aye; Nay; Adjournment; Notes 1.19. #5766 Mark Posner&Laura Posner 32 Bonwit Road New one family home w/ finished basement and attached two-car garage. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.20. #5770 Caroline Kent 107 Brush Hollow Close Rear deck and remove existing brick patio. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes NEXT MEETING: October 19, 2022 Page 4 of 4 T '��T`�►� ,t��t1•' r � � fff�� rjl���` djf, i41f�'�(j 'tf if 1'• i(91� t'�� °,t��� fl !t'.�� 1 �_�• (8t, ���QR•:. - '. . (}tss/> �,�;shah__,.�`t_ • .s:{::- Nu!1 wt �01..�_���_��: c• � .i. •1 lta)►i Aps ` I,I- ll ci N O tlss>" �`c p t�f Cd >~ 40. Ii loom( � e•� vl �' � W (i J a Y a r �as r ♦ 'y: I: �1 t� W t 00 O v kection Q k uo r h #j"�✓' r/� of 0 ,,,, `,, Ilk LL C' .� ,r �.! - y� • 4-o Q U N U W ,a o �edaQ ? . ' 1ww � �:,j Ix tu 1t�64, �i , ,;/;�;t' . •.'��Il' t�"fig 1S��'�` � i r F flf p � 1/f • .► � w i 'VJ W ��v,,,,,,y�y n � ^ p�+�� �^ 4�'1�{ •• `.t� r. ?��,♦• „�. 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I�ti��,1 /1�/1���/ r 1 ��r'�I�ti'f, 'f�l'i�il��,, -1'i'�ii4 �_t i'ii�to „ . r,: 'll►�1�1, q�Tl 1t/��"ti1i4c+ ipw �E ';.!��1t� `��i '�'1�1'r' :alb 6t�� ,►/ 1►,� Eft► .�,►1Ii � ft tl �► .4' if A iG i � r '1f1 � t y ¢ � t✓ J i .� 1 4 ' Q r���:� ,f?y�+' �'�','Wl� O .�{1�?,'*yr� � ""a5?:�.�}�i� Q r '�'SsI7€ka � �'•�hrk5}��7+" � t#�'R Q X $lil�r$t.k J7�3 �'twwY vMSdrrJF .nr.�. t v \ti, vet t �i a R 7• ,a Ir 32e_:ytt'' �:k;.w, n 7t`�S ,4c R CERTIFICATE OF LIABILITY INSURANCE FD07Tje192 �DmrY) 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: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, 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 endorsement(s). PRODUCER CONTACT Marsh Risk 8 Insurance Services NAME: - 1735 Technology Drive,Suite 790 PHONE xt) _ _ � Not: San Jose,CA 95110 E-MAIL Attn:SanJose.CertRequest@marsh.com;F:212-948-4335 ADDRESS: INSURE S AFFORDING COVERAGE NAIC 9 CN102680983-STND-GAW-22-23 INSURER A:Aspen Specialty Insurance Company 10717 INSURED SunPower Corporation INSURER B:Hartford Fire Insurance Company 19682 SunPower Corporation,Systems INSURER C: 1414 Harbour Way,Suite 1901 INSURER D: Richmond,CA 94804 INSURER E INSURER F: Ell COVERAGES CERTIFICATE NUMBER: SEA-D03843662-01 REVISION NUMBER: 7 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. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY CROMF122 04/01/2022 D4/01/2023 EACH OCCURRENCE $ 2,D00,000 DAMAGE TO RENTEl5__ CLAIMS-MADE C OCCUR PREMISES Ea occurrence $ 1,000,000 MED EXP(Any one person $ PERSONAL d ADV INJURY $ 2'6'000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 4,000,000 X POLICY❑ jE O- LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) f OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident s UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I i RETENTIONS s B WORKERS COMPENSATION 57 WV W00015 9101/2023 X I PER O AND EMPLOYERS'LIABILITY STATUTE R ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N 1,DOO,000 OFF IC ER/MEMBER EXCLUDED? IN N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Installation of a 12 87kW Grid-Tied,Roof-Mounted Solar System at 25 Hillandale Road Rye Brook,NY 10573 RP#:338606. Village of Rye Brook is included as additional insured where required by written contract with respect to general liability.Waiver of subrogation is applicable where required by written contract and subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE 7&'W4 Red & 1 aaaa4'W snv'cc" ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • J'-�Ew Workers' YORK CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name and address of Insured (use street 1b. Business Telephone Number of Insured address only) 888-249-8550 SUNPOWER CORPORATION, SYSTEMS 1c. NYS Unemployment Insurance Employer Registration 1414 HARBOUR WAY SOUTH #1901 Number of Insured RICHMOND CA 94804 Work Location of Insured (Only required if coverage is 1d. Federal Employer Identification Number of Insured or specifically limited to certain locations in New York State, Social Security Number i.e., a Wrap-Up Policy) 9 4-3 0 0 8 9 6 9 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) HARTFORD ACCIDENT AND INDEMNITY COMP 3b. Policy Number of Entity Listed in Box "la": RYE BROOK VILLAGE 57 WV WQ0015 BUILDING DEPARTMENT 3c. Policy effective period: 938 KING ST RYE BROOK, NY 10573 04/01/22 to 04/01/23 3d. The Proprietor, Partners or Executive Officers are �X Included. (Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A 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"2". The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c", whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Worker's Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new 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 certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Danielle Clausen (print name of authorized representative or licensed agent of insurance carrier) Approved by: 1.,•, ,, 03/04/2022 (Signature) (Date) Title: Operations Manager Telephone Number of authorized representative or licensed agent of insurance carrier: (877) 853-2582 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. r.-1nr 10-171 Fnrm Wr RA 41 71 F Printarl in I I q A arum%Alrh nv nnu Pang 1 of 9 z � � r� V r cl >1 FCC Ertl n m0. 0 0 "'n tv �( � �� � m Fri O rr 0 I'z .- CA 0 0 1 1 f �M CCU' c � z f•-1 0 -n > ,j ,..., w O 70 0T�' M 60 7o r -v _ 01 z > 0 �C-)o I�r-I O D D — < --i �Q M D 1— zm z m C7 Lj m 0 —q D 00 -Q 0' r m m m rn m C < .0 U) , ry U) 0 , cn � cn N N o Q o r X r -i X m rm- D rrn- -0 rm- m '� _ p --i m c z~ �i 0 �i C) > z C Q m C� � � � � rn X D D T' A - r l7 G) r D O m� 0 >r M 0 O 20 r- r n O '� --i O D m ClQ 3 E--� A z>i D vzi T > D Q C m O tm,� z 0 m � Q cl) z G7 n � D � O 3 Q z X C JODY RASCH ANN PARKIN = nm D m -i 70 0 -A � m D z 12.87 kW GRID -TIED PHOTOVOLTAIC SYST > rn m 3 < 25 HILLANDALE ROAD PD < z M, Z� RYE BROOK, NEW YORK 10573 CD � V o w w -' US N a z i m SOLAR INDIVIDUAL PERMIT PACKAGE 77 COVER SHEET H z 0 0 c r z z C� N^N^rnN^NIVIVNNNN rn 0C3Ot�03 NNrOv►0v0 t02 'in Ono n000000© z<z- ;uu�crn-rvMrn U` O z -< z rnc^��ypoQO x 0 D z zz D n r M �owrlm0_4 rfl I- z rn cz >00 C)0Dr— n C7 Zzm0mm0 �rn O O O C7 F� D-<zOzzp z0m-nr-nmm - 1 0 O z 0 m z��z ~ rn m Q 0��O rn z::E 0 z rn m (1) X Ln x -n -n > m Vi D --A > p rnzm>mm> ��rn v0°rn O w 0 O n r. O z z ,-. 3 � rn U)� �� rn rn SPRI - NEW YORK 777 WESTCHESTER AVE WHITE PLAINS, NY 10604 0 0 a m z O 3 D O z S U N P Q'i W E R' CORPORATION, SYSTEMS 1414 HARBOUR WAY SOUTH RICHM0ND, CA 94804 ( 5 1 0 ) 5 4 0 - 0 5 5 0 cr�r u�r G>_ �,/ �r Q -v °0,<X 00 N� C0 2 o ��-t� o�(Z 0 0 -'� 9° 0 ©A o O m c: z> `C< n rn �O D ) � ~M 3 m p C z m Q1 N G O W W Ljqv , A A A � I 0 --r _ z m Q% GZ rn 3 , U) ` n -- NJ —, .� © r"i o tIS cn C7 � z � yn > V) y r rn m Q n D z z ` �. 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Qca a 5 F, Doo /rnr-�` Z z o _� z -� m3 C r Om K a + - rn z 1 � X n # 00_� - D' _ I O � � G r FI r MICROINVERTER EXCLUSION ZONE D z JODY RASCH I ANN PARKIN �r't m r- m m � D O -i -i D r- m A z W 12.87 kW GRID -TIED PHOTOVOLTAIC SY �� (1 0 � Pq v% � Z m ;o Q V/ YORK '.a M 25 HILLANDALE ROAD PD �,•., O SPRI - NEW C ";� z �zC 777 WESTCHESTER AVE. 2 O 41} C1) i Z� � > �, o z RYE BROOK, NEW YORK 10573 j"� WHITE PLAINS, NY 1.06UG W r.t W rn � , z r� US `_j � �� ``^" L: o a o' m 0 o m SOLAR INDIVIDUAL PERMIT PACKAGE D A STRUCTURAL INFORMATION r Q AND MOUNTING DETAILS S U W E R"' CORPORATION, SYSTEMS 1 4 1 4 HARBOUR WAY SOUTH RICHMOND, CA 94804 (510) 540-0550 . . 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