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2016 - Roof Mounted Solar System Electrical
TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860)848-3030 X382 FAX. (860) 848-7231 ELECTRICAL PERMIT Permit Number: E2016-0045 Date: 29-Feb-16 Map/Lot: 028/005-050 Owner ID: 5484000 • Project Location: 64 PHEASANT RUN Unit: Job Description: Electrical for Roof Mounted Solar System Owner Nam Steven C and Kathryn M Kienle Tenant Name N/A Careof: 64 Pheasant Run Oakdale £T 06370- Telephone: (860)848-3364 Applicant Name Genesis Cornejo Telephone: (860)899-4625 DBA: SolarCity Lic/Reg Type El Lic/Reg N 125305 714 Brook Street,Suite 150 Exp Date: 30-Sep-16 Rocky Hill CT 06067- Construction Value Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: IRC Plumbing Value: S0.00 Plumbing Fee: $0.00 Code: 2005 State Building Code Mechanical Valu $0.00 Mechanical Fe $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type IRC Total Value: $0.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: S0.00 Comment Plan Review Fe $0.00 Fees Included with Building Permit State Ed Fee: $0.00 Total Fee Paid: $0.00 It shall be theowners repsonsibility to schedule the following inspections a minimum of 2 business days in advance: Field set of approved construction documents shall be available onsite during all inspections. BUILDING PERMIT INSPECTIONS PLUMBING,MECHANICAL,ELECTRICAL PERMIT INSPECTIONS ❑ Footing-Prior to pouring concrete ❑ R Plumbing and leak test ❑ Deck Piers 1i R Electrical ❑ Backfill-Footing drains and waterproofing ❑ Elec Trench-with conduit installed ❑ Concrete Slab-Prior to pouring concrete ❑ Pool Bonding ❑ Anchor Bolts-with sill plate and prior to floor frami ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation Certifi ate of Approval -rtificate of Occupancy Building Official's Approval: _ ../4."1-et/ _ �� Town of Montville Building Department 310 Norwich-New London Tpke. Tel 860-848-3030, Ext 382 Uncasvitie, CT 06382 Fax. 860-848-7231 RESIDENTIAL PERMIT APPLICATION FORM Permit No.:e aoke - 5 Type of Work Occupancy Type Permit Type 0 New Construction 8 Single Family L Building C Addition 0 Two-Family El Plumbing 0 Alteration ❑Townhouse 0 Mechanical 0 Accessory Structure El Electrical CRS#: Property Address: 64 Pheasant Run (Number) (Street) (Unit) Job Description: Wiring of 63 Roof Mounted Solar Panels (15.75 kW) Owner: Steven Kienle Address: 64 Pheasant Run city: Oakdale State: Ct zip Code: 0637° Telephone{860 eaa _ 3364 Applicant: Genesis Cornejo SolarCity OSA: Address: 714 Brook St, STE 150 City. Rocky Hill State: CT rip code:06067 Telephone L___)_860 ' 899 - 4625 Contractors -Complete the Following: License Type: El License Noy 0125305 Expiration DateW30/15 f eretry certtry that the proposed want MT contarrn to the State r• .' Oaae and aft ottercodes as adapted 6y Me Sate of Connectirat and Me Town of Montville and further attest that the proposed work is.a o by the owner in fee and that!am authorized to make application for a permit for such work as described above. Owner/Agent Signature:' • ����•�— per: 1 0/22/1 5 Construcfton Value Permit Fees Building Value: $11,103 Building Fee: CD I L1 Cl Plumbing Value: Plumbing Fee: Mechanical Value: Mechanical Fee: Electrical Value: $25,408 Electrical Fee: 1 3.1 8'. 1 LI Total Value: $37,012 Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: Total Fee: -1-1(105 `J FlcvimC,uBust23,2007 � W Solareity Date: IQ 1(0 J Dear Sir or Madam: I, the nders. ned DArrell R. Michalek, CT Electrical License Number E1125305, hereby give � �� c 0 authorization to apply for electrical permits under my license. Please call me with ny questions or concerns. Address: (0L( PIl six-) CnOcinea& 000 Description: Solar panel roof mount installation ( 1 < ()\N F CTICI "i h°PRIM rIle\ ELECTRICAL UNLIMITED CONTRACTOR DARRELL R MICHALEK System size: 15 �j K\,JJ 3 T101I I I,C ET 06677 PLti T111,C86-7023 CC-11-FG.fab _.__.,___FFFECTNF ELC.0125305-E1 10/01/2015 04/30/2016 Start Date: Q/ INI A4.'i/� 1�,t� �_�/�ngt�(///f), it Sincerely, Darrell Michalek 860-670-3542 CT Electrical License ELC. 0125305-E1 A`� s M/ CERTIFICATE OF LIABILITY INSURANCE DATE(MDD/YYYY) r 08/17/2015 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(ies) must 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& INSURANCE SERVICES NAME: 345 CALIFORNIA STREET,SUITE 1300 PHONE FAX CALIFORNIA LICENSE NO.0437153 1E-MAIL (A/C.No): o SAN FRANCISCO,CA 94104 ADDRESS: Attn:Shannon Scott 415-743-8334 INSURER(S)AFFORDING COVERAGE NAIC 0 998301-STND-GAWUE-15-16 INSURER A:Zurich American Insurance Company 16535 INSURED SolarCity Corporation INSURER B:N/A N/A 3055 Clearview Way INSURER C:N/A N/A San Mateo,CA 94402 INSURER D:American Zurich Insurance Company 40142 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-002713836-08 REVISION NUMBER:4 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 ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBERPOLICY EFF POLICY EXP - (MM/DD/YYYY) (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY GL00182016-00 09/01/2015 09/01/2016 EACH OCCURRENCE $ 3,000,000 GE TO CLAIMS-MADE j X I OCCUR PREMISES(EaENTED occurrence) $ 3,000,000 X SIR:$250,000 MED EXP(Any one person) _ $ 5,000 PERSONAL&ADV INJURY $ 3,000,000 GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6,000,000 X POLICY PRO- — JECT LOC PRODUCTS-COMP/OP AGG $ 6,000,000 $ OTHER: A AUTOMOBILE LIABILITY BAP0182017-00 09/01/2015 09/01/2016 COMBINED SINGLE LIMIT (Ea accident) $ 5,000,000 X ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED X SCHEDULED _ AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS $ (Per accident) _ COMP/COLL DED: $ $55000 UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ D WORKERS COMPENSATION WC0182014-00(AOS) 09/01/2015 '09/01/2016 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC0182015-00(MA) 09/01/2015 09/01/2016 OFFICER/MEMBER EXCLUDED? N N/A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) WC DEDUCTIBLE:$500,000 If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of insurance. CERTIFICATE HOLDER CANCELLATION SolarCity Corporation 3055 Clearview Way SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE San Mateo,CA 99402 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk&Insurance Services Charles Marmolejo .,�- / —yam ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD