DOCUMENTS Imtlm App&ulbn Dam:(---1 l DII 7 Appi n# 1 • 5OO4373/
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Centel Permitting 108 E.Frond Week Ulli glop.NC 27546 Phone:(910)8917525 mat Fax:ENO)8932789 va.Mmatcorgpernls
"A RECORDED SURVEY NAP,RECOIDED DEED(OR OFFER TO PURCHASE)8 SITE PUN ARE REWIREDWHEN SUMERPIG A LAND USE APPUCATDN`
LANDOWNER'
Paul Kook Ma0Ing Address: 2554 Comahury Rd
City: State:Varma Slam:NC Zip: Contact Contact Na 919-7709106 Fid: tc3hmwkeye®YehOO.Ccm
APPLICANT:Terre Sommers MangAdak
115 Galina Mey#109
City: State'Slab.NC Zip: Contact Coiled No: 88&935-5505 Email:
'Fiala m out applI n btme ai it anal nal eal larevmm
88835-5505
CONTACT NAME APPLYING IN OFFICE:Terre Sommers Plnorne# 9
PROPERTY LOCATION:Subdivision: Ne Lott. Lot She
•
State Road#5562 State Road Nene: Cokaebury Rd Map Book S Page:
Farrel: 050535030902 PIN: 0635.563031
Zoning:HA30 Flood Zone:MlnlmurWelarenae: Deed Bok!Pape. 3501 1396 Pater Conpany: Duke Energy
New Sucks Mth Progress Energy ea service war need m supply premise nember We ProWass Energy.
PROPOSED USE:
Monolithic
O SFO:(She Sri Bedtimes_I Berms:_BenIerICWMO beth):_Gmape:_Deck;_CrSM Space:_Slab`315E--
(Is the
ab`Mfle bonus room mtlehed?U yes (J no Ma closet?L yes (_J no Of yes adder Mth•bebaoma)
O Mod(Size S* (Mwo bath)_Garage:_Ste BUM Deck:_ On Frame Olt Franc_
(Is the second floor SSW Ll yes Li no My Ober it bunt additions?U yea Li no
O Manufactured Home:_SW_ W_1W(Size x )IBedrooms:_Garape:_(Nm bdk7.)Der1c_(Blte
D DIplex:(Size s)No.BUMh9e: No.Bedrooms Per 1St
a Home Occupation:I Rooms: Use' Han of Operation ttEmployses:,
Adtl6mrUAaawrynOR:(She x 1 IAD Residential solar Closets It addition?(__)Yes L)no
Water Supply /1 County _Ethang WM —New NAti(1a/Meage using wee )Vest have operable water More final
Sewage Supply: New Septic Tads(Caleb ChackaiO —Existing Septic Tart(Casaba CAsdWeO _County Sewer
Does www of Bra trail of land,ata land that onWre a manufactured Mme vAWn lye hundred feet WO)oftract listed above?L)yes ( )no
Does the properly conth may easements Sather ueeground or overhead Li nes Li re
Structures(eSOng or proposed):Single Way Mang* Meelecleed Homes: Other(aped)»'
Required Residential Property Use Setbacks: Common:Adding 35 ground mounted solar modules,10.16kw
Front Minimum Actual_
Rear
Closest SMe
SideMetner tit
Nearest Bolding
on Deme tit
Residential Land Use Application Papa 1 old U3/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY PROM LILLINOTON: Head N on S Main St toward E Remelt SIN Turn L onto McKinney
Pkwy l/Tum L onto US-401N//Turn L onto Christian Light Rd/I TUm L onto Columbary Rd/I Continue straight b stay on Cokeebury
Rdll
N pods ant granted I agree to conform to all ordinances and lass of the Stab of NOM Carolina regulayrlp such work and the spodfcations of plans submitted.
I hereby state that fsegcleg statements are accurate and caned to the best of my lopwbdpe. Pemll$Wjed to revocation If false lyddmadon Is prodded.
•O.RMM 4- .B Bvvt.Uu4.t/d" 4/3/2018
Slgrwture of Owner or Owners Agent Date
µIt Is the onnMapplicents responsibility to provide the county with any applicably)bfarmados about the subject properly.Inducibug but not limited
to:boundary Information,how location,underground or ove hnd enwnants,etc.The county or Its employees M not responsible for any
Incorrect or mining bdomedon that le contained within these applications.µ
"This application expires a monde from the Initial dab If permits have not been Inured
Residential Land Use application Page 2 of g 03111
+CClarrtrsPecs .solar - appiica.wt
09109(11 Application#
Harnett County Central Permitting
Each aecban below to be filled out PO Box 65 Lillington NC 27546
910 893 7525 Fax 910 893 2793 www hamett orgipermits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name 8 phone must match
Owners Name Paul Kosik Date
Site Address 5542 Cokesbury Rd Varina,NC 27526 Phone 919-770-9404
Directions to job site from Lillington Take US-401 N and Christian Li!ht Rd to Oakridce River Rd in
Buckhorn. Turn L onto Oakridge River Rd. Turn R onto Cokesbury Rd.Continue straight to stay
on Cokesbury Rd.
Subdivision Lot
Description of Proposed Work Adding 35 roof mounted modules, 10.15kw #of Bedrooms _
Heated SF Unheated SF Finished Bonus Room' Crawl Space Slab
General Contractor Information
Kelly Miles 7049608110
Building Contractors Company Name Telephone
116 Gasoline Alley Suite 109 Mooresville,NC 28117 kbmiles92@aol.com
Address Email Address
51355
License#
Electrical Contractor Information
Description of Work Service Size Amps T-Pole _Yes_No
Lighting Electric - Kevin Kutsch 704-361-ROl I
Electrical Contractor s Company Name Telephone
230 Blacksnake Rd Stanley,NC 28164 liehtingelectricl@gmail.com
Address Email Address
29517
License#
MechanicallHVAC Contractor Information
Description of Work
Mechanical Contractors Company Name Telephone
Address Email Address
License#
Plumbing Contractor Information
Description of Work #Baths
Plumbing Contractors Company Name Telephone
Address Email Address
License#
Insulation Contractor Information
Insulation Contractors Company Name&Address Telephone
'NOTE General Contractor must fill out and sign the second page of this application
t tit
I hereby certrfy that I have the authority to make necessary application that the application is correct
and that-the construction will conform to the regulations in the Building Electrical Plumbing and
Mechanical codes and the Harnett County Zoning Ordinance I state the information on the above
contractors is correct as known to me and that by signing below I have obtained all subcontractors
permission to obtain these permits and if azi changes occur including listed contractors site plan
number of bedrooms building and trade plans Environmental Health permit changes or proposed use
changes I certify it is my responsibility to notify the Harnett County Central Permitting Department of
any and all changes
EXPIRED PERMIT FEES-6 Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is as per current fee schedule
3/27/2018
Signature of Owner/Contractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation NC G S 87-14
The undersigned applicant being the
General Contractor _Owner x Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s) firm(s)or corporation(s)performing the work
set forth in the permit
Has three(3)or more employees and has obtained workers compensation insurance to cover them
Has one(1)or more subcontractors(s)and has obtained workers compensation insurance to cover
them
x Has one(1)or more subcontractors(s)who has their own policy of workers compensation insurance
covering themselves
Has no more than two(2)employees and no subcontractors
While working on the project for which this permit is sought it is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of workers compensation insurance pnor
to issuance of the permit and at any time dunng the permitted work from any person firm or corporation
carrying out the work
Company or Na - Ene • Conservation Solutions
Sign w/Title ',, , II Jl Date 3/27/2018
V'
Application# _
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546 - Ph:910-893-7525 - Fx:910-893-2793 - www.hamett.org/permits
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner(s)of Structure: Paul Kosik Phone:919-770-9404
Owner(5) Mailing Address:5542 Cokesbury Rd Fuquay Varina, NC 27526
Land Owner Name(s): Paul Kosik Phone:919-770-9404
Construction or Site Address:5542 Cokesbury Rd Fuquay Varina, NC 27526
PIN# 0635-54-3034 Parcel# 050635 0309 02
Job Cost: 60460 Description of Work to be done Adding 35 roof mounted modules,grid-tied, 10.15kw
solar installation on existing
Mechanical: New Unit With Ductwork_ New Unit Without Ductwork_ Gas Piping_Other
Electrical*: 200 Amp_<200 Amp_Service Change_ Service Reconnect_ Other
" For Progress Energy customers we need the premise number
Plumbing: Water/Sewer Tap Number of Baths Water Heater
Specific Directions to Job from Lillington:
Take US-401N and Christian Light Rd to Oakridge River Rd in Buckhorn. Turn L onto Oakridge River Rd.Turn R
onto Cokesbury Rd. Continue straight to stay on Cokesbury Rd
Subdivision: Lot#:
I Kevin Kutsch will provide the Electrical labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is 29511 ,which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building Code and all
other applicable State and local laws, ordinances and regulations.
Lighting Electric 704-361-8011
Contractor's Company Name Telephone
230 Blacksnake Rd Stanley, NC 28164 lightingelectric1@gmail.com
Address Email Address
29517
License#
Structure Owner/Contractor Signature: Date:3/27/2018
By signing this application you affirm that you have obtained permission from the above listed license holder to
purchase permits on their behalf. If doing the work as owner you understand that you cannot rent, lease or sell
the listed property for 12 months after completion of the listed work.
`Company name, address, & phone must match information on license
DocuSign Envelope ID:7DF 10079-2F63-491 D-A346-52ECI C4BFFBB
Interconnection Request Application Form
for Interconnecting a Certified Inverter-Based
Generating Facility No Larger than 20 kW
This Interconnection Request Application Form is considered complete when it
provides all applicable and correct information required below. Additional
information to evaluate the Interconnection Request may be required.
Processing Fee
A non-refundable processing fee of $100 must accompany this Interconnection
Request Application Form.
If the Interconnection Request is submitted solely due to a transfer of ownership
of the Generating Facility, the fee is $50.
Interconnection Customer
Name: Paul Kosik
Contact Person: Taylor Granelle
Email Address: fc3hawkeye@yahoo.com
Address: 5542 Cokesbury Rd.
City: Fuquay Varina
State: NC
Zip: 27526
County: Harnett
Telephone (Day): 9197709404
(Evening):
Fax:
Contact (if different than Interconnection Customer)
Name: Gene Granelle
Email Address: tgranelle@ecs.solar
Address: 116 Gasoline Alley STE 109
City: Mooresville
State: NC
Zip: 28117
County: Iredell
Telephone (Day): 7042300498
(Evening):
Fax:
Owner(s) of the Generating Facility:
1
NC 20 kW Inverter
DocuSign Envelope ID:7DF10079-2F63-491 D-A346-52EC1 C4BFFBB
Generating Facility Information
Facility Location (if different from above):
Address: 5542 Cokesbury Rd.
City: Fuquay Varina
State: NC
Zip: 27526
County: Harnett
Utility Duke Energy Progress
Account Number: 8954002864
For photovoltaic sources only:
Inverter Manufacturer: Inverter: 35 x Enphase Energy 0.2 kW(Model IQ6-
Model: 60-X-US (240V))
Total panel capacity: Inverter Rating (ea): 0.23 kW AC Efficiency: 97%
Nameplate Rating (each inverter): PV Module Array: 35 x SolarWorld 290W (Model
SW 290 Mono Black)
Module Rating (ea): 290 W DC, 266.1 W PTC
Tilt: 30 Azimuth: 3 Tracking: Fixed
Nameplate Rating: 10.15 kW DC
AC Rating: 9.034 kW CEC-AC
Estimated Annual Production: 9254 kWh
Design Factor: 60.3 %
12.687 kVA(Ac) (each inverter)
240 VoItsiAcl (each inverter)
Phase:
System Design Capacity: 12.687kVA(Ac)
Maximum Physical Export kW(Ac)
Capability Requested:
Prime Mover Photovoltaic
ENERGY SOURCE TABLE
Renewable Non-Renewable
H-1. Solar— Photovoltaic
Is the equipment UL 1741 Listed?
2
NC 20 kW Inverter
Docusign Envelope ID:70F10079-2F63-491 D-A346-52ECIC4BFFB6
If Yes, attach manufacturer's cut-sheet showing UL 1741 listing
Estimated Installation Date 4/5/2018
Estimated In-Service Date 4/26/2018
The 20 kW Inverter Process is available only for inverter-based Generating
Facilities no larger than 20 kW that meet the codes, standards, and certification
requirements of Attachments 3 and 4 of the North Carolina Interconnection
Procedures, or the Utility has reviewed the design or tested the proposed
Generating Facility and is satisfied that it is safe to operate.
List components of the Generating Facility equipment package that are currently
certified:
Number Equipment Type Certifying Entity
1.
2.
3.
4.
5.
3
NC 20 kW Inverter
DocuSign Envelope ID:7DF10079-2F63491 D-A346-52ECI C4BFFB8
Interconnection Customer Signature
I hereby certify that, to the best of my knowledge, the information provided in this
Interconnection Request Application Form is true. I agree to abide by the Terms
and Conditions for Interconnecting a Certified Inverter-Based Generating Facility
No Larger than 20 kW and return the Certificate of Completion when the
Generating Facility has been installed.
signed by;
Signec: P' tztsi(c
Title: Date: 3120/2018
4
NC 20 kW Inverter
DocuSign Envelope ID'.70F10079-2F63-491D-A346-52EC1C4BFFB8
Terms and Conditions
for Interconnecting a Certified Inverter-Based
Generating Facility No Larger than 20 kW
1.0 Construction of the Facility
The Interconnection Customer (Customer) may proceed to construct
(including operational testing not to exceed two hours) the Generating
Facility when the Utility approves the Interconnection Request and returns
it to the Customer.
2.0 Interconnection and Operation
The Customer may interconnect the Generating Facility with the Utility's
System and operate in parallel with the Utility's System once all of the
following have occurred:
2.1 Upon completing construction, the Customer will cause the
Generating Facility to be inspected or otherwise certified by the
appropriate local electrical wiring inspector with jurisdiction, and
2.2 The Customer returns the Certificate of Completion to the Utility,
and
2.3 The Utility has either:
2.3.1 Completed its inspection of the Generating Facility to
ensure that all equipment has been appropriately
installed and that all electrical connections have been
made in accordance with applicable codes. All
inspections must be conducted by the Utility, at its own
expense, within ten Business Days after receipt of the
Certificate of Completion and shall take place at a time
agreeable to the Parties. The Utility shall provide a
written statement that the Generating Facility has passed
inspection or shall notify the Customer of what steps it
must take to pass inspection as soon as practicable after
the inspection takes place; or
2.3.2 If the Utility does not schedule an inspection of the
Generating Facility within ten Business Days after
receiving the Certificate of Completion, the witness test is •
deemed waived (unless the Parties agree otherwise); or
2.3.3 The Utility waives the right to inspect the Generating
Facility.
5
NC 20 kW Inverter
DocuSign Envelope ID:70F10079-2F63-491 D-A346-52EC1 C4BFFB8
2.4 The Utility has the right to disconnect the Generating Facility in the
event of improper installation or failure to return the Certificate of
Completion.
2.5 Revenue quality metering equipment must be installed and tested
in accordance with applicable American National Standards
• Institute (ANSI) standards and all applicable regulatory
requirements.
3.0 Safe Operations and Maintenance
The Customer shall be fully responsible to operate, maintain, and repair
the Generating Facility as required to ensure that it complies at all times
with the interconnection standards to which it has been certified.
4.0 Access
The Utility shall have access to the disconnect switch (if a disconnect
switch is required) and metering equipment of the Generating Facility at all
times. The Utility shall provide reasonable notice to the Customer, when
possible, prior to using its right of access.
5.0 Disconnection
The Utility may temporarily disconnect the Generating Facility upon the
following conditions:
5.1 For scheduled outages upon reasonable notice.
5.2 For unscheduled outages or emergency conditions.
5.3 If the Generating Facility does not operate in a manner consistent
with these Terms and Conditions.
5.4 The Utility shall inform the Customer in advance of any scheduled
disconnection, or as soon as is reasonable after an unscheduled
disconnection.
6.0 Indemnification
The Parties shall at all times indemnify, defend, and save the other Party
harmless from, any and all damages, losses, claims, including claims and
actions relating to injury to or death of any person or damage to property,
demand, suits, recoveries, costs and expenses, court costs, attorney fees,
and all other obligations by or to third parties, arising out of or resulting
from the other Party's action or inactions of its obligations hereunder on
6
NC 20 kW Inverter
DocuSign Envelope ID:7DF10079-2F63-4910-A346-52EC1C4BFFB6
behalf of the indemnifying Party, except in cases of gross negligence or
intentional wrongdoing by the indemnified Party.
7. 0 Insurance
All insurance policies must be maintained with insurers authorized to do
business in North Carolina. The Parties agree to the following insurance
requirements:
7.1 If the Customer is a residential customer of the Utility, the required
coverage shall be a standard homeowner's insurance policy with
liability coverage in the amount of at least $100,000 per
occurrence.
7.2 For an Interconnection Customer that is a non-residential customer
of the Utility proposing to interconnect a Generating Facility no
larger than 250 kW, the required coverage shall be comprehensive
general liability insurance with coverage in the amount of at least
$300,000 per occurrence.
7.3 The Customer may provide this insurance via a self-insurance
program if it has a self-insurance program established in accordance
with commercially acceptable risk management practices.
8.0 Limitation of Liability
Each Party's liability to the other Party for any loss, cost, claim, injury, or
expense, including reasonable attorney's fees, relating to or arising from
any act or omission hereunder, shall be limited to the amount of direct
damage actually incurred. In no event shall either Party be liable to the
other Party for any indirect, special, incidental, consequential, or punitive
damages of any kind.
9.0 Termination
The agreement to interconnect and operate in parallel may be terminated
under the following conditions:
9.1 By the Customer
By providing written notice to the Utility and physically and
permanently disconnecting the Generating Facility.
9.2 By the Utility
If the Generating Facility fails to operate for any consecutive
12-month period or the Customer fails to remedy a violation of
these Terms and Conditions.
7
NC 20 kW Inverter
DocuSign Envelope ID:7DF10079-2F63-491D-A346-52EC1C4BFF B8
9.3 Permanent Disconnection
In the event this Agreement is terminated, the Utility shall have the
right to disconnect its facilities or direct the Customer to disconnect
its Generating Facility.
9.4 Survival Rights
This Agreement shall continue in effect after termination to the
extent necessary to allow or require either Party to fulfill rights or
obligations that arose under the Agreement.
10.0 Assignment/Transfer of Ownership of the Facility
10.1 This Agreement shall not survive the transfer of ownership of the
Generating Facility to a new owner.
10.2 The new owner must complete and submit a new Interconnection
Request agreeing to abide by these Terms and Conditions for
interconnection and parallel operations within 20 Business Days of
the transfer of ownership. The Utility shall acknowledge receipt and
return a signed copy of the Interconnection Request Application
Form within ten Business Days.
10.3 The Utility shall not study or inspect the Generating Facility unless the new
owner's Interconnection Request Application Form indicates that a Material
Modification has occurred or is proposed.
8
NC 20 kW Inverter
Docusign Envelope ID:336E49E8-5A07-4F9B-9071-7246E0851600
Attachment 6
Contingent Approval to Interconnect the Generating Facility (For Utility use onlyl
Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions
for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return
of the Certificate of Completion.
�000uslyned by:
Utility Signature: Usstr
`8ese5o3eoo0347o..
Title: Smart Energy Specialist Date: 3/26/2018
Interconnection Request ID number: INTCO-09077
Utility waives inspection/witness test? No
NC 10 kW Inverter Process 1