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HomeMy WebLinkAboutBuilding Permit # 2/19/2016 BUILDING PERMIT0 16 �kORTH TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION /7 41 Permit No#: 1/) Date Received I- 11-NC us Date Issued: c7L WI?6RTANT: Applicant must complete all items on this page 51 W, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 11 New Building 40ne family 11 Addition El Two or more family 11 Industrial El Alteration No. of units: El Commercial El Repair, replacement El Assessory Bldg El Others: El Demolition 0 Other ers h dibstrict ❑u,UVater/Sewer e DESCRIPTION OF WORK TO BE PERFORM �LJ Identification- Please Type or Print Clearly OWNER: Name: nq 4 Phone: U Address: -76 fr .. ............. OT(AP, r N m .......... kw'u� 'k� N ....... 7 '4M Home Improvementr Exp ARCHITECT/ENGINEER Phone: t/lj- 337//37- Address: C3 Ars 0,ee­ vies,_, L/0&_/ &n &Lo Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project COSI: $ 000 FEE: $ X16- 06) Receipt No.: S6?()3j Check No.�) K� - NOTE: Persons contra ting with egisterecd contractors do not have access to the fund SignafureofAgent/Owner S�g gj� ure of contractor Version#53.6-TBD PIL SolarCity February 18, 2016 RE: CERTIFICATION LETTER Project/Job# 0183485 Project Address: An Residence 70 Thistle Rd North Andover, MA 01845 AHJ North Andover SC Office Wilmington Design Criteria: -Applicable Codes= MA Res.Code,8th Edition,ASCE 7-05,and 2005 NDS - Risk Category = II -Wind Speed = 100 mph,Exposure Category C -Ground Snow Load = 50 psf - MP1: Roof DL= 14 psf, Roof LL/SL= 35 psf(Non-PV Areas), Roof LL/SL= 20 psf(PV Areas) - MP2: Roof DL= 11 psf, Roof LL/SL= 35 psf(Non-PV Areas), Roof LL/SL= 20 psf(PV Areas) - MP3: Roof DL= 11 psf, Roof LL/SL= 35 psf(Non-PV Areas), Roof LL/SL= 20 psf(PV Areas) Note: Per IBC 1613.1; Seismic check is not required because Ss =0.33365 < 0.4g and Seismic Design Category(SDC) = C < D To Whom It May Concern, A jobsite survey of the existing framing system of the address indicated above was performed by a site survey team from SolarCity. Structural evaluation was based on site observations and the design criteria listed above. Based on this evaluationI certify that the existing structure directly supporting the PV system is adequate to withstand all loading indicated in the design criteria above based on the requirements of the applicable existing building and/or new building provisions adopted/referenced above. Additionally,I certify that the PV module assembly including all standoffs supporting it have been reviewed to be in accordance with the manufacturer's specifications and to meet and/or exceed all requirements set forth by the ASCE 7 standards for loading. The PV assembly hardware specifications are contained in the plans submitted for approval. Additionally a summary of the structural review is provided in the results summary tables on the following page. F Sincerely, Digitally signed by HumphreyIuK, «. OS7 uCTURAL to Humphrey Kariuki, P.E. Ka ri u ki v NO.51uaa Tr 443.4513515neer Date: 2016.02.18 20:49:13 -05'00' % GIsTe email: hkariuki@solarcity.com NAL 3055 Clearview Way San Mateo, CA 94402 T(650)638-1028 (888)SOL-CITY F(650)638-1029 Version#53.6-TBD PIL ity SolarG HARDWARE DESIGN AND STRUCTURAL ANALYSIS RESULTS SUMMARY TABLES Landscape Hardware-Landscape Modules'Standoff Specifications Hardware X-X Spacing X-X Cantilever Y-Y Spacing Y-Y Cantilever Configuration Uplift DCR MPI 64" 24" 39" NA Staggered 62.8% MP2 64" 24" 39" NA Staggered 62.8% MP3 64" 24" 39" NA Staggered 62.8% Portrait Hardware-Portrait Modules'Standoff Specifications Hardware X-X Spacing X-X Cantilever Y-Y Spacing Y-Y Cantilever Configuration Uplift DCR 141133 48" 19" 65" NA Staggered 78.4% MP2 48" 19" 65" NA Staggered 78.4% MP3 48" 19" 65" NA Staggered 78.4% Structure Mounting;Plane Framing Qualification Results Type Spacing Pitch Member Evaluation Results MP1 Vaulted Ceiling @ 16 in.O.C. 360 Member Impact Check OK MP2 Stick Frame @ 16 in.O.C. 360 Member Impact Check OK MP3 Stick Frame @ 16 in.O.C. 360 Member Impact Check OK Refer to the submitted drawings for details of Information collected during a site survey. All member analysis and/or evaluation is based on framing information gathered on site.The existing gravity and lateral load carrying members were evaluated in accordance with the IBC and the IEBC 3055 Clearview Way San Mateo, CA 94402 s(650)638-1028 (888)SOL-CITY F(650)638-1029 solarcity.com STRUCTURE ANALYSIS LOADING SUMMARY AND MEMBER CHECK MPi Member Properties Summary MPI Horizontal Members ans Rafter Pro ertiet` Overhang 1.16 ft Actual W 1.50" Roof SyAern Pro ernes San 1 9:25 ft Actual D 9.25" Number of Spans(w/o Overhang) 1 San 2 Nominal Yes Roofing Material Comp,Roof San 3 A 13.88 In./12, Re-Roof No Span 4 SX 21.39 in A3 Plywood Sheathing Yes San 5 1 98,93!in.^4 Board Sheathing None Total Rake Span 12.87 ft TL Defit Limit 180 Vaulted Ceiling Yes PV 1 Start 1.25 ft Wood Species SPF Ceiling Finish 1/2"Gypsum Board PV 1 End 9.25 ft Wood Grade #2 Rafter Slope 360 PV 2 Start Fb 875 psi Rafter Spacing 16"O.C. PV 2 End F„ 135 psi Top Lat Bracing Full PV 3 Start E 1400000 psi Bot Lat Bracing Full PV 3 End Em;" 510000 psi Member Loading mary Roof Pitch 9/12 Initial Pitch Adjust Non-PV Areas PV Areas Roof Dead Load DL 14.0 psf x 1.24 17.3 psf 17.3 psf PV Dead load PV-DL 3.0 psf x 1,24 3.7,psf Roof Jive Load RLL 20.0 psf x 0.78 15.5 psf Live/Snow Load LL SLl12 50.0 psf x 0.7 1 x 0.4 35.0 psf 20.0,psf Total Load(Governing LC I TL 1 52.3 Psf 41.0 psf Notes: 1. ps=Cs*pf; Cs-roof,Cs-pv per ASCE 7[Figure 7-21 2. pf=0.7(Ce)(Ct)(IS)pg; Ce=0.9,Ct=1.1,I5=1.0 Member Design,Summa (Oer NDS Governin ,Load Comb CD CL + CL = CF Cr D+S 1.15 1.00 1 1.00 1 1.1 1.15 Member Analysis Results marV GoVJ3rnin§Analysis I Pre-PV'Demand Post-P1/Demand Net Im act Result Gravity Loading Check 408 psi 311 psi 0.76 Pass CALCULATION OF;DESIGN WIND LOADS MP1` Mounting Plane Information Roofing Material Comp Roof PV System Type Solardty SleekMount"m Spanning Vents No Standoff Attachment Hardware Comp Mount Tye C Roof'Slope 360 Rafter Spacing 16"O.C. Framing Type Direction Y-Y Rafters Purlin Spacing X-X Purlins Only NA Tile Reveal Tile Roofs Only NA Tile;Attachment System Tile Roofs Only NA Standin Seam/Trap Spacing SM Seam Only NA Wind Desi n Criteria Wind Design Code ASCE 7-05 Wind Design Method Partially/Fully Enclosed Method Basic Wind Speed V 100 mph Fig. 6-1 Exposure Category C Section 6.5.6.3 Roof Style Gable Roof Fig.6-11B/C/D-14A/B Mean Roof Height h 25 ft Section 6.2 Wind Pressure Calculation Coefficients Wind Pressure Exposure KZ 0.95 Table 6-3 Topographic Factor KA 1.00 Section 6.5.7 Wind Directionality Factor Kd 0.85 Table 6-4 Importance lFactor I 1,0 Table 6-1 Velocity Pressure qh qh= 0.00256(Kz)(Kzt)(Kd)(V^2)(I) Equation 6-15 20.6 psf Wind rPressure Ext. Pressure Coefficient U GC -0.95 Fig.6-11B/C/D-14A/B Ext.Pressure Coefficient Down GC „n i 0,88„ Fig.6-11B/C/D44A/B Design Wind Pressure p p= qh(GC) Equation 6-22 Wind Pressure Up Pful)) -19.6 psf Wind Pressure Down 18.0 psf ALLOWABLE STANDOFF SPACINGS X-Direction; Y-Direction Max Allowable Standoff Spacing Landscape 64" 39" Max Allowable Cantilever Landscape 24" NA Standoff Configuration Landscape Staggered Max Standoff Tributary Area Trib 17 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at Standoff T-actual -314 lbs Uplift Capacity of Standoff T-allow 500 lbs Standoff Demand/Capacity I DCR 1 62.8% X-Direction Y-Direction Max Allowable Standoff Spacing Portrait 48" 65" Max Allowable Cantilever Portrait 19" NA Standoff Configuration Portrait Staggered Max Standoff Tributary Area Trib 22 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at Standoff T-actual 392 lbs Uplift Capacity of Standoff T-allow 500 lbs Standoff Demand/Capacity DCR 1 78.4% STRUCTURE ANALYSIS LOADING SUMMARY AND MEMBER CHECK MP2 Member Properties Summary MP2 Horizontal'Member:S ans Rafter Pro erties Overhang 1.16 ft Actual W 1.501, Roof System Properties San 1 14.65 ft Actual D 9.25" Number of Spans(w/o Overhang) 1 San 2 Nominal Yes Roofing Material Comp Roof San 3 A 13.88 in.^2 Re-Roof No Span 4 S. 21.39 in.^3 Plywood Sheathing Yes San 5 11 98.93 in^4 Board Sheathing None Total Rake Span 19.54 ft TL DefPn Limit 120 Vaulted Ceiling No PV 1 Start 1:25 ft Wood Species SPF Ceilina Finish 1/2"Gypsum Board PV 1 End 9.25 ft Wood Grade #2 Rafter Slope 360 PV 2 Start Fb 875 psi Rafter Spacing 16"O.C. PV 2 End F„ 135 psi T6p Lat Bracing Full PV 3 Start E 1400000 psi Bot Lat Bracing At Supports PV 3 End Emi„ 510000 psi Member Loading mary Roof Pitch 0/12 Initial Pitch Adjust Non-PV Areas _'PV Areas Roof Dead Load DL 11.0 psf x 1.24 13.6 psf 13.6 psf PV Dead Load PV-DL 3.0 "psf x 1.24 L 3.7 psf Roof Live Load RLL 20.0 psf x 0.78 15.5 psf Live/Snow Load LL/SL 1,2 50.0 psf x 0.7; 1 x 0.4 35.0 psf 20.0 p5f Total Load(Goveming LC I TL 1 1 48.5 psf 1 37.3 psf Notes: 1. ps=Cs*pf,Cs-roof, Cs-pv per ASCE 7[Figure 7-2] 2. pf=0.7(Ce)(CO(IS)pg; Ce=0.9,Ct=1.1,I5=1.0 Member Design Summa (per NDS Governing Load Comb CD CL + CL+a) CF Cr D+S 1.15 1.00 1 0.29 i.i 1.15 Member Anal sis Results Summary Governin'Anal sis Pre-PV Demand Post-PV Demand Net Im act . Result Gravity Loading Check 966 psi 821 psi 0.85 Pass CALCULATION OF DESIGN WIND LOADS - MP2 Mountin Plane Information Roofing Material Comp Roof PV System Type SolarCity SleekMountTm Spanning Vents No Standoff Attachment Hardware Comp Mount Type C Roof Slope 360 Rafter Spacing 16"O.C. Framing Type Direction Y-Y Rafters Purlin Spacing X-X Purlins Only NA Tile Reveal Tile Roofs Only NA TileAttachment System Tile Roofs Only NA ,Standing Seam/Trap Spacing SM Seam Only NA Wind Design Criteria Wind Design Code ASCE 7-05 Wind Design Method Partially/Fully Enclosed Method Basic Wind Speed V 100 mph Fig. 6-1 Exposure Category C Section 6.5.6.3 Roof Style Gable Roof Fig.6-11B/C/D-14A/B Mean Roof Height h 25 ft Section 6.2 Wind Pressure Calculation Coefficients Wind Pressure Exposure KZ 0.95 Table 6-3 Topographic Factor KA 1.00 Section 6.5.7 Wind Directionality Factor Kd 0.85 Table 6-4 Importance Factor I 1.0 Table 6-1 Velocity Pressure qh qh =0.00256(Kz)(Kzt)(Kd)(V^2)(I) Equation 6-15 20.6 psf Wind Pressure Ext. Pressure Coefficient U GC -0.95 Fig.6-1113/C/D-14A/13 Ext.'Pressure Coefficient Down GC,(Dow,,)' 0.88 Fig.6-11B/C/D-14A/B Design Wind Pressure p p=qh (GC) Equation 6-22 Wind Pressure U ! „ -19.6 psf Wind Pressure Down Wdownl 18.0 psf ALLOWABLE STANDOFF SPACINGS X-Direction Y-Direction Max Allowable Standoff Spacing Landscape 64" 39" Max Allowable Cantilever Landscape 24" NA Standoff Configuration Landscape, Staggered Max Standoff Tributary Area Trib 17 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at Standoff T-actual -314 lbs Uplift Capacity of Standoff T-allow 500 lbs Standoff Demand/Capacity DCR 62.8% X-Direction Y-Direction Max Allowable Standoff Spacing Portrait 48" 65" Max Allowable Cantilever Portrait 19" NA Standoff Configuration Portrait Staggered Max Standoff Tributary Area Trib 22 sf, PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at Standoff T-actual -392 lbs Uplift Capacity of Standoff T-allow 500 lbs Standoff Demand/Cap I acity DCR 78.4% STRUCTURE ANALYSIS LOADING SUMMARY AND MEMBER CHECK MP3 Member Properties Summary MP3 Horizontal Member Spans i Rafter Pro ernes'' Overhang 1.16 ft Actual W 1.50" Roof System Pro ernes San 1 14.44 ft Actual D 9.25" Number of Spans(w/o Overhang) 1 San 2 Nominal Yes Roofing Material Comp Roof San 3 A 13.88 in.1%2 Re-Roof No Span 4 S,t 21.39 in.^3 Plywood Sheathing Yes San 5 I 98.93^in.^4 Board Sheathing None Total Rake Span 19.28 ft TL Defl'n Limit 120 Vaulted Ceiling No PV 1 Start 0.92 ft Wood Species SPF Ceiling Finish 1/2"Gypsum Board PV 1 End 11.58 ft Wood Grade #2 Rafter Slope 360 PV2 Start Fb 875 psi Rafter S acin 16"O.C. PV 2 End F„ 135 psi Top Lat'Bracing Full PV 3 Start E 1400000 psi Bot Lat Bracing I At Supports PV 3 End Emi„ 510000 psi Member Loading Summa Roof Pitch 9 12 Initial Pitch Adjust Non-PV Areas PV Areas Roof Dead Load DL 11.0 psf x 1.24 13.6 psf 13.6 psf PV Dead Load PV DL 3.0 psf x; 1.24 3.7 P$f. Roof Live Load RLL 20.0 psf x 0.78 15.5 psf Live/Snow Load LL/SL"2 50.0 psf x,0.7 I x 0.4 35.0 psf 20.0 psf Total Load(Governing LC TL 48.6 psf 37.3 psf Notes: 1. ps=Cs*pf;Cs-roof,Cs-pv per ASCE 7[Figure 7-2] 2. pf=0.7(Ce)(Ct)(IS)p9; Ce=0.9,Ct=1.1,I5=1.0 Member Design Summa (per NDS Governing Load Comb l) Cl. + Cl. - CF Cr D+S 1.15 1.00 1 0.30 1 1.1 1.15 Member Anal sis Results Summa Governing Analysis Pre-PV Demand 1post-PvDeinandi Net Im act I Result Gravity Loading Check 938 psi 1 748 psi 1 0.80 1 Pass CALCULATION OF DESIGN WIND LOADS MP3 Mounting Plane Information Roofing Material Comp Roof PV System Type SolarCity SleekMountTm Spanning Vents No Standoff Attachment Hardware Comp Mount Type C Roof Slope 360 Rafter Spacing 16"O.C. Framing Type Direction Y-Y Rafters Purlin Spacing X-X'Purlins Only NA Tile Reveal Tile Roofs Only NA Tile Attachment System Tile Roofs Only NA Standing Seam/Trap Spacing SM Seam Only NA Wind Design Criteria Wind Design Code ASCE 7-05 Wind Design Method Partially/Fully Enclosed Method Basic Wind Speed V 100 mph Fig. 6-1 Exposure Category C Section 6.5.6.3 Roof Style Gable Roof Fig.6-116/C/D-14A/13 Mean Roof Height In 25 ft Section 6.2 Wind Pressure Calculation Coefficients Wind Pressure Exposure KZ 0.95 Table 6-3 Topographic Factor KA 1.00 Section 6.5.7 Wind Directionality Factor Kd 0.85 Table 6-4 Importance factor I 1,0 Table 6-1 Velocity Pressure qh qh = 0.00256(Kz)(Kzt)(Kd)(V^2)(I) Equation 6-15 20.6 psf Wind Pressure Ext. Pressure Coefficient U GC -0.95 Fig.6-11B/C/D-14A/B Ext.Pressure Coefficient Down GCwn 0.88 Fig,6-118/G/D-14A/B Design Wind Pressure p p = qh(GC ) Equation 6-22 Wind Pressure U -19.6 psf Wind Pressure Down 18.0 psf ALLOWABLE STANDOFF SPACINGS X-Direction Y-Direction Max Allowable Standoff Spacing Landscape 64" 39" Max Allowable Cantilever Landscape 24" NA Standoff Configuration Landscape Staggered Max Standoff Tributary Area i Trib 17 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at Standoff T actual " -314 lbs Uplift Capacity of Standoff T-allow 500 lbs Standoff Demand/Capacity DCR 62.8% X-Direction "Y-Direction Max Allowable Standoff Spacing Portrait 48" 65 Max Allowable Cantilever Portrait 19" NA Standoff Confi uration Portrait Staggered Max Standoff Tributary Area Trib 22 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at Standoff T actual -392 lbs Uplift Capacity of Standoff T-allow 500 lbs Standoff Demand/Capadty DCR 78.4% DocuSign Envelope ID:39544A8E-OCE7-4AOC-BODO-437C4B42BEA5 PPACustomer Name and Address Installation Location Date Hong An 70 Thistle Rd 2/15/2016 70 Thistle Rd North Andover,MA 01845 North Andover,MA 01845 Here are the key tert'ns of your Pcw.rer Purchase Agreement OF&4 A 0 a�_'Vs toso07C S stern installation cost ' Electricity rate .) (tWh A reentent��ii�m Initial here Initial here DS The SolarCh(y Proixiise _j /9- •We guarantee that If you sell your Home,the buyer will qualify to assume your Agreement ........ ........................... Initial here f� •We warrant all of our roofing work. DS •We restore your roof at the end of the Agreement. •We warrant,insure,maintain and repair the System. .......................... ..... ........ ....... ........_. .. ............................................................... Initial here. •We fix or pay for any damage we may cause to your property. •We provide 24/7 web-enabled monitoring at no additional cost. •The rate you pay us will never increase by more than 2.90%per year. •The pricing in this Agreement is valid for 30 days after 2/15/2016. MEMO- Your Solar0ty Power Durchase Agree_rne.nt Details Your Choices at the End of the Initial Options for System Purchase: Amount due at contract signing Term: •At certain times,as specified in $0 •SolarCity will remove the System at no the Agreement,you may Est.amount due at installation cost to you. purchase the System. $0 •You can upgrade to a new System with •These options apply during the 20 the latest solar technology under a new year term of our Agreement and Est.amount due at building inspection $0 contract. not beyond that term. •You may purchase the System from Est.first year production ' SolarCity for its fair market value as 8,864 kWh specified in the Agreement. •You may renew this Agreement for up to ten(10)years in two(2)five(5)year increments. 3(i . le ry€e w Way, St n Mateo, a0888.7651489 ( solarch:y.com 1575924 Power Purchase Agreement,version 9.1.0,November 11,2015 SAPC/SEFA Compliant Contractors License MA HIC 168572/EL-1136MR Document generated on 2/15/2016 [mj]:X� Copyright 2008-2015 SolarCity Corporation,All Rights Reserved �k . DocuSign Envelope ID:39544A8E-OCE7-4AOC-BODO-437C4B42BEA5 23. NOTICE OF RIGHT TO CANCEL. I have read this Power Purchase Agreement and the Exhibits in YOU MAY CANCEL THIS CONTRACT AT ANY TIME PRIOR their entirety and I acknowledge that I have received a TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE complete copy of this Power Purchase Agreement. DATE YOU SIGN THIS CONTRACT. SEE EXHIBIT 1.THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN Customer's Name: Hong An EXPLANATION OF THIS RIGHT. Docusigned by: 24. ADDITIONAL RIGHTS TO CANCEL. Signature: IN ADDITION TO ANY RIGHTS YOU MAY HAVE TO CANCEL THIS PPA UNDER SECTION 23,YOU MAY ALSO CANCEL Date: 2/15/2016 THIS PPA AT NO COST AT ANY TIME PRIOR TO COMMENCEMENT OF CONSTRUCTION ON YOUR HOME. 25. Pricing The pricing in this PPA is valid for 30 days after 2/15/2016. Customer's Name: If you don't sign this PPA and return it to us on or prior to 30 days after 2/15/2016,SolarCity reserves the right to Signature: reject this PPA unless you agree to our then current pricing. Date: Power Purchase Agreement SolarCity approved Signature: Lyndon Rive, CEO Date: 2/15/2016 Power Purchase Agreement,version 9.1.0,November 11,2015 :N6 . 1575924 0 Tile C'ommeniueailh of1' msuebusctts Department efIndusirtalAce"eats Office of-1nvestiga&ns X C'ungress Street,Suite Igo Aostan,M4 OIJ14.2017 www.mass.gotldia Workers'Compensation InsuranceA.ffidaVit;Baitt�exatl�o�trac�vrslEfi~ctrici�aattsl�"Iltem�ers Anglicgnt Inform tia>n pI< se Print l } Iv Name(Business(orgUIzatiottltndMduat}: SolarCity Corp. Address: 3055 Clearview Way City/.StatcfZi : San Mateo CA. 94402 Phone#: 8. 88-765_-2489 Are you-an employer',Check the appropriate bole: `Type of project(required): I.Qi am a employer with 5,000 _ 4. ❑ I ain a general Contootor and 1 G Ne>;':construction employees(full and/or par#-time),* have hired the sub-contractors 2.❑ I am a state proprietor or partner- listed on the attached steel. y. ❑Remodeling ship and have no employees 'those sub-catitractors have S, ©Demolition v'orkin for melt in an capacity. ornploFYees ead have workers' g Y P tY• 3 9. j�13uildiug addition [No v:orkers'comp.Insurance comp.insurtmce. required./ 5:[] We arc a corporation and its 10.Q F.leeteioal repairs or additions 3.❑ 1 am a homeowner doing all`work officors have exercised their I1,E].plumbing repairs or additions myself.[No werkers'comp. A&Iof exeaVt rni per r"G'L I2. ]Roof repairs insurance requlred.l t c. 152,§1(4),and ive have no 13 pttuer Solar/PV employees.[No workers' comp.igsurance required.] 'Any applicant that checks box Hi mustsiso fill out the section belowshowing their workers'compedsa ion poricy inibrmation. I Homeowners who,submitthis affldavtt Indicating titfy are doing all work and then hire outside submit a new affidavit(ndicatinCsuoh. rContmotors that cheek this box must attached on additional sheet showing file name or the sub-contractors and state whether or not those entities have employees. if the,sub•contrmtorshave sniptoyees,they must provide their workers'comp policy number. .1 triaa an etarpl[tpea t'ftad is propWol ig worlmrs'compensation.insururrce for rrrY dH.�'llayees. Ba'dow is tole pcllcy feud job site darfurrarutinrr. Insurance Company Name: Zurich American Insurance Company Policy 4 or Self-ins°,Lio.#: WIC,0182015-00 Expiration Dewe�:p9/1 J/20n16__ j� (y Job Site Address: !o „1 ►I I t I e _,\ citylstat..Izip:/�®�'119 A h t)yer / to 01 K ( 5 Attu&a copy of the workers'competYtiatlion policy rlaeluration page(sltow;ng the policy number and expiretlor,date). Failure to secure coverage as required under Section 25A of MGL n. 152 tart lead to the imposition of c6minal penalties of a fine up to$1,500.00 and/or etre-year imprisonment,as well as civil penalties in the feat of a STOP WORK ORDER and a fine of up to$250.00-a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of 1'nvestigations of the DIA for insurance coverage verification. r der hereby cerd�y gfperfrrrthat die pzPre er€coffec S' afore: C� tc Phoa�e#• D,f�rchd use olsty. Do not wrlte in fess gree;to he c-unipleted by Baty or tatyrr oferfol, City or Town; )Perrnit/l�iet nse# Issuing Milh,oritp(rarcle one); ��Hifa l.e- 0.®ii t♦ W "i�ii.:iv.� ,• •- ry• �• 4w.}v:ww� 2 RL__tal, .— e... ,,. w,4140 . 0.2 gjlSj,cL'wt7i �,6filinifHl�2ilJ�leCFUC Contact Person; Phone 4: DATE(MMIODNYYY) CERTIFICATE OF LIABILITY INSURANCE 08117r2015 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 INSURERJS), 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 CO TACT MARSHRISK&INSURANCE SERVICES _N9M1 ._._......_ ._..._. PHONE .. .. .... .... . ... . ..... .... ..r FAX......_._.._._ ....__.._....—..-- 345 CALIFORNIA STREET.SUITE 1300 {Atc As.ext)c......._.._ ._- •-- . ........... .. .._.. .3..1lVC,N91:........... ._........................... CALIFORNIA LICENSE NO.0437153 E•MArL SAN FRANCISCO,CA 94104 ApP..RBIs:. ..... .... ........ ..... _.._...._..---...._.._._....__...._.. ._........_........._.... Alin:Shannon Scod415-743.8304 INSURERIS)AFFORDING}COVERAs3E. .•. -_. NAIC# 998301-STND•GAWUE-15.15 _.. ....._ _.._....._..._.. -..._._.. .INSURER A:Zurich American Insurance Company _... 16535 INSUREDINSURER B;NIA 'NIA SolarCity Corporation +.. ., . 3055 Clearvlew Way _INSURER,C;NIA NIA San Mateo,CA 94402 INSURER D.-American Zurich Insurance Company t40142 - . .._......... ..... .. ...... ........ _.__.._. _........._ ._.__..... _........t - ..... ..... 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 13Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THF;TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN R15DUCED BY PAID CLAIMS. ....... __ ..._ ..._.._.. LTR TYPE!OF INSURANCE Tdo-riL{SIIBRT P L1CY NUMBER ( rAA 1DOY EFF . MMl D £xY ! LIMITS AX COMMERCIALGENERAL LIABILITY ! IGLO0182016 00 0910112015 '0910112016 EACH OCCURRENCE :S .. 3,000,004 I i t Oi1f 4A Ef ITEO • GE TOR X !OCCUR ; ° j PR�Mt$EsiEaoccurregcz}----•-_...._....._.3,000,000 _ ..... CLAIMS-MADE ---- X SIR:$250,000 MED EXP(Rny ono person) S 6,000 PERSONAL&ADV INJURY :$ ' i GENEt7ALAGGREflATE. . •••••, 3,000,000 E GEN'L AGGREGATE LIMIT APPLIES PER »$ 6,000,000 ' X POLICY i-•- .'PE0 C. ,..y LOC i I PRODUCTS•COMPIOP AGG ;$_._ •. _ -_ 6,000,OOD i THER. $ A AUTOMOBILE LIAOILITY :BAP0182017.00 10910112015 '0910112016 :COMBINED SIN LELIMIT y 5,000,000 BO X ANY AUTO I ; R : r._..OILY INJURY(Per person) $ . .. .... ....i..._......_ X {ALL OWNED 'X SCHEDULED ; BODILY INJURY(Pec accident);$ }...i AUTOS E ... AUTOS (.....__._...__..........._. . . 4- ......... ._... ------- X X HIRI:OAUTOS NON-OWNED : i �,{PeOtacGPtjDAMAGE' $ r,•,�AUTOS f �.. ........... _._.._ .... I COMPICOLLDED: :S $5,000 UMBRELLA LIAB :OCCUR : EACH OCCURRENCE 3 1 , f...._.._._. .} _.... I EXCESS UAB I CLAIMS MAC1E ! AGGREGATE $ i DEC')* I RETENTIO $ ! S D WORKERS COMPENSATION WC0182014400(AOS) 0910112015 0910112016 i X R I 'IT AND EMPLOYERS'LIABILITY I._...i STATUTE.;..... ..R...._ _. _. .._......_.._ A ANY PROPRIETORIPARTNERIEXECUTIVE Y/N I :WC0182015.00(MA) :0910112015 109101/2016 E L.EACH ACCIDENT 1 S 1,000,000 O>FICER/MEM6ER EXCLUDED? w N/A i r-..._..._...... . ._.._.... (Mandatory In NH) SWC DEDUCTIBLE:$500,000 E.L DISEASE•EA EMPLOYE 5 1,000,000 If yes.dsc erbe under I ._.._._.. ..... DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT;$ 1,000,000 1 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD.1101,Additional Remarks Schedule,may no attached It more space Is required) Evidence of insurance. CERTIFICATE HOLDER CANCELLATION SolarCrly Corporation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3055 Clearview Vijay THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN San Mateo,CA 90402 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk&Insurance Services Charles Marmolejo ," c�' O 19882014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORN 0iff ce of Consumer Affairs and Business Regulation 10 Park Plaza. - Suite 5170 Aston, Massachusetts 02116 Home Improvement Contract®r Registration Registration: 168672 Type: Supplement Card SOLAR CITY CORPORA T ICON Expiration: 318/2017 ®AN EONZI _. ____--_.---_____ _._ ___.-.. 24 ST MARTIN STREET BL® 2UNIT 11 MARLBOROUGH, MA 01752 �------__---- Update Address and return card.Mark reason for change. [J Address J Renewal [j Employment ._-] Lost Card Wice of Consumer Affairs&Business regulation License or registration valid for individul use only 140ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business regulation Registration: 168572 Type: 10 Park Plaza-Suite S 170 Expiration: 3/8/2017 Supplement Cerd Boston,MA 02116 SOLAR CITY CORPORATION DAN FONZI 3055 CLEARVIEW WAY SAN MATEO,CA 94402 Undersecretary Not valid without signature CS-101687 DANIEL D FOaN4 15 KELLEY WILMMGTON NA 01-44- 09/1W2016