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HomeMy WebLinkAboutBuilding Permit # 6/7/2016 TM BUILDING ITTOWN OF NORTH ANDOVER � APPLICATION FOR LAN EXAM I NxpQN ,. m Permit Nvae Date Received Date Issued: ) IMPORTANT:A licant must c lete all items cert this LOCATION TION 141 Berry Street; Print pRbPERTYOWNER Jeffrey and Tiffany Tun Print MAP NC. PARCEL.: ( NI NC DIST IC °:mom Historic District ' yes, n Lachine Shop Village yes n TYPE OF IMPROVEMENT PF OPOSP.D USE Residential Non- Residential ❑ New Building M One family ❑ Addition CI Two or more family Cl Industrial ❑Alteration No. of units: I-] Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well 0 Floodplain 0 Wetlands ❑ Watershed District ❑ .Wa.ter/Sewer Installation of 29 Solar PV Modules on existing roof m Identification Please Type or Print Clearly) OWNER: Name: Jeffrey and Tiffany Moon Phone: (978) 884-9520 Address: 141 Berry Street CONTRACTOR Name: Phone: (508) 930-1405 Philip McCarron /Bay State Scalar 2 Shayl e,Lane, Lakeville, MA 02347 Supervisor'sConstruction License Exp, Date. CS-071992 05/09/2018 Home IMprovement License: P p. Mato: '179404 07/.2812016 ARCFIIT CT/ENGINEER James Clancy Phone: (856) 358-1125 Address: 601 Asbury Ave, National park, NJ 08063 Reg No. 4.6775 PEE SCHEDULE:BULDING PERMIT:IT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$126.00 PER S.F. Total Project Cost: $9,500.00 FEE: Check No.: 400 Receipt� t No.: NOTE: Persons contractingwhir unregistered contractors do not have access to tizcguaranty.fund Signature, cif Agent/Owner Signature of contractor_­77, aw ,A F tkoR g Town of Andover 0 ® _ C, LANE ` ver, Mass, COC NICHE WICK y1' QATED ll BOARD OF HEALTH Food/Kitchen P E I T�tf T L D Septic System THIS CERTIFIES THAT BUILDING INSPECTOR has permission to erect buildings on . Foundation Rough to be occupied as .. ...9..... .. . ..... ... ........ .. .. .... ... ... .............. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS ION S Rough Service .. . ... . .. ..4BUIiLD61iN�G�l PU/'* Final T GAS INSPECTOR Occupancy Permit Regiiired to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingr Dry Wall aDone FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. JAM ESA . CLANCY PROFESSIONAL ENGINEER 601 ASBURY AEN U E NATIONAL PARK, NJ 08063 (8 56) 358- 1125 FA X : (8 56) 358- 1511 Date: May 31,2016 Re: Structural Roof Certification Subj: Moon Residence, 141 Berry Street, N Andover MA 01845 We have provided a review of the house roof construction of the above named property in regards to verifying the capacity of the existing roof for installation of a new Solar Panel Array. We have found the residence roof to be of wood frame construction bearing walls with Roof I of 2x10 @ 16" rafter framed roof and sheathed with 1/2" ext-ply decking and a single layer of composite shingle roofing. Roof 2 is of 2x10 @ 16" rafter fi-ained roof with 2x8 @ 32" o.c. collar ties and sheathed with 1/2"ext-ply decking and a single layer of composite shingle roofing. The wood framed roof structure bears directly upon the framed exterior wall system. The existing rafters as installed meet the required (MA 780 CMR) IRC-2009 table 802 design span ratings with sufficient capacity to early the 2.89#/sf additional load imposed by the proposed solar array per the details below. Installation of solar rack systems shall be as follows: Each panel row shall be supported upon 2 mounting rails. Rails shall be screw anchored through roof and directly to rafters or purlins below. Rail attachment points to rafters shall be staggered each row with exception to the first fastener row from the gable end which is attached to two adjacent rafters/trusses with Stainless Steel fasteners, Rail attachment to roof sliall be fastened 16-32"o.c. at corners and 48" o.c. through the field. Rails are to be placed at 24-48"o.c. on the roof, When installed per the above specifications the system shall meet the required 100 MPH wind load and 50 PSI'ground snow load requirements. Should you have any further question or comment please feel fi-ee to contact our office. Respectfully, JA, ES A. o.46775 James A. Clancy ai Professional Engineer NA, MA License# 46775 �9 J i e BayState Homeowner's Agent AuthorizatIOUFor / y (} arn the z �. / /rrr /✓/ // //// r/jilt , r l /rl/i // � i. @� ,�.. a� � // //r��i r!ii r rjl� �l r/y rl'/i I>✓ �I /�I%�/l I hereby authorize Bay State Solar to act asy agent for the I 11 mited c r for and obtaining local building and offer permits rsi the t77, ort rrisdict on as required for the install tlo , l" o 0raltl property. Customer Signa ¢ �'�w Datta. � r s � d"1C�t HCl // � 1r%r//,rid r�r//✓��J+�, ��/I,� a / u i� I' v'?� / r /� i/ /%rr/ fi/�//✓/�/�/l r i (l //i,,i/%ri iii✓f/��/�/y/ /�%///r�jr��// /�f//ilii/N1 '�� I�P� �rfl , N M 0 W BERRY STREET �G E z � � w LOCATION MAP: 195 MODULE z ORIENTATION Z 39 TILT MAIN PANEL F' 00 EXISTING METER z PV AC DISCONNECT PROJECT DATA GENERATION METER INVERTER CODES CMR-780 IRC-2009 U MEC-2014 NEC-2014 BUILDING USE: DRIVEWAY EXISTING: R-RESIDENTIAL SINGLE FAMILY CONST.CLASS 5-B UNPROTECTED o p O SOLAR ARRAY: x O Q PANEL: LG 300N1C-G4 PV ARRAY a z 26 MODULES 1STRING OF 9MOON RESIDENCh x _ _ I STRING OF 17 RACKING: FLUSH TO ROOF @ Net 39° INVERTER SOLAR EDGE SE6000A-US Metered ® �LkW Du"' - SYSTEM RATING: 7,800 Watts DC-STC ' w • 0-kW THE PSBEEN RALUATED E REVISIONS ROOF LOADS: THE PROPOSED NEW SOLAR LOAD AND DETERMINED TO B OF SUFFICIENT CAPACITY TO INSTALL THE PROPOSED SOLAR °A"N ROA GROUND SNOW 50 PST ARRAY AS FOLLOWS: A-1: COVER PAGE A-5: STRING SIZER IRCAF IASNOT • °q� 0&31•M16 WIND LOAD 100 MPH A)SHINGLE ROOF-MECHANICALLY FASTENED RACK SYSTEM A-2: ROOF LAYOUT A 6; LABELS SAY STATE SOLAR SOLAR ARRAY 4.0 PSF NOT TO EXCEED A WEIGHT OF 4.0 LBS/SQ.FT. A-3: STRUCTURAL A-7: DATA SHEETS v LANE A-4: ELECTRICAL u � �ui 42341 [ A MONITORING M N EQUIPMENT SHALL o NO NEW CONSTRUCTION IS BEING PROPOSED, MOUNT ADJACENT o 4 PV SYSTEM IS TO BE MOUNTED ON EXISTING TO INVERTER ROOF STRUCTURE. M � z , ° MAIN PANEL 0 D z M 195°MODULE ALUMINUM SOLAR EXISTING METER 0 Z ORIENTATION MOUNTING RAIL w/MTG PV AC DISCONNECT a p m 39 TILT FOOT @ 48"O.C. GENERATION METER INVERTER Z 4' 1'41 —►It *4 its U d W G - -- - G a O PV MODULE O EQ 16'-7" EQ PV STRING ®39°TILT 5 2' 32'-6" 5+-5++ 39°TILT 2-1 STRING LABEL(INVERTER-STRING) Raa. G RACKING GROUND CONNECTION REVISIONS ❑ INVERTER THE EXISTING ROOF STRUCTURE HAS BEEN EVALUATED FOR EY AC LOADCENTER THE PROPOSED NEW SOLAR LOAD AND DETERMINED TO BE OF DR— Ia°A SUFFICIENT CAPACITY TO INSTALL THE PROPOSED SOLAR ❑ ARRAY AS FOLLOWS: 9G LE AS"°AC DISCONNECT nA� oo-a+-zmc ��l D METER A)SHINGLE ROOF-MECHANICALLY FASTENED RACK SYSTEM BAY STATE SOLAR NOT TO EXCEED A WEIGHT OF 4.0 LBS/SQ.FT. =SHAYLEELANE G1h2VRL$MA 4:347 PV Modulern Weight=46 lbs Area=39" x 65"nominal (17.6 SgFt) U4 'Go Mounting Rail(Extruded Aluminum) Weight=1.03/lf ; SOLAR PANEL 62Do J a� There are 80"of rail per module=6.87 lbs SOLAR MOUNT C RAAIIL Z ^///w Module+Rail=52.87 lbs over 17.6 SgFt=3.00#/SgFt TOP MOUNT CLAMPS J ± O J HIDE ENDREQUIRED Typical rail spacing is 32"o.c. across panel width with 2 rows per module. IRAILATTACHMENT a J HARDWARE BY SHINGLE MOUNT FLASHING KIT O MFG'R WwMEOPRENE WASHER lQ I as M Typical layout provides 13 feet on one rail for each 10 modules in a row, i gZrFSSTLAGI—T a a ANGLE (wed pea Notes LOCATION This provides for an average of 1.3 feet/module/rail x 2 rails=2.6 P_W11 HN feet/module. SHINGLE —ROOF / y FLASHING DECKINGJ H � J Module+Rail weight distributed per mounting foot 52.87 lbs/2.6 feet=20.33 lbs/mtg foot. ��� FROOF RAMING % > SHINGLE MOUNT DETAIL `MOUNTING RAIL SPACING MAY VARY FROM 20"-54"O.C. CONTRACTOR TO VERIFY PANEL MANUFACTURER'S SPECIFICATIONS AND INSTALLATION REQUIREMENTS, `�� IRON RIDGE RACKING,-' OOT SPACING SHALL BE MAX.4'&"O.C.ALONG RAIL. O un d 2 0 0 � ® ® SHINGLE MOUNT FLASHING KIT a z W/NEOPRENE WASHER EXTRUDED ALUMINUM ;0* SOLAR MOUNTING RAILTTa = �? -, * 5/16"LAG BOLT U , INTO RAFTER EXISTING "-= 2x8 @ 32"O.C.COLLAR TIES 2x10 @ 16"O:SHINGLE S SHEATHED WY I LAYER COMPOS �� REVISIONS 2x10 @ 16"O.C.RAFTERS � SHEATHED WITH 1/2"PLY DRwN Rcn 1 LAYER COMPOSITE SHINGLE 11'-S" RCMP. AS NOTED DATE 05-11.2016 SAY STATE SOLAR ROOF SECTION 4'-11" 8'-4" 2:HAn,2EE�AWE A-3 scALE:tAi"=1'•0" I.A[SHAY.E.MANE Confirm line side voltage m POWER OUTPUT=PTC RATING x#MODULES x M.INV EFF at electric utility service �O entrance BEFORE 0 INVERTERS 1 = 279.6 W x 26 x 0.975=7,087.86 W entrance I =1 TOTAL=7,087.86 W g inverter and y ensure proper operational W m range required by system M inverter. G WIRE AMPACITY W cc NEC TABLE 310.15(B)(16) EXISTING WIRING Ua ,",�• WIRE AMPACITY 25A x 1.25=31.25A MIN OCPD #10 THWN Cu 35A RATED u zQ #8 THWN Cu 50A RATED Z - #6 THWN Cu 65A RATED L2 TO UTILITY p vNry Oaa (4 wires)#8 THWN-2 I GND rO++,3 (4 wires)#8 PV WIRE 3/4"CONDUIT I I EXISTING ELECTRIC t °c #8GND 60A RATED I I UTILITY METER 35A FUSED 25A (3 wires)#8 THWN (3 wires)#8 THWN DISCONNECT (3 wires)#6 THWN y #6 GND #6 GND 120/240V #6 GND I 5" w 1"CONDUIT 1"CONDUIT 1"CONDUIT 00� O ----------- '—- ————•— a— N W �O _.—._._ ._._. m y z a L2 ( L2 I f LINE TAP IN �UEXISTING MAINy L1 I PANEL ENCLOSURE I i I a r-- ? Vv o4o I�L I I I Interconnection to Utility O V p and System Grounding a ALL CONDUCTORS ARE COPPER UNLESS NOTED OTHERWISE, i per NEC-2014 Article 690 ^� z Provide signage as req'd I by NEC-2014 Article 690, ALL EXTERIOR MOUNTED I lTa"i RAPID SHUT DOWN COMBINERS,JUNCTION BOXES, ( ALL outdoor equipment �r ' Contractor to enable Rapid TROUGHS,DISCONNECTS,ETC. I shall be a minimum of NEMA-3R rated, AC&DC GROUNDING CONDUCTORS Shutdown functionality on Solar SHALL BE MIN.NEMA 3R RATED. PER NEC ARTICLE 690,47(-)(2) Edge Inverter per S.E.doc.# CONNECTED AS PER 250.64(.)(1) MAN-01-00186-1.6 as required per N U y NEC-2014 Article 690.12(1)thru(4). GND EXISTING 200A BUSS MAIN SVC PANEL 120/240V REVISIONS Electrical contractor to verify interconnection requirements with Electrical Utility for connection location and standards. DRV N FfA -Electrical Contractor to provide expansion joints and anchoring of all conduit runs �n 1 as per NEC requirements. 9ULE 1L"11E1 -Provide label/placard at existing utility connection with"WARNING-CUSTOMER nn usa,ao,e OWNED ELECTRICAL GENERATION EQUIPMENT CONNECTED"with BAY STATE SOLAR appropriate hazard and output ratings of PV System, 25eAYLEELPNM LAXEV MLE,MA 42347 North Andover MIMAP June 7, 2016 106.D-0073 106.D-0041 v44 ASH 5T 11 ASH ST � 106.D-0042 r 106.D-0038 V) 52.Ci4 R3 160 BERRY 5T k11) 106.D-0039 106.D-0058 R2. �() 180 BERRY 5.1" 64,0 . Nz106.D-0076 1.42 BERRY ST �r 6 190 BERRY ST " r 106.a-0077 ire n, t 106.D-0036 1p6.D-0075 �� 1,49 BERRY,ST cc: 141 BERRY ST � 106.D-0074 49, !r 6� 106.a-0044 vi L JOE.; 179 BERRY 9T 106.D-0056 '.+IFE,;,yl,r .. 193 BERRY BT 6'J1, ^1pG:a-003'2"_' ; 106.a-0463 106.a-0049 , c 203 BERRY 6•T 16 "BEtrtY T dr 48 G Mf'/195 F"C}I'PJT 10'6.a-0055 5 1f. pktl^ubf �r t210-BERR5T 66.C1-0054 4, M MVPC Bo Zoning Overlay Zoning rj Adult Entertainment Distdo Busine s 1 District ( Municipal Boundary I, 'j Machine Shop Village Ove ,I'. Basins!s 2 District Horizontal Datum:MA Staleplane Coordinate System,Datum NAD83, Rail Line Watershed Protection Dist M Busine s 3 District Meters Data Sources:The data for this neap was produced by Merrimack Interstates 0 Historic Mill Area M Busine s 4 District pORTp Valley Planning Commission(MVPC)using data provided by the Town of ._...I tT Medical Marijuana N Gener Business District 6f go 'q t„ North Andover.Additional data provided by the Executive Office of --SR (,„'�Downtown Overlay District N,Plarme Commercial Dev ��Y� rp*a 41 Environmental Aflalrs/MassGIS,The Information depicted on this map is Roads ®` Historic District Conido Development Dist + OL for planning purposes only.It may not be adequate for legal boundary Osgood Smart Growth(40 Conido Development Dist O '" M definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER 5�y Easements i Hydrographic Features IN Conido Development Dist F MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ❑Parcels Industri I 1 District M - * THE ACCURACY"COMPLETENESS,RELIABILITY,OR SUITABILITY Streams Ind ustri 12 District r, :� n # OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Wetlands '+1. Industri 13 District +f CQ ,*4c ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 11 Industri I S District q.,``"""'" THIS INFORMATION Exempt Lands Reside ce 1 District Reside ca 2 District ACHUS� R—de ce3 District de ce 4 District 1 e= 126 ftde ce 5 District ,de ce 0 District ���age osldential District North Andover MIMAP June 7, 2016 r k, M /rr �r I f 0 I ;•lr� w!1��� d;'' m � /�`�� ay /i lr���fi��✓� ! /iii � tl �� e /�� � I� � I, /1 f ii rl ✓ i iii � yu^,I /r r ✓ ti V a , ry ! f�„ nl . f� roS�w y'r�Y2apf7�"s is?w f 0 MVPC Bo Interstates Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —SR Meters Data Sources:The data for this map was produced by Merrimack NpRYp Valley Planning Commission(MVPC)using data provided by the Town of Roads 4'�,t`•o q North Andover.Additional data provided by the Executive Office of q'p Easements ,�. a° `4a40 Environmental Affairs/MassGIS.The information depicted on this map is Parcels for planning purposes only.It may riot be adequate for legal boundary 4 •—• mA definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER F. MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING {t * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION SA US 1"=126ft " 'i" North Andover MIMAP June 7, 2016 106.D-0073 106.D-0041 44 AS H ST 11 ASH s'r 106.D-0042 (n 106.D-0038 rw J2,64 160 BERR, 106.D-0039 106.D-0058 180 BERRY ST 6A 9' 142 BERRY ST 106.D-0076 190 BERRY s'r 2 106.D-0077 106.D-0036 106.D-0075 rir iii 1,/4 9�B a-R R Y,S T nj 141 BERRY ST 106.D-0074 C"i 106.D-0044 3.7.9 BERRY ST 106.D-0056 ........... T 193 BERRY .4r' '--106"D-00 2---%, 106.D-0063 106.D-0049 .... ...... .... . 203 BERRY ST Al cf.)m 169 6Ek�Y' 106.D-0055 48 PA§�,'�' NT Al I . ? 4O- BERRYST A -06b .0 A,/ -,1.id6.b-00!54 -0 -7, 'A/ L Ir d Cl "VPC B. Municipal Boundary H.d,-W Datum:MA Statelplane Cm,nliu.ta System,Datum NAD83, Rail Line Meters Data Sources:The data for this map was produced by Merrimack Interstate. %AORTN Valley Planning Commission(MVPC)using data provided by the Town of North Andover,Additional data provided by the Executive Office of 6 0 Environmental Affairs/MassGIS.The Information depicted on this map is Roads 4 for planning purposes only.It may not be adequate for legal boundary 0 definition or regulatory Interpretation.THE TOWN OF NORTH ANDOVER Easements MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY El Parcels OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Trails iF o 41 ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF Hydrographic Features o THIS INFORMATION Streams Wetlands Exempt Lands 1"= 126 ft ® DATE(MM/DD/YYYY) ACCOR00 CERTIFICATE OF LIABILITY INSURANCE 8/31/2015 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(les) 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). CONTACT PRODUCER NA E: Hadley Insurit Group PHONE508-678-5267 (AMFAX 508-673-0322 246 Durfee St E-MAIL Fall River MA 02720 chadley@hadleyinsurit.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Scottsdale Insurance Company INSURED MCCAR-1 INSURER B:Pilgrim Ins Co Philip McCarron DBA INSURERC: Bay State Solar INSURER D: 2 Shaylee Lane Lakeville MA 02347 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:796962432 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP ?LTR TYPE OF IADDLSUBR NSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPS2195257 8/24/2015 8/24/2016 EACH OCCURRENCE $1,000,000 DAMAGE fO—RENTED CLAIMS-MADE I—XI OCCUR PREMISES Ea occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- LOC PRODUCTS-COMP/OP AGG $2,000,000 POLICY JECT $ OTHER: 4/2/2015 4!2!2016 COMBINEDSINGL L IT $1,000,000 8 AUTOMOBILE LIABILITY PGC00001018678 a accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS X HIRED AUTOS X AUTOS Perracc,denDAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITYY/N STATUTE ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑N/A E L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below A Builders Risk CPS1898681 8/24/2015 8/24/2016 Installation Floater 50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Bay State Solar ACCORDANCE WITH THE POLICY PROVISIONS. 2 Shaylee Lane Lakevill MA 02347 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD RightFax C3-2 9/21/2015 6; 08:29 AM PAGE 2/002 Fax Server CERTIFICATE LIABILITY INSURANCE DATE(MM/DDNYYY) 44� 0242:11 TWAAMIFICATE 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 08 PRODUCER IAND TUE ER F E HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the polieWes)must be endorsed. If SUBROGATION IS WAIVED,subject to he terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: HADLY INSURIT GROUP PHONE FAX 246 DUFEE ST. (A1C,No,Ext): (A/C,No): E-MAIL FALL RIVER,MA 02720 ADDRESS: 78275 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: HARTFORDUNDERWRI'I'ERSINSURANCE COMPANY MCCARRON,PHILIP DBA BAY STATE SOLAR INSURER B: INSURE R C: INSURER D: 2 SHAYLEE LANE INSURER E: LAKEVILLE,MA 02347 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THE IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO 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 MAYBE 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 ADD SUB POLICY EFF DATE POLICY EXPDATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MUMDWYYY) (MMDDSYYYY) LIMITS GENERAL LIABILITY FACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $ CLAIMS MADE OCCUR. 3,REMISES(Ea occurence) ED EXP(Any one person) $ ERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: ENERALAGGREGATE $ POLICY PROJECT®LOC 3RODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per perwn) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ 11 (Per accident) UMBRELLA LIAR []OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE W®� $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND XWC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-9975A2132-15 09/19/2015 09/19/2016 LIMITS ANY PROPERITORJPARTNER/EXECUTIVE rN1 N/A E.L.EACH ACCIDENT _ $ 1,00o,000 OFFICERIMFNIFIER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 B yes describe Older DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRIGnONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AF'EEC TNG WORKERS COMP COVERAGE. MCCARRON,PHILIP IS COVERED BY THE WORKERS'COMPENSATION POLICY. CERTIFICATE HOLDER CANCELLATION BAY STATE SOLAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 2 SHAYLEE LANE BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIO .;,,.- AUTHORIZED REPRESENTATIVE LAKEVILLE,MA 02347 ;? f ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORP 3R iT1 /X( 're reserved. The Commonwealth of Massachusetts Dej)(irtinent of Inditstrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.inass.govIdia Workers' Compensation Insurance Affidavit: Builders/Conti-actoi-s/Electi-icians[Plumbet-s AvDlicant Information Please PEiMLLggjhh Name(Business/Organization/Individual): Philip McCarron DBA Bay State Solar Address: 2 Shaylee Lane City/State/Zip: Lakeville, Ma, 02347 Phone#: 508-930-1405 Are you an employer? Check the appropriate box: Type of project(required): 1.21 1 am a employer with 5 4. EJ I am a general contractor and 1 6. New construction employees(full and/or part-time).* have hired the sub-contractors 7. Remodeling 213 1 am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers' comp. insurance. 9. E]Building addition [No workers' comp, insurance 5. [] We are a corporation and its 10.0 Electrical repairs or additions 0 required.] officers have exercised their 3. 1 am a homeowner doing all work right of exemption per MGL 11.D Plumbing repairs or additions myself. [No workers' comp. c. 152, X1(4), and we have no 12,[:]Roof repairs insurance required.]f employees. [No workers' 13.0 Other Solar comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'corapensationpolicy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check,this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I ant an employer that is providing workers'compensation insurancefor nay employees. Below is the policy and.job site it!f0rination. Insurance Company Name: Hadley Insurit Group Policy ff or Self-ins.Lic. #: UB-9975A282-15 Expiration Date:09/19/2016 Job Site Address: 141 Berry Street City/State/Zip: North Andover, MA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under the panis andpenalties ofperjury that the information provided above is true and correct. Signature: Date: 06 1 Q Phone U,L2 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Pei-soft: Phone ,; ()1A1icf ()1'C'crnsunwr Affairs and 13LISir1('SS 1 e tlla 1011 10 Pari 1'1,17,1 trite 5170 13o) ton, 1MaSS,1ChUSetts 021 16 lc�r�r 1111pro�vellient Contractor Rei,,ismition R4�go luaiior7 i 794 D4 I, f,,e indmrlu al Exprralrtan 7/2812016 Tr# 255733 PHILIP MCCLARRON PHILIP MCCARRON 2 3HAYLE LAN LAKEVILLE, MA 02347 Violate Address and return card. "stark reason for change. Address Idcnewal - l:mpluy'nrertt I.tas't Gard ,„.... I.icensc or registration valid for individul use anlY airs te9ulri<nOrrrrcofConsumcr4fi before the expir;atiurr date. If found return ur: ltd' fY MEIMPROVEMENT CONTRACTOR C)free of('onsumer .Affairs and flusmess Reg"latitns registration: 179404 Typo. 1() Park Plaza - Suite 5170 :Expiration: 7128/2015 drrdwx7 ai e fiostara, 'a1 1 02116 PHU MCCLARRON PHILeP MCCARRON LAKEVILLE,MA 02347 Undersecretary Not valid without signature r , .: ft 'i ANS. , SRG t Ci ' `l� MASTER ELECTR I C I'AS �� ISSUESA. OLLOW1`NG L 1°C NSE i LIES 'THE FULLOW' NG L 1 NSE AN AS A R1°G Jf1tJRNE`YMAt+t ELECTRICIAN f� � PHILIP MCCARRON i' MCCA1jR'0N ELECT- 11 1 C 1t i t.l`P KCCAPON 2 SHAYL EE LANE i 2 .SyAY'LEE LN � LAKEVILLE MA 02347-1852 1-: • VI1LLE MA 023147-18526 $1 31,460 E 07/31116 36982 46 .. E 07/ "1./.16 36981 Massachusetts Department assaof Public Safety Board of Building Regulations and Standards License: CS-071932 Construction Supervisor ;, PHILIP MCCARRON �. 2 SMAYLEE LN LAKEVILLE MA 023 r�r'j nr Expiration, Commissioner 06/0912018