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Home My WebLink AboutBuilding Permit # 6/16/2016 OORTPI BUILDING PER ITI'�o TOWN OF NORTH ANDOVER '6 APPLICATION FOR PLAN EXAMINATION n 1> Permit No#°° r® Date Received ;ED Pea°$5 9SS�acr+us�R Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION S `R j d u s Lckn<- T Print PROPERTY OWNER -cD �Z Print 100 Year Structure yes no MAP ARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes rte' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Wbne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other a; , i? .�„nr.Y (�” 4��, m ? r?,aarF'^.r' ??L�f,;.l'� ep r Wel�� ® FlaodplainD Wetlantlsx r 1Naters a ed&Di'strtctg ? ,rv,;Cf^.%^ .5?. XrON " .if DESCRIPTION OF WORK TO BE PERFORMED: In s SG ko& te-cmc, 1S t% o f cci5tl b c�rv�z. -td b.e 1� der cc�►�r r_k��a �i�-�a�n�w�es el°� �-r�c� 0 l 9 �0 lam-W Identification fication- Please'.Type or Print Clearly OWNER: Name: NI i K-L Ftp x Phone: 918- 1014 -3� Address: 4-5 Bn e-S LCk,n-L SC)lc(-rcI Contractor Name: Dcm,)i k b Phone: 9-7S- Email: -7 S-Email 0`( 1iSc)n lCtI L&U (CD)_. 50L0xck:1U • c2-an Address: ►5 ; V-e l l e, 4 '1116 MW 0 I sr-6 a-- Supervisor's Construction License: 10 1,�D Exp. Dater ► (� Home Improvement License: l to `�5� 2 Exp. Date'. - lb 1 -7 ARCHITECT/ENGINEER J0.SUY1 -C0YY1CM/) Phone: low " �0�`� - 10 Z-E; Address: 3055 CI ,r\1► Reg. No. 15155+ Grin tVVCA,_K o CES ft C141 U FEE SCHEDULE.BULDING PERMIT.$12.00 P $9000.00 O T EFAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 301 (YJ FEE: $ (9 0 Check No.: M 5Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted El Plans Waived F-1 Certified Plot Plan El Stamped Plans ❑ TYPE OF PE SEWER-AGE, DISPOSAL 0",S Public Sewer El Tanning/Massage/B ody Art F1 Swim-ning Pools ❑ Sewer Well 11 Tobacco Sales ❑ Food Packaging/Sales El Private (septic tank, etc. 11 Permanent Dumpster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature- COMMENTS... 00.� CONSERVATION Reviewed on C, V9, COMMENTS—�" Q)c, cez, CJ"A rc, A HEALTH Reviewed on* Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receiptsubmitted yes Planning Board Decision: —Comments Conservation Decision: Comments Water& Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street b FIRE "Aft ,�ib P, ENT,/ Temp Dumpster on site; yes-,: A COMMENTS F o®RTH Town ofA ndover .Z *. 0% ® LAKff h ver, SSS' ^16 TAW Acoc"Ic"twocx y1. o�ATE® C) V BOARD OF HEALTH Food/Kitchen PEIN IT T LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR has permission to erect buildings on ., .. .. ..... Foundation Rough to be occupied as ...Ro.ov....J. ........................................... 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 EXPIRESPERMIT IN 6-MONTHSELECTRICAL INSPECTOR UNLESS CONS ION Rough Service .. ...... ..... ..... Final BUILDING I PEC OR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Displayin a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Version#58.7-TBD i PIL ',SolarCty- June 14, 2016 RE: CERTIFICATION LETTER Project/Job #0183884 Project Address: Fox Residence JASON WIL IAM 45 Bridges Ln f m North Andover, MA 01845 o TOMAN U STRUCTURAL 0) AHJ North AndoverNo.51554 SC Office Wilmington Ado 9F�irSTVfl- ANG Design Criteria: SSS/ONAL 016 -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 -ALL MPs: Roof DL = 10.5 psf, Roof LL/SL = 35 psf(Non-PV Areas), Roof LL/SL= 22 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 evaluation,I 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 referenced codes for loading. The PV assembly hardware specifications are contained in the plans/docs submitted for approval. Digitally signed by Jason Toman Date: 2016.06.14 10:35:05 -07'00' 2055 Clearvle+v'-vVay Sat)PAateo,Ch.9,1402 r(6�0)5718 1028 (888)5!>L C iTY -(650)6-1`b- 1029,,olarctty xom Version#58.7-TBD PIL S o I a r C'ty,-,, 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 ALL MPs 64" 24" 39" NA Staggered 57.1% Portrait Hardware-Portrait Modules'Standoff Specifications Hardware X-X Spacing X-X Cantilever Y-Y Spacing Y-Y Cantilever Configuration Uplift DCR ALL MPs 48" 17" 65" NA Staggered 71.2% Structure Mounting Plane Framing Qualifications Results Type Spacing Pitch Member Evaluation Results ALL MPs Stick Frame @ 16 in.O.C. 320 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. f��0?t, � ,,055�leai:r,,;='Afay Sar,Mate, CA 94,102 f650)6,58�-1028 (8F 8)SU( �CIT( ( - iU2I_rlarcitr.,v.r STRUCTURE ANALYSIS - LOADING SUMMARY AND MEMBER CHECK-ALL MPS Member Properties Summary ALL MPS Horizontal Member"Spans Rafter Properties Overhang 1.16 ft Actual W 1.50" Roof stem Pro ernes San 1 13.50 ft Actual'D 7.25" Number of Spans w/o Overhang) 1 Span 2 Nominal Yes Roofing Material Comp Roof Span 3 A 10.88 1n.^2 Re-Roof No Span 4 S. 13.14 in A3 Plywood Sheathing Yes San 5 11 47.63 in.^4 Board Sheathing None Total Rake Span 17.29 ft TL DefPn Limit 120 Vaulted Ceiling No PV 1 Start 5.00 ft Wood Species SPF Ceiling Finish 1/2"Gypsum Board PV 1 End 10.58 ft Wood Grade #2 Rafter Slope " 320 PV 2 Start Fb 875 psi RafterSpacing 16"O.C. PV 2 End F„ -135 psi Top Lat Bracing ! Full PV 3 Start E + 1400000 psi Bot Lat Bracing At Supports PV 3 End E,,,;,, 510000 psi Member Loading Summary Roof Pitch . 8/12 Initial, Pitch Adjust Non-PV Areas PV Areas Roof Dead Load DL 10.5 psf x 1.18 12.4 psf 12.4 psf PV Dead Load PV-DL 3.0"psf x 1.18 3.5 psf Roof Live Load RLL 20.0 psf x 0.83 16.5 psf Live '/Snow Load LL/SL112 50.0 psf x 0.7 1 x 0.44 35.0 psf 22.0 psf Total Load TG-overning LC TL 47.4 psf 37.9 psf Notes: 1. ps=Cs*pf, Cs-roof,Cs-pv per ASCE 7[Figure 7-2] 2. pf=0.7(Ce)(Q)(IS)p9; Ce=0.9,Q=1.1, IS=1.0 Member Design Summary(per ND5) Governing Load Comb CD CL + CL - Cf Cr D+S 1.15 : 1.00 1 0.39 1.2 1.15 Member Analysis Results Summary- Governin`Analysis Pre-PV Demand Post-PV Demand Net lmpact7T77Result Gravity Loading Check 1299 psi 1116 psi 0.86 Pass CALCULATION OF DESIGN WIND LOADS -ALL MPS Mounting Plane Information Roofing Material Comp Roof Roof Slope 320 Rafter Spacing 16"O.C. Framing Type/Direction Y-Y Rafters PV System Type SolarCity SleekMountTm Zep System Type ZS Comp Standoff Attachment Hardware Comp Mount SRV Spanning Vents No 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 1 i 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 GCp(Up) -0.95 Fig.6-11B/C/D-14A/B Ext.Pressure Coefficient Down GCp(Down) 0.88 Fig,6-11B/C/D-14A/B Design Wind Pressure p p =qh (GCp) Equation 6-22 Wind Pressure Up Mum -19.6 psf Wind Pressure Down o,,n 18.0 psf ALLOWABLE STANDOFF SPACINGS X-DirectionY-Direction Max Allowable Standoff Spacing Landscape 64" 39" Max Allowable Cantilever Landscape 24" NA Standoff Confi uration 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 -313 lbs Uplift Capacity of Standoff T-allow 548 lbs Standoff Demand/Capacity DCR 57.1% X-Direction Y-Direction Max Allowable Standoff Spacing Portrait 48" 65" Max Allowable Cantilever Portrait 17" NA Standoff Configuration Portrait Sta ered Max Standoff Tributary Area Trib 22 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at Standoff T actual -390 lbs Uplift Capacity of Standoff T-allow 548 lbs Standoff Demand/Capacity DCR 71.2% DocuSign Envelope ID:5E790249-75CB-435B-B6E9-9DE592FA9AAD 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:Mike Fox 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: 6/10/2016 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 6/10/2016. Customer's Name: If you don't sign this PPA and return it to us on or prior to 30 days after 6/10/2016,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: 6/10/2016 Power Purchase Agreernent,version 9.2.1,May 5,2016 NMI 10 1909302 DocuSign Envelope ID:5E790249-75CB-435B-B6E9-9DE592FA9AAD SolarCity Customer Name and Address Installation Location Date Mike Fox 45 Bridges Ln 6/10/2016 45 Bridges Ln (North Andover,MA 01845 North Andover,MA 01845 Mere are the key terms of your Power°Purchase Agreement $0 1397'Oc 20yrs System installation cost Electricityrate kWh Agreem t T90 Initial here Initial here Ds The SolarCity Promise � ®We guarantee that if you sell your Home,the buyer will qualify to assume your Agreement. ........ . . ........ . ....... initial here I� ®We warrant all of our roofing work. os ®We restore your roof at the end of the Agreement 1 ' L� ®We warrant,insure, maintain and repair the System. .... .... .......:` ... .. ...... ............................................. ... ...... .. ..... ..... Initial here 1 ®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 6/10/2016. Your SolarCity Power Purchase Agreement 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 $o ®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 11,419 kWh specified in the Agreement. ®You may renew this Agreement for up to ten(10)years in two(2)five(5)year increments. 3055 Clearview Way, San Mateo, CA 94402 1 888.765.2489 1 solarc'tty,com 1909302 Power Purchase Agreement,version 9.2.1,May 5,2016 SAPC/SEFA Compliant Contractors License MA HIC 168572/EL 1136MR Document generated on 6/10/2016 Copyright 2008-2015 SolarCity Corporation,All Rights Reserved F!1 Tile Catrurtonnfeaf h of 1tfassucltuselts Department of XndustrialAccidents Ogce ofblivestfgadons Z Congress Street,Suite 100 Aoston,MA 02114-2017 nowt mass gouldiu '1W4rkers'Compensation Insurance Affidavit;8uttr�ra alCu�tr�tcicrrslElectt rcia>kis/pl�m>beri3 Aup_HpAnt InfoYmalitin Please Print ice it ix Name Sola City Corp. Address: 3055 Clearview Way Ci1.y/Statc j.i : San Mateo CA. 94402 Phone#1: 888-765-2489 Are you an employer?Cheek the appropriate box: .'Type of pro'eet{required}: 1.0 am a employer with 5,000 4• E] I am a general contractor and i employees{full andlvr0ar#=time},* have hired the sub-contractors New construction 2.0 1 am a sole proprietor or partner- listed on the attached sheet: !. Remodeling ship and have no employees These sub-canbraotors have R. Demolition working for the in any capacity. employees acid have workers' 9. Building addition [go workers'comp, insurance camp. instrance. required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing ail-work officers have exercisedtheirI LEI.Plumbing repairs or additions myself [No workers' camp. i`ry i W axeurption pw MTGL 12.n Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 130other Solar/PV comp- insurance required.] *Any appticaat that cliackr box N1 must also tilt out the section below showing tboir workers'competssatyen policy in bunation. I Homeowners who submit this affidavit indicallna atey are doing et(work and then hire outside contractors must submit a new atlidavit indioatingsuch. lContmotors that cluck this box must attached on sdditioaal sheet showing the name of the sub-wntractora anti state whether or not those entities have emptoyeos. if the sub-contraotocs have employees,they must ptovidc their workers'cutup policy number. lain an employer ifldi is prorldfitg workers'con:pensatiort-insurwree for my employees, Below is ilia policy and job site itrforrnaliun. Insurance Company Name. Zurich American Insurance Company Policy 4 or Sc1f--ins,Liu.#: WC0182015-00 Expiration Date:9/1/2016 _ _ Job Site Address: L S r11,1S -- L�XyL City/State/Lip: t4C)CLjnftdNt Attach a copy of the workers'compensation policy decluration page(showing the policy nnnmbor and expiration date). Failure to secure coverage as required under'Scution 25A of MGL c. 152 can lead to the imposition of c6minal penalties of it fine up to 51,500.00 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of tip to$250.00-a day against the violoor. Be advised that a copy of this statement may be fonvarded to the Office of investigations of 14e IIIA for insurance coverage verification. .r do hereby ceri6 ar the pains andperrallies pfperjury Ykat Me in,formatlen provided above is fare acid correctow . Si aturc: tc; I& Rhone#: Of,iclal use alsly. J)01801 1P.-he hf iltis area,re be cV111pleted by city or fawn official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2,Building Department 3.City/Town Clerk 4,'Clectrical Inspector 5.Plumbing Inspector ti.Other Contact Person: Phone:4: ACCERTIFICATE OF LIABILITY INSURANCE FPATE{Mh11DD/YYYY) 0811712015 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). PRODUCER CONTACT MARSH RISK&INSURANCE SERVICES PHONE__........ .......... _FAX......_._. ..__ ....__..._...._.._._ 345 CALIFORNIA STREET,SUITE 1300 dA?c.L+e tcxrlc.... ... .... ..._ .. . ........... .. .._.. ....I!Vc,raoh............ ._.._......... CALIFORNIA LICENSE NO.0437153 r.MAIL SAN FRANCISCO,CA 94104 -..- ----ss:.. ..... .... ........ Attn:Shannon Scott 415-743-0334 _.._INSURER(S)AFFORDINCa COVERAGE NAIC 9 998301-STND-GAWUE-15.16 INSURER A•Zurich American Insurance Company t 6535 INSURED ......... .... ..._ ... SoiarCityCorporation rx. -... - NIA _ f. 3055 Clearview Way INSURER C:NIA WA San Mateo,CA 94402 - ..... ._..__... -._...... ..........._.._..'f- - ... . INSURER D.-American Zurich Insurance Company 40142 INSURER E:,., INSURER P: COVERAGES CERTIFICATE NUMBER, SEA-002713836.08 REVISION NUMBEwR: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. _..... INSA ...... ..__........... .._ ...... .._... .....TADfiLi5178R�._.—....._.._........... _._... _ ........._.. __...._.-.. ...._ ._.. __. ......... .... .... .. LTR TYPEOFINSURANCE POLi6YEPf POLICY YYYj! POLICY NUMBER I MMIDDIYYYY r11MID01YYYY ! LIMITS A X COMiAERCIALGENERALL1A81LITY ;GL0018201600 09/01/2015 09/0112016 EACH OCCURRENCE Cl A1M5•MADB ! X OCCllR DRA MGE TO RLNT6U _ ........ . ... ._. _ P.._ . MESLEa occurrence g __.-- 3,000,000 X SIR:$250,000 I ME _._._.. _ _ _ 5,000 _..___....__.._..........._........... .... I PERSONAL&ADV INJURY $ 3,000,000 GENT AGGREGATE LIMETAPPLIESPER i GENERALAGGREGATE $ 6.000,000_ PRO- I —. X i POLICY ,JECT `LOC PRODUCTS-COMPIOP AGG $ 6,000,000 t_......... _...._. ... .... . __... .,...... OTHER. $ A ,AUTOMOBILE LIABILITY 'BAP0182017,00 `09/0112015 0910112016 COMBINED SINGLE LIMIT $ 55,_000,000 ANY AUTO X _ I 0DILY INJURY(Per person) :$ X..I ALL OWNED X r SCHEDULED BODILY. _.. i...... ....... ...._.. .... - ...,�AUTOS ...�AUTOS r IINJURY(Per accident):F F.x HIRED AUTOS X.i AUTOSWNED ) r{Per accanl}.AMAGE... -'--�� ......... __._.._......._ i 'COMPICOLL DED' $ $5,000 UMBRELLA LIAe ! 1 OCCUR EACH OCCURRENCE +$ iF...._....._..._. ....... .... . .... ._ ._ ...._... : EXCESS LIAB I 'CLAIMS MADE. . L..._'.. ....T---- T.._. AGGREG .._.._.1..._�_—. .._.__.j i FATE _...$.. .. .... . . ........._ '. DED RETENTIONS I S D WORKERS COMPENSATION WC0182014.00(A05} 09lOiI2015 09101/2016 X `PER :oTH• 1 AND EMPLOYERS'LIABILITY I 1.._._�.STATVTE_;....,. ER...._.1.... ._......_ A ANY PRDPRIETDRIPARTNERIEXECUTIVE YIN WC0182015.00(MA) 0910112015 0910112016 B L.EACH nccrp�Nr 1$ 1,000,000 OFFICER/MEMBER EXCLUCiED9 N N/A i F_..___-...... . ....... . ........ ...... .............. (Mandatory In NH) ❑i WC DEDUCTIBLE'$500,000 If yes,describe under I I E.-L.DISEASE•EA EMPLOYE 5 1000,000 DESCRIPTION OF OPERATIONS below L DISEASE-POLICY LIMIT 5 1.000,000 i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD.101,Additional Remarks Schedule,may be attached If more space Is required) Evidence of insurance. CERTIFICATE HOLDER CANCELLATION SolarCily Corporation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3055 Clearview Way THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 1N San Mateo,CA 99402 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk&Insurance Services Charles Marmolejo �-. -7 z;:-z Q 19882014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 10 Park Plaza. - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 168572 Type: Supplement Card SOLAR CITY CORPORATION Expiration: 3l812017 CLAN FONZI — -----� _-- 24 ST MARTIN STREET BLD 2UNIT 1 --- ------ i ARLBOROUGH, MA 01752 Update address and return card.Mark reason for change. ❑ address ::] Renewal Employment _ Lost Card Office of Consumer Affairs&Business Regulation License or registration valid for individul use only NOME IMPROVEMENT CONTRACTOR before the expiration date. of found return to. Office of Consumer�4 airs and Business Regulation Registration: 168572 Type: 10 park plaza-Suite 5170 Expiration: 31812017 Supplement Card Boston,IVIG 02116 SOLAR CETY CORPORATION DAN FONZI 3055 CE-EARVEEW WAY SAN MATED,CA 94402 Undersecretary Not valid without signature CS-101687 j 15 KELLEY RDm WILNIIINGTON f 01987 09/13120116