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HomeMy WebLinkAboutBuilding Permit # 6/27/2016 2,r' ;) C pORTH q Ottt�eo �6e + BUILDING PERMIT �� g 6 0� TOWN OF NORTH ANDOVER ° o /APPLICATION FOR PLAN EXAMINATION * d Permit N012 Date Received e Date Issued.a SACHUS� IMPORTANT:Applicant must complete all items on this page LOCATION 20 Foss Road Print PROPERTY OWNER June Corey Print MAP NO: RCEL:_ ZONING DISTRICT: Historic District yes rn6o Machine Shop Village yes no u TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg �'Others: ❑ Demolition ❑ Other El Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District o Water/Sewer Installation of an interconnected solar PV system: 29 panels (7.69kW DC) Identification Please Type or Print Clearly) OWNER: Name: June Corey Phone: 978-837-8605 Address: 20 Foss Road CONTRACTOR Name: Phone: 978-793-7227 Steven A Kelly/Sunrun Installation Services,Inc. Address: 200 Research Drive, Wilmington MA 01877 Supervisor's Construction License: Exp. Date: CS-040622 8/1/17 Home Improvement License: Exp. Date: 180120 10/14/16 ARCHITECT/ENGINEER Paul K Zacher/PZSE Inc. Phone: 916-961-3960 Address: 8150 Sierra College Blvd., Suite 150 Roseville CA 95661 Reg. No. 50100 FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PAR S.F. Total Project Cost: $ 16,061.65 FEE: $ Check No.: 6 Receipt No.: :769 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner `°�� Signature of contractor . tkORTH Town of Andover 0 ,1" ,- 'k i - LAKEass, Ore W7 zQ16 cocmlcnawocK BOARD OF HEALTH Food/Kitchen PERM ' T LD Septic System THIS CERTIFIES THAT ................ .. .... . ..... .. .. .. .. ................................ BUILDING INSPECTOR ~ has permission to erect .......................... buildings on .................. ... ... . .. . ................................ Foundation Rough tobe occupied as ...Age.. .. ... ..... . ............ ... ....... . . ............. .. .. ... .. 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 MONTHSPERMIT EXPIRES IN 6 ELECTRICAL INSPECTOR UNLESS CONS TIO Rough Service .... .... ..... Final j BUILDIN INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in 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. IIIII i i OWNER'S AUTHORIZATION FORM For Permit Application(s) The sole purpose of this form is to provide Sun Run Inc with the Necessary permission from the Owner to file Permit Application(s) for such Project work as agreed upon between the Owner and the Owner's Authorized Company and its designated subcontractors. Owner's Name: Richard Conrad Solar Project Address: Signature: D ,� 'A"', C4w,,to Owner's Authorized Company: Sun Run Inc. Company's Address: 595 Market St 29th Floor, San Francisco, CA 94105 Affiliation: Contractor Applicable License: State: MA �t e STNI011RAL 9461HEIRS April 14, 2016 Sunrun Inc. 133 Technology Dr, Suite 100 Irvine, CA 92618 Attn.: To Whom It May Concern re: Job 2016-04729 : Richard Conrad- 222R-067CONR The following calculations are for the structural engineering design of the photovoltaic panels located at 67 Colgate Drive, North Andover, MA 01845.After review, PZSE, Inc. certifies that the roof structure lacks sufficient structural capacity for the applied PV loads. See the following calculations and Plan Sheets for location and repair to bring the roof structure up to the required capacity. If you have any questions on the above, do not hesitate to call. Prepared By: �kA Oti'r4s PZSE, Inc. - Structural Engineers nAULK_ , Roseville, CA zACHER R ' STRUCTURAL No,50100 s�arvAL ''` 1`3 f''a(.)Sy V"'(n d;o F,u" i"o„ulevouu, :Gu4l, i')O Rn it11u, (A 9'fhb,V 9 6 u ` 1,,,I3960 6" 916,90 3965 uviva 1 of 8 Gravity Loading Roof Snow Load Calculations pg=Ground Snow Load= 50 psf C.=Exposure Factor= 0.9 (ASCE7-Table 7-2) C,=Thermal Factor= 1.1 (ASCE7-Table 7-3) 1=Importance Factor= 1 pf=0.7 C8 C,I pg 35 psf (ASCE7-Eq 7-1) where pg:5 20 psf,Pf min=I x pg= N/A min snow load(I.N.e K W) where pg>20 psf,Pf min=20 x I= 20 psf min snow load(oorsior <15°) Therefore,pr=Flat Roof Snow Load= 35 psf ps=Cspf (ASCE7-Eq 7-2) Cs=Slope Factor= 0.967 ARRAY 1(CARPORT) Cs=Slope Factor= 0.967 ARRAY 1 Ps=Sloped Roof Snow Load= 33.5 psf ARRAY 1(CARPORT) Ps =Sloped Roof Snow Load= 33.5 psf ARRAY 1 PV Dead Load=3 psf(Per Sunrun Inc.) Roof Live Load= 20.00 psf ARRAY 1 (CARPORT) Roof Live Load= 20.00 psf ARRAY 1 Note:Roof live load is removed in area's covered by PV array. Roof Dead toad ARRAY 1(CARPORT) Composition Shingle 4.00 (2 layers) 1x Decking 2.00 2x6 Rafters @ 16"o.c. 1.13 Vaulted Ceiling 4.00 Miscellaneous 0.87 Total Roof DL ARRAY 1(CARPORT) 12.0 psf DL Adjusted to 12 Degree Slope 12.3 psf Roof Dead Load ARRAY 1 Composition Shingle 4.00 (2 layers) 1x Decking 2.00 2x6 Rafters @ 16"o.c. 1.13 Vaulted Ceiling 4.00 Miscellaneous 0.87 Total Roof DL ARRAY 1 12.0 psf DL Adjusted to 12 Degree Slope 12.3 psf 2of8 Wind Calculations Per ASCE 7-05 Components and Cladding Input Variabl Wind Speed 100 mph Exposure Category C Roof Shape Gable/Hip Roof Slope 12 degrees Mean Roof Height 20 ft Building Least Width 24R Effective Wind Area 10.8sf Design Wind PCalculations qh=U.0D256^Kz°Kzt°Kd°V^2°| (Eq_6'15) Kz(Exposure Coefficient)= 0.9 (Table 6-3) Kzt(topographic factor)= 1 (Fig.6-4) Kd(Wind Directionality Factor)= 0.05 (Table 6-4) V(Design Wind Speed)= 100 mph Importance Factor 1 (Table 6-1) qh= 19.58 Standoff Uplift Calculations Zone 1 Zone 2 Zone 3 Positive QCp= '0.90 4J0 '2.60 0.50 Uplift Pressure= '17.61pnf -33.31pof '50.82pmf 8.76pof Max Rail Span Length= 4.0 ft 4.0 ft 4.0 ft � Longitudinal Length= 2.7 ft 2.7 ft 2.7 ft Attachment Tributary Area= 10.8W 10.8ef 18.8ef Footing Uplift= -189 lb -357 lb -546 lb Standoff Uplift Ch k Maximum Design Uplift= -546 lb Standoff Uplift Capacity = 700 lb 7OD|bcapacity>548|bdemand rhwrwfore.OK Fastener Capacity Ch Number ufFasteners= 1 Minimum Threaded Embedment Depth= 2.5 Pullout Capacity Per Inch= 305|b Fastener Capacity= 820 lb 82O|bcapacity>546|hdemand Therefore,OK 3 of Framing Check ARRAY (CARPORT) PASS w=G6p|f Dead Load 12.3 psf PV Load 3.0puf Snow Load 33.5 psf 2x8Rafters @1G"o.c, Governing Load Comb. DL+SL Note:Attachments shall hoStaggered, Total Load 48.0pmf Member Properties Member Size S(in A 3) 1(in A 4) Lumber Sp/Gr Member Spacing 2x0 7.56 20.80 SPF#2 @1G"n.n. Check Bending Stress Fb(psi)= fb x Cd x Cf x Cr (NDS Table 4.3.1) 875 x 1.15 x 1.3 x 1.15 Allowed Bending Stress=15O4.3psi Maximum Moment = (wL^2)/8 = 898.608 8# = 1O75O.3 in# Actual Bending Stress=(Maximum Moment)/8 =1422.8psi Allowed>Actual~94.6%Stressed -, 7hemw0»nm,OK Check Deflection Allowed Deflection(Total Load) U240 (E 1400000 psi Per NDS) = O.5%5in Deflection Criteria Based on = Continuous Span Actual Deflection(Total Load) = (w-1-114) (185-EI) = 0.184in = UG85 < LC240 11"mrefore OK Allowed Deflection(Live Load) = L1360 0.35 in Actual Deflection(Live Load) = (WL114)/(18S°E°1) 0.175 in U720 < L860 Therefore OK Check Uear Member Area= 8.3 in A2 Fv(psi)= 135 psi (NDS Table 4A) Allowed Shear = Pv°A = 1114|b Mox8heax(V)=w°L/2 = 342|b ANmsmd>Actual 303%Stressed ~ �henmNwwm,OK File=S92016 PVjobg\Conrad16_�0472KNGRTV panel.ec(l [ZWo,,o.,d Beaffl ENERCALC,INC.1983-2016,Build:6.16.3.4,Ver:6.16.3.4 Description ARRAY 146 Beam CODE REIZEREM"ES Calculations per NDS 2015, IBC 2015, CBC 2016, ASCE 7-10 Load Combination Set: IBC 2009 MateriM Properties Analysis Method: Allowable Stress Design Fb-Tension 875.0 psi E:Modulus of Elasticity Load Combination 313C 2009 Fb-Compr 875.0 psi Ebend-xx 1,400,0ksi Fc-Prll 1 j 50.0 psi Eminbend-xx 510.0 ksi Wood Species Spruce- Pine -Fir Fc-Perp 425,0 psi Wood Grade No, I/No, 2 Fv 135,0 psi Ft 4 50.0 psi Density 26,210pcf Beam Bracing Bearn is FWly Braced against lateraktorsior4 buckling 0 0 G84255s(O 2294 75) Q0 V055) 4x6 Span-5,50 ft Applied Loads Service loads entered. Load Factors will be applied for calculations. Uniform Load D=0.0030 ksf, Tributary Width=6.(350 ft Uniform I oad D=0.0050, Tributary Width=1.0 ft Uniforrn Load D=0.0'1230, S=0.03350 ksf, Tributary Width=5.850 ft DESIGN SUMMARY' MaAffl(Jrn Bending Stress Ratio O.66"e. 1 Maximum Shear Stress Ratio = 0.393 : I Section used for this span 4x6 Section used for this span 4x6 fb:Actual = 8'72,43psi fv:Actual = 61,03 psi FB:Allowable = 1,308, 13psi Fv:Allowable = 155.25 psi Load Combination +D O-S-H-i Load Combination 4D+S4-1 Location of maximum on span = 2.750ft Location of maximum on span = 5,058 ft Span#where maximum occurs = Span 4 1 Span#where maximum occurs Span#I Maximum Deflection Max Downward Transient Deflection Cr0'70 in Ratio= 10,1„3>=180. Max Upward Transient Deflection 0.000 in Ratio= 0<180.0 Max Downward Total Deflection 0,103 in Ratio= 62,8>=120, Max Upward Total Deflection 0.000 in Ratio= 0<120.0 Maxinriutyw Forces & Stresses for Load Combinations Load Combination Max Stress Ratios Moment Values Shear Values Segment Length Span# M V C d C FN C i Cr C, C t C L M 1b Pb V fV F'v D Only 0.00 0.00 0.00 0.00 Length=5.50 ft 1 0,276 0.163 0.90 1.300 1.00 1.00 1.00 1,00 1.00 0,42 282.36 102335 0.25 19.75 121.50 +D+L+H 1.300 1.00 1.00 1.00 1.00 1.00 0.00 0.00 0.00 0,00 Length=5.50 ft 1 0.248 0.146 1.00 1.300 1.00 1.00 1.00 1.00 1.00 0.42 282.36 1137.50 0.25 19.75 135.00 +D+Lr+H 1.300 1.00 1.00 1.00 1.00 1.00 0.00 0.00 0.00 0.00 Length=5.50 it 1 0.199 0.117 1.25 1.300 1.00 1.00 1.00 1.00 1.00 0.42 282.36 1421.88 0.25 19.75 168,75 +D+S+H 1.300 1.00 1.00 1.00 1.00 1,00 0.00 0.00 0.00 0.00 Length=5.50 ft 1 0.667 0.393 1.15 1.300 1.00 1.00 1.00 1.00 1.00 1.28 872.43 1308.13 038 61.03 155.25 +D+0.750Lr+0.750L+H 1.300 1.00 1.00 1.00 1.00 1.00 0.00 0.00 0.00 0.00 Length=5,50 ft 1 0.199 0.117 1.25 1,300 1.00 1.00 1.00 1.00 1.00 0.42 282.36 1421.88 0.25 19.75 168.75 5 of 8 File=S:QO16 PVjobs\Conradl6 04729kENGRTV panel.ec6 K Wood Bearn ENERCALC,INC.1983-2016,Build:6.16.3.4,Ner:6.16.3.4 Description ARRAY 146 Beam Load Combination Max Stress Ratios Moment Values Shear Values Segment Length Span# M V Cd C FN C i Cr C m C t C L M fb Fb V fv, Fv +D+0.750L+0.750S+H 1,300 1.00 1.00 1.00 1.00 1.00 0.00 Ho 0.00 0,00 Length=5.50 ft 1 0.554 0.327 1.15 1.300 1.00 1.00 1.00 1.00 1.00 1.07 724.91 1308.13 0.65 50.71 155.25 +D+W+H 1.300 1.00 1.00 1.00 1.00 1.00 0.00 0.00 0.00 0.00 Length=5.50 It 1 0.155 0.091 1.60 1.300 1.00 1.00 1.00 1.00 1.00 0.42 282,36 1820.00 0.25 19.75 216.00 +D+0.70E+H 1.300 1.00 1.00 1.00 1.00 1.00 0.00 0.00 0.00 0.00 Length=5.50 ft 1 0.155 0,091 1.60 1.300 1.00 1.00 1.00 1.00 1.00 0.42 282.36 1820,00 0.25 19.75 216.00 +D+0,750Lr+0.750L+0.750W+H 1.300 1.00 1.00 1.00 1.00 1.00 0.00 0.00 0.00 0.00 Length=5.50 ft 1 0.155 0.091 1.60 1.300 1.00 1.00 1.00 1.00 1.00 0.42 282.36 1820.00 0.25 19.75 216,00 +D+0.750L+0.750S+0.750W+H 1,300 1,00 1.00 1,00 1,00 1.00 0.00 0.00 0.00 0.00 Length=5.50 ft 1 0,398 0.235 1.60 1.300 1.00 1.00 1.00 1.00 1.00 1.07 724.91 1820.00 0.65 50,71 216.00 +D+0.750Lr+0.750L+0.5250E+H 1,300 1.00 1.00 1.00 1.00 UO 0.00 0.00 0.00 0.00 Length=5.50 ft 1 0.155 0.091 1.60 1.300 1.00 1.00 1.00 1.00 1.00 0,42 282.36 1820.00 0.25 19.75 216.00 +D+0.750L+0.750S+0.5250E+H 1.300 1.00 1.00 1.00 1.00 1,00 0.00 0.00 0.00 0.00 Length=5.50 It 1 0.398 0,235 1.60 1.300 1.00 1.00 1.00 1.00 1.00 1.07 724.91 1820.00 0.65 50.71 216,00 +0.60D+W+H 1.300 1.00 1.00 1,00 1,00 1.00 0.00 0.00 0.00 0.00 Length=5.50 ft 1 0.093 0.055 1.60 1.300 1.00 1,00 1.00 1.00 1.00 0.25 169.41 1820.00 0A5 11.85 216.00 +0,60D+030E+H 1.300 1.00 1.00 1.00 1.00 1.00 0.00 Ho 0.00 0.00 Length=5.50 ft 1 0.093 0.055 1.60 1.300 1.00 1.00 1.00 1.00 1.00 0,25 169.41 1820.00 0.15 11.85 216.00 Overall Maximum Deflections Load Combination Span Max."-"Deft Location in Span Load Combination Max."+"Deft Location in Span +D+S+H 1 0.1034 2.770 0,0000 0.000 Vertical Reactions Support notation Far left is#1 Values in KIPS Load Combination Support 1 Support 2 Overall MAXimum 0.933 0.933 Overall MINimum 0.181 0.181 D Only 0.302 0.302 +D+L+H 0.302 0.302 +D+Lr+H 0.302 0.302 +D+S+H 0,933 0.933 +D+0.750Lr+0.750L+H 0.302 0.302 +D+0.750L+0.750S+H 0.775 0.775 +D+W+H 0.302 0.302 +D+0.70E+H 0.302 0.302 +D+0.750Lr+0.750L+0.750W+H 0.302 0.302 +D+0.750L+0.750S4.750W+H 0.775 0,775 +D+0,750Lr+0.750L+0,5250E+H 0.302 0.302 +D+0.750L+0.750S+0.5250E+H 0.775 0.775 +0.60D+W+H 0.181 0.181 460D+030E+H 0.181 0.181 D Only 0.302 0.302 Lr Only L Only S Only 0.631 0.631 W Only E Only H Only 6 of 8 Framing Check ARRAY PASS w=65 Dead Load 12.3 psf PV Load 3.0psf Snow Load 33.5psf 2x6 Rafters @1G"n.n. Governing Load Comb. DL+SL Note:Attachments shall buStaggered. Total Load 48.8 psf Member Properties Member Size S(in A 3) 1(in A 4) Lumber Sp/Gr Member Spacing 2x6 7.56 20.80 SPF#2 @1G"o.o. Check Bending Stress Fb(psi)= fb x Cd x Cf x Cr (NDS Table 4.3.1) 875 x 1.15 x 1.3 x 1.15 Allowed Bending Stress=15U4.3psi Maximum Moment = kwL^2 /8 = 733.O58 8# = 8807.5 in# Actual Bending Stress=(Maximum Moment)/S =11G4.7psi ANowed>ActumK~77.5&Stressed — "rhmrefomm,OK Check Deflection Allowed Deflection(Total Load) LJ240 (E 1400000 psi Per NDS) = 8.475in Deflection Criteria Based on = Simple Span Actual Deflection(Total Load) = (5°w°L^4)/(3W4-E^V = 0.287in = U384 < L240 ThmrmfmmoOK Allowed Deflection(Live Load) = U360 0.316 in Actual Deflection(Live Load) (5*w*L^4)/(384*E°0 0.282 in U405 < U380 I herefore OK Check Shear Member Area 8.3 in A 2 Fv(psi) 135 psi (NDS Table 4A) Allowed Shear = Fv°A = 1114|h MomShoar(V)=w°L/2 = 309 lb AWowed>ActmM~27.096Stressed ~ �hwreNmmm.OK 7of8 Lateral Existing Weight of Effected Building -7] Area Weight(pso Weight(lb) 2009 IBC CH34 1320 sf 12.3 psf 16236 lb 7N ��|�| (20'WaUHeighV Int.Walls 158 It 6.4 psf 20224 lb Existing Weight myEffected Building 42780 lb Proposed Weight of PV System Weight u/PVSystem(PerSuoron Inc.) 3.0psf Approx.Area of Proposed PV System 659 sf Approximate Total Weight ofPVSystem 1877|b 10%Comparison 10%of Existing Building Weight(Allowed) 4278 lb Approximate Weight ofPVSystem(Actua|) 1977|b Percent Increase 4.6% 4278|h>1G?7lb,Therefore OK uF=i ;E;S, April 14, 2016 STRUGURAL ENGIRE16 Sunrun Inc. 133 Technology Dr, Suite 100 Irvine, CA 92618 Subject: Structural Certification for Installation of Solar Panels Job Number: 2016-04729 Client: Richard Conrad-222R-067CONR Address: 67 Colgate Drive, North Andover, MA 01845 Attn.: To Whom It May Concern A field observation of the condition of the existing framing system was performed by an audit team from Sunrun Inc.. From the field observation of the property,the existing roof structures was observed as follows: The existing roof structure consists of: • Composition Shingle over 1x Decking is supported by 2x6 Rafters @ 16"o.c.at ARRAY 1 (CARPORT).The rafters are sloped at approximately 12 degree and have a maximum projected horizontal span of 10 ft 6 in between load bearing walls.The rafters are supported by a 4x6 beam spanning 8 ft.6 in. • Composition Shingle over 1x Decking is supported by 2x6 Rafters @ 16"o.c.at ARRAY 1.The rafters are sloped at approximately 12 degree and have a maximum projected horizontal span of 9 ft 6 in between load bearing walls. Design Criteria: • Applicable Codes=2009 IBC,ASCE 7-05, and NDS-05 • Ground Snow Load=50 psf • Roof Dead Load= 12.3 psf ARRAY 1 (CARPORT) ; 12.3 psf ARRAY 1 • Basic Wind Speed= 100 mph Exposure Category C • Solar modules=as indicated in attached drawings As a result of the completed field observation and design checks: • ARRAY 1 (CARPORT)2x6 rafters are adequate to support the loading imposed by the installation of the solar panels and modules.Array 1 (CARPORT)46 beam is inadequate to support the loading imposed by the installation of solar panel and modules. New SPF#2 44 knee braces shall be installed to support the additional loading on the 46 beam. • ARRAY 1 is adequate to support the loading imposed by the installation of solar panels and modules.Therefore, no structural upgrades are required. certify that the capacity of the structural roof framing that directly supports the additional gravity loading due to the solar panel supports and modules had been reviewed and determined to meet or exceed the requirements with structural upgrade in accordance with the 2009 IBC. If you have any questions on the above, do not hesitate to call. ttA OFfi9q,S Prepared By: PAULK. u7 PZSE, Inc.-Structural Engineers ZACMER " STRUCTURAL Roseville, CA rxNo.50100 rr $�C7NA1 1of1 81 0 (.A �5A6 9 6 Cyy 6 MCA 9 16 96 1.3,96! _,. The Conrmonweaitlr of Massachusetts - Departnient of IndustrraiAccrderrts 1 Congress Str-eet, Suite 100 Boston,MA 021142017 w www.nutss.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Naive (Business/Organization/Individual):Sunrun Installation Services, Inc. Address:775 Fiera Lane, Suite 200 City/State/Zip:San Luis Obispo, CA 93401 phone#:978-549-9438 Are you an employer?Check the appropriate box: Type of project(required): 1.[D I am a employer with 35 employees(full and/or part-time).* 7. E]New construction 2.®I am a sole proprietor or partnership and have no employees working for me in &. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 1 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10E]Building addition 4.®1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.Fl Plumbing repairs or additions 5.®I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 E:]Roof repairs `these sub-contractors have employees and have workers'comp.insurance.$ 14.QOther Rooftop Solar 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] IL *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am ars employer that is providing)pothers'cornpensatiorr irrsurarrce for'my employees. Below is the policy and job site information. Insurance Company Name:Zurich American Insurance Company Policy#or Self-ins.Lic.#:WC013696001 &WC013696101 Expiration Date:10/01/2016 Job Site Address;67 Colgate Dr 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 MGL c. 152,§25A is a criminal violation punishable by 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. 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 thepains andpenalties of perjury that the information provided above is true and correct. Signature: Zee Date: Phone#:978-549-9468 Official use only. Do not write in this area,to be completed by city or to)vii 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 Person: Phone#: �� � ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/01/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH RISK&INSURANCE SERVICES NAME: 345 CALIFORNIA STREET,SUITE 1300 PHAIC No ONE FAX Ext): A/C No CALIFORNIA LICENSE NO.0437153 E-MAIL SAN FRANCISCO,CA 94104 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# 104960339-STND-GAX-15-16 INSURER A:James River Insurance Company 12203 INSURED INSURER B:N/A N/A Sunrun Installation Services,Inc. and REC Solar,Inc. INSURER C:Houston Casualty Company 42374 775 Fiero Lane,Suite 200 INSURER D: San Luis Obispo,CA 93401 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-002994222-03 REVISION NUMBER:5 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY 000641241 10/01/2015 10/01/2016 EACH OCCURRENCE $ 1,000,000 IMAGE TO CLAIMS-MADE �OCCUR PREMISES (E.occu D"C'.) ce) $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT X OTHER: Host Liquor Liability TOTAL POLICY LIMIT $ 10,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident C UMBRELLA LIAB X OCCUR H15XC5023203 10/01/2015 10/01/2016 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STER EERH ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:Permitting within jurisdiction. CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 120 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk&Insurance Services Stefan Szulc ..c g -- —_ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Ac REP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/8/2015 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). PRODUCER CONTACT NAME: Arthur J. Gallagher&Co. Insurance Brokers of CA. PHONE 415-546-9300 FAC o.415-536-8499 1255 Battery Street#450 E-MAIL San Francisco CA 94111 INSURERS AFFORDING COVERAGE NAIC# INSURERA:Zurich American Insurance Company 16535 INSURED SUNRINC-01 INSURER B: Sunrun Installation Services Inc. INSURERC: 775 Fiero Lane, Suite 200 San Luis Obispo, CA 93401 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:944362624 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. INSR TY OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F OCCUR DAMAGE TO RENTED PREMISES Ea .cu".".) currence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO- POLICY ❑LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY Ea accident IT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ '.. EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION Y WC013696001 0/1/2015 10/1/2016X PER OTH- A AND EMPLOYERS'LIABILITY Y/N WCO13696101 0/1/2015 10/1/2016 STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) WC013696001 -$25,000 Deductible;WC013696101 -FL, HI, MA, NJ, NY, OR,VA,WI only. Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main St North Andover MA 01845 USA AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD v Office! of Consumer Affairs afid Business Regulation ,;f V. 10 Park Plaza - Suite 5170 Aston, Massachusetts 02116 Home e prove tractor Registration Registration: 180120 Type: Supplement Card SUNRUN INSTALLATION SERVICES INC. Expiration: 10/14/20166 STEPHEN KELLY 775 FIERO LANE SUITE 200 SAN LMS OBISPO, CA 93401 Update Address and return card. Marr reason for change. SCA 1 0 20M-05111 I Address Renewal E] Employment Lost Card ice of Consumer Affairs& Business Regulation License or registration valid for individul use only E IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Office of Consumer Affairs and Business Regulation Q sgistsa#gra 18120 TYFr 0 Parr Plaza-Suite 5170 Ex lration 10L14I2 1€� Supplement Cara Boston,MA 02116 SUNRUN INSTALLATIO ' SERVICES INC. STEPHEN KELLY 775 EIERO LANE SUITE 200 1 -- SAN LUIS C BISPQ, CA 93401 Undersecretary Not valid without A tore SETT NS OT.jueI5S0506i292 3 DC wuw -0 x ` \ NSTEPH PARKWAY16 __a� - use eo e of .a oaf " Board Building Regi at ons aStandarcis n : b Q : 4, , z= STEPHEN E16 PARKWAY ROADy STONEHAM MA 0 Com ussione, I ! 17