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HomeMy WebLinkAboutBuilding Permit #652-2017 - 113 ADAMS AVENUE 12/19/2016 BUILDING PERMIT o� NORry q ✓ � 2 .111" 6 tLE O6 �O TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * . y Permit No#:�Q�^�17 Date Received O ATEP r ��SSgCHII`�Et�y Date Issued: IMPORTANT: Applicant must complete all items on thig page LOCATION ` Print PROPERTY OWNER DSV Print 100 Year Structure yes 10 MAP E PARCEL:_ZONING DISTRICT: Historic District yes no . Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑One family �Addition FPTwo or more family ❑ Industrial Alteration No. of units: 2 ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other p Septic ClWeI� i]F,loodpin C]Wetlantls 1Natershed Distract 1l/atter DESCRIPTION OF WORK TO BE PERFORMED: In,z,ta1 t 601OLr elCCMC_ -Lylnct n �Mt n(1- PxtsT�K).a V oyytilf w i n omcs e I-c,�Yi cou (sU s rn is Identification- Please Type or Print Clearly OWNER: Name: Z)M� a Phone:9.'l 9,l �Wo" 52-1 o1 -+ Address: `Contractor Name: IQ) 1-(Sy -Cl Phone: Email: 6 i 1eu n SM r 1N -C 8fy) Address Y1 " Supervisor.'s. ConstructionLicense-JUlU 1— Exp. Date: � 1 4 1`� —r. Home-Improvement License. -Exp. Date: 1 ARCHITECT/ENGINEER (',hrl c, Y, ) Phone: b56-V;8 -- 102 Address:��55 Cte-Ofq ItW 1JQ, l� �:&n M CXIrU 0; Reg. No. 15Z4--�0 FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ t FEE: $ Check No.: 294q o7 /' Receipt No.: NOTE: Persons contracting w�ti`i unrgj(listeyedZ, ntractors do not have access to the arantyi fun Signature ofxAaPnt/Ow�era _, : ._. -�-: IF Location 113 w DA VA S A v e No. t9��^ d�aJ� Date ` �5'`�1 4. TOWN OF NORTH ANDOVER t Certificate of Occupancy $ Building/Frame Permit Fee $ [� y Foundation Permit Fee $ ` Other Permit Fee $ TOTAL $ k i Check# 9d ? Building Inspector Plans Submitted ❑ " Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWER-AGE DISPOSAL Public Sewer ❑ Tanning/Massage/13ody Art ❑ Swiuvning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dmnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM PLANNING DEVELOPMENT Reviewed On Signature_ COMMENTS - r CONSERVATION Reviewed on Signature i COMMENTS Y b HEALTH Reviewed on Signature I t COMMENTS I Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEP, AcRTM Tt T�em. Dum�p,�ste� nite, yesoo Located at 124 Main Sfreeta Fire De p artrnens �!C;OIUIMEj;1TfS�� Dimension I Number of Stories: Total square feet of floorarea, based on Exterior dimensions. Total land area, sq. ft.: - - I ELECTRICAL: Movement of Meter location, mast orRservice drop rec(bires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department arse) i I I' i i ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work :rr Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application iL Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 4- Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code g6 Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 f i I Version#64.7 solarCity. RU PIL o=� 'AN OF ylq�G c Project/Job# 0183994 o CHRIS H. KIM v CIVIL RE: Installation Approval Letter .a .52430 �p F61 TER�O Project: Chiasson Residence 113 Adams Ave North Andover,MA 01845 Date of Review 12/28/2016Digitally signed Chris by Chris Kim Date: SC North Andover Ki m 2016.12.28 SC Office Wilmington 16:48:33 -05'00' To Whom It May Concern, On the above referenced project,the roof structural framing has been reviewed for additional loading due to the installation of the solar PV addition to the roof.The structural review, including the plans and calculations only apply to the section of roof that is directly supporting the solar PV system and its supporting elements. The capacity of the structural roof framing directly supporting the additional gravity loading due to the solar panel supports and modules had been reviewed and determined to be in accordance with the requirements of the MA Res.Code,8th Edition. The work has been completed in accordance of the provisions of the approved permits of the applicable code. Should you have any further questions or requirements pertaining to this project, please do not hesitate to contact me. t I Chris I'il'Jm Civil Engineer I SolarCity t: 888-7652489„55373 m: 704.616-4187 Email:chris.kim0solarcity.com 3055 Clearview Way San Mateo,CA 04402 r(650)638-1028 (888)SOL-CITY c(650)638-1020 solarclty.com NORTH F own oAndover . o - yr , No. oh , ver, Mass, / 9 • �4! COC NIc.2 wlC. 1' �ds R'STED U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ............ ...D�Ho.e.L....D.A ................................................ BUILDING INSPECTOR Foundation has permission to erect.......................... buildings on .....�.�.. .�./�. ..r� ........ . .......... . N Rough t0be OCCUpled as ....... ........ ...... ..... .... .........�. ..�...�/. ....... ..... ..... Chimney provided that the person accepting thi permit shall in every respect conform to the terms of the application Final 1 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 IPERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI RT Rough Service .......... .... ... .. .. .. ...4BUILDING .. .......... Final INSPECTOR GAS INSPECTOR i Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. by 101 ,',Solarcl ty1v December 6,11p 2411 TO—ShamimShahid Per SolarCit+y police,we want to inform you that yourneighbor,David G iasson Ilt,will be installirrk solar panelson his half of the roof. PLEASE NOTE:The panetswill ONLY beput on hisportion of the roof and will have zero effect on you or yourproperty.Please acknowledge that you received this notice below..lf you hake any further questio'ns/bonoems,Please feel free to reach out to William Randolph J917-370-2412)priorto:Deoember 17'e- Thank you far your time and cooperation.have a sunny day! ShamimSahid Signature /A -r_.._ Davi I ttl i Version#61.7-TBD RU PIL SolarCity. of � September 21,2016 C � � CHRIS H. KIM RE: CERTIFICATION LETTER 0 CIVIL ,o .52430 Project/Job#0183994 �p FGf Tt� Project Address: Chiasson Residence I 113 Adams Ave North Andover, MA 01845 AHJ North AndoverDigitally signed by SC Office Wilmington Chris Chris Kim Design Criteria: Location:888.765.2489„55373 Kim -Applicable Codes=MA Res.Code,8th Edition,ASCE 7-05,and 2005 NDS Date:2016.09.21 -Risk Category=II 10:43:20-04'00' -Wind Speed= 100 mph,Exposure Category C -Ground Snow Load= 50 psf - MP1,2,3: 3x7 @ 16”OC, Roof DL= 12.5 psf, Roof LL/SL=35 psf(Non-PV), Roof LL/SL=35 psf(PV) I 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,with upgrades specified in the plans, 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. 3055 Clearview Way San Mateo,CA 94402 1(650)638-1028 (888)SOL-CITY F(650)638-1029 solarcity.com �MM.:..-?A7P:i:,1�T71'zp,_.n541,. AC'..f t_ ..1 l E'"'l4±; ry •• • 1..' D e'-;Vr,e - [ 3l:'u �. :•'.:":e,T+-r.C.i n EeT_:U'/'e Hl:t ^>71'^ ,15.01'5:IlA ::1I. •l 115EMH MDM'1'` 'A',�1`; • N�-17,11 .NH1`47't.'S:`M 0. N. �p"{'.nC !' c.,et.)`-1—N41EV. "���9.5J•�:'`.^iGi�.� ."Y _C4�1r61:It:7919.(,14R 41�-1 D!t H , Ar1F4,•V ft to It'a"b 4_7�7ra.A:7:nV„51:'1'.d EltT"` Y ,n .,t...3 .,�I..A 0.••Vt;p1::::'LM.•V.yP!_elDar,4..• reA:k llt>:.rrf14,4/1CJ[L4�4m Fr 5Ir21* ..t'�rtl HT�'Ad 41... ..,ILl I We'1 n14t... W :.1i9 H1,',N 'N.JL 11.4 0<-A y14 1C .. [Ei. ♦1:" Y: 141 1`,IiiF F•....4..1 b{ f - .A' .419.1111'.11 -1-V'.r It 1,Mr -an.� .n1, . mfr'l" �,1 MOc i and rn ._41•", y . ,e,t'«.rltlt lit•.:i4 .. ,V..t.1...i {. nil . r 4.0 w7 ie+i...xn pnlee II Version#61.7-TBD ANSolarCit RU PIL s z e 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 MP3,2,3 64" 24" 39" NA Staggered 46.1% I Portrait Hardware-Portrait Modules'Standoff Specifications Hardware X-X Spacing X-X Cantilever Y-Y Spacing Y-Y Cantilever Configuration Uplift DCR MP1,2,3 32" 15" 651, NA Staggered 38.3% Structure Mounting Plane Framing Qualification Results Type Spacing Pitch Member Evaluation Results MP1,2,3 Stick Frame 16"O.C. 25° Member Analysis OK w/Upgrades as Specified in Plans I I 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 r(650)638-1028 (888)SOL-CITY r(650)638-1029 solarcity.com AI A!A:'1 _.t`.'1 .v. :'a:' 1 rX ar';]X 1.i')F'E041 .1lh r-1 .1., o'. :.a..nll: .1..::.C'!:'1: 'L,: r+.:..,t. F1 E I' .. t.v J.m.0.,a5.VAr./eJ:J, 11•.:4u,.p H- _ 11. '..1 s4- ?M tot IC I�4'— �wt�y,-:Mij R`.1 tF . "� ..A4 4"-•Cn.Y{i:1:91 r„•y'^11+43.;1 i A T1!W P."llti kILL`y ',i .A EIE.i 5151)i r,IM '�V.A$".AS' OI-1`1::A '„.f/..M•, J.. r1.4 .J F-.b�- .Wl P ,,F 1H 1.'/�4.4V+--1,%fl, ..._?11 W+1'vaterve '•R h ':.:l C.A$r E•:�',Tlf ttl C�+�h. 4.A1.•,"Il .itl�.°�.Hir,•:'11hF 'SY',`D.A k k p.Oetl Cy"I YC itYF' - n ;Aimma.eel. [.1.`�.,SAe hl ne ..p:..:.... .'..,.G C,•"+0-ewa..Ste's8e.'.-.. �.... er✓_._.♦..,r rw ��e+xron'.wa.. o.�.+- - :'7::S-0 C. m.—en. —4111: . I •,[ .,...[_.nl c.-.ad Wi--It11,'.i 41"1 n met"d 3,00" w Number fii qtr o erlhan I Pn, Nominal, i Yes ? � Re-Roof Q aim 4 SX(in.A 20 � Board Sheathirw Notre TOM Rake an 1%50 ft n Deft"n UmIt 120 ma �W CON Finish 1/2"Gypsum Board PV 1 End 15,42 ft Wood Grade # ._.. Ra acorn 1C'"C1Pv 2 End .135 rWm OO t L ' cirt A u res P end F rmmin s 510 nnn hoof Dead road 1318 sf 13.8 sf t Roof Live Load R ! X0 psf 0.93 1.8.5 Psf Note,,,;,, 1. p,,;!= s*pf,Cs-roof,Cs- r per ASF (Figure 7-21 2. pf=0.7(Q( f,} Member Design Summary(per NDS) Goveming Load Comb CD CL + CL - CF Cr D+S 1.15 1.00 0.94 1.2 1.15 Member Analysis Results Summary Governing Analysis Max Moment @ Location capacity DER Result + Bending Stress(psi) 1,154 10.1 ft 1,389 0.83 Pass ;CALCULATION OF DESIGN WIND LOADS MP1,2,3 Mounting Plane Information Roofing Material Comp Roof Roof Slope 250 _ Rafter Spacing 16"O.C. Framing Type/Direction Y-Y Rafters PV System Type _ SolarCity SleekMounVTm Zep System Type _ - ZS Comp — Standoff Attachment Hardware). Comp Mount SRV Spanning Vents No Wind Design Criteria Wind Design Code IBC_ 2009 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 15 ft Section 6.2 Wind Pressure Calculation Coefficients Wind Pressure Exposure KZ 0.85 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)18.5 psf Equation 6-15 Wind Pressure Ext. Pressure Coefficient U GCp(U ) -0.88 Fig.6-11B/C/D-14A/B Ext. Pressure Coefficient Down GCp(Down) 0.45 Fig.6-11B/C/D-14A/B Design Wind Pressure p p=qh(GCp) Equation 6-22 Wind Pressure Up Pc„ -16.2 psf Wind Pressure Down down 10.0 psf ALLOWABLE STANDOFF SPACINGS X-Direction Y-Direction Max Allowable Standoff Spacing Landscape 64" 39" Max Allowable Cantilever Landscape 24" NA_ Standoff Configuration Landsca a Staggered Max Standoff Tributary Area Trib _- 17 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at Standoff T-actual -252 lbs Uplift Capacity of Standoff T-allow 548 lbs Standoff Demand/Capaci DCR 46.10/c X-Direction Y-Direction Max Allowable Standoff Spacing Portrait 32" 65" Max Allowable Cantilever Portrait 15" NA Standoff Configuration Portrait Staggered Max Standoff Tributary Area Trib 14 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at Standoff T-actual -210 lbs Uplift Capacity of Standoff T-allow 548 lbs Standoff Demana/cawity DCR 38.3% , i DocuSign Envelope ID:843EE8A9-3A83-4E83-8719-08E629082244 SolarCity I PPA Costar er Name anti Addre.., srsst it rtdaan C ca<at,en , Date David Chiasm III 113 dards Aveat 8/1./2016 113 Adams Avenue t4oithAndover,MA 0184S "North Andover,MA 01946, qt A 'the"! �4 $ , i efi } x i "U ?i C 4 y:. tzt�4fjt t "ju . 1 53t Jtiz��'i, l S I P k S M" t i i Da The SolarCRV Promise *We guarantee that if you sell your Home,the buyer arils'Oaffy to assume your Agreement. initial .We warrant all of our roofing work, •We restore your roof at the end of the. . .. fgeeerrtept, .We warrant,insure,maintain and r aair the Sy , sTr .We fix or pay for any damage wire may cause to ya ttr pros ertyW We provide 24/7 web-enabled morditoring at no,4sloitional cost. *"tae rate you pay us w€i)never increase y mors an 2. 1/o per year. a The pricing in this A � rrT 'i 'vA€f f6r 0 days after 8/1/2016. � M Your SalarCityer Puithase Agreement Details Your Choices at the End o Initial Options for System Purchase: €aa�ut at p8st��i Term: At certain times,as specified in •SolarCity will remove the Sq- to at no � the Agreement,you may � 6s1 nt� �inagatti cost to you. purchase the System. •You can upgrade to a new System sth •These options apply during the 20 the latest solar technology under a new year term of our Agreement and Est"a oont dee at.6ol�#ln i � � n contract. not beyond that term. .You may purchase the System from kst #1t-ydr raun SolarCity for its fair market value as 161 specified in the Agreement. •You may renew this Agreement for up to ten(10)years in two(2)five(5)year increments. i 3055 Clearview Way,San Mateo,CA 94402 888.765.2489 solarcity.com 2041747 Power Purchase Agreemont,afire "2,2.2,Jdne24,2016 SAPC/SEFA Compliant Contractors License MA 16C 168572,rEt-11ARA Document generated on 3/ ;2U.t6 Copyright 2008-2015 Sol nr er rpara,i e Nt ights Reserved I DocuSign Envelope ID:843EE8A9-3A83-4E83-8719-08E629D82244 23. NOTICE OF RIGHT TO CANCEL. I have read this Power Purchase Agreement and the Exhibits in YOU MAY CANCEL THIS CONTRAT ANY P!PRIOR their entirety and I acknowledge that I have received a TO MIDNIGHT OF THE THIRD C DAY ftT1E complete copy of this Power Purchase Agreement. DATE YOU SIGN THIS CON Ctk� THE ' ATTACHED NOTICEP d'TtAT SRM FOR AN Customer's Name:David Chissi RI EXPLANATION 9F.T,1 RIGS tv, 2 . ADOPTION RI TO , I ATION TOCr 0€1 MAY HAVE TO CANCEL Signatst Th I PPA UNtt ►E SECT `23 Y MAY ALSO CANCEL THIS PPA AT NOWST AT ANY TIME PRIOR TO Datet 1 COMMENCEIVI OF CONSTRUCTION ON YOUR HOME. .'1 P The priting in this PPA is valid for 30 days after 8/1/2016. If you don't sign this PPA and return it to us on or prior to Customer's Dame: 30 days after 8/1/2016,SolarCity reserves the right to reject this PPA unless you agree to our then current pricing. Signature: r l — I Date: Power Purchase Agreement SolarCity approved Sign", Lvndbn Rive, CEO i; Date: " 8/1/2016 I i Power Purchase Agreement,version 9.2.1,June 24,2016 a 2041747 ti I � " A Common wealth of Manach usetts Depadmient oflndustrialAccidents Office of InVeSdg4&M X Congress Street,Suite 100 Boston,MA 02114-2017 wwrwsmass gau/ilia Workers'Compensation Insurance A.ffiidavit.8stilr�ex�ICvnlr'�lctvrslElrctricians/Ylumbtrrs -- li ntInformation Please Print Legibly Name(ausineworgariization/individual): SolarCity—Corp- Address:- orp.Address: 3055 Clearview Way City/statt'11i : San Mateo CA. 94402 Phoney#: 888-765-2489 Are you an employer?Check the appropriate box: .Type:of project(required): 1.(01 and a employer with 5,000 4- 0 I am a general contractor and 1 ernplayees(Cull andlorpart-time),* have hired the sub-contractors New construction 2.0 I am a sole proprietor or partner- listed©rt the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8, Demolition working forme in Any capacity. employees and have workers' 9. �13uilding addition [No workers'comp.insurance comp.Mm Treace. required.] 5.C] We are a corporation and its 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work officors have exercised their 11,0 Plumbing repairs or additions . m selfNo workers'comp. AV-ht of cxerr]ptlort�MGL y � P 12.E]RaaErepairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13[Dether Solar/PV camp.insurance required.] *Any appticaot that checks box M t must also Ml out the section below showing their workets'cotapetfmtien pdticy infhtmation. t Homeowners who submit this affidavit indicating lttay ate doinga#work and then hint outside contractors must submit a new afltdavit indiotdlnesueh, :Coatmtors that cheok this box must atimbcd on aEdditiouol sheet showing die name of the sub•comacun and state whether or not ibosc entities have employ,ws. if(lie sub-contrectars have emplayees,they artist ptovide their workers'comp policynumber. Y asci air employer ilial is providing workers'compensation itisirranee for my employees. Below is the policy and job Bile lrrjrrmati'on. Insurance company Warne- Zurich American Insurance Company Policy Nor Self-ins.Lic.#: WC0182015-01 Expiration nate;9/1/2017 Job siteAddres,: 113 Adams Avenue City/State/Lip: North Andover Attach a copy of the workers'compensation policy decluration 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 andlor one-year imprisonment,as well as civil penalties in the farm of a STOP WORK ORDER and a fine of up to 5250.00-a day against the violater, Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. Ido hereby cert6 u, the pains and penalties aj perjrrrp ilial lire ittforrrratlorr prorided above is trite and correct. 1�7;i store: ` Date: 12/19/16 Phone#: Official use only. Do trot write bt dais area,to be cmapleted by city or town official. I City or Town: Permit/License 4 Issuing Aulttority(circle one); 1.Board ol"Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.tither Contact Person: Phone#: DATE(MMIDDIYYYY) A`R v® CERTIFICATE OF LIABILITY INSURANCE 08119/2016 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 afid 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 AA/Cm N FAx CALIFORNIA LICENSE NO.0437153 E-MAIL SAN FRANCISCO,CA 94104 ADDRESS: Attn:Shannon Scott 415-743-8334 INSURER(S)AFFORDING COVERAGE NAIC# 998301-STND-GAWUE-16-17 INSURER A:Zurich American Insurance Company 16535 INSURED INSURER 8:N/A N/A SolarCity Corporation 3055 Clearview Way INSURER C:N/A N/A San Mateo,CA 94402 INSURER D:American Zurich Insurance Company 40142 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: SEA-003003278-03 REVISION NUMBER:6 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 SUER POLICY NUMBER (MMI DPOLICY EFF POLICY EXP LTR /YYYY MM DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLOO182016-01 09101/2016 09/01/2017 EACH OCCURRENCE $ 1,000,000 DAMAGETO RENT .I �OCCUR PREMISES EaoccuneED nce $ 1,000,000 X SIR:$250,OOD MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY[—]JEo LOC PRODUCTS-COMP/OPAGG $- _ _ __2,000,000 i OTHER: ----------------$ - A AUTOMOBILE LIABILITY BAP0182017-01 09101/2016 09/01/2017 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X X NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Peraccident)_ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ D WORKERS COMPENSATION WC0182014-01(AOS) 09101/2016 09101/2017 X PER oTH- ANDEMPLOYERS'LIABILITY _ _STATUTE ER _—_ -- D ANY PROPRIETOR/PARTNER/EXECUTIVE Y�NIA WC0182015-01(MA) 09101/2016 09101/2017 E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EWS 0162018-01(CA) 09101/2016 09101/2017 E L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under Limits apply excess of$500K SIR-CA 1,000,000 DESCRIPTION OF OPERATIONS below pp y E.L.DISEASE-POLICY LIMIT $ i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 161,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SolarCity Corporation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3055 Clearview WayTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN San Mateo,CA 94402 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk&Insurance Services Stephanie Guaiumi Atwz-_i CO— ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD V' /fir I �J+ i�♦ Ji v.. •t �J/�ff ♦ !i/tf..iftf Jfff.;I ��♦ I Office of Consumer Affairs and Business Regulation j 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 188572 Type: Supplement Card SOLAR CITY CORPORATION Expiration: 38/2017 DAN FONZt - ------ - -- -_ 24 ST MARTIN STREET BLD 2UNIT 1'1 MARLBOROUGH, MA 41752 Update Address and return card.Mark reason for change. [� Address Renewal O Employment I] Lost Card �Atflte ofCousnater AfrAW h Business Rego lsdoa License or registration valid for individul use only !HOME IMPROtl WENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration-. 168572 Type. 10 Park Plaza-Suite 51.70 Exptratlon: 3M2017 Supplement Cerd Boston,MA 02116 SOLAR CITY CORPORATION DAN FONZI 3038 CLEARVIEW WAY .c •_ . — SAN MATEO,CA 94402 Underseeretsry Not valid without signature f ki=a';hu DepWAsw.,t of Pub"Se=ly C3trar l of Eau"jt:Z;RcUtdctwo 06d g tract; CS401087' Ccsrctr +fieCr...='waor DAMSEL D FONZI 3#0AWMERSTREET —V? VNLMOOMN#All"W ..M CA— Exp4rebon rniaSSCner O>lf1S/20t1