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HomeMy WebLinkAboutBuilding Permit #1273-2016 - 141 BERRY STREET 6/7/2016 NORTF{ Of,�.a.ao "6'1a L BUILDING PERMIT - mrd. - °oma TOWN OF NORTH ANDOVER t / e APPLICATION FOR PLAN EXAMINATION " Permit NO: Date Received 406 Date Issued: 6046 (� 'l /& �tss�c1Us t� EUPORTANT:Applicant must complete all items on this page LOCATION 141 Berry Street Print PROPERTY OWNER Jeffrey and Tiffany Moon 04 Print ` / MAP NO: PARCEL: ZONING DISTRICT: y Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE A I M1 Residential Non- Residential d� ❑ New Building © One family ❑Addition 0 Two or more family ❑ industrial 0 Alteration No. of units: ❑ Commercial 0 Repair, replacement 0 Assessory Bldg 0 Others: 0 Demolition 0 Other 0 Septic 0 Well ❑ Floodplain 0 Wetlands 0 Watershed District 0 Water/Sewer Installation of 29 Solar PV Modules on existing roof 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 Solar Address: 2 Shaylee Lane,Lakeville, MA 02347 Supervisor's Construction License: Exp. Date: CS-071992 05/09/2018 Home Improvement License: Exp. Date: /2 179404 0712816 0 ARCHITECT/ENGINEER James Clancy Phone: (856)358-1125 601 Asbury Ave, National park, NJ 08063 —Reg.g. No. 46775 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $9,500.00 FEE: $ 1?:�Q — Check No.: ,QVO 4�0 Receipt No.: 301-6T NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor's - Location _ t r No. �� '��'_' / Date DL5 D:?- af-,vlz5p • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ • � l Building/Frame Permit Fee $ -- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �, Check# -94 ' Building fnspector f Plans Submitted ❑ Plans Waived ❑ Certified Piot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENT'S CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Hanning Board Decision: Comments Conservation Decision: Comments VDater& Sewer Connection/Signafiure� Date Driveway Permifi DPW Town Engineer: Signature: Located 384 Osgood Street FIREMEPARTMENT - Team jDumpster on site mq- ed of�1241b"m t-eet - r Fi�eiDe�aartrrient,sgrlatiare/date COMMENTS I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, avast or service drop requires 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 ease) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i I 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 Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4, Building Permit Application 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) 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 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 orspecial permit was required the Town Clerks office must stamp the decision from the Board of Appeals i 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 ma R TFC Town of t soh ver, Mass, A- COCHICHIWICN 7,95 RgT10 p.Pa�,�S V BOARD OF HEALTH PER IT Food/Kitchen Septic System THIS CERTIFIES THAT .�.�7T.. z.Co. .'! . . x.. BUILDING INSPECTOR ,has permission to erect ................... buildings on . .� A':1, • Foundation /� � � � Rough to be occupied as .. ...9..... .... �conforr�io ..�. ....... Chimney provided that the person accepting this permit shall in every respthe 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 ... .. .. .. ............. .. BUILDING 1 CT 2-14 GAS INSPECTOR Occupancy Permit Reguired 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. Lopation 141 J �_ No. /Z�/ zo`k Date o6 D -23v1 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 30465 Building spect r � NORTI� Town of 3� _ 0L dw I 3 Dh ver, Mass,LAKE CO[MIc"t Wttu RATED 11 BOARD OF HEALTH Food/Kitchen Septic System L D THIS CERTIFIES THAT .....PERVIT 4 . . x.. � BUILDING INSPECTOR has permission to erect .......................... buildings on .� :�.., P7Foundation Rough to be occupied as ..rw:. .....s��.�....�� .. ..... ... ....... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS ION S Rough Service ... .. .. .. ............. Final BUILDING I CT GAS INSPECTOR 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. JAM ESA . CLANCY PROFESSION AL EN GIN EER 601 A SB U R Y A V EN U E NATIONAL PARK, NJ 08063 (8 56) 358- 1125 FAX : (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 1 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 framed 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 carry 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 shall be fastened 16-32"o.c. at corners and 48"o.c. through the field Rails are to be placers 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 PSF ground snow load requirements. Should you have any further question or comment please feel free to contact our office. Respectfully, t1�QF�n ti ( ES A. G CL NCY a4o.46775 ca James A. Clancy Q�sz Professional Engineer ALG MA License#46775 BayState SOLAR Homeowner's Agent Authorization Form I, !EF'rQ Y P. MOOYA am the property owner of the property located at address: 141 6617,g-Y ST¢eET Na9-TN A a DN Eg—, MAS oi84 57 I hereby authorize Bay State Solar to act as my agent for the limited purpose of applying for and obtaining local building and other permits from the Authority Having Jurisdiction as required for the installation of a Photovoltaic System located on my property. Customer Signature: attire: Date: 01 tvt1'i 2 iCo Print Name: jEkjV-e4 P. A^aan1 ,fin -y -."N"nil hk r iq16F1 r�.3 tea} lr X MIM W ti W a( 231 Weaver St Fail River MA,02720 508-738-5112 u a PV Module Weight=46 lbs Area=39"x 65"nominal (17.6 SgFt) , `.�`\` � N � Mounting Rail(Extruded Aluminum) i �� o SOUR PANEL 1 Weight=1.03/If � ` N There are 80"of railer module=6.871bs EXTRUDEDAWMINUM P.I.Q. (� P i SOUR MOUNT NO RAI . BERRY STREET TOP LIMPS III END RE Module+Rail=52.87 lbs over 17.6 SgFt=3.00#/SgFt � MID END REQUIRED FYYYYY Typical rail spacing is 32"o.c. across panel width with 2 rows per module. i RAILATTACNMENT SHINGLE MOUNT FLASHINGKIT � z. HARDWARE \wMEOPRENE WASHER MFG'R z'R 1 O Typical layout provides 13 feet on one rail for each 10 modules in a row. I 6f,SSx4.85T LAO EDLT ` SERRATED EACH FOOT LOCATION This provides for an average of 1.3 feet/module/rail x 2 rails=2.6 ANaLRATED (�.FO TLOC Hd. "'> 195°MODULE O O feet/module. ` SINGLE ROOFLl QQ� ,�FUSNING DECKING LOCATION MAP: ORIENTATION cC 06 i 39 TILT MAIN PANEL C'' I-I T Module+Rail weight distributed per mounting foot= ��\ EXISTING METER z 52.87 lbs/2.6 feet=20.33 lbs/mtg foot. �� ROOF i PV AC DISCONNECT SHINGLE MOUNT DETAIL GENERATION METER MOUNTING RAIL SPACING MAY VARY FROM 20"-54"O.C. s ScA[ENT. CONTRACTOR TO VERIFY PANEL MANUFACTURER'S `� i PROJECT DATA INVERTER SPECIFICATIONS AND INSTALLATION REQUIREMENTS. ``IRON RIDGE RACKING, F W FOOT SPACING SHALL BE MAX.4'-6'0.C.ALONG RAIL. _—r a0 CODES CMR-780 IRC-2009 U U a MEC-2014 NEC-2014 F p BUILDING USE: DRIVEWAY 4® EXISTING: R-RESIDENTIAL SINGLE FAMILY SHINGLE MOUNT FLASHING KIT CONST.CLASS 5-B UNPROTECTED Z WNEOPRENE WASHER EXTRUDED ALUMINUM SOLARARRAY: 0 Jy SOLAR MOUNTING RAIL r PANEL: PV ARRAY z A„ s� LG 300NIC-G4 I5/16"NTO LAG BOLT 26 MODULES MOON RESIDENCE INTO RAFTER I 1 STRING OF 9 1 STRING OF 17EXISTING �JgETTB_. 2x8 @ 32" NG O.C.COLLAR TIES RACKING; FLUSH TO ROOF 0 39° Net Metered 7.80-kW D C 2x10 @ 16"O.C.RAFTERS INVERTER: SOLAR EDGE SE6000A-US SHEATHED WITH 1/2"PLY SYSTEM RATING: 7,800 Watts DC-STC v I LAYER COMPOSITE SHINGLE M ° � 6.0-kW AC 2x10 @ 16"O.C.RAFTERS EXISTI SHEATHED WITH 1/2"PLY "j 1 LAYER COMPOSITE SHINGLE C, nsv�s�oNs oALE ROOF LOADS. THE EXISTING ROOF STRUCTURE HAS BEEN EVALUATED FOR I ROOF SECTION 4'-11" $',¢" BAY STATE SOLAR THE PROPOSED NEW SOLAR LOAD AND DETERMINED TO BE OF ORWN RCA A-9 scALE:3a• SE— -sNAvcEaLANe SUFFICIENT CAPACITY TO INSTALL THE PROPOSED SOLAR CREW NC S 1 GROUND SNOW 50 PSF ARRAY AS FOLLOWS: A-1: OVER PAGE A-5: STRING SIZER SCALE ASO e LAXEVI LLE,MA 42347DATE WIND LOAD 100 MPH A-2: ROOF LAYOUT A-6. LABELS BAY STATE SOLAR SOLAR ARRAY 4.0 PSF A)SHINGLE ROOF-MECHANICALLY FASTENED RACK SYSTEM NOT TO EXCEED A WEIGHT OF 4.0 LBS/SQ.FT. A-3: STRUCTURAL A-7: JDATASHEETS 28NAYLEELANE A� 1 A-4: ELECTRICAL LAXE4TLLE.MA42347 - 1 r Confirm line side voltage r1 at electric utility service 8 POWER OUTPUT-PTC RATING x#MODULES x M.INV EFF entrance BEFORE a0 INVERTERS 1 = 278.6 W x 26 x =7,087.86 W connecting inverter and TOTAL =7,087.86 W ensure proper operational FlJ` M range required by system inverter. U y Ea WIREAMPACITY a W 4 00s NEC TABLE 310.15(B)(16) EXISTING W RING U ry WIRE AMPACITY 25A x 1.25=31.25A MIN OCPD #10 THWN Cu 35A RATED Li #8 THWN Cu 50A RATED z pa w #6 THWN Cu 65A RATEDL2 M TO UTILITY O ; oa (4 wires)#8 THWN-2#8 GND GND a (4 wires)#8 PV WIRE 3/4'CONDUIT I I EXISTING ELECTRIC UTILITY METER #8 GND 60A RATED I I z'' 25A (3 wires)#8 THWN 35A FUSED (3 wires)#8THWN DISCONNECT (3 wires)#6 THWN m #6 GND #6 GND 120/240V #6 GND 5" W 1"CONDUIT 1"CONDUIT 1"CONDUIT OOK --- — - - - - —~— N .— ......-- - - � V N L2 I L2 LINE TAP IN U r��y a I EXISTING MAIN W —� L1 M I L1 I PANELENCLOSURE F I � la_ i I } I I I I Interconnection to Utility V j I and System Grounding f-4 . I z ALL CONDUCTORS ARE COPPER UNLESS NOTED OTHERWISE. per NEC-2014 Article 690 I I Provide signage as req'd I I by NEC-2014 Article 690. ALL EXTERIOR MOUNTED I T RAPID SHUT DOWN I ALLoutdoorminimum COMBINERS,JUNCTION BOXES, I shall be a minimum of Contractor to enable Rapid TROUGHS,DISCONNECTS,ETC. I NEMA-3R rated. AC&DC GROUNDING CONDUCTORS Shutdown functionality on Solar SHALL BE MIN.NEMA 3R RATED. PER NEC ARTICLE 680.47(c)(2) Edge Inverter per S.E.doc.# L CONNECTED AS PER 250.64(c)(1) MAN-01-00186-1.6 as required per N NEC_2014 Article 690.12(1)thru(4). GND 0 EXISTING 200A BUSS I MAIN SVC PANEL 1 120/240V REVISIONS -Electrical contractor to verify Interconnection requirements with Electrical Utility for connection location and standards. IDR" Rc -Electrical Contractor to provide expansion joints and anchoring of all conduit runs r reD we as per NEC requirements. 3c Ls In NOTED -Provide label/placard at existing utility connection with"WARNING-CUSTOMER asa+-zmo OWNED ELECTRICAL GENERATION EQUIPMENT CONNECTED"with BAY STATE SOLAR appropriate hazard and output ratings of PV System. x SHAYLEE LANE A-41 LAxsva.LE,I 42347 North Andover MIMAP June 7, 2016 106.D-0073 106.D-0041 v 44 ASH ST 11 ASH ST 106.D-0042 M s 106.0-0038 r0)i Q ti • 5 2.64 R3 160'BERRY ST 0� 106.D-0039 106.D-0058 R2 180 BERRY ST 64 p9' 106.D-0076 142 BERRY ST 6S5j `\ \ 47 190 BERRY ST ( 6 106.D-0077 106.D-0036 106.0-0075 ) (C) 149 BERRY ST 1441 BERRY ST f r 106..D-0074 r' 49, l Rt 106.D-0044 VRA.: 17.9 BERRY'S? d:._. 106.D-0056 11 lu? - Wez -'- 1 193 BERRY ST •`-•'•106:0=003 2�`=�.. 52 COMPASS PAINT 106.0-OQ49 r�Z _. •.. Lu..._. �� .... 1, = �� _' 203 BERRY ST 169.BERRY.tiST aallr 10.6.D-0055 8 COMPASS POINT ?1a21O_BERRY S ••:: a6t�.:__.'�!� 0-0054 MVPC Bo Zoning Overlay Zoning 13 Municipal Boundary 13 Adult Entertainment Distric Busine s 1 District C)Machine Shop Village Ove 12 Busine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, -- Rail Line M Watershed Protection Dist D Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack Interstates 0 Historic Mill Area ®Busine s 4 District NORTH Valley Planning Commission(MVPC)using data provided by the Town of _1 ©Medical Marijuana O Gencri Business District Ot t° q� North Andover.Additional data provided by the Executive Office of —SR ®Downtown Overlay District G Planne I Commercial Dev 2 ��t� ,s�.O Environmental Affairs/MassGIS.The information depicted on this map is 0 Historic District _ Corrido Development Dist 3. �' _ CL for planning purposes only.It may not be adequate for legal boundary Roads �j Osgood Smart Growth(40 O Conido Development Dis[ O -- en definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER %71 Easementsi,"Hydrographic Features O Conido Development Dist F 9 MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING - Industri 11 District 4L ; THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY El Parcels -- Streams -:Industri 12 District IF i * OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Wetlands 10 Industri 13 District iF 0 . _ ��� ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF O Indus In I S District THIS INFORMATION Exempt Lands Residence 1 District li °+.n° Reside ce 2 District SSACHUsfc Reside ce 3 District de 1Le 4 District"=126 ft de s District � E de ce6 District .­ge evidential District North •• - " June 7, 20 • WF7 r Ft y,. ` �Y 43 � r' � r try,°1�T'`i4:•.� _ ;�.� 1,�I �. r4, '�':.4 ly �y� ���.a&`�" " r'� '� #- j} s XN lk 4 I,�i'd, `' f.3, �' .t 'Lo.. �•`°ty'> _ _ �.��. .. a' .: 'vim A ,f"�` 4+' 7 f l`tel � .. Y .X'g '-"Ts ,h`w fes• .«tet'` ;40 ' ;✓E �` rr ar,'x •.�� r�-> � r 'T-/; � �a�e =,,ed {��r °f ���.� .���:.. � � �',%`��yr0 r •,� �4 er)'+ t � •_ qty � North Andover MIMAP June 7, 2016 r 106.D-0073 106.D-0041 v 44 ASH ST 11 ASN ST 106.D-0042 M t 106.D-0038 y 19 f M Q Z. 4 160 BERRY ST (0 106.D-0039 106.D-0058 per' 180 BERRY ST 6�p9' 106.D-0076 142 BERRY ST 190 BERRY ST S 147 6 106.D-0077 �:�-g-qty-StrP M I \t-I 106.D-0036 106.D-0075 "+ 149 BERRY,STko ry 141 BERRY ST `•�` 106.D-0074 rn rn 4g, o, v 106.D-0044 17.9 BERRY ST 106.D-0056 ,,i,._- •"`:.:"> ;�.,i...:... "::.'. {•`x'•106':D'=003'2•"%.. 193 BERRY ST 5_2::COMPASS:POINT.. �altr.:_._:•:'. u:_:vJu�:_:_. 106.D-0063 r .::_: :. � �JJr.: 106.D-0049 -70 106.D-0049 ::... S.... _. �bcr.:_._: ...• ::. ...._ .._.. - Salu.:i�_= •._..�:; Iii:::�=••---•'.::_:{.••:�ltr.•::: .. :•.: .: 203 BER'vw.. .�`` 169 BERRY.:=ST':uJei' 8 COMPASS POINT'.slt. "-'_. I._.. ...__,I, `~--. lO6.D-0055 YY-1SSTT •`p..::;_._: .:_:? `••.. .,•.._: .__:.. :::..? '°'_;_:_'` _: : 1O_BERRY S 106'D-..0017:. '='.... .: 6? •._: -0054 ..._..- ....._.. �SI,f!..._. Iri::::::'1.11.:::_:":'•:4,_�J,•<.::::: „l.,C.:::.:"'Jk�ll.:::_:::.' -,. :")?. - ._ __•lSl, C.MVPC Bo [3 Municipal Boundary Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, - Rail Line Meters Data Sources:The data for this map was produced by Merrimack Interstates V40RTH Valley Planning Commission(MVPC)using data provided by the Town of —I pE"'s. ' q,{. North Andover.Additional data provided by the Executive Office of —SR ♦ �a O Environmental Affairs/MassGIS.The information depicted on this map is Roads 3? a 0L for planning purposes only.It may not be adequate for legal boundary O definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER q r Easements F p MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ❑Parcels 11 } THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY • OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT - Trails ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF V Hydrographic Features ,J ^o '�``{j THIS INFORMATION --Streams ,SSACMUS�S Wetlands Exempt Lands 1"=126 ft "�` DATE(MM/DDNYYY) A�EP CERTIFICATE OF LIABILITY INSURANCE 8!3112015 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 WANED,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 CONT A NA Hadley Insurit Group = 508-67&5267 FAx 508-673-0322 246 Durfee St E-MAIL Fall River MA 02720 .chadley@hadleyinsurit.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:Scottsdale Insurance Company INSURED MCCAR-1 INSURER B:Pilgrim Ins Co Philip McCarron DBA INSURER C: Bay State Solar 2 Shaylee Lane INSURER D Lakeville MA 02347 INSURER E INSURER F: COVERAGE 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. INSR TYPE OF INSURANCEADDLSUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPS2195257 8/242015 8/24/2016 EACH OCCURRENCE $1,000,000 X❑OCCUR DAMAGE TO RENTED MEM E Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PROJECT El Loc PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY PGC00001018678 4/2/2015 422016B $ X. accident 1,000,000 ANY AUTO BODILY INJURY(Per Person) $ ALL UTOS�ED X--'AUTOS BODILY INJURY(Per accident) $ X NON-OWNED PROPERTY DAMAGE HIRED AUTOS X AUTOS er accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION I PERTUTE OTH- AND EMPLOYERS'LIABILITY Y/N STAER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ if yes,describe under DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT 1$ A Builders Risk CPS1898681 8242015 8242016 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 AUTHOR2FD REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(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 DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE T - IFICATE 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 POLICES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORED F IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to he terms and conditions of the policy,certain policies may require and endorsement A statement an this certificate does not confer rights to he certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: HAI)LY INSURIT GROUP PHONE FAX 246 DUFEE ST. (AIC,No,Ext): (AIC,No): E-MAIL FALL RIVER,MA 02720 ADDRESS: 7827S INSURER(S)AFFORDING COVERAGE NAIC 1f INSURED INSURER A: HARMRDUNDERWRrTER$INSURANCE COMPANY MCCARRON,PHILIP DBA BAY STATE SOLAR INSURER B: INSURER C: INSURER D: 2 SHAYLEE LANE INSURER E: LAKEVILLE,MA 02347 INSURERF: COVERAGES CERTIFICATE NUMBER: 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 CERTIRCATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PA®CLAIM NSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (UNN)MYYYY) (MM`NJDAYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMAGETO RENTED $ CLAIMS MADE C—]OCCUR. 3REMISES(Ea occurrence) ED EXP(Any one person) $ ERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: ENERAL AGGREGATE $ POLICY [—]PROJECT[::]LOC IRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per acciderrl) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND x I wcswuroRY OTHER EMPLOYERS LIABILITY YIN UB-9975A282-15 09/192015 OBIISM16 LIMITS ANY PROPERITORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? MN N/A E.L EACH ACCIDENT $ 1,000,0()o (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E_L DISEASE-POLICY LIMIT $ 1,0G0,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES(RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIRCATE ISSUED TO THE CERIMCATE HOLDER AFFECTING WORKERS COMP COVERAGE MCCARRON,PHILIP IS COVERED BY THE WORKERSCOMPENSATION POLICY_ CERTIFICATE HOLDER CANCELLATION w BAY STATE SOLAR SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED 2 SHAYLEE LANE BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISI . l:.. AUTHORIZED REPRESENTATIVE N LAKEVILLE,MA 02347 ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORP is reserved. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UT www.mass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 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): 1.211 am a employer with 5 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. [I We are a corporation and its required.] officers have exercised their 10.[]Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' 13.2 Other Solar comp. insurance required.] *Any applicant that checks box 41 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Hadley Insurit Group Policy#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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: / Date: 06/031'2 G 1 _ Phone#: (50R—Q 30 -1 y US Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Office of Consumer Affairs and Business Regulation �v 10 Park Plaza - Suite S 170 Boston, Massachusetts 021 16 Home Improvement Contractor Registration Regjstrat;on 179434 e,+ a Individual Exptrahon: 72812016 Tr# 255733 PHILIP MCCLARRON -- - PHILIP MCCARRON 2 SHAYLEE LANE - LAKEViLLE, MA 02347 Update Address and return card.Mark reason for change. Addrecc Renewal -- Employment lost Gard SCA+ ij 20M05' , -ij, f, //i..7 //...... •. I/. License or registration valid for individul use only {?(rice of Consumer:l(fairs Business Regulation hefore the expiration date. Ir round return to: "f ME IMPROVEMENT CONTRACTOR office of Consumer affairs and Business Regulation egistrdtion: 179404 Type: lndry+dual 10 Park P1a7A-Suite 5i?0 expiration: 7/2812016 Boston.%1 A 021 16 7� i PHILIP MCCLARRON PHILIP MCCARRON 2 SHAYLEE LANE �—�✓ --- tAKEVILLE,MA 02347 Undersecretary Not valid without signature -- . ! aP► ----- r t ! F s ` •t • e l' RGARQVIF `t'CIANS ., ELECC`IAS .-. k E 1 SU ISES TH-E TOLLOW1'1r1G :l�ftENSE { > SSt1ES "EC 1:t WING 't_Ki-NSE AS A. STER ELECTRICIAN AS A=REG JOURNEYMA14 ELECTRICIAN R$tr-.t SFi1 IdA5 PHILIP nCCARRONu . J 'OiMLIT1jC 'AR N' 2 SHAYtEI LAME I i 2 .g1lAYiEf'LN' 02347-1852 : 1 LAKEVILLE FSA 02347-1852 Att t:LE 36981 34460 E - 07/31/16 36982 1#ti6�$ 07/31/16- - ..-�reaicrir�' s •• — Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-071992 ' Construction Supervisor PHIUP MCCARRON V 2 SHAYLEE LN LAKEVILLE MA 023 ' f (\/�,,x� �, Expiration: ' Commissioner 05108/2018