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Building Permit #838-16 - 1785 SALEM STREET 1/26/2016
y 1 b BUILDING PERMIT ``�so .~ 3r 4f.„p. ODL TOWN OF NORTH ANDOVER t '` o APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received -.-�. ” ZS 1CHu5 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION % E� V,(4L &L,.( n Print PROPERTY OWNER Ur,1014 J J, ) Print MAP NO: PARCEL:_ ZONING DISTRICT: Historic District Machine Shop yes no ves f no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial teration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Li Septic a Well Ll Floodplain L Wetlands L Watershed District ❑ Water/Sewer 2 Identification Please Type or Print Clearly) OWNER: Name: Address: CONTRACTOR Name: �n iSs'Phone: Address: _ I t _ I .. I I JA n , Supervisor's Construction Home Improvement License: T /(4 Exp. Date: Sal= -� ) Cf,z I �-L 4 S- E �- LI Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. 7 FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 3 I , 9 30 FEES $ 383,80 Check No.: `e 2 4 S Receip o.: NOTE: Persons contracting with unregistered contractors do no have acc ss to gu a and Signature of Agent/Owner Signature of co ra V ` Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan -",ice stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Well ❑ Tobacco Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ Swimming Pools ❑ Food Packaging/Sales ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Ir Reviewed On Signature Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes J Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer ConneCtiort/Signature &Date Driveway Permit DPW Town Engineer: Signature: r y�� Loca ted 384 Osgood Street FIRE DE~PARdTMEN{T��4.ge �Dumpsteronlsiter;yes� �u � ';, * o)#"' (,Located - _... Fire Departmentsignatiiare/dater._ �i�� ♦��? � ��. ,� y�:i++S �4-°iti fig � �.�,r w6.,o7,.ai-.H.,.! ,r._•. �k + � V'Jtr j J} . 1z,'Y i _}.�,�... �` h i1.�. tir^} ft'I//'Z S.w �•�Y r,�'.. n-.�.._a .�...5 �.e-_ .a....m�. .�-.;v.r((� C®MMENTS; L Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast 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 Doc.Building Permit Revised 2014 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 4� 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 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) 74Building Permit Application 4. Certified Proposed Plot Plan 4 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 TE: 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 Location / 4 , No. ez 6� 7A -p - Check # Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee $- TOTAL $ �)� lv� A �'ulilding Inspector I %9, 3 0 1=0 =m/ 4 1 V O Q LLI S LL c O m O L Y Y \ o LL T N U a vi W N Z C7z Z_ m O O N 'O 0 LLL L =3 w v C E U m LL O uj Z m d L w LL t 0 d H Z Q U W W L K U V) LL O V a z Q L °° d' LL CZ C H oc w W U. L N c m O Z a+ °' {% Y o N _ 0 � R v o •� L Q � Q - 0 E Q Y L N �+ s � O E im _ o = z Q h ' c a Z 0 cn Cc E NJ L �, a Z H A C) _ n4W o , c�.o c H cao� > a� o X, LLI O E c c U Q Nz =o 48: `� o w o M.5 o W —1 aZ CL CL y w m 0 cc o y � o r c = Q �V: ca o o U) coC13 LU LLI °' *C; rn = o 'E j..O LU v V CL 0-0 Q 0 CL0 0 OG > w W 0 W 0 0 0 Z N 0 I � 0 � N Cit. I.-. O �+ d v O o CL a 0- a� Q 0 -_ �0-0,4; � Z � 0 U U) .�, C CL 0 sunGEVITY" GENERATE POSITIVE" January 25, 2016 Subject: Structural Certification for Installation of Solar Panels Job #: 1342850 Client: Sweetra Address: 1785 Salem Street, North Andover, MA 01845 To Whom It May Concern, A field observation and design check of the subject property was conducted to determine the suitability of the existing roof structure to support the installation of solar panels. From the field observation of the property, the existing roof structure was observed as follows: The existing roof structure consists of a single layer of composition shingles over plywood sheathing that is supported by 2x8 roof rafters spaced at 16" on center at Array 1 and true 2x8 roof rafters spaced at 16" on center at Array 2. The rafters are sloped at approximately 12 degrees at Array 1 and 27 degrees at Array 2. The rafters have a maximum projected horizontal span of 12'-2" at Array 1 and 11'-6" at Array 2 between load bearing walls. The roof is about 10 years old and appears to be in good condition. Utilizing the information determined from the field observation, the attached structural calculations have been prepared for the subject property in accordance with the following design criteria: • Applicable Codes: 2009 IBC, ASCE 7-05 and 2005 NDS • Basic Wind Speed = 100 mph • Exposure Category = B • Ground Snow Load = 50 psf As a result of the completed field observation and design check, I certify that the capacity of the existing roof structure that directly supports the additional loading due to the installation of solar panel supports and modules has been reviewed and determined to meet or exceed the requirements of the 2009 International Building Code. Please feel free to contact me at (510) 496-4422 with any further questions or concerns regarding this project. tN OF MA 0„ Sincerely, I&Ulul Janyce Spencer, PE JANYCE �\ AKIKO SPENCERIVIL N N0051861 66 Franklin Street, Suite 310 p 510.496.5500 866.SUN.4ALL Oakland, CA 94607 USA f 510.496.5501 www.sungevity.com DocuSign Envelope ID: 1 D4CD571 -CFA6-4840-B5F8-1 B2C47D8A90A sunrun EXHIBIT A �'. SOLAR FACILITY ADDENDUM CONTRACT P87A1V1A716EKEF THIS SOLAR FACILITY ADDENDUM CONTRACT ("Addendum") is made by and between Sunrun Inc. ("Sunrun") and Sungevity, Inc. ("Contractor") for the design, engineering, procurement, installation, and construction of the Solar Facility described herein. This Addendum hereby incorporates, in total, the terms and conditions set forth in the Master Solar Facility Turnkey Contract ("Contract"), and all schedules and exhibits thereto, executed by Sunrun and Sungevity, Inc. in March 10, 2014. Capitalized terms contained herein have the meanings set forth in the Contract. SOLAR FACILITY TOTAL SOLAR CUSTOM Contract Price: $31,930.00 Host Customer: Ronald Sweetra Street Address: 1785 Salem St, North Andover, MA, 01845 Rebate Level: $0.00 per watt Utility: National Grid TECHNICAL SPECIFICATIONS System Size >escription Rating tandard Test Condition Direct Current (STC DC kW) 9.000 :EC Alternating Current (CEC AC kW) 7.778 Generation Equipment Photovoltaic collectors Manufacturer Model number STC DC rating Quantity Array 1 Hyundai Heavy Industries HiS-M250RG(BK) 250 W 14 Array 2 Hyundai Heavy Industries HiS-M250RG(BK) 250 W 16 Array 3 Hyundai Heavy Industries HiS-M250RG(BK) 250 W 6 Inverters Manufacturer Model number Efficiency Quantity Array 1 SolarEdge Technologies SE 7600A -US (240V) 0.975 1 Array 2 SolarEdge Technologies SE 7600A -US (240V) 0.975 1 Array 3 SolarEdge Technologies SE 7600A -US (240V) 0.975 1 Total Number of Panels: 36 Total Number of Inverters: 1 Meter Information Aeter Description Aanufacturer Meter selected from approved vendor list provided by Sunrun. Aodel number Meter selected from approved vendor list provided by Sunrun. 12/15/2015 P87A1V1A716EKEF-H (Custom PPA Fixed) Pagel of 2 kCHUSKTTS - r�; ave d Wow 1 z N0' St6332806 • it d9 -'i IMORATH CL.r► Ma3Z=hUSetts - Department of P'uCbC Sa'ctY 9oard of Buitdanq RegulatiW111 a:id S:artdaras License; CSFA-104576 i DANIELJ MCGRATH . 114 BOYLSTON SC MALDEN MA 02148 i -A... Exprratton Corrnrxssioner 09115=16 7 S]WHE OF CONNECTICUT DEPART7fF,,VT Ul- CONSE.1rrx rxn�r_'C7.rn,� •, DAtr1IFL j btCrRATH 114 T301LS7'014 ST MALDEN, MA 02148-7931 it(: ; lit"C, NQ. �-'tC`T1�E E1(PI� �••= •7�— ELC;.04}185S-E1 08131/201q 09/30/2016 r COMMONWEALTH'OF MASSA WU I BOARD OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A REGISTERED MASTER ELECTRICIAN UNITED SOLAR ASSOCIATES LLC r DANIEL J MCGRATH 114 SOYLSTOR ST MALDEN • AA 02148-7931 t - 2006 a o7f311?6 2 2. COMM EALTM F M errs ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A -REG joURNEYMAN ELECTRICIAN DANIEL J MCGRATH 114 90YLSTON ST MALOEN MA 02148-7931 • 1146 B o 1 16 � r %w' (!n/!t l/iv, i/tt'vwt��tt v f ^ �(Ii,],ivlPllrlJ/`✓%i Office of Consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR - gistration: 184392 Type: 1 piration: 115/2018 Corporation UNITED SOLAR ASSOCIATES LLC DANIEL MCGRATH 414 BOYLSTON ST. MALDEN, MA 02148 Undersecretary �.y I `�/• �; ('1N /NI/Nt/4Y/�f// I��'��IldtlYtlfS(°�IJ 0frice orConsumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR registration: 168524 Type: expiration. 3/7/2017 Individual DANIEL MCGRATH DANIEL MCGRATH 114 BOYLSTON ST MALDEN, MA 02148 Undersecretary OSHA Th*Cod OoWp•lunrl����•• • Cor�asMiw tiui� �tK1f iMM Danid McGr+adt Keil* M. PMKderpost 31211112011 t�•tiMam-ON•MMI (�•�+••M1MM License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 1.0 Park Plaza - Suite 5170 Boston, MA 02116 . Q—��4 Not valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents Az d I Congress Street, Suite 100 Boston, MA 02114-2017 ,M www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): United Solar Associates, LLC Address: 376 Washington St, Suite 104 City/State/Zip: Malden, MA 02148 Are you an employer? Check the appropriate box: Phone #: 855-786-1776 1. E] I am a employer with 5 employees (full and/or part-time).* 2.❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.M I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4. [:II 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 proprietors with no employees. 5.E] I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 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.] Type of project (required): 7. ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12.E] Plumbing repairs or additions 13.E:] Roof repairs 14. ❑✓ Other Solar Install *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 an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: TRAVELERS Policy # or Self -ins. Lic. #: 7PJUB-5B50763-8-15 Expiration Date: 7/23/2016 Job Site Address: City/State/Zip:NAL a „C (L 6 "IS 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. b I do hereby certify under the painandlpenal 'es ofperjury t t�theiormation provided above is true and correct Signature: ( Date: Phone #: 855-786-1776 � / ! z " Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: A`� o® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) TYPE OF INSURANCE 11/9/2015 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 NAME: Asset One Insurance PHONE 714-625-8204 (A/C, No, Ext): (ac, No): 714-625-8290 575 Anton Blvd., 3rd FL ADDRESS: ara@solarinsure.com INSURER(S) AFFORDING COVERAGE NAIC # MED EXP (Any one person) $ 10,000 INSURER A : Westchester Surplus Lines Insurance Company 10172 Costa Mesa CA 92626 INSURED INSURER B : TRAVELERS PROPERTY CASUALTY COMPANY OF AMERK 25674 INSURER c : American Zurich Insurance Company 16535 United Solar Associates, LLC INSURER D: 452 Pleasant Street, Second Floor INSURER E: INSURER F: Malden MA 02148 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 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 LTR TYPE OF INSURANCE AUUL INSD bUtSK WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR G27527966 001 11/10/2015 11/10/2016 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurcence) $ 50,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑PECT RO 17 LOC J OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE LU161LrrY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per accident) $ A UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 7PJUB-5B50763-8-15 7/23/2015 7/23/2016 X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Property ER07771654 5/26/2015 5/26/2016 $522,302.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is Additional Insured. CERTIFICATE HOLDER CANCELLATION Town of North Andover Attn: Building Department 1600 Osgood St., Building 20, Suite 2035 North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE MA 01845 9TJLl1 5f7`Od�1.lCGlI ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD -2 ( z _ - ! E > § _ c ! U) (�§§(kk® \ •.k b e` \ ( o < \ } \ \ § E � E § § S 2 » / Im |\ $ ) �)) m ) ) ° ix 0 ( \ § §; \ ® > , ) > z » w 7� w \ $ ` \ ® 'w m ! o w z m = }/:§k§� § - # L = m § k § §■. . 0 0 < � 5 /mom }r W c> . 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TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that � oe—"� ................................................................................................... has permission to perform - Ave . ... . .... �IL-'A) ...... wiring in the building of ....... ....................................................................................................... at ....... ......... . North Andover, Mass. ...................................................................................... Fee ...... 12.57 ........... Lic. No.zNk�r. Check # ELECTRICAL INSPECTOR Commonwealth of Massachusetts Official Use Only lug Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC),7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: � 1/1Z City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice ofhisor her intention to perform the electrical work described below. Location (Street & Number) ! 7 b� S' lfO,l V Owner or Tenant Q,.,y„ ��"�r� Telephone No. Owner's Address5`� Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building �,{ 1 �,� l Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Tin, -CL `� 3 4 S41 t� L 44. C= l Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners of Detection and No. Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump I Number Tons KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local E]M Connection [-]Other No. of Dryers Heating Appliances KW Security ystems: No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: J-0 6p 0 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cove ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE W BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, thdt the ' ation on this application is true and complete. FIRM NAME: U S tS LIC. NO.: Licensee:�-' Sig atu e i LIC. NO.: (If applicable, enter "exempt" in the lic nse num er line.) Bus. Tel. No.• Address: Alt. Tel. No.: *Per M.G.L c. 147, s. 5-T-- 1, secu 'ty work requires Department of Public Safety "S" Lice n`s Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent Owner/Agent PERMIT FEE: $ 1Al Signature Telephone No. sunGEVITY® GENERATE POSITIVE" January 25, 2016 Subject: Structural Certification for Installation of Solar Panels Job* 1342850 Client: Sweetra Address: 1785 Salem Street, North Andover, MA 01845 To Whom It May Concern, A field observation and design check of the subject property was conducted to determine the suitability of the existing roof structure to support the installation of solar panels. From the field observation of the property, the existing roof structure was observed as follows: The existing roof structure consists of a single layer of composition shingles over plywood sheathing that is supported by 2x8 roof rafters spaced at 16" on center at Array 1 and true 2x8 roof rafters spaced at 16" on center at Array 2. The rafters are sloped at approximately 12 degrees at Array 1 and 27 degrees at Array 2. The rafters have a maximum projected horizontal span of 12'-2" at Array 1 and 11'-6" at Array 2 between load bearing walls. The roof is about 10 years old and appears to be in good condition. Utilizing the information determined from the field observation, the attached structural calculations have been prepared for the subject property in accordance with the following design criteria: • Applicable Codes: 2009 IBC, ASCE 7-05 and 2005 NDS • Basic Wind Speed= 100 mph • Exposure Category = B • Ground Snow Load = 50 psf As a result of the completed field observation and design check, I certify that the capacity of the existing roof structure that directly supports the additional loading due to the installation of solar panel supports and modules has been reviewed and determined to meet or exceed the requirements of the 2009 International Building Code. Please feel free to contact me at (510) 496-4422 with any further questions or concerns regarding this project. OF Sincerely,�,���c Janyce Spencer, PE JANYCE AKIKO SPENCERIVIN N0051861 'j 66 Franklin Street, Suite 310 p 510.496.5500 866.SUN.4ALL Oakland, CA 94607 USA f 510.496.5501 www.sungevity.com The Commonwealth of Massachusetts z Department of Industrial Accidents a I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): United Solar Associates, LLC Address: 376 Washington St, Suite 104 City/State/Zip: Malden, MA 02148 Are you an employer? Check the appropriate box: Phone #: 855-786-1776 1.0 lain a employer with 5 employees (full and/or part-time).* 2.M I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.M I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. M I 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 proprietors with no employees. 5.n I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6.n 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.] Type of project (required): 7. [—] New construction 8. EIRemodeling 9. ❑ Demolition 10E] Building addition l l.E] Electrical repairs or additions 12. n Plumbing repairs or additions 13.E:] Roof repairs 14. ❑✓ Other Solar Install *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 an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: TRAVELERS Policy # or Self -ins. Lic. #: 71"JUB-51350763-8-15 Expiration Date: 7/23/2016 Job Site Address: b� s6 tro, S J City/State/Zip:1kkA irk �,J > ( %MTS 01 HJ 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 th pai(ts an enalties of per ury tyhh the information provided above is true and correct. 855-786-1776 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: DocuSign Envelope ID: 1 D4CD571 -CFA6-4840-B5F8-1 B2C47D8A90A sunrun EXHIBIT A SOLAR FACILITY ADDENDUM CONTRACT P87A1V1A716EKEF THIS SOLAR FACILITY ADDENDUM CONTRACT ("Addendum") is made by and between Sunrun Inc. ("Sunrun") and Sungevity, Inc. ("Contractor") for the design, engineering, procurement, installation, and construction of the Solar Facility described herein. This Addendum hereby incorporates, in total, the terms and conditions set forth in the Master Solar Facility Turnkey Contract ("Contract"), and all schedules and exhibits thereto, executed by Sunrun and Sungevity, Inc. in March 10, 2014. Capitalized terms contained herein have the meanings set forth in the Contract. SOLAR FACILITY TOTAL SOLAR CUSTOM Contract Price: $31,930.00 Host Customer: Ronald Sweetra Street Address: 1785 Salem St, North Andover, MA, 01845 Rebate Level: $0.00 per watt Utility: National Grid TECHNICAL SPECIFICATIONS System Size )escription Rating itandard Test Condition Direct Current (STC DC kW) 9.000 =EC Alternating Current (CEC AC kW) 7.778 Generation Equipment Photovoltaic collectors Manufacturer Model number STC DC rating Quantity Array 1 Hyundai Heavy Industries HiS-M250RG(BK) 250 W 14 Array 2 Hyundai Heavy Industries HiS-M250RG(BK) 250 W 16 Array 3 Hyundai Heavy Industries HiS-M250RG(BK) 250 W 6 Inverters Manufacturer Model number Efficiency Quantity Array 1 SolarEdge Technologies SE 7600A -US (240V) 0.975 1 Array 2 SolarEdge Technologies SE 7600A -US (240V) 0.975 1 Array 3 SolarEdge Technologies SE 7600A -US (240V) 0.975 1 Total Number of Panels: 36 Total Number of Inverters: 1 Meter Information Vleter Description vlanufacturer Meter selected from approved vendor list provided by Sunrun. vlodel number Meter selected from approved vendor list provided by Sunrun. 12/15/2015 P87A1V1A716EKEF-H (Custom PPA Fixed) Page 1 of 2 AC<?Ro® CERTIFICATE OF LIABILITY INSURANCE E(MMIDDmYY) 711/9/2015 TYPE OF INSURANCE INSD 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 NAME: Asset One Insurance A/c No, Ext): 714 625 8204 (A/c, No): 714-625-8290 ADDRESS: aracsolarinsure.com 575 Anton Blvd., 3rd FL INSURER(S) AFFORDING COVERAGE NAIC # MED EXP (Any one person) $ 10,000 INSURER A: Westchester Surplus Lines Insurance Company 10172 Costa Mesa CA 92626 INSURED INSURER B: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERK 25674 INSURER C: American Zurich Insurance Company 16535 United Solar Associates, LLC INSURER D: 452 Pleasant Street, Second Floor INSURER E : INSURER F: Malden MA 02148 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 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. NSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER P (MM/DD/YYYY) (MM/DD/YYY`f) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX]OCCUR 1600 Osgood St., Building 20, Suite 2035 G27527966001 11/10/2015 11/10/2016 EACH OCCURRENCE $ 1,000,000 UA AUEENI _D PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) $ 10,000 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO ❑ LOC JECT X OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per accident) $ A UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBEREXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 7PJUB-5B50763-8-15 7/23/2015 7/23/2016 STATUTE ER EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 I E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 C Property ER07771654 5/26/2015 5/26/2016 $522,302.00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Certificate Holder is Additional Insured. CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover Attn: Building Department AUTHORIZED REPRESENTATIVE 1600 Osgood St., Building 20, Suite 2035 North Andover MA 01845 //// //// 9 4e 95`.06 7 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD + CO 01�tlS10332806 ►w t M%r%3f'L^ I n s SWEL J • 444 NOYMON ST �, `�// - ` MALOMW •ttq-7.34 J/ -L � saot�uaa:s,.r.+saw *7n MassachuSM5 000a"Ont of Public Safety Board of Butiding Regula:;O,s a^d S:ardaraa („n•tr6icn.,n 1jper%i.,-r 1 a Lkenae: CSFA-10476 _ r DANIEL J MCGRATH 114 .BOYLSTON ST MALDEN MA 01148 r� I+IJW. Exp.rtraom cor7 mss loner 09/16l2016 E,LEC-J'RICAL LJNL tAZ1TFDCo1FgTRhC1;0R DANIFI,J MCCRATH 114 13OS'LS7'ON ST MALDEN, MA U2148-7931 'f; ; tit'G (v4.-E��CTI4E E1(Pli•,_ E[�C:.ULt}I8�5-EI C'S/31Y2015 U4130iAI6 r'- SIi3Nt� r CpM{ytaNIA !'OF MASSA HUSETTS aAhn OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A , REGISTERED MASTER ELECTRICIAN I UNITED SOLAR ASSOCIATES LLC' i DANIEL J MCGRATH 114 BOYLSTOR ST MALDEN MA 02148-7931 20616 A 07/31/16 1172 2 ,Ka�.ya iso ri��+� n■� mow. • .'4 COMM f:ALTH OF M ' is •Ing ••• ' ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A•REG JOURNEYMAN ELECTRICIAN ����'Frururr„rrrrrr�(%r r f ^�lrrJsrrr`�rtu1%; P,.� Office of Consumer Affairs & Business Regulation A ME IMPROVEMENT CONTRACTOR - �gistration: 184392 Type: Lxpiration: 115/2018 Corporation UNITED SOLAR ASSOCIATES LLC DANIEL MCGRATH 414 BOYLSTON ST. MALDEN, MA 02148 Undersecretary DANIEL J MCGRATH lt4 BOYLSTON ST MALGEN MA 02148-7931 1146 8 0 1 16 /wi�r. � r,ir,xn,rit+rvr�/� r, /'' 1�tl,rrr�rlir /Js VJffice of Consumer Afrairs & Business Regulation ME IMPROVEMENT CONTRACTOR 8glstration: 186824 Type: I.Expiration. 3/712017 Individual DANIEL MCGRATH DANIEL MCGRATH 114 BOYLSTON ST MALDEN, MA 02148 �`�<•” Undersecretary OSHA .fto 4410a'iii ma are «dno�w pn in tit wd�Yei tr• aMr•rtea► �� • Da l” McGWAI Keit M. rest 31jWW" License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 t Not valid without signature 2 § _ z z o. _ - ; m / _ _ , ! (�\§($|& [§ ( U) LL (\ 2 / \ \ § / o ( k ) z < Z | § § k ` k k k ` 9� ; 2 I , > o z» (w w z G t� w �§ &m�05; o § .� U. 2 G! 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G>) H O N L 0 0 Doc ;Sign Envelope ID: 7D10C38A-97FC-44B0-B8C0-7AB6CC3B13CA SUf1GEVITY' Homeowner's Agent Authorization Form State of Massachusetts I, Ronald Sweetra (print name) am the owner of the property located at address: 1785 Salem St. North Andover MA 01845 (print address) I hereby authorize Sungevity or its subcontractor 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. OxuSigned by: Customer Signature: � � Swt, lm 2116063D3"GC482. Date: 12/16/2015 Print Name: Ronald Sweetra Sungevity MA Home Improvement Contractors License # 168430 66 Franklin Street, Suite 310 p 510.496.5500 866.SUN.4ALL Oakland, CA 94607 USA f 510.496.5501 www,sungevity.com