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HomeMy WebLinkAboutBuilding Permit #873-2017 - 193 FOSTER STREET 7/22/2016"AV�,Q L ` BUILDING PERMIT Y TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION. Permit No#: Date Received—� Date Issued: IMPORTANT: Applicant must complete all items on this page TION � , t � r '. � Print ` } � '• .e-r�t'� s i �� `� A ?ER TY OWNER r 9 ,<' �.#-00 Year Struetu�e 6 ``''es o .., PFmt1i�` v zrK+ * w.- "PARCEL ZONING DISTRICT Histone Districts yes rio Machine Shop Village. yes° no m A 7a ADRA7ED PPP �.(°J TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 'JZ0ne family Pho D�� n 15 v ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: V' ❑ Demolition ❑ Other oodplain eWasntl❑Spfid- � -!4 ❑ Neli� ' r t �►'❑F � ❑_ daters;"ed ©i.stncta � ❑ F111% ter/S'�"we ,� � _ j ;..--� OF WORK TO BE PERFORMED: - - __ nF-Q['_RtPT1ON Identification - Please Type or Print Clearly OWNER: Name:CAalAla CtA)z\s Phone: (ul1 --7qq -g513 Address: 1 13 �iskr Sk Contractor Name Pho D�� n 15 v Email xebyl � ; 1 Z�� .r r -: .. � p _ '.. '. .. • ' ..k'"S �`v5 tib: r }r SupervisoronstructionaS�License'lb"I g7" Expo Date, s''S..,�F 1': 7• ij. i`Fi°` y f4 '-} ]„-' { - _ 't t'.,i •# -!4 Exp: Date 3�g:�2a�1: Home Improvement License lobi ARCHITECT/ENGINEER S010trrtri /Z40.V1 Phone: &-,so rg?F /v;Lz Address:RLS C'I.e View law -s an rye.a Igg67- Reg. No. 1;Z -13c) FEE SCHEDULE. BULDING PERMIT. $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ $ 000 FEE: Check No.: 7EC119 Receipt No.:� IV/' NOTE: Persons contracting unre.g&ered contractors do not have access tot uar ty fund L- Location No. -7127 1 Date TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3 0649 Bu'il-din'-g-inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ 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 m U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature, CONSERVATION Reviewed on Sianature COMMENTS HEALTH COMMENTS Reviewed on _ Signature Zoning Board of Appeals; Variance, Petition No: Zoning. Decision/receipt submitted yes Planning Board Decision: Comments .-. ' Cr,Tservation Decision: Comments 14tater & Sewer Connection/Signature & Date Driveway Permit DPW Town ]Engineer: Signature: LOcatea ;Jd4 US900CI Street Main Sireet t `°' FSy. 9 j[T�' mentsignature/dates F g: iF Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop regUires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — ( For department use U Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 No _ 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 4s Floor Plan Or Proposed Interior Work 4. 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) 4, Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products TOTE: 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 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 r= H Q W SH LL. 0 Q m C NJ L j[ O O LL ate+ Ln Q UJ VI O W d Z Z O J C m 7 O LL = O N C E L U C LL O W d LA Z Z m J d L OD 7 O fY f0 C LL 0 W d H Z U W W L toN 7 O d' U i v Ln f0 C LL CC O ~ U a Z Q L .:3 O K f9 C LL Z Wc G Q W W LL i i 7 CO Z -+ U1 Ln +.+ Y O V1 rA .V` _O :v C Cc O • c C. x O Y • � s H y.+ Cc 1NGCL M � V i 10 � J � a o® i>% N • dC > Cc L C Oy d O = O � w�: C t Q C O E 0 O 0- CD No0 N 3 c I' Im o 0 =a CL 0 0 g y a, t- � c __ Q i a®f i O O N W O 'C +r O O " ®uj Li N R to C O W E V C •= i 1-- • (� N O •a N y,., O c O H .c Z noV > z L) co LLIJ z 00 ti 9 0 lw July 13, 2016 RE: Project/Job # 0183921 Project Address: AHJ SC Office Design Criteria: CERTIFICATION LETTER Owens Residence 193 Foster St. North Andover, MA 01845 North Andover Wilmington ro\0NAL - Applicable Codes = MA Res. Code, 8th Edition, ASCE-7-05, and 2005 NDS - Risk Category = II - Wind Speed = 100 mph, Exposure Category C - Ground Snow Load = 50 psf - MP1: 2x5 @ 28" OC, Roof DL = 10.5 psf, Roof LL/SL = 32.5 psf (Non -PV), Roof LL/SL = 17.5 psf (PV) Version #61.2 - TBD PIL 07/13/2016 0� j r�aMAS�P Note: Per IBC 1613.1; Seismic check is not required because Ss = 0.33365 < 0.4g and Seismic Design Category (SDC) = C < D To Whom It May Concern, A jobsite survey of the existing framing system of the address indicated above was performed by a site survey team from SolarCity. Structural evaluation was based on site observations and the design criteria listed above. Based on this evaluation, I certify that the existing structure directly supporting the PV system is adequate to withstand all loading indicated in the design criteria above based on the requirements of the applicable existing building and/or new building provisions adopted/referenced above. Additionally, I certify that the PV module assembly including all standoffs supporting it have been reviewed to be in accordance with the manufacturer's specifications and to meet and/or exceed all requirements set forth by the referenced codes for loading. The PV assembly hardware specifications are contained in the plans/docs submitted for approval. Digitally signed by Ryan Hillstrom Pv Date: 2016.07.113 1°7:34:16 -06'00' 3055 Clearview Way San Mateo, CA 94402 -(650)6.38-1028 (888)SOL-CITY F (650) 638 - 1029 solarcity.com ALO&IaO. i ASV,,.,, 24.4_0.i.:.!eS aEwel.s Co EMU`. 'IT FOCC.,Sz.<..s4: ,. .�..'l,�u-:-��i�36MC$�a�z�S. Oh .,.,1`t2nss`ec, .F•i+3a. ril, ..zb.HCT .v...:. �;_t. CCs?,. Mn"C L�.J:€-' EL 1><,za�,ri„M., 4_UC ,k.. L, 7k PE�.._. .,�a :;; E3LaSy_ S��.b E.._.:.r h..,. _ :, ta7L�S<..c ....R,'.� �4Jt, 3Si�.P.Cyt'i>7. <Ii*a r .,c 3 +bL, �: ... .s;iw', iE?`_€t Is..,�s;-+-'L;E4.t, Rock:�•ex=tiBb2.rt,q•€50 .,. i 5<..3et t•.;i �f4, tvC.,�.c.:.-i.,�, ?. Y.0 P206'^c€-3c: .,,.fS1uv '.r»ed PJ9C4r'e83 t3iaE .. H:/4Ydd85, 3e. :}�jcP SC'�N .. 2 ..k Vi i+. _"i%.,e �..n:�b.i-v .,fi. .`1:S:.4 ik4'd£:. Js,v.� _r fi'iRS ,.P,.M .> ,,. ba Uhe De.' a;e State 5.4. a^3r._s[2 ... �r ¢n�. k., ,� .a l,al,.—'11-1.1 -rt.m `ter 014 2.14E4 W C•Ct :t¢^:.- :�M Ai4k... _:c:L 'X i _ .@'•f!'✓E ,i i ..,. .� ,._ 1,,.� x^:243:.. si':,n:QQ:'t _✓sX5 4LM Version #61.2 - TBD PIL HARDWARE DESIGN AND STRUCTURAL ANALYSIS RESULTS SUMMARY TABLES Landscape Hardware Hardware � _landscape Modulas Standoff Specificati4ins X -X Spacing ° X -X Cantilever Y -Y Spacing Y -Y Cantilever Configuration Uplift DCR MP1 56" 24" 39" NA Staggered 50.4% Portrait r`< i� Hardware - Portratt.Modules' Standoff Specifications. H Hardware -X-X Spacing X -X Cantilever Y -Y Spacing Y -Y Cantilever Configuration Uplift DCR MPI 56" 19" 65" NA Staggered 83.8% Structure Mounting' Plane Framing Type Spacing Pitch ualificaHiSn Results —Member Evaluation Results MPI Stick Frame 28" O.C. 400 Member Analysis OK Refer to the submitted drawings for details of information collected during a site survey. All member analysis and/or evaluation is based on framing information gathered on site. The existing gravity and lateral load carrying members were evaluated in accordance with the IBC and the IEBC. 3055 Clearview Way San Mateo, CA 94402 - (650) 638 -1028 (888) SOL - CITY G (650) 638 - 1029 solarcity.com Al CS.:»"Ks. n"Y,rs'2-,A2Pv,a 2,711,T0,45450,.�WRIW,t, FMAA",-Tfi4MU2..6A.,a 012&WE. Do DECK,:,. Ft.. ,.:.0--":..,N iT _a,,.;, t,, !: 5, MA iCU1.W,2! Et 41.,CdE:-y= '6313,77iTE-.7006,'-iT S...6490^`r�...', VA, RE:2,061a _,'Ca=.�'4i441tc4ih?�4., f7,Nhe rn. 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Yr.`. #: COAD ff& 4ATWP!-Wl PV Sys"m Load - PV Module Weight (psf) "ka-rdware 2.5 psf Weigh 'A" ft Ig sf -0.5 P PV Sygem Weight (psf) - 14, 3.0 014 Roof -Dead load Non -PV Areas Materkit Load Roof Category DesLrqtion LO MPI Table 4-1 Existing k—R664f rial At -WERS mp Roof 5.0,psf- Re-Roof ASCE q 7 4 , E: �ff No Uncleig 32.3-j` —Roii g, Pape'F 0.5 f Plywood Sheathing R2 Yes 1.5 psf Board„Sheathing._ 7 -Sheathing _ 1. 2, P, s f Rafter Size and Spacing Table 7-2 2 x 5 @ 28 in.O'.L'— 1.1 psf Vaulted Ceiling Table M 77"1 7 7—"'---"-= -- No Miscellaneous Miscellaneous Items 1.3 psf Total: Roof ,Dead Load 7.3.4 & 7.10 10.5 pst, (Mpl) Reddt'ed Roof ILL Non -PV Areas Valtie ASCE 7-05� Roof Live Load LO 20.0 psf Table 4-1 Member ,Tributary xr—e At < Roof Slope ASCE q 7 4 , E: �ff 10/12 fril5u7tii:i_Ai Area _R 32.3-j` Horiz. Distance from Eve to Ridge Section,4.q Sloped Roof Reduction R2 0.7 Section 4.9 kedRuc d Roof -Ove Load 7 Lr L. (RA 7- 9�on,74&1 lReduced Roof Live Loik Table 7-2 14 psf 1 14.0 PW' Reduced Ground Reif Live Snow Loans Code Ground Snow Load P9 50.0 psf ASCE Table 7-1 S"n—owLidad Reductions Allowed? All Other Surfaces 0.9 Figure 7-2 7 Snow Guards to be Installed? No ASCE q 7 4 , E: �ff Surrounding Roof 32.3-j` Horiz. Distance from Eve to Ridge W 13.9 ft '77' Snow Importance F.. 1.0 Table 1.5w2 7 Snow Exposure Factor cl� Fully Exposed 0.9 Table 7-2 Snow Thermal Factor I -, - IC zing 6 above freezing just Structures , Table M Minimum Flat Roof —Snow Load (w/ Pf-min 35.0 psf 7.3.4 & 7.10 Rain-on-SnowSurshargt)i _-7 _71 RW �i_ - U51,11.1, P pf. rfi. 9, f in , ,, Eq: 7.3-1 Flat Roof Snow Load pf 35.0 p f-70% ASCE, Design Sloped Roo f Snow Load Over Surroundift, Roof, Surface Condition of Sur . rounding Roof Cs -roof All Other Surfaces 0.9 Figure 7-2 Design,Rbof Snow Load,Oyiar Ps -roof -f ASCE q 7 4 , E: �ff Surrounding Roof 32.3-j` 65% Modules �� 17.6 psf GEOMETRY Results Summary Rafter Span Ridge to Eve, R 10.34 ft Overhang, 0 0.24 ft Floor Joist Span, F 7.17 ft Rafter Slope, S 40 degrees Exterior Wall to Knee Wall, X 4.58 ft PV Start, PVS 1.42 ft PV End, PVE 9.83 ft Rafter Spacing 28 in Floor Joist Spacing 28 in Roof Material / Layers Comp Roof 1 LOADING 1356 psi Ceiling Material None Deflection Sheathing Plywood/OSB + Skip Sheath Roof Dead Load 10.1 psf Rafter Depth 4.75 in Rafter Width 1.785 in Rafter Species SPF Rafter Grade #2 Floor Joist Depth 6 in Floor Joist Width 2 in Floor Joist Species SPF Floor Joist Grade #2 Allowable Overstress 5 % Ground Snow Load 50 psf Vaulted Dead Load 1 psf PV Dead Load 3 psf S Non -PV Areas 32 psf S PV -Areas 18 psf Lr Non -PV Areas 14 psf Lr PV Areas 0 psf Floor Dead Load 8 psf Finished Attic Live Load 30 psf Storage Behind Knee Wall 0 psf Knee Wall Dead Load 0 psf IS SNOW REDUCIBLE? Yes Allowable Rafter Deflection, L/ 180 Allowable Floor Joist Deflection, L/ 240 ANALYSIS N�k ��SolarGty. EXTERIOR LBW All Checks OK LBW Results Summary Member Item Controlling LC Demand Capacity D/C Ratio Shear D+S 36 psi 155 psi 0.23 Rafter + Bending D+S 509 psi 1409 psi 0.36 - Bending D+S 266 psi 1356 psi 0.20 Deflection D+S -0.2 in -0.90 in 0.24 Shear D+0.75S+0.75L 79 psi 155 psi 0.51 Floor Joist + Bending D+S 928 psi 1277 psi 0.73 Deflection D+0.75S+0.75L -0.1 in -0.36 in 0.39 All Checks OK LBW Mounting Plane informatics Roofing Material Como, Roof Roof Slope 400 Rafter S ac n i8; O.C. Framing-lyRePirection Y -Y Rafters u._Type y S "ek ou ---------- Kep System Type ZS Comp Standoff chment', Hardware)a Comp INaunt SRH; Spanning Vents No ........... -7- A Wind Design Ctiteria Ir Wind Design Code Fig. 6-118/C/D-14A/B ASCE 7-05 W88Fig. Wind' —Design Method__ Design Wind Pressure P _,_ u,,, Partially/Fully Enclosed Method Equation 6-22 Basic Wind Speed V 100 mph Fig. 6-1 '7777�— Exposure EKP "v- C Section 6. .63 Roof Stye Gable Roof----- Fig. 6-II6/C/D-14AjB' Mean Roof Hei g —777— ..- 25#t Section6.2 Wind Pr#ssure CalculStion'Obefficients Wind Pressure Exposure K, 0.95 Table 6-3 --0- Se Con 6.SJ',, —' T67pqgraph!c Factor K DO A m. Wind Directionality Factor Kd 0.85 Table 6-4 jm ortance Factorable 6-I Velocity Pressure qh qh = 0.00256 (Kz) (Kzt) (Kd) (VA2) (1) Equation 6-15 20.6 psf vvindfissure Ext. Pressure Coefficient (Up) GCp (Up) -0.95 Fig. 6-118/C/D-14A/B Ext Pressure Coefficient (Down) GC Down W88Fig. Fig:-6-i1B/QD-14AjB Design Wind Pressure P p = qh (GCp) Equation 6-22 Wind Pressure Up PfU01 -19.6-psf Wind Pressure 6o"wn 18,0,Psf "v- A—LM - -- ----------- W STAND DocuSign Envelope ID: 3274675F-FF81-48F4-B315-OE3AA8868177 t 22. PRIVACY/PUBLICITY a 1 have read this Lease and the Exhit You grant SolarCity the right to,publicly use, display, share, acknowledge that I have received a and advertise the photographic images,.Prpject details, Lease. price and any other non -personally identifying information of your Project. SolarCity shall not knowingly'reIease any personally identifiable information about you or' any data associating you with the Project location. You may opt -out of these publicity rights by giving us written notice and mailing it to: SolarCity Corporation, Attention: Publicity Opt Out, 3055 Clearview Way, San Mateo, CA 94402. 23. NOTICE OF RIGHT TO CANCEL YOU MAY CANCEL THIS LEASE AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE YOU SIGN THIS LEASE. SEE EXHIBIT 1, THE ATTACHED NOTICE OF CANCELLATION FORM, FOR AN EXPLANATION OF THIS RIGHT. 24. ADDITIONAL RIGHTS TO CANCEL IN ADDITION TO ANY RIGHTS YOU MAYHAVE TO CANCEI THIS LEASE UNDER SECTIONS 6 AND 23, YOU'MAY ALSO ° CANCEL THIS LEASE AT NO COST AT ANY TIME PRIOR TO COMMENCEMENT OF CONSTRUCTION ON YOUR HOME. 25. Pricing The pricing in this°Lease is valid for 30 days after 6/26/2016. If you don't sign this Lease and return it to us on`or prior to 30 days after 6/26/2016, SolarCity reserves the right�to rejectthis lease unless you agree to our then current pricing. i i I Customer's Name: Doc f I«PI Date: i%/312016' `u Customer's Name: Owens E f, SolarCity` approve", �C SolafLease Agreement, version 7:2.4, June 2.4; 2016 1'949479` The Commonwealth ©fMamacfaasetts Department of Industrial Accidents Office of Investg4dans ' 1 Congress Street S'r, Ue 100 Boston, MA 02114-207 www inass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciansiplumbers AoRlicant Information Please Print Le ibl Name(13usincss(0rganizationtindividuu€): SolarCity Corp. Address: 3055 Clearview Way City/Stateizip: San Mateo CA. 94402 Phone #:888-765-2489 Are you stn employer? Check the appropriate box: - 1. [El am 2 employer will, 000 4. ❑ I ani a general contractor and I Type of project (regaireti): _15, employees (full and/or part-time),* have hired the sub -contractors ❑ Nc�t construetian 2. ❑ 1 and a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have S. ❑ Demolition working for me in any capacity, employees and have workers' 9. © Building addition [No workers' camp. insurance required.) camp. wurlmce.3 5• ❑ We are a corporation and its 10.❑ Electrioal repairs or additions 3. ❑ l am a homeowner doing all work officers have exercised their 11,E] Plumbing repairs or additions jYu wor3ers' camp. rtglitufe)eillplioilpey'-'uyseii, 12.❑ Roof repairs insurance required.) t t:. 152, § 1(4), and we have no 13[a other Solar/PV employees. {No workers' camp. insurance required.1 *Any applicant that ebecks box N l most also fall out the section below showing their workers' mmpomsation policy information. I Homeowners who submit this affidavit indicating ntey are doing all nark and then lure outside cantraiaors must submit a new affidavit indicating such. :Contmemrs that check this box must attached an additional sheet showing the name of tha subcontractors aril statc wheilier or not those entities have employees. ,f the sub•COMMIM have employees, thoy rnust provide their workers' comp policy number. 1 ani an employer that is prov&ing workers' compensation. insurance for my employees. Below is the prolicy and job site information. Insurance Company Name: Zurich American Insurance Company Policy 4 or Se]Nns. l ic. #: WC0182015-00 Expiration Date: 9/1 /2016 lob site Address: 193 Foster St c1ty1$tate/zip: N Andover MA Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). li aifure to secure coverage as required under ,election 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDFA and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby eertry andq Me pains andpenollies afpErjury chat the infornsa danprovided above is true and correct not, 7/21/2016 Phone ;;F: Of,ftcial use only, Leo net )prlte in this area, to U completed by city or town official, City or Town-, Permit/License b Issuing Authority (circle orale): 1. Board oflirallh 2. ltuilding Department, 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Uther Contact Person• Phone C�0 A V>R CERTIFICATE OF LIABILITY INSURANCE PATE{YYYY) ` p8f1712015,2�,$ 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 1S WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME:_"-.....-.--..-, MARSHRISK& INSURANCE SERVICES PHONE....._...................... .. ... ... FA).. ..... .... ................---.._... 395 CALIFORNIA STREET, SUITE 1300.............. .. ..........{Alc, Nol:.................................... CALIFORNIA LICENSE NO. 0437153 E-MAIL SAN FRANCISCO, CA 94104 -A0n89!§:.................... ............. .. Atin: Shannon Scoff 415-743-8334 - ....... __..INSURERS) AFFORDING COVERAGE MAIC # 998301-STND-GAWUE-15.16 INSURER A; Zurich American Insurance Company 16535 INSURED INSURER S : NIA ;WA SolarCity Corporation _............. +.. ......... .... 3055 Clearview Way INSURER C : NIA 'NIA _.... _. ....... .. ........ . .. ..... ........ ..........._......_......_.._...... ....._............+... ..... ................ San Mateo, CA 94402 INSURER.D : American Zurich Insurance Company 40142 , .. .............. .. .. ..... F PRODUCTS • COMPIOF AGG S ' INSURER E:, INSURER F: COVERAGES CERTIFICATE NUMBER: SEA -002713836-08 REVISION NUMBER:4 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD tNOICATED. 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. INSRT _ _ TADpL.5l19RT POL3CY 60 06mucY EIrP TYPE OF INSURANCE LTR POLICY NUMBER I MMIDDIYYYY MMIDOIYYY LIMITS A X COMMERCIAL GENERAL LIABILITY !GLO0182016-00 0910112015 0910100H EACH OCCURRENCE S 3,040,000 _.� �...._. CLAIMS -MADE _X I OCCUR I DAPoIAGST� RENTED _... PREMISES (Ea oxurrencel ....+_$ .. 3,aoD,000 X SER $25O,OOD M _ ..ED EXP (Any one person) _ S 5 OOO ... ...... .... ......... ........ .... : 4 ...............:................__........_............. F Y PERSONAL& ADVINJURY ........5............ 3,000,000 ...._..__....__. ' GENLAGGREGA_ TE LIMIT APPLIES PER GENERAL AGGREGATE { $ ........... 00 _ .. .. .... .. ,..E . . ,....._ :. X POLICY r PRO- ,, LOC JECT ' , .. .............. .. .. ..... F PRODUCTS • COMPIOF AGG S 6,000,000 OTHER S A AUTOMOSiLELfABILITY 'BAP0182017.00 :0910112015 09101/2018 COMBINED SINGLE LIMIT g 5,000,000 XANY AUTO BODILY INJURY {Per person). S . ... .. .......... ........ _ : ALLONED ;.... X 'WSCHEDULED X _.. _ . .. .): $ .. INJURY NJUU RY (Per accstent); $ i.. ..� AUTOS r.... .AUTOS �FROPERTY .. XX NON -OWNED 1. ....' NIREO AUTOS r... AUTOS : . DAMAGE F (Peraccident) . ..... ..... .....+.. .. ...... _.............. .... 1 COMPICOLL DED: S $5,000 UMBRELLA LIAR: OCCURE I ACH OCCURRENCE S } T EXC S ;ESLIAB CLAIMS MADE' I....EXCESS .r......---..1....� .....---....---.j AGGREGATE $ r ......... ... ....... .. .. i..... ... ............... DED RETENTIONS i 5 D WORKERS COMPENSATION WC0162014-00 (AOS) 0910112015 0910112016 6 X : PER ORTH- ' AND EMPLOYERS' LIABILITYYIN: A Y r N - WG018201500 MA 09101/2015 0910112016 ZANY PROPR€£TORlPARTNERIEXECUTIV£ ( : F.-._. STATUTE. ;......i �. .... I .... .... El EACH ACCIDENT ' $ ..... .... ............ 1,000,000 'OFFICERIMEMBEREXCLUQED� - NIA �it ,Mandatary in NHl WC DEDUCTIBLE: $500,000 I F-....------ ................... ...... . 4 E.L DISEASE - EA EMPLOYE S 1.000,000 If yes. describe under DESCRIPTION OF OPERATIONS below _............... .. .. ... ...... .... ..... E L DISEASE - POLICY LIMIT 1 S ... ........ 1.000,000 I i I DESCRIPTION OF OPERATIONS/ LOCATIONS] VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Evidence of insurance. llze;L91111614 V SDIarCily Corporation 3055 Crearview Way San Mateo, CA 99402 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 of Marsh Risk & Insurance Services Charles Marrnolejo G' © 9988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014144) The ACORD name and logo are registered marks of ACORD o" Ht. 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