HomeMy WebLinkAboutBuilding Permit #623-2014 - 225 HAY MEADOW ROAD 11/19/2015NORTh q
BUILDING PERMIT o ``,eO �°
TOWN OF NORTH ANDOVER ° a
APPLICATION FOR PLAN EXAMINATI N
(p n
Permit NO: i Z- . ��� Date Received w
I
Date Issued: !I k 9SSAc►+us��
IMPORTANT: Applicant must complete all items on this pate
LOCATION a5- fl" Nt A Doo i2n
Print
PROPERTY OWNER �81-A N PECV- and UN -1111A PEC.
�,r/ Print
MAP NO: 10 PARCELA 1 ZONING DISTRICT: Historic District yesno
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
One family
❑ dition
❑ Two or more family
❑ Industrial
Alterationv r T
No. of units:
1) Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
S►2S' ,u 47 c o ta-r A a-ndgal L Q x � 4I Lng ✓� .
Identification Please Type or Print Clearly)
OWNER: Name: ALAN PRY— a,vLd CyN f to Ill PECI- Phone:
Address:
CONTRACTOR Name: Phone: %f JW 1776
DANMCC "i`E-t
Address: p,j KEASAN i S?_ O JFL M-ALDM l OJik �
w
ri
Supervisor's Construction License: `Dlgg -76 Exp. Date: Oq f iS,14o r
Home Improvement License: Exp. Date: ()5/ b7/ j O t-1
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 3� . X97 FEE: $��
Check No.:.'MID Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access t* gu ranty f ad
5i nature of A ent/Owner� _ _ i �!
�g ___.g __ _ __, Signature of contractor a�✓
e .-'q
Plans Submitted ❑ Plans Waived.❑ Certified Plot 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 - U FORM
PLANNING & DEVELOPMENT Reviewed On
Signature
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
y HEALTH
COMMENTS
Reviewed on Si nature
Zoning Board of Appeals: Variance, Petition No:
Planning Board Decision:
Conservation Decision:
Comments
Comments
Zoning Decision/receipt submitted yes
Water & Sewer Connection/signature & Date Driveway Permit
DPW Town Engineer: Signature:
,�Ma FIRE PLocated.at 12..nStreet" --- ----
Fire Department signature/d;ate
M
-7— --
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 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 use)
t-�- Vy\
AMA
❑ Notified for pickup Call Email
Date Time Contact Name
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
❑ 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
NOTE: 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 AffidaWs,for,Engineereq products
NOTE: All dumpster permits requite -Ugn eff frA Fere Department.' riot to issuance of Bldg Permit
New
Construction (Single and Vivo Family) t
❑
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
❑
Mass check Energy Compliance Report
❑
Engineering Affidavits for Engineered products
NOTE: 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
No. Co?
. . �,;� .
Check #
2,3700
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $4(00
Foundation Permit Fee $
Other Permit Fee $-
TOTAL $ ga
Building Inspector
NORT/r
BUILDING PERMIT 32ogt�6°0
TOWN OF NORTH ANDOVER ° t
APPLICATION FOR PLAN EXAMINATI N
Permit NO: "1.ye(j Date Received �1 l7°4�
r A�AATE0
Date Issued: �I I P5 '9SS .CHU
IMPORTANT: Applicant must complete all items on this page
LOCATION s) `a -HAY MEA (}0'V�
Print
PROPERTY OWNER -ALA N PECK a vt d C7NTH I A PF—CY—
Print
MAP NO: 10PARCEL:bb%( ZONING DISTRICT: Historic District yesrn
Machine Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
21bne family
❑ P
>ddition
❑ Two or more family
❑ Industrial
Alterations r
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
11 Water/Sewer
OWNER: Name:
V
idress:
Identification Please Type or Print Clearly)
ALAN P ° aiAd Q -Y N —1 i IA PECX Phone:
k1J.
CONTRACTOR Name: Phone: J��-T7 1`77r':
DAN MC.:d"TH
Address: use: PLEAS Ni S7. OJFL "At—DcN cj I i'
Supervisor's Construction License: lCIt -7( Exp. Date: iDq' 15,/4c, 1 t
Home Improvement License: Exp. Date: D3/ b7/ JC1-7
t 6��2y
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000,00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ FEE: $ 46o
Check No.: ;� i I t� r Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access I
gnature of Agent/Owner - Signature of
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"A'30111 =�AZWWIWN
PROFESSIONAL ENGINEER
601 ASBURY AVENUE
NATIONAL ]SARK, NJ 08063
(856) 358-1125 FAX: (856) 358-1511
Date: July 20, 2015
Re: Structural Roof Certification
Subj: Alan Peck Residence, 225 Hay Meadow Road, North 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 is s of
2x8 @ 16" o.c. rafter framed construction with 1x8 collar ties @ 32" o.c. and is sheathed with 1/2" ext -
ply sheathing and a single layer of composite shingles.
The wood framed roof structure bears directly upon the framed exterior wall system. The existing
members 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 16-24"o.c. at corners and 48" o.c. through the field.
Rails are to be placed at 24-48" o.c. on the roof.
When installed per the above specifications the system shall meet the required 105 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,
OFlse�
AMES A.
CLANCY
o.46775
James A. Clancy
Professional EngineerONALC'
MA License # 46775
-40
Residential Solar Energy System installation Agreement
BLUESEL HOME SOLAR e
(Retail Installment Sale Agreement - Subject to State Regulation) r
a
Customer; Alan S Cynthia Peck
Site: 225 Ray Meadow Rd., N. Andover, MA 01845
Site is Principal Residence?
E Yes ❑ No
Mailing Address: I&Chc d sanicas Sate
Q New Construction E Retrofit
Preferred Phone: (978) 886-1098
Entail: alanpeck@comcast.net
Email Document Delivery? 19 Yes Q No
Utility Company: National Grid
Rate Code: Residential R-1
Account;;: 66089-29000
I;f
System Type(s): E Photovoltaic
PV It of Modules: 28
Thermal a of Panels:
PV System Sire {kW DC): 7.0
0 Tt;ermai
PV Module / Therltal Panel Manufacturer E Model(s): SunPower 250w AC
Estimated PV Production: 8,368 kWh (1"
year)
inverter ivanufacturer & Ivlodrl:
Auto SREC Reporting
Permits Included(f:ulid,r:g/tte::trie/ptumb,ngl:
of inverters: 0 x
(optional): E Yes ❑ No
® Yes ❑ No
Other Components / Equipment, DAT/Locus Cell 10yr Reporting
(] Check box if Addendum is attached
System ❑will ® will not operate during a Utility Company power outage lif "will not" is checkeu, you will not have power during an outage.)
The Preliminary System & Total Peace shown are based upon estimates. When you sign this Agreement you have a Ri to cel. When that
right expires (Section 1q), Installerwill provide a Final System Design. See Final System Design Process (Sectio (initials)
�i Financed: Totai Pike tincluCL5 sales tax, a applicable) $ 38,297
❑ Cash: Total Price (inctudPt <atrstas, ilarl,Iiratrtet $ 36, 765
❑Down Payment (Optional) $
®Same as Cash Total loan Amount$12,489 Corif
Payment Schedule
SAC loan Advances to installer; tt1$6,244.50 P2$6,244.50
$5,515 1nitiai it,, this co r act
E Yes ❑ No include State Tax Credit (Est.: Amt.) $1,000
$18,383 2"' Paal order equipment (50%)
Xpriori.
SAC Loon.must be paid within 365 E days ❑months'"
$9,191 3"� Paytart Date, upon invoice (25%)
E Reduced Interest RateLean (RIL) $25, 808 Conn ri
$3,676 �l'` Pa;je Completion (10%)
RIL Rate: 2. 99% RIL Term: 10 Years RIL Monthly Payment $-249
Principal Residence, Sales Tax Exempt or ❑ Sales rax drnourtt, included ,n Total Price $
If, due to existing conditions a municipal authority will not issue a permit or the utility provider will not permit Interconnection, and the corrective
measures needed will cost more than $500, upon notification of same by Installer, Customer shall have ten (10) calendar days in which to cancel
this Agreement by notifying installer. Within seven (7) days of such cancellation, Installer shall rela all fund . by Customer, save for fees paid
to the municipality and for engineering studies, upon which this Agreement shall be void. (initials)
Massachusetts Home Improvement Contractor Registration Number. 166151, expires April 29, 2016
You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may
be his main office or branch thereof, provided you notify the seller in writing at his main office or branch, by ordinary mail
posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement.
See the attached Notice of Cancellation form for an explanation of this right.
I was informed of my Right to Cancel and provided with two Notices of Cancellatior�,�� - y - 9-U'finitials & date)
NOTICE TO BUYER:
1, Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are
left blank.
2. You are entitled to a copy of this Agreement at the time you sign it.
3. You may at any time pay off the full unpaid balance due under this agreement, and in so doing you may receive a partial rebate
of the finance and insurance charges.
This agreement, signed as a sealed instrument, can only be changed by a writing signed by both parties.
61ue5ei H Solar, 'Inc/j eater tDtt Date:
Customer:
Date:
U
slueset Home Solar, Inc..
(781) 281.8130
Fax; (508) 833.9501
www:BkueSeLcom
600 W. Cummings Park 17 Jan Sebastian Drive
Suite 4200 Suite 12
Woburn, MA 01801 Sandwich, MA 02563
The terms of this agreement are contained on more than one page.
Wesldemu, m..7015-07-1 7
Page 1 of 5
This Agreement is by and between Customer and BlueSel Home
Solar, Inc., for the purchase and installation of the System
described herein. The terms, rights, obligations, and warranties of
each party are governed by this Agreement.
1) Definitions
a) "Agreement Date" — The latter of (i) the date on which
Customer and Installer sign this Agreement; and (ii) the date
on which Customer is provided a fully signed copy of the
Agreement.
b) "Balance of System" — The items, equipment, and materials
needed to install the System not specifically described in the
System section on the first page of this Agreement.
c) "Business Day" — Any day of the week other than Sunday.
The following holidays are not Business Days: New Year's
Day, Martin Luther King, Jr.'s Birthday, President's Day,
Memorial Day, Independence Day, Labor Day, Columbus
Day, Veterans' Day, Thanksgiving Day, and Christmas Day.
d) "Change Order" — Any amendment to this Agreement and/or
changes to the System, reduced to writing and signed by both
parties.
e) "Commissioning" — In the case of a photovoltaic solar energy
system, connection of the System to the electric utility grid.
f) "Contract Date" — The first Business Day after the later of (i)
the expiration of the Right to Cancel; and, (ii) the System
Lock -In Date.
g) "Customer" — The person(s) named in the Customer section
on the first page of this Agreement that has contracted with
Installer for the installation of the System as defined herein.
h) "Effective Date" — The first Business Day after the expiration
of Customer's Right to Cancel.
i) "Final System Design" — A plan based upon Customer's
needs and Site specific criteria prepared after the Solar Site
Assessment that, upon System Lock -In, will become the
System to be installed at the Site.
j) "Final System Price" — The cost of the System as shown on
the Final System Design.
k) "Installer'— BlueSel Home Solar, Inc. with a principal office at
600 West Cummings Park, Suite 4200, Woburn, MA 01801,
which address shall be used for all written notices.
1) "Mailing Address" — The address to which any notice, invoice,
or other written communication provided to Customer should
be sent.
m) "Permits' — Namely, the building permit, electrical permit,
and/or plumbing permit issued by the local permit issuing
authority. Other permits (e.g., conservation commission,
planning board, historic commission, etc.), are not usual, and
are not included in this definition, but may be required.
n) "Preliminary System Design" — The solar energy system
and/or other equipment, system(s), and improvements,
described in the Preliminary System Design section on the
first page of this Agreement, and the Balance of System items
as defined herein.
o) "Project Completion" — Installation of the System and final
approved inspection of the System as required by Permit
issuing authorities, typically within four to five weeks after
Project Start Date.
p) "Project Start Date" — The date on which Installer begins to
install the System.
q) "Right to Cancel" — The option of Customer to cancel this
Agreement, for any reason, until midnight of the third
business day after the Agreement Date, as described in the
Notices and Signatures section on the first page of this
Agreement, and as described in the Notices of Cancellation
form delivered to Customer with this Agreement.
Residential Solar Energy System Installation Agreement
The terms of this agreement are contained on more than one page.
F-
r) "Sales Representative" — The person with whom Customer
primarily dealt prior to the signing of this Agreement and who
acted on behalf of installer.
s) "Site" — The address, identified in the Customer section on
the first page of this Agreement, at which Installer shall install
the System.
t) "Solar Site Assessment" — A review of the Site that may
include, but is not limited to, measurements of the location
where the System will be installed, a review of the existing
surface and structure intended to support the System, a
shading analysis, and a review of the Site's existing electrical
and/or plumbing systems.
u) "System" — The solar energy system and/or other equipment,
system(s), and improvements as shown on the Final System
Design and that will be installed at the Site.
v) "System Lock -In" — The date and time upon which the Final
System Design is deemed accepted by Customer.
w) "Total Price" — The cost of the System as shown on the first
page of this Agreement.
2) Final System Design Process
a) Within fourteen (14) days of the Effective Date, Installer shall:
i) Conduct a Solar Site Assessment, if one has not already
been conducted. Customer will provide access to the
Site at a mutually acceptable time in order to conduct the
Solar Site Assessment.
ii) Based upon the information obtained during the Solar
Site Assessment, confirm the Preliminary System, and if
necessary for technical, structural, dimensional and/or
other reasons, alter the Preliminary System.
iii) Prepare and deliver to Customer the Final System
Design, which shall include at least:
(1) The quantity, manufacturer, and model of the PV
Modules or Thermal Panels;
(2) The quantity, manufacturer, and model of the PV
Inverter, if applicable;
(3) Description of other components and equipment not
included in the Balance of System;
(4) The Final System Price; and,
(5) The projected PV Production of the System in the
first year after installation of the System, if
applicable.
b) If elected on the first page of this Agreement, Final System
Design may be delivered by email, of which Customer shall
acknowledge receipt.
c) If email delivery is not so elected, Final System Design may
be in person, by regular mail, or by another means agreed
upon by the parties. Customer shall acknowledge receipt of
the delivery of the Final System Design.
d) If either,
i) the Final System Price is more than the Total Price; or,
ii) the projected PV Production of the Final System Design
is less than 95% of the PV Production of the Preliminary
System as shown on the first page of this Agreement,
then System Lock -In shall occur at 11:59 p.m. on the fifth (5`h)
Business Day after delivery of the Final System Design to
Customer.
e) If Final System Design differs from Preliminary System
Design in either of the manners described in Section 2)d)
above, Customer may cancel this Agreement in a writing
mailed to Installer, postmarked prior to System Lock -In. To
insure such cancellation is properly received, it is also
suggested that Customer inform Installer of such cancellation
by telephone or email prior to System Lock -In.
f) If Final System Design does not differ from the Preliminary
System in either of the manners described in Section 2)d)
Page 2 of 5
above, then System Lock -In shall occur upon delivery of Final
System Design to Customer (which will, in all cases, be after
the expiration of the Right to Cancel).
g) Unless Customer cancels this Agreement prior to System
Lock -In as described herein, if any terms, price, and/or items
included in the Final System Design differ from those on the
first page of this Agreement, those terms, price, and/or items
in the Final System Design shall govern.
h) If Customer cancels this Agreement pursuant to Section 2)e)
above, the obligations, rights, and duties of each party are
canceled and this Agreement shall be of no further effect.
i) Upon System Lock -In, this Agreement, including the Final
System Design shall become binding upon each party, and
may be amended only by a Change Order.
3) Installer Obligations and Responsibilities
a) Within fourteen days of System Lock -In, Installer will file
applications for the Permits, Grid Interconnect Application,
and other paperwork related to the installation of the System,
and it shall be the obligation of Installer to obtain these.
b) Installer shall provide and install all equipment, components,
and materials included in the System, as well as the Balance
of System, in a professional manner according to standard
industry practices.
c) Project Start Date shall be within thirty (30) days of receipt of
all permits, grid interconnect authorization, verification of
receipt of deposited funds, but not before the signing of this
Agreement and transmittal to Customer a copy of this
Agreement signed by all parties.
d) Project Completion is typically within five (5) weeks after
Project Start Date.
e) Delays beyond the control of Installer such as, but not limited
to, inclement weather, shipping delays, delivery delays,
structural analysis and/or improvements, and lack of access
to the Site, may affect time periods identified, and such
delays shall not be grounds for breach of this Agreement by
Installer.
f) Installer shall, upon request of Customer, provide evidence of
insurance for general liability and workmen's compensation.
4) Customer Rights, Obligations, and Responsibilities
a) The fee(s) for all permits are the responsibility of Customer
and shall be billed to Customer by Installer separately. If
"Permits Included" is checked in the affirmative on the first
page of this Agreement, the cost for a building permit,
electrical permit, and plumbing permit is included. Other
permit fees remain the responsibility of Customer.
b) If required by municipal permit issuing authorities, a structural
analysis of the Site may be conducted by a professional
engineer. The cost of the structural analysis and required
improvements are the responsibility of Customer.
c) In the case of a Cash purchase, as may be indicated on the
first page of this Agreement, Customer shall comply with the
Payment Schedule.
d) Customer shall cooperate in a timely manner with all requests
of Installer to complete and/or sign any documents related to
the installation of the System, including, but not limited to,
permit applications, Grid Interconnect Application, and
documents requested by financing entity, as applicable.
e) In the event that Customer is financing the installation of the
System and the Final System Price should change in
accordance with the terms of this Agreement, Customer
agrees to perform all steps required of the financing entity
needed to perfect the financing of the System.
f) Should Customer secure any construction -related permits, or
deal with unregistered contractors, Customer shall be
Residential Solar Energy System Installation Agreement
The terms of this agreement are contained on more than one page.
excluded from access to the Guarantee Fund under MGL
142A.
g) Customer understands and agrees that Installer may include
Customer's name, Site Address, a description of the System,
costs, energy savings, and other information relating to the
System in reports, studies, testimonials, Web sites, and
marketing materials.
5) Installer Representations
a) Installer Federal Employer ID Number: 47-2714223
b) Installer Massachusetts Home Improvement Contractor
Registration Number: 166151, expires April 29, 2016
c) Installer Massachusetts Construction Supervisor License
Number: 5813, expires January 3, 2016
d) Unless noted otherwise, this Agreement shall not create a lien
or other security interest in the Site.
e) The System will:
i) Comply with all manufacturers' requirements,
ii) Be installed according to manufacturers' recom-
mendations,
iii) Meet all applicable requirements of the applicable current
state building code, and the National Building Code 2008.
iv) Comply with your electric utility company's interconnection
agreement
v) Utilize photovoltaic modules certified by a nationally
recognized testing laboratory as meeting the requirements
of UL 1703 all, as applicable.
6) Customer Representations
a) Customer is authorized to contract with Installer to install the
System.
b) Customer warrants that the statement concerning whether the
Site is the Principal Residence or not the Principal Residence
of Customer is true and accurate. Installer may rely upon this
statement in determining whether to collect sales tax on the
System. Customer is responsible for any sales tax owed.
c) Customer shall make the Site available to Installer at mutually
acceptable times for the purpose of installing the System, and
for any purpose related to the installation.
7) Information About Home Improvement Contractors
a) All home improvement contractors and subcontractors shall
be registered and any inquiries about a contractor or
subcontractor relating to a registration should be directed to:
Office of Consumer Affairs and Business Regulation
Ten Park Plaza, Suite 5170
Boston, MA 02116
Phone: (617) 973-8700
b) If you want to verify the registration of a contractor or if
you have questions or need additional information
specifically about the contractor registration component of
the Home Improvement Contractor Law, contact:
Director of Home Improvement Contractor Registration
Bureau of Building Regulations and Standards
One Ashburton Place, Room 1301
Boston, MA 02108
Phone: (617) 727-3200
c) For assistance with informal mediation of disputes or to
register formal complaints against a business, call:
Consumer Complaint Section
Office of the Attorney General
(617) 727-8400
Page 3 of 5
8) Arbitration
a) Installer and Customer hereby mutually agree in advance that
in the event that Installer has a dispute concerning this
contract, the contractor may submit such dispute to a private
arbitration service which has been approved by the Office of
Consumer Affairs and Business Regulation and Customer
shall be required to submit to such arbitration as provided in
MGL c. 142A.
Custo Date: 4 ZOtr
Installer r ate:
NOTICE: The signatures of parties above apply only to the
agreement of the parties to alternate dispute resolution initiated by
Installer. Customer may Initiate alternative dispute resolution even
where this section Is not signed separately by the parties.
9) Disclaimers
a) Although Installer has endeavored to provide Customer with
accurate projections and estimates and has based all
estimates and projections of PV Production, electric utility
company rates, the value of solar renewable energy credits,
and other financial items are not guaranteed or assured.
Customer is encouraged to conduct its own research on
these matters.
b) Financial incentives for solar energy systems change
frequently. Customers qualification for and receipt of
incentives depend upon numerous factors, including, but not
limited to Customer's approval for the program, availability of
funding, and Customer's tax situation. All financial incentives
discussed or presented in other documents by Installer are
presented as estimates for general information and are not
intended as tax or financial advice. Installer strongly
recommends that you consult your financial and tax advisors
to determine the applicability of these incentives to your
project and individual situation.
10) Warranty Terms and Conditions
a) Installer shalt repair and replace components of the System
during the ten (10) years following the Project Completion in
the event of:
Q Defective workmanship,
i7 System breakdown except for the components of a data
acquisition system,
iii} Degradation in electrical output of a solar photovoltaic
panel of more than the manufacturer's rated maximum
degradation during the Installer's warranty period.
b) The warranty covers the System, including PV modules and
inverters, and provides for no -cost repair or replacement of
the System or system components, including any associated
labor. Normal labor charges will apply after the 10 -year
Warranty period. .
11) Termination
a) Upon System Lock -in, Customer may only terminate this
Agreement for substantial breach of a material section of this
Agreement.
i) In order to effect termination under this Section 1 O)b),
Customer must notify Installer in writing of its intent to
terminate, and clearly identify the substantial breach
of a material section of this Agreement.
ii) Upon receipt of Customers notification, Installer shall
acknowledge receipt of the notification, and have ten
(10) Business Days to cure the breach.
Residential Solar Energy System Installation Agreement
The terms of this agreement are contained on more than one page.
iii) In the event that Installer does not cure, Installer shall
cease all work on the installation of the System and
provide Customer with all original Permits, receipts
for items purchased and special ordered for the
System, and shall settle its account with Customer
for any out-of-pocket expenses paid on Customers
behalf.
12) Miscellaneous
a) The captions of the sections of this Agreement are for
convenience and shall not be construed as substantive
language of the Agreement.
b) The laws of the Commonwealth of Massachusetts shall apply
in interpreting and enforcing this Agreement.
c) Should any section or sections of the Agreement be deemed
unlawful or unenforceable, the remaining sections shall
remain in full force.
Your SlueSel Nome Solar, Inc. Sales Representative is:
Name: Dave Judelson
Phone: 781-799-4743
Email: djudeison@biuesel.com
DO NOT SIGN THIS AGREEMENT IF ANY SPACES ARE BLANK.
THE REMAINDER OF THIS PAGE IS INTENTIONALLY BLANK.
Page 4 of 5
[You are being provided with two copies of this form, one for you to use, if you choose to cancel, and one to keep.]
NOTICE OF CANCELLATION
Customer(s): Alan & cXmrh.a aeck
Site Address: 225 say Meadow Rd., N. Andover, MA 01845
Date of Transaction: 4: if/ d
You may cancel this transaction, without any penalty or obligation, within three business days from the above
date.
If you cancel, any property traded in, any payments .made by you under the agreement, and any negotiable
instrument executed by you will be returned within ten business days following receipt by the seller of your
cancellation notice, and any security interest arising out of the transaction will be cancelled.
If you cancel, you must make available to the seller at your residence, in substantially as good condition as when
received, any goods delivered to you under this agreement; or you may if you wish, comply with the instructions
of tte [3eitier regav0jrlg the lIjFll shiplF!ellt of flip g4s3ds et the $elegy's experlss aqd ri4,
If you do make the goods available to the seller and the seller does not pick them up within twenty days of the
date of your notice of cancellation, you may -retain or dispose of the goods without any further obligation. H you
fail to make the goods available to the seller, or if you agree to return the goods to the seller and fall to do so,
then you remain liable for performance of all obligations under the contract. :
To cancel this transectign, mail pr deliver a signed and dated 99py of thi's cancellation notice or any other written
notice, or send a telegram to.:
BlueSel Home Solar, Inc., 600 West Cummings Park, Suite 4200, Woburn, MA 01801,
, �
not later than midnight onbZ— 20�r
.: _ _ _ _.
• I hereby cancel this transaction.
Date: Customer's Signature .
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ACRO® 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 No): 714-625-8290
AIC, E Ext): FAX
ADDRESS: ara@solarinsure.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.
INSR
LTR
TYPE OF INSURANCE
AUUL15U13K
INSD
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 occurrence) $ 50,000
MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY ❑PRO JECT F-1LOC
OTHER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ 2,000,000
AUTOMOBILE
LIABILITYUUMIJINLL)$
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/MEMBER EXCLUDED? ❑
(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 EMPLOYEE $ 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, maybe 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 y 7`/ �7DM�'
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 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.
Avvlicant Information Please Print Legibly
Name (Business/Organization/Individual): United Solar Associates, LLC
Address: 452 Pleasant Street, Second Floor
City/State/Zip: Malden, MA 02148
Are you an employer? Check the appropriate box:
Phone #: 855-786-1776
1.0 lam 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.❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t
4. ❑ 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.❑ 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. F1 Electrical repairs or additions
12. ❑ Plumbing repairs or additions
13.❑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: 225 Hay Meadow Rd City/State/Zip: North Andover, MA 01$4'
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 viQlatoor. Amy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification ' \ h .s"
I do hereby certify ujderre7pas and lilti& erjury that the information provided above is true and correct.
Signature: Date:
DL--- u. 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 #:
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