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HomeMy WebLinkAboutBuilding Permit #610-16 - 29 PADDOCK LANE 11/17/2015- //-AP-/J- BUILDING /-AP/J- Permit No#: O 1 (4�� Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received )RTANT: Applicant must complete all items on this /O �tfl.ED 16\ LOCATION IDCL dC C)G�cLt Pn t PROPERTY OWNER GUC 14"(112 S Print 100 Year Structure yes o MAP 0-7•1-0 PARCEL:000-7 ZONING DISTRICT: Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Exp. Date: Residential Non- Residential ❑ New Building L,,6ne family Exp. Date: ❑ Addition ❑ Two or more family ❑ Industrial Pf Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ElSeptic ElWell ❑ Floodplain El -Wetlands ❑Watershed Districtn _ n Water/Sf*er DESGRIPI IUN Ut- VVUMM I U tat rr-mrumviw. n s� a II �'Z �r�lar el eco; �a hal s 'fa Fed a� 5. 12 4 Lu an -10 rode ♦���I.a r• _ ,�� SII• i 4N1 5 NYl Identification - Please Type or Print Clearly q4 -qlO OWNER: Name: <-)Jd i l -h QT--nOSt Phone: Address: V PQd d(5C-1c C -n Nor -4-h gnda `Pl Mck- 01 W-` -) Contractor Name: CrA Phone: 7fs'2l�' Z3�3 Email: abkQYlCo(Parc-T W.coni Address: $00 Xe'Wj3y-J, Vr wll mi 0�60_Q_ C61 t Supervisor's Construction License: 01 05� Exp. Date: Home Improvement License: I (o�S1�- Exp. Date: 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: $ 1 � , 00C) FEE: $ I 0 Check No.: ::) `11 --) Lai Receipt No.: Qq %o -fes NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submittedo Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swumning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales 0 Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: =__=__ -. _ -- r.......,_:_ _ Located 384 Osgood Street IVI 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use) -1115 ❑ Notified for pickup Call Email ( Date Time Contact Name Doc.Building Permit Revised 2014 No t r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application ,,. Workers Comp Affidavit :s. 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 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 4 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 E: 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 Locatiorwy-x No. Date Check # -n 2 .5 6 0 7 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee $ TOTAL Building Inspector �Z CD O Cr 2 CL >cc O m CL Cr2 CD O W CD Q O U) O n' N CD CD CCD U) (D U) iv z 70 CD O N Z� rrn m Cl) - nC) M Z cnm c Cl) rzft nz O z Cl) Z Cl) U) v Coz G7 z n O 0 = 'a O o3i -~; a cn CD CDCL • CD m coi CL C•) 3 O=r N <D O O .� Q O =o,a N o CD CDID o ID to rIL� U) c ■+ �.s� �� CD O C (O O O ca 0 h a c D CDU a n �. Q 0 to < CD O CDC �CD r� ■ N . rCD cn o 0 rt � o O � rt CD=7 0 <D y O -+ nCD CD -0 a� o C y 0 V1 3 O 77m fD � O V1 (D Z co C T D m T �' N .Z7 O C H O �0 T j D) N OO ;!C � s m m A > T O D) Z7 O C 3 C G) 0 T j N n 3 (D .Z7 O C T O C Q O > W C v Z f,� m m 0 N fD "O n CD 3 T O O CL n S (D O � O D = 0 a > . 4k, Version #52.3 - TBD PIL (-Eg- r C ty, October 20, 2015 RE: CERTIFICATION LETTER Wr ' -- ,1 1, �A'014 WIL 1AM Project/Job # 0182914OMAi Project Address: Arnost ResidenceTRIGTRr1L 29 Paddock Ln North Andover, MA 01845 No. 51554 Design Criteria: '�F�i�iDe' �—o n Toman Date: :49 -07'00' - 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 - MPI: Roof DL = 10.5 psf, Roof LL/SL = 35 psf (Non -PV Areas), Roof LL/SL = 35 psf (PV Areas) 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. This review relies on the roof's structural system having been originally designed and constructed in accordance with the building code requirements and having been maintained to be in good condition. 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 ASCE 7 standards for loading. The PV assembly hardware specifications are contained in the plans submitted for approval. Additionally a summary of the structural review is provided in the results summary tables on the following page. Jason W. Toman, P.E. Professional Engineer T:480-553-8115 x58115 email: jtoman@solarcity.com 3055 Clearview Way San Mateo, CA 94402 T Ia50i 638-1.C28 (885) tiaC3L.: CITY F (650) 638-1020 Uolarcity.com i k - Version #52.3 - TXD- PIL HARDWARE DESIGN AND STRUCTURAL ANALYSIS RESULTS SUMMARY TABLES Landscape Hardware Hardware - Landscape Modules' Standoff Specifications X -X Spacing X -X Cantilever Y -Y Spacing Y -Y Cantilever Configuration Uplift DCR MPI 64" 22" 39" NA 64 62.4% Portrait Hardware Hardware - Portrait Modules' Standoff Specifications X -X Spacing X -X Cantilever Y -Y Spacing Y -Y Cantilever Configuration Uplift DCR MPI 32" 14" 65" NA Staggered 51.9% Structure Mounting Plane Framing Qualification Results Type Spacing Pitch Member Evaluation Results MPI Stick Frame @ 16 in. O.C. 280 Member Analysis OK Refer to the submitted drawings for details of information collected during a site survey on. 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 T (650) 638-1028 (888) SOL -C1lY F (653) 638-1Q29 solarcity.corn STRUCTURE ANALYSIS - LOADING SUMMARY AND MEMBER CHECK - MPI iwLes: i. ps = �-.s•pr; Ls -roor, is -pv per Abt.t i (i -figure i -t) G. pr = U./ ((:e) (LJ (is) pg; L,=U.9, 4=1.1, 15=1.0 Member Design Summary (per NDS Governing Load Comb CD CL + CL - CF Cr D + S 1.15 1.00 1 0.40 1 1.2 1.15 Member Anal sis Results Summary Governing Analysis Max Demand @ Location Capacity DCR Result Bending + Stress 1414 psi 7.9 ft 1389 psi 1.02 Pass Member Properties Summary mary MP1 Roof Pitch Horizontal Member Spans Overhang 0.99 ft Rafter Properties Actual W 1.50" Roof System Properties Span 1 13.69 ft Actual D 7.25" Number of Spans w/o Overhang) 1 Span 2 Nominal Yes Roofing Material Comp Roof San 3 A 10.88 in. ^2 Re -Roof No San 4 S. 13.14 in.^3 PI wood Sheathing Yes San 5 I 47.63 in.^4 Board Sheathing None Total Rake Span 16.63 ft TL DefTn Limit 120 Vaulted Ceiling No PV 1 Start 2.08 ft Wood Species SPF Ceiling Finish 1/2" Gypsum Board PV 1 End 13.58 ft Wood Grade #2 Rafter Sloe 280 PV 2 Start Fb 875 psi Rafter Spacing 16" O.C. PV 2 End I F„ 135 psi Top Lat Bracing Full PV 3 Start E 1400000 psi Bot Lat Bracing At Supports PV 3 End Emin 510000 psi iwLes: i. ps = �-.s•pr; Ls -roor, is -pv per Abt.t i (i -figure i -t) G. pr = U./ ((:e) (LJ (is) pg; L,=U.9, 4=1.1, 15=1.0 Member Design Summary (per NDS Governing Load Comb CD CL + CL - CF Cr D + S 1.15 1.00 1 0.40 1 1.2 1.15 Member Anal sis Results Summary Governing Analysis Max Demand @ Location Capacity DCR Result Bending + Stress 1414 psi 7.9 ft 1389 psi 1.02 Pass Member Loading mary Roof Pitch 7/12 Initial Pitch Ad'ust Non -PV Areas PV Areas Roof Dead Load DL 10.5 psf x 1.13 11.9 psf 11.9 psf PV Dead Load PV -DL 3.0 psf x 1.13 3.4 psf Roof Live Load RLL 20.0 psf x 0.88 17.5 psf Live/Snow Load LL/SL'-12 50.0 psf x 0.7 1 x 0.7 35.0 psf 35.0 psf Total Load(Governing LC TL 1 46.9 psf 50.3 psf iwLes: i. ps = �-.s•pr; Ls -roor, is -pv per Abt.t i (i -figure i -t) G. pr = U./ ((:e) (LJ (is) pg; L,=U.9, 4=1.1, 15=1.0 Member Design Summary (per NDS Governing Load Comb CD CL + CL - CF Cr D + S 1.15 1.00 1 0.40 1 1.2 1.15 Member Anal sis Results Summary Governing Analysis Max Demand @ Location Capacity DCR Result Bending + Stress 1414 psi 7.9 ft 1389 psi 1.02 Pass � b• CALCULATION OF DESIGN WIND LOADS - MP1 Mounting Plane Information Roofing Material KZ Comp Roof Table 6-3 PV System Type K, SolarCity SleekMountTM Section 6.5.7 Spanning Vents V No Fig. 6-1 Standoff Attachment Hardware I Comp Mount Type C Section 6.5.6.3 Roof Slope qh 280 Fig. 6-11B/C/D-14A/B Rafter Spacing h 16" O.C. I Section 6.2 Framing Type Direction Y -Y Rafters T -actual Purlin Spacing X -X Purlins Only NA T -allow Tile Reveal Tile Roofs Only NA DCR Tile Attachment System Tile Roofs Only NA ,Standing Seam/Trap Spacing SM Seam Only NA Wind Design Criteria Wind Design Code KZ ASCE 7-05 Table 6-3 Wind Design Method K, Partially/Fully Enclosed Method Section 6.5.7 Basic Wind Speed V 100 mph Fig. 6-1 Exposure Category I C Section 6.5.6.3 Roof Style qh Gable Roof Fig. 6-11B/C/D-14A/B Mean Roof Height h 1 25 ft I Section 6.2 Wind Pressure Calculation Coefficients Wind Pressure Exposure KZ 0.95 Table 6-3 Topographic Factor K, 1.00 Section 6.5.7 Wind Directionality Factor Kd 0.85 Table 6-4 Importance Factor I 1.0 Table 6-1 Velocity Pressure qh qh = 0.00256 (Kz) (Kzt) (Kd) (V^2) (I) Equation 6-15 3.0 psf 20.6 psf P -PV Wind Pressure Ext. Pressure Coefficient U GC -0.95 Fig. 6-11B/C/D-14A/B Ext. Pressure Coefficient Down G Down 0.88 Fig. 6-11B/C/D-14A/B Design Wind Pressure p p = qh (GC) Equation 6-22 Wind Pressure U -19.6 psf Wind Pressure Down 18.0 Psf ALLOWABLE STANDOFF SPACINGS X -Direction Y -Direction Max Allowable Standoff Spacing Landscape 64" 39" Max Allowable Cantilever Landscape 22" NA Standoff Configuration Landscape Staggered Max Standoff Tributary Area Trib 17 sf PV Assembly Dead Load W -PV 3.0 psf PV Dead Load at Standoff P -PV 52 lbs Net Wind Uplift at Standoff T -actual -312 lbs Uplift Capacity of Standoff T -allow 500 lbs Standoff Demand/Capacity DCR 62.4% X -Direction Y -Direction Max Allowable Standoff Spacing Portrait 32" 65" Max Allowable Cantilever Portrait 14" NA Standoff Configuration Portrait Staggered Max Standoff Tributary Area Trib 14 sf PV Assembly Dead Load W -PV 3.0 psf PV Dead Load at Standoff P -PV 43 lbs Net Wind Uplift at Standoff T -actual -259 lbs Uplift Capacity of Standoff T -allow 500 lbs Standoff Demand/Capacity DCR 51.9% DocuSign Envelope ID: DB7F66E8-3F67-49DB-BD00-A9EF96475E8B �5olarCity I PPA :ustomer Name and Address Judith Arnost 29 Paddock Ln North Andover, MA 01845 Installation Location Date 29 Paddock Ln 10/9/2015 North Andover, MA 01845 Here are the key terms of your prepaid Power Purchase Agreement System installation cost Q The SolarCity Promise LJ � F0,do Electricity rate ns kWh Ja Initial here .................. . • We provide a money back energy performance guarantee. • We guarantee that if you sell your Home, the buyer will qualify to assume your Agreement • We warrant all of our roofing work. • We restore your roof at the end of the Agreement. • We warrant, insure, maintain and repair the System. • We fix or pay for any damage we may cause to your property. • We provide 24/7 web -enabled monitoring at no additional cost. • The rate you pay us will remain fixed for the term of the Agreement. • The pricing in this Agreement is valid for 30 days after 10/9/2015. • You are free to cancel any time prior to construction at no charge. 0 Your SolarCity Power Purchase Agreement Details Amount due at contract signing $0 Est. amount due at installation $3,320 Est. amount due at building inspection $3,320 Est. first year production 3,998 kWh Your Choices at the End of the Initial Term: • SolarCity will remove the System at no cost to you. • You can upgrade to a new System with the latest solar technology under a new contract. • You may purchase the System from SolarCity for its fair market value as specified in the Agreement. • You may renew this Agreement for up to ten (10) years in two (2) five (5) year increments. 3055 Clearview Way, San Mateo, CA 94402 1 888.765.2489 ( solarcity.com Power Purchase Agreernent, version 9.0.3, August 24, 2015 SAPC/SEFA Compliant Contractors License MA HIC 168572/EL-1.1.36MR. Docurnent generated on 1.0/9/2015 Copyright: 2008-2015 SolarCity Corporation, All Rights Reserved Agreemen am �a Initial here ................................ hhDS JQ ................................... Initial here Pi_ J"` _.._............................................. Initial here. Options for System Purchase: • At certain times, as specified in the Agreement, you may purchase the System. • These options apply during the 20 year term of our Agreement and not beyond that term. 1.186383 DocuSign Envelope ID: DB7F66E8-3F67-49DB-BD00-A9EF96475E8B 23. NOTICE OF RIGHT TO CANCEL. YOU MAY CANCEL THIS CONTRACT AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE YOU SIGN THIS CONTRACT. SEE EXHIBIT 1, THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. 24. ADDITIONAL RIGHTS TO CANCEL. 4'' ' . I have read this Power Purchase Agreement and the Exhibits in their entirety and I acknowledge that I have received a complete copy of this Power Purchase Agreement. Customer's Name: Judith Arnost DocuSigned by: Signature: J��T� aV�n sl k1 Ub44b IN ADDITION TO ANY RIGHTS YOU MAY HAVE TO CANCEL THIS PPA UNDER SECTION 23, YOU MAY ALSO CANCEL Date: THIS PPA AT NO COST AT ANY TIME PRIOR TO COMMENCEMENT OF CONSTRUCTION ON YOUR HOME. 25. Pricing , The pricing in this PPA is valid for 30 days after 10/9/2015. If you don't sign this PPA and return it to us on or prior to 30 days after 10/9/2015, SolarCity reserves the right to reject this PPA unless you agree to our then current pricing. Customer's Name: Signature: Date: 10/9/2015 Power Purchase Agreement Signature: Date SolarCity approved 0 Lyndon Rive, CEO 10/9/2015 �Jn�yr r �>I��'t,'Y7;, c: a. ,^,.P'i:"''iY�E'i?. '�tE'f ii: i,. ,�.I..... !�•.!i:''!;:.i.. ❑, 7 A, ' The Common pealth o• f Massachusetts ipDepartment of Industrial Aceidents Office of Investigadans 1 Congress Street, Suite 100 Boston, MA 021.4--20.17 wwtnoss.govldia Workers' Compensation Insurance Affidavit: Builders/Contracts rs/Electticians/Plumbelrst Applicant Information Please Print Le lilt! Nairn (Basi,less/Orguixationti;nd€viduitl): SolarCity Corp. Address: 3055 Clearview Way C:1Ey/NlatcfL p: Jatt tvtdtcu UP%. ZI"U/- Phone #:000-1 V1)-41FV.V Are you ar employer? Check the appropriate box: Type of project (requited),. 1. ZI am a employer with 5,000 4 ❑ t ant a general contractor and I employees (full andlar part-time},' have hired the sub -contractors h Now cs>nstructian 2. ❑ 1 aril it sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees Theso sub -contractors have 1 g. ❑ Demolition working for me in any capacity, ernployees and have workers' [No workers` comp. insurance comp. insurancc'.l 9. © Building addition required.] 5. ❑ We are a corporatism and its 10.[3 Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions l,rtyscif. [No workers' . cam rsylltuf uKeni tion Per W -WI P 12.❑ Roof repairs insurance required,) t c. 152, §1(4), and we have no employees. [No workers' 13[0Other Solar/PV camp, insurance required.] "Any applicant that rbecks boxfl I mast also fill out the section Wow showing their workers' o mpcnsation 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. =Conn ewts that them: this box must attached an additional sheet showing the name of tho sub•contractots and stats whether or not those entities have employees. If the sub -contractors have employees, they trust provide their workers' comp policy number. I'arra an employer that isprouuiiitg workers' Compensation. insurance formy employees. Below is the policy andjob site information. Insurance Company Name: Zurich American Insurance Company Policy 9 or Sell -ins. Lie. #: WC0182015-00 Expiration Date:: 9/1/2016 Job Site Address-.—. I)Gmnct city/State/'Gip: NCJr4�h cvw Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. I52 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 fort of a STOP WORK ORDER and a fine of up to $250.00-a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance: coverage verification. I do hereby certuy, lire pants and penott'les vfperjury that tine information provided above is true and correct. Si atu Date: Phi:. taf"icial use only, Do not }Vrite Al this area, to be completed by city or lawn offi-cial, City or Town: Permit/Lkease'W Issuing Authority (circle one): 1. Board ofIfealth 2. guildting Department 3. City/Town Cterk 4, Electrical inspector S. Plumbing Inspector 6. Other Contact Person: Phone M. Illrrr777���... CERTIFICATE OF LIABILITY INSURANCE A`0 �0 PATE (MMIDDIYYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN iS SUBJECT TO ALL THE TERMS, 06/17/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLIA: 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 poticy(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 CONTACT NAME; HAMS;_-----.-.--.-...-"- MARSH RISK& INSURANCE SERVICES -•„ ,•... FAX - .._.. . 345 CALIFORNIA STREET, SUITE 1340 [Atc. Cts:LExt1-....... _ .... .................... .. .........i .441c, No):, ..................................... CALIFORNIA LICENSE NO. 0437153 EMAIL :. SAN FRANCISCO, CA 94104 _ADDRE55..... .............. ... ...... .. ..........: Alin; Shannon Scott 4i5-743.8334INSURERIS) AFFORDING COVERAGE + NAM* 998301-STND-GAWUE-15.16 INSURER A; Zurich American Insurance Company 16535 ........... ...... .. ....................... . INSURED INSURER a ;NIA NIA SolarCity Corporation .......... ..... . - .. ., ...... ...... - .......... +.. ......... .... 3055 Clearview Way INSURER C: NIA NIA J.- _. ....... ......... .: ..... ........ ............ ............._............................+........ ................ San Mateo, CA 94402 1Nsurzrm n : American Zurich Insurance Company 40142 t...._ ............... 6,000,000 INSURER E: INSURER r: COVERAGES CERTIFICATE NUMBER: SEA -00271383&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 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 PAIL} CLAIMS. San Mateo, CA 99402 ACCORDANCE WITH THE POLICY PROVISIONS. _.TISR _ - - - - ADOL'SUB.R_rPOLICY EFF Y E .. .. ...... ....... ............ ....-. ...... ....... ........... ...... ...... LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMPOLIrDCtNYYYXPY LIMITS Charles Marmolejo��-- A X COMMERc1Ar_GENERAL LIABILITY ; 'GLOO182016-00 0910112015 '0910112016 OCCURRENCE S CLAIMS -MADE X ]OCCUR I J.E" DAMAGE TO RENTED .......... ...... PRWISE5 (Ea q:xugence� *_S " -_... _.._.. 3RD0,000 X SIR: $250,000 ... ... ......................................... ...... MED EXP (Any one person) S 5.000 4 . i ............................... _...... ....... .._........ &ADV INJUR.Y......_............. 00,000 ......... 3,000,000 LAGGREGA7ELIMI7APPLIESPER 'PERSbNAL SGENERALAGGREGATE 6,000,000 .G..E..N'I .._..I PRO, i K POLICY iJEC7 LOC PRODUCTS - COMPIOP AGG : $ 6,000,000 OTHER A AUTOMOBILE LIABILITY . `$AP0182017-00 ;;0910112015 :0910112016 COMBINED SINGLE LIMIT g 5,000,000 XANY AUTO - .: "BODILY INJURY (Per person): $ ,.. ..; ALL OWNED ;.... SCHEDULED X X ..... .. _.. _..... . .. ... ..;�; BODILY INJURY (Per accaienf $ ......... ........ _ AUTOS AUTOS I AUTOS X NON-OWNED PROPERTY DAlv1AGE {. ....i HIRED AUTOS r... AUTOS t F(PeracCldentj . .......... .....+.. .. ........................... _ COMPiGOLL DED_ $ $5.000 t UMBRELLA LIAROCCUR I EACH OCCURRENCE S EXCESS LIAR CLAIMS MADE' ........1. - AGGREGATE S ... ... DED RETENTIONS £ D WORKERS COMPENSATION (AOS) ;0910112015 ;0910112016 X PTnruT oRla :w,0182014.00 AND EMPLOYERS' LIABILITY A YIN :WC0182015.00 MA :0910112015 09/0112016 ZANY PROPRIETORIPARTNERIEXECUTIVE ( } : F---- . ;_ .....i ..... . ' El EACH ACCIDENT N OFFICERIMEMBEREXCLUDED� NIA; IMandatory In NH) j SWC DEDUCTIBLE: $500,000 F - E.L DISEASE • EA EMPLOYEF $ 1,000,000 If yes. describe under DESCRIPTION OF OPERATIONS below _ ._........_..... ..... ......... .. E L DISEASE - POLICY LIMIT I S 1,000,000 I i I i I DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe aHached If more space Is required) Evidence of insurance. CERTIFICATE HOLDER CANCELLATION SolarCity Corporation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3055 C)eaMew Way THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 1N San Mateo, CA 99402 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services Charles Marmolejo��-- © 9988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014141) The ACORD name and logo are registered marks of ACORD �f�ll?11Zf�lltcfelll�llf1�J�.%lel-GG:�;If�`Clllf�f'1#��• Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration SOLAR CITY CORPORATION ASTRID BLANCO 3055 CLEARVIEW WAY SAN MATEO, CA 94402 SCA 1 0 20M-05!11 �frice of Consumer Affairs & Business Regulation , �'..'OME IMPROVEMENT CONTRACTOR Registration: 168572 Type: Expiration: 3/8/2017 Supplement Card SOLAR CITY CORPORATION ASTRID BLANCO 24 ST MARTIN STREET BLD 2UNI -•e9.� 'KALBOROUGH, MA 01752 Undersecretary Registration: 168572 Type: Supplement Card Expiration: 3/8/2017 Update Address and return card. Mark reason for change. Address n Renewal . j Employment n Lost Card License or registration valid for individul use only before the expiration date. 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