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HomeMy WebLinkAboutBuilding Permit #609-16 - 31 WOOD AVENUE 11/17/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 0 Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page .LOCATION J30cd 4V Print PROPERTY OWNER�Senc U f'6bctQ Print 100 Year Structure yes no MAP 73. PARCEL-. ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other —b . Septic ❑Well. [I Floodplain L Wetlands 11 WatershedDistrict Water/Sewer-- Ut5GKIF I FUN U1- vvumn 1 v 0c r r<rvt`inw. Identification- Please Type or Print Clearly OWNER: Name: Senaau ' %J Phone: Address: Contractor Name: Email: alnJaU4 Address: C'00__ Supervisor's Construction License: t7 Home Improvement License: ARCH ITECT/ENGINEE vs --239-3 Exp: Date: q -t; -A0 Exp. Date:" 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: $ 1q.000 FEE: $ 2'Z'S CheckNo ��� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t Aa anty fundM Arm C _ - C .-. 4.1 pro ^f ,^n+rmr,+nr y j 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 HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 'Planning Board Decision: Comments o' conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street 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 droprequires q approval of Electrical Inspector yes No i DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine wv i tb ana UA. l A — (For department use MVW ( I ❑ Notified for pickup Call Email [ Date Time Contact Name t 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 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 TE: 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 I ECC Energy code Engineering Affidavits for Engineered products TOTE: 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, 2)1 No. Date Check # 29686 TOWN OF NORTH ANDOVER , { Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $_ - Other Permit Fee $ TOTAL $'% Building Inspector x J W W Q m C L U Y Y \ 0 O 0 a0 � U :F. a 0)LL l/) O (� a IA ? Z_ _ m G O a+ O0 C 7 LL tc OD 7 LL' T au E U — LL x oO� W CL H z �_ m ? d 00 7 K — LL W C 2 Z Q U_ W W t to 7 K U i N LL oc O U W Z Q CA 7 C — N LL z W W clW LL i i m O z Ul N U1 Q Y O Ln F LLII 0 Z ~ Lu - C N xZ w0 V Lu W J Q. w I.: V CL CD IM a c DocuSign Envelope ID: A2199361-3803-436F-953A-1FF33F378D1 B SolarCity I PPA Customer Name and Address Senay Abbay Samuel Abbay 31 Wood Ave North Andover, MA 01845 Installation Location Date 31 Wood Ave 9/17/2015 North Andover, MA 01845 Here are the key terms of your Power Purchase Agreement System installation cost Electricity rat ger kWh Agreemen ggm Initial here Initial here DS ED The SolarCity Promise SQ • We guarantee that if you sell your Home, the buyer will qualify to assume your Agreement . .................... .... ....................... .................. .... Initial here[KI • We warrant all of our roofing work. DS • We restore your roof at the end of the Agreement. �a • We warrant, insure, maintain and repair the System. ......... Initial here.. _.. • 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 never increase by more than 2.90% per year. • The pricing in this Agreement is valid for 30 days after 9/15/2015. • You are free to cancel any time prior to construction at no charge. Your SolarCity Power Purchase Agreement Details 3055 Clearview Way, San Mateo, CA 94402 1 888.765.2489 1 solarcity.com 1118253 Power Purchase Agreement, version 9.0.3, August 24, 2015 SAPC/SEFA Compliant Contractors License MA HIC 168572/EL-1.136MR �� Document generated on 9/15/2015 10 Copyright 2008-2015 SolarCity Corporation, All Rights Reserved T50R FRI Your Choices at the End of the Initial Options for System Purchase: Amount due at contract signing Term: • At certain times, as specified in $0 • SolarCity will remove the System at no the Agreement, you may Est, amount due at installation cost to you. purchase the System. $0 • You can upgrade to a new System with • These options apply during the 20 the latest solar technology under a new year term of our Agreement and Est. amount due at building inspection contract. not beyond that term. $0 • You may purchase the System from Est. first year production SolarCity for its fair market value as 41542 kWh 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 1 solarcity.com 1118253 Power Purchase Agreement, version 9.0.3, August 24, 2015 SAPC/SEFA Compliant Contractors License MA HIC 168572/EL-1.136MR �� Document generated on 9/15/2015 10 Copyright 2008-2015 SolarCity Corporation, All Rights Reserved T50R FRI DocuSign Envelope ID: A2199361-3B03-436F-953A-1FF33F378D1B 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. IN ADDITION TO ANY RIGHTS YOU MAY HAVE TO CANCEL THIS PPA UNDER SECTION 23, YOU MAY ALSO CANCEL 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 9/15/2015. If you don't sign this PPA and return it to us on or prior to 30 days after 9/15/2015, SolarCity reserves the right to reject this PPA unless you agree to our then current pricing. 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: Senay Abbay DocuSigned by: Signature: F�" 06 Date: 9/17/2015 Customer's Name: Samuel Abbay Docu..Signffed by: Signature: �AaMIML Q�� I Date: 9/17/2015 Power Purchase Agreement SolarCity approved Signature: ' Lyndon Rive, CEO Date: 9/15/2015 Power Purr.hase Agreement version 9.0.:3, AuE;ust 74, 2015 r� •❑ 11.1.82 53 ti � October 8, 2015 Project/Job # 0182750 RE: CERTIFICATION LEITER Project: Abbay Residence 31 Wood Ave North Andover, MA 01845 To Whom It May Concern, Version #49.3 A jobsite survey of the existing framing system was performed by a site survey team from SolarCity. Structural review was based on site observations and the design criteria listed below: Design Criteria: - 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 & MP2: Roof DL = 13.5 psf, Roof LL/SL = 35 psf (Non -PV Areas), Roof LL/SL = 21.5 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 On the above referenced project, the components of the structural roof framing impacted by the installation of the PV assembly have been reviewed. After this review it has been determined that the existing structure is adequate to withstand the applicable roof dead load, PV assembly load, and live/snow loads indicated in the design criteria above. I certify that the structural roof framing and the new attachments that directly support the gravity loading and wind uplift loading from PV modules have been reviewed and determined to meet or exceed structural strength requirements of the MA Res. Code, 8th Edition. Please contact me with any questions or concerns regarding this project. Digitally signed by Kyle Jackson Date: 2015.10.08 09:48:04 -06'00' Kyle Jackson, P.E. Professional Engineer T: 888.765.2489, ext. 51520 email: kjackson@solarcity.com 3055 Clearview Way San Mateo, CA 94402 T (650) 638-1028 (888) SOL -CITY F (650) 638-1029 solarcity.com A2ROC 2 —`71 '_.A i.3:.k31681 bC'11, C7 H4: i.G.n>.. <, Uri.:•.J ?11";1 -,. 7C' HllH'7' 1014i ;ICT 27.6.Ma V" Nil i 10.08.2015 °`�•PSV System Structural Version #49:3 o I ar" C tY4, Design Software PROJECT INFORMATION & TABLE OF CONTENTS Project Name: Abbay Residence AHJ:North Andover Job Number: 0182750 Building Coder_ MA Res. Code, 8th Edition_ _ Customer Name: Abbay, Senay_ _ Based On:- IRC 2009 / IBC 2009 Address. 31 Wood Ave ASCE Code:j ASCE 7-05 City/State North Andover, MA _. _._.... _ _. Risk Category:' II Zip Code 01845 Upgrades Req'd?J No Latitude / Longitude. 42.685071 -71.107100 Stamp Req'd? i Yes SC Office. Wilmington PV Designer: Wen'ia Wang Certification Letter 1 Project Information, Table Of Contents, & Vicinity Map 2 Structure Analysis (Loading Summary and Member Check) 3 Hardware Design (PV System Assembly) 4 Note: Per IBC 1613.1; Seismic check is not required because Ss = 0.33365 < 0.4g and Seismic Design Category (SDC) = C < D 31 Wood Ave, North Andover, MA 01845 Latitude: 42.685071, Longitude: -71.1071, Exposure Category: C ;STRUCTURE ANALYSIS - LOADING SUMMARY AND MEMBER CHECK MP1 & MP2 (votes: 1. ps = Ls -pr; Ls -root, Ls -pv per ASct / [hgure /-Z] Z. pt = U./ (L,) (L0 Us) pg; (e=U.9, C2=1.1, 15=1.0 Member Desi,on Summa(per NDS Governing Load Comb CD CL + CL - CF Cr D + S 1.15 1.00 1 1.00 1 1.2 1.15 Member Properties Summary mary MPI & MP2 Roof Pitch Horizontal Member Spans Overhang 0.91 ft Rafter Pro erties Actual W 1.50" Roof System Pro erties San 1 13.72 ft ActualD 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 SX 13.14 in.^3 Plywood Sheathing Yes San 5 I 47.63 in.^4 Board Sheathing None Total Rake Span 17.44 ft TL DefPn Limit 180 Vaulted Ceiling Yes PV i Start 1.08 ft Wood Species SPF Ceiling Finish 1/2" Gypsum Board PV 1 End 12.92 ft Wood Grade #2 Rafter Sloe 330-' PV 2 Start Fb 875 psi Rafter Spacing 16" O.C. PV 2 End F„ 1 135 psi Top Lat Bracing Full PV 3 Start E 1400000 psi Bot Lat Bracing Full PV 3 End Emi„ 510000 psi (votes: 1. ps = Ls -pr; Ls -root, Ls -pv per ASct / [hgure /-Z] Z. pt = U./ (L,) (L0 Us) pg; (e=U.9, C2=1.1, 15=1.0 Member Desi,on Summa(per NDS Governing Load Comb CD CL + CL - CF Cr D + S 1.15 1.00 1 1.00 1 1.2 1.15 Member Loading mary Maximum Roof Pitch 8112 Initial Pitch Adjust Non -PV Areas PV Areas Roof Dead Load DL 13.5 psf x 1.19 16.1 psf 16.1 psf PV Dead Load PV -DL 3.0 psf x 1.19 0 + S 3.6 psf Roof Live Load RLL 20.0 psf x 0.80 16.0 psf Total Load Deflection Live/Snow Load LL SL1,2 50.0 psf x 0.7 1 x 0.43 35.0 psf' 21.5 psf Total Load(Governing LC TL 51.1 psf 41.2 psf (votes: 1. ps = Ls -pr; Ls -root, Ls -pv per ASct / [hgure /-Z] Z. pt = U./ (L,) (L0 Us) pg; (e=U.9, C2=1.1, 15=1.0 Member Desi,on Summa(per NDS Governing Load Comb CD CL + CL - CF Cr D + S 1.15 1.00 1 1.00 1 1.2 1.15 Member Ana) 'sis Results Summary Maximum Max Demand @ Location Capacity DCR Load Combo Shear Stress 50 psi 0.9 ft. 155 psi 0.32 D + S Bending + Stress 1170 psi 7.8 ft. 1389 psi 0.84 0 + S Bending Stress -37 psi 0.9 ft. -1389 psi 0.03 D + S Total Load Deflection 0.92 in. 213 7.8 ft. 1.09 in. 180 0.85 D + S CALCULATION OF DESIGN WIND LOADS.- MP1 & MP2 Mounting Plane Information Roofing Material KZ Comp Roof Table 6-3 PV System Type KA 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 Slope3 qh Gable Roof Fig. 6-11B/C/D-14A/B Rafter Spacing h - . _ -. .... - . 16' O.C. Section 6.2 Framing Type Direction Y -Y Rafters T -allow Purlin Spacing _ _ X -X Purlins Only NA DCR Tile RevealTile Roofs Only NA Tile Attachment System Tile Roofs Only NA Standin Seam/Trap spacing SM Seam Only NA Wind Design Criteria Wind Design Code KZ ASCE 7-05 Table 6-3 _ Wind Design Method KA _ Partially/Fully Enclosed Method T 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 35 ft Section 6.2 Wind Pressure Calculation Coefficients Wind Pressure Exposure KZ 1.01 Table 6-3 Topographic Factor KA 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 22.1 psf T -actual Wind Pressure Ext. Pressure Coefficient U G -0.95 Fig. 6-11B/C/D-14A/B Ext. Pressure Coefficient Down G W 0.88 Fig. 6-11B/C/D-14A/B Design Wind Pressure P p = qh (GC,) Equation 6-22 Wind Pressure U -21.0 psf Wind Pressure Down 19.3 psf ALLOWABLE STANDOFF SPACINGS X -Direction Y -Direction Max Allowable Standoff Spacing Landscape 64" 39" Max Allowable Cantilever Landscape 24" NA Standoff Configuration Landscape Staggered Max Standoff Tributary Area Trib 17 sf PV Assembly Dead Load W -PV 3.0 psf Net Wind Uplift at Standoff T -actual -338 lbs Uplift Capacity of Standoff T -allow 500 lbs Standoff Demand/Capacity DCR 67.6% X -Direction Y -Direction Max Allowable Standoff Spacing Portrait 48" 65" Max Allowable Cantilever Portrait 17" NA Standoff Configuration Portrait Staggered Max Standoff Tributary Area Trib 22 sf PV Assembly Dead Load W -PV 3.0 psf Net Wind Uplift at Standoff T -actual -422 lbs Uplift Capacity of Standoff T -allow 500 lbs emand Ca aci Standoff Demand/Capacity- DCR 1 84.4% Astrid Blanco From: Jennifer Schramm <jschramm@solarcity.com> Sent: Monday, November 02, 2015 9:26 AM To: Astrid Blanco Subject: FW: -0 * * SolarCity Categories: links and info Hi Astrid, I have updated the notes with the email below. Looks like Mr. Abbay has permission to install. Is the email adequate? Thank you, Jennifer Schramm I Solar Concierge ( Customer Account Management Group I SolarCity I T: 888.765.2489, ext. 63937 1 F: 866.819.7858 1 jschramm@solarcity.com I www.solarcitv.com From: Sami Abbay [mailto:sabbay(@gmail.com] Sent: Sunday, November 01, 2015 10:18 AM To: Jennifer Schramm; Kevin Connolly Subject: Fwd: 0 * * SolarCity 0 Hi Jennifer, Take a look at the email below with permission from our neighbor. Please let me know if that is adequate. If you need a form filled out or a letter, can you please provide a template? Thanks, Senay ---------- Forwarded message ---------- From: Senay Abbay <senba�(a�gmail.com> Date: Saturday, October 31, 2015 Subject: * * * SolarCity * 0 To: Samuel Abbay <sabbayna gmail.com> Begin forwarded message: From: abrelle o verizon.net Date: October 31, 2015 at 3:50:22 PM EDT To: senbn0l@gmaii.com o gmail.com Subject: Re: Fwd: 3:� * * SolarCity 3:� * -3�- Hi Senay, We have no problem with installation of the solar panels on your half of the property. 1 •J April Ferreira 33 Wood Avenue Please let me know if you need anything more formal or with a signature. I didn't see any forms attached. April On 10/30/15, Senay Abbay<senbay01(cDgmail.com> wrote: ---------- Forwarded message ---------- From: Jennifer Schramm <jschram m(osolarcity.com> Date: Friday, October 30, 2015 Subject: * 0 0 SolarCity * * * To: "sabbay(c gmail.com" <sabbaymail.com> Cc: Kevin Connolly <kconnolly(ftolarcity.com> Hello Senay, Hope this email finds you well. I just wanted to let you know the status of your project. It looks like we are unable to obtain permits until a few items are clarified. Since your home is a condo, we will need permission from the Condo Association or neighbor (in the event there is no association) to install. Are you able to obtain approval from either of these so we can move your project forward? Please let me know if I can be of assistance.with this. Best, Jennifer Schramm I Solar Concierge I Customer Account Management Group j SolarCity I T: 888.765.2489, ext. 63937 1 F: 866.819.7858 nisi chramm@solarcity_com larci v.com 'The Comtnoniveatlth ofM=achusetts DTyprrrtnrent of IndustriaiAccidetts Office o0nVestigadons ' 1 Congress Street, Suite 100 Boston, MA 02114-20 7 www inass govldia Workers' Compensation insuranceA.#tdavit: Buitdexs/ComfractursfElectrici:cnslFiumberx Applicant Gtformatian Please Print Le ibl Naine{Husincss(Urganizationlindividual): SolarCity Corp. Address: 3055 Clearview Way City/`ajt&tCfZip: Jan Ivlateo u/-\. u44uL Phone #:000-100-Z,40U Are you ar employer? Check the appropriate box: Type at'project(regairetl): 1. a✓ I am a employer with .5,000 4. ❑ I ant a general contractor and I ❑ Novi, construction ernplayelr_a(fulf and/arpart-time).* 2.❑ 1 aril a sole proprietor or partner- have hired the subcontractors listed on the attached sheet. 7. ❑ Remodeling ship and have no employees Theso sub-wntrmetors have S. Demolition working for me in any Capacity, employees and have workers' ©Building addition [Ala workers' Cotrtp. insurance required.) comp. inswanco? 5. ❑ V9/Ta are a corporation and its 10.[3 Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work officers have exercised their I i.© Plumbing repairs or additions trrysclt. [No Wooers' Comp. right Of ekemptior! Pei-Iv`u,-1 12.E] Roof repairs insurance required.) t c. 152, §1(4), and %ve have no 13Z other Solar/PV employees. (No workers' comp, insurance required.] kAny applieant that chocks boxfl l must also fill out The section below showing their Ivorkas' =mpcovation policy information. t Hameowners who submit this affidavit indicating They are doing all mark and then him oulsido contrsctom crust submit a new atrtdavit indicating such. rCoatracwrs that cheek - this hay must attadhed on additional sheet showing The name of the sub.cornraetors anrt sthtc whether or not thoseeotities have employees. If the su4-oontrb0tors have employees, they roust provide their workers' temp policy number. IC[[I 11� IS 1� 1 inn an employer that isproviding workers' Compensation. h7surance formy employees. Below is thepormey andlah site Information. Insurance Company Tune: Zurich American Insurance Company Policy g or Sel[-ins. Laic. f: WC^�0182015-000 Expiration Date: 9/1/2016 Job Site Addre=. i) U)006 fivLe city/Slate/'Gip: ��CVQC Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required undcr 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 aiE it penalties in the form of a STOP WORK ORDER and a fine of up to $250.00•a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1110 hereby Ceriv—pumiq the paints and penalties of perjury that tine rn, formatlon provided above is true and correct Phone 6., ofricial »se otrfy, Do Trot tPrlte At this area, to be completed by city ar lawn off7ciar. City or Town: Permit/Lteense t# Issuing Authority (circle one): 1. Board of Health 2.Ouilding Department 3. CitylFown Clerk 4. Eleetriml Inspector 5. Plumbing Inspeetor 6. Other Contact Person: Phone ft; T 0 AC Ro CERTIFICATE OF LIABILITY INSURANCE DATE {MMIDD/YYYY) Darl�rzal5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEN. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLfCIE-y BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER_ IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS 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 MARSH RISK & INSURANCE SERVICES CONTACT NAME:_.._....._._..........._... _ . ............ . PHONE 745 CALIFORNIA STREET, SUITE 1300 _1At4.2L*_5xQL_..... .. _ ........................ . ...... .....;nac,- EMAIL CALIFORNIA LICENSE N0.0437153 .......................... _...............................__.�....................... -- SANFRANCISCO, CA 94104 _A_D�Bgss;- _............... INSURERtS] AFFORDING COVERAGE ... - .. , - .......... ... NAIL_# _- - Attn: Shannon Soft 998301-STND-GAWUE-15.16 INSURER A; Zurich American Insurance Comparry 16535 ......... INSURED INSURER 8! MA WA , . + SolarCity Corporalion rNSURER C.: NIA. NIA 3055 Clearview Wap .. ................. ..........� GENERAL AGGREGATE 5. ---- - San Mateo, CA 94402 INSURER 0: American Zurich Insurance Company 40142 PRODUCTS PRODUCTS - COMPIOP AGG ; S ....... ..... INSURERE: ............. .. ... ............. ....._._.. _.. ......_ . __........ _ .. ._. - - +---...... .. . . JECT i... INSURER r: CERTIFICATE NUMBER' 8EA-002713838-08 REVISION NUMBER -.4 COVERAGES 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS................... ._........ .._......7.._......._.................... ..........................TADOL.'SUBRT....._...................—.._.................. IN ...r POurlyEFF .` POLICY EXP -I LIMITS or Marsh Risk a: Insurance Services FR TYPE OR INSURANCE POLICY NUMBER I I MMlDD/YYYY MMIDDIYYYY A X C01MMERCIALGENERALLIABILITY iGLOO182016-00 0910112015 !091011201$ EACH OCCURRENCE $ _ 3,000,(100 _ _ l CLAIMS -MADE X..J OCCUi OAMAGE TO RENTED PREMESES(Eaaccurrescel...,+,5 .._ .._............_ 3 0 --- X SFR: $250,460 F MED EXP (Any one persanl-- 5009 . _. ......................... . PERSONAL & ADV INJURY - S ... _........ 3,000,00{} ........._....... 4 i .................... .........._...... ..........., ...... I, GEN'LAGGREGATELIMITAPPLIESPER .. ................. ..........� GENERAL AGGREGATE 5. ---- - 8,000,000 ---- PRO - X POLICY LOC i PRODUCTS PRODUCTS - COMPIOP AGG ; S ....... ..... B4ODD,OOD ..... ... JECT i... �...._..._................ ........ 5 i OTHER i A ; AUTOMOMLELfABILITY BAP0182017.00 i ;0910112015 09101/2016 COMBINED SINGLE LIMIT g 5,000,D00 X BODILY INJURY (Per person) ANY AUTO X ..i ALL OWNED X SCHEDULED I *BODILY INJURY (Per acc,de,14: S AUTpSAUTOS h- 'NON PROPERTY OWNED. X iHIRED AUTOS rx- AUTOS4COMPICIOLLDED. DAMAGE�� +$ - - - 5,000 '. UMBRELLA UAB`OCCUR :: I .F EACH OCCURRENCE . _ ..., .. _ S ....... ........... +. ......... f......{._i i EXCESS UAB I CLAIMS -MADE _ , AGGREGAT7=... .. - -. i. S.. ... ............... DED I S D IWORKERS COMPENSATION : W00182014.00 (AOS) ;09101f2015 09t01f2018 F X .' STATUTE,;LIrRM..4�. .... ............... A IAND EMPLOYERS' LIABILITY YIN :WC0182015.00 (MA) IANYPROARIETORIPARTNER!EXECUTIVE .... .09111112015 ;09!01!2016 E.L EACH ACCIDENT ' $ _ CIDFIN� .......4. F--- ---- - 1,000,000 �� OFFICERIMEMBER EXCLUDED? ;NIA In NH) I �WC DEDUCTIBLE, $5000DO E.L DISEASE - EA EMPLOYE .$ ._ ._........__... ..... _._ . 1,049,000 - ....._ 0, (Mandetoty If yes, describe under .._ E L DISEASE - POLICY LIMIT I S 1,000,000 DESCRIPTION OF OPERATIONS below I I DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached If more space Is required) Evidence of insurance. CANCELLATION CERTIFICATE HOLDER SolarCity Corporation 3056CieaMawWay 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 or Marsh Risk a: Insurance Services Charles Marmolejo V iy8o-ty-14 M%,WMU %0%jm "llr1K[ lVIY. ngqp.— ,vv ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 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 % 2010-05/11 ;--Office of Consumer Affairs &Business Regulation rad° '1 ``1 ° OME IMPROVEMENT CONTRACTOR t '" Registration: 168572 Type: k X5;3 Expiration: 3/8/2017 Supplement Card SOLAR CITY CORPORATION ASTRID BLANCO 24 ST MARTIN STREET BLD 2UNi ToAhLBOROUGH, MA 01752 Registration: 168572 Type: Supplement Card Expiration: 3/8/2017 Update Address and return card. Mark reason for change. 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