HomeMy WebLinkAboutBuilding Permit #671-14 - 49 WENTWORTH AVENUE 4/1/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
1
Permit N0:_J c Date Received
Date Issued: t 1
'IMPORTANT: Applicant must complete all items on this
- -
LOCATION 14 0�
Print.
PROPERTY OWNER QQNWk -
�y., Print 100 Year Old Structure yesn
MAP NO: PARCELM ZONING DISTRICT: Historic District yesMachine-Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
O.One family
[1Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
(pF rccx eny M+e Q e, Glsxa4steyn
� �Cn - a----4- - -
Identification Please Type or Print Clearly)
OWNER: Name: D.di 'd C Mmak Phone: qPR ° C0�1'3
Address: Q.
CONTRACTOR Name: Phone: I ZA
Address: 1") 11::rwCAV�& M Q, 601OU
Supervisor's Construction License: ?)qco 2.5y. Exp: Date: '1�6
s
Home Improvement License: Exp. Date -
ARCH ITECT/ENGINEER
ate:ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
J3�.Oo -tEt 3a'LIC0.ov r r
Total Project Cosi: $ C -0-2)b FEE: $
Check No.: Sc Receipt No.: r`�- ?�
NOTE: .Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature, of Agent/Owner
Plans Submitted ❑ Plans Waived ❑
Slgiature of contracts I
Certified Plot Plan ❑ S meed Plans ❑
Plans Submitted ❑
Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE-OF-SEWERAGE.DISPOSAL
Public Sewer ❑
Tanning/MassageBodyArt ❑
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
DATE REJECTED
PLANNING & DEVELOPMENT ❑
DATE APPROVED
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
r
} Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes .
Planning Board Decision: Comments
Conservation Decision: Comments
s Water & Sewer Connection/Signature & Date Driveway Permit
DPW Tow2.Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT- Temp Dumpster on site yes no
_Located at 124 Mair,, Street
Fire Departmerit sigriatUre/date
COMMENTS
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
® Notified for pickup - Date
Doe.Building Permit Revised 2010
Building Department
The foli�owing is -a list of the required forms to be filled out for the appropriate. permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
o Building Permit Application
o Workers Comp Affidavit
a Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
a Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
a Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
o 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 apo• -al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc.Building Permit Revised 2012
Location
No. Dateq
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $Tb-��,--
T-
Foundation Permit Fee
Other Permit Fee
TOTAL $
Check # t 5-D —19i
27397 Building Inspector
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Vivint Solar - PV Solar Rooftop System Permit Submittal
1. Project Information
Project Name: DAVID CORDIMA
Project Address: 49 Wentworth Ave, North Andover MA
A. System Description:
The array consists of a 6.75 kW DC roof -mounted Photovoltaic power system operating in parallel with the utility grid. There are (27)
250 -watt modules and (27) 215 -watt micro -inverters, mounted on the back of each PV module. The array includes (2) PV circuit(s). The
array is mounted to the roof using the engineered racking solution from Zep Solar.
B. Site Design Temperature: (From Lawrence MUNI weather station)
Average low temperature: -24.3 °C (-11.74 °F)
Average high temperature: 37.6 °C (99.68 °F)
C. Minimum Design Loads:
Ground Snow Load: 50 psf (State Board BR&S)
Design Wind Speed: 100 mph (State Board BR&S)
2. Structural Review of PV Array Mounting System:
A. System Description:
1. Roof type: Comp. Shingle
2. Method and type of weatherproofing roof penetrations: Flashing
B. Mounting System Information:
1. Mounting system is an engineered product designed to mount PV modules
2. For manufactured mounting systems, following information applies:
a. Mounting System Manufacturer: Zep Solar
b. Product Name:
c. Total Weight of PV Modules and mounting hardware:
d. Total number of attachment points:
e. Weight per attachment point:
f. Maximum spacing between attachment points:
g. Total surface area of PV array:
h. Array pounds per square foot:
i. Distributed weight of PV array on roof sections:
-Roof section 1: (25) modules, (66) attachments
-Roof section 2: (2) modules, (9) attachments
ZS Comp
1161 lbs
75
15.48 lbs/square foot
* See attached Zep engineering talcs
475.47 square feet
2.44 lbs/square foot
16.28 pounds per square foot
9.55 pounds per square foot
%4%4 ,- ,
3. Electrical Components:
A. Module (UL 1703 Listed) Qty
Trina TSM 250-PA05.18 27 modules
Module Specs
Pmax - nominal maximum power at STC - 250 watts
Vmp - rated voltage at maximum power - 30.3 volts
Voc - rated open -circuit voltage - 37.6 volts
Imp - rated current at maximum power - 8.27 amps
Isc - rate short circuit current - 8.85 amps
B. Inverter (UL 1741 listed)
Qty
Enphase M215-60-2LL-S22
27 inverters
Inverter Specs
1. Input Data (DC in)
Recommended input power (DC)
- 260 watts
Max. input DC Voltage
- 45 volts
Peak power tracking voltage
- 22V - 36V
Min./Max. start voltage
- 22V/45V
Max. DC short circuit current
- 15 amps
Max. input current
- 10.5 amps
2. Output Data (AC Out)
Max. output power
- 215 watts
Nominal output current
- 0.9 amps
Nominal voltage
- 240 volts
Max. units per PV circuit
- 17 micro -inverters
Max. OCPD rating
- 20 amp circuit breaker
C. System Configuration
Number of PV circuits 2
PV circuit 1 - 17 modules/inverters (20) amp breaker
PV circuit 2 - 10 modules/inverters (15) amp breaker
uta. grit
D. Electrical Calculations
1. PV Circuit current
PV circuit nominal current 15.3 amps
Continuous current adjustment factor 125% 2011 NEC Article 705.60(B)
PV circuit continuous current rating 19.125 amps
2. Overcurrent protection device rating
PV circuit continuous current rating 19.125 amps
Next standard size fuse/breaker to protect conductors 20 amp breaker
Use 20 amp AC rated fuse or breaker
3. Conductor conditions of use adjustment (conductor ampacity derate)
a. Temperature adder
Average high temperature 37.6 °C (99.68 °F)
Conduit is installed 1" above the roof surface Add 22 °C to ambient
Adjusted maximum ambient temperature 59.6 °C (139.28°F)
b. PV Circuit current adjustment for new ambient temperature
Derate factor for 59.6 °C (139.28°F) 71%
Adjusted PV circuit continuous current 26.9 amps
c. PV Circuit current adjustment for conduit fill
Number of current -carrying conductors 6 conductors
Conduit fill derate factor 80%
Final Adjusted PV circuit continuous current 33.6 amps
Total derated ampacity for PV circuit
33.6 amps
Conductors (tag2 on 1 -line) must be rated for a minimum of 33.6 amps
THWN-2 (90 °C) #10AWG conductor is rated for 40 amps (Use #10AWG or larger)
4. Voltage drop (keep below 3% total)
2 arts:
1. Voltage drop across longest PV circuit micro -inverters (from modules to j -box)
2. Voltage drop across AC conductors (from j -box to point of interconnection)
1. Mirco-inverter voltage drop:
The largest number of micro -inverters in a row in the entire array is 10 inCircuit 1. According to
manufacturer's specifications this equals a voltage drop of 0.48 %.
2. AC conductor voltage drop:
= I x R x D (= 240 x 100 to convert to percent)
_ (Nominal current of largest circuit) x (Resistance of #10AWG copper) x (Total wire run)
_ (Circuit 1 nominal current is 15.3 amps) x (0.0012652) x (190) _ (240 volts) x (100)
2011 NEC Table 310.15(B)(3)(c)
2011 NEC Table 310.15(B)(2)(a)
2011 NEC Table 310.15 (B)(3)(a)
2011 NEC Table 310.15(B)(16)
0.48%
1.52%
Total system voltage drop: 2%
3/22/2014
N.
ZepSotar
Engineering Calculations
3604783 rs 2
Name:
Email:
Phone:
System Details
Module Manufacturer Trina Solar
PV Module TSM-250-PA05.18
Quantity of PV Modules 2
Array Size (kW) 0.500
3604783 rs 2 - Zepulator
Street Address:
Suite/PO#:
City, State, Zip: North Andover, Massachusetts
Country: United States
Mounting System
Manufacturer
Mounting System Type
Roof type
Attachment Type
Module -level
electronics
Zep Solar
ZS Comp
Composition Shingle
Comp Mount, Type C
Enphase Energy - M215 -Z
http://zepulator.comlprojects/51333/summarVeng i neeri ng_pri nt 1/4
3/22/2014 3604783 rs 2 - Zepulator
Engineering Calculations
Design Variables
Description (Symbol)
Value
Unit
Module Orientation
Landscape
37.8 psf
Module Weight
44.8
lbs
Average Roof Height (h)
15.0
ft
Least Horizontal Dimension (Ihd)
30.0
ft
Edge and Corner Dimension "a"
3.0
ft
Roof Slope (0)
22.0
deg
Rafter/Truss spacing
16.0
in
Rafter/Truss dimension
Min. nominal framing member depth of 4"
Basic Wind Speed (V)
110
mph
Exposure Category
B
Ground Snow Load (Pg)
50
psf
Risk Category
II
Topographic Factor (Kt)
1.0
Thermal Factor for Snow Load (Ct)
1.2
Exposure Factor for Snow Load (Ce)
0.9
Effective Wind Area
10
ft2
Snow Load Calculations (Using calculation procedure of ASCE 7-10 Chapter 7)
Description (Symbol) Interior
Edge
Corner Unit
Flat Roof Snow Load (Pf) 37.8
37.8
37.8 psf
Slope Factor (Cs) 0.9
0.9
0.9
Roof Snow Load 33.0
33.0
33.0 psf
Wind Pressure Calculations (Using simplified procedure
of ASCE 7-10 Chapter 27)
Description (Symbol)
Interior
Edge Corner Unit
Net Design Wind Pressure uplift (Pne=-Up)
-19.9
-34.7 -51.3 psf
Net Design Wind Pressure downforce (P„et3o down)
12.5
12.5 12.5 psf
http://zepulator.com/projects/51333/sunworVengineering_print 2/4
3/22/2014
3604783 rs 2 - Zepulator
Adjustment Factor for Height and Exposure Category (A)
1.0
1.0
1.0
Unit
Design Wind Pressure uplift (W„p)
-19.9
-34.7
-51.3
psf
Design Wind Pressure downforce (Wdown)
16.0
16.0
16.0
psf
ASD Load Combinations (Using calculation procedure of ASCE 7-10 Section 2.4)
Description (Symbol)
Interior
Edge
Corner
Unit
Dead Load (D)
2.5
2.5
2.5
psf
Snow Load (S)
30.6
30.6
30.6
psf
Load Combination 1 (D+0.75"(0.6'Wdown)+0.75'S)
30.8
30.8
30.8
psf
Load Combination 2 (D+0.6*Wdown)
12.0
12.0
12.0
psf
Load Combination 3 (D+S)
30.7
30.7
30.7
psf
Uplift Design Load (0.6'D+0.6'W„ p)
-10.5
-19.4
-29.4
psf
Maximum Absolute Design Load (Pabs)
30.8
30.8
30.8
psf
Spacing Calculations
Description (Symbol)
Interior
Edge
Corner Unit
Max allowable spacing between attachments
72.0
72.0
72.0 in
User selected spacing between attachments given a rafter/truss spacing of 16.0 in
32.0
64.0
64.0 in
Max cantilever from attachments to perimeter of PV array
24.0
24.0
24.0 in
Distributed and Point Load Calculations (In conformance with Solar ABC's Expedited Permit Process
for PV System (EPP))
Description (Symbol)
Value
Unit
Weight of Modules
89.6
lbs
Weight of Mounting System
18.77
lbs
Total System Weight
108.37
lbs
Total Array Area
35.23
ft2
Distributed Weight
3.08
psf
Total Number of Attachments
9
Weight per Attachment Point
12.04
psf
http://zepul ator.conVprojects/51333/summarVeng i neeri ng_print 314
3/22/2014
3604783 rs 2 - Zepulator
http://zepulator.con-Vprojects/51333/sumrtiar)#eng ineering_print 4/4
3127/2014
8.
ZepSoiar
Engineering Calculations
3604783
Name:
Email:
Phone:
System Details
Module Manufacturer Trina Solar
PV Module TSM-250-PA05.18
Quantity of PV Modules 25
Array Size (kW) 6.250
3604783 - Zepulator
Street Address:
Suite/PO#:
City, State, Zip: North Andover, Massachusetts
Country: United States
Mounting System
Manufacturer
Mounting System Type
Roof type
Attachment Type
Module -level
electronics
Zep Solar
ZS Comp
Composition Shingle
Comp Mount, Type C
Enphase Energy - M215 -Z
http://mmN.zepulator.conitprojects/51332/summarVengineering_print 1/4
3/27/2014
Engineering Calculations
Design Variables
3604783 - Zepulator
Description (Symbol)
Value
Module Orientation
Landscape
Module Weight
44.8
Average Roof Height (h)
15.0
Least Horizontal Dimension (Ihd)
30.0
Edge and Corner Dimension "a"
3.0
Roof Slope (6)
24.0
Rafter/Truss spacing
16.0
Rafter/Truss dimension
Min. nominal framing member depth of 4"
Basic Wind Speed (V)
110
Exposure Category
B
Ground Snow Load (Pg)
50
Risk Category
II
Topographic Factor (Kt)
1.0
Thermal Factor for Snow Load (Ct)
1.2
Exposure Factor for Snow Load (Ce)
0.9
Effective Wind Area
10
Snow Load Calculations (Using calculation procedure of ASCE 7-10 Chapter 7)
Description (Symbol) Interior
Edge
Corner
Flat Roof Snow Load (Pf) 37.8
37.8
37.8
Slope Factor (Cs) 0.8
0.8
0.8
Roof Snow Load 31.6
31.6
31.6
Wind Pressure Calculations (Using simplified procedure
of ASCE 7-10 Chapter 27)
Description (Symbol)
Interior
Edge Corner
Net Design Wind Pressure uplift (PnetW—up)
-19.9
-34.7 -51.3
Net Design Wind Pressure downforce (PnetBo down)
12.5
12.5 12.5
Unit
psf
psf
Unit
lbs
ft
ft
ft
deg
in
mph
psf
ft2
Unit
psf
psf
http://wrvw.zepulator.comtprojects/51332/summarVengineering_print 214
3/27/2014
3604783 - Zepulator
Adjustment Factor for Height and Exposure Category (A)
1.0
1.0
1.0
Unit
Design Wind Pressure uplift (Wup)
-19.9
-34.7
-51.3
psf
Design Wind Pressure downforce (Wdown)
16.0
16.0
16.0
psf
ASD Load Combinations (Using calculation procedure of ASCE 7-10 Section 2.4)
Description (Symbol)
Interior
Edge
Corner
Unit
Dead Load (D)
2.5
2.5
2.5
psf
Snow Load (S)
28.9
28.9
28.9
psf
Load Combination 1 (D+0.75*(0.6*Wdown)+0.75*S)
29.3
29.3
29.3
psf
Load Combination 2 (D+0.6*Wdown)
11.9
11.9
11.9
psf
Load Combination 3 (D+S)
28.7
28.7
28.7
psf
Uplift Design Load (0.6*D+0.6*W„p)
-10.5
-19.4
-29.4
psf
Maximum Absolute Design Load (Pabs)
29.3
29.3
29.3
psf
Spacing Calculations
Description (Symbol)
Interior
Edge Corner
Unit
Max allowable spacing between attachments
72.0
72.0 72.0
in
User selected spacing between attachments given a rafter/truss spacing of 16.0 in
32.0
64.0 64.0
in
Max cantilever from attachments to perimeter of PV array
24.0
24.0 24.0
in
Distributed and Point Load Calculations (In conformance with Solar ABC's Expedited Permit Process
for PV System (EPP))
Description (Symbol)
Value
Unit
Weight of Modules
1120.0
lbs
Weight of Mounting System
144.38
lbs
Total System Weight
1264.38
lbs
Total Array Area
440.33
ft2
Distributed Weight
2.87
psf
Total Number of Attachments
66
Weight per Attachment Point
19.16
psf
http://wvwv.zepulator.com/projects/51332/summary/engineering_print 314
3/27/2014
3604783 - Zepul ator
http:/Ammv.zepulator.com/proj ects/51332/summary/eng i neeri ng_pri nt 4/4
VV CONSULT114G
Scott E. Wyssling, PE, PP, CME
March 24, 2014
Mr. Dan Rock, Project Manager
Vivint Solar
24 Normac Road
Woburn MA 01801
Wyssling Consulting
321 West Main Street
Boonton, NJ 07005
office (973) 335-3500
cell (201) 874-3483
fax (973) 335-3535
swyssling@wysslingconsulting.com
Re: Structural Engineering Services
Cordina Residence
49 Wentworth Ave., N. Andover MA
AR# 3604783
2.5 kW System
Dear Mr. Rock:
Pursuant to your request, we have reviewed the following information regarding solar panel installation on
the roof of the above referenced home:
1. Site Visit/Verification Form prepared by a Vivint Solar representative identifying specific site
information including size and spacing of rafters for the existing roof structure.
2. Design drawings of the proposed system including a site plan, roof plan and connection
details for the solar panels. This information was prepared by Vivint Solar and will be
utilized for approval and construction of the proposed system.
3. Photovoltaic Rooftop Solar System Permit Submittal prepared by Vivint Solar identifying
design parameters for the solar system.
4. Photographs of the interior and exterior of the roof system identifying existing structural
members and their conditions.
Based on the above information we have evaluated the structural capacity of the existing roof system to
support the additional loads imposed by the solar panels and have the following comments related to our
review and evaluation:
Description of Residence:
The existing residence is typical wood framing construction with the roof system consisting of 2 x 6
dimensional lumber at 16" on center with 2 x 6 collar ties every 32". The attic space is unfinished and
photos indicate that there was free access to visually inspect the size and condition of the roof rafters. All
wood material utilized for the roof system is assumed to be Spruce -Pine -Fir #2 or better with standard
construction components. Our review of the photos of the exterior roof does not indicate any signs of
settlement or misalignment caused by overstressed underlying members.
Stability Evaluation:
A. Wind Uplift Loading
1. Refer to attached ZEP calculations sheet for ASCE/SEI 7-10 Minimum Design Loads for Buildings
and other Structures, wind speed of 100 mph based on Exposure Category "B" and 22 and 24
degree roof slopes on the dwelling areas. Ground snow load is 50 PSF for Exposure "B", Zone 2
per (ASCE/SE17-10).
2. Total area subject to wind uplift is calculated for the Interior, Edge and Corner Zones of the dwelling.
,.� is age 2 of 2
B. Loading Criteria
• 10 PSF =Dead Load roofing/framing 50 PSF = Live Load (ground snow load)
• 5 PSF = Dead Load solar panels/mounting hardware
Total Dead Load =15 PSF
The above values are within acceptable limits of recognized industry standards for similar
structures. Analysis performed of the existing roof structure utilizing the above loading criteria
indicates that the existing rafters will support the additional panel loading without damage, if
installed correctly.
C. Roof Structure Capacity
The photographs provided of the attic space and roof rafters show that the framing is in good
condition with no visible signs of damage caused by prior overstressing.
The dwelling owners shall be made aware that long term build-up of heavy snow conditions may
produce deflections in the roof. If any deflection is noticed, then it is recommended that the solar
panels be cleared of accumulated snow more than one (1) foot deep over a period of one week. If
no deflections are visible under any snow loading over a period of time, then there is no need to
clear the solar panels.
D. Solar Panel Anchorage
1. The solar panels shall be mounted in accordance with the most recent "ZEP Code Compliant
Installation Manual", which can be found on the ZEP website (zepsolar.com). If during solar panel
installation, the roof framing members appear unstable, deteriorated, structurally compromised or
deflect non -uniformly, our office should be notified before proceeding with the installation.
2. Maximum allowable pullout per lag screw is 235 lbs/inch of penetration as identified in the National
Design Standards (NDS) of timber construction specifications for Hem -Fir (North Lumber) assumed.
Based on our evaluation, the pullout value, utilizing a penetration depth of 2'/2", is less than what is
allowable per connection and therefore is adequate. Based on the variable factors for the existing
roof framing and installation tolerances, using a thread depth of 2 '/2" with a minimum size of 5/16"
lag screw per attachment point for panel anchor mounts should be adequate with a sufficient factor
of safety.
3. Considering the roof slopes, the size, spacing, condition of roof, the panel supports shall be placed
at and attached to no greater than every fourth roof rafter as panels are installed perpendicular
across rafters and no greater than the panel length when installed parallel to the rafters (portrait).
No panel supports spacing shall be greater than four (4) rafter spaces or 64" o/c, whichever is less.
4. Panel supports connections shall be staggered to distribute load to adjacent rafters.
Based on the above evaluation, it is the opinion of this office that with appropriate panel anchors being utilized
the roof system will adequately support the additional loading imposed by the solar panels. This evaluation is
based on information supplied to us at the time of this report and current industry standards and practices.
Should you have any questions regarding the above or if you require further information do not hesitate to
contact me.
Ay tr y+E cott
Y E. Wys PE
C, c+v+ v MA Licens o.5 7
0.50
90,E FGISTEP�
FSS/ONA\_
VV CONSULTING
Office of Consumer Affairs end Business R-- e-gu-l-at-i:o-n
10 Park Plaza - Suite 5 170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
VIVINT SOLAR DEVELOPER LLC.
JAMES SHERMAN
4931 NORTH 300 WEST
PROVO, UT 84604
SCA 1 0 20M415h i
ACNI . - Cox.
Vffice of Consumer Affairs & Business Regulation
ME IMPROVEMENT CONTRACTOR
Registration, 170848 Type:
Expiration: 115/2016 Supplement and
VIVINT SOLAR DEVELOPER LLC.
JAMES SHERMAN
4931 NORTH 300 WEST
PROVO, UT 84604
Undersecretary
Registration: 170848
Type: Supplement Card
Expiration: 1/512016
Update Address and return card. Mark reason for change,
[:] Address F-] Renewal [:] Employment � Lost Card
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, MA 02116
Not valid without signature
Massachusetts - i3epartm- ent of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS -045254
JAWS R SBYRX1N C -a
81 MAIN, ST
SAUGUS MA 015W
vr
Expiration
Commissioner 08/28/2014
Boston, MA 02114-2017
m' j^ waa. mass.gov1dla
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Tease Pripi Legibly
Name (Business/Organization/Individual):
Vivirlt Solar Developer, LLC
Address: 4931 North 300 West
Clty/State/Zip: Provo, UT 84604
Phone #:801-704-9389
Are you an employer? Check the appropriate box:
.. Q I am a employer with 10 4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2. ❑ I am a sole proprietor or partner-
ship 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.] "
have hired the sub -contractors
listed on the attached sheet.
These sub -contractors have
employees and have workers'
comp. insurance. t
5. ❑ 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):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.0 Roof repairs
13 . ❑ Other
*Any applicant that checks box 1 must also fit; out the section belaw showing their workers' compensation poticy information.
fi Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new atfdavit 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 ever.ters' compensatioR insupance for my employees. Below as the policy and job site
information.
Insurance Company Name: New Hampshire Insurance Comany
Policy # or Self-ins..Lic. #: 029342228
Expiration Date: 11-01-14
Job Site Address: (t - 1 U-AACUJLXA 1'1 City/State/Zip:
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. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. 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 cern underr.l paint andpenaaltaes of perjury that the information provided above as true and correct.
CivnatiirP• � C��% il� �� �-----� r�_�_. � 1 �7 1 1 I [ .F
Phone #: 507-704-9389
Official use only. Do not write in this area, to be completed by city or town official.
City or Towyn:
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 #:
. 6. O CERTIFICATE OF LIABILITY INSURANCE
��
DATE/2013 /YYYY)
11/01/2013
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
MARSH USA INC.
122517TH STREET, SUITE 1300
DENVER, CO 80202-5534E-MAIL
Attn: Denver.cedrequest@marsh.com, Fax: 212.948.4381
CONTACT
NAME'
AHI No Ext): A No):
ADDRESS:
A
GENERAL LIABILITY
INSURERS AFFORDING COVERAGE NAIC #
iNSURERA: Evanston Insurance Company 35378
462738-STND-GAWUE-13-14
INSURED
91 Solar, Inc.
43
4931 N 300 W
INSURER B ; National union Fire Insurance Cc of PA
NH
INSURER C :ew Hampshire Insurance Company 23841
Provo, UT 84604
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: I SEA -00236600406 REVISION NUMBER:1
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
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MM/DD
POLICY EXP
MM/DD/YYYY
LIMITS
A
GENERAL LIABILITY
13PKGWE00274
11/01/2013
11/01/2014
EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE M OCCUR
DAMAGE TO RE TED 50,000
PREMISES Ea occurrence $
MED EXP (Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 2,000,000
X POLICY PRO-JCT LOC
$
B
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
9701087
9701088
11101/2013
11/01/2013
1110112014
11/01/2014
COEa accident $MBINED SINGLE LIMIT 1,000,000
BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS
( BODILY INJURY Per accident) $
X
HIRED AUTOS X NON -OWNED
AUTOS
PROPERTY DAMAGE $
Per accident
$
A
X
UMBRELLA LIAB
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
13EFXWE00088
11/01/2013
11/01/2014
EACH OCCURRENCE $ 10,000,000
AGGREGATE $ 10,000,000
DED I I RETENTION $
$
G
WORKERS COMPENSATION
029342334; 029342335
11/01/2013
11/01/2014X
WC STATU- OTH-
C
C
AND EMPLOYERS' LIABILITYI
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED?
(Mandatory it NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
029342336; 029342337
029342338
11/01/2013
11/01/2013
11/01/2014
11/01/2014
ER
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
A
Errors & Omissions &
13PKGW00029
11/01/2013
11/01/2014
LIMIT 1,000,000
Contractors Pollution
DEDUCTIBLE 5,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
The Certificate Holder and others as defined in the written agreement are included as additional insured where required by written contract with respect to General Liability. This insurance is primary and non-
ntributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract. Waiver of subrogation is applicable where required by written
ntract with respect to General Liability and Workers Compensation.
CERTIFICATE,HOLDER CANCELLATION
Town of Andover { SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
36 Bartlett Street 999 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
` Andover, MA 01810 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Kathleen M. Parsloe 7yr. 12L¢6'e-
@ 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
4931 North 300 Wes[, Provo, UT 84604 Employer Identification No.: 80-0756438
'M
Massachusetts 141C License No.: 170848
Phone: (877)404-4129 Fax:(801)765-5758
Vivi nt. sol a r E -Mail: supportCvivintsolar.com AR No.:
www.vivinlsolar.com
RESIDENTIAL POWER PURCHASE AGREEMENT
intoThis RESIDENTIAL. POWER PURCHASE AG EEM and therundegrsi¢¢Ied C "Agreement")
a
ml
Delaware
`You"byYour ),taseof fheen lTransactiN INT OnnADateset fonhPbe DEVELOPER, a
Delaware limited liability company ("
�EM
ame {F;r,+, Mr. L-0
Full Name tFirn, M1,, t.°+ri'� avv r� F Owner. O Yu a.a
Customer(s): P°PP1ry Rer` r 13 N.
Telephone No.: .g is, S } ' b3
l: d ran4110•t c ��•
Street Address: li Q wto�wcx P✓ L
Property m� 0��5 'M,.reti ¢ I`t81
Address: City, County, Sate, Zip: Nar Q t�
I. SERVICES
A. DESIGN AND INSTALLATION. We will design, install, service and maintain a solar photovI int system Customerhe Your Propertthe y, which Order will include all
as further describe(
solarp o els to You s, meters, and other ll material ponenssof the Systlemtwill lihe re installed by Our employedttechnic ans and electricians and not tsubcontractors.
will With Your cooperation, We will (i) design, install and connect the System in material compliance with all applicable laws•, (10 that We
may obtain Your
all required
e wpgc Inusagedhiistory from m allrequired
ui electric utility (theifications and "Uhlifl(y and You shall?,rovermits. In Order to viide Us withstera that meets Your copies of Your Utility bills as Ws you agreee may reasonably request
Other than the activation fee described m Section LB, We w111 des' and msall the S st�Inswalil.fio�n
t11 interconnect the System with the Utility, and
B. ACTIVATION. You agree to pay Us a one-ume se rva'on ee m t e amount o
cause the System to generate enemy measured in kilowatt hours ("kWK') (the "En¢f the System generally takes one day and 1s
anticipated to begin nd be substanuatly complete between two (2) i 6 weeks hereYou will have no property interest in the System.
C. OWNERSHIP OF SYSTEM. We shall own the System as Our sole personal property.
D. OPERATIONS AND MAINTENANCE. We will operate and maintain the System (i) at Our sole cost and expense; (ii) in good condition; and (iii) in
immaterial compliance with all applicable laws and permits and the Utility's requirements. propertyinsurance y
t nforINSU con eE. a ca nscommeandltg ser it liacopy of Our nce, well certi a e of i suras e, please visinsation it: www. t ntsolar.coMin uracee System. For more
2, TERM, PRICE PAYMENTS, AND FINANCIAL DISCLOSURES los a licable taxes.
produced b the System, You shall a Us $0.. / r7 per kWh (the "Energy Price"), P hP.
A. ENERGY PRICE. For all Energy p Y Y P Y --d"j• $ k
The Energy Price shall Increase each year by two and nine -tenths percentf) A goo art estimate of the yYstem output, measured m rlowatt hours,
will be provided to You m the Customer Packet. THIS AGREEMENT ISFOA THE SALE OF ENERGY IIY US "I O YOU AND NOT FOR THE SALE OF
A SOLADate (the
R ENERGY DEVICE.nnive twentie
Term') TERM. T"In-Serviceement Datef the In
"shallti the first day after all of the foll)wingsaction Date and ehave been arch eved: (i) a System has rsbaen ins installed anth d isecapable of
inspections and gy, (iii) all permits
erms s n under applicable op claw or System
the Utility ha a been compleed orthe yreceivedstem s been interconnected
with the Utility, and (ivit B) all
C. PAYMENTS. ! e2in dnb the Shstem in heareviloustm monththe . You shall makn-Service Date enmonthlyd throll�aymentsut the lto Us by¢auttorl all send ou ent.t deduan ction 9. Y ur
charges for Energy pmd Y Y dp funds or dp ere is no finan p
chargeaassoctated withcco this Agreement C For all is nnems rorestha. ten ( 0) days past duearWe meat' impose a latee ha ge qual to Twenty Fi a Dollars ($2�)
ill
and Interest at n annual rate of en percent (10%), plus applicable axes. If You continue to fail to n eke ay paymat within ten (10) days after We give
You written notice, then We may exercise all remedies available to Us pursuant to Sectgiron 13
Us andEcNancWelAttLiis At etement(i epurcVlase the Systemta, to (2end of [heon nue tTennsand canceltth s year-to-year
tp ichue Option' )e or (t cancel this
eo..rment and have t e System removed at no.cost io You, Gouw nl ne nd pr peri W Us thewrinthgen curcenconceminfair markettvalue oC(the)Systemnbased hone an
o + nrnvided to You it
RENEW ON A YLAK-ll - - -
DAYS PRIOR TO THE END OF THE RENEWAL TERM.the authorize Us to
F. redin Your
CRE Blend reEport fIn romccredittrcportingthe
ggenc estt(u) [oof ureport Your paymentt and at is Agreenaperform nceny time nunder thisnAg eementbto redit reportingtagacles; and
(iii) disclose this and other information to Our aflillates and actual or prospective lenders, financing parties, investors, insurers, and acquirers.
CREDITS ORE. YOU CAN CHOOSE TO STOP RECEIVING PR SCR EN DED I I'TOFOF] OF CREDIT F OM
567-8688. SEE PRESC
NUS OTICE OTHER (SEC IO 4 29) BELOW FOR MORE INFORMATIOY CALLING TOLL-FREEN ABOUT PRESCREENED OFFERS. EN &OPT -OUT
3. LIMITED WARRANTY
A. LIMITED INSTALLATION WARRANTY. We provide a workmanship warranty that the System shall be free from material defects iof
s in desidgan and
lnstallation.tpWe dor not prolvide any operating
tosfor Youtwith respect to any cc pot nt ont f the rooftop penetrations
amtnufacturinstall arranty sin ddiuon 1 ' re, inoi d,
of, this limited Ido not provide
warranty. This war'rantY does not cover problems resulting from exposure to harmful materials and chemicals, fire, flood,
earthquake, or other acts of god, vandalism alteration of system by anyone not authorized by Us, or any other cause beyond Our control. )
B. MANUFACTURERS'ee AAofRANTemules' electncal outp's solar ut twill not dules egigrade by minimum
more than enruarmflacpercent (1warranty from the original yra ed output and
(a) during the fust ten (10) y gm me g
b doing the first twenty (20) years of use, the modules' electrical output will not years
a Inst defects or twenty
breakdowns. During the Term,ed
on t. The System's inverters carry a minimum manufacturer's warrant often (10) y age
will enforce these warranties to the fullest extent possible.
C. DISCLAIMER OF WARRANTY. EXCEPT AS SET FORTH IN THIS SECTION 3OR STATT , WE MAKE NO OTHER WARRANTY TO
FYOU OR ANY ITNESS FOR ANY IPURPOSE OOF THE TE UIPMENTHER S EXPRESS, INSTALLATION, DESIGN, OPERATIONAS TO TOR MAINTENANCE HE LOF THE
ED PRODUCTION OR
WHICH WEDHER BYELI YEXPRESSLY ENERGY, OR
OURELI LIABILITY FOR ANEXTENT Y VBREACH OF ANY
AGREEmENT.SY ULIMITED
ACKNOWLEDGE THAT WE ARE RIiG THE SYSTEM LYING ON THIS SECTION 3.CR YOUR PROPERTY TO EAS A CONDITION ANDI
.__._ , —Tr n Tl-nc A(IRFFMENT. TI4ERE ARE NO W TIES WHICH EXTEND BEYOND THE
DESCRIPTION OF THE FACE HEREUr. 4 REMOVAL OFTHE SYSTEM
You shall not ill
make any Alterattiyions (as defined in Section ere9 c to the System. If You want to make repYou must gairs or imvrovemeuts((to Your Property that require
rior iivritten notice
(ae`CusPomer re Req�va
ested Shutd "cm). rYou aout
gree that any repairto Pimprovetnnl ioce or Your P' perry shall not mateive Us ats lily altereast yYour roof where the System is
insalled. Ascomense I for Our removal, storage, and remstallatron of the System, You agree to pay to Us a fee equal to Four Hundred and Ninety-Nined
e
5 IC We are unable to timely
arsbere We remove the System. You shall be required to pay the hutdown Paymem (as defined in Section 15 tf the S stem is not reinstall
wit
within t Irty 30)y days of removal. In the event of a emergency affecntrg the System, You shall contact Us tmm late y.
the cmergemi maYtiutshall be rc pons tile foe any damage to the Sysemgthart redsultslfrom acluons taken byremove tYourcontractor.stem as cessary to make repairs required by
5. ARBITRAiIcc
yTION OF DISPUTbcainour ES
ce
customer service department is unable to resolve Yotuge n crit You a dIIWe agree tosresolve anyyer iDisdppu a (as defined bel)DwG)0
th4ougg9h bindOnggr
THATtt((I) YOU ARE HEREBY WAIVING THE RIGHT T� A TRIAL BY JURY AND (I) OYOUYMAY BRINOG CLAIMS AGAINSTRUS
REPRESENTOATIVE PROCEEDING. You and We agreepto arbitrate allldispues, calm end ontroversies arsingOoutToflorCrelaling
m.,.,nnwserrs imn r,z>.,
ems v{, t.-.i�, a<,�i„i,�:. i.t.c. An a,S•m>a.u:�::a.
(i) any aspect of the relationship between You and Us, whether based in contract, tort, statute or any other legal theory; (ii) this Agreement or
any other agreement concerning the sul'ect matter hereof; (iii)gany breach, defaultination , or termination of this Agfreement; and (iv) the
interpretation,
p pure) prior o commencing arbitration, this
aAarty mut firsts etnd athe
written Notice of Di pthe utscope or is ceittifiedlmail to the this Sect
c ernpe tharDrtyacThe
Notice
f Dispute
ute must daysa thenbeithernparty may commence and as.is for the Darbiitratioispute n tThe he tarbitrat�ou%n siefs hall beYOU aadministered bnd We are y JAMS to IPvursu le The
nd
Streamlined Arbitration Rules and Procedures (available at: http://www.1amsadr com/rules-streamlined-arbitration,er the the "JAMS Rules") the
and
mat
under the rules set forth in this Agreement. The arbitrator shall be bound by the terms of this Agreement. No
Youinitiate azbitration,SYou
arbitrator shall not award punitive, s ctal, exemplary, indirect, or consequential damages to either party.
shall be responsible to pay $250. A�attomeys' fees, travel expenses, and other costs of the arbitration shall be home by You and Us in
accordance with the JAMS Rules and appplicable law. The arbitration shall be conducted at a mutually agreeable location near Your Property.
Judgment on an arbitration award may be entered in any court of competent jurisdiction. No
in this Section 5 shall preclude You or We
from seeking provisional remedies in aid of arbitration from a court of competent jurisdiction.
NOTICE: BY INITIALING IN THE SPACE BELOW YOU ARE AGREEING TO HAVE ANY DISPUTE ARISING OUT OF THE
MATTERS NCUDED IN THE "AITRATIONR OVI EDIBYLAPPLICABLE LAW AND YOU ARE GIVING SUP ANY SRIGHTS ION CYOU MIGHT POSSESSIDED BY RTO HAVE THE
DISPUTE LITIGATED IN A COURT OR JURY TRIAL. BY INITIALING IN THE SPACE BELOW YOU ARE GIVING UP
YOUR JUDICIAL TO DISCVERY AGREEING TO THISH ROIS'ION, YOU MAY P
BECOMPEL LED TD APPEAL. IF YOU OARBITRATE.BSUBMITFUSE TO YOUR A43REEMEN TTO THIS
SUBMLTADISPUTESARI5NG OUT OF THE MATTERS INCLUDED IN THE "BARB TRATIONTAND THE OOF DISPUTES" ROVISIOREGOING AND AGREE N
Custome,(s Initials:
TO NEUTRAL ARBITRATION.
I/WE AGREE TO ARBITRATION AND WAIVE. THE RIGHT TO A JURY TRIAL:
6. NOTICE TO CUSTOMERS
A. LIST OF DOCUMENTS TO BE INCORPORATED INTO THE CONTRACT: (i) this Agreement, (ii) the Additional Terms and
Conditions, (iii) the Customer Packet, and (iv) the Work Order. These documents are expressly incorporated into this Agreement and apply
to the relationship between You and Us.
IT IS NOT LEGAL FOR US TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE
TO REMOVE GOODS INSTALLED UNDER THIS AGREEMENT.
C. DO NOT SIGN THIS AGREEMENT BEFORE YOU HAVE READ ALL OF ITS PAGES. You acknowledge that You have read
and received a legible copy of this Agreement, that We have signed the Agreement, and that You have read and received a legible copy of
every document that We have signed during the negotiation.
D. DO NOT SIGN THIS AGREEMENT IF THIS AGREEMENT CONTAINS ANY BLANK SPACES. You are entitled to a
completely titled G copy IS this Agreement, signed by both You and Us, before any work may be staION AT ANY TIME PRIOR TO THE LATER OF: rted.
(E. YOU 3tti) BUSINESS SS DAY AFTER THE TRANSACTION DATE, OR (ll) THE START OF INSTALLAT OIN OF THEYSTEM. SEENIGHT OF THE E
THE NOTICE OF CANCELLATION BELOW FOR AN EXPLANATION OF THIS RIGHT.
VIVNT SOLAR DEVELOP R, LC CUSTOMER(S):
By: By.
t Printed Name:
Printed Name:
B•
Title:
y:
Printed Name:
Transaction Date:
FOR INFORMATION ABOUT CONTRACTOR REGISTRATION REQUIREMENTS, CONTACT THE MASSACHUSETTS
OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION: TEN PARK PLAZA, SUITE 5170, BOSTON, MA 02116,
(617) 973-8700 OR 888-283-3757. --------,
------------------
NOTICE OF CANCELLATION
Transaction Date:
YOU MAY CANCEL THIS TRANSACTION, WITHOUT ANY PENALTY OR
DAYS OF THE ABOVE DATE, OR (IF LATERLt
PA ENTS MADE
CANCEL, ANY PROPERTY TRADED IN, ANY B
NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETUR
FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION
ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU C
THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CON
DELIVEREDOFT H THE REGARDING HE REUNDER THIS CONTRACT ORTURN SH SHIPMENT OR YOU (
INSTRUCTIONS UT
AND RISK. IF YOUWITHIN TWENTY(DO MAKE THE GOODS AVAILABLE TO HE SELLER A
OF CAN
OF HE GOODS WITHOUT ANY FURTHER OBLIGATION. DAYS OF THE DATE OF YOURrIF YOU ICE I
SELLER, OR IF YOU AGREE TO RETURN THE GODS TO THE SELLER
...ur v cnu vt+RFORMANCE OF ALL OBLIGATIONS UNDER THE CON
START
Date:
VER A SIGNED AND DATED CC
VD
(VIVINT SO
) TELEGRAM,
OO
OF THE THIRD
AL ATION OF THE SYSTEM. I H
Ut_'. All RI&I 11e.c11"1
Customer's Signature:
AR No.:
TION, WITHIN THREE 1.3) BUSINESS
ATION OF THE S ST EN IF
1.3)
ANY
✓ITHN TEN (10) BUSINESS DAYS
E, AND ANY SECURITY INTEREST
YOU MUST MAKE AVAILABLE TO
I' AS WHEN RECEIVED, ANY GOODS
YOU WISH, COMPLY WITH THE
GOODS AT THE SELLER'S EXPENSE
E SELLER DOES NOT PICK THEM UP
ON, YOU MAY RETAIN OR DISPOSE
LE THE GOODS AVAILABLE TO THE
AIL TO DO SO, THEN YOU REMAIN
TO CANCEL HIS TRANSACTION,
NOTICE OR ANY OTHER WRITTEN
N 300 W, PROVO, UT 84604 PRIOR TO
E TRANSACTION DATE, OR (H) THE
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