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Building Permit #054-2017 - 59 ADAMS AVENUE 7/18/2016 (2)
t%OR BUILDING PERMIT of "Go "l E �.Ty TOWN OF NORTH ANDOVER s6 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received gDR•�7ED �gSSACH�S�� Date Issued: l IMPORTANT:Applicant must complete all items on this page LOCATION 52 A MI:r Aye Print PROPERTY OWNER AA r,P. C k1e tt � Print 100 Year Structure yes no MAP PARCEL:n` \ ZONING DISTRICT: Historic District yes(: no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building )dOne family ❑Addition 0 Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial 0 Repair, replacement ❑Assessory Bldg ❑ Others: 0 Demolition ❑ Other e-t I 'I©oda eta ds W to e• t .,tr -t e ew. DESCRIPTION OF WORK TO BE PERFORMED: nnec� �j Ylem6 Z-F v-:gP7,e/_r Identification- Please Type or Print Clearly OWNER: Name: Phone: Rl?• Z5 0 Address: Contractor Name: Phone: 9l,9•z I S ' 03ko Email: Address: o lFY7 Supervisor's Construction License: Exp. Date:_qV-111-3 fzal6 _ Home Improvement License: ,,G8 572 Exp. Date: 3Lp ark ARCHITECT/ENG INEER— �010W&y/J0SOn—To_m,5L4 Phone:_ ,,, sv - 639 YOa � Address: moss Clecv-1Au o wav .G�� I►'4alTuClf� Reg. No. 6-I SS� FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ��, ()bcU FEE: $ 77 Check No.:__-7800c1 c,� Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. it.: I 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 I I i I ❑ Notified for pickup - Date Doc:.Building Pemiit Revised 2008mi --— F J 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract u Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products (VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application o Certified Surveyed Plot Plan u Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) u 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) Li Building Permit Application u Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses Li Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract u 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 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: Doc.Building Permit Revised 2008mi ?.i - F_ 1 NORTH .c . . ver 0 No. Uri 1-2611irlwl� : Lfth ver, Mass, 2z lw COCNIC.§WICKa1_ . ��S R1Teo �Q ��S U BOARD OF HEALTH LD Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT..... V�.....4 BUILDING INSPECTOR has permission to erect buildings on ..04J #j ".� Foundation .......................... ... .... .... . . ................... p .. ...........I... Z. 74..# Rough y t0 be OCCU ied as .. ....... 1!. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TIO Rough Service ..... . .. . ...... ..... ............ Final BUILDI IN ECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Version 456.4-TBD � PIL .1"adarG May 3, 2016 RE: CERTIFICATION LETTER Project/job#0183774 -- Project Address: Meckel Residence 59 Adams Ave c' North Andover,MA 01845 g JASON WILLIAM yu, g TOMAN , AHJ North Andover o STRUCTURAL v SC Office Wilmington A No.51554 Q 0- Design Criteria: ONAL -Applicable Codes= MA Res. Code,8th Edition,ASCE 7-05,and 2005 NDS 016 -Risk Category= II -Wind Speed = 100 mph,Exposure Category C -Ground Snow Load = 50 psf -MPI: Roof DL=8.5 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. Additionally,I certify that the PV module assembly including all standoffs supporting it have been reviewed to be in accordance with the manufacturer's specifications and to meet and/or exceed all requirements set forth by the referenced codes for loading. The PV assembly hardware specifications are contained in the plans/docs submitted for approval. Digitally signed by Jason Toman Date:2016.05.03 11:06:04-07'00' I :50055 Ciearview%,Jay San Mateo,CA 94402 =(650)638-1028 (888)SOL-Ct1Y r(650)638-1029 scJarcitp c--m y Version#56.4-TBD r � PIL ,;-,,..-,,,So1aHARDWARE DESIGN AND STRUCTURAL ANALYSIS RESULTS SUMMARY TABLES Landscape Hardware-Landscape Modules'Standoff Specifications Hardware X-X Spacing X-X Cantilever Y-Y Spacing Y-Y Cantilever Configuration Uplift DCR MPI 64" 23" 39" NA Staggered 50.3% Portrait Hardware-Portrait Modules'Standoff Specifications Hardware X-X Spacing X-X Cantilever Y-Y Spacing Y-Y Cantilever Configuration Uplift DCR MPI _32" 15" 65" NA Staggered 41.9% Structure Mounting Plane Framing Qualification Results Type Spacing Pitch Member Evaluation Results MPI Stick Frame @ 16 in.O.C. 220 Member Analysis OK Refer to the submitted drawings for details of information collected during a site survey. All member analysis and/or evaluation is based on framing information gathered on site.The existing gravity and lateral load carrying members were evaluated in accordance with the IBC and the IEBC. i I 3055 Clear-vietir`Way San Mateo,CA 94402 *#660)638-1,028 (888)3OL-CITY r(6of 636-1029 solarciry,com STRUCTURE ANALYSIS- LOADING SUMMARY AND MEMBER CHECK- MP1 Member Properties Summary MPl Horizontal Member Spans Rafter Pro erties Overhang 1.41 ft Actual W 1.50" Roof System Pro erties Span 1 11.15 ft Actual D 5.50" Number of Spans(w/o Overhang) 1 San 2 Nominal Yes Roofing Material Comp Roof San 3 A 8.25 in.^2 Re-Roof No Span 4 S. 7.56 in.^3 Plywood Sheathing No Span S I 20.80 in.^4 Board Sheathing Solid-Sheathing Total Rake Span 13.55 ft TL Defl'n Limit 120 Vaulted Ceiling No PV 1 Start 3.25 ft Wood Species SPF Ceiling Finish 1/2"Gypsum Board PV 1 End 12.50 ft Wood Grade #2 Rafter Slope 220 PV"2 Start Fb 875 psi Rafter Spacing 16"O.C. PV 2 End F„ 135 psi Top Lat Bracing Full PV 3 Start E 1400000psi' Bot Lat Bracing At Supports PV 3 End Em;,, 510000 psi Member Loading mary Roof Pitch 5/12 Initial Pitch A 'ust Non-PV Areas PV Areas Roof Dead Load DL 8.5 psf x 1.08 9.2 psf 9.2 psf PV Dead Load PV-DL 3.0 psf x 1.08 3.2 psf Roof Live Load RLL 20.0 psf x 0.95 19.0 psf Live/Snow Load LL/SL 1,2 50.0 psf x 0.7 1 x 0.7 35.0 psf 35.0 psf Total load(Governing LC TL 44.2 psf 47.4 psf Notes: 1. ps=Cs*pf;Cs-roof,Cs-pv per ASCE 7[Figure 7-2] 2. pf=0.7(Ce)(Ct)(IS)py; Ce=0.9,Ct=1.1,I5=1.0 Member Design Summa (per NDS Governing Load Comb CD CL + Cl CF Cr D+S 1.15 1.00 1 0.60 1 1.3 1.15 Member Analysis Results Summary Governing Analysis Max Demand @ Location I-Capacity Result Bending + Stress 1499 psi 7.1 ft 1504 psi 1.00 Pass i CALCULATION Of DESIGN WIND LOADS - MP1 Mounting Plane Information Roofing Material Comp Roof PV System Type SolarCity SleekMount1m Spanning Vents No Standoff Attachment Hardware Comp Mount Type C Roof Slope 220 Rafter Spacing 16"O.C. Framing Type Direction Y-Y Rafters Purlin Spacing X-X Purlins Only NA Tile Reveal Tile Roofs Only NA Tile Attachment System Tile Roofs Only NA Standin Seam/Trap Spacing SM Seam Only NA Wind Design Criteria Wind Design Code ASCE 7-05 Wind Design Method Partially/Fully Enclosed Method Basic Wind Speed V 100 mph Fig. 6-1 Exposure Category C Section 6.5.6.3 Roof Style Gable Roof Fig.6-11B/C/D-14A/B Mean Roof Height h 15 ft Section 6.2 Wind Pressure Calculation Coefficients Wind Pressure Exposure KZ 0.85 Table 6-3 Topographic Factor Kn 1.00 Section 6.5.7 Wind Directionality Factor Kd 0.85 Table 6-4 Im ortance Factor I 1.0 Table 6-1 Velocity Pressure qh qh=0.00256(Kz)(Kzt)(Kd)(VA2)(I) Equation 6-15 18.5 Psf Wind Pressure Ext. Pressure Coefficient U GCp(Up) -0.88 Fig.6-11B/C/D-14A/B Ext. Pressure Coefficient Down GCp(Down) 0.45 Fig.6-116/C/D-144/6 Design Wind Pressure p p=qh(GCp) Equation 6-22 Wind Pressure U „ -16.2 psf Wind Pressure Down 10.0 Psf ALLOWABLE STANDOFF SPACINGS X-Direction Y-Direction Max Allowable Standoff Spacing Landscape 64" 39" Max Allowable Cantilever Landscape 23" 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 -252 lbs Uplift Capacity of Standoff T-allow 500 lbs Standoff Demand/Capacity DCR 50.3% X-Direction Y-Direction Max Allowable Standoff Spacing Portrait 32" 65" Max Allowable Cantilever Portrait 15" NA Standoff Configuration Portrait Staggered Max Standoff Tributary Area Trib 14 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at Standoff T-actual -209 lbs Uplift Capacity of Standoff T-allow 500 lbs Standoff Demand/Capacity DCR 1 41.9% DocuSign Envelope ID:46046C63-C1264621-8AB9-D257FF89C6E4 SolarCity PPA Customer Name and Address Installation Location Date 7/6/2016 June M Eckel 59 Adams Ave 59 Adams Ave North Andover,MA 01845 North Andover,MA 01845 177 �`�' T titer are the keyrterims of your Power Pu chase Agreeme t ` j fj1 20 rs 17 5 sIle installation cost Electricity rate per kwh_'_ Agreement Term DS Initial here ._ � Initial here The SolarCity Promise DS •We guarantee that if you sell your Home,the buyer will qualify to assume your Agreement. ....... ......... . .. . ............ initial here _J_�"t •We warrant all of our roofing work. •We restore your roof at the end of the Agreement. D5 •We warrant,insure,maintain and repair`the Systeim. . . . ..... ....: .. .. .......... ......... ...... ...... . . ......... .. ... .. Initial ere _...._ ....... •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 reverincreaseby more than 2.90%per year. •The pricing in this Agreement is valid for days after 5/3/2016. Yo.ur.Solall Power Purchase Agreement Details Your Choices at the End of the Initial Options for System Purchase: Amount.due at nntract Signing i Term: s, * � . At certain times,as specified in $0� •SolarCity will remove the System at no the Agreement,you may cost to you. `Eif arno6t flu at Installation y purchase the System. $b •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 flue at buildifg inspection contract. not beyond that term. $0 •You may'purchase the System from Est.first year production SolarCity for its fair market value as 2,802 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 888.765.2489 solarcity.com 1806166 Power Purchase Agreement versioPa 9 2.0;Warch 28,20* SAPC/SEFA Compliant Contractors License MA HIC168572/EL-1136MR Document generated on 5/3/2016 [9 Copyright 2008-2015 SolarCity.Corporation,All Rights Reserved DocuSign Envelope ID:46046C63-C126-4621-8AB9-D257FF89C6E4 23. NOTICE OF RIGHT TO CANCEL. I have read this Power Purchase Agreement and-.,the Exhibits in YOU MAY CANCEL THIS CONTRACT AT ANY TIME PRIOR their entirety and I acknowledge that I have received a TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE complete copy of this Power Purchase Agreement. DATE YOU SIGN THIS CONTRACT. SEE,-EXHIBIT 1.THE ATTACHED NOTICE OF'CANCELLATION FORM FOR AN Customer's Name:June M Eckel. EXPLANATION OF THIS RIGHT. —DoW31g6ed bV: _ 24. ADDITIONAL RIGHTS TO CANCEL, Signature: `s. ,-. .�f IN ADDITION TO ANY RIGHTS YOU MAY HAVE TO CANCEL EoeeweEcooensc THIS PPA UNDER SECTION 23,YOU MAY ALSO CANCEL Date: ` 7/,61-2016 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 5/3/2016. Customer's Name: If you don't sign this PPA and return it to us on or prior to 30 days after 5/3/2016,SolarCity reserves the right to Signature: reject this PPA unless you agree to our then current pricing. Date: Power Purchase Agreement Solna rCity approved Signature: Lyndon Rive, CEO Date: =5/3/2016 {�gWfl Purcha e Ag ecr'lent,vcisi:l _,L.O,mar.lh B )� 7806166 7. 7 The Commoniveallth ofMamachusetts Departarent ofludusirialAceidernts Office ofInvesdgadens ' 1 Congress Street,Suite 100 Boston,MA 02114-2017 www tsmass.gov/dia "Werkers,Compensation Insurance Affidavit.Builders/Contractors/Elcctriciansiplumbers Applicant Inll'ormatian Please Print Le Uhl Name(1lusincss/organizationlfndividuiti): SolarCity Corp. Address: 3055 Clearview Way city/statefip: San Mateo CA. 94402 Phone#:888-765-2489 Are you ar employer?Check the appropriate box: Type of project(regnireti): 1.a✓ I am it employer with 15,000 4. ❑ I ani a general contractor and I empiuyet3s(full andloroart-time}. have hired the sub-contractors 0 Q Now construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet_ 7. ❑Remodeling ship and have no employees These sub wntractors have g, Q Demolition working for me in any Capacity, employees and have workers' [Noworlers' comp.insurance comp.insurauce.t []Building addition required.] 5. Q We are a corporation and its 10.❑Electr€Cal repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself into workers' camp. rls,lituf uXualptton pr MIUL p l2.❑Roof repairs insurance required.J t c- 152,§1(4),and we have no employees.tWo workers' i3ZOther Solar/PV comp, insurance required. *Any applicant that cbecka box N t must also fall out the section Wow showing their workers'compensation policy information, t ttameowners who submit this affidavit indicating they are doing all work and then litre otnsido rontractots must submit a naw atfrdavit indicating such, tContracrnrs that cheat,this box must attached an additional sheat showing the name ofthe sub•contraaotsand stats wheliter or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp policy number. Yarn att employer that isprovkang workers'compensation instrrnnee far my employees. Below is tlrepolicy andlob site informat&ate. Insurance company Name: Zurich American Insurance Company Policy 9 or Sc€€-ins.Lic.#: WC0182015-00 Expiration Elate: 9/1/2016 Job site Address: 59 Adams Ave city/State/zip: N. Andover MA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date}. Failure to secure coverage as required under Sectien 25,E of MGL c. I52 can lead to the imposition of crrninal penalties of a fine up to 51,500.00 andlor one-year imprisonment,as well as civil penalties in the firm of a STOP WORK ORDER and a fine of up to$250,00-a day against the violator. Be advised thata copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. r da�eeylylj pants anrtpenalties gfpprjt[ry that tJre informationprovided above is true and correct Si Date: 7/18/2016 Phone ii; Official use only, leo not ivrhd iY this area,to be campleted by city ar town official. City or Town: Permit/Limuse tf Issuing Authority(circle one): 1.Board of Health 2.11ailding Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Uther Contact Person, Phone#: ATEj!I1MIDF CERTIFICATE OF LIABILITY INSURANCE D0811712015oNYVY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION 1S WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH RISK& INSURANCE SERVICES NAME PHONE FAX.. .,... -- 345 CALIFORNIA STREET,SUITE 1300 dRtc.�r Ext1�....._......... .... .. ..... . . ........ 1A1C,Nola .. ..... ........ ................... CALIFORNIA LICENSE N0:C437163 E-MAIL SAN FRANCISCO,CA 94104 _nonRgss. .... ........... ... ...... .. ... ..... . ............ .._.... ....._. ......T.. ..... .... Alin:Shannon SwU415-743.83M ,._.. . ...... -INSURER(S)AFFORDING COVERAGE NAIC# _ 998301-STND-GAWUE-15.16 INSURER.A;Zurich American Insurance Company 16535 INSURED INSURER 8:NIA -NIA SolarCity Corporation _... .1- ....... . .. +. .. 1055 Clearview Way [HSURER c:NIA NIA SanMateo,CA 94402 _.. _. ......... ... .... .. . ., ..... ... .... .... ._ .._. .........._.... ........._. ........+....... ......... . INSURER.[,:American Zurich Insurance Company :40142 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-002713636.08 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 PAID CLAIMS. IHSit ... ......TYPE OF INSURANCE'. .. . .....TAOOL SUBR.. _. ..._.. . .—...... ......... ... .POLK:Y EFF POLICY EXP ..... ......... _LIMITS ......._"._.-- ._ -.. LTR POLICY NUMBER I M10D1YYYY MMf A X GOMMERc1ALGENERAF uaealTY AL00182015-00 09!0712415 091011201$ .... EACH OCCURRENCE $ 3000.000 EA DAMAGE T AtNTED _._...� . CLAIMS-MADE x]OCCUR I ! PREMtSES(EAp9wrmol,__t.5 _."_.._.__._ „_._ _ 3,000,000 X SOI $25Q000 MED EXP(Any one perscn} 5 5,000 ...... ................................._.......... . . ...... r.....,._..... _......,...,...... ._ .-........_.._._ r ._..._...... ................._.._.....-............. PERSONAL&ADV INJURY -S 3,000,000 4 -. - __.-._......._._.. ........._...._.. GEN'LAGGREGATE LIMITAPPLIES PER !GENERAL AGGREGATE 5. 6,000,000 (..... PRO• x i POLICY ;J£CT ;... LOC i PRODUCTS•COMPIOP AGG S 6,000,0{?0 OTHER 5 A AUTOMOBiLELIA9ILITY BAP0%2017.00 :0910112015 091012016 COMBINED SINGLE LIMIT $ 3,000,000 :ffa.accodenl)...- -. x ANY AUTO BODILY INJURY(Par person) S – 'ALL OWNED SCHEDULED ,-.... .. X AUTOS x AUTOS ,BODILY INJURY(Per accident);5 e. .., f.... ! L - .,.. .y........... ...... ... ... . ........... NON-OWNED •PROPERTYDAMAGE 'x �HIREDAUTOS fix, AUTOSFiPeraccident) +� .. .......... ................ COMPICOU.DED. X5,000 UMBRELLA LIAR 'OCCUR ....' I °EACH. OC..C......URRE.NN.CE. $ }......d i r .. ....... . ...._. .....a.._..... ........ i .-iCLAIMS-MADE' AGGREGATE 3 EXCESS LIAB .... 'r r...... ... .. ..,..... DED R.ETENTIONS 5 D !WORKERS COMPENSATION WC0182014.00(AOS) 10910112015 J01 016 ; x PER OTH- ' 'AND EMPLOYERS'LIABILITY YIN F."...�STATUTE_;_..... ER A ANY PROPR€ETORIPARTNERIEXECUTIVE WC0182015.00{MA) 09101/2015 09101/2016 9,000,000 ' If EACH ACCIDENT ...a$. 'OFFICER/MEMBER EXCLUDED? a.N/A: F_ CI.E T .,. ...,. (Mandatory in NMI I WC DEDUCTIBLE:$500,000 �E.L DISEASE•EA EMRLOYE 'S 1000,000 It yes.describe under I _.._................ ..... ._......�....... ._.. . DESCRIPTION OF OPERATIONS below I E L DISEASE-POLICY LIMIT I$ 1.000,000 i I DESCRIPTION OF OPERATIONS 1 LOCATIONS]VEHICLES(ACORD 101,Addillonal Romarks Schedule,may be attached It more space Is required) Evidence of insurance. CERTIFICATE HOLDER CANCELLATION SolarCity Corporation SHOULD ANY OF THE ABOVE:DESCRIBED POLICIES BE CANCELLED BEFORE 3055CiearviewWay THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 1N San Mateo,CA 99402 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk a:Insurance Services Charles Marmolejo '��--- U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD .Fk �da`r' 9 e"/>° rlri` .+.r}tr�,�g,✓"� r f - t�68`r.�.tt'�f.!''fP'.lr't'} a Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 168572 Type: Supplement Card SOLAR CITY CORPORATION Expiration: 3/812017 DAN FONZI 24 ST MARTIN STREET BLD 2UNIT 11 --- - - ---- -- MARLBOROUGH, MA 01752 Update Address and return card.Mark reason for change. r, Address J Renewal F� Employment ;_ Lost Card f ice of Consumer Affairs&Business Regulation License or registration valid for individul use only 4+10ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 168572 Type: 10 Park Plaza-Suite 5170 Expiration: 3/8/2017 Supplement Card Boston,MA 02116 SOLAR CITY CORPORATION DAN FONZi y 3055 CLEARVIEW WAY . .-• -.- — s-� SAN MATEO,CA 94402 Undersecretary Not valid without signature �nso C$-151687 DANIEL FONZ--' 15 KELLEY RD WH2*ENGTON MA 01307 09/1312016 DocuSign Envelope ID:46046C63-C126-4621-8AB9-D257FF89C6E4 23. NOTICE OF RIGHT TO CANCEL. I have read this Power Purchase Agreement and the Exhibits in YOU MAY CANCEL THIS CONTRACT AT ANY TIME PRIOR their entirety and I acknowledge that I have received a TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE complete copy of this Power Purchase Agreement. DATE YOU SIGN THIS CONTRACT. SEE EXHIBIT 1,THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN Customer's Name:June M Eckel EXPLANATION OF THIS RIGHT. �DoeuSlgmd by! 24. ADDITIONAL RIGHTS TO CANCEL. Signature: i 9i ,A), Vit. f_ZW, IN ADDITION TO ANY RIGHTS YOU MAY HAVE TO CANCEL EOB6606ECDDB48C... THIS PPA UNDER SECTION 23,YOU MAY ALSO CANCEL Date: 7/6/2016 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 5/3/2016. Customer's Name: If you don't sign this PPA and return it to us on or prior to 30 days after 5/3/2016,SolarCity reserves the right to Signature: reject this PPA unless you agree to our then current pricing. Date: Power Purchase Agreement i SolarCity approved Signature: Lyndon Rive, CEO Date: 5/3/2016 ,r w,. r Furdiase A.greemcnt,v rsicn x.2.0;Marc"2F,2016 ov"maonEnvelope ID:4so4ocoo-C1us4ou1 | ��� -~~~ | ~�^ �~�« | PPA / Customer m,mrand Address Installation Location Date 7/6/2016 '| June xA Eckel E9Adams Ave � 59Adams Ave North Andover,MA 01845 � North Andover,N140z845 ` | Here are the key terms ufyour Power Purchase Agreement � m� - , coSo �� �� ~�o� ��� ~ System installation cost Electricity rate per 4VVh Agreement Term � Lj�D m Initial here Initial here The SofarCitm Promise DS •We guarantee that if you sell your Home,the buyer will qualify to assume your Agreement. Initial here 2~_f �� °VVewarrant all ofour roofing work. °VVerestore your roof atthe end ofthe Agreement. DS "VYewarrant,insure,maintain and repair the System. -...................................................................................................................................... ................................. ............... initial here ,VVefix orpay for any damage wemay cause tuyour property. ,VYeprovide 24/7web-enabled monitoring otnoadditional cost. ,The rate you pay us will never increase by more than 2.90%per year. "The pricing inthis Agreement isvalid for 3Odays after 5/]/2Ol6. Your SolarCity Power Purchase Agreement [Details ' Your Choices utthe End ofthe Initial Options for System Purchase: � Amount due atcontract signing Tenn' ^At certain times,as specified in $o ,So|arCitywill remove the System atno the Agreement,you may co�ttoynu purchase�heSy��em Es�a�oun�duea0�n�a||ation � . $O ,You can upgrade toa new System with ^These options apply during the 20 --- the latest solar technology under anew year term ofour Agreement and Est.amount due atbuilding inspection contract. not beyond that term. $V "You may purchase the System from Est.first year production 3o|arCio/for its fair market value as 2,802 kWh specified inthe Agreement. ,You may renew this Agreement for upto ten(l0)years intwo(2)five(5)year increments. 3055 Clea,viexoWay,San Mateo,CA 94402 | 888'765.2489 | mokmrchy'corn Power Purchase Agreement,version ez4March z8,2016 SApC/sFmc"mplum . Contractors License Mxmc16or2/EL-113mwn Document generated""5/auo10 Copyright umv-2oz5w/",c/*Corporation,All Rights Reserved D5- 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) I f ® Notified for pickup Call Email t Date Time Contact Name I Doc.Baildiug 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 16 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 s (If Applicable) i Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products . OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 4z Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses E iL Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) iL Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application i i Doc:Building Permit Revised 2014 COMiVI"NT, ---- i _.. LD, ,P r:ursP- if D b ut4 vemi Imv35 v...x u Town of North Andover,MA Q eer.h O- A 20935 *Electrical Permit-IN Conjunction with a Building Permit(Commercial or Residential) TIMELINE ® submission received (/ Your request is in progress — -- 1w18,2015 a029am --- \ we'll letyou know of any updates via email.Feel free to check the �j status at any time by coming back to this page. ® Electrical Review In Progrr,: p� P��.-r+a F'e' (� Ave .i un "ar.• Qt txsumcc �� t��llnf•r Vf. t_I ....__.. Allison Kelley 59 ADAMS AVENUE,NORTH ANDOVER, MA MECKEL.JUNE Attachments 4 -OMYYQI00IF_Mor.,Jul_18 2016 1129:.P13F GRIM � AM `+����� )��� 9:29 711 at20t613 Monday,Jul 18,2016 09:29 AM tftlijiOPPU@Ll�L p'� pa3aGh K && Official Use Only Permit No. . a ar n o Lre aruico9 Occupancy and fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL 'WORK All work to bo performed in accordance with the Massachusetts Electrical Code(MEC},527 CMR 12,00 (PLEASE- PRINT ININK OR TYPE ALL 1AWORAMTION) Date: 7/18/2016 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 59 Adams St Owner or Tenant June M Eckel Telephone No. 978-258-5166 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No, ExistingServiee Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install Solar Electric-Photovoltaic (PV) system [ 9 1 panels rated f 2.34 1 kW a STC Grid Tied. In conjunction with a Building Permit Cont letion of the followh table tray be lraived by the lti, ector of 1'Yires. No.of Recessed Luminaires No,of Ceil.-Susp,(Paddle)Fans N Transformers [CVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above n- NO—01 Emergency Lighting No.of Luminaires Swimming Pool rnd. Elrnd, Butter Unifs No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS N&of Zones No.of Switches No.of Gas Burners o.of Detection an Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heatump mtnher Fous IC o.of Self-Contained ' Totals: Detection/Alerting Devices No.of Dishwashers Space/Arca Pleating ICR' "Call[] Connie t oln E] other N%of Dryers Heating Appliances KW SecuritySystems:* No.of Devices or Equivalent No.of Witer KW o,of No.of Data Wiring: —Heaters Signs Ballasts No.of Devices or E uivalent No.Ilydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Anach additional detail if desired,oras required by the Inspector of Wires. Estimated Value of Electrical Work: $4,000 (When required by municipal policy.) Work to start:ASAP Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including,"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Q BOND ❑ OTHER ❑ (Specify:) I cert f,under the pains and petnal ies ofperjuty,dial the b forma'tiou on this application is true and complete. FIRM NAME: SOLARCITY CORPORATION LIC,NO.:1136MR Licensee: MATTHEW T.MARKHAM Signature giZA fg&&f LIC.NO.:1136MR (If applicable,enter"uxempr-in the license number lite) Bus.Tel,No.!77a45"180 Address.- 24 5T MARTIN DRIVE(BUILDING 2-UNIT 11)MARLBOROUGH,MA 04752 Alt.TCI.Nn.:774-258-8505 &Per M.G.L.c. 147,s.0.61,security work requires Department of Public Saicty"S"License: Lia No, OWNER'S INSURANCE WAIVER: l am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I atm the(check ane)[]owner ❑Owner's a ent. Uwn nt PERMIT FEE: $ Signature htrc Telephone 11'0. ' The Commonweallli ofli?assaellUsews Department of IndustrialAceidents Once of In vestigations u,p I Congress Street,Suite 100 Boston,MA 02114-2017 Ivtuw.Mnuss.gov/dra Workers'Compensation Insurance Affidavit,Builders/ContractordElectricians/Plumbers Applicant Informat'ia>il Please.Print La ibl Name(13usiness/organization/Individual): SolarCity Corp. �� ^ Address: 3055 Clearview Way City/StateMp: San Mateo CA. 94402 Pone#: 888-765-2489 Are you an employer?Check the appropriate box: 'Type of project(required): 1,ly_I'am a employer with 15,000 4- 0 1 wn a general s;ontractor and I 13tnp1nyeT:s(full andlar part-time).*x have Hired the sub-contractors a New sonsmrction Z.❑ l am a sole proprietor or partner• listed on the attached sheet. 7. ❑Remodeling ship and have no employees These subcontractors have g ❑Demolition working forme in any capacity. employees and have workers' (No workers'comp.insurance camp.insttrAttta? []Building addition required.) 5, [:] We are a corporation and its 10_[]Electrical repairs or additions 3.0 1 aw a hurneowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself.selfNu workers' comp. Agtit of exeutption-pat i+%tGL l A 12 EJ Roof repairs insurance required.]f c. 152,§1(4),and we have no employees.[No workers' 13EPther Solar/PV comp,insurance required.] *Any applicant that checks box#1 must atso ftlt out The section below showing their worin:rs'compensation poilcy information. 'Homeowners wha suhmitthis affidavit indicating ibey ire doing all wort;and then firs outside eontramrs musT submit anew offidaWi lndicating such. ;Coatractw that check this box must Winched an additional sheet showing ilia name of the subcontractors and stetc whether or not those entities have employees, If the sub•cortimlors havo employees,they must provide their workers'comp policy number. I afn art employer that isproviding workers'Compensation insurance far my employees. Below is ilii:policy and job site inrjormaiion. Insurance CompanyNazac: Zurich American Insurance Company Policy ig or Self-ins.Lic.#: WC0182O15-00 Expiration Date: 9/1/2016 .lob Site Address: 59 Adams Ave City/state/zip: N. Andover MA Attach a copy of the workers'cornpensatiifm policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MOL c. 152 can least to the imposition of criminal penalties of a fine up to S 1,500.40 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of tip to$250.00-a day against tha violator. Be advised that a copy of this statement maybe forwarded to the Office,of Investigations of the DIA for insurance coverage verification. X do hereby cei d ander the parrs and perralti'es of perjtrrfr that the infarnratlon prorirled above is true arra¢onset. Si tura: Date: Phone Qf,{ieinl::se only, .Lea tial wrN.e in liiis area,to be completed by eliy or town.offtrial. City or Town: Perrnit/Lleettse;f Issuing Authority(circle one): 1.Board of health 2.Utdiding Departrneut 3.CitylTown Clerk 4.Electrical Inspector S.Plautbing Inspector tiI her Contact person: phone#; 7 CJ `J 5 Date.. //�Y///.... .. t TM 3? ' 6 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION is CNUSESSy This certifies that . . . . .t,2? . . .. . !. :. . . . . . . . . . has permission for gas installation . J �. '. . . . . . . . in the buildings of . . .Q.� . . . , /. . . . . . . . . . . . . . at � m S • . . � . �. . . . . . . . . . . . . ., North Andowerv, ass. Fee.,6 4. Lic. No../.O.I-Q.l. GAS INSPECTOR Check# 5 l MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:O ' MA. Date: /—W `--W I Permit# Building Location: Owners Name: M12:v Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Institutional ❑ ResidentialO New: ❑ Alteration: ❑ Renovation: ❑ Replacement. Plans Submitted: Yes❑ No❑ FIXTURES UJ Z � N = � Q V F m =0 W W V N H O = W W Z H W w a0' O H O w N w gino < O Q h Q a w x > rn cwi Z to � O w cn o w o = u. U W Z O J ~H P O Z —t a L N W H W W O LLI W Q 0: LL7 m > O Z O W Z Z W :3Q H D o o u_ c9 0 x x � 0 a �a � l— > > > O SUB BSMT. BASEMENT 1 1 FLOOR 2 FLOOR 3 FLOOR 4 1 H FLOOR 61H FLOOR 6 FLOOR jTFF FLOOR 8 FLOOR Installing Company Namlr j /1°� ,. �� ,l p�� Check One Only Certificate# ��// `` \ //,, '' ❑Corporation AddressF6 60o - 70� City/Town: K!' 9-.1' State: U/ (�c� L / c C El Partnership Business Tel:. 7 /a —lel q —�3��' Fax: / ?r� �" �3�U Z:�Firm/Company Name of Licensed PlumberlGas Fit �i. .-� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalentwhich meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy/' Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ -Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and i rmation 1 have s miffed(or tered)regardi i application are true and accurate to the best of my Knowledge and that all plumbing wor nd installations perfo med un the permit i ed f t application will be in compliance with all Pertinent provision of the Massachusetts St to Plumbing Code an hap te 1 of Ge ral L s. Ty f License: By Plumber Title ❑Gas itter Signature of Lice sed Plu er/Gas Fitter aster CitylTown []journeymanLicense Numbe : �o ! APPROVED OFFICE USE ONLY ❑LP Installer TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: " �/ Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 59 Print PROPERTY OWNER Z_og,,,._a,e P ,, Print ` MAP NO.q '� PARCEL: COY/ ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building I'One family ❑Addition 0 Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg �4 Others: / ❑ Demolition ❑ Other O'Sept c II Well' OFloodplairr 0 Wetlands ❑ Watershed District ❑Water/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: Zt Zr 74 (Identification. Please Type or Print Clearly) OWNER: Name: 4 261_e_✓ Phone: 57 9 ZS-7.161 Address: 9 /�,-llo>e � CONTRACTOR Name: 6 R Phone: t�'l 7J 2d Address: Z � zG Supervisor's Construction License: r� D Exp. Date: �`/�. A c� � Home Improvement License: I !o y ol - Exp. Date: ARCHITECT/ENGINEER Phone: 1 Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ C;-t) (o u , �'AA FEE: $ /•a� Check No.: r �2 2 Receipt No.:_2 ';�' Z 7/ NOTE: Persons contracting with Rnr is r d ntractors do not have access to the guaranty fund Si natureof A ent/Own&L.. contra ure of; ctor t:. .9 ..._ ,gam .._ _ ._-._ F Location_S-l`, A G!G//As Ale No. /F,3-3-// Date ,.QRTry TOWN OF NORTH ANDOVER , �o ; , Certificate of Occupancy $ SA Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t Check # �2 24 � 5 'i t `Bbilding Inspector 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS 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: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS ® of NORT1y Andove � r --rr -. ;:1. ,,. ,� No. 3� o , dover, Mass., COCHICHEWICK �9S0RATE D P? 5 . BOARD OF HEALTH Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......�/ '�' . ` lC."` '�` X............................................................................................... Foundation has permission to erect.................................. buildings on .�j .,� 1...... . ... .. . ..... .�.°�.�..................................................... Rough p �F n� lG T /-jr l/'4! c$ <<v� e?:ley Chimney to be occupied as ...........�.....f.�r....:..¢.......-...:r..,r.:.....:... ................. /�:-... .. ..... . ................. .... ..... .:. . . . . . .......... . . provided that the person accepting this permit shall in every aspect co�orm to the term of the application on file in Finan this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERIvHT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough r` ! '!� �T �' :•�................ .. ........ .......................... BUILDING INSPECTOR Service Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 1lassuchusetts- Department of Public Safety Board of Buildim4,Regulatioas and Standards Construction Supervisor Liceris6 License: CS 90902 h� RICHARD B BORGES 1 28 HAMILTON ROAD : PEABODY, MA 01960 Expiration: 11/1/2012 (7(— TO: Wl ,{rt�iaaasJapon , x:09660 b'W'1,4081i3d ^– ,'-Mi NO1-1IWt1H 8Z t., 539809 (18t/H0IH , -0li swumos Aq)43N3 O30NVAi3N udrlesodaoa :adAl 31162 #Jl 6 60Z/0£IL 6 :uollendx3 £69G96 :uoltejlsl6aa k 250-Lo"1N001N3W3AOLIdWI3WOH r !30 -- ; "Ouginzalt ssauisng�g !�)3d iawnsao0 3 o aa� i I Job Number 38554 DATE s-May-11 Client JOANNE RITTER address 59 ADAMS AVE city I town NO.ANDOVER MA 978-257-1017 i contractor ADVANCED ENERGY SOLUTIONS 1.WEATHERSTRIPPING/CAULKING QUANTITY TOTAL. AUDITOR NOTES I Door[Qts Q-len or Equiv. 2 86.00 Door Sweeps(Regular) 1 15.00 Door Sweeps(Automatic) 2 44.00 RegiazeWindows/in.inch 0 0.00 l Window.Weathstr Schiegal per side 0 0.00 AtticlBasement bypass sealing man/hr 1 60.00 Attic sealing with 2-part foam mart/hr 1.5 112.50 MAKE SURE THE FAN IS VENTED FOR THE E I - SUSTOTALS 317.60 i i i 2A.INFILTRATION!INSULATION AUDITOR NOTES Domestic pipe Hot Water Tank 1st 6 1 15.00 Sill Insulation R-19 CF 0 0-01) Sill Two Part Foam w/Fiberglass Batt 116 232.00 PLEASE SEE AUDIT NOTES i Drape Perimeter R-5 Anch.Sq.it. 0 0.00 Drape DOOR R-5 Anch. 0 0.00 Tape Joints(Alums Grip only)per hr_ 0 0.00 Duct insulation&Tape in.ft. 0 0.00 Rigid Foam Board Anch. 1" 0 0.00 Hydropic pipe insulation to 1"R-5 55 18200 i Hydronic pipe ins.125-1.5"R-5 197 689.50 112-85 j Steampipe Ins.tol.25"iron pipe R-5 0 0.00 i Steamplpe Ins.1.5"-2"iron pipe R-5 0 0.00 Steampipe Ins.3"iron pipe R-5 0 0.00 Air Conditioner Meeting Rail 0 0.00 Air Conditioner Cover 0 0-00 Air Conditioner Cover Special Order 0 0.00 i SUBTOTALS 1118.50 i i 28.INSULATION AUDITOR NOTES { Open Unrestricted R 49 0 0.00 I Open Unrestricted R 36 1040 1456.00 1 WANT TO SEE PRIOR TO BLOWING t Open Unrestricted R 30 0 0.00 Open Unrestricted R 20 0 0.00 Open Unrestricted R 10 0 0.00 3 Restrict FUSloped R 30 0 0-00 i Restrict FUSloped R 20 0 0.00 i _ Restrict FUSloped R 10 0 0.00 i R-19 FGB open raffers/walls/kneewalls 0 0.00 R-11 FGB open rafters/walls/kneewalls 0 0.00 Attie Stairs(stairwell&common wall) 0 17.00 { Cover Pull Down Stairs Thermadame 0 0.00 { Site built pull down stairs 2"foam tax 0 0.00 i Page 2 t -f { i AUDITOR NOTES Attic/Kneewal Floor Transition.Dense pack cellulose 0 0.00 W.S.&bat Hatch R-19/Q-Lon or= 0 0.00 W.S.&bat Hatch R-0/Q-Lon or= 0 0.00 IN GARAGE DO NOT DO Kneewall R-12 cell behind Per.Memb 0 0,00 Open Rafter R-20 Cell.Av poly 0 0.00 Open Rather R-30 Cell./w poly 0 0.00 Basement Overhead R-19 fiberglass 0 0.00 Basement Overhead R-W fiberglass 0 0100 c Crawipace Overhead<4'high Rig 0 0.00 CtaMpace Overhead<4`high R30 0 0.00 Garage Ceiling cavity filled wl cellulose 0 0,00 Wood,ShakeClaptroard,ShinglesVinyi 1014 1723.60 VERY NICE USE CAUTION PLEASE 11!fl!I Asbestos(single nai0 f Asphalt 0 0.00 Asbestos(doub.Nail)/Aluminum 0 0.00 Brick/Stucco 0 0.00 Vinyl over Asbestos 0 0.00 Mutt-layered 3 or more layers 0 0.00 i Drill rough plaster or finish wood plug 0 0.00 Drill finish plaster 144 260.64 GARAGE WALL # Test Drill Walls(all 4) 0 0.00 SUBTOTALS 3440.44 2.INSULATION TOTAL 2A.+2B. 469.94 i 3.STORM WINDOWS/DEADLITES AUDITOR NOTES Plexiglass up to 88 u_L 0 0.00 Additional per UI over W' 0 0.00 Other(Negotiated Price) 0 0.00 SUBTOTALS 0.00 S.OTHER MATERIAL AUDITOR NOTES Ridge vent In ft. 0 0.00 MAKE SURE IT IS OPEN Vents Gable rectangular 0 0.00 Varipitch Vent 0 0.00 Vent Roof 135(1 sq ft NM Large 0 0.00 Vent Roof 865(A sq ft NFV)Small 2 152.00 LO ON THE LONG SIDE OF REAR OF HOUSE Vent Soffit Round 1) 0.00 i Vent Soffa Rectangular 0 0.00 i Turbine Vents All 0 0.00 j Stack Vent 0 0.00 Propa Vent 0 0,00 Permable House Wrap 0 0.00 Vapor barrier 0 0.00 i Energy Star R-4 Rigid Vinyl Repi to 73"U.!. 0 0.00 Energy Star R-4 Rigid Vinyl Rep174-84"U.I. 0 0.00 j Energy Star R-4Rigid Vinyl Rep184-W u.1. 0 0.01) I k Energy Star R-4 Rigid Vinyl Rept 94-1oi U.I. 0 0.00 i S SUBTOTALS 162.00 6.17.E.C.MATERIAL/LABOR 5028,44 Page 3 I , 8a. HEALTH&SAFETY AUDITOR NOTES Vent Bath/Kitchen Fan 0 0.00 MAKE SURE BATH 13 VENTED Dryer vent w/exhaust duct Heartland 0 0.00 Dryer Transition Duct only, 1 38.00 Blower Door Test Pre Post 0 O.OD PRE 3400 DOOR CLOSED i SUBTOTALS 38.00 8b.REPAIR MATERIALILABOR AUDITOR NOTES Basement outside door only 0 0.OD Basement outside door w/jambs 0 0.00 Door Repl pre hung 3236"Steel" 0 0.00 j Door Repl interior solid core 25-32" 0 0.00 Door Repi pre hung 32-35'wood` 0 0.00 Window Replacement w/SIR less than 1 0 0.00 Basement Window Repl.Awning/Hopper 0 0.00 Basement Window Repl.With a frame 0 0.00 Loc kset(door)Schlage or equal 0 0.00 Repair/Refit Door 0 0.00 Replace Side Stop 0 0.00 ' Replace Casing 0 0.00 Glass Replacement to 64 W. 0 0.00 Glass Replacement per u.i.over 64 0 0.00 Sash SIdeIoGk/Top Replacement 0 0.00 Threshold(Wood) 0 0.00 Threshold(Aluminum) 0 0.00 , Slide Bolts 0 0.00 Plug Plate Cover 0 0.00 jCut/finish attic-kneewall access 0 0.00 4 Cut/close attic-kneewall access 0 0.00 Labor Rate Hours 0 0.00 IPermits/Fees(Wap only) 0 0.00 SUBTOTALS 0.00 j TOTAL REPAIR+HEALTH&SAFETY 38.00 l E( GRAND TOTAL WORK ORDER# (A) 3854 5066.44 i r alterations or deviations from the above f Any specifications involving extra costs must be cleared in writing before installation. j The Work Order must be complete within 15 working days from acceptance -�' date below: CONTRACTOWCOMPANY: ADVANCED ENERGY SOLUTIONS ACCEPTANCE:Company/Contractor . AUTHORIZED SIGNATURE: Date' AGENCY APPROVALS: I CTI Authorized Signature: Date GLCAC Authorized Signature: Date i I i i A��® DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 4/26/11 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 thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Paul T. Murphy Insurance Agenc PHONE A/X No: 628 Broadway ADM"RESs: Malden, MA 02148 PRODUCER 7064 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Scottsdale Ins Advanced Energy Solutions LLC INSURER B:Peerless Ins 75 Greenwood Ave INSURERC:AIG Wakefield, MA 01880 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPEOFINSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/Y MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENEPAL LIABILITY CPS1014919 5/7/10 5/7/11 DAMAGE TO RENTED $ 100,000 ncL CLAIMS-MADE OCCUR 5/7/11 5/7/12 ME D EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER PRODUCTS-GO MP/OP AGG $ 2,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANYAUTO B ALL OWNED AUTOS 8633314 3/19/11 3/19/12 BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPE RTY DAMAGE $ X HIREDAUTOS (Per accident) X NON-OWNEDAUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION006789459 5/14/10 5/14/11 WT.CSTATU- OTH- AND EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE �YN/NI 5/14/11 5/14/12 E.L.EACH ACCIDENT $ 500,000 OFFICE RIMEMBER EXCLUDED? J N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insulation-Coveraqe is subjectto policy terms conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE < ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registers marks of ACORD The Commonwealth ofMassachusetts 1 Department oflndustrial.accidents i Office of Investigations 600 Washington Street =,' f Boston,MA 02111 www.rnassgov/dia Workers, CompensationYnsuxance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information . Please PrinfLelribly Name(Business/Organization/Individual): �G,gl�nS Address: Cityl tate/Zip: Q Phone##: F. you ail employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. El am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. [}Mew construction 2.❑ I amt a sole proprietor or partner- listed on the attached sheet.1 7. F1 Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers'comp,insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[]Plumbing repairs or additions myself.[No workers'comp, c.1-52,§1(4),and we have no 12.❑Roofrepalrs " insurance required.]T employees.[No workers' 13.❑Other comp.insurance required.] *Any ppplicant that checks box 0 must also fill out the sections below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they ale doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors acid their workers'comp.policy infarmation. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. / Insurance Company Naane: R G l f Policy#or Self-ins.Lic.#: 424/11 7z 9y / Expiration Data: 5_/!4/7Z& Job Site Address: fiL , 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 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00d day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby certify under t pains and penalties of perjury that the information provided above is true and correct Si ature: 0/ Date: p ' Phone#: y Officia l Use Use only. Do-not write in.this arei,4 to be e0mpleted by city or town official Town: Permit/License# Authority(circle one): d of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector r Person• Phone#: