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HomeMy WebLinkAboutBuilding Permit #1340-2016 - 67 COLGATE DRIVE 6/27/2016 q )-L2 ?C-067 c 0AJC tyORT1{ 0 f„ II BUILDING PERMIT 3� b�'�. •_ � o� TOWN OF NORTH ANDOVER o I�PPLICATION FOR PLAN EXAMINATION Permit N0: Date Received ,,came:'`It Date Issued: �9SS�CHus t I ORTANT:Applicant must complete all items on this page LOCATION 67 Colgate Dr Print PROPERTY OWNER J Richard Conrad Print MAP NO: _PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑lAddition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement El ,,4ssessory Bldg ❑ Others: i ❑ Demolition VOther -Solar Installation ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer Installation of an interconnected rooftop PV system-38 panels(9.1kVV) Identification Please Type or Print Clearly) OWNER: Name: J Richard Conrad Phone: 978-609-2532 Address: 67 Colgate Dr,North Andover MA 01845 CONTRACTOR Name: Stephen A Kelly/Sunrun Installation Services Inc Phone: 978-793-7227 Address: 200 Research Dr,VYilmington MA 01887 Supervisor's Construction License: CS-040622 Exp. Date: 8/1/17 Home Improvement License: 180120 Exp. Date: 10/14/16 ARCHITECT/ENGINEER Paul KZacher Phone: 916-961-3960 Address: 8150 Sierra College Boulevard,Ste 150,Roseville CA 95661 Reg. No. 50100 ' r FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 21046.30 FEE: $ o Check No.: Receipt Receipt No.: y NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner /' - e':2 Signature of contractor Location r,�/4, �! i No. R 7A 6— Z U 1�0 Date(n ? 1 . - TOWN OF NORTH ANDOVER . '• Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ • Check.-2 �r_`•�{� j Building Inspector NORTH own of ndove'r ' O ti" to Ah , ver, Mass, 6 �A COC NICNEWICK �1` - - - - - 'x,95 R�►reo �pa��5 11 BOARD OF HEALTH Food/Kitchen PERMIT T f LD Septic System THIS CERTIFIES THAT ......•-,t ... ..�.� ��. .... .... .. ................................. BUILDING INSPECTOR Foundation has permission to erect .......................... buildi son .......6. ....... #..�w .I ..' ... .. ........ I Rough to be occupied as .. .far.... .. ...... .4.......... .... ... .................1.9 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 CTI 4BUI Rough Service .. .. . ......... ....... FinalN NSPE OR 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. ❑ AWN k, @90%RM-a OWNER'S AUTHORIZATION FORM For Permit Application(s) The sole purpose of this form is to provide Sun Run Inc with the Necessary permission from the Owner to file Permit Application(s) for such Project work as agreed upon between the Owner and the Owner's Authorized Company and its designated subcontractors. Owner's Name: tune a Corey Solar Project Address: Signature: ± k con Owner's Authorized Company: Sun Run Inc. Company's Address: 595 Market St 29th Floor, San Francisco, CA 94105 Affiliation: Contractor Applicable License: State: MA CSLB#96975,NJ#13VH07020300 It i STRUCTURAL ENGINEERS March 28, 2016 Sunrun Inc. 133 Technology Dr, Suite 100 Irvine, CA 92618 Attn.: To Whom It May Concern re: Job 2016-04332 : June Corey-222R-02000RE The following calculations are for the structural engineering design of the photovoltaic panels located at 20 Foss Road, North Andover, MA 01845.After review, PZSE, Inc. certifies that the roof structure has sufficient structural capacity for the applied PV loads. If you have any questions on the above, do not hesitate to call. kp�TN OFMASsq PAULK CyG Prepared By: ZACH PZSE, Inc. -Structural Engineers ° sTR .50100 L WoSo1 co Roseville, CA a SSS/ONAI-�G� 1 of 5 8150 57=o Colege Bold+Suite 150 Rosi 9e,(A 95661 916.961.3960 P 916.961.3965 � r�lwir�,pzse.+�o Gravity Loading Roof Snow Load Calculations pg=Ground Snow Load= 50 psf C.=Exposure Factor= 0.9 (ASCE7-Table 7-2) Cf=Thermal Factor= 1.1 (ASCE7-Table 7-3) 1=Importance Factor= 1 pf=0.7 Ce C,I p9 35 psf (ASCE7-Eq 7-1) where p.!5 20 psf,Pf min=I x pg= N/A min snow load(mofslope 15) where pg>20 psf,Pf min=20 x I= N/A min snow load(mofslope<15°> Therefore,p,=Flat Roof Snow Load= 35 psf Pa=4f (ASCE7-Eq 7-2) Cs=Slope Factor= 0.667 ARRAY 1 Ps=Sloped Roof Snow Load= 23.1 psf ARRAY 1 PV Dead Load=3 psf(Per Sunrun Inc.) _ Roof Live Load= 17.07 psfARRAY 1 Note:Roof live load is removed in area's covered by PV array. F— Roof Dead Load ARRAY 1 —�— I Composition Shingle 4.00 I Roof Plywood 1.50 ; 2x8 Rafters @ 16"o.c. 1.49 Vaulted Ceiling 0.00 (Ceiling Not Vaulted) Miscellaneous 0.01 Total Roof DL ARRAY 1 7.0 psf ! DL Adjusted to 30 Degree Slope 8.1 psf i I 2 of 5 i I I Wind Calculations Per ASCE 7-05 Components and Cladding — -- -Input Variables Wind Speed 100 mph Exposure Category C Roof Shape Gable/Hip Roof Slope 30 degrees Mean Roof Height 20 ft Building Least Width 32 ft Effective Wind Area 10.8 sf Design Wind Pressure Calculations -`-� Wind Pressure P=qh*(G*Cp) qh=0.00256*Kz*Kzt*Kd*V^2*I (Eq_6-15) Kz(Exposure Coefficient)= 0.9 (Table 6-3) Kzt(topographic factor)= 1 (Fig.64) Kd(Wind Directionality Factor)= 0.85 (Table 64) V(Design Wind Speed)= 100 mph Importance Factor= 1 (Table 6-1) qh= 19.58 ` Standoff Uplift Calculations Zone 1 Zone 2 Zone 3 Positive GCp= -1.00 -1.20 -1.20 0.90 Uplift Pressure= -19.55 psf -23.47 psf -23.47 psf 17.61 psf Max Rail Span Length= 4.0 ft 4.0 ft 4.0 ft Longitudinal Length= 2.7 It 2.7 ft 2.7 It Attachment Tributary Area= 10.8 sf 10.8 sf 10.8 sf Footing Uplift= -210 Ib -252 Ib -252 Ib T Standoff Upliff Check Maximum Design Uplift= -252 Ib Standoff Uplift Capacity = 700 Ib 700 Ib capacity>252 Ib demand Therefore,OK Fastener Capacity Check — Fastener= 1-5116"dia Lag Number of Fasteners= 1 Minimum Threaded Embedment Depth= 2.5 Pullout Capacity Per Inch= 205 Ib Fastener Capacity= 820 Ib 820 Ib capacity>252 Ib demand Therefore,OK i 3of5 i Framing Check ARRAY 1 PASS w=46 plf Dead Load 8.1 psf PV Load 3.0 psf Snow Load 23.1 psf I '2x8 Rafters @ 16"o.c. Member Span=13'-11" Governing Load Comb. DL+SL Note:Attachments shall be Staggered. Total Load 34.2 psf Member Properties Member Size S(in^3) I(in^4) Lumber Sp/Gr Member Spacing 2x8 13.14 47.63 SPF#2 @ 16"o.c. Check Bending Stress Fb(psi)= fb x Cd x Cf x Cr (NDS Table 4.3.1) 875 x 1.15 x 1.2 x 1.15 Allowed Bending Stress=1388.6 psi Maximum Moment = (wL"2)/8 i = 1103.94 ft# = 13247.3 in# Actual Bending Stress=(Maximum Moment)/S =1008.2 psi Allowed>Actual—72.71/6 Stressed — Therefore,OK Check Deflection Allowed Deflection(Total Load) = U120 (E=1400000 psi Per NDS) = 1.391 in Deflection Criteria Based on = Simple Span Actual Deflection(Total Load) _ (5*w*L114)/(384*E*1) = 0.188 in = U889 < U120 Therefore OK Allowed Deflection(Live Load) = U180 0.927 in Actual Deflection(Live Load) _ (5*w*L"4)/(384*E*1) 0.390 in U429 < U180 Therefore OK Check Shear Member Area= 10.9 in^2 Fv(psi)= 135 psi (NDS Table 4A) Allowed Shear = Fv*A = 1468 Ib Max Shear(V)=w*L/2 = 317 Ib Allowed>Actual—21.70/6 Stressed — Therefore,OK 4of5 + I Lateral 2009 IBC CH34 Existing Weight of Effected Building Level Area Weight(pso Wei ht Ib Roof 1216 sf 8.1 psf 9850 Ib Ceiling 1216 sf 6.0 psf 7296 Ib Vinyl Siding 140 ft 2.0 psf 5600 Ib (20'Wall Height) Int.Walls 140 ft 1 6.4 psf 1 17920 lb Existing Weight of Effected Building 40666 Ib Proposed Weight of PV System Weight of PV System(Per Sunrun Inc.) 3.0 psf Approx.Area of Proposed PV System 503 sf Approximate Total Weight of PV System 1509 Ib I i 10%Comparison ' 10%of Existing Building Weight(Allowed) 4067 Ib Approximate Weight of PV System(Actual) 1509 Ib Percent Increase 3.7% 4067 Ib>1509 Ib,Therefore OK 5 of 5 March 28,2016 STRU(TURALENGINEERS Sunrun Inc. 133 Technology Dr, Suite 100 Irvine, CA 92618 Subject: Structural Certification for Installation of Solar Panels Job Number:2016-04332 Client:June Corey-222R-02000RE Address:20 Foss Road, North Andover, MA 01845 Attn.:To Whom It May Concern A field observation of the condition of the existing framing system was performed by an audit team from Sunrun Inc.. From the field observation of the property,the existing roof structures was observed as follows: The existing roof structure consists of: • Composition Shingle over Roof Plywood is supported by 2x8 Rafters @ 16"o.c.at ARRAY 1.The rafters are sloped at approximately 30 degree and have a maximum projected horizontal span of 13 ft 11 in between load bearing walls. Design Criteria: • Applicable Codes=2009 IBC,ASCE 7-05, and NDS-05 • Ground Snow Load=50 psf • Roof Dead Load=8.1 psf ARRAY 1 { • Basic Wind Speed= 100 mph Exposure Category C • Solar modules=as indicated in attached drawings As a result of the completed field observation and design checks: • ARRAY 1 is adequate to support the loading imposed by the installation of solar panels and modules.Therefore, no structural upgrades are required. I certify that the capacity of the structural roof framing that directly supports the additional gravity loading due to the solar panel supports and modules had been reviewed and determined to meet or exceed the requirements without structural upgrade in accordance with the 2009 IBC. ��ZN OF Af,4 If you have any questions on the above,do not hesitate to call. PAULK. G Prepared By: ZACH92 -a PZSE, Inc.-Structural Engineers sTR No.5010050100 Roseville, CA �SS�ONAL�G` 1of1 8150 Sierra Colege Bi rd.,Sante 150 RosevOe,CA 95661 916.961 MOP • 916.961.3965 Oi VOVawPne.car The Commonwealth of Massachusetts Department of IndustrialAccidents o I Congress Street, Suite 100 Boston,MA 02114-2017 M www mass.gov/dia 117orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):Sunrun Installation Services, Inc. Address:775 Fiero Lane, Suite 200 City/State/Zip:San Luis Obispo, CA 93401 Phone#:978-549-9438 Are you an employer?Check the appropriate box: Type of project(required): 1.[D I am a employer with 35 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. [1 Demolition In I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E]Building addition 4.[:]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.[7 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other Rooftop Solar 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Zurich American Insurance Company Policy#or Self-ins.Lic.#:WC013696001 &WC013696101 Expiration Date:10/01/2016 Job Site Address:20 Foss Road City/State/Zip:N Andover, MA 01845 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct Si me nature: (:� Date: Phone#:978-549-9468 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i AC�® DATE(MM/DD/YYYY) `./, CERTIFICATE OF LIABILITY INSURANCE 10/01/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH RISK&INSURANCE SERVICES NAME: 345 CALIFORNIA STREET,SUITE 1300 A/CNNo Ext): A/C No): CALIFORNIA LICENSE NO.0437153 E-MAIL SAN FRANCISCO,CA 94104 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# 104960339-STND-GAX-15-16 INSURER A:James River Insurance Company 12203 INSURED INSURERS:N/A N/A Sunrun Installation Services,Inc. and REC Solar,Inc. INSURER C:Houston Casualty Company 42374 775 Fiero Lane,Suite 200 San Luis Obispo,CA 93401 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-002994222-03 REVISION NUMBER:5 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDIYYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY 000641241 10/01/2015 10/01/2016 EACH OCCURRENCE i $ 1,000,000 �OCCUR DAMAGE TO RENTED CLAIMS-MADE PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X OTHER: Host Liquor Liability TOTAL POLICY LIMIT $ 10,000,000 AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $ Ea acc dent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident C UMBRELLA LAB X OCCUR H15XC5023203 10/01/2015 10/01/2016 EACH OCCURRENCE $ 10,000,000 X EXCESS Ll AB CLAIMS-MADE AGGREGATE $ 10,000,000 DED I $ WORKERS COMPENSATION SPER 5 H- AND EMPLOYERS'LIABILITY Y/N TATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? r N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Re:Permitting within jurisdiction. I CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 120 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE of Marsh Risk&Insurance Services Stefan Szulc ------mr ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD AC40 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `.�.� 1 10/8/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Arthur J. Gallagher&Co. Insurance Brokers of CA. NAME:PHONE 415-546-9300 FAX 415-536-8499 1255 Battery Street#450 E-MAIL San Francisco CA 94111 INSURERS AFFORDING COVERAGE NAIC# INSURERA:Zurich American Insurance Company 16535 INSURED S U N R I N C-01 INSURER B: Sunrun Installation Services Inc. INSURER C: 775 Fiero Lane, Suite 200 INSURER D: San Luis Obispo, CA 93401 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:944362624 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MMIDDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE. $ CLAIMS-MADE F OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY F]PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: 1 $ AUTOMOBILE LIABILITY Ea accident $ ANY AUTO BODILY INJURY(Per person) $ AUTOS�ED SCHEDULED BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE : $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE . $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED I $ A WORKERS COMPENSATION Y WC013696001 0/1/2015 10/1/2016 X STATUTE ORH A AND EMPLOYERS'LIABILITY Y/N WC013696101 10/1/2015 10/1/2016 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT , $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) WC013696001 -$25,000 Deductible;WC013696101 -FL, HI, MA, NJ, NY, OR,VA,WI only. Evidence of Insurance 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. 120 Main St North Andover MA 01845 USA AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 A Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 180120 ' Type: Supplement Card ' SUNRUN INSTALLATION SERVICES INC. Expiration: 10/14/2016 STEPHEN KELLY 775 FIERO LANE SUITE 200 SAN LUIS OBISPO, CA 93401 Update Address and return card. Mark reason for change. SCA 1 0 2OM-05/11 - F� Address F] Renewal F-] Employment F� Lost Card �Le anrmu�a�ae�rlGf a/,,QW&jacfureM, ice of Consumer Affairs&Business Regulation. License or registration valid for indiividul use only __ E IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation gistration 1gQ1 ( Type: 10 Park Plaza-Suite 5170 Expiration01 /201fy _ 1 Supplement Card pp Boston,MA 02115 SUNRUN INSTALLATION, S;ERVa6 INC. STEPHEN KELLY01 775 FIERO LANE SUITE'2WD --- SAN LUIS OBISPO, CA 93401 Undersecretary Not valid without si ture T-- f �AeSSAUSETTS LIE a: 1.a.48 9aEH� acl fKlplpt'P{ a OT•13-2015 No"E 505061292 ow 0 8.01-�02U 08-01.1959 ° ft � : �< KELLY i STEPHER A a 18 pARKWAY RD ( STONEHAM,MA 02180-2921 „ { Massachusetts Department of Public Safety Board of Building Regulations and Standards , License: CS-W622 Construction Supervisor STEPHEN A KELLY 16 PARKWAY ROAD - STONEHAM MA 02180 r Expiration: Commissioner 08/01/2017 SCOPE OF WORK GENERAL NOTES LEGEND AND ABBREVIATIONS TABLE OF CONTENTS PAGE# DESCRIPTION • SYSTEM SIZE: 7685W DC,6960W AC • ALL WORK SHALL COMPLY WITH 2014 NEC,2009 IBC, MUNICIPAL CODE,ANDSERVICE ENTRANCE ED SOLAR MODULES PV-1.0 COVER SHEET • MODULES: (29)CANADIAN SOLAR: CS6P-265P ALL F r— RAIL PV-2.0 SITE PLAN • INVERTEFZ(S): MANUFACTURERS' LISTINGS AND INSTALLATION INSTRUCTIONS. (29) ENPHASE ENERGY: M250-60-2LL-S2X • PHOTOVOLTAIC SYSTEM WILL COMPLY WITH 2014 NEC. Mp MAIN PANEL PV-3.0 LAYOUT • RACKING: SNAPNRACK SERIES 100 UL; FLASHED L FOOT. . ELECTRICAL SYSTEM GROUNDING WILL COMPLY WITH 2014 NEC. PV-4.0 ELECTRICAL SEE PEN D01. • PHOTOVOLTAIC SYSTEM IS UNGROUNDED. NO CONDUCTORS ARE SOLIDLY GROUNDED IN THE INVERTER. SYSTEM COMPLIES WITH 690.35. SP SUB-PANEL STANDOFFS & PV-5.0 SIGNAGE • MODULES CONFORM TO AND ARE LISTED UNDER UL 1703. FOOTINGS • INVERTER CONFORMS TO AND IS LISTED UNDER UL 1741. -- - -• RACKING CONFORMS TO AND IS LISTED UNDER.UL 2703. LC PV LOAD CENTER ® CHIMNEY - - • CONSTRUCTION FOREMAN TO PLACE CONDUIT RUN PER 690.31(E)AND 2012 IFC 605.11.2. • ARRAY DC CONDUCTORS ARE SIZED FOR DERATED CURRENT. SM SUNRUN METER Q ATTIC VENT • 9.23 AMPS MODULE SHORT CIRCUIT CURRENT. • 14.42 AMPS DERATED SHORT CIRCUIT CURRENT(690.8 (a)&690.8 (b)). FLUSH ATTIC VENT 11A OF&t% PM DEDICATED PV METER 9 0 PVC PIPE VENT PAUL ZACHER INVERTER(S)WITH ® METAL PIPE VENT TRUCTURAL INV INTEGRATED DC 50100 DISCONNECT AND AFCI ® T-VENT ?.6/3 ST C AC DISCONNECT(S) �SS/ONA1 SATELLITE DISH DC DC DISCONNECT(S) FIRE SETBACKS 0 FO For Structural Only CB — COMBINER BOX HARDSCAPE INTERIOR EQUIPMENT —PL— PROPERTY LINE sunrunLE:J SHOWN AS DASHED SCALE: NTS A AMPERE AC ALTERNATING CURRENT #180120 AFCI ARC FAULT CIRCUIT INTERRUPTER AZIM AZIMUTH VICINITYMAP COMP COMPOSITION 200 RESEARCH DR,WILMINGTON,MA 01887 fDC DIRECT CURRENT PHONE 888.657.6527 q_ (E) EXISTING FAX 805.528.9701 EXT EXTERIOR FRM FRAMING CUSTOMER RESIDENCE: � INT INTERIOR JUNE 20 FOSS RD,LBW LOAD BEARING WALL NORTH ANDOVER, MAG MAGNETIC MA, 01845 MSP MAIN SERVICE PANEL (N) NEW TEL.(978)837-8605 APN#:047.0-0090 NTS NOT TO SCALE PROJECT NUMBER: OC ON CENTER 2228-02000RE r PRE-FAB PRE-FABRICATED DESIGNER: PSF POUNDS PER SQUARE FOOT PV PHOTOVOLTAIC NICOLE THOMPSON 415.342.3123 TL TRANSFORMERLESS DRAFTER: ' TYP TYPICAL <, V VOLTS DIMENSION I W WATTS SHEET – - - REV ---NAME —DATE COMMENTS --COVER-SHEET A REV:A 3/26/2016 PAGE PV-1 .0 SITE PLAN-SCALE=1/16"=1'-0" PITCH TRUE MAG PV AREA AZIM AZIM (SQFT) ® AR-01 30' 2170 231° 502.7 A� Qv .44: d ° • . .. ' " fit{OF*SiS' 4 d ".° d 4. e a ! PAUL K. 9 G ZACHER (E) FENCEa a ° TRUCTURAL co 50100 /srE` " �sS/pNAI�G a . Qv Qv � sunrun & Ac--] #180120 IE—Di AC 200 SE O17870 PHONE 8657.827�LMINGTON,MA 01887 Qv FAX 805.528.9701 CUSTOMER RESIDENCE: A� JUNE COREY (E) RESIDENCE 20 FOSS RD, NORTH ANDOVER, MA, 01845 (N)ARRAY AR-01 TEL.(978)837-8605 APN#:047.0-0090 A< w PROJECT NUMBER: 222R-02000RE DESIGNER: A� NICOLE THOMPSON 415.342.3123 DRAFTER: ev DIMENSION I (E) FENCE SHEET - - - - - --- -- - - - - -- - -- --SITE-PLAN-- -- - REV:A 3/26/2016 PAGE PV-2.0 ROOF TYPE ATTACHMENT ROOF HEIGHT ROOF FRAME FRAME TYPE FRAME MAX FRAME OC ROOF EDGE MAX RAIL MAX RAIL DESIGN CRITERIA EXPOSURE MATERIAL SIZE SPAN SPACING ZONE SPAN OVERHANG MODULES: AR-01 COMP SHINGLE FLASHED L FOOT. SEE PEN D01. TWO STORY ATTIC WOOD RAFTER 2 X 8 16'-8" 16" N/A 4'-0" 1'-4" CANADIAN SOLAR: CS6P-265P MODULE DIMS: 64.5"x 38.7"x 1.57" D1 -AR-01 -SCALE: 1/4"= 1'-0" MODULE CLAMPS: PITCH: 30° Portrait: 13.39"- 16.14" AZIM:217° Landscape: 7.87"-9.84" ® MAX DISTRIBUTED LOAD: 3 PSF SNOW LOAD: 50 PSF WIND SPEED: 100 MPH 3-SEC GUST. LAG SCREWS: - - 5/16"x3.5": 2.5" MIN EMBEDMENT PENETRATION SPACING: 6" STAGGERED - 32'-7" t f 6" I(AOF*q q PAUL e— ZACH R 9�m TRUCTURALCIO 50100 �O /S TE —e —e e— �`SS/ONAL�G� -G- Q._ —Q 16'_2" sunrun #180120 .e 0 -$ 200 RESEARCHDR,WILMINGTON,MA 01887 PHONE 888.657.6527 16'-3" 13' FAX 805.528.9701 —e $ CUSTOMER RESIDENCE: JUNE COREY 20 FOSS RD, NORTH ANDOVER, 10 MA, 01845 TEL.(978)837-8605 APN#:047.0-0090 PROJECT NUMBER: 222R-02000RE DESIGNER: NICOLE THOMPSON 415.342.3123 DRAFTER: DIMENSION I SHEET - - -- LAYOUT _ -- REV:A 3/26/2016 PAGE PV-3.0 ~ WARNING: PHOTOVOLTAIC (C)(CB) LABEL LOCATION: A WARN I N G POWER • PER CODE:NEC690.13.G.3&NEC MAIN PHOTOVOLTAIC LABEL LOCATION: 690.13.G.4 SYSTEM AC (AC)(POI) THIS EQUIPMENT FED BY MULTIPLE SOURCE PER CODE:705.12(D)(2) PER CODE:NEC690.13.B TOTAL RATING OF OVER CURRENT DISCONNECT DEVICES,EXCLUDING MAIN SUPPLY OVERCURRENT DEVICE SHALL NOT EXCEED PHOTOVOLTAIC SYSTEAMPACITY OF BUSBAR EQUIPPED WITH R ' PER CODE:NEC690.56(C) SHUTDOWNPHOTOVOLTAIC LABEL LOCATION: • SOURCE (UNDER ROOFING MATERIAL) ,. INEXACT PER CODE:NEC690.13.G.1 POWER SOURCE DIRECTLY BELOW - A WARNING - - LABEL LOCATION: DC PHOTOVOLTAIC LABEL LOCATION: ELECTRIC SHOCK HAZARD (DC)(INV) (DC)(INV) LABEL LOCATION: PER CODE:NEC 690.35(F)TO BE USED SOLAR • ON POWERONE INVERTER THE CONDUCTORS THIS � • PER CODE:NEC690.13.B PHOTOVOLTAIC SYSTEMM ARE WHEN INVERTER IS UNGROUNDED PER CODE:NEC 690.15 AND NEC 690.13(B) UNGROUNDED AND MAY BE ENERGIZED CAUTION: SOLAR ELECTRIC AC PHOTOVOLTAIC LABEL LOCATION: SYSTEM CONNECTED A WARN I N G (AC)(POI) DISCONNECT PER CODE:NEC690.13.6 LABEL LOCATION: LABEL LOCATION: TURN OFF PHOTOVOLTAIC pER CODE:NEC110.27(C) • NOT OPEN UNDER LOAD (AC)(POI) AC DISCONNECT PRIOR TO PER CODE:NEC690.16.6 WORKING INSIDE PANEL PHOTOVOLTAIC DISCONNECT '-• • • LABEL LOCATION: MAXIMUM AC LABEL LOCATION: (AC) PER(POI) OPERATING • PER CODE:NEC690.33.E.2 MAXIMUM AC PER CODE:NEC690.54 A WA R N I N G OPERATING ' LABEL LOCATION: ELECTRIC SHOCK HAZARD LABEL LOCATION: DO NOT TOUCH TERMINALS (POI) PER ACAUTION PER CODE:NEC 690.17.E sunrun (INDIVIDUAL BREAKERS) TERMINALS ON BOTH LINE AND PHOTOVOLTAIC SYSTEM CIRCUIT IS BACKED PER CODE:NEC705.12.D.3.4 LOAD SIDES MAY BE ENERGIZED NOTICE IN THE OPEN POSITION PV • . DC VOLTAGE IS ALWAYS PRESENT PANEL WHEN SOLAR MODULES ARE #180120 • NOT ADD LOADSTO THIS PANEL PHOTOVOLTAIC • • LABEL LOCATION: EXPOSED TO SUNLIGHT LABEL LOCATION: (DC)(INV)PER CODE:IFC60113 IFC 605.11.1.4 200 RESEARCH DR,WILMINGTON,MA 01887 . . . LOAD CENTER ■/.,�. 6527 [Only use when applicable for PV load center] NEC 690.15,NEC 690.13(B)&NEC A WARN I N V FAx 05526 970PHONE 888.657 1 690.14C. 2. INVERTER OUTPUT CONNECTION LABEL LOCATION: CUSTOMER RESIDENCE: (POI) DC- DISCONNECT DO NOT RELOCATE THIS PER CODE:NEC 705.12.D.2 JUNE COREY OVERCURRENT DEVICE 20 FOSS RD, NORTH ANDOVER, MA, 01845 TEL.(978)837-8605 APN#:047.0-0090 PHOTOVOLTAIC— LABEL LOCATION: A WA R N I N G LEGEND (AC) PER CODE:690.13.6 PROJECT NUMBER: 222R-02000RE (AC):AC DisconnectLABEL LOCATION: ELECTRIC SHOCK HAZARD (C):Conduit (AC)(POI) (CB)Combiner Box DO NOT TOUCH TERMINALS PER CODE:NEC 690.17.E DESIGNER: (D)Distribution Panel TERMINALS ON BOTH LINE AND NICOLE THOMPSON (DC):DC Disconnect ® LOAD SIDES MAY BE ENERGIZED 415.342.3123 (IC):Interior Run Conduit IN THE OPEN POSITION DRAFTER: (INV):Inverter with integrated DC disconnect ;aj (LC):Load Center DIMENSION I (M):Utility Meter NOTICE _ (POI):,Point of interconnection SHEET - - - - - SIGNAGE- �PO NOT ADD,1,1LOADS TO THIS PANJI REV:A 3/26/2016 LABEL LOCATION: LOAD CENTER PAGE [Only use when applicable for PV load center] PV-5.0 120/240 VAC SINGLE PHASE SERVICE •MAX 16 MICRO-INVERTERS PER BRANCH CIRCUIT •MULTIPLE BRANCH CIRCUITS IN PARALLEL O METER#: •ENPHASE MULTI-PIN CONNECTORS--1 ST AC CONNECTOR AT M NATIONAL GRID 57947220 EACH BRANCH CIRCUIT IS A SUITABLE DISCONNECTING MEANS. UTILITY AC COMBINER ENPHSE �DO NOT DISCONNECT/CONNECT UNDER LOAD GRID [WITH(3) PRE-INSTALLEDCANADIAN SOLAR: CS6P-265P 4 20A PV BREAKERS AND + fff + fff ENPHASE ENERGY: + fff MODULES ENVOY COMMUNICATION M250-60-2LL-S2X GATEWAY] _ - -- _ (29)CANADIAN SOLAR: _ - - CS6P-265P AND 1 EXISTING 200A (N)LOCKABLE MICRO-INVERTER PAIRS (1) BRANCH OF C MAIN BREAKER BLADE TYPE (N)LOCKABLE '-- --- (16) MICRO-INVERTERS FUSED BLADE TYPE (N)SUN RUN (1) BRANCH OF 1 AC DISCONNECT AC DISCONNECT METER JUNCTION BOX (13) MICRO-INVERTERS OR EQUIVALENT EXISTING 3 3 3 2 1 200A MAIN FACILITY PANEL LOADS FACILIW 140A FUSE GROUND SQUARE D 250V METER SQUARE D DU222RB SOCKET 20A BREAKER(A) D222NRB 3R,60A,2P 125A CONTINUOUS 20A BREAKER(B) 3R,60A 120/240VAC & 120/240VAC 240V METER 200A, FORM 2S CONDUIT SCHEDULE NOTES TO INSTALLER: 1. INSTALL NEW 60 AMP ENPHASE AC COMBINER BOX WITH (3) PRE-INSTALLED # CONDUIT CONDUCTOR NEUTRAL GROUND 20A BREAKERS. sunrun (2) 12 AWG ENGAGE CABLE (1) 12 AWG ENGAGE CABLE (1) 12 AWG ENGAGE CABLE 2. CONNECT SYSTEM VIA INSULATION PIERCING ON SUPPLY SIDE OF MAIN 1 NONE PER BRANCH CIRCUIT PER BRANCH CIRCUIT PER BRANCH CIRCUIT BREAKER IN MAIN PANEL ENCLOSURE. CONDUCTORS ARE FIELD INSTALLED. 2 3/4"EMT OR EQUIV. (4) 10 AWG THHN/THWN-2 (2) 10 AWG THHN/THWN-2 (1)8 AWG THHN/THWN-2 #180120 3 3/4"EMT OR EQUIV. (2)8 AWG THHN/THWN-2 (1) 8 AWG THHN/THWN-2 (1)8 AWG THHN/THWN-2 4 3/4" EMT OR EQUIV. (2)6 AWG THHN/THWN-2 (1)6 AWG THHN/THWN-2 (1)8 AWG THHNrrHWN-2 200 RESEARCH DR,WILMINGTON,MA 01887 PHONE 888.657.6527 FAX 805.528.9701 CUSTOMER RESIDENCE: JUNE COREY 20 FOSS RD, NORTH ANDOVER, MA, 01845 MODULE CHARACTERISTICS TEL.(978)837-8605 APN n:047.0-0090 CANADIAN SOLAR: 265 W PROJECT NUMBER: CS6P-265P 222R-02000RE OPEN CIRCUIT VOLTAGE 37.7 V DESIGNER: MAX POWER VOLTAGE 30.6 V NICOLE THOMPSON 415.342.3123 SHORT CIRCUIT CURRENT 9.23 A DRAFTER: DIMENSION I SHEET - - - - - - ELECTRICAL REV:A 3/26/2016 PAGE PV-4.0 w Y NORTH - - Town of 0 0 WOW h ver, Mass, o 6 q r" L^ Gcoc"ICNlWKK 1' RATED U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ...... ... ..��................................. BUILDING INSPECTOR Foundation has permission to erect buildi s on 6 �r..,rw .� .. .......................... ....... ........ ... ... . � Rough to be occupied as ..e.0.1w.... .. ...... .L......... 10..... yk.x ................9�.�./1�►.�l� 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 CTI 4BUILD61i=!iPift* Rough Service .2 I nna die R 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. /4� Location No. t5Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee '-' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#2Z71�� 1 30554 Building Inspector I Final Construction Control Document To be submitted at completion of construction by a Registered Design Professional aN . for work per the 81h edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Conrad Residence - 222R-067CONR Date: 7/14/16 Permit No. ' f Property Address: 67 Colgate Drive, North Andover, MA 01845 J I Project: Check one or both as applicable: ❑ New construction X Existing Construction Project description: PV Panel Installation I Paul Zacher MA Registration Number: 50100 Expiration date: 06/30/2018 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Architectural Structural [ J Mechanical [ ] Fire Protection [ ] Electrical [ ] Other: for the above named project. I, or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge, information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CM OFA44S PAUL K. �S Enter in the space to the right a"wet"or ZACHER m electronic signature and seal: o STRUCTURAL CIO No.50100 .06/30/2G�A Phone number: (916) 961-3960 Email: aul zse.com pNAl. Building Official Use Only J Building Official Name: Permit No.: Date: Version 06 11 2013 1 $y+iiF At 41 d ' µ ' III777 ,. . v 1 � 4 q tr 1 l y , I, 11111111111111111111 Code End PU3 apo 1111111111111111II lillI Code Start :P84S apo 11111111 , 11 1 1111 1 11I Staple aldels 1111111 "1 11111111111 , 1111 II t Date...,5 -.�..- ... r10RTM 0� TOWN OF NORTH ANDOVER PERMIT FOR WIRING S3 CMUS� 9 This certifies that j . ...........". % ............................. `V has permission to perform C wiring in the building of o l e6A'/' ,, F at........... ' ..... �. . ............. .................... .North Andover,Mass. Fee.. :.'.. Lic.No��1 ............����,r!/........ ......... ..... ELECTRICAL INSPEC'!�R Check # �'• 7 4 I, i Jim UU1MVU1y rrcrtW n Ur ire U"ftu J1511 J �••w�/��-«•«� DEPARME VfOFPURK Permit No. BOARDOFFIREPREVEMON ONS5rCM128o Occupancy&Fees Checked APPLICA77ONFOR PE AffTO P ORMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MA CHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date slqlz Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the Actrical rk escribed belo . Location(Street&Number) � 3 Owner or Tenant J Owner's Address Is this pI ermit in conjunction with a building permit: L- \-4e No (Check Appropriate Box) Purpose of Building l Utility Authorization No. Existing Service AmpsVolts Overhead a Underground No.of Meters New Service AmpsVolts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transforrners Total KVA \lo.of Lighting Fixtures Swimming Pool Above Below Generators KVA ro ground No.of Oil Burners No. f Emer e `.of Receptacle Outlets o g racy Lighting Battery Units ��.of Switch Outlets No.of Gas Burners o.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps . Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW LocalMunicipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis i No.Hydro Massage Tubs No.of Motors Total HP r OTHER• lttstttattceCo�age:Plnq�attbl4tetac}taerrla�safM�adz�fl4 L1ws IhaveaamlrtliabrTiylrwiattoel�6cy' CrarVi* critsst>istrialapvalm�t YES NO Ihawa triMdva6aptoofofsane Offi=YES lfyouhawched®dYEScate ,pk=indtttetypeof by d >g box LL���JJJ INSMANCE BOND 0 OIIIEx M raw**). �jEslin ddValleofD WcalWhk$ li w«kbstatt kWecli nDaleRegttesiddRout Find (�f Sgried F N NIE LiomNo. � X33 LiomueNo Btsir=Te1NaC11 !�3 Adles�.- ILJ�, 1,1-7� Aral A1711% OWNER'SMURANCEWAIVE1Uamawatethellomneaotsnotty:net�ieirlsua'MaNcriFodtsa )swmddegLivalmltasmgaitedbyN GffnWIaws ` anddratmysg&ncnthispaukappLrat*rnwarsttismw*m ntmt (Please check one) Owner [:3 Agent p� Telephone No. PERMIT FEES � F signature o caner gen -