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Building Permit #079-2017 - 76 BOSTON HILL ROAD 5/1/2018
L r BUILDING PERMIT ONoRT" � F�zteO TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION '' ZO Permit No#: Date ReceivedTED . ��SSgcHus���5 Date Issued: MORTANT:Applicant must complete.0 items on this page LOCATION. Print PROPERTY OWNER Print 100 Year Structure yesno MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes n i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement- ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑'Septic ❑Well I]Floodplain ' ❑Wetlands ❑ VVe ers_he'd District o Water/Sewer.: DESCRIPTION OF WORK TO BE PERFO Identification- e T or ri Clear OWNER: Name: Phone: Address: Contractor me' T � P ne: Email: Address: Superviso nstruction License: Exp. Date: Home Impro ent License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons eon tractin ed contractors do not have access to the guaranty fund Location < V No w �-- Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 1 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector L .. y, 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. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS i HEALTH Reviewed on_ Siqnature I COMMENTS i * 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 DEPS RTNiENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector lies 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 ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 { BuildingDepartment p nt The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work iL Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit R Addition Or Decks i. Building Permit Application I Certified Surveyed Plot Plan Workers Comp Affidavit ? Photo Copy of H.I.C. And C.S.L. Licenses � Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit ! Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And I Hydraulic Calculations (If Applicable) Copy of Contract 4- 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 Doe:Building Permit Revised 2014 i � NORTF� Town of ndover No. Z � �Ih � ver, Mass, ©� 2�' 0 I.Nf C OC NIC Nf WICN V i A�'#ATE0 ►PP,`�(5 S fJ BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT ...... .� BUILDING INSPECTOR . . .. .... ... . I...� . . Foundation has permission to erect .......................... buildings on ....... ..... �Q.'��. .d�4�... ....... . Rough to be occupied as .... .... ........................................ �r....t �� 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 1 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST ON Rough Service .. ... . ....... .... .. .... .. I BUILDING.INSPECTOR. Final 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. +L EAH Structural Consulting 11 Ponybrook Lane Lexington, MA 02421 PHONE 1.978.406.8921 E:AH C,Q,NBUL TING Elaine(k_-DEAHstructural.com July 15, 2016 To: Sunbug Solar 411A Highland Ave Somerville,MA 02144 Subject: Structural Certification for Installation of Solar Panels Dube Residence 76 Boston Hill Road North Andover,MA.01845 To Whom It May Concern, A design check for the subject residence was done on the existing roofing and framing systems for the installation of solar panels over the roof. From a field inspection of the property,the existing roof support structures were observed by the client's auditors as follows: The roof structure of(MP1and MP2)consists of composition shingle on roof plywood that is supported by nominal 2x8 rafters @ 16"o.c.,paired with nominal 2x8 ceiling joists @ 16"o.c..The rafters have a max projected horizontal span of 12'-0",with a slope of 20 degrees.The rafters are connected at the ridge to a continuous 2x10 ridge board and are supported at the eave by a load bearing wall. The existing roof framing system of(MP1and MP2)is judged to be adequate to withstand the loading imposed by the installation of the solar panels.No reinforcement is necessary. The spacing of the solar standoffs should be kept at 48"o.c.. I further certify that all applicable loads required by the codes and design criteria listed below were applied to the AEE SnapNRack solar rail system and analyzed.Furthermore,the installation crews have been thoroughly trained to install the solar panels based on the specific roof installation instructions developed by AEE SnapNRack for the racking system and AEE for the roof connections. Finally,I accept the certifications indicated by the solar panel manufacturer for the ability of the panels to withstand high wind and snow loads. Design Criteria: • Applicable Codes=Massachusetts Residential Code,8th Edition,ASCE 7-05,and 2005 NDS • Roof Dead Load=9 psf(MPland MP2) • Roof Live Load=20 psf • Wind Speed=100 mph,Exposure B • Ground Snow Load=50 psf - Roof Snow Load=35 psf Please contact me with any further questions or concerns regarding this project. Sincerely, �Z'OFAf4V ELAINE A. GN C.7 HUANG � CIVIL y Elaine Huang,P.E. Na 49029 Project Engineer ZONAL ENG Dube Residence, North Andover 1 •. A I EAH Structural Consulting 11 Ponybrook Lane Lexington, MA 02421 PHONE 1.978.406.8921 Caw CON5ULTING ElaineiuEAHstructural.com Gravity Loadinq Roof Snow Load Calculations pg=Ground Snow Load= 50 psf pf=0.7 Ce Ct I pg (ASCE7-Eq 7-1) Ce=Exposure Factor= 1 (ASCE7-Table 7-2) Ct=Thermal Factor= 1 (ASCE7-Table 7-3) 1=Importance Factor= 1 pf=Flat Roof Snow Load= 35.0 psf ps=4f (ASCE7-Eq 7-2) Cs=Slope Factor= 1 ps=Sloped Roof Snow Load= 35.0 psf PV Dead Load=4 psf(Per Sunbug Solar) Roof Dead Load(Mand MP2) Composition Shingle 4.00 Roof Plywood 2.00 2x8 Rafters @ 16"o.c. 2.27 Vaulted Ceiling 0.00 (Ceiling Not Vaulted) Miscellaneous 0.73 Total Roof DL(MP1and MP2) 9.0 psf DL Adjusted to 20 Degree Slope 9.6 psf Dube Residence, North Andover 2 w EAH Structural Consulting it Ponybrook Lane Lexington,MA 02421 PHONE 1.978.406.8921 CAM Cor4s t-nNr, ElaineCEAHstructural.com Wind Calulations Per ASCE 7-05 Components and Cladding Input Variables Wind Speed 100 mph Exposure Category B Roof Shape Gable/Hip Roof Slope 20 degrees Mean Roof Height 20 ft Building Least Width 40 ft Effective Wind Area 17.5 ft Design Wind Pressure Calculations Wind Pressure P=qh*(G*Cp) qh=0.00256*Kz*Kzt*Kd*V12*I (Eq_6-15) Kz(Exposure Coefficient)= 0.7 (Table 6-3) Kzt(topographic factor)= 1 (Fig.6-4) Kd(Wind Directionality Factor)= 0.85 (Table 6-4) V(Design Wind Speed)= 100 mph I Importance Factor= 1 (Table 6-1) qh= 15.23 Standoff Uplift Calculations Zone 1 Zone 2 Zone 3 Positive GCp= -0.85 -1.45 -2.30 0.40 (Fig.6-11) Uplift Pressure= -12.95 psf -22.09 psf -35.03 psf 10.0 psf (Minimum) X Standoff Spacing= 4.00 4.00 4.00 Y Standoff Spacing= 2.75 2.75 2.75 Tributary Area= 11.00 11.00 11.00 Footing Uplift= -142 Ib -243 Ib -385 Ib Standoff Uplift Check Maximum Design Uplift= -385 Ib Standoff Uplift Capacity =400 Ib 400 Ib capacity>385 Ib demand Therefore,OK Fastener Capacity Check Fastener= 1 -5116"dia Lag Number of Fasteners= 1 Embedment Depth= 2.5 Pullout Capacity Per Inch=250 Ib Fastener Capacity=625 Ib w/F.S.of 1.5= 417 Ib 417 Ib capacity>385 Ib demand Therefore,OK Dube Residence, North Andover 3 I EAH Structural Consulting 11 Ponybrook Lane Lexington,MA 02421 PHONE 1.978.406.8921 CAH CQNSut-riNo Elaine@EAHstructural.com Framing Check (Mand MP2) PASS I w=65 plf j Dead Load 9.6 psf PV Load 4.0 psf Snow Load 35.0 psf 2x8 Rafters @ 16"o.c. ® Q Governing Load Combo=DL+SL Member Span 12'-0" Total Load 48.6 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 = (wL12)/8 = 1165.86 ft# = 13990.3 in# Actual Bending Stress=(Maximum Moment)/S =1064.7 psi Allowed>Actual--76.7%Stressed -- Therefore,OK Check Deflection Allowed Deflection(Total Load) = U180 (E=1400000 psi Per NDS) = 0.8 in Deflection Criteria Based on = Simple Span Actual Deflection(Total Load) _ (5'w*L^4)/(384*E"1) = 0.454 in = U318 > U180 Therefore OK Allowed Deflection(Live Load) = U240 0.6 in Actual Deflection(Live Load) _ (5'w*L"4)/(384'E"I) 0.327 in U441 > U240 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 12 = 389 Ib Allowed>Actual--26.5%Stressed -- Therefore,OK Dube Residence, North Andover 4 J DocuSign Envelope ID:36E6B30A-DO60-4CB3-9023-1AB5FE58EAE3 j • • O M n n u g Solar' TURNKEY INSTALLATION AGREEMENT THIS AGREEMENT,dated 6/2/2016 (the"Effective Date's is entered into between Kevin Dube("Owner")and SunBug Solar,LLC("Installer")whose physical address is 1165R Mass Ave.Arlington MA 02476 and HIC License number is 163091, for the installation and/or improvement of a solar system at the Owner's premises located at 76 Boston Hill Rd North Andover,MA 01845(the"Premises"),all as more specifically described below(the"Protect"). 1. THE WORK. Installer has previously submitted and Owner has approved the Proposal for the Project(the"Proposal'). By way of summary only,Installer's Scope of Work consists of the following elements as indicated: Materials Procurement Permitting Completion of Incentive Paperwork Turnkey Installation Electrical Interconnection Support Owner Operation Training Customer is responsible forproviding internet connection for onkne monitoring services 2. CONTRACT DOCUMENTS. This Turnkey Installation Agreement together with the Terns & Conditions set forth below(the"Terms and Conditions"),any change orders executed by the parties("Change Orders")and the Proposal(each of which are incorporated herein by reference and may be referred to as the"Contract Documents") comprise the entire agreement of the parties and may be referred to as"this Agreement." 3. CONTRACT SUM,PAYMENTS,REBATES. a.The cost of the Project,including all materials,labor and Installer's fees (described as the gross price in the Proposal)is $41,500 dollars("Guaranteed Maximum Price"). The Guaranteed Maximum Price is a fixed price,not an estimate,and can only be changed by the parties executing and delivering a Change Order(see Section 10 of the Terms&Conditions for more information on Change Orders). However, the cost of the Project may be affected by unanticipated regulatory requirements(eg.,such as wetlands studies)and unforeseen conditions occasionally discovered after Installer's engineering analysis (U., structural reinforcement or roof repair). If this is the case, a Change Order reflecting a new Guaranteed Maximum Price will be required in order for the Project to continue. b.Owner will make payments to Installer in accordance with the following schedule: Payment Terms Breakdown Amounts Down payment $1,000 $1,000.0 0%due on order of materials 50% $20,750.0 0%due on construction completion 40% $16,600.0 Balance due on Utility Interconnnection Balance $3,150.0 Total $41,500.0 c.During construction,Installer may bill Owner partial progress payments for construction work(ems.,when some work is scheduled to be done before or after our primary construction mobilization we may bill a portion of the construction payment for that work;rough-in electrical work,critter guard,etc.) d.Installer shall apply,on behalf of Owner,for applicable rebates including any rebates as offered by Owner's utility service. Unless otherwise noted below,any rebates shall be payable directly to Owner subject to utility or other third-party approval. Owner acknowledges that rebates payable to Installer have reduced the contract sum payable to Installer by Owner. ❑ Rebates will be paid directly to Installer(Check only if rebates to installer). e.If requested by Owner, Installer shall submit a Massachusetts Department of Energy Resources (DOER) and Massachusetts Clean Energy Center(MassCEC)Mass Solar Loan Technical Application.In that case,this Agreement and subsequent work is contingent on Program Loan approval(the"CEC Loan Approvals'). f. Installer shall secure all necessary construction related permits,other permits and/or governmental licenses and inspections necessary for the completion of the Project. Unless otherwise noted,fees associated with acquiring such permits,licenses and inspections will be home by Installer; owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. 4. NOTICE OF RIGHT TO CANCEL. Owner may cancel this Agreement and the transactions contemplated hereby with no liability at any time prior to midnight on the third business day following the Effective Date. 5. CONFLICTS. In the event of a conflict between this Turnkey Installation Agreement and any Contract Document or between the Terms and Conditions and any other Contract Document,this Turnkey Installation Agreement and the Terms and Conditions,respectively,shall govern. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Page 1 of 6— SUNBUG SOLAR,LLC 0 2015 INSTALLATION AGREEMENT DocuSign Envelope ID:36E6B30A-DO60-4CB3-9023-1AB5FE58EAE3 Entered into as of the Effective Date: Mgned by: Docuft"� SUNBUG SOLAR,LLC �1. L V 'ignature] FD738894BCE7432... 3A4B269EDA1E40C... / Kevin Dube Jennifer L Dube By: By:Ben Mayer,Residential Sales Manager 6/2/2016 Date: Solar Consultant Chris Miller i Page 2 of 6— SUNBUG SOLAR,LLC©2015 INSTALLATION AGREEMENT i I DocuSign Envelope ID:36E6B30A-D060-4CB3-9023-1AB5FE58EAE3 I Zuw o uoi Solar® TERMS& CONDITIONS These Terms&Conditions are incorporated by reference into that certain Turnkey Installation Agreement between Installer and Owner(together with these Terms&Conditions and the other documents incorporated by reference therein,this"Agreement")and applies to all products and services furnished by Installer thereunder. Capitalized terms used but not otherwise defined in these Terms&Conditions shall have the meanings assigned to them in the documents comprising this Agreement. 1. TIME OF COMMENCEMENT&SUBSTANTIAL COMPLETION. a. Work on the Project (including all labor, materials, equipment and services, whether completed or partially completed under this Agreement,the"Work's will,unless otherwise scheduled in the Proposal,commence no later than sixty days (60) following the receipt of all applicable approvals including but not limited to the CEC Loan Approvals(the"Start Date"). b. Installer estimates that the Work will be substantially completed within one hundred twenty(120)days following the Start Date (the"Completion Date"). Substantially complete shall be defined as the date the Owners receive a utility interconnection,or similar such certification from the applicable authority. C. If the Work is delayed at any time by causes beyond Installers reasonable control,which causes may include,but not be limited to,weather,acts of war or terrorism,material shortages,delays in the delivery of materials,Change Orders, inspection/permitting delays, labor disputes, design changes, hazardous site conditions, design flaws or impairments,subcontractor disputes,or Owner's use or directives,then the Completion Date will be extended for such equal number of days as occasioned the delay. In addition,the Completion Date may be extended for such reasonable time as Owner and Installer may determine in writing pursuant to a Change Order. d. Installer shall have all materials required to commence the Work at the Premises no later than the Start Date. e. Installer shall supervise and direct the Work in accordance with industry and regulatory standards,and it shall be solely responsible for all construction means,methods,techniques,sequences and procedures and for coordinating all portions of the Work hereunder. 2. WARRANTIES OF INSTALLER. a. Installer warrants to Owner that all materials and equipment incorporated into the Work by Installer will be new unless otherwise agreed in the Proposal,and that the Work shall be of good quality,free from material defects and in material conformance with the Contract Documents. All Work not conforming to these requirements may be referred to as"Defective Work." b. Upon written notice from Owner delivered to Installer no later than the 10th anniversary date of the Completion Date,Installer shall promptly correct any Defective Work. The provisions of this Article apply to Work done by subcontractors of Installer as well as to work done by direct employees of the Installer. C. To the extent assignable, Installer shall pass through to Owner all original manufacturers'warranties and shall provide Owner with its reasonable assistance in connection with any warranty claim for defective materials. d. Installer's warranty does not extend to any materials or equipment not selected by Installer or its agents,or to work performed by third parties not engaged by Installer or not under direct subcontract to Installer.Damage or defect caused by abuse,modifications not executed by Installer,improper or insufficient maintenance,improper operation or normal wear and tear shall void Installer's warranty. e. Installer disclaims any and all warranties or guarantees with respect to the level of electrical production of the Project. Information with respect to electrical production of the Project is based on manufacturer's estimates of installed materials,and of peak sun hours,sun direction and other factors.Factors such as dust,shading,snow,ice, weather and other natural and man-made elements,including usage,may adversely affect electrical production. THE FOREGOING WARRANTIES ARE EXCLUSIVE AND IN LIEU OF ALL OTHER WARRANTIES OF QUALITY AND PERFORMANCE,WHETHER WRITTEN,ORAL OR IMPLIED,AND ALL OTHER WARRANTIES INCLUDING ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, NONINFRINGEMENT OR USAGE OF TRADE ARE HEREBY DISCLAIMED. THE REMEDIES STATED HEREIN CONSTITUTE OWNER'S EXCLUSIVE REMEDIES AND INSTALLER'S ENTIRE LIABILITY FOR ANY BREACH OF WARRANTY. 3. COMPLIANCE WITH LAWS. Page 3 of 6— SUNBUG SOLAR,LLC 0 2015 INSTALLATION AGREEMENT DocuSign Envelope ID:36E6B30A-D060-4CB3-9023-1AB5FE58EAE3 a. Unless otherwise specified in this Agreement, Installer shall secure all necessary permits, any applicable rebate applications, other governmental licenses and inspections necessary for the completion of the Project. Unless otherwise specified in this Agreement,fees associated with acquiring such permits,licenses and inspections will be home by Installer. b. Owner shall furnish at Owner's expense,all of the following as deemed necessary by the Installer: (i) Legal descriptions (including legal limitations such as easements, rights of way, codes, covenants, conditions,restrictions,design guidelines),surveys and utility locations for the Premises;and (ii) Any required engineering plans,drawings,calculations,or specifications(the"Additional Plans") (i)in order to obtain any required non-ministerial permits or inspections,or(ii)in order to adequately secure the Premises and provide reasonable safety precautions.Owner acknowledges that some municipalities, utilities or other necessary permitting parties may require specific engineering studies or inspections in addition to those customary required or already obtained by Owner C. Installer shall give all notices and comply with all laws,ordinances,rules,regulations,and lawful orders of any public authority applicable to the performance of the Work,and shall promptly notify Owner if it has a reasonable basis to conclude that the designs,plans or Additional Plans are at variance therewith. d. Installer shall be responsible for all safety precautions in connection with the Work. Installer shall take all legally required and commercially reasonable safety precautions at the Premises. e. Installer and all subcontractors shall be registered as home improvement contractors and any inquiries relating to a registration should be directed to:Office of Consumer Affairs and Business Regulation Ten Park Plaza,Suite 5170 Boston,MA 02116 Phone:(617)973-8700 4. INSURANCE. Installer's liability insurance shall be purchased and maintained by the Installer to cover claims under workers'compensation acts and other employee benefit acts,claims for damage because of bodily injury,including death,and from claims for property damage to the Premises which may arise out of or result from Installers operations under this Agreement,whether such operations be by itself or by any subcontractor or anyone directly or indirectly employed by any of them.This insurance shall be written for not less than the minimums required by the state where the Project is located under applicable law and state rebate programs.Certificates of such insurance shall be filed with Owner prior to the commencement of the Work at Owner(s)' request. Owner shall maintain liability insurance (either as separate policy or included in a homeowners or excess liability policy)sufficient to meet to Owner indemnity obligations under Section 8 below. 5. SUBCONTRACTORS. Owner acknowledges that portions of the Work may be allocated to Subcontractors. Installer shall not employ any subcontractor to whom the Owner may have a reasonable objection. Installer shall not be required to contract with anyone to whom it has a reasonable objection.The Guaranteed Maximum Price includes the cost of a qualified electrician for electrical interconnection to the utility. Unless specifically noted in the Proposal, additional costs for any required electrical upgrades or improvements to the site's electrical service and components shall be the responsibility of Owner and are not included in the Guaranteed Maximum Price. 6. SITE CONDITIONS. Owner has no knowledge of any pre-existing toxic materials,hazardous substances,or defective or dangerous conditions,structural or otherwise which may pose a health or injury risk to Installer or Installer's employees or agents. In the event that Installer observes hazardous site conditions,Installer will notify Owner promptly and Owner and Installer will,if feasible, execute a Change Order for the remediation of such conditions. Such hazardous conditions will postpone the Completion Date by the amount of days required to complete remediation.The Guaranteed Maximum Price includes the cost of basic site preparation,but does not include the cost of any remedial site preparation as contemplated in this Section.The cost of such remedial site preparation shall be the responsibility of Owner. 7. INCENTIVE APPLICATIONS. Unless otherwise set forth in this Agreement,Installer shall apply for available incentives on behalf of Owner.Owner will assist Installer in such application process and warrants that all Owner information provided therein (including financial information,home value information and other personal information) shall be true,correct and complete as of the date of the application.Owner agrees that Installer will be listed as the primary installer/contractor on any application and be credited as the installer of record on all public documents and correspondence concerning the Project. Owner hereby acknowledges that Installer makes no warranty or guarantee of the availability of all,or any part of,any federal, state,local or utility incentives,tax credits or deductions. Owner is encouraged to consult with a tax advisor as to the avaihbik'ty of tax credits with aspect to the Project. 8. INDEMNITY. a. To the fullest extent permitted by law,Owner shall indemnity,hold harmless and reimburse Installer,its agents and employees from and against all claims, damages, losses and expenses (including, but not limited to reasonable attorney's fees) arising out of or resulting from any death, bodily injury or illness or destruction to property, including any resulting loss of use thereof(i)due to a breach of Owner's warranty contained in the first sentence of Page 4 of 6— SUNBUG SOLAR,LLC©2015 INSTALLATION AGREEMENT DocuSign Envelope ID:36E6B30A-D060-4CB3-9023-1AB5FE58EAE3 Section 6 above or(ii)to the extent resulting from the negligence or misconduct of Owner or its invitees or agents (other than Installer and its subcontractors).Owner's indemnification obligations herein are conditioned upon the following.(a)it is promptly notified in writing,provided,that the indemnified party's failure to promptly notify shall not relieve the indemnifying party of its obligations hereunder to the extent the indemnifying party is not actually prejudiced,(b) Owner is allowed to exercise sole control over the defense of any claim and all related settlement negotiations (with counsel reasonably acceptable to the indemnified party);and(c)the indemnified party provides Owner,at Owner's expense,all reasonably necessary assistance,information,and authority to perform the above. The indemnified party shall have the right to participate in its defense with counsel of its own choosing at the indemnified party's sole cost and expense. b. The foregoing notwithstanding, Owner will not make any offers of settlement nor enter into any settlement agreements without the written consent of the indemnified party,which consent will not be unreasonably withheld or delayed. 9. LIMITATIONS ON DAMAGES AND LIABILITY. Except in connection with Owner's obligations under Section 8, neither Owner nor Installer shall be liable to the other for any indirect,punitive,special,incidental or consequential damages, regardless of the form of action,whether in contract,tort, strict liability or otherwise,even if such party could have been aware of the possibility of such damages.Installer's aggregate liability for all claims arising under this Agreement or otherwise shall not exceed the gross amount paid or owed to Installer hereunder. This waiver shall survive any termination of this Agreement. 10. CHANGE IN THE WORK. Owner,without invalidating this Agreement,may seek changes in the Project consisting of additions,deletions, or modifications. In addition,changes in the Project may be necessitated by permitting or regulatory requirements.All such changes in the Project shall be authorized by a written Change Order signed by Owner and Installer. Installer will advise Owner of the cost of a proposed Change Order,and,if executed,the Guaranteed Maximum Price or price per watt will be adjusted accordingly.All Change Orders will include revision of the Completion Date. 11. TERMINATION. a. If a Change Order is necessary to complete the work,either party has the option to terminate the agreement. b. Either party may terminate this Agreement by a written notice(a"Default Notice's if the other party commits any material breach of this Agreement;provided,that if such breach is capable of cure,such party shall have seven(7) days following its receipt of a Default Notice(the"Cure Period's to cure such breach to the non-breaching party's reasonable satisfaction.If such breach is not cured prior to the expiration of the Cure Period,the non-breaching party may terminate this Agreement immediately by written notice. By way of example only,material breaches include the following. (a)Owner fails to make a payment when due(1n which event Installer may,in its discretion, also suspend work until payment is made);(b)Owner fails to promptly execute a Change Order necessitated by a revision in the Minimum Technical Requirements of a permitting body or regulator; (c) Installer persistently or repeatedly refuses or fails to supply enough properly skilled workers or proper materials;(d)Installer fails to make payment to subcontractors for materials or labor in accordance with the respective agreements between the Installer and subcontractors; and (e) Installer persistently disregards laws, ordinances, or rules, regulations or orders of a public authority having jurisdiction. C. If the CEC Loan Approvals are not obtained,this Agreement shall automatically terminate unless Owner provides Installer with prompt written notice that it wishes to proceed with the Project. d. Either Owner or Installer may terminate this Agreement upon fifteen(15)days prior written notice,if the parties are unable to promptly agree on the terms of a Change Order reasonably necessary for the completion of the Project(e.g.,changes due to regulatory requirements or hazardous conditions). e. If this Agreement is terminated for any reason,Owner shall pay Installer for all work completed and materials used through the date of termination. f Notwithstanding anything to the contrary set forth herein,Sections 2,the first sentence of Section 6, 8, 9,11(d), 11(e),12,13 and 14 of this Agreement and any remedies for the breach thereof,shall survive the termination of this Agreement under the terms hereof. Termination of this Agreement shall not relieve or release either party from any rights,liabilities or obligations which it or she has accrued prior the effective date of such termination. 12. CHOICE OF LAW. This Agreement shall be governed by the internal laws of the Commonwealth of Massachusetts without regard to principles of conflicts of laws. Disputes arising hereunder shall be adjudicated solely and exclusively in Boston, Massachusetts. 13. PROMOTIONAL USE OF PROJECT. Installer may use the description and images of the Project along with any supplied recommendations or testimony of Owner for promotional purposes. (Ifpromotional consent not granted,or if owner requires individualpriorimitten consent,check beret c) Page 5 of 6— SUNBUG SOLAR,LLC 0 2015 INSTALLATION AGREEMENT DocuSign Envelope ID:36E6B30A-D060-4CB3-9023-1AB5FE58EAE3 14. GENERAL PROVISIONS. This Agreement set forth the entire agreement and understanding between Owner and Installer relating to the subject matter hereof, and merges all prior discussions between them. If any one or more of the provisions in this Agreement are deemed void by law,then the remaining provisions will continue in full force and effect. No waiver by either parry of any term or condition of this Agreement,whether by conduct or otherwise,in any one or more instance,shall be deemed a continuing waiver of any such term or condition,or a waiver of any other term or condition of this Agreement. Headings set forth in this Agreement are solely for the convenience of the parties and have no legal effect. The singular shall include the plural,and the masculine gender shall include the feminine and neuter,and vice versa,unless the context otherwise requires.This Agreement may be executed and delivered either originally or by facsimile transmission,and in one or more counterparts,each of which shall be deemed an original and all of which taken together shall constitute one and the same instrument. This Agreement shall be(J) binding upon,and will inure to the benefit of, the parties and their permitted respective successors and assigns and (ii) construed without presumption of any rule requiring construction to be made against the party causing it to be drafted. Page 6 of 6— SUNBUG SOLAR,LLC©2015 INSTALLATION AGREEMENT PVWire in exposed locations ---_ --- ` N 0 co U)O ---- > -_--- f6 Z DC Wires in EMT l rn E inside building ----- • a U) r 0 Solar array composed of 40 LG NeON Mono 300 watt panels z° Wired in 2 series string of 12 panels and 1 string of 16 panels o Panels installed with SolarEdge P320 OptimizersY=< Module frames grounded to main panel ground or ground rod. m_ C `m To utility grid o 000' m , �¢ SolarEdge SE10000A-US Output 10000 Watt, 240V,42 Amps C: �R UL#1741 ungrounded .0 N With Revenue Grade Metering IX E L1 .E Lockable 3R 2-pole Utility NET o DC Disconnect - Black Inverter 60A Fused O Meter w Ungrounded AC Disconnect Inverter Integrated Suitable for use as Pos Disconnected (3)AWG#6 THWN-2 Service Equipment Neg Disconnected (1)AWG#8 GND In Open position + Red in 3/4" EMT boa, o \, Notes: sooA Service Panel a 200A w 1)All equipment to be listed or Solar 240V AC labeled for its application Production 200A Rated 2)installation to be compliant with Meter June 2,2016 National Electric Code Panel 3)Equipment labels to comply Utility Lockable 1 Not to scale with NEC 690 3R 2-pole 4)Point of connection to existing power External distribution system shall be coordinated AC Disconnect E-1 with local utility company i C O lL VV yid k, � � A14 d � ,I'. � � ��•,> �� �� � �I �� G u i i � < i ,°� � I Y u m m I Life's Good LG NeO lack LG's new module,NeONTM'2 Black,adopts Cello technology. Cello technology replaces 3 busbars with 12 thin wires APPROVED PRODUCT to enhance power output and reliability.NeCNTm 2 Black 60 cell demonstrates LG's efforts to increase customers values G E C E "� \Mcs/ beyond efficiency.It features enhanced warranty,durability, Intertek v performance under real environment,and aesthetic design 5b457P 3 a'CMo&tm 15 suitable for roofs. Enhanced Performance Warranty •• High Power Output LG NEONTM'2 has an enhanced performance warranty. Compared with previous models,the LG NEON"'2 The annual degradation has fallen from-0.7%/yr to has been designed to significantly enhance its output -0.6%/yr.Even after 25 years,the cell guarantees 2.4%p efficiency,thereby making it efficient even in limited space. more output than the previous NeONTM modules. Aesthetic Roof ® Outstanding Durability LG NeONTM 2 has been designed with aesthetics in mind; With its newly reinforced frame design,LG has extended thinner wires that appear all black at a distance.The the warranty of the NEON'2 for an additional 2 years. product may increase the value of a property with its Additionally,LG NeONI 2 can endure a front load up to modern design. 6000 Pa,and a rear load up to 5400 Pa. Better Performance on a SunnyDa Double-Sided Cell Structure �•� LG NEON'2 now performs better on sunny days thanks VL The rear of the cell used in LG NeONTM 2 will contribute to to its improved temperature coefficiency. generation,just like the front the light beam reflected from the rear of the module is reabsorbed to generate a great amount of additional power. About LG Electronics LG Electronics is a global player who has been committed to expanding its capacity,based on solar energy business as its future growth engine.We embarked on a solar energy source research program in 1985,supported by LG Group's rich experience in semi-conductor,LCD,chemistry,and materials industry.We successfully released the first Mono X®series to the market in 2010,which were exported to 32 countries in the following 2 years,thereafter.In 2013,NeONTM(previously known as Mono X®NeON)won"Intersolar Award';which proved LG is the leader of innovation in the industry. Y LG NeONzerack i Mechanical Properties Electrical Properties(STC*) Cells 6 x 10 300 W Cell Vendor LG MPP Voltage(Vmpp) 32.5 Cell Type Monocrystalline/N-type MPP Current(Impp) 9.26 Cell Dimensions 156.75 x 156.75 mm/6 x 6 inch Open Circuit Voltage(Voc) 39.7 u of Busbar 12(Multi Wire Busbar) Short Circuit Current(Isc) 9.70 Dimensions(L x W x H) 1640 x 1000 x 40 mm Module Efficiency(%) 18.3 64.57 x 39.37 x 1.57 inch Operating Temperature(°C) -40-+90 Front Load 6000 Pa/125 psf Maximum System Voltage(V) 1000 Rear Load 5400 Pa/113 psf( Maximum Series Fuse Rating(A) 20 Weight 17.0 t 0.5 kg/37.48 t 1.1 lbs Power Tolerance(%) 0-+3 Connector Type MC4,MC4 Compatible,IP67 *STC(Standard Test Condition):Irradiance 1000 W/m',Module Temperature 25°C,AM 1.5 Junction Box I P67 with 3 Bypass Diodes •The nameplate power output is measured and determined by US Electronics at its sole and absolute discretion. •The typical change in module efficiency at 200 W/m'In relation to 1000 W/m'Is-3.0%. Length of cables 2 x 1000 mm/2 x 39.37 inch Glass High Transmission Tempered Glass P Electrical Properties(NOCT*) Frame Anodized Aluminum 300 W Certifications and Warranty Maximum Power(Pmpp) 218 MPP Voltage(Vmpp) 29.5 Certifications(In Progress) IEC 61215,IEC 61730-1/-2,UL 1703, MPP Current(Impp) 7.38 ISO 9001,IEC 62716(Ammonia Test), Open Circuit Voltage(Voc) 36.5 IEC 61701(Salt Mist Corrosion Test) Short Circuit Current(Isc) 7.83 Module Fire Performance Type 2(UL 1703) •NOR(Nom nal Operating Cell Temperature):Irradiance 800 VV/m2,ambient temperature 20 C,wind speed 1 m/s Product Warranty 12 years I*"1y Output warranty of Pmax Linear warranty* Dimensions Dimensions(mm/in) (measurement Tolerance t 3%) •1)1 st year 98%,2)After 2nd year 0.6%p annual degradation,3)83.6%for 25 years Temperature Coefficients 5 5 NOCT 46 t 3°C d SPP -0.38%/°C( 9 Voc -0.28%/°C -x wv9r 0.wz a,.b.t� sn�ra4.t� Isc 0.02%/°C AM 1flaJM�1 Characteristic Curves 3 t 0aow 11010 r4rYa» am e00w 1-I0 6.00 600w R Ib�, Ya.°pnoege�) 4.00 400w 2.00 - 200W w,�N p pp Y 4 vara•M am 5.00 10.00 1500 tom 25.00 3000 35.00 40.00 4s.0D ,�q gR 1m i t2o 40 vma I 20 g R 8 0 TwipYrm,rt CQ m -25 0 25 so Ts 90 The distance between the center of the mounting/grounding holes LG North America Solar Business Team Product specifications are subject to change without notice. LG Electronics USA Inc DS-N2-60-K-G-F-EN-50427 ME a Lifes Good 1000 Sylvan Ave,Englewood Cliffs,NJ 07632 - Copyright©2015 LG Electronics.All rights reserved. Innovation fora Better Life , Contact Ig.solar a@lge.com 01/04/2015 www.Igsolarusa.com i. SERIES 100 ROOF SnapNrack Residential PV Mounting Systemsi The SnapNrack line of solar mounting systems is designed to reduce total installation costs. The system features technical innovations proven on more than 10OMW of solar projects to simplify ' installation and reduce costs. Pitched Roof Arrays Simplified i The SnapNrack Series 100 Roof Mount System is an efficient,visually appealing, photovoltaic (PV) module installation system.Series 100 was developed in the field by a team of veteran solar engineers and installers. Their goal was to ensure a quick,efficient installation. Series 100 has been tested on megawatts of real-world Roof System In 4 Simples: residential and commercial installations. Industry leading installation times are achieved with unique 1)identify Site Conditions(Array Tiff Building Snap-in fasteners and fully adjustable components that Height,Roof Type,Wind and Snow toads) make installation of roof mounted solar arrays easy )Determine while achieving lower installation coDetermineootrnr `Span from Engineering Tables(downfoad at www.stiapr)rack.com) • Up to 3"of height adjustability at roof connection )Choose cotor(Clear or Black)and roof • Waterproof full-metal flashing at each roof penetration attachment type • Works on virtually all composition and tile roofs `f) place Order with your distributor. Purchase material for d single project or order in bulk • Single wrench size for all system hardware for additional saviri s • Configures easily as low profile or tilt(0-60 Degrees) v Rail&Module Clamps Attachments • Rail channels provide excellent wire management .Array Accessories Patent Pending SnapN� rack- Simple MP Quick assembly and clean aesthetic finish • One wrench fits every bolt in the system Low profile installation on any roof °ia F n Adaptable • Compatible with virtually all 60 and 72 cell modules • Unique"snap-in"channel nuts can be installed anywhere on the rail • Rail channels provide improved wire management Strong • Excellent seismic,wind,and snow-loading protection • Vertical and horizontal adjustments ensure superior fit • Rain-tight metal flashing ensures waterproofing Innovative Universal End Clamps • One size fits any standard L frame module • Clean look-nothing extends beyond module frames • Less waste- rail lengths match most modules SnapNrack Series 100 Technical Data Patent Pending I Materials • 6000 Series aluminum • Stainless steel • Galvanized steel Material Finish •Clear and black anodized aluminum Installation •Quick and efficient mounting •Adjustable hardware to ensure clean and level finish •Worry-free waterproof flashing Calcs. & Certifications • Wind speeds up to 150 MPH and snow loads to 120 PSF Grounding • Washer, Electrical Equipment Bond (WEEB) or lay-In lugs Warranty • 10 Year material and worksmanship (download full details at snapnrack.com) Snap Mrack- FV [`v=VtUrL2 SJf t3M (877) 732-2860 www.SnapNrack.com 0 Printed on recycled paper using soy based inks.. ©2012 by SnapNrack PV Mounting System.All rights reserved. solar - . • SolarEdge Single Phase Inverters For North America SE3000A-US/ SE380OA-US/ SE5000A-US/ SE6000A-US/ SE760OA-US/ SE1000OA-US/ SE1140OA-US 7, lie iplie 2 � :'cam w8� i ra�O�JY� V r� I+ I I r � ` The best choice for SolarEdge enabled systems Integrated arc fault protection(Type 1)for NEC 2011690.11 compliance Superior efficiency(98%) Small,lightweight and easy to install on provided bracket Built-in module-level monitoring Internet connection through Ethernet or Wireless Outdoor and indoor installation Fixed voltage inverter,DC/AC conversion only Pre-assembled Safety Switch for faster installation Optional—revenue grade data,ANSI C12.1 USA-GERMANY-ITALY-FRANCE-JAPAN-CHINA-AUSTRALIA-THE NETHERLANDS-ISRAEL www.solaredge.us .Gl solar=@sSingle Phase Inverters for North America SE3000A-US/SE380OA-US/SE5000A-US/SE6000A-US/ SE760OA-US/SE1000OA-US/SE1140OA-US SE3000A-US I SE380OA-US I SE5000A-US I SE6000A-US SE760OA-US I SE1000OA-US I SE1140OA-US OUTPUT Nominal AC Power Output 3000 3800 5000 6000 7600 9980 @ 208V 11400 VA 10000 240V ........................................... ................ ............... ................. ................ ................ ......... ....... .................. ........... Max.AC Power Output 3300 4150 5400 @ 208V 6000 8350 10800 @ 208V 12000 VA ........................................... ................ . 5450.�2aov 109s0�2aoV.. .................. ........... .............. ....... . . ................ ................ ......... AC Output Voltage Min:Nom:Max!') V 183-208 .-.2.........29 Vac . .......... .................... ................ ............... ................. ................ ................ .................. .................. ........... AC Output Voltage Min:Nom:Max!') 211-240-264 Vac ........................................... ................ ............... ................. ................ ................ .................. .................. ........... AC Frequency Min:-Nom:Max.)t) 59.3-60-60.5(with HI country setting 57:60;60:5) Hz ........... Max.Continuous Output Current 12 5 16 24�° 208V 25......�.......32 I 48 @ 240V J 47.5 A ........................................... 21 240V.. ................ .......... .... ...42 @ .......... GFDI Threshold1 A ........................................... .......................................................................................................................... ........... Utility Monitoring,Islanding Protection,Country Configurable Thresholds Yes Yes INPUT Maximum DC Power(STC) 4050 5100 6750 8100 10250 13500 15350 W ........................................... ................ ............... ................. ................ ................ .................. .................. ........... Transformer-less,Ungrounded Yes ........................................... .......................................................................................................................... ........... Max.Input Voltage 500 Vdc ........................................... .......................................................................................................................... ........... Nom.DC Input Volt age325 @ 208V/350 @ 240V Vdc ........................................... ................ ........... 16.5 @ 208V 33 @ 208V Max.Input Current)') 9.5 13 18 23 34.5 Adc ...... .15:5.x°.240 3 V. ................ ................ .. 05 @ 240V .. ............ Max.Input Short Circuit Current 45 Adc ........................................... .......................................................................................................................... ........... Reverse-Polarity Protection Yes ........................................... .......................................................................................................................... ........... Ground-Fault Isolation Detection 600koSensitivity ........................................... ................ ............... . .............. .................. .................. ........... Maximum Inverter Efficiency.......... .... 97:7....., 98:2..... ... 98:3 98:3 98....... 98 98 ................. 97.5 @ 208V 97 @ 208V CECWeighte......ency•••.•.•..•.•... .•... .........• ......98...... .... . 97.5 97.5 97.5 ............................ 98 P.240V.. ................ ................ ..97;5 @ 240V Nighttime Power Consumption <2.5 <4 W ADDITIONAL FEATURES Supported Communication Interfaces RS485,RS232,Ethernet,ZigBee(optional) .................................... ................................................................................... ........... Revenue Grade Data,ANSI C12.1 Optional)') ........................................... ......................................... ................................................................................ ........... Rapid Shutdown—NEC 2014 690.12 Functionality enabled when SolarEdge rapid shutdown kit is installed(4) STANDARD COMPLIANCE Safety UL1741,UL1699B,UL1998,CSA 22.2 ........................................... .......................................................................................................................... ........... Grid Connection Standards IEEE1547 ........................................... .......................................................................................................................... ........... Emissions FCC part15 class B INSTALLATION SPECIFICATIONS AC output conduit size/AWG range 3/4"minimum/16-6 AWG 3/4"minimum/8-3 AWG ........................................... .................................................................................... ..................................... ........... DC input conduit size/#of strings/ 3/4"minimum/1-2 strings/ AWG ran a 3/4"minimum/1.2 strings/16.6 AWG &.............................. . 14;6 AWG ............. ........... Dimensions with Safety Switch 30.5 x 12.5 x 7.2/775 x 315 x 184 30.5 x 12.5 x 10.5/ in/ lj WMp 775,x 315 x 260......... „_mm„ .. ....... ................................ ................................ ................................................... .......... Weight with Safety Switch 51.2/23.2 I 54:7/24:7 88.4/40.1 Ib kg ............... .. ................ . ...................... . ....... Natural convection Cooling Natural Convection and internal Fans(user replaceable) fan(user ........................................... ................................................................... .replaceable). . .................................... ........... Noise <25 <50 dBA ........................................... ................................................................. . ...................................................... ........... Min:Max.Operating Temperature -13 to+140/ 25 to+60(-40 to+60 version available)')) 'F/-C Ran e Protection Rating NEMA 3R ........................................... .......................................................................................................................... ........... Ui For other regional settings please contact SolarEdge support. pz A higher current source may be used;the inverter will limit its input current to the values stated. iii Revenue grade inverter P/N:SExxnA-USODONNR2(for 76DOW inverter:SE7600A-US002NN R2). "I Rapid shutdown kit P/N:SE1000-RSD-SI. (')-40 version P/N:MoaxA-USOOONN1,14(for 7600W inverter:SE7600A-1.15002NN1.14). sunsaEc RoHS Q SolarEdge Technologies.Inc-All rights reserved.SOLAREDGE,the SolarEdge logo.OPTIMIZED are I'dem arks or registered trademarks oSolarEdge are trademarks of tneir respective owners... (Mice of Consumer A11alrs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 0-1116 home Improvement Contractor Registration Registration 163091 Type LLC Expiration 5/112017 Trfi 164932 SUN BUG SOLAR LLC CHENEY BRAND 411A HIGHLAND AVE. ST 312 SOMERVILLE, MA 02144 I.pdate Addre%%and return card.%lark reason for change. Address Renenal Employment Lost Card _ Office of(+,nwmrr 1ffAir%S 6ucmr,Reculatiue License or registration snlid for individul use nnit ,HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: }63097 Typo: Office ofC'onsumer Affairs and Rucinrss Regulation -{ Expiration: 5!t1f20t7 LLC 10 Park Plain-Suite 5170 ftaswn,11A 112116 SUN BUG SOLAR LLC CHENEY BRAND l 411A HIGHLAND AVE.ST 312 SOMERVILLE,MA 02144 tndersrcreun x withoutsignal to" 19 Savo Of 13 `11i.tg 4c-gu �'. G'3 am:j 3,�_m 73'Js f`GC CS-099437 10 8 CHENEY G BRAND ¢� I I MORRISON PLACE NO.2 �4 SOMERVILLE MA 02114 - Ota 12!2018 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):SunBug Solar Address: 411 A Highland Avenue, Suite 312 City/State/Zip: Somerville, MA Phone#: 617-500-3936 Are ou an employer?Check the appropri X. Type of project(required): 1 t♦ II am a employer with 10 4 l am a general contractor and I 6. ew construction employees(full and/or part-time).* have hired the sub-contractors 2F_11 am a sole proprietor or partner- listed on the attached sheet.$ emodeling ship and have no employees These sub-contractors have 8. lemolition working for me in any capacity. workers' comp.insurance. 9. uilding addition [No workers' comp. insurance 5.E:]We are a corporation and its required.] officers have exercised their 10 lectrical repairs or additions 3r_]I am a homeowner doing all work right of exemption per MGL 11 lumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12 toof repairs insurance required.]t employees. [No workers' c13 they Solar Installation 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Liberty Mutual Insurance Group Policy#or Self-ins.Lic.#: WC231 S381595-016 Expiration Date: 4.30.1 7 Job site Address: 76 Boston Hill Rd City/State/Zip: Y 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature;---- Date: Phone#: 6&-500-3936 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#: ACO CERTIFICATE OF LIABILITY INSURANCE F DATEdMMiD♦aWWJ 05f10/2D16 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,.AHD THE CERTIFICATE HOLDER- IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be enclorsed. tf SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement an:this certificate does not confer rights to the certificate holder m(lieu of such endorsement(s).. PRODUCER CONTACT enure Lukas. T. EDMUND GARRITY&GO., INC. (Cl7)35"04D JFa No): ►�9�Y annDG A4n5urarlt:e.com Dl�ss: 549 CONCORD AVENUE INSURER s AFFORDINOCOLIERAGE MAIC s CAMBRIDGE MA 02138 INSURER A: LIBERTY MUTUAL FIRE INS CO 23035 INSUREQ INSURER B' G NBUG SOLAR L_( INSURER INSURER 0: 411 A HIGHLAND AVE STE 312 INSURER E: SOMERVILLE MA 02144 DISURER F: COVERAGES CERTIFICATE NUMBER: 51883 REVISION NUMBER: THIS IS TO C+ERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWfIHSTAND!NG ANY REQUIREMENT.TERfd OR CONDITION OF ANY OONTRAC i 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. (NSR I TYPE OF INRUSRANCE DDL SUER POLICY EFF POLICYEXP LTR POLICYYY'NUYBER MYIDWMd:bNYYYyy Y LIMITS COMMERCULL.OEMERAL LIABILITY EACH OCCURRENCE S CJ.&w-k ADE F_10=1.111 y MED EXF Ww ane person) S N/A PERSONAL A ADW INJURY 5 GEN1AGGREG7ELIMIT APPLIES PER:. GENERAL AGOREGATE S PJE'rPour--rPour--rCT F-1 LOC PRODUCTS-COMPfoF'AAG S OTHER' I 1 S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S . aodden ANY ALITO BODILY IUJURY(Per person) S ALL OrWAED OGHEDULED AUTOS AUTOS N/A BODILY PWRY rr-er accident) S HIREDAUTOB AUTOS PROP�ERTYfkWJkGE S S UMBRELLALIAB OCCUR I EACH OCCURRENCE 5 (EXCESS LIAR HCLAIMS-MADE WA AGGREGATE S DED I I RETEWnON S WORKE7iL COMPENIATIONV PER 0rH.. AND EMPLOYERS'LIABIUffY WIN M X A OFFICERWE16MEANYPROFRIEMRRAEXCLIA]ND? CUTNE NPA MIA MLI WC231S381595016 0413D2018 04/3132017 E.LEACHAACIDENT ; 11.11100.11100 41111andderirMNM E.L02EABE-EAEMPLOYE S 1.000.000 It M,desabe under DESCRI:TION OF OPERATIOKa brow E.L.DIZEA9E-POLICY LIMIT S 1,0at1,0D0 N/A DESCRIPTION OF OP91ATNINSPLOCATNONS I VEHICLES tACORD lot,Adalltanel RarearkC SoAedklWffl y be aLtwhad 11 more apm;z rrgd4ed) Workers'Compensation benefits wdl be paid to Massachusetfs employees arty.Pursuant to Endorsement WC 20 03 DB B.no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts, ts, This certi cafe of insurance shows the policy in force on the date that this.oer frafe was issued(unless the expiration date on the above policy precedes the issue date of this eertifiDate of insurance). The status of this coverage can be monftred daily by accessing the Proof of Coverage-Coverage Verification Search tod:at www.mass.govllwd',Iworkers-eompensatKnrrcvestigationsf. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE SLID BEFORE THE EXPIRATION DATE THEREOF, NOTICE MALL BE DELIVERED IN The commonwealth of MasssChllsetks ACCORDANCE INfIHTHE PDUCYI IONS. 000 Washington Street AUTHORIZED REPRESENTATIVE 11 1 r C" Boston MA 02111 Daniel M.Crowley,CPCU,Vice President—Residual Market—WICRrl3Uk 01988-2014ACORD CORPORATION_ All rights reserved. 3ii}3Ts 01J The ACORD(Tame and logo are registered)marks of ACOR,D li