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Building Permit #781-2016 - 97 PALOMINO DRIVE 1/5/2016
V -. BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: / ll — 1-ul (o Date Received Date Issued: I I J IMPORTANT: Applicant must complete all items on this page i1 -C- LOCATION 177 IOA(,ny Pnn PROPERTY OWNER Gl�� h %�- C,i4 M ve- 1 Print 100 Year structure yes no MAPPARCEL:6ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Reside tial Non- Residential ❑ New Building a-dne family - ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial impair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑ Well ❑ Floodplain ❑ Wetlands p Watershed! District ❑ Water,/Sewer DESCRIPTION OF WORK TO BE PERFORMED: i'► -to y e, 5 ,t %k1e1(- 5 4L;� /t IZoo f, /VpiLL) 77(D �/,,,.tL /4vtA(,gC,6 k1,-/ Identification - Please Type or Print Clearly OWNER: Name: L11" e7 D. CAA -Y -, ye - L Phone: ZAE -S-P-' 6 �O Address: q7 ' )nr-,`vC_ Contractor Name: Email: Address: 76 l- 7;7 S t- / y/-/ 7 Supervisor's Construction License: C-5 " 10771-1 Exp Home Improvement License: % 3 7bi� - Exp: Date: /z�L1712CC� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ 6 TM Check No.: Ilt 35 Receipt No.: AA NOTE: Persons contractin ith unreg' t ed contractors do not have access to the guar,0 Wfund Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract 4. 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 Hydraulic Calculations (If Applicable) Copy of Contract 2012 I ECC Energy code Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Y } !Manning Board Decision: d Comments Zoning Decision/receipt submitted yes Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Lo ated at 1211%lain Str e r p Fire Departm.ent�.ianatu /` to a� Lo�cratea Jd4 usgooa Street t Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Locationlovy a ^'Q C�v e— No. / Date Check # .0 88,4 TOWN OF NORTH AND�u Certificate of Occupancy $`� Building/Frame Permit Fee $9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $_ IV . Building Inspector Date .... 8 . ..I ................................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .............................................. ........................................................ • has permission to perform 4.�' � 2). 2, ILVJ ............ ........................ i ........................................... wiring in the building of... .................................................................. i. - at ....... 9.1 ....... el"�J.0 ... V'v` . .......... .......... .....4Z........ . North Andover, Mass. ............... .............. Pee ... �75 ............ Lic. No.t...... ........ ........ ELECTRICAL INSPECTOR Check 4�' < n:� o SO mc U)) = < CCD -0a O CL O CD 0 • 0 C-0 3 m Z _ y O y rt <D T --ft=rN CCD W n O y O CK CD cD D O Q y C t O O O CL to O y O O w rt cD m 13 CD -0 rL co O = y ca z y 1 rt O 0 Cr rt M L O S m .r :A a �. D y y C•iO CL 0 O. < \ y r0) rt O CD = S CL O . CD CD r y. CA 0 o r� O CD CD '•� CD CD rfN y 0 0, �' � S n CD (DD -0 a1 N O O ^ `' Z a° >0 w C r� O y r :;o O . C' N Z m O Ax �v A O C s m m Z 0 T_ 7 S31 ;;o O c C W cZi ZLA m 0 -n 7 Dl (� S 3 7 C z O 1Q 7 T C 7 a rr O 7Ip W C z tZil m Ln '6 K L .0 Ne 3 T O O_ S N 7 W O O �+ 2 D C � 1 57 n o CD c m �� • r m = m� CL Cl) n m cam, o v CD m �c c_ `, ccr M z CD �1 j4 CD 0 ic CD0 w vo CDN• Q SD �cn �• 0 N cD I v' 5 U) v Z., A; . 0 oo - CD 0 0- '• z O CD Z N C 0 0 . < n:� o SO mc U)) = < CCD -0a O CL O CD 0 • 0 C-0 3 m Z _ y O y rt <D T --ft=rN CCD W n O y O CK CD cD D O Q y C t O O O CL to O y O O w rt cD m 13 CD -0 rL co O = y ca z y 1 rt O 0 Cr rt M L O S m .r :A a �. D y y C•iO CL 0 O. < \ y r0) rt O CD = S CL O . CD CD r y. CA 0 o r� O CD CD '•� CD CD rfN y 0 0, �' � S n CD (DD -0 a1 N O O ^ `' Z a° >0 w C r� O y r :;o O . C' N Z m O Ax In N z (D A O C s m m Z 0 T_ 7 S31 ;;o O c 3 O (D Ln (D z O w C r� •n o v D D A 1 T S. N :;o O . C' N Z m T S. N In N z (D A O C s m m Z 0 T_ 7 S31 ;;o O c C W cZi ZLA m 0 -n 7 Dl (� S 3 7 C z O 1Q 7 T C 7 a rr O 7Ip W C z tZil m Ln '6 K L .0 Ne 3 T O O_ S N 7 W O O �+ 2 D 52. CONTRACT U.S. Roofing a division of Building Maintenance Corp. P.O. Box 3118 Peabody, MA 01961-3118 Telephone: (978) 532-6300 Fax: (978) 977-0803 The Owner(s) of the premises described below ("Job Address"), hereby contract with and authorize U.S. Roofing, a division of Building Maintenance Corp. ("Contractor"), to furnish all necessary materials, supplies, labor and workmanship, and to install, construct and place improvements at said Job Address, according to the followino specifications. terms and conditions: 1. Owner's Name: Glenn D. Chamuel 97 Palomino Drive North Andover, MA 01845 2. Job Address: 97 Palomino Dr., North Andover, MA 01845 3. specirications LonEractor agrees to perrorm the rollowing ser7vices in a guuu and workmanlike manner: (Rear Main Roof/Rear Garage Roof only) - Remove all existing shinqle layers down to exposed wooden roof sheathing; replacing up to 32'ft2 included in project - Dispose of all roofing debris in a legal landfill - Install six-foot (61 widths; includinq valleys, roof penetrations - Nail Deck-ArmorTm Breathable Underlayment over remaining roof surfaces - Install 8" aluminum drip edge to all applicable roof perimeters (rakes & fascia) - Install GAFTm Timberline@ HD Architectural shinqles to all roof surfaces; storm nailing each (six nails per shingle) - Install Cobra@ roof ridge vent at peak locations for ventilation of attic spaces if applicable - Flash all existing roof penetrations including providing and installing all new plumbing vent pipe flanges according to National Roofing Standards - Cap ridges with GAFTm Timbertex° Architectural Hip & Ridge shingles - Secure and clean all existing gutters at completion of project 4. Possible Alternates: Minor sheathing replacement: Existing rotted sheathing or board replacement cost (if needed above and beyond 32ft2) would be subiect to an additional cost $4.001ft.2 5. Warranties: The above work comes with a GAF'"' Roof Material Warranty (furnished to Owner from GAF"" directiv) 6. Payment Terms: The Base cost of the contra s $ 4,735.00 P ment shall be rendered in the following manner: To be billed on percentage completion basis: 100% due upon successful completion of all work; 7. Attorney's Fees: In the event of default, the Owner shall pay costs for collecting amounts owing including, without limitation, court costs, expenses and reasonable attorney's fees, in addition to any sum that the member may be called on to pay. 8. Entire Agreement: This contract constitutes the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. The Owner agrees that Contractor has made no statements, promises, commitments or representations not rnnfainerl herein. AW 9. Modification: Other than that required as a result of paragraph 4 above, any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if evidenced in writing signed by each party or an authorized representative of each oarty. 10. Unforseen Circumstances: Contractor is not liable for delays due to weather, strikes, accidents, acts of God or other circumstances arising out of causes beyond its reasonable control and without its fault or negligence including but not limited to: interior damages, ice damming due to pre- existina conditions: i.e. lack of roof ventilation, hot soots or unmaintained snow or ice loads. 11. Governing Law: It is agreed that this agreement shall be governed by, construed, and enforced in arrnrrianra with the lawc nf_tha CnmmnnwPalfh of MaccarhwzPttc_ IN WITNESS WHEREOF, the parties have signed their names hereto: Date- 12-9-2015 U.S. Roofing, by its agent, Michael S. Murray Date,- 12 . i J Owner or Owne Agent: Printed Name: Glenn D. Chamuel List desired shingle color: (Please Print) 1) TAMKO Architechtural Weathered Wood '- _'- Alk The Commonwealth of Massachusetts Department of IndusirialAccidents Offiee of Invesfigations I Congress Street, Suite 100 Boston, MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders /ContractorslElectricia P nit Legibl I am an employer that is providing workers' compensation hnsur'"` fo ray information. _ F, Insurance Company Name: �C 2i � �- �1 C." % � � 66, ©3� -�%51� Expiration Date: a� 3 �Of Policy # or Self -ins. Lic. #: h, fi 01164-5 City/State/Zip: ��/0 i � expiration date). Job Site Address: a (showing the policy number and exp Attach a copy of the workers' compensation policy declaration pag ( g p osition of criminal penalties of a Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imp 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 50.00 iolator. Be advised that a copy of this statement may be forwarded to the Office of of up t0 $2 a day against the vverification. Investigations of the TA for insurance verage rovided above is true and correct I do Thereby certify the p . aloes of perjury that the informadonF Date: / Si afore: i- - Phone #: pf Wial use only. Do not write in this area, to be completed by city or town offieiaL permit/License City or Town: Issuing Authority (circle one): cut 3. CitylTown Clerk 4,: Electrical Inspector S. Plumbing Inspector 1. Board Of Health Z. Building Departm 6. Other _- _-- --- - Phone #: _ Contact Person- L // �.� l zoo P;6 -,i 0 Name Musiness/Org inizad on/Individuat):ZM rZ E — Address:_ 0`6 h -A /tl i� d i �_,6- _ City/State/Zip: G� _ Are yo an employer? Check a appropriate box: or and I 4- ❑ 1 am a general contract Type of project (required): 6- ❑ New, construction with �_ 1. 1 am a employerhave employees (full and/or part-time)2I hired the sub -contractors listed on the attached sheet. 7. [� Remodeling 2. ❑ 1 an a sole proprietor or partner- These sub -cofactors have 8. ❑ Demolition ship and have no employees employees and have workers' Q addition 9. Building working for me m any capacity- co insurance_t ' 10.[] Electrical repairs or additions [No workers' comp: insurance 5 0 We are a corporation and its requir ed J officers have exercised their 11.�] Plumbing repairs or additions 3 _ ❑ 1 am a homeowner doing all work right of exemption per MGL 12.,0__..,, Roof repairs myself_ [No workers' comp- c. 152, § 1(4), and we have no 13.11'011ter insurancet re4uired-J employees. [No workers, comp. insurance required below showing theirouts compensation policy information. submit this affidavit indicating they are doing all work and then hire outside canttaetors must submits new affidavit indicating such -Any applicant thatecks lox #1 must chalso fill out the section bireuts t state whether or not those entities have Homeowners who their workers °comp policy nnmberand IContraetors that check this box must attached an additional sheet sbowing they must provide. employees- If tt►esub-contractors have employees, eyrploy die and Job site Bow is policy I am an employer that is providing workers' compensation hnsur'"` fo ray information. _ F, Insurance Company Name: �C 2i � �- �1 C." % � � 66, ©3� -�%51� Expiration Date: a� 3 �Of Policy # or Self -ins. Lic. #: h, fi 01164-5 City/State/Zip: ��/0 i � expiration date). Job Site Address: a (showing the policy number and exp Attach a copy of the workers' compensation policy declaration pag ( g p osition of criminal penalties of a Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imp 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 50.00 iolator. Be advised that a copy of this statement may be forwarded to the Office of of up t0 $2 a day against the vverification. Investigations of the TA for insurance verage rovided above is true and correct I do Thereby certify the p . aloes of perjury that the informadonF Date: / Si afore: i- - Phone #: pf Wial use only. Do not write in this area, to be completed by city or town offieiaL permit/License City or Town: Issuing Authority (circle one): cut 3. CitylTown Clerk 4,: Electrical Inspector S. Plumbing Inspector 1. Board Of Health Z. Building Departm 6. Other _- _-- --- - Phone #: _ Contact Person- AcoRO® CERTIFICATE OF LIABILITY INSURANCE DATEYYYY) 12/21/2021120 15 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 poiicy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 06175-001 TDA Inc dba The Driscoll Agency 93 Longwater Circle Norwell, MA 02061 pN�p NAME: CT Branch 6175-1 108.10. Ext : (781) 681-6656 IWNI.: (781) 681-6686 ADDRESS: kseip@driscollagency.com INSURERLSLAFFORDING COVERAGE NAIC # INSURER A : A.I.M. Mutual Insurance Company 33,758 INSURED Building Maintenance Corp US Roofing P O Box 3118 Peabody, MA 01961 INSURER B: INSURERC: INSURER D'. INSURER E: INSURER F, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE AIR& We POLICY NUMBER MPWDC AAQ LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED $ PREMISES (Ea occurrence MED EXP (Any one person) $ PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ EN'LAGGREGATE LIMIT APPLIES PER POLICY ECT OC PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOS NON -OWNED AUTOS COMBINED INGLE LIMIT Ea accident)S$ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ RNNEgTENTION $ $ A yypRKKDEEEDgg ppMM roeJAR R Y qN yPR pPR�E7p R/PqR TNER /E� ECUTIVE Y I N EXCLUDEp? ® (MandatoryIn NH) ({{Ma@@ndat��ossry��Ibbn N�Hd)e� Dgg,C dIPTION OF OPERATIONS below NIA VWC-100-6018031-2015A 12/23/2015 12/23/2016 yyC g TTUU H X TORY LAMITS OER E.L. EACH ACCIDENT $ 500,000,00 E.L. DISEASE - EA EMPLOYEE $ 500,000.00 E.L. DISEASE -POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Town Of North Andover 1600 Osgood Street North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (��&_ea A%.Umu ca (cU1U/Ua) I ne ACUKU name ana logo are registered marks of ACORD A�0 LJ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/22/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DdtS NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER The Driscoll Agency, Inc.PHONE 93 Longwater Circle Norwell MA 02061 CONTACT NAME: 781-681-6656 FAc o • 781-681-6686 E-MAIL .jbd@driscollagency.com INSURERS AFFORDING COVERAGE NAIC # Y INSURERA:AIM Mutal Ins Co 33758 CPA 5232495 INSURED 3327 INSURERB:ACadla Insurance Group, LLC 31325 INSURER C: Peerless Ins Co 24198 BUllding Maintenance Corp. dba U.S. Roofing PO Box 3118 INSURER D:Navigators Specialty Insurance Com Peabody MA 01961 INSURER E: INSURER F : cnVFRArFR CERTIFICATE NUMBER. 263404672 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MWDD LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y CPA 5232495 12/23/2015 12/23/2016 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X❑ OCCUR DA AGE ToRNTED PREM SES (EaEoccurrance $250,000 MED EXP (Any one person) $5,000 x XCU X Inc Contractual PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JECT � LOC PRODUCTS -COMP/OPAGG $2,000,000 $ OTHER: C AUTOMOBILE LIABILITY Y Y gA8730382 12/23/2015OMBINED 12/23/2016 SINGLE Ea accident I $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ASNEDXUTSULEDUTOAO BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident $ D X UMBRELLA LIAB X OCCUR IS15EXC8590761C 12/23/2015 12/23/2016 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DED ,X RETENTION$0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PAhTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N / A Issued by Carrier 12/23/2015 12/23/2016 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ B Installation Floater CPA 5232495 12/23/2015 12/23/2016 Job Site Limit $100,000 Leased Rented Equip $180,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached Ir more space Is required) RE: 58-60 Edgelawn Ave., North Andover MA I+CR 1 Iri%,m 1 r- r1VLIJrM GAIVGtLL.A I IUN Town of North Andover Massachusetts Attn: Building Department 1600 Osgood St. North Andover MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED/REPRESENNTT/TAACTIVE dl(vi I,/ i see y' (0 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Tf VOY, add C( C/? (ti, e116 Business Regulation � WIN _; �5_ t Office of Consumer Affairs and _0 Mgt U 10 park Plaza - S'Ae 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration BUILDING MAINTENANCE CORP PETER ALLARD P.O. BOX 3118 PEABODY, MA 01961 SCA1 2OM-OS/11 Off ee of Consumer Affairs &Business Regulation ,_.E��qOME IMPROVEMENT CONTRACTOR Type: Regi - 137667 Private Corporation: piration. BUILDING MAINTENANCE CORP. PETER ALLARD 1445 wILLARD ST PEABODy. MA 01960 Undersecretary Registration: 137667 Type: Private CorPOratTiOn 1211712016 r# 260114 Expiration: I Update Address and return card- Marl, reason for change - Employment Lost Card r -I Renewal El Address License or registration Vstration valid for individal use only before the 6jp1ration date. if found return W Office of C 916surner Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Mk,02116 ---------- N4 valid without signature 1, Unrestricted - Buildings of any use group which contain less than 35,000 cubic feel. (991M) of enclosed space. , Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Ucensi ng information visit: www_M: ss.Gov/DPS i Massachusetts - Department of Public Safety ! Board of Building Regulations and Standards ' Construction Supervisor License: CS -107719 l i+• CRAIG MURRAX= ' 48 PTTMAN ROAD Marblehead MA x1945 i J.•�..� ��, '+ " Expiration I Commissioner 06/08/2017 _ Commonwealth of Massachusetts Qlfici L sen►yl r f Permit No. Department of Fire Services V1 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 11/991 (Imveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMA 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 8/3/15 City or Town of. N. Andover To the Inspector of Wires.- By ires:By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 97 Palomino Owner or Tenant Glenn chamuel Telephone No. Owner's Address 97 Palomino N Andover Is this permit in conjunction with a building permit? Yes F-/] No (Check Appropriate Box) Purpose of Building Solar installation Utility Authorization No. Existing Service 200 Amps 120/240 Volts Overhea Undgr ✓ No. of Meters 1 New Service Amps / Volts Overhead ❑ Undgrd No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: rooftop mounted solar array Completion of the, following table may be iwived by 1he Inspector of JPires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) F TransFlans r Total Tsformers ICVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above El E] rad. rnd. No. o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of zones No. of Switches No, of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons I KW I No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ElOther Connection No. of Dryers Heating Appliances Ir Security Systems: No, of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total 1-1-P Telecommunications Wiring: No. of Devices or Eq uivalent OTHER: 48 panels Attach additlonal Ma111fdesired, or• as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: 2500.00 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and pe»alties ofpeijttiy, that the information oir this application is true and complete. FIRM NAME: ASTRUM SOLAR ff LIC. NO... A21555 Licensee: JASON RILEY Signature (I,fopplicable, enter "exempt "in the license number line.) Address: 15 Avenue E Hopkinton. Ma. 01748 OWNER'S IN: required by law Owner/Agent Signature ,_ URAINUL WAIVER: 1 am aware that the Licensee [toes By my signature below, I hereby waive this requirement. Telephone N -14 LIC. NO.: Bus. Tel. No.:508-614-0143 Alt. Tel. No.: not have the liability insurance coverage normally lain the (check one) ❑ owner [:]owner's agent. PERMIT FEE. $ /0?�-- Please visit our web site at http://Www.mass.gpv/dpl/boards/EL ASTRUM SOLAR INC JASON P RILEY (EL) 18 HOPKINS ST' WILMINGTON MA 01887-2210 {fix OMlU10NW MTFI OF M"M MUs = a a 0 �IRAN ; ISSUERS, URNELt:0 "Ib' AS.5` R�ICIA �. A RINORILEY I .. _ , 18 HOPK NS S� 1 P INS ST c a + �f 4OrTO. -�, 01887-221AR � 13 +63 1 3 ,416kDA00020 I Fold, Then Detach Along Alt Pa. orallona, i . OMMONWEA TH OF M! ills S : _ s t D ® 0 0 0 0 0 fiffff FA di 1 SSUES T OLLOWING L o613 E AS�l "P 'R`� Mas. F� Ec7 R I c I AN iR SOLAR I N R 11 18 H OP.I(`h2� �l x a �{A'1Tt� 01887 2'2 ;o t 21555' 'A .,o /3 �,M. -80019 o. a 5m < X X W D n D r CHAMUEL PROJECT 97 PALOMINO N. ANDOVER, MA 01845 UTILITY ACCT# - 7856200002 ------------ REV. DATE REMARKS TSIs 9 DIRECT ENERGY SOLAR 15 AVENUE HOPKINTON, MA, 01748 Saturday, January 00, 1900 0 on E. 3 0 n a 3 N v 0 0 ir0 0 D >C <N(/�D C,?DAt�lA rT•-�70 rTA-i _O A_ -!� -I>O_ 7J° �e �ArrtliTN��GC nRoA p�j» WE x S-A..1I AAcA�,' Sp J Ao505 cO p, a• AmJocccc QSAr 3A nV3E:p, n n-�1`t ao`� mL?Ki�K cOa S00000°. pi Ga �n-s` w0� ob cv_.n ocv D aa...p3Q. R ��' o C N N Ei n [� EI C d l0 s w D A O w J Gmw kp. DOn Qm S: 3A °$g: �J J��o2� ��Ao', o•: $n A aiDwa ° rc; a3�� wo 3c w�Eg.-K �qo�°J: n•$,i �: �° �Jc �.$ ,Qo e�i m, g 'g 4-•i i ^`� .h5 mm. i w. a o:"nn A�N� :. :. •• .� �m gni'. .,� �(c'� m�'"�� �R! � fii ;,i i 0=1 G 9 W p 0I 00� .. fJO .. (��NC b Om CW p o� OHO C IJJ�� W �N �1D0 _•. ��.00m ..mo �1 o n nJ^�.. Oo .Y•... C�ztzilno 41 ppX NOOd [O� c C NWS ND d d�p (BOO TT41•xnr g�N Y IIOOi .. V0NT11 N W N Wk 01 P N Q 10 p x 2 Aip O bb e 41 N C a ° A W� N ' o m a W S S' s DC NyD (�DAV1A sT-1p O rTA A-� A(] AAArr TN ae g� 9 ° o X T" � O w N c R N �1 O � O a 0 0 0 0 0 0 d O C O 5 A -• ,. G d J A q J J J J J J C A J C+ O A Oen` o,n1D c �r2.'g .nrn' c 2 P nnnn '� r� D-.� A m x S A^ A m c .rl -• poo A A o c o w• j w� c c c c n n g�r�no Sam' gdcq�+� 1w3.^.a�3Ro5o5aOo�n�eoi+ n3 �3�3��. 33� r�ei g �d3rtzmt Gt .�ACtto w'72 Nva 9-- it ,3, �•�c,� ov go� Pn�Cd�� 8i m�()f1 O1 OJ GWS kpn pggn,S-'N. 8: 3A a?'Q: €•,j���ao'; �_., ° rc U3 m oGS oz WS A:. i ate. c 00 0 q,i m W �jX n O C NOW AZZfn-s vr� Om AAn .. (a C A N S pvp ' w = < W m n pk T a G GGW v [] N E P O a S (� REV. DATE REMARKS mCHAMUEL PROJECT DIRECT ENERGY SOLAR ,10 C -i 97 PALOMINO , 1 15 AVENUE E N. ANDOVER, MA 01845 HOPKINTON, MA, 01748 5 A 2 O D z � (n UTILITY ACCT# - 7856200002 3 Saturday, January 00, 1900 z - g R c 3 - N 3C ;E r m q 3 3 9 3 a 9 � R. 0 on E. 3 0 n a 3 N v 0 0 ir0 0 D >C <N(/�D C,?DAt�lA rT•-�70 rTA-i _O A_ -!� -I>O_ 7J° �e �ArrtliTN��GC nRoA p�j» WE x S-A..1I AAcA�,' Sp J Ao505 cO p, a• AmJocccc QSAr 3A nV3E:p, n n-�1`t ao`� mL?Ki�K cOa S00000°. pi Ga �n-s` w0� ob cv_.n ocv D aa...p3Q. R ��' o C N N Ei n [� EI C d l0 s w D A O w J Gmw kp. DOn Qm S: 3A °$g: �J J��o2� ��Ao', o•: $n A aiDwa ° rc; a3�� wo 3c w�Eg.-K �qo�°J: n•$,i �: �° �Jc �.$ ,Qo e�i m, g 'g 4-•i i ^`� .h5 mm. i w. a o:"nn A�N� :. :. •• .� �m gni'. .,� �(c'� m�'"�� �R! � fii ;,i i 0=1 G 9 W p 0I 00� .. fJO .. (��NC b Om CW p o� OHO C IJJ�� W �N �1D0 _•. ��.00m ..mo �1 o n nJ^�.. Oo .Y•... C�ztzilno 41 ppX NOOd [O� c C NWS ND d d�p (BOO TT41•xnr g�N Y IIOOi .. V0NT11 N W N Wk 01 P N Q 10 p x 2 Aip O bb e 41 N C a ° A W� N ' o m a W S S' s DC NyD (�DAV1A sT-1p O rTA A-� A(] AAArr TN ae g� 9 ° o X T" � O w N c R N �1 O � O a 0 0 0 0 0 0 d O C O 5 A -• ,. G d J A q J J J J J J C A J C+ O A Oen` o,n1D c �r2.'g .nrn' c 2 P nnnn '� r� D-.� A m x S A^ A m c .rl -• poo A A o c o w• j w� c c c c n n g�r�no Sam' gdcq�+� 1w3.^.a�3Ro5o5aOo�n�eoi+ n3 �3�3��. 33� r�ei g �d3rtzmt Gt .�ACtto w'72 Nva 9-- it ,3, �•�c,� ov go� Pn�Cd�� 8i m�()f1 O1 OJ GWS kpn pggn,S-'N. 8: 3A a?'Q: €•,j���ao'; �_., ° rc U3 m oGS oz WS A:. i ate. c 00 0 q,i m W �jX n O C NOW AZZfn-s vr� Om AAn .. (a C A N S pvp ' w = < W m n pk T a G GGW v [] N E P O a S (� REV. DATE REMARKS mCHAMUEL PROJECT DIRECT ENERGY SOLAR ,10 C -i 97 PALOMINO , 1 15 AVENUE E N. ANDOVER, MA 01845 HOPKINTON, MA, 01748 5 A 2 O D z � (n UTILITY ACCT# - 7856200002 3 Saturday, January 00, 1900 R c 3 - N 3C ;E r m 9 3 a 9 � R. 0 on E. 3 0 n a 3 N v 0 0 ir0 0 D >C <N(/�D C,?DAt�lA rT•-�70 rTA-i _O A_ -!� -I>O_ 7J° �e �ArrtliTN��GC nRoA p�j» WE x S-A..1I AAcA�,' Sp J Ao505 cO p, a• AmJocccc QSAr 3A nV3E:p, n n-�1`t ao`� mL?Ki�K cOa S00000°. pi Ga �n-s` w0� ob cv_.n ocv D aa...p3Q. R ��' o C N N Ei n [� EI C d l0 s w D A O w J Gmw kp. DOn Qm S: 3A °$g: �J J��o2� ��Ao', o•: $n A aiDwa ° rc; a3�� wo 3c w�Eg.-K �qo�°J: n•$,i �: �° �Jc �.$ ,Qo e�i m, g 'g 4-•i i ^`� .h5 mm. i w. a o:"nn A�N� :. :. •• .� �m gni'. .,� �(c'� m�'"�� �R! � fii ;,i i 0=1 G 9 W p 0I 00� .. fJO .. (��NC b Om CW p o� OHO C IJJ�� W �N �1D0 _•. ��.00m ..mo �1 o n nJ^�.. Oo .Y•... C�ztzilno 41 ppX NOOd [O� c C NWS ND d d�p (BOO TT41•xnr g�N Y IIOOi .. V0NT11 N W N Wk 01 P N Q 10 p x 2 Aip O bb e 41 N C a ° A W� N ' o m a W S S' s DC NyD (�DAV1A sT-1p O rTA A-� A(] AAArr TN ae g� 9 ° o X T" � O w N c R N �1 O � O a 0 0 0 0 0 0 d O C O 5 A -• ,. G d J A q J J J J J J C A J C+ O A Oen` o,n1D c �r2.'g .nrn' c 2 P nnnn '� r� D-.� A m x S A^ A m c .rl -• poo A A o c o w• j w� c c c c n n g�r�no Sam' gdcq�+� 1w3.^.a�3Ro5o5aOo�n�eoi+ n3 �3�3��. 33� r�ei g �d3rtzmt Gt .�ACtto w'72 Nva 9-- it ,3, �•�c,� ov go� Pn�Cd�� 8i m�()f1 O1 OJ GWS kpn pggn,S-'N. 8: 3A a?'Q: €•,j���ao'; �_., ° rc U3 m oGS oz WS A:. i ate. c 00 0 q,i m W �jX n O C NOW AZZfn-s vr� Om AAn .. (a C A N S pvp ' w = < W m n pk T a G GGW v [] N E P O a S (� REV. DATE REMARKS mCHAMUEL PROJECT DIRECT ENERGY SOLAR ,10 C -i 97 PALOMINO , 1 15 AVENUE E N. ANDOVER, MA 01845 HOPKINTON, MA, 01748 5 A 2 O D z � (n UTILITY ACCT# - 7856200002 3 Saturday, January 00, 1900 :1011t Energy Fif m g -1 m C C o n Qo gXa=. =' x r) CL a o. C. C. w f1 G ®CL� G a I ® ❑ ❑ ❑ Ct s rn� DATE REMARKS DIRECT ENERGY SOLAR 15 AVENUE HOPKINTON, MA, 01748 Saturday, January 00, 1900 C1 E n » a „ s Z y v CHAMUEL PROJECT C A 97 PALOMINO -1 Z N. ANDOVER, MA 01845 4. O c m -o ow N 00 3 m ° S A ° N 2 V O ' 3 N O G) °G rt T m a o m m °o o cr F :. D v � °� d F m � oo'Dw 1 0 O - V N O A o m O xmm oDoo 0 o o o o -O mm ti doa= .i o � D D D D D m o u, D 3 T 3 O O O O ON c ? a �' a• o. 3c 4 =. o N n w' ml m » IS w 3 d m om a o 3 0 m m F 3 'm m ( o ° T m 2 v m a x mo F o _ ? o g Cr 3 + T » m � K o m M o C w I ° 3 'o 3 s o »aod s n �o'°oo ° Oas a"I n m ° D ° O M » 3a s s m v- 2 N O y j w � T .di 'o o o A � a c 2 ^sTs ° a T R ( o -' 3 n Sm T � £ o- 0 O O O T ^- c o 0 3 c n s T N o I <1T9< i v d ° o o a> > _ o :1011t Energy Fif m g -1 m C C o n Qo gXa=. =' x r) CL a o. C. C. w f1 G ®CL� G a I ® ❑ ❑ ❑ Ct s rn� DATE REMARKS DIRECT ENERGY SOLAR 15 AVENUE HOPKINTON, MA, 01748 Saturday, January 00, 1900 C1 O Z y v CHAMUEL PROJECT C A 97 PALOMINO -1 Z N. ANDOVER, MA 01845 4. O UTILITY ACCip -7856200002 :1011t Energy Fif m g -1 m C C o n Qo gXa=. =' x r) CL a o. C. C. w f1 G ®CL� G a I ® ❑ ❑ ❑ Ct s rn� DATE REMARKS DIRECT ENERGY SOLAR 15 AVENUE HOPKINTON, MA, 01748 Saturday, January 00, 1900 'o W V3 M v0Ap a vW mm Zm 3 mz0- a w O � o v C S o o'c w' £ w a o' a �. w n n. o z£ �° m °: m m m a m GT 0 0 Q s 3 o' c� m a j^ s ° o F d a f a K C aq O E. 3 -Ni O' m 7 A ,�. m N m= n x' '" ^Er a 00 p o == f n a m p= m x N ,m» m m .^. O m d v>> o' s- m m o c^ m w n 0 a m m w v^ o_ = a Q - m z w '" 3 m n tl9 m o o o o o- im= 0 a jr) -{ �^ a0 o- N K O D z N D C N O C s 3 v O Op➢-' �- o m > > > a a _ a vpi x v m d n >• c 3= - _ T. m m m c O ° n o o m a w = n -= a z o --.' N a m �' a N p rr S S O N m 3 N .r 3 '" 0 o- 9 d a^ - a a s a `� m o m P 3 m " S m m y m p F o .'". m a n a m f. v 5 d a m v a m m$ io A 2 m v O G p- 2 a O m w o D m= m a O .'". O<_-O c d j 2 p tpi O' = m< m m N O a o H o �^ O 3 N y > D a C m E� o m S Q' m0 =. O ."' c F O O c N F o !^ N N G o w w n cr a N m o o- O p m s n m 01 ^ x m N u. m O m y= m c O s m c >• m Nn a IM a v s s z ., m n 0 m ° j O m o Q m > >. v 3 f m y n F O c £ 3 a 3 x vv 3 z c w c m H n° m m f, _c a n o• z m p m D m p u n a m �' 3i m" a' '� = N O 3 a j d 'm 3T5 m RL 3 - m 3 m 0 0 v m '� �. 2 w m� m o x' 0 -° g O m n o °x F ^ S m m N m 0 ? o-1 O m am a am o m vm G^ m c s o n. a 0 m p _ O � � m f° m o o 0 a N 3 m o- � o m 3 N M.a? i a a d N p m>> m c O W w 0➢ � % p, C S m O w a o 3 3 c m o f 30 m m m 3m 3 O a m 3 N p on 0 0 0 N OA Om m m y S .. j p 3 O c� o � m 3 x O c � .°'. O N m O. d m - 0 3 3 v d N HCT 3 IP 3: ?, c m10 - C F 3 _ m m - S = =' w 3 v w < '. o w F F' m c v o- v 0 0 s = w a m a Fr 5 m m s or > o a O ^ m = > a r m 4 0 0- Sm > > c m a a o O = m o c s 0 w m a p a m N m m m d O 0 o m FL - a m m 3 O m n 3 'a o o m n � a v 0 m p - � � c - ° 1 a m a m a m m o G m m ' � � REV. DATE REMARKS rrn CHAMUEL PROJECT DIRECT ENERGY SOLAR C A c ;aN. 97 PALOMINO - '�^'�XJ 1 AVENUE E V1 � ANDOVER, MA 01845 �. HOPKININTON, MA, 01748 _I z 6 .. _ Z UTILITY ACCiq -7856200002 L Saturday, January 00, 1900 Britt Form T1re Conirironlvenitll of Massachilsefts - Departuieirt ofIndristridl Accidents : Office of Invest g�rtio is I Corrgres_s Street, Suite 100 Boston, MMA 02114-2017 wjj jvjngss.gov/dia Workers' Compensation Insurance Affidavit: Builiters/CdintrttctorsX�lectricians/Plumbers Applicant Infoi oration please Print Legibly Nanle (Business/orgatiization/individual): Astrum Solar Address: 15 Avenue E Hopkinton, Ma, 01748 Phone #:508-614-0146 Are you an employer?'Check the approp► iate`box: 1. �✓ l am a employer with 15 4. [] I. am a general contractor and I cnlployees (full and/orpait-time).* have hired the sub -contractors listed on the attached sheet. 2. El atn a sole propfietor or partner- These sub -contractors have ship and have no employees 1- d have workers' working for me in any capacity. [No workers' comp. insurance required.] 3 ❑ I am a hoineowner doing all work myself, No workers' comp. insurance required.] t emp ogees an .. comp. insurance. S. ❑ We.are a corporation and its officers have exercised their right of exemption per MGL c. 752, §'1(4), and we have no employees. [No w(y3•ket4' Type of Project (requircil): 6. ❑ New construction 7. [j Remodeling ii. ❑ Demolition 9. [p Ruiidit g addition 10.❑ Electrical repairs or additions 11.[] Plumbing repairs or additions 12.❑ Roof repairs l3.[]✓ OtherPV Solar Installation *Any applicant Iha#.checks boxiil must;ntso fill oiit the section.below.shoivillg theirworkers' compensation policy inforivation. t Homeownerswlto submit this affidavit indicating Ilwy me doing all work and thenhire.outside contractors mist submit anew affidavii.iucticn}ingsock, tcontractors thrit check this box must attached anzaddilional sheet showifiithe tiame of the sub -contractors and state whether br.not those eutitieshave employees. 'lithe siib,contmctors have employees, they mast provide tlieir workers' comp. policy nunlhcr. I ant an emplgyer that is providing tuorhela' copeusatiou iusrnrnrce forruy erf�loyees. Below is. the policy null fob site irrforvuatiou. insurance Company Policy-# or Self --ins. Lic. #: Zurich American Insurance Co. 59536 goo Expiration Date:1/1 /2016 Job Site Address: _ Giry/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure. to secure coverage as required under Section 25A. of MGL c. 152 can lead to theitnposition 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 WORTS ORDER and a fine of up to $250.00 a day against theyy��olator. Be advised that a copy of this statement may be ;forwarded to the Office of rnvpctivatinns of the DIA for insulate coveiage verification. _ I tlo hel•eby c 'rtl - undell• Si` nature: _,_ A08-614=0146 llulja — provided above is tare nail ci Offrclnl rise Drily. Do Trot terite iu Iters area,, to hecoup/elerl by city or town oclrrl. City or Town: Permit/License Issuing Authority (circle one): L Board of Hetilth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone SPpya Ih, 0, d S�h k SUNIVA OPPIM USIERIES MONOCRYSTALLINE SOLAA MODUL€S S: OPT 60 CELL MODULES (BLACK FRAME) It, opitimusomodules are.known for their superior quality and jong-teirm.keliability- These high-powered modules ENGINEERING EXCELLENCE consist of SuniVa's premium APTisunL' Select cell technology ■ Built exclusively withSu-ni4tVrerriiu-mARTtsunand are designed and manufactured in the U.S.A. using our Sblecceelk. pfovidinLg.one-ofthe highest:power pioneering ion.impluitation technology. Suniva's high outputs per square meter at an affordable peke power -density pptimus modules provide excellent ■ 4univ�a !AA,V;S.- based company spun out from -,the performance and value. Georgia Tech Pnive roty Center 'of Excellendi in FEATURES Photovoltaics ; one of only two such researchresearchcenters - U.S. in the 0 Contains pre m-ium ARTisuin Select cell ■Suni4i5tate-okhe art manu gturiqg and m dule �USA. lab -facilities the e most advanced equipment. - -1. - - technology � over 19% and technology 0 Extensive%materials testing and certifications; safeguard reliability QUALITY .& RELIABILITY C) Marine grade aluminum frame with hard 0 $univa Optirnus modules are manufacturedand anodized coating Warranted to out specifications assuring consistent High oeerbtmani:6 and high quality. -0 Buy America-complimt upon request m Rigorous in-houtequa it management tests Ny beyond standard ULand lEG standards 0 Qualifies for U.S. EXIA4 fina.hung 0 Performanco- longevity vi.ith.advanced C) System -and design services available polymer backsheet - Passed the most stringent salt tpeay tests --based C) Industry leading linear warranty: 10 year on, I 0C 61701 warranty on workmanship and -materials; s - d 6-1215 passed enhanced stress tests" 6asoon ', , 25 year linear performance -warranty c9n4uapd at Fraunhofer ISP delivering 80%, power at STC n Cettified PIV. free by.PV Evolution labs (PVEL) v PAN files are ifildqpendently validated CERTIFIGAT I.ONS C-1: *OREL. It, Haa rowancea Vary #A.2mm �e• m fae ,sa• aan as• ba wase§`ry, M ss =/wavma=smwa.o—wawnu—.rwweo—awwu�—ieeowlmuu c YEARS PLEASE RECYCLE AUGUST 14; 2014 (REV. 18) (SAMD_00161 OPTIMUS SERIES: OPT 60 CELL MODULES ELECTRICAL DATA (NOMINAL) The rated oowermav only vary by +/- 2.5Wp and ail other electrical parameters by-+ 55A Model Number High-efficiencyARTisun 5elect,celLs of 156,x 156 ram (6.1n.) 270 W 275 W .i .1 :1 280 W Power Classification (Pin;) 265 W: ModuleElficiency(%) 16.3395 iG.6346 16.9596 17.2695 Voltage at Max. Power Point (Vmp) 30.70 V 31.0U V 31.50 V 31.90 V Current at Max. Power Point (Imp) 8.64 A 8.70 A 8.74 A 8.78 A Open Circuit Voltage (Voc) 38:30 V $8.40 V 38.60 V 38.80'V Short Circuit Current (Isc) 9.12 A 9.18 A 9.28 A 9.31 A The electrical data apply to standard test conditions (STC): Irradiance o/ 1000 W/m= with AM 1.5 spectra at 25°C. CHARACTERISTIC DATA 'Type of Solar Cell High-efficiencyARTisun 5elect,celLs of 156,x 156 ram (6.1n.) Frame Black anodized aluminum alloy Glass Tempered (low -iron); anti -reflective coating junction -Box NEMA IP67 rated; 3 internal bypass diodes Cable &Connectors 12 AWG; (4 mm') PV Wire cable mrith mtiltiple connector options available; cable.length approx:1000. mm MP1714ANICAI S Cells / Module 60 (6x10) Module Dimensions 1652 x 982 mm (65.04 x 38.66 In.) Module Thickness (Depth) 40 mm (1:57 in.) Approximate Weight 17.9 +1- 0.25 kg. (39.5 +/- 03.1b.1 TEMPERATURE COEFFICIENTS Voltage. 9; Voc (9'0/°0 -0.335 Current c lsc:(%/°C) +0.047 Power y, Pmaz;(96/°C) =0.420 NOCT Avg (+/- 2 "C) 46.0 I. hILi Max. System Voltage 1000 VDC for IEC,,, 1000 VDC for UL Max Series Fuse Rating 15 Amps Operating Module Temperature -40"C to +85"C (401 to +185°P) Storm_ Resistance/Static Load Tested to IEC 61215 for.loads of 5400 Pa (113 psf); hail and.wind:resistant SuhivaO reserves the right to change the data at any time. View manual at suniva.com. 'UV g0 kWh, TC 400; DH 2000— ?Tests were Conducted on module type OPT 60 Silver frame. Tease read installation manual before installing til- working With module., HEADQUARTERS��L • • ' • Nor Peachtree industrial 9 USABlvd.Sunwa- I � • - • • Norcross, Georgia 30092 USA 1(.sliverVand cell 25 28 700 Tel: +1 404 477 2700 blaek) www.suniva.com The Brilliance of Solar Made Senslblem Enphase® Microinverters Enphase°M250 The `IEnghase M250 M cro(nverter-delivers increased energy harvest and reduces design and installation complexity with its all -AC approach. With the M250, the DC circuit is isolated and insulated from ground, so no Ground Electrode Conductor (GEC) is required for the microinverter. This further simplifies installation, enhances safety, and saves on labor and materials costs. The Enphase M250 integrates seamlessly with the Engage Cable, the Envoy Communications Gateway", and Enlighten®, Enphase's monitoring and analysis software. P A t' D',646- T -I .V E - Optimized for higher -power modules -.Maximizes energy production - Minimizes impact of shading, dust, and debris r enphase° L E N E R. G Y 6,1 RL E No GEC needed for microiriverter No DC design or string calculation required Easy installation with.Errgage Cable R,E LEI -A O'L E; 4th -generation product -. More than 1 million hours of testing and 3 million units shipped Industry-leading warranty, up to 25 years 6 c us Enphase° M250 Microinverter /% DATA INPUT DATA (DC) M250-60=2LL-S22/S23/S24 Recommended input power (STC) 210 - 300 W Maximum input DC voltage 48V Peak power tracking voltage 27 V = 39 V Operating range 16 V - 48 V Min/Max start voltage 22 V /:48 V Max DC short circuit current 15 A Max input current 9.8 A MITpuT DATA (ACI 0208 VAC @240 VAC Peak output power Rated (continuous) output power Nominal output current Nominal voltage/range Nominal frequency/range Extended frequency range" Power factor 250 W 240 W 1.15 A (A rms at nominal duration) 208 V / 183-229 V 60.0 / 57-61 Hz 57-62.5 Hz AM 250 W 240 W' 1,o A (A rms a.t nominal duration) 240 V / 211-264 V 60.0 / W--61 'Hz 57-62.5 Hz >0:95 Maximum units per 20 A branch circuit 24 (three phase) 16 (single phase) Maximum output fault current _ 850 mA rms:for:6 cycles 850 mA rms,for 6 cycles EFFICIENCY CEC weighted efficiency, 240 VAC 96:5%. CEC weighted efficiency, 208 VAC 96.0%: Peak invert& efficiency 96.5% Static MPPT efficiency (weighted, reference EN50530) 00.4% Night .time powereonsumption 65 mW max --- - MECHANICAL DATA Free lifetime monitoring via Enlighten software AMhle.nt temperature range -40°C to +6500 Operating temperature range (intemal) -40°C to. +85°C Dimensions (WxHxD) 171 mm x-17.3 rrim,x 30,mm' (Without mounting bracket) Weight - 2.0 kg Cooling Natural convection - No fans Enclosure environmental rating Outdoor- NEMA 6 - FEATURES Compatibility - - i _ `Compatible With 60-0e11 PV modules. Communication Power line Integrated ground The DC^.circuit meets the requirements for ungrounded PV arrays in NEC:690.35. Equiprrierit ground is.provided in the Engage Cable. No additional, GEC or ground is required. Monitoring Free lifetime monitoring via Enlighten software Compliance U121741/IEEE1547, FCC Part'15-Class B, CAN/CSA-C22.2 NO. 0-M91, 0.4-04, and 107:1-01 ' Frequency ranges can be extended beyond nominal if required by the utility To learn more about Enphase Microinverter technology, r 1 eh Kasee visit eriphas�.com. L J E N E R G Y 0 M13 Enphase Energy: AO dghts.reserved. Al trademarks or brands in this document are registered by their.re'spective owner.