HomeMy WebLinkAboutBuilding Permit #162-2016 - 97 PALOMINO DRIVE 8/5/2015 W + "QRTh
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BUILDING PERMIT + e•;.r. - ^•.•• °oma
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
q
Permit NO: 70 Date Received '' ..�;es • +
I�
S
/ ��S �►Too
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION
PROPERTY OWNER tC 1 e ri n Print C A 4 My e_
Print
MAP NO: /6 PARCEL:0/7 ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
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 Floodplain Wetlands Watershed District
Water/Sewer /
—ins T I �d hq I- 04 rr h /y i,� ra
91q-Cte 2
�f?elf � � 7,
/ Identification Please Type or Print Clearly)
OWNER: Name: nr% Cogfn ve ( Phone:
Address: '3 '7 /00 M - n o Al: Ai
CONTRACTOR Name: cc Phone: S C�' F/ C
Address: 4q ke- �
Supervisor's Construction License: .S f — Exp. Date: �� /• /�
Home Improvement License: (� Exp. Date: /
ARCHITECT/ENGINEER . �'nie Phone:
Address: e D J—_Vf� Reg. No. oa f
FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$123.00 PER S.F. -(
Total Project Cost: $ FEE: $ �Y 2
Check No.: Receipt No.:
NOTE: Persons contracting wills u e istered contractors do not have accesst t/a guara d
ignature of Agent/Owner Signature of contractor i
Building Department 1
The foltAving:s-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
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
o Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/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
NOTE: 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
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
r
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:LNSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
BUILDING PERMIT NORTH
., A. O�tt�eD bq�0
TOWN OF NORTH ANDOVER 3a
APPLICATION FOR PLAN EXAMINATION 70
Permit No#: Date Received
ADR/l7ED
gSSACHU5�t
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
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 _
El Septic DWelt El FloodplainoWetlands E Watershed District
0 Water:/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address:
Contractor Name: Phone:
Email
Address:
Supervisor's Construction License: Exp. Date:
i
Home Improvement 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$125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to th_e g,_ucaranty fund
C�
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
a. 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
Hydraulic Calculations (If Applicable)
Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:Building Permit Revised 2014
1
Plans Submit ed ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunming 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 Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
i
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
P
r
Planning Board Decision: Comments
` Conservation Decision: Comments
Water& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
�DEPAR4TMENT Tuernp Dumpster on site ahF
ocatedat,1t24.Main
Fi ep rtrnents q aft
!4_4 g
i ".. 4.
CMMENTS� ,
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department ease)
i
El Notified for pickup Call Email
Date Time Contact Name
Doc.Building Pemit Revised 2014
` 3
j
Location
� �o YYU4 0
i
No: ZDate
. - TOWN OF NORTH ANDOVER
` Certificate of Occupancy $
Building/Frame Permit Fee $(otZ.
Foundation Permit Fee $
Other Permit Fee $
A TOTAL $
Check#
�building Inspector
2916
OORTH
Town of s E ndover
O 0%
� o� y2.6S
h ver, Mass, A � � �
Coc MIc"t WICK
�•9 A°Rwreo �Pp,��(5
s u
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ....... .kt W� ��Qftu A BUILDING INSPECTOR
..... ......................... .. .................... ....................
... . .... .. . . . . ........
has permission to erect ................:......... buildin s on ....... . ..... .. .
.. .. . Foundation
Rough
to be occupied as ...... k...N46..... .�J5. .........(3.'*.�... ........................... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTI TARTS Rough
�1...................................... Service
................. ..... . . .
Final
BUILDING INSPECTOR
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.
Dalrect Energy.
law-
August 1, 2015
To: Town of North Andover
120 North Main Street
North Andover, MA 01845
Subject: Structural Certification for Installation of Solar Panels
Chamuel Residence
97 Palomino Drive
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 Direct
Energy Solar auditors as follows:
The roof structure of(Roof A)consists of composition shingle on roof plywood that is supported by nominal 2x10 rafters @
16"o.c., paired with nominal 2x8 raised ceiling joists @ 16"o.c..The rafters have a max projected horizontal span of 11'-0",with
a slope of 40 degrees.The rafters are connected at the ridge to a continuous 2x12 ridge board and are supported at the eave by
a load bearing wall. There are 1x8 collar ties @ 32"o.c.for structural stability.
The roof structure of(Roof B)consists of composition shingle on roof plywood that is supported by nominal 2x10 rafters @
16"o.c., paired with nominal 2x8 ceiling joists @ 16"o.c..The rafters have a max projected horizontal span of 14'-0",with a slope
of 40 degrees.The rafters are connected at the ridge to a continuous 2x12 ridge board and are supported at the eave by a load
bearing wall. There are 1x8 collar ties @ 32"o.c.for structural stability.
The existing roof framing system of(Roof A)is judged to be adequate to withstand the loading imposed by the installation of
the solar panels. No reinforcement is necessary.
The existing roof framing system of(Roof B)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.with a staggered pattern to ensure proper distribution of loads.
I further certify that all applicable loads required by the codes and design criteria listed below were applied to the Unirac
Solarmount 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 Unirac Solarmount for the racking system and Ecofasten
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(Roof A) -- 9 psf(Roof B)
• Roof Live Load=20 psf
• Wind Speed= 100 mph, Exposure C
• Ground Snow Load=50 psf - Roof Snow Load=35 psf
8955 Henkeis Lane • Suite 'SOB * Annapolis Junction,Mill) 20701
Phone:800903-6130. * Fax,-. 443-267-10036 . 'Web.-direc,tenergigsolar.com
G";0 Direct Energy.
C!�-Con Ilam
Please contact me with any further questions or concerns regarding this project.
Sincerely, o� IIA OFryAss
ELAINE A. u
a HUANG `_4
CIVIL y
Elaine Huang, P.E. No.49O29
Project Engineer �`�G
SfaNAL'O'
8955 Henkels Lane Suite 508 + Annapolis Junction, MQ 20?01
Phone:800.903.6130 * Fax:443.267-0036 • Web:directen6rgysolar.casm
C?f;O Mored Ene
C!qe�) Boase
Please contact me with any further questions or concerns regarding this project.
I
Sincerely, bv� L�NOF4f.1'V
ELAINE A.
p HUANG
co
CIVIL m
Elaine Huang, P.E. _0 No.490290.
Project Engineer �G
S�aNAL ANG
8955 Henkele Lane + Suite 'SU8 * Annapolis Junction, MD RUM
Phone-800.903-6130 + Fax.443.26?>1)®36 • Web.directen6rgpola.r roam
Chamuel Residence 0
97 palomino 0
N.Andover,Ma 01845 c m
r
Raof B o w o S
Ridge:8" z
Down•S' z
System Ratings
13.2 kW DC Photovoltaic Solar Array Roof A G z
Ridge:Centered x
12 kW AC Photovoltaic Solar Array z
Down:6" o $
22 4" N
19'S" S4 S3 S2
Equipment Summary
48 Suniva 275 Mono Black Modules
48 Enphase M250-60-2LL-S22 Inverters 15'7' w
111 Roof Attachments w
Meter
Sheetlndez
PV-1 Cover
PV-2.1 Description of Work and Load Calculations- a o
PV-2.2 Description of Work and Load Calculations- b
PV-3 Electrical Diagram
PV-3.1 Electrical Calculations w M
a
PV-4 String and Conduit Layout
PV-5 Wiring Description
PV-6 Equipment Ratings&Signage
Governing Codes
2014 National Electric Code
Massachusetts Residential Code,8th Edition
Underwriters Labratories(UL)Standards
OSHA 29 CFR 1910.269
m
ASCE-7-10 '� �: O o
O z ¢
a � �
PREPARED BY:
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#N/A = m z
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#N/A
COVER SHEET
PV-1
a Typical Section
4.125 kW Dc Photovohalc Solar Array
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V m
5 88
This solar arra Bed of 155univa 275 Man,Blacksolar u.The Is are mounted using he Unirac Solar Mount solar—Min ON w O 00
yB comer pane Pane gt g Q �
rail to the building's 2x10,spaced at 16 oc.Eachsolar panel Brttachad to an EnphaseM250-60-2LL-S22 micro-inverteraho mounted to the O
Unirac Solar Mount rail dl—ly beneath the panel. Z
w Z m
a �yto-' G z
The solar panels produce DC power when struck bysunlight.The DC power is co nvertedto240VAC,oweratthei—ner.Micro-inverters
are connected in strings with a maximum number of 36 micro-1--rs in each string. s
t
N
Thu system will be grid-tied.If the solar pane6 produce more power than is used by the bullding,the excess power flows back into the utility
grid through a net meter to be available for other power users.
Y
All metal parts indudinQ solar panel ft,roes,micro-inverters,and mounting raiB are grounded using the manufacturefs recommended K
grounding method and WEED technology along with R6 AWG grounding wire. Q
K
The building was comtructed in 2001.
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Panel LaWut tt
Panel Dimensions 65.04 in x 38.661, System Weight 934 Los
Panel Weight 39.5 lbs System Distributed Load 3.6 psf Syt` t
System Square Footage 262 sq ft Roof Support 2x10 �a
Racking Weight 275 lbs Actual Point Load Max Spacing 4f o�64M•"
Micro-Inverter Weight 66 lb, Total number of Roof Penetrations 38 a
Max Allowable Rail Overhang 16 in C
Members are Hem,Fir(North)allowing 235 lbs per inch thread depth
Note 1:Use 5/16"x 4"1-1ex Head Stainless Steel Lag Screws
Variables Note 2:Roof Support Members are 2x10
h 32 ft aft Pnet Downforce 14.9 psf Nora 3:Unirac Solar Mount Racking Nate 4:
H 22 ft Wind Downforce 14.9 psf Pnet Uplift -18 psf
Roof Pitch 40 degrees Wind Uplift -18 psf B 5.4 Load Combinations wMax 145 pif
V 100 mph KIT 1 Dl D2 D3 Uplift Max Span 3I
Snow Load 50 psf Exposure Category B Dead Load D 3.6 3.6 3.6 2.1 psf Actual Span 4f F
Roof Zone 3 A 1 Snow load 5 50.0 0.0 37.5 0.0 psf Rd 581 lb w p o
E 838 1 1 DWL• Pnet 1 0.01 14.9 11.2 -18.0 psf Ru 172 lbs Z Q
Total Load psa 53.6 18.5 52.2 15.9 psf Required Thread Depth 0.73 in 0 et
Oistrib TL 145.2 50.0 141.6 43.0 plf Actual Thread Depth 2.25 in nw a � u
th 0 Q
•DWL:Design Wind Load U m
Z r
••Absolute values ore indicated for the calculated quantities of P-Uplii t and w-Uplift
Glossary of Terms for Load Calculations
A Building Height 2 Adjustment Fa R,r for height
H Building least Horizontal
Roof Pitch Roof Pitch I Importance Factorof forasinglefamilyresidence
V Basic Wind Speed DESCRIPTION OF
Snow Load Snow Load B Module length perpendicular to beams
RaoJ Zane WORK&LOAD
Roof Zone Rd Point Load-Maximum Downforce
E Eff-N.Roof Area Ru Point Lead-Uplift CALCULATIONS
Roof Zone Setback Length Eapasure B-SuburbansinQle fatuity dwelling
Pnet Downforce Net Design Downforce pressure f tegory
Pnet Uplift Net Design Uplift Pressure
Krt Topographlc Factg'')L/or A -2 s 7
b Typical Section
9.075 kW DC PhMovohaic$olar Array
as O
g
This solararray 6 comprised of 33 Suniva 275 Mono Blacksolarpaneh.The pane6 a re mounted using the Univac Solar Mount solar
mountingrailtotha building's h10,spaced at 16 oc.Eachsolar Panel baM,h,d to an Enphase M250�60-3LL-S22 micro-inverterabo
mounted to the Univac Solar Mount rail directly beneath the panel. US
US Z
Z QZ
O
V`I r�e�w5 G a
ThesolarpanelsproduceDCpowerwhenatruckbysunlight.The DCpoweriz converted to 240 VAC power atthelnverter.Micro- F-K .ad'm M
Inverters are connected in strings wrth a maximum number of 16 micro-Inverters In each string. G�'�
This system will be grid-tied.If the solar pane6 produce more power than is used by the building,the excess power flows back Into the
utility grid through a net meter m be available for other power users.
All metal parts Including solar panel frames,micro-inverters,and mounting rails are grounded using the manWactureI's recommended Y
goandingmethod and WEEB technologa long R6 AWG groandin
gwie
The QK
building was constructed in 2001.
EO
K
Panel Layout 4EE '
Panel Dimensions 65.041n x 38.661n System Weight 205416s F°
Panel Weight 39.516s System Distributed Load 3.6 psf dd'�
System Square Footage 576 sq f[ Roof5upport 2x10 yt Mf'w
Racking Weight 6051bs Actual Point Load Max Spacing 4f ap��
Micro4hyerter Weight 145.2 lbs Total n umber of Roof Penetrations 73
Max Allowable Rail Overhang 16 in
a
allowing lbs per inch thread depth
Note 1:Use 5116',4'Hex Head Stainless Steel Lag Screws
Variables Note 2:R-J'Suppart Members are 2,10
h 32 ft 3f Pnet Downforce 14.9 psf Note3:Unirac Solar Mount Racking Nate4:
H 26 ft Wind Downforce 14.9 psf Pnet Uplift -18 psf
Roof Pitch 40 degrees Wind Uplift -18 psf B 5.4 Load Combinations wMax 145 PH
V 100 mph Kzt 1 D1 D2 D3 Uplift Max Span 3f
Snow Load 50 psf Exposure Category 8 Dead Load D 3.6 3.6 3.6 2.2 psf Actual Span 4fto I
G
Roof Zane 3 A1 Snow Load 5 50.0 0.0 37.5 0.0 psf Rd 581 lbs p o
E 838 1 1 DWL• Pnet 0.0 14.9 11.2 -18.0 psf Ru 172 lbs z 4
a � �
Total Load pe• 53.6 18.5 52.3 15.8 psf Required Thread Depth 0.73 in O of
Distrib TL 145.3 50.1 141.7 42.9 plf Actual Thread Depth 2.25 in a ' G
•DWL:Design Wind Load U Q
Z
as Absolute values are indicated for the calculated quantities of P-Uplift and w-Uplift M
Glossary of Terms for Load Calculations
h Building Height A Adjustment Factor for height
H Building Least Horizontal
R JP(tch Roof P6ch 1 Importance Factor of for aurgle familyresidehce
V Basic Wind Speed
DESCRIPTION OF
Snow Load Shaw Load B Module length perpendicular to beams WORK&LOAD
Roof Zone Roof Zone Rd Point Load-Maximum Downforce
E Effective Roof Area Ru Point Load-Uplift CALCULATIONS
Roof Zone Setback Length Exposure B-Suburbansingle fa roily dwelling
Pnet Downforce Net Design Downforce Pressure Category
Pnet Uplift Net Design Uplift Pressure
Kit Topcgraph[,Factor PV-2.2
P P s
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P P P
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REV. DATE REMARKS
p � CHAMUEL PROJECT DIRECT ENERGY SOLAR
m 97 PALOMINO ••(� 1 15 AVENUE E
C 'n � N.ANDOVER,MA 01845 '—'^'"'tJ"J HOPKININTON,MA,01748
W f7 • 2
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UTILITY ACCT#-7856200002 3 Saturday,January 00,1900
Electrical Diagram for Chamuel-13.2 kW DC Photovoltaic Solar Array
C,
� m m
Calculation for PV Breaker PV Circuit Conductors .'�.
PV Circuit Conductors g
Calculation for Main PV Breaker&Circuits PV Combiner Panel to PV Array Interconnection:LST u, o
Minimum#10 AWG Wire Calc#1 Minimum#4 AWG Wire Calc#2 it
System Current= 48 1 = 48AmpsZ
WIRE SIZING CALCULATION #4 AWG for 60 degree rating at 60 Amps uu �
Design Amperage= 48 x 125% = 60 Amps 20112014 NEC Article 310 16VIRE SIZING CALCULATION w a o q
Main Buss rutting= 200 x 120% = 240 Amps Full Load Amperage.............:16 20112014 NEC Article 310 G _z >
Existing Main Breaker = 200 Amps Source Voltage.................:240 Full Load Amperage ......:48 '� a
a
Length of Run(Feet)...........:80 Source Voltage.................:240 o i '
Max Solar Breaker 240 1-I1 2001 40 Amps Load Duty ........:Continuous Length of Run Feet 30
Circuit#1= 16 x 1 x 125%= 20 Amps Conductor Application..........:Conductors in Raceway,Cable or Earth Load Duty......................:Continuous
Circuit#2= 16 x 1 x 125%= 20 Amps Conductor Ampacity Table.......:NEC Table 310-15(8)(16) Conductor Application....._....:Conductors in Raceway,Cable or Earth
Circuit#3= 16 x 1 x 125%= 20 Amps Conductor Type.................:THHN Copper Conductor Ampacity Table.......:NEC Table 310.15(6)(16)
Conductor Location....._._...:Dry/Damp Conductor Type .............:THHN Copper
Conductor Insulation Temperature:90 eC Conductor Location._..........:DryfDarmp
Rooftop Installation:NEC 310.15(8)(3)(c) Conductor Insulation Temperature:90'C
Distance Above Roof-_-..-..--..:Above 13 nun to 90 mm[above 12 inch to 3 12 inch] Ambient Temperature------------:26-30 eC=78-86`F „I
Average Outside Temp...........:90 Deg.F 322 Deg.C Terminal Temperature Rating.._:60 eC a
Temperature Adder..............:40 Deg.F 22 Deg,C Circuit Type:Single Phase 3 Wire(2 phase conductors&neutral)
Ory.of Cucud Current-Carrying Conductors:2
Adjusted Ambient Temperature...:130.0 Deg.F 54.2 Deg.C Conductor Requirement:
Terminal Temperature Rating._..:60 eC Full Load Amps...........:48.0
Circuit Type:Single Phase 3 Wire(2 phase conductors&neutral) Load Duty Multiplier.....:1.25
City.of Circuit Curem-Carrying Conductors:2 Ambient Temp.Multiplier.:1.0
Additional CurremLanying Conductors .:41 Oty-Conductors Multiplier:1-0
Total City.Current-Carrying Conductors...._:6 Required Conductor Ampacity-.60.0 0
Conductor Requirement: Terminal Requirement:
Full Load Amps......._..:16.0 Full Load Amps..........:48.0
Load Duty Multiplier-....:1.25 Load Duty Multiplier_-._:125
Ambient Temp.Multiplier.:1.32
City.Conductors Multiplier:125 Required Terminal Ampacity:60.0 CC
Selected Conductor.
Required Conductor Ampacity:33.0 Conductor Ampacity....... 70.0
Terminal Requirement Ambient Temp.Derste.....:1:0
Full Load Amps._.._....:16.0 Ory.Conductors Derate...:1.0 '
Load Duty Multiplier.....:1.25
Adjusted Ampacity........:70.0
Required Terminal Ampacity:20.0 SELECTED CONDUCTOR S12E:4 Awg
Selected Conductor. 2 x OhmsfMilFt x Length x Amps 2 x 0.308 x 30 x 60.0
Conductor Ampacity_..._:30.0 VD - -0.89 n
Ambient Temp.Derate.....:0.76 1000 x Oty Wires per Phase 1000 x 1
City.Conductors Derate...:0.8 Volts At Load Terminals......:239.11
Actual Percent Voltage Drop.:0.37
Adjusted Ampacdy........:1824
SELECTED CONDUCTOR SIZE:10 Awg
Electrical Notes 2 x OhmsfMiiFt x Length x Amps 2 x 124 x 80 x 33.0
1)Allegulpmentto be listed and labeled for Bsappliation. VD- - -3.17
1000 2)All cendunors shall benipper,rated for 90C and war envlronment,unless Volts OryadTemi Vilfires Phase 1000x1
Volts At load Terminals......:236.83
otherwise netad. Actual Percent Voltage Drop.:1.32 m
G
3)working clearoncesaroundalnewand-kningelecoloal eq,ip-m,h,l1 l+r p O
mmplywkh NEC110.26 Z G
a � �
4)Allwireterminatlonsshall beappropriately labeledand readilyalsable. O oc
a > G
5)Module groundingclips to be installed between module frameand mZ
odule U
r p Q
m
support rall,per groundingclipmanufacturers lnstruRlon. V Q Z
Z �
6)Module support rail to be bonded to continuous capper GEC,1,W EES lug per
NEC 690.4([).
7)B used PV power source breaker to be looted at bottom of bus per NEC
690.64(8)(7).
a)AC mmbiner panels shall be labeled as"Inverter AC Combiner Panel".
9)ilrting agency name and number to be indlcated on Inverters and modules per ELECTRICAL
NEC 110.3(8) CALCULATIONS
10)Pv power source breaker to be--table for backieed per NEC 690.64(8)(5).
PV-3.1
String and Conduit Layout
0
� a rn
S
O w o o
0
Circuit 1(16)❑ h _ Z z
w > zo
Circuit 2(16)❑ ;
42.10^ G z
i
Circuit 3(16)❑
o o_
Junction Box
t
Soladeck
r.
End Cap ® i
Trunk Cable— Roof A
Ridge:Centered x
Interior Conduit— Dow"'6"
`� zz'a•
Exterior Conduit—
A UG
Q
O
................__......._._—._........_.,.__.___.__ ................................ ...._...__.___......_......................._..__...._........_.___.._........................_._......._......._.....................__.....
Chamuel,Glenn.Residence Electrical Review
W Palomino Dr.North Andover,MA 01845
Westford MA Office:Daniel Goodridge
Reviewed By:Melissa D.(610-680-0805)
Financing:Purchase
(48)Suniva 275W Black Panels with(48)M250 Inverters
PV meter type:Enphase RGM
Emu location:In the basement by the house panel.
Internet Connection:Bridge
Main House Panel:200 Amp Square D HOM(22 KAIC rated main breaker) C p o
Utility:National Grid z a
o
Circuit Calculations:48 M250 inverters x 1/Inverter=48 Amps x 1.25=60 FLA. a� > G
PV combiner with(3)20 Amp,2 pole circuit breakers,(1)15 Amp,1 pole circuit breaker(for EMU) a m o a
V Q
Interconnection calculation:N/A,Line-Side-Tap z
Interconnection will be a line-side-tap in the gutter space of the existing main panel.From the LST install wiring to a 125 Amp main breaker enclosure with a 60 Amp(22 K rated)circuit breaker mounted adjacent to the main service panel.Wiring
from this main breaker enclosure will install outside to a 60 Amp non-fused disconnect located adjacent to the utility meter.From the 60 amp non-fused disconnect bring the conduit back into the basement and wire through the PV meter and into
the PV combiner panel(a backer board will need to be installed).From the PV combiner panel run the flex to the rear of the basement and then outside.Once outside run the conduit up the wall until it can penetrate into the attic space.Continue
to run the conduit through the attic to the two Soladecks located under the upper array.From the second Soladeck run conduit through the attic and penetrate out the east gable end.From the penetration run the conduit down the wall and
follow along the ridge line to thejunction box located under the array,as shown in the drawing.All conduit on the roof must be run at least 1"above the surface of the roof and fastened accordingly.There will be three circuits of inverters to the
roof.
STRING&
Main PV Disconnnect Interior Adjacent to Main Panel basement CONDUIT LAYOUT
Utility PV Disconnect Exterior Adjacent to Utility Meter
PV Meter Interior Adjacent to Main Panel
PV Combiner Panel Interior Adjacent to Main Panel
SE Inverter N/A
EMU Interior Adjacent to Main Panel PVA
Comunication Equipment Bridge
Wiring Description
0
3
Special Notes:
0
z
Z < z
O q
Meter Type
Enphase RGM p
o =
The standard process for installing a LST in the gutter space. N
1)Access the work space and move any obstacles that will be in the way while working
2)Put on the proper PPE
3)Inspect the panel and surrounding area for hazards
4)Remove the panel cover
5)Determine that the panel is suitable for the LST
6) Determine the location of the new fused disconnect switch(60 Amp minimum)or main circuit breaker enclosure(125 Amp minimum).This must be within 10'of the tap location.If FMC or Sealtite is used it cannot be
more than 6'and must be bonded on both ends.
7)Install the switch or circuit breaker enclosure.If the main breaker enclosure is being installed in an existing finished wall or finished living space,recess the enclosure if possible.
8)Install metal conduit from main service panel to the new switch or main circuit breaker enclosure.Bonding bushings are required.Minimum 1",but sized as designed and necessary depending on LST wire size.
9)Install COPPER wiring for the LST.#4 Minimum,but sized as designed and required by the LST amperage.Bring the wire in behind all existing wiring in the panel.Enter the panel on the same side as the tap when
possible.Our standard"B-Tap"are rated for 4/0 wire.If an existing service conductor has tape on the exterior,remove the tape before installing the"B-Tap".
10)Terminate wiring at the fused disconnect switch or the main buss in the new main circuit breaker enclosure. o
11)Neutral WILL be BONDED in this enclosure.
12)Locate best location to install the B-Taps and complete the taps in the main service panel.Check and dress all wiring in this panel.
13)Test power on the LINE SIDE of the main breaker installed in the new main circuit breaker enclosure.If all is good,move on,if not troubleshoot the taps.
14)Install the lock out tag out kit
15)Take photos of connections and taps and close up the main service panel.
e
Conduit Runs:
1)All conduit runs shall be sized appropriately for the conductors being installed.The lead electrician is responsible for verifying that the correct conduit size,and type is being installed.
2)Greenfield(flexible metal conduit,FMC)shall be Aluminum,ONLY.Size shall be as designed.
3)Greenfield,PVC,and EMT shall be installed in a neat and workmanlike manner.
a.Following building lines
b.Square with the building
c.Straight and level
d.Supported as per the NEC G o 0
e.Penetrations shall be sealed,inside and out. o ? <
PVC will require expansion fittings as required by the NEC p
Conductor Installation: a o u
1)DC wiring inside of a building must be installed in metallic conduit. = m z <
2)Any DC wiring installed in conduit will need to be labeled appropriately u a
z
3)USE-2 cannot be used inside a home even when sleeved in conduit.
4)All wiring shall be sized as designed.Any questions concerning wire size should be directed to the designer or your manager.
5)All wiring MUST be THHN-THWN-2 Copper,unless otherwise specified
6)All circuits MUST be labeled appropriately on both ends with the circuit identification
7)Conductors as much as possible should be installed from the soladeck orjunction box to the PV combiner panel in one continuous length with no additional splices.If splices are necessary,the circuits MUST be
identified in the junction box,also.The junction box MUST be sized appropriately and bonded as necessary.The same applies to boxes specifically used as pull boxes.
8)Care MUST be taken to assure that the conductors are not damaged during installation.Use appropriate pulling compounds,if necessary. WIRING
9)The number of conductors/circuits installed in each conduit is listed on the design.This number MUST be adhered to.Conduit fill and de-rating calculations have been done in the design and MUST be followed.If it is
necessary to change the conductors in a conduit,check with the designer or your manager. DESCRIPTION
10)Once all conductors have been installed in a conduit,the conduit opening MUST be sealed to prevent air exchange between cold and warm atmospheres that can cause moisture buildup and damage to the interior of
the property.Ductseal compound is to be used for this.
PV-5
€
Sunivef
the M6/6etl;e of Wit,ht,ide Sen till".
SUNIVA OPTIMUSO SERIES
MONOCRYSTALLINE SOLAR MODULES
OPT SERIES:OPT 60 CELL MODULES(BLACK FRAME)
optimuse modules are known for thea superior quality
and long-term reliability. These high-powered modules
ENGINEERING EXCELLENCE consist ofSuniva'spremium ARTisun®Select cell technology
■ Built exclusively with 5univa's.premium ARTisun and are designed and manufactured in the U.S.A.using our
Select cells;providing one of the highest Power pioneering:ion implantation technology. Suniva's high
output
,,s square meter at'an affordable price power-density Optimus modules provide excellent
■ Suniva is a U.S.•based company spun out from the performance and value.
Georgia Tech University Center of Excellence in FEATURES %ci S p�
Photovoltaics;one of only two such research centers �o
in the d
Contains premium.ARTisun Select cell
■ Suniva's state-of-the art manufacturing and module. U SK
i lab-facilities feature the most advanced equipment technology-over 19%
and technology
Extensive'materials testing and
certifications safeguard reliability
QUALITY & RELIABILITY Marine grade aluminum frame with hard
■ Suniva Optimus modules are manufactured and I anodized coating
I warranted to our specifications-assuring consistent
i high performance and high quality.
Buy America-compliant upon request
■. Rigorous in-house quality.management-tests
i
beyond standard UL.and IEC standards Qualifies for U.S.EXIM.financing
■ Performance longevitywith advanced_ System and design services available
polymer backsheet
• Passed,the most stringent salt spray tests based 0 Industry leading linear warranty:10 year
on IEC 61701 warranty-on workmanship and materials;.
1! Passed;enhanced stress te3te based,on IEC 61215 2.5 year linear performance warranty
conducted at Fraunhofer ISE= delivering 80%power at STC.
Certified PID free by PV Evolution Labs(PVEQ
■ PAN files are'indepe-ndentlyvalidated CERTIFICATIONS
C CPVL
OPTIMUS SERIES: OPT 60 CELL MODULES
ELECTRICAL DATA(NOMINAL)
The rated power may only vary by+/-2.514p and all other electrical parameters by f 5%
i
•' •' •� OP
Model •-
.t :t 270-60-4-1:f .t :f 280-60-4-1:9
PoWTr Classification(Pint) 265W ' 270 W 275 W 280 W
r1:17.26°0
I ' ( ModuleEflicicliry(90) 16.3345 16.6340 16.9540
+ I Voltage at Max.Power Point(Vmp) 30.70 V 31.00 V 31.50 V 31.90 V
I I I Current at Max.Power Point(Imp) 8.64 A 1 8.70 A 8.74 A 8.78 A
i
Open.Circuit`Voltage(Vac) 303Q V 38.40 V 38.60 V 38.80 V
Short Circuit'Current'(Isc) 9.12 A 9.18 A 9.2.8 A 9.31 A
Q The electrical data apply to standard test conditions(STC);Irradiance of 1000 WIm2 with AM 1.5 spectra at 25°C.
t CHARACTERISTIC DATA
or,�rhl• -
Type of Solar Cell fiigli-efficiency ARTiswi Selectcells of 156 x 1.56 mm(6 in.)
Frame Black anodized aluminum alloy
' KMltq 5101Glass "Tempered(low-iron),anti-reflective coating [
t-9f 17 -
1
A Junction.Box NEMA IP67 rated;3 internal bypass diodes
Cable&Connectors 12 AWG(4 mm')PV Wire cable with multiple connector options I
' available;cable len th a rox.0000 nim
g PP
cw�a�u moi.
B
v MECHANICALS
I
Cells I Module 60(6 x 10)
Module Dimensions 1652'x.982 rum(65.04 x 38.66 in.)
Module Thickness(Depth) 40 mm(1.57 In.)
Approximate Weight 17.9+/-0.25 kg.(39.5+/-0.5 Ib.)
Hnfs loloranc�es Vnlyi/-Zmm. .
1 7YfN,onlwap.a..4sn«r xow+nwe.uafu,uvaN. TEMPERATURE COEFFICIENTS
CviifnNhlU7.Uy n+rumen elmyq.u.n N:M'1.4e- .
TxfpnNii
Voltage 9,Voc{9G/4C) 4:_335
Current a,Isc('10/'C) +0.047
v 1•I =_ (LL._. Power y,Pmax("6/°C) 0.420
,•I s - __
- - - NOCT Avg (+/ 2"C) 46.0
40 EL f41 t17 N4 .110 107 14, /tf
1 VOlmpe(Vj
I{ -.�n�.-,�r ,-«.N�-,mwm �•;, tae ;a LIMITS
f t Max._System Voltage i00o VDclor-IEC,1006 VPC for UL
i Max Series Fuse Rating 15 Amps
1
100%.- H/[i Operating Module Temperature -404C to-+85"C(-40°17 to+185"F)
x 97% FqR FRFNO Storm Resistance/Stati4L'oad Tested to IEC'6121'5 for loads of 5400 Pa(113 psf);
hail and wind resistant
90%.
o h'gRRO/N• Sunivam reserves the right to change the data at any View manual at suniva corn.
0 " qMr G rUV 90 kWh,TC 400,DH 2000. 2TeMs were conducted on module type,OPT 60 silver frame.
d 80%
Please read installation manual.beldre irtstAlling for wvrtfing with module.
� 0 1 12 X25
YEARS
HEADQUARTERS F
5765 Peacttilrea Industrial Blvd.,orcrob
PLEASE'RECYCLE { •. N i+s.G 044772eorgia �7000SA ��
OPT-60 cell 25 28 700 � u
AUGUST 14,2014(REV.18)[SAMD OOt6) (sliver and black) i www.suniva.coni The Brilliance of Solar Made Sensible'
V
I
I
Enphase°Microinverters
d
Enp _hale M25Q
67F_ 4
The Enph�ase°' M25.6' reinverter'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'O, Enphase's monitoring and analysis software.
,PRO.DU-CTI-V It, Ad"
d 011-t REL1ABLE
-optimized for higher-power No GEC needed for micro-inverter -4th:generation product
modules _No DC design or string calculation -More than 1 million hours of testing
-Maximizes energy production required and 3 million units shipped
Minimizes impact of shading, Easy installation with Engage -Industry-leading warranty,up-to 25
dust,and debris Cable years
r ] enphase° Ge
LJ E N E R G Y C us
Enphase°M250 Microinverter//DATA
INPUT DATA(DO)^ 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 .-
OUTPUT DATA(AC) @208 VAC @240 VAC
� Peak,output power
250:W 250 W
Rated(continuous)output pow_er -240 W 240 W
NOminal output current 1.15 A(A rens:at nominal c,_ .'ion) 1.O A(A rms at nominal duration)
Nominal voltage/range 208 V/183-229 V 240 V/211-264 V
Nominal frequency/range 60.0/57-61 Hz 60.0/57-61 Hz_
Extended frequency range 57-62.5 Hz 57-62:5 Hz
Power factor 4.95 X0.95
Maximum units per 20 A branch circuit 24(three phase) 16(single phase)
Maximum output.fault current_ 850 mA rms f9r-6 cycles 850 mA rms for 6 cycle's
EFFICIENCY
CEGweighted efficiency,240 VAC 913:50/0
CEC weighted efficiency,208 VAC 96:0%
Peak Inverter"efficiency 96.5%
Static MPPT efficiency(weighted,reference EN50530) 99.49/6
Night time_power consumption_ _ 65 mW.max
MECHANICAL DATA
Atiiblent.tem -460C to-+650C
erature p rang e- _
operating temperature range.(internal) -40°C to+85°C
Dimensions(WxHxD) 171 m.m x 173 mm 30.mm(without mounting bracket)
Weight 2.0 kg
Cooling Natural convection-00 fans
Enclosure environmental rating Outdoor"NEMA 6
FEATURES
Compatibility _ Compatible with 60=cell PV modules.
Communication Power line
Integrated ground _ The DC circuit meets the requirements for-ungrounded PV arrays in
NEC 690.35.Equ'ipment;ground Is provided in the Engage Cable.No
additional GEC or ground is.required.
Monitoring Free lifetime monitoring via Enlighten software
Compliance. 0-
0741AEEE1547,.FCC?art 15 Class B;CAN/CSA-022.2 NO.0=MM,
IIA-04,.and 107.1=01
Frequency ranges can be,extended beyond nominal if required by the utility
To learn more about Enphase Microinverter technology,, enphase°
visit.enptiase e�orn
' E N E R G Y
0 2013 Enphase Energy.All rights reserved.Ali trademarks or brands in this document are registered by their respective owner.
0
i t I - - - ::°uL� �
Technical r r A HIM GROUP CONIVAMY
'SOLARMOUNT:Beam Connection Hardware
S`O,L'ARMO.UNT'L"-Fant
Park No.3'040p0C;.30401i0D1
- L-Foot material:One of the following extruded aluminum alloys:15005-
T5,6105-T5,6061-T6
005-
T5,6105-T5,6061-T6
* Ultimate tensile:38ksi Yield:35 ksi
• Finish:Clear or Dark Anodized
• L-Foot weight:0.215 lbs(98g)
• Allowable and design loads are valid when components are
assembled with SOLARMOUNT series beams°according to authorized
Bea UNIRAC documents
Bolt
L4Fo6t For the beam to L-Foot connection:
•Assemble with one ASTM F593 MV-16 hex head screw and one
errate ASTM F594'/"serrated flange nut
Flange N •Use anti-seize and tighten to 30 ft-lbs of torque
Resistance factors and safety factors are determined according to part
1 section 9 of the 2005 Aluminum Design Manual and third-party test
Y results from an IAS accredited laboratory
A NOTE: Loads are given for the L-Foot to,beam connection only;be
L,x sure to check load limits for standoff,.lag screw,or other
attachment method
Applied Load Average Safety Design Resistance
3xsiorFOR Direction Ultimate Allowable Load Factor,
301 Load Factor,
U.HARDWARE lbs(N) lbs(N) FS lbs(N) 0
- Sliding,Zt 1766(7856) 755(3356) 2.34 1141 (5077) 0:646
Tension,Y+ 1859(8269) 707(3144) 2.63 1069(4755) 0.575
Dimensions specified in inches unless noted Compression,Y- 3258(14492) 1325(5893) 2.46 2004(8913) 0.615
323(1436) 0.664
Traverse,Xt 486(2162) 213(949) 2.28
i
0
UNIRSOLARMOUNT - ♦ rs - - AC
A Hun rkcur coairnNY
mom
SOLARMOUNT.Beam's
Part'N4.310132G; 310132C-B, 3'10168iC;31.0;1,60C-13,,31016ib
316208C, 31'G2-08.C-B,-310240.C,31024.6G�B, 310,240%
4410144M,41016.8M,00204M;410240M
Properties Units SOLARMOUNT SOLARMOUNT HD
Beam Height in 2:5 3.0
Approximate Weight(per linear ft) plf 0.811 1.271
Total.Cross Sectional Area int 0.676 1.059
Section Modulus(X-Axis) in3 0.353 0.898
Section Modulus(Y Axis) in3 0.113 0.221
Moment of Inertia(X-Axis) In, 0.464 1.450
Moment of Inertia(YAxis) in' 0.644 0.267
Radius of Gyration(X-Axis) in 0.289 1 1.170
Radius of Gyration(Y-Axis) in 0.254 0.502
'Rails are extruded usi rig these aluminum alloys. 6005-T5 6105-T5, 6061-T6
SLOT FOR T-BOLT ORdo 1.728
SLOT FOR T-BOLT OR
4"HEX HEAD SCREW 4"HEX HEAD SCREW .
2X"SLOT FOR SLOT FOR
BOTTOM CLIP 2.500 BOTTOM CLIP
3.000
1.316
� SLOT FOR
3 „
HEX BOLT 0 SLOT FOR 1:385
3Ia" HEX BOLT
:387
750 -- 1,207
Y I+--1.875 —
Y �►X
�X
SOLARMOUNT Beam SOLARMOUNT HD Beam
Dimensions specified in inches unless noted
a
Llnirac Code-Compliant Installation Manual SolarMount
UN I RAC
ASCE 7-05 AND ASCE 7-10
Step 2:Determine the Distributed Load on the rail, Step 3:Determine Rail Span/L-Foot Spacing
w(P If) Using the distributed load,.iv,from kart 11,Step 2,look up the
allowable spans,L,for each Unirac rail type,SOLARMOUN T
Determine the DistributedLorid,iv(p j),by multiplying the (SM)and SOLARMOUNT HeavyDuty(HD)in table 14.
module length,B(ft),by the Total Design Load,p(psf)and
dividing by two.Use the maximum absolute value.of the three
downforce cases and the Uplift Case. We assume each module. The L-Foot SOLARMOUNT Series Rail Span Table uses a single
is supported by two rails. L-foot connection to the roof,wall or stand-off. Please refer to
w=PB/2 the Part III for more installation_information.
x+=Distributed Load(pounds perlinearfoo4 plf)
B=Module Length Perpendicular to Rails(ft)
P=Total Design Pressure(pounds per square foot,psf)
i
i
Table 14.L-Foot SOLARMOUNT Series Rail Span
SM-SOLARMOUNT HD-SOLARMOUNT Heavy Duty
Span _ Dhtdbuied Load unddrm-r rwd
(i) 20 25 30 40 50 60 80 100 120 140 160 180 200 220 240 250
2 SM SM SM SM SM -SM SM, Am. SM SM SM SM SM SM SM. SM,
2.5 SM SM SM SM SM SM SM SM SM- $M SM SM SM HD` HD HD
3 SM SM SM- SM SM SM SM. SM SM SM SM'.. HD HD HD HD HO
3.5 SM SM SMSM SM SM SM SM SM SM Ht5 HD HD, HO
4 'SM. SM SM SM SM` SM SM SM SMPHD
HD HD`
4.5 SM SM SM SM SM SSM SM, SM. HD
5 SM SM SM SM' SM SM, SM SM HD
5:5 SM SM: SM SM 3M SM. SM �HD HD
6 SM SM SM' SM' SM SM SM HD HD.
6.5 SM SM 'SM SM SM SM SM HD HD
7 SM SM' SM SM SM SM, }JD HD
7.5 ,SM SM SM SM SM SM HD HD
e SM SM. SM SM SM 'SM HD HD
8.5 SM SM SM SM SM HD, HO
9 SM SM SM SM Hb; HD HD
9.5 SM SM SM SM HR HD HD
10 SM SM' SM Hb. HD HD Hp
10.5 SM SM SM HP HD HD
II SM SM HD HD HD HD
1L5 SM HD HR H9 HD HD
12 SM Hb HD HD HD HD
iia•
26
Tire Commonwealth of Massachusetts �Rrint Form
Department of bidustrialAccidents
Office.of Investigatiolls
' 1 Congress Stiieet,Suite 100
_
Boston,AM02114 2017
unpip.mtass.gov%dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/LiLi lectricians/Plumbets
.A milicant Information Please Print-Legibly
Name(Business/Organizatiot>/tndividuat):
Astrurn Solar
Address: 15 Avenue E
City/State/Zip: Hopkinton, Me,01748 Phone#:508-614-0146
Are youlin employer?Cheelc the appropriate box: Type of project(required)4
1.0 I am a employer with 15 4. [] 1 am a general contractor and 1 6. ❑Now construction
employees(full andlor part-time).* have hired the sub-eontfactdrs
I ❑
listed on the attached sheet. 7. [—]Remodeling
2. 1 am a sole proprietor or partner-
ship and have no employees employees These sub-contractors have g, Demolition
land have workers'
working for me in any capacity. 9. ❑Building addition
[No workers'com_p.insurance comp.insurance:#
required.] 5. El We are a corporation and its 10.❑Elechicai repairs or additions
3,❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself.[No workers'comp. right ofexempttonper'IvIGL 12.❑Roof repairs
required.]t
C. 152,41(4),and we have no PV Solar Installation
insurance re
q ] employees.[No workers' 13.]Other
comp.insurance required]
j *Any applicanithat cfiecks box 61 must also fill out thesection below showing theirworkers'conipeusation policy infoniiatioh.
t Homeowners wlto.submit this affidavit indicatingthey are doing all work and then hire outside contractors must submit a new of .davit indicating such.
te'nlractors that check this box tnust.attaclied an additional sheet showing lic name oriho sub-contractors and state whether or not those entities have
employees. if ilia sub-con(roctorslnsve employees,they must provide Blair workeis'comp.policy number.
I mr1 i7t1 en loyeV that is providheg rvor leers'coiifpeirsnlion iiisrirmrce for my ejnPloyees. Below!s ill¢policy nridjoL site
Information.
Insurance Cotnpany Natne:Zurich American Insurance Co.
Policy#or Se1f--ins.Lica#:59536900 Expiration Date:1/1/2016
Job Site Address: /9-/6 M'h <) ``� r _!State/Zip:
Attach a copy of the worke;i�s'compeiishtion policy deelaratioh page(Atowing the policy number and expiration date).
Failure to secure coverage aslequhed under Section 25A of MGL c. 152 caulead to the imposition of criminal penalties of a
fine up to:$1 500.00 and/or one 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 copy of-this statement maybe forwarded to the Office of
Investigations of the DIA-for insurance_overage verification.
I do hereb ceriffy r filera pains alkl4enallies ofgatilly brat ilte h ornlation provided above/s tine an correct.
Si ilia a ate �..... I
Phone,#•508-614=0146
Official use o»ly. Do not write in ibis area,to be coal leted by city or town official.
City or ToWn: Permit/License#
Issuing Authority(cirele one):
1..Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector
6..Other
Contact Persona Phone#:
A� CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 02104/200115'
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
Willis of Texas, Inc. PHONE FAX
c/o 26 Century Blvd. 877-945-7378 888-467-2378
P.O. Box 305191 E-MAIL certificates@willis.com
Nashville, TN 37230-5191
INSURER(S)AFFORDINGCOVERAGE NAIC#
INSURERA:ACE American Insurance Company 22667-302
INSURED Direct Energy and its majority owned INSURERB: Zurich American Insurance Company 16535-305
subsidiaries and affiliates including INSURERC:American Zurich Insurance Company 16535-306
Astrum Solar
5 Lyberty Way, Suite 3 INSURER D:
Westford, MA 01886 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:22748483 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS'OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPEOFINSURANCE DDL SUB POLICY NUMBER POLICY EFF POLICYEXPI TR LIMITS
A X COMMERCIAL GENERAL LIABILITY XSLG27341226 1/1/2015 1/1/2016 EACH OCCURRENCE $ 11000,000
DpAAMMF�S77QENTErD
CLAIMS-MADE X OCCUR
$ 100,000
X SIR: $500,000 MED EXP(Any one person) $ 5 000
PERSONAL&ADV INJURY $ 11000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 11000,000
POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 1,000,000
JECT
OTHER: 1XI $
B AUTOMOBILE LIABILITY BAP595396601 1/1/2015 1/1/2016 COMBINED SINGLE LIMIT 1,000,000
(Ea accident) $
X ANYAUTO BODILY INJURY(Per person) $
ALLOWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
HIREDAUTOS NON-OWNED PROPERTYDAMAGE
AUTOS (Peraccidenl) $
A X UMBRELLALIAB X OCCUR XOOG25703728 1/1/2015 1/1/2016 EACH OCCURRENCE$ 2,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000
DED I RETENTION$ $
C WORKERS COMPENSATION WC595396901 1/1/2015 1/1/2016 X STAPERTLITF FIR
oTH-
AND EMPLOYERS'LIABILITY
B ANY PROPRIETOR/PARTNER/EXECUTIVE Y] N/A WC595397301 1/1/2015 1/1/2016 E.L.EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED?
fMandatory,in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
f yes,descnbe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additonal Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
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
Town of North Andover
206 Forest St
North Andover, MA 01845
Coll:4618435 Tpl:1917373 Cert:22748483 @ 1988tK2014ACORDCORPORATION.Allrightsreserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
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