Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 12 HARWOOD STREET 4/30/2018
/ 12 HARWOOD STREET 210/010.0-00540000.0 i I Date.... ........ TOWN OF NORTH ANDOVER V . PERMIT FOR WIRING This certifies that CrA ................................... has permission to perform ...... . ... ...... ............................. wiring in the building at .......................................................................................................,North Andover,Mass. 95-- 12(68l Fee..............................Lic.No. .................. ................................................................................... ► ELECTRICAL INSPECTOR Check# r Cotn»wnwealth o�cc77 adeaeiia�e> Official Use Only �LJePar�rnsnE o��tire�ervieed Permit No. I�(�1 I�—I 1 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 11/23/2015 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intentio7terform the el ctrical work described below. Location(Street& Number) 12 Har wood Street � V.,00( Owner or Tenant Lila Vinogradov Telephone No. 617-504-6993 Owner's Address same Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: main service panel swap to accommodate solar Com letion o the ollowin Coble may be waivedbv the Inspector of!Vires. X No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o.of Tota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ 0.0Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection an Total Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat um Num•.er ons o.oSelf-Contained Totals:Is "'""......""""".....""'•"•"......' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ unicipal ElOther Connection No.of Dryers Heating Appliances KW ecuritySystems:* No.of Devices or Equivalent No.o ea KW No.Si o.as Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP a ecommunications irmg: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of 111ires. Estimated Value of Electrical Work: $1500.00 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Boston Solar LIC.NO.: 12689A Licensee: William T. Foglietta Signature O,Q,Qf� r��_ LIC.NO.: ! (/f applicable,enter "exem t"in the license number line.) Bus.Tel.No.: 781-462-8702 Address: 55 Sixth Goad Woburn MA 01801 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE. ,S SignatureturaTelephone No. / Mailing address:Boston Solar,55 Sixth Road,Wobun MA 01801,Attn:permits, Email address:permits@bostonsolar.us The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricions/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business�Organization/individual):The Boston Solar Company Address:55 Sixth Road City/State/Zip:Woburn MA 01801 Phone#:617-858-1645 Are you an employer?Check the appropriate box: Type of project(required): I.01 am a employer with 20 employees(full and/or part-time)." 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. [:]Remodeling any capacity.[No workers'comp.insurance required.) 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]! 9. El Demolition 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.QPIumbing repairs or additions 5.Q 1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.❑ repairs re airs These sub-contractors have employees and have workers'comp.insurance.' 14.�✓ Other solar 6.0 We are a corporation and its officers have exercised their right of exemption per MGI.c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an ensployer titat is providiirg workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:HDI-Gerling America Insurance Company Policy#or Self-ins.Lic.#:EWGCC000153815 Expiration Date:1/14/2016 Job Site Address: 12 Hardwood Street City/State/Zip:North Andover MA 01845 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pain n !ties of perjury that the information provided above is true and correct Signature: Date: 11/23/2015 Phone th 617-858-1645 Oficial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: e COMMONWEALTH OF M&ffimUS�TTS BOARD Of ELECTRICIANS I ISSUES THE FOLLOWING LICENSE AS A REGISTERED MASTER..ELECTRICIAN THE BOSTON SOLAR COMPANY LLC WILLIAM T EOGLIETTA III 10 CHURCHILL PLACE LYNN MA 01902.-2719 MAMA 120 i CONTROL# IMPORTANT If your license is lost,damaged or destroyed;Is inaccurate;or needs to be corrected,visit our web site st mass.gov/dpl for Instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations.Your license is a privilege,and cannot be lent or assigned to any person or entity under penalty of law.Keep this license on your person or posted as required by law and/or regulations. Client#:103109 BOSSO DATE(MMIDDIYYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 1/13/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME CT Peggy J.Merati People's United Ins.Agency CT a8NN Et):860 524-7624 ac No):844 702-8075 One Goodwin Square ADDRESS: peggy.merati@peoples.com Hartford,CT 06103 INSURER(S)AFFORDING COVERAGE NAIC# 860 524-7600 INSURER A:HDI-Gerling America Insurance C 41343 INSURED INSURER B:Merchants Mutual Insurance Co 23329 The Boston Solar Company,LLC INSURER C 55 Sixth Road,Suite 1 INSURER D Woburn,MA 01801 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /NSR TYPE OF INSURANCE ADD! UB POLICY EFF POLICY EXP LTR /NSR WVD POLICY NUMBER MM/DD MMIDD LIMITS A GENERAL LIABILITY EGGCC000153814 1010312014 0110112016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea o rrence $100,000 CLAIMS-MADE F—R OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s2,000,000 POLICY X PR0. LOC $ A AUTOMOBILE LIABILITY EAGCC000153814 10/03/2014 01/01/201 E°a d9ISINGLE LIMIT 1,000,000 A X ANY AUTO EAGCC000153914 0/03/2014 01101/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident S B X UMBRELLA LIAB X OCCUR CUP0001367 0/03/2014 01/0112016 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5.000.000 DED I X RETENTION$10,000 $ A WORKERS COMPENSATION EWGCC000153815 114/2015 01/14/201 X WCSTATU- IER OTH- AND EMPLOYERS'LIABILnY ANY PROPRIETORIPARTNERIEXECUTIVE Y l N E.L.EACH ACCIDENT $1,0001000 OFFICERIMEMBER EXCLUDED? NIA, (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) RE:Permit Work Certificate Holder is included as Additional Insured per the terms,conditions and exclusions of the referenced general liability and umbrella policies,if required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE 0A*d�YuWA1k(( ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S565647/MS65467 SMGCT Datel.l. .�. . �. .................. OF NORTH,�� 3a; ;•. �o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,s`SACHU5�t This certifies that ......... ...... .......�.� ..cler4 c ......................................................... has permission to perfor .................................. � N-PA� e k �• . `7`L1� pp ........j...................... wiring in the building of.... tS,I. at ...... .�Z--- ;.t+A. ,urc?C�cX...........................................,North Andover,Mass. Fee... —..........Lic.Nd. °. ..... ..................................................................................... ELECTRICAL INSPECTOR Check# Zoly vtolklu, a Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit Number Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (Leave Blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12.00 (Please print in ink or type all information) Date: 11/06/2015 City or Town of: North Andover To the inspector of Wires By this application the undersigned gives notice of their intention to perform the electrical work described below. Location(Street&number) 12 Hariwood St. Owner or Tenant Illia Vinogradov Telephone No. (617)504-6993 Owners Address Is this permit in conjunction with a building permit? YES ® NO❑ (Check appropriate box) Purpose of building Utility Authorization No. Existing service Amps Volts Overhead❑ Underground ❑ No.of meters New service Amps Volts Overhead❑ Underground ❑ No.of meters Number of Feeders and Ampacity Location and nature of Proposed Electrical Work: Install 23 solar panels on existing roof. System size of 5.75 kW Completion of the following table may be waived by the Ins ector of Wires No of Total No. of Recessed Luminaires No. of Ceil.-susp.(paddle)fans Transformers KVA No. of Luminaires Outlets No of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above❑ Below❑ No.of Emergency Lighting Battery units No. of Receptacle Outlets No.of Oil Burners Fire Number of zones Alarms No.of Switches No.of Gas Burners No.of Detection and Initiating devices No.of Ranges No. of Air Total No. of Alerting Devices Cond. tons No.of Waste Disposers Heat pump Number Tons KW No.of Self Contained Detection/Alerting No.of Dishwashers Space/Area heating KW Local Municipal Other❑ ❑ connection❑ No. of Dryers Heating Appliances KW Security Systems: * No.of devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters signs Ballasts No.of devices or Equivalent No.Hydro massage Bathtubs No.of Motors Total HP Telecommunications Wiring:No.of devices or Equivalent Other: 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 (Spec): 07/23/2016 Estimated Value of Electrical Work $11,174 (When required by municipal policy) (Expiration Date) Work to Start: Inspections to be requested in accqrdance 'th MEC rule 10.And upon completion. I certify,under the pains and penalties ofperjury,that the information on this application is tru nd comp te. j Firm United Solar Associates,LLC Name: No.: Licensee: Dan McGrath Signature: )4"`4/ c.No.: 20616A (If applicable,enter"exempt"in the license number line) City of Leominster contractor No. Bus. Tel..No.: 855-786-1776 Address: 452 Pleasant Street, Second Floor,Malden,MA 02148 Alt.Tel..No.: * Security System Contractor License required for this work:If applicable,enter license number here Lic.No.: Owner's Insurance waiver:I am aware that the licensee does not have the liability coverage I am the(check one)Owner❑ Owner's Agent❑ normally required by law.By my signature below I hereby waive this requirement Owner/Agent Telephone Signature Number Permit Fee: $ �Z� DocuSign Envelope ID: 126167CB-8818-4EDB-8062-OAF813886415 sunGEVITY` Homeowner's Agent Authorization Form State of Massachusetts J Ilia Vinogradov & Natalia Shutova (print name) am the owner of the property located at address: 12 Harwood st North Andover MA 01845 (print address) I hereby authorize Sungevity or its subcontractor to act as my Agent for the limited purpose of applying for and obtaining local building and other permits from the Authority Having Jurisdiction as required for the installation of a PhotoVoltaic System located on my Property. DocuSigned by: Customer Signature: 88DMFBV854AA... Date: 10/7/2015 Print Name: Ilia Vinogradov & Natalia Shutova Sungevity MA Home Improvement Contractors License # 168430 66 Franklin Street, Suite 3.10 P 510.496.5500 866.SUN.4ALL Oakland,CA 94607 USA f 510.496.5501 www.sungevity.com 77m- EI=LC-RE�: STRUCTURAL ENGINEERS October 14,2015 Sungevity 66 Franklin Street Oakland,CA 94607 TEL: (510)496-5621 Subject: Structural Certification for Installation of Solar Panels Job Number: 20156984 Client: Vinogradov-1787588 Address: 12 Harwood St.,North Andover,MA 01845 Attn.: To Whom It May Concern, A field observation of the condition of the existing framing system was performed by an audit team from Sungevity. From the field observation of the property,the existing roof structure was observed as follows: The existing roof structure consists of composition shingles over plywood sheathing that is supported by 2x6 roof rafters at 16"on center at Arrays 1 &2. The rafters at all arrays are sloped at approximately 25 degrees and have a maximum projected horizontal span of 13'-4"at Array 1 and 12'-7"at Array 2 between load bearing walls. All attached structural calculations are based on these observations and the design criteria listed below: Design Criteria: • Applicable Codes=2009 IBC,ASCE 7-05 and 2005 NDS • Ground Snow Load=55 psf • Roof Dead Load=7.4 psf(All Arrays) • Basic Wind Speed= 110 mph Exposure Category C • Solar modules=as indicated in attached drawings. As a result of the completed field observation and design checks: • Arrays 1 &2 are inadequate to support the loading imposed by the installation of solar panels and modules.New 2x6 SPF No.2 rafters are required to be sistered to the existing roof rafters to support the additional loading. See drawing sheet PV- 2.0 for structural upgrades. I certify that the capacity of the structural roof framing that directly supports the additional gravity loading due to the solar panel supports and modules had been reviewed and determined to meet or exceed the requirements in accordance with the 2009 IBC. If you have any questions on the above,do not hesitate to call. SIH OF*SS� 9 PAUL K. c�G ZACHER Prepared by TRUCTURAL co PZSE, INC. - Structural Engineers ..0100 Roseville, CA 0, /STe°� SS/ONAI�G 8150 Sierra College Blvd,Suite 150—Roseville,CA 95661—916.961.3960 p —916.961.3965—www.pzse.com 1 2 3 4 5 SHEETINDEX PHOTOVOLTAICSYSTEM SYSTEM SIZE: EQUIPMENT: PV0.0 COVER AND SITE PLAN AC/DC kW STC: 5.004kW\5.75kW PV MODULES: (23)Hyundai HIS-M250RG(BK) PV1.O GENERAL NOTES SCOPE OF WORK: INVERTER(S): (1)SolarEdge SE5000A-US PV2.0 ARRAY LAYOUT INSTALLATION OF A SAFE AND CODE-COMPLIANT PV3.0 LINE DIAGRAM GRID-TIED SOLAR PV SYSTEM ON AN EXISTING PV4.0 LABELS RESIDENTIAL ROOF TOP. PV5.0 DIRECTORY A S1.0-1.1 STRUCTURAL UPGRADES A KEY: PROPERTY LINE //�� — CONDUITRUN ❑" INVERTER O /J DRIVEWAY Q SUBPANEL —�— FENCE O DC DISCONNECT O FIRE CLEARANCE O AC DISCONNECT STRUCTURAL UPGRADES I]I]JUNCTION BOX SOLAR MODULE ❑' MONITORING UNIT Q MAIN SERVICE PANEL Q COMBINER BOX Q UTILITY METER ROOF Q PV METER OBSTRUCTION APPLICABLE CODES: 2014 NEC 2009 INTERNATIONAL CODES WITH MA AMENDMENTS B ��,9y CONTRACTOR INFORMATION: B \� BOSTON SOLAR WOBURN 55 SIXTH ROAD WOBURN,MA 01801 JURISDICTIONAL INFORMATION: LOCATION OF(N)MSP, \ CONDUIT RUN ON ROOF NORTH ANDOVER,TOWN OF INSIDE GARAGE 1600 OSGOOD ST. ,yf NORTH ANDOVER,MA 01845 A. 4f NOTES TO INSTALLER: 0 ROOF 1 ROOF2 ARRAY 1 FOR INSTALLER USE ONLY ARRAY POST INSTALL SUNEYES REQUIRED4 YES I CERTIFY THAT NO CHANGES HAVE C BEEN MADE TO THE ARRAY LAYOUT: C � CONDUIT RUN ON ROOF CUSTOMER INFORMATION: ILIA VINOGRADOV 12 HARWOOD ST NORTH ANDOVER,MA 01845 SITE PLAN CONDUIT RUN ON Q _4 (617)504-6993/#1787588 I V INTERIOR WALL - SCALE: N.T.S. i�"V( DESIGNED BY: REV#: DATE: TUSHAR.K 1 0 10/13/15 PVA 0.0 SUN-Y W0.68 FRRMOIN ST SUTE 3100AgAND,G4 W601 BY.MHENiE 0.M--low0on'.VNeOradw-116T5SSSV19,eH Sze:11.11 THESEDRAMA .SPEOFIUT .ANDDESONSPRETPEPROPERTYOFSUNOEN 1W.NOPMTSH LBECOPIEDORUBEDFOROVATHPNYOTIIERNORKOTHERTNNTHESPEORCPRWJ FORw CHTHEYMVESEENOEVELOPED�THOITOURKARTENCON W 1 2 3 4 5 MODULE SPECIFICATIONS (23)Hyundai HIS-M250RG(BK) MODULE WEIGHT: 37.9 SISTER RAFTERS TO EXISTING FRAMING �2'-2„y MODULE LENGTH: 64.57 MEMBERS THAT EXCEED 12'-4"IN THE1 MODULE WIDTH: 39.29 HORIZONTAL DIMENSION INTO WHICH ROOF 1 SPECS THE ARRAY IS LAGGED. RAFTER slzE: 2xs NOM NAL SEE STRUCTURAL UPGRADE PAGE S1.1 RAFTER SPAN: 13'-, FOR DETAILS f RAFTER SPACING: 16" - - -- ------ ROOF MATERIAL: COMPOSITE SHINGLE —144 -� I CONTINUE TO ARRAY SPECS ARRAY2 NUMBER OF MODULES: 17 A I I I I TOTAL MOD.WEIGHT(lbs): 644.3 A -- RACKING WEIGHT(lbs): 136.8 ARRAY WEIGHT(IW): 781.1 ARRAY 1 I i ' :..I.... I....,.I ...I.... �......t.......I .....I......�.... I. '2 I = ARRAY AREA(sgft): 299.5 I I I I I 7 ARRAY DEAD LOAD(bs/sgft): 2.6 ROOF 1 1 I -' I I NUMBER OF MOUNTS: LOAD PER MOUNT(Ibs): 1905 ARRAY AZIMUTH(') 213 �-44 ' I 4_ ARRAY TILT(') 25 NUMBER OF FLOORS 2 I......J. I ' I 1......�....�.... I. f.....�.......I .....11 A.... !.....I....... ....(''I 7 I I I ROOF SPECS I I I ( I lo I 7 i I f I I I I RAFTER SIZE: 2X6 NOMINAL 1-7 __ _: __ I I RAFTER SPAN: 12'_7*' t I I I I RAFTER SPACING: 16" N. ROOF MATERIAL: I COMPOSITE SHINGLE ARRAY2SPECS NUMBER OF MODULES: 6 32'-11" 8'1" TOTAL MOD.WEIGHT(lbs): 227.4 RACKING WEIGHT(lbs): 42.6 RRAY-1 LAYOUT ARRAY WEIGHT(lbs): 270 1 ARRAY AREA(sqft): 105.7 SCALE: 3/16"=V-0" ARRAY DEAD LOAD(lbs/sgft): 2.6 NUMBER OF MOUNTS: 14 SISTER RAFTERS TO EXISTING LOAD PER MOUNT(Ibs): 19.3 FRAMING MEMBERS THAT ARRAY AZIMUTH(') 123 B EXCEED 12'-4"IN THE ARRAY TILT(') 25 B HORIZONTAL DIMENSION INTO NUMBER OF FLOORS 2 WHICH THE ARRAY IS NOTE: LAGGED. MODULES SHALL NOT BE GREATER THAN 6 SEE STRUCTURAL UPGRADE SYMBOL KEY: INCHES ABOVE ROOF COVERING I PAGE S1.1 FOR DETAILS _ _ _ RAIL I ———— RAFTERS ROOF FIRE CLEARANCE ARRAY p I I I 2 ® Qn STRINGCONFIG. o I a STRUCTURAL SOLAR MODULE CONTINUE I UPGRADES I FROMARRAYI Q SOLAR MODULE ® MOUNT I b I o IRONRIDGE XR100 I I I T ® SKYLIGHT I ROOF 2 L-FOOT I ® CHIMNEY QMSE-LAG SHINGLE a PLUMBING OR 7'-11" 13'-2" ATTIC VENT COMPOSITE SHINGLE /� 0 ATTIC VENT C C 5"X -LAG 2.6"MIN.EMBEDMENT PER RRAY-2 LAYOUT CUSTOMER INFORMATION: SCREW 2 SCALE: 3/16"=1'-0" �SHOF&tqSLS ILIA VINOGRADOV 2X6 NOMINAL,16 O.C. q 12 HARWOOD ST PAUL K NORTH ANDOVER,MA 01845 AMOUNTING DETAILCHER ZA TRUCTURAL n 5010 -' (617)504-6993/#1787588 y 50100 SCALE: NTS Po �Is`is DESIGNED BY: REV#: DATE: �SS/ONALE ' PV-2.0 TUSHAR. 1 0 10/13/15 SUROEVRYdO.ee FRANNLINSTSUTEdI00N-D. 6yI—E OaM1.—Lecatlen:Ynep�Oev-I)3"ISBES/I Sn.x Srs.:11x1] THESE IXNWINGS.SFECIFKATpN3,PND DESIGNS PRE THE PROPERTY OF SUN3ENiY INC.NOPMiSNALL BE CA%EDOR USED FOR ORWITH Hm OTHER YroRIt OTHERTWWTHE 3PELtFlL PROJECT FORNHLH THEY INVEeEEN DEVELOPEDN1TgUT OURWRITTEN CONSENT 1 2 3 4 5 ELECTRICAL KEY: INVERTER 1 SPECIFICATIONSMODULE ELECTRICAL SPECIFICATIONS SOLAREDGE SESOOOA-US (23)Hyundai HIS-M25ORG(BK) -1 BREAKER RATED WATTS(EACH): 5000 SHORT CIRCUIT CURRENT(Isc): 8.7 �— SWITCH AC OPERATING VOLTAGE(V): 240 OPEN CIRCUIT VOLTAGE(Voc): 37.4 �. SCREW TERMINAL AC OPERATING CURRENT(A): 21 OPERATING CURRENT(IMP): 8.1 m FUSE NUMBER OF MPPT CHANNELS 0 OPERATING VOLTAGE(VMP): 30.9 • SPLICE INVERTER EFFICIENCY: 0.98 MAX SERIES FUSE RATING: 15 = EARTH GROUND INTEGRATED DC DISCONNECT STC RATING 250 M CHASSIS GROUND INVERTER I INPUT SPECIFICATIONS PTC RATING: 222 ——— GEC NOMINAL CURRENT PER STRING(Inom): 7.9,8.6 DESIGN CONDITIONS EGC NOMINAL VOLTAGE(Vnom): 350 HIGHEST 2%DB DESIGN TEMP(•C): 32 MAXSYSTEM VOLTAGE(Vmax): 500 MIN.MEAN EXTREME ANNUAL DB(°C): -18 A MAX CURRENT PER STRING(Imax): 75 A MAX INPUT CIRCUIT CURRENT(Imax): 3D 100A.MAIN BREAKER (3)#10 THWN-2 (3)#10 THWN-2 (3)#10 THWN-2 (4)#10 PV-Wire (4)#10 THWN-2 (1)#8 GEC (1)#8 GEC (1)#8 GEC (1)#10 EGC (1)#10 EGC 3/4"EMT 3/4"EMT 3/4"EMT FREE AIR 3/4"EMT 4METER AC DISCONNECT, (E)LOADS (N)SE5000A-US 30AMP, INVERTER W/INTEGRATED NON-FUSIBLE,C-H (E)LOADS DC DISCONNECTS DG221URB (N)125A MSP 1 STRING OF + AC LOCUS 30A 2P 240V 2P 3-W 1T6 D 11 MODULES D �UT METER OPT.CURRENT=7.86A DC_ OUTPUT LOAD LINE 1 STRING OF + D 12 MODULES D INVERTER _OPT.CURRENT=8.57A i GEC IRREVERSIBLY SPLICED TO EXISTING GEC OR BONDED DIRECTLY TO EXISTING GROUNDING ELECTRODE (IF APPLICABLE) MIN.NEMA3R UL LISTED JUNCTION BOX WITH 90°C TERMINAL RATINGS LOCATED ON ROOF { C C Inom=(12 x 250W)/350V=8.6A CONDUIT ELEVATION:1/2 TO 3-1/2"=22°C 23 MODULES TOTAL OPERATING VOLTAGE=350VDC(REGULATED) HIGH AMBIENT TEMPERATURE:32°C 23 x 222(PTC WATTS)x 0.98=5004 CEC WATTS CUSTOMER INFORMATION: EXTREME LOW:-18°C ILIA VINOGRADOV 125 x 1.2=150 ROOFTOP AMBIENT TEMP(Tcorr):54°C=0.76 SE5000A-US MAX OUTPUT CURRENT=21A 150-100(MCB)=50A CONDUIT FILL(Cfill):0.8 BREAKER SIZE=21A x 1.25=26.25A=>30A 12 HARWOOD ST MAX ALLOWABLE AC PV BREAKER=50A NORTH ANDOVER,MA 01845 CONTINUOUS USE=Imax'1.25=15A (617)504-6993/#1787588 CONDITIONS OF USE=Imax/Tcorr/Cfll =15A/076/0.8=24.67A CONDUCTOR SIZE FOR 24.67A DESIGNED BY: REV#: DATE: INSTALLATION SHALL USE MIN.#10 AWG PV-3.0 TUSHAR.K 0 10/13/15 scaoevrt C.ssE NWN ST sure 110oa¢um.us.saT Br:NNE�r�wn:—L«.w":v�°yNe°„-iTeTsea sv�sn..isn._11 T EauvnNas,sPEaPlcnnDNs.amoescNs,weMRttasuucemrwc.r+o TswaLKWPIEDoa Us Do RMWMH O�Rw RKOrM T TMESMOa CPRWMTroa��w BEEN�LOMO n�MRn lm Mcou W 1 2 3 4 5 NOTE: IF WOOD IS SEEN SPLITTING DURING CONSTRUCTION PRE-DRILL HOLES INTO RAFTERS A A /---------------� (N)SISTER RAFTER \ SIMPSON SDW22300 WOOD SCREWS AT 16"O.C.STAGGERED (E)RAFTER I\ (E)RAFTER (N)2 x 6 LAPPED SISTER\\\ (E)RAFTER OR#14X2-7/8"GRABBER LAG MASTER SCREWS AT 16"O.C.STAGGERED _______________/ RAFTER SEE DETAIL FOR TOP VIEW OR 16d COMMON NAILS AT 6"O.C.STAGGERED \\\,,, SIMPSON SDW22300 WOOD SCREWS (N)2 x6SISTER RAFTER / �- _ �! OR#14X2-7/8"GRABBER LAG MASERAGGERED SCREWS SEEZOP J\��' 0 ♦i!��� AT 16"O.C.STAGGERED 2 FASTENERS EACH END-TYP 2 FASTENERS EACH END-TYP (E)ROOF TRUSS WEB MEMBERS (E)ROOF TRUSS WEB MEMBERS WHERE OCCURS _/ WHERE OCCURS _t__.�__— e/ _-------____________ ___ __ --------------- _ _____________________ NG__JOIST_ Sib \(E)CEILIWHERE-0 C-CUR- CCURS 5 b (E)CEILING JOIST WHERE OCCURS (E)BEARING WALL (E)BEARING WALL A A SIDE VIEW-OPTION#1 1 B SIDE VIEW-OPTION #2 SCALE: NTS SCALE: NITS RAFTER REINFORCEMENT DETAIL-ROOF 1 "gSS9 1 jt1 OF SCALE: NTS PAUL K. ZACHER an TRUCTURAL y 50ss11p00 NAL�G C C CUSTOMER INFORMATION: ILIA VINOGRADOV 12 HARWOOD ST NORTH ANDOVER,MA 01845 DESIGNED BY:IREV#:I DATE: TM 1 0110/13/151 S � SONOEVRYMO.83 FRAM HST BUITE3100—D,CABd60l By.MHEIN2E OSM1—L«nMn:Vinoy,eew-1TBTSS 1B-tB.hall THERE DRAWINGS BFECIRGTIONS,ANDDESIGNB ME THE PROPERTY OF SUNGENTY INC.NO PART SHALL BE COPIEDORUSEDFOR OR WITHANYOTHERWORx OTHERTHRN THE SPECIFICPROJECTFORWMCH THEY H-E BEEN DE—OPEOWITHOUTOURVrWTTENCONSEM 1 2 3 4 5 NOTE: IF WOOD IS SEEN SPLITTING DURING CONSTRUCTION PRE-DRILL HOLES INTO RAFTERS A A --------------- (N) --------- —(N)SISTER RAFTER SIMPSON SDW22300 WOOD SCREWS AT 16"O.C.STAGGERED (E)RAFTER I� (E)RAFTER (N)2 x 6 LAPPED SISTER (E)RAFTER OR 414X2-7/8"GRABBER LAG MASTER SCREWS AT 16"O.C.STAGGERED \_______________/ RAFTER SEE DETAIL FOR TOP VIEW OR 16d COMMON NAILS AT 6"O.C.STAGGERED / SIMPSON SDW22300 WOOD SCREWS (N)2 x 6 SISTER RAFTER AT 16"O.C.STAGGERED OR#14X2-7/8"GRABBEAG MASTER SCREWS R 16"D.C.STAGGERED olP 2 FASTENERS EACH END-TYP /e • i'\ 2 FASTENERS EACH END-TYP '� i� (E)ROOF TRUSS WEB MEMBERS (E)ROOF TRUSS WEB MEMBERS WHERE OCCURS % WHERE OCCURS i i B e i • �e_-------------------L_ e � B o � t e� _ ____________________ ___________________________________ VX `(E)CEILING JOIST WHERE OCCURS 6 `(E)CEILING JOIST WHERE OCCURS (E)BEARING WALL (EI BEARING WALL � SIDE VIEW-OPTION#1SIDE VIEW-OPTION#2 �M SCALE: NTS 1 B SCALE: NTS ZH OFA1q�9 RAFTER REINFORCEMENT DETAIL-ROOF 2 PAUL K. 1 SCALE: NTS ZACHER TRUCTURAL m 50ss11p0{{0 /STEy` ss/ONAL C C CUSTOMER INFORMATION: ILIA VINOGRADOV 12 HARWOOD ST NORTH ANDOVER,MA 01845 DESIGNED BY:IREV#:I DATE: TM 1 0110/13/15 s1-1l SUIroEVRYB5C65 FRNYI(UN 9TSUITET130AxLPND,G9d63] By.MHEINZE Dem—lae5on. opnaw f]BTSSSSVt SEeat—Itzt] THESE DWIWINGS.SPECIFICATIONS.AND DESIGNS ARE THE PROPERTY OF SUNGENttINC.WO TSHALLBECOPIEOORUSEDFORORWITH OTHERWORKOTHERTHANTHESPECIFICPROJECTFORv.Ma1THEYH BEENOERE EDWITHOUTOURWRITTENCONSENT I Electrical Characteristics Poly-crystalline Type 1 Nominal output(Pmpp) W 230 233 235 238 240 245 250 Voltage at Pmax(Vmpp) V 30.1 30.3 303 F30.4 ! 30.5 30.7 30.9 Current atPmax(Impp) A 7.7 7.7 7.8 7.8 7.9 8.0 8.1 Open circuit voltage(Voc) V 37.1 37.3 37.4 37.4 I 37.7 38.0 38.2 Short circuit current(Isc) A 8.2 8.2 8.3 8.3 8.3 8.4 8.6 Outputtolerance % +3/-0 No.of cells&connections PCs 60 in series Cell type 6"Polycrystalline silicon Module efficiency % 14.2 14.4 14,5 14.7 14.8 15.2 15.5 Temperature coefficient of Pmpp %/K -0.43 -0.43 -0.43 -0.43 -0.43 -0.43 -0.43 Temperature coefficient of Voc %/K -0.32 -0.32 -0.32 -0.32 I -0.32 -0.32 -0.32 Temperature coefficient of Isc %/K 0.048 0.048 0.048 0.048 0.048 0.048 0.048 XAII data at STC(Standard Test Conditions).Above data may be changed without prior notice. Mono-crystalline Type Nominal output(Pmpp) W 240 243 I 245 248 250 255 Voltage at Pmax(Vmpp) V 30.1 30.1 30.3 30.3 30.5 30.8 Current at Pmax(Ini A 8.0 8.1 8.1 8.2 8.2 8.3 Open circuit voltage(Voc) V 37.3 37.3 37.4 37.5 37.5 37.7 Short circuit current(Isc) A 8.5 8.6 I 8.6 8.7 8.7 8.8 Output tolerance % +3/-0 No.of cells&connections PCs 60 in series Cell type 6"Mono-crystalline silicon Module efficiency % 14.8 ( 15.0 15.2 15.3 15.5 15.8 Temperature coefficient of Pmpp %/K -0.45 -0.45 -0.45 -0.45 -0.45 -0.45 Temperature coefficient of Voc %/K -0.33 -0.33 -0.33 -0.33 -0.33 -0.33 Temperature coefficient of Isc %/K 0.032 0.032 0.032 0.032 0.032 0.032 XAII data at STC(Standard Test Conditions).Above data may be changed without prior notice. Module Diagram (unit:mm,Inch) I-V Curves r• Wllent W 19 N 9 6 6 Bs I-) R) 85033 4 IXidIMd=1,000W/m+ IA00mm(393T) 1,000mm(39371 MAIL s -Open ivCdliemp=Se 4mm+CABIE6 ImMG9IF& -Opening CdlT -21C CONNKMR COWWR � 4-07IlDTTHpa1 z -op"Ncellr w 45-C OpentagCe1ITemp=65[ � ¢_ o s to Is w zs zo as Vd GRDUNDMFX Q 81031 cui-tIAI "(VI §f to 9 - I¢Irgd�1100}V/m' Ntld_. , I W/W 4x012 DETAILS ;i Irted-900W/m GROUNDHOLE 60(2{'1 Il0.43 16b(Ob6� In .I +800 W/ .6 a brad=700 w/ ,. a 939(3&97') � s _ 1B OA s N C ! z A "+ 3003n 1 Celltemp=25C 9R3 3&7 C' 2415 .66 SECnON CC o s 10 Is m xs n as VONapeM Installation Safety Guide , , tit} 1,11 - 46,C t 2 •Only qualified personnel should install or perform maintenance. :Iger;,r,L ,rT ] -40-85'C •Be aware of dangerous high DC voltage. T DC 1,000V(IEC) id�7ce tib t7 •Do not damage or scratch the rear surface of the module. DC 600 V(UIQ � -�-_� -- •Do not handle or install modules when they are wet. - 15 A I Latest Update:July 20121 SANEL SOLAR-SANEL NV-SANEL BV pnmedonp6ecenl0ed Antwerpsesteenweg 491A-2500 Lier-Belgie HYUNDAI FSC eCO{n �P"` Sacramentsbogerd 21-3343 BP Hendrik-Ido-Ambacht-Nederland HEAVY INDUSTRIES CO.,LTD. T(BE):+32(0)3 451.21.54-T(NL)+31(0)78 682.20.44 - www.sanel-solar.be-www.sanel-solar.nl-sales@sanel-solar.be-sales@saneI-solar.nl solar=@ " Single Phase Inverters for North America SE3000A-US/SE3800A-US/SE5000A-US/SE6000A-US/ SE760OA-US/SE1000OA-US/SE1140OA-US SE3000A-US I SE380OA-US SE5000A-US SE6000A-US SE760OA-US I SE10000A-US I SE1140OA-US OUTPUT Nominal AC Power Output 3000 3800 5000 6000 7600 9980 @ 208V 11400 VA ........................................... ................ ............... ................. ................ ............... . .. ...1000 ,Q240V. .................. ........... 0 Max.AC Power Output 3300 4150 5400 @ 208V 6000 8350 10800 @ 208V 12000 VA ........................................... ................ . 5450 @ 240V 10950,@ 240V. .................. ........... .............. ........ .. ..... ................ ................ . .. ... AC Output Voltage Min.-Nom.-Max!') 183-208-229 Vac . ......................................... ................ ............... ................. ................ ................ .................. .................. ........... AC Output Voltage Min:Nom:Max!') 211-240-264Vac AC Frequency Min. -.Max.(') 59.3-60-60.5(with Hl country setting 57:60:60.5) Hz .... .. ` .. .. .. Max.Continuous Output Current 12.5 I 16 21(al 240V I 25 I 3? 42 a 240V 47 5 A ............. ......... ......... ........ . .......... GFDI Threshold1 A ........................................... .......................................................................................................................... ........... Utility Monitoring,Islanding Protection,Country Configurable Thresholds Yes Yes INPUT Maximum DC Power(STC) 4050 5100 6750 8100 10250 13500 15350 W Trans former.less,Un rounded........ ................ ............... .........................Yes.... ................ .................. ................ ......... ..................s....0.................. .......................................................................................................................... ........... Max.Input Voltage .........................................................500 Vdc . ..................... . ........................................................... ........... Nom.DC Input Voltage 325 @ 208V/350 fI@ 240V Vdc Max.Input Current1�1 9.5.......I......13......1..15:5.@.240V..I.......18......1.......23....... 345Adc 1..30 �1u 5, .249V..1....... . ....... ... .... Max.Input Short Circuit Current 45 Adc ........................................... .......................................................................................................................... ........... Reverse-Polarit Protection Yes Ground-Fault Isolation Detection 600kn Sensitivity ................................t.......... ................ ............... . . . ................ .................. .................. ........... Maximum Inverter Efficiency 97.7 98.2 98.3 98.3 98 98 98 97....208V. ................ 97 @ 208V... CEC Weighted Efficiency 97:5 98 97.5 97.5 97.5 98, 240V 975 @ 240V.. .................. ........... Nighttime Power Consumption <2.5 <4 W ADDITIONAL FEATURES Supported Communication Interfaces R5485,RS232,Ethernet,ZigBee(optional) ........................................... .................................................................(.......................................................... ........... Revenue Grade Data,ANSI C12.1 Optional ..........................................'4....................... ........... Rapid Shutdown—NEC 2014 690.12 Functionality enabled when SolarEdge rapid shutdown kit is installed STANDARD COMPLIANCE Safety UL1741,UL1699B,UL1998(CSA 22.2 ........................................ ........... Grid Connection Standards IEEE1547 ........................................... .......................................................................................................................... ........... Emissions FCC partly class B INSTALLATION SPECIFICATIONS AC output conduit size/AWG ran a 3/4,'minimum/16-6 AWG 3/4"minimum/8-3 AWG .................... DC input conduit size/#of strings/ 3/4"minimum/1-2 strings/ AWG ran a 3/4'.minimum/1.2 strings/16-6 AWG ...........$.............................. . ............14.6 AWG............. ........... ........................... . Dimensions with Safety Switch 30.5 x 12.5 x 7.2/775 x 315 x 184 30.5 x 12.5 x 10.5/ in/ (HXWX�)................................ ................................ ................................................... ..........775 x 315 x 260.......... ...T!'?.... Weight with Safety Switch 51.2/23.2 I 54.7/24.7 88.4/40.1 Ib/kg.. ... ................ ..................................... ........ Natural convection Cooling Natural Convection and internal Fans(user replaceable) fan(user ........................................... ................................................................... .replaceable). . .................................... ........... Noise <25 <50 dBA ........................................... ................................................................. ...................................................... ........... Min.-Max.Operating Temperature -13 to+140/ 25 to+60(40 to+60 version available(5)) 'F/'C Rang?................................... .......................................................................................................................... ........... Protection RatingNEMA 3R ........................................... .......................................................................................................................... ........... For other regional settings please contact SolarEdge support. Uzi A higher current source may be used;the inverter will limit its input current to the values stated. Revenue grade inverter P/N:SExxxxA-USOOONNR2(for 7600W inverterSE7600A-U5002NNR2). i0(Rapid shutdown kit P/N:SE1000-11SD-Sl. (s)-40 version P/N:SExxxxA-USOOONNU4(for 7600W inverter:SE7600A-US002NNU4). sunsaec ROHS (D SolarEdge Technologies,Inc.All rights reserved.SOLAREDGE,the SolarEdge logo,OPTIMIZED SolarEdgeare trademarks or registered trademarks of •Technologies, /Id IRONRIDGE Roof Mount System AUTHORIZATION TO MARK This authorizes the application of the Certification Mark(s)shown below to the models described In the Product(s) Covered section when made in accordance with the conditions set forth in the Certification Agreement and Listing Report.This authorization also applies to multiple listee model(s)identified on the correlation page of the Listing Report. This document is the property of Intertek Testing Services and is not transferable.The certification mark(s)may be applied only at the location of the Party Authorized To Apply Mark. Applicant: IronRidge,Inc. Manufacturer: IronRidge,Inc. Address: 1495 Zephyr Ave Address: 1435 Baechtel Road y - Hayward,CA 94544 Willits,CA 95490 Country: USA Country: USA t - am Contact: Vann Schwarz Contact: Jim Norsworthy Phone: (800)227-9523 Phone: (800)227-9523 (510)225-0973 FAX: (707)459-1833 FAX: (707)459-1833 Email: yschw m@ironddge.com Email: jnorsworthy@ironridge.com Party Authorized To Apply Mark: Same as Manufacturer /'� �Q�,r �.,A- C Report Issuing Office: Lake Forest,CA ! nrk . Z Control Number: 4007559 Authorized by: `Y' for Thomas J.Patterson,Certification Manager M CUIRSIIM �I US i Built for solar's toughest roofs. _ Intertek This document supersedes all previous Authorizations to Mark for the noted Report Number. IronRidge builds the strongest roof mounting system in solar.Every component has been tested to the limit Thk AUW1—t Madrsla MeI du.used hid--and is pr dpurs d,dddM ¢Mptan epreemaM-n Me eks re po G eM WNryare ua cwaawroa Me agreement knertex ammorw kdl bony paM.atner Men bine aeM in aocwdarce wn Me agre d.tar anybw,e.perrse a,aamace acaaaimed and proven In extreme environments. ey..dp aNuis PUNw¢aUonbN+rk ONy lne 4eMroeurMr¢ed to permilcapyv,p ordutriEurrondtnis AUYwr¢a4en to Mark end Men Dory in asmtYery.Usedkdditd Cede do M.1k1 Y dadp,Me wndngns bid aul In Me agreement and in Mis ANnor6eYon to Mark AnyNMer used Me-.1 name..Ma sW..,adver4s rd M the tested mplenel.Drpdu.or Id..must Our rigorous approach has led to unique structural features,such as curved rails and reinforced flashings,and do DY lntedek Mi bl FaaoryA wen atl.I-Semces are targd Wrppae d aswrnp apprap a u egad NeC mlk p mark in acw dace wN apreem l tMer are 1raw wrpooaas Inprodamonnad.romaa em dprwt rexeee MacbMa..uekpanw Mu,:reaped is also why our products are fully certified,code compliant and backed by a 20-year warranty. Intertek Testing Services NA Inc. 545 East Algonquin Road,Arlington Heights,IL 60005 Telephone 800-345-3851 or 847439-5667 Fax 312-283-1672 Strength Tested PE Certified UL Subject 2703 Outline of Investigation for Rack Mounting Systems and Clamping Devices for Flat-Plate All components evaluated for superior Pre-stamped engineering letters Standard(s): Photovoltaic Modules and Panels,Issue Number:1,October 4,2010 ,1479 structural performance. available in most states. Product: xR Rails with Integrated Grounding. Brand Name: N/A Models: 51-61GD-005,51.61GD-0056,51-5000-001,and 51-65-001 Class A Fire Rating Design Software 061 Certified to maintain the fire resistance ® Online tool generates a complete bill of rating of the existing roof. materials in minutes. Integrated Grounding 20 Year Warranty UL 2703 system eliminates separate a Twice the protection offered by module grounding components. competitors. ATM for Report 101541132LAX-002 Page 1 of 3 ATM Issued:10-Nov-2014 ED 16.3.15(14-3)Mandatory 0 0 /fd IRON RIDGE Integrated Grounding System Installation Overview Safety Install Roof Attachments Simplified Grounding Install appropriate roof flashing and/or standoff for roof type. For Greater Safety&Lower Cost t r •Attach L-Feet to clashing or standoff. -- Traditionally,solar modules are grounded by attaching lugs,bolts or clips to the module frame,then connecting Prepare Rail Connections these to a copper conductor that runs throughout the array.This process adds time and cost to the installation, Insert splice into first rail,then secure with Grounding Strap and and often results in improper grounding,creating self-drilling screw. significant long-term safety risks. •Slide second rail over splice,then secure with opposite end of The IronRidge Integrated Grounding System solves these Grounding Strap and self-drilling screw. challenges by bonding modules directly to the mounting rails.This approach eliminates separate module ® Mount&Ground Rails grounding hardware,and it creates many parallel grounding paths throughout the array,providing Attach rails to L-Feet and level rails. sC greater safety for system owners. Grounding Mid Clamp •Install one Grounding Lug per row of modules. Each Grounding Mid Clamp pierces through the Connect Grounding LU to grounding conductor. anodized coatings of both the module frame and g g g g _ the mounting rail to form secure electrical bonds, which are repeated throughout the array. Install Modules&Clamps Install first module using End Clamps and Grounding Mid Clamps. - Install additional modules using Grounding Mid Clamps. l-- Finish row with a second pair of End Clamps. Testing&Certification The IronRidge Integrated Grounding l ei Module Frame Compatibility System has been tested and certified to Dimension_ Range UL 2703 by Intertek Group plc. A 31.Omm-51.Omm UL 2703 is a proposed UL standard f3 S.OSmm(minimum) for evaluating solar module mounting Any module frames whose parameters are not listed in the and clamping devices.It ensures these provided table have not been tested for compatibility devices will maintain strong electrical and 3 mechanical connections over an extended period of time in extreme outdoor The Grounding Clamp has proven robust in grounding 6U-cell and environments. 72-cell solar module frames with box construction and a range of �r anodization thicknesses. 2 - J?' The testing process closely mirrors that All solar modules listed to UL 1703 and with frame construction Grounding Strap of UL 1703,the solar module testing within the parameters stated above are compatible with the Grounding Straps are used to Standard,includingtemperature and bona rail-to-rail connections. Grounding Lug p IronRidge Integrated Grounding System. They are only-rail c wired on the humidity cycling,electrical and mechanical A single Grounding Lug y rail with the grounding lug. connects an entire row load testing,and manufacturing quality Go to ironridge.cam/ig of Pv modules to the reviews. grounding conductor. rc 'Sktt-tTt�'n:'^+^-[�SL�rStT+^'YRki'►•rwt ,� The Commonwealth of Massachusetts Department of Industrial Accidents a 1 Congress Street,Suite 100 �< Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aaulicant Information Please Print Let=_ibly Name (Business/Organization/Individual):United Solar Associates, LLC Address:452 Pleasant Street, Second Floor City/State/Zip:Malden, MA 02148 Phone #:855-786-1776 Are you an employer?Check the appropriate box: Type of project(required): 1.Q I am a employer with 5 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.F11 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.[:]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 14.❑✓ Other Solar Install 6.F1We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:TRAVELERS Policy#or Self-ins.Lic.#:7PJUB-5B50763-8-15 Expiration Date:7/23/2016 Job Site Address: 12 Hardwood St City/State/Zip:N.Andover, MA 01845 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th pains and penaltie f pe u at the information provided above is true and correct. Si nature: Date: Phone#:855-786-1776 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: A�Ro® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER./THS 5 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 ADDITIONALINSURED,the polic- -. 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 NAME: Asset One Insurance HNE, 714-625-8204 575 Anton Blvd.,3rd FL (A/C,Noy, 714-625-8290 ADDRESS: araOsolarinsure.com INSURER(S)AFFORDING COVERAGE NAIC# Costa Mesa CA 92626 INSURER A: Westchester Surplus Lines Insurance Company 10172 INSURED INSURER B: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERK 25674 United Solar Associates,LLC INsuRER c: American Zurich Insurance Company 16535 452 Pleasant Street,Second Floor INSURER D: INSURER E: Malden MA 02148 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 CONTRACTOR 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. TII LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER X COMMERCIAL GENERAL LIABILITY (MM/DD/YYYY) (MM DN LIMITS CLAIMS-MADE �OCCUR EACH OCCURRENCE $ 1,000,000 I PREMISES(Ea occurrence) $ 50,000 A MED EXP(Any one person) $ 10,000 G27527966 001 11/10/2015 11/10/2016 PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: $ 1,000,000 X POLICY❑ IRI- LOC GENERAL AGGREGATE $ 2,000,000 X OTHER: PRODUCTS-COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY $ ANY AUTO (Ea accident) $ ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOSNON OWNED BODILY INJURY(Per accident) $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB $ OCCUR A EXCESS LIAB CLAIMS-MADE EACH OCCURRENCE $ DED RETENTION$ AGGREGATE $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Y/N X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE B OFFICER/MEMBER EXCLUDED? ❑ N/A 7PJUB-5B50763-8-15 7/23/2015 7/23/2016 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $ 1,000,000 DESCRIPTION OF OPERATIONS below C Property E.L.DISEASE-POLICY LIMIT $ 1,000,000 ER07771654 5/26/2015 5/26/2016 $522,302.00 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Certificate Holder is Additional Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Building Department 1600 Osgood St., Building 20,Suite 2035 AUTHORIZED REPRESENTATIVE North Andover MA 01845 ( ) The ACORD name and logo are registered marks o ACORD RD CORPORATION. All rights reserved. ACORD 25 2014/01 • it — �. ofCOM • • • • Y ;. M 4 Nam ELECTRICIANS ' MUM ISSUES THE FOLLOWING LICENSE �► AS A•REG JOURNEYMAN ELECTRICIAN ', I c►rrx M , _— DANIEL J MCGRATH ' - 1I4 80YLSTON ST p w.r 4 i �4h1!!1 $ , , ��,f.. }eo 2MAstp-Wow MALDEN MA 02148-7931 , CL 15" ''lIA& r 1146 B 07 1 Ib Z lAassa chusMill -Department of Public Safety Board of Building Rcguiatio;ls and Standan:s camttrura"n�aap�r+I..Er i .i f F.ralaai� A w► License: CSFA-10416 DANTRLd MCGRA t 1 �"'�"'� 11 11 1 "� IltirMr++�W• xwwOwAidw 114 BOYLs'roN St , - MAMEN MA 0f145 Damfetllle�ir+atik ��.. � Expiration 1Ci1it6SLlrw1 1/ l�Ot3 Cortlrrrusssaor►er 0911af.Z016 I (Rwnra1111s•-hilt rti10�1 �•watf•sM Rice of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR ELECTRICAL UNLIMITED JOLRNEYPERSON +elstr+tion: 168524 Type: DANIEL j MCGRATH Frau°^ 3/7/2017 Individual 114 BOYLSTON ST DANIEL MCGRATH MALDENN,MA 02148-7931 DANIEL MCGRATH 114 BOYLSTON ST L .,REG NO. ~ I 933x I U MALDEN,MA 02148 A. 1 1 14 9 LC 0199 -E2 0/0 /20 © /30/2015 Undersecretary GNED � , STATE OF MAINE +. DEPT OF EAI°N fAMlt� 90AM ELEt;i'P.ICAL UNLIMITED CONTRACTOEtVal DANIEL) MCGR.AT14 ' LICENSE 0MSS00WM 114 BOYLSTON ST NIALDEN,MA 02148-7934 DANIEL MCGRATH MASTER ELECTRICIAN Tr, ,erre W. --;rCTN E E xaif-.Es ISSUED Aug 26,2013 EXPIRES Aup 31,2016 UC-O'L01855-E1 0S131/2015 0)(30!2016 SI3NE3 DocuSign Envelope ID:7597CA37-B95D4B23-9677-0443EEE735EB DocuSign Envelope to:7597CA37-B95D4B23-9677-0443EEE735EB Solar Service Agreement SUnGEVITY' Agreement Overview SUnGEVITY' Solar Power Service Agreement Summary GENERATE POSITIVE' 6V6 GENERATE POSITIVE' Ilia Vinogradov 12 Harwood st,North Andover, MA,01845 SOLAR PEACE OF MIND ESTIMATED SOLAR ENERGY OUTPUT TO BE DELIVERED . Sunrun offers a Performance Guarantee.If your system does not produce the power output guaranteed in this YEAR 1: 6,340 kilowatt-hours(kWhs) agreement,we'll refund you for lost power. INITIAL TERM: 120,493 kWhs . If your system overperforms you keep the excess power free of charge. . Our customer care team is available by phone and email to respond promptly to any questions or concerns you have. CONTRACT PRICE . When we arrange for installation of a system,Sunrun owns the panels,and we monitor them constantly.Sunrun will insure,maintain,and repair the Solar Facility at no additional cost to you including inverter replacement. Non-refundable Electricity Deposit(due today) 80 . Sunrun only works with insured partners who have all required licenses to perform the work necessary to install and maintain your system. Initial Electricity Payment(due at start of installation) 80 AGREEMENT OVERVIEW Monthly billt Year 1 874.38(plus taxes,if applicable) While it's still necessary to read your entire Agreement,there are a few important points to be aware of: Annual increase 0.0% . After going solar you will continue to receive a bill from your Utility.Based on the information you provided about your Cost perk Year 1 80.141,excluding Upfront Payment(if any) previous year's power consumption of 6,425 kWhs,your system is sized to offset 99%of the power you currently purchase from your Utility. t Monthly payments shown include a$15.00 discount for paying through ACH withdrawal from your checking or savings account.If you do not elect automatic payment through ACH withdrawal from your checking or savings account you will not receive this discount and each monthly . This Agreement becomes effective when both you and Sunrun have signed the Agreement and continues in effect for payment will be$15.00 greater. 20 years following the date your Utility grants permission to operate the Solar Facility. . Your first year monthly payment amount is 874.38.This amount will increase by 0.0%annually for the term of the Your initials indicate that you have read,understand and accept the explanation of estimated energy output,energy Agreement.This amount includes a 815.00 discount per month for automatic payment through ACH withdrawal from sources and payment terms.You understand that Sunrun has the right to check your credit and you agree that Sunrun will your checking or savings account. make final determination of customer eligibility. os . Sunrun offers a 10046 Performance Guarantee.If your system underperforms,Sunrun will refund you for lost power at �V the rates shown in Exhibit A.If your system overperforms,you keep the excess power at no extra charge.Sunrun _IItJVi warrants that roof penetrations will be weather-tight for a period of five(5)years after installation. . You are responsible for payments during the full term of this Agreement.If you sell your house,you have two options: 1)Transfer the Agreement to the new homeowner,2)Purchase the system.You may prepay the remainder of the THE SOLAR FACILITY IS OWNED BY SUNRUN INC.AND/OR ITS AFFILIATES. payments due under the Agreement to make the transfer even more attractive to the new homeowner. Whichever SUNRUN INC.1 595 Market Street,29th Floor,San Francisco,CA 94105 1 1-855-478-6786 option you choose,Sunrun will guide you through the process. . Your request for a pricing plan change must be submitted within 21 days of signing this Agreement,but before installation has begun.If installation begins within 21 days of signing this Agreement,the start of installation will mark the date after which you can no longer change your pricing plan. . You may only purchase the Solar System at certain specific times during the term of this Agreement.Those times are listed in section 10. . At the end of this Agreement's 20 year Initial Term:1)Sunrun will remove the Solar Facility at no cost to you,unless you 2)Purchase the Solar Facility at its then fair market value,or unless 3)This Agreement is automatically renewed per the terms specified in Section 12 #xhibit A. �V Your initials indicate that you have read,understand and accept the information listed above. 09/23/2015 P87A14FFBVB9V93-H(Custom PPA Fixed) Page 1 of 18 09/23/2015 P87A14FFBVB9V93-H(Custom PPA Fixed) Page 2 of 18 DoouSign Envelope ID:7597CA37-B95D4B23-9677-0443EEE735EB DocuSign Envelope ID:7597CA37-895D-4823-9677-0443EEE735EB SUNRUN SOLAR POWER SERVICE AGREEMENT 3.DPn ga and Installation THIS DOCUMENT DESCRIBES THE TERMS AND CONDITIONS OF YOUR RECEIPT OF AND PAYMENT FOR ELECTRIC ENERGY TO BE SUPPLIED BY A SOLAR (a)The design for the Solar Facility will be presented to you prior to installation.You will have five(5)business days following this presentation to request PHOTOVOLTAIC SYSTEM THAT WILL BE INSTALLED AT YOUR PROPERTY AND OWNED AND MAINTAINED BY SUNRUN INC. change or cancel this Agreement pursuant to Section 12(e).Otherwise,you will be deemed to have approved the Solar Facility design.With your written, 1.Introduction deemed,or verbal approval,Solar Facility installation may begin at any time. (a)You are entering into this Sunrun Solar Power Service Agreement("Agreement")with Sunrun Inc.,together with its successors and Assignees, (b)If you wish to change the design or installation process,Sunrun will use commercially reasonable efforts to accommodate your request. ("Sunrun").You represent that you are at least eighteen(18)years of age,that you are the owner of the property located at 12 Harwood st North Andover, Massachusetts,01845("Property'),angihat your current utility is National Grid.You further represent that every person or entity with an ownership agree If an obligation excluded from this Agreement in Section 20 must performed in order to properly effect the installation of the Solar Facility,you agree[o contract separately,and at your own expense,with a contractor who has been designated by or approved by Sunrun to perform such obligation. interest in the Property has agree tR bound by this Agreement In this instance,Sunrun will not unreasonably withhold such approval. -Accepted by(Initials): V _ - -• (d)You agree to cooperate with Sunrun and assist Sunrun in obtaining any permits needed,including the NEM Service application in Section 5(a).You (b)Sunrun is a Delaware Corporation.You may contact Sunrun by mail at 595 Market Street 29th Floor,San Francisco,CA 94105,by telephone at agree to complete and return to Sunrun and/or its representatives,as appropriate,all applicable rebate documentation and,where applicable,Renewable 1-855-717-6527,or over the Internet at www.sunrun.com.Sunrun will arrange for the design,permitting,construction,installation,testing,and activation Energy Credit documentation,upon request and fallowing the In-Service Date.If you do not return the rebate or Renewable Energy Credit documentation, of a solar photovoltaic system("Sotarfacdity')to be located on the roof of your house and/or grounds of the Property. Sunrun may invoice you for the Final Rebate amount(as defined in Section 4(a)(iii)). (c)You agree to allow Sunrun to install and maintain the Solar Facility on the grounds and/or roof of the Property at a specific location to be approved by (e)For the Initial Term and any Renewal Terms you agree to maintain the Property,at your expense,such that the Solar Facility retains shading conditions Sunrun.You further agree to purchase all electric energy generated by the Solar Facility at the price specified in this Agreement present at the time of Installation. 2.Solar Facility (f)Sunrun requires its contractors to employ licensed personnel whenever required by applicable law,regulation or code. (a)Sunrun will arrange for the design,permitting,construction,installation and testing of the Solar Facility on the roof or grounds,as applicable,of the (g)Sunrun,its contractors and agents shall at the end of each business day keep the Property reasonably free from waste materials or rubbish caused by Property in material accordance with a system design that you will have approved.Thereafter,Sunrun will operate and maintain the Solar Facility so as to their operations.Prior to the In-Service Date,Sunrun and its agents shall remove all of their tools,construction/installation equipment machinery,waste generate electric energy for use at the Property.Sunrun will perform these obligations("Sunrun's Obligations")during the Initial Term of this Agreement. materials and rubbish from and around the Property. During any Renewal Terms Sunrun will perform Sunrun's Obligations for as long as the Solar Facility remains economically viable,and will make a good faith effort to notify you if this is not the case per Section 12(0, (h)Subject to the exclusions set forth in Section 20,Sunrun will return your Property to a condition similar to its original condition,provided that you notify Sunrun in writing or by e-mail of any deficiencies in restoration within five(5)business days of the municipal building inspector approval of the (b)You acknowledge and agree that: Solar Facility. (i)The Solar Facility will be removable equipment and will not be a fixture or otherwise part of the Property. 4.Changes to the Agreement (ii)Sunrun will own the Solar Facility and you will have no ownership interest in the Solar Facility. (iii)The Solar Facility will not be subject to any lien,security interest,claim,mortgage or deed of trust that may be imposed on or assessed against your (a)Prior to installation,the following conditions may change the expected costs and benefits of the Solar Facility[o both you and Sunrun: interest in the Property,or any other property belonging to you.You will have no right to sell,give away,transfer,pledge,remove,relocate,alter or tamper (i)Change to the design of your Solar Facility. with the Solar Facility at any time.As such,Sunrun will not apply a lien to your title for the Property. (iv)The Solar Facility will be used primarily for household purposes but not to heat a swimming pool. (ii)Change"the system's annual energy production estimate,expressed in kWh,provided by the National Renewable Energy Laboratory PVWatts (v)You agree that Sunrun or a Sunrun affiliate may file any UCC-1 financing statement that confirms our or our affiliate's ownership of the Solar Facility. Calculator(in the finrts l rebate a')oFina/Year One Production Fstihe So). (iii)Change in the final rebate amount associated with installing the Solar Facility("qnd/Rebate'")or any change in your applicable tariff(including any (c)Sunrun will be responsible for all costs and expenses related to performing Sunrun's Obligations.You agree that Sunrun has the authority and changes to net metering). discretion to use contractors or agents to perform or assist Sunrun in performing Sunrun's Obligations. (iv)The availability of cellular service at the Property. (d)Sunrun estimates that the Solar Facility will be capable of generating 6,340 kilowatt-hours("Initial Year One Production Fsfirnate")of electric energy If any of these conditions occur,Sunrun may choose to modify the terms of this Agreement or cancel the Agreement.If Sunrun chooses to modify the during its first year of operation,but due to several reasons,including natural variation in weather,actual production will vary.Due to expected panel terms,Sunrun will notify you in writing and you will have five(5)business days to accept the modified terms or cancel this Agreement pursuant to Section degradation,Sunrun estimates that the Solar Facility will be capable of generating 19.0052 times this amount of kilowatt-hours("kWY1")during the Initial 12(e).If you do not respond to Sunrun within five(5)business days,Sunrun may deem you to have cancelled the Agreement. Term("Guaranteed Output').As set forth in Section 8,Sunrun will issue a refund to you if your system does not perform as expected.Sunrun makes no other representation,warranty or guarantee of any kind regarding the Solar Facility's actual or expected output or performance. Pa you may choose to accept changes under this Section 4 in writing by electronic mail.If change pursuant to this Section 4 increases the Upfront Payment after you have already paid it to Sunrun,you agree to immediately pay Sunrun the inn crease in the Upfront Payment.Sunrun may suspend (e)You agree that Sunrun,at its awn expense,will install,maintain,and periodically test a meter at the Property that will measure all electric energy installation until this payment is received. delivered to you from the Solar Facility.If the meter breaks or is found to be inaccurate,Sunrun will adjust the bill as applicable in the next billing cycle by (c)If for a period of one hundred eighty(180)days Sunrun fails to perform its obligations required to commence installation of the Solar Facility and you applying a credit for any overcharges or applying an additional charge for any under-charges.You agree not to tamper with,damage or modify the meter have fulfilled all of your obligations under this Agreement you may cancel this Agreement in which case Sunrun will refund to you the Upfront Payment in any way.You will be responsible for any damage or inaccuracies in the meter that are caused by you or any other person unrelated to Sunrun who may set forth in Exhibit A,provided that your Property was accessible and in a state fully ready to permit the installation of the Solar Facility.It is your come onto the Property with your knowledge or permission. obligation to exercise reasonable efforts to respond to Sunrun in a timely manner on questions and requests for approvals and/or appointments.If you cause Solar Facility to be delayed in excess of thirty(30)days due to your unresponsiveness,Sunrun may cancel this Agreement. (d)Your request for a pricing plan change must be submitted within 21 days of signing the Agreement but before installation has begun.Once installation has begun,you can no longer change your pricing plan.If installation begins within 21 days of signing the Agreement the start of installation will mark the date after which you can no longer change your pricing plan. 09/23/2015 P87A14FFBV99V93-H(Custom PPA Fixed) Page 3 of 18 09/23/2015 P87Al4FFBVB9V93-H(Custom PPA Fixed) Page 4 of 18 J DocuSign Envelope ID:7597CA37-B95D4B23-9677-0443EEE735EB DocuSign Envelope ID:7597CA37-B95D4B23-9677-0443EEE735EB 5,Purchase and Sale of Electricity 7.Prepayments for Electric Energy (a)As of the In-Service Date,you must be taking service from the Standard Net Metering Service("NEMSen ice')from your local utility("bTi/ity').You agree (a)At any time,you may prepay all of the expected amounts you will owe Sunrun during the remaining portion of the Initial Term("Prepayrh,,nf)by that you will continue to take NEM Service for as long as this Agreement is in effect.You agree to use the NEM Service currently in effect for this Utility or, contacting Sunrun. in the event that the NEM Service is no longer in effect,you agree to use a substitute metering program as chosen by Sunrun.You agree to execute all documentation associated with NEM Service,or any substitute metering service,and any refund,credit,or rebate program promptly at the request of (b)The Prepayment shall equal the remaining monthly payments for the current year,plus the discounted value of each successive year's expected annual Sunrun,its affiliates,and/or the Utility. payment.Future year's expected payments will be calculated by multiplying the Estimated Output for that year by the price per kWh rate as set forth in Exhibit A.The future years'payments will be discounted at the lesser of(x)the prime rate(as published by the Wall Streetjournal)plus 100 basis points or (b)Sunrun agrees to sell to you,and you agree to purchase from Sunrun,all electric energy produced by the Solar Facility.All electric energy produced by (y)5.0%. the Solar Facility will be made available to you for use at the Property. (c)If you make a Prepayment,Sunrun will continue to guarantee the output of your Solar Facility and will issue refunds as described in Section 8. (c)If at any time you need more electric energy than is being produced by the Solar Facility("Supp/ernenta/Energy'),you will be solely responsible for purchasing that electric energy from another supplier,such as your Utility.During the term of this Agreement you should expect to purchase (d)If you decide to make a Prepayment,the Solar Facility will remain at your Property and Sunrun will maintain it for the remainder of the Initial Term. Supplemental Energy from your Utility.Depending on the terms of your NEM Services,the Utility will bill you either annually or monthly.Sunrun will not be in default of this Agreement and will not be responsible for any Supplemental Energy you purchase to complement the electric energy produced by the B.Guaranteed reed Outo�t and Refunds Solar Facility. (a)Sunrun guarantees that the Solar Facility will generate one-hundred percent(100%)of the Guaranteed Output during the Initial Term of this (d)You agree that for all electric energy you purchase from Sunrun under this Agreement you will pay Sunrun the prices set forth in Exhibit A. Agreement or Sunrun will issue you a refund as described below. (e)The price specified in subpart(d)above does not include taxes.If any taxes are assessed on the sale of electric energy,the Property,or on your (b)On the anniversary of the In-Service Date and on every anniversary thereafter,Sunrun will calculate the"Actual Output"of the Solar Facility.For the purchase of the Solar Facility from Sunrun under this Agreement,and such taxes are paid by Sunrun rather than you,you agree to pay or reimburse purposes of this Agreement,"gctua/OuSou!'shall mean the amount of electric energy created by the Solar Facility to date plus any kWh for which you Sunrun for all such taxes,except to the extent that you are prohibited from doing so by applicable laws. have previously received a refund.If the Actual Output is less than the Guaranteed Output for that anniversary date set forth on Exhibit A.Sunrun will issue you a refund.This refund will be calculated by subtracting the Actual Output for that anniversary date from the Guaranteed Output for that (f)You agree that title to and risk of loss for the electric energy purchased under this Agreement shall pass from Sunrun to you at the time when the anniversary date,and multiplying the result by the kWh rate for that anniversary date set forth in Exhibit A. electric energy reaches the point of interconnection,i.e.,at the point where the Solar Facility connects to the Property's connection to your Utility. (c)If you purchase the Solar Facility from Sunrun pursuant to Section 10,and at the time of purchase the Actual Output is less than the Guaranteed Output (g)You agree that Sunrun alone will receive any credit,rebate,environmental attribute,or other payment or offset that may be attributable to the Solar for that anniversary date,Sunrun will apply a credit towards the purchase price for the Solar Facility.This credit will be calculated by subtracting the Actual Facility and all incentives will be sole property of and transferable by Sunrun.Notwithstanding the foregoing,if you purchase the Solar Facility from Output from the Guaranteed Output and then multiplying the result by the refund per kWh set forth on ExhibitA for the anniversary date that precedes Sunrun,you will own,and be entitled to proceeds from the sales of,solar renewable energy credit and renewable energy credit earned after the date you the date of purchase. purchase the solar facility from Sunrun. (d)If Actual Output is greater than Guaranteed Output per Exhibit A you will not be charged any additional amount for this overproduction.Sunrun may 6.B'I�and Payment use this overproduction amount(kWhs)to offset future underproduction should Actual Output be less than Guaranteed Output. (a)For each billing cycle,Sunrun will prepare a written or electronic invoice and charge your account for the Monthly Payment as set forth in Exhibit A. (e)For the purposes of the prior calculations,Actual Output shall include any kWh of electricity that would have likely been produced during any day that a Your billing cycle begins on the In-Service Date,and subsequent billing cycles will begin on the same date each month(the"Billing Cycle Days.You will be grid failure disabled the Solar Facility or any day that you caused or requested the system to be shut down or to generate significantly less electric energy. billed on a monthly basis.You will receive this invoice within 10 days of the conclusion of the billing cycle and your payment will be due the day before the For the avoidance of doubt,Guaranteed Output will be reduced if Sunrun notifies you that a tree or other obstruction is reducing electric energy next Billing Cycle Day.Sunrun reserves the right to update its billing systems from time to time and will notify you if your payment due date changes.In no production and you do not remedy,or cause to be remedied,such reduced energy production within 30 days. event will Sunrun decrease the amount of time you have to pay your invoices. 9.cub�sti�e?avments (b)Sunrun will mail or e-mail you an invoice no later than ten(10)days after the end of each billing cycle.You agree to pay the amount specified in each invoice by the due date specified in such invoice.If Sunrun does not receive your payment by the due date on the invoice,Sunrun may charge you the (a)You agree that if,through no fault of Sunrun,you cause or request the Solar Facility to be shut down,or if you cause an event that significantly reduces lesser of an administrative late fee of(i)one and a half(1.5%)percent per month on the portion of your balance that is more than thirty(30)days past the production of electric energy by the Solar Facility,you will pay Sunrun a fee during each month that the Solar Facility is shut down or experiencing due,or(ii)the maximum amount permitted under and subject to applicable law.This late fee is not an interest charge,finance charge,time price reduced production("Substitute Payments').However,Sunrun will not charge you Substitute Payments for the first seven(7)days during the Initial Term differential or other such charge or payment of a similar nature. that the Solar Facility has been shut down or is experiencing reduced output. (c)Monthly payments shown include a$15.00 discount for paying through Automated Clearing House(ACH)withdrawal.If you do not elect automatic (b)For each billing cycle during the first year that this Agreement is in effect.the Substitute Payment will equal(i)the current price per kWh established in payment through ACH withdrawal from your checking or savings account you will not receive this discount and each monthly payment will be$15.00 Exhibit A,multiplied by(ii)the estimated daily generation implied in Section 2(d),as well as the number of days for which Substitute Payments are due, greater. minus(iii)any payment due for any kWh that are produced by the Solar Facility during the current billing cycle.Substitute Payments shall be in addition to other payments otherwise due under this Agreement. (d)Deposit and Initial Payment payable with credit card,money order or a check drawn on a United States bank account.Monthly payments are payable with a check drawn on a United States bank account or you may agree to authorize Sunrun to deduct the invoice amount directly from your bank account (c)For each billing cycle after the first year that this Agreement is in effect.the Substitute Payment will equal(i)the current price per kWh established in each month(subject to subsection(c)above). Exhibit A.multiplied by(ii)the kWh produced by the Solar Facility during the corresponding billing cycle in the previous year,minus(iii)any payment due for any kWh that are produced by the Solar Facility during the current billing cycle.Substitute Payments shall be in addition to other payments otherwise due under this Agreement. (d)You will not be charged Substitute Payments for times when a grid failure results in the Solar Facility being deactivated. 09/23/2015 P87A14FFBVB9V93-H(Custom PPA Fixed) Page 5 of 18 09/23/2015 P87A74FFBVB9V93-H(Custom PPA Fixed) Page 6 of 18 DocuSign Envelope ID:7597CA37-B95D4B23-9677-0443EEE735EB DocuSign Envelope ID:7597CA37-895D-4B23-9677-0443EEE735EB 10.Options to Purchase 12.Term and Termination (a)You have the option to purchase the Solar Facility at the following times during the Initial Term: (a)You agree that this Agreement will become effective only when both you and Sunrun have signed the Agreement (i)Upon the fifth anniversary of the In-Service Date (b)This Agreement will continue in effect for twenty(20)years following the date Sunrun receives notice from the Utility that the Solar Facility is approved (ii)At the end of the Initial Term of this Agreement for operation("7n-Serwm Date").This period shall be called the"Initia/7em," (iii)Should you sell your Property during the Initial Term (iv)Should Sunrun fail to perform Sunrun's Obligations(in accordance with Section 18) (c)At the end of the Initial Term,this Agreement will be automatically renewed for an additional one-year term("Renetw/Teary'),unless you have purchased the Solar Facility or unless either you or Sunrun gives the other party to this Agreement a termination notice at least thirty(30)days prior to the (b)To purchase the Solar Facility pursuant to Section 10(a),you must deliver a written notice to Sunrun of your intent to purchase within sixty(60)days of expiration of the Initial Term.At the end of any Renewal Term,this Agreement shall be automatically renewed for an additional Renewal Term,unless the applicable date and deliver payment to Sunrun within thirty(30)days of receiving an invoice from Sunrun for the purchase price. either you or Sunrun gives the other parry to this Agreement a termination notice at least thirty(30)days prior to the expiration of the Renewal Term then in effect. (c)The purchase price will be the greater of(i)fair market value,as determined at the time("FlAW)and(ii)the minimum price set forth in Exhibit A. Annually,Sunrun will determine the FMV of the Solar Facility by hiring an independent appraiser to estimate the value of a comparable in-service solar (d)At the end of the term of this Agreement.if either you or Sunrun do not wish to renew it,Sunrun will remove the Solar Facility at no cost to you(unless facility in your state and utility service area.This valuation will take into account the Solar Facility's age;location;size;and other market characteristics you purchase the Solar Facility at the end of the Initial Term,or unless the term of this Agreement is automatically renewed).Sunrun agrees to leave your such as equipment type and equipment operating,maintenance and service costs,value of electricity in your area,and any applicable solar incentives. Property in the same general condition that existed immediately prior to removal of the Solar Facility. (d)Sunrun will credit the purchase price by any refund due to you pursuant to Section 8(b),provided however,that in no case shall such a credit result in a (e)If you cancel this Agreement pursuant to Section 3,you will not be refunded your Deposit,and you will not owe Sunrun any further payments.If net purchase price that is less than the minimum purchase price set forth on Exhibit A. Sunrun modifies your Agreement pursuant to any of the factors listed in Section 4(a)such that there is a decrease in the annual energy production estimate,or if the payment terms increase,or if it is determined that you must pay for any site improvements to accommodate a solar system,then you (e)At other times,please contact Sunrun at(855)478-6786 to discuss the possibility of purchasing the Solar Facility. may cancel this Agreement and your Deposit will be refunded. (f)If you purchase the Solar Facility,Sunrun will continue to monitor the Solar Facility for as long as the meter continues to function,or until the twentieth (f)Sunrun will make a good faith effort to notify you between 30 and 60 days before the end of the Initial Term about(i)your end of term options and(ii) anniversary of this Agreement,whichever is sooner.However,Sunrun will not provide any maintenance or repair unless you enter into a separate the rate for electric energy in the first Renewal Term(if applicable).Sunrun will make a good faith effort to notify you between 30 and 60 days before the agreement with Sunrun,at your expense,to perform these services.If possible,Sunrun will assign to you any product and/or workmanship warranties still end of any Renewal Term about(i)your end of term options and(ii)the rate for electric energy in the next scheduled Renewal Term(if applicable). in effect for the Solar Facility. 13.Access Maintenance and Reoa"r 11.Sale of PropeM and Assignment (a)You agree to grant Sunrun or its contractors access to your Property for the purpose of designing,installing,operating,maintaining and testing the (a)If you sell the Property you may assign this Agreement to the new owner,provided that the new owner meets Sunrun's reasonable credit requirements Solar Facility and performing Sunrun's Obligations.Sunrun agrees to give you reasonable notice when Sunrun needs to access your Property for any of the and first agrees in writing to be bound by all of the terms and conditions set forth herein.Please contact Sunrun or visit www.sunrun.com to obtain an foregoing purposes and will endeavor to restrict such access to normal business hours. assignment agreement. (b)When possible you agree to allow Sunrun and construction professionals(an engineer,architect,or licensed contractor or their representative)hired by (b)During the Initial Term,within sixty(60)days of entering into a contract to sell the Property you will have the option to purchase the Solar Facility in Sunrun to access your Property to inspect any buildings and,if applicable,roofs prior to the installation of the Solar Facility to ensure that your Property accordance with Section 10. can accommodate the Solar Facility. (c)if you sell or otherwise transfer your interest in the Property without either purchasing the Solar Facility or assigning this Agreement to the new owner (c)If parts fail during the term of this Agreement,Sunrun will use commercially reasonable efforts to replace them with like equipment;however,you in accordance with the terms of this Agreement,or if the new owner refuses to take assignment then you will be deemed to have terminated this acknowledge that due to parts availability and other factors,this may not be possible.Sunrun agrees that any change in equipment will not reduce the Agreement,and Sunrun may exercise its rights under Section 19(a), Guaranteed Output set forth in Section 8. (d)Sunrun may assign,lease,sublease,or transfer the Solar Facility and this Agreement along with all rights and obligations hereunder to any third party (d)If you plan to move or temporarily disconnect the Solar Facility to allow for maintenance of and/or repair to the Property,you agree,at your expense, (each,an"Assignee"),without first giving notice to you or obtaining your consent,for any purpose,including,without limitation,collection of unpaid either(i)to hire Sunrun to perform this work or(ii)to obtain Sunrun's approval of your contractor,who you agree must carry commercial general liability amounts,financing of the Solar Facility's installation,or in the event of an acquisition,corporate reorganization,merger or sale of substantially all of its policy in an amount not less than one million($1,000,000)dollars per occurrence and name Sunrun,and its successor or assigns,as additional insured. assets to another entity.If Sunrun or its Assignee chooses to transfer the Solar Facility or this Agreement to another party,you agree to treat this other party as your counterparty under this Agreement.Otherwise,the terms of this Agreement will not change if this Agreement or the Solar Facility is (e)Sunrun warrants that roof penetrations will be weather-tight for a 5-year period after installation. assigned,leased,or transferred by Sunrun or its Assignee,and the Assignee will not be able to interfere with your rights to the Solar Facility as long as you are fulfilling your obligations under this Agreement.If Sunrun transfers the Solar Facility or this Agreement to an Assignee,Sunrun will continue to operate (f)You agree to make best efforts to provide a safe and secure work environment at your Property during the course of the Solar Facility installation and and maintain the Solar Facility until you receive written notice otherwise. maintenance. 09/23/2015 P87A74FFBVB9V93-H(Custom PPA Fixed) Page 7 of 18 09/23/2015 P87A14FFBVB9V93-H(Custom PPA Fixed) Page 8 of 18 DocuSign Envelope ID:7597CA37-B95DAB23-9677-0443EEE735EB DocuSign Envelope ID:7597CA37-895DAB23-9677-0443EEE735EB 14 Ince 16.R sol rtig__-_on of Disputes (a)Sunrun agrees to carry insurance that covers all damage to and theft of Sunrun's Solar Facility.You will not be responsible for insuring the Solar Facility. (a)You agree that to expedite the resolution of and to control the costs of disputes,resolution of any dispute relating to this Agreement("DispuW%will be Sunrun agrees to provide you evidence of Sunrun's insurance policy for the Solar Facility upon request If Sunrun does not maintain insurance that covers resolved according to the procedure set forth in this Section 16. damage to Sunrun's Solar Facility,it will be responsible for the consequences of not maintaining such insurance. (b)Unless otherwise agreed in writing,Sunrun and you agree to continue to perform each party's respective obligations under this Agreement during the (b)You agree to carry insurance that covers all damage to your Property during the term of this Agreement including damage resulting from the Solar course of the resolution of the Dispute. Facility,provided such damage was not caused by the gross negligence of Sunrun.It is your responsibility to determine if the installation of the Solar Facility will impact your existing coverage.If additional insurance is required to maintain your existing coverage,you will be responsible for either(i) (c)You and Sunrun agree to first try to resolve informally and in good faith any Dispute.Accordingly,you agree to send a written notice of Dispute to the procuring and maintaining such insurance or(ii)the consequences of not procuring and maintaining such insurance. address on the first page of this Agreement and Sunrun will send a written notice of Dispute to your billing address.If you and Sunrun do not reach an informal agreement to resolve the Dispute within 45 days after the notice of Dispute is received,you or Sunrun may commence a formal proceeding as (c)Sunrun requires its contractors performing the Solar Facility installation to maintain insurance coverage as follows:workers compensation,subject to detailed below.All applicable statutes of limitation and defenses based upon the passage of time shall be tolled for the 45 days during which the parties statutory limits;Employers liability,with a minimum of one million($7,000,000)dollars each occurrence;commercial general liability,in an amount not try to informally resolve any Dispute. less than one million(81,000,000)dollars per occurrence and two million(82,000,000)dollars annual aggregate;commercial automobile liability,in an amount not less than a combined bodily injury and property damage limit of one million($1,000,000)dollars per accident;excess liability insurance with a (d)If Sunrun and you cannot resolve the Dispute informally,the Dispute will be resolved by binding arbitration.ARBITRATION MEANS YOU WANE YOUR limit of one million($1,000,000)dollars per occurrence and in the annual aggregate in excess of the limits of insurance provided above;and any other RIGHT TO A JURYTRIAL AND ALL DISPUTES SHALL BE DECIDED BY AN ARBITRATOR.This agreement to arbitrate Disputes is governed by the Federal insurance required by applicable laws or regulations. Arbitration Act("FAA'I.The arbitration will be conducted under the rules of JAMS that are in effect at the time the arbitration is initiated("Jgi1.f5Ruies")and under the rules set forth in this Agreement.If there is a conflict between the JAMS Rules and this Agreement this Agreement will govern. es Your initials indicate that you havere6and understand and accept the limitations and obligations set forth in this Section 14. (V (e)CLASS ACTION WAIVER.ARBITRATION MUST BE ON AN INDIVIDUAL BASIS.AS A RESULT,NEITHER YOU NOR SUNRUN MAVJOIN OR CONSOLIDATE Accepted by(Initials): CLAIMS IN ARBITRATION BY OR AGAINST OTHER CUSTOMERS,OR LITIGATE IN COURT OR ARBITRATE ANY CLAIMS AS A REPRESENTATIVE OR MEMBER OF A CLASS OR IN A PRIVATE ATTORNEY GENERAL CAPACITY. 15.1 m tations of I b'I try (f)You may,in arbitration,seek all remedies available to you under this Agreement as interpreted under California law.If you decide to initiate arbitration against Sunrun,Sunrun will pay the costs for initiating the arbitration proceedings.If Sunrun decides to initiate arbitration,Sunrun will be required to pay (a)SUNRUN WILL BE LIABLE TO YOU AND ANY OTHER PERSON FOR DAMAGES OR LOSSES DIRECTLY ATTRIBUTABLE TO ITS NEGLIGENCE OR WILLFUL the costs associated with initiating the arbitration proceeding.Sunrun also agrees to pay the costs of initiating the arbitration proceeding if the arbitrator MISCONDUCT.TOTAL LIABILITY FOR SUCH DIRECT DAMAGES OR LOSSES WILL IN NO EVENT EXCEED ONE MILLION DOLLARS.THIS WILL BE YOUR SOLE finds in your favor.Other fees,such as attorneys'fees and expenses of travel to the arbitration,will be paid in accordance with JAMS Rules.If the AND EXCLUSIVE REMEDY AND ALL OTHER REMEDIES OR DAMAGES AT LAW OR EQUITY ARE WAIVED,EVEN IF YOU HAVE GREATER RIGHTS UNDER arbitrator finds in your favor,Sunrun will pay your attorneys fees and expenses of travel to the arbitration.The arbitration hearing will take place in the MASSACHUSETTS'S LAWS,WHICH YOU SHOULD CONSULT.SUNRUN IS NOT RESPONSIBLE FOR ANY CONSEQUENTIAL,INCIDENTAL,PUNITIVE,EXEMPLARY federal judicial district of your residence,unless you and Sunrun agree to another location in writing.In order to initiate arbitration proceedings,you or OR INDIRECT DAMAGES,LOST PROFITS OR LOSSES RELATING TO THIS AGREEMENT,IN TORT OR CONTRACT,INCLUDING ANY NEGLIGENCE OR Sunrun must take the following actions: OTHERWISE. (i)Write a demand for arbitration.The demand must include a description of the Dispute and the amount of damages you are seeking.The form of (b)EXCEPT AS EXPRESSLY PROVIDED HEREIN,SUNRUN MAKES NO WARRANTY OR REPRESENTATION,EITHER EXPRESS OR IMPLIED,REGARDING ITS Demand for Arbitration can be found under ADR Forms at www.jamsadr.com. OBLIGATIONS OR THE SOLAR FACILITY.THERE IS NO WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE,AND ANY AND ALL (ii)Send three copies of the demand for arbitration to the currentJAMS10cation in San Francisco,California. IMPLIED WARRANTIES ARE DISCLAIMED. (iii)Send one copy of the demand for arbitration to the other party. (g)In accordance with the FAA and the JAMS Rules,the arbitrator's decision will be final and binding.Any right to appeal is likewise governed by the FAA and JAMS Rules.Any arbitration award may be enforced in any court with jurisdiction. (h)You and Sunrun agree to receive service of process of the arbitration demand by registered or certified mail,return receipt requested,at your billing address and Sunrun's principal executive office,as applicable. 17.Force Ma eure (a)Neither you nor Sunrun will be in default of this Agreement for any delay or failure in the performance under this Agreement(including any obligation to deliver or accept the electric energy output of the Solar Facility)if the delay or failure is due to Farce Majeure.Force Majeure includes acts of God such as storms,fires,floods,lightning and earthquakes,sabotage or destruction by a third party of the Solar Facilities,war,riot,acts of a public enemy or other civil disturbance,or a strike,walkout lockout or other significant labor dispute.Force Majeure does not include economic hardship of either you or Sunrun,a power grid failure(except if caused directly by a Force Majeure event),a failure or delay in the granting of permits,or insufficiency, unavailability,failure,or diminishment of solar resources,except as a result of an event that would otherwise qualify as a Force Majeure. (b)Force Majeure cannot be attributable to fault or negligence on the part of the party claiming Force Majeure and must be caused by things beyond that party's reasonable control.Additionally,you or Sunrun must have taken all reasonable technical and commercial precautions to prevent the event (c)In order to claim Force Majeure as a reason for non-performance,you or Sunrun must give notice to the other party of the Force Majeure within fourteen(14)days of the occurrence of the Force Majeure and estimate how long it will last and what the potential impact is on the Agreement.The party claiming Force Majeure must(i)make reasonable attempts to continue to perform under the Agreement(ii)quickly take action to correct the problem caused by the Force Majeure,and(iii)make reasonable efforts to limit damage to the other parry.Finally,the party claiming Force Majeure must notify the other party when the Force Majeure event ends and performance will resume as contemplated in this Agreement. (d)If you or Sunrun is prevented from performing under this Agreement for a period of either(i)three hundred sixty-five(365)consecutive days or more, or(ii)seven hundred thirty(730)non-consecutive days or more(whether full or partial days),the other parry may terminate this Agreement without liability of either party to the other,upon thirty(30)days written notice at any time during the Farce Majeure. 09/23/2015 P87A14FFBV89V93-H(Custom PPA Fixed) Page 9 of 18 09/23/2015 P87A74FFBVB9V93-H(Custom PPA Fixed) Page 10 of 18 DocuSign Envelope ID:7597CA37-B95D4B23-9677-0443EEE735EB DocuSign Envelope ID:7597CA37-B95D-4B239677-0443EEE735EB 18.Your Remedies 22.NOTICE OF RIGHTTO CANCEL (a)In addition to any other remedies you have under this Agreement if Sunrun(i)makes a general assignment for the benefit of creditors,files a petition YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE 10TH CALENDAR DAY AFTER YOU SIGN in bankruptcy,appoints a trustee or receiver,or has all or substantially all of its assets subject to attachment execution or other judicial seizure,or(ii)fails THIS AGREEMENT AND ANY DEPOSIT PAID WILL BE REFUNDED.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR to perform an obligation under the Agreement and such failure continues beyond a period of ninety(90)days(provided,in each case,this Agreement is otherwise in full force and effect prior to such event),you will have the option to purchase the Solar Facility as set forth in Section 10(a)(iv). AN EXPLANATION OF THIS RIGHT. 19.S,ser_un's,Remedies By initialing below,you expressly acknowledge that you have been advised on your right to cancel this Agreement and have received duplicate copies of (a)If you terminate this Agreement under Section 11(c),you will be required within thirty(30)days either(i)to pay Sunrun a termination payment equal to the Notice of Cancellation. the Pre-payment of all future estimated energy to be produced during the Initial Term("Make Who/e9,as calculated in Section 7(b)or(ii)to purchase the 1D/s Solar Facility pursuant to Section 10(b). IU (b)If you fail to perform a material obligation under the Agreemen4 and you do not correct the failure within one hundred twenty(120)days,if such Accepted by(Initials): failure continues beyond a period of one hundred twenty(120)days,then Sunrun can require you to pay Sunrun a Make Whole payment. (c)If you make a general assignment for the benefit of creditors,file a petition in bankruptcy,appoint a trustee or receiver,or have all or substantially all SUNRUN INC. CUSTOMER of your assets subject to attachment,execution or other judicial seizure,or you become insolvent or unable to pay your debts,or vacate or abandon the Date: 9/28/2015 An2hatyllrrnt,nr Hnlrrer Property,then Sunrun can require you to pay Sunrun a Make Whole payment. Ian Date' 9/23/2015 (d)If you(i)are required to make a Make Whole payment and do not make the payment(ii)terminate this Agreement without also purchasing the Solar Signature: I 0.r4kir KtSYA Facility,or(iii)do not make any other payment or payments as contemplated and required under this Agreement Sunrun shall,subject to any cure rights rosntea eatexeo —s'ene 1 by- provided herein,have the right to disconnect your Solar Facility and/or enter your Property and remove the Solar Facility. Amber Russell Signature:. CGa u,,�& Print Name: (e)If as a result of your default Sunrun removes the Solar Facility,then in addition to the Make Whole payment,you will be obligated to pay Sunrun an 818Nfli@g�d6Y amount equal to the value of any federal,state and local incentives that Sunrun must return as a result of such removal. Title: Project Operations .Account email address*: vinogradovilial@qmail.com 20.Fvrin<inn< _ *This emanaddrers K411 be used bi Sunrun forofroa/torrtapoodence,such assending (a)This Agreement does not include an obligation by Sunrun to:remove or dispose of any hazardous substances that currently exist on the Property; monthry bins orotherinwices.Sunrun will newrshare orsenyourewd address to any improve the construction of the roof or the Property to support the Solar Facility;remove or replace existing rot,rust,or insect infested structures;provide SALES CONSULTANT thintparties. structural framing for any part of the Property;pay for or correct construction errors,omissions and deficiencies by you or your contractors;pay for, remove or remediate mold,fungus,mildew,or organic pathogens;upgrade your existing electrical service;install any smoke detectors,sprinklers or life Sysigningbelowlacknow/edge thatlarn Sunrun acc ctitea that safer equipment re uired b municipal code or inspectors as a result of the Solar Facility installation; a for the removal or re-location of equipment, (presented this agreement according to"Me Right Stuff'and the Account phone number: 6175046993 y9 y P P ty pay obstacles or vegetation in the vicinity of the Solar Facility;pay for any costs associated with municipal design or architectural review,or other specialty Sunrun Code of Conduct and that I obtained the homeowner's permits(this includes cost to attend any public hearings,notification of neighbors,or additional drawings required);paint electrical boxes or conduit at the signature on this agreement ce. dagrlJamt.n r Hn ld r(op n Property;and move items unassociated with the Solar Facility around the Property. 21.Miscellaneous Name: e by: t�,����LL t>«19-1ALA SWr && (a)You agree that this Agreement constitutes the entire agreement between you and Sunrun.If any provision is declared to be invalid,that provision will (Print Nam el Signature: 1 O be deleted or modified,and the rest of the Agreement will remain enforceable.The terms of this Agreement that expressly or by their nature survive esoxssreerasraw... Sunrun 10 a^ Natalia Shutova termination shall continue thereafter until fully performed,which shall include,without limitation,the obligation to make payments hereunder. (70-digit number you recetLed from SunruN Print Name: (b)This Agreement shall be interpreted in accordance with and governed by the laws of the State of Massachusetts,without regard to the conflict of laws principles thereof. (c)You agree that Sunrun has the right to periodically check your consumer credit report. (d)You agree that Sunrun has the right to obtain photographic images of the Solar Facility and the Property,and to use such photographic images for internal and quality control purposes.Sunrun will not use photographic images of the Solar Facility or the Property in its marketing and promotional materials without first obtaining your express written approval. (e)This Agreement supersedes any prior understandings,agreements,or representations by or between the parties,written or oral,to the extent they related in any way to the subject matter hereof. (1)Any notice or other communication to be made hereunder,even if otherwise required to be in writing under other provisions of this Consent or any other documents or agreements that have been provided to you in connection with this Consent,may alternatively be made in an electronic record transmitted electronically to the electronic addresses provided by you.Any notice or other communication made in electronic form will have the same legal effect and enforceability as if made in non-electronic form. (g)This Agreement is binding upon,and inures to the benefit of,the parties and their respective heirs,executors,administrators,legal representatives, successors and assigns. (Remainder of Page Intentionally[eft B/ankl 09/23/2015 P87A14FFBVB9V93-H(Custom PPA Fixed) Page 11 of 18 09/23/2015 P87A14FFBVB9V93-H(Custom PPA Fixed) Page 12 of 18 / DocuSign Envelope ID:7597CA37-B95D4B23-9677-0443EEE735EB DocuSign Envelope ID:7597CA37-B95D4B23-9677-0443EEE735EB EXHIBIT A SUNRUN ELECTRICITY PRICING SUNRUN MONTHLY AUTOMATIC ELECTRONIC PAYMENTS At the signing of this Agreement,you will pay Sunrun a nonrefundable Deposit("Deposit")of$0.At the start of installation of the Solar Facility,you will As a Sunrun customer,you agree to pay your monthly bill with automatic electronic payments.If you do not choose to select automatic payment as a form pay Sunrun an Initial Payment("7nicia/payment')of$0.Together,these payments comprise the Upfront Payment("Upfront Payment'). of payment,then you will lose the discount in Section 6 and be expected to pay your monthly Sunrun bill by-check payments.Regardless,you will receive all Sunrun bills via email unless you contact Sunrun directly to request invoices to be sent through the US mail. Electricity Payments:In addition to the Upfront Payment,you agree that for all electric energy you purchase from Sunrun during the Initial Term of this Agreement,you Will pay a price per kWh in the form of monthly payments("Monthly Payments'l as shown below.The Monthly Payments shall increase by 0.0%annually during the Initial Term of this Agreement effective as of the Monthly Payment that covers any calendar month that includes an anniversary Terms and Conditions for Recurring Payments: of the In-Service Date(and such increase would not apply to any part of a Monthly Payment that covers the days in a calendar month leading up to an anniversary of the In-Service Date).The payments shown below are before any applicable taxes and include a$15.00 discount for paying through BY ACCEPTING THE TERMS AND CONDITIONS AND ENROLLING IN THE AUTOMATIC ELECTRONIC PAYMENT OPTION,YOU ARE AUTHORING SUNRUN TO Automated Clearing House(ACH)withdrawal.If you do not elect automatic payment through ACH withdrawal from your checking or savings account you AUTOMATICALLY DEDUCT YOUR MONTHLY INVOICE AMOUNT FROM THE BANK ACCOUNT YOU HAVE DESIGNATED.SUNRUN WILL ADVISE YOU BY will not receive this discount and each monthly payment will be$15.00 greater.(As described in Section 6(a),the table below also is based on the MONTHLY INVOICE OF THE AMOUNT AND DATE OF THE PAYMENT THAT WILL BE AUTOMATICALLY DEBITED. assumption,for convenience purposes,that the In-Service Date will be the 1st day of the month.) 1.Sunrun will provide you with a monthly electronic statement of your account.You agree to review each invoice you receive for any errors.Under federal law,you have the right to hold up or stop an electronic funds transfer provided you give your financial institution or credit card issuer notice of at least _.-.. .. ....... .........._ _ ................. three business days before the scheduled transfer date.If you inform Sunrun that an error exists on your statement Sunrun will attempt to correct that .......... I Performance Guarantee Prepay Option Purchase Option Estimated Price[o Prepay Balance of p error prior to your next statement to the extent permitted bylaw.Sunrun shall bear no liability or responsibility for any losses o any in that you may Year P y P _-_ Yearly Price Monthly Guaranteed kWh Refund/kWh If Guaranteed P Y ' Minimum Cash incur as a result of an erroneous statement or due to any delay in the actual date on which your account is debited. End of Per kWh Payment Output to Dale output Not Met Initial Term Purchase Price --- p- -- ----- - ` - 2.If any changes occur in the information on your application,you must immediately notify Sunrun in writing of such changes.If Sunrun incurs charge- N/A N/A N/A N/A $11,865 N/A back fees as a result of inaccurate information you provide,then Sunrun shall bill you for those fees. 1 $0.141 $74.38 6,340 $0.141 $11,477 _ N/A 3.If you either do not notify Sunrun in writing of such changes or do so in an untimely fashion,Sunrun shall bear no liability or responsibility for any .-...._._ _. r-...._. _... 0.-141 ..._. _ '2 $0.141 474.38 12,633 $0.141 511,072 .$21,174 losses incurred to the extent permitted by law.Sunrun'S sole liability to you shall be Sunrun's obligation to make any appropriate changes once in receipt - - - of your written notification.The actual settlement date(or date the ACH transaction occurs against your checking or savings account or is charged to your 3 $0.142 $74.38 18,895 $0.142 $10,650 $17,385 check or credit card)will be no earlier than three(3)days before the invoice due date. 14 $0.143 $74.38 25,125 $0.143 $10,211 $13,578 4.You agree to ensure that there are sufficient funds in your designated account on the settlement date to pay the amount of the debit.If Sunrun incurs 5 $0.144 $74.38 31,323 $0.144 $9,752 $9,752 charge-back fees as a result of insufficient funds in your designated account,then Sunrun shall bill you for those fees. 6 $0.144 $74.38 37,489 $0.144 $9,274 •$9,274 5.Sunrun reserves the right to change these conditions at any time.Notice may be given on or with your bill or by other methods.Either party may 7 $0.145 $74.38 43,624 $0.145 $8,776 $8,776 terminate this arrangement at anytime by giving the other party written notice reasonably in advance of the date of termination or any scheduled _., _ _ -._ __ ...... .._ .... .___.. .....--_..--._ settlement date.You may also terminate this arrangement by calling Sunrun Customer Care at 1-855-478-6786 or by changing your billing preference in 8 '�.$0.146 $74.38 49,728 $0.146 $8,256 $8,256 the Sunrun Customer Portal.Termination shall not prevent a debit transaction authorized before any notice of termination. 9 $0.147 $74.38 55,799 $0.147 $7,714 $7,714 6.You agree to be bound by any rules your financial institution requires far pre-authorized electronic funds transfer or credit card issuer requires for pre- 10 $0.147 $74.38 61,839 $0.147 $7,150 $7,150 authorized credit card charges. t 1 $0.148 $7x.38 67,847 $0.148 $6,561 46,561 7.Check with your financial institution to see if there are any fees associated with the pre-authorized payment option.You will be responsible for all such fees. 12 ,50149 $7438 73,823 $0.149 $5,947 $5,947 ................. .....-.... ____. _...._ .._. -.._. ............... _.__. _......... 1 authorize automatic electronic payments and accept these Terms and Conditions.You will receive a separate electronic request to securely enter your 13 $0.150 $74.38 79,768 $0.150 $5,308 $5,308 bank account information. 110.1 ......,. _..- ..... 14 --150.150 $74.38 85,681 $0.150 $4,641 1$4,641 15 $0.151 $74.38 91,562 $0.151 $3,946 $3,946 CUSTOMER 116 $0.152 $74.38 97,412 $0.152 $3,221 .$3,221 17 $0.153 $74.38 103,230 $0.153 $2,465 $2,465 118 .$0153 $7438 109,016 $0.153 $1,677 $1,677 Date:. 9/23/2015 119 $0.154 $7438 114,770 -- $0.154 - $856 $856 -agee4 by 'Si nature: (6 VIIAh 20 $0.155 $74.38 120,493 50.155 f0 f0 8 _ Pursuant to Section 7,you may prepay the balance of your estimated obligations under this Agreement Any prepayments you make to Sunrun will increase the refunds for which you are IRRWBF 6 eligible. After the Initial Term,SunRun shall on each anniversary of the In-Service Date establish anew price per kWh that Is equal to ten percent(10%)less than the"Average cost of electric energy'as established by your Utility or Its successor."Average cost of electric energy"shall be the price you would otherwise pay for electric energy to your Utility or its successor for the 12 months preceding the start of each Renewal Term. Notwithstanding the foregoing,in no event shall this price per kWh be less than$0.010 per kWh. Pursuant to Section 10,If you purchase the Solar Facility before the Guaranteed Output has been achieved,Sunrun will issue you a refund.The estimates in this column assume the Solar Facility achieves its Estimated Output and that you make the final Initial Payment upon the first anniversary. 09/23/2015 P87A14FFBVB9V93-H(Custom PPA Fixed) Page 13 of 18 09/23/2015 P87Al 4FFBVB9V93-H(Custom PPA Fixed) Page 14 of 18 DocuSign Envelope ID:7597CA37-B95D-4B23-9677-0443EEE735EB DocuSign Envelope ID:7597CA37-B951)dB23-9677-0443EEE735EB EXHIBIT NOTICE OF CANCELLATION DATE: (Enter date of transaction) 9/23/2015 YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN TEN CALENDAR DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENT MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN 10 CALENDAR DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE [Intentionally left blank] CANCELLED. IF YOU CANCEL YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE;OR YOU MAY,IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN 20 DAYS OF THE DATE OF YOUR NOTICE OF CANCELLATION,YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUTANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER,OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE TO SUNRUN INC.,595 MARKET STREET,29TH FLOOR,SAN FRANCISCO,CA 94105 NOT LATER THAN MIDNIGHT OF (DATE) I HEREBY CANCEL THIS TRANSACTION. DATE: CUSTOMER SIGNATURE: NOTICE OF CANCELLATION MAY BE SENTTO SUNRUN ATTHE ADDRESS NOTED ON THE FIRST PAGE OFTHIS CONTRACT. 09/23/2015 P87A14FFBVB9V93-H(Custom PPA Fixed) Page 15 of 18 09/23/2015 P87A14FFBVB9V93-H(Custom PPA Fixed) Page 16 of 18 DocuSign Envelope 10:7597CA37-B95D-4B23-9677-0443EEE735ES DocuSign Envelope ID:7597CA37-B95D-4B23-9677-0443EEE735EB DUPLICATE COPY EXHIBIT E:SUNRUN DEPOSIT FORM If you are paying your deposit by check,please enclose this document with your payment and include your Sunrun Proposal ID reference in the memo line of your check. Name:Ilia Vinogradov Address:12 Harwood s4 North Andover,MA 01845 NOTICE OF CANCELLATION ProposalID:P87A74FFBVB9V93 Deposit Amount:$0 DATE: Please send payments to: (Enter date of transaction) Sunrun Inc. P.O.Box 511612 Los Angeles,CA 90051-8167 Thank you for choosing Sunrun! YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN TEN CALENDAR DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENT MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN 10 CALENDAR DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE;OR YOU MAY,IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN 20 DAYS OF THE DATE OF YOUR NOTICE OF CANCELLATION,YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER,OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE TO SUNRUN INC.,595 MARKET STREET,29TH FLOOR,SAN FRANCISCO,CA 94105 NOT LATER THAN MIDNIGHT OF (DATE) I HEREBY CANCEL THIS TRANSACTION. DATE: CUSTOMER SIGNATURE: NOTICE OF CANCELLATION MAY BE SENT TO SUNRUN AT THE ADDRESS NOTED ON THE FIRST PAGE OF THIS CONTRACT. 09/23/2015 P87A74FFBVB9V93-H(Custom PPA Fixed) Page 17 of 18 09/23/2015 P87A14FF8VB9V93-H(Custom PPA Fixed) Page 18 of 18 DocuSign Envelope to:7597CA37-B95D4B23-9677-0443EEE735EB DocuSign Envelope to:7597CA37-B95DAB23-9677-0443EEE735EB 2 PM Parties agreed to:Compliance Check �Uss,cu uo Certiflcate Of Completion Envelope Number:B3DlO8D7626941CC8967FE2A2151DEBD Status:Sent Consumer Disclosure NOT Required Subject:Sign Sungevity sumun_agreement-Reference#:1787588 Source Envelope: Document Pages:18 Signatures:3 Envelope Onginator: Certificate Pages:2 Initials:5 The E-Signing Manager AutoNav:Enabled 66 Franklin Street Envelopeld Stamping:Enabled Oakland,CA 94607 docusign@sungevity.com IP Address:52.2.190.53 Record Tracking Status:Original Holder:The E-Signing Manager Location:DocuSign 9/23/2015 10:59:20 AM PT dmusign@sungevily.com Signer Events Signature Timestamp Ilia Vinogradov Sent:9/23/2015 10:59:21 AM PT vinognadovilial@gmail.com Security Level:In Session Electronic Record and Signature Disclosure: Not Offered ID: Natalia Shutova vinogmdmilial@gmail.com Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered to: Compliance Check CompliancaCheck@sungevity.com Security Level:In Session Electronic Record and Signature Disclosure: Accepted:7/7/2015 3:49:45 PM PT ID:fa7fc667-f344-44ac-blc4-a519baOaOad4 In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Notary Events Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 9/23/2015 10:59:21 AM PT Electronic Record and Signature Disclosure Date....�!.. �. of NowrN,h TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING l . ,g3�cHUs�� } This certifies that....A.Art4?pt.:.....-4oN4. '.......................................... has permission to perform.....S .................................................................. plumbing�'i/In the buildings of............................................................................................. at.....! ...H ?rtvo ...... .................................... orth©Andover, Mass. FeeGrl ?�..Lic. Nod . ............ 9 .�"� l PLUMBING INSPECTOR Check# 173-3 V Date..../)........... . nrn 31� Li :! f NORTh TOWN OF NORTH ANDOVER ° 9 PERMIT FOR PLUMBING W.,-.o q * This certifies that..A N I D ti l.......-J A��Z`� /_....,.,.............;.................................................. w has permission to perform..,& ����::�!,!��l.-/..(',✓?�s plumbingin the buildings of............................................................................................. at....1.4..... . . f.....................................,Leo h Andover, Mass. Fee:3.S�..Lic. Nox;L.< . ...........4�.c......................x....................................... /1 PLUMBING INSPECTOR Check# 733 v I ' / i !�1 � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK .i.e,,41 CITY _ N ioQ l,. `2 ( MA DATEj�.(-���(_ ,( PERMIT# JOBSITE ADDRESS 12 fw 0 aJp OWNER'S NAME POWNER ADDRESS iY E TEL FAX L ( TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL © RESIDENTIAL�! PRINT CLEARLY NEW: M RENOVATION:® REPLACEMENT: PLANS SUBMITTED: YES E0 NOD Q FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 � a BATHTUB CROSS CONNECTION DEVICE ]k = { ._ _ = 1 _„ - _.r__fi _._ ( k Mj DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM I .1 __fI.--._ DISHWASHERt DRINKING FOUNTAIN ! J ---- I ._._.J _I I __.._.._..� - � ..__.._a ...._.. f ..____ _...__ FOOD DISPOSER FLOOR/AREA DRAIN _.__ INTERCEPTOR(INTERIOR) KITCHEN SINK ____j .{ --____1 ..____._ G _-_—( -__--_J LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 _-- ! __. I ---J= jl= URINAL WASHING MACHINE CONNECTION J= T f .--._ =J= = _.__.. WATER HEATER ALL TYPES _—! j=J=J====J== ic- WATER PIPING OTHER INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES -1 NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND EJ VQ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT I© SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tr nd accurate to the Vest of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c, a ce with all Pe"provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1/#� PLUMBER'S NAME < I LICENSE# . `� �' C SIGNATUR fVIP© JPI CORPORATIONFID# PARTNERSHIP # LLC COMPANY NAME la$a0 d2 f l U M a)A)&- 7-11 ADDRESS ` 00 S O N LIU CITY kA k JD-0 L E 10 N STATEP-1471 ZIP O I Ll —� TEL FAX .. ._ k CELL�I EMAIL VSA lZ_:_ L_� i � ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECU-10-N NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts Department ofIndustriglAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/Individual): /,�6U �2 4�U d7 Address: D F,-6l C4e SOW City/State/Zip: r1 l -k-1)L C 70 141 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 ' employees(full and/or part-time).* have hired the sub-contractors ❑New construction 2. 7. ❑Remodeling I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g (�Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing'all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]i employees.[No workers' 131J Other comp.insurance required.] *Any applicant that checks box#1 must also fill outthe section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they a-re doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: ,Q Job Site Address: �4 City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requireclunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. Ido hereby derthepansan enaltiesoertjury that the information provided above is true and correct. Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or.written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Gomju aonwealth.of Massachumtts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston?MA.02111 T01.#617-727-4900 ext 406 ox 1-877rMASSA.k'B Revised 5-26-05 Fax#617-727-7749 www.mass,govldia MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY JnP U2- MA DATE _II- 10 I PERMIT# JOBSITE ADDRESS _ .rD d7 L7 S }OWNER-S NAME rf LI 19 _AI l/V ✓ ,I�4 GOWNER ADDRESS TEFAX TYPE OR OCCUPANCY TYPE COMMERCIAL ) EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:® REPLACEMENT: PLANS SUBMITTED: YES 0 NOD APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE j [�n! ._ I .__._ ..._ __ _._.. DIRECT VENT HEATER -�"___._I DRYER FIREPLACE _� 1 _ - FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT -OVEN ._ -- _ POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER I' INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO C] 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Pa OTHER TYPE INDEMNITY E] BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com liith all Pe ' nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUM BER-GASFITTER NAME 119070061 ._ MC 2� C LICENSE# ?.SSS. SIG TUR ---I MP 0 MGF El JP W JGF 0 LPGI© CORPORATION©#E=PARTNERSHIP 0#=l LLC®# COMPANY NAME: l(J c'-R Vo Ni") ADDRESS 3 6/`/,�,a SQA' _JW CITY —Y�>—��- ,��ri1 — j STATE1 via JJZIP �1 i,Y� `{�_ TEL _ 7J0 O FAX L� CELL _ �IEMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION N ES Yes No S' ` 12— THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES r ' The Commonwealth of Massachusetts - Department of lnclustrzctrAcciclents Office ofluvestigations 604 Washington Street Boston,MA 02111 -www.mass.gov/clia Workers'Compensation][assurance Affidavit:]udders/Cont°actors/Electri.cians/flumbe>rs _Applicant It�forcitnation Please Plr nt Leal Name(Business/Orgmiization/C &idual): A-) L �� Address: `3 671Y571'z� AJ Z—trU - City/State0l): Ii t (�q L G l0 w Phone#:—q ISI 7 5 '0 t Are you an employer?Check the appropriate box: Type of project(required): 1.❑ T am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or pax-time)* have liked the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet. 7. []Remodeling ship and'haveno employees These sub-contractors have S. ElDemolition working for me in any capacity, workers'comp.insurance. 9. Building addition _ [No workers' comp.insurance 5. ❑We are a corporation and its 10.[]Electrical repairs or additions required.] officers have exercised.their 3.E1 I am a homeowner doing all work right of exemption per MGL 11.❑Phartbing repairs or additions myself[Eo workers'comp. c.152,§1(4),andwehaveno 12,0 Roofrepairs insurancere fixed. employees.[No workers' ] 13.❑Other comp.insurance required.] xAny applicant that checks box#1 must also fill out the section bel6w showing their workers'compensation policy information. i Homeowners who submit this affidavit indicatingthey tie doing allworlc and then hire outside contractors must submit a new affidavit indicating such. tContractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. X am an employer that isproviding workers'compensation insurance formy ernployees Below is thepoliey and job site information. lusuxance Company Name: Policy#or Self ins.UG.#: Expiration Date: Job Site Address; � — �� to 6J-o �� Sr pity/State/zip: /V ku 0 �.%, . Attach a copy o#the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure ooverage as requft dander Section 25A ofMGL o.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or 'one year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. .1 do Hereby cert&under the pains and penalties ofperlury that the information provided above is true and correct. - Simeture• Date: Phone##: Official use oply. .Do not write in this area,to be completed by city or town official. City or Town: PermitMeense ff Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phoney: I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,. express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two ormore of the foregoing engaged in a joint enterprise,and including the Iegal representatives of a•deceased employer,or the receiver or.trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having notmore than three apartments and who resides therein,or the occupant ofthe dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be,deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MOL chapter 152,§25C(7)states `Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with,the insurance requirements of this chapter have beenpresentedto the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phonenumber(s)along with theircertificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other that the members or partners,are notrequired to carry workers'compensation insurance. If au LLC or LLP does have employees,a policy is.required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents fox confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a Workers compensationpolicy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be.sure that the affidavit is complete andprinted legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be-sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/Rcense applications in any given year,need only submit one affidavit indicating cutrent policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as " of that a valid affidavit-ii on file'for future permits or li censes. .A new affidavit must b e filled out each year."Where a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e.a dog license orpermit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any ciuestions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Gox oJ1We,@AofM-0ssach,v.effq Departmnt offadusWal,A,ccidenta Qffloo offAvostigatim 600 Wase.Street TQL#617-7.2,7-4.900 at 406 or 1-877.;MASS Revised 5-26-05 Fax 0 617-727-7749 www.x�as�.gov�clia . o:6z 6 N1 �21XA 4 9�1 �13�W x.11 �N`' d� ONd 9 � : :>• O�;b ;; Heb s �s�' - Location 43 No. r"'S Date HpRT�y TOWN OF NORTH ANDOVER f? a r Certificate of Occupancy $ MUS Eta' Building/Frame Permit Fee $ AC Foundation Permit Fee $ Other Permit Fee $ � i J TOTAL $ Check # ����= 3f)!7 1 6 6 1 ., --- Building insp&br TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERNUT NUMBER. O DATE ISSUED: / SIGNATURE: Building Commissioner/inspector of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property1 Address: 1.2 Assessors Map and Parcel Number: l Numb 1� ri�nwad� 9/0- Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R iredProvided Required Provided v 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: lic ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No X11 2.1 oOwnner of Record 2Namea /d m L i C,c , �L 1/l0l ��1 O _ /2- Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 licensed Construction Supervisor: Not Applicable ❑ -,,.. 6 Ol�pI e oho iZ p Li nce sj ed Construction Supervisor: /C)s/ %ct L/-.p S License Number m 'l. � �'Lt�l..c,a.. Address q 061. r C?Y, !r 't Expiration Date Signature Telephone r 3.2 Registered Home Improvemelntt Contractor Not Applicable ❑ v !:rya e"'o I'd t�- G t dy/Fl••rte C moC pany N Name /2 m Id � /( Registration Numberi-- �t.6ue dl�..�� S P Y) -�r>!t..�..ca.,�- � Address _ Expiration Date ^Z Signature Telephone Y+ SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application: Failure to provide this affidavit will result in the denial of the issuance of the building permit. -Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Descrition of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s),A Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be #RCIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e)X (b) 4 Mechanical HVAC / 5 Fire Protection 6 Total 1+2+3+4+5 '' " " Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN t OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property , Hereby authorize to act on My behalf 'i all matters relative to work authorized by this building permit applica on. Signature of Owner ate SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB RD SIZE OF FLOOR TINMERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHFVWEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE AORTH Town of fAndover o ;r. ,., 70 No. ti h O' o� dower, Mass., ADRA7ED S BOARD OF HEALTH PERMIT . T D Food/Kitchen Septic System �° • BUILDING INSPECTOR THIS CERTIFIES THAT......... da A .......`............ . ................ .............................................................. Foundation has permission to erect....... . g Z .............................. buildings on ..................... .. ... .. ... ... ......... Rough 46 to be occupied as......... Chimney . .... .. . . ................................................................ provided that the p on acceptin is permit shal in eve respect form to the terms of the application on file in Final this office, and to the provisions the Codes and By-La s relating the Inspection, Alteration and Construction of Buildings in the Town of North ndover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIONS T ELECTRICAL INSPECTOR Rough ................................................................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR £i Number: CS 060112 Birthdate: 08/04/1956 Expires:08/04/2004 Tr.no: 97 Restricted: 00 THOMAS T DOYLE 8 WEST STS— SALEM, NH 03079 Administrator 7Ae �o7rrmranu�erttl�i o iffa wtrT�uaelt Board of Building Regulations and Standards iHOw ME IMPROVEMENT CONTRACTOR Registration: 128612 Expiration: 4/28/2005 Type: DBA THOMPSON'S ROOFING THOMAS DOYLE 8WEST ST SALEM,NH 03079 Administrator Propogat Page of Free Estimates 105 Haverhill Street Fully Insured Methuen, MA 018,04 THOMPSON'S ROOFING (978) 691-1355 Shingles — Slate — Rubber Roof Single Ply — Copper Work PROPOSAL SUBMITTED TO PHONE DATE Lynn Licciardello 5-15-03 STREET JOB NAME CITY,STATE AND ZIP CODE JOB LOCATION 12 Harwood Dr . North Andover MA ARCHITECT DATE OF PLANS JOB PHONE FAX Tk �,78 686-6410 I We hereby submit specifications and estimates for: ( Strip off all roof shingles on house Renail all loose boards Instal:i aluminum dri*o edge around roof line Apply ice and water shield 6 ft . up all along edge Apply 151b . felt paper on rest of roof area Reshingle with a 30 year Anccitect shingle Install new flange around soil pipe Waterproof chimney flashing Cut in a ridge vent �1I' Remove all work related debris i 30 year warranty on material 10 year guarantee on labor construction lic . #060112 improvement #128612 We 3prOPOOC hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: Six thousand two hundred ---- dollars($ 6 200 _ 00 Payment to be made as follows: $2 , 000 . 00 start of job balance upon completion r erial is guaranteed to be as specified.All work to be completed in a workmanlike mannerrding to standard practices.Any alteration or deviation from above specifications involving Authorized costs will be executed only upon written orders,and will become an extra charge over and Signature ' above the estimate.All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully Note:This proposal may be covered by Workmen's Compensation Insurance. withdrawn by us if n9t'accepted wit ' days. &CePtantt Of %)rOPOgat—The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payment will be made as outlined above. Signature Date of Acceptance:/Z� Signature r CERT I F 1 C A T E OF L I AB I L I TY I N S U R A N C E DATE 7/10/03 (MM/DD/YY; PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS A� UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER PELHAM INSURANCE SERVICES INC THE COVERAGE AFFORDED BY THE POLICIES BELOW. 122 BRIDGE STREET 122 BRIDGE STREET I N S U R E R S AFFORD I NG COVERAGE PELHAM NH 03076- INSURER A: Western World INSURED INSURER B: Liberty Mutual Thomas Doyle DBA INSURER C: Thompson's Contruction & Roofing 8 West St. INSURER D: Salem NH 03079 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000.0001 A [X] COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ C ] [ ] CLAIMS MADE [X] OCCUR NPP770609 04.17.03 04-17-04 MED EXP (Any one person) $ 50,000 [ ] PERSONAL & ADV INJURY $1,000,000 [ ] GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $2,000,000 CX]POLICY [ ]PROJECT [ ]LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT [ ] ANY AUTO (Each accident) $ C ] ALL OWNED AUTOS BODILY INJURY ] SCHEDULED AUTOS (Per person) $ [ ] HIRED AUTOS BODILY INJURY [ ] NON-OWNED AUTOS (Per accident) $ [ ] PROPERTY DAMAGE [ l (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ [ ] ANY AUTO OTHER THAN EA ACC $ [ ] AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ [ ] OCCUR [ ] CLAIMS MADE AGGREGATE $ $ [ ] DEDUCTIBLE $ [ ] RETENTION $ $ WORKER'S COMPENSATION AND [X] WC STATUTORY [ ] OTHER B EMPLOYER'S LIABILITY E.L. EACH ACCIDENT $100,000 WC2-31S-314995.013 04.21-03 04.21.04 E.L. DISEASE-EA EMPLOYEE $100,000 E.L. DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Job: Various for Kevin Murphy Construction. CERTIFICATE HOLDER CX]ADDITIONAL INSURED: INSURED LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR Kevin Murphy Construction TO DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 169 Boxford Rd. E LEFT---,,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY ANY KIND UPON THE INSURER. ITS AGENTS OR N Andover MA 01845 R PRE ENTATIVE . AUT RIZEDR RESENTATIV (7/97) Page I of 2 u, b. The Commonwealth of Massachusetts tl Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: y,., b 0 `I'I . Location: 17 C-t.k wyc,0 City L U 2 A Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: 7-64e,"- r2 c d `c �F. [ Address /d S HILI ept. 1 ." 5 City: '� tL4,4 lM ti Phone# Insurance:Co. t.t r Policv# .r Z - 312- 5 S Companv name: Address City Phone#. Insurance Co. Policv# Failure to segue coverage as required under Section 25A or MGL 152 can lead to the krvmwon cf aftinal penalties of.a fine andfor one years'impnso Las vwe�Las_ci Mjwnalbes-nshelmn- a—STDP _arme-cf fD w- upto tt,5of?.00 understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for e verification.ion. s 1 !do hereby c&y under fhe pains and penalties ofperjwy that Me##brrnabw provided above is hue and correct. Signature Print name T6z"a d Pbone-# lo ( — t 3.5�r— Official use only do not write in this area to be completed by city or town dfiaar City or Town PermitAacensin4 Q Buifohng. Dept DCheck if immediate response is required .a Licensing Board ❑ Selectman's Office Contact person: Phone A E] Health Department ❑ Other NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Numberis that the debris resulting from this work shall be disposed of in properly licensed solid waste.disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: 410 S �v �( Set, (le W (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector