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Miscellaneous - 13 GLENWOOD STREET 4/30/2018
13 GLENWOOD STREET ' 210/006.0-0047-0000.0 I i II. I I Date....,.... JI.................. OF�ORfM,h TOWN OF NORTH ANDOVER o PERMIT FOR WIRING S3ACHU5� dl This certifies that ... .................................................................. has ermission to erform . ` e ����eA5 '"� • 0`[5 Pp ................................................................................................... wiring in the building of.........L. a�� .......................................................................................... at .................. � P`.....`......................................r............,North Andover,Mass. - 13 Fee..�.................... ....Lic.No. 1.: J►(( ..... r ?..�`'T..................... ELECTRICAL IIJSPECTdR Check#���y"t`' 1 3 . ,� /� Print Form _rte` t.ornrnpneueelipo3ttrtalrll! Official tIse Only �+ tt�� cc77 {� Permit No. .lJalrardrnenl o/.tier-)Permit --- - Occupancy and Fee("hecked � .� BOARD OF FIRE PREVENTION REGULATIONS IRev. 1/071 (leave freak) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 1'11 cvcnk to ht performed in aCemdancr with file Mas.aehu%euc I•:Iechical('ode(MEC),527 CMR 1?410 3 IPLEASE 1111A Y IN INA:OR TYPE ALL ANP ORi IATION) Date: City or Town of: /UOQ(-4#i I 1 d �0\,�r To Me Incpechn-of IVire.v: -- -- Q BY this aPPlicalr.m the lutdelsigned gives notice ofhisor her intention to perform the electrical work deccribetl below. Location(Street &Number) 126 6(P_n Qd Sf— 6 Owner or Tenant ( i _ [vn v i Telephone No.Q)g- 30p,,, Owner's Address _ Is this permit in conjunction with a building permit? Yes n No [,� (Check Appropriate Box) Purpose of liuildin); w/Solar-PV Utility Authorization Na. nla Viisting Service - Amps ! _Volts - Overhead U Ilndgrd[J No.of Meters 3 New Service Amps ! Volts Overhead U llndgrcl r-1 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 'Install Solar Electric-Photovoltaic(PV)system ] /9 panels] rated�(�&�(�kW-OC @ S.T.C.Grid fled. In conjunction with a Building Permit. cons rle9imt u/lbe•fidlan•irr•dal./r'mor/ce•n•erire•d h•the ills re7uroJ lt'ir r c. No.of Recessed Luminaires No.of Ceile-Susp.(Paddle)Fans o.o Total Transformers KV A No.of Imminaire Outlets No,of Hot Tabs Generators KVA !�o.at Luminaires Swimming Pool A ve 0 n- Q o.a Emergency Tr g ng rod. rnd. liaucr�' Units _ No.of Receptacle Outlets No.of Oil Burners 1-1141' Al 1 R N I S Nit.of!eines 3 No.of Switches Na.ofCas Burners 'ire+►!f)rterli11n a11d' Gritiatiu);Nei ice• No.of Ranges No.of Cond. oda • ti11. til Ak r'lint;ttev irc% Tons No.of Waste Disposers eat PUMP FNumlrrr ions a,n�'iclT tain�d� 'lbtals: L� Ie14-eti11ntttrrlin 1)CAice� No.of Dishw.tshers Space/Area heating KW I.ocul El (ilctniripa !-1 Other _ oft lection No.of Dryers Heating Appliances KW fSecurily.yystems: No.of Devices orf. UIVAICI I No.-07 Water Heaters Kms, n.n __ _—amu.n Data Wiring:Sf ns Ballasts Nit.of Devices or Et uiealent No.Ilydromassage Bathtubs No.of Motors Total lip a crotttmun caUoiii Wiring: M1o.of Devices or N' uiralcul OTHERO - .t rlaCh additional de lad i/dr xir•avl.lot-as rrynirrd ht•the hoxp c•tor o/Wires. Istimalel Valise of F.[ectricab Wort:: �0� _ (When required by municipal policy.) t Work to Start: A.S.A.P. luspections.to be requested in accordance with MFC Itulc 10'.1111111111111 rumplelrcm I:V5L'RANCF C(WFRA(:E: t Inh sx aitived by the owner,no pcnnit for the licrhirmancc of electrical wort,m.ly i%aur unless the liecowe pit)%ides pruul(it liablilly irtxulanre inChi,ling"cutnplelCJJ crprralion-coverage or its subsl,nrtral equkale m. 'I hr undersigned certilies that such coverage is in force,and has exhibited proal'afsame to the permit is suing office. (' EVD(ONF: 1NSUKANC'I: Q BOND Q OTIIFk (] (s11C.•il'v:) I res7ffy,render Ilie pains and penallfez of perjury,anal Ilse iu%nrntation all this application is true and ramplele. FIRM NAME: SOLARCITY CORPORATION LIC. NO.: 1136 MR Licensee: Matthew T. MarkhamSignature _ . f ,,i LIC.NO.: 1136 MR - Ul adrllirable,rat.•r "t Ad-MIll 1.sit for lir rias,menden line./ Bus.1'el.Nu.•774-258-8181) Address: 24 St. Martin Drive(8uildinp 21 Unit 111 Marlborough MA 01752 All.'fel.No.:774-258-0505 •I'er M.6.1..e. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic. Na. OWNER'S INSURANCE WAIVER: 1 ant aware that the Licensee daces not hart,(Ile liability insurance coverage itunnally required by law. fly my signature below,I hereby waive ihix requirement. I am the(check line)[I owner owner's a cut. Owner/Agent Signature _ Telephone No. Pr.RAIIT T'F.F.. S lie .1 J1fnrt of(:oasararr Affairs d Oarinen Reguistion '81 "021:IMPROVEMENT CONTRACTOR rs1311atK,t► asesrl Type Ezplrntwn 31 ml!i Supplement SOLARCIYY CORPORATION MATTHEW MARKHAM 24 ST MARTIN STREET 13LD ZUNI % ••,.: __ IUALSOROUGH.MA 01732 l laderscerttrr} QMMONVV Al1 t 4FJMA.VSACHur�r1TS E L.ECIRICIANS ISSUES THE FOLLOWING LICENSf AS A- REGISTERED MASTER ELECTRICIAN N \r ' SOLARCITY CORPORATION MATTHEW T MARNHAM r' t4 SAINT MARTIN DR BLDG 2 UNIT 11 MARLBOROUGH MA 01752-3060 f . t The Commonwealth of Massachusetts } Department of Industrial Accidents Once of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(BusinesfOrganizationtindividual): SOIARCITY CORP Address:3055 CLEARVIEW WAY Cit lstatc/Li :SAN MATEO,CA 94402 Phone#:888-765-2489 Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with 5000 -" 4. ❑ I am a general contractor and employees(full and/or part-time).* have hired the sub-contractors 6 El New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y9. ❑Building addition (No workers' comp. insurance comp. insurance; required.] 3. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work offs ers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGI, 12.[] Roof repairs insurance required.] c. 152,§1(4),and we have no employees.INo workers' 13.®Other /FV _ comp.insurance required.] "Any applicant that chects box It I must also fill ont the section talon•showing their workers'etmrpensation policy inrarmation. t Ilomeowners who submit this affidavit indicatingtltey are doing all work and then hite outside contraetots must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the suh•eontractots and state whether or not those entities have employers. Irthe sub•catttractors have employees.they must providetheir workers'comp.policy number. I Ao an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site Information. Insurance Company Namo LIBERTY MUTUAL INSURANCE COMPANY Policy#or Self-ins. Lic. it:WA7-66D-066265-024 - Expiration Date:09/01/2015 Job Site Address:J3(S CD_C` 5�- City/Statelzip:_&h,rf ' er Attach a copy of the workers'compensation policy declaration Inge(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may he forwarded to the Office of Investigations of the IIIA for insurance coverage verification. I do hereby certify nnder the palms and enaldes of perjrrry#hot lite information provided above is true and correct. S.t l tri r ,[„_• _ 141t v 'hone H: Offleial use anly. Do not write in this area,lobe completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/1'own Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: A�D® CERTIFICATE OF LIABILITY INSURANCE DATE ' ' ► THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCERT NAME: MARSH RISK d INSURANCE SERVICES PHONE I FAX 345 CALIFORNIA STREET,SUITE 1300 (AIC.N0.Em1: __ _- I(AIC,Ne): CALIFORNIA LICENSE NO.0437153 E SAN FRANCISCO,CA 94104 ADDRESS: INSURERS)AFFORDING COVERAGE + NAIC a 998301-STNO-GAWUE•14-15 INSURER A: MSN Fwe WWMM Carnpany116566 INSURED INSURER 9:1"N>stxance 11142101 Ph(650)963.5100 Sol-votf CorporatXXl INSURER C:NIA 1NIA 3055 CieaMew Way INSURER O: San Mateo.CA 94402 LNSURER'E: INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-002.44026402 REVISION NUMBER:4 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VVITH 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. IiSR' ADDL SUER; POUCY EFF POLICY EXP TYPE OF INSURANCE ! POLICY NUMBER i MMDD I MMODIVYYY LIMITS A 'GENERAL UOMUTY A ; TB2661066265014 09DU2011 09101!2015 EACH OCCURRENCE f 1.000M 000 X COMMERCIAL GENERAL LIABILITY I PREMISES(EaocPfr1m)DAMAGE TORENTED 100,f [LAMAS MADE X I OCCUR I IAEO EXP(Anyn0 aporsan) f 10000 i f PERSONAL a ADV INJURY O S 1.000000 (i GENERAL AGGREGATE S 2'000.ODO i GEN'L AGGREGATE LIMIT APPLIES PER, I PRODUCTS•COMPIOP AGO'f 2.000.000 X I POLICY I X PRO i LOC Deductible f 25AW A AUTOMOBILE UABIUTY AS2.661-066265.OU 09.101/2014 099112015 �� Iaa tleMl INGLE LIMIT 3 100,000 X ANY AUTO 4 BODILY INJURY(Per Person) f 1 ALL OWNED j SCIlLOULEll BODILY WJURY(Perwchdem)t f +AUTOS X c NON OWNED I I PROPERTY DAMAGE X }f I141REDAUTOS AUTOS (per amowl) X .Phys.Damage i COMPICOLL DEO: s y1,0001siA00 UMBRELLA UAe iiI OCCUR ` f EACH OCCURRENCE f EXCESS UAB I CLAIMS.MADE' 4 I t AGGREGATE f DEC RETENTION f B WORKERS COMPENSATION WA7.66D-M265-024 !0411112014 109/0112015 1 X WCSTATU- OTH.I AND EMPLOYERS'LIABILITY Y r N } I :TORY LIMITS. . ER i B yWCi-66i.M265-034(WI) 09x0112014 090112015 1.�0.0� ANY PROPRIETORIPARTNFRIEXECUIIVE E L EACHACC�ENT i OFFoCERM.EMSER EXCLUDED r N ;NIA. 1 B (Myyaeenda M in NH) 'INC DEDUCTIBLE:5350.000' t E I DISEASE-EA EMPLOYE[,f DES[desenbe m3ei OF OPERATIONS be'�w E I DISEASE POLICY LIMIT f 1 { DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ANach ACORD 101,AddIU0081 Remark,Sehodulc N more specs U required) (Wde1m 0'IOwamm r CERTIFICATE HOLDER CANCELLATION SolarCdy Cwpw&m SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3055CIeaMmWay THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN San Mateo.CA 94402 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE or Marsh Risk 9 Insurance Services Charles Marmoteio 01900.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1 ABBREVIATIONS ELECTRICAL NOTES JURISDICTION NOTES j -A AMPERE 1. THIS SYSTEM IS GRID—INTER11ED VIA A AC ALTERNATING CURRENT UL—LISTED POWER—CONDITIONING INVERTER. BLDG BUILDING 2. THIS SYSTEM HAS NO BATTERIES, NO UPS. CONC CONCRETE 3. A NATIONALLY—RECOGNIZED TESTING DC DIRECT CURRENT LABORATORY SHALL LIST ALL EQUIPMENT IN EGC EQUIPMENT GROUNDING CONDUCTOR COMPLIANCE WITH ART. 110.3. (E) EXISTING 4. WHERE ALL TERMINALS OF THE DISCONNECTING EMT ELECTRICAL METALLIC TUBING MEANS MAY BE ENERGIZED IN THE OPEN POSITION, FSB FIRE SET—BACK A SIGN WILL BE PROVIDED WARNING OF THE GALV GALVANIZED HAZARDS PER ART. 690.17. GEC GROUNDING ELECTRODE CONDUCTOR 5. EACH UNGROUNDED CONDUCTOR OF THE GND GROUND MULTIWIRE BRANCH CIRCUIT WILL BE IDENTIFIED BY HDG HOT DIPPED GALVANIZED PHASE AND SYSTEM PER ART. 210.5. I CURRENT 6. CIRCUITS OVER 250V TO GROUND SHALL Imp CURRENT AT MAX POWER _ COMPLY WITH ART. 250.97, 250.92(B). Isc SHORT CIRCUIT CURRENT 7. DC CONDUCTORS EITHER DO NOT ENTER kVA KILOVOLT AMPERE BUILDING OR ARE RUN IN METALLIC RACEWAYS OR kW KILOWATT ENCLOSURES TO THE FIRST ACCESSIBLE DC LBW LOAD BEARING WALL DISCONNECTING MEANS PER'ART. 690.31(E). MIN MINIMUM 8. ALL WIRES SHALL BE PROVIDED WITH STRAIN (N) NEW RELIEF AT ALL ENTRY INTO BOXES AS REQUIRED BY NEUT NEUTRAL UL LISTING. NTS NOT TO SCALE 9. MODULE FRAMES SHALL BE GROUNDED AT THE OC ON CENTER UL—LISTED LOCATION PROVIDED BY THE PL PROPERTY LINE MANUFACTURER USING UL LISTED GROUNDING POI POINT OF INTERCONNECTION HARDWARE. PV PHOTOVOLTAIC 10. MODULE FRAMES, RAIL, AND POSTS SHALL BE SCH SCHEDULE BONDED WITH EQUIPMENT GROUND CONDUCTORS. S STAINLESS STEEL STC STANDARD TESTING CONDITIONS TYP TYPICAL UPS UNINTERRUPTIBLE POWER SUPPLY V VOLT Vmp VOLTAGE AT MAX POWER VICINITY MAP INDEX Voc VOLTAGE AT OPEN CIRCUIT i W WATT 3R NEMA 3R, RAINTIGHT PV1 COVER SHEET PV2 SITE PLAN PV3 STRUCTURAL VIEWS PV4 UPLIFT CALCULATIONS LICENSE GENERAL NOTES PV5 THREE LINE DIAGRAM Cutsheets Attached GEN #168572 1. ALL WORK TO BE DONE TO THE 8TH EDITION ELEC 1136 MR OF THE MA STATE BUILDING CODE. 2. ALL ELECTRICAL WORK SHALL COMPLY WITH THE 2014 NATIONAL ELECTRIC CODE INCLUDING MASSACHUSETTS AMENDMENTS. MODULE GROUNDING METHOD: ZEP SOLAR AHJ: North Andover REV BY DATE COMMENTS • REV A NAME DATE COMMENTS UTILITY: National Grid USA (Massachusetts Electric) L W &I RJAIV CONFIDENTIAL– THE INFORMATION HEREIN JOB NUMBER: JB-01 81253 00 PREMISE OWNER: DESCMPRON: DESIGN: \� CONTAINED SHALL NOT E USED FOR THE LEAVITT, CLIFFORD LEAVITT RESIDENCE Kyle Pecevich SolareCity. BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: •� NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Com Mount Type C 13 GLENWOOD ST 4.845 KW PV ARRAY PART IZ OTHERS OUTSIDE THE RECIPIENT'S MODULEP NORTH ANDOVER MA 01845 ORGANIZATION, EXCEPT IN CONNECTION WITH r THE SALE AND USE OF THE RESPECTIVE (19) CANADIAN SOLAR # CS6P-255PX za St- Martin Dire, Building z,unit 11 Marlbor SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: PAGE NAME: SHEET: REV: DATE T. (650)638-1026 F: (650)tn38-1029 PERMISSION OF SOLARCITY INC. SOLAREDGE SE3800A—USOOOSNR2 (978) 683-3008 COVER SHEET PV 1 11/13/2014 (888)-SOL-CITY(7e5-2489) www.8dorcitycom PITCH: 35 ARRAY PITCH:35 MP1 AZIMUTH:214 ARRAY AZIMUTH: 214 MATERIAL: Comp Shingle STORY: 2 Stories �tNOF YOO JIN K cA No.4 Digitally Jin Kim Date: 201 .11.13 14:23:07 -08'00' ® J MP1 ® B Front Of House LEGEND O (E) UTILITY METER & WARNING LABEL INVERTER W/ INTEGRATED DC DISCO & WARNING LABELS L` D ' AC © DC DISCONNECT & WARNING LABELS o © © AC DISCONNECT & WARNING LABELS O DC JUNCTION/COMBINER BOX & LABELS DISTRIBUTION PANEL & LABELS c^j G-) Lc LOAD CENTER & WARNING LABELS CD 1 (E) DRIVEWAY o O DEDICATED PV SYSTEM METER Q Q STANDOFF LOCATIONS CONDUIT RUN ON EXTERIOR --- CONDUIT RUN ON INTERIOR GATE/FENCE Q HEAT PRODUCING VENTS ARE RED r, It 11 INTERIOR EQUIPMENT IS DASHED L="J SITE PLAN Scale: 1/8" = 1' 0 1' 8' 16' S JB-01 81253 0 0 PREMISE OWNER: DESCRIPTION: DESIGN CONAL— THE INFORMATION HEREIN JOB NUMBER: .,,SOIarClty. CONTAINED SHALL NOT BE USED FOR THE LEAVITT, CLIFFORD LEAVITT RESIDENCE Kyle Pecevich BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: �. NOR SHALL IT BE DISCLOSED IN MOLE OR IN Comp Mount Type C 13 GLENWOOD ST 4.845 KW PV ARRAY PART TO OTHERS OUTSIDE THE RECIPIENTS MODULES. NORTH ANDOVER MA 01845 ORGANIZATION.THE SALE AND USE OF INEXCEPT CONNECTION RES EC71VE�TM (19) CANADIAN SOLAR # CS6P-255PX ' 24 Si Martin w1b D gh, MA 01g 2 Unit 11 SOLARC(TY EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME SHEET: REN DATE Marlbwou MA 01752 INVERTER: T: (650)638-1028 F: (650) 638-1029 PERMISSION OF SOLARCITY INC ISOLAREDGE SE3800A—USOOOSNR2 (978) 683-3008 SITE PLAN PV 2 11/13/2014 (888)-SOL-CITY(765-2489) www.selo«Ity.corn i 1 { • (E) 1-1/2"x3-1/2" PV MODULE 5/16" BOLT WITH LOCK INSTALLATION ORDER & FENDER WASHERS LOCATE RAFTER, MARK HOLE ZEP LEVELING FOOT (1) LOCATION, AND DRILL PILOT S1 ZEP ARRAY SKIRT (6) HOLE. (4) (2) SEAL PILOT HOLE WITH POLYURETHANE SEALANT. ZEP COMP MOUNT C ZEP FLASHING C (3) (3) INSERT FLASHING. (E) LBW (E) COMP. SHINGLE (1) (4) PLACE MOUNT. SIDE VIEW OF MP1 NTS (E) ROOF DECKING (2) (5) INSTALL LAG BOLT WITH 5/16" DIA STAINLESS (5) SEALING WASHER. MP1 X-SPACING X-CANTILEVER Y-SPACING I Y-CANTILEVER NOTES STEEL LAG BOLT LOWEST MODULE SUBSEQUENT MODULES INSTALL LEVELING FOOT WITH LANDSCAPE 72" (2-1/2' EMBED, MIN) 24" STAGGERED WITH SEALING WASHER C(6) BOLT & WASHERS. PORTRAIT 1 4$" 1 20° ROOF AZI 214 PITCH 35 2"X6"@ 24"OC STA N D O F F RAFTER ARRAYAZI 214 PITCH 35 STORIES: 2 E RAFTER C.I. 2"x6"@24"OC Comp Shingle C i OF Y00 JIN K VI y No.4 Digitally oo Jin Kim Date: 2014.11.13 14:23:13 -08'00' CONFIDENTIAL— THE INFORMATION HEREIN FMOWDULES, R: PREMLSE OWNER: DESCRIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THEJB-0181253 00 LEAVITT, CLIFFORD LEAVITT RESIDENCE Kyle Pecevich SolarGety. BENEFIT OF ANYONE EXCEPT SOLARCITY INC., SYSTEM ���+ NOR SHALL IT BE DISCLOSED IN WHOLE OR INMount Type C 13 GLENWOOD ST 4.845 KW PV ARRAY PART TO OTHERS OUTSIDE THE RECIPIENT'S �' NORTH ANDOVER MA 01845 ORGANIZATION, EXCEPT IN CONNECTION N7TH ,THE SALE AND USE OF THE RESPECTIVE ANADIAN SOLAR # CS6P-255PX24 St. MartM Drive, BuIlding 2, Unit 11 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME: SHEET` REV. DATE: T: (650)Marlborou638-1028'F:A(65752 636-1029 PERMISSION OF SOLARCITY INC. EDGE SE380OA—USOOOSNR2 (978) 683-3008 STRUCTURAL VIEWS PV 3 11/13/2014 (efi6)-SCI-CITY(265-2469) www.soIarcnY.com UPLIFT CALCULATIONS SEE SEPARATE PACKET FOR STRUCTURAL CALCULATIONS. JB-01 81253 00 PREMISE OWNER: DESCRIPTION: DESIGN: — THE INFORMATION HEREIN JOB NUMBERe Pecevich ��solarCity.CONTAINED SHALL NOT BE USED FOR THE LEAVITT CLIFFORD LEAVITT RESIDENCE KYIBENEFIT OF ANYONE EXCEPT SOLARCITY INC.. MOUNTING SYSTEM �. NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 13 GLENWOOD ST 4.845 KW PV ARRAY PART TO OTHERS OUTSIDE THE RECIPIENT'S MODULES NORTH ANDOVER MA 01845 ORGANIZATION, EXCEPT IN CONNECTION WITH 24 St. Martin Drive, Building 2, Unit 11 THE SALE AND USE OF THE RESPECTIVE (19) CANADIAN SOLAR # CS6P-255PX PAGE NAME: SHEET: REN: DATE: Marlborough,MA 01752 SOLARCFTY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: T: (650)638-1028 F: (650)638-1029 PERMISSION OF sotARgTY INC SOLAREDGE SE380OA—USOOOSNR2 (978) 683-3008 UPLIFT CALCULATIONS PV 4 11/13/2014 (BBBrsa-CITY(765-2489) www.solarcity.corn GROUND SPECS MAIN PANEL SPECS GENERAL NOTES INVERTER SPECS MODULE SPECS LICENSE -BOND (N) #8 GEC TO TWO (N) GROUND Panel Number:LC120D5 - Crouse-Hin s Inv 1: DC Ungrounded ! # _ GEN #168572 ODS AT PANEL WITH IRREVERSIBLE CRIMP Meter Number:12802552 INV 1 -(1)Inverter; 3800WE 240V, 97 57o;w/UnifedBD LABEL: and ZB,RGM,AFCI -(19)CPVAModule 0255W," 234 3W2PTCX Block Frame, MC4, ZEP Enabled ELEC 1136 MR Overhead Service Entrance INV 2 Voc: 37.4 Vpmax: 30.2 INV 3 Isc AND Imp ARE SHOWN IN THE DC STRINGS IDENTIFIER �E 100A MAIN SERVICE PANEL (E) 125A SUB PANEL E� 10OA/2P MAIN CIRCUIT BREAKER (E) WIRING MAIN SERVICE PANEL 50A/2P CUTLER-HAMMER Inverter 1 (E) LOADS Disconnect 3 SOLAREDGE 100A/2P ^ �• - NR2 (E) LOADS 2�4P aB ::�: • zao Ll v SolarCity • /1 L2 N A 50A/2P N ____ GND BGC/ DC+ 2 1 DC+ A r— GND =_ — ------------------------- — GEC ---TN DG Dc- MP 1: 1x19 I ♦ L B 1 GND EGC —————————————————————— ———,———— —— EGC—————————————————_ j I I I I N 1 I I I I 1 p EGC I I Z ——— — I 1 � I 1 — I I To 120/240V SINGLE PHASE 1 1 UTILITY SERVICE I 1 1 I I I PHOTO VOLTAIC SYSTEM EQUIPPED WITH RAPID SHUTDOWN Voc* = MAX VOC AT MIN TEMP POI (1)MURRAY/MP220 PV BACKFEED BREAKER B (I)CUTLER—HAMMER l DG221URB /� A (1)SolarCitY 4 STRING JUNCTION BOX D Breaker, 20A/2P, 2 Spaces Disconnect; 30A, 24OVac, Non—Fusible, NEMA 3R A 2x2 SiR�GS, UNFUSED, GROUNDED —(2)Ground Rod; 5/8"x 8', Copper —0)CUTLER—�IAMMER�DG03ONB Ground/►reutrai it; 30A, General Duty(DG) PV (19)SOLAREDGE X300-2NA4AZS PowerBox Optimizer, 30OW, H4, DC to DC, ZEP nd (1)AWG #6, Solid Bare Copper —(1)Ground Rod; 5/8" x 8', Copper (N) ARRAY GROUND PER 690.47(D). NOTE: PER EXCEPTION NO. 2, ADDITIONAL ELECTRODE MAY NOT BE REQUIRED DEPENDING ON LOCATION OF (E) ELECTRODE RF 1 AWG g10, THWN-2, Black 1 AWG/10, THWN-2, Black Voc* =500 VDC Isc =15 ADC (2)AWG f10;PV WIRE, Black Voc* =500 VDC Isc =15 ADC O sT(1)AWG#10, THWN-2, Red O (1)AWG #10, THWN-2, Red Vmp =350 VDC Imp=13.66 ADC O IoH(1)AWG J6, Solid Bare Copper ECC Vmp =350 VDC Imp=13.66 ADC ISL (I)AWG #10, THWN-2, White NEUTRAL Vmp =240 VAC Imp=15.83 AAC (1)AWG /10, TIiYMI-2,.Green. . EGC. , . .-(1)Conduit_Kit;.3/4'.EMT 11�JJ . . . . . . .70 AYIG#8,.TH_WN72,.Green . . EGC/GEC-0)Conduit,Kit:.3/47.EM7. . . . . . . . . . CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER: PREMISE OWNER: DESCRIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THE JB-0181253 0 0 Jit, BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SnTEM: LEAVITT, CLIFFORD LEAVITT RESIDENCE Kyle Pecevich �_ .SO�a�C■�ty. NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Com Mount Type C 13 GLENWOOD ST 4.845 KW PV ARRAY ►� PART TO OTHERS OUTSIDE THE RECIPIENTS Moout>x NORTH ANDOVER MA 01845 ORGANIZATION, EXCEPT IN CONNECTION VWTH 24 St. Martin Drive, Building 2,Unit 11 THE SALE AND USE OF THE RESPECTIVE (19) CANADIAN SOLAR # CS6P-255PX SHS: REV DATE. Marlborough,MA 01752 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: PAGE NAME T: (650)638-1028 F: (650)638-1029 PERMISSION OF SOLARCITY INC. SOLAREDGE # SE380OA-USOOOSNR2 (978) 683-3008 THREE LINE DIAGRAM PV 5 11/13/2014 (8m)-sat.-CITY(765-2489) www.solarcitycom Label Label WARNING:PHOTOVOLTAIC POUVER SOURCE - Code: WARNING Code:Location: WARNING •,_Location: NEC 690.31.G.3 ELECTRIC SHOCK HAZARDNEC .•1 ELECTRIC SHOCK HAZARD 690.35(F) DO NOT TOUCH TERMINALS THE DC CONDUCTORS OF THIS Label • • TERMINALS ON BOTH LINE AND PHOTOVOLTAIC SYSTEM ARETO BE USED WHEN PHOTOVOINVERTERIS LTAIC DC LOADN THE OPEN POSiI IONIZED P' MAY BE ENDRG ZED DISCONNECT - Code:; � UNGROUNDED NEC Label Location: Label Location: WARNING • _ NIAXIMUM POWER- A INVERTER OUTPUT POINT CURRENT(Imp)_ Per . CONNECTION MAXIMUM POWER- VNEC 690.53 DO NOT RELOCATE POINT VOLTAGE.(Vmp} THIS OVERCURRENT MAXIMUM SYSTEM V DEVICE VOLTAGE(Voc) SHORT-CIRCUIT A CURRENT(Isc) Label • • PHOTOVOLTAIC POINT OF Label • • INTERCONNECTIONPer Code: WARNING WARNING: ELECTRIC SHOCK NEC 1 690.54 Per HAZARD. DO NOT TOUCH Code: TERMINALS.TERMINALS ON ELECTRICAL SHOCK HAZARD BOTH THE LINE AND LOAD SIDE DO NOT TOUCH TERMINALS 690.17(4) MAY BE ENERGIZED IN THE OPEN TERMINALS ON BOTH LINE AND POSITION. FOR SERVICE LOAD SIDES MAY BE ENERGIZED DE-ENERGIZE BOTH SOURCE IN THE OPEN POSITION AND MAIN BREAKER. DC VOLTAGE IS PV POWER SOURCE ALWAYS PRESENT WHEN MAXIMUM AC A SOLAR MODULES ARE OPERATING CURRENT EXPOSED TO SUNLIGHT MAXIMUM AC OPERATING VOLTAGE V Label • • WARNINGLocation: Per ELECTRIC SHOCK HAZARD �.; CAUTION D (PO Code:NEC IF A GROUND FAULT IS INDICATED PHOTOVOLTAIC SYSTEM NORMALLY GROUNDED CIRCUIT IS BACKFED 690.64.13.4 CONDUCTORS MAY BE UNGROUNDED AND ENERGIZED Label • • Label Location: PHOTOVOLTAIC AC CAUTION '_• � DUAL POWER SOURCE odeA A Disconnect DISCONNECT Per Code: PHOTOVOLTAOICSYSTEM 690.64.13.4 Conduit NEC 6.1 - :. (D): Distribution Panel (DC): DC Disconnect (IC): Interior Run Conduit Label Location: (INV): Inverter With Integrated DC Disconnect MAXIMUM AC A Load OPERATING CURRENTPer Code: AC V NEC •1 '• Point of • • OPERATING VOLTAGE - SC :a � � � ••r �• � r � � ■• ■ouu• cup■ Label Setnurnnrunn.murnnrunin r � � � � ' � urn u:• a umnmrrn■■■■uuu�nrninn■ a a W if •wC i i SolarCity SleekMountTM - Comp SolarCity SleekMountTM - Comp The SolarCity SleekMount hardware solution •Utilizes Zep Solar hardware and UL 1703 listed _ Installation Instructions is optimized to achieve superior strength and Zep CompatibleTM modules ; •�� aesthetics while minimizing roof disruption and1� Drill Pilot Hole of Proper Diameter for labor.The elimination of visible rail ends and •Interlock and grounding devices in system UL Fastener Size Per NDS Section 1.1.3.2 mounting clamps, combined with the addition listed to UL 2703 of array trim and a lower profile all contribute •Interlock and Ground Zep ETL listed to UL 1703 Seal pilot hole with roofing sealant to a more visually appealing system.SleekMount as"Grounding and Bonding System" Insert Comp Mount flashing under upper utilizes Zep Compatible TM modules with •Ground Zep UL and ETL listed to UL 467 as layer of shingle strengthened frames that attach directly to grounding device _ ® Place Comp Mount centered Zep Solar standoffs,effectively eliminating the need for rail and reducing the number of •Painted galvanized waterproof flashing upon flashing standoffs required. In addition, composition .Anodized components for corrosion resistance Install lag pursuant to NDS Section 11.1.3 shingles are not required to be cut for this with sealing washer. system, allowing for minimal roof disturbance. •Applicable for vent spanning functions © Secure Leveling Foot to the Comp Mount using machine Screw 70 Place module ® Components © 5/16"Machine Screw © Leveling Foot © Lag Screw ® Comp Mount —� © 0 Comp Mount Flashing D obi ��►1�� �oMPArm •� a -��SolarCity® January 2013 �c�: ON U� LISTED ����SolarCity® January 2013 DMPP e��,d�eesg� CS6P-235/240/245/250/255PX %°r CanadianSolar Black-framed eleak�tilo Electrical Data STC CS6P-235P CS6P-240P CS6P-245P CS6P-250PXCS6P-255PX Temperature Characteristics Nominal Maximum Power(Pmax) 235W 240W 245W 25OW 255W _ _ Optimum Operating Voltage(Vmp) 29.8V 29.9V 30.OV 30.1V 30.2V Pmax -0.43%/•C Optimum Operating Current(Imp) 7.90A 8.03A 8.17A 8.30A 8.43A Temperature Coefficient Voc -0.34%rC Open Circuit Voltage(Voc) 36.9V 37.OV 37.1V 37.2V 37.4V Isc 0.065%rC Black-framed Short Circuit Current(Isc) 8.46A 8.59A 8.74A 8.87A 9.00A Normal Operating Cell Temperature 45±2'C • Module Efficiency 14.61% 1 14.92% 15.23% 15.54% 15.85% Operating Temperature -40°C-+85•C Performance at Low Irradiance 235/240/245/2 50/2 55PX Maximum System Voltage 1000V IEC /600v ul_ Industry leading performance,at low irradiation Maximum Series Fuse Rating 15A environment,+95.5%module efficiency from an Application Classification ClassA irradiance of 1000w/m'to 200w/m' Power Tolerance 0-+5W (AM 1.5,25-C) Next Generation Solar Module Under Standard Test Conditions(STC)of irradiance of 1000W/m2,spectrum AM 1.5and cell temperature of 25'C NewEdge,the next generation module designed for multiple -- -- - -- Engineering Drawings NOCT- CS6P-235P CS6P-240PX CS6P-245PX CS6P-250PX CS6P-255PX types of mounting systems,offers customers the added Nominal Maximum Power(Pmax) 170W 174W 178W 181W 185W value of minimal system costs,aesthetic seamless Optimum Operating Voltage(Vmp)_27.2V 27.3V 27AV 27.5V 27.5V appearance,auto groundingand theft resistance. Optimum Operating Current(Imp) 6.27A 6.38A 6.49A 6.60A 6.71A Open Circuit Voltage(Voc) 33.9V 34.OV 34.1 V 34.2V 34AV The black-framed CS6P-PX is a robust 60 cell solar module Short circuit current(Isc) _ 6.86A 6.96A 7.08A 7.19A 7.29A incorporating the groundbreaking Zep compatible frame. Under Normal operating Cell Temperature,Irradiance of 800 W/m',spectrum AM 1.5,ambient temperature 20'C. The specially designed frame allows for rail-free fast wind speed 1 m/s installation with the industry's most reliable grounding Mechanical Data system.The module uses high efficiency poly-crystalline Cell Type Poly-crystalline 156 x 156mm,2 or 3 Busbars Key Features silicon cells laminated with a white back sheet and framed Cell Arrangement 60(6 x 10) with black anodized aluminum.The black-framed CS6P-PX Dimensions 1638 x 982 x 40mm(64.5 x 38.7 x 1.57in) • Quick and easy to install - dramatically is the perfect choice for customers who are looking for a high Weight 20.5kg(45.2 lbs) reduces installation time quality aesthetic module with lowest system cost. Front Cover 3.2mm Tempered glass Frame Material Anodized aluminium alloy • Lower system costs - can cut rooftopJ-BOx IP65,3 diodes installation costs in half Best Quality • 235 quality control points in module production Cable 4mm'(IEC)/12AWG(UL),1000mm Connectors MC4 or MC4 Comparable • Aesthetic seamless appearance - low profile EL screening to eliminate product defects Standard Packaging(Modules per Pallet) zapcs with auto leveling and alignment Current binning to improve system performance Module Pieces per container(40 ft.Container) 672pcs(40'HQ) • Accredited Salt mist resistant ---- ----- - --------- • Built-in hyper-bonded grounding system - if it's I-V Curves (CS6P-255PX) mounted,it's grounded Best Warranty Insurance i • Theft resistant hardware • 25 years worldwide coverage 0 1 Section A-A • 100/o warranty term coverage _ _-_-_ I _____ _ • Ultra-low parts count - 3 parts for the mounting • Providing third party bankruptcy rights 35.0 and grounding system • Non-cancellable - I • Industry first comprehensive warranty insurance by Immediate coverage 1 4 ' AM Best rated leading insurance companies in the • Insured by 3 world top insurance companies o , world - -; -- Comprehensive Certificates � ' - • Industry leading plus only power tolerance:0-+5W • IEC 61215,IEC 61730, IEC61701 ED2,UL1703, 15 .. • Backward compatibility with all standard rooftop and CEC Listed,CE and MCS ground mounting systems • IS09001:2008:Quality Management System • ISO/TS16949:2009:The automotive quality •Speciflcalions Included in thisdatasheet are subject to change without prior notice. • Backed By Our New 10/25 Linear Power Warranty management system Plus our added 25 year insurance coverage • IS014001:2004:Standards for Environmental About Canadian Solar management system Canadian Solar Inc. Is one of the world's largest solar Canadian Solar was founded in Canada in 2001 and was 1000% ,4 • QC080000HSPM:TheCertificationfor companies. As a leading vertically-integrated successfully listed on NASDAQ Exchange (symbol: CSIQ) in dded Value From Hazardous Substances Regulations manufacturer of ingots,wafers,cells,solar modules and November 2006. Canadian Solar has module manufacturing sox M Warranty solar systems, Canadian Solar delivers solar power capacity of 2.05GW and cell manufacturing capacity of 1.3GW. • OHSAS 18001:2007 International standards for products of uncompromising quality to worldwide sov occupational health and safety customers. Canadian Solar's world class team of °v • REACH Compliance professionals works closely with our customers to 5 10 15 20 25 P provide them with solutions for all their solar needs. Headquarters • •10 year product warranty on materials and workmanshipFax:+1 519 837 2550 $p coni _�E•'" Tel:+1 519 837 1881 •25 year linear power output warranty www.canadiansolar.com EN-Rev 10.17 Copyright 0 2012 can ad Ian Soler Inc. i solar.=ee solar=@@SolarEdge Power Optimizer Module Add-On for North America P300 / P350 / P400 SolarEdge Power Optimizer P300 P350 P400 _F Module Add-On For North America (for6D PV (for 72-cell PV (for 'cell PV modules) modules) modules) P300 / P350 / P400 • INPUT Rated Input DC Power"I 300 350 400 W Absolute Maximum In ut Volta a Voc at lowest tem erature 48 60 80 Vdc ............................................................................................................................................................................ MPPT Operating Range 8-48 8-60 8-80 Vdc ............................................................................................................................................................................ • Maximum Short Circuit Current(Isc) SO Adc Maximum DC Input Current 12.5 - .............................................................................................................................................................................. Maximum Efficiency Weighted Efficiency 98.8 % .............................................................................................................................................................................. Overvoltage Category 11 OUTPUT DURING OPERATION(POWER OPTIMIZER CONNECTED TO OPERATING INVERTER) _ Maximum Output Curren[ 15 Adc Maximum Output Voltage 60 Vdc • OUTPUT DURING STANDBY(POWER OPTIMIZER DISCONNECTED FROM INVERTER OR INVERTER OFF) Safety Output Voltage per Power Optimizer 1 Vdc !A� STANDARD COMPLIANCE EMC ................... .......... .................................................. CPa.r.t.15 Pass 4E..C.6..1.0..0.0..-.6.-.3. .......................... SafetY.........................................................................................IEC62109-1(class II safety)..UL1741....................... RoHS Yes INSTALLATION SPECIFICATIONS Maximum Allowed System Voltage.........................................................................1000 Vdc Dimensions(W x L x H) 141x 212 x 40.5/5.55 x 8.34 x 1.59 mm/in .................................................................................................................................................................. ... Weight(inducting cables) 95012.1 gr/Ib ..................................................................................................................... ................................................... Input Connector MC4/Amphenol/Tyco ..................................... ...... ..... .. .. ... .. ... .. .... ` Output Wire Type/Connector Double Insulated Amphenol �� Output Wire Length 0;95/30 I 12/3.9 m/k .. .. ................................ .. ............ .. .... .. ..... ... ........... ..... - 0 erafing Temperature Range............................................................. ....-0l)-.+85/,'40_+185...............................Y/�. Protection Rafing IP65/NEMA4 - .............................................................................................................................................................................. ..Relative Humidity....................................................... ........ . . 0-100 % .................... .. .................................................................................... Rated M power of the module.Module of up co.5%power coleance allowed. PV SYSTEM DESIGN USING A SOLAREDGE SINGLE PHASE THREE PHASE THREE PHASE INVERTER 208V 480V PV power Optimization at the module-level Minimum String Length(Power Optimizers) 8 10 18 ....................................................................................................................................................................... — Up to 25%more energy Maximum String Length(Power Optimizers) 25 25 50 .................................................................................................... Maximum Power per String 5250 6000 12750 W — Superior efficiency(99.5%) ..... .............. .............................. ..... .... . ...... Parallel Strings of Different Lengths or Orientations Yes ....... .. ....... .... .. .. .. .... ...... .. ....... ...... ... ....... .... — Mitigates a types of module mismatch losses,from manufacturing tolerance to partial shading ""' — Flexible system design for maximum space utilization — Fast installation with a single bolt — Next generation maintenance with module-level monitoring — Module-level voltage shutdown for installer and firefighter safety USA - GERMANY - ITALY - FRANCE - JAPAN - CHINA - ISRAEL - AUSTRALIA www.solaredge.us i solar a r=9s Single Phase Inverters for North America soIar _ SE3000A-US/SE380OA-US/SE5000A-US/SE6000A-US/ SE760OA-US/SE10000A-US/SE1140OA-US SE3000A-US I SE380OA-US I SESOOOA-US I SE6000A-US I SE760OA-US I SE10000A-US I SE1140OA-US OUTPUT 9980 @ 208V S o I a r E d g e Single Phase Inverters • Nominal AC Power Output 3000 3800 5000 6000 7600 10000 @240V 11400 VA ............... .................. ........... 5400 @ 208V 10800 @ 208V For North America Max AC Power Output 3300 4150 6000 8350 12000 VA _ 5450 @240V 10950 @240V AC Output Voltage Min.-Nom.-Max.* _ SE3000A-US/SE380OA-US/SE5000A-US/SE6000A-US/ 183-208-229 Vac . ......................................... ................ ............... ................. ................ ................ .................. .................. ........... AC Output Voltage Min.-Nom.-Max.* � � � � � v/ � SE760OA-US/SE1000OA-US/ SE1140OA-US 211-240-264Vac AC Frequency Min.-Nom.:Max."....... ................ ... 59.3-60-60.5(with Hl country setting -60.:60.5)............. ................ .Hz,... Max.Continuous output Current- - 12 5 I 16.- 25 I .32. .--. ...42 @ 240V... ....,.47.5 A GFDI 1A ........................................................... ..... ..... ` Utility Monitoring,Islanding Protection,Country Configurable Yes -`�w e rfe�`•.. Thresholds INPUT 12 Recommended Max.DC Power** .leafs r (STC) 3750 4750 6250 7500 9500 12400 14250 W .................................. ................ ............... ................. ................ ................ .................. ................ ......... �, �`•,Tr' Transformer-Iess,Un groundedYes .. ..... .............. ....................................................................................................................... . Max.Input Voltage .........................................................500 Vdc.... Nom.DC Input Voltage 325 @ 208V/350 @ 240V Vdc .............. ......... ................ ........... 16.5 @ 208V ........... a Max.Input Current*'• 9.5 13 18 23 34.5 Adc I...............I.......@ 240V I...... � 15.5 30.5 @ 240V Max.lnputShort Circuit Current ..............................30. ........................45.......................... ...Adc.... �4 Reverse-Polarity Protection Yes Ground-.a#1 lsolationDetection,... ............................................................. 600koSensitivity .... .... Maximum Inverter Efficiency 97.7 98.2 98.3 98.3 98 98 98 % .............................. ........ ........... 97.5 @ 208V 97 @ 208V . .. } CEC Weighted Efficiency 97.5 98 98..240V 97.5 97. 97.5 @ 5 97.5 % 1 .. .. _.. Nighttime Power Consumption <2.5 <4 W ADDITIONAL FEATURES Supported Communiration Interfaces RS485,RS232,Ethernet,ZigB.ee(optional) ........................................... ............ ...................................................... ........... -- Revenue Grade Data,ANSI C12.1 Optional STANDARD COMPLIANCE UL3741,UL1699B,UL3998,CSA 22.2 ........... Grid Connection Standards IEEE1547 ......................................... ....... .......................................................................................................................... ........... Emissions FCC part15 class B INSTALLATION SPECIFICATIONS AC output conduit size/AWG range 3/4"minimum/24-6 AWG 3/4"minimum/8-3 AWG .InpuIt. nduitsIze................... ................................................................... ...................................................... ........... DC input conduit size/#of strings/ AWG range3/4"minimum/1-2 strings/24-6 AWG 3/4"minimum/1-2 strings/14-6 AWG Dimensions with AC/DC Safety 30.5x12.5x7% 30.Sz12.5x7.5% ...m%.... 30.Sx12.5x10.5/775x315x260 Switch HxWxD 775 x 315 x 172 775 x 315 x 191 mm Weight with AC/DC Safety Switch...... .......... . ..._......_54.7/24.7....._..... .........__.........,88.4/40:1lb/kg .................,.., . . ,.. Cooling Natural Convection Fans(user replaceable) The best choice for SolarEd a enabled s stems Noise <zs . _ <sD *... ...... ... ...daA.... g y Mm.Max.Operating Temperature 13 to+140/-25 to+60(CAN version**** 40 to+60) 'F/'C - Integrated arc fault protection(Type 1)for NEC 2011 690.11 compliance Range ... ...................... .......................................................................................................................... ........... Protection Rating NEMA 3R Superior efficiency(98%) .................. Su........................................................................................................... ............. ........... •For other reglonal settings please contact SolarEdge pport. Small,lightweight and eas to install on rovided bracket Limited to 125%for locations where the yearly average high temperature is above 77'F/25'C and to 135%for locations where it is below 77'F/25'C. y p For detailed information,refer to htto//wwwsolaredeeus/files/odfs/inverter do ovemIzlne euidexcif — Built-in module-level monitoring •.'A higher current source maybe used;the inverter will limit its Input current to the values stated. g ••CAN P/Ns are eligible for the Ontario FIT and micmnT(micmFlT exc.SE11400A-U5-CAN). — Internet connection through Ethernet or Wireless — Outdoor and indoor installation — Fixed voltage inverter,DC/AC conversion only — Pre-assembled AC/DC Safety Switch for faster installation — Optional—revenue grade data,ANSI C12.1 sunsaEc RoHS USA-GERMANY-ITALY-FRANCE-JAPAN-CHINA-AUSTRALIA-THE NETHERLANDS-ISRAEL www.solaredge.us Date.. . Npit Tly pf „to Abp oTOWN OF NORTH ZANVER PERMIT FOR. GAS ILATION . o �1S SACMUSE�h r / !! This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installationf.'. . . 3%. . . . . . . . . in the buildings of . . ./�4`�.��r-- . . . . . . . . . . . . . . . . . . . at . f. . -6 &. OVO'0,0 . ! yG'. . . . . ., North Andover, Masse Fee.2`s�i 6. . Lic. No..!J:*/ . . . . . . . . . . . . . . . . . . . . . . . . .r�'1 GAS INSPECT& Check# J 6647 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Pzint or Type) �te iv;�j Mass. Date204 Permit# B01 ding Location (!516A.,"Co Owner's Name—ak� Owner Tel# Type of Occupancy-- New 0 Renovation El Replacement o Plan Submitted: Yes 0 No n FIXTURES rAU < C,) W O vs 0 0 U z < 0 z z 0 1-, W 0 z GO 0 0 114 W UJ W W z E- W �3i C4 (9 1-- 2! -J z < W �L. U C z 0 < WLLJ 0w Q C7 0 > 0 SUB- SNIT BASEMENT F I ST FLOOR ! 2"FLOOR 3RD FLOOR 4`FLOOR 5T"FLOOR 6m FLOC - 7T"FLOOR 8T"FLOOR In talling Company Name. Check one: Certificate Address ET-Corporation - 1 15(S 3 EI Partnership 6 Business Telephone Firm r - ' Name of Licensed Plumber or Gas Fitter—.— F1 k4 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. Yes ET--" No F-i It you have checked yes,plE ise indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity 0 Bond C3 OVAINER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement- Check one: Omer 0 Agent 0 Signature of Owner or Owner's Agent 1 hereby certify that all of the details and information I have submitted(or entered)in above application are.true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issue 'i I this application will be in compliance with all ertinent rovisions of the Massachusetts State Gas Code and Chapter 142 of the Genf I S., BY 1:6yye of License: se: lumber Sign 'Licensed ensed Plumber or Gas Fitter Title -Gas fitter 1.�1 j gLicense Number i-J"4 i- - �. ;�.�e City/Town a-Journeyman APPROVED(OFFICE USE ONLY) Location -�-- - v No. Date MORTN TOWN OF NORTH ANDOVER F. 9 41 Certificate of Occupancy $ cMuBuilding/Frame Permit Fee $ st Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 17826 1- /�Uiiding Inspec r i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED SIGNATURE: Buildin Commissioner for of Buildings Date ll—g -e SECTION 1-SITE INFORMATION Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O 13 6(enwcx,� S k moo &---- K)t� A-,ACjpS A46 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 Required Provided Required Provided v 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Flistoric Istrict: Yes NO rn 2.1 Owner of Record C �.� Gi.1 ' 13 G IPnwoy,�, S-I- 2f ,Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: III Name Print Address for Service: Z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES g 3.1 Licensed Construction Supervisor: Not Applicable ZL�— Licensed Construction Supervisor: � License Number Address D Expiration Date ic Signature Telephone r.. 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number rnr Address r 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.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: \ r SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL-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(a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 2,0 L)J-OJ Check Number SECTION 7a OWNER AUTHOIkIZATION TO BE COMPLETED WHEN OWNERS AGE(N�T�OR/ CONTRACTOR APPLIES FOR BUILDING PERMIT as Owmer/Authorized Agent of subject property ' Hereby authorize to act on My b i iatt elative t work authorized by this building permit application. /rr 1 ZZ/bpi Si ature of Wer Date SECTION 76 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 SIZE OF FLOOR TEMBERS 1 2ND 3 SPAN DIN ENSIONS OF SILLS D.RvMNSIONS OF POSTS DEMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 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 Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: lMo�fy�5 (Location of Facility) Signature of Permit Applicant Nuv z� , z goy Date NOTE: Demolition permit from the Town of North Andover must be obtained.. d for this project through the Office of the Building Inspector NORTH 1TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT ° 400 Osgood Street North Andover, Massachusetts 01 845 ?SS�ICHUS�� D.Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: (It 21 ��y JOB LOCATION: i Number Street Address Map/Lot HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS &A City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNAT APPROVAL OF BUILDING OFFICIAL BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NORTIy Town of Andover 0 .1, V" No. h L A E d over, Mass., COCHICHEWICK 7�S RATED i'P5 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System r BUILDING INSPECTOR THIS CERTIFIES THAT ..................a............. ........................................................ ................................................................. Foundation has permission to erect........................................ buildings on ....... .. 01 .......... Rough to be occupied a ....l..... . ........- Chimney . .... .... ..... . .. ................................................::............................................ provided that the perso ccepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the visions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Hermit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .................... r...` .. ..... .................... Service............ BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Final ugh 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. 1 Location lc� �t"V No. a� 8 Date MORTM TOWN OF NORTH ANDOVER F • 1 ow A i Certificate of Occupancy $ • s„ # �ss�cMusE< Building/Frame Permit Fee $ 3 V Foundation Permit Fee $ Other Permit Fee $ TOTAL $ '"� Check # �}J 18599 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APkICATION TO CONSTRUCTREP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING a�t�-" x BUILDING PERMIT NUMBER: DATE ISSUED. 7 SIGNATURE: Building Commissionern r of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O n `f� xQo r r-t 1r��i�Jt� wk 2\ Map Numb Parcel Number /�1 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R 'red Provide Required Provided R red Provided -41.3. Flood Zone Information: v 1.7 water s l.e sew nPPIY M.G.LC.40. 34) zone O��Flood Zona 0 M �8e D�aposal System Public ❑ Private ❑ unkipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT MISToric UIS rlC : es 0 rn 2.1 Owner of Record Name(Print) Address for Service: of Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z Signature Telephone rn SECTION 3-CONSTRUCTION SERVICES QO 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone •— r 3.2 Registered Home Improvement Contractor rNotApplicableCompany Name stration Number �kddress r f Z Signature TelExpiration Date hone G) 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 Description of Proposed Work(check all a ticaMe New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition 0 Other 0 Specify Brief Description of Proposed Work: j d.tr o�S.e 8 )c C 5 g ML ,'r.- SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of 3 © pr a Construction 3 Plumbing Building Permit fee(a) x (b) 4 Mechanical HVAC 3 0 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on -My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date 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 Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvII3ERS oZ`<< IS[ 2ND 3RD SPAN 1 k DDAENSIONS OF SILLS DIMENSIONS OF POSTS DUVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FELLED LAND { IS BUILDING CONNECTED TO NATURAL GAS LINE ti9�s ass MORTGAGE INSPECTION PLANtio�&9so r 13- GLEN WOOD STREET r N0. ANDOVER , MASS . : , SCALE : i =2d JUL.20 2005 S�:�,,,,,� � —TROY . MEDE & ASSOCIATES— REGISTERED LAND SURVEYOR 1455 MAIN ST. TEWKSBURY, -MASS. w 50' i O O O E�•is'Ci NG OW EW�G 12' 50 �L�I�i t�ooD 5�2e�T I HEREBY CERTIFY IID THE TITLE INSUROR , THE LENDING INSTITUTION � , AND OTHERS 2 THAT THE DWELLING IS LOCATED ON THE LOT AS SHOWN 3 ,AND THAT IT DOES CONFORM WITH THE'feWN OF Me-AwDOVE2 ZONING REGULATIONS REGARDING FRONT, SIDE .AND REAR LOT LUNE SETBACKS. o MEDE JR- V) I FURTHER CERTIFY THAT THIS DWELLING IS144'r LOCATED IN THE FEDERAL 36864 FLOOD HAZARD AREA AS SHOWN COMMUNITY PANEL NUMBER : 250095 `r �# 0 DATED : JUL1.15 4983 SIGNATURE NOT VALID UNLESS IN RED INK. REGISTERED PROFESSIONAL LAND SURVEYOR _ DATE: O 7 74 zwr- 2- 3 -THE BASIS FOR THIS LOCATION IS A TAPED'FIELD SURVEY AND IS NOT TO BE USED FOR THE CONSTRUCTION OF FENCES. SHRUBS . LANDSCAPING OF ANY KIND .ADDITIONS .PORCHES.DECKS.OR OTHER ACCESSORY STRUCTURES , A PROPERTY SURVEY UNDER THE STANDARDS GOVERNING CADASTRAL , ORIGINAL OR RETRACE MENT SURVEY IS STRONGLY RECOMMENDED BEFORE ANY CONSTRUCTION OF THE AFORE MENTIONED. NOTE: BOUNDARY INFORMATION TAKEN FROM :kLE.IZ.D. PLAO : 463 . . A FORM U - LOT RELEASE FORM RV-A r�p OL&I" t oS-- INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT l` f.E�",H— PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT(S) STREET�,( nL ST. NUMBER I OFFICIAL USE ONL M N A OF ' N AGENTS: '��OfS�ERVATI160 ADMINISTRATOR DATE APPROVED 12W AIZ,2 DATE REJECTED COMMENTS WhK100 r TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 Jm 4 e , f NORTH TOWN OF NORTH ANDOVER OFFICE OF p BUILDING DEPARTMENT « > 400 Osgood Street North Andover, Massachusetts 01845 -TS US D. Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE:—?// �0 JOB LOCATION: / 6-len o ooZ S�- Nrumberii __ Street Address Map/Lot HOMEOWNER C I�t h��yv G 3_ S39- 2 33 - 0(b(o-2— Name Name Home Phone Work Phone PRESENT MAILING ADDRESS l , 6 Cen tA�, City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL HOARD OF,VITALS 688-9541 CONSERVATION 688-95.30 HFAL 11 68X-9540 PLANNI\G 688-9535 a 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 at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. p The debris will be disposed of in: 10c.02, (Location of Facility) ignature of Permit Applicant Fire Department Sign off: Dumpster Permit Date NORTH Town of 4Andover 0 No. Z Q 8 ' 3 TLA dover, Mass., 9'• o?3- a COCHICHEWICK ' ORATED S BOARD OF HEALTH Food/Kitchen . PERMIT T D Septic System THIS CERTIFIES C r BUILDING INSPECTOR CI IES THAT............��... .. .........................Y................................................................................ .......... Foundation 3 ��+�•••�rdQ . has permission to erect..�.. � . buildings on 1. Rough f .......... ....... .... ................ .... .................................................... to be occu pied as i V� W �� t K Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Law relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. ` PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS t Rough ORO&Ad A .. . .. . . . . . .......... ..... ........ 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. Chi AC) cel CASs-;i 1n1�nt�Ow• N os � _ N g�h Io"w x 1 3, , ►o �,�„ w Sia-f-►�� � ! v�� Seat\ 0 131 �� BUILDING PERMIT o`"�°T b�tio TOWN OF NORTH ANDOVER OyE APPLICATION FOR PLAN EXAMINATION np ey Permit No#: 3_0_9_0k/ Date Received "°.ArED ir. �5 G, gSSACHV`��� Date Issued: ` Z I (A fAIPORTANT: Applicant must complete all items on this page LOCATION i?ZGL&NLJot0 S"T fV. �'�-_t M14' 011 Print PROPERTY OWNER Citi-F- 1- MOMLA Lfc1AM-1 — - Print 100 Year Structure yes nc -- MAP PARCEL:6341 ZONING DISTRICT: Historic District yes Machine Shop Village yes n � i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ;Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition 0 Other D Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: -.i' Vt Y ion i A3 u�IL tZG�wyby.IJ S%,01-Pa?,a4 ! n Identification- Please Type or Print Clearly OWNER: Name: CuifF + Phone: 3-jg-227-d&(oZ Address: Contractor Name: ( Phone: bt_'?_• ;34- Email: Address: -z P41:72_vrw lc)►t rt'+ d 30SI Supervisor's Construction License: 09(040!5 Exp. Date: Home Improvement License: Exp. Date:. 1012,)JZc) - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 10, HOC) o s. FEE: Check No.: Receipt No.: NOTE: Persons contraeting with unregistered contractors do not have access to the ranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature r t COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FERE DEPARTMENT = Temp Dumpster on site yes no ' Located at 124 Main Street _ Fire Department signature/date ._ COMMENTS.. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email 3 _ Date Time Contact Name Doc.Building Pennit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work a Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location �'�' ° J No. 01- 20Date iV7 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 2 `? Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i Check#-4q39 ' r. `Building Inspector` / i NORTH Town of s ndover to h ver, Mass, o .�lo%0 21 Zal �q COCNIC"IWK.1 D S U BOARD OF HEALTH { Food/Kitchen PERMI � L D Septic System THIS CERTIFIES THAT ...4...... 4 r BUILDING INSPECTOR .... . ... .. . Foundation has permission to erect .............. build" son ....... ..... ....... ..... !.`.1 .... ............... Rough to be occupied as ..... .. ... �.�w.. .��..'.'.!!� ..SA1. t. ��.. . .... Chimney provided that the person ac epting this permit shall in every r�ect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to Te Inspection;Alteration and Construction of Buildings in the Town of North Andover. I W& . PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. ���� �� � PERMIT EXPIRES IN 6 MONTHS Final gfp ELECTRICAL INSPECTOR UNLESS CONS TI ' R'ough Rough Service .. ... .. ... . .... ......... ..... .......... Final BUILD NSP CTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final a No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. � I i I Licensed R Insured Member of Boston Better Business Bureau �� oal Page No of Pages BROOKLINE MAL DEN (617) 734.9100COH N (781) 322-0822 ANDOVER ON mokTOLL FREE (978) 475.1145 -646-9111 FULLYLICENSED HOME IMPROVEMENT SPECIALISTS FULLYINSURED 405 WALTHAM,ST.#336,LEXINGTON,MA 02421 PROPOSAL SUBMITTED TO: PHONE DATE CLIFF ,- Mv-i(A L-LAVITT 330l-Zz7-a(a-,Z old z.31lts STREET JOB NAME I� Cu4p tw000 sr CITY,STATE AND ZIP CODE JOB LOCATION mk(LI H /tAP0&14EQ . ARCHITECT DATE OF PLANS --T JOB PHONE Scow l.f;Av�Nt �x+STvvt Sct'F-IT M^,� �"►Fr��,'ifzU-t rti"h �E Fx„rwCa 11'A,YL Ss0V%,Cj MtiAL CUvtZ^(,t To Iry �uwS � _ .Ta.+S?�t.L VtA Yt_ I"r,*t�.11.�l: �Xi�-;zr75 r �'(1-IA*���S A�4��.,.�•� '�+�,,;ir��z�,��cf�,S M-hy�wy�, Lt E�It� ��c�5. �A OHS Vt�y . StO++�!► S�•^twn�t-S. �nS(�+(-�T W'^lt�u�f ►'r�a�rr t�r,�lz S�n� +.c,zcl�i rt.z>:A' # ti E Into LJ(X 5 lnnnat c�-,� AA^ 0�a2 ' I VC i3ropOfSE hereby to furnish material and labor-complete in accordance with above specifications for the sum of: O.JSA,1� tC,,,iZ nc�t- A-041) Icio dollars ($ 110,40()) Payment to be made as follows. t All material is guaranteed to be as specified.Allwork to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications involving Authorized extra 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 covered by Note:This proposaitby'be Workman's Compensation Insurance. withdrawn by us if not accepted within _ days. 2[LLP taurr Of Dropool - The aboverices specifications P �. and conditions are satisfactory and are hereby accepted.You are authorizes to do the work as specified.Payment will be made as outlined above. Signature 4 1. Date of Acceptance ��j ' � P � � �"--` � � Signature Massachusetts Rome Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information CWVF fi MOAACA LGAjtTr Name Company Name 1 Wvvni 9r C�I Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name a o City/Town tate Zip Code Business Address(must include a street address) z?-0" 1, 8r 0 33(P Daytime Phone Everting Phone City/Town State Zip Code 02)4 ZL MailrngAddress(It different from above) Business Phone Federal Employer ID or S.S.Number Home Improvement ContraetorReg.Nomber Expimtiondate Law""hes that most home Improvement caofinetors bavo nvalid registnli—mmle, 4iAJOTI U 1/G �9i,A-7 The Contractor agrees to do the following work for the Homeowner: f 1�Y V N�6•+�Y/ (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary �swrt.. lw_� WffL, S1Dt�, fig- g em►�— wwNov--r5 Required Permits-The following building permits are required Proposed Start and Completion Schedule-The follotiving schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of Date when contractor will begin contracted work. MGL chapter 142A.) Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total stun of: (*) Payments will be made according to the following schedule: $ upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ ` by / / or upon completion of $ by / / or upon completion of $ tO,1304) upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins bi order to meet the completion schedule.(**) $ to be paid for NOTES:(')rncluding all finance charges(*')Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-fs an express warranty being provided by the contractor? ❑Na Wy.(all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor father agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Tmprovement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY B K SPACES!!! Two identical copies of the contract must be completed and signed.One copy should go to the homeowner. copy should be kept by the �ahactor. e ftAAA U�P_Q" on eowner's Signature ntra s S ibiEire, (5-Lit U4tU 0911U II& Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the sanle right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,chapter 1 Homeowner.'s Signatureacto e NO'T'ICE:The signatures of the parties above apply only to the agreement of the artier to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enimieration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have r n inner oineowner rights contact the Consumer Information Hotline listed below). questions about your cos /h C ( ) q Y Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at litto://www.niass.Rov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at bttp://www.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http://db.state.ma.us/homeimprovement/I icenseel ist.asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1-11/22/2010 The Common-wealth of Massae husetts Department ofIndustrialAccidents I Congress street,Suite 100 .s Boon,MA 02114-2 017 <4 vww.mass gov1dia S� 9 kers'Comp ensatioulnmrance.�tdavit:Builders/CoretraelEorsMeetxic zaxxsll'Ibexs. TO BE'yff D QRS`I'H'MPm,IInTMGAUTROMTY. A- 7icant�o£oxmation Please Print Le�iXy Name (Eusiness/()rganizaFionllndividuat): ,3.�1 CAN'T Ry � , Address: 466- cd S y #33U citylstate/zip: t 2,1 Phone#: &17-331-M &O Areyouanemployex?Checkilreap�, opriatehog: Type Of project{TeCjIIIIe[1): 1.FlT am a employer-P&h employees(full audlorpar�fine).* 7. []New coni rction a e oe to eesworkin formein $.�Remo[1e1i1ig etornr atine andh v n y g2.�lam a sole propn p rship mPany capacity_[No workers'comp.insurance required] 9, emolition iniamahomeownerdaiag4workmysel;[No workers'comp_dnsmancaragnired] 10 El$uilqing addition 4. 1 am a homeovmmmawM behiring confractoo to conduct all work onmy property: Iwill ensure fiat all contra. ors eitherhave wo'kers'compeosationins<,ranee orate sole 11:[]Electrical repairs or.additious P1.6brieton withno employees. Plumbing repairs or additions 3.{ Iamageneralconfraofor2nd lbavehiredthe sub-conactarslisted onthe aachedsheat. I3;EjRooixepaiTs �"'.these sub-coutractnrsliave employees andhaveworkars'comp_>nsurancef 6.E]We,areacorporatbm m dies affears have exercised 7leix 49ht of eaemptionperNlGL c. 14.❑Othzr 152,§I(4),andwehave no„es gployees.[No worl ers'comp.insurance required.] 'Any applicaotthat cheoksbaxil must also M outthe sectionbelow showingthei-workm'compensauonpolicyi ofomlaticm 3HomeownersaliosobiW'4bis4dav MfflGem9theyaredoingallworkandthenhireoutsideomtaetonmastsibmitanewaffidavRindicatingsuch Cnofmctorshatrbeckt�isba mus�atfacbedanarldiiienaIsheetshovzmgfhenameof-thesub-contractorsands=ata-gotberornotihoseentideshave employees. Ifthe sub-corairkcfors have employees,&ymust providefheir workers'comp.policy number. I aiw an erliployer trz at isTioviding-pp orkersI compensation insurance for my employees'Belo7v is=thepolicy mid jog SR info nation. InsurauceCompany 2Tame: iAAfi� 1NJ50� 69�MPPMI policy or Self-ins.lia.#: Q 11j( P0,40-7i RKpirationDate: 0.4 17 2d Z? Job Site Address: t3 GLinjST i A cilli-rLi M� City/State/dip: ©1 q Lf cJ Attach a copy oftILeTvu kers' compep4ationpolicy declaration page(showingthepolicynunaber and expirations-date). Failure to secure cov-c*a as required under.M(3L c. 152, §25A is a criminal violation punishable by a fine np to$1,500.00 and/or one-year iinprIoZment,as well as civilpenalties inthe form of a STOP WORK ORDER and a ire of up to$250.00 a day against the-aiolator.A,copy of this statement map be forwarded to the Office of Investigations of thGDIA for inmranm coverage verifloatiorL. Tdo hereby certify er the pawns and that he hvformaaonprovided above is rue and correct Si afore Date: 001 tau1 Pho Q-334 396,6 Offzcial zcse only. .Do not-Write in this area,to be completed by city or tOvn official City or Town: Pexmit/l icense# Issuing AntRox ty-(circle one): ; 1.Board offe&la2.BvildingDepaxtamt 3.City/Town Clerk 4.Electrical Inspector 5.Plurnbingluspectox 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter X52 requires all employers to provide workers'compensation for thet employees. Pursuant to this statute,an em -pl'ayee is defined as"...every person in the service of another under any contract of hire, expxess or implied,oral or written." Au employer is defined as"an individual,partnership,asso ciation,corporation or ot7ier 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 anotherwho 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 b6 deemed to be an employer." MGL chapter 152,§250(6)also states that"every state or local licenshag agency shall withhold the ismance or renewal of a Incense or permit to operate a business or to construct buildings in the cominonwealtix for any applicautwho Sias)tot produced acceptable evidence of compliance-with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states`Neither the commonwealth nor any ofits 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 b een presented to the contracting authority." -Applicants Please fill-out-the workers' compensation affidavit completely,by checldngth6 boxes that apply to your situation and,if necessary, supply sub'contraatoi(s)name(s),addresses)and•phonenumber(s)along with their certificate(s)of insurance. I imitedT lability Oompanies(LLC)or Lim%tedLia6ility Partnerships(LLP)with no employees'other than the members orpartners,arenotrequiredto carryworkers' compensationinsurance. If an LLC or=doeshave employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of.I-adustdral ,Accidents fol-confnmation ofii=ance 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 IndustrialAccidenis. Should you have any questions regarding the law ox ifyoa-'are xeggired to obtain a wbrkers' compensation policy,please call the Department at the number listed below. Self-insured-companies should'entex their self-insurafice 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 xegarding the applicant. Please be sure to El in the permit/license number which will be used as areference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current poli6y information(if necessary)and under`Uob 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 maybe provided to the applicant as proof that a valid affidavit is on file fox future p emv-ts or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license orpermit notrelated to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT xequired to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Iladustdal Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel_# 617-•727-•4900 ext.7406 or 1-877-MASSAFE Fax#617•-727•-7749 Revised 02-23-15 www.mass.gov/dia ACo CERTIFICATE OF LIABILITY INSURANCE 709120/16 E(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Eric Jansen Hasbany&Regan Insurance Agency A//CN o Ext), 978-685-3188 FAA/C,No): 978-685-9460 254 Pleasant Street h-MAILss: ericCa hasbanv.com Methuen,MA 01844 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Nautilus Insurnace Company INSURED INSURER B: American Zurich Insurance Company Cohen Construction,Inc INSURER C: 405 Waltham St.-Ste 336 INSURER D: Lexington,MA 02421 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 100,000 MED EXP Any one person) $ 10.000 A WS246378 07/05/16 07/05/17 PERSONAL&ADV INJURY $ 1.000.000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000.000 IOTHER: POLICY JE� F-1LOC PRODUCTS-COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident AUTOS AUTOS ( ) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATIONPER X OT AND EMPLOYERS'LIABILITY STATUTE /� ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1.000.000 B FFICER/MEMBER EXCLUDED? ❑Y N/A 6ZZUB-9F80793-4-16 07/06/16 07/06/17 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/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Exclude Craig Cohen,President of Cohen Construction INC from Workers compensation as he has elected to exclude himself. Operations:Siding and basement windows Location: 13 Glenwood RD North Andover MA 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. Building Inspector North Andover MA AUTHORIZED REPRESENTATIVE Eric Jansen ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards I License: CS-096405 Construction Supervisor i CRAIG R COHEN 7 PATRICIA DR HUDSON NH 03051 ^/►�,"'� l� Expiration: Commissioner 06/14/2018 &xe j b License or registration vafid for individul use-only j Offras of Consumer'Affairs&IIusin�ss 13e9y1ati" ' g INt1iNPROVEMENT CbM1l�TRACTOR before the expiration date. If found return to egfsttation 148746 = Type: Office of Consumer Affairs and Business Regulation xpiration 90/20/201:7 Individual 10 Park Plaza-Suite.5170 x floston,MA 02116.* CRAIG C bHEN .i CIS IG COHE _ .� N PATRICIA DRIVE ` €il�USO{V,NH 03051 undersecretary No .valid without signature