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North AIndover Board of Assessors
aliproperty Record Card
Location: 30 AMBERVILLE ROAD
Owner Name: GUZMAN, CARLOS
ESPINOSA, ANA
Owner Address: 30 AMERVILLE ROAD
City: NORTH ANDOVER State: MA Zip: 01845
Neighborhood: 6 - 6 Land Area: 0.31 acres
Use Code: 101-SNGL-FAM-RES Total Finished Area: 2712 sqft
ASSESSMENTS CURRENTYEAR. PREVIOUS YEAR
Total Value: 540,900 523,500
Building Value: 361,600 342,500
Land Value: 179,300 181,000
Market Land Value: 179,300
Chapter Land Value:
http://csc-ma.us/PROPAPP/display.do?linkld=2258868&town=NandoverPubAce 3/19/2013
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National General
Auto, Horne & Heafth Insurance
August 9, 2016
Town of North Andover
Building Inspector's Office
1600 Osgood Street
Building 20, Suite 2035
North Andover, MA 0 184 5
Claim Number:
Date of Loss:
Insured:
Loss Location:
Underwriting Company:
Policy Number:
2511699
08/06/2016
Carlos Guzman
30 Amberville Road
Integon National Insurance Company
2003181257
PO Box 1623
Winston-Salem, NC 27102
Claim has been made involving loss, damage or destruction of the above -captioned
property, which may either exceed $ 1000 or cause Massachusetts General Laws, Chapter
143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter
139, Section 3B is appropriate, please direct it to the attention of this writer and include a
reference to the above -captioned insured, location, policy number, date of loss and claim
number.
On this date, I caused copies of this notice to be sent to the persons named above at the
address indicated above by first class mail.
M cwk, C " e*ir"
Signature:
Mark- Charpentier, Property Claim Specialist
314-813-2916
National General Insurance
PO Box 1623
Winston Salem, NC 27102-1623
C,
....... . ............
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
.... ...... .... ........ . .... ..
has permission to perform ...... ... ..... oo( . . ...... ........
winngin the bum ding of .............. ......... .........................................................
at ....... er Mass.
Yrth A d
Fee I C�
............ Lie. No�j .......... ... ................ .. 2TRIC-AL- .1-N-S-PECTOR .......................
2cs;
Check #
12654 2M - �Zcl y
(fllmmonwea& ol Maijac4aJetb
eptlice.4
ire
20partm'ent 0/ 7
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
PermitNo. U -U94 -1 -
Occupancy and Fee Checked
[Rev- 1/07] (leae 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 PPJNT IN INK OR 7-YPE ALL INFORMA TION) Date: 9/3/15
City or Town of. North Andover, MA To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) 30 Amberville Rd
Owner or Tenant Carlos Guzman 7185512173
Telephone No.
Owner's Address 30 Amberville Rd. North Andover, MA 01845
Is this permit in conjunction with a building permit? Yes 21
Purpose of Building PV Solar System
No El (Check Appropriate Box)
Utility Authorization No.
Existing Service 200 Amps 225 240 voits Overhead
New Service Amps Volts Overhead E]
Undgrd
Undgrd
No. of Meters
No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Installation of a safe and code compliant grid tied
PV solar system on an existing residential rooftop - 46 Panels 111.5 RVV
Comnletion of the following table mav be waived bv the Inspector of Wires-
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
N"o. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above [I In-
Swimming Pool grnd. grnd. E]
IN of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
INo. of Zones
No. of Detection and
No. of Switches
No. of Gas Burners
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
Hcat Pump
Tons
KW
No. of Self -Contained
No. of Waste Disposers
Totals:
J.NM!R41�rj
. ......
................
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Ej MunicipPl [-] Other
Local Connection
No. of Dryers
Heating Appliances KW
Security SVstems:*
No. of Devices or Equivalent
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
TeFe—communications Wiring:
No. Hydromassage Bathtubs
No. of Motors Total HP
No. of Devices or Equivalent
OTHER:
Estimated Value of Electrical Work$ 3 1 000 Attach additional detail Y desired, or as required by the Inspector of �Vlres.
(When required by municipal policy.)
Work to Start: 10/3/15 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 k BOND 0 OTHERE] (Specify:)
I certify, under the pains andpenalties ofperjury, that the information on this application is trite and complete.
FIRM NAME: Skyline Solar LLC LIC. NO.: 21667A
Licensee: JarneS Leavitt Signature Wq�n&& LIC. NO.: 12572B
(Ifapplicable, enter "exempt" in the license number line) -5us. Tel. No. - 732-354-3111
Address: 124 Turnpike t. Suite 10 West Bridgewater, MA 023// 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
Signature Telephone No. FEE: S
rN
The Commonwealth ofMassachusetts
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
Boston, MA 02114-20-17
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information
Please Print Legibly
Skyline Solar LLC
Name (Business/Organization/Individual):
Address: 124 Turnpike Street Suite 10
City/State/Zip: West Bridgewater, MA 02379 Phone #: 732-354-3111
Are you an employer? Check the appropriate box:
60 4. C) I am a contractor and 1
Type of project (required):
1.8 1 am a employer with general
6. 0 New construction
employees (full and/or part-time).* have hired the sub -contractors
2. C1 I am a sole proprietor or partner- listed on the attached sheet.
7. C) Remodeling
ship and have no employees These sub -contractors have
8. C1 Demolition
working for me in any capacity. employees and have workers'
9. CJ Building addition
[No workers' comp. insurance comp. insuranceJ
required.] 5. We are a corporation and its
I 0.CJ Electrical repairs or additions
3. C) I am a homeowner doing all work officers have exercised their
11.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL
12.Cl Roof repairs
insurance required.] f c. 152, § 1(4), and we have no
13.8 Other FIV Solar
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 isproviding workers' compensation insurancefor my employees. Below is the policy andjob site
information. A.I.M. Mutual Insurance Company
Insurance Company Name:
Policy # or Self -ins. Lic. fl:
VWC-1 00-6018336-2015A
Expiration Date: 3/8/2016
Job Site Address: 30 Amberville Rd. North Andover, MA 01845 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 required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cfp�4ndjr the pains and penalties of perjury that the information provided above is true and correct.
9/3/15
ill
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
I J/111zulb
THIS CER'rIFICATE 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
B9LOW. 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 endorsementl
PRODUCER
The Hamilton Group, LLC
3 Wing Drive
Cedar Knolls NJ D7927
CONTA T
-NAME::
FAX
(PAH/c.10, E)3);973-292-2292 (AIC, No):
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC
INSURER A:Selectmve Way Ins 26301
INSURED SKYLI-3
Skyline Solar LLC
124 Turnpike Street, Ste 10
West Bridgewater MA 02379
INSURER B;SIeCtiVe Ins Co of the S. East 39926
INSURER C:A.I.M. Mututal Insurance Company 33758
INSURER D:
INSURER E:
I INSURER F:
COVERAGES CERTIFICATE NUMBER: 1089928575 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
ILTR.
TYPE OF INSURANCE
ADDLSUBR
INSR
WVID
POLICY NUMBER
POLICY EFF
tMWDDNYYY)
POLICY EXP
(MWDDNYYYI
LIMITS
B
GENERAL LIABILITY
S 2106548
2)612015
2/6/2016
EACH OCCURRENCE $1,000,000
COMMERCIAL GENERAL LIABILITY
DAMA ; TO RENTED
P"M :S (Ea occurrence) $100,000
MED EXP (Any one person) $10,000
CLAIMS -MADE FTIOCCUR
ADV INJURY $1,000,000
-PERSONAL&
GENERAL AGGREGATE $3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $3,000,000
$
PRO
1-1 POLICY F7 J,,� F LOC
B
AUTOMOBILE LIABILITY
A 9093015
2/2412015
2/24/2016
NED bINULL LIMI I
t0E),Mrcident) $1,000,000
-
BODILY INJURY (Per person) $
ANY AUTO
BODILY INJURY (Per accident) $
ALL OWNED S HEDULED
AUTOS ACUTOS
NON -OWNED
X HIRED AUTO AUTOS
F -PROPERTY DAMAGE
I (Per accident) $
1 $
A
X
UMBRELLA LIA.B
X
OCCUR
S 2000480
10/11/2014
10/11/2015
EACH OCCURRENCE $5,000,000
AGGREGATE s5,000,000
EXCESS LIAB
CLAIMS -MADE
DED IX I RETENTION $10,000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNER/EXECUTIVEFY-1
OFFICER/MEMBER EXCLUDEDI
(Mandatory in NH)
N/A
VVVC-100-6018336-2015A
3/8/2015
3/8/2016
X I TORUM I I CETR"
E.L. EACH ACCIDENT $1,000,000.00
E.L. DISEASE - EA EMPLOYEE $1,000,000.00
E.L. DISEASE -POLICY LIMIT $1,000,000.00
if yes, describe under
I DESCRIPTION OF OPERATIONS below
I A
I
I
B
Installation Floater
S 2106548
216/2015
/6/2016
Any One Occurrence $25,000
Property
Business Property $100,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
LIMMICIL.L.M
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
/VP
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2012 Massachusetts Electrical Code Amendments 527 CMR:12.00 § Rule 8: in accordance -with the provisions of M.G.L. G. 143� §. 3L, the
A
permit application form to provide notice ofinstallation ofwIrIng shall be uniform throughoutthe Commonwealth, and applications shall be filed"
on the prescribed form. After a permit application has been accepted by an Inspector of Wires aplohated pursuant to M. CT.L o. 166, § 32, an
electrical permit shall be issued to the, person, firrn or corporation stated on the permit application. Such entity shall be responsible for the
notification ' of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall -be limited as to the time of.ongoirg construction activity, and may'beZeomed-by-thtJnspector-of-Wires abandoned-and-firvalid-ifhe-_
or she has determined that the authorized work has not commenced Or has not progressed during the preceding 12 -month period. Uponwritten
application, an extension of time. for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on thq permit application.
El The Permit Extension Actwas created by 5ection 173 ofMaDLer 240 ofthe Arts of2010 and extendedby Scotions.74 and 75 ofChapter 238 of
the Acts of`2012. The purpose ofthis act is to promote -job, -growth and long-ttim economic xecovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain -permits -and licenses conce rt
Ladled exce mingthePsG or development ofreal prope y. With
ptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, anypermit or approval that was
'in effect or existence" duringthe qualifying period beginning on August 15,2008and extendirigthrougb August 15
2012
e 8 — Permit/Date Closed: Z-cp Note:)Reapply for new perm
)tul
11 Permit Extension Aet — Permit/Date Closed:
10 1 64 Date ..............................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...................
. .................... ......... I ........ I ........ I ............
has permission to perform ........ 5:; . .......
wiringin the building of ...................................................................................
at ............ , - L..? ... . North Andover, Mass.
Fee.
rr:,r7r�. Lic. No.'�� .............
C heck #
Official Use Only
Permit NO.
- Ell
op and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS Occupanc
[Rev. U07] . (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
ith thex.lassochusem Electrical Code (,MEQ. 527 CMR 12-00
All work to be performed in accord3nce N% Date:
(PLEASE PRJNfT IN LVK OR TYPE ALL 1-YFOPL4'Lti T10.
/2/0,�L_r --To ih o Wires:
City -or Town of: _.;� 4;�bLltl e kispecroi f .
BV this application the undersigned gives notice of his or her intenti�on to perform the electrical -,vork described belo.w.
Number) /- le
Locati.on (Street & 1 3 Q 4w' a'ell "I Telephone No.
OwnerorTenint , 4
Owncr's Address
it i6 conjunction -with a buildin�_, permit? Yes L] NO (Check- Appropriate Box
Is this perm Litility Authorization No.
purpose of Building
Existing Service Amps It Overhead Undg,d ;No. f.'Yleters
overhead Undard F] 'No. ofiNfeters,
New Servi�A A m-ps
'Number of �eeders.2nd Amp3city
Loc2tion and Nature of Proposed Electrical Work: La,4�zua��
'the 1,�ll-vi,inuiablemi3vbeivaii!edbi.ri7e Insoectorof[Vires.
No. of Recessed Lu itrTaire.50
No. of Luminaire Outlets
No. of Luminaires,.
No.,of Recept2cle Qvtlets
No. of Switches
No. of Ranges
No. of W2ste Disposers..
No. of Dishw2shers
No. of Dryers
LorrLier n 0
(P-addle)�Fans
_T 'o- of _al�ssp
No. of Hot Tubs
Above
JSwimming Pool, �nd. Err
1,,10. of Oil Burricrs
No. of G25 Burners
No. of Air Cond. Tons
t P U M P ��a�LTe L.
Tot2ls:
2celA:rea,He2t.)pg KW.'.
Heating Appliances
T �on I
KV
-Transformers.
KVA
Ge�ner2tOrS
1 0. 01 rneig ricy.17igFiting
Bat-tery Unirs
No. of-Zories
FTRZ ALARIYIS 1. . -
!To__�jf -DeteciJon 2nci
InitiatinE Devices
Devices
e d
Deiection/Alerting Devices
unicip3l El other
Conhe'ction
JjeYices or Equiva
No. ofWater ' .1 . . 0. of o.,01 . - 2 . 2 YY1r g:..
B2112sts . No. ofDeviceS or EquivzhLI't
Heaters Si�!ns Telecoramunic2tiOn Wiring;
Tot I HP f Devices o Eguiv��ient
No. Hydrornass2-e Baihtb, _7
�:JNQ. of Pyloturs No. o
-the Irispector of Wires.
LOTHER-:::��5/ irired by
ed, or ps,req
__pch additional detail ifdesir
W
Estimated Value of al Work: hen req �red by municipal po c nplet:dn.
ork to Staxt.' Inspections*to be requested in accordance with mEC Rule 10, and upon col
he erformance of electrical work may issue unless
INSURANCE COVERAGE: UnIC5S waived by the owner, no permft for t p
-completed operation" coverage or its substantial equivalent. The
the licensee provides proof of liability insurance including it S . suing office.
undersiarred certifies th . at such coverage is in force, and has exhibited proof ofsame to the permi
self Insured
CHECK ONE: INSURANCE [21 BONDEJ OTH ' ER (Specify-.) n this application is true I. and complete
clqrtify, under the pains andpenallies ofperiury, Oat the orinafion 0 LIC. NO.:
nation or' "I's upp"'
FIRMNANIE: P -DT Security Services
LIC. NO.: C-45
Licensee: Mark A. BroiDhv' Sianatiu e
,qo.: 603-594-5928
Bus Tel.
appiicdbl , ellier in the license number line.)
e j NH Aft. Tel. INIO.:
Address: 1 8 Clinton Drive T4-gllis NH
-quires Department of Public Safety "S" License: Lic. No 00953
*Per M.G.L. c. 147, s. 57-61, security work rc
ONVNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
I- I am the (check one) El owner D owner's w4ent_
required by law. By my signature b�low, I hereby waive this requiremen
Owner/A.gent PEPVIT FE -E: 5 Ll�_,
Signature Telephone No.
G STER-ED
I
i;UES --HE ABOVE LIC N
'S E R V T C I N C
S E- C T�y
7T.
ly(, A R K.;: -.A B. R 0 PHY.: SP
R I Y.- AVE
h A" 0 20 9 0
8 9.17
C4
5 C
F.td.Th—
change of add ress nCtificatl
Keep top for receipt a nd
DPS,,,
SAFETY
DEPARTMENT PF: -PU5I-'C�
s - License
-q
Numbi-.- SS 00 Doo953
Expires-':b2J07120 Tr'. no: 195.0
s.License' ADT
MARK A BROPHY-SR
SAFE CALL CEN TER: (Ss8) 344-7233
q
410 uNIVERSITY AVE
A
DIG
OC)D. MA 02090
WEsTVV Co
2012 Massachusetts Electrical code Amendments 527 CMR12,00 § Rule 8: fn accordalace-withtherx0visions OfM.G.L. c. 143, §.3L, the
NV,—. permit application form to provide notice ofinstauation ofw1ring sh . all be. uniforin throughout the Commonwealth, and applications shall be filed'
bn the proscribed fDrin. After a permit application has been accepted by an Inspector of Wires apbointed pursuant to M. G.L c. 166, § 32, an
electrical permit shall be issued to the person, f or corp'
U�n oration stated on the permit application. Such entity shall be, responsible for the
notiftcation Of completion ofthc work as required in M,6 -.L. 0. 143, § 3L.
Permits sb�Lboliinited as to thetime ofougoing construction -activity, and may bedeerned-by. the Jiispector_of_W�ires abai�doned_and_in,,validifhe-_.
or she -has determined th�t the auffiorized work has not commenced or has not progrcssed during The preceding 12 -month period. Upon written
application, an extension oftirric for completion ofwork shall be permittedfor reasonable cause. -A pennit shall. be terminated uponthe written
request ofeltherthe owner Orthe installing entity stated onthqperinitapplfcation.
El The Permit Extension Act was creatzd by Section 173 OfChapter240 oftheActs of`2010 and extendedby Sertions.74 and75 ofChapter238 of
the Acts of`2012. The puTpost ofthis act is to prornotejob,growth and long-term eronornic recovery and the Permit Extension Act furthers this
Purpose by establishing an automatic four-year extensloato certain -permits -and lice esconce
limited exceptions, the Act autDmati ally dxtends, for four years beyond its oth ' i ns Ining the ' use or development ofreal property. With
�G erwise applicable expiration date, mypermit or approval that was
"in effector existence" during the qualifying period beginning oa August 15, 20D8 -a dextendiag"throughAu"15,2012.
n
e 8 —Permit/Date Closed: *Note: R apply for new permit
e
11 Permit E�Aension Act — Permit/Date Closed:
0200 Date ......
...................
TOWN OF NORTH ANDOVER
0
I- 'A
PERMIT FOR WIRING
SA,C14US
This certifies that ................... 1140
..........................................................................
has permission to perform .................................
wiring in the building of .....
N rthn An d ov er N
at ............ 3.52/v1v&"
......... . .........................................
ass.
.. .................
Fee ................... Lic. No . ...... ...... . .................. : .. ........ .....
ELECTRICAL INSPECTQR
Check #
Permit No.
Occupancy and Fee Check
BOARD OF FIRE PREVENTION REGULATIONS [Rev.]/'071 (1,,v,blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR
All work- to be performed in accordance with the X-125sachuscas Electrical Code (,%4EQ. 5?7 CMP, 12.00
Date:
(PLE.4SEFFJ,YTL-VJ,VK0R
—1W -76 the Inspectol- 0 Vil-es:
City -or Town of: /��j (%�_e I\,
By this application the undersigned gives otice of his or her intent pe I m the electrical %vork aescrilied belo.w.
17/10
Location (Street & Number)
Co (�, -,? M 9.,) Telephone No. TZL0627
Owner or Teni
Owner's Address
Is this'permit iri �conjunction Nvith n buildin,� permit? Yes F I No (Check._ipproprinte Box
Litilin- Authorization -",*o-__
Purpose of Building
Overhead UndgrdFj No. of Nleters
Eiisting Service j Vclts�
F-� Un
�io I its O'Verhend 8 -;rd F] No. oNkleters, ......
New Servisj� Amps
Number of. eeders and Ampacitv
-Ature of Proposed Electrical Work- U
Location and N. P ,
. . .. . . f I Wires
tabfe rflov be tvoi%7ea ui r ie nsDeclor ot
hefiollpyving
�Compjetio� off _f__
kNu. of Tota
ans
Of Ceil.-Susp,(P�addle F Transfoi V
'No. of Recessed Lumirr aires F,, 'o,
KVA.
No. of Luminnire O-utlets No. of Hot Tilbs -C .
ergenEV i!D�iting
173 -_0
Swimmin- Po Above In-. d B2tter'v Units
01.g�nd. L7 -j _91"n —0.
No. of Luminaires.,
r n�v I�Z: FMF AjL.A 1\1o. of-Zories
urners _pj,,j.s �
Z So. 0 1
No. of Receptade QQt.lPts'_. - ' - :
o.-ofDeteciionand
No.-OfG25 Burners Initiatinz Devices
No. of Swit�bcs Total
'f XI�rting Devices
N10. OrRanges No. of Air-cond. Tons _�o 1. . I
__'�ont2in
_'ting
le
- 'f�
0 f tained
u b Tons 0 of elf-. 0 -ting Devices.
No. of Wast6 Disposers.. e2t Pump De�=_ttect�io n/Aler
Totals:
I 9c. . Mpunicipal '
Other* -
KW -jri�cti
L9_
No. of Dishwashers Space/A:re2 Hea in,
S ecu kity �ft cp s
t
He2tina Appliances : K'�V N.o. of Devices uiv2lent
O.-ol Vat2 wir1n��:
No.OfWnter No. of
YIW Ball2sts No, of'De-yices or E uival�n*
Hezte.rs Si -ns Teiecommitnic2tions Wiring:
tu lNo. ofPelot6rs Ton 1. H P No—of DevicP5 o r Equiv:iient
No. Hydromass2ae J�2ih bs
OTHER: 34 ector of Wires.
Teg irire.d by the Insp
.4vpch additional detail ifdesired. or. as
y municipal poli,
Estimated Value ofElectrica[ Work: I kWh ' en reqll4lred b cy-) idn.
�Vork to Stax-t., 14 Inspec.tions to be requcs- ted in accordance with MEC Rule 10, and upon cornple6::
INSURANCE COVERAGE: Unless waived by the owner, no permft for the performance ofelectrical %York may issue unless
peration" coverage or its substantial equivalent. The
the licensee provides. proof of liability insurance including "completed ol . ' ng officc.
in force, and has exhibited proof of same to the permit issui
undersiarred certifies that such coverage is
Ej (Specify:) Self Insured
CHECK ONE: INSURANCE M BOND F OTHER !on is true and complete.
fy, under thepail's andpenaldes ofperjury, that the ' orination on this applicat . '5'
I c rd t1o"on 0" 1C. NO.:
.q L
FIRIM NAME: ADT Security Services
LIC. NO.: C-45
Lice-risee: Mark A. Brophy' Si.anaiu e o.: 603-S94-_'),1zb
in the license 1'7umber lil7e.) Bus. Tel. iN
11fopplicdbl?, Mier 'exefllpt Alt. Tel. N'o.:
Address: 18 Clinton Drive 'g-ollis , NH t "S" License: Lic. No. 00953
* Per M. . G.L. c. 147, s. 57-61, security work requires Department of Public Safe y
OWNER,S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coveraae normally
nt. I am the (check one) 0 owner E] owner's agent.
required by law. By my signature be'low, I hereby waive this requireme
ONYner/Agent Telephone No. PERMIT_: S
Si-nnture —
E-GjS7EHc:L)
-S-,-�-iEA60VE.LICENs2Tb'-..-
'SER V .
T -Y.
mAR K-;�. BRC�Hy-: SR
AVE
U.
02-09 273
-E'S T W 0 OD
C -
q
Th-- D.1-Cn Aj�--A'
r
d change Of address nOr Ica,
Keep top for rE!reiPt an
_kl
pU SAFETY
DEPA'RTmENT PF.,.
S -- L-Icense
N umbeif SS CC 000953
3 Tr. no:
Expi r.es:'.62J07120 . 1
S -License: ADT
MARK A BROPHY-SR
4ioUNIV.ERSITY AVE
D�G SAFE CALL CENTER: (gBB) 344-7233
VVESTN00D. MA 02090
ccmmissioMl
.e- - — ,
FR�K� JAMES E. BUCHANAN ELECTRIC, INC.
P.O. BOX 544
SUTTON, MA 01590-0544
TO
Rep�y
ED URGENT
0 SOON AS
POSSIBLE
11/15/00
ED NO REPLY
DATE:
NEEDED
ATTENTION: JIM DECOLA , INSPECTOR
T TOWN OF NORTH ANDOVER SUBJECT ADDITIONAL FEES
OW
ELECTRICAL PERMITS FOR SERVICE PERMITS
L CT
27 CHARLES STREET
C
N 0 .
0. ANDOVER MA 01845
ATTACHED IS A COPY OF DOCUMENT FROM MR. DECOLA, STATING THAT WE UNDERPAID THE
V=TT�fl� nvn�xl� V --n A� -n-1-
m
E THE CHECKS ARE ATTACHED TO MAKE UP FOR THE SHORT FALL.
S
S
A
G
SIGNED JAMES E. BUCHANAN
I
R
E
P
L
y
SIGNED
m5trucuon io receiver.
1) Write reply. 2) Keep pink copy. Return white to sender.
-0 140V 1 2000
RECEIVE
01
X Cl e 3 7, /;'�Z)
�7- A,! -
t:Q 7y
4/�2
c ci-
.. . ... . ...... ........ .
0, -e ------- ----- --
40
Date,
TOWN OF NORTH ANDOVER
0
PERMIT FOR PLUMBING
S CHUS
This certifies that . . . . . . . . . . . . . . . . . . . . . . . .
has permission to perfo m .... I ..... .. .... .......... I ........
plumbing in the buildings of ... ..............
.................
North Andover, Mass.
..........
Fee . ...... Lic. No ......... � Q
Check # 2-13 Al- PLUMBING INSPECTOR
5007
J
O� MASSACHUSETTS UNIFORM APPUCATION- FOR PERMIT TO 00 PLUMBING
1 (Print or Type) K,) OZ"k ^m.OcNtM
',Mas& Date, rmit
Pe
i2 AA �A
B.�dl.. L...ii.n'30 1AM6Lr-V1 ;e10 Owner"s'Nante Vt
Nok,-r'* Antooroe- -64A" RIE"6.
ccupancy-�
—41011=0011�
New M Renovation Replacement- Subinitted: Yes'[] No 0
Plans
FD(TURKS
r
Installing Company Name - 4 ReA-T-tAs & Check one: Certificate
Address P&r-_- F I L -L'3 D9. 0 Corporation
Arb-il*vM A.A 6 r7o) 0 Partnership
Business Telephone L 5-&, J!�o b -7'q 9 (=CL7 EkRrm/Co.
Name of Ucensed Plumber
INSURANCE. COVERAGE:.
I have a n nc - policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
' W ity IN sum e
Yes 00
If you have 2'7ed'�tm please Indicate the type coverage by checking the appropriate box
A liability Insurance policy Pther typeof Indemnity 0 Bond 0
OWNER'S INSURANCE WAIVEJR: I arii a*are that the licensee does -not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws. and that my signature on'thlis permt application walves this requirement.
Check.one:
Owner 0 Agent 0
I hereby cw* that all of the details and information I haft submitted (or entered) In abow application am bus and accurate to the best of my
knoWedge and VW all plumbing vx* and installations performed under the permit Issued for this application YAII be in compliance with all
pardnerrt prervIslons of the Massachusetts State Plumbing Code and Chapter 142 of the General Law&
Signature of 1.16007ruim-Bw-
Tttlp
Type of Ucense: Master Journeyman 0
Cltv/Town 0 q j�>,b
APPRIM Ucense Number
0
49
ic
LU
x
CC
ca
CM
cc
2
-4
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0
UA
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0
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0
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0
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0
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0
U
.4
dc
.4
0
.4
-j
-j
-C
0
4
A
ca
0
0
-C
W
SUR-83MT.
BASEMENT
IST FLOOR
2110 FLOOR
3RD FLOOR,
4TH FLOOR
-5TH FLO-OR
6TH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name - 4 ReA-T-tAs & Check one: Certificate
Address P&r-_- F I L -L'3 D9. 0 Corporation
Arb-il*vM A.A 6 r7o) 0 Partnership
Business Telephone L 5-&, J!�o b -7'q 9 (=CL7 EkRrm/Co.
Name of Ucensed Plumber
INSURANCE. COVERAGE:.
I have a n nc - policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
' W ity IN sum e
Yes 00
If you have 2'7ed'�tm please Indicate the type coverage by checking the appropriate box
A liability Insurance policy Pther typeof Indemnity 0 Bond 0
OWNER'S INSURANCE WAIVEJR: I arii a*are that the licensee does -not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws. and that my signature on'thlis permt application walves this requirement.
Check.one:
Owner 0 Agent 0
I hereby cw* that all of the details and information I haft submitted (or entered) In abow application am bus and accurate to the best of my
knoWedge and VW all plumbing vx* and installations performed under the permit Issued for this application YAII be in compliance with all
pardnerrt prervIslons of the Massachusetts State Plumbing Code and Chapter 142 of the General Law&
Signature of 1.16007ruim-Bw-
Tttlp
Type of Ucense: Master Journeyman 0
Cltv/Town 0 q j�>,b
APPRIM Ucense Number
N2 2730 Date...
Of
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
S3"c u
This certifies that ...... ........... C-
..... ................................
has permission to perform ..... ....... Wom.. -P . .............. .................
wiring in the building of .... .......................................
/,`North Andover, S'
at ..... -' ;Cfi.J ......
Fee..J.).Y�4- Lie. No. ............... ............ /% ......... ..............
ELECTRICAL INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Ofn _4t
The Commonwealth of Massachusetts
P_
Department of Public Safety Occuv..cy L r r C6�1,"
3/90 0— b6A I
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12M
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All w.-ork to be performed in accordance with the Ma"achusetts Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
City or Town of.- 0 CD - A 17- To the Inspector of Wires:
The undersigned applies for a permit to 1>erform the electrical work described belo-.
Loc.ation (Street & Number)- A_t-_
a A "iz-L
0%.--ner or Tenant_7Pt>L_-rt:_-- 'CA C>Nes - -715-7
-7 __�
Owner's Address Z -5 % N.;) 17- )*�A 1:1 L K, tzc=� /)*,V:b A
Is this permit in conjunction with a building permit: Yes NOD (Check Appropriate Box)
Nrpose of Building Utility Authorization NO.
Existing Service Amps Volts Overhead UndgrdED No. of Keters
New Service �(D �Amps L7 -4n 7 -LA -0 volts Overhead Undgrd[�r No. of Meters
Number of Feeders and Ampacit
ell
Location and Nature of Proposed Electri.cal Work kf
1K
0
X
W
_J
D
IL
I
Ix
0
IL
No.
of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KVA
No.
of LighLing Fixtures
Swtmi Above
ng Pool grnd.
In -
grnd
Generators KVA
No.
of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting
Battery Units
No.
of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Local LJ Municipal
ConnectionDOther
No. of Ranges
Total
No. of Air Cond. tons
No. of Disposals
-
No. of Heat Total Total
Pumps Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No.
of Water Heaters KW
No, of No. of
Signs Ballasts
—
Lo Itage
Wtwriv.;
No.
Hydro Massage Tubs
No. of Motors Total UP
OXIIER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YESCM NOD I have submitted valid proof of same to this office. YES[3 NO D
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE K] BOND [D OTHERE] (Please Specify)
Estimated Value of Electrical Work 5
Work to Start Inspection Date Requested: Rough
Signed under the penalties of perjury -
FIRM NAME-- JAMES E. BUCHANAN ELECTRIC -INC.
Licensee JAMES E. BUCHANAN Signat e
ueel
r'
Address P.O. BOX 544 SUTTON MA Ot590'-
OWNER'S INSURANCE WAIVER: I am aware that the Licen do
stantial equivalent as required by Massachusetts General
a p p lication waives this requirement. Owner Agent
(Signature of Owner or Agent) Telephone No
WILL CALL
__D__
(Expiration ateT
Final
LIC. 1pi.A15616
LIC. NO. E32062
Bus. lel. No. JUt3-136-5-3335
Alt. Tel. No.
not have the Insurance coverage or its sub-
, and that my signature on this permit
ease check one)
0
PERMIT FEE S,�4
7 L/
N2 4661
U
'T CHUS
.7
//— 3 6—
Date .............
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
Y- 0'-7 '� C"�. , ( ( r
This certifies that ... ............ .................
has permission to perform .... ku. . . V �- :-� .............
plumbing in the buildings of ... r re -
a t j':� �; ....................... North Andover, Mass.
Fee.-:)-?"-. . Lic. No.. . ......... I
PL�UIVIBING INSPECTOR
Check # 2 2 2 f,
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
'? ?y
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
N0127IL4 A'jbove-le Mass. oate' Permit#
Building Location 360 4A4A,'-;A VII -LL 'eA -/tor4wner's Name PVurC 140MIC coRP.
RESIAE'dTIAL Type of Occupancy
New
Renovation
C3
Replacem
Lnt
0
Plans
Submined
Yes
No 0
FEATURES
z
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uj
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C'3
SUB-BSMT.
BASEMENT
1 ST FLOOR -L-LJ
1
12
1
1
1
2ND FLOOR
3RD FLOOR
4T, -i FLOOR
5Tri FLOOR
5TH FLOOR
77H FLOOR
8TH FLOOR
installing Company Name rl�,qzie-x ,,' it-)zu-s Aaomiole,4c- Check one: Certificate
Address /10 0, 16 0 X 67? GPI"Corporation . -2 /- q 0 C
L) 0 Pannershlp
Business Telephone 978- 689-7-17-1 0. fi=Irm/co,
Name of Licensed Plumber ("-HA�&SS IW16IA2
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142,
Yes 0 No D
If you have checked yes, please indicate the type of coverage by checking the appropriate box,
A �iability insurance policy 0 Other type of indemnity 0 Bond 0
OWNERS 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:
Owner 0 Agent 0
hereby certify that all of the details and information I have submitted (or entered) In above. application are true and accurate to
he b -est of my knowledge and that all plumbing work and Installations parlormed under the permit issued for this application efill
pe in compliance with all pertinent provisions of the Massachusetts State Plumbing Code. and Chapter 142 of the General Laws.
By �- EtL�-
U—ignature Of Licensed Plumber
Type of License: Master K Journeyman C1
Ciry[Town License Number ----
APPROVED OFFICE USE ONLY)
Location So �) rl? o / //,c
No. �0 q 17 Date 1211S --06
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check# /-/ 3 o3
14416 P1311ri,�g--
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
77,7,777,77-
-:� 1,40 .0
BUILDING PERMLIT NUMBER:
DATE ISSUED:
1
SIGNATURE: A#C
Building Colnmissioner/12�e2ctdr of Buildings Date
I " I-aiLiLK, JUqr%jjN1V1^j11%jrq i
1.1 Property Address-
2.1 Owner of Record
PO /+ I,—
Name (Pnint))
1.2 Assessors Map and Parcel Number:
/ 07 -13 /W/
Map Number Parcel Number
Address for Service: V PIA,
7S-7 Or,�Z- —AFA ZS7,"--
Signature Telephone
1.3 Zoning Information-
cj—p
� �fj,.— -r".,I,
ZoningDistnct Proposed Use
2-2 Owner of Record:
1.4 Property Dimensions:
-e
/3 S - �' /00
Lot Area (sf) Front-ge (f[)
1.6 BUnJ)ING SETBACKS (ft)
Signature Telephone
FTOnt Yard
Side Yard Rear Yard
Reqwred Provide
Required
Not Applicable 0
Provided Required
Provided
los-, -
/�- ,
so
I
1.7 Water Supply M.G.L.C.40. 54) 1.5.
Public 4-- private 0 Zoac
Flood Zone Information: 1.8 Sewerage Disposal System:
Outside Flood Zoae 0 Mutticipal 4— On Site Disposal System 0
I JLW1'4 I- - JrJMWJrM2C-L X "W1'4Z1V5JMW/AU 1114JKLLZD A(iJL.N'I-
2.1 Owner of Record
PO /+ I,—
Name (Pnint))
Address for Service: V PIA,
7S-7 Or,�Z- —AFA ZS7,"--
Signature Telephone
2-2 Owner of Record:
Name Print
Address for Service-.
Signature Telephone
SECTION 3 - CONSTRUCTION SERVIECES
3.1 LicensedVonstruction Supervisor:
Not Applicable 0
D AV) d ho '41
Licensed Construction Supervisor:
License Number
Ad
g- 3 n� kz7 V7
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
1114410
0
z
M
0
ic
0
M
z
0
I SECTION 4 - WORKERS COMPENSATION MG.1L C 152 8 25c(6) I
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 -- ---- 0 No ....... 0
SECTION 5 Description o Proposed Work (check applicable)
New Construction F]
Existing Building 0
Repair(s) 0
Alterations(s) 0
P ddition 0
Accessory Bldg- 11
Demolition 0
Other 0 Specify
Brief Description of Proposed Iklork:
P -L Crdc,�, ZReex,
__Qfck
SECTION 6 - ESTMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by permit a licant
LAL,
I . Building
(a) Building Permit Fee
Multiplie
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)
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BU"ING PERMIT
I_ 4Dd!FzC//"_ as subject property
Hereby authorize to act on
My be�lhl�Ili a matters re c to work- audipr6ed b i's building pennit application.
Signaiurie of Owner Date
SFCTION 7b OWNERJAUTHORIZED AGENT DECLARATION
1, --as Owner/Authorized Agent of subject
propeny
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 -nature of Owner/Apent Date
NO. OF 777REEs SIZE
BASEMENT OR SI -AB
SIZE OF FLOOR TlNffiERS 2 MD 3 RD
SPAN
DIMENSIONS OF SILLS
DIIVIENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION TMCKNESS
SIZE OF FOOTING x
MATERIAL OF CHRANEY
IS l3tJlLD1NG ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
OCT -2Z-2000 04:47 PM MARCHIONDAQASSOCIATES 721 4Z2 9654 P-02
7
SA L %E-: I lr%vAqj I
7-URNPij<,
KE
't 114
S5 *1 7'29"E 62.07* ol L''
7717
#2 �;I
. 74
40 F -T. t�o CUT SUFFER
AM13ERVILLE ROAD
)q -Z. 3 4k)
WE HEREBY CERTIFY THAT WE HAVE EXAMINED
THE PREMISES AND THAT THE BUILDING IS LOCATED
T Is L N is INTENDED FOR ZONING
AS SHOWN, THE STRUCTURE SHOWN CONFORMS
TO THE ZONING LAWS OF THE MUNICIPALITY
PURPOSES ONLY. IT WAS PREPARED
FROM EXISTING PLANS AND RECORDS
WHEN CONSTRUCTED, ALSO. ACCORDING TO THE
F.E,M.A./H.U.D� FLOOD INSURANCE RATE MAP,
WITH THL STRUCTURES SHOWN LOCATED
BY AN INSTRUMENT SURVEY- THIS PLAN
COMMUNITY PANEL NO. 250098 0015 C
DATED 6/2/1993 . THE STRUCTURE IS NOT LOCATED
SHOULD NOT BE USED FOR PROPERTY
IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE.
LINE DETERMINATION-
44
48A
12143 S -F,
MARCHIONDA & ASSOC.,,L.P.
NORTH ANDOVER, MA
I
N
6 CCL
0.28 Ac.
PULTE HOME CORP. OF NEW ENGLAND
LOT 49
0)
CN
SCALE: 1 30' DATE: 10/23/00
13529 S,F.
0,31 Ac.
23,6'
26.21
FOUNDATION
EXISTING FOUNDATION
EL -160.08'
C\4
(XISTIN
EL
aO,3'
30,01
30,9'
32,0'
32.4'
27.0'
Nf>2-34'50"W
N62.3�5-0'w� 9�
-4'� STE,HFN M.
AM13ERVILLE ROAD
)q -Z. 3 4k)
WE HEREBY CERTIFY THAT WE HAVE EXAMINED
THE PREMISES AND THAT THE BUILDING IS LOCATED
T Is L N is INTENDED FOR ZONING
AS SHOWN, THE STRUCTURE SHOWN CONFORMS
TO THE ZONING LAWS OF THE MUNICIPALITY
PURPOSES ONLY. IT WAS PREPARED
FROM EXISTING PLANS AND RECORDS
WHEN CONSTRUCTED, ALSO. ACCORDING TO THE
F.E,M.A./H.U.D� FLOOD INSURANCE RATE MAP,
WITH THL STRUCTURES SHOWN LOCATED
BY AN INSTRUMENT SURVEY- THIS PLAN
COMMUNITY PANEL NO. 250098 0015 C
DATED 6/2/1993 . THE STRUCTURE IS NOT LOCATED
SHOULD NOT BE USED FOR PROPERTY
IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE.
LINE DETERMINATION-
CERTIPIED FOUNDATION PLAN
LOT 49 FOREST MEW ESTATES
MARCHIONDA & ASSOC.,,L.P.
NORTH ANDOVER, MA
I
ENGINEERING AND PLANNING CONSULTANTS
62 MONTVALE AVE. SUITE I
PULTE HOME CORP. OF NEW ENGLAND
STONEHAM, MA, 02180
(781) 438-6121
257 TURNPIKE ROAD SUITE 200
SOUTHBOROUGH, MASSACHUSETTS 01721 1
SCALE: 1 30' DATE: 10/23/00
OCT -16-2000 10:33 AM MARCHIONDA&ASSOCIATES 781 438 9654 P.03
If4 ORDER TO AQHRLYt �mvl— - -- -- 11 - - . jmzm rlc�
ACr-oMMODATE THE CONSTRUGlION OF THE HOME IN THE MOST OPTIMUM WAY,
MAY BE MADE VATHOUT CONSULTATION VNITH THE BU-YER IN ORDER 'TO EXPEDITE THE CONSTRUC'nON OF THE HOME'
PROPOSED SITE PLAN
LOT 49 FOREST VIEW F-STA7ES MARCHIONDA & ASSOC.,L-P�
NORTH ANDOVER, MA ENGINEERING AND PLANNINCo CONSULTA14TS
FJ�EPARED FOR 62 MONTYALE AVE, SUITE I
STONEHAM, MA, 02180
PULTE HOME CORP, OF NEW ENGLAND 1 (617) 435-6121 DATE. 10/1,3/00
257 TURNPIKE ROAD - SUITE 200 SCALE: 1"=20'
SOUTHOOROU0H. MASSACHUSETTS 01772
0(--�t-12-00 03:30P P-01
1H I _t:� � �:Jt Jt -A I C,
CERTIFICATE OF INSURANCE ISSUE DATE: wz"a
11'HIS CERTIFICATE IS A MATTFR OF INFORMATION ONLY AND C40NFERS NO RJOHTS UPCw Tjjr;; CERTIFICATL HOLDCR. Ttils clFfmr(CATE
DOES NOT AMENU, EXTEND Oft ALTER THE COVRRAGE AFFORDED BY THE POLICIES BELOW -
INSURED COMPAN(FS AFFORD(NG COVIERAGE
Puke HOM 0"Orx4arj of NL COMPANY A Padlic Ernoayan Irwwance Compsny
257 T4mptica Road, Guilr2t)(5 COMPANY 0 Lealon Insurance Company
SouMboroup, FAA 01712 COMPANY C
"WflANY D Ace Amdon IrpLonca Company
B,
TtI118 16 TO CEMlIFY rMAT 7HF POLICIES OF INSURANCE LJbWn FISLOW MAVF BEEN ISSUF.13 TO THE INSUFtED WAKED APM�7 FOR TVJE PQI-jr`Y PERIOD
0 1
INPICKTIEP, NOlWT43TANQlNf4 ANY REQUIREMENT, TeRM OR CONDrMON OF ANY 'DO"A(-.T 00 OTHIER DOCUM11INT MTH RESPECT rQ Mir" THI's
NP C '
�-8'T P T6
CERTIFICATE MAY K ISSUED 08 MAY PER7AIN. 'THI! INSUFANCE AFFORMO QVJW POLIC4.8 DESCRIBED HERFIN M, lU9jFr.TTn kLL THra TERMs,
M C , , 'S
LUSIOWS AND CONDITIONS Of BUCH NXICIIES. LIMITS $11CM" MAY HAVE BEEN REDUCED BY PAID CLAm$.
F-FFFMV9 T FIFIA-nPN
GENERAL UABILITY
COMMERCIAL GENE RAL WAS ILITY G�4-0222042
ON AN OCCMFt&4rf ft^041L
ADDITIONAL INSURED:
AUTOM084LE
LOSS PAYEF-
0 ADDITIONAL INSUpteo-.
EXCESS LLABIL17Y
C^L HO 7682049
VMRKERIS COMPENSATION andi MR C4 301107A
Al IRlVlP`L0YF�RS'LIA0jLIj'Y MA, NIV SOF 04 301 i8al
FR0I2iZR-Iy
LOSS PAYEE,
MORTGAGLE:
OTHW
subdWlan Wrftr Hei9w warceaw.
Cfty of %%rceslor
455 Win ftraa
Woreeater, MA 0115139
5/1100
—4491144 AGGREnATE
PRODWT�rCOMMP AQCJ.
PFIRSONAL & APY, 114JUKY
EACH =UJ`RFtF.N0V
FtRF PAAlPO46 (AINY b" ft)
MED. WSW (Any on* RaFaQn)
COMPREHANSIVF 01SMUCTtKE
COMBINED SINGV: ILIAMILITY WAAJT
0AC11 GCCUM�NCF
5111100 -511101 STA.11.1r6ftY LIMITS
DISFASrc,-POLACY LIMIT $1,000,000
DISEAlli-EACH EMPLOYEE
RFAL AND PBRSORAL PROPI�RTY, INCLUIJIW WHILr;
IN COASS OF CONMLK-TION:
PER OCCURRENCE LIMIT
8priCIAL FOPAI (INCI.upINa ft�OW AND &qlRTHQWAI<Q
0MUCTIOLF PEF 0CCWRRr-NM
WIOULD Ai`4Y 01"1416 APOVE t*=RIWD P0qClFIt IRK P"NOUL1:0
UIEFORF THE FxPIRATION DATE THER�top. WF VALL ENPFAV&R
TO MNL X DAYS "ITTIEN NOTICE TO THF rj!RTjFjcATE
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Location A
No. Date 1-1,73?12-26
TOWN OF NORTH ANDOVER
Certificate of OCCUDancv $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee s
TOTAL $
Check # 30
14 42) 7 "/Q -B'2-
Location Z:�5,41 -P
No. &C�2 1 — Date
a
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ X62)
Check # ew5��O
1 S' 0 Building inspector
Mesiti Dev Group Fax:978-5578160 Jun 13 2000 12:43 P-02
TOWN OF NORTH ANDOVER
BLIELDING DEPARTWNT
PFUCATION TO CONSTRUCT REPAIR, RF-VOVkTF, OR DEMOLISH A OKE OR TWO FAMILY DV�r,
UU-DING PERMIT NUNMER:
DATE ISSUED.
M
T GNA-rT-FRE:
'Riiilcii-na (nrnmi,;-,;innEy6 95 Date
ln-,za�or of Buildin
=---, , .— I to% -l- .101
1.1 J-rWert� Addrms:
1.2 Asscssors Mxp and Pw-crl'NmMbcr
-2
bey-
Ain V1,
io 7 G /(.0
M
,\,i.p Number Fw-cd Number
1.3 Zcnmg Lufan=axion:
1-4 Propnrty Dunexi=ons:
--�I'Aiq& r -AAA& RC--"lL4aVU:
/3-'SZ2 A20, c3a
cning Dl�CL
Let -k— (Sr) Frcc3-xz= (ft)
.6 BU-aDL"(G SETBACKS (fr)
Front Yard Side Yard Rear Yard
pj-_qu.ir--d Provide Required ded Provided
7W� s.?ptyM-G-LC.W.!�,14) Mimi O.SiL-Dip—1 System 0
C=.le Flod Z— C I c
ECTION 2 - PROPERTY OWiNlRSHIP/ALTTHoRlZF-D -ALG214T
L 0,xucrof R�rd
L r-
Lv,n a L u r --
I
.2 Owner o C R--c-ord:
Name P-rint I
�iqnaturc
retephorle
Tcicuhoac
9uj+nAj St Sciii-a 2E zV,.Afvckc—Vt-
Address for S-ervicc
A,ddress for Senicc:
--j�IrCTIO,,f SFRvlcF-s
;ECTfON .3 - CONSr Not AppLicable 0
Construction Super�isor!
GDAW v z 6 V's; -4/
,locnscd Cc�n5tructiOnSuclervisOr Licen-se 'Number
19- QAl10A1 S�- N-.AA10QVl;:lZ A4.4
,ddress "g
4-0-s —
Expirarioa Dare
'a, arurC Teiephone
.2 Pc-gj:;t,-r--d IIOMd Lmprovernent ---onumcmr
:onapany Name-
,ddrcss
Not AppEr-able 0
Rc'-p1straticri 'Numbcr
Explraccxi Datc
-V
M
Z-
0
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1c)
Mesiti Dev Group Fax: 978-557816C. Jun 13 2000 12:43 P. 03
SECTION 4 - WORI(ERS COWENSATION XG-1- C 152 § 25,z(6)
Workers Compensation fnsurance affidavit must be completed and submirtcd with this applicaiion. Failum to pruvide this affidavit will Ilt
in the denial of the iszuancc of the building permit.
Signed affidavit Attached Yes ...... A No ...... �C]
SECTION 5 Descriptdiolul a Proposed Work (check 2ppdxAble)
m
New Construction a t Existing Building 0 Repair(s) 0 Alteratons(s) 0 Addition C
Accessory Bldg. 0 DemoliLien C. Cthex� 0 Specify
BriefDescTiption of Rroposed Work:
14
SECTION 6 - ESTENIATED CONSTRUMON COSTS
tern
EsbmaEed Cost C ar) c
............ .11 . . . . . . .
TIMM
icant
Cornpleted by pe=t aDpi'
I
Building
Al
7,!�_
(a) Building Pernut Fee
S__
7�
Multiplicr
2
Electrical
(b) Estiinared Total Cost of
C,a 0 0
Coestructior,
3
Plumbing
C?0�9
Building Pennit fee (b)
Nf-zcharLicai ('HVAC)
4C
5
Fire F'rotectzon
6
Total (1+2+3+4-�-i)
Cheek Nuinber
SECTION 7a OWNIRAL7MOPLUATION TO BE COMPLETEDW-HEN
OWNERS AGENT OR CONTRACTORAPPLIES FOR BUMDD�G FERrvuT
1, as C",1,1ierJ_AuZhorizcd Agect of subject pr
opery
Ht-�ebv authoriz -to act on
If.' Cit rel -JI -t! to vor� authorized by tlus building p, -.mut application./
A A - - -4/
_Slg-qatuxt t er Date
SECTIO,:�7,b b�w_NE UTF1 D AGENT DECLARATION
az 0--ter/Authonzed Agent of subject
property 3
Hereby declare. chat the statements and information on the foregoing applicationare lrue and accurate, to the best of my knowledte
alld
S�9_ILL-e of Owner/A �fnt
!, RI
NO, OF STORJES SIZE At -Min --g Z ot 3 S- /--4
ZZ.A 20
B SE, A
ASENEEZNrT OR SLA3
S SIZE 0 F
IZE OF FLOOR T11,1BERS
Sp
DNIENSiON5 OF SILLS
DIMENSIONS OF POSTS
D NMENSIrONS OF GGZ_DERS L VZ_
OF FOUWDATION
SLZE OF FOOTU-�G
&[-\TERL-kL OF CFMD�EK 0 C=- 49ANCO
IS BUMCLNG 0,\� SCLUD 0��FIT_L.ED L. -\N -D
IS BU'U,DNG CON'NECTED TO SATTY.R�AL GAS L2,�-E
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Dr_p0TtMMtof_TubfIr,Safe,ty
527 CMR 4.00 - Form I
Applic.ation for rcrmit, Pcr-rni(, and Ccr(ificatic of conifilction for 111c Instil I 12tion or
Ahcrition of Fucl Oil Buniing Equipmrrif nnd the Storagc of FucJ Oil
c� �,2
(City or To�in) (Datc)
Pcirmiii 9"s: FD EJec.
FDIDAf: FccPajd: r!774
Owncr/Occupa,nt Namc: TI-) LTE / "/ Tcl 0: SD 9 79-7
ScnAccd Floor or Unit V:
ListaIJ26on Address:.,
/ -7 _3 0 Am"&tz w 1,e Ok
Uriii 0 DomcsLic XVztcr Hcztcr 0 Power Vcnt 0 Othcr
Burner: 6,N< 0 Exi�g Location:
Trade Naxne: WE: ��.d
Type: Model 9 or Size: 4,E6 Nozzle Size: J, th X 700)5FdJ00
P,,F'5"Cl Oil 0 Kerosene 0 Waste oll
StoragcTank-: GL,?I'c-%v_ 0 E-dsting Location:
_75- gals. No. of Tanks:
Type: Capacity: __ (--?
Special rcquircmcnt5 (or additional safety devices)
OOSXI Valve tAl line protected OShect Ikock F-]SprirJJ-cr
Co. Namc:
AFUE:'b/ycs Ono EF: Dyes Ono
(Fumacc and boilers) (W2tcr heater)
Tc'_ 975?ZY_/ V`IQ3_
J4'6 �vsV___ zip: -=7-A
Completion Date: U
Combustion Test: Gross StacL- Tcmp.: Net Stack- Tcmp.:
COI Test- /0' 7v -Breech Draft:
3 4"
Smoke: —0 Ovcrfirc DraR: Efficiency rain 11�j
_q '/.: yy - /0
L the undcnip�d "ri;fy tj�,i the iixes,1146an �( f,,I bw.;,.t eT;q�vnt &" lo� Ze ;,% �4d M.GJL c. 1411 —A 527 CMR 4.00
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'COMpkic iwx"�I;cw " to its b.— b,-- fw,�tt-d to the p� to, -4� the
InsuDcr: 'M
P,;.f Ktz-f Ccri 0
.fcf
Address: I. -Ai )c;,3 ke
City: 111c
Loe
Once signed by the firc dcp:%nrncn%,hJs a PERNUT for the storage and use of oil burning cquipmcn(.
,_e�
elld
Approved by: Date:
Iszucdvnhc�(caspcn-ut. TI-�sforrnM3%.bcphcmocop-ed.
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Town of North Andover %AORTk
Building Department . I . 16
27 Charles Street 0
North Andover, Massachusetts 0 1845
(978) 688-9545 Fax (978) 688-9542
CHU
APPLICATION FOR CERTIEFICATE OF OCCUPANCY INSPECTION
ADDRESS3()Sb A01,RIERVILt-I.E RoAct
LOT NUMBER 4/7 SUBDIVISION__J�-�
DATE REQUEST FrLED
-2
DATE READY FOR INSPECTION 4 '_ 7 - 0
FIVE (5) DAYS NOTICE PRIOR *ro CLOSING DATE IS REQUIRED
ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN TIES TIME
FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE
I-ITARGyj T� _F
_J -.F - -FIE—S-71FRIUCTURE-DOES NOT MEET ALL-AT�PLICABPLE -CODES.
*_.rjL 117 1
SIGNATURE
OFFICIAL USE ONLY
ROUTING
CONSERVATI DATE
PLANNING DATE /0
D.P.W. - WATER ITER 1h6101 -7 DATE A)
D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED
PRI711
SPECTI REQUEST DATE.
SIGNATURE / DPW AUTHORIZATION
Location mt-erut,4-
:3Q 9 W. - I
No. Date
TOWN OF NORTH ANDOVER
0
* A so
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check# 43 10
14339
$ /081?
,/� A (G,
Building Inspector
OCT -23-2000 04:47 PM MARCHIONDA&ASSOCIATIES 781 438 9654 P.02
'pe
Q.P-ecO-
SALEh4 TUR�4p,,JCE: 3D
fROU TE 114
S5 17'29-E 6Z07' OPEN SPACE PARCEL jE,
5 "17'2 9 "E
99-74F
40 sr?-. No CUr BUFFER
72t 40 4
v
46A 6
12143 SY,
? 0.28 Ac. LOT 49
13529 S,F.
0-31 Ac.
2,3,6'
2 6,2'
"X'SnNo FOUNDATraw 76.6.
Eke"SS-04
X'S "" FOUNDAT;Om 7"
l'Ek,*,3SJ-04 .1 at
.C"i
30,01
7. CO) J'n�
V
(n
30.9-
a.>S� N62. -j750 -w
En EN M
EXISTING FOUNDATION
EL -160.09'
N62'34'50"W
100.00'
32,0' 32.4'
iN EXISTM
:0 -
EL
Ex�
'SP'4
EL
20,3'
17T
2 .0,
7.0'
AMBERVILLE ROAD
THAT WE HAVE EXAMINED
s uwl
WE HEREBY CERTIFY
THE PREMISES AND THAT THE BUILDING IS LOCATED
THIS L N IS INTENDED FOR ZONING
PURPOSES ONLY. IT WAS PREPARED
AS SHOWN, THE STRUCTURE SHOWN CONFORMS
To THE ZONING LAWS OF THE MUNICIPALITY
FROM EXISTING PLANS AND RECORDS
THE STRUCTURES SHOWN LOCATED
W"EN CONSTRUCTED. ALSO. ACCORDING TO THL
F,E,M.A./H.U.D- FLOOD INSURANCE RATE MAP,
WITH
BY AN INSTRUMENT SURVEY. THIS PLAN
COMMUNITY PANEL NO. 250098 0015 C NOT LOCATED
DATED 6/2/1993 . THE STRUCTURE IS
SHOULD NOT BE USED FOR PROPERTY
IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE.
LINE DETERMINATION -
CERTIrIED FOUNDATIO N PLAN
LOT 49 FOREST VIEW ESTATES
MARCHIONDA & ASSOC.L.P.
NORTH ANDOVER, MA
d ENGINEERING AND PLANNING CONSULTANTS
62 MONTVALE AVE. SUITE I
PULTE HOME CORP. OF NEW ENGLAND
STONEHAM, MA. 02180
(781) 438-6121
257 TURNPIKE ROAD SUITE 200
SOUTHBOROUGH, MASSACHUSETTS 01721 1
SCALE: 1 30' DATE: 10/23/00
—
I SECTION 4 - WORKERS COMPENSATION (r*LG.IL C 152 § 25c(6) I
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 pennit.
Signed affidavit Attached Yes � ...... 0 No ....... F1
SECTION 5 Description o Proposed Work (check applicable)
New Construction r]
Existing Building 0
Repair(s) F1
Alterations(s) 0
Addition 0
Accessory Bldg. 0
Demolition 0
Other 0 Specify
Brief Description of Proposed Work:
12
!�q Zbe 0 S
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by permit applicant
6—
00 IC VIA
1. Building L/
Ze OS—
(a) Building Pennit Fee
Multiplier
2 Electrical I
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Pernfit fee (a) x (b)
4 Mechanical (HVAC)
5 Fire Protection 757
6 Total (1+2+3+4+5) 3 " "S 5: 0
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as OlArner/Authorized Agent of subject property
Herebv authorize to act on
My belialf, in all matters relative to work authorized by this building permit application -
Signature of OxAmer Date
SECTION 7b OWNEP/AUTHORIZED AGENT DECLARATION
/Q as Owner/Authojized Agent of subject
�/qr
property
Herebv declare that the statements and infonnation on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Signature of Owfier/A,,,ent Date
NO. OF STORLES SIZE
BASETVIENT OR SLAB
SIZE OF FLOOR TRABERS 2 ND
SPAN
DMENSIONS OF SILLS ee
DIMENSIONS OF POSTS
DiNENSIONS; OF GIRDERS Z 114
FIEIGHT OF FOUNDATION TMCKNESS
S17E OF FOOTING –2 Q X /0
MATERIAL OF CHM-4EY L.,.
IS BUILDING ON SOLID OR FILLED LAND J, 1W
IS BUILDING CONNECTED TO NATURAL GAS LINE AM
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
-7,
BUELDING PERMIT NUMBER:
DATE ISSUED:
SIGNATURE:
Building Commissioner/Iq�eEtor of Buildings Date
—.—I .- i
1. 1 . Property Address- 1.2 Assessors NUp and Parcel Number:
�30 A0q6WmVj'//t,-... R. 411to
FOV eS,
V
Map'llumbet- Parcel Number
1.3 Zoning Informatim- 1.4 Property Dimensions:
U -P, si'lig; z- 91 .00
Zoning Distnct Pio—posed LS6 (sf) Frontage (fl)
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yard Rear Yard
Required Provide Requi d Provided ReS Luired Provided
1.7 Water Supply M.G.L.C.40. 1 54) 1.5. Flood Zm. laferxnation: 1.8 Se�arage Disposal Syst�;
Public 0 Prwate L1 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal S�stem 11
SECTION 2 - PROPERTY OWNERSHM/AUTHORIZED AGENT
21 Owner of Record
-PC/#a 110ptt'ej cotz-10
Name (P ' I Address for Service
: 2 -t za: f- SOL- 79-7-OOOZ-- )F9(
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Lice ed C struction Superv, . or: Not Applicable 0
AlA-- - IS 0 11
��Wction Supervisor: -7-739,6
License Number
Z? --Z- "57ec-k-r- -es OIL -
Address
3
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable 0
Company Name
Registration Number
Address
Signature Telephone Expiration Date
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I,Jesiti Dev f3roup Fax:978-5578160 3un 13 2000 12:50 P.13
FORM U LOT RELEASE FORM
INSTRUCTIONS: This form is used to venify that all -necessary approval permits from
Boards and Dep2rtments havingjunisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable. requirements.
a . d 6 d . . . . . . . . . d . . . . . . d d d . . . . . . . . d a . A d . . . . . . . . . . . W d. . . . .
A.PPLICAINT,4
:VzQ<x-,e &;j� PHONE 5W, —
ASSESSORSMAP \14L'1�43ER LOT NUMB ER /W/,O
SUBDLVISION LOT NUMBER
STREET ?"_ &_6 STREET NUMBER 30
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a . . 9 . . . . . . . . . a d . . .
OFFICIAL USE ONLY
I o . d d6. . . . . . . . . . . i6. d . � � . . d . 8 N a . . . a . a on . . . . . . . . . . . . . . . V . . . . . . . . d a . N
REC NUAENDAT N 0 OWN AGENTS
d a d a d a . . . . .
DATE APPROVED
CONSERVATION A-DM2,11STRATOR
n,s-rp Prmc-rpr)
CnM-NfE`,47`S.
FOOD ENSPECTOR - HEALTH
- - Z—d TL�
SEPTIC INSPECTOR - HEALTH
PUBLIC WORKS - SEWER / WATER CONNECTIONS -.7e
DRIVEWAY PERMTr
e- Z_,f_ a C.0
DEP
DATE REJECTE-D
DATE A.PPROVED
DATE REJECTED
DATE APPROVED -4 A�L eOl /61`�
DATE REJECTED
DATE APPROVI
DATE REJECTED
CONgvEYM
RECEIVED BY BUILDING INSPECTOR DATE
.i
50
3 SF' (
PULTE HOME CORPORATION RESERVES THE RIGHT TO MAKE FIELD CHANGES TO THIS PLOT PLAN
IN ORDER TO ACHIEVE PROPOER SITE DRAINAGE, MEET SETBACK REQUIREMENTS, AVOID LEDGE OR
ACCOMMODATE THE CONSTRUCTION OF THE HOME IN THE MOST OPTIMUM WAY. THESE FIELD ADJUSTMENTS
MAY BE MADE WITHOUT CONSULTATION WITH THE BUYER IN ORDER TO EXPEDITE THE CONSTRUCTION OF THE HOME.
PROPOSED SITE PLAN
LOT 49 FOREST VIEW ESTATES
NORTH ANDOVER, MA
PREPARED FOR
PULTE HOME CORP. OF NEW ENGLAND
257 TURNPIKE ROAD - SUITE 200
SOUTHBOROUGH, MASSACHUSETTS 01772
MARCHIONDA & ASSOC.,L.P.
ENGINEERING AND PLANNING CONSULTANTS
62 MONTVALE AVE. SUITE I
STONEHAM, MA. 02180
(617) 438-6121
SCALE: 1"=20' DATE: 6/27/00
a
t
50
3 SF
----------- OREN -SPACE- E-
PULTE HOME CORPORATION RESERVES THE RIGHT TO MAKE FIELD CHANGES TO THIS PLOT PLAN NAL
,BACK REQUIREMENTS, AVOID LEDGE OR
IN ORDER TO ACHIEVE PROPOER SITE DRAINAGE. MEET SET
ACCOMMODATE THE CONSTRUCTION OF THE HOME IN THE MOST OPTIMUM WAY. THESE FIELD ADjUSTMENTS
MAY BE MACE WITHOUT CONSULTATION WITH THE BUYER IN ORDER TO EXPEDITE THE CONSTRUCTION OF ME HOME.
r PROPOSED SITE PLAN
LOT 49 FOREST VIEW ESTATES
NORTH ANDOVER, MA
PREPARED FOR
PULTE HOME CORP. OF NEW ENCLAND
257 TURNPIKE ROAD - SUITE 200
SOUTHBOROUGH, MASSACHUSE77S 01772
MARCHIONDA & ASSOC-L.P.
ENGINEERING AND PLANNING CONSULTANTS
62 MONTVALE AVE. SUITE I
STONEHAM. MA- 02180
(617) 4.33-6121
SCALE: 1"=20' DATE. 6/14-/00
7 - a 0 0 -,;L �c
Two Fai
Applicant's Phone Number Single Famj1v Mily
I the undersigned applicant For the above property attest that the attached building permit forwhich this form is contp, eied.,
does comply with the ENEMPTION section 8.7.6 oftheGrowth Management Bylaw. I ilso unde�rstand providitg�Ws form,does.not'.
absolve me or any party to this permit from the requirements ofobtain-ing other permits required prior to ihe-i&suance ofthe buildifig
Permit. Further I uriderstart d that my interprdzdon of the exemption status is subject to review. by the Rildin g:D,:prtmcrk aad:�Js only
officially accepted when the building permit is issued.
Based an section 8.7.6 afthe North Andover Growth Bylaw the above lot and thework as app fied for on the above lot�. in . thej�iidi�g
permit application andassociated attachments, complies with one ormore ofthe following sections as indicated bys, ch eck*m�r�.:,�
This i s an app I ication fo r a buildin g p ermit for the an largement restoration or reconstrua�icn of a dwel I ing in existericeas
ofthe ed�ctivc date ofd--iis byl3w, provided that no additional residential unit is created.
lot.(s) was were cr--ded prior to May 6, 1996 and are exerript from the provisions ofsection 8.7 ofthe Zoning,Bylaw.
This application is For dwellingunits for low and ormodente incomelamilies or individuaLs, whereaU oftheciondiLions
of 8.7.6 are mts: and,:rr rcpresents dwelling units for senior residents, where occupancy ofthe units is restricted to senior cm" * zca3
through a properly executed and recorded deed restriction running with the land, For purpose3 Dfthis section "senior" shall Mean
persons over the age of'5 5.
This applic-ion is pan ofa development project which voluntarily agreedto a minimum 40 %permanentr, . educt.16nz mi..-.
density (buildable lots) below the density permitted under 7=iogand feasible given the environmental conditions ofthetract; wiLhthe-',
surplus land eq=l. to at least ten buildable a cre3 and permanently desigpated as open space or fArmland- The Iandlo be preseiryecfshall�
be prateaed from development by a -n AgricuPairal Preserydion Restriction, Conservation Restriction, dedi=ion to the Towa,o'rpther
similar mechanism approved by t -be planning board that will ensure its protection.
This application represents a tract of land e--cisting and not held by a Developer in co. onowngrship.withanadjacent-
parcel on the effective date ofthis Section 8.7 and shall receive a onetime exemption from the Planned Growth Rate and.
Development Scheduling provisions for the purpose ofconstructing one single family dwellingunit onthe.parcel..
This application represent% a lot which is ready for 3 building permit ( all other permits from all otherboards and
commissions have been received and the project is in compliancewith those permits� and the Development Schedule does not.
accommodate issuing a budding permit in that year. One buildingpermit will be issued per yearper Developmew until suchtime as�.
the develop=ent schedule accommodates issuing building permit%. AppLicant must submit an approved FORM U with this
PLEASE PROVIDE. -%-NY t% -ND ALL ENFORMATION THAT WOULD ASSIST BUILDING DEPARTMENT LN,\CAXJNG A,
DETERNIINATION THAT TIES APPLICATION IS ALLOWED UNDER ONE OR MORE OF TBE ABOVE EXEMPTIONS.:
BY SIGNTING BELOW T AT7FST TOTHE.-kCCURACY OF TBE ENFORIviATION PROVIDED.AND THAT TBE ATTACHED.'
BUILDD4G PERMIT IS ALLOWED -ANEXENiPTIONAS CITED ABOVE.
FU`R=R I UNDERST.AND THAT TEE SUBMI"I'TAL OF I'vUSLEADING OR INACCURATE IN'FORMATION OR THE-'.
CHECRING OFYOF A ABOVE E=,MPTION WMCH DOES NOT COMPLY, WBE=R DONE, TO NfY KNOWLEDGE OR
NOT IS WUND S FO P R-EFUS Al.. BY THE BUILDING DEPARn�fENT TO ISSUE A BUILDING PEn,-fIT.
APPLICANTS STCJ-NA-IJJRF- DATE
THIS FORM TO BE ATTACHED TO TEE BUILDING PEPd'v[[T APPLICATION
Mesiti Dev Group Fax:W8-5578160 Jun 13 2000 12:5.3 P. 18
B UILD LNG D EP ARTNENIT
DEBRIS DISPOSAL FORM
In accardarice with the p—ruvm—o"*ns of MGL c 40 S 54, a condition of Building Permit Number
Is that the debris resultim t-, form this work shall be disposed of in a properi7 lic--nsed solid waste disposal facility as
dedned by MGL c 11, S 150 A
'ne detnis wW be Wsmsed of in:
Mesiti Dev Group Fax:978-5578160 Jun 13 2000 12:54 P. 19
The Commonwealth of Massachusetts
Department of industrial Accidents
Office of Investigations
Boston, Mass.* 02111
Workers' Compensation (nsurance Affidavit
Please Print
Name:
Location:
city Phone
am a homeowner performing all wark myself.
I am a sale proprietor and have no one working in any capacity
I am an employer providing warkers' compensation far my employees working on this job.
eo
m name. r
—Co – P—
Address
Ie d. 0 C',
City- Sourll&qvez�g a 7,2.;, Ph -one 7VOY– 6 0 0,�Z,25
Insurance Co. IoLi-i e- 1,y -C, e2a. Policy e -q 3o i I kYl
Comcanv name
Address
CitV7 Phone
Insurance Co- Policy
Failure to secure coverage as required under S6cdon 25A or MGL 152 can lead to the impostdcri d criminal penalties of a fine up to $1,5CO.CC
and/or one years' imprisonment as well as civil penalties in the form arf a STCP WCRK ORLER and a fine of ($100.00) a day against me I
understand that a copy af this statement m�y beforwarded to the Cffice cf Investigations af the OLA for coverage verification.
do herby ceft� ander ma pains and penalties of pejury that the information provAded above is ne and correcl-
Signature Date
Print nam Phone'*
Official use crly do not write in this area to be completed by city or town officid'
C]Check if imme&ate response is requked Building Dept
C40ntaCf PerSOM
I
;RM WORKMAN'S COUPENSAT70H
#7
F -T Building Dept
0 Licensing Board
Selectman's Cffid--
Health Department
Other
Cl
CERTIFICATE OF INSURANCE ISSUE DATE: 61`16/00
THIS CERTIFICATE IS A MATTER OF I NFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURED COMPANIES AFFORDING COVERAGE
I
COMPANY A Pacific Employers Insurance Company
COMPANY 8
COMPANY C
COMPANY D
COVERAGES
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.
EFFEC TI
TYPE OF INSURANCE _l___P0__Ll_C__�___ - ___ --F --DATE DATE LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
ON AN OCCURRENCE BASIS
ADDITIONAL INSURED:
AUTOMOBILE
LOSS PAYEE:
ADDITIONAL INSURED:
GENERAL AGGREGATE
PRODUCTS-COMPIOP AGG.
PERSONAL & ADV. INJURY
EACH OCCURRENCE
FIRE DAMAGE (Any one fire)
MED. EXPENSE (Any one person)
COLLISION DEDUCTIBLE
COMPREHENSIVE DEDUCTIBLE
COMBINED SINGLE LIABILITY LIMIT
(Owned, Hired & Non -owned)
OTHER
t
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS
TIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, WE WILL ENDEAVOR
TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE
HOLDER NAMED TO THE LEFT.
AUTHORIZED
REPRESENTATIVE/
EXCESS LIABILITY
WLR C4 301187A
5/11/00
5/1101
EACH OCCURRENCE
AGGREGATE
--- -- ----------- ---- ------- -
STATUTORY LIMITS I ...................
WORKER'S COMPENSATION and
A
EMPLOYERS'LIABILITY
.............................................................................................
EACH ACCIDENT $1,000,000
—i� MA,NV
SCF C4 3011881
5/l/00
5/1101
DISEASE -POLICY LIMIT $1,000,000
DISEASE -EACH EMPLOYEE $1,000,000__
PROPERTY
REAL AND PERSONAL PROPERTY, INCLUDING WHILE
LOSS PAYEE:
IN COURSE OF CONSTRUCTION:
PER OCCURRENCE LIMIT
MORTGAGEE:
SPECIAL FORM (INCLUDING FLOOD AND EARTHQUAKE)
DEDUCTIBLE PER OCCURRENCE
OTHER
t
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS
TIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, WE WILL ENDEAVOR
TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE
HOLDER NAMED TO THE LEFT.
AUTHORIZED
REPRESENTATIVE/
MAScheck COMPLIANCE REPORT
Massachusetts Energy Code
MAScheck Software Version 2.01
CITY: Andover
STATE: Massachusetts
HDD: 6322
CONSTRUCTION TYPE: I or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non -Electric Resistance)
DAT�E: �6- �-2YOC 7
lington Elevation 4 3 Forest V.e- �
-----------
PROJECT INFORMATION:
Forest View North Andover, MA
COMPANY INFORMATION!
Pulte Home Corporation New England Division
Permit #
Checked by/Date
NOTES:
customer purchased elev. 43, two walk out bays, one additional window,
& a transom package.
COMPLIANCE: PASSES
Required UA = S75
Your Home = 573
Area or Cavity Cont. Glazing/Door
Perimeter R -Value R -Value U -Value UA
-------------------------------------------------------------------------------
CEILINGS 1907 4� 3 �8O 0.0 57
WALLS: Wood Frame, 16" O�C- 2785 13.0 0 . 0 229
GLAZING: windows or Doors 571 188
DOORS 44 0.280 12
DOORS 20 0.1G0 3
FLOORS: Over Unconditioned Space 248 30.0 0.0 B
FLOORS: Over Unconditioned Space 1676 r---2 T 0—) 0 - 0 73
FLOORS: Over outside Air 32 30.0 0.0 1
HVAC EQUIPMENT: Furnace, 80.0 AFUE
-------------------------------------------------------------------------------
COMPLIANCE STATEMENT: The proposed building design described here is
consistent with the building plans, specifications, and other calculations
submitted with the permit application. The proposed building has been
designed to meet the requirements of the Massachusetts Energy Code.
The heating load for this building, and the cooling load if appropriate,
has been determined using the applicable Standard Design Conditions found
in the Code. The HVAC equipment selected to heat or cool the building
shall be no greater than 12 of e design load as specified in
Sections 780CMR .4.
Builder/Designer Date
MAScheck INSPECTION CHECKLIST
Massachusetts Energy Code
mAScheck Software Version 2.01
Lot # 49 Wellington Elevation # 3
DATE: 6-16-2000
Bldg.1
Dept.1
Use I
Forest View
CEILINGS:
1. R-38
Comments /Locatio.--mo
WALLS:
1. Wood Frame, 161, O.C., R-
Comments/Location
WINDOWS AND GLASS DOORS:
1. U -value: 0.33
For windows without label(pd U -values, describe eat
I j
# Panes Frame Type VjfjV L-�' Thermal Brea ? No
r
Comments/Location L� r
DOORS:
1. U -value: 0.28
Comments /Location
2. U -value: 0.16
Comments/Location
FLOORS:
1. Over Unconditioned Space, R-30
Comments/Location J�
2. over Unconditioned Space, R-
Comments/Location �1�?]
3. Over Outside Air, R-30
Comments/Location
HVAC EQUIPMENT:
1. Furnace, 80.0 AFUE or higher
Make and Model Number
AIR LEAKAGE:
Joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. When
installed in the building envelope, recessed lighting fixtures
shall meet one of the following requirements:
1. Ty -pe IC rated, manufactured with no penetrations between the
inside of the recessed fixture and ceiling cavity and sealed or
gasketed to prevent air leakage into the unconditioned space -
2. Type IC rated, in accordance with Standard ASTM E 283, with no
more than 2.0 cfm (0.944 L/s) air movement from the the
conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 lbs/ft2 pressure
difference and shall be labeled.
VAPOR RETARDER:
Required on the warm -in -winter side of all non -vented framed
ceilings, walls, and floors.
MATERIALS IDENTIFICATION:
materials and equipment must be identified so that compliance can
be determined. Manufacturer manuals for all installed heating
and cooling equipment and service water heating equipment must be
provided. Insulation R -values, glazing U -values, and heating
equipment efficiency must be clearly marked on the building plans
or specifications.
DUCT INSULATION:
Ducts shall be insulated per Table J4.4.7.1.
DUCT CONSTRUCTION:
All accessible joints, seams, and connections of supply and return
ductwork located outside conditioned space, including stud bays or
joist cavities/spaces used to transport air, shall be sealed
using mastic and fibrous backing tape installed according to the
manufacturer's installation instructions. Mesh tape may be
omitted where gaps are less than 1/8 inch. Duct tape is not
permitted. The HVAC system must provide a means for balancing
air and water systems.
TEMPERATURE CONTROLS:
Thermostats are required for each separate HVAC system. A manual
or automatic means to partially restrict or shut off the heating
and/or cooling input to each zone or floor shall be provided.
HVAC EQUIPMENT SIZING:
Rated output capacity of the heating/cooling system is
not greater than 125% of the design load as specified
in Sections 780CMR 1310 and J4.4.
SWIMMING POOLS:
All heated swimming pools must have an on/off heater switch and
require a cover unless over 20-'. of the heating energy is from
non-depletable sources. Pool pumps require a time clock.
HVAC PIPING INSULATION:
HVAC piping conveying fluids above 120 F or chilled fluids
below SS F must be insulated to the following levels (in.):
PIPE SIZES (in.)
HEATING SYSTEMS: TEMP (F) 211 RUNOUTS 0-111 1-25-211 2.5-411
Low pressure/temp. 201-250 1.0 1.5 1.S 2.0
Low temperature 120-200 0.5 1.0 1.0 1.5
Steam condensate any 1.0 1.0 1.5 2.0
COOLING SYSTEMS:
Chilled water or 40-55 0-5 0.5 0.75 1.0
refrigerant below 40 1.0 1.0 1.5 1.5
CIRCULATING HOT WATER SYSTEMS:
insulate circulating hot water pipes to the following levels (in.):
NOTES TO FIELD (Building Department Use Only) -------------------------
PIPE
SIZES (in.)
NON -CIRCULATING
CIRCULATING MAINS &
RUNOUTS
HEATED WATER TEMP
(F): RUNOUTS 0-111
0-1.2511
1.5-2.011
2.0+11
170-180
0.5
1.0
1.5
2.0
140-160
0.5
0.5
1.0
1.5
100-130
0.5
0_5
0.5
1-0
NOTES TO FIELD (Building Department Use Only) -------------------------
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Buildino Value Calculation - for Propemt at.....
Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost
Kitchen 22 14 308.00
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10,920.00
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Garage 20 20 400.00 14,000.00
Entry 14 8 112.00
7,280.00
Basement Finished
Deck
Screened Porch
Breakfast Nook
AR --
Bedroom 1 19 15 285.00
18,525-00
Bedroom 2 14 12 ..................
10,920.00
Bedroom 3 14 10 140.00
9,100.00
Bedroom 4 12 12 144.00 9,360.00
Y
Bedroom 5 35,
Bathroom 1 10 6 6000 $ 3,900.00
Bathroom 2 13 10 130.00 $ 8,450.00
Bathroom 3
Bathroom 4
Bathroom 5
12 k
cop-)
C9
Town of
NORTH ANDOVER
BUILDING PERMIT INSPECTION REPORT
PERMIT NO.: -261 PROJECT: --9//- *A-ZA - I
:.00 A'
f
UNIT NO.: FLOOR:
WING: BUILDING NO.: Xt-,-k A101
z;,vL- 3 0
19m 6 t�'e U t 4
REMARKS:
Excavation - depth and soil conditions
Framing -
Other:
Date:
Date: 3
Date:
Inspector
Inspector
Inspector
Footings and foundations and drains -
Insulation -
Other:
Date:
Date:
Date:
Inspector-
Inspector
Inspector
Electrical - rough -
Plumbing and/or gas - rough -
Other:
Date:
Date:
Date:
Inspector
Inspector
Inspector -
Electrical - final
Plumbing and/or g*s - final
Other:
Date:
Date.
Date:
Inspec
Inspector—
Inspector
Fire De/
oil burner, tank, stove, smoke detectors
Final inspection
Ce ' 'cate of Use and Occupancy
Date:
Date: 0
a e. C of 0
Inspector ".4"MC6
Inspector
Inspector
Location b zf -2
No. Date
2 1- �
�/l 30
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee
Other Permit Fee $
TOTAL $
Building Inspector
'S�� I r�-A4U � Lr'
Permit NO: 1 "7 1'
Date Issued: I —
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
I IMPORTANT: Applicant must complete all items on this page I
LOCAT16W '..-3.OAmberviRe Road -
Print.
PROPEWTY OWNER Carlos GqJzrnan
yes
MAP N NING,DISTRICT: Hi Cie District yes
`�Machine ShoD Villacie _v6 s
Print- 100 Year'01d Stru6ture
0:/6.44_PA'RCEL- ZO sto
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
D New Building
0 One family
0 Addition
D Two or more family
0 Industrial
W Alteration
No. of units:
D Commercial
11 Repair, replacement
0 Assessory Bldg
11 Others:
El Demolition
0 Other
D Septic 0 Well
D Floodplain 11 Wetlands
0 Weitershed District
0 Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Installation of an 11.5 kw (46 panels) rooftop solar arrE
Identification Please Type or Print Clearly)
OWNER: Name: Carlos Guzman Phone: 781-551-2173
Aridrinq4z- '10 Amberville Road
CONTRACTOR Name:—Romain Strecker �..P_hone:..7R1_46.1._R_7o?,_
Addfess:
10 Churchill Place, L=n MA -01902
Supervisor's Construction Licer�se: -096385 Exib, Ddte: im 2oi6
Home Improvement License: 169698 Exp.. Date: 7/27/2015
ARCHITECT/ENGI NEER Paul Zacher Phone:
Address: 8150 Sierra College Blvd, Roseville CA Reg. No. 50100
FEE SCHEDULE. BULDING PERMIT. $1Z00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 41,902 FEE: $
Check No.: (0 ReceiptNo.:
NOTE: Persons contracting with unregistered contractors do not have acce:ss tr6gua7ran!tYf'U*W'-
Signature of Agent/Owner-see signed contract Sigiiature of contractor
Building Department
The foLowing ls--'a list of the k.equired-forms to be filled out for the appropriate -permit to, be obtained.
Roofivg, Siding, Interior Rehabilitation Permits
c3 Building Permit Application
c3 Workers Comp Affidavit
• Photo Copy Of H. 1. C. And/Or G. S. L. Licenses
• Copy of Contract
• Floor Plan Or Proposed Interior Work
c3 Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
• Building Permit Application
• Certified Surveyed Plot Plan
• Workers Comp Affidavit
• Photo Copy of H.I.C. And C.S.L. Licenses
• Copy Of Contract
Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (if Applicable)
• Mass check Energy Compliance Report (If Applicable)
• Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
u Building Permit Application
c3 Certified Proposed Plot Plan
• Photo of H.I.C. And C.S.L. Licenses
• Workers Comp Affidavit
• . Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
• Copy of Contract
• Mass check Energy Compliance Report
c3 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 apo, -al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc.Buifflng Permit Revised 2012
Plans Submitted PlansWaived-l-I Certified Plot Plan El Stamped Plans El
TYPE-�OYSEWERAGE DISPOSAL -
Public Sewer El
TanninggWassage/Body Art
Swinuning Pools 0
Well E3
Tobacco Sales
Food Packaging/Sales 0
Private (septic tank, etc..
Permanent Dumpster on -Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED. DATE APPROVED
PLANNING & DEVELOPMENT" El
COMMENTS
CONSERVATION Reviewed on —Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: V2riance, Petition No: Zoning Decision/receipt submitted yes
Plarining Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Conn ecti on/Siq nature & Date Driveway Permit
DPW Tow;2 Engineer: Signature:
Located 384
-'FIRE 13tPA'ATMENt __ Ter' -hp, Dump'�itet on site Yes_ no
Located'at 124 Nair. Street
- Fire Deliaiftme! It signature/date'
COMMENTS
Street
,.-Dimension
i
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 21 A �F and G min.$100-$1000 fine
NOTES and DATA — (For department use)
El Notified for pickup - Date
Doe.Building Permit Revised 2010
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QWAMMM�
July 16, 2015
Sungevity
66 Franklin Street
I" OFNS
Oakland, CA 94607
0
TEL: (510) 496-5621
PAUL
ZACH
Subject: Structural Certification for Installation of Solar Panels
TRUCTURAL
Job Number: 20153497
50100
Client: Guzman - 1869744
Address: 30 Amberville Rd, North Andover, MA 01845
'ONAL
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 2x 10 roof rafters
at 16" on center all Arrays. The rafters at Arrays I & 2 are sloped at approximately 33 degrees, while the rafters at Arrays
3 & 4 are sloped at approximately 45 degrees. Array I rafters have a maximum projected horizontal span of 13'-5", 101 -
7" at Array 2, and 8'-7" at Arrays 3 & 4 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= 10.7 psf (Arrays 1 & 2) 12.7 psf (Arrays 3 & 4)
• 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:
All Arrays are adequate to support the loading imposed by the installation of
solar panels and modules. Therefore, no structural upgrades are required.
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.
Sincerely, L
Paul Zacher, SE - President
8150 Sierra College Blvd, Suite 150 — Roseville, CA 95661 — 916.961.3960 p — 916.961.3965 — www.pzse.com
July 16, 2015
Sungevity
66 Franklin Street
Oakland, CA 94607
TEL: (510) 496-5621
FAX:
Attn.: To Whom It May Concern
re: Job 20153497: Guzman - 1869744
STRU(TURAL ENGINEERS
The following calculations are for the Structural Engineering Design of the Photovoltaic Panels
located at 30 Amberville Rd, North Andover, MA 0 1845. After review, PZSE, Inc. certifies
that the roof structure has sufficient structural capacity for the applied PV loads.
If you have any questions on the above, do not hesitate to call.
Sincerely,
Paul Zacher, SE - President
��A OF&tq ,
In
PAUL K.
ZA
CHER
R UCTU
UCTURAL
8150 Sierra College Boulevard, Suite 150 e Roseville, CA 95661 e 916.961.3960 P e 916.961.3965 e www.pzse.com
1 of 8
Gravity Loading
Roof Snow Load Calculations
pg = Ground Snow Load
55 psf
C. Exposure Factor
0.9
Ct Thermal Factor =
1
1 = Importance Factor
1
pf = 0.7 Ce Ct I pq
35 psf
where p. 5 20 psf, Pf min = I x p 9 =
NIA
where pg > 20 psf, Pf min = 20 x I =
N/A
Therefore, pf = Flat Roof Snow Load --
35 psf
(ASCE7 - Table 7-2)
(ASCE7 - Table 7-3)
(ASCE7 - Eq 7-1)
min snow load (.f �,,, � 15-)
min snow load (roofslo� � 15a)
p� = C.'pf (ASCE7 - Eq 7-2)
Cs = Slope Factor 0.925
ps = Sloped Roof Snow Load 32.1 psf
f PV Dead Load = 3 psf (Per Sungevity)
Roof Dead Load (ARRAY 1)
Composition Shingle
4.00
Roof Plywood
2.00
2x1O Rafters @ 16"o.c.
2.90
Vaulted Ceiling
0.00 (Ceiling Not Vaulted)
Miscellaneous
0.10
Total Roof DL (ARRAY 1)
9.0 psf
DL Adjusted to 33 Degree Slope
10.7 psf
F- Roof Dead Load (ARRAY 2)
Composition Shingle
TOO
Roof Plywood
2.00
2x1O Rafters @ 16"o.c.
2.90
Vaulted Ceiling
0.00 (Ceiling Not Vaulted)
Miscellaneous
0.10
Total Roof DIL (ARRAY 2)
9.0 psf
DL Adjusted to 33 Degree Slope
10.7 psf
Roof Dead Load (ARRAY 3)
Composition Shingle 4.00
Roof Plywood 2.00
200 Rafters @ 16"o.c. 2.90
Vaulted Ceiling 0.00 (Ceiling Not Vaulted)
Miscellaneous 0.10
Total Roof DL (ARRAY 3) 9.0 psf
DL Adjusted to 45 Degree Slope 12.7 psf
Roof Dead Load (ARRAY 4)
Composition Shingle 4.00
Roof Plywood 2.00
2x1O Rafters @ 16"o.c. 2.90
Vaulted Ceiling 0.00 (Ceiling Not Vaulted)
Miscellaneous 0.10
Total Roof DIL (ARRAY 3) 9.0 psf
DL Adjusted to 45 Degree Slolbof 8 12.7 psf
Guzman Structural CaIcs 1
Wind Calculations
Per ASCE 7-05 Components and Cladding
F-14-ut V—afliblis
Wind Speed
110 mph
Exposure Category
C
Roof Shape
Gable/Hip
Roof Slope
33 degrees
Mean Roof Height
18ft
Building Least Width
16ft
Effective Wind Area
17.5 ft
Design Wind Pressure Ca E-uliflons
Sfaind-Off Uplift Ca ions
Wind Pressure P = qh*(G*Cp)
qh = 0.00256 * Kz * Kzt * Kd * V12 * I
(Eq -6-15)
Kz (Exposure Coefficient) 0.88
(Table 6-3)
Kzt (topographic factor) 1
(Fig. 64)
Kd (Wind Directionality Factor) 0.85
(Table 64)
V (Design Wind Speed) 110 mph
-25.49 psf
Importance Factor 1
(Table 6-1)
qh 23.17
4.00
—'Standoff Uolift-Ch-e-&-—
Maximum Design Uplift = -549 lb
Standoff Uplift Capacity = 700 lb
700 lb capacity > 549 lb demand Therefore, OK
F-- ---- -Fastener CTp—ac1qCK-e-ck--
Fastener = I - 5/16" dia Lag
Number of Fasteners= 1
Minimum Threaded Embedment Depth = 2.5
Pullout Capacity Per Inch = 205 lb
Fastener Capacity = 820 lb
820 lb capacity > 549 lb demand Therefore, OK
3 of 8
Guzman Structural CaIcs 2
Sfaind-Off Uplift Ca ions
Zone 1
Zone 2
Zone 3 Positive
GCp =
-0.90
-1.10
-1.10 0.85 (Fig. 6-11)
Uplift Pressure =
-20.85 psf
-25.49 psf
-25.49 psf 19.7 psf
X Standoff Spacing =
4.00
4.00
4.00
Y Standoff Spacing =
5.38
5.38
5.38
Tributary Area =
21.52
21.52
21.52
Footing Uplift=
-449 lb
-549 lb
-549 lb
—'Standoff Uolift-Ch-e-&-—
Maximum Design Uplift = -549 lb
Standoff Uplift Capacity = 700 lb
700 lb capacity > 549 lb demand Therefore, OK
F-- ---- -Fastener CTp—ac1qCK-e-ck--
Fastener = I - 5/16" dia Lag
Number of Fasteners= 1
Minimum Threaded Embedment Depth = 2.5
Pullout Capacity Per Inch = 205 lb
Fastener Capacity = 820 lb
820 lb capacity > 549 lb demand Therefore, OK
3 of 8
Guzman Structural CaIcs 2
Framing Check
(ARRAY 1) PASS
w = 61 plf
Dead Load 10.7 psf
PV Load 3.0 psf
Snow Load 32.1 psf ix 10 R—aft—ers
16
�e �o
16"o.c.
_0
Governing Load Combo DL + SL Member Span 13'- 5" >
Total Load 45.8 psf
Member Properties
Member Size S (in A 3) 1 (in A 4) Lumber Sp/Gr Member Spacing
2x1O 21.39 98.93 SPF#2 @ 16"o.c.
Check Bending Stress I
Fb (psi) fb X Cd x Cf x Cr (NDS Table 4.3.1)
875 x 1.15 x 1.1 x 1.15
Allowed Bending Stress = 1272.9 psi
Maximum Moment = (wL A 2)/8
= 1374.05 ft#
= 16488.6 in#
Actual Bending Stress = (Maximum Moment) I S
= 770.9 psi
Allowed > Actual -- 60.6% Stressed -- Therefore, OK
F- Check Deflection
Allowed Deflection (Total Load) U1 20 (E = 1400000 psi P;r NDS)
= 1.341 in
Deflection Criteria Based on Simple Span
Actual Deflection (Total Load) (5*w*L'4) / (384*E*I)
= 0.322 in
= U500 > U120 Therefore OK
Allowed Deflection (Live Load) =
Actual Deflection (Live Load) =
U1 80
0.894 in
(5*w*L'4) / (384*E*I)
0.226 in
U713 > Ul 80 Therefore OK
Member Area= 13.9in'2 Fv (psi)= 135 psi (NDS Table 4A)
Aflowed Shear = Fv * A = 1873 lb MaxShear(V)=w*L/2 = 410 lb
Allowed > Actual -- 21.9% Stressed -- Therefore, OK
4 of 8
Guzman Structural Calcs 3
Framing Check
(ARRAY 2) PASS
w = 61 plf
Dead Load 10.7 psf
PV Load 3.0 psf
�Oa6e s�- 6�
Snow Load 32.1 psf O.C.
0 C
Governing Load Combo = DL + SL Member Span = 10'- 7"
Total Load 45.8 psf
iber Size S (in A 3) 1 (in A 4) Lumber Sp/Gr Member Spa(
2x1O 21.39 98.93 SPF#2 @ 16"o.c.
F Check Bending Stress
Fb (psi) fb x Cd x Cf x Cr (NDS Table 4.3.1)
875 x 1.15 x 1.1 x 1.15
Allowed Bending Stress = 1272.9 psi
Maximum Moment = (wL A 2)/8
= 854.986 ft#
= 10259.8 in#
Actual Bending Stress = (Maximum Moment) / S
= 479.7 psi
Allowed > Actual - 37.7% Stressed -- Therefore, OK
Check Deflection
Allowed Deflection (Total Load) U120 (E = 1400000 psi Per NDS)
1.058 in
Deflection Criteria Based on Simple Span
Actual Deflection (Total Load) (5*w*LA4) / (384*E*I)
0.125 in
U1016 > U120 Therefore OK
Allowed Deflection (Live Load) =
Actual Deflection (Live Load) =
Ul 80
0.705 in
(5*w*LA4) / (384*E*I)
0.088 in
U1444 > U180 Therefore OK
Check Shear
Member Area = 13.9 in A 2 Fv (psi) 135 psi (NDS Table 4A)
Allowed Shear = Fv * A = 1873 lb Max Shear (V) = w * L / 2 = 323 lb
Allowed > Actual -- 17.3% Stressed -- Therefore, OK
5 of 8
Guzman Structural Calcs; 4
Framing Check
(ARRAY 3) PASS
w = 64 plf
Dead Load 12.7 psf
PV Load 3.0 psf
Snow Load 32.1 psf 200 Rafters 6� 16"o.c.-----
0
Governing Load Combo = DL + SL Member Span = 8'- 7" >
Total Load 47.8 psf
Member Properties
Member Size S (in A 3) 1 (in'4) Lumber Sp/Gr Member Spacing
2x1 0 21.39 98.93 SPF#2 @ 16"o.c.
F- Check Bending Stress
Fb (psi) fb x Cd x Cf x Cr (NDS Table 4.3.1)
875 x 1.15 x 1.1 x 1.15
Allowed Bending Stress = 1272.9 psi
Maximum Moment = (wL A 2)/8
= 586.933 ft#
= 7043.2 in#
Actual Bending Stress = (Maximum Moment) / S
= 329.3 psi
Allowed > Actual - 25.9% Stressed -- Therefore, OK
Check Deflection
Allowed Deflection (Total Load) U120 (E = 1400000 psi Per NDS)
0.858 in
Deflection Criteria Based on Simple Span
Actual Deflection (Total Load) (5 -w -L-4) / (384-E-1)
0.057 in
U1808 > U120 Therefore OK
Allowed Deflection (Live Load) =
Actual Deflection (Live Load) =
U180
0.572 in
(5*w*L A 4) / (384*E*I)
0.038 in
U2711 > U180 Therefore OK
Check Shear
Member Area= 13.9 in A 2 Fv (psi) 135 psi (NDS Table 4A)
Allowed Shear = Fv * A = 1873 lb Max Shear(V) =w* L/2 = 274 lb
Allowed > Actual -- 14.7% Stressed -- Therefore, OK
6 of 8
Guzman Structural Calcs 5
Framing Check
(ARRAY 4) PASS
w = 64 plf
Dead Load 12.7 psf
PV Load 3.0 psf
Snow Load 32.1 psf F--�x-10-R- —afters @-16"o—c-.-
0
Governing Load Combo = DL + SL Member Span = 8'- 7"
Total Load 47.8 psf
Member Properties
Member Size S (inA3) I (in A 4) Lumber Sp/Gr Member Spacing
2x1O 21.39 98.93 SPF#2 @ 16"o.c.
F Check Bending Stress
Fb (psi) fb x Cd x Cf x Cr (NDS Table 4.3. 1)
875 x 1.15 x 1.1 x 1.15
Allowed Bending Stress = 1272.9 psi
Maximum Moment = (wL A 2)/8
= 586.933 ftft
= 7043.2 in#
Actual Bending Stress = (Maximum Moment) / S
= 329.3 psi
Allowed > Actual -- 25.9% Stressed -- Therefore, OK
F Check Deflection
Allowed Deflection (Total Load) U1 20 (E � 1700000 psi Per NDS)
1.341 in
Deflection Criteria Based on Simple Span
Actual Deflection (Total Load) (5*w*L A 4)1(384*E*I)
0.057 in
U1808 > U120 Therefore OK
Allowed Deflection (Live Load) =
Actual Deflection (Live Load) =
U180
0.894 in
(5*w*L A 4) / (384*E*I)
0.038 in
U2711 > U180 Therefore OK
—Ch-e-c—k S-h--ea—r
Member Area= 13.9 in A 2 Fv (psi) 135 psi (NDS Table 4A)
Allowed Shear = Fv * A = 1873 lb MaxShear(V)=w*L/2 = 274 lb
Allowed > Actual -- 14.7% Stressed -- Therefore, OK
7 of 8
Guzman Structural CaIcs 6
Lateral
Per 2009 IBC Chapter 34
Level
Area
Weight (psf)
Weight (lb)
Roof
1021 sf
10.7 psf
10925 lb
Ceiling
1021 sf
6.0 psf
6126 lb
Vinyl Siding
158 ft
2.0 psf
5694 lb (8'-0" Wall Height)
Int. Walls
158 ft
6.4 psf
18221 lb
Existing Weight of Effected Building
40966 lb
Proposed Weight of PV System
Weight of PV System (Per Sungevity)
3.0 psf
Approx. Area of Proposed PV System
803 sf
Approximate Total Weight of PV System
2409 lb
10% Comparison
10% of Existing Building Weight (Allowed)
4097 lb
Approximate Weight of PV System (Actual)
2409 lb
Percentincrease
5.9%
4097 lb > 2409 lb, Therefore OK
8 of 8
Guzman Structural Calcs 7
m 70 0) Cl) < 0 0
'o 0 m K
E5 5 V 0
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Do,�uSign Envelope ID: BlC4374D-804B-49EF-9140-669F3FEE9DB5
. 1111
sunGEVITY�
GENERATE POSITIVE -
HOME IMPROVEMENT CONTRACT FOR PURCHASE OF SOLAR SYSTEM
Sungevity, Inc.
Name and Address of Customer(s):
Address for Installation
66 Franklin Street, Suite 310
Carlos Guzman
(if different from Address of
Oakland, CA 94607
30 Amberville Rd
Customer):
866.SUN.4ALL
North Andover, MA 0 1845
30 Amberville Rd
Federal I.D. No: 01-0904328
North Andover, MA 01845
Contractor License: 168430
Name of additional Customer(s)
Contract signed by Customer
(if applicable):
Email Address and/or Facsimile
on:
Number for Notices (optional):
6/22/2015
cguzmanmd@gmail.com
1 . Introduction. This is the Home Improvement Contract for a Home Solar System (the "Contract" )
between Sungevity, Inc. ("Sunaevity," "Contracto " "us," or "we ") and the property owner(s) listed
above (collectively "you," "Custome " or "Buyer," together with Sungevity as the "Parties" each
individually a "Party") for the purchase of the photovoltaic solar energy system that is more fully
described below (the "System"). By signing this Contract, you agree to purchase from us and we
agree to furnish to you the System on the terms and conditions contained in this Contract. Our
obligations under this Contract include the design, procurement of equipment, and installation of the
System at the address listed above (the "Property' or the "Home") and your obligations include
making the payments described in Section 5. Please ask your Sungevity solar consultant if you have
any questions regarding these or any other terms of this Contract. Also, please note that this
Contract contains disclosures required by applicable state law.
2. List of Documents to be Incorporated into the Contract. The Contract includes this document
and the following attachments:
Exhibit A: Three (3) Day Right to Cancel - Notice of Cancellation Form (in duplicate)
Exhibit B: 20 Year Energy Performance Guarantee and Limited Warranty
Exhibit C: Location Specific Terms and Disclosures
You are entitled to a completely filled in copy of this Contract signed by both
you and Sungevity before any work may be started.
You have the right to cancel this Contract until midnight of the third business day after the
date you receive a completely filled in copy signed by both you and Sungevity. If you choose
to exercise this right, you should mail, fax, email or deliver the Notice of Cancellation (Exhibit
A) to Sungevity, Inc., 66 Franklin Street Suite 310 Oakland CA 94607 (see the Contract for
cancellation details).
3. Descriotion of the Proiect and DescriDtion of the Sianificant Materials to be Used and
Equipment to be Installed. Sungevity is responsible for the provisioning of all materials, including
the photovoltaic modules, inverter(s), and monitoring equipment described below, as well as all
balance of System components required for a typical home solar system including racking equipment,
mounting rails, standoffs and flashing and electrical accessories, machinery, tools, transportation,
administration and other services, and items typically required to complete and deliver a fully
integrated, installed, and tested System, all on a fixed price turnkey basis, and otherwise in
accordance with this Contract, applicable laws and applicable standards.
Home Improvement Contract for Home Solar System Page I of 24
4.23.15MA
DocuSign Envelope ID: BlC4374D-804B-49EF-9140-669F3FEE9DB5
(a) System Description
System Size/Type:
11.5 kW DC STC / 9.9897 kW CEC-AC Roof -Mounted Solar System
Modules:
Hyundai Heavy Industries HiS-M250RG(BK) —qty: 46
Inverters:
SolarEdge Technologies SE 500OA-US (240V) —qty: 2
Monitoring:
20 years monitoring services included
(b) Commencement of Work. We will commence work when this Contract is signed by both you and
us, and we have received the Downpayment (described in Section 5(b)). We will provide you with
periodic updates as to the progress of the work by phone or email.
(c) Home Visit. After this Contract becomes effective, we or our contractor or representative (the
"Preferred Installer") will visit your Home to conduct a visual inspection of the Home and
surrounding property to verify its suitability and adequacy for installation of the System (the
"Home Visi ").
(d) Design & Permitting. Following the Home Visit, we will design the System per applicable code
and the requirements of the authority having jurisdiction ("AHJ"), prudent industry standards and
utility requirements. The design will be stamped by a licensed professional engineer ("LE') to the
extent required by applicable law. Sungevity or the Preferred Installer will obtain and maintain in
full force and effect all standard building permits typically required for a residential solar system
project ("AHJ Permits").
(e) Installation. We will install your System in accordance with the design and AHJ code
requirements. Installation dates we provide are approximate and are based on current
scheduling, and as such are subject to change. We will coordinate the work of any contractors or
subcontractors we hire to perform work on the System, including the Preferred Installer, and we
will be responsible for the quality completion of their work.
(f) Completion and Interconnection. The System will be substantially complete ("Substantial
.Completion") on the day that Sungevity completes installation of the System but prior to AHJ
inspecting the System and approving the AHJ Permits. Following Substantial Completion and
after the AHJ inspects the System and approves the AHJ Permits, Sungevity will provide you with
reasonable assistance with obtaining permission to operate ("PTO") the System from the utility in
order to connect the System to the electrical grid.
(g) Monitoring. The monitoring hardware is included as part of the System. Monitoring requirements
including connectivity specifications are further described in the 20 Year Energy Performance
Guarantee and Limited Warranty in Exhibit B. Installation of Monitoring equipment may occur
after the day that the AHJ inspects the System and approves (signs off) on the AHJ Permits or, if
there is no applicable AHJ inspection, after Substantial Completion of the System.
4. 20 Year Enenciv Performance Guarantee and Sunaevity Customer Manual. We have included as
part of this Contract the 20 Year Energy Performance Guarantee and Limited Warranty (the "20 Year
Energy Performance Guarantee") as set forth in Exhibit B. We will also provide you with a copy of the
"Sungevity Customer Manual" (the "Manual "). Please be sure to read these carefully as these
documents are referenced in this Contract and include some of your obligations with respect to the
System.
Home Improvement Contract for Home Solar System Page 2 of 24
4.23.15MA
DocuSign �nvelope ID: BlC4374D-804B-49EF-9140-669F3FEE9DB5
5. Price and Payments.
(a) Contract Price
(b) Downpayment
(c) Schedule of Progress Payments
You agree to pay us the
The following down payment
1. A first Progress Payment of (the
following aggregate purchase
/ deposit ("Downpayment I') is
"First Payment'):
price for the System:
due upon the signing of this
$20,701.00
Contract:
is due on the day that the AHJ Permits
$41,902.00
$500.00
are issued by the AHJ, and covers labor
and materials for System design,
(the "Contract Price"), subject to
permitting, and project administration.
any additions and deductions
described in an authorized
(signed) Change Orders.
Notice: Any deposit
2. A second Progress Payment of (the
required to be paid in
"Second Payment I'):
advance of the start of the
$20,701.00
The Contract Price includes
work SHALL NOT exceed
is due on the day of Substantial
labor, materials, normal costs of
one-third (1/3) of the total
Completion and covers the balance of
AHJ Permits and, if applicable
contract price or the actual
materials, equipment, and labor to
in your local area, sales tax.
cost of any material or
install the System as well as project
equipment of a special
administration.
order or customer made
The Contract Price assumes
nature, which must be
that you have assigned or will
ordered in advance of the
3. A final Progress Payment of (the
assign applicable solar rebates
start of the work to assure
"Final Payment"):
or incentives to Sungevity to the
that the project will
$0.00
extent described in Exhibit C.
proceed on schedule.
is anticipated to be paid to Sungevity
directly by the applicable utility or rebate
administrator, covering the balance of
By subtracting the estimated
work on the System, and project
rebate amount of $0.00 from
administration.
your Contract Price, your net
system cost is estimated at:
No demand for final payment will be
$41,902.00
made until the contract is completed to
the satisfaction of the parties to the
contract.
(d) Other Important Terms: See below for additional information on termination, warranties, late and
default charges, recommended insurance and transferring the 20 Year Energy Performance Guarantee to
a purchaser of your Home. See Exhibit C for information about Rebates (if applicable to your System).
6. Obligations,.
(a) Payments. You agree to make the payments described in this Contract.
(b) Authority. You represent and warrant that everyone with an ownership interest in the Property or
the System has consented to the terms of this Contract, including with respect to the 20 Year
Energy Performance Guarantee.
(c) C000eration with Permits. You agree to cooperate with us in our efforts to obtain the AHJ
Permits described in Section 3(d). Any other permits or permissions that are required for the
System will be your responsibility to timely obtain, such as permits associated with historic or
Home Improvement Contract for Home Solar System Page 3 of 24
4.23.15MA
DocuSign Envelope ID: BIC4374D-804B-49EF-9140-669F3FEE9DB5
landmarked structures, or Homeowners' Association ("HOA") approvals, provided however that
we will provide you with reasonable assistance in obtaining such permits and approvals if you
request.
(d) Other Equigment and Labor. You agree that Sungevity has no liability for equipment, materials or
labor not purchased or performed under this Contract.
(e) Markings and Identification Tags. You agree not to remove the markings and identification tags
on the System.
(f) Site Access and Rights of Way. You agree to provide full access to your Home as needed for
Sungevity, including its contractors, representatives and agents including the designated
Preferred Installer, to perform the work contemplated under this Contract, including the Home
Visit, installation of the System, and service or repair work under the 20 Year Energy
Performance Guarantee. If you delay access, then we retain the right to make an equitable
adjustment in the time and Contract Price it takes to perform our obligations under this Contract.
You agree not to directly or indirectly retain any other person or entity to provide services at the
Home during the time Sungevity is installing your System if those services might interrupt our
access to the Home or the System installation, provided that we will reasonably cooperate with
you in scheduling such work if you provide us reasonable advance warning.
(g) Late Charges: Fees and Costs: Security Interest in the System: Ri-ght to Assign. Payments not
made when due Will accrue interest at the lesser of: (i) twelve percent (12%) per year, and (ii) the
maximum amount permitted by applicable law. You will be assessed an additional fee of fifteen
dollars ($15) for each return or refusal of your bank to honor a check. A malfunction, minor
damage or blemishes to installed equipment and materials is not a reason to withhold payment.
If you do not pay on time, we can stop work on your System until you pay in full, and we can
remove equipment and components from your System, whether installed or not. You grant us a
security interest in your System and agree that we can file a mechanic's lien against your
Property to secure your payment under this Contract. We can sell your payment obligation(s) to
a third party, and if you have a past due balance referred to a collection agency, you will be liable
for all costs of collection, including collection agency costs and aftorneys'fees.
(h) Insurance. The risk of loss to any component of the System passes to you upon installation. We
encourage you to update your property insurance to cover the System as soon as it is installed.
(i) Taxes. The Contract Price includes all applicable sales tax as of the date this document was sent
to you. In the event of a change in applicable sales tax rate enacted after the date this Contract
becomes effective, we will prepare and send a Change Order to you for resulting reduction or
increase to the Contract Price. You are responsible for paying any applicable personal property
taxes on the System that your state or local jurisdiction may levy.
Marketing and Signa-ge. You agree that we can photograph your System during and after
installation and use those photographs in our promotional materials and advertising without
restriction. You agree that Sungevity will have exclusive ownership of such photographs,
promotional materials and associated intellectual property. We will never release your address
publicly without your prior consent. You agree that during the installation of your System, we can
place reasonable signage at your Home identifying Sungevity as the project contractor.
(k) Indemnity. To the fullest extent permitted by law, you agree to defend and indemnify us against,
and hold us harmless from, any and all losses, claims, damages, liabilities and related expenses
(including all reasonable fees, costs and expenses of counsel), incurred by us or asserted against
us by you or any third party arising out of, in connection with, or as a result of your gross
negligence, willful misconduct or breach of your contractual obligations to us. However, you will
not be required to indemnify us for our own gross negligence or willful misconduct. This
indemnity obligation will survive termination or expiration of this Contract.
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7. Unforeseen Site Conditions: Change Orders.
(a) No Existing Conditions. By signing this Contract, you are representing that to your knowledge,
there are no conditions (concealed, hidden, hazardous or otherwise), at, on or beneath the Home
that would or may prevent the installation or operation of the System as provided in this Contract.
Proper operation of your System may depend on other features or equipment already present at
the Property, which, if changed, may result in additional work and require a Change Order.
(b) Unforeseen Conditions. If at any time we discover or encounter conditions at the Home beyond
our reasonable control which in Sungevity's opinion renders the Home in such a condition that it
is not suitable or adequate for installation of the System to proceed (for example, if your Property
requires structural repairs or improvements to support the System, or we discover pre-existing
hazardous substances on your Property) ("Unforeseen Conditions I'), then we will stop further
work and notify you.
(i) If we are appropriately qualified and licensed to do so, we will provide you with an estimate
for Sungevity to complete the additional work required to correct or address the Unforeseen
Conditions by sending you a proposed Change Order, which you will be able to accept or
decline.
(ii) If you accept the proposed Change Order, we will perform the additional work pursuant the
terms of the Change Order and this Contract.
(iii) If you do not accept the proposed Change Order, or if we do not provide a proposed Change
Order for the additional work, then you must engage another contractor separately and have
the additional work performed at your expense. If you do not, then either Party may
terminate this Contract by written notice to the other Party, in which case the following will
apply:
(A) If we encountered or discovered the Unforeseen Conditions during the Home Visit, upon
termination each Party is released from all obligations under the Contract, provided that
Sungevity will promptly refund you any payments you have previously made to us under
the Contract.
(B) If we encountered or discovered the Unforeseen Conditions subsequent to the Home
Visit (for instance during the design phase, permitting phase or installation phase), then
provided that such Unforeseen Conditions were not reasonably discoverable by us during
our proper performance of the Home Visit, you will be responsible for paying us the
portion of the Contract Price for work we have performed and materials we have installed
to the date of termination including reasonable profit and overhead.
(c) YOU AUTHORIZE US TO MAKE CORRECTIONS TO THE REBATE AND OTHER
ENVIRONMENTAL INCENTIVE PAPERWORK DESCRIBED IN SECTION 9 AND EXHIBIT C TO
CONFORM TO THIS CONTRACT OR ANY CHANGE NOTICE OR CHANGE ORDER TO THIS
CONTRACT.
(d) Change Orders. Either Party may request changes to the scope of Sungevity's work under this
Contract, provided that such changes are not binding until a written order prepared by Sungevity
describing the changes is signed by both Parties (a "Chan-cle Order"), unless an automatic
change is provided for under this Contract, in which case you will be given a notice of such
change ("Change Notice" ). For instance, Sungevity may propose alternative equipment by
sending you a proposed Change Order. The Change Order will describe the changes to the
System or the scope of our work, any increase or decrease to the Contract Price or schedule of
Progress Payments, and any change to the schedule for installing your System. Any changes
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that are automatic under this Contract (for instance substitutions pursuant to Section 11) will be
documented via and effective upon issuance by Sungevity of a Change Notice.
(e) Note about Extra Work and Change Orders: Extra work and Change Orders become part of the
Contract once the order is prepared in writing and signed by the Parties prior to the
commencement of any work covered by the new change order. The order must describe the
scope of the extra work or change, the cost to be added or subtracted from the Contract, and the
effect the order will have on the schedule of progress payments. A Change Order is not
enforceable against the Customer without this information. However, non-compliance with these
requirements does not preclude recovery of compensation based on legal or equitable remedies
designed to prevent unjust enrichment.
(f) Utility and Government Inspection Costs. Utilities and governments sometimes impose their own
costs and requirements for solar system installations. These can include, for example, charges
for new electricity meters, switchgear and transformers. Where possible, we will inform you of
these costs and charges in advance of starting the installation, or otherwise as soon as we
become aware of them. Legally required inspections may determine that pre-existing conditions
at the Home must be corrected or modified before the final AHJ Permits inspection is approved.
All such charges and costs are outside the scope of Sungevity's work under this Contract and are
not included in the Contract Price, and do not change your obligation to pay for the System as
stated in this Contract. If additional work outside the scope of this Contract is required by a utility
or government that may delay or prevent AHJ Permits inspection, and the Rebate is anticipated
to be paid directly to Sungevity under Section 5(c) and Exhibit C, you must promptly complete the
required additional work at your own expense. If you do not, and final AHJ Permits inspection
approval or other approval is delayed by more than 30 days after we have otherwise completed
installation of the System, then to the extent possible, you will be required to pay the outstanding
balance of the Contract Price within 10 days of notice from us. Once it is paid, we will notify the
solar rebate program administrator to send you the Rebate directly upon final permit approval and
system interconnection.
(g) Other Exclusions. The following work is excluded from this Contract, unless incorporated by a
Change Order signed by both you and us: correcting concealed or substandard framing or
substandard roofing; removal or disposal of materials containing hazardous materials such as
without limitation asbestos; removing or repairing rot or insect infestation; structural framing work
for any part of the roof or structure; correcting errors or omissions by other contractors or
subcontractors (not including Sungevity or Sungevity's contractors or subcontractors); cost of
correcting, testing, or remediating mold, fungus, mildew or organic pathogens unless such
condition is the result of a Sungevity caused construction defect; painting of conduit or other
structural parts; or correcting pre-existing conditions at the Property, including your roof, or
correcting damage or problems arising from such pre-existing conditions, which may be
aggravated by normal installation traffic and material handling procedures on the roof when
installing your System.
B. Warranty. The 20 Year Energy Performance Guarantee and Limited Warranty is set forth in Exhibit B
attached to this Contract. For warranty service, you must give us timely written notice of all claimed
problems or defects. If you are in breach of any of your obligations under this Contract, then your
warranty rights may be terminated or suspended until you remedy the breach.
9. Ownership of the System; Tax Credits; Rebates. This Contract is a purchase contract. Upon
payment of the Contract Price, you will own the System for all purposes. See Exhibit C for additional
specific information concerning ownership of environmental incentives and tax benefits that may be
available with respect to the System, including, without limitation, any renewable energy credits, utility
rebates (including performance based incentives), and any other environmental attributes associated
with the electricity output from the System. Any rebates, financial incentives and tax credits for your
System other than those specifically addressed in Exhibit C will accrue directly to you. The
availability and amount of these incentives change often and depend on many factors. We will
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attempt to inform you of all applicable incentives, however, we cannot guarantee any rebates,
whether or not discussed in this Contract. We recommend that you consult with a lawyer or
accountant to learn more about your eligibility for the Federal Investment Tax Credit ("LTC" or "FTC" )
or any other tax credits or incentives that may be available to you. This Contract is not conditioned
on your ability to get any rebates, incentives or credits other than as expressly provided for in this
Contract. See Exhibit C for additional terms and conditions concerning rebates in your local area.
10. Assignment; Transfer. Neither you nor we may assign or delegate this Contract or any of your or
our respective rights or duties hereunder, directly, indirectly, by operation of law or otherwise, without
the written consent of the other Party, and any such purported assignment or delegation shall be void.
Notwithstanding the foregoing, (a) we may (i) use subcontractors, and (ii) assign this Contract in
connection with the sale or other transfer of all or substantially all of our equity or assets to which this
Contract relates; and (b) you may assign the 20 Year Energy Performance Guarantee in Exhibit B to
a subsequent owner of the Home by providing us with written notice of the assignment; provided that
(i) such warranties are still in effect, (ii) you are not otherwise in breach of the Contract, (iii) the
System is not moved or altered, and (iv) you notify the subsequent owner of the provisions of Section
7 concerning any required assignment of RECs, and the subsequent owner complies with your
obligations hereunder. This Contract binds you and all your successors and permitted assigns.
11. Eguipment Substitutions and Changes. Equipment specifications in Section 3 are subject to
change. You hereby agree that Sungevity may substitute equipment listed in Section 3 provided it is
of equivalent performance by issuing a Change Notice provided there is no increase to the Contract
Price for such substitution. For other equipment changes, we will send you a proposed Change
Order. If this occurs prior to the commencement of installation and you do not approve the Change
Order for alternative equipment, we reserve the right to terminate this Contract, in which case neither
Party will have further liability. Administrative changes to equipment specifications (such as a change
in model number) do not constitute a change to the equipment and will not require a Change Order or
Change Notice.
12. Force Mameure. Our performance under this Contract will be excused for the duration of any Force
Majeure Event (as defined in Exhibit B). In such a case, we may proceed with the work provided that
we reach agreement on a Change Order to the extent our performance under this Contract was
impacted by such Force Majeure Event.
13. Sale of the Property. See Section 10 and Exhibit B for a description of the process to transfer the
20 Year Energy Performance Guarantee to a person who buys your Home during the Warranty
Period.
14. Loss or Damage. Risk of loss passes to you upon installation of the System. Provided that you
have made all payments due in accordance with this Contract, title to work and materials permanently
installed as part of the System and supplied by us or our contractors under this Contract will pass to
you upon payment for such work and materials.
15. Indemnity by Suncievity. To the fullest extent permitted by law, Sungevity will indemnify you
against, and hold you harmless from, any and all losses, claims, damages, liabilities and related
expenses (including all reasonable fees, costs and expenses of counsel), incurred by you or asserted
against you by any third party arising out of, in connection with, or as a result of our, or our
subcontractors', gross negligence or willful misconduct. We will not be required to indemnify you for
your own gross negligence or willful misconduct. This indemnity obligation will survive termination or
expiration of this Contract.
16. Default. You will be in default under this Contract if:
(a) you do not make the Down Payment or any Progress Payment or any other payment under this
Contract when due and such failure continues for ten (10) days;
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(b) you fail to observe, keep or perform any other material term or condition of this Contract and such
failure continues for fifteen (15) days after receiving notice from us; or
(c) you or your guarantor admits in writing its insolvency, assigns its assets for the benefit of
creditors, enters any bankruptcy or reorganization proceeding (either voluntary or involuntary), is
otherwise adjudicated bankrupt or insolvent or the occurrence of any similar event.
17. Remedies in Case of Default.
(a) If you are in default under this Contract, we may take any one (or more) of the following actions.
We will, to the extent required by this Contract or applicable law, provide you notice and wait for
the expiration of any applicable cure period before taking any of these actions. We may:
(i) terminate this Contract;
(ii) take any court actions or actions at law or in equity to enforce performance by you of the
terms and conditions of this Contract and/or recover damages for your breach;
(iii) take any action we deem reasonable to correct or cover your default; or
(iv) take any other action or pursue any other remedy available to us under this Contract or by
law.
(b) Please note that by taking any one or more of these actions (or by not taking any one or more of
these actions) we do not give up the right to take any of the above actions in connection with the
then -existing default or any future default. Additionally, we may take any of the above actions
without notice to you, unless applicable law or the terms of this Contract require us to provide you
notice, in which case we will provide notice as required by this Contract or applicable law.
(c) You agree that you will reimburse us for any reasonable costs and expenses paid by us to correct
or cover your default. Any such amounts, costs or expenses paid by us will be immediately due
and will be added to the amount owed by you under this Contract. Such costs include without
limitation all costs (including reasonable attorneys' fees), overhead, and profit we and our
subcontractors would have earned if you had not defaulted and your System had been fully
installed.
(d) In addition to the rights and remedies for default outlined above, in the event that you do not
make a payment due under this Contract on the due date, we reserve the right to suspend work
immediately until such payment is made.
18. EarIV Termination of this Agreemen . If you terminate the Contract under Section 7(b)(iii)(A)
because we encountered Unforeseen Conditions during the Home Visit, we will promptly refund you
any Downpayment or other payments you have previously paid to us under the Contract, and
thereafter both Parties will be released from any liability under the Contract.
19. Applicable Law. This Contract is governed by the laws of Massachusetts.
20. Limitation of Liability. TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, NEITHER
WE NOR ANY OF OUR AFFILIATES, OFFICERS, SHAREHOLDERS, DIRECTORS, EMPLOYEES,
OR AGENTS WILL BE LIABLE TO YOU UNDER ANY LEGAL THEORY FOR ANY INDIRECT,
SPECIAL, INCIDENTAL OR CONSEQUENTIAL LOSS OR DAMAGE, INCLUDING WITHOUT
LIMITATION, LOSS OF PROFITS OR USE, EVEN IF SUCH LOSS OR DAMAGE COULD HAVE
BEEN FORESEEN. OTHER THAN AS SPECIFICALLY STATED IN THIS CONTRACT, TO THE
FULLEST EXTENT PERMITTED BY APPLICABLE LAW, AND WITHOUT LIMITING THE
GENERALITY OF THE FOREGOING SENTENCE, YOU ACKNOWLEDGE AND AGREE THAT OUR
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TOTAL LIABILITY FOR ALL CLAIMS ARISING OUT OF OR RELATED TO THIS CONTRACT OR
WORK HEREUNDER IS LIMITED TO THE AMOUNT OF THE PRICE YOU PAY US UNDER THIS
CONTRACT.
21. Survival. Sections 6(b), 6(d), 6(e), 6(g), 6(i), 60), 6(k), 15, 17, 19, 20, 21, 22, 24, 25, 26 and each
other provision that should reasonably be expected to survive expiration or termination of this
Contract will remain in full force and effect and survive the expiration or termination of this Contract.
22. Notic2ls. Any notice required or given under this Contract must be in writing and delivered either by
personal delivery, overnight courier, facsimile transmission, electronic mail, certified mail or registered
mail, return receipt requested. Notices will be deemed received either (a) upon personal delivery,
(b) acknowledgment of receipt of electronic transmission, (c) the promised delivery date after deposit
with overnight courier, or (d) five (5) days after deposit in the mail. Notices may be delivered either to
the address listed in this Contract or any other address specified in writing. Documents received
electronically shall be deemed an original document.
23. Other Rights . The state in which the Property is located may provide you with additional rights or
impose additional responsibilities on us, including disclosure responsibilities, in addition to those
attached hereto as Exhibit C.
24. Remedies. All duties, obligations, rights, and remedies of each Party under this Contract are
cumulative and do not limit any duties, obligations, rights, and remedies otherwise imposed or
available by law, unless otherwise stated.
25. Waiver and Severability. A Party's failure at any time to require strict performance of any of the
provisions of this Contract will not waive or diminish its right thereafter to demand strict compliance of
that provision or of any other provision of this Contract. If any provision of this Contract is determined
to be unenforceable, the remaining provisions shall be enforced in accordance with their terms or
shall be interpreted so as to make them enforceable.
26. Entire Contract; Amendment; Waiver. This Contract contains the entire agreement and
understanding between the Parties to this Contract relating to the purchase of the System and
supersedes any prior or contemporaneous contract, either written or verbal. Any changes or
amendments to, or waivers of, any provisions of this Contract will only be effective if they are in
writing and signed by both you and us. Our failure at any time to require strict performance by you or
any of the provisions of this Contract will not waive or diminish our right thereafter to demand strict
compliance by you of that provision or of any other provision of this Contract. If any provision of this
Contract is determined to be unenforceable, the remaining provisions shall be enforced in accordance
with their terms or shall be interpreted so as to make them enforceable.
27. Notice of Right to Cancel. You have the right to cancel this Contract at any time prior to
midnight of the third business day after the date you receive a completely filled in copy signed
by both you and Sungevity. See the attached Notice of Cancellation (Exhibit A for an
explanation of this right.
[Signatures appear on the following page]
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DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES (OTHER THAN SIGNATURE
BLOCKS).
Each Party has read this Contract and the Exhibits in their entirety and acknowledges that such Party has
received a complete copy of this Contract and enters into the Contract as of the last date set forth below:
SUNGEVITY, INC.
By: rcuSigned by:
a-�Vit -esso"
— 7164DCB7FD2A457
Title: Authorized Signer
Date: 6/23/2015
Customer Name: Carlos Guzman
D"uSigned by:
Signature: S
-r-E�"c;F187405
Date: 6/22/2015
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EXHIBIT A
* sunGEVITYO
THREE (3) DAY RIGHT TO CANCEL - NOTIFICATION FORM
NOTICE OF CANCELLATION
(supplied in duplicate)
Date of transaction 20
(enter date of transaction)
You may cancel this transaction, without any penalty or obligation, within THREE (3)
BUSINESS DAYS from the above date.
If you cancel, any property traded in, any payments made by you under the Contract or
sale, and any negotiable instrument executed by you will be returned within TEN (10) BUSINESS
DAYS following receipt by the seller of your cancellation notice, and any security interest arising
out of the transaction will be canceled.
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 twenty (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, or send a telegram, to SUNGEVITY, INC. at 66 Franklin Street,
Suite 310, Oakland, CA 94607 NOT LATER THAN MIDNIGHT OF 20_
(Date of third business day after this transaction).
I HEREBY CANCEL THIS TRANSACTION.
Date Buyer's Signature
Date
2"" Buyer's Signature (if applicable)
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EXHIBIT A (CONTINUED) (COPY)
THREE (3) DAY RIGHT TO CANCEL - NOTIFICATION FORM
NOTICE OF CANCELLATION
(supplied in duplicate)
Date of transaction 20
(enter date of transaction)
You may cancel this transaction, without any penalty or obligation, within THREE (3)
BUSINESS DAYS from the above date.
If you cancel, any property traded in, any payments made by you under the Contract or
sale, and any negotiable instrument executed by you will be returned within TEN (10) BUSINESS
DAYS following receipt by the seller of your cancellation notice, and any security interest arising
out of the transaction will be canceled.
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 twenty (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, or send a telegram, to SUNGEVITY, INC. at 66 Franklin Street,
Suite 310, Oakland, CA 94607 NOT LATER THAN MIDNIGHT OF 20_
(Date of third business day after this transaction).
I HEREBY CANCEL THIS TRANSACTION.
Date
Date
Buyer's Signature
2 No Buyer's Signature (if applicable)
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*A0:11-1111111:1
20 YEAR ENERGY PERFORMANCE GUARANTEE AND LIMITED WARRANTY
This 20 Year Energy Performance Guarantee and Limited Warranty Agreement (the "20 Year
Performance Guarantee I') provides you with the warranties on the System that you purchased under the
Contract. The System is described in Section 3(a) of the Contract. Where we use terms in this 20 Year
Performance Guarantee that have been defined in the Contract, they have the meaning defined in the
Contract.
1. 20 Year Energy Performance Guarantee.
a. Performance Guarantee. Sungevity guarantees that the System will generate the guaranteed
annual kilowatt-hours ("kWh") of energy during each of the 20 successive Production Years (the
"Rerformance Guarantee Term") as set forth in the Table of Guaranteed Annual kWh attached in
Annex I to this 20 Year Performance Guarantee (the "Guaranteed Annual kWh" ) subject to the
terms of this 20 Year Performance Guarantee.
b. Production Year Deficit Payment. If at the end a Production Year (defined below), the Actual
Annual kWh (defined below) generated by the System is less than the Guaranteed Annual kWh
(a "Production Year Deficit "), then we will send you a refund equal to the difference between
that Production Year's Actual Annual kWh and Guaranteed Annual kWh (minus any previous
years' surpluses), multiplied by that Production Year's Guaranteed Energy Price per kWh (as set
forth in the Table of Guaranteed Annual kWh attached in Annex I to this 20 Year Performance
Guarantee). We will make that payment within thirty (30) days of the end of the calendar year in
which the Production Year Deficit occurred.
For example, if a Production Year commenced on October 1, 2014 and ended on September
30, 2015, and had a Guaranteed Annual kWh of 5, 000 kWh, and the Actual Annual kWh for
that Production Year was only 4,500 kWh, and the Guaranteed $IkWh Price for that
Production Year was $0. 10, then assuming no prior Production Year Surpluses or payments
for System Failures applied (as defined below), we would send you a refund for $50. 00 within
thirty (30) days after December 31, 2015.
c. Production Year Sur0us Carried Over. If at the end of a Production Year the Actual Annual kWh
is greater than the Guaranteed Annual kWh for that Production Year, there will be no additional
cost to you for this surplus energy. However, this surplus will be carried over and used by
Sungevity to offset any future Production Year Deficits.
d. Monitoring. During the Performance Guarantee Term, Sungevity will provide you at no additional
cost a monitoring service ("Monitoring"), which is a third party proprietary monitoring system that
records and displays historical energy generation data and consists of hardware installed by
Sungevity on site and software accessed by Sungevity. If your System is not operating within
normal ranges, Monitoring will tell us and we will notify you promptly at the notice address set
forth in Section 9, by email (provided by you) or at a telephone number (provided by you).
e. Definitions.
1. "Actual Annual kWh" means the AC electricity produced by your System in kWh measured
and recorded by Sungevity during each Production Year. Sungevity uses the Sungevity
Monitoring Service described below to measure the Actual kWh. To the extent such service
is not available, we will estimate the Actual kWh by reasonable means, subject to the
requirements of Section 3.b below.
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ii. "Production Year" means the twelve (12) month period beginning on the 1st day of the month
following the date on which your System commenced operation, and each successive twelve
(12) month period thereafter during the Performance Guarantee Term. For example, if the
original interconnection date for your System occurred on March 15, each Production Year
would run from April 1 to March 31.
2. Limited Warranties.
a. limited Warranties. Sungevity warrants the System as follows:
I. System Warranty. During the Warranty Period and subject to 2.a.ii (Repair Warranty), under
normal use and service conditions, the System will be free from defects in workmanship or
defects in, or a breakdown of, materials or components.
ii. Repair Warraniy. During the Warranty Period, claims for warranty service must be submitted
in writing to us and describe the claimed problems or defects. To the extent there are defects
in the workmanship provided by Sungevity in the installation of your System during the
Warranty Period, then Sungevity agrees to re -perform such work, at no cost or expense to
you (including all labor costs) to correct such defective workmanship. If Sungevity damages
your Property or your belongings, Sungevity will repair the damage or pay you for the
damage that we caused in accordance with the provisions of Section 8 below. Solar
photovoltaic modules and inverters supplied under this Contract for your System are covered
exclusively by the manufacturers' warranties and not by us, and we will work with the
manufacturers to have such manufacturers' warranties assigned to you. Sungevity agrees to
purchase 20 year warranties from the manufacturers of solar photovoltaic modules and
inverters that will be used in your System when the Warranty Period commences. Sungevity
will also provide reasonable assistance on your behalf to coordinate any warranty claims with
the manufacture to repair or replace, at no cost or expense to you (including all labor costs),
any defective solar photovoltaic modules and inverters. You agree to take full advantage of
such warranties including, but not limited to, giving us timely written notice of all warranty
claims. Sungevity or the manufacturers may use new or reconditioned parts when making
repairs or replacements. The Warranty Period is not extended if we repair or replace a
warranted product or any parts. Sungevity may also, at no additional cost to you, upgrade or
add to any part of the System to ensure that it performs according to the guarantees set forth
in this 20 Year Performance Guarantee.
iii. Roof Warranty. If we penetrate your roof during System installation, we will warrant roof
damage that we cause due to such roof penetrations. This roof warranty will last for the
longer of (a) one (1) year following the completion of the System installation or (b) the
remainder of any then -existing installation warranty on your roof (the "Roof Warranty Period").
iv. Output Warranty. The System's electrical output shall not decrease by more than fifteen
percent (15%) during the period starting on the date the System commences operation until
the tenth (10th) anniversary of such date.
v. Warranty Period Defined. With respect to Sections 2.a.i and 2.a.ii, above, the "Warranty
Period" commences on the date your System is inspected by the authority having jurisdiction
and runs through the 20th anniversary of such day.
b. Making a Warranty Claim. You can make a warranty claim by:
ii. Emailing us at: customerserviceO-)sungevity.com
iiii. Writing us a letter and sending it to us via certified or registered U.S. Mail or a reputable
overnight delivery service at the address in Section 9 below; or
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!I!. Sending us a fax at the number in Section 9 below.
Warranty service will be performed promptly and typically on site. If the affected equipment
requires off site warranty service, Sungevity will arrange for its transportation under warranty.
3. Maintenance and Operation.
a. General. When you sign your Contract you will be given a copy of the Manual. This Manual
provides you with System operation and maintenance instructions, answers to frequently asked
questions, troubleshooting tips and service information.
b. Monitoring Connectivity. Monitoring requires a high-speed Internet connection to operate unless
your System includes a cellular metering System (which is not available for all Systems).
Therefore, during the Performance Guarantee Term, you agree to maintain the communication
link between the on-site Monitoring hardware and the System and between the on-site Monitoring
hardware and the Internet or you agree to maintain the cellular metering if applicable. For
Monitoring that requires Internet connection, you agree to maintain and make available, at your
cost, a functioning indoor Internet connection with one available wired Ethernet port and standard
AC power outlet within eighty (80) feet of the System's AC/DC inverter(s) (which shall not require
Sungevity to perform trenching to access). This communication link must be a 10/100 Mbps
Ethernet connection that supports common Internet protocols (TCP/IP and DHCP). If you do not
have and maintain a working high-speed Internet line or the cellular metering, as applicable, we
will not be able to monitor your System and provide you with an Energy Performance Guarantee.
c. Module Cleaning. The Manual contains certain recommendations about periodically cleaning the
solar modules, especially during the summer, or removing snow in areas that experience fair
amounts of snow fall. If Monitoring indicates a drop in actual energy production by the System,
we recommend that you arrange for cleaning or clearing of the solar modules. Sungevity will be
happy to assist you with cleaning of solar modules at our customary rates, however often times
rain or a hose from the ground is sufficient for cleaning. If your System becomes covered by
snowfall, the modules will often be able to heat up sufficiently for the snow to slide right off. AS
WITH REGULAR SNOW ACCUMULATION ON YOUR ROOF, PLEASE BE AWARE OF
FALLING SNOW FROM THE TILTED PANELS AND EXERCISE CAUTION WHEN STANDING
OR WALKING UNDER THE EDGE OF YOUR ROOF. PLEASE TRY TO AVOID PARKING
YOUR CAR, OR KEEPING OTHER VALUABLES, UNDER THE EDGE OF YOUR ROOF. WE
STRONGLY RECOMMEND THAT YOU NEVER CLIMB ONTO YOUR ROOF UNLESS YOU
HAVE APPROPRIATE AND PROFESSIONAL SAFETY TRAINING AND MEASURES IN PLACE.
4. Sungevilty's Standards.
The standards for our performance for the purpose of this 20 Year Performance Guarantee will be
(i) normal professional standards of performance in the solar photovoltaic power generation industry
in the relevant market; and (ii) Prudent Industry Practices. "Prudent Industry Practices" means those
practices, as changed from time to time, that are engaged in or approved by a significant portion of
the solar energy electrical generation industry operating in the United States to operate electric
equipment lawfully and with reasonable safety, dependability, efficiency and economy.
5. System Repair, Relocation or Removal; Additional Obligations.
You agree that if the System needs any repairs that are not the responsibility of Sungevity under this
20 Year Performance Guarantee, you will have Sungevity, or another similarly qualified service
provider approved by Sungevity, perform such repairs at your expense on a time and materials basis.
In addition, you agree that if the System needs to be removed and reinstalled for roof repairs, you will
have Sungevity, or another similarly qualified service provider approved by Sungevity, remove and
reinstall the System at your Home for a fixed fee of $1,000 provided that materials used for the roof
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repair are of the same type of materials used in the original roof and that the roof design and
specifications will not change in such a way that the original design of the System must be modified in
order to reinstall the System on your roof. You also agree to be responsible for the storage of the
System following its removal from your roof and for any damages incurred to the System while it is in
storage.
You further agree:
a. To grant Sungevity and its employees, agents and contractors the right to reasonable access to
your Property as necessary to inspect or repair the System or otherwise for the purposes of
complying with this 20 Year Performance Guarantee;
b. To only have the System repaired pursuant to this 20 Year Performance Guarantee and
reasonably cooperate when repairs are being made;
c. To give Sungevity authority to act on your behalf to contact the manufacturers of the equipment
used in the System with respect to warranty claims covered by Section 2.a;
d. To keep the panels clean, pursuant to this 20 Year Performance Guarantee and the Manual;
e. To not modify your Home in any way that shades the System and to keep trees, bushes, and
hedges trimmed so that the System receives as much sunlight as it did when Sungevity initially
installed it;
f. To not remove any markings or identification tags on the System;
g. To not do anything, permit or allow to exist any condition or circumstance that would cause the
System not to operate as intended;
h. To notify Sungevity if you think the System is damaged, appears unsafe or is stolen; and
ii. That you will not make any modifications, improvements, revisions or additions to the System or
take any other action that could void the 20 Year Performance Guarantee.
6. Force Majeure.
If Sungevity is unable to perform all or some of its obligations under this 20 Year Performance
Guarantee because of a Force Majeure Event, Sungevity will be excused from whatever performance
is affected by the Force Majeure Event, provided that:
a. Sungevity gives you reasonably prompt notice describing the Force Majeure Event; and
b. The scope and duration of Sungevity's suspension of its obligations is no greater than is required
by the Force Majeure Event.
"Force Maffieure Event" means any event, condition or circumstance beyond the reasonable control of
and not caused by Sungevity's fault or negligence. It shall include, without limitation, failure or
interruption of the production, delivery or acceptance of electricity due to: an act of god, war (declared
or undeclared), sabotage, riot, insurrection, civil unrest or disturbance, military or guerilla action,
terrorism, economic sanction or embargo, civil strike, work stoppage, slow -down, or lock -out,
unavailability of suitable and sufficient labor, explosion, fire, earthquake, abnormal weather conditions
or actions of the elements, hurricane, flood, lightning, wind, hail, drought, the binding order of any
governmental authority, the failure to act on the part of any governmental authority, unavailability of
electricity from the utility grid, equipment, supplies or products (but not to the extent that any such
availability of any of the foregoing results from Sungevity's failure to have exercised reasonable
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diligence), or unusual utility grid voltage fluctuations, failure of equipment not utilized by Sungevity or
under its control.
7. Exclusions and Disclaimers.
The limited warranties and performance guarantee provided in this 20 Year Performance Guarantee
do not apply to (i) any lost electricity production or (ii) any damage, repair, replacement or correction
required due to the following:
a. Someone other than Sungevity or its approved service providers installed, removed, re -installed
or repaired the System or removed any of the product identifying information listed on the
equipment;
b. Destruction or damage to the System or its ability to safely produce energy not caused by
Sungevity or its approved service providers (e.g., a tree falls on the System, an animal causes
damage, chemicals or other materials have been applied to the System, glass breakage in the
solar panels to the extent it was caused by external factors (including golf balls) or the System is
moved or damaged during roofing work);
c. Your failure to per -form, or breach of, your obligations under the Contract (such as if you modify or
alter the System or you fail to pay amounts due and owing to Sungevity);
d. Your breach of this 20 Year Performance Guarantee, including your being unavailable to provide
access to the Property or assistance to us in diagnosing or repairing a problem, or your failing to
maintain the System as stated in the Manual, or if you modify or alter the System;
e. Any Force Majeure Event (as defined above);
f. Water ponding or puddling on your roof (i.e. standing water that fails to drain) not caused by
Sungevity or its approved service providers;
g. Damages resulting from mold, fungus and other organic pathogens, regardless of the cause;
h. Superficial changes in the appearance of System components due to exposure to weather and
atmospheric conditions (e.g., chalking, blemishes, scratches, rust, mold, discoloration of the solar
panels) that do not materially impact System performance;
ii. Increased shading (e.g. from foliage that is new growth or is not kept trimmed to its appearance
on the date the System was installed, from snow that covers the System, or from new
construction on your Property or adjacent property);
j. Theft of the System or any System failure not caused by a System defect (e.g., the System is not
producing power because the System has been removed for remodeling or you have required us
to locate the inverter in a non -shaded area);
k. Any excluded work pursuant to the Contract;
1. Any pre-existing conditions of any roof or for damage or problems arising from such pre-existing
conditions, which may be aggravated by normal traffic and material handling procedures on the
roof associated with installing the equipment supplied under the Contract; and
m. Removal of the System from your roof and/or the storage of the System as a result of roof
repairs.
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THIS 20 YEAR PERFORMANCE GUARANTEE GIVES YOU SPECIFIC RIGHTS, AND YOU MAY
ALSO HAVE OTHER RIGHTS INCLUDING, BUT NOT LIMITED TO, RIGHTS BASED ON FEDERAL
LAW AND OTHER RIGHTS THAT VARY FROM STATE TO STATE. THIS 20 YEAR
PERFORMANCE GUARANTEE DOES NOT WARRANT ANY SPECIFIC ELECTRICAL
PERFORMANCE OF THE SYSTEM, OTHER THAN THAT DESCRIBED ABOVE.
THE LIMITED WARRANTIES DESCRIBED IN SECTION 2.a ABOVE ARE THE ONLY EXPRESS
WARRANTIES MADE BY SUNGEVITY WITH RESPECT TO THE SYSTEM. SUNGEVITY HEREBY
DISCLAIMS, AND ANY BENEFICIARY OF THIS 20 YEAR PERFORMANCE GUARANTEE HEREBY
WAIVES, ANY WARRANTY WITH RESPECT TO ANY COST SAVINGS FROM USING THE
SYSTEM. UPON RECEIPT OF PAYMENT IN FULL UNDER THE CONTRACT, ALL WARRANTIES
THAT ARE PROVIDED BY MANUFACTURERS OF EQUIPMENT USED IN THE SYSTEM WILL BE
TRANSFERRED DIRECTLY TO YOU. YOU UNDERSTAND THAT SUNGEVITY HAS NO
RESPONSIBILITIES WITH RESPECT TO SUCH WARRANTIES OTHER THAN TO TRANSFER
THEM TO YOU.
8. Limitations of Liability.
a. No Consequential Damages. YOU MAY ONLY RECOVER DIRECT DAMAGES, INCLUDING
THOSE AMOUNTS DUE PURSUANT TO SECTION 1.b UNDER THIS 20 YEAR
PERFORMANCE GUARANTEE, AND IN NO EVENT SHALL SUNGEVITY OR ITS AGENTS OR
SUBCONTRACTORS BE LIABLE TO YOU OR YOUR ASSIGNS FOR SPECIAL, INDIRECT,
PUNITIVE, EXEMPLARY, INCIDENTAL OR CONSEQUENTIAL DAMAGES OF ANY NATURE.
SOME STATES DO NOT ALLOW THE EXCLUSION OR LIMITATION OF INCIDENTAL OR
CONSEQUENTIAL DAMAGES, SO THE ABOVE LIMITATION MAY NOT APPLY TO YOU.
b. Disclaimer and Limitation of Duration of Implied Warranties. ANY IMPLIED WARRANTIES,
INCLUDING THE IMPLIED WARRANTIES OF FITNESS FOR A PARTICULAR PURPOSE AND
MERCHANTABILITY ARE HEREBY DISCLAIMED TO THE EXTENT PERMITTED UNDER
APPLICABLE LAW. ANY SUCH IMPLIED WARRANTIES THAT ARE NOT DISCLAIMABLE
UNDER APPLICABLE LAW SHALL IN NO EVENT EXTEND PAST THE EXPIRATION OF ANY
WARRANTY PERIOD IN THIS 20 YEAR PERFORMANCE GUARANTEE. SOME STATES DO
NOT ALLOW DISCLAIMERS OR LIMITATIONS ON HOW LONG AN IMPLIED WARRANTY
LASTS, SO THE ABOVE DISCLAIMER AND DURATION LIMITATION MAY NOT APPLY TO
YOU.
c. Liability Cap. Notwithstanding any other provision of this 20 Year Performance Guarantee to the
contrary, and subject to the exclusion of consequential damages above, Sungevity's total liability
arising out of or relating to this 20 Year Performance Guarantee shall in no event exceed:
i. For System replacement, the original cost of the System; and
ii. Two million dollars ($2,000,000) in the event of damage to your Home, Property or
belongings.
9. Notices.
All notices under this 20 Year Performance Guarantee shall be in writing and shall be provided by (a)
personal delivery, (b) facsimile transmission with confirmation of successful transmission, (c)
overnight courier, or (d) certified or registered U.S. mail (return receipt requested). A notice shall be
deemed received upon personal delivery, confirmation of receipt of facsimile transmission, the
promised delivery date after deposit with a reputable overnight courier, or five (5) days after deposit in
the mail. Notices shall be sent to the address set forth below or such other address as either Party
may specify in writing. Each Party shall deem a document faxed to it as an original document.
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Notices to Sungevity:
Sungevity, Inc.
Attn: Warranty Claim
66 Franklin Street, Suite 310
Oakland, CA 94607
Fax: 510-550-2628
Tel: 510-496-5500
10. Applicable Law/Arbitration.
Notices To You:
At the installation address, any subsequent
address or email address you give us. Change of
address notices should be sent to Sungevity at the
address listed for all other Notices.
This warranty agreement is governed by the laws of Massachusetts. Unless specifically prohibited by
State law, all claims, disagreements and disputes between you and us pertaining to the within
warranty will be resolved through binding arbitration in accordance with the below procedures in the
county where the Property is located. If either party refuses or fails to participate in arbitration after
receiving notice, then the arbitrator shall make an award based on the evidence presented. The
judgments and awards of the arbitrator may be entered into any court having jurisdiction. All
applicable statutes of limitations to the claim, disagreement or dispute shall also apply to any
arbitration.
The parties agree that JAMS ("JAMS") will administer each arbitration (including the selection of a
single arbitrator) under its arbitration rules Commercial Arbitration Rule and the Due Process Protocol
for Mediation and Arbitration of Consumer Disputes most recently in effect. Arbitration will be
governed by the Federal Arbitration Act (Title 9 of the U.S. Code), notwithstanding the provisions of
this Contract specifying the application of State law. Either party can initiate an arbitration proceeding
by filing the necessary forms with JAMS. To learn more about arbitration, you can call any JAMS
office or review the materials at www.jamsadr.com. If a JAMS office does not exist in the county
where you are located, and there is an office for the American Arbitration Association ("AAA") within
that same area, the parties agree that AAA will administer each arbitration (including the selection of
a single arbitrator) under its Supplementary Procedures for Consumer -Related Disputes most
recently in effect. If neither JAMS nor AAA have an office in the county where you are located,
another arbitrator will be agreed upon or if no other arbitrator can be agreed upon, then we will use
the JAMS office closest to the Property.
The parties will each bear their own costs and expenses, including attorneys' fees, with respect to
any arbitration.
Only disputes involving you and us may be addressed in the arbitration. You agree that you cannot
pursue any dispute as a "class action." This means that the arbitration may not address disputes
involving other persons which may be similar to the disputes between you and us. The arbitrator
shall have the authority to award any legal or equitable remedy or relief that a court could order or
grant. The arbitrator, however, is not authorized to change or alter the terms of this Contract or to
make any award that would extend to any transaction other than your own. Because we have agreed
to arbitrate all disputes, UNLESS PROHIBITED BY STATE LAW, NEITHER OF US WILL HAVE THE
RIGHT TO LITIGATE THAT DISPUTE IN COURT, OR TO HAVE A JURY TRIAL ON THAT
DISPUTE, OR ENGAGE IN DISCOVERY EXCEPT AS PROVIDED FOR IN THE APPLICABLE
ARBITRATION RULES. FURTHER, YOU WILL NOT HAVE THE RIGHT TO PARTICIPATE AS A
REPRESENTATIVE OR MEMBER OF ANY CLASS PERTAINING TO ANY DISPUTE. THE
ARBITRATOR'S DECISION WILL BE FINAL AND BINDING, EXCEPT TO THE EXTENT IT IS
SUBJECT TO REVIEW IN ACCORDANCE WITH THE APPLICABLE LAW GOVERNING THE
REVIEW OF ARBITRATION AWARDS. OTHER RIGHTS THAT YOU OR WE WOULD HAVE IN
COURT MAY ALSO NOT BE AVAILABLE IN ARBITRATION.
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11. Assignment and Transfer of this 20 Year Performance Guarantee.
Sungevity may assign its rights or obligations under this 20 Year Performance Guarantee to a third
party without your consent, provided that any assignment of Sungevity's obligations under this
20 Year Performance Guarantee shall be to a party qualified to perform such obligation. This 20 Year
Performance Guarantee protects only you as the person who owns the System; provided, however
that your rights and obligations under this 20 Year Performance Guarantee will be automatically
transferred to any person who purchases the System and the Property on which the System is
located from you. Sungevity will accept and honor any valid and properly submitted warranty claim
under this 20 Year Performance Guarantee made during any applicable warranty period by any
person who purchases from you the System and the property on which the System is located.
12. Entire Agreement; Changes.
This 20 Year Performance Guarantee contains the Parties' entire agreement regarding the limited
warranties and guarantees of the System and supersedes any prior or contemporaneous agreement,
either written or verbal. There are no other agreements regarding the 20 Year Performance
Guarantee of the System, either written or spoken. Any change to this 20 Year Performance
Guarantee must be in writing and signed by both Parties.
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ANNEX I
Table of Guaranteed Annual kWh
Production Year
Guaranteed Energy
Price Per kWh
Guaranteed Annual
kWh
Cumulative Total
Guaranteed kWh
1
$0.22
11,562
11,562
2
$0.22
11,505
23,067
3
$0.23
11,447
34,514
4
$0.23
11,390
45,904
5
$0.24
11,333
57,237
6
$0.24
11,276
68,513
7
$0.25
11,220
79,733
8
$0.25
11,164
90,897
9
$0.26
11,108
102,005
10
$0.26
11,052
113,057
11
$0.27
10,997
124,054
12
$0.27
10,942
134,996
13
$0.28
10,887
145,883
14
$0.28
10,833
156,716
15
$0.29
10,779
167,495
16
$0.29
10,725
178,220
17
$0.30
10,671
188,891
18
$0.31
10,618
199,509
19
$0.31
10,565
210,074
20
$0.32
10,512
220,586
Note: This Table may be updated by Sungevity prior to installation of the System. An update would only
occur if Sungevity or its approved installation contractor determines after physically inspecting your
Property that due to unforeseen factors (e.g., as a result of unanticipated shading or roof obstructions,
etc.), the System output will be materially lower than originally estimated.
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EXHIBIT C
LOCATION SPECIFIC TERMS & DISCLOSURES
MASSACHUSETTS
A. Home Improvement Contract Provisions.
The Massachusetts Contractors License Number for Sungevity, Inc. is 168430. In addition, installation of
the System will be performed by a licensed subcontractor that we select who will be identified to you in
writing prior to the commencement of installation.
B. Customer Acknowledgements.
You acknowledge the following notices required by Massachusetts:
a. Arbitration:
The homeowner, as provided by law, is entitled to submit disputes to arbitration as
provided under Massachusetts General Laws chapter 142A, § 4
DocuSigned by:
Owner: r_(,�Zs C-j4I%aJA,
�—'eaq�672CF187405_
Docuftne
Contractor: 5vit tsst:?.
�-7164DCUFMA457
b. Contractors. All home improvement contractors and subcontractors shall be registered and that any
inquiries about a contractor or subcontractor relating to a registration should be directed to:
Office of Consumer Affairs and Business Regulation
Ten Park Plaza, Suite 5170
Boston, MA 02116
Phone: (617) 973-8700
c. Approximate Start and Approximate Completion Date. We will start work on the System as soon
as the Contract is signed. We estimate that construction and installation of the System at the Site will
begin on or about 10122/2015 and will be Substantially Complete on or about 11/1 /2015.
d. Lien Notices:
The contractor or subcontractor who performs on the contract or the materialman who provides home
improvement goods or services and is not paid may have a claim against the owner which may be
enforced against the property in accordance with the applicable lien laws.
Any contractor, subcontractor, or materialman who provides home improvement goods or services
pursuant to your home improvement contract and who is not paid may have a valid legal claim
against your property known as a mechanic's lien. Any mechanic's lien filed against your property
may be discharged. Payment of the agreed-upon price under the home improvement contract prior to
filing of a mechanic's lien may invalidate such lien. The owner may contact an attorney to determine
his rights to discharge a mechanic's lien.
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We are hiring and paying the installation subcontractor to provide and install the System. Provided
that you have paid us all amounts owed under this Contract, we will indemnify you and resolve any
mechanic's lien that is recorded with regard to the System.
e. Commercial General Liability (CGL) and Workers' Compensation Insurance. Sungevity carries
commercial general liability and workers' compensation insurance. You can contact the individual
listed below to confirm our coverage. You can also email your Sungevity consultant and that person
will be happy to email a proof of insurance to you.
Insurance Companv
ontact Name Phone Number
Email
Zurich American
Insurance Co.
David Liebes of (650) 393-2008
I Hays Compai
dliebes@hayscompanies.com
I
C. Rebates.
a. Wet Ink Signature Required. The rebate programs applicable to this System ("Rebate Pro -gram")
may require a printed hard copy of the Contract with your original signature to be eligible for a rebate
("Rebate"). If you have signed this Contract online or returned it to us by fax or email, upon our
request, you will need to send us a printed hard copy of the Contract with your original signature.
b. Rebate Assigned to Sungevity. You hereby assign the Rebate to Sungevity. The foregoing
assignment is irrevocable subject to Sungevity's performance of the Contract. The amount you pay
Sungevity will be the Contract Price, less the Rebate, subject to the other conditions set forth in this
Exhibit C.
c. Rebate Paperwork; Prompt Payment. You agree to give us all information and documents
necessary for the Rebate to be assigned and paid directly to us; and you agree to pay all Progress
Payments immediately when due. Your payment of all Progress Payments to Sungevity when due is
a pre -condition to the Rebate Program paying us the Rebate.
d. Changes to Rebate Amount. The Rebate amount listed in Section 5(c) of the Contract is our
calculation based on our Remote Solar Design of your System prior to entering into the Contract.
The final Rebate actually paid by the Rebate Program will be based on factors that include, but are
not limited to, System size, design, shading, orientation of the System, tilt, your address, and so forth.
Other factors that may affect the Rebate amount include, but are not limited to, the following:
1. When we perform the Home Visit and do a detailed design for your System, we will finalize the
Rebate calculations. However, if there is subsequent proposed change to the size or design of
the proposed System, then the Rebate amount may increase or decrease pursuant to an
authorized Change Order.
iii. The Rebate Program periodically reduces rebate levels, sometimes with little or no advance
warning. If the Rebate decreases due to reasons outside your control, then either (a) Sungevity
will reduce the Contract Price by the same amount of such decrease in the Rebate amount in
which case your other Progress Payments will remain the same, or (b) your Contract can be
terminated by either you or Sungevity and we will refund all payments previously made by you,
provided that installation of your System has not begun.
iiii. If the Rebate amount decreases due to your failure to meet an obligation under the Contract or
under the agreement with the Rebate Program or utility governing the payment of the Rebate,
you agree the Contract Price will remain the same and that you will pay an amount equal to the
lost Rebate amount within 15 days after receiving notice from Sungevity. Examples of when a
decrease in Rebate amount will fall under your control includes, but is not limited to, if you cause
or request a delay to install your System, if you do not timely return completed Rebate paperwork
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or make a Progress Payment, or if you do not make previously agreed upon changes to your
Property such as reducing shading (shade reduces power output and, therefore, will reduce the
available Rebate).
iv. To maximize your Rebate, Sungevity recommends you remove any features that will shade your
System before we submit the Rebate reservation paperwork and prior to installation. If you agree
to reduce shading in order to obtain a certain Rebate level, you agree to perform the necessary
work prior to installation, and then maintain shading levels for the period required by the Rebate
Program.
v. Note that increases to your System size that are made after we have submitted the Rebate
reservation will be at the Rebate Program's then -current rebate level, which may be lower than
the rebate level when the original reservation application was made.
e. Energy Efficiency Audit / Proof of Homeowners Insurance. As a pre -condition to issuing certain
financial incentives to you, the Rebate Program may require that you perform and/or provide
evidence of a recent energy efficiency audit for the Home where the System is installed, as well as
have insurance in place for the installed System. If this is applicable to your Rebate, you must
promptly have any such audit done, give us the required information about the audit and provide
proof of homeowners insurance for your System.
f. Assignment of Renewable Energy Certificates. The Rebate Program may require that in order for
the full Rebate to be paid, you must assign any "renewable energy certificates" or "greentags"
("RECs") or other environmental attributes associated with the energy produced by the System during
a specified period of years to the Rebate Program, or the utility or a government agency. In such
event, you agree that you assign the RECs for the required time -period, and you agree to complete
any paperwork necessary to complete the assignment.
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of�o-
ci r-> s u nGEVITY'
%�Y
Homeowner's Agent Authorization Form
State of Massachusetts
Carlos Guzman
(print name)
am the owner of the property located at address:
30 Amberville Rd 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.
DocuSigrwd by -
Customer Signature:
C 2M874,05
Date: 7/1/2015
Print Name: Carlos Guzman
Sungevity MA Home Improvement Contractors License # 168430
66 Franklin Street, Suite 310 P 510.496.5500 866.SUNAALL
Oaklard, CA 94607 USA f 510.496.5501 WWW.Sungevityxonn
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electii'cians/Plumbers
Applicant Information Please Print Ley-ibly
Name (Business/Organization/Individual): The Boston Solar Company
Address: 10 Churchill Place
Lynn, MA 01902
Phone #: 617-858-1645
Are you an employer? Check the appropriate box:
LH I am a employer with 20
4. [] I am a general contractor and I
employees (full and/or part-time).
have hired the sub -contractors
2.E3 I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.:
required.)
5.0 We are a corporation and its
3.0 1 am a homeowner doing all work
officers have exercised their
myself [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, § 1(4), and we have no
employees. [No workers'
comv. insurance reQuired.1
Type of project (required):
6. M New construction
7. F1 Remodeling
8. E] Demolition
9. 0 Building addition
I0.EJ Electrical repairs or additions
11.0 Plumbing repairs or additions
12.[] Roof repairs
13.K Other solar
Any applicant that checks box #1 must also fill out the section below shoming their workers' compensation policy information.
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 whetheror not those entities have
employees. Ifthc sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers'compensation insurancefor my emplqvees. Below is the policy andjob site
information.
Insurance Company Name: HDI -Gerling America Insurance Company
Policy # or Self -ins. Lic. M EWGCCOOO 153815 Expiration Date: 1/14/2016
Job Site Address: 30 Amberville Road 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certifi, under 0"ains andpenallies ofperjury that the information provided above is trite and correct.
Phone #: 6178581645
Official use only. Do not write in this area, to be captipleted by city or town official
City or Town: Permit/License 4
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#:
91H. - 4n.2 -InG
MnQQn
ACORD. CERTIFICATE OF LIABILITY INSURANCE
DATE (MWDDNYYY)
1/1312015
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 pollcy(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 endomement(s).
PRODUCER
People's United Ins. Agency CT
WOTE�cr Peggy J. Merati
PHONE
(A/C, No, Ft): 860 524-7624 ('A"/C, 844 702-8075
E-MAIL
ADDRESS: peggy-merati@?peoples.com
One Goodwin Square
INSURER(S) AFFORDING COVERAGE NAIC #
Hartford, CT 06103
860 524-7600
INSURERA: HDI -Gerling America Insurance C 41343
INSURED
The Boston Solar Company, LLC
55 Sixth Road, Suite 1
Woburn, MA 01801
INSURER 13: Merchants Mutual Insurance Co 23329
INSURER C,
INSURER D:
INSURER E:
INSURER F :
9-r1Vr-QAr.P_q r.FRTIFICATF NDMRFR! REVISION NUMESER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDLSUBR
I
WVD
POLICY NUMBER
I POLICY EFF
MMfDDrrCM
POLICY EXP LIMITS
IMMIDDIYYYY)
A
GENERAL LIABILITY
EGGCC0001 53814
10/0312014
01101/2016 -EACH OCCURRENCE $1.000.000
COMMERCIAL GENERAL LIABILITY
co,
t&ENTED
pAEMA% JaO 00CU nce) $100,000
CLAIMS -MADE F—ROCCUR
$
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE s2,000,000
PRODUCTS - COMPIOP AGG s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
F_;�_11
POLICY I ^I JPERnT F-1 LOC
$
A
AUTOMOBILE LIABILITY
EAGCCO00153814
10/0312014
01101/2016 COMBINED
(Ea accide $1,000,000
*
ANY AUTO
EAGCCO00153914
10/0312014
01101/2016 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
BODILY INJURY (Per accident) $
AUTOS AUTOS
X NON -OWNED
I
PROPERTY DAMAGE
HIREDAUTOS AUTOS
(Per accident
$
*
X
UMBRELLA LIAB
X
OCCUR
CUP0001367
1010312014
01/0112016EACH OCCURRENCE $5,000.000
EXCESS LIAB
I CLAIMS -MADE
1
AGGREGATE $5,000,000
DED I X1 RETENTION $10,000
$
A
WORKERS COMPENSATION
EWGCCO00153815
0111412015
0111412016 X
AND EMPLOYERSLIABILITY YIN
ANY PROPRIETOR/PARTNERIEXECUTIVE __1
rV
E.L. EACH ACCIDENT $1,000,000
OFFICERIMEMBER EXCLUDED?
NfA
(mandatory In NH)
E.L. DISEASE- EA EMPLOYEE $1,000,000
if Wescnbe
Drsunder
RIPTION OF OPERATIONS )e1ow
E,L. DISEASE - POLICY LIMIT _L1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddItIonal RemarM 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.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS.
North Andover, MA 01845
AUTHOR12ED REPRESENTATIVE
)OWp&�
(9 1938-2010 AGOKLI CUKIPUKATIUN. All rignts reserveo.
ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD
#SS65647/M565467 SMGCT
Ail t— Office ofConsuinerAlTskirs &Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistration: 169698 Type: Office of Consumer Affairs and Business Regulation
,F 10 Park Plaza - Suite 5170
I_'
xpiration: 7127/2015 LLC
Boston, MA 02116
THE BOSTON SOLAR COMPANY LLC
ROMAIN STRECKER
10 CHURCHILL PLACE
LYNN, MA 01902 Undersetreta–ry Not valid without signature
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
cojw ruction supvr% i*41F — I
License: CS -M385
ROMAIN D STRE
X
WWI
10CEnJRC1HJLLP1A'"'!'1� lip
LYNN MA 0190rf
Expiration
Commissioner 10/0812016