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Miscellaneous - 41 CROSSBOW LANE 4/30/2018
/ 41 CROSSBOW LANE J 210/106.6-0211-0000.0 I I I i I i �I Date.....�.... .�..�.�. ............... NOR7h 0 ,,,-- ,.4 TOWN OF NORTH ANDOVER - n PERMIT FOR WIRING ;,ss�CHUS��� Thiscertifies that .................... ................................... _ ......................... has permission to perform YJ;Ij,�..`"�P 5 CJC,` O� ` tS —)ILW ....................................................................�......... wiring in the building of......... U1..!e ............ ........................... ........................................ at ...... .........4.`✓. .....................l .. .�.:.............................North Andover,Mass. ......n. Fee.V�.........Lic. . ................. ............ .................. .......................... ...... `y Check# ll�b �Z3 Z Z ,/►�/ i ` n77 I i r Cone»ronwea o�'�/aolacaif� Official Use Only 2c� Permit No. "/� spav war ol.?ire Sorvicos Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1/15/20 15 City or Town of: North Andover . 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) 41 Crossbow Lane .. Owner or Tenant Anthony Peluis Telephone No. 781-944-.9449 Owner's Address same Is his permit inconjunction with a building permit? Yesx❑ No ❑ (Check Appropriate Box) . Purpose of Building .. residence Utility Authorization No. i Existing Service Amps / Volts _ Overhead❑ Undgrd❑ No.of Meters I New Service . Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:. Installation of a 7 kw(28 Panels)rooftop solar array Completion o thefollowingtable m be waived b the ins ector o .Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of.LuminairesSwimming Pool Above n- ❑ o.of Emergency Lighting . rnd. amd. Battery Units + No of Receptacle Outlets No.of Oil Burners FIRE ALARMS .No.of Zones . / No.of SwitchesNo.of Gas Burners o.o Detection an Initiating Devices . No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices Heat Pum umber ons KW o.o Self-Contained No.of Waste Disposers p .._......._............................_...._........................... Totals: Detection/Alerting Devices { No.of Dishwashers Space/Area Heating KW Local[Dunrcrpal [] Other i Connection. No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KWNo:of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors . Total HP a ecommunicahons rrrn g No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. -j Estimated Value of Electrical Work: $15,500 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE:'Unless waived by the owner,no permit for the performance of electrical work may issue unless 1 the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: The Boston Solar Company LIC.NO.: 12689A Licensee: William T.Foglietta Signature L JIM /\.. LIC.NO.: (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: 781-462=8702 Address: 10 Churchill Place,Lynn MA 01902Alt.Tel.No. 978-836-6220. *Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required.by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's went. Owner/Agent PERMIT FEE:$ Signature Telephone No. j.� � L l lQ�d/1� _o "3/ '71 7 k I I- C155- 1`7? le,7 0-7 SE � �i '� } � r 1 �� i I QOMMONWEALTH OF MASSACHUSETf:'S • • • -- • • OA1Rl Up EU-CTRICIANS ISSUES THE FOLLOWING 'LICENSE AS:V , R`EGlSTERED ,MASTER ELECTRICIAN l TH ' BOSTON SOLAR COMPANY LLC Ail WILLIAM T FOGLIETTA III 10 CHURCHILL PLACE W C tYtl''ttpp MA 01902-2719 nraa.rtlrlrOt]_ 'E i n7/47 �::�{.. �R�71R CONTROL# J.2841-88 I . IMPORTANT If your license is lost,damaged or destroyed;is inaccurate;or needs to be corrected,visit our web site at mass.gov/dp1 for instructions to ensure the proper mailing of your Renewal ,Application and any other correspondence. I This license is subject to Massachusetts General Laws and regulations.Your license is a privilege,and cannot be lent or assigned to any person or entity under penalty of law.Keep this license on your person or posted as required by law and/or regulations. I I I i Client#:103109 BOSSO ACOR& CERTIFICATE OF LIABILITY INSURANCEDTE3I2015� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER k0ANTEAcT Peggy J.Merati People's United Ins.Agency CT ac°NN u17 860 524.7624 A1c No):844 702-8075 One Goodwin Square E-MAIL a merati eo les.com ADDRESS: p ggy @P p Hartford,CT 06103 INSURER(S)AFFORDING COVERAGE NAIC tt 860 524.7600 INSURER A:HDI-Gerling America Insurance C 41343 INSURED The Boston Solar Company,LLC INSURER B:Merchants Mutual Insurance Co 23329 INSURER C: 55 Sixth Road,Suite 1 : Woburn,MA 01801 INSURER D INSURER E INSURER Ft COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED., NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rNSR TYPE OF INSURANCE DL UB POLICY EFF POLICY EXP LIMITS TR INSR POLICY NUMBER MM1DD MM1DD A GENERAL LIABILITY EGGCC000153814 0/03/2014 01/01/2016 EEACCHq�oEcTcuRRENCE $1,000000 X COMMERCIAL GENERAL LIABILITY PREMISES EaEa%. $100,000 CLAIMS-MADE FX OCCUR MED EXP(Any one ) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY X PRO LOC $ A AUTOMOBILELIABILIY EAGCCO00153814 0/03/2014 01/01/201 t"E.",, dntSINGLELIMIr 1,000,000 AX ANY AUTO EAGCC000153914 0/03/2014 01101/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOSX AUTOS Per accident $ B X UMBRELLA UAB X OCCUR CUP0001367 0/0312014 01101/2016 EACH OCCURRENCE $5 OOO OOO EXCESS UAB CLAIMS-MADE AGGREGATE $5,000,000 DEO I X RETENTION$10,000 $ A WORKERS COMPENSATION EWGCC000153815 1/14/2015 01114/201 X WCSTATu- OTH- AND EMPLOYERS'LIABILITY ER ANY PROPRIETORIPARTNER/EXECUTNE YIN E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? V 1 N 1 A (Mandstoiy in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 I(yss describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(Attach ACORO 101,Additional Remarks Schedule,If more space Is required) RE:Permit Work Certificate Holder is included as Additional Insured per the terns,conditions and exclusions of the referenced general liability and umbrella policies,if required by written contract or agreement. i CERTIFICATE HOLDER CANCELLATION Town Of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S565647/M565467 SMGCT I s The Commonwealth of Massachusetts Department of Industrial Accidents Ogee of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetr"icians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual): The Boston Solar Company Address: 10 Churchill Place City/State/Zip:Lynn, MA 01902 Phone#:617-858-1645 Are you an employer?Check the appropriate box: Type of project(required): I.Q I am a employer with 20 4. I am a general contractor and I 6. E)New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a soleproprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, []Demolition workingfor me in an capacity. employees and have workers' y p �'• t 9. E]Building addition [No workers' comp.insurance comp.insurance. required.] 5. E] We are a corporation and its 10.C]Electrical repairs or additions 3.El f am a homeowner.doing all work officers have exercised their 1I.0 Plumbing repairs or additions myself. [No workers'.comp. right of exemption per MGL 12.[]Roof repairs insurance required.]t c. 152,§1(4),and we have no 13. Other 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. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:HDI-Gerling America Insurance Company Policy#or Self-ins. Lic.M EWGCC000153815 Expiration Date: 1/14/2016 Job Site Address: 41 Crossbow Lane 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 certify under t airs and penalties of perjury that the information provided above is true and correct. Signature: Date: 1/16/2015 PP Ione!#: 6178581645 Offcial 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.tither Contact Person: Phone#: 1 2 3 4 5 PHOTOVOLTAIC SYSTEM SNEETINDEX PV0.0 COVER AND SITE PLAN PV0.1 SITE PLAN DETAIL SYSTEM SIZE: PV1.0 GENERAL NOTES AC/DC kW STC: 6.061 kW%7kW PV2.0 ARRAY LAYOUT PV3.0 LINE DIAGRAM A EQUIPMENT: -- _-_- CROgS✓O PV4.0 LABELS V W �N A PV MODULES: (28)Hyundai HIS-M250MG(BK) / -�_ KEY: INVERTER(S): (1)SolarEdge SE6000A-US / - —�_ — PROPERTY UNE ®6UBPANEL _— — CONDUIT RUN O DC DISCONNECT / —— DRIVEWAY OAC DISCONNECT SCOPE OF WORK: / _ FENCE O SOLAR MODULE ®®JUNCTION BOX INSTALLATION OF A SAFE AND CODE-COMPLIANT / // 0 MAIN SERVICE PANEL ©MONITORING UNIT GRID-TIED SOLAR PV SYSTEM ON AN EXISTING // / [] UTILITY METER ❑D COMBINER BOX RESIDENTIAL ROOF TOP. (�-.� ® PV METER ROOF OBSTRUCTION INVERTER APPLICABLE CODES: 2014 NEC / 2009 INTERNATIONAL CODES WITH MA AMENDMENTS Y / CONTRACTOR INFORMATION: BOSTON SOLAR WOBURN B // 55 SIXTH ROAD B WOBURN,MA 01801 JURISDICTIONAL INFORMATION: NORTH ANDOVER,TOWN OF 1600 OSGOOD ST. NORTH ANDOVER,MA 01845 NOTES TO INSTALLER: / ARRAY IT SOS: CONDUIT RUN FROM ARRAY,ROOF MOUNTED AND ON EXTERIOR WALL TO BOB. / BOB TO TIE IN: O M RUN FROM BOB ON AND THROUGH EXTERIOR WALL T (E) TO ITMBP INSIDE UTILITY ROOM IN BASEMENT. / ADDITIONAL NOTES: CHECK CELLULAR CONNECTIVITY FOR LGATE 120,ELSE NEED / TO USE CATW6 CABLE FOR MONITORING. TANDEM(E)BREAKERS TO MAKE ROOM FOR SOLAR. - POC:BREAKER IN(E)MSP. / FOR INSTALLER USE ONLY / - POST INSTALL SUNEYES REQUIRED? YES 1 CERTIFY THAT NO CHANGES HAVE C C BEEN MADE TO THE ARRAY LAYOUT: / CUSTOMER INFORMATION: / ANTHONY R JR PELUSI 41 CROSSBOW LN NORTH ANDOVER,MA 01845 SITE PLAN N (761)944-9449/#1260046 SCALE: N.T.S. - DESIGNED DATE: -- - - - - -- — - TM - 0 01/16/15 PV'0.0 EO17—NC.68 FRANI—TeUTE3fO—D:G9i6UT ft:Trvya PHETNEMOPERTYOFBUNGEVIWlNCWN TSW LBEWMDORUSEDFORORWITI OT MRKOTHERTNWTNESME MPRWJ FORNMdITHEYW B NDEV£LOMDYA1HOUf OURMrt ENMNWW 1 2 9 4 5 KEY: ---- PROPERTY LINE ®SUBPANEL ---- CONDUIT RUN O DC DISCONNECT --.DRIVEWAY O AC DISCONNECT +— FENCE SOLAR MODULE ®®JUNCTION BOX 0 MAIN SERVICE PANEL MONITORING UNIT '❑R UTILITY METER COMBINER BOX ® PV METER 0 ROOF OBSTRUCTION ® INVERTER A A LOCATION OF(E)MSP INSIDE UTILITY ROOM IN BASEMENT CONDUIT RUN ALONG EXTERIOR WALL � 2 U Q a 2 Mt CONDUIT RUN ON ROOF B B O C C CUSTOMER INFORMATION: ANTHONY R JR PELUSI 41 CROSSBOW LN NORTH ANDOVER,MA 01845 SITE PLAN DETAIL N (781)944-9449/#1260046 SCALE: N.T.S. DESIGNED BY:IWOM DATE: I i TM 1 0 01/16/15 01, SDNOEVRYMG M FPPNIO.IN ST SUf1E 3100NONID,CA 8060) By:Trop,.Doti O1I16H5Loution:C:WwnWapu lOowJwtiWYabwIG CUWomanlFWN-11500161PNus1- 1HESE IXtAMANOS.SPEQFlCAIiONS,MID OE&IGNS RRE THE PROPERTYOFSUNGENTYINC.NO PMT6NALL BE COPIED OR USED FOR IXt NATNANY OTHER WORNOTHER TIMN THE SPEQFlC PROJECT FOR WHCH THEY HNVEBEEN DEVELOPEDN111gUyOVRNRRTEN CON3EN! 2 3 4 5 GENERAL NOTES. ELECTRICAL NOTES: GENERAL NOTES: El.ALL EQUIPMENT.IS LISTED FOR USE. Nl.DRAWINGS ARE DIAGRAMMATIC ONLY.THE LOCATION AND ROUTING OF E2.MAXIMUM VOLTAGE DOES NOT EXCEED 600VDC. RACEWAYS SHALL BE DETERMINED BY THE CONTRACTOR UNLESS OTHERWISE E3.ANY EQUIPMENT OR ELECTRICAL MATERIALS USED FOR THIS INSTALLATION SHALL BE NOTED OR STANDARDIZED. NEW AND LISTED BY A RECOGNIZED ELECTRICAL TESTING LABORATORY. N2.ALL EQUATIONS ACCOUNT FOR WORST CASE CONDITIONS. E4.AN INVERTER IN AN INTERACTIVE SOLAR PV SYSTEM SHALL AUTOMATICALLY A N3.IF A DISCREPANCY IN QUANTITY OR SIZE OF CONDUIT,WIRE,EQUIPMENT DE-ENERGIZE ITS OUTPUT TO THE CONNECTED ELECTRICAL PRODUCTION AND A DEVICES,OVERCURRENT PROTECTION,GROUNDING SYSTEMS,ETC.(ALL DISTRIBUTION NETWORK UPON LOSS OF VOLTAGE IN THAT SYSTEM AND SHALL REMAIN EQUIPMENT AND MATERIALS)THE CONTRACTOR SHALL BE RESPONSIBLE FOR IN THAT STATE UNTIL THE ELECTRICAL PRODUCTION AND DISTRIBUTION NETWORK PROVIDING AND INSTALLING ALL MATERIALS AND SERVICES REQUIRED BY THE VOLTAGE HAS BEEN RESTORED. STRICTEST CONDITIONS IN THE SPECIFICATIONS OR NOTED ON THE PLANS TO ES.ALL PV ARRAYS SHALL BE EQUIPPED WITH DC GROUND FAULT PROTECTION. ENSURE COMPLETE COMPLIANCE WITH ALL CODES AND TO ENSURE THE E6.ANY AC COMPONENT SHALL MEET OR EXCEED THE AVAILABLE FAULT CURRENT LONGEVITY AND SAFETY OF THE OPERABLE SYSTEM. CALCULATED AT THAT COMPONENT. N4.ALL OUTDOOR EQUIPMENT SHALL BE MIN.NEMA 311 RATED. E7.ALL MODULES AND ANY RELATED ROOF MOUNTED METALLIC EQUIPMENT SHALL BE NS.METAL CONDUIT AND ENCLOSURES SHALL BE USED WHERE PV SOURCE OR PROPERLY GROUNDED. OUTPUT CIRCUITS ARE RUN INSIDE A BUILDING. E8.DC EQUIPMENT SHALL BE 60OVDC RATED MINIMUM. N6.MODULES SHALL NOT BE PLACED OVER ANY PLUMBING VENTS AND AT LEAST E9.MARKINGS SHALL BE PROVIDED TO INDICATE THAT ALL CONTACTS OF THE 6"ABOVE FLUSH VENTS. DISCONNECT EQUIPMENT MIGHT BE ENERGIZED. N7.THE ELECTRICAL CONTRACTOR SHALL COMPLY WITH ANY AND ALL E10.CONDUIT RUNS SHALL BE PROVIDED WITH SUFFICIENT WEATHERPROOF PULL BOXES REQUIREMENTS GIVEN BY UTILITY COMPANIES. OR JUNCTION BOXES/COMBINER BOXES PER APPROPRIATE JURISDICTIONAL N8.FOR ADDITIONAL EQUIPMENT SPECIFICATIONS,SEE PROVIDED CUT SHEETS. REQUIREMENTS. N9.ALL LABELS AND MARKINGS SHALL BE ATTACHED ACCORDING TO Ell.FOR ANY UNGROUNDED PV SYSTEM,A LABEL READING: B REQUIREMENTS BY NEC AND THE LOCAL AHJ.THE AHJ MAY HAVE SPECIAL LABEL "WARNING-ELECTRICAL SHOCK HAZARD.THE DC CONDUCTORS OF THIS PHOTOVOLTAIC B REQUIREMENTS BEYOND THE SCOPE OF THIS DOCUMENT.THIS MAY ENCOMPASS LANGUAGE INCLUDING,BUT NOT LIMITED TO,THAT FOUND IN NEC ARTICLES SYSTEM ARE UNGROUNDED AND MAYBE ENERGIZED." 690.5(C),690.14(C)(2),690.17,690.53,690.35(F), 690.54,690.64(B)(7)and SHALL BE PLACED AT EACH JUNCTION BOX,COMBINER BOX,DISCONNECT AND DEVICE 705.10 WHERE ENERGIZED,UNGROUNDED CIRCUITS MAY BE EXPOSED DURING SERVICE. N10.INSTALLER TO FOLLOW ALL LOCAL JURISDICTION GUIDELINES. E12.INVERTER(5)SHALL CONTAIN A GROUND FAULT DETECTION AND INTERRUPTION Nll.ALL NEC REFERENCES SHALL BE DIRECTLY INTERCHANGEABLE WITH CEC DEVICE. REFERENCES. E13.ALL METALLIC RACEWAYS AND EQUIPMENT SHALL BE BONDED AND ELECTRICALLY CONTINUOUS. STRUCTURAL NOTES: E14.THE POINT OF CONNECTION COMPLIES WITH APPLICABLE CEC/NEC. Sl.MOUNTS ARE DIAGRAMMATIC AND EXACT LOCATION MAY CHANGE,BUT ESS.BACKFED SOLAR BREAKER(S)SHALL BE INSTALLED AT THE OPPOSITE END OF THE SHALL BE ACCURATELY SPACED. CIRCUIT OR FURTHEST AWAY FROM THE MAIN BREAKER. S2.MOUNTS SHALL BE STAGGERED WHEN NECESSARY TO EVENLY DISTRIBUTE E16.ALL WIRE,VOLTAGES,AMPERAGES AND EQUIPMENT IS SIZED ACCORDING TO LOAD AMONGST RAFTERS. TEMPERATURE DERATING AND LOCATION. 53.DO NOT SPLICE RAILS IN MIDDLE 50%OF SPAN BETWEEN TWO MOUNTS. E17.ONLY COPPER(CU)CONDUCTORS SHALL BE USED.CONDUCTORS SHALL BE STRANDED OR SOLID WITH PROPERLY RATED CONNECTORS. C C E18.DISCONNECT SHALL BE WIRED SO NO BLADES ARE ENERGIZED E19.ALL MODULES AND RACKING SHALL BE GROUNDED VIA IRON RIDGE RAIL INTEGRATED CUSTOMER INFORMATION: GROUNDING(PLEASE SEE DATA SHEET)OR WITH TIN PLATED DIRECT BURIAL RATED LAY IN ANTHONY R JR PELUSI LUGS USING STAINLESS STEEL HARDWARE,STAR WASHERS,AND THREAD FORMING BOLTS 41 CROSSBOW LN OR WEEBS. NORTH ANDOVER,MA 01845 E20.ALL EQUIPMENT SHALL BE GROUNDED,INCLUDING BONDING JUMPERS WHERE (781)9449449 #1260046 NECESSARY ACROSS RAIL SPLICE PLATES TO BOND INDIVIDUAL PIECES OF RAIL. - _ DESIGNED BY: REV#: DATE:.. _ TM 1 0 01/13/15 PV-1.0 8UNOEWtt1N-FRMIKUNSTSUITEB100M8 M-0160) NOPMlTS BECOWEDORUS FORORWR OTIERWORKOTHERTHM ESPCIFICRR ECTFORWNCNTIEY1 BEEND LOREDWITN OURWRRTENCONSEM 1 2 3 4 5 SYMBOL KEY: MODULE (28)Hyundai HIS-M250MG(BK) ® MOUNT MODULE WEIGHT: 41.9 ------- RAIL 1�-1" 6" MODULE LENGTH: 64.76 ———— RAFTERS38.7 35-11" ROOF 1 SPECS ROOF RAFTER SIZE: 2X8 NOMINAL — SETBACK RAFTER SPAN: I 12'-6' R SPACING,I is* Q SOLAR MODULE ROOF MATERIAL: COMPOSITE SHINGLE (D............•O STRING CONFIG. _( _ a_ _ AR SPECS ® SKYLIGHT I NUMBER OF MODULES: 28 A .. .................. ......... .................. ................. .................. .................. ................. .................. ......... TOTAL MOD.WEIGHT(Ibs): 1173.2 A ® CHIMNEY f � f � ( RACKING WEIGHT Ob.): 220.7 ARRAY WEIGHT(Ibs): 1393.9 PLUMBING OR -j }- - j } ARRAVAREA(sgR): d8z3 ATTIC VENT ARRAY DEAD LOAD(Ibs/sattg 82.9 7. ATTIC VENT I I I I ( I I NUMBEROFMOUNTS: 61 1 1 LOAD PER MOUNT(Ibs): 22.9 .1 ARRAY AZIMUTH(') 197 {....... ......I.......I......{.......{...... .......'.......I.. ...f.......1..... {.......I.......I. ....{.......I......I.. 1 2 ... ..f.......�...... ......f.: I ARRAYTILT(') 31 _l NUMBER OF FLOORS 2 ............. ........ I. ............(.......(........ ....i.......(............... ................ ..�.......(.. ..... ..t RRAY LAYOUT 7SCALE: 3/16"=VWO' B B SF1 OFIy,1S� Solar Modul PAUL K. W ZACHER TRUCTURAL y 100 IronRidge XR10 FC/S re L-Foot SS�ONAL C C QMLPC Shingle-Low Profil Fxv. soiaa Composite Shing l CUSTOMER INFORMATION: 5"x 5/16"-La ANTHONY R JR PELUSI 41 CROSSBOW LN 2x8 Nominal,16 O.C. NORTH ANDOVER,MA 01845 (781)944-9449/#1260046 r,,--�MOUNTING DETAIL L SCALE: NTS DESIGNED BK. REV#: DATE: PV-2.0 TM 1 0 01/13/15 auweEMavixe es rwwrcur+srsureaio oua�o.uwsm sr s�-��.avvns�ous�:cw...w�.mo"�oo.tiow.�sr.✓�wcwmww.�w- TMESE wuvnrws.srecnicnnows.,wo oes�er�s u�n�anorerstt of suHoevrtv nc.riov�wrswu se wcienon used con on wim u+ro.NsevrowcoTMFnrH�mesvecsic rRaEcr ron vmcx n�v wwe eE�oEVEioceo wrmouram wnmFi+conse'+r 4 , 1 2 3 4 5 ELECTRICAL KEY: ELECTRICALMODULE F NS (28)Hyundai HIS-M25OMG(BK) st BREAKER SHORT CIRCUIT CURRENT(Isc): 8.6 �— SWITCH - OPEN CIRCUIT VOLTAGE(Voc): 38.2 SCREW TERMINAL OPERATING CURRENT(IMP): 8.1 m FUSE NOTE: OPERATING VOLTAGE(VMP): 30.9 • SPLICE SINGLE#8
 GROUNDING CONDUCTOR USED FOR DC GEC&AC EGG PER ARTICLE 690.47 MAX SERIES FUSE RATING: 15 'w EARTH GROUND STC RATING: 250 PTC RATING: 222 !/7' CHASSIS GROUND DESIGN CONDITIONS ——GEC - - - HIGHEST 2%OB DESIGN TEMP(°C): 32 EGCMIN.MEAN EXTREME ANNUAL DB('C): -18 A - - INVERTER I SPECFICATIONS A SOLAREDGE SE6000A-US _ - RATED WATTS(EACH): 6000 AC OPERATING VOLTAGE(V): 240 AC OPERATING CURRENT(A): 25 NUMBER OF MPPT CHANNELS 0 INVERTER EFFICIENCY: 0.975 INTEGRATED DC DISCONNECT FMR I INPUTSPECIFICATIONS NOMINAL CURRENT PER STRING(In=): 10,10 NOMINAL VOLTAGE(Vnom): 3m MAX SYSTEM VOLTAGE(Vmax): 600 MAX CURRENT PER STRING(Imax): is MAX INPUT CIRCUIT CURRENT(Imax): 30 200A MAIN BREAKER (3)#8 THWN-2 (3)#8 THWN-2 (3)#8 THWN-2 (4)#10PV-Wire (4)#10THWN-2 (1)#10 EGC (1)#IOEGC (1)#10EG C (2)#10 EGC (2)#10EGC (1)#8 GEC (1)#8 GEC (1)#8 GEC FREE AIR 3/4"EMT 3/4"EMi 3l4'EMT 3/4"EMT METER (E)LOADS (N)SE6000A-US AC DISCONNECT, INVERTER W/DC DISCONNECTS GRATED NON-FUSIBLE,C-H (E)LOADS (E)200A ITE MSP - DG222UR8 B 1 STRING 0 _AC LOCUS 35A 2P 24ov 2P 3-w is B 14 MODULES MEI ER OPT.CURRENT=10.00A OC v OUTPUT LOAD LINE 1 STRING OF .. 14 MODULES ` INVERTER OPT.CURRENT=t0.00A y GEC IRREVERSIBLY SPLICED TO EXISTING DEC OR BONDED DIRECTLY TO EXISTING GROUNDING ELECTRODE - MIN.NEKWR UL LISTED MICTION BOX WITH 90°C TERMINAL RATINGS LOCATED ON ROOF C C Inom=(14 x 250W)/350V=10A CONDITIONS OF USE=15A/0.76/0.8=24.67A 28 MODULES TOTAL OPERATING VOLTAGE='35OVDC(REGULATED) BASIC AMPACITY CALC=18.75 28 x 222(PTC WATTS)x 0.975=6061 CEC WATTS CUSTOMER INFORMATION: CONDUCTOR SIZE FOR 24.67ADC=#10 AWG ANTHONY R JR PELUSI 200 x 1.2=240 INSTALLATION SHALL USE MIN.#10 AWG SE6000A-US MAX OUTPUT CURRENT=25A 240-200(MCB)=40A MAX DESIGN CURRENT=25A z 1.25=35A 41 CROSSBOW LN MAX ALLOWABLE AC PV BREAKER=40A NORTH ANDOVER,MA 01845 CONDUIT ELEVATION:1/2 TO 3-1/2"=22"C (781)944-9449/#1260046 HIGH AMBIENT TEMPERATURE:32°C EXTREME LOW:-18°C _ ROOFTOP AMBIENT TEMP:54°.C-=0.76 — — — DESIGNED BY: DATE: p — CONDUIT FILL:0.8 TM 0 101/13/151'V-3.0 a suN�rrlNc.sesnuuOlNWWM310u 0.uaism - a1-wl,.nm om.vvivuL�w,:ew..srw,.w�no..b.m�s+..r�.wwm".,evaw- rHFss ow,wwos.svecmu,nas,um oescws,vff il�Paovemror swieEvm nie.no P�arsw,LLee coNenoa usm waonvrtmu+r on+rie xomc oT anuu, svccPlcPw�crroievmcx Aar Tuve stEn oevE�ovEownxourouawartEN corrsEHr - 3 1 2 3 4 5 NEC 690.5(c) NEC 690.31(E)3&4;2012 IFC 605.11.1 INTERACTIVE PHOTOVOLTAIC POWER SOURCE PLACE THIS LABEL ON INVERTER(S)OR NEAR PLACE ON ALL JUNCTION BOXES,EXPOSED GROUND-FAULT INDICATOR(ON INVERTER(S)U.O.N.) RACEWAYS EVERY 10'AND V FROM BENDS RATED AC OUTPUT CURRENT(A): 25 AND PENETRATIONS,ADJACENT TO THE NOMINAL OPERATING AC VOLTAGE M: 240 MAIN SERVICE DISCONNECT INVERTER 1 DC DISCONNECT . PHOTOVOLTAIC SYSTEM DISCONNECT RATED MAX POWER POINT CURRENT(Imp): 60 A ELECTRIC SHOCK HAZARD A IF A GROUND FAULT IS INDICATED, PHOTOVOLTAIC POWER RATED MAX POWER POINT VOLTAGE(Vmp): 350 NORMALLY GROUNDED CONDUCTORS MAX SYSTEM VOLTAGE(Voc): 500 MAY BE UNGROUNDED AND ENERGIZED SOURCE SHORT CIRCUIT CURRENT(Isc): 10.8 NEC 690.17(E) NEC 690.35(F) PLACE THIS LABEL ON ALL DISCONNECTING PLACE THIS LABEL AT EACH JUNCTION BOX,COMBINER BOX, MEANS WHERE ENERGIZED IN AN OPEN POSITION DISCONNECT AND DEVICE WHERE ENERGIZED,UNGROUNDED CIRCUITS MAY BE EXPOSED DURING SERVICE: ELECTRIC SHOCK HAZARD DO NOT TOUCH TERMINALS ELECTRIC SHOCK HAZARD TERMINALS ON BOTH THE LINE AND LOAD THE DC CONDUCTORS OF THIS SIDE MAY BE ENERGIZED IN THE OPEN PHOTOVOLTAIC SYSTEM ARE UNGROUNDED POSITION AND MAY BE ENERGIZED NEC 705.12(D)(2)(b) PLACE THIS LABEL AT P.O.C.TO SERVICE B DISTRIBUTION EQUIPMENT(I.E.MAIN PANEL(AND B SUBPANEL IF APPLICABLE)) NEC 690.56(c) PLACE ON RAPID SHUT DOWN DISCONNECT WHEN RAPID SHUT y DOWN IS INSTALLED INVERTER OUTPUT CONNECTION PHOTOVOLTAIC SYSTEM EQUIPPED DO NOT RELOCATE THIS WITH RAPID' SHUTDOWN OVERCURRENT DEVICE NEC 705.12(D)(3) PLACE LABEL ON ALL EQUIPMENT CONTAINING OVERCURRENT DEVICES IN CIRCUITS SUPPLYING POWER TO A BUSBAR OR CONDUCTORS SUPPLIED FROM MULTIPLE SOURCES. A CAUTION NOTE: OUTSIDE LABELING OF SYSTEM COMPONENTS AND METERS IS TO BE DONE IN A WAY SUITABLE FOR THE ENVIRONMENT IN WHICH CONTAINS MULTIPLE POWER THE EQUIPMENT IS INSTALLED.NO STICKERS ARE PERMITTED. C C SOURCES CUSTOMER INFORMATION: ANTHONY R JR PELUSI 41 CROSSBOW LN NORTH ANDOVER,MA 01845 (781)9449449/#1260046 DESIGNED BY: REV#-j DATE: PV-4.0 TM 1 0 01/13/15 auwennuc.ee cwaiwHsr surenooucwio.uasm ay ssti�oe.cvv�s�wr�c:ww.rw.«Mm.�.misr�-..wcw�w.wiw- TM�.se oruwwcs.s�acMwnoNs.,wo oescris u�n�raoaErttt or suHcnmrs�c.Ho rum sw�u ee wnm on usm waon mn1 ury on�n worocon�n Truw�svecFw mo.rtcrFoawNa��rruve eff oeveioren wirnour wrswwrt�caseHr %(I�Date... � ................ • �3 oZ7 3a; ~ OWN OF NORTH ANDOVER 0 T PERMIT FOR WIRING BSACMU �j� 1 , This certifies that ..U v.� ,, l a P'�� ' ► +�-�►�- ................. I has permission to perform � :!�?...fr-I p Y S � :✓1.................. ........ ............................... ....... wiring in the building „ ...............� ` ! ............................... ................................ a*,-, l0). � ....... North Andover,Mass. Fe .....1 .5...........Lic.No. 1�. P... ........................ . . ............................ ..: y` ILCTRICAL INSPECCOR Check# �_ V ` of Mamac elmmo►uvealdt itude�l Official Use Only . 2P Pernut No. �L, e a►'t►Y -t O }ire SPPrrt6e� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR T PE ALL INFORMATION) Date: 41 A9(1 LI City or Town of: %r\ P'y*NQ,1' 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) 4c qJ crDS.5 bold (n. Owner or Tenant ,hp ILS rZA(t.i l Telephone No. Owner's Address is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of BuildingIC Utility Authorization No.— T Existing SerAce Amps / Volts vencNa ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �N �l Completion; the followingtable may be waived by the Ins vector of Wires. No.of Recessed Luminaires No.of Ccil.-Susp.(Paddle)Fans o,of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above n- No.ot Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units j No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of 15etection an Initiating Devices No.of Ranges No.of Air Cond. °Lal No.of Alerting Devices Tons g No.of Waste Disposers eat Pump I Number Tons KN' No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW ecurity vstems:* Y r • No.of or Equivalent No.of WaterK,,`, o.of o•of Data Wiring: Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications VVirmg: No,of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Iflires. A Estimated Value of Electrical Work: 131 (When required by municipal policy.) OCO Work to Start: A,,g„A„p, Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE S1 RANCE COVERAGE: Unlesswatved by the owner,no permst 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 m BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is trite and complete. FIRM NAME: ol Go c V- % LIC.NO.: Licensee: jU�g -yam 'T', p,M„ Signature LIC.NO.: 11. (1j'applicab&;enter- "exempt"in the license number line) 13vadt.� � Bus.Tel.No.: Address: Alt.Tel.No.: :P3`I`X58- SSSS *Per M.G.L.c. 147,s.57-61,security work requires Departmen 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,l hereby waive this requirement. I am the(check one)❑owner ❑owner's agent, Own tura nt PERMIT FEE: $ / Signature Telephone No. r COMMONWEALTH OF MASSACHUSETTS BOARD OF ELECTRICIANS ., ISSUES THE FOLLOWING LICENSE AS A,\), REGISTERED MASTER ELECTRICIAN ' � r j. SOLARCITY CORPORATION MATTHEW T MARKHAM 24 'SAINT MARTIN DR BLDG 2 UNIT 11 MARLBOROUGH MA 01752-3o6o 113bMR _OZL31/lb ._ _ 74921 t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 wwm lnass.gov/din Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ Please Print Legibly Name(Business/Organization/Individual): SOlarCity Corporation Address: 3055 Clearview Way City/State/Zip: San Mateo/CA/94402 Phone#: 650-963-5100 Are you an employer?Check the appropriate box: Type of project(required): 1.❑E I am a employer with 3000 4. ❑ I am a general contractor and I employees (full and/or part-time). have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. [] We are a corporation and its I O.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no Solar/PV employees. [No workers' 13A Other comp. insurance required.] *Ally applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mus(submit anew affidavit indicating such. TGontractors 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, lam an employer that is providing workers'compensation insurance for ni y employees. Below is lire policy and job site information. Insurance Company Name: Liberty Mutual Insurance Company Policy#or'Self--ins. Lic. #: WA766DO66265023 Expiration Date: 09/01/2014 Job Site Address: All Locations 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 Inves*atiot s of the DIA for insurance coverage verification. I do he rebh certify under the pains and penalties of rj that d information provided above is trite and correct. Si Jnature: - Date: Phone#: 9782152359 Official use only. Do not write in bids 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 Ac RO V CERTIFICATE 4F LIABILITY INSURANCE °08/2/20 3' �- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be.endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 0726293 1-415-546-9300 F TACT Brendan Quinlan _ E: _ Arthur J. Gallagher s Co. NE 415-536-40201 FAx Insurance Brokers of California, Inc., License #0726293 Nn.EXI). 1255 Batter Street #450 IL brendan inlan@a' Coln Y RESS: 9u� ]g• _ San Francisco, CA 94111 _INSURER(S► ORDING COVERAGE _ NAIC# _ INSURER A: LIBERTY MUT FIRE INS CO _ 23035 INSURED v` INSURER 8: LIBERTY INS CORP 42404 SolarCity Corporation —— INSURER C: _ 3055 Clearview Way INSURER D: ` San Mateo , CA 94402 INSURE E: INSURER F: COVERAGES CERTIFICATE NUMBER: 35272277 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDArY1 Y MM/DDIYYYY A GENERAL LIABILITY TB2661066265053 09/01/1 09/01/14 EACH OCCURRENCE $ 1,000,000 DAMAGES(RENTED 100 000 COMMERCIAL GENERAL LIABILITY PREMISEEa oc rrence $ , _ CLAIMS-MADE a OCCUR MED EXP(Anyone _!son)_ $ 20,000 X Deductible: $25,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY PRO LOC $ A AUTOMOBILE LIABILITY AS26 1 4 COMBINED SINGLE LIMIT (Ea accident 1,000,004 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS __ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS AUTOS Peraccident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ S B WORKERS COMPENSATION WC7661066265033 (WI Retr ) 09/01/1 09/01/14 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY TRO Y L112T B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WA766DO66265023 (Ded) 09/01/1 09/01/14 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? NN_—] NIA (Mandatory in NHI E.L.DISEASE-EA EMPLOYEq S 1 000 000 11 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Proof Of Insurance. d CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD satyasan 35272277 • 1 ABBREVIATIONS ELECTRICAL NOTES JURISDICTION NOTES A AMPERE 1. WHERE ALL TERMINALS OF THE DISCONNECTING AC ALTERNATING CURRENT MEANS MAY BE ENERGIZED IN THE OPEN POSITION, BLDG BUILDING A SIGN WILL BE PROVIDED WARNING OF THE CONIC CONCRETE HAZARDS PER ART. 690.17. DC DIRECT CURRENT 2. EACH UNGROUNDED CONDUCTOR OF THE EGC EQUIPMENT GROUNDING CONDUCTOR MULTIWIRE BRANCH CIRCUIT WILL BE IDENTIFIED BY (E) EXISTING PHASE AND SYSTEM PER ART. 210.5. EMT ELECTRICAL METALLIC TUBING 3. A NATIONALLY-RECOGNIZED TESTING GALV GALVANIZED LABORATORY SHALL LIST ALL EQUIPMENT IN GEC GROUNDING ELECTRODE CONDUCTOR COMPLIANCE WITH ART. 110.3. GND GROUND 4. CIRCUITS OVER 250V TO GROUND SHALL HDG HOT DIPPED GALVANIZED COMPLY WITH ART. 250.97, 250.92(B) I CURRENT 5. DC CONDUCTORS EITHER DO NOT ENTER Imp CURRENT AT MAX POWER BUILDING OR ARE RUN IN METALLIC RACEWAYS OR Isc SHORT CIRCUIT CURRENT ENCLOSURES TO THE FIRST ACCESSIBLE DC kVA KILOVOLT AMPERE DISCONNECTING MEANS PER ART. 690.31(E). kW KILOWATT 6. ALL WIRES SHALL BE PROVIDED WITH STRAIN LBW LOAD BEARING WALL RELIEF AT ALL ENTRY INTO BOXES AS REQUIRED BY MIN MINIMUM UL LISTING. (N) NEW 7. MODULE FRAMES SHALL BE GROUNDED AT THE NEUT NEUTRAL UL-LISTED LOCATION PROVIDED BY THE NTS NOT TO SCALE MANUFACTURER USING UL LISTED GROUNDING OC ON CENTER HARDWARE. PL PROPERTY LINE 8. MODULE FRAMES, RAIL, AND POSTS SHALL BE POI POINT OF INTERCONNECTION BONDED WITH EQUIPMENT GROUND CONDUCTORS AND PV PHOTOVOLTAIC GROUNDED AT THE MAIN ELECTRIC PANEL. SCH SCHEDULE 9. THE DC GROUNDING ELECTRODE CONDUCTOR SS STAINLESS STEEL SHALL BE SIZED ACCORDING TO ART. 250.166(B) & STC STANDARD TESTING CONDITIONS 690.47. TYP TYPICAL UPS UNINTERRUPTIBLE POWER SUPPLY V VOLT Vmp VOLTAGE AT MAX POWER VOLTAGE AT OPEN CIRCUIT W WATT VICINITY MAP INDEX W 3R NEMA 3R, RAINTIGHT PV1 COVER SHEET PV2 SITE PLAN PV3 STRUCTURAL VIEWS PV4 UPLIFT CALCULATIONS LICENSE GENERAL NOTES PV5 THREE LINE DIAGRAM Cutsheets Attached GEN #168572 1. THIS SYSTEM IS GRID-INTERTIED VIA A , ELEC 1136 MR UL-LISTED POWER-CONDITIONING INVERTER. 2. THIS SYSTEM HAS NO BATTERIES, NO UPS. 3. SOLAR MOUNTING FRAMES ARE TO BE + GROUNDED. 4. ALL WORK TO BE DONE TO THE 8TH EDITION MODULE-GROUNDING-METHOD * -OF THE-MA STATE-BUILDING-CODE. — - 5. ALL ELECTRICAL WORK SHALL COMPLY WITH REV BY DATE COMMENTS AHJ: North Andover THE 2014 NATIONAL ELECTRIC CODE INCLUDING REV A NAME DATE COMMENTS MASSACHUSETTS AMENDMENTS. UTILITY: National Grid USA (Massachusetts Electric) r CONFIDENTIAL — THE INFORMATION HEREIN JOB NUMBER: PREMISE OWNER: DESCRIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THE JB-018440 00 PELUSI, ANTHONY PELUSI RESIDENCE Juan RiosBENEFI NOR SHTOF ALL ITYONE BE DISCLOSED IN WHRCITY OLE ORCIN MOUNTING om Mount 41 CROSSBOW LN .A SOlafCity/ PART TO OTHERS OUTSIDE THE RECIPIENT'S Comp Mount Type C 7.5 KW PV Array ORGANIZATION, EXCEPT IN CONNECTION WITH MODULES: NORTH ANDOVER, MA 01845 THE SALE AND USE OF THE RESPECTIVE (30) YINGLI # YL250P-29b 24 St.Martin Drive, Binding 2, Unit 11 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME SHEEP REV: DATE Marlborough, MA 01752 PERMISSION OF SOLARCITY INC. INVERTER: 7819449449 PV 1 4/15/2014 (MB)- CITY -2489)(650)638-1029 Multiple Inverters COVER SHEET PITCH: 30 ARRAY PITCH:3a MP1 AZIMUTH: 195 ARRAY AZIMUTH: 195 MATERIAL: Comp Shingle STORY: 1 Story �ytK OF� YOO JIN K VI No.4 7 Front Of House T Af. Digitall igned by Yoo Jin Kim Date: 2014.04.16 08:20:13 -07'00' O AC LEGEND D (E) UTILITY METER & WARNING LABEL LC INVERTER W/ INTEGRATED DC DISCO Inv & WARNING LABELS FDC DC DISCONNECT & WARNING LABELS B Inv © AC DISCONNECT & WARNING LABELS a p1 Q DC JUNCTION/COMBINER BOX & LABELS DISTRIBUTION PANEL & LABELS ° Lc LOAD CENTER & WARNING LABELS O DEDICATED PV SYSTEM METER A 0 STANDOFF LOCATIONS CONDUIT RUN ON EXTERIOR -- CONDUIT RUN ON INTERIOR GATE/FENCE 0 HEAT PRODUCING VENTS ARE RED r,_-i It 'i INTERIOR EQUIPMENT IS DASHED L_-'J SITE PLAN N Scale: 1/8" = V E 0 1' 8' 16' W S JB-01 8 440 00 PREMISE OWNER: DESCRIPTION: DESIGN: CONTAINED L— THE INFORMATION HEREIN JOB NUMBER: `\� SolarCit CONTAINED SHALL NOT BE USED FOR THE PELUSI, ANTHONY PELUSI RESIDENCE Juan Rios �_ ; NOR SHALL ANYONE EXCEPT N MOLE OR IN MOUNTING SYSTEM: 41 CROSSBOW LN 7.5 KW PV Arra '•." PART TO OTHERS OUTSIDE THE RECIPIENT'S Comp Mount Type C Y ORGANIZATION, EXCEPT IN CONNECTION WITH MODULES: NORTH ANDOVER, MA 01845 THE SALE AND USE OF THE RESPECTIVE 30 YINGLI YL250P-29b 24 St. Martin Drive, Binding 2, Unit 11 ( ) PAGE NAME: SHEET: REV: DATE Mar8-1028 MA 50) 1752 SOLARCIN EQUIPMENT, WITHOUT THE WRITTEN INVERTER: T: (650)638-1028 F. (650) 638-1029 PERMISSION OF SOIARCITY INC. Multiple Inverters 7819449449 SITE PLAN PV 2 4/15/2014 (888)-SOL-CITY(765-2489) w w.s0larcitycam A y Sl YOO JIN wilik � VI , No.4 7 4" 1' 13'-7" (E) LBW A SIDE VIEW OF MP1 NTs Digitall signed by Yoo Jin Kim Date: 2014.04.16 08:20:21 MPI X-SPACING X-CANTILEVER Y-SPACING Y-CANTILEVER NOTES -07'00' LANDSCAPE 64" 24" STAGGERED PORTRAIT 48" 19" RAFTER: 2X8 @ 16"OC ROOF AZI 195 PITCH 30 ARRAY AZI 195 PITCH 30 STORIES: 1 C.).: 2x8 @16"OC Comp Shingle PV MODULE 5/16" BOLT WITH LOCK FINSTALLATION ORDER & FENDER WASHERS LOCATE RAFTER, =PILOT ZEP LEVELING FOOT (1) LOCATION, AND ZEP ARRAY SKIRT (6) HOLE. (4) G(2) SEAL PILOT HOLE WITH POLYURETHANE SEALANT. ZEP COMP MOUNT C ZEP FLASHING C (3) (3) INSERT FLASHING. (E) COMP. SHINGLE (4) PLACE MOUNT. (1) (E) ROOF DECKING (2) U INSTALL LAG BOLT WITH 5/16" DIA LAG BOLT (5) (5) SEALING WASHER. WITH SEALING WASHER LOWEST MODULE SUBSEQUENT MODULES J(6) NSTALL LEVELING FOOT WITH (2-1/2" EMBED, MIN) BOLT & WASHERS. (E) RAFTER - S JB-01EINVMTE®R: 8440 0 0 PREMISE OWNER. DESCRIPTION: DESIGN: CONFIDENTIAL - THE INFORMATION HEREIN \\��a � CONTAINED SHALL NOT BE USED FOR THE PELUSI, ANTHONY PELUSI RESIDENCE Juan Rios ��:SO�afC�ty. BENEFIT OF ANYONE EXCEPT SOLARCITY INC., : vs NOR SHALL IT BE DISCLOSED IN WHOLE OR INunt Type C 41 CROSSBOW LN 7.5 KW PV Array PART TO OTHERS OUTSIDE THE RECIPIENT'S ORGANIZATION. EXCEPT IN CONNECTION WITH NORTH ANDOVER, MA 01845 24 St. Martin Drive, Building z Unit 11 THE SALE AND USE OF THE RESPECTIVE LI # YL250P-29b SHEET- REV: pA� Marlborough,MA 01752 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN vERPAGE NAME T: (650)638-1028 F. (650)638-1029 PERMISSION OF SOLARCITY INC. verters 7819449449 STRUCTURAL VIEWS PV 3 4/15/2014 (888)-SOL-CITY(765-2489) www.solarcity.com r , UPLIFT CALCULATIONS SEE SEPARATE PACKET FOR STRUCTURAL CALCULATIONS. CONFIDENTIAL — THE INFORMATION HEREIN JOB NUMBER: PREMISE OWNER. DESCRIPTION: DESIGN: CONTAINOF ANYONE ED SHALL NOT BE USED FOR THE JB-018440 00 PELUSI, ANTHONY PELUSI RESIDENCE Juan Rios solarCity.BENEFIT ITT BEE DISCLOSEDT N WHROLE OR IN M01Comm s>SNOR SH41 CROSSBOW LN 7.5 KW PV Arra .►; PART TO OTHERS OUTSIDE THE RECIPIENT'S p Mount Type C y ORGANIZATION, EXCEPT IN CONNECTION HATH MODULES: NORTH ANDOVER, MA 01845 THE SALE AND USE OF THE RESPECTIVE (30) YINGLI # YL250P-29b 24 St. Martin Drive Building 2 Unit 11 SOLARCITY EQUIPMENT, VATHOUT THE WRITTEN NVFRIER: PAGE NAME: SHS- REV. DATE MorlboT. (650)638 1028, F. (65052 ) 638-1029 PERMISSION OF SOLARCITY INC. Multiple Inverters 7819449449 UPLIFT CALCULATIONS PV 4 4/15/2014 (sea)-SOL-aTr(765-2489) www.solarcity.com .GROUND SPECS MAIN PANEL SPECS GENERAL NOTES INVERTER SPECS MODULE SPECS LICENSE (BOND N 8 GEC TO TWO N GROUND Panel Number: Inv 1: DC Ungrounded Epg�E. GEN #168572 ( ) # ( ) Inv 2: DC Ungrounded INV 1 -(1)Inv�t�800W 284OV 9 5% w�nifedl%scco and ZB, AFCI -(30)APV Module;250W 9226.2W PTC, H4, 46mm, YGE-Z 60, Black Frame, ZEP Enabled ELEC 1136 MR ODS AT PANEL WITH IRREVERSIBLE CRIMP Meter Number:l3 816 604 9 Underground Service Entrance INV 2 -(1)ner�GE OQow 2040oV 975R;�wNnifed DisBo and ZB, AFq Voc: 37.6 Vpmax: 29.8 INV 3 1 Ise AND Imp ARE SHOWN IN THE DC STRINGS IDENTIFIER �E 200A MAIN SERVICE PANEL E� 20OA/2P MAIN CIRCUIT BREAKER Inverter 1 (E) WIRING SOLARGUARD BRYANT CUTLER-HAMMER METER (N) Load Center 200A/2P Disconnect 7 5 SOLAREDGE SE380OA-US-ZB-U (E) LOADS B C I D 20A/2P 2.V SolarCity �, o ~ N 3 A 1 40A/2P -_-_ GND EGG DC+ DC+ (1 3) A - -- GND --- - -; r--------- ---- - GEC ---�N DG DG IString(s)Of160nMP1 B I Z I GND EGC--------------------------- EGC I I I I I I I I N _--J ♦J Inverter 2 I o EGCLEC I o i � 1 6 SOLAREDGE I i SE3000A-US-ZO-U I 20A/2P a 2aov SolarCity `- GECT_ 1 I L TO 120/240V I I I N 4 A jDC+ I SINGLE PHASE i i L_ ________________ _ EGG ___ DC+ - -UTILITY SERVICE I I GEC II DG DG1 Strings)Of 140n MPl GND EGC--------------------------- -- EGC I I �- I I I Voc* = MAX VOC AT MIN TEMP OI (1)SIEMENS #0240 0452- / 2P BREAKER B (I)CUTLER-HAMMER #DG222URB /t, A (2)SKYity 4 STRING JUNCTION BOX D� Breaker, 4OA/2P, 2 Spaces Disconnect; 60A, 24OVac, Non-Fusble, NEMA 3R /y 2x2 STR GS, UNFUSED, GROUNDED -(2)Ground Rod; 5/8' x 8, Copper -(i)CUTLER-tIAMMER�DG100NB ( ) # /►J - 2 ZEP 850-1196-002 D Ground eutral It 60-t00A, General Duty(DG) Universal Box Bracket; [PKG B] (I)BRYANT#BR816LI25RP Load Center; 125A, 120/24OV, NEMA 3R C SolarGuard Monitoring System H(N) ARRAY (30)SOLAREDGE(300-2NA4AZS -(2)CUTLER-HAMM #BR220 PowerBox timizer, 300W, H4, DC to DC, ZEP Breaker, 20A 2P, 2 Spaces (1)AWG #6, Solid Bare Copper -(1)Ground Rod; 5/8' x 8'. Copper GROUND PER 690.47(D). NOTE: PER EXCEPTION NO. 2, ADDITIONAL El ECTRODF MAY NOT RF RFDIJIRFD _ DING ON I(KATION OF_( - - � 1 AWG #8, THWN-2, Block ��TT' 1 AWG #10, THWN-2, Black (1)AWG 110, THWN-2,Black _ _ Voc* 500 VDC Isc =15- ADC (2)AWG #10, PV WIRE,Black Voc* =500 VDC Isc =15 ADC O�L(1)AWG #8, THWN-2, Red _ _ _ O IgI-(1)AWG#10, THWN-2,Red - - - - O (1)AWG #10, THWN-2, Red Vmp =350 VDC Imp=11.28 ADC O (1)AWG #6, Solid Bare Copper EGC Vmp =350 VDC Imp=11.28 ADC �L(1)AWG #8;THWN=2, White NEUTRAL VmP =240 VAC Imp=28.33AAC II (i)AWG #10, THWN-2, White NEUTRAL Vmp =240 VAC Imp=15.83 AAC (1)AWG #10, THWN-2,.Green_ . EGC_ . " -(1)Conduit.Kit; 3/4' EMT . . . . . . .7.6)AWG #8,.ii I"-2,,Green . . EGC/GEC.-(1)Conduit.Kit;.3/4'.EMT. . " . . . . " . . . . _ . . . _-(1)AWG #8,.TFIWN-2,"Green - . TGC/GEC.-0).Conduit,Kit;.3/4'.EMT, . . . . . . . . . (1)AWG 110, THWN-2, Blaclk Voc* =500 VDC Isc =15 ADC (2)AWG #10, PV WIRE, Bladk Voc* =500 VDC Isc =15 ADC (1)AWG #10, THWN-2, Block ®�(1)AWG 110, THWN-2, Red Vmp =350 VDC Imp=9.87 ADC O (1)AWG #6, Solid Bare Copper EGC Vmp =350 VDC Imp=9.87 ADC N (N ©�(1)AWG #10, THWN-2, Red (1)AWG #10, THWN-2,,Green. . EGC_ . , -(1)Conduit,Kit;.3/4'.EMT. . . . - , . . . . (11)AWG #10, THWN-2, White NEUTRAL Vmp =240 VAC Imp=12.5 AAC -(1)AWG #8,.T}IWN-2,_Green " . EGC/GEC.-(1)Conduit.Kit;.3/4'.EMT. . . . . . . . . . JB-018440 0 0 PRIMASE OYINER: DESCRIPTION: DESIGN: CONFIDENTIAL - THE INFORMATION HEREIN JOB NUMBER: w CONTAINED SHALL NOT BE USED FOR THE PELUSI, ANTHONY PELUSI RESIDENCE Juan Rios �:,;So�arCity. BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: �'4$ NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 41 CROSSBOW LN 7.5 KW PV Array PART TO OTHERS OUTSIDE THE RECIPIENTS ORGANIZATION, EXCEPT IN CONNECTION WITH MODULM- NORTH ANDOVER, MA 01845 24 St.Martin Drive,Building 2,Unit 11 THE SALE AND USE OF THE RESPECTIVE (30) YINGLI # YL250P-29b g{ET; REV; DATE; Marlborough, MA 01752 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME T- (650)638-1028 F. (650)638-1029 PERMISSION OF SOLARCITY INC. IMulltip le Inverters 7819449449 THREE LINE DIAGRAM PV 5 4/15/2014 (888)-SCI-CITY(765-2489) www.solarkAtycom CAUTION POWER TO THIS BUILDING IS ALSO SUPPLIED FROM THE FOLLOWING SOURCES WITH DISCONNECTS LOCATED AS SHOWN: - Address: 41 Crossbow Ln INVERTER AND DC DISCONNECT INVERTER AND --------------- DC DISCONNECT I r_1 L, II I ----J L----------J UTILITY SERVICE r--------------------------� i SOLAR PHOTOVOLTAIC ARRAYS) L--------------------------J PHOTOVOLTAIC BACK-FED CIRCUIT BREAKER IN MAIN ELECTRICAL PANEL IS AN A/C DISCONNECT PER NEC 690.17 - OPERATING VOLTAGE = 240V MAX CURRENT = 28.33 A CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER: PREMISE OWNER: DESCRIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THE JB-01 8440 00 PELUSI, ANTHONY PELUSI RESIDENCE Juan RiosBENEFI ' NOR SHTOF ALL IT BENDISCL�D N MOLE ORT SOLARCITY CIN MOUNTING STSII]A: 41 CROSSBOW LN 7.5 KW PV Arra 'AsolarC�ty. PART TO OTHERS OUTSIDE THE RECIPIENT'S Comp Mount Type C Y ORGANIZATION, EXCEPT IN CONNECTION NTH MODULES NORTH ANDOVER, MA 01845 THE SALE AND USE OF THE RESPECTIVE (30) YINGLI # YL250P-29b 24 St. Martin Drive, Building 2, Unit 11 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: PAGE NAME SHEET: REV: DATE 52 T: (650) 638 1028 F:A(817 638-1029 PERMISSION OF SOLARCITY INC. MUItI le Inverters 7819449449 SITE PLAN PLACARD PV 6 4/15/2014 (888)-SOL-CITY(765-2489) www.solarcitycom SolarCity SleekMountTM - Comp SolarCity SleekMounff - Comp The SolarCity SleekMount hardware solution • Utilizes Zep Solar hardware and UL 1703 listed Installation Instructions is optimized to achieve superior strength and Zep CompatibleTM modules aesthetics while minimizing roof disruption and Drill Pilot Hole of Proper Diameter for labor. The elimination of visible rail ends and • Interlock and grounding devices in system UL ! Fastener Size Per NDS Section 1.1.3.2 listed to UL 2703 mounting clamps, combined with the addition /'y 0Seal pilot hole with roofing sealant of array trim and a lower profile all contribute • Interlock and Ground Zep ETL listed to UL 1703 to a more visually appealing system.SleekMount as"Grounding and Bonding System" 3O Insert Comp Mount flashing under upper utilizes Zep Compatible TM modules with •Ground Zep UL and ETL listed to UL 467 as � � layer of shingle strengthened frames that attach directly to grounding device ® Place Comp Mount centered Zep Solar standoffs, effectively eliminating the need for rail and reducing the number of • Painted galvanized waterproof flashing upon flashing standoffs required. In addition, compositionO5 Install lag pursuant to NDS Section 11.1.3 •Anodized components for corrosion resistance shingles are not required to be cut for this with sealing washer. system, allowing for minimal roof disturbance. •Applicable for vent spanning functions © Secure Leveling Foot to the Comp Mount using machine Screw f� Place module O Components Q 5/16"Machine Screw ` © Leveling Foot - © Lag Screw OD Comp Mount '--� © Q Comp Mount Flashing Q ® 3 SolarCity. y January 2013LISTED SolarCitnr i�January 2013 �o Pre ® • so I a r - • • so I a r ' • • z. SolarEdge Power Optimizer Module Add-On for North America P300 / P350 / P400 SolarEdge Power Optimizer Module Add-On For North America (for P300 0-cell PV (for P350 P400 PV (for 96cell PV modules) modules) modules) P300 / P350 / P400 • INPUT _- Rated Input DC Poweri') 300 350 400 W -- -- - -- - - Absolute Maximum Input Voltage(Voc at lowest temperature) 48 60 80 Vdc MPPT Operating Range 8-48 8-60 8-80 Vdc • Maximum Short Circuit Current(Isc) 30 Adc Maximum DC Input Current i 12.5 Adc Maximum Efficient 99.5 °/ Weighted Efficient _ _ 98.8 % Overvoltage Category OUTPUT DURING OPERATION(POWER OPTIMIZER CONNECTED TO OPERATING INVERTER) _ Maximum Output Curren[ 15 Adc _Maximum Output Voltage _ 60 ___ Vdc • OUTPUT DURING STANDBY(POWER OPTIMIZER DISCONNECTED FROM INVERTER OR INVERTER_OFF) Safety Output Voltage per Power Optimizer 1 Vdc STANDARD COMPLIANCE ' EMC FCC Part15 Class B,IEC61000 6 2,IEC61000-6-3 . . . ..... . ............. Safety IEC62109 1(class II safety),UL1741 ROHS _ _ _ _ Yes INSTALLATION SPECIFICATIONS Maximum Allowed System Voltage _ 1000 Vdc _.., .... . .I .. .. ..... ... . . Dimensions(W x L x H) 141 x 21? 8.34 x 1.59 mm/in Weight(including cables) 950/2.1 . Input Connector MC4/Amphenol/Tyco Output Wire Type/Connector Double Insulated;Amphenol Output Wire Length 0.95/3.0 1:2/3.9 rn k Operating Temperature Range -40 +85/-40-+185 Protection Rating IP65/NEMA4 Relative Humidity 0- "',d "'meed ss Power Pane n oWo..—Io or w mszpowerwlerance mowea. PV SYSTEM DESIGN USING A SOLAREDGE THREE PHASE THREE PHASE INVERTER SINGLE PHASE 208V _ 480V PV power optimization at the module-level Minimum String Length Optimizers) 8 10 18 ...... .. _. - I I - Up to 25%more energy Maximum String Length(Power Optimizers) 25 25 50 -... .... ... .... .... .. ... .... MaxiPoper String 5250 6000 12750 W - Superior efficiency(99.5%) -... mum wer..._ ..-.._. ..... .. _.. ..... .. .... ... . .. .. .... i Parallel Strings of Different Lengths or Orientations Yes - Mitigates all types of module mismatch losses,from manufacturing tolerance to partial shading """ " - - - ----- -- -- - - - - - ......... - Flexible system design for maximum space utilization - Fast installation with a single bolt - Next generation maintenance with module-level monitoring - Module-level voltage shutdown for installer and firefighter safety USA - GERMANY - ITALY - FRANCE - JAPAN - CHINA - ISRAEL - AUSTRALIA www.solaredge.us s E o Z 6 G YL255P-296 YGE - Z ® CELL SERIES Powered by YINCSU CELL SERIES YL250P-296 YIII�r7�W -- LAR YL245P-29b ELECTRICAL PERFORMANCE YL240P-29b U.S.Soccer Powered by Yingli Solar Electrical parameters at StandardGENERAL CHARACTERISTICS Module type _-- YL26OP-29b i YL255P-29b YL250P-29b YL245P-29b YL240P-29b Dimensions(L/W/H) I 64.96in(1650rnm)/38.9&(990mrn)/- Power output__--_ -. Pm.x. _WWWW _-_260 _255 j 250 245 240 _ Pf 1.81 in(46mrn) -_ Power output tolerances GF.,.x % I -0/+3 Weight 45.2lbs(20.5kg) • Ideal for residential Module efficiency qm -% 15.9 15.6 j 15.3 15.0 14.7 Voltage at P� V-P V 30.3 30.0 ) 29.8 29.6 29.3 and commercial applications where cost savings -- - - - - - - -1--- -- -- - - T - - Current at Pm,x I,.PP A 8.59 8.49 k 8.39 8.28 8.18 PACKAGING SPECIFICATIONS installation time, and aesthetics matter most. Open-circuit voltage - - V«-F V 37.7 37.7 37.6 37.5 37.5_ Number of modules per pallet 22 Short-circuit current I- A _9.09 9.01 -"f 8.92 8.83 8.75Number of pallets per 40'container 28 STC:1000W/m'irradiance,25°C cell temperature,AM1.59 spectrum according to EN 60904-3 I • • ♦ Average relative efficiency reduction of 3.3%at 200W/m'according to EN 60904-1 Packaging box dimensions 67in(1710mm)/45in(1145mm)/ (L/W/H) 46in(1178mrr� Lower balance-of-system costs with Zep Electrical parameters at Nominal Operating Cell Temperature • sax we. ht pp g p 1067lbs(484kg) Com atible'"frame. Power output Pn W 189.7 186.0 182.4 178.7 175.1 - Reduce on-roof labor costs by more than Voltage at Pm.. vmPP v 27.6 27.4 z7z 2zo 26.8 Units:inch(mm) Current atPm,. _ --__.--._._I"'PP_._A _. .6.87 ..Y.- -6.79 -�_ 6.71 6.62 � - 6.54 .. 25%. -- -- 38.98 990 Open-circuit voltage V« V 34.8 34.8 34.7 34.6 34.6 Leverage the built-in grounding system- Short-circuit current - - - - - 36.as(936 1.81(46) Iu A 7.35 7.28 7.21 7.14 7.07 0 If It's mounted, It's grounded. NOCT:opentircuit module operation temperature at 800w/m'irradiance,20°C ambient temperature,1m/s wind speed P Decrease your parts count-eliminate screws, THERMAL CHARACTERISTICS rails, mounting clips, and grounding hardware. Nominal operating cell temperature NOCT °C 46+/.2 $ Temperature coefficient of Pm Y %/°C -0.42 Temperature coefficient of V« w 0- -%/°C - - -- - - - --0.32FZ - -- Minimize roof penetrations while maintaining Temperature coefficient of I- ar %/°C� 0.05 Grounding holes e® the system's structural integrity. - - - - O f .6-0.236 6 n • o ° C,OMPATj� Temperature coefficient of V, P yVmpp %PCR -0.42 P Invest in an attractive solar array that includes .tv / ��i -- -- ---- - - -- ---- -- -- a black frame, low mounting profile,and OPERATING CONDITIONS aesthetic array skirt. � Vs unting holes A � Max..system voltage b00V°c or 1000Voc COMPp•(� _ ____ ____ _ __ _ ___ 4-0.256x0.315(6.5x8) Increase energy output with flexible module Max.series fuse rating 15A layouts(portrait or landscape). ---- - - - --- Limiting reverse current 15A G Drainage holes C p C Trust in the reliability and theft-resistance of - --------- - -�-- ---- -- - 8-0.12x0.315(3x8) `1 Operating temperature range -40 to 185°F(-40 to 85°C) the Zep Compatible'"system. - --- - - -- - --- - .. . - � � • • 3 Max.static load 2400Pa 3.94(100) Max.hailstone impact(diameter/velocity) 25mm/23m/s 0.47(12) AC SOLUTION OPTION Leading limited power warranty*ensures 91.2%of rated power for 10 years,and 80.7% tilillil ; The YGE-Z Series is now available as i of rated power for 25 years. CONSTRUCTION MATERIALS 11 an Enphase Energized'"AC Solution. - - Front cover(material/thickness) low-iron tempered glass/3.2r m a I [e] SECTION C-C ; This solution delivers o timum p Cell(quantity/material/dimensions/ 60/muhicrystalline silicon/ 10-year limited product warranty. � ( / performance and integrated intelligence. number ofbusbars) 4 156mmx156mm/2or3 1`\ enpha54' The Enphase M215-Z Zep Compatible L- . _ _ _ _ - _-_ ._ _ Encapsulant(material) ethylene vinyl acetate(EVA) Microinverter is desi designed t0 Connect *In compliance with our warranty terms and conditions. iioo Frame material/color/ed a sealin 1 - 1.38(35) g ( 4. 9) anodized aluminum alloy/black/silicone or tape directly into the Z Series module groove,eliminating )unction box(ingress protection rating) ZIP65 the need for tools or fasteners-all with one easy step. - ----- -- warning:Read the Installation and User Manual in its entirety v` Cable(length/cross-sectional area) 11 00m/4mrnz _ _ _ A before handling,installing,and operating Yingli modules. • • 1 1 C • _ -- - - -- - - - - Connector(type%ingress protection rating) Y MC4 or Amphenol H4/z IP67 - f Our Partners UL 1703 and ULC 1703,CEC,FSEC,ISO 9001:2008,ISO i 14001:2004,BS OHSAS 18001:2007,SA8000 Intelligent real-time monitoring at the system I C -- If you buy from Yingli Americas,Yingli Americas The specifications in this datasheet are not guaranteed and are subject to change without prior notice. and module level with I CUL as acts as the importer and complies with all This datasheet complies with EN 50380:2003 requirements. Enlighten. v�� applicable tariffs.Customers can buy from Yingli LISTED Americas with no worry that they will be liable for (PHOTOVOLTAIC MODULE) m•eae.vs any Import tariffs. i wino Yingli Green Energy Americas, Inc. info@yingliamericas.com Tel: +1 (888)686-8820 YINII - LAR YINGLISOLAR.COMNS I NYSENGE Pe Y I N G L I S O L A R.C O M/U S I Yingli Americas 0 Yingli Green Energy Holding Co.Ltd. I YGEZ60CellSeries2013-EN-201309_V01 U.S.Soccer Powered by Yingli Solar solar=@@ Single Phase Inverters for North America OIar , . SE3000A-US/SE380OA-US/SE5000A-US/SE6000A-US/ SE760OA-US/SE1000OA-US/SE1140OA-US _ - - -I SE3000A-_ S! SE3800A-U� SESOOOA-U15E6000A-US J SE7600A_US�SE10000A-USJ SE11400A-US l--_ PUT SolarEdge Single Phase InvertersOUT -------- ----r -- 5200@208VT--- -- - - - 9960@208V -- -- - --- Nominal.. Power Output 3300 3840 5520 @240V. .....6000 7680 10080 @240V 11520 VA ....... . ................ ........... ................ 5600 @ 208V 10800 @208V For North America Max.AC Power Output 3650 4150 6000 8350 12000 VA 6000 @240V 10950 @240V SE3000A-US/SE380OA-US/SE5000A-US/SE6000A-US/ AC Output Voltage Min.Nom Max* I ..183-208-.2.29,Vac . .- ... J I ✓ AC Output Voltage Min.-Nom.-Max.* ; SE760OA-US/SE1000OA-US/SE1140OA-US 211-240-264 Vac I I _ AC Frequency Min.-Nom.-Max.* 59.3 60-60.5(with HI country setting 57-60-60.5) Hz - 1 25 @ 208V 48 @ 208V s Output Current i 14 16 Max.Connnuou - 23 @ 240V 25 32 I 42 @ 240V ( 48 I A 00 GFDI .. ..... 1..... .. ..........._-.... ... ... .-A�.�.. Utility Monitoring,Islanding \pverte�. Protection,Country Configurable 1 Yes Thresholds - --- - ---- - -- - - - - -- --------- -- - - - - - -- - -- --- -- - -` INPUT �_ - ��WanaO Recommended Max.DC Power** T 4100 4800 6500 T 7500 1I 9600 12400 T 14400 W •�s11ah��� (STC) .......... .......I...,... ... _�............ _�.. ... .......-L.. _..... .... I ... . . ..-.1 .. ...... . . .................I......... ....... ......... { Transformer-less,Ungrounded Yes Max.Input Voltage _ _ 500 Vdc Nom.DC Input Voltage. 325 @ 208V/350 @ 240V .,. _ Vdc . . .. .. .. .. '3'0.5 ...... .. .. .. . Max.Input Current*** 11 I 13 I 17 @ 240V 18 23.5 30 5 @2241 35 Adc Max.Input Short Circuit Current 30 45 Adc .................. ......................- ................ .... ........_...................................-...-.._................. ......... ... .. ..... .. ........... Reverse-Polarity Protection Yes ............................... ....... .. .. .._............-... ..,... ........................... ......................................... ......... Ground-Fault Isolation Detection 600kn Sensitivity ... .... .. ... .. ... ... ... ....... ... ...... .. ..... .. .. .. ..... .. ..... .. .. .. .. ... -� Maximum Inverter Efficiency 97.7 98.2 98.3 98.3. 98 98 98 %.. .. ... ... ... . 97.5 @ 208V 97 @ 208V CEC Weighted Efficiency 97.5 98 97.5 97.5 97.5 ............... .. ... ... .... ..98 @,240V.. ............. ................ 240V.. .................. + Nighttime Power Consumption ----- .----.- --.-. <2.5-- ----.-- -.-.- -_-- - - _-_---_-- <4-_-_ _—- _ - _ W ADDITIONAL FEATURES i Supported Communication Interf_ace_s_I - - RS485,RS232,Ethernet,ZigBee(optional) _ r STANDARD COMPLIANCE _ -- Safety. UL1741,UL3699B(Part numbers ending in"-U"),UL1998,CSA 22.2 Grid Connection Standards T IEEE 1547 ._...Standards ... ... ... -._. ..... .. .. .... .. Emissions 1 _-- _- FCC partlS class B - INSTALLATION SPECIFICATIONS A_ +� AC output conduit size/AWG range 3/4"minimum/24-6 AWG 3/4"minimum/8-3 AWG ... ..... ....... ............. ........ ...... .. . ...... - .... .. DC input conduit size/#of strings/ 3/4"minimum/1-2 strings/24-6 AWG 3/4"minimum/1-2 strings/14-6 AWG AWG range Dimensions with AC/DC Safety 30.5 x 12.5 x 7/ 30.5 x 12.5 x 7.5/ 10.5/775 in/ Switch(HxWxD) 775 x 315 x 172 775 x 315 x 1915 x x mm Weight with AC/DC Safety Switch 51.2/23.2 24.7 88.4/40.1 x Ib/kg ..... . ....... .. .. .. ... .. ... Cooling................. ....... ... .. .......................NaturalConvection,.,..,.,........_,.,,. _.._...,.._.....,...._.._Fans.(userreplaceable) .__. ... Noise <25 <SO dBA ....... ... ....... ... ........... ... ... ....... ......... I..,. .. .... • Min.-Max. 13 to - **** The best choke for SolarEdge enabled systems - / 25 to+60(CAN version -40 to+60) -F/-C g Y Range Integrated arc fault protection(Type 1)for NEC 2011690.11 compliance(part numbers ending in"-U") Protection Rating I NEMA 3R •For otheegional settings please contact SolarEdge support — Superior efficiency(98%) limited to 125%for locations where the year[v average high temperature is above 77eF/252C and to 135%for locations where it is below 772F/25eC. For detailed information,refer to htto//www alar d u/fil /odfs/inv rt r d ov r z n ed odf — Small,lightweight and easy to install on provided bracket •••Ahigher current source may be used;the inverter will limit its input current to the values stated. '•"CAN P/Ns are eligible for the Ontario FIT and microFIT(microFIT exc.5E 11400A-US-CAN) — Built-in module-level monitoring — Internet connection through Ethernet or Wireless — Outdoor and indoor installation — Fixed voltage inverter,DC/AC conversion only — Pre-assembled AC/DC Safety Switch for faster installation sunsaEc RoHS USA - GERMANY - ITALY - FRANCE - JAPAN - CHINA - ISRAEL - AUSTRALIA www.solaredge.us are traceniarks of the,respec�ive a.neDate: r Navvy � ' 77 4. NORTH ANDOVER BUILDING DEPARTMENTf c4 u5 1600 Osgood Street �SSAw � • • • North Andover Tel: 978-688-9545 Fax: 978-688-9542 • C .BUSINESS FORM FOR TOWN CLERK DA'it: 1 / 3 ) l NAME: 6 �C�c�s o CL uS I �- sS 0C l AT(- An mss: 1 S S L f ONdNGDiSTRIC1. TYPE OF BUSINESS.: oAW 6l C)� G pj BUILDING LAYOUT PROVIDED: YES NO �4 VAlLABLE PARis..MG SPACES: ZONINGBY LAW USAGE: YES NO BUJI DING INSPECTOR.SIGNATUM BUSINMSS FORM FOR4TOWN CLERK ' s sz . 2.40 Home Occupation(19 9/ ) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his pnncipal address, which is clearly secondary'to the use.of the building for living purposes. Home occupations shall 'include,"but not'limited to the following uses; personal services such as £unushed by an artist or instructor, but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business or the manufacturing of goods which impacts the residential nature of the neighborhood 4. For use of a dwelling in any residential district or multi-family district for a home occupation, the following conditions shall apply: a. Not more than a total of three (3) people may be employed in the home occupation, one of whom shall be the owuier of the home occupation and residing in said divelfing; b. The use is carried on strictly within the principal building; c. There shall be no exterior alterations, accessory buildings, or display which are not customary with residential buildings; d. Not more than twenty-five (25) percent of the existing gross floor area of the divelIing unit. so used, not to exceed one thousand (1000) square feet, is devoted to'such use. In connection with such use, there is to be kept no stock in trade, commodities or products which occup5T space beyond these,limits; e. There will be no display of goods or wares visible from the strut; f The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the exterior appearance, emission of odor, gas, smoke, dust, noise, disturbance, or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shall include no features of design not customary in buildings for residential use. signature � Date Date �� �gh .........../............ ................ t CF 4oRr#t ?; co TOWN OF NORTH ANDOVER 9 PERMIT FOR WIRING zc- This certifies that ......................................................................................................./Z..................... has permission to perform wiring in the building of.......... ....U..5�............................................................................... C,�� h� h N Acmilc�AL Andover,Mass at ............. ...................... ^................ .............................. Fee 6...1.. Lic.No. �l '� !.1!......... ......... EEcrm `Check# 1 C..ommonwea�h o��a�sac�xuseffd Official Use Only Permit No.. 0 eL.JeParEmerzt'o�,}ir¢�ervrcel Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev,I/o7] ea�eblank 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 W INK OR*TYPELL MO.RAUTION) Date: City or Town of: 1U weflo the Inspector of Wires. By this application the,ttrtdersignotice of his or her intention to perform the electrical work described below. Location(Street&Number) ro s66�! Owner or Tenant. 0,1U Telephone No. u. : P 0'a� Owner's Address - — ° ` d a Is this permit in co unctio wit a buildin y h P �,� g permit? Yes ❑ No ❑ (Check Appropriate Box) i r c Purpose of Building IOe4'- Utility Authorization No. 3 c Existing Service Amps / Volts Overbead❑ Undgrd❑ No.of Meters e c ° New Service Amps / Volts Overhead❑ Und rd -- g ❑ No.of Meters % ° c Number of Feeders and Ampacity g c uv Location and Nature of Proposed Electrical Work: i e f mo+. ` ( � ,���a Il r c�✓ _�cf .�rrz oyt�es, P 14 2 v o� E cc! 1 t C$S T KlL7D q Jl' ..�C ar ul is CR Com letlon of tit Ulowinr .table nt be waived the l ` ctor o ex. �► +�- g,o AI m No of Recessed Luminaires No.°of Ceil.-Susp.(Paddle)Fans Transformers KNo.Iff VA a . No,of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Above In- o.o �mergency g c' Swimming Pool d ❑ rnd• ❑ Rattell Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of hones No:of Switches No.of Gas Burners o.of. etect axt an - Initiati I3evices Ci No.of Ranges No,of Air Cond. No.of Alerting'Devices aL Tons ` . utio No. Weat Pump ., «. _ _ o.ofOil Totals ....._. Detection/Alen 1'n Devices ' uni pal w O. No.of Dishwashers Space/Area Heating KW Local❑ ❑ Other _. CouneMion E No.of Dryers Heating Appliances KW Security ecurr ;..- �, y Nis:of or uivalent o.o stet C. £ Heaters KW o.o; o.o Data Wiring: S!'"S Ballasts No.ofDovices or ' uivateat to to No Hydromassage Bathtubs No.of Motors Total.HP a ecommuntcattons , i n '. .. o- C 0) No.,o(Devices,orEauiva ent _ I �E in C OTHER; I ,- Attach additional detail f desired or as required by the inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof same to the uprmit issuing office. CHECK ONE: INSURANCE�] BOND ❑ OTHER ❑ (Specify.) I certify,under the pains and penalties of perjury,that the information on this application is true andel Zompletr- FIRM NAME: AJ, m 5 a,Pr c r.tC e ` LL LIC.NO..: ' L Licensee: V' �1GS .`r'" c �t2 Signatu LIC.NO.: S3 S a lreable,a "exe !'in the license mrmber litre�D�epa No.- ter l7f PPmP" ) Bus,Tel. Address: `� own-� �wk i L.c. 147,s.57-61,securityequirnt 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(clie ik bite)❑owner ❑owner's a ent. . OwneeA:gent- Signature Telephone No. PERMIT FEE: $ N i wn'wv:.eay.egy� -_ ---nr++mrw.w"iwv:.wa«au�µa!.^nww�uanie.w.wn.s +M.�wm 3 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Coinpensatioo.Insurance Affidavit: Builders/Contractors/Electricia Alicant" ns/Plumbers - Itrforrrla#io><< Please Print L lil' • INaMe'(Business/Organization/individual): l �o ��S r-.a c S Address: City/State/Zip (�J e ro,5 !'✓lA 0 f Phone#;--2s O f Areyou an employer?Check the appropriate box: 1.( I am a empio er with 4. ❑ I am a general contractor and I Type of project(required): employee (full d/or part-time-).* have hired the sub-contractors 6• ❑New construction 2•❑ I arti a sole oprietor or partner- listed on the attachad sheet. 7. Remodeling ship and have no employees `These subcontractors Have 8. ❑Demolition working for me in any capacity, employees and have workers'" [No workers' comp.insurance comp.insurance.l 9. ❑Building addition iequired.] 5.°Q We are a corporation and its" 10.[❑Electrical repairs or additions 3.[] I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.:(Nd*drkers'comp. right of exemption per MGL insurance rbgtilred.].t.. c. 152,§10),and we have no 12.0 Roof repairs employees.. 13.❑Other [No workers' ` c0mp.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 nnu5t submit.A nsv sffidav{t mdicating such. #Contractors that check this box must attached an additionsheet shanring the nameof the sub-coniractbrssnd state whether:ornot those entities have employees. lf.the sub contractors have employees,they roust provide their", omp,policy number. I am an employer that is providing workers'compensation inUrancefor my employees. Below is thepolicy and fob site 3 informatiori. -�-- r Insurance Company Name;-- ,3,c,�ere r. i Policy#or Self-ins.Lic.#:_ /,�C.j L-T S —9 Expiration Date:00 Job Site Adclr"s: r'vsks b ,,., j /� QJj j � P City/State/Zip: AQ� !`�Mxc�V e^ t Attach a copy of the workers'compensation policy p p y g declaration—page(showing( We 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 j 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 certify under the pains and penaltdes of perjury that the information provided above is true and correct i f i' stale: Date- Phone © eta,use only. Do not write in this area,to...a completed Ly cite 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 E Contact Person: Phone#: 10105 Date . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . .'.`.� ��� . .�G",P�3 has permission to perform .� . 'J�,9°'`J I' .6�k(?� ✓r J plumbing in the buildin sof. . .'. North Andover, Mass. Feed. Lic. No.I��3 l. . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check# 1-i�� � 1 i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK oe — CITY NORTH ANDOVER_ _ _ _ MA DATE 8115/2013 PERMIT# JOBSITE ADDRESS 41 CROSSBOW LANE OWNER'S NAMEJ PELOSI P OWNER ADDRESS I SAME_ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL RESIDENTIAL E] 3 PRINT CLEARLY NEW:[ RENOVATION:El REPLACEMENT: PLANS SUBMITTED: YES EJ] NOE] FIXTURES-1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM N DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM —� DISHWASHER DRINKING FOUNTAIN FOOD DISPOSERff"E__ "NOR X FLOOR/AREA DRAIN _ INTERCEPTOR(INTERIOR) _ -; KITCHEN SINK 1 LAVATORY ROOF DRAIN 1LLD ) SHOWER STALL ---- 1- - _ --- -- --- --. - SERVICE/MOP SINKTOILET } } ' .-._ URINAL WASHING MACHINE CONNECTION -- WATER HEATER ALL TYPES WATER PIPING OTHER I ~� INSURANCE COVERAGE: I have'a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[] NOE] IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND El OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [:] AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all P rti nit provi ion o Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME rKENNETH J ROBERTS LICENSE# 11934 SIGNATURE MPM' JPO CORPORATION,]# 3304 PARTNERSHIPO#=LLC®# COMPANY NAME ABSOLUTE PRECISION =ADDRESS P.O. BOX 1260 CITY M IDDLETON STATEMA ZIP 01.949 —� TEL 978-475-1751 FAX 978 777 5371 CELL 97875-1751 EMAIL I KEN@ABSOLUTEPRECISIONPLUMBING.COM r-a ��°►�1� Inr1Z a 07Y l�� ' The Commonwealth of Massachusetts S Department of Industrial Accidents Office of Investigations 600 Washington Street fi Boston,MA 02111 _ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please PLegibly np Print Le� v Name (Business/organization/Individual): R6s0�V E CT'S Z7-1 Address: /0. 0 13 Ok- 6 y City/State/Zip: /lil ���C/ 71-0 Z Phone #: 5i* -7 7 7 S/ Are you an employer?Check the appropriate box: Type of project(required): 1 I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. PMemodeling ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' insurance.: 9. ❑ Building addition comp.[No workers' comp. insurance P• required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions p myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers H Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 1-1^ Zw rC -,!1-7 Policy#or Self-ins.Lic./#: li(/G xpiration Date: Job Site Address: /! .�5 �d 4� L,�, �-- City/State/Zip: we,41" 0lO���` 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 Ido hereby cert/ify under the pains and penalties of perju that the information provided above is true and correct Sign re: !`� Date: IF Phone Official use only. Do not write in this area,to be completed by city or town offzciaL 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 COMMONWEALTH OF MASSACHUSETTS . it'll• :• , „ R.GISTIERED AS A GASFITTERS LUM ING CORP I ISSUES THE ABOVE LICENSE TO; KENNETH J ROBERT ABSOLUTE PRECISION PLB . HEA_ R 5 WILDWOOD RD j MIDDLETON MA 01949-2133 3304 05/01/14 1687-18 COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS LICENSED AS A JOURNEYMAN PLUMBER� ISSUES THE ABOVE LICENSE T0: E KENNETH J ' ROBERTS t� 5 WILDWOOD RD I; MIDD tETONMA 0 194 9_2133.`: 22552 05/01/14 172894 WCOMNfONWEALTH OF MASSACHUSETTS � ~ PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: :ENNETR J ROBERTS P . O. BOX 1260 MIDDLET ON MA 01949-3260 V 11934 05/01/14 168725 �