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Miscellaneous - 45 HIGHLAND VIEW AVENUE 4/30/2018 (2)
45 HIGHLAND VIEW AVENUE 210/066.0-0015-0000.0 Massachusetts Electric Company M.D.P.U.No. 1176 Nantucket Electric Company Canceling M.D.T.E.No.1116-A STANDARDS FOR INTERCONNECTING DISTRIBUTED GENERATION ATTACHMENT 2 Certificate of Completion for Simplified Process Interconnections Installation Information: ❑ Check if owner-installed Customer or Company Name(print): SolarCity Corp. Contact Person,if Company: Interconnection Admin Mailing Address: 3055 Clearview Way city: San Mateo State: CA Zip code: 94402 Telephone(Primary): 702-703-8981 Telephone(Secondary): Fax: 650-240-1672 1 Email: interconnection.ma@solarcity.com Facility Address(If different from above): 45 Highland View Ave City: North Andover state: MA zip code: 01845 Account Number: Meter Number: Electrical Contractor's Company or Name(print): SolarCity Corp. Electrician Name,if Company: Matthew T. Markham Mailing Address: 24 St. Martin Drive City: Marlborough State: MA Zip Code: 01752 Telephone(Primary): 774-258-8505 Telephone(Secondary): 978-995-6584 Fax: 978-429-0898 Email: mmarkham@solarcity.com License number: MR1136 Date of approval to install Facility granted by the Company: Application ID number: I Inspection: The system has been installed and inspected in compliance with the local Building/Electrical Code of: North Andover (City/Town) Signed(Local Electrical Wiring Inspector,or attach signed electrical inspection): � �� Wiring Inspector Name(printed): ( Phone Number: Email Address: G��bl V Ja t J s t c j p DAG As a condition of interconnection you are required to email a copy of this form along with a copy of the signed electrical permit to distributed.generation@us.ngrid.com Version#58.7 .06. 5oiarCet o Y Project/Job #018919 RE: Installation Approval Letter Project: Armano Residence 45 Highland View Ave Apt 1 North Andover, MA 01845 Date of Review 7/11/2016 AHJ North Andover SC Office Wilmington To Whom It May Concern, On the above referenced project,the roof structural framing has been reviewed for additional loading due to the installation of the solar PV addition to the roof.The structural review, including the plans and calculations only apply to the section of roof that is directly supporting the solar PV system and its supporting elements. The capacity of the structural roof framing directly supporting the additional gravity loading due to the solar panel supports and modules had been reviewed and determined to be in accordance with the requirements of the MA Res. Code,8th Edition. The work has been completed in accordance of the provisions of the approved permits of the applicable code. Should you have any further questions or requirements pertaining to this project, please do not hesitate to contact me. Yoo Jin Kim, P.E. Professional Engineer T: 510.647.6816 ,ty{OFI p_c email: ykimim@so@solarcity.com Y00 AN yG V No.4 6 .o p 90 6 1 P� Digitally s oo Jin Kim Date:2016 7.11 14:08:54 -07'00' 3055 Clearview Way San Mateo,CA 94402 T(650)638-1028 (888)SOL-CITY F(650)638-1029 solarcity.com AL 06A10,AR M 8737.AZ B.00 243771AM 4!4 50.CAC LB .t:.f.:0 tL;'Wt cT a 013Z77SALC 01`x105,!5C 410SI4:n7Oc DE<011<038 s.TT 6.12,FL EC1W06226.lil CT 17770.IL 1 SJLY_�<.MA HIL.168571i E1.i136MR MD HC 12814 8111B06.WC I(d'01-u 1 103411.0252 M,NJ'3.1f --4 f N f061606c J ,4EB'OM2Tn.NM EE78 370570,FN 7N/O721L351)2/C2 1A"17864UF2'-OJ 1110.CH EL 47707.OR C1318 W^-E rC�4<.FA FM((-i,.'r714t,F; A00047U/q�38311,TX IECL27006.UT 87.605u 56!*L VA CLE170515`.2)8.YT EN-CSAZp,Vii�SC)L ARC`710OVSOLAR C-OMP7 Ata 1,19.GraaneA"26 rq._Hd4J4TJCUt1,F!u .�r.FC.G01 F cYkrd Fl-11@14-.:U�TOJ,SWfrv'k 5_'*057-H.Werl3w5ta4vC 2tr83-HiZ,1.J YC 87901384{±CA SC NC;N r C L L11--d ne� en el�t0.*004485.15:2•:51u5L 6tR F' U,t 11 Fr,ljyn,ItY'11C�t N..01t.;6-0CP.A..pan.Irr,ndtd Cu S..arCl luS,,,. r,,,wny.i� CAFIn41i<ei.alde$UL 44605046 SeleCty Fnsr CO reny,LLC11 ^a dby he Dei 45•:ere StatefixYCamr•1 sr to mg..g•.n r..'S D 4�..arey S#2033fnSe DWmtMl pt9a;1,MO G4mdmerl+ a 1e<1dl Nd in44M .,.L:bnb' eIL15113r'7170:4 RIEea. ,ILende d70FA10S1L.Th Rty'S W Credto,14000EM6..2014040 Lmd L,c a#6766 t4ORT#j Town Of : It . Andover No. LAKI- O h ver, Mass �1%0 COCHICHEWICK U BOARD OF HEALTH Food/Kitchen PERMIT T LD`� Septic System THIS CERTIFIES THAT v 0 � ��� BUILDING INSPECTOR ....................................... ................. ........................... �1................ ............ has permission to erect ....... buildings on ..... ,. .�. . 1 .... Q Foundation Rough to be occupied as ...43....RAWNBEWT_.9 . W. .... ..............�.11s.. ... ....... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final zo 'tv l on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. -PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES. IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STAR S Service \ t ..................................... .. .. ..............-......' Final_O BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Date.�1..�A`.� .1 ................ '' O�r►ORT�y,� TOWN OF NORTH ANDOVER c PERMIT FOR WIRING � °" ss+cau5� This certifies that D ! .c • ..................... . •.....•. has permission to perform4�,.. tc �'0, 11` ZZ �W ........................................... wiring in the building of.:...,;7W1 .. .................................................................... at ...••... :- `�.-- ' .'.<`' .. --� ".� North Andover,Mass. ................................... Fee... � �"?...........Lic.No. .. i. : ? .... ..1.? ................................................................... ELECTRICALINSPECTOR Check 4t-1 12770 � `� r / Print Forrn �am�aonruerr !' o/Mn.4,4acII(Artl$ MkIcial Ilse Only Permit No. D 770�4 Occupuncy ani hcc CheckedtBOARD OF FIRE PREVENTION REGULATIONS Rev. 1/p7J (Icxvc hl mk) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK !11 walk to he pcifornicd in accordance with the:Masaachulcttc Iaecnical Code(MEC).527 CMR 13.110 (PLEASE PRIAY IN INK OR TYPE.ALL lAt/O]?A IIOAIj Date: 9/22/2014 City or Town of. North Andover To the hispe to 'q IVitfv; ^- By this:lpplicauun (lie undce sivied Fives notice of his or tier intention to petfunn the electrical work described below. Location(Street & Number)45 Highland View Ave Apt 1 Owner or Tenant InSpphArmano Telephone No.(978702-6187 Owner's Address _ Is this permit in conjunction with a building permit" Ves [®] No U (Check Appropriate Box) Purpose of Building w/Solar-PV ^ Wilily Authorization No. n(a Figisting Service Amps / —Volts Overhead 1_7 Undgrd❑ No.of Meters New Service Amps / Volts Overhead U Undgrd❑ No.of Meters T Number of(Feeders and Ainpacity Location and Nature of Proposed Electrical Work: Install Solar Elortria-Pholovoilaic(PV)system ( {43 panels] rated 11.22 kW-DC @ S.T.C.Grid Tied. in conjunction with a Building Permit. Canildetials(I/flee oble rijay he D ui vet 1)•the_Ins a No.of Recessed Luminaires No.of Cei1.,Susp.(Paddle)Fans No.° Total Transformers KVA No.of L.utninaire Outlets No.of trot Tubs Generators KVA Luminaires Saimndng Pool Above n' e.n _Emergency'7,g ng No.of 1 grad. ® rnd. 0 Itaticrti L aids No.of Receptacle Outlets No.of Oil Burners F1 11F .nl.•%itNtS ofzancs \�—D. ilir FFci rc[iitcl asrel ' No.otSwitches Na of Gas Burners` � lntlia6int;I_„Delices No.of Ranges ata No.of Air Cond. Tons ��. Irl A1e t tori},ilea ice• 1o.of Waste Disposers Ileat ump ;�Unther 'Pons hN' Nn n�`i•1= nnlnrio�e' _. —_ totals: ���^ lDeti•etiaiilt,llcrtio1g11rvicr. No.of Dishwashers fi arc/Arca Ilealin+ KW Local 1lutrici,IDal _ Space/Area t' ( nnnection r� other r j ystems: —`lea.of Dryers treating Appliances KW ecuty y � No.of Water No.of Devices or Equivah•nl Heaters KW Wiring: iring: Sinus Ballasts No.of Devices or Fi uivaient No.Ilydromassage Bathtubs No.of Motors Total IIP a ecorrununicaflunsWiring: No.of Ucvices or Equivalent �ihrc h addititrnal detail i(th•sirr•ri,a►•as tr•yaired ht•the hmpet tt,l•uJ(tfrr•r•s. Ise 111,11:d Value of Electrical Work: 19 000.00__. (When required by municipal policy.) A Work to Stied: A.S.A.P, luspectioris to he requested in accarclance with ME('Itulc IO.1111d u11u11 rl+mplctic�la INSURANCE;C(WERAGF• Unless%%a we l by the owner•no permit for the peribrinancc of electrical wort: 111.1y i%-,11c unless the license:provide.pruut ul liahilnv ioxluatice including"%•umplcicd operatiun-coverage or its sul+slautlal cyukalc-111, 'I he undersigned Certifies that such coventFc is in fierce,and has exhibited proof of samc tip the permit issuing office. ('filiQ`K ONE: iNSURANCE Q Il(1ND ❑ 0TiIFR ❑ (Sperily:l 1 cerfoyr..strider Ilie pains and penalties of perjury,float file infi►rmad0o"on this application it true and romplete. FIRM NAME: SOLARCITY CORPORATION I.IC.`. NO.; 1136 MR Licensee: Matthew T. Markttatn__ Signature LiC. NO.: 1136 MR .-._. (/J ap/dirohh•, wn.•t "exrnrlrr"oto ehr lire nst•rernlbrr lure''/ Bus.Tel.No.:774-258-8180_ w Address: 24 St. Martin Drive(Buildlnp 21 Unit 11).Marlborough.MA,(}1752 Alt.'fc1.No.:774-258-8505 •I'cr M Ci.l..c. 147,s. 57-61,security work requires Department (if pulilic Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I ant aware that the L:iceelu a drpes ern!have the liability insutalce cove age itorniall • requited by law. B to signature below, b > Y Y F ,1 hereby waive this requirement. 1 am the(check ane owner owt`cr's a gent. Owner/Agent Signature 'Telephone No. PERMIT FEE: S 12'S_ i i , r x -�11Tlce of Consumer.4ffain$Huxinen Regulation "FrME IMPROVEMENT CONTRACTOR 'f Registr tiara 169572 TypE • ExpirAtion• 302015 Supplement SOLARCITY CORPORATION MATTHEW MARKHAM 24 ST MARTIN STREET BLD 2UN1 IKIIAkLBOROUGH.MA 01752 tlndrrsccreiar? V OA I1 - ILE'CTAICIANS ISSUES THL FOLLOWING LICENSE. AS Aa REGISTERED MASTER ELECTRICIAN SULARC I TY CORPORATION MATTHEW T MARKHAM 24 SAINT MARTIN OR SLOG 2 'UNIT 11 MARLBOROUGH FIA 017$2-3o6o • t i 4 ., The Commonwealth of Massachusetts 3 . Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 14' Y Boston,MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Busincss/Organization/Individual):_SOLARCITY CORP Address:3055 CLEARVIEW WAY cit /Statelzi :SAN MATEO,CA 94402 Phone#:886-765-2489 Are you an employer?Check the appropriate box: Type of project(required): LE I am a employer with 5000 _ 4. 1 atm a general contractor and 1 6. El New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. E]Demolition working for nee in any capacity., employees and have workers' comp. insurance.t q ❑Building addition [No workers' comp. insurance required'.] 5. E] We are a corporation and its 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing al work officers have exercised their 1 I.[]Plumbing repairs or additions myself [No workers' comp. right of exemption per MGI. 12.E] Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. f No workers' 13.1M Other— comp. insurance required.] 'Any applicant that checks box ill must also till oiit the section below showing their workers'compensation policy information. I f lomcowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have emptoyeac. tr the sub-contractors have employees,they must provide their workers'comp.policy number, 1 anion employer that Is providing workers'compensation insurance for my employees. Below is lire policy alai job site Information Insurance Company Name:.LIBERTY MUTUAL INSURANCE COMPANY Policy If or Self-ins. Lic. If:WA7-66D-066265-024 Nxpiration Date:09/01/2015, Job Site Address:45 Highland View Ave Apt 1 t;ity/state/zip:North Andover 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 � g coverage verification. Investigations of the DIA for insurance j 1 do hereby cer1W curler lite pnJns null penalties ojperJrtry there lite iu formation provider!above IV trite and correct. ,, A Signature_ �- r _____ l m,%9/22/2014 Phone r1: _ Offlclal use only. Do not write/it this area,to be completed by city or town oJrcial. 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 I ® DATE(AM1DDIYYYY) A�o CERTIFICATE OF LIABILITY INSURANCE F 08.1292014 ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME:PHONE MARSH RISK&INSURANCE SERVICES - I FAX 345 CALIFORNIA STREET,SUITE 1300 tA1C.No,Ea1l: __.._-_ Imo,Net: CALIFORNIA LICENSE NO.0437153 A MAIL A SAN FRANCISCO,CA 94104 DDRESS: _.. INSURERS)AFFORDING COVERAGE NAIL N 998301-5TND GAWUE 14-15INSURER A:Liberty Mutual Fire Insurance Company I165B6 INSUREDINSURER 6:Liberty Insurance Corporation ,42404 Ph(650)963.5100 NIA - ;WA SdarCiry,Corporation MSURER C: 3055 Clunriew way - INSURER 0: � San Mateo.CA 94402 INSURER E INSURER F: _ COVERAGES CERTIFICATE NUMBER: SEA•002440269-02 REVISION NUMBER:4 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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_. LTR ` ADDIL SR; ( POLICY EFF POUCY EXP LIMITS TYPE OF IN_ SURANCE POUCY NUMBER MM1DD MWI)DIYYYY A 'GENERAL LIASILITV 1 i TB2-661-066265.014 09/01120114 09/01/2015 EACH OCCURRENCE S 1.O 000 XI I REM SES Ea AMAGC TO RENTED Nyumenro) 5 100,000 1 COMMERCUIL GENERAL L1A81[ITY P t q X t MED fXP(Any ana porsor+) i S 10,000 f +CLAIMS•MAOE I OCCUR S i I I PERSONA/bAOY INJURY S 1,000.000 I GENERAt.AGGREGATE '5 2,000.000 t GEML AGGREGATE LIMIT APPLIES PER. ii PRODUCTS•COMPIOP AGG S 2,000.000 X POLICY X PRO- LOC Deductible S 25.000 A AUTOMOBILE LIABILITY AS2.661.066265044 091010014 109,10112015 COMBBIINEDdent}SINGLE LIMIT $ 1,000,000 X ( BODILY INJURY(Per person) ;S L )ANY AUTO ML OYMIED }}SCHEDULED `BODILY INJURY(Pefacc,den9;S i AUTOS 1 AUTOS i 1 NON OWNED PROPERTY DAMAGE 5 X }HIRED AUTOS X I AUTOS I (Per accloonl) I T5 X Ph Damage ICOMPICOLL DED: ,S f1.000151.000 i UMBRELLA LtAB1 OCCUR ( f EACH OCCURRENCE S EXCESS UAB ± I CLAIMS-MADE, 1 AGGREGATE S 1 I OED RETENTIONS I S B ;WORKERSCOMPENSATIONWA7.66D•066265-014 0910112014 (0910(12015 1 X ! WC STATU- i ,OTH•: AND EMPLOYERS'UABIUTY I I I TORY LIMITS 1 i ER l g ANY PROPRIEFORIPARTNF.RrEXECUtuVE �WC7.66"66265034(Wq 0970112014 09/0112015 ! 1,000,000 Q t E l EACH ACCIDENT ,5 t OFFICERNEMBER EXCLUDEW N NIA t 1 B t IMandatory in NH► I INC/ DEDUCTIBLE:5350.000' E I DISEASE-EA EMPLOYEE, S 1.000,000 I tl yyccs descnbo under I 1.000M !DESCRIPTION OF OPERATIONS be:ow ( { I E l OISF.ASE-POLICY LIMIT f DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORO 1011,Additional Remarks Schedule,If more space Is required) ENde molInsurance CERTIFICATE HOLDER CANCELLATION SolarClty Corporation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3055 Clearview Way THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN San Mateo.CA 94402 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Mamh Risk b Insurance Services Charles Marmolejo ��- 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD ,. ABBREVIATIONS ELECTRICAL NOTES JURISDICTION NOTES A . AMPERE 1. THIS SYSTEM IS GRID—INTERTIED VIA A AC ALTERNATING CURRENT UL—LISTED POWER—CONDITIONING INVERTER. BLDG BUILDING 2. THIS SYSTEM HAS NO BATTERIES, NO UPS. CONIC CONCRETE 3. A NATIONALLY—RECOGNIZED TESTING DC DIRECT CURRENT LABORATORY SHALL LIST ALL EQUIPMENT IN EGC EQUIPMENT GROUNDING CONDUCTOR COMPLIANCE WITH ART. 110.3. (E) EXISTING 4. WHERE ALL TERMINALS OF THE DISCONNECTING EMT ELECTRICAL METALLIC TUBING MEANS MAY BE ENERGIZED IN THE OPEN POSITION, FSB FIRE SET—BACK A SIGN WILL BE PROVIDED WARNING OF THE GALV GALVANIZED HAZARDS PER ART. 690.17. GEC GROUNDING ELECTRODE CONDUCTOR 5. EACH UNGROUNDED CONDUCTOR OF THE GND GROUND MULTIWIRE BRANCH CIRCUIT WILL BE IDENTIFIED BY HDG HOT DIPPED GALVANIZED PHASE AND SYSTEM PER ART. 210.5. 1 CURRENT 6. CIRCUITS OVER 250V TO GROUND SHALL Imp CURRENT AT MAX POWER COMPLY WITH ART. 250.97, 250.92(8). Isc SHORT CIRCUIT CURRENT 7. DC CONDUCTORS EITHER DO NOT ENTER kVA KILOVOLT AMPERE BUILDING OR ARE RUN IN METALLIC RACEWAYS OR kW KILOWATT ENCLOSURES TO THE FIRST ACCESSIBLE DC LBW LOAD BEARING WALL DISCONNECTING MEANS PER ART. 690.31-(E). MIN MINIMUM 8. ALL WIRES SHALL BE PROVIDED WITH STRAIN (N) NEW RELIEF AT ALL ENTRY INTO BOXES AS REQUIRED BY NEUT NEUTRAL UL LISTING. NTS NOT TO SCALE 9. MODULE FRAMES SHALL BE GROUNDED AT THE OC ON CENTER UL—LISTED LOCATION PROVIDED BY THE PL PROPERTY LINE MANUFACTURER USING UL LISTED GROUNDING P01 POINT OF INTERCONNECTION HARDWARE. PV PHOTOVOLTAIC 10. MODULE FRAMES, RAIL, AND POSTS SHALL BE SCH SCHEDULE BONDED WITH EQUIPMENT GROUND CONDUCTORS. S STAINLESS STEEL STC STANDARD TESTING CONDITIONS TYP TYPICAL UPS UNINTERRUPTIBLE POWER SUPPLY V VOLT Vmp VOLTAGE AT MAX POWER VICINITY MAP INDEX Voc VOLTAGE AT OPEN CIRCUIT W WATT 313 NEMA 3R, RAINTIGHT PV1 COVER SHEET PV2 SITE PLAN PV3 STRUCTURAL VIEWS P-V4 UPLIFT CALCULATIONS LICENSE GENERAL NOTES PV5 THREE LINE DIAGRAM Cutsheets Attached GEN #168572 1. ALL WORK TO BE DONE TO THE 8TH EDITION X ELEC 1136 MR OF THE MA STATE BUILDING CODE. 2. ALL ELECTRICAL WORK SHALL COMPLY WITH THE 2014 NATIONAL ELECTRIC CODE INCLUDING MASSACHUSETTS AMENDMENTS. - MODULE GROUNDING METHOD: * II AHJ: North Andover .�^ ' REV BY DATE COMMENTS :.* REV A NAME DATE COMMENTS UTILITY: National Grid USA (Massachusetts Electric) ,2 PREMISE OWNER: DESCRIPTION: DESIGN: CONFIDENTIAL — THE INFORMATION HEREIN JOB NUMBER JB-01 8919 00 ARMANO, JOSEPH ARMANO RESIDENCE Marie Galbraith �\,s CONTAINED SHALL NOT BE USED FOR THE BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: `` olarCity NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Com Mount Type C 45 HIGHLAND VIEW. AVE APT 1 11.22 KW PV ARRAY '►�� PART TO OTHERS OUTSIDE THE RECIPIENTS MODULES: NORTH ANDOVER, MA 01845 ORGANIZATION, EXCEPT IN CONNECTION WITH24 St. Martin Drive, Building 2, Unit 11 THE SALE AND USE OF THE RESPECTIVE (44) CANADIAN SOLAR # CS6P-255PX SHEET: REV: DATE: Marlborough, MA 01752 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: PAGE NAME: L (650)638-1028 F: (650)638-1029 PERMISSION OF SOLARCITY INC. Multiple Inverters (978) 702-6187 COVER SHEET PV 1 9/16/2014 (BBB)-soL-CITY(765-2489) www.solarcitycom PITCH: 35 ARRAY PITCH:35 MP1 AZIMUTH: 254 ARRAY AZIMUTH: 254 MATERIAL: Comp Shingle STORY: 2 Stories PITCH: 30 ARRAY PITCH:30 MP2 AZIMUTH: 254 ARRAY AZIMUTH: 254 MATERIAL: Comp Shingle STORY: 2 Stories PITCH: 30 ARRAY PITCH:30 MP3 AZIMUTH:83 ARRAY AZIMUTH: 83 MATERIAL: Comp Shingle STORY: 2 Stories sr?��LA OF YOB JIN +� K No,A H 3 v Digitally igned by Yoo Jin Kim LEGEND Date:2014.09.16 10:54:59 s -07'00' O (E) UTILITY METER & WARNING LABEL F(9-1 INVERTER W/ INTEGRATED DC DISCO & WARNING LABELS -� JEEDI DC DISCONNECT & WARNING LABELS AC AC DISCONNECT & WARNING LABELS O DC JUNCTION/COMBINER BOX & LABELS ]AU, 0 DISTRIBUTION PANEL & LABELS Lc LOAD CENTER & WARNING LABELS ODEDICATED PV SYSTEM METER Q STANDOFF LOCATIONS CONDUIT RUN ON EXTERIOR -- CONDUIT RUN ON INTERIOR GATE/FENCE 102) Q HEAT PRODUCING VENTS ARE RED 1 INTERIOR EQUIPMENT IS DASHED L-='i SITE PLAN N Scale:1/16" = 1' W 01' 16' 32' E S JB-01 8 919 O O PREMISE OWNER: DESCRIPTION: DESIGN: CONFIDENTIAL THE INFORMATION HEREIN JOB NUMBER: ���?. ■ CONTAINED SHALL NOT BE USED FOR THE ARMANO, JOSEPH ARMANO. RESIDENCE Marie Galbraith �i,`�Olar�'�� BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: �'" NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 45 HIGHLAND VIEW AVE APT 1 11.22 KW PV ARRAY PART TO OTHERS OUTSIDE THE RECIPIENTS MODULES NORTH ANDOVER MA 01845 ORGANIZAo THE SALE AND USEEPT OF ITHERESPECTIVENECTION NTM 44 CANADIAN SOLAR CS6P-255PX 24 St Marlboin rough, MA01752 Building 2 Unit 11 ( ) PAGE NAME SHEET: REV DALE SOLARGT�EQUIPMENT, WITHOUT THE WRITTEN INVERTER: T: (650)638-1028 F: (650) 638-1029 PERMISSION OF SOLARCITY INC. Multiple Inverters (978) 702-6187 SITE PLAN PV 9/16/2014 (808)-SOL-CITY(765-2489) �.solarci►ycom S1 S1 „ p Y00 AN 1'-3 (E) LBW K 1'-3 (E) LBW B SIDE VIEW OF MP2 NTS No.4 ti SIDE VIEW OF MP3 NTS C MP2 X-SPACING X CANTILEVER Y-SPACING Y CANTILEVER NOTES AL MP3 X-SPACING X-CANTILEVER Y-SPACING Y-CANTILEVER NOTES LANDSCAPE 64" 24" STAGGERED Digitally Ig y Y00 Jin Kim LANDSCAPE 64" 23" STAGGERED PORTRAIT 48" 20" Date: 2 14.09.1610:55:07 PORTRAIT 32" 14" RAFTER 2X10 @ 16" OC ROOF AZI 254 PITCH 30 STORIES: 2 RAFTER 2X10 @ 16" OC ROOF AZI 83 PITCH 30 STORIES: 2 ARRAY AZI 254 PITCH 30 -07 00 ARRAY AZI 83 PITCH 30 C.J. 2x8 @16" OC Comp Shingle C.J. 2x8 @16" OC Comp Shingle PV MODULE 5/16" BOLT WITH LOCK INSTALLATION ORDER & FENDER WASHERS LOCATE RAFTER, MARK HOLE S1 ZEP LEVELING FOOT (1) LOCATION, AND DRILL PILOT ZEP ARRAY SKIRT (6) HOLE. (4) (2) SEAL PILOT HOLE WITH POLY ZEP COMP MOUNT C URETHANE SEALANT. ZEP FLASHING C (3) (3) INSERT FLASHING. (E) COMP. SHINGLE (1) (4) PLACE MOUNT. 1'-3 (E) LBW (E) ROOF DECKING V (2) V INSTALL LAG BOLT WITH 5/16" DIA STAINLESS (5) (5) SEALING WASHER. A SIDE VIEW OF M P 1 NTS STEEL LAG BOLT LOWEST MODULE SUBSEQUENT MODULES INSTALL LEVELING FOOT WITH WITH SEALING WASHER (6) BOLT & WASHERS. (2-1/2" EMBED, MIN) MP1 X-SPACING X-CANTILEVER Y-SPACING Y-CANTILEVER NOTES LANDSCAPE 64" 24" STAGGERED (E) RAFTER STAN DOFF PORTRAIT 48" 20" S ROOF AZI 254 PITCH 35 RAFTER 2x6 @ 16" OC ARRAY AZI 254 PITCH 35 STORIES: 2 C.J. 2X6 @16" OC Comp Shingle CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER: PREMISE OWNER: DESCRIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THE JB-01 8 919 0 0 BENEFIT OF ANYONE EXCEPT SOLARCITY INC„ MOUNTING SYSTEM: ARMANO, JOSEPH ARMANO RESIDENCE Marie Galbraith solarCity.NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Com Mount T e C 45 HIGHLAND VIEW AVE APT 1 11.22 KW PV ARRAY ►� PART TO OTHERS OUTSIDE THE RECIPIENTS MODULES,P NORTH AND 0 VE R M A 01845 ORGANIZATION, EXCEPT IN CONNECTION WITH THE SALE AND USE OF THE RESPECTIVE (44) CANADIAN SOLAR # CS6P-255PX 24 St. Martin Drive, Building 2, Unit 11 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: PAGE NAME SHEET: REV: DATE: T. (650)6 Marlborough. F:A(61752 638-1029 PERMISSION OF SOLARCITY INC. Multiple Inverters (978) 702-6187 STRUCTURAL VIEWS PV 3 9/16/2014 (888)—SOL—CITY.(�e5-2489) www.solarcity.com 2" MAX 2" MIN CLEAR SPAN UPLIFT CALCULATIONS Dill AMETER TO UNDERSIDE VENT SPANNING DETAIL _ OF MODULE NTS i 6" MIN. VENT HEIGHT FROM TOP SOLAR PANEL % ' OF ROOFI G MATERIAL SOLAR MODULE MOUNTING HARDWARE (SEE STANDOFF DETAIL) ROOFING MATERIAL PLYWOOD VENT PIPE (E) RAFTER SPANNING PHOTOVOLTAIC MODULES OVER VENTS MINIMUM VENT HEIGHT IS 6" ABOVE THE SURFACE OF THE ROOF PER 2007 CPC SECTION 906.1. 2013 CPC 310.5 STATES 'NO FITTING, FIXTURE, AND PIPING CONNECTION, APPLIANCE, DEVICE, OR METHOD OF INSTALLATION THAT OBSTRUCTS SEE SEPARATE PACKET FOR STRUCTURAL CALCULATIONS. OR RETARDS THE FLOW OF WATER, WASTES, SEWAGE, OR AIR IN THE DRAINAGE OR VENTING SYSTEMS IN AN AMOUNT EXCEEDING THE NORMAL FRICTIONAL RESISTANCE TO FLOW, SHALL BE USED UNLESS IT IS INDICATED AS ACCEPTABLE IN THIS CODE OR IS APPROVED IN ACCORDANCE WITH SECTION 301.1 OF THIS CODE." FROM THIS SECTION, IT IS CLEAR THAT MOUNTING SOLAR MODULES OVER A VENT IN A MANNER THAT WILL NOT HAVE A GREATER FRICTIONAL RESISTANCE TO AIR FLOW WOULD BE ACCEPTABLE. EQUATIONS: THE FRICTIONAL RESISTANCE TO FLOW IS DIRECTLY PROPORTIONAL TO THE AREA THAT THE AIR CAN FLOW THROUGH. IN THE VENT, THAT IS THE CROSS—SECTIONAL AREA OF THE VENT PIPE: Avent = 7T*R' - WHEN THE AIR EXITS THE VENT, THE AREA IT HAS TO FLOW THROUGH IS THE CIRCUMFERENCE OF THE VENT TIMES THE VERTICAL DISTANCE BETWEEM THE VENT AND THE MODULE ABOVE (IN THIS CASE, WE ARE LEAVING THE DIAMETER BETWEEN THE TOP OF THE VENT AND THE BOTTOM OF THE PANEL). THIS METHODOLOGY ASSUMES THE WORST CASE SCENARIO OF MOUNTING THE MODULES HORIZONTALLY OVER THE VENT. IN ACTUALITY, THE MODULES WILL BE TILTED WHICH WILL OFFER MORE AREA FOR AIR TO FLOW THROUGH. Agap = C*CLEARANCE = (71*D)*D = (7T*2*R)*(2*R) = 4*7T*R2 4*7r*R2 > 7<*R2 FROM THE EQUATIONS ABOVE, IT IS EVIDENT THAT MOUNTING THE MODULES IN THIS MANNER ALLOWS FOUR TIMES THE AMOUNT OF AIR FLOW ABOVE THE VENT THAN IN THE VENT ITSELF. VENT HEIGHT WILL BE A MINIMUM OF 6 INCHES ABOVE THE ROOF, OR THE MINIMUM VALUE ALLOWED BY LOCAL BUILDING CODE. MINIMUM CLEARANCE BETWEEN THE TOP OF THE VENT AND THE BOTTOM OF THE SOLAR MODULE GLASS SHALL BE AT LEAST THE DIAMETER OF THE VENT. IN THE DIRECTION OF THE SLOPE OF THE ROOF, THERE SHALL BE A GAP OF AT LEAST 1/2 INCH BETWEEN MODULES. THE ROOF SLOPE MUST HAVE A MINIMUM INCLINATION OF 10' OR THE PANELS MUST BE SLOPED AT A MINIMUM INCLINATION OF 10'. PREMISE OWNER: DESCRIPTION: DESIGN: CONFIDENTIAL— THE INFORMATION HEREIN NUMBER: J B-018 919 0 0 Marie Galbraith CONTAINED SHALL NOT BE USED FOR THE ARMANO, JOSEPH ARMANO RESIDENCE ';,;SOIa�City. BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: wg NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 45 HIGHLAND VIEW AVE APT 1 11.22 KW PV ARRAY PART TO OTHERS OUTSIDE THE RECIPIENT'S MODULES NORTH ANDOVER MA 01845 a ORGANIZATION, EXCEPT IN CONNECTION WITH ' 24 St. Martin Drive, Building 2. Unit 11 THE SALE AND USE OF THE RESPECTIVE (44) CANADIAN SOLAR # CS6P-255PX PAGE NAME SHEET: REV: DATE: Marlborough, MA 01752 PERMISSIONITY EOFISOELARCITY INC. THE WRITTEN INVERTER: 978 702-6187 PV 4 9/16/2014 (888)—SOLT. (765-2489)638-1028 F. 650) c www.solarcity.com Multiple Inverters UPLIFT CALCULATIONS GROUND SPECS MAIN PANEL SPECS GENERAL NOTES INVERTER SPECS MODULE SPECS LICENSE BOND (N) ,#6 GEC TO TWO (N) GROUND Panel Number: Inv 1: DC Ungrounded 2 �� GEN 168572 ODS AT PANEL WITH IRREVERSIBLE CRIMP Meter Number: INV 1 -(1)SOLAREDGE�SE50o0A-uS? SNR A -(44)CANADIAN SOLAR # CS6P-255PX # 93 276 201 Inv 2: DC Ungrounded Inverter, 50 O 24OV, s7.5% w m s Isco and ZB,RGM,AFCI PV Module; 255 234.3W PTC, Black Frame, MC4, ZEP Enabled ELEC 1136 MR Underground Service Entrance INV 2-(I)SOLAREDGE#SE380OA-US000SNg2 LAg�- B Inverter, 3800W, 24OV, 97.574 w nifed Disco and ZB,RGM,AFCI Voc: 37.4 Vpmax: 30.2 INV 3 Isc AND Imp ARE SHOWN IN THE DC STRINGS IDENTIFIER E 200A MAIN SERVICE PANEL E 10OA/2P MAIN CIRCUIT BREAKER (E) WIRING CUTLER-HAMMER BRYANT Inverter 1 (N) 100A/2P Disconnect 9 125A Load Center 7 SOLAREDGE SE5000A-USOOOSNR2 (E) LOADS g C 30A/2P z�v SolarCity 2 �- Li .- L2 + - - MP1,MP2,MP3: - - N S A - 1x13 1 SOA/2P ------ - EGcl --- DC+ + - MP1,MP2,MP3: - 1 A a r ------------------ GEC T -,- - 1x12 - FI I I N DG - 1X12 B I I Z 11T'JI EGC __4ND EGC---------------------------- --- - 1 J --- N I __ I Inverter 2 ' o EGC/GEC_ SOLAREDGE ' SE380OA-USOOOSNR2 I 20A/2P I 0 3 4 I _ Gec_r_♦ i Lz z�v Dc+ - - MP1,MP2,MP3: ' TO 120/240V i N 6 DG 1X10 SINGLE PHASE MP1,MP2,MP3: MP3: UTILITY SERVICE ' ' L- ---------------------------- _ EGC/ ___ Dc+ Dc+ - - I I 1 GEC T N DG DC-11 1X9 I I ND -_ EGC------------------- EGC ----- -- -J � I i PHOTO VOLTAIC SYSTEM EQUIPPED WITH RAPID SHUTDOWN Voc* = MAX VOC AT MIN TEMP POI (1)MURRAY#MP25020 PV ACKFEED BREAKER B (1)CUTLER-HAMMER #DG222UR6 ^ A (1)SolarCitY�p 4 STRING JUNCTION BOX D Breaker, 20A/1P-50A/2P-20A�1P, 2 Spaces, Quad Disconnect; 60A, 24OVac, Non-Fusible, NEMA 3R A 2x2 SiRMGS, UNFUSED, GROUNDED -(2)Ground Rod; 5/8" x 8% Copper -0)CUTLER-�IAMMER #DG10ON6 Ground/Neutral Kit; 60-100A, General Duty(DG) PV (44)SOLAREDGE 300-2NA4AZS C (I)BRYANT# BR816LI25RP PowerBox Optimizer, 30OW, H4, DC to DC, ZEP Load Center, 125A, 120/24OV, NEMA 3R nd ( 1)AWG #6, Solid Bare Copper -(1)CUTLER-HAMM R #BR230 Breaker, 30A 2P, 2 Spaces -(1)Ground Rod; 5/8' x 8', Copper -(1)CBreaker,H2OAE/2P, 2 RSpaces (N) ARRAY GROUND PER 690.47(D). NOTE: PER EXCEPTION NO. 2, ADDITIONAL ELECTRODE MAY NOT BE REQUIRED DEPENDING ON LOCATION OF (E) ELECTRODE 1 AWG#8, THWN-2, Black 1 AWG #10, THWN-2, Black 1 AWG #6, THWN-2, Black Voc* =500 VDC Isc =30 ADC (2)AWG #10, PV WIRE, Block Voc* =500 VDC Isc =15 ADC O (1 AWG #8, THWN-2, Red O (1)AWG #10, THWN-2, Red O (1)AWG #6, THWN-2, Red Vmp =350 VDC Imp=17.98 ADC O (1)AWG #6, Solid Bare Copper EGC Vmp =350 VDC Imp=9.35 ADC (I AWG #8, THWN-2, White NEUTRAL Vmp =240 VAC Imp=36.66AAC (1)AWG #10, THWN-2, White NEUTRAL Vmp =240 VAC Imp=20.83AAC (1 AWG 10, THWN-2, Green - EGC -0)Conduit Kit; 3 47 EMT # , THWN . . . . . . . . . . . . . . . . . .* . . . / . . . . . . . . . . . . . . . . . . _ . . .-(1)AWG #6,.THWN-2,.Green . . EGC/GEC (1)Conduit.Kit;,3/4'.EMT. . . . . . . . . . . . . . -(1)AWG #6,.TH.WN-2,.Green , , EGC/GEC.-0)Conduit.Kit;.3/4'.EMT. . . . . . . , , , (1 AWG #6, THWN-2, Black Voc 500 VDC Isc =30 ADC (2)AWG #10, PV WIRE, Black Voc =500 VDC Isc =15 ADC (1)AWG #10, THWN-2, Black © (1)AWG #6, THWN-2, Red Vmp =350 VDC Imp=13.66 ADC O (1)AWG #6, Solid Bare Copper EGC Vmp =350 VDC Imp=8.63 ADC O 0)AWG #10, THWN-2, Red (1 AWG 10, THWN-2, Green EGC - 1 Conduit Kit; 3 4 EMT 1 AWG 10, THWN-2, White NEUTRAL Vmp =240 VAC IMP=15.83AAC 0 ,P , k . ( ) # P p- (2)AWG #10, PV WIRE, Black Voc* =500 VDC Isc =15 ADC -(1)AWG #6,.TFIWN72,_Green . . EGC/GEC.-(i)Conduit,Kit; 3/47.E101T. . . . , , , . . , O (1)AWG #6, Solid Bare Copper EGC Vmp =350 VDC Imp=7.19 ADC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 (2)AWG #10, PV WIRE, Black Voc* =500 VDC ISC =15 ADC AWG 1 ( ) #6, Solid Bare Copper EGC Vmp =350 -VDC Imp=6.47 ADC PREMISE OWNER: DESCRIPTION: DESIGN: CONFIDENTIAL THE INFORMATION HEREIN JOB NUMBER: JB-018919 00 ARMANO, JOSEPH ARMANO RESIDENCE Marie Galbraith -`` CONTAINED SHALL NOT E USED FOR THE ``�,�SolarCity BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: ��� NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Com Mount Type C 45 HIGHLAND VIEW AVE APT 1 11.22 KW PV ARRAY PART TO OTHERS OUTSIDE THE RECIPIENTS MODULES- - NORTH ANDOVER MA 01845 ORGANIZATION, EXCEPT IN CONNECTION WITH , THE SALE AND USE OF THE RESPECTIVE (44) CANADIAN SOLAR # CS6P-.255PX 24 St. Martin Drive, Building 2, Unit 11 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: PAGE NAME: SHEET: REV: DATE: 52 T: (650) 63bo1roug F:A(617 636-1029 PERMISSION OF SOLARCITY INC. MUItl le Inverters (978) 702-6187 THREE LINE DIAGRAM PV 5 9/16/2014 (888)-SOL-CITY(765-2489) www.solarcity.com CAUTION POWER TO THIS BUILDING IS ALSO SUPPLIED FROM THE FOLLOWING SOURCES WITH DISCONNECTS LOCATED AS SHOWN: - Address: 45 Highland View Ave Apt 1 UTILITY SERVICE I I INVERTER AND ~� DC DISCONNECT I AC ' I I DISCONNECT � I II INVERTER AND DC DISCONNECT r--------------------------� 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 JB-01 8 919 0 0 PREMISE OWNER: DESCRIPTION: DESIGN: CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER: ■ CONTAINED SHALL NOT BE USED FOR THE ARMANO, JOSEPH ARMANO RESIDENCE Marie Galbraith �:;,So�a�C�ty. BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: �'" NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 45 HIGHLAND VIEW AVE APT 1 11.22 KW PV ARRAY PART TO OTHERS OUTSIDE THE RECIPIENTS MODULES: NORTH ANDOVER MA 01845 a ORGANIZATION, EXCEPT IN CONNECTION WITH ' 24 St. Martin Drive, Building 2, Unit 11 THE SALE AND USE OF THE RESPECTIVE (44) CANADIAN SOLAR # CS6P-255PXPAGE NAME SHEET: REV.: DATE: Marlborough, MA 01752 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: T. (650)638-1028 F: (650)638-1029 PERMISSION OF SOLARCITY INC. Multiple Inverters (978) 702-6187 SITE PLAN PLACARD PV 6 9/16/2014 (888)-SOL-CITY(765-2489) www.solarcity.com Label Location: Label Location: Label Location: (C)(CB) o O( (AC)(POI) (DC) (INV) Per Code: uu���"�� Per Code: u _ Per Code: NEC 690.31.G.3 ° NEC 690.17.ED -o D o e- •��w NEC 690.35(F) Label Location: fop-MINNOW• - 0 0 0 q TO BE USED WHEN (DC) (INV) o•D D - D -o D D • D INVERTER IS D 0 Per Code: 0 0 ° UNGROUNDED NEC 690.14.C.2 Label Location: Label Location: o Q (POI) (DC) (INV) _ uu4� Per Code: _ Per Code: - 0 ° o- NEC 690.64.B.7 NEC 690.53 �o o .. ° o- Label Location: 0 0 0 -0 otT (POI) Label Location: ° ° Per Code: o (DC) (CB) • • •-D D o o NEC 690.17.4; NEC 690.54 Per Code: - o -pI(f�;• D 0•D D NEC 690.17(4) D o- D��-gyp0- o•D ° - MIN 0• OD �p -o D o oa- d Label Location: c (DC) (INV) Label Location: Per Code: (D) (POI) ID 0`-° NEC 690.5(C) - 0 0 0 • Per Code: • o- -o D D• Dn D NEC 690.64.B.4 - 0 D O- -O D D D D Label Location: Label Location: (POI) (AC) (POI) Am Per Code: (AC): AC Disconnect Per Code: NEC 690.64.B.4 (C): Conduit NEC 690.14.C.2 (CB): Combiner Box (D): Distribution Panel (DC): DC Disconnect (IC): Interior Run Conduit Label Location: (AC) (POI) (INV): Inverter With Integrated DC Disconnect °' r te' ► �A Per Code: (LC): Load Center (M): Utility Meter �+� NEC 690.54 (POI): Point of Interconnection CONFIDENTIAL - THE INFORMATION HEREIN CONTAINED SHALL NOT BE USED FOR THE BENEFIT OF ANYONE EXCEPT SOLARCITY INC., NOR SHALL IT BE DISCLOSED �`�lop:0 S®M� IN WHOLE OR IN PART TO OTHERS OUTSIDE THE RECIPIENTS ORGANIZATION, SC Label Set /,',/,`�Of���� T EXCEPT IN CONNECTION WITH THE SALE AND USE OF THE RESPECTIVE /� ®oLmm' SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PERMISSION OF SOLARCITY INC. o SolarCity SleekMountTM - Comp SolarCity SleekMountTM - Comp The SolarCity SleekMount hardware solution •Utilizes Zep Solar hardware and UL 1703 listed ' // Installation Instructions is optimized to achieve superior strength and Zep CompatibleTM modules aesthetics while minimizing roof disruption and Drill Pilot Hole of Proper Diameter for • Interlock and grounding devices in system UL Fastener Size Per NDS Section 1.1.3.2 labor.The elimination of visible rail ends and listed to UL 2703 ��'�" mounting clamps, combined with the addition / V Seal pilot hole with roofing sealant of array trim and a lower profile all contribute • Interlock and Ground Zep ETL listed to UL 1703 O` !' to a more visually appealing system.SleekMount as"Grounding and Bonding System" 03 Insert Comp Mount flashing under-upper utilizes Zep Compatible T"' modules with •Ground Zep UL and ETL listed to UL 467 as layer of shingle strengthened frames that attach directly-to grounding device a Place Comp Mount centered Zep Solar standoffs, effectively eliminating the need for rail and reducing the number of •Painted galvanized waterproof flashing upon flashing standoffs required. In addition, composition ' O 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 � � LTJ Secure Leveling Foot to the Comp Mount using machine Screw a 7 Place module O Components ® 5/16" Machine Screw ©B Leveling Foot © Lag Screw . © Comp Mount © ® Comp Mount Flashing D o`i SoIar�'ty® January 2013 �,�/0 �I r LISTED ���`SolarCity® January 2013 MP i metas' 'e, N/a CS6P-235/240/245/250/255PX tn� F` ®r CanadianSolar Electrical Data Black-framed STC CS6P-235P CS6P-240P CS6P-245P CS6P-250PXCS6P-255PX Temperature Characteristics Nominal Maximum Power(Pmax) 235W 240W 245W 250W 255W Optimum Operating Voltage(Vmp) 29.8V 29.9V 30.OV 30.1V 30.2V Pmax -0.43%/°C �� I,} ww1IVVJJ\\►VfJ��LL��II// {I�Q�Q�IIIVVJJ Optimum Operating Current(Imp) 7.90A 8.03A 8.17A 8.30A 8.43A Temperature Coefficient Voc -0.34 WC Open Circuit Voltage(Voc) 36.9V 37.OV 37.1V 37.2V 37AV Isc 10.065%/'C = s Short Circuit Current(Isc) 8.46A 8.59A 8.74A 8.87A 9.00A Normal Operating Cell Temperature 4512°C Module Efficiency 14.61% 14.92% 15.23% 1 15.54% 15.85% Operating Temperature -40°C-+85°C Performance at Low Irradiance Maximum System Voltage 100ov IEC /600V UL Industry leading performance at low irradiation --- -- - Maximum Series Fuse Rating 15A environment,+95.5%module efficiency from an Application Classification Class A irradiance of 1000w/m'to 20Qw/rri'- Next Generation Solar Module Power Tolerance 0-+5W (AM 1.5,25-C) Under Standard Test Conditions(STC)of irradiance of 1000W/m',spectrum AM 1.5 and cell temperature of 25'C NewEdge,the next generation module designed for multiple Engineering Drawings types of mounting systems,offers customers the added NocT a= m CS6P-235PXCS6P-240PXCS6P-245P CS6P-250PXCS6P-255PX Nominal Maximum Power(Pmax) 170W 174W 178W 181W 185W value of minimal system costs,aesthetic seamless Optimum Operating Voltage(Vmp) 27.2V 27.3V 27.4V 27.5V 27.5V appearance,auto groundingand theft resistance. Optimum Operating Current(Imp) 6.27A 6.38A 6.49A 6.60A 6.71A " Open Circuit Voltage(Voc) 33.9V 34.OV 34.1V 34.2V 34AV The black-framed CS6P-PX is a robust 60 cell solar module Short Circuit Current(Isc) 6.86A 6.96A 7.08A 7.19A 7.29A incorporating the groundbreaking Zep compatible frame. Under Normal Operating Cell Temperature,Irradiance of 800 Won',spectrum AM 1.5,ambient temperature 20'C, The specially designed frame allows for rail-free fast wind speed 1 m/s installation with the industry's most reliable grounding Mechanical Data system.The module uses high efficiency poly-crystalline Cell Type Poly-crystalline 156 x 156mm,2 or 3 Busbars Key Features silicon cells laminated with a white back sheet and framed Cell Arrangement 60(6 x 10) with black anodized aluminum.The black-framed CS6P-PX Dimensions 1638 x 982 x 40mm(64.5 x 38.7 x 1.57in) • Quick and easy to install dramatically is the perfect choice for customers who are looking for a high Weight 20.5kg(45.2 lbs) reduces installation time quality aesthetic module with lowest system cost. i Front cover 3.2mm Tempered glass J Frame Material Anodized aluminium alloy • Lower system costs - can cut rooftop installation costs in half Best Quality �-Bbx IPss,3 diodes - Cable 4mm'(IEC)/12AWG(Ul_),1000mm • 235 quality control points in module production Connectors MC4 or MC4 Comparable • Aesthetic seamless appearance - low profile • EL screening to eliminate product defects with auto leveling and alignment • Current binning to improve system performance Standard Packaging(Modules per Pallet) 24pcs • Accredited Salt mist resistant Module Pieces per container(40 ft.Container) 672pcs(40'HQ) • • Built-in hyper-bonded grounding system - if it's mounted,it's groundedBest Warranty Insurance I-V Curves (CS6P-255PX) • -Theft resistant hardware • 25 years worldwide coverage i e • 100%warranty term coverage • a 1 Section A-A • Ultra-low parts count - 3 parts for the mounting Providing third party bankruptcy rights ' 7 li 35.0 and grounding system. Non-cancellable • Immediate coverage $ 3 • Industry first comprehensive warranty insurance by $ , j AM Best rated leading insurance companies in the Insured by 3 world top insurance companiesn:orr j world 3 3 -1aa1/mz Comprehensive Certificates _ -•� +m= _ -�5 • Industry leading plus only power tolerance:0-+5W • IEC 61215,IEC 61730, IEC61701 ED2,UL1703, • Backward compatibility with all standard rooftop and CEC Listed,CE and MCS in 1s.20 2sm 5 a° 3s ao ground mounting systems IS09001:2008:Quality Management System • ISO/TS16949:2009:The automotive quality 'Specifications included in this datasheet are subject to change without prior notice. • Backed By Our New 10/25 Linear Power Warranty management system Plus our added 25 year insurance coverage • IS014001:2004:Standards for Environmental About Canadian Solar 100 management system Canadian Solar Inc. is one of the world's largest solar Canadian Solar was founded in Canada in 2001 and was 9 7 % '4ddQC080000HSPM:The Certification for companies. As a leading vertically-integrated successfully listed on NASDAQ Exchange (symbol: CSIQ) in 90% ed t/afue From,W Hazardous Substances Regulations � manufacturer of ingots,wafers,cells,solar modules and November 2006. Canadian Solar has module manufacturing Warrant solar systems, Canadian Solar delivers solar power capacity of 2.05GW and cell manufacturing capacity of 1.3GW. • OHSAS 18001:2007 International standards for products of uncompromising quality to worldwide so% - ; occupational health and safety customers. Canadian Solar's world class team of 0% s 10 1s 20 25 REACH Compliance t professionals works closely with our customers to provide them with solutions for all their solar needs. = ; •_ __ Q, . . • 10 year product warranty on materials and workmanship g d� '~ $p• M:, --, w ac ,....... �k©4 �I _ _ •25 year linear power output warranty ' www.canadiansolar.com EN-Rev 10.17 Copyright 0 2012 Canadian Solar Inc. ' =oo � SO�ar - p p SolarEdge Power Optimizer SoIar Module Add-On for North America P300 / P350 / P400 SolarEdge Power Optimizer Z C= P300 PW P400 Module Add-On For North America (� (fomodulerodule PV (for 72-cell PV (for 96 cell PV s) modules) modules) INPUT _t P300 / P350 / P400 300....... 350...... ............44D......... ....W..... Q Absolute Maximum Input Voltage(Voc at lowest temperature) 48 60 SD Vdc .. ........ ..... ............ .. .......... .......... ........ ............. .......... .MPPT Operating Range._.._......................................... .........8..48.....................8..60 .......8..80 ........Vdc /1+� Maximum Short Circuit Current(Isc) 10 Adc .......................................................................................................................................................................... Maximum DC Input Current ......................................12:5..........................................Adc ............................................................................... Maximum Efficiency ........-..................99:5...............:....................... ............. ........................................................................................ Weighted Efficiency 98.8 % .............................................................................. ................................................................................... ............. Overvoltage Category II OUTPUT DURING OPERATION(POWER OPTIMIZER CONNECTED TO OPERATING INVERTER) O Maximum Outpu[Current 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 q STANDARD COMPLIANCE 4 EMC FCC Part15 Class B,IEC63000-6-2,IEC61000-6-3 ........ .. ..... .........IEC62109-1(class II safety)UL1741 .... .. ..... Safety � ........... ................. ...................... .............. ..................... Yes ... ... ..... ....... r: ROHS INSTALLATION SPECIFICATIONS Fes`' A - Maximum Allowed System Voltage 1000 Vdc '` :✓` rr� Dimensions(WxLx H) 141x212x40.5/5.55 x8.34x1.59 mm/in �,: �, f ............................ ..............................._......... ............950/2.1.............._................... ..gr.(Ib... .. ... ... Weight(including cables) «,. ,,r- �^ Q` Input Connector ...........................MC4/Amphenol/Tyco Output Wire Type/Connector Double Insulated;Amphenol m ............. .. /" r`r` ..Output Wue Length.. ... 095/3.0 .. ..1.2/3.9..................... ..m/ft.. " Operating Temperature Range 40-+85/40 +185 'C/'F ....... ... ... ... .......... ........... ... ..... Protection Rating IP /NEMA4 .. .. ...... ........... ......... ..... ... ..... ,r Relative Humidity ..,_.,,_...................._.,._0_-.100 % ............................................................................... .......................................... ���Rated Sic power of d,e module.Module of uD to�5X power[ole2r�re albwed. ' PV SYSTEM DESIGN USING A SOLAREDGE SINGLE PHASE THREE PHASE THREE PHASE INVERTER 208V 490V PV power Optimization at the module-level Minimum String Length(Power Optimizers) S 10 18 ....axim...............ngth............timizers)....................... ...........................................................................I...........I...... U to 25%more energy Maximum PowLength Pg wer O timizers........................ ............25........................25........................50......................... String g ( P ) i P 8Y Maximum Power er Strin 5250 6000 12750 W ................. ................ — Superior efficiency(99.5%) Parallel Strings of Different Lengths or Orientations Yes I — 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 J — Module-level voltage shutdown for installer and firefighter safety rz USA - GERMANY - ITALY - FRANCE - JAPAN - CHINA - ISRAEL - AUSTRALIA www.solaredge.us Date. 3v��.Z.. .. . ... .. NORTH 3? '` TOWN OF NORTH ANDOVER O p PERMIT FOR GAS INSTALLATION ISS�ICHUSESth• (� t This certifies that . . .`. .. . . . .. . . . !�Q r'�' . . .'S . . . - has permission for ga-w-stallation . . . . . . . . . . . . . �. �a:� . . . . . in the buildings//of � n r n a at . . ,5�/ hGvrf! U� ?4/ ..,.North An over, Mass. 52 Fee.3� Lic. No..2�Z� � 3 GAS INSPECTOR Check# 8032 T J� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY /(/G t✓fil" /�ti�.. � PERMIT# MA DATE f'- (ri /J- 1 JOBSITEADDRESS ��r yG,�q,,,d v e 1 t,,, I OWNER'S NAME 0 c� OWNER ADDRESS TE. j FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAtH-- PRIPIT CLEARLY NEW. RENOVATION: REPLACEMENT:�/� PLANS SUBMITTED: YES NO] FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 a 9 '10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIIJSAND SYSTEM L A DEDICATED GREASE SYSTEM — DEDICATED GRAY WATER SYSTEM _ i DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAmJ i FOOD DISPOSER FLOOR/AREA DRAIN s _ INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY i 9 i ) ROOF DRAIN SHOWER STALL SERVICE IMOP SINK i } TOILETURINAI -- WASHING MACHINE CONNECTION NATER HEATER ALL TYPES. WATER PIPING —_ _ OTHER ;i } — I z _ I INSURANCE COVERAGE: I have a ctirrentliafzility insitratice policy.or its substantial equivalent which meets the regtiirenients of MGL Ch.142. YES j ,� NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE-OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND I' I OWNER'S INSURANCE:WAIVER:1 am aware that the licensee-does not have the'insurancecoverage required by Chapter•142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirolent. CHECK ONE ONLY: OWNER AGENT ( J SIONATURE OF OWNER OR AGENT tfierebycerlifylhat all of the details and irifonnation I have Subniflted of entered regarding'lhis application are true and a o the best of my knowledge and that all:plumbing%%vrk anddnstallations performedunder the permit issued'for lhis.application will be in compliant WIN provision of the Nlassacbuselts Stale PlumtikQ Cate and Ghapt(pr 142 of the General Laws. I PLUMBER'S NAME W rn e S' AaA t?/I't' r JLICENSE#19,%) S 1 I SIGNATURE MPS I JPCORPOI2ATION1IA! PARTNERSHIP #} ILLCI1� �� 3 COMPANY NAME ADDRESS 3 re�.,r,Glr` k ! CITY /VeL,: vifi' ISTATE{ A1# ZIP 03sr5 � .._.. � ..TELI FAX — CELL fJ EMAIL . t I IItOUCH PLU NIQAN0 2N2fi97ClON NO7CLS BELOW FOL.O ,ICL ugr,, ONLY ZNAL-OSPE,MON NOT'E'S Yes No THIS APPLICATIOM VERt,2S AS THE PERMIT ❑: ❑ FEE: PERMIT PLAN 1^KV-mw ES i� � I J- E 3 1YO 'ptxttiroi{[�►ectltli �Eclt�r*so X����rx�lu�eiCo��tt�r��tol�cc�rl�irts a �DO�Yr�sltt�;toi�SYf�et BOOM,MA.Offil lv,�ra.►,�ctsx�o,��ttt � ��'Q>_Itei:���GTant���isnt•Qoi��lft�&�g�vtft�c�4t'fights►e�.l3�t�c�sf�'fig€im�tors!!I'!e�[glctit>:#st�'�tuii���Y� � '� Otiili'ellstfIiife�ulipGlblt P�e's ''rtiir :)r: ' Ci•► i I €cttiif;ul¢t�r0iguuiitionrfildiltidual} �.,�am ti . �—J . . . . r--- I. tC}�tr�ltleitliildtiel2G�leci.tElehpiltoitrirtieboxe }n�dfEilojeet�ictlle;j: r:Q tnpttteulplo crreittt� rj.Q1ialitnge+tcrnlcoi�lrnctormH l E ilip[o}ccs(fitlfnuctforp�tt tiiuc}. (lareittred'o,csit--coritrnolam d Hc14 Cdllstriicliotu �.Q am o sole proprietororr�atiner lislecl'tilt 111te�tfaelted ieor;t • d Retitodding sitiP,ntedltft���no clnjlio}ices 7ilcscsllG coiitrnc,lors h1vo �]'Denlotition 3iorR[og COrillohlonyCttjitieiw. %oifers,colap Plmarmue, - j � ❑'pttlfcltngnctditioll; [Igo•leortccl��cotitp.'Jl,suroltco �:Q 1Veare tt av'o Atio,l and its ngldinlf} ®t,lcersli.lvicecercirecltlicir IOQIifecl4a4 eplim.+oi-a(Mitoas. .Q LAI lillonieotriierd4ugti ki%Kw tofc�eauptio►t�lel`MGI. ki Q1'ltnlliZ115n jiur�osncEditioilS ,lt�sejf.[Isa�ibrkcr�.colop. �.lS2,1� f) tittcf�ecllt�•e,lo _ t:2,[j?Roofrepalirs insurmlccrc2uired.]'� r. S ' ilii yfo cos. atlorkere i3 comp.6lsurtulccregnEtcctj iller e5ns i iipl Gli}t th�Sets;cTs lei l'L i,Fr54 r1�o rrif cl il%a se.,in M;IV sltoct+ngitttirt+rrt-w Cci lr:ILIicyluCoimitio j '6,t�+u atur:rs�rita.abrititttd�rfti;tuit,nOrc,�fwlccptrcrt�at,rlin.�il,rrallhceltGeduGi6tfcttlraacrxiu;lsugilitnii@te,i`t?�tulttJicatingsucG. E fLlatr Lf-illlllGlit:Irt:iLtiSYflltil0a:htx�9enraJitiRtt s;:ttfshsri�t� F • c=..,..• ___ �_ zl..rurtt�ifl5astib•r��nlrl�lE�ru;dllc;ifui+ikcr c.Y+:�s_�.S2iirLli�+rtu,V'r.,tr_ _ lRtrOarl�erri�,JvlxrFlt+irrllsliiv�rlrlitt��n�atic°fs'caitliprtscr(laidirrtrrirncefar�fil+elr�fvf�ecs IletaitrlrUt�Erultet�•ntutJoGslfe'u�`. fiiforarrtflott. �I1S{ICdIIGGC011lj3861}�11"Hilt@S..� t j .. .. ... •. - F k'oficss,/EorSaifit�s 1tc.tF: . • . • lC-tjif>htiaitttate•_ Jttb ill¢a�c�ctriss Lill/SfaEc7Zr��.. Af(pelt n coyly b)tlactl;orllais'cniujieltsiitioilit�lie�tieclnrtzttuiipnga(sJikati��tb�tiot et�liutil)ler_it felt filar ilNo�� i hii[llicict,3o�ur,�:fid�estgensrequttzdiotietSectW MofMldrs t��cN►ieacltatltctilirtoslGioi Q cciiiliiiA p�uattic.oCa Eiit�njtto�Sr,SQQ.tIQattc�'�i-oilcy�e;ll•" r•'is®nlltenl;.asti►°a1l'nsciiiCpenateics.iit�tli foto!of€ISTOP:�1rfkRi{OgtU�ttiritGnfiity taftgt foS2Sa.Op n day+ngltfitst ltic atot; tic nlit�isoif,itiit:hcctpg aFgi'lisstatEttictit tilgr(re£ol�i�ArieJ to 1E3�Ufiice aC flivestigalions.o[i(ieDrli l'os' n ilcecoierage:eetYficatibtt. dl j trirr r 18 MT icsafperjrrrtt�Fintllrl frl{orrrurtibttpn�3iFilaLal }t lircRfirrt'FrtF�iscl; OfAtlirkqr n rb110111,l1W4INSarera,r-06ecotrr1i�c ilLict ;o�tatrtrgj'IclaR �� G�fj'ol lbj5�t� •il'c,ritilf(G¢e�cbscr&' � ii� r i Isstihi�/.1iiC6eot Ef*i��ilTeoile�; a f.l3oarctof Iicattll 2.lTnr(ditig 1}ert,�rtitieilt l c-korouvt da* A Cifctets aa81 ttsjiec{oi �1'I�illUla,g k►rsjte�folr 6,Otho Cofi(ittt['ei�o,t .. _ l'ilofltlFr ' , �� Ty 1 � n'fassncliusEfts.GeneraZL�t«sohapte:X52re (►itie�oltetnpIbgers oa�xati=detYoPiccrs'co]niettsfi 04foFthek.ent&yees:. Altstlanttotitisistafttfe;nneu rvy�e i eTe6ttedas`:.,lii�etyrpersoniitiitie�eeliceofattotltc'riititicr tyconfragtofltite,. e pt s orhitplieB.prat of t,+V'itfejo.; :.. Rudd IoJer'istie iztetlas"oii nilivitjzial,p i ts7up;R pciatioh;cpXpprotlbnQiotherleg teiitiCytotrony[�Eraaaiho mioia a€tits;foiegoingeitg�gectmajrom{=eiitetprise,aitc�mol}tcling-the:I�g�lizpresentativs:.s:o�ac'leceasedetgpto}yet;orae aecen:esortizisleeo€ottuuiE�id�tal,I�arGteasLi i:nsSoctittion:oho[IterlegaTe�i ;ettlp}g�=Ing;orvpIo}rees Hatyefer o+oneso rtcltrelliughofi o.having itof bl7ifelbah,three!Opaftuiolll S;RtIAvlIO rdsides:.Mdreuy,:op the occupautOft he cline!#ipgltoltseoftttiofliernilto entployspetspustddoan�infenaitce,cip intctfortofrtspairCtori:ortsuc?icitc�llutg.Ittiiise brnl,:t{t�grotntdso•1?nildittgoltpartenanttherelo,Sitalltttobbacaase�ofsticlt.einploy=ntentb:cTsenteiFtbbe,o�employer;" 11GL;cltapict IS2;` iG 6.a1s0'statestltat'`•`esct �sfa[eoXocaZticelt6ivangcitct�sllrtaFivitiiitoFcTthess_t�attceor }•citetval`•a3fn IIe6Jl5�of perm{fro•operate a Uttsitaessot�taeonsfr[tcE ittilldiugs in fhe conttri0iuvea[fh.Toi•ittt`� .rtppliesttt�s��l►as.a�otlttotlutad ncce�f;�blecf'feteltcc of cauiltliattcet+•ititfl�ei�rsti►•nnce fioker�ge reciidrec�" • Additiottall};�YIGi:cll�pter:IS�Z;25C(7j states,"�ieltiter ineeomntomve�ltlu�oraa}-ofits palitic�l.subcliyj'sion�silt! t!?tit'into Oki,contactfor(Ito perrornla#iccofpuUlicivorl;tintilacceP1 TeeviclEliceofool4iiancetvitlitli.insur,utce x: of this ictingauthori[y:' I?Jeaseftllout jjie iV7ot:�r�cath eilsatiolz�T iil ii�tiniplt<ta1 ; . T.tec iitgt�te otestlt faplily ayoyirsitnaliozimid,if • atecessat};sttpplysilh-aontracfor(s}�telue.(s),ttdcTress(cs)'fllictpltonenutlitiet;(sjalong�vithfiteu-cect'i�ea3e�s)pf msiirall .•LfntitedUaUilifyCoinpatues(LI C).ormintfedL1abifif P atinotshi s 11P y'. . P (L )14ltlt uo employ eesotltec:#li�trelte 1heiithers oi`parbters;:trenotrequired to eat a ivorkese corltpensatiolt instnance.Xfan IC or LLP does hart e> playeassapo]icysrecyuired..B�ttdvised`tltaffhistifficlaeifutaybesiiUmiflee!totlteDep;ttftttenio£7ndustrinl - Accidentsforconfimiationofinsmaucocoverage. 'isobesltrefosignnucltlntetltettf Aat=it< Thaciftidavifshould I lie returliedCo tlte•cit}=or toit!ri[haF tits npplisation for the permit or license is being rerltvsstcd,ml the Deparlmen`s o il inrlasidal Accidolts. shatild yoil11"wo ndty'•flttesl?gns rcgar�iiltg.11te law of ifyroit are required to obt,lht a tivorkers' 01ti1eit0fionpolicy;please call tite'pejiatiineiti.rjttitenutn6erfistedbslott. pelf-lit§ttre<1.conipatt'tessttotticlenterttteir belt higU Lance license notnberotLtlte Qppropriale line. City orTolSilOfficials { Pieaseb � :ttretitat:fIteafCdaticlTscoti�lett;attdprintedleglbly: 7liebepatfifientltasprovidetiz?.Fp;irpztflte.Goltoltt ' oFtlie;aftidat=if foi yaiLtii ftl ont-in tlteevenf.fheOMceofIniest6tionshas fo coittnc€yroari'gi.Al.kibe applicant. PleaseUe e ttr$tofilll in thepenttitflicensea�ntnberti lticit fvil{,be.ttsed asa;refcreucetittntbet:Inaddition,an applic�tut { frtafmuststtUtititmultiple petmiiJticeitse applications in aa}*git=est yeast tteetl'atiysnbmiEone affidavit indica[mg ctnrant I policyfurbnttation(ifnece-maty)Patd'ilndei"Job siteAdctrzss"the appticatit'shoulcturite'!ailloca{iousin (cid or i fait:tij!'e?f copy oFthe aRidati�ic tltatliSsTieen offciallystatnped oi'ntarked by the city=or te�t�t niay�lteprovidccl fo lite applicant as prooffhafa vattd' if.fl& sfisotifil6forliture-Dermis of licenses.Atfe+t•.tift1davit nmsiliefillecl out each l l year.�!jtere3honie Ql+'net orestizeu is dblalutilga jicenseorperliilt 1101 related to anj�bttslfness orconmtercial ventti e F f Oe-a dog lieeuse Wliefrinkto burn leaves cip jsaidiperso(t is NOTnquirect to cotvpletethistiffi_diML The 606t_baiwifigationsaron'1dlike Wtha k--}blrillaikancefortotit Ca ` , � lG4s� Q �t' !Ott iilld S�1Q�1�(l;ill l afl�'ouestiotl§, ; P do not Itesitafetctgive its it calf_ fittcb trtt,tettl'sad(Iress,telepltone•WOfanIlift tker: = +Tiiti�etitttxttit��4�e?'�tl';��?Z'itls��lti;sctts - - DePt:-lMNA O f f lidusWO tic twits 3 off-Kee Of ItiE's?Sdgmiow ` 600ZVashingtoit Slrect Boston,AM.02111 0617127-000 Olt[406-of 1477 MASSArp, I�eithwil 5-26-os F-10 £Y-.727=7749 1�t�te��.i�tossgotrklia t L Banco Plumbing & Heating dae 60 Rockingham Road (reap) unit #$ Windham, WDo 03089 (603)898-1745 Dear Plumbing Inspector, I Daniel J. Murray JR, due hereby wish to dismiss my permit for job located at 45 Highland View North Andover, MA. Permit number 9186. If you have any questions please do not hesitate to call me at (603)396-9464, thank you for your time and cooperation. Sincerely, (J" e Daniel J. Murray J . License#15305 9186 Date. ./. TOWN OF NORTH ANDOVER a _ r PERMIT FOR PLUMBING ,SSACMUS� This certifies that . .An. . C4-4.44. . . . .../. . .... . . . . . . . . . . . . . . has permission to perform . . . ./rr oi'./ . .�laC� rt : . . . . . . plumbing in the buildingseof . �i970"7/. . . . . . . . . . . . . . . . .6 /9w. . . . . . . . ., hh Andover, Mass. t, Fee.A*C9.Lie. No. ✓��,1•f PLUMBING INSPECTOR Check # 2 /�' l ff� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING MA. ' Date:_///`j.��� permit# Building Location: �Q �,�� Owners Name: "f�� "�r dais Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional ❑ Residential(� New:[] Alteration:❑ Renovation: Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES / LU DEDICATED LJ, z SYSTEMS W O U y N Ln Q Ln ��" 2 N (ij 0 _j U F- W O D cn Z Q Q w C7 cr 2 m 'n oac H in w Q vFi ,n O,n z h N vQi w w I W O Q ce a K W Y W X d _ 3 z A o w w `n z a LL. 41 Q Qm Q y y O O~ FU- O O O OO Z z v=i IW- F W di O LLLI -SUB BSMT. BASEMENT 1 1sT FLOOR 2ND RD FLOOR Beo FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7TH FLOOR 8T"FLOOR Inst ijir� Co�iip�:r,;r idHmn: p `.c �� ��'G' Check One eniv w e�I, t%�/i� 3 ❑Corporation Address: City/Town: p State: Business Tel: ��/`7ll— G � ElPartnership Fax: Name of Licensed Plumber: El Firm/Company low INSURANCE COVERAGE: 1 have a current Iia_ bilifv Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes If you have checked Yes,please indicat the-type of coverage b checking the ❑ g y g appropriate box below. A liability insurance policy- Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee doesnotthe insurance coverage re Massachusetts General Laws,and that my signature on this permit application waives this requirement. 9 qurred by Chapter 142 of the >i nature Of Owner or Owner's A ent Check One Only Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate bestof Knowledge and that a!1 plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 1v2'm the at to the o,niy // ral Laws. Type of License: :fe ❑,P mber Signa ure of Lice ed Plu er `y/Town Il Master 'PROVED(OFFICE USE ONLY) ❑Journeyman License Number: The Commonwealth ofMassachusetts Deart P. ment o f Industrial Accidents Qfjrce oflnvestigations' 600 Washington Street Boston,MA 02111 5� www,massgov/d'ia Workers' Compensation Insurance Affidavit:guilders/Contractors/Elechicians/Plumbers A licant Information please Print Legibly Name(Business/Organization/l'ndividual): C� Address: elpCo) City/State/Zip: l�qG!�' sr%1Z1GW17 Phone Are yan employer?Check the appropriate box: 1. U1 am a employer with 4. Type of project(required): ❑T 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.t 7• ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers'comp.insurance. 8' El Demolition 9• ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 3.❑ required.] officers have exercised their 10 El EIectrical repairs or additions I am a homeowner doing all work right of exemption per 1VIGL 11. umbing repairs oradditions myself.[No workers' comp. • c.152, §1(4),and we have no r red. insurancere ui , 12.D Roof repairs Q ] � employees.[No workers POMP,insurancerequired.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. -111M an employer that isproviding workePs'compensation znsurance forIny employees. Below is tlaepolicy anrZjob life information. Insurance Company Name: Policy#or Self ins.Lic.#: lei j �',� Expiration Date: -!5r— Job J'ob Site Address: �`1'7 City/State/Zip: �l.S *W 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 ofMGL 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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the D9 for insurance coverage verification. i t-do hereby cert' u er tl nd ena ties o P fperjury that the inforatation pjovided above is true and correct. ii nature: • /n Date• � � `hone#: C,�G Official use orzly. Do not write in this area,to be coin leted b ci p or f Y ty own official. City or Town: Permit/L' ice nse# Issuing Authority(circle one). Y.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: Date.. . .. . .. . MORTM o= '` TOWN OF NORTH ANDOVER - PERMIT FOR GASINSTALLATION �9SSACHUSES This certifies that . Ae7. . ./*,0-X — . . . . . . . . . . . . . . . . - has permission for gas installation I�64 r . . . . . . . . in the buildings of . . . . .. at . . l?!JJ. . ...�?. .: . . . . . . .�., /North Andover Mass. Fee.40-t$: Lic. No.� - R3 . /J�� 4h 1 , i�/,-r'`� . . GASINSPECTOR Check# Z71& 7896 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:/0 `���� MA. Date:^6 // Permit' Building Location: Owners Name: . P-e 10e~A0V 1 Type of Occupancy: Commercial❑ Educational❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration:❑ Renovation: [!KReplacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES W vi Lu co W Cdre Q = zLY 0 z to Wz F)=11 uj o ~ O 2 w � y11 > w Q4 °° o a a II o w X COL) z W V W Q 0 J W Z 2 w I— p WW z _� ? tZ' ", Q Q m W O z O 1-- I,-j0WWXw Iw- w W F- SUB BSMT. BASEMENT 1 FLOOR , 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Name: �,/'C"j wA�<'6 bio- heck One Only Certificate# Address:l��zf���f ,r�,! Ci /Town:�//olo�f ❑Corporation A4111 ! 5 ty O�I9, State:` Business Tel.�a �l � Fax: ©34�- ElPartnership Name of Licensed Plumber/Gas Fitter: El Firm/Company INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes 10 If you have checked Yes,please Ind' to the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity demnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent ❑ By checking this box E];I hereby certify that ali of the detail3-1:11 1 1 information I have submitted(or entered)regarding thisapplication are true and accurate to the best of y Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian a with all P in t provision of the Massachusetts state Plumbing Code and C ter 142 of the General Laws. By Type of License: ❑Plumber Title ❑Gas Fitter Sign re ice d PlumlyerlGas Fitter ❑Master City/Town OJourneyman .�A I APPROVED OFFICE USE ONLY ❑LP Installer License Number: ,��/ The Commonwealth ofMassachusetts Department oflndustria[Accidents Office of Investigations, 600 Washington Street s� Boston,MA 02111 www.mass govldia Workers' Compensation Insurance on Affidavit: Builders/ContractorsElectricianA Applicant sPumbers Please Print Le ibl Name(Businesslorganization/Individual): Address:z ©& City/State/Zip: Phone#: A5�1n employer?Check the appropriate box: 1. a employer with 4. I a Type of project(required): ❑ m a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 2. 6. F1 New construction El am a sole proprietor p p or partner- listed on the attached 7. a lied sheket.:. ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers'comp.insurance, g' E]Demolition 9• El Building addition [No workers'comp.insurance 5. El We are a corporation and its 3.❑ required.) officers have exercised their 10.❑Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL 11. lumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no insurance required.]t employees.[No workers 12.[]Roof repairs comp,insurance required.] 13"[]Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 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 their workers,comp,policy information. 'am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and'ob site information. 1 Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date:Job Site Site Address: 41/��iS��,oC<i`���/ 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 certi er a pains nd enalties o er'unformation rovide , fP _� �that the iP d above is true and correct. si nature: Date: 'none#: Official use only. Do not write in this area,to be completed by city or town official City or Town: # Issuing authority(circle one): Permit/License I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspecto5Plumbing 6.Other r . n g Inspector Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.,, Applicants Please fill out the workers',compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required fired to carryworkers ' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy.;please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom ' of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/licerise applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on .file for future permits or licenses. A new affidavit must be filled out each year.'Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. , The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: T he Conbuorcwealth of Massae u—setts Deparhnent of Industrial Accidents Office of Investigations _ 600 Washington Street Boston;MA 02111 Tol.#617-727.4900 ext 406 ox 1-877-•MA,SS.AFE Revised 5-26-05 Fax#617-727-7749 www.mass.govfdia 9288 Date. ".OR' �tio TOWN OF NORTH ANDOVER 0 12111111b. p PERMIT FOR PLUMBING �,sSACows� ' t This certifies that 1-'e.S. . S .'S �ZQG/ has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �O2rh© plumbing inth buildings o . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . / , Forth Andover, Mass. �= Fee. . . . . . . . Lic. No. PLUMBING INSPECTOR Check # /U�� je,00 iql 00 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 6�} � a MA DATE �`� �P MIT# �. V _ _ JOBSITE ADDRESS L OWNER S NAME ti� m. /_ate I .. _ .. _ OWNER ADDRESS TE FAX _a� TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: Y.ESEJ NO�j APPLIANCES 7 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER I CONVERSION BURNER -` I ' COOK STOVE DIRECT VENT HEATER �J DRYER _1_� - - FIREPLACE FRYOLATOR FURNACE -- — GENERATOR GRILLE u INFRARED HEATER _- LABORATORY COCKS MAKEUP AIR UNIT - - OVEN - _ POOL HEATER -- ROOM/SPACE HEATERROOFTOP UNITI- -- -._� — =, -- TEST s L i ... - Fi r � -- UNIT HEATER I. UNVENTED ROOM HEATER WATER HEATER.._ I INSURANCE COVERAGE _ have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES NO r I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OFCOVE aE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts Generaltaws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [7 AGENT 17J 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 accurat the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wit � I rlinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER NAME LICENSE#fa�la��l GNATURE .-- I MP MGF JP JGF�_j LPGI [ CORPORATION PARTNERSHIP # ^�w�y LLCM # COMPANY NAME @ _._ ..�___._ ._. ADDRESS CITY v�v : STATE ZIP SE JTEL /✓fit.,. FAX[---.,.=CELL. — �EMAIL� ._... _ ROUGH PLUMBING I&SPECTION NOTES BELOW FOOFFICE USE ONLY FINAL INSPECTION NOTES Yes No 11 117 �7 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ Xl- FEE: $ PERMIT# PLAN REVIEW NOTES �ti� Qk Thg COgbr#onnzrttlth ofMjT"rcclitffOft Deparblmut of,InAtistt IdAe iakift w ofinp ggertons 600I€ts1Mjtr rWn,S' (red, R6ston,, MA, 02.111 �ivrt�,rrrass.got►fi�rc '�j�actters"Cbanll�tzstefibau�nsc�sn��A#'frtt��+�t li��lcrrsfi�n�frnoysfl�ec�e�ci��sl ��iJs; Masi i tt ilt:foa iaz ti t: Please hint,L gffrY - f xttL1 QI9rso.[vsE!Otgt►tn' iutliuTtii�dbe _,i TGS�/i r Addim 43 d -7d, Aa a ou an emi t%ma?gtedt theappropt-€ate bozo T of ro ectr tttc 1 If]Il am,a eanplbyer rclti: 4.[11 alts a.general ctuttracror�nxtR}. { �ees,(ttitsandlacpare tiin} LaveGired the sub-comneters fry Q,l�fiei� 2. 1 ana a,sole proprietoror partner- Iisted on ho-attaelred Aeefe I j 7. '�ttemadefing, Ship and,have:no cnrplo,ees lime snlr confracrom,hm oz ! & Dentomfon, worft t`ornithvitycapaciy. work econfpainsiiraftc 9. ©' luldingadditiotu [Ileb,teorkfeeoarlp.insurance• ❑We are,acorporat►omand its, mredl oGfrcerslfac�e Gaerei lrcF(heirCtl'.[�Bleetrical.r r, di m4,. h 3.®ram,m lion�eoarfrerd'onrg.a!1�vorCt 'Will,of ecmptiom per M,GL I i Q Plhmfiinggcgafrs oradditnons; 1 - rrt�seEIN*%ror-LeWCw1p: c.f52p�1('1� a�ttretl�eno � C2�]mootrepaii�, iarsnratrc¢reclnired]'i t� euaplbyees.W6 work-em" r comp.insrtrance reggirecf 13[]Gtlier �liet�rpplprutfff�rtetl,eRsBay@tntuafCF fiEtouial sceGottrctotashOttiiigQ , rfiettnrFcaa`¢bitrpctt5aieanttolrsyrttfonttatton $t{erinc.inu.rswb)sa6rnitthesaffildteerindi-6119•IFeef;are&iiig�nli%rofktmd then tern:aulsut"COJIUscti�is roiusrsUbMit eSlawOf Edtt R indibline seiefe iGYrattr�Utt�,lJ�tds;t�rirsl;a�rnn;!'attert'aniuiditia tishe.Y.sQattma=,liar rienQiifrstitFa�ttSw�cwr�,t+rtG[Ihircmi s'ntmp.Porzaydim ;nnariom 5 l Ria a�;era'.Co,ee tlinCfs raeirlir :ilrnr�ecs'cum 7erasaf n. er. . TP �' P � �. 1n lrr�rrrrrtZce,�artttt.erar�rlo�-eas lt'etr►n.f�.tU.e�polfel.ana�fnfi�tf� fatfarpnrllon., ; c InsifrattcCCompaymanw. f I Polite or ins'Lie.Iff: Ti►plmtibl Date: E Job 93110i11'Ss::; itxttftp„. Atfacla n Co'{ of fTtc tx ari erg°¢oanptrnsirtibu polfey deeraroffoir page(stforrffr tlielaolic ramnrbe3^oartt esp3y-n r:d Path=to s cuverrge as requii ed tinderSection,,25A,of MGL co 11527- n,read to the rmpositiofu 0fernirtistrlC pelta Cks ofia, t"a a trp t 50,500 QO.andCairone}earimpnsotrrnent„as<<s:eCl.as;ci`.if penalties im the fano of n SMPI WORK dttDI:it>fiid ar fine- of, tiptoS25OLOjD1 ('aYg5tfitstthevioMror. t3 iscdtIiata°copS�of[this,stataarctitnaa�stiefoa ac[e t'mtftmQf6ctof hivestaghtibimeftheMA,for iitsur.. age erii'rcariou: s l _ I Icfertrt"r 5yr crrtifj ttia er~llre gs crt t jrerrnCl c Ofprrjary gat Nie byamu(Man,viPrCerl aDnv is!leas tr►rrt`cnrrert C�fCMfcWO11l, ur tTils area,°to be cirri rfeffff 6^cl orrow"o ftcfal: � I� Cffyofrmv7,nL'crndt .feer�ej IssuingAnt?tof ty(eircleone]y, 1.D"i"ng of ffeddi�2 Iinildfltg;Department 3..Cifyf own Berk. 4.Cteetri>;al,ruspeetof= 5 1'lir�trtit�tg ISrsiteCfota &0 flier (;oaiL�ct:IrCrsinin I=ltofir�: i 1 I Inform on ' macfiusettg General Laws chapter.152 regcnres an employers to,.pxo'a de;rvorl els'CoiVediWon for their aem I'ntrscianf to,&isstatute¢anenployee is demi �-`-ev � etperson irrft4e searire o€anotlerdera�iycontracta�f'hire e:+tpress or.implied;,oralor%wictem!- 'An,enrpfoy-e is defined as"an individual,pmjiwersjSasMati011;caVara6611 or offer k9dIerr Ofthe a Joint erste rf CAW, on any hvat or more Of th rp �and ceding ft,furl irepresentatives af'a.deceased eiiiplo yer„or the �erorfrusfee' y ofam ind vi i dt a1z, arhtersl' � assn p ctatiorn oar �n other D entt em, o Ltir. g Hotveveafhe dk%,cer&h d�wa of,a,house fiavtng:not mote f4an�;�aparttnertts xnd(Who)resides therei q,or,they occupant of the d�;'eRlntg ltioure ofanoEl er�€ho ecnpibys persons to db nmul'enan,ce-tcoiasfrr ecinn,orxepair,,,vork on swh,digelting house or cin.the grottuds or building appurtenant thereto shaSf not:because ofsuch,,employment:ba deemed to bean employer. MGT.chapter 157,:§25C(6)atsn,states that"every,state;or Weld flemisingagency,slha![wfalliorit the is�anee or re tralofaItccpseorpemittoyoperateabreisorfog¢onsfr,ucfbtu'ldinpi'crfhecomirwoniisealthiforany applicant IVho has.not produced accepiabfe evideme arcompMnee t4;ith€flie insurr3n¢e co¢cragc.required' enter otratT „MGI:chapter 1'52„&2°SC(7)?states"gleildl er Elie crrmMOnwvealtih nor any of ffs potffkali subdivisions shall'' ereterimtaany colitmctfOrthOPerfmmanceofpnbiic;tvor-.tmtufa tablesevfdenceofcomplianw�*itlhtheirsurarsce requirements ofthis chapter have,been,presented,to,thecottfractfng,authwfiy.�" Iipf emtts Pfease Elft out the irorkers'eonipensation affi ihvit coat tel byp.c&ceking;fheBoxes that apply tc yaursituatz n and,.if Imo. ' ne ,supplyl sulkconcrac or(s)ttatne(s address(exZ ands phone number(s)along with their certificates)of hisuramm Limited Liability Cwnpanies,(LLCM,orLfmctedfi iabrlttyr ParEFtersIups tvifIa.no errs:lo. Members orpartwrsn arenotrequired to cam workers ram ensat-'F iff cuarrre; If air, , -nG p other than,the. em. 1' des a Policy is LC L,Lp,does have p oy x p ' required Be adwtsed that this'atfda"ff Mayr be submitted to the:Departumt of Industrial tS ccidettfs£or confirmation of imtnrance.coverage. AhO be sure ta,sight anal da te.f1`uw'affidavit 'tee affidavit should be returned to the city or toren that the application for[ce pe wit or tccense is being.requested;nOt,th,D'cpartmeut of fniiEarstrfat Accidents. Shoteld you have any quesfioirs a regarding.tlte. ►v of if}roil.ate torofiteiit rvorkcrs'' compensation policy,,please call theDePartmentt ac thenumber:listed)below,._Self-insured companies should!enter their sdfI-h%wmnce'license number on Zile appro " fe Ione.. 'or Town Officials Please be sure thatt the affidavit is cotupfete.andprinted Iegifily. Tlie Depatfiitent has.provided a<space at the bottom: of'tbe,affidavit£or you,to ftll out two the evenf:the off ice of Investigations flag to,contaef y ou r . . . Pfemse be sure to fill in the . mutliicense number'tdliclli wsst7'i be used,as a reference n m mer, I tiara a applicant... � n;an applicant thatHurst submit multiple.permit/Iiceuse applibaffens in any?gift year,need only submit one affidavit indicating current PORO information(if necessary)and under"Jot,Site Address-the applicant stsould write art locations in (city or tom,7 A COP;;ofthe affidavittl�f Itas been of ial ,sfa Wiped:ormarl:ed byr the city°ortor,n may be provided]to the applicartf as proof that a real id'affidaw4t i*on,ff to for future permits.or licenses: A near affidavit must tie filled out each year.:,lfiIftere a frame owwmer or cfttzen fs obtaining a.lfcenseor permft not related to any, business;or commercial venture 3 (ke--a dog Iicense or permit to bump leaves etc.),said personrNOTraquirecitocompletefhigaffitavtt: Tl C7£ftca of'"estcgations would Iike to thank you tm advance for your cooperation and should youliar any clttesticnas3 - ply:do not 1ic�itafe to give us a carp. kneait's address,telephone and fax minit a The Cbmmonwraltil ofMa &tom l rOpartment of 1-nd stri ar Acctcl'ett is � F Office of In-NUf' .ig f.a, ons 600 Washington Street. Boston,ASA 0211! Tel.#617=727-4900 ext 406 or: I-&77-MASSAk Iyer= 5-2G-05 Fax#617,-7,27-7749. IW'-fttass govferia f w� Date.....i. 5 r.t. .... �40RTH, TOWN OF NORTH ANDOVER T' No PERMIT FOR WIRING .,SSACNUS� �iU r This certifies that ..... ....................... ... .. �.��.. �................ ....... has permission to performl RJ ' wiring in the building of Aw�. p..........a. yS` .. .. (,SLE at................... l..........p................... .. ... ,North Andover, ass. Fee .20.-.... . Lic.No.-�7..4� �� .. ,i. ..... .. . ... . .... . ELECTRICAL INSPECTO Check tl -/- -__--- 1 0475 _ ®1F1I9F®Pl�l�ee31 'h of Massachusetts - Official Use Only _. Department of#ere Services Permit No. I t�4/ Occupancy and Fee Checked k BOARD.OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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 PRINTININK OR TYPE ALL INFORMATION) Date: -W JA4-Md cK ?i 76 6 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) i4.5 ( G-i J L„4q0 VZ -!j Owner or Tenant - - A NO 14 oU,, A P.,m A(V� Telephone No. Owner's Address L1,S- W aLA JV lJ' V1412 Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building J LsMUtility Authorization No. Existing Service 10 0 Amps 0/ Z L/6Volts Overhead � Undgrd❑ No.of Meters New Service ZO Amps 120 / ZqAVolts Overhead� Undgrd❑ No.of Meters Number of Feeders and.Ampacity +' Location and Nature of Proposed Electrical Work: a N66 51 N ALF 84�/ `��-��� 4)i QP 6I9, b f' S C 2? 1-1c& A IVQ iR6m,6 ,oc-4 i e vrr��—a /,1 V I) G;i r� "06 n71 Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle) No.of Total Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA IN No.of Luminaires Swimming Pool Above ❑ 'In- ❑ o,o Units Emergency Lighting nd. rad. Batter Units - No.of receptacle Outlets No.of Oil BUrne-r"? FIREALARMS Nc.of Zones No.of Switches No.of Gas Burners No..of Detection and InitiatingDevices No.of Ranges No.of Air Cond. Total No.of Alerting Devices � .. Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: No.Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal [:1 Other Connection No.of Dryers Heating Appliances Kyr Security Systems:* i'4o.of Devices or Equivalent No.of Water ICS No.of No.of Data Wiring: Heaters Signs Ballasts. No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: ECSIO6r 0A-R-1906 M S A 6? 400 A�JTt�19'AJ Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 4 S A P 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 E] BOND F] OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: 1 I - r J �� LTC.NO.: Licensee: ��,UJ1 �h < �.f)JA /1Jd hsignature ` LIC.NO.: 3- (If applicable,enter"`exempt" th in e license number line) Bus.Tel.No.• / I-)-6fa6 Address: 13 I C �" L r- - )4 6 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 bylaw. By ir- si aturebelowI hereby waive this requirement. T am the(check one owner ❑owner's agent.Owner/A � , ,$'' 1 ej� PERMIT FEE: The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street ; ! Boston, MA 02111 www.tnass gov/dia --� Workers' Compensation Insurance Affidavit: Builders/Con tor°sXieetricians/Plumbers A�lolicant Information Please Print Legibly Name (Business/Organization/Individual):_ 7�/Cfi VI G 6l Address: I, 1/ �I® ill-A_ I✓ City/State/Zip: )4 46PI A14 636-72 Phone#:_. eldL _ Are you an employer?Cheek.the appropriate box: ' Type of project(required): L❑ I,aro'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.PQ I am.a.sole proprietor.or partner- listed on the attached sheet.t �• �(Remodeling ship and have no employees These subcontractors have 8. Q Demolition working for mein any capacity, workers' comp,insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its E required.] - � � officers have exercised#h 10. eir ®� lectrical repairs or additions 3.❑ I ain a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself,[No-Worke'rs'comp, c. 1.52, §1(4),'and we have no 12.[]Roof repairs insurancerequired.]t employees.[No workers' comp. insurance required.] 13.❑.0ther 'Any applicant that checks bo)t#l must also fiat out the section below showing their workers'compensation policy information, t Homeowners who submit this affidavit indicating they doing all work and then hire outside contractors must submit a new affidavit indicating such. - #Contractors that cheoc this box must attacked an additional shpt show rg r-he name of the sub-contractors and their Pierka:s'comp.policy information, arca an errapinyor that cs pY®a Ad'eFag:tva,ltepr infarrraatiora. 'co��apeRseadu4 lnsui'afice fO?Jhy.employees. Below is the policy and job site Insurance Company Name, ' Policy 4 or Self-ins.Lie..#: Expiration Bate: Jab Site Address: 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 Iead 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 certa f e e an enalties of perjury that the information provided above is true and correct: J Sienature:- Date: Phone 4: Official use only. Do not write hi this area,to he coy„p eted by chy' 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]Jnspedor 6.Other Contact Person: Phone#: I ....................... Nr105sa Date. .a 1 HpRT1{ TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �SS�cHUSEt This certifies that � .. .. .................................................................. has permission to perform IV/, ............:..... , ................ �..�(�.......................... wiring in the building of. ........... .......................................... ....... ....... .. ..... .. .........�'` CNorth Andover,Mass. e .............. Lic.N °� .. \ ...... r.......... .... ........ 4� � ^,,ELECTRICAL INSPECTOR 1 05/12/99 11:27 35.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer ThE C0AM0NWE4L7T10FMASS4CHUSE77S' Office Use only— DEPARTA&NT0FPUBLICS4= Permit No. ! BOARD OFF7REPREVEMONREGUMMAS527CMR 12:00 Occupancy&Fees Checked L� kVJ4PPLICATIONFOR PERAffTO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 ` (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �Ck-4 O 1 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location Street&Number q!s Nil Owner ems-- 11r�ee,44 G"co Owner's Address �� �1��,�R�ai�1�Ap� ►iJ� Is this permit in conjunction with a building permit: Yes[3� No F-1 (Check Appropriate Box) Purpose of Building N 2;ae XNe0 Utility Authorization No. Existing Service Amps / Volts Overhead M Underground M No.of Meters New Service Amps / Volts Overhead r_7 Underground No.of Meters Number of Feeders and Ampacity rc Location and Nature of Proposed Electrical Work V)1PQ. 4"P_ ZVamt-%J Qz fl , o.of Lighting Outlets No.of Hot Tubs No.ofTransfonners Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA and round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units I No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local ® Municipal ® Other Connections No.�nf Water Heaters KW No.of No.of / Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER Iris"=Ca,aage.Ptastianc>t�thert tritenaiLs�GenaalLaws Iha\eaa ettLi bhyhisLxa=Pcbcyutdt&gCcrnpkt CoAra crdsa egz,,?ffft YES Lg:�J NO 1ha\esutxrtbtedvandpmfofsmrlothe0ffm YES NU ® Ifjwha%edakedYES, pleaseirdic thetypeofoo� byctt igthe Tpoprialebox INSURANCE ® BOND ® OTHER&R ® (Please Spm) NQ1 VIS, CO3 Estirrma�Vah�e tical Wait$ WaktoStart his cnDt Ragt>atad Ra* Final Sigred utxia�ie Pl�taltics ofpajiuy. FIRM NAME Uta 0s Lioai9� Ty-h o.) � �J i n.2 Signattne a Licet Se,, Bts¢rssT�.Na X78�6 a^ ArI 1rr�c aS Lar„,g,l�a1 e4 AQ, I(1'1 d Alt Tel% OWNER'S INSURANCE WAMY,Ia<rimmthaatheLr=dxsnott the mamrxcwy o ca-Z AkZrtdecg zdatasm4xedbyMassadx&asG=rJ12m acid�my sigrrahaern this pamit apli�ti wanes ibis rac�enart. (Please check one) Owner ® Agent Telephone No. PERMIT FEE S Location �'� A No." � �� Date Sb 9� NONT1y TOWN OF NORTH ANDOVER n Certificate of Occupancy $ i • 4 Building/Frame Permit Fee $ Foundation Permit Fee $ sgCHUSE Other Permit Fee bo i $ o� Sewer Connection Fee $ Water Connection Fee $ TOTAL $ r Building Inspector { ri OG 044/99 11:34 3.00 PAID Div. Public Works f. PERMIT NO. � q3 ,.-----A,1'I'LICA'1'1ON 1�OIt I'LItMI"1' "1'O 13UIL1)********NOIt"1'11 ANUOVI�;It, A /, 6 / I r,rgo.� 1. Nk:( ONI)f)FO\\'NIRSIIIP - DATE B06 PACE $ti/N'tFl•�=.�LO,f N/G)A�=�" p LUI ,(1117N � � f ' PIMM)SSL(7FHIJ111)ING13u�e— rw4 OWNER*S NAME /1l e �av�lJ Nt), Of-SIORI1 5 SIZE ()WNI_R'S ADDRESS BASEMENT(N(SI All AR(1 II 1 E(—I'S NAME SIZE OF FL(.X)R I IMHERS I ST 2ND - )RD HIM DER'S N.MIE SPAN DISI ANCE TO NEAREST"BUII.DING DIMENSIONS()F SILL S UIS I ANCE FROM STREET DINIL•NSI(NJS OF 1X IS IS (•1 DIS I ANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LC)T FRO NJ I ACE HEIGHT f r(v FOt)NDATI(NJ TI I ICF:N E SS 4 IS B(III_DING NEW SIZEOF HX Yl ING X IS BUILDING ADDITION MArERIAI.(Y C111AINEY IS BI)II.DIM;ALTERATION IS BUII.DIN(;(Nd SOLIDOR FII LED LAND WILL BUILDING CONFORM TO REQ IIREMENI S OF CGDE IS 131011.DING C(1NNLCI ED 10 TOWN WA'I ER BOARD OF APPEALS ACTION, IF ANY ' IS BI111.DING C(N,7NEC1 ED TO TOWN SI:WLR IS BUILDING CONNEC-1 ED 10 NA FURAL GAS I.INE INST(7(TIoNS 3. PROPF-111-1- INFORh1A110N I.AND COST ES1. BI GD . COST ✓ (S7� PAGE 1 FL 11. Olrf SECTIONS I-) ///�''ZV EST'. Bl.lk . COST PL SQ. FT. ` EST. B C oLR R(X)M LE ECTRIC METERS MUST BE OTJ(NITSIDE OF BI111.DIN(i / C_JL.— SEI'1lC PER PERMI r f NNO. A"ACIIEDGARAGES MOST C(NJFORM'rOSTATEFIRERE(;IILATIONS i. APPROVED BY: PLANS MUST BE FILED AND APPROVED BY BI 11L.DING INSPECTOR / B1111.111NG INSI'E('TOIL i l DAIEFII ED13r OWNERSIE.La COKI R.1 EI.N SIGNAf1IRF.(>FOWN: (NtAlfllN IY1: )AGI.NT C(NJTR.1101 Flil: C2S e -- n.LC.a PERMIT GRANTED I FORM U - LOT -RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICA-NT FILLS OUT THIS SECTION*********************** APPLICANT Z, (�ec'-CJ PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET 4j�— /iar- o��`-'' ` `�' ST. NUM13ER USE ONLY**kk ** * *** * *** RECOMMENDATIONS OF TOWN AGENTS: CO SE VATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTSi TOWN PLANNER DATE APPROVED DATE REJECTED C° COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED ° COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm o C II Town of North Andover Q NORTH OFFICE OF ��° 4s° COMMUNITY DEVELOPMENT AND SERVICES 0 p 27 Charles Street North Andover, Massachusetts 01845 �,9 *Eo•°" <y WILLIAM J. SCOTT SSACHUSE Director (978)688-9531 Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION /N/um er Street Address Section of Town "HOMEOWNER ys', /x-i///eG� ��- C� moi" D -�GU.- f �,1r"�' u ber Home Phone Work Phone PRESENT MAILING ADDRESS �, � , r���✓' City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling,attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws,rules and regulations, The undersigned"homeowner'certifies that he/she understand e T of No.Andover Building Department minimum inspection proced and it d that he/she will comply with said procedures and requirem t . HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwelling 35,000 cubic feet, or larger,will be required to comply with State Building Code Section 127.0 Construction Control. t , i BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NORTH Town of Andover 0 No. 113 O �n dover, Mass.,COCh11C E ICK AO RA TED P9a��,�5 S H E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... 1>!vC to....................Gprew.......................... ..................................................... Foundation pw* I L/ �r #!.T _has permission to erect.. . OZB.......... buildings on ........'T V /Jf�AM o� y!1 W �fUt Rough to be occupied as.. VA'.1........ P46 SPAPO1 APO/ I.0 F1*41% t � Chimney . . ................................................................................ ... . ................................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough pC PERMIT EXPIRES IN 6 MONTHS Final 3i3� S 1 UNLESS CON STRUC T� ELECTRICAL INSPECTOR Rough .. .................................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. ,r�'�?:'�.-:+"v�Jl` a•r+.�4;"its` .:.�;�i��[rS+i"" '�� 'KGs"w:.+r "was''i•s,<'i`°K•"`,}"r+•.+r...�. Location VzAr No. Date NaRTh TOWN OF NORTH ANDOVER` v°�tioo Certificate of Occupancy $ 41 Building/Frame Permit Fee $ oundation Permitfee $ s�CHU [ W Sewer Connection Fee $ Water Connection Fee $ TOTAL $ c>ea w A Building Inspector 8051 Div. Public Works Location s 1110IJ-12✓2 VIEW I`EPS No. OF�-1 Date of %ORT., ti TOWN OF NORTH ANDOVER j Io wAbL p Certificate of Occupancy $ �,500f + ; Building/Frame Permit Fee $ 1,5-0, 00 . t ; r4 Foundation Permit Fee $ emusEt' �I Other Permit Fee $ enection Fee $ A14p Water Conkction Fee— $ � ,� OTAL �/ Zo $ 2c)O, 00 � �"�'-Po � / / � Bing Insp/ector� 5 0 Div. Public Works Location No. CPa1 ' h10 Date NOR7►� TOWN OF NORTH ANDOVER Certi:f -icate�of-Occupancy $ ,lJ # : Building/Frame Permit Fee $ ,SSACMUSEt Foundation Permit Fee $ t er Permit Fee $ 2S RECEIVED P ewer Connection Fee— $ As connection Fee $ _ TOTAL $ NO.A oi� VE�tBuilding Inspector �c/cP 5064 Div. Public Works y t. PER.111T NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. �,L ��j PAGE 1 MAP iJO�/ LOT NO./ 2 RECORD OF OWNERSHIP DATE (BOOK PAGE — ZONE SUB DIV. LOT NO. �� �w �t f7 J Icy LOCATION _ r7 PURPOSE OF BUI I .y OWNER'S NAME� �` 1� NO. OF STORIES SIZE OWNER'S ADDRESS � BASEMENT OR SLAB SCJ i ii ARCHITECT'S NAME,� SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING�� DIMENSIONS OF SILLS DISTANCE FROM STREET /� POSTS 11 DISTANCE FROM LOT LINES-SIDD 0�i� //L REARGIRDERS AREA OF LOT ow-1/ FRONTAGE�j���i� HEIGHT OF FOUNDATION THICKNESS" 11 IS BUILDING,NEW /�?-�7 ✓�f / SIZE OF FOOTING X l IS BUILDING ADDITION Y MATERIAL OF CHIMNEY IS BUILDING ALTERATION A✓G IS BUILDING ON SOLID OR FILLED LAND •JY WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY Y IS BUILDING CONNECTED TO TOWN SEWER y _ IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS o ` PLANSMUSTBE FILED AND APPROVED BY BUILDING INSPECTOR OWNER TEL.#g "1-3 73 DATE hhLED-3 / CQi`TR.TEL.#__ JJ ��'•iTR t�„ :4 BOARD OF HEALTH SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE � ��SO► �t� + PLANNING BOARD PERMIT GRANTED �i L7 19 / 2 BOARD OF SELECTMEN ./✓�✓� BUILD' CTOR WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer � s w Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE JOB LOCATION Number Street Address Section of town HOMEOWNER s�h Name Home Phone Work Phone PRESENT MAILING ADDRESS City/To'wn State Zip code The current exemption for "homeowners" was extended to include owner occupied dwellings of six units or less and to allow such homeowners to ; engage an individual for hire who does not possess a license , provided that the owner acts as supervisor . (State Building Code , Section 109 . 1 . 1) DEFINITION OF HOMEOWNER: Person(s ) who owns a parcel of land on which he/she resides or intends to reside , on which there is , or is intended to be, a one to six family dwell- ing , attached or detached structures accessory to such use and/or farm structures . A person who constructs more than one home in a two-year period shall not be considered a homeowner . Such "homeowner" shall submit to the Building Official , on a form acceptable to the Bulding Official , that he/she shall be responsible for all such work performed under the i;,building permit.. (Section 109 . 1 . 1) -The undersigned "homeowner" assumes responsibility for compliance with the Building Code and other applicable codes , by-laws , rules and � . ,State regulations . The undersigned "homeowner" certifies that he/she understands the Town of , . ,North Andover Building Department minimum inspection procedures and requirements and that he/she wit om ly w ' th said procedures and requirements . t ' -HOMEOWNER ' S SIGNATURE APPROVAL OF BUILDING OFFIC 6A Note : Three family dwellings 35 , 000 cubic feet , or large will be 0,required to comply with State Building Code Section 127 . Co _uctlon Control . i i Ar. `� FU It1 i U TOWN OF NORTH ANDOVER LOT RELEASE FORM j SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANENTDRESS ( SSIGNED BY D.P.W. STREET i APPLICANT PHONE DATE OF APPLICATION . S TOWN USE BELOW THIS LINE PLANNING BOARD DATE APPROVED TOWN PLANNER DATE REJECTED CONSERVATION COtIMISSION DATE APPROVED CONSE VATION DATE REJECTED BOAP OF HEALTH DATE APPROVED �AALTHLSANITARIAN UA'1'E REJECTED DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS a1FIRE DEPT. �- RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and health Boards, the Conservation Commission prior to the issuance of any .building permits 4 for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. Q U 0 L, Lf I J L d k� ORT11 T cc) 6 ' 01 own of - Andover n -1K K& Ma 6;4er, Mas )RIVEWAY ENTRY PERMLIIT C L HE W111C K W_ BOARD OF HEALTH PERMIT T THIS CERTIFIES TH AT W...... ............................................. Aff BUILDING INSPECTOR has permission tow"p....... .. . buildings on ...... *. .......**Ar Rough W =A a viv tra w 414;1�; j Chimney t be .A" 0 @r..WjWj-.-.T....cfe.... .. ......... ..... .. .. .. . Final provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids twi e�rm� PERMIT EXPIRWI 0 I IONTFIS ELECTRICAL INSPECTOR Rough UNLESS C STRUCT Service Final .. .. . ...... BUILDING INSPE GAS INSPECTOR Occupancy Permit Required to Occupy Bull Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by STREET Smoke Det. Building Inspector Locations No. Date 3 �7 1�" AORTM TOWN OF NORTH ANDOVER ` o - Certificate of Occupancy $ ,�, 0 y ' S Building/Frame Permit Fee $ /o 0, 00 �,�°"•��•''�� Foundation Permit Fee $ ss�CHust Other Permit Fee $ Sewer Connection Fee $ Water Connection F $ TOTAL "BuIldingginspe 5063 Div. Public works i NORiN Town of OFFICES OF: : o < 120 Main Street APPEALS '� NORTH ANDOVER North Andover, " BUII.I-)INC; MilssiWI USCIIS 01 845 CONSERVATION DIVISION OF W 1 7)tits 5.477 HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIREC'YOR i f I I i In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number / is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: ,owt �7 ' (Location of Facility) I i ature of r Applicant` Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. T, !RTt ; own of 40 over No.0 4b �Y. o A fort, dover, Mass., • �•� 199V �A COCHiCHEWICK\� 1 L BOARD OF HEALTH Food/Kitchen s-y Septic System O� i. -- BUILDING INSPECTOR Ea THIS CERTIFIES THAT... .......PERMIT T D J ........ undation has permission to erec i61wel s on .....`I. . . ' V 9 FPWough to be occupied a /!. t.... ....� .�.. . . .. 0..11. .......... . . . . ... chimney provided that the person pting this permit shall in every respect co m o the terms of the application on file in Final ;. P this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PER1\41T EXPRES IN 6 MONTI-IS UNLESS COI�,ISTRU�'rTION STARTS ELECTRICAL INSPECTOR � Rough Service 4YLDING INSPECTOR Fina( Ocaipancy Permit Requirecl to Occ q)y BLtildir1.g GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P Y P Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SFWFR/WATER_ FINAL DRIVEWAY ENTRY PERMIT m--�....+ ,.a....r.-da.,.�:,..-�_.�-�..r's:=-•--r' ;ye'�.._..- ,.-.Y�.:.-.� 'S":--s,y,-+.:.e..--..i¢'w,�`rr'^::��y.qr'+.._ R y� ' Location tY1i��lUJ Wl€L() .AUS ` No. Date �C� Q NpRTq If TOWN OF NORTH ANDOVER 9 X s + ; Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ 35 s�cMust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 30 Check # e�s L� 17570 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 'tndUe BUDLDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Comtrussioner/Inspector of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 416 —15 J bva/ y/9 f C�L!/C /I Map Number Parcel Number 1 1.3 Zoning Information: / N� 1.4 Property Dimensions: (�+ Zoning District Proposed Use LA Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard RaIttired Provide Required I Provided Regaired Provided 1.7 wear Supply M.G L.C.40. s4) 1.5. Flood Zone Information: 1.8 saw Zana Outside Flood Zone ❑ MpOn Site Dis unicial ❑�Deposal S ystenx Public ❑ Private ❑ posal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT L)1 i U L. TF. LName wner o Record �` n r 67 Address for Service Signature - Telephone A +2.2 Owner of Record: Name Print Address for Service: Signature Tel hone SECTION 3-CONSTRUCTION SERVICES �l 3.1 Licensed Construction Supervisor: Not Applicable ❑ fl Licensed Construction Supervisor: �/5,116 //ww License Number C Address Signatu Telephone Expiration Date r 3.2 Registered Honle Improvement Contractor Not Applicable p 1 Company Name Registration Number M Address r r Si nature Expiration Date z Telephone G) i Y' SECTION 4-WORKERS COMPENSATION(KG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building it. Si ned affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: I - SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee GGl/ C� Multiplier 2 Electrical �_ (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) x tbl 4 Mechanical HVAC 5 Fire Protection i 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby,authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION as Owner/Authorized Agent of subject property Herebv 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 attire of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2ND 3 RD SPAN DIMENSIONS OF SILLS Y DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING x MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM. In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) Si a of ermit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector hQ8%k -- Town of North Andover Building Department 27 Charles Street b r, North Andover, MA. 01845 �sS9CNt15�< D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542.Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE P JOB LOCATIONZX/ Number Street Add ess Map/lot "HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homedwners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1 DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling,attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than onehome in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and require and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL NORTH I F Town of 4 L over No A; 0 ......... ...8 - * -� - D � % LA E dover, Mass., I� COCMICMEMCK y�. 7�ADRATED PPS` �y H BOARD OF HEALTH Food/Kitchen P.ERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ ./V..C ........................ ...r. .� o ndation ..................... D 40M has permission to erect.. .. ................................ buildings on ......Y Rough w 1ti to be occupied a!`' 00� w w/ Chimney ................................................................... .. . . ..................................... provided that the person accepting this permit shall in every respect conform to the to sof the application on file in Final this office, and to the provisions of the Codes and By- ws plating to the Inspecti , Alteration and Construction of Buildings in the Town of North Andover. 4 /S� j PLUMBING INSPECTOR. VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI N STS Rough ... .... .. . .. . ... .... ......... ............ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina, No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det.