Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutMiscellaneous - 47 EMPIRE DRIVE 4/30/2018 /I /�_
% �
/ _ � .; '.1
J
`� I �
Date...... ...............................
NORTH
Ba •"`:;': ��0� TOWN OF NORTH ANDOVER
o
PERMIT FOR WIRING
ssACHUS��
This certifies tha(�V:� `\�'
Uj
has permission to perform .. 1?U 4-s ,A....Sv� 2 Z p... . .................................... ..........................
wiring in the building of........�.!.U�'r` '�- ' "-�
. ......................................................................................
at .... �. C...............................%`2'.J 2� ,....,North Andover,Mass.
................ iA J�..............
Fee...+ .J... )� t` i i(� .......,.{!/.C1 .........
........Lic.No. ................. .................... - .....^ .
ELECTRICAL INSPECTOR`
Check# as
COmmonweX Of 7&46."th Official Use Only
c� Permit No. 13 01�
"+ aLl¢partment o��ire�ervice�
k Occupancy and Fee Checked
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 C),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: i115115
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) 47 Empire Drive
Owner or Tenant Eugene Blumkin Telephone No. 617-590-5680
Owner's Address 47 Empire Drive, North Andover, MA 01845
Is this permit in conjunction with a building permit? Yes -1 No ❑ (Check Appropriate Box)
Purpose of Building Residence-no change Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Installation of a 6.16kW roof mounted solar array using 22 SolarWorld
SW280 Mono modules, 22 Enphase M250-60-2LL-S22 micro inverters, and all associated electrical work.
Completion of the ollowin table ma
y be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting
grnd. d. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection an
Initiating Devices
No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump I Number Tons KW No.of Self-Contained
Totals: ... ......................................W- Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal E] other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW o.of o.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or E uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: $19,000 (When required by municipal policy.)
Work to Start: Apr 2015 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 M BOND ❑ OTHER ❑ (Specify:)
I cetfify,under thepains andpenaldes ofperjuty,that the informatto n this applica ' n is true and complete.
FIRM NAME: Alteris Renewables dba RGS Ener LIC.NO.: 14005-A
Licensee: Craig T. Reekie Signature ,ter LIC.NO.:
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:860-535-3370
Address: 32 TauQwonk Spur.A-12.Stoninpton.CT 06378Alt.Tel.No.:781-738-7156
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent.
Owner/Agent PERMIT FEE. S 125.00
SignatureturaTelephone No.
Z)
EALTH OF M.' . ET
lit
=..
7 --i I C I AN
-CS
FOLLOWING ENS E
0 MAST CTRICIA E A%
I NC DBA RGS
A E ff
Ll a
200129
AC V CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY)
`-� 1/1/2016 1/6/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER Lockton Companies CONTACT
8110 E.Union Avenue PHONEFAX
Suite 700 E-MAIL AIC Nol:
Denver CO 80237 ADDRESS:
(303)414-6000 INSURERS AFFORDING COVERAGE NAIC#
INSURER A:First Specialty Insurance Corporation 34916
INSURED Alteris Renewables,Inc. INSURER B: C aInsurance m 1 535
1344665 dba Real Goods Solar INSURER C:Starr Indemnity&Liability Company 38318
dba RGS Energy INSURER D:
32 Taugwonk Spur,Unit Al2
Stonington,CT 06378 INSURER E:
INSURER F
COVERAGES REAG001 CERTIFICATE NUMBER: 13294607 REVISION NUMBER: XXXXXXX
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR LTR TYPE OF INSURANCE ADD SUBR POLICY EFF POLICY EXP
INSD POLICY NUMBER MMIDDIYYYY MMIDD LIMITS
A X COMMERCIAL GENERAL LIABILITY N N IRG2000528 1/1/2015 1/1/2016 EACH OCCURRENCE s 00000
CLAIMS-MADE aOCCUR DAMAGE TO RENTED
PREMISES(Ea occurrence) $ 50,000
MED EXP(Any oneperson)
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000000
POLICY � JERCOT- [—]LOC PRODUCTS-COMPIOP AGG $ 00
OTHER:
B AUTOMOBILE LIABILITY N N BAP5852403 1/1/2015 1/1/2016 $
(Ea accident) 1,000,000
X ANY AUTO BODILY INJURY(Per person) $ X? XXXX
X ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY Per accident $ XXXXXXX
X HIRED AUTOS X AUTOS NON-OWNED PROPERTY DAMAGE(Per neddentl $ XXXXXXX
$ XXXXmX
A X UMBRELLA LIAB X OCCUR N N IR-E2000563 1/1/2015 1/1/2016 EACH OCCURRENCE $ 10000000
C X EXCESS LIAB CLAIMS-MADE 1000021478 1/1/2015 1/1/2016 AGGREGATE $ 000 000
DED RETENTION$ $ X
B WORKERS COMPENSATION N
AND EMPLOYERS'LIABILITY YIN WC5852405 1/1/2015 1/1/2016 X STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED2 � NIA E.L.EACH ACCIDENT $ l 000 000
(Mandatory In NH)
If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ l 000,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
13294607
for information only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRES AT VE
L
arl✓� � � 1�1
©1988- 014 ACORD COR PO TION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/organization/Individual): Alteris Renewables, Inc. dba RGS Energy
Address: 32 Tauqwonk Spur, Unit A-12
City/State/Zip: Stonington, CT 06378 Phone #: (860)535-3370
Are you an employer? Check the appropriate box: Type of project(required):
1. x❑ I am a employer with 320 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. + 7• ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.]t employees. [No workers'
comp. insurance required.] 13.❑x Other solar panels
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Zurich American Insurance Co.
Policy#or Self-ins.Lic.#: WC5852405 Expiration Date: 01/01/2016
Job Site Address: 47 Empire Drive City/State/Zip: North Andover, MA 01845
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: �,,�n Date: )I:
Phone#: (860) 535-3370
Official use only. Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
FOR CONSTRUCTION
WIRE SCHEDULE WIRE SIZING VOLTAGE DROP
Notes: Ground 90°C Derated Amapacity 75°C ®�0
1. All conduit to use water-tight expansion fittings. Tag Qty Conductor Size &Type Conduit Length V. Drop
2. All Rooftop conduit to be a minimum of 1"above the Size &Type (Allowable Amps x Temp Derate x Fill Derate) Ampacity `RG S
roof surface. A 3 #12 AWG ENGAGE CABLE #6 AWG BARE Cu FREE AIR 30A X 0.84 = 25.20 A 25.00 A N/A 0.21% E I�!E RGY
.......................................................................................................................................................... ......
...................................................... ........I..............._. .. . . . ......
3. PV Connection into Load Center shall be positioned at B 9 #10 AWG THWN-2 #8 AWG THWN-2 1" EMT 40A X 0.84 X 0.7 = 23.52 A 35.00 A 70 Ft 0.58%
................................_................................................................................................... ...... ....I....... ... ..... .. ...... 32 Taugwonk Spur,Al2
. .. . ...... _............A 35...........
the opposite end from the Utility Input feeder C 3 #10 AWG THWN-2 #8 AWG THWN-2 3/4 EMT 40A X 1.05 X 1 - 42.00 A 35.00 A 10 Ft 0.23%
tocation.(Where applicable) :........................................................................... ................................................................... ...................................................... ................................................ onginton,C 06378
.� st
Phone(860)535-3370
4. All equipment to be rated NEMA-3R unless otherwise DC.... ---. Fax(413)683-2225
noted. AC 1.02%
5. Lowest expected ambient temperature based on GRID-TIED
ASHRAE min. mean extreme dry bulb temperature for PHOTOVOLTAIC SYSTE
ASHRAE location most similar to installation.
6.160kW DC @ STC
6. Highest continuous ambient temperature based on
ASHRAE highest month 2% dry bulb temperature for BLUMKIN, EUGENE
ASHRAE location most similar to installation. 47 EMPIRE DR
NORTH ANDOVER, MA 01
7. All conductors to be copper unless noted otherwise.
8. Conductor sizing shall limit Voltage drop to 2% DC & SYSTEM LABELING SPECIFICATIONS Project# 10240621
1.5%AC (2%for Enphase Systems).
Max. DC Voltage(-18 °C): 44.6V DC Max. Current: 12.14 A DESIGNER: Val Ionescu
............................................................................... .......................................................................
DC Operating Voltage: 31.2 V DC Operating Current: 9.07 A REVIEWER: MLM
........................................................... ................................................I............ O
AC Nominal Voltage: 240 V Max.AC Current: 22.0 A VERSION DATE. 2015-01-08
MAIN SERVICE PANEL REVISIONS
INTERCONNECTION # By DateNotes
120% Rule 705.12(D)(2)
Utility Feed + Solar Backfeed 1 EG '12130/2014 Layout change
2 EG 1!9/2014 Layout Cheng°
200 A + 30 A = 230 A
Buss Rating x 120% s
200 A x 120% = 240 A 4
5
m
0
4
u�
0
N
_____________1
,� ;EXTERIOR ;
0 22 Solarworld Plus SW 280 mono black Modules with 22 (N) Enphase �)�> 1-Phase
Enphase Energy M250-60-2LL-S22 Micro-Inverters Envoy 120/240V
Branch of 8 (N)AC Combiner l- "-:!--
Square DM
i m Q0612L100RB 1208 ; '
I 100A
240VAC L----------- ------------I
LL
(N) PV Meter
Branch of 8 (N)
Enphase Energy �..
J-Box 4x4x4 240VAC — 200A
_ E _ 15A
15A
a
15A M (N)30A
o N _ N
Branch of 6 j ( S IE Not to Scale
v.
___.._ .____ E)
200A
G GE"=2 Murray ELECTRICAL DIAGF
C C
l
Rooftop Electrical Basement PV-E01
_______________________________________________________________________L_----- ____--________-_-___________-_J
OR CONSTRUCTION ooDGDo�
Votes: WIRE SCHEDULE WIRE SIZING VOLTAGE DROP
1. All conduit to use water-tight expansion fittings. Ta Qty Conductor Size 8�T Ground 90°C Derated Amapacity 76°C ooQO®
2. All Rooftop conduit to be a minimum of 1"above the g y Type Size&Type Conduit Length V. Drop
yp (Allowable Amps x Temp Derate x Fill Derate) Ampacity RGS
roof surface. A 3 #12 AWG ENGAGE CABLE #6 AWG BARE Cu FREE AIR 30A X 0.84 = 25.20 A 25.00 A N/A 0.21%
...................... ..........................................................................................................................
3. PV Connection into Load Center shall be positioned at B 9 #10 AWG THWN-2 #8 AWG THWN-2 1" EMT 40A X 0.84 X 0.7 = 23.52 A 35.00 A 70 Ft 0.58%
the opposite end from the Utility Input feeder ... .... ...
.. ..... ..... ...... .... ..
C 3 #10 AWG THWN-2 #8 AWG THWN-2 3/4 EMT 40A X 1.05 X 1 = 42.00 A 35.00 A 10 Ft 0.23% Taugwonk Spur,Al2
location.(Where applicable) .......................:......................................................... .........................................:................................. ................................................................... ........................ ............................. ........................ .I..................... 3stonginton,CT 06378
t. All equipment to be rated NEMA-3R unless otherwiseDC -Y- Phone(860)535-3370
noted.
................:.........................
Fax(413)683-2225
5. Lowest expected ambient temperature based on AC 1.02%
GRID-TIED
ASHRAE min. mean extreme dry bulb temperature for PHOTOVOLTAIC SYSTEM
ASHRAE location most similar to installation.
5. Highest continuous ambient temperature based on 6.160kW DC @ STC
ASHRAE highest month 2% dry bulb temperature for BLUMKIN, EUGENE
ASHRAE location most similar to installation. 47 EMPIRE DR
All conductors to be copper unless noted otherwise. NORTH ANDOVER, MA 01845
3. Conductor sizing shall limit Voltage drop to 2% DC& Project# 10240621
1.5%AC (2%for Enphase Systems). SYSTEM LABELING SPECIFICATIONS
Max. DC Voltage (-18 °C): 44.6 V DC Max. Current: 12.14 A DESIGNER: Val Ionescu
............................................................................... .......................................................................
DC Operating Voltage: 31.2 V DC Operating Current: 9.07 A REVIEWER: MLM
.................... .............. . . . . . . ......................... .......................................................................
AC Nominal Voltage: 240 V Max. AC Current: 22.0 A VERSION DATE. 2015-01-08
MAIN SERVICE PANEL REVISIONS
INTERCONNECTION # BY Date Notes
120% Rule-705.12(D)(2)
Utility Feed + Solar Backfeed 1 EG 12/30/2014 Layout change
200 A + 30 A = 230 A 2 EG 1/9/2014 Layout Change
Buss Rating x 120% 3
200 A x 120% = 240 A 4
5
EXTERIOR
22 Solarworld Plus SW 280 mono black Modules with 22 (N) Enphase °)�> 1-Phase
Enphase Energy M250-60-2LL-S22 Micro-Inverters Envoy ,
Branch of 8 120/240V ;
(N)AC Combiner0 El
Ti
Square D fl
Q0612L100R6 120V M
100A
-- ;
240VAC n ------------ --
-----------�
0
(N) PV Meter
Branch of 8 (N) Enphase Energy
J-Box 4x4x4 240VAC r 200A
— 15A
15A
15A M (N)30A
N N
Branch of 6
i
(E) E Not to Scale
A B200A
G G . «"^"' Murray ELECTRICAL DIAGRAM
C C
RooftopElectricalBasement
-------------------- -------------------------------------------------------------
O
Enphase®Microinverters
Enphase@M250
A
i. tet„
T
The Enphase® M250 Microinverter delivers increased energy harvest and reduces design and
installation complexity with its all-AC approach. With the M250, the DC circuit is isolated and insulated
from ground, so no Ground Electrode Conductor(GEC) is required for the microinverter. This
further simplifies installation, enhances safety, and saves on labor and materials costs.
The Enphase M250 integrates seamlessly with the Engage® Cable, the Envoy® Communications
Gateway?m, and Enlighten®, Enphase's monitoring and analysis software.
PRODUCTIVE SIMPLE RELIABLE
- Optimized for higher-power - No GEC needed for microinverter - 4th-generation product
modules - No DC design or string calculation - More than 1 million hours of testing
- Maximizes energy production required and 3 million units shipped
- Minimizes impact of shading, - Easy installation with Engage - Industry-leading warranty, up to 25
dust, and debris Cable years
enphase® s�®
E N E R G Y
C us
s'
Enphase®M250 Microinverter//DATA
INPUT DATA(DC) M250-60-2LL-S22/S23/S24
Recommended input power(STC) 210-300 W
Maximum input DC voltage 48 V
Peak power tracking voltage 27 V-39 V
Operating range 16 V-48 V
Min/Max start voltage 22 V/48 V
Max DC short circuit current 15 A
Max input current 9.8 A
OUTPUT DATA (AC) @208 VAC @240 VAC
Peak output power 250 W 250 W
Rated (continuous)output power 240 W 240 W
Nominal output current 1.15 A(A rms at nominal duration) 1.0 A(A rms at nominal duration)
Nominal voltage/range 208 V/183-229 V 240 V/211-264 V
Nominal frequency/range 60.0/57-61 Hz 60.0/57-61 Hz
Extended frequency range* 57-62.5 Hz 57-62.5 Hz
Power factor >0.95 >0.95
Maximum units per 20 A branch circuit 24(three phase) 16(single phase)
Maximum output fault current 850 mA rms for 6 cycles 850 mA rms for 6 cycles
EFFICIENCY
CEC weighted efficiency,240 VAC 96.5%
CEC weighted efficiency,208 VAC 96.0%
Peak inverter efficiency 96.5%
Static MPPT efficiency(weighted, reference EN50530) 99.4%
Night time power consumption 65 mW max
MECHANICAL DATA
Ambient temperature range -40°C to+65°C
Operating temperature range(internal) -40°C to+85°C
Dimensions(WxHxD) 171 mm x 173 mm x 30 mm(without mounting bracket)
Weight 2.0 kg
Cooling Natural convection-No fans
Enclosure environmental rating Outdoor- NEMA 6
FEATURES
Compatibility Compatible with 60-cell PV modules.
Communication Power line
Integrated ground The DC circuit meets the requirements for ungrounded PV arrays in
NEC 690.35. Equipment ground is provided in the Engage Cable. No
additional GEC or ground is required.
Monitoring Free lifetime monitoring via Enlighten software
Compliance UL1741/IEEE1547,FCC Part 15 Class B,CAN/CSA-022.2 NO.0-M91,
0.4-04,and 107.1-01
*Frequency ranges can be extended beyond nominal if required by the utility
To learn more about Enphase Microinverter technology, ( l enphase®
visit enphase.com E N E R G Y
0 2013 Enphase Energy.All rights reserved.All trademarks or brands in this document are registered by their respective owner.
ooDoOeo
0o RGS ENERGY
oaClean Power.Bright Savings.
January 15,2015
Town of North Andover
Electrical Inspector
1600 Osgood St,Bldg 20,Suite 2035
North Andover,MA 01845
Hello,
I have enclosed an electrical permit application,applicable fee and supporting
documents for a residential solar installation in your town.Please let me know if
anything else is required to approve our permit.
Once the permit is ready please use the enclosed self-addressed stamped envelope to us.
Thank you and let me know if you need anything else,
4- ji
Kim Hendel
Operations Specialist
RGS Energy
32 Taugwonk Spur Road,Al2
Stonington CT 06378
Ph 860-535-3370
Fax 413-683-2225
kimberly.hendel@RGSenergy.co
32 '1'augwonk Shur,Al2,Stonington,C'I'06378 I tel. 860.535.3370 I fax 41.3.683.2225 I
RGSEnergy.com
Date.4.,-/ .
of Noar#j
a; ora TOWN OF NORTH ANDOVER
o
t PERMIT FOR WIRING
CHUSE
�� �G
This certifies that �./u�!' :. ................................................' rR
... ...............C.. '
has permission to perform ............................... 21 P�rQ.. ....10.:�.
1 L-�L......................................
ring in the building of..: ` .!`n.....-��
at .......43....��`+�'.'2�2,.....�..�2'!�-....................!N�rthAndover Mass.
> ee,. ��...........Lica No. �.L ....".l.� .. ......
......... ..
ELECTRICAL INSPECTOR
Check#" Aa
4(D(O-V� vim.
•
Print Form
C.oi»a►oa►uea h o! as+at�uaolle - Official Use Onlylu I'crnlil No.
f
t 1 2er"rlmeul o f Sire_ ,141;a..4
! ' t)ccupancy and Fcc Checked
BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/071 (Ieavc blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
111 work to lie llcifm•mc►I in arco►dance with the Mnssachuscttc I:Iccbical Code(MEC).527 CMR 13,410
(PLEASE I WAY IN INK OR TYPE ALL lNl7)RA4A'/'/nN) nate: lo-27 2y—
City
YCity or Town of. AJ&r44) doW_ To file Inspector n/'Wm-r: ~- --
fly thin applicatloll lilt: gives notice of his or her intention to perrunn the electrical work described below.
Location(Sireel & Number) GUY)Pt re Dr-. .- _--__
Owner or'I'rnant �4 to e _3_u l� _ Tcicphonc Nu.(�/1�- -S1,18-0Owner's Address _
Is this permit in conjunction with a building permit? Yes F No LJ (Check Appropriate But)
Purpose of Building; w/Solar-PV utility Authorization No. n/a
Existing Service Amps / wVolts Overhead L,] Undgrd❑ No.of Meters
New Service Amps / Volts Overhead F1 thtdgrd❑ No.of Meters
Number of feeders and Arnpacily
Location anti Nature of Proposed Electrical Work: Install Solar Elartric-Photovoltaic(PV)system [Z7 panels)
rated6„g�S kW-DC Q S.T.C.Grid Tied. In conjunction with a Building Permit.
C iso 111 tinn to the lidlumin,lnhlr mar/n-n oisvil 19.the hes erlar
No.of Recessed Luminaires No.of Cei1.-Susp.(Paddle)Fans 7 o.of Total
formers KVA
No.of Luminaire Outlets No,of[tot Tubs generators KVA
No.of Luminaires Swimming Pool
Above ❑ n- ❑ o.o ,mergcncy-7,g; rag S1
JS
�rnd. rnd. Itall_crl- Units
No.of Receptacle Outlets No,of Oil Burners I.1 RF AI 6t Nt!, I'm,of%tmrs
No.of Switches No.of Gas Burners •e41•Of butt-enol! and
Initiliing Drtic•e►
No.of RanT
Res No.of Air Cond. ota'Pons So.of Ali-cling I)e%ire••
No.of 114'astc Disposers eat ampumhcr Pons n:of ficl - ontain�d�
_ '1'utals: � Uc•Irrti_nui.Uartin�llcricr4
No.of Dishwashers 5 ace/Area Ileatin g KW Local �t►nurlg'al
Space/Area k ❑ Connection [-� tkbcr
Security, stems: In
No.of Dryers Heating Appliances KW tY y
No.of I/evicts ur F.yuival���l
ka.of Water , o.o _--�No.o
KW Ilatalt ming:
"eaters Signs No.of Devices or Foulvident
No.Ilydromassage Bathtubs No.of Motors Total lip
Telecommunications iWiring,
d No.of Devices or E uivalcot
OTH1N It: V
Allnrh additional detail it devirt-4 en•im n-ijuired hl•Nm h►sIn-vtor til 111u•es.
I:stimaled Value of Electrical Work: 12 r D 0� _ (When required by municipal policy.)
Work to Start: A.S.A.P, inspection%to be requested in accordance with MEc Itule ill,cold info%runlidrti(III
INSURANCE COVERAGE: !talcs.a awed by the owner.no pennit for the pert innance of electrical work map i%sur unless
the licensee provides proal tit 141111111V insu►anrr inc•ludinb A:oinplctcd opciatiutl-coverage or its Sul+gtauri►al ecluk alcrnl. 'I he
underrigued cert hies that quell coverage is in force,and has exhibited protil'of sank to clic permit issuing office.
(` 11111(ONE: INSURANCE Q MIND ❑ 0TI1FR 0 (Svc.•itv:)
I cerloy',tinder Noe pains and penattles of perjury,float floe inJnrmado i nn this applivalion is true and roonlytele.
l v��a FUM NAME: SOLARCITY CORPORATION I.W.NO.: 1136 MR -
nl,1 Licensee: Matthew T. Markham signature l r }_ LIC. Nt1.: 1136 MR
Com" (lt n/rllliwiI.1' "r>acnylt"in lilt,1&vc1►se number lou-./ Bus.Td.No.:774-258-8180
Address: 24 St. Martin Drive(Building 2/Unit 11).Mariborough,MA.01752 All.Tel.No.:774-258.8505
*Per M.O.l..e. 147,s.57-61,security work requires Dcpatlment of Public Safety"S"Lic nse: Lie.No.
_1 OWNER'S INSIiKANCE WAIVER: 1 um aware that the Liccnsw doev not/rate the liability insufatlec coverage 11arn1a11y
required by law, fly my signature be-low,l hereby waive this requirement. 1 am the(check tine)[I owner owner' t.
Owner/Agent
Signature ^___� 'Telephone No. PERMIT ME : S
z
t �
1
j1willMet of Consumer Aflaim d Rosiness Regulation
f}OMEIMPROVEMENT CONTRACTOR
Registration 168572 Type
Expirattnn 302015 Supplement
SOLARCITY CORPORATION
MATTHEW MARKHAM
24 ST MARTIN STREET BLD 2UN1 r.':.t•,.: __
UhLBOROUGH.MA 01752
Undersecretary
pMMONW JlCHU�F ITfi
T4s. `-'e_ ej • t +
ELECTRICIANS
ISSUES THE FOLLOWING LICENSE. AS A
REGISTERED MASTER ELECTRICIAN
SOLARC I T11 CORPORATION '�
MATTHEW T MARKHAM � .
24 SAINT MARTIN OR
BLDG 2 UNIT 11
MARLBOROUGH MA 01752-3060
r
f
The Commonwealth of Massachusetts
I Department of Industrial Accidents
Office of Investigations
I Congress Street,Suite 100
IS _�' Boston, MA 02114-2017
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Aonlicant Information Please Print Legibly
Name(Business/Organi2,ation/Individual): SOLARCITY CORP
Address:3055 CLEARViEW WAY
City/State/Zip: SAN MATEO,CA 94402 Phone #:886-765-2489
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 5000 -
4. E] I am a general contractor and 1
employees (full and/or part-time).* have hired the sub-contractors 6. C]New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y4. [1 Building addition
[No workers' comp. insurance comp. insurance;
required.] 5. ❑ We are a corporation and its 10.❑ 1?lectrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGI. I2.❑ Roof repairs
insurance required.] c. 152,§1(4),and we have no 13.®Other SOLAR I PV
employees. [No workers' -- -- —
camp. insurance required.]
$Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy information.
I Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit anew aff davit indicating such.
tContractars that check this box must attached an additional shat showing the name of the sub-contractors and state:whether or not those entities have
employees. If the sub•contraclors have employees,they must provide their workers'comp.policy number.
I ant an employer that Is providing workers'compensation insurance for my employees. Below Is the policy and job site
Information.
Insurance Company Namc:.LIBERTY MUTUAL INSURANCE COMPANY
Policy#or Self-ins. Lic. 0:WA7-66D-066265-024 _-- Expiration Datc:09/0112015
Job Site Address: y _ f _ _ City/State/I..ip: NCi-I'L.Rn
Attach a copy of the workers' compensation policy declaration Mage(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 avid a tine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Off icc of
Investigations of the DIA for insurance coverage verification.
do hereby cer1W tntder lite pains and enaltes of perjitry!hot the litformallon provided above is true and correct.
'
Slsl!€tlitre: l►atr /0-27—t((
r �..._ .
Phone#:
Qlylcial use only. Do net write in this area,to be completed by city or town official.
City or Town: _ Permit/License# i
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3.Cityfi'own Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
♦�l
DATE(MMIDDIYYYY)
ACORD
�' CERTIFICATE OF LIABILITY INSURANCE 08.%2014
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
MARSH RISK b INSURANCE SERVICES NAME
345 CALIFORNIA STREET,SUITE 1300 PMC ,NE EIA): _ __ FAX No):
CALIFORNIA LICENSE NO.0437153 ADDRESS,
SAN FRANCISCO,CA 94104 -
INSURER(S)AFFORDING COVERAGE NAIC a
998301-STND-GAWUE•14-15 INSURER A;LIb1Uty MUtual Fire Insurance Company 16586
INSUREDINSURER B:LIDOrIy Insurance Corpora6otl 42404
Ph(650)963.5100
SdarGty Corporation INSURER C:WA WA
3055 Cleavlew Way INSURER 0:
San Mateo.CA 94401
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 REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR TYPE OF INSURANCE DL OR i POLICY EFF POLICY EXP LIMITS
LTR POLICY NUMBER M MMIDDIYYYY
A GENERAL LIABILITY ( T82-661-066265-014 09}0112014 09101/2015 EACH OCCURRENCE. 6 1ADO'ow
X1
COMMERCIAL GENERAL LIABILITY PREMI ES(Es ocpW- encu) S AMAGE TO RENTED 100'000
1 CLAOAS•MADE I X I OCCUR MED EXP(Any ono person) i 10.000
1 1 PERSONAL R ADV INJURY !S 1,000-000
11 GENERAL AGGREGATE 1'S 2,000•000
GENL AGGREGATE LIMIT APPLIES PER. I PRODUCTS•COMPIOP AGG S 2,000.000
X POLICY( X PER LOC Deductible S 25,000
A AUTOMOBILE UABILITY AS2.661.066265044 09MI12014 109,10110115 �COMBINED SINGLE LIMIT 1��
(Es accident) S
X I ANY AUTO BODII Y INJURY(Per person) :S
ALL OWNED jSCHEDULED I BODILY INJURY(Per acc.dent)IS
AUTOSI NON
' '.PROPERTY DAMAGE
X f HIRED AUtOS ;AUTOSi
(Per aoca") S
X � �EO I �
X I Phys.Damage , COMPICOLL DED: S $1,000151.000
UMBRELLA UAB 'OCCUR I I T EACH OCCURRENCE f
EXCESS LIAB 1 CLAIMS MADE' ! I AGGREGATE S
I
U RETENtI N S
B WORKERS COMPENSATION I WA7.66D•066265-024 090112014 0910112015 X WG STATu• oTw
AND EMPLOYERS'LIABILITY { ,TORY LIMITS. ER ,
BANY �WCI661-066265034(WI} �09ro112014 09A112015 1,000,000
OFFICERIMEM ER EXCLUDED�LCUtIVE NIA EL EACH ACCIDENT S
B 1ManddM In NMI �WC DEDUCTIBLE:5350.000 (E L DISEASE•EA EMPLOYEE, $ 1.000,000
'4descnbe
CRIPTION unOFdoOPERATNS 'ow E 1. DISEASE POLICY LIMIT 1S 1.000.000
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Sehe",N more space Is required)
I vldelmof Insurance
CERTIFICATE HOLDER CANCELLATION
Solarcity Corporation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
3055 CloaNiewWay THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
San Mateo.CA 94407 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh Risk i Insurance Services
Charles Marmole)o c=-
0 1988-2010
©1988.2010 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.
I CURRENT 6. CIRCUITS OVER 250V TO GROUND SHALL
Imp CURRENT AT MAX POWER COMPLY WITH ART. 250.97, 250.92(B).
Isc SHORT CIRCUIT CURRENT 7. DC CONDUCTORS EITHER DO NOT ENTER
kVA KILOVOLT AMPERE BUILDING OR ARE RUN IN METALLIC RACEWAYS OR
kW KILOWATT ENCLOSURES TO THE FIRST ACCESSIBLE DC
LBW LOAD BEARING WALL DISCONNECTING MEANS PER ART. 690.31(E).
MIN MINIMUM 8. ALL WIRES SHALL BE PROVIDED WITH STRAIN
(N) NEW RELIEF AT ALL ENTRY INTO BOXES AS REQUIRED BY
NEUT NEUTRAL UL LISTING.
NTS NOT TO SCALE 9. MODULE FRAMES SHALL BE GROUNDED AT THE
OC ON CENTER UL—LISTED LOCATION PROVIDED BY THE
PL PROPERTY LINE MANUFACTURER USING UL LISTED GROUNDING
POI POINT OF INTERCONNECTION HARDWARE.
PV PHOTOVOLTAIC 10. MODULE FRAMES, RAIL, AND POSTS SHALL BE
SCH SCHEDULE BONDED WITH EQUIPMENT GROUND CONDUCTORS.
S STAINLESS STEEL
STC STANDARD TESTING CONDITIONS
TYP TYPICAL
UPS UNINTERRUPTIBLE POWER SUPPLY
V VOLT
VOLTAGE AT MAX
V cp VOLTAGE AT OPENPOWER CIIRCUIT VICINITY- MAP INDEX
W WATT
3R NEMA 3R, RAINTIGHT PV1 COVER SHEET
PV2 SITE PLAN
PV3 STRUCTURAL VIEWS
P 14 UPLIFT CALCULATIONS
LICENSE GENERAL NOTES ' PV5 THREE LINE DIAGRAM
i Cutsheets Attached
r
GEN #168572 1. ALL WORK TO BE DONE TO THE 8TH EDITION
ELEC 1136 MR OF THE MA STATE BUILDING CODE.
2. ALL ELECTRICAL WORK SHALL COMPLY WITH
Ben Liu
� o THE 2014 NATIONAL ELECTRIC CODE INCLUDING
,
MASSACHUSETTS AMENDMENTS. � �, •
MODULE GROUNDING METHOD: * --
AHJ: Lawrence REV BY DATE COMMENTS
�"�""�"�'"" REV A NAME DATE COMMENTS
UTILITY: National Grid USA (Massachusetts Electric) qtr t
JB-01 8116 6 0 0 PREMISE OWNER: DESCRIPTION: DESIGN:
CONFIDENTIAL — THE INFORMATION HEREIN X06 NUMBER: BLUMKIN, EUGENE BLUMKIN RESIDENCE Raymond Planas •
CONTAINED SHALL NOT E USED FOR THE =SolarCit
BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: 47 EMPIRE DR. LOT 24
NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C # 6.885 KW PV ARRAY '0,1 y
PART TO OTHERS OUTSIDE THE RECIPIENTS MooI,LEs: NORTH ANDOVER MA 01845
ORGANIZATION, EXCEPT IN CONNECTION HATH
THE SALE AND USE OF THE RESPECTIVE (27) CANADIAN SOLAR # CS6P-255PX 24 St. Martin Drive, Building 2, Unit 11
SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME: SHEET: REV: DATE: Marlborough, MA 01752
PERMISSION OF SOLARCITY INC. INVERTER' 617 590-5680 T. (650)638-1026 F: (650)638-1029
SOLAREDGE SE5000A—USOOOSNR2 COVER SHEET PV 1 10/14/2014 (666)-SOL-CITY(765-2469) www.solarcitycom
Ben Liu PITCH: 40 ARRAY PITCH:40
o MP1 AZIMUTH: 259 ARRAY AZIMUTH: 259
MATERIAL: Comp Shingle STORY: 2 Storie
PITCH: 40 ARRAY PITCH:40
MP2 AZIMUTH: 169 ARRAY AZIMUTH: 169
MATERIAL: Comp Shingle STORY: 1 Story
AC
Inv
AC
0
O D F. DC
Pitc
lo/
LEGEND
121 A 3
21Q (E) UTILITY METER & WARNING LABEL
O Inv INVERTER W/ INTEGRATED DC DISCO
& WARNING LABELS
DC DISCONNECT & WARNING LABELS
AC DISCONNECT & WARNING LABELS
m MP
Wilk
D. m Q DC JUNCTION/COMBINER BOX & LABELS
B ; ISTRurruRAL
No.47310 DISTRIBUTION PANEL & LABELS
S
NAL Lc LOAD CENTER & WARNING LABELS
O DEDICATED PV SYSTEM METER
STAMPED & SIGNED Q STANDOFF LOCATIONS
FOR STRUCTURAL ONLY CONDUIT RUN ON EXTERIOR
CONDUIT RUN ON INTERIOR
Digitally signed by Andrew White GATE/FENCE
Date: 2014.10.15 15:53:04-04'00' Q HEAT PRODUCING VENTS ARE RED
17-�'_1 INTERIOR EQUIPMENT IS DASHED
L_"J
SITE PLAN N
Scale: 1/8" = 1' W
0 1' 8' 16'
S
PREMISE OWNER: DESCRIPTION: DESIGN:
CONFIDENTIAL A THE INFORMATION HEREIN Ioe NUMBER: JB-0181166 0 0 Raymond Planas \�!r So�arC�t�
CONTAINED SHALL NOT BE USED FOR THE BLUMKIN, EUGENE BLUMKIN RESIDENCE Ym
NORBENEFIT OF SHALL IT BENE EXCEPT SOLARCITY DISCLOSED N WHOLE ORCIN Moon SYSTEM: 47 EMPIRE DR. LOT 24 6.885 KW PV ARRAY �'IN
Comp Mount Type C # '
PART TO OTHERS OUTSIDE THE RECIPIENTS NORTH ANDOVER MA 01845
ORGANIZATION, EXCEPT IN CONNECTION WITH MODULES r 24 St. Martin Drive, Building 2, Unit 11
THE SALE AND USE OF THE RESPECTIVE (27) CANADIAN SOLAR # CS6P-255PX PAGE 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. SOLAREDGE SE5000A—US000SNR2 (617) 590-5680 SITE PLAN PV 2 10/14/2014 (ees)-sa-clTr(7ss-lass) www.solarcity.
Ben Lig
Sy qNIr, EW
WIIITE
STRUCTURAL
Na-473'10
l$1'E �e
S 1 NAL
S1
STAPED & SIGNED
FOR STM UC UR L ONLY
(E) LBW - 12'-2"
(E) LBW
A SIDE VIEW OF MP1 NTS SIDE VIEW OF MP2 NTS
0
D
MPI X-SPACING X-CANTILEVER Y-SPACING Y-CANTILEVER NOTES
LANDSCAPE 64" 24" STAGGERED
MP2 X-SPACING X-CANTILEVER Y-SPACING Y-CANTILEVER NOTES
PORTRAIT 64" 20"
LANDSCAPE 64" 24" STAGGERED
PORTRAIT 1 64" 20"
RAFTER 2X10 @ 16"OC ROOF AZI 259 PITCH 40 STORIES: 2 ROOF AZI 169 PITCH 40
ARRAY AZI 259 PITCH 40 RAFTER 2X10 @ 16"OC ARRAY AZI 169 PITCH 40 STORIES: 1
C.I. 2x12 @16"OC Comp Shingle C.I. 2x10 @16"OC
I, Comp Shingle
PV MODULE
5/16" BOLT WITH LOCK INSTALLATION ORDER
& FENDER WASHERS
LOCATE RAFTER, MARK HOLE
ZEP LEVELING FOOT (1) LOCATION, AND DRILL PILOT
ZEP ARRAY SKIRT (6) HOLE.
(4) (2) SEAL PILOT HOLE WITH
ZEP COMP MOUNT C POLYURETHANE SEALANT.
ZEP FLASHING C (3) (3) INSERT FLASHING.
(E) COMP. SHINGLE
(1) (4) �PLAC�EMOU�NT �
(E) ROOF DECKING u (2) u INSTALL LAG BOLT WITH
5/16" DIA STAINLESS (5) (5) SEALING WASHER.
STEEL LAG BOLT
WITH SEALING WASHER LOWEST MODULE SUBSEQUENT MODULES (6) INSTALL LEVELING FOOT WITH
(2-1/2" EMBED, MIN) BOLT & WASHERS.
(E) RAFTER STANDOFF
SScale: 1 1/2" = 1'
CONFIDENTIAL — THE INFORMATION HEREIN JOB NUMBER: JB-01 8116 6 0 0 PREMISE OWNER: DESCRIPTION: DESIGN:
CONTAINED SHALL NOT E USED FOR THE BLUMKIN, EUGENE BLUMKIN RESIDENCE Raymond Planas , ■
BENEFIT OF ANYONE EXCEPT IN MOLE INC., MOUNTING SYSTEM: SO�arClt
NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 47 EMPIRE DR. LOT #24 6.885 KW PV ARRAY .I"� y
PART TO OTHERS OUTSIDE THE RECIPIENTS NORTH ANDOVER, MA 01845
ORGANIZATION, EXCEPT IN CONNECTION WITH MODULES
THE SALE AND USE OF THE RESPECTIVE (27) CANADIAN SOLAR # CS6P-255PXSOLARC24 Si. Martin Drive, Building 2, Unit 11
PERMISSION
EQUIPMENT, WITHOUT THE WRITTEN INVERTER: PAGE NAME: SHEET: REV: DATE: Marlborough,MA 01752
PERMISSION OF SOLARCITY INC. SOLAREDGE SE5000A—USOOOSNR2 (617) 590-5680 STRUCTURAL VIEWS PV 3 10/14/2014 T: (650)638-1028 F: (650)638-1029
(888)-SOL-CITY(765-2489) www.solarcity.com
Ben Li(
UPLIFT CALCULATIONS
SEE SEPARATE PACKET FOR STRUCTURAL CALCULATIONS.
PREMISE OWNER:
DESCRIPTION: DESIGN:
■
CONFIDENTIAL — THE INFORMATION HEREIN JOB NUMBER: JB-01 81166 00 BLUMKIN EUGENE BLUMKIN RESIDENCE Raymond Plonas '�,`SolarC�t`
CONTAINED SHALL NOT BE USED FOR THE �1d
BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: 47 EMPIRE DR. LOT #24 6.885 KW PV ARRAY
NOR PART�TO OTHERS OUTSIDEALL IT BE ED IN VMOLE THE RECIPIENT'S IN Comp Mount Type C
ORGANIZATLON, EXCEPT IN CONNECTION WITH MODUL NORTH ANDOVER, MA 01845 24 St. Martin Drive, Building 2 Unit 11
THE SALE AND USE OF THE RESPECTIVE (27) CANADIAN SOLAR # CS6P-255PX SHEET: REV DATE: Marlborough,38-128MA 50)
SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME T: (850)838-1028 F: (850)838-1029
PERMISSION OF SOLARCITY TY INC. INVERTER: (61 7) 590-5680 UPLIFT CALCULATIONS PV 4 10/14/2014 (888)—SOL—CITY(785-2489) www.solarcity.
SOLAREDGE SE5000A-USO00SNR2
GROUND SPECS MAIN PANEL SPECS GENERAL NOTES INVERTER SPECS MODULE SPECS LICENSE
BOND (N) #8 GEC TO TWO RSI GROUND Panel Number: Inv 1: DC Ungrounded INV 1 -(1)SOLAREDGE ##SE5000A-USOOOSNR LABEL: A -(27)CANADIAN SOLAR # CS6P-255PX GEN #168572
ODS AT PANEL WITH IRREVERSIBLE CRIMP Meter Number:44842592 Inverter; 5000W, 240V, 97.59'; w/,Unifed Disco and ZB,RGM,AFCIPV Module; 255W' 2343W PTCBlack FraMC4ZEP EELEC 1136 MR
, . , me, , Enabled Underground Service Entrance INV 2 Ben Liu
INV 3
Voc: 37.4 Vpmax: 30.2 re- c
E 200A MAIN SERVICE PANEL
Isc AND Imp ARE SHOWN IN THE DC STRINGS IDENTIFIER h,CU
E 20OA/2P MAIN CIRCUIT BREAKER
(E) WIRING Inverter 1
CUTLER-HAMMER CUTLER-HAMMER
200A/2P Disconnect Disconnect 4 SOLAREDGE
(E) LOADS C C SE5000A-USOOOSNR2
24OV SQUARE D SolarCity
Lt
L2 RoofTop Disconnect 1 2
DC+
30A/2P " B 3 A Dc- MP1,MP2: 1x16
I ---- GND - ---- GND ------------------------- EGC/ DC+ D31) c+ - MP1,MP2: 1X11 -
I B I GEC ---Ll
DC
LJ�DC-
------------- -- -------- - '---- EGC ---------- --
- ----- --
N
~ o EGC/GEC
1
I I
I 1
- GEC-r- 1
TO 120/240V 1 I
SINGLE PHASE I I
UTILITY SERVICE 1
I I
1 I
I I
I I
I I
i, PHOTO VOLTAIC SYSTEM EQUIPPED WITH RAPID SHUTDOWN
I
Voc* = MAX VOC AT MIN TEMP
POI (1)MURRAY #MP230 PV BACKFEED BREAKER C (2)CUTLER-HAMMER #DG221UR6 ^C (1)SQUARE D # HU362R8
Breaker; 30A/2P, 2 Spaces Disconnect; 30A, 240Vac, Non-Fusible, NEMA 3R A u Disconnect; 60A, 60OV, NEMA 3R A -(1)SolarCi,! ,p 4 STRING JUNCTION BOX D�
-(2)Ground Rod; 5/8' x 8', Copper -(2)CUTLER-{1AMMER #DG030NB 2x2 STRfNGS, UNFUSED, GROUNDED
Ground eutral it; 30A, General Duty(DG)
PV127)SOLAREDGE30D-2NA4AZS
PowerBox ptimizer, 300% H4, DC to DC, ZEP
nd (1)AWG #6, Solid Bare Copper
-(1)Ground Rod; 5/8' x 8', Copper
(N) ARRAY GROUND PER 690.47(D). NOTE: PER EXCEPTION NO. 2, ADDITIONAL
ELECTRODE MAY NOT BE REQUIRED DEPENDING ON LOCATION OF (E) ELECTRODE
®� 1 AWG #10, THWN-2, Black 1 AWG #8, THWN-2, Black Voc* =500 VDC Isc =30 ADC 2)AWG #10, PV WIRE, Black Voc* =500 VDC Isc =15 ADC
IAF (1)AWG #10, THWN-2, Red O (1)AWG #8, THWN-2, Red Vmp =350 VDC Imp=19.42 ADC O (1)AWG #6, Solid Bare Copper EGC Vmp =350 VDC Imp=11.51 ADC
II��LL(1)AWG #10, THWN-2, White NEUTRAL Vmp =240 VAC Imp=20.83 AAC L-L(1)AWG #10, TIiWN-2,.Green EGC. . -(1)Conduit.Kit; 3/4' EMT
7-MMP �. .
#B,,TI{WN-2,.Green . EGC/GEC,-(1)Conduit.Kit;,3/4'.EMT. . (2}AWG #10, PV WIRE, Black . . . Voc* =500 VDC Isc =15 ADC
O (1)AWG #6, Solid Bare Copper EGC Vmp =350 VDC Imp=7.91 ADC
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CONFIDENTIAL - THE INFORMATION HEREIN FNUMBER: B-018116 6 O O PREMISE OWNER: DESCRIPTION: DESIGN:
CONTAINED SHALL NOT E USED FOR THE BLUMKIN, EUGENE BLUMKIN RESIDENCE Ra •NOR SH OF ANYONE EXCEPT SOLWHOLE INC., ymOnCl PlanaSSolarC�tNOR SHALL IT BE DISCLOSED IN WHOLE OR IN Type C 47 EMPIRE DR. LOT #24 6.885 KW PV ARRAY �iPART TO OTHERS OUTSIDE THE RECIPIENTS „ yORGANIZATION, EXCEPT IN CONNECTION WITH NORTH ANDOVER, MA 01845
THE SALE AND USE OF THE RESPECTIVE (27) CANADIAN SOLAR # CS6P-255PX 24 St. Martin Drive, Building 2, Unit 11
PERMISSION
EQUIPMENT, WITHOUT THE WRITTEN INVERTER: PAGE NAME: SHEET: REV: DATE: Marlborough, MA 01752
PERMISSION of soIARGITY INC. SOLAREDGE SE5000A-USOOOSNR2 (617) 590-5680 THREE LINE DIAGRAM PV 5 10/]14/2014T. (650)638-1028 F: (650)638-1029
(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: 47 Empire Dr. Lot #24
I I
1 I
I 1
DC 1 I
1 I
L J
DISCONNECT
AC
DISCONNECT
INVERTER AND r-- ----------
DC DISCONNECT
I I
I I
AC L----------------
DISCONNECT
UTILITY
SERVICE I SOLAR PHOTOVOLTAIC ARRAYS) 1
- -------------------------
--------------------- — J
PHOTOVOLTAIC BACK-FED CIRCUIT BREAKER IN MAIN ELECTRICAL PANEL
IS AN A/C DISCONNECT PER NEC 690.17
OPERATING VOLTAGE = 240V
JB-0181166 0 0 PREMISE OWNER: DESCRIPTION: DESIGN:
CONFIDENTIAL — THE INFORMATION HEREIN TOB NUMBER: BLUMKIN EUGENE BLUMKIN RESIDENCE Raymond Planus "\� SolarCit,
CONTAINED SHALL NOT BE USED FOR THE !'A
BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: 47 EMPIRE D R. LOT #24 6.885 KW PV ARRAY
NOR SHALL IT BE DISCLOSED IN WHOLE OR IN COMPMount Type C
PART TO OTHERS OUTSIDE THE RECIPIENTS n' NORTH ANDOVER, MA 01845
ORGANIZATION, EXCEPT IN CONNECTION WITH MODULES: 24 St. Martin Drive,Building 2 Unit 11
THE SALE"AND USE OF THE RESPECTIVE (27) CANADIAN SOLAR # CS6P-255PX PAGE NAME SHEET: REV DALE Marlborough,38-128MA 50)
r SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: T. (650)638-1028 F: (650) 638-102f
PERMISSION of SOLARCITY INC. SOLAREDGE SE5000A—USOOOSNR2 (617) 590-5680 SITE PLAN PLACARD PV 6 10/14/2014 (m)—SOL-CITY(ass-2aas) .>:OIar�Itr.
•
solar - e • ! solar=ee SolarEdge Power Optimizer
Module Add-On for North America
P300 / P350 / P400
SolarEdge Power Optimizer
P300 P350 P400
Module Add-On For North America (for 60 cell PV (for 72-cell PV (for 96 cell PV
modules) modules) modules)
P300 / P350 / P400 • INPUT
.,Rated Input DC Power" 300......................350...,.....,.,..........400_.......,
..Absolute Maximum Input Voltage(Voc at lowest temperature) 48 60 80 Vdc
............... ... ................................. ........ ..........
MPPT Operating Range.............................................. .........8 48 .......8. 60 ...$..80 .....I. ...Vdc..
• Maximum Short Circuit Current(Isc)................................. ........................................10................................I....... ...Adc.....
Maximum DC Input Current 12.5 Adc
............................................................................... ...................................... . ....
Maximum Efficiency .....................................99:5 ....%......
....................
........................................
WeightedEfficiencY...........................................................................................9a:8....................................................
Overvoltage Category I it
OUTPUT DURING OPERATION(POWER OPTIMIZER CONNECTED TO OPERATING INVERTER)
_ Maximum Output Current 15 Adc
Maximum Output Voltage 1 60 Vdc
•
OUTPUT DURING STANDBY(POWER OPTIMIZER DISCONNECTED FROM INVERTER OR INVERTER OFF)
Safety Output Voltage per Power Optimizer
STANDARD COMPLIANCE
+ EMCFCC Part15 Class B,IEC61000-6-2,IEC61000-6-3
.............................................................................. ................................................................................... .............
Safety IEC62109-1(class II safety),UL1741
RoHS Yes
INSTALLATION SPECIFICATIONS
Maximum Allowed System Voltage 1000 Vdc
Dimensions(W xLx H) 141x212 x40.5/S.SSxS.34x1.59 mm/in
................................................ ................................................................................... .............
Weight(including cables) 950/2.1 gr/Ib
................................................................ .......................................................................I........... ...... .....
Input Connector MC4/Amphenol/Tyco
Output Wire Type/Connector Double Insulated;Amphenol
......................................................................... .
Output W ire Length........................................................... :95./.3: .......I.......................1V.2!:? h....
Operating Temperature Range........................................ ..............................40-+85/,-40:+185............................. ..:V.,11
F...
Protection Rating IP65/NEMA4
Relative ................................. .
Humidity .................................... .....................................:. ....%......
-ed STC power or the module.Module of up to v5%power�ole[an[e allowed.
PV SYSTEM DESIGN USING A SOLAREDGE SINGLE PHASE THREE PHASE THREE PHASE
INVERTER 208V 480V
PV power Optimization at the module-leve( Minimum StringLength(PowerOptimizers) 8 10 18
..................................... ...................................................... ........................................
Up to 25%more energy Maximum String Length(Power Optimizers) 25 25 50
.........................................................................
..... ...................................................... ..............I.........................
Maximum Power per String 5250 6000 12750 W
- Superior efficiency(99.5%) .......................................................................... ............
Parallel Strings of Different Lengths or Orientations Yes
- Mitigates all types of module mismatch losses,from manufacturing tolerance to partial shading """"""""""""'"""""""""'""" '"'
— Flexible system design for maximum space utilization
— Fast installation with a single bolt -
- Next generation maintenance with module-level monitoring
— Module-level voltage shutdown for installer and firefighter safety
USA - GERMANY - ITALY - FRANCE - JAPAN - CHINA - ISRAEL - AUSTRALIA www.solaredge.us
i
CS6P-235/240/245/250/255PX
ge eSA11 0�f Black-framed
*00.0 �r CanadianSolar Electrical
CS6P•235P CS6P-240PXCS6P-245P CS6P-25OPXCS6P-255PX Temperature Characteristics
01e� � STC
Nominal Maximum Power (Pmax) 235W 240W 245W 250W 255W Pmax -0.43%/°C
Optimum Operating Voltage(Vmp) 29.BV 29.9V 30.OV 30.1V 30.2V Temperature Coefficient Voc -0.34%rC
NewEdge Optimum Operating Current(Imp) 7.90A 8.03A 8.17A 8.30A 8.43A
Isc 0.065%/C
Open Circuit Voltage(Voc) 36.9V 37.OV 37.1V 37.2V 37.4V Normal Operating Cell Temperature 4512°C
Short Circuit Current(Isc) 8.46A 8.59A 8.74A 8.87A 9.00A
Black-framed Module Efficiency 14.61% 14.92% 1 15.23% 15.54% 15.85%
Performance at Low Irradiance
Operating Temperature -40°C-+85°C
• Maximum System Voltage 1nnnv IEC Maximum Series Fuse Rating 15A 1600V UL °/a Industry leading performance at low irradiation
environment,+95.5 module efficiency from an
23 '
Class A irradiance of 1000w/m'to 200w/m'
Application Classification (AM 1.5,25'C)
Power Tolerance 0-+5W
Next Generation Solar Module Under Standard Test Conditions(STC)ofirradianceof1000W1m',spectrumAM1.5andcelltemperatureof25'C Engineering Drawings
NewEdge,the next generation module designed for multiple NOCT CS6P-235PX CS6P-240PXCS6P-245PX CS6P-250PX CS6P-255PX
types of mounting systems,offers customers the added Nominal Maximum Power (Pmax) 170W 174W 178W 181W 185W
value of minimal system costs,aesthetic seamless Optimum Operating Voltage(Vmp) z7.2V 27.3V 27.4V 27.5V A
.71
Optimum Operating Current(Imp) 6.27A 6.38A 6.49A 6.60A 66.71A
appearance,auto groundingand theft resistance. Open Circuit voltage(Voc) 33.9V 34.OV 34.1V 34.2V 34.4V
Short Circuit Current(Isc) 6.86A 6.96A 7.08A 7.19A 7.29A
r'I The black-framed CS6P-PX is a robust 60 cell solar module Under Normal Operating Cell Temperature,Irradiance of 800 W/m',spectrum AM 1.5,ambient temperature 20'C,
incorporating the groundbreaking Zep compatible frame. wind speed 1 m/s
The specially designed frame allows for rail-free fast Mechanical Data
installation with the industry's most reliable grounding Cell Type Poly-crystalline 156 x 156mm,2 or 3 Busbars
system.The module uses high efficiency poly-crystalline Cell Arrangement 60(6 x 10)
silicon cells laminated with a white back sheet and framed Dimensions 1638 x 982 x 40mm(64.5 x 38.7 x 1.571n)
Key Features with black anodized aluminum.The black-framed CS6P-PX 20.5kg(45.2 lbs)
Weight
Quick and easy to install - dramatically is the perfect choice for customers who are looking for a high Front Cover 3.2mm Tempered glass
• reduces installation time quality aesthetic module with lowest system cost. Frame Material Anodized aluminium alloy
J-BOX IP65,3 diodes 912
• Lower system costs - can cut rooftop Best Quality Cable 4mm'(IEC)/12AWG(UL),1000mm
installation costs in half . 235 quality control points in module production Connectors MC4 or MC4 Comparable I
• Aesthetic seamless appearance - low profile • EL screening to eliminate product defects Standard Packaging(Modules per Pallet) 24pcs
with auto leveling and alignment • Current binning to improve system performance Module Pieces per container(40 It.Container) 672pcs(40'HO)
• Accredited Salt mist resistant
I-V Curves (CS6P-255PX)
• Built-in hyper-bonded grounding system - if it's
1a I
mounted,it's grounded Best Warranty Insurance
• 25 years worldwide coverage 9 s Section A-A ___ __ --
•
• Theft resistant hardware 100%warranty term coverage r
135.D
• Ultra-low parts count - 3 parts for the mounting Providing third party bankruptcy rights 1
{
• Non-cancellableI I
and grounding system Ir ' qa�
I ' '
• Immediate coverage
• Industry first comprehensive warranty insurance by Insured by 3 world top insurance companies AM Best rated leading insurance companies in the
world Comprehensive Certificates -4_-
t5
• Industry leading plus only power tolerance:05W . IEC 61215,IEC 61730, IEC61701 ED2,UL1703,
• Backward compatibility with all standard rooftop and CEC Listed,CE and MCS -
ground mounting systems • IS09001:2008:Quality Management System Specifications included in this datasheel are subject to change without prior notice.
. ISO/TS16949:2009:The automotive quality
management system About Canadian Solar
a
• Backed Our New 10/25 Linear Power Warranty . IS014001:2004:Standards for Environmental
Plus our added 25 year insurance coverage Canadian Solar is one of the world's largest solar Canadian Solar was founded in Canada in 20 an was
management system
companies. Ass a leading vertically-integrated successfully listed on NASDAQ Exchange (symbol:
: CSIQ) in
100% • QC080000 HSPM:The Certification for manufacturer of ingots,wafers,cells,solar modules and November 2006. Canadian Solar has module manufacturing
97% Added value F Hazardous Substances Regulations solar systems, Canadian Solar delivers solar power capacity of 2.05GW and cell manufacturing capacity of 11.3131W.90% romWarranty OHSAS 18001:2007 International standards for
• products of uncompromising quality to worldwide
customers. Canadian Solar's world class team of
80% occupational health and safety professionals works closely with our customers to
HeadqUarters 1545 Speedvale Avenue West
0% 0 REACH Compliance provide them with solutions for all their solar needs.
5 10 18 2U 25GUelOntario
Tek+1 519 837!py, fes. �{wo�ircu'~. ."-.T.r 519 837 • it
• 10 year product warranty on materials and workmanship 0 aE y; SP,(E \"' _ $ v - -
•25 year linear power output warranty www•canadiansolar.com
EN-Rev 70.17 Copyright m 2012 Canadian Solar Inc.
SolarOlty SleekMountTM - Comp SolarCity SleekMountTM - Comp
• Utilizes Zep Solar hardware and UL 1703 listed Installation Instructions
The SolarCity SleekMount hardware solution < t
is optimized to achieve superior strength and Zep CompatibleTM modules
` \ `, O Drill Pilot Hole of Proper Diameter for
aesthetics while minimizing roof disruption and . 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 / _ 0 Seal pilot hole with roofing sealant i
of array trim and a lower profile all contribute • Interlock and Ground Zep ETL listed to UL 1703
as"Grounding and Bonding System" � 0 Insert Comp Mount flashing under upper
to a more visually appealing system.SleekMount layer of shingle
utilizes Zep Compatible TM modules with •Ground Zep UL and ETL listed to UL 467 as
strengthened frames that attach directly to grounding device ® Place Comp Mount centered
Zep Solar standoffs, effectively eliminating the upon flashing
need for rail and reducing the number of • Painted galvanized waterproof flashing
O Install lag pursuant to NDS Section 11.1.3
standoffs required. In addition, composition •Anodized components for corrosion resistance
shingles are not required to be cut for this \ with sealing washer.
system, allowing for minimal roof disturbance. •Applicable for vent spanning functions © Secure Leveling Foot to the Comp Mount
I
using machine Screw
low 0 Place module
® Components
1® 5/16" Machine Screw _
® Leveling Foot O
O Lag Screw
IS
® Comp Mount
© Q Comp Mount Flashing
0 0�
® 0 I
I
.
Q`v. Q .:,..:Solar�ity® January
SolarCityEta �� LISTED •��January 2013 �pMppn W
Janua 2013
WARNNG;PHOTOVOLTAIC POWER SOURCE �' ' - •" • - • _ ,_ , _ ,
WARNING WARNING '
• ELECTRIC SHOCK HAZARD •• -
•• •
DO NOT TOUCH TERMINALS ELECTRIC SHOCK HAZARD
DC CONDUCTORS OF THIS
•- • - • TERMINALS ON BOTH LINE AND PHOTOVOLTAIC SYSTEM ARE • :
PHOTOVOLTAIC DC LOAD SIDES MAY BE ENERGIZED UNGROUNDEDAND
_ MAY BE ENERGIZED
DISCONNECT IN THE OPEN POSITION . .
MAXIMUM POWER- WARNING
POINT CURRENT(Imp) A .- • _ INVERTER OUTPUT • •
MAXIMUM POWER- CONNECTION
POINT VOLTAGE(Vmp)_V •• DO NOT RELOCATE
MAXIMUM SYSTEMTHIS OVERCURRENT
VOLTAGE (Voc)_V DEVICE
SHORT-CIRCUIT
_A
CURRENT(Isc)
PHOTOVOLTAIC POINT OF '•
INTERCONNECTION
WARNING WARNING: ELECTRIC SHOCK •
_ HAZARD. DO NOT TOUCH ' •• '
ELECTRICAL SHOCK HAZARD TERMINALS, TERMINALS ON
DO NOT TOUCH TERMINALS •' BOTH THE LINE AND LOAD SIDE
TERMINALS ON BOTH LINE AND MAY BE ENERGIZED IN THE OPEN
LOAD SIDES MAY BE ENERGIZED POSITION. FOR SERVICE
IN THE OPEN POSITION DE-ENERGIZE BOTH SOURCE
DC VOLTAGE IS
AND MAIN BREAKER,ALWAYS PRESENT WHEN PV POWER SOURCEMAXIMUM AC
SOLAR MODULES ARE OPERATING CURRENT A
EXPOSED TO SUNLIGHT
MAXIMUM AC
OPERATING VOLTAGE V
WARNING . . .
ELECTRIC SHOCK HAZARD
'_ '• _
IF A GROUND FAULT IS INDICATED Sol CAUTION PHOTOVOLTAIC SYSTEM
CONDUCTORS MAY BE �•
NORMALLY GROUNDED CIRCUIT IS BACKFE E • •' '
UNGROUNDED AND ENERGIZED
CAUTION '•
PHOTOVOLTAIC AC • DUAL POWER SOURCE - •■ - • _
DISCONNECT •• ' SECOND SOURCE IS ,., •, . ,
•. PHOTOVOLTAIC SYSTEM • •
MAXIMUM AC A ' '• _ - _• •
OPERATING CURRENT ._ •• _ •I•
MAXIMUM AC ••,
OPERATING VOLTAGESC V
• • Label Set ■■ ■mm■ ■uu■■
� � � ' * unmm��nnl■■!���In■�mmn�■ uuluu�wlouu■
(o IZ
Date.& ................
..................
OF NOa7h,�
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
ss�►cHU
This certifies that -�`��- 115/ '
has permission to perform .................�/V`0 � ``zk- (rJn�CL-A`�.V. SS►�D+`^
wiring in the building of.........�`U V'(`��
_ ..... ......................................................................
at ..........�......�hn � �IP v L.....................41olh Andover,Mass.
�• Fee....:a.-�?. ........Lic. No Z�I.4. N.V.
....... ........ .. ..�I�S
EL OR
Check#
! `� r
ts.
k�
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(IvIEC),527 CMR 12.00
(PLEASE PRINT ININK OR TYPE ALL)NFORMATIOA9 Date: 6 -26 - l Y
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) q 7 b r'. 1V&,-,1A o/
�✓1 nvP/
Owner or Tenant t Rlym k.'n Telephone No.
Owner's Address q7 F-14''c O r , Ala--A
Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
- Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: _ Pka s,-m e✓7 >!' F,'-i.'5
S
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- El
o Emergency ig ting
rnd. rnd. Battery Units
No.of Receptacle Outlets IS- No.of Oil Burners FIRE ALARMS No. of Zones
No.of SwitchesNo.of Gas Burners No. of Detection and
Initiatin Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices r
Tons �
No. of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: "'" ' ......"'...""""' Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection �—
No.of Dryers Heating Appliances KW Security Systems:''
No.of Devices or Equivalent
No.of Water KW No.of No. of Data Wiring: f
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or E uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated'Value of Electrical Work: d 0 (When required by municipal policy.)
Work to Start: 6- 1S-/y 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 tZ BOND ❑ OTHER ❑ (Specify:)
I certify,iinder the pains and penalties ofperjury,that the information on this application is true and complete.
FIRM NAME: . LIC.NO.:
Licensee: A1:115 Signature LIC.NO.: y D 7 y
(If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: 508' 713-3 frT S'
Address: ? e 0. tVort r54{✓ /11J. 01609 Alt.Tel.No.:
*Per M.G.L c. 147,s.57-6 1,security work requires Department of Public Safety"S"License: Lic.No.
�
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE: $ '!�5
Signature Telephone No.
+4
❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the'"
a
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed
on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166,§32,an '
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L.c.143,§3L.
Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written
application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With
limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was
"in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012.
❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑
❑Permit Extension Act—Permit/Date Closed:
Trench Inspection
Pass Failed Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
SERVICE INSPECTION:
Pass 1E Failed Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
PARTIAL ROUGH INSPECTION:
Pass 2 Failed Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
ROUGH INSPEC ION:
i
Pass M Failed 0 Re-Inspection Required($.) ❑
Inspectors Comments:
Inspectors Signature: Date:
FINAL INSPECTN:
Pass 0 Failed Re-Inspection Required($.) ❑
Inspectors Comm is
Inspectors Signature: Date:
DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com
p r
F
The Commonwealth of Massachusetts -
Department oflndustriglAccitlents
Office of Investigations
600 Washington Street
Boston,AVIA.02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): ID-n 1 e,ll S
Address: ? ���r9�FJQ S1, L,)rrCPS 4r1_• /x'1,4. 01602-
City/State/Zip: W o f t e S AA 6160 D. Phone ih S d 9 713 - 3 5 T S
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction
employees(fulland/or part-time).* have hired the sub-contractors
2.® lam a sole proprietor or partner- listed on the attached sheet.? �• Remodeling
ship and'have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their ME]Electrical repairs or additions
3.❑ I am a homeowner,doing all work right of exemption per MGL 1 L Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roofrepairs
insurance required.]t employees.[No workers' 13.❑Other
comp.insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
T Homeowners who submit this affidavit indicating they hire doing all work and then hire outside contractors must submit anew 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.
lain an employer that is providing workers'compensation insurance for my employee3: Below is the policy and job site
information.
Insurance Company Name:.
Policy#or Self-ins.Lic.#: ExpirationDate:
'Tob 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 requiredunder 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 maybe forwarded to the Office of
investigations of the DIA for insurance coverage verification.
Ido laereby cer i under the pains and penal ies ofperjury that the information provided above is true and correct. -
Sim Date: - 96- /Y
Phone#• SG R- 713- 3 V 5-5-
Official
SOfficial use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other - -
Contact Person: Phone#:
Information and Instructi®lIls
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 1
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LL C or LLP does have
employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents for confnmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only.submit one affidavit indicating current
policy information(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 bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Conmozawealth ofMassach-usetts
Depafteat offadustdal Accidents
0ftice of Investigations
600 Washington Street
Boston}MA 02111
Tel,#617-727-4900 eyt 406 or 1-877�MASSAFB
Revised 5-26-05 Fax W 617-727-7749
ZTFCSFCSF rr»nn rsnts�a::..
Please visit our web site at http:://www.mass.gov/dpi/boards/EL
DALE L MILLS JR
(EL)
7 FIRGLADE STREET
WORCESTER MA 01602=1228
r
Fold,Then Detach Along All Perforations
COMMONWEALTH OF MAS"CHUS TTS
• Kj W Leioin U.-rela mm •
BOARD OF
E L E CTR I C I ANS': "'
ISSUES THE FOLLOWING LICENSE:
AS A;;REG JOURNEYMAN ELECTRICIAN 1�
is
;z
,c
7 F I RGLADE STREET lui
WORCESTER MA 01602-1228
C
7 4 L J Date..l. lG
NORTH
06 TOWN OF NORTH ANDOY9R
PERMIT FOR GAS INSTALATION
ACMUSE�
This certifies that . . . .l,'�.���t!t!lf ?. �• . . . . . . .
has permission for gas installation . . .�`�!�► .r.!, -. . . . .
in the buildings of . . . °t. . . . . . . V!.
` /
� • . : . . . . . . . . .
at . . . . . 't�.LY�. . . . �. . . ., North dover, as
``(( 8.
Fee. ./. . . . Lic. No.J6.�.:T.
GAS INSPECTOR
Check#
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
f
Cityffown: MA. Date: 18 Permit#
Building Location: 14r? IEVAPA i-C hi—Lk— Owners Name: .a IF
v t�1 rY�
Type of Occupancy: Commercial ❑ Educational❑ Industrial❑ Institutional❑ Residential [�
New: E Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No❑
FIXTURES
U) vi
UJ W
Z <Q t!1 U = Q
m = O w UJ U w �_ O = Ix w
0 -j } N O w X
Z W w Z tY W 0 � �
O W Q m o D ui O Q t—
> N U Z W t7 Q U) 0 d Q _ _X
H w Q w w ~ p u_
Uj
> V w Z O -� t` H O z (9 u_ w i— w w
z UJ• UO 0 O (9 t9 2 = n > O Q O w Z Z W Q H
SUB BSMT.
BASEMENT
1 FLOOR
2 FLOOR
3 FLOOR
4 FLOOR
-5'FLOOR
6 FLOOR
-i'FLOOR
8 FLOOR
�� Check One Only Certificate#
Installing Company Name: �✓►�+ 1 �' � � c>Q�P �-b
/� f ' CCorporation
Address.V w\A 17 O i Cityrrown: LL State: M A
- - -]Partnership -
--
BusinessTel: 7�` 3��(-1343 Fax: n71- 5 X13,'
Firm/Company
Name of Licensed Plumber/Gas Fitter: S'T£V"ASv-�.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes t�O No❑
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy V Other type of 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 General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and
accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General taws.
FGIas
of License:
13y umber
Title Fitter of of 1-censed Plum r Gas Fitter
Master
City/Town Lijoumeyman License Number:
APPROVED OFFICE USE ONLY ❑LP Installer
8725 Date.,� , rll'�
1+ <40RT:'tio TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
s +
• , •
,ssACMUs� /n (
This certifies that . . 6x .� . . . . . _ �.! . . . . . . . . . . .
has permission to perform `. .( . . . . . . . . .
plumbing in the buildings of . .(J'? ti4 V, v--.v--: . .
at ... .� . . . . �(e. . . . . . . . ., North Andover, s.
ee.44�` t
0� .� Lic. No.. tQ 5 . . . . . . . .."+! �. .
PLUMBING INSPECTOR
Check # 2
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City/Town: tlto" MA. Date:-10 -20- 10 Permit#
Building Location:_ �`I 1 L (� Owners Name:
Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential(✓]�
New: Alteration:❑ Renovation: ❑ Replacement:❑ Plans Submitted: Yes ❑ No
FIXTURES
DEDICATED
cc z SYSTEMS
W z
C! �
WV
Y O
,6n Y Q v ~ zCr
Z a W Q D z cc W z H N Z O Q Q LULU
Q N N W
m cc > Q Y �, ° X = J a 3
Q O Q 0 Q z 0 W W z W J z V d LL
LL 3 0 d' 3 W o 0 'n J Q ¢ oc z W
Q Y = = a O = z Q LL 3 a Y = W W W I } 1-
V ~ N h ~ z z Q Q Q = to W Q Q
Q m m o o LL = Y J J 3 3 3 o a l9 3
SUB BSMT.
BASEMENT
1'FLOOR + I
21dD FLOOR
3i0 FLOOR
47H FLOOR
5'FLOOR
6'FLOOR
7'FLOOR
8"'FLOOR
rr ,,II Check One Only Certificate#
Installing Company Name: V 5�+n&k V G
PCorporation
Address:?'o-t3 .6y- 1- o 1 City/Town: (-- "Lsiu tLt . state: M4.
Business Tel:q 7>f- 3 7 t( -0 y 3 Fax: r17 F- 5 2I- y(3 ( ❑Firm/Company
Name of Licensed Plumber:
INSURANCE COVERAGE:
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes 19 No❑
If you have checked Yes please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy r Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 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 El Agent E]
I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my
Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By TO
pe of License: C_ -
Title Plumber Signature of L censed Plumber
C !Town
Master
APPROVED(OFFICE USE ONLY) Journeyman License Number: O 3 Li
I
a
9766 //
Date.. ................ ....
3?O. �ORT►���OOL TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
ACKUs��
This certifies that ... ......... ..........................
has permission to perform A! .. .... .� . ........ ...4-.................
wiring in the building of....&..1,..........1'7`SS.: !I. . ..............................
.��7.... �7 ..:.c.�... `/A North Andover,Mass.
Syd a3 Q ....�
....Fee. N ................... ..... .... �=.
ELEcriucAL IMPEcroR
4 Check # Z2/o
Of
Massachusetts 4fticiai Use only.
Department of Fire Services Permit No. __ 974 4
GUARD OF FIRE PREVENTION REGULATIONS OLcuPart`'y and Fee Checked
Rev_ iJ071 (leave blank) —'------_._� .
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL
All work at be(xrfarmecl in ac cordantx with the M:usachtt"'AL Electrical Cube(MEC).5-27(; }WORK
(1'L ASf:'PR1iVT 1N INK OR TYPEALL INFORMA710N)
City Or*Town of: NORTH ANDOVER Date: —�G rU
By this application the undersiWi
gned gives notice of his or her intention to perform�the e�c4l work. re gibed below.
location(Street& 'Number) �,c
Owner or Tenant
s 4 Telephone No.
t)wner's:address -c-
Is
tIs this permit in conjunction with a building permit? Yes
Purpose of Building { No IF
Appropriate Box)
a Utility Authorization No.�G��,? y
Existing Service - mps Volts Overhead ❑ Undgrd❑ ;No. of Meters
New Ce Zed Amps 12tl 1 Z
—.�1 Volts overhead❑ Undgrd
Number of Feeders and Ampacity No.of Meters
i.oeation and Nature of Propose Electrical Work:
t Com letion o "the ollow•intable mfr be waived by the Insciur of Hire.
INo.of Recessed Luminaires No.of Ceil:S
usp.(Paddle) Fans o.of ora
No.of f,utninaire OutletsTraasfermers KVA
No.of Hat Tubs Generators KVA
No,of Luminaires Generators
pool
rode ❑ rnd ❑ o o mergcncy Ig Ing
No.of Reeeptacte Outlets Batte iltaits
No,of Oil Burners FIRE�
No.of Switches ARMS No.of'Zones
No.of Gas Burners 0.0 techon an
No.of Ranges tnitiatin Deviees
No.of Air COO id. ora
Tons No.of Alerting Devices
No. of Waste Disposers eat mp um r ons
Totals- © o r -All 11111tal
No. of DishwashersDetection/Atertin Devices
Space/Area Heating KW Local El . unictps
Other
No.of Dryers Heating Appliances ort Connection ❑
o•t> ater KWa.o t} -yste-ms:
Healers KW
o.o �0,of Devices or Equivalent
Data wiring:Da
Si ns Ballasts HiQ of Dvices or E givatent
Na_ Hydromassage Bathtubs
No.of Motors Total HP a eco---mu---cations Iring.-
OTHER: do of Devices or ' uivaleut
t'-s"mat`d Value,,0I i-lectrical Work: lunch addiliesnal detail itw sitccl or as r•eyrtired ht ihr Jn.�prciuruj'i#'ire
j
Work to Start: (When required by municipal policy.)
(� In���O _ .-
-spections to be requested in accordance with MEC Rule 10,and upon completion_
1!N)11RA1NCls COVERAGE: lJnlese waived by the owner,no
ration"cove
the lie-n,-'c provides proof of liability insurance including perrcd for the performance of electrical work may issue unless
undrr,igued teratic,that such coverage is in farce,and has exhibited prof of same to the permit issuing rage 01 otliceuivalent. The
CIIECK ONF: INSt_iRANCF OND ❑ UTHER g
certify-under the pain. and penalties u r u ❑ ( pec toys)
FIRM NANIE; IPe J e,1',that the irrforneatifrn un this applicatiwn it true and complete.
Licensee:��Izrx
l - LIC. NO.: qy 3 j
,� _ Signature
!!,tl+/�Jrt'NhJ�°. 'rcrrrgr 1/te/icrrrce rturrtherlinr./ s` LI(`. 11In.: qaddress: c �
Bus. el.NO.:
'Ycr �t.(.i.i.c. l a7,,. 5 -/it, security work requires De art' Aft.Tel. No.:
OWNE:R'1 INSURANCE WAIVER: I am aware that the t.icens Public due.y rias teftuvc'the liability insurance(overage normally
Owner/Agent
d by law. liy my,ignature below, 1 hereby waive this requirement- I a►n rhe(:heck one)❑auner awrier'� a�e
(')wnerJ:lgrnt nt.
Signature
Telephone No.—.. PERMIT FETE: .
T
ELECTRICAL PERMIT NO. INSPECTION REPORT:
ELECTRICAL INSPECTOR-DOUG SMALL
1.ROUGH INSPECTION:
Passed— Failed—[ ] Re-inspection required($50.00)- [ ]
Inspectors' comments:
(Inspectors'Signature-no initials) / Date --/(
2.FINAL INSPEC ON:
Passed—[ Failed—[ j Re-inspection required($50.00)-[ ]
Inspectors' comments:
(Inspectors'Signature-no initials) Date •�- .>^
r
3. UNDER GROUND INSPECTION:
Passed—[ ) Failed—[ ] Re-inspection required($50.00)-[ ]
r
Inspectors'comments:
(Inspectors'Signature-no initials) Date
4. INSPECTION—SERVICE:
DATE CALLED NATIONAL GRID: NAME:
Passed—[ j Failed—( ] Re-inspection required($50.00)- [ ]
Inspectors' comments:
(Inspectors'Signature-no initials) Date
5.INSPECTION-OTHER:
Passed—[ j Failed—[ ] Re-inspection required($50.00)- [ j
Inspectors' comments:
(Inspectors'Signature-no initials) Date
DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT
ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED.