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Miscellaneous - 56 BAY STATE ROAD 4/30/2018
56 BAY STATE ROAD 2101058.A-0020.0000.0 1 Date. .. :� I NORiH TOWN OF NORTH ANDOVER O 9 PERMIT FOR WIRING sswCHus� This certifies that ... ...... �- ' r ........................... .. P................... ....... �2-1,�S� -dlkQ/-.� San4f has permission to perform ........�A� .�. ............................. ........................................... wiring in the building of......� 7T0.................: .................................................................. at .......J ..... . .... ?` .7. .. ^�:...f...�............. ... rthAnd over,M Fee..- ...........Lic.No.�.7d .��....--�....,'. ....... ................................................................. .. ... ..... ELECTRICAL INSPECTOR Check# 12 Commonwealth of Massachusetts Official Use 0 ly Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07j (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: 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 ectrical work described below. Location(Street&Number TA Te-n Owner or Tenant t e- D Telephone No.-Zfd gcc-S-2 c1J Owner's Address �S 47,L::� Is this permit in conjunction with a bY/, g�permit? Yes ❑ No R (Check Appropriate Box � . Purpose of Building 'D � Utility Authorization No. /(�a 3 [1 ' Existing Service �0 Amps 2-0/ 2 °molts Overhead O�ndgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Q Number of Feeders and Ampacity Locatiioln,and Nature of Proo used Electrical Work: �'`��/� C �(,j� Completion of thefollowing 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- ❑ o.o mergency Lighting rnd. grnd. Battery Units \� a No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. TotalTons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ... "."'""."'.�"'�'�������.......... Detection/Ale rting Devices No.of Dishwashers Space/Area Heating KW Local El Connection [I 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: 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: (When required by municipal policy.) Work to Start:le)—Z 7-/yInspections to be requested in accordance with NEC 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 force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) I certify,under the pal and penalties of per ,t1 a the infprWatian on this application is true and complete. FIRM NAME: . L LIC.NO.:E170 Licensee: l2 L Signature LTC.NO.: (If applicable, r�xx� 'in th - e n tuber 1' e. Bus.Tel.No.• / d`�'���- Address: r (� f lid Alt.Tel.No.: *Per M.G. c. 147,s.57-61,security work requires r rk quires Departme o 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:$ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the Q �` v 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 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass N Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: E Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass R Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: j Inspectors Signature: Date: FINAL INSPECTION: Pass Failed 0 Re-Inspection Required($.)❑ Inspectors Com nts Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com ryThe Commonwealth of n2assachuseftsiNS- Depa>rtment of)ndusfr!a1 Accid&fs Office oflnvestigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers'Compensation Insurance Affidavit:]3uUders/Cont°actors/ElectricianslPliimbers Applicant Information Please Print Lealbly Name(Businessioxgmization&dividual): Address: City/State/Zip: Phone#• Are you an employer?Check the appropriate box: Type of project(required): i.E] 1 am a employer with 4. F1 I am a general contractor and 1 6. ❑New constriction employees(fulland/or part_time).* have J*cd the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and'haveno_employees These sub-contractors have S. []Demolition worldng forme is any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑We area corporation and its 10.0 Electrical repairs or additions X equired.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.[J Plumbingxepairs or additions myself.[No workers'comp. c.152,§1(4),and we have no Q p l2. Roofre airs insurancere ed.a employees.[No workers' 13.0 Other comp.insurance required] 'Any applicant that checks box#1 must also M out the section beldw showingtheirwbrkers'compensationpoliey information. 7-Homeowners who submitihis affidavit iadicatingthe?9e doing alt work and then hire outside contractors must submit anew affidavit indicating such. tContractors that cheekthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. X am are employer that is providing workers,compensation insurance for my employees .Below is the policy andjoh site information. Insurance Company Name:_ Policy#or Self-in-s.Lic.#: Expiration Date: Job Site Address; City[State/Zip: Attach a copy oldie workers'contpensationpolley declaration page(showing the policy number and expiration date). Failure to secure ooverage as requiredunder Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a fne up to$1,500.00 and/or oneyear 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 fl6 statement may be forwarded to the Office of Investigations of the DIA.for ibsuxance coverage verification. X do hereby certify under the pains and penarties of perjury that:the information provided above is true and correct. Signature: Date: Phone#• official use only. Do not write in this area,to be completed by city or town official. City,or Town: FermiflLicense 0 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk d.EIectrical Inspector 5.-plumbing Inspector 6.Other - - - Contact Person: Phone#: • r 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 defmod as",..every person hi the service of another under any contract ofhire; express or Implied,oral Orwritten." An employee is defined as"an individual,partnership,association,corporation or other legal entity,or anytwo or more Of the foregoing engaged in a joint enterprise,and including the legal zepresentatives 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 aparknents and who xesides 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 employes." 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 busimess 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 ofpublic 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 Ilia boxes that apply to your situation and,if necessary,supply sub-oontractor(s)name(s),addresses)andphonenumber(s)alongwiththeir certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)withno employees other than.the members or partners,are notrequired to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Baadvised thatthisaffidavit may besubmittedtothe 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 viorkers' 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 thatthe affidavit is complete andprinted legibly. The Departmenthas 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 whichwill be used as a reference number. In addition,an applicant that roust submit multiple pormit/license applications in any given year,need only submit one affidavit indicating cuttent Policy infounation(ifnecessary)and under"fob Site Address"the applicantshouldwrite"all locations in (city or to-WA),A copy ofthe affidavit that has been officially stamped or marked byte city or town maybe 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. i 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: Tho Commonwaldl of Massaeamotts Depa .eut Qf111du3A,ccldonts Offiee OuRvestigatioxts 69 wawng m sf=-t Boston,MA.02111 Td.#61.7.22'x_4900 Q9 406 ox 1-877r" Revised 5-26-05 Fax#617-727-7749 www.Mms,90VI is 10/28/2014 Division of Professional Licensure:License Search �r >fhe',c'�ffieial Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> ONLINE SERVICES ..........................................................................................._............_............................................................................................................................................................................. Check License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency More... LICENSEE Name: RALPH PETI-O III. REFERENCES& SAUGUS,MA RELATED INFO NEW SEARCH Disclaimer Regarding Website License Searches Licensing Board: ELECTRICIANS Glossary of License Status Codes License Type: JOURNEYMAN ELECTRICIAN TYPE CLASS: E More... License Number: 27015 Status: CURRENT Expiration Date: 7/31/2016 • Issue Date: 1/24/1983 Exam Date: School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Tuesday,October 28,2014 at 12:24:17 PM. 2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http:/Aicense.reg.state.ma.us/public/pubLicenseQ.asp?board code=EL&type class=_E&license_number=000027015&color=red&lb=EL 1/1 W � �r / � � 39D9 � l 0 IDDIYYYY) .�►C,�sO CERTIFICATE OF LIABILITY INSURANCE 177 (MM 8/4/14 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: Richard A. Kowalsky Insurance PHONEFAX231-2020 FAX No): (781) 231-2021 544 Lincoln Avenue ADDRESS: RK@KowalskyInsurance.com P.O. Box 999 INSURER(S) AFFORDING COVERAGE NAIC# Saugus, MA 01906 INSURER A:Foremost S1 nature Insurance C INSURED INSURER B: Ralph Petto III INSURER C: 92 Great Woods Rd INSURER D: Saugus, MA 01906-1254 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AWL SUBR - POLICY EFF POUCY EXP LTR TYPE OF INSURANCE INSR W POLICY NUMBER MIDDIY MM/DD/YYYY LIMITS A GENERAL LIABILITY SCP031422216 5/28/14 5/28/15 EACH OCCURRENCE $ 500,000 X COMMERCIAL GENE RAL LIABILITY PRM4GETORENTED $ 300,000 CLAIMS-MADE 1-1 OCCUR MED EXP(Ary one person) $ 10,000 PERSO NA L&ADV I NJU RY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-OOMP/OP AGO $ 1,000,000 POLICY 7 PRO--D JECT LOC $ AUTOMOBILE LIABILITY COMHINED SINGLE LIMIT Ea accidem $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS _AUTOS .,accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ IXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.E AC H ACCI DENT OFFICER/MEMBER EXCLUDED? N IA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 1D1,Additional Remarks Schedule,if more space is regri red) .I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ramona D. Kowalsky ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201 W05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: rpetiii@iuno.com t { Date..........,(i...l..i . .............. x OF r►OR7/y,� TOWN OF NORTH ANDOVER * PERMIT FOR WIRING t gSwcMvs� Thiscertifies that .......1. [.h !...............1..................................................... .... ......... has permission to perform' �'` f�.2�SC(� � wiringin the build' g of........If................................................................................................... .� L.XiI at ............�4 `. ............ .North Andover,M s. Fee.... .. l ......../.f!!. .CTEIE Check# �W 1276?276 ? r ����sl d�c j�-l7-/ �� �� _� 'r `�'� (,.c0/�11pi01{ll/eQ�L O f c��r�Qd:3tEC�7.U�ettb vuavaaa v.av vaaa� �epartaeenE o�Mire�ervices Permit No. 17-1 Y t Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] eaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Q_a,)-,(�4 - City or Town of: 0drN K o A To the Inspector of Fires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) , ( iQ r Owner or Tenant An Q *D' Telephone No. Owner's Address 1=1 w-V E Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Boz) Purpose of Building Sin a IQ_ fQf n I)LA {V)fn,-2 Utility Authorization No. � Existing Service;tO {Amps ta0 /8t4o Vohs Overhead❑ Undgrd❑ No.of Meters New Service Amps 1 Volts Overhead❑ Undgrd❑ No.of Meters —� Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: jOC�-ail r�F< �l (4 rCY(* TyAg I X'SCpJ Q' Completion o the ollowin table maybe watvedby the Ins ector of WiresINO . No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans of Tota Traa nsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above - o.o Emergency Lighting n No.of Luminaires Swimming Pool grnd. ❑ d. ❑ BatteKy Units Cl No.of Receptacle Outlets No.of OR Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o InitiatinDevices an evices ' No.of Ranges No.of Air Cond. TotalTonsNo.of Alerting Devices Beat Pum umber Tons o.of Self-Contained otals:I Detectlowmerime VFT-1ces No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ �� p g Cyonnection No.of Dryers Heating Appliances KW Security of Devices or Equivalent No.of Water KW Signs of o.of Data Wiring: - Heaters Si Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: ���(� "Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: i (When required by municipal policy.) Work to Start: 0'CT�F` Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including,u completed operation»coverage or its substantial equivalent. The, undersigned certifies that such coverage is in force;aiid has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under thepains amtpenaNes ofperjury,that the information on this application is nd complete. FIRM NAME: I l'lt � Y- '( LIC.NO; �,lLt 1� Licensee: Zam Ick Signatur LIC.NO.: Pr (If applicabl ,enter" empt-in the Zice a member line.) Bus.TeL NO.: Address: ` Alt Tel.No.:(z-4-1c1q•510z' *Per M.O.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 requimd by law, By my signalue elow hereby waive this requirement. I am the check one owner El owner's agent Signature Telephone No. f �,� ...��. vv.u..anu.cram ry�wcaaea urs arB adJJbBLfEf4SJ�6@.J Department of'Industrial Accidents M ®ice of Investigations I Congress.Street, Suite 100 Boston, MA 02114-2017 wwr .mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): Vivint Solar LLC. Address:29 Draper st City/State/Zip:Woburn, MA. 01801 Phone#:781-305-3065 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 10 4. ❑ I am a general contractor and I � employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working foi;,me in any capacity. employees and have workers' insurance-: 9. ❑ Building addition coo [No workers' comp. insurance P. required.] 5. F-1We are a corporation and its 10.[1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. }Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:MJ Insurance, Inc Policy#or Self-ins. Lic. #:029342338 Expiration Date:1111/14 Job Site Address: "E 1 � r� 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 foe 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 hereb u .er the pains and penalties of perjury that the information provided above is true and correct. 1 Si ature: Date: Phone#: 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 VIVINT SOLAR DEVELOPER LLC PHILIP F ZAMPITELLA JR (EL) 4931 K 300 W PROVO UT 84604 rid,Then Detach M=9 M pa fmas OF sv..•,fin Z; E.SSUES TME FOLLOWING WERSE AS t S 'Rt-O MASTED ELECTRICIAN E VFVTN#T SOLAR DEVELOPER LLC PHILIP EAMM1ELLA JR 4931 U. 300 W faffj o ' UT 84604 f tr4i .� 0713• ! 101580 56 BAY STATE RD, NORTH ANDOVER MA 01845 U �m /D _N w w m I I fnaw� (D 0Z I /V PV SYSTEM SIZE: I �mQZ) A, 5.25 kW DC I 0�0a Z> JUNCTION BOX ATTACHED TO ^ t: ARRAY USING ECO HARDWARE TO LL J 5'OF 1"PVC CONDUIT KEEP JUNCTION BOX OFF ROOF FROM JUNCTION BOX TO ELEC PANEL I I I I 1 I I I PV INTERCONNECTION POINT, I O LOCKABLE DISCONNECT SWITCH, J ANSI METER LOCATION, v 8 UTILITY METER LOCATION N rn 9 vu 00 v 0 I I I � v _ 0 0 O � U 1 > z w m I I w w N > W W Z In J J J j cn z co I I SHEET NAME: �- - - - - - NUMBER:- - - - - - -� � a SHEET (21)Trina Solar TSM-250 PA05.18 MODULES WITH Al En MOUNTED ON THE BACK OF EACH MODULE PV SYSTEM SITE PLAN o r SCALE:3/32"= 1'-0" > s Co n A Z 0 0 K m m w� K O �t OA O O FE- M A O O T z I m CA c m z m ❑z m W A A A O C o 0 0 C� O mit .u— (n.m N 3 n \ D r C/) m � w Cn m II O O o r D p Z m ci D= INSTALLER:VIVINT SOLAR ® o Petto Residence P�/2.0 A� ROOOF 7 MAL CENSE:MAHIC 170848K M INSTALLER NUMBER,1.87404.4129 wow" n INI NORT56 BAY H ANDOVERERD MA 01845 V PLAN DRAWN BY:BRG AR 3236251 Last Modified:918/2014 918/2014 UTILITY ACCOUNT NUMBER:16290.48005 CLAMP MOUNTING SEALING PV3.0 DETAIL WASHER �N LOWER -0 it SUPPORTNaw m ® Q�NoZ �y O LLazz M<5 PV MODULES, TYP. MOUNT ''"' "'` �'`'"`''"° 0.'o OF COMP SHINGLE ROOF, FLASHINGz< PARALLEL TO ROOF PLANE 2 1/2" MIN 0- 5/16"0 x 4 1/2" MINIMUM PV ARRAY TYP. ELEVATION STEEL AGTSCREWS NOT TO SCALE TORQUE=13±2 ft-lbs CLAMP ATTACHMENT NOT TO SCALE N 00 CLAMP+ ATTACHMENT CANTELEVER L/4 OR LESS _ a� COUPLING J L=PERMITTED CLAMP ECO SPACING SEE CODE COMPLIANT COMPATIBLE LETTER FOR MAX ALLOWABLE MODULE CLAMP SPACING. o N PERMITTED COUPLING 5 CAMP+ CLAMP CLAMP U) a ATTACHMENT SPACING z m COUPLING PHOTOVOLTAIC MODULE > < it > Z W M � wv� i Ls w z m V J J > F F J Q>Q Aco Q4zxx/ K -A in mmr 7 1 SHEET NAME: L=PORTRAIT CAMP SPACING HTU ? Q 01-- ECO p L=LANDSCAPE COMPATIBLE SHEET CLAMP SPACING MODULE PV SYSTEM MOUNTING DETAIL NUMBER: MODULES IN PORTRAIT/LANDSCAPE NOT TO SCALE 1 o m NOT TO SCALE Inverter Ratings(Guide Section 4) Conduit and Conductor Schedule Inverter Make/Model Enphase M215-60-2LL-$2x-ZC MODULE DETAIL Max DD Voll Rating 451 Volts Tag Desciption Wire Gauge #of Conductors Conduit Typo Conduit$iee Max Power@40°C 215 Walt- 1 Enphase engage cable-THWN-2 12 AWG 4 Cord NfA-Free Air Nominat AC Vdtage 240 Volts o Trina Solar TSM-250 PA05.18 Max AC Current 0.9 Amps 1 Bare Copper Ground(EGC/GEC) 6AWG 1 N/A-Free Air NIA-Free Air /♦ m� SOLAR MODULE Max OCPD Rating 20 Amps 2 THWN-2 10AWG 0 PVC Max Number of PaneolCircuit 17 2 THWN-2-Ground 8AWG 1 PVC 0'-1" o� 3 THWN-2 BAWG 3 PVC 0'-1" �Q NOTES FOR INVERTER CIRCUITS(Guide Section 8 and It ` of w 3 THWN-2-GroundBAWG 1 PVC 0'-1" . W�In 1.)IF UTILITY REQUIRES A VISIBLE-BREAK SWITCH,DOES THIS N Q w� PV Module Ratings @STC(Guide Section 5) h» Enphase M215-60-2LL-S2x-ZC SWITCH MEET THE REQUIREMENTS? rn O Z MICRO-INVERTER AT YES NO X NA Model MakelModel Trina Solar TSM-250 PAD5.18 N>p F Max Power-Point Current(Imp) 8.27 Amps L.L EACH MODULE,ATTACHED 2.)IF GENERATION METER REQUIRED,DOES THIS METER Max Power-Point Voltage(Vmp) 30.3 Volts W co Q O WITH ECO HARDWARE rn H O SOCKET MEET THE REQUIREMENTS? - O YES NO XNA Open-Circuit Current 37.6 Volts � KO Short-Circuit Current(Isc) 8.85 Amps a--r Z Q 3J SIZE PHOTOVOLTAIC POWER SOURCE(DC)CONDUCTORS Max Series Fuse(OCPD) 15 Amps BASED ON MAX CURRENT ON NEC 690.53 SIGNOR OCPD Nominal Maximum Power at STC(Pmax) 250 Watts MICROINVERTER CONNECTION ___ RATING AT DISCONNECT. Maximum System Voltage 1000(IEC)/600(UL) j TO ENGAGE TRUNK CABLE 4.)SIZE INVERTER OUTPUT(AC)CONDUCTORS ACCORDING Voc Temperature Coefficient -0,32 %I°C TO INVERTER OCPD AMPERE RATING(See Guide Section 9). 5.)TOTAL OF 2 INVERTER OGPD(s).ONE FOR EACH NOTES FOR ARRAY CIRCUIT WIRING(Guide Section 6 and 8 and Appendix D): PV CIRCUIT.DOES TOTAL SUPPLY BREAKERS COMPLY WITH 120%BUSBAR EXCEPTION IN 1.)Lowest expected ambient temperature based on ASHRAE minimum mean extreme #6 BARE CU GROUND NEC 690.64(B)(2)(a)? X YES NO dry bulb temperature for ASHRAE location most similar t0 installation location: -19'C I -— _ (GROUNDING ARRAY) _ _ Signs(See Guide Section 7) 2.)Highest continuous ambient temperature based on ASHRAE highest month 2%dry bulb temperature for ASHRAE location most similar to installation location: 39"C Sign for inverter OCPD and AC Disconnect: 3.)2005 ASHRAE fundamentals 2%design temperatures do not exceed 47°C in the United States(Palm Springs,CA is 44.1°C).For less than 9 current-carrying conductors Solar PV System AC Point of Connection in roof-mounted sunlit conduit at least 0.5"above roof and using the outdoor design AC Out Current 18.900000 Amps temperature 0147°C or less(all of United States). _ O Nominal AC Voltage 240 Volts a.)12 AWG,90°C conductors are generally acceptable for modules with Isc of 7.58 Amps v or less when protected 6y a 12-Amp or smaller fuse. THIS PANEL FED BY MULTIPLE SOURCES N (UTILITY AND SOLAR) b.)10 AWG,90°G conductors are generally acceptable for modules with Isc of 9.6 Amps or less when protected by a 15-Amp or smaller fuse. O� NOTE: NEUTRAL CONDUCTOR(S)OMITTED FOR CLARITY - ALL INVERTER OUTPUT CIRCUITS WILL HAVE A NEUTRAL CONDUCTOR o= J N V PV CIRCUIT 1: 13 MODULES/PARALLEL ENVOY Box a ^ a 13 //''��WP to Q 1 h W = I}I{ Z g a C7 2 cc -J, -� E 1.o MURRAY POINT OF DELIVERY '� N Co COMBINER AND INTERCONNECTION LU J w m \SO PO PANEL 125A/240V SIEMENS acv 3 j \Gd,G2 LWO04NR 60A/240V a a 4a �O\t<` O OR EQUIVALENT UNFUSED NEMA3 1201011� i z PV CIRCUIT 2: 8 MODULES/PARALLEL o I OT\�-F 1s SREC/ANSI LNF222R OR SHEET METER EXISTING EQUIVALENT NAME: I \O O . . O O j \p 240V/200A W 1 I 1sA LOAD-CENTER J I \ E 1.0 � '\, F, ,sA M � D I SHEET --- -- --- ---- ------A-- ---^- — NUMBER: \\ MILBANK �_ CD JUNCTION BOX 2 \\ 3 100A OR bVIS113LEILOCKABLE 'KNIFE'A/CNEC 2014 Compliant WITH IRREVERSIBLE E 1 0 \ EQUIVALENT DISCONNECT GROUND SPLICE E 10U5934-XL-BLG E E 1.0 LIj 1 r Vivint Solar - PV Solar Rooftop System Permit Submittal 1. Project Information Project Name: PHILLIP PETTO Project Address: 56 BAY STATE RD,NORTH ANDOVER MA A.System Description: The array consists of a 5.25 kW DC roof-mounted Photovoltaic power system operating in parallel with the utility grid.There are(21) 250-watt modules and(21)215-watt micro-inverters,mounted on the back of each PV module.The array includes(2)PV circuit(s).The array is mounted to the roof using the engineered racking solution from Ecobbrium Solar. B.Site Design Temperature: (From Lawrence MUNI weather station) Average low temperature: -24.3°C (A 1.74°F) Average high temperature: 37.6°C (99.68°F) C.Minimum Design Loads: Ground Snow Load: 50 psf (State Board BR&S) Design Wind Speed: 100 mph (State Board BR&S) 2. Structural Review of PV Array Mounting System: A.System Description: 1.Roof type: Comp.Shingle 2.Method and type of weatherproofing roof penetrations: Flashing B. Mounting System Information: 1.Mounting system is an engineered product designed to mount PV modules 2.For manufactured mounting systems,following information applies: a.Mounting System Manufacturer: Ecolibrium Solar b.Product Name: Eco ra i c.Total Weight of PV Modules and mounting hardware: 903 lbs d.Total number of attachment points: 70 e.Weight per attachment point: 12.9 lbs f.Maximum spacing between attachment points: *See attached engineering talcs g.Total surface area of PV array: 369.81 square feet h.Array pounds per square foot: 2.44 lbs/square foot i.Distributed weight of PV array on roof sections: -Roof section 1: (21)modules,(70)attachments 12.9 pounds 1JUUYiIr _:� A 3. Electrical Components: A.Module (UL 1703 Listed) Qty Trina TSM 250-PA05.18 21 modules Module Specs Pmax-nominal maximum power at STC 250 watts Vmp-rated voltage at maximum power 30.3 volts Voc-rated open-circuit voltage 37.6 volts Imp-rated current at maximum power 8.27 amps Isc-rate short circuit current 8.85 amps B.Inverter (UL 1741 listed) Qty Enphase M215-60-2LL-S22 21 inverters Inverter Specs 1. Input Data (DC in) Recommended input power(DC) 260 watts Max.input DC Voltage 45 volts Peak power tracking voltage 22V-36V Min./Max.start voltage 22V/45V Max.DC short circuit current 15 amps Max.input current 10.5 amps 2.Output Data (AC Out) Max.output power 215 watts Nominal output current 0.9 amps Nominal voltage 240 volts Max.units per PV circuit 17 micro-inverters Max.OCPD rating 20 amp circuit breaker C.System Configuration Number of PV circuits 2 PV circuit 1 13 modules/inverters (15)amp breaker PV circuit 2 - 8 modules/inverters (15)amp breaker 2011 NEC Article 705.60(6) D.Electrical Calculations 1.PV Circuit current PV circuit nominal current 11.7 amps Continuous current adjustment factor 125% 2011 NEC Article 705.60(B) PV circuit continuous current rating 14.625 amps 2.Overcurrent protection device rating PV circuit continuous current rating 14.625 amps Next standard size fuse/breaker to protect conductors 15 amp breaker Use 15 amp AC rated fuse or breaker 3.Conductor conditions of use adjustment(conductor ampacity derate) a.Temperature adder Average high temperature 37.6°C (99.68°F) Conduit is installed 1"above the roof surface Add 22°C to ambient 2011 NEC Article 705.60(B) Adjusted maximum ambient temperature 59.6°C (139.28°F) b.PV Circuit current adjustment for new ambient temperature Derate factor for 59.6°C (139.28°F) 71% 2011 NEC Article 705.60(B) Adjusted PV circuit continuous current 20.5 amps c.PV Circuit current adjustment for conduit fill Number of current-carrying conductors 6 conductors Conduit fill derate factor 80% 2011 NEC Article 705.60(B) Final Adjusted PV circuit continuous current 25.7 amps Total derated ampacity for PV circuit 25.7 amps i Conductors(tag2 on 1-line)must be rated for a minimum of 25.7 amps THWN-2(90°C)#14AWG conductor is rated for 25 amps (Use#14AWG or larger) 2011 NEC Article 705.60(B) 4.Voltage drop(keep below 3%total) 2 arts: 1.Voltage drop across longest PV circuit micro-inverters(from modules to j-box) 2.Voltage drop across AC conductors(from j-box to point of interconnection) 1.Nfirco-inverter voltage drop: 0.31% The largest number of micro-inverters in a row in the entire array is 8 inCircuit 2.According to manufacturer's specifications this equals a voltage drop of 0.31 %. 2.AC conductor voltage drop: =I x R x D (=240 x 100 to convert to percent) _(Nominal current of largest circuit)x(Resistance of#14AWG copper)x(Total wire run) _(Circuit 1 nominal current is 11.7 amps)x(0.00319Q)x(110) -(240 volts)x(100) 1.71% Total system voltage drop: 2.02% l' 126 EcoliblriumSoEar Customer Info Name: Email: Phone: Project Info Identifier: 11222 Street Address Line 1: 56 BAY STATE RD Street Address Line 2: City: NORTH ANDOVER State: MA Zip: 01845 Country: United States System Info Module Manufacturer:Trina Solar Module Model:TSM-250 PA05.18 Module Quantity:21 Array Size(DC watts):5250.0 Mounting System Manufacturer: Ecolibrium Solar Mounting System Product: EcoX Inverter Manufacturer: Enphase Energy Inverter Model: M215 Project Design Variables Module Weight: 41.0 lbs Module Length: 64.95 in Module Width: 39.05 in Basic Wind Speed: 110.0 mph Ground Snow Load:50.0 psf Seismic:0.0 Exposure Category: B Importance Factor: II Exposure on Roof: Partially Exposed Topographic Factor: 1.0 Thermal Factor for Snow Load: 1.2 Lag Bolt Design Load-Upward: 820 Ibf Lag Bolt Design Load-Lateral: 300 Ibf EcoX Design Load-Downward: 493 Ibf EcoX Design Load-Upward: 568 Ibf EcoX Design Load-Downslope: 353 Ibf EcoX Design Load-Lateral: 233 Ibf Module Design Moment—Upward:3655 in-Ib Module Design Moment—Downward:3655 in-Ib Effective Wind Area:20 ft2 Min Nominal Framing Depth:2.5 in Min Top Chord Specific Gravity: 0.42 Plane Calculations (ASCE 7-10): R1 Roof Type: Composition Shingle Average Roof Height: 20.0 ft Least Horizontal Dimension: 36.5 ft Roof Slope: 21.0 deg Truss Spacing: 16.0 in Edge and Corner Dimension: 3.65 ft Snow Load Calculations Description Interior Edge Corner Unit Flat Roof Snow Load 42.0 42.0 42.0 psf Slope Factor 0.9 0.9 0.9 Roof Snow Load 37.8 37.8 37.8 psf Wind Pressure Calculations Description Interior Edge Corner Unit Net Design Wind Pressure Uplift -19.4 -31.9 -47.9 psf Net Design Wind Pressure Downforce 11.4 11.4 11.4 psf Adjustment Factor for Height and Exposure Category 1.0 1.0 1.0 Design Wind Pressure Uplift -19.4 -31.9 -47.9 psf Design Wind Pressure Downforce 11.4 11.4 11.4 psf ASD Load Combinations Description Interior Edge Corner Unit Dead Load 2.3 2.3 2.3 psf Snow Load 37.8 37.8 37.8 psf Downslope: Load Combination 3 13.5 13.5 13.5 psf Down:Load Combination 3 35.1 35.1 35.1 psf Down:Load Combination 5 9.0 9.0 9.0 psf Down:Load Combination 6a 32.0 32.0 32.0 psf Up: Load Combination 7 -10.3 -17.8 -27.4 psf Down Max 35.1 35.1 35.1 psf Spacing Results(Landscape) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 51.8 51.8 51.8 in Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 48.0 48.0 48.0 in Max Cantilever from Attachment to Perimeter of PV Array 17.3 17.3 17.3 in Spacing Results(Portrait) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 31.1 31.1 31.1 in Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 16.0 16.0 16.0 in Max Cantilever from Attachment to Perimeter of PV Array 10.4 10.4 10.4 in " Layout skirt o Coupling Warning: PV Modules may need to be shifted with respect to roof trusses to comply with 0 Clamp maximum allowable overhang. A Distributed Weight(All Planes) In Conformance with Solar ABC's Expedited Permit Process for PV System (EPP) Weight of Modules:861 lbs Weight of Mounting System: 140 lbs Total System Weight: 1001 lbs Total Array Area: 370 ft2 Distributed Weight:2.71 psf Number of Attachments: 70 Weight per Attachment Point: 14 lbs Bill Of Materials Part Name Quantity ESEG01 CLASA EcoX Clamp Assembly 70 ESEG01COASA EcoX Coupling Assembly 25 ESEG01SKKTA EccX Landscape Skirt Kit 6 ESEG01SKKTA EcoX Portrait Skirt Kit 1 ESEG01CPKTA EcoX Composition Attachment Kit 70 ESEG01 ELASA EcoX Electrical Assembly 1 i •- Location 10 p No. 2 1�'"� 4 Date . - TOWN OF NORTH ANDOVER ' :_ ^ • Certificate of Occupancy $ � Building/Frame Permit Fee _ Foundation Permit Fee $ s� Other Permit Fee $ TOTAL $ T Check# t 26060 Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this age - LOCATION r _ - Pint PROPERTY QWNER _ a . - Print 1:00 Year Qld StrUe#ure yes no- '.MAP NO: � ..FARCE-1 ZONING DISTRICT Histone District, yes no Machine Shop_Village: yes ;no TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential flew Building 5-Gne family El Addition ❑Two or more family 11 Industrial ❑Alteration No. of units: ❑Commercial ElRepair, replacement ElAssessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic o Well° r` ❑ Floodplainr q Wetlands 0 Watershed-District- ❑Water/Sewer: _ DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Address: CONTRACTOR`' Name:<� Phone` .� Addressu Supervisor's Construction License: Exp. Date: 2 ]t Ex. Date: Home-lmprovementLicense: � ? _- - p ARCHITECT/ENGINEER Phone: —Add es . _ - -- - - - - - - - Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 2to2�.co �� Total Project Cost: $a i b t4 �ac� , FEE: $ Check No.: Receipt No.: j NOTE: Persons contracting with unregisteredcontractors do not have access to the guaranty fund Signature of P,gent/Owner L Plans Submitted ❑ Plans Waived ertified Plot Plan ❑ Stamped Plans ❑ Building Department The fol'.owing 194-list of the.required-forms to befilled out for.the appropriate.permit to`.be obtained. R.00fivg, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/0'r-C.S.L Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster.permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application a Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to Issuance o —Bldg Permit In all casi�s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apodal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application oc Buil ' g ed 2012 Doc: D dmb P,,rmtt Revis ■ Plans Submitted ❑ . : Plans�IVaived ❑-= ...'-Certified Plot Plan ❑ Stamped Plans- -TYPE-OF SEWERAGEDISPOSAL- Public Sewer ❑ Tanning/Massage/Body Art ❑. Swimming Pools ❑ Well ❑ Tobacco.Sales -•Food PackagingLSales ❑ -.Erivate{septic tank,etc- ❑ PermanentDumpster on-site ❑ THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM :-.'DATE REJECTED DATEAPPR-OVED PLANNING &DEVELOPMENT' El COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments !Water&Severer Connection Driveway Permit A DPW To6va2 Engineer: Signature: Located 3840s ood Street FIRE DEPARIK!P='NT :Temp Dump'stjbt on site yes no ed at 124¢Mair Locaf -`Fireh �. Departme�it signature/date f *r _ t 1, lt } co WENTS -: : Dimensiflli' Number of Stories: Total square feet of floor area, based on Exterior dimensions. .Total land area;sq. ft.: ELECTRICAL: Movement of Meter location,m-ast-or service drop requires approval of Electrical Inspector Yes No DANGERZONE LITERATURE: Yes No MGL-.Chapter 166.Section 21A=F and G min.$10041000..fine NOTES and DATA— For department use ® Notified for pickup - Date E Doc.Building Permit Revised 2010 NORTH Town TE No. T y y o "I'll h ver, Mass, _ 23, 2-A�q coc.u:"""' .1c. - 1' 7,95 Rw r - U BOARD OF HEALTH Food/Kitchen PER T T LD Septic System THIS CERTIFIES THAT ............ .. .. . �.Il BUILDING INSPECTOR has permission to erect .......................... buildings on . :�: .... .� . Foundation _ .... .... ................ ...�............. Rough to be occupied as X.'......qA&P. �....�..S41�...P ...... ............... �... !... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to 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 CONSTRUCTIO Rough Service ................................................................................ Final 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. A CERTIFICATE OF LIABILITY INSURANCE °1101/2013 '"r' 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 endomement(s). PRODUCER CONTACT NAME: MARSH USA INC. 122517TH STREET,SUITE 1300 ac No Ext): (Ale,No): DENVER,CO 80202-5534 ADDRESS: Attn:Denver.certrequestla@marsh.com,Fax:212.94BA381 INSURER(S) AFFORDING COVERAGE NAIC# 462738-STND-GAWUE-13-14 INSURER A:Evanston Insurance Company 35378 INSURED INSURER B:National Union Rre Insurance Cc of PA Vivint Solar,Inc. 4931 N 300 W INSURER C:New Hampshire Insurance Company 23841 Provo,UT 84604 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-002368004.06 REVISION NUMBER:1 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INAR WVD POLICY NUMBER MM/DD MM/DD LIMITS A GENERAL LIABILITY 13PKGWE00274 11/0112013 11101/2014 EACH OCCURRENCE $ 1'000,000 X COMMERCIAL GENERAL LIABILITY A A E RENTED 50,000PREM/ E$ Ea occurrence $ CLAIMS-MADE M OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PROT F]- LOC $ B AUTOMOBILE LIABILITY 9701087 1110112013 11/01/2014 (AaBadentSINGLE LIMIT $ 1,000,000 B X ANY AUTO 9701088 11101/2013 11101/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ A UMBRELLA LIAR X OCCUR 13EFXWE00088 11/0112013 11101/2014 EACH OCCURRENCE $ 10,000,000 X EXCESS UAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ $ C WORKERS COMPENSATION 029342334; 029342335 11/0112013 1110112014 X W'C STATU- OTH- AND EMPLOYERS'LIABILITYER C ANY PROPRIETOR/PARTNER/E(ECUTIVE YIN 029342336;029342337 1110112013 11/0112014 E.L.EACH ACCIDENT $ 1'000'000 D OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) 029342338 - 11/0112013 11/0112014 E.L.DISEASE-EA EMPLOYEO$ 1,000,000 If yes,describe Under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Errors&Omissions& 13PKGW00029 11101/2013 11/01/2014 LIMIT 1,000,000 Contractors Pollution DEDUCTIBLE 5,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) The Certificate Holder and others as defined in the written agreement are included as additional insured where required by written contract with respect to General Liability.This insurance is primary and non- ontributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract.Waiver of subrogation is applicable where required by written ntract with respect to General Liability and Workers Compensation. CERTIFICATE HOLDER CANCELLATION Town of Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 36 Bartlett Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Andover,MA 01810 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Kathleen M.Parsloe z't-f2r.¢6iG ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD m 4111111,West,Provo,UT 84604 Employer Identification No.: 80-0756438 V'�nt sol ^ Phone:(877)404-4129 Fax:(801)765-5758 Massachusetts H icense No.: 170848 dE-Mail: ort@vivintsolar.com ��G � www.vivintsintsolar.com AR No.: "[ RESIDENTIAL POWER PURCHA E AGREEMENT This RESIDENTIAL POWER PURCHASE AGREEMENT(this"A Delaware limited liability company("We","Us","Our")and thgreemenP')is entered into b�and between VIVINT SOLAR DEVELOPER LLC,a e undersigned Customer(s)CYou", Your"),as of the Transaction Date set forth below. Full Name(Pint,,tri,tmq Full Name rsi 4.w.L.,) Customer(s): P11-00— Aop-lyOmer❑ra❑No Telephone No.: - S Q 1 E- it: e Property Street Address: Z Address: City,County,State,Zi 2C- ^ I.SERVICES A. DESIGN AND INSTALLATION. We will design install,service and maintain a solar photovoltaic system on Your Property,which will include all solar panels,inverters,meters,and other components(collectively,the"System")as further described in the Customer Packet and rhe Work Order that We will provide to You hereafter. All material portions of the System will be installed by Our employed technicians and electricians,and not subcontractors. With Your copeiration, We will(i)design,install and connect the System in material compliance with all applicable laws;(ril complete all required inspections;and(iii)obtain all required certifications and permits. In order to design a System that meets Your needs,You agree that We may obtain Your electrical usage history from Your electric utility(the"Unt! ")and You shall provide DJs with copies of Your Utility bills as We may reasonably request. Other than the activation fee described in Section 1.B. I deli and install the System at no cost to You. B. ACTIVATION. You agree to pay Us a one-time activation fee in t e amount o We will interconnect the System with the Utility,and cause the System to generate energgyy measured in kilowatt hours("kWh" (the"Energy Installation of the System generally takes one day and is anticipated to begin and be substantially complete between two(2)and six(6;weeks hereafter. C. OWNERSHIP OF SYSTEM. We shall own the System as Our sole personal property. You will have no property interest in the System. D. OPERATIONS AND MAINTENANCE. We will operate and maintain the System(i)at Our sole cost and expense;(ii)in good condition;and(iii)in material compliance with all applicable laws and permits and the Utility's requirements. E. INSURANCE. We carry commercial general liability insurance,workers' su and property insurance on the S stem For more information concerning Our insurance,and to obtain a copy of Our cera ca e o insurance,p ease visit www.vivin solar.com/insumnce. Sy stern. TERM PRICE,PAYMENTS,AND FINANCIAL DISCLOSURES A. ENERGY PRICE. For all Energy produced yduccd by the System,pYeorucesnhalt pad)Us SOg. per kWh ftyhe"Energy price"),plusmeasured,a plicable taxes, The be Price to You n theceCustomeerr packet twoand AGREEMENT ISt�2.9FOR/7H SA E Ono F ENERGY BY USstem YOUtpAND NOT OR THE SALE OP A SOLAR ENERGY DEVICE. B. TERM. This Agreement shall be effective as of the Transaction Date and continue until the twentieth(20s)anniversary of the In-Service Date(the Term'). The"In-Service Date"shall be the first day after all of the following have been achieved: (i)the System has been installed and is capable of generating Energy,(ii)all permits necessary to operate the System have been obtained,(iii)the System has been interconnected with the Utility,and(iv)all inspections and certificates required under applicable law or by the Utility have been completed or received. ^ C. PAYMENTS. Beginning with the first month following the In-Service Date and throughout the Terin,We will send You an invoice reflecting the charges for Energy produced by the System in the previous month. You shall make monthly payments to Us by automatic payymment deduction from Your designated checking account or credit card. It is Your responsibility to ensure that there are adequate funds or adequate credit[imiL There is no firm ' charge associated with this Agreement. For all pa is more than ten(10)dais past due,We may impose a late charge equal to Twenty-Five Dollars($2 and interest at an arcual rate often percent(10%plus applicable taxes. [f You continue to fail to make any payment within ten(IQ)days after We give You written notice,then We may exercise all remedies available to Us pursuant to Section 13(b). D. RENEWAL. At the end of the Tenn,You may elect to(i)continue with this Agreement on a year-to-year basis;(ii)enter into a new Agreement with Us and cel this Agreement;(iii)purchase the System at the end of the Term and cancel this Agreement(the"Purckase Opdon") or(iv)cancel this can Agreement and have the System removed at no cost to You. You will need to notify Us in writing concerning Your election sixty(60)�ays prior to the end of the Term. If You elect the Purchase Option,the"Purchase option Price"will be the then-current fou market value of the System based on an independent appraiser's valuation of similarly sized photovoltaic systems in.Your geographic re ion. The appraiser's valuation will be provided to You in writing and will be binding. If We receive Your payment of the Purchase Option Pr cc.costs of the appraisal applicable taxes,and all other amounts then owing and unpaid hereunder,We will transfer ownership of the System to You at the end of the Term on an"As Is,Where Is"basis. If You elect to have the System removed,We will remove the System from Your Property within ninett90da s after the end of the Tenn. IF YOU DO NOT NOTIFY US OFYOUR ELECTION TO ER $ SNTLYOtFAGREEMENT AUTOMATICALLYRENEW ON A EAR-TO-YEAR BASISUIYOU NOTIFY US WRITING OF OUR ELECTION TO CANCEL AT LEAST SIXTY( ) DAYS PRIOR TO THE END OF THE RENEWAL TERM. E. CREDIT CHECIG In connection with the execution of this Agreement and at any time during the Term,You hereby authorize Us to(i)obtain Your credit rating and report from credit reporting aaggencies;(ii)to report Your payment performance under this Agreement to credit reporting agencies;and (iii)disclose this and other information to Our atI-iliates and actual or prospective lenders,financing parties,investors,insurers,and acquirers. WE MAY HAVE PRESCREENED YOUR CREDIT. PRESCREENING OF CREDIT DOES NOT IMPACT YOUR CREDIT SCORE. YOU CAN CHOOSE TO STOP RECEIVING"PRESCREENED"OFFERS OF CREDIT FROM US AND OTHER COMPANIES BY CALLING TOLL-FREE (888) 567-8688. SEE PRESCREEN & OPT-OUT NOTICE(SECTION 29)BELOW FOR MORE INFORMATION ABOUT PRESCREENED OFFERS. �' 3.LIMITED WARRANTY A. LIMITED INSTALLATION WARRANTY. We provide a workmanship warranty that the System shall be free from material defects in design and workmanship under normal operating conditions for the Term. We further warrant that all rooftop penetrations We install shall be watertight as of the date of installation. We do not provide any warranty to You with respect to any component of the System. Any manufacturer's warranty is in addition to,not in lieu of,this limited installation warranty. This warranty does not cover problems resulting from exposure to harmful materials and chemicals,fire,flood, earthquake,or other acts of god,vandalism,alteration of system by anyone not authorized by Us,or any other cause beyond Our control. B. MANUFACTURERS'WARRANTIES. The System's solar modules carry a minimum manufacturer's warranty of twenty(20 years as follows: a during the first ten(10)years of use,the modules'electrical output will no', ot degrade by more than ten percent(10%)from the origmaf�p rated output;and �b�during the fust twenty(20)years of use,the modules'electrical output will not degrade by more than twenty percent(20%)from the origfinally rated outptit The System's inverters carry a minimum manufacturer's warranty of ten(10)years against defects or component breakdowns. During the Term We will enforce these warranties to the fullest extent possible. MER DISCLA YOU OR ANY OT ER ON WHET ER EXPRESS, PLI D THIS 3YW WEAKE NO OTHER THE MERCHANTABILITY ort FITNESS FOR ANY PURPOSE OF THE EQUIPMENT, INSTALLATION, DESIGN, OPERATION, OR MAINTENANCE OF THE SYSTEM, THE PRODUCTION OR DELIVERY OF ENERGY, OR ANY OTHER ASSOCIATED SERVICE N MATTER HEREUNDER, ALL OF WHICH WE HEREBY EXPRESSLY DISCLAIM. OUR LIABILITY FOR ANQY BREACH OF ANY UIRED UNDER THIS AGREEMENTTY`SLIMITED TO REPAIRING YOU ACKNOWLEDGE THATTHE ARE RELYING ON PROPERTYEM OR YOUR IIS SECTIONN 3.C. EXTENT AS A CONDITION AND.MATERIAL INDUCEMENT TO ENTER INTO THIS AGREEMENT. THERE ARE NO ARRA TIES WHICH EXTEND BEYOND THE DESCRIPTION OF THE FACE HEREOF. 4.REMOVAL OF THE SYSTEM You shall not make any Alterations(as defined in Section 9 c to the System. If You want to make repairs or improvements to Your Property that require the temporary removal of the Syystem or that could rate ere wit its performance or operas on,You must gfive Us at 3east thirty(30)days'prior written notice (a"Customer-Requested Shutdown"). You agree that an repair or improvement m Your Property shall not materially alter Your roof where the System is installed. As compensation for Our removal,storage,andyreinstallation of the System,You agree to ay m Us a fee equal to Four Hundred and Ninety-Nine Dollars before We remove the System. You shall be required to pay the Shutdown Paymentas defined in Section i5 if the Syystem is not reinstalled within t0)days of removal. In the event of an emergency affectm the System,You sha I contact Us Imm rate y. [f We are unable to timely respond,Youuty roay(at Your own expense)contract with a licensed and qualiftged solar installer to remove the System as necessary to make repairs required by the emergency. You shall be responsible for any damage to[he System that results from actions taken by Your contractor. 5.ARBITRATION OF DISPUTES Most customer concerns can be resolved quickly and amicably by calling Our customer service department at(877)404-4129. If Our customer service department is unable to resolve Your concern,You and We agree to resolve any Dispute(as defined below)through binding arbitration or small claims court instead of courts of eneral,jurisdiction. BYSIGNING BELOW YOU ACKNOWLEDGE AND AGREE G CLAIMS AGAINST US ONLY THAT I)YOU YOUR IINNDIIVIIDUAL CAPACITY,BY ANTHE D NOT AS A PLAINTIFF OR'ANDCLAS5IMEMB R IN ANYOU MAY Y PURPORTED CLASS OR REPRESENTATIVE PROCEEDING. You and We agree to arbitrate all disputes,claims and controversies arising out of or relating to C:pwigly is^01.7 4'i�n:i Solar Ile,�loper.LL<'.All Rigntn Ii�xiniJ. \1 N'c,�CHI)cIfTS PPA n1�i OF OUR AFFILIATES. DIRECTORS EMPLOYEES, AGENTS; a dine l by to msmxr art m ununr sigrul t y twin Yee and lls. OR CONTR.4CT01tS. FOR, ANY SPECIAL, EXEMPLARY. i�ndnon;Uc Cutsome�Packet,tlhe vsiork Order Ind v inki,Additional terms f I INDIRECT INCIDENTAL, CON:SEQLENTiAL OR PUNITIVE docaiments mcogqx;rated h r with:c nsnhu tfr rontir a�cement between You and List DAMAGES(WHETHER OR NOT TILE CLAiM (HEREFORE IS and supctS°de all prior oral mid wfluen negotiations_comrinncutiow,discussions and BASED ON CONTRACT.TORT,DUTY IMPOSED BY LAW OR corres�on ING ppe FEC w thcsublet;matter h rebt 22 R NUINC F.FPFC This Agr nun shall be bmtimg upon and inert m'the OTHERWISE).IN CONNECTION WITH,ARISING OUT OF,OR he„ctit of You and Us ani(her and tour respective heirs.kcal represcmatives. iN ANY WAY RELATED TO TH17 TRANSACTIONS sliecessom and pennined i i3c. Lvc pt tc othcrnrse expressly provittci m this CONTEMPLATED BY Tf:11S AGREEMENT OR ANY .ACT OR Agrc ment,or by operation oT law,n ntzi this Agreemznt aqr any of the rights.. OMISSION OR EVENT OCCURRING IN CONNECTION con esL,or N asst eons hereunder may ut a rrpned by You without(Air prior written c m cot. Any tsar mcnl by You without Our prior nnllen consent shall lice void. THEREWITH. YOU HEREBY WAIVE RELEASE,AND AGREE'. 23 GOVERNING LAN This \grc.mcnt. and any instrument or acreemcnt NOT TO SUE UPON ANY.SUCH CLAIM FOR ANY SUCH reymr I hereunder shall he governed bv,and construed under,the mm tcal laws ofthe WHETHER st«tw'heteUteProPertvislte«rd. DAMAGES. WHETHER OR NOT ACCRUED AND OR NOT KNOWN OR SUSPECTED f0 EXIST IN YOUR per NOTICE.to An notices r this s,demands,and other communicationslk-regqa'T e permitted to h even under this Aer mcnt shall be in uritmg-deh'cred to the FAVOR. YOU FURTHF,R AGREE THAT NO CL.AiM, applicable party tt the address set fon3i in this Astrecin nt or to such other address as LAWSUIT, OR ANY OTHER LEGAL OR ARBITRATION an ptrtvmaydeugnatziroinantetoum bywn«cmnoticetotheotherprty. PROCEEDING IN CONNECTION WITH,ARISING OUT OF,OR whiSLb,th AI. Atter tennirided orexpirationoc of this Agreement any provisions smch by cher nahireare intended to Sonne such r tmmsenn a cancellation shall IN ANY WAY RELATED TO THIS AGREEMENT MAY BE suroivc.mdudinpiwithouthmiumon)Scwunus ,.3 s 11,11,14..17.18,and 19, BROUGHT, COMMENCED OR FILED N40RE THAN ONE (1) 26.SEVERAIIIIATY, Fan)'pmvisum of this Agreement ii ehFto be invalid, YEAR.AFTER THE INCIDENT GIVING RISE TO SUCH CLAIM. pnhihctio or_otherwise unenll beatilz by ct arbitrator a osuch r coon of competent YOU ACKNOWLEDGE THAT WE ARE RELYING.ON THIS Jurisdiction- irioltsoratiaento the extent it i td tcrd invalid,lprobibited•(it uncmtarxnble SECTION 17 AS A CONDITION AND MATERIAL, ion errau Inge dniya incts h i on maLiwmcm y be madenenflull ceableeand by limitation the INDUCEMENT TO F,NTER INTO THIS 1GREF.MENT' then such provision shall be deemed t i-Irse so limited and shall We enfarecahte to the IS.INDEN1NIFICA TION. To the fullest extent pennitted by maxnmime+tentpcmr«cdbvnpplivablelaw. applicable law, You hereby a-rec to indemnify; advance ex ensc ; 27.C•OUNTERPNRIFS. "Flus A4rccment ntav be executed in one or more coanterpams..mr!all such counterparts shall be deemed to constitute one insnumenr. and hold harmbur Us and affiliates. tiirectons, em o}'ees. A iaotmi!e or portable document formal L-pdt")shall cores one;In oriemal Jor agents, contractors, and Our successors and assigns (each, a purposcs tiered "Covered Person") from any and all third party claims, actions, 28 PUBLICITY. You hereby authorize us to use Your and Your Property's voice, costs, expenses(includint reasonable attorneys'tees and expenses), phi a grapy r idco.and likeness in print media.radio t levimm,c mail uxml nlemi) damaFcs,Irabilitie§,penalties,losses,obligations,injuries.demands web materials,and:mgr ludto or video rr wd;ne;pre,idrd that Ykc agrce that We will pe I trot disclose anv of Your persouallti rdana tyi g mfomtation(zxczpt,as provided in and hens of any kind Or native in connection with,arising out of,or Se_nui_(c You waive and forever release Us for any Dispute relatute to or ams;is in any way related to(i)Your breach of this Agreement,or(n)Your out of ihrs Sect 28. negligence or willful misconduct; provided that Your 29.PRE CREEK . AND OPT-OUT. NOTICE. THIS indemnification obligations under this Section 18 shall not apply if "PR L IZ SED ON the harm or damage that is the basis for such third party citun INFORMATION IN YOUR CREDIT REPORT INDICATING occurred while one of Our employees or agents was at Your Property THAT YOU MEET CER:TAiN CRITERIA. THiS OFFER iS NOT and such harm or damagge was solely caused by the active negligence GUARANTEED iF YOU DO NOT MEET OUR CRITERIA. iF or willful ntisrnnductofsuch employee oragent. YOU DO NOT WANT TO RECEIVE PRESCREENED OFFERS. 19.SUBROGATION. You agree to release all Covered'Persons Of CREDIT FRO ivI US AND OTHER COMPANIES:CALL THE from any claims of any parties suing through Your authority or in CONSUMER REPORTING AGENCIES TOLL-FREE, (888) 567- Your name, such as Your insurance company-. and You agree to 8658;OR WRITE: EXPERI.AN OPT OUT,P.O.BOX 919 ALLEN, defend Us against any such claim. YOU AGREE TO NOTIFY TX 75013; TRA NSC1N10:N NAME REMOVAL OPTION, P.O. YOUR INSURANCE COMPANY OF THIS RELEASE. BOX 505 WOODLYN, PA 19094; EQUIFAX OPTIONS, P.O. 20.AMENDMENTS AND WAIVERS. This Agreement may only tx amended or BOX 740123 ATLANTA,GA 30374-01273. (i)any aspect of the relationship between You and Us,whether based in contras tort,e statute or any other legal theory ee this Agreement or any other agreement concerning the sub'ect matter hereof; (iii) any breach, default, or termination of this Agement; and (iv)the interpretation,validity,or enforceability of this Agreement,including the determination of the scoQe or applicability of this Section 5(each,a Dispute"). Prior to commencing arbitration,a party must first send a written"Notice of Dispute'via certified mail to the ot�i p—arty The Notice of rspute must describe the nature and basis for the Dispute and the relief sought. If You and We are unable to resolve the Dispute within thirty(30) days, then either party may commence arbitration. The arbitration shall be administered by JAMS pursuant to its Streamlined Arbitration Rules and Procedures available at: http://www.'amsadr.com/rules-streamlined-arbitration,the"JAMS Rules")and under the rules set forth in this Agreement. The arbitrator shall be bound by the terms of this Agreement. No matter the circumstances,the arbitrator shall not award punitive,special,exemplary,indirect,or consequential damages to either party. If You initiate arbitration You shall be responsible to pay$250. A►1 attomeys' fees,travel expenses,and other costs of the arbitration shall be bome by You and Us in accordance with the JAIC,IS Rules and applicable law. The arbitration shall be conducted at a mutually agreeable location near Your Property Judgment on pr arbitration award maybe entered in an court of commppetent jurisdiction. Nothing in this Section 5 shall preclude You or we from seeking provisional remedies in aid of arbitration from a court ofcompetent jurisdiction. NOTICE:BY INITIALING IN THE SPACE BELOW YOU ARE AGREEING TO HAVE ANY DISPUTE ARISING OUT OF THE MATTERS INCLUDED IN THE"ARBITRATION OF DISPUTES"PROVISION DECIDED BY NEUTRAL ARBITRATION AS PROVIDED BY APPLICABLE LAW AND YOU ARE GIVING UP ANY RIGHTS YOU MIGHT POSSESS TO HAVE THE DISPUTE LITIGATED IN A COURT OR JURY TRIAL. BY INITIALING IN THE SPACE BELOW YOU ARE GIVING UP YOUR JUDICIAL RIGHTS TO DISCOVERY AND APPEAL. IF YOU REFUSE TO SUBMIT TO ARBITRATION AFTER AGREEING TO THIS PROVISION, YOU MAY BE COMPELLED TO ARBITRATE. YOUR AGREEMENT TO THIS ARBITRATION PROVISION IS VOLUNTARY. YOU HAVE READ AND UNDERSTAND THE FOREGOING AND AGREE TO SUBMIT DISPUTES ARISING OUT OF THE MATTERS INCLUDED IN THE"ARBITRATION OF DISPUTES"PROVISION TO NEUTRAL ARBITRATION. WE AGREE TO ARBITRATION AND WAIVE THE RIGHT TO A JURY TRIAL �j�rt4 r�lcat�. U 6.NOTICE TO CUSTOMERS A. LIST OF DOCUMENTS TO BE INCORPORATED INTO THE CONTRACT: (i)this Agreement,(ii)the Additional Terms and Conditions,(iii)the Customer Packet,and(iv)the Work Order. These documents are expressly incorporated into this Agreement and apply to the relationship between You and Us. B. IT IS NOT LEGAL FOR US TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REMOVE GOODS INSTALLED UNDER THIS AGREEMENT. C. DO NOT SIGN THIS AGREEMENT BEFORE YOU HAVE READ ALL OF ITS PAGES. You acknowledge that You have read and received a legible copy of this Agreement,that We have signed the Agreement,and that You have read and received a legible copy of every document that We have signed during the negotiation. D. DO NOT SIGN THIS AGREEMENT IF THIS AGREEMENT CONTAINS ANY BLANK SPACES. You are entitled to a completely filled in copy of this Agreement,signed by both You and Us,before any work may be starOR TO THE LATER OF: ted. E. (3"YOU DAMAY Y AFTER THE TREL THIS ANSACTION CTION DATE,OR TCTION AT ANY TIME HE START START"F INSTALLATMIDNIGHT OF ION OF THEYSTEM.HSSEEE THE NOTICE OF CANCELLATION ELOW FOR N EXPLANATION OF THIS RIGHT. VIVINT SOLAR D CUSTOMER(S): By:DiC Printed N Printed Name.-Y, Title: By: Printed Name: Transaction Date: FOR INFORMATION ABOUT CONTRACTOR REGISTRATION REQUHZEMEN`f9, NTACT MASSACHUSETTS THE MASSACHUS OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION:TEN PARK PLAZA,SUITE THE BOSTON,MA ETTS (617)9'73-8700 OR 888-283-3757. - x--------------------------------------- ------------- NOTICE OF CANCELLATION Transaction Date: AR No.: YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE T((3)BUSINESS DAYS OF THE ABOVE CANCEL,ANY PROPERTY DATE, D IN,ANY PAYMENTS MAUNTIL THEDE BY YOU UNDER THE CONTRATART OF INSTALLATION OF CT OR SALE,ANIND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE, OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PECK THEM UP WITHIN TWENTY 20)DAYS OF THE DATE OF YOUR NOTICE OF CANCELLATION,YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER,OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND A TELEGRAM,TO VIVINT SOLe DEVELOPER,LLC,AT 4931 N 300 W,PROVO,UT 84604 PRIOR TO THE LATER OF: (1)MIDNIGHT OF THE THIR)(3 ")BUSINESS DAY AFTER THE TRANSACTION DATE,OR(EI)THE START OF INSTALLATION OF THE SYSTEM. I HERESY CANCEL THIS TRANSACTION: Date: Customer's Signature: Calnrighr u,.OU Vivien Salm Ikveloper.�J('..11!Rlchr.RixervN. \1.liSAC rll:�l ITti PPA::2.4 AI)DITIONAL TERMS AND.CONDITIONS 7. RF"PRESFNTrATIONS AND WARRAN'I'ILS. Yourepresent, variant and may lenniont this Agicemenl oil written nonce to You and You will be obligated to . stereo that each itt the I'ollowina is true and correct:ti)all inti conccming You pav to U} an amount equal to Four Dollars t$4)per watt installed,subjt vt to a s: hcrein.ns true,coned,and coinplek (n)You.arc the Doty Yce silliVe owners)of the reduction of five prneul(5 )p t vcar(<g.iu r'wr 20,the Transfer 1'a)'mrnt will M1e Property(r c.You have full anJ excht.Ive oivivenhip ri�'1' to the Pmperty):Intl You 5L5(,tier wall installed),pills a%cable tares ftIt 'Tr=%ftr PayinenP). After You are a Ices[rightee r(78).}'cars of age,f n')You currently have and agree to maintain pay to Us the Tinnsfer('aym•nt, 4e will transfer nwnershgp of the System[n You on am at Ian propt•rty and h rbtht-v:utstirau with respect to Your 1 n Ira}} and(v)You an"As Is,Where Is'basis `notwithstanding any other prtvtsnm m this.gme•ren.if have had the op tuntmuy to review•and d+sCus;tilts:1;rceinem with Uur sale'agent the proposed transfer of Your Properly to Property fransface is a lease or otlier and am'other a�visor`roe may desire to consult. You understand that m mistake, t I sfer that Is not a lec simple+tile,You will remain responsible lot performance of misre prescatffiion,or,imnsion m this lgrremenl made by You is a material breach of Yuur obltuations under this Agreement. You agree that the death of all Cu.tome'rs this agreement and entitle CLs to.the remedies provided for in Section I t We hereunder shall be:deemed a transfer of Your Propertv,and We will work with Your make no re.prescnmtion:Or ,anvnlics except us expre slv set h rth m Wii;r gree mens. successors and heirs to urn for this Agreement pursmun to the tents and condmm�s of %. OUR SERVICES.ICES. (ai Mucnn we will install perform all c mcre(s)a-needed section L2(h. to-nlcUR the Energy (ill Nipro,l ed In,y the System We well collect(url'oananu data �3 EY�ENi'A OF DEFAULT. ((t) Cu tamer Default. A"Custunrer Default shall remotely or use Our personnel to collect the data. We will pro,ide this data t)You mean the occurrence of anv of the to twin•.p)�ur t elute to make any paynienl neon Your rcasonablc request. You 3¢ree to allow Chu personnel reasonable access to under this A r ement within tel(10)d ros,of wffen due and suell failure is tot cured 5 Om Prolierty to co11ar1 such dant. At Our Jiscro[ion,We may lest til-•accuracy of the widun ten ilii)days after W"e•+ave You welders nonce utsuch fvhrrz,(ii)Your(allure pp��.•rtonnamk meters from time to lime. If testing indicates that tie meter is inaccurate to peiti,nn any obligation under this riften notic and such failure i('nrn cured within by more than+i-5°b.We will(ij repair and rxalibrate the meter.at no cost to You; thine(31))days atter We gne)',ill written nonce of-such fsrlure (iirj You deny o Wird(ii)make 41-S,.W willmx:nts repair Your ptymrnts based on corrected meter data Our cunlr."i,or agents.govemmental authorities,or the Utility access to No lbr the period of such maceumev. If the meter is Inoperable Cor any reason including Property and such access is not given within thirty 13f1)days Aller cy.give YOU Your failure to.maintain working broadband ince nct or electrical connections,A�'e written notice of the flilur it)pioyide such access:1n)Yourb,tnl.rupuy.insolvency may charge You for the Shuldotvll Pavntent. ih)tasu,dt Losses. It rile Sy tem is ur aJmissien of Your nabihty m pay Your debts as tiev mature:i.r(r)Your t roppcity damaged or destroyed by fire,storm Floud:raitlrqua c,a of er disaster or accident hexomurg subject to a fort,h sure proa•edine (b)Rent day-for Customer fktauli. (f (etch,a"CaraulQ'E"renr")covered b-Ciur msumncc,We will promptly repair anal a Custoner Default [cons, YVo inn ierctsc any of ibz idTwing,rcmcilies: replace the dmna,�portions of the Nysten,as net' sary to resmre it ni ga(al working ((r)terminate this Ayim nteut and demand You(lav the Default Pay nient,III)leave the conditicn. if the ystcm is damaged or destmyrd h)a Cam Event not covered by System in place nn Your Property',but deny You aces,tit and use of the Energy i Our insurance,We may,at Uur option ii)repair and restore the System to ootid ppnduces,which may Ic redirected and sold at(hu elroipn:(ut)Jasrdmnrct or ale noticing condition:or(n)terminate this Agreement and, al Your el,It 1.either Hnck the SvSicm as pcnnittcd by apph able law;i,)place a Ian on Your Proe k1ft convey the System in its then-exisllrtg cnndfuen.".As Is.W`hue Is'.to You for no (+)etinage a Collection act cy to collect p rmtents from You:(vu)report.Yew ddeFauh additional Svst crauon or ttmmxe the System loom Motu Properly. (c)Disconnection to ewdit reporting ageneses;andlnr(vii)ex&mw anv other remedy available to Us in 0(5�stz n. We may cause the Systun to he disconnected from the I ItiIItV s act arcs t this Ara'ecment or under applicable law I Seller Default. :1"Seller D.4.1C shall t icl y reytttre such disconnectiou m We are required to Jo so under applicable lawv: mean the occurrence of anv of the tollowme: 1 Chu failure to prttiirm any of Our 9. YOUR DUTIES.(a)Use.S±I•th s stem. You shall use ih Giery fin residential material obligations under this Agreement and the rfTvi of soh failure is not cured PConly and not for lhcxnmg as sw inuniug p�mI At all lines, ou shall ensure }within thin}.(30 days after You give lis written nonce of such failure.or(ii)Our eat the Property remains grid-cennened to the Utility. (b)Broadband Internet h.'mkrupl'cy,.utsov�encv or dmission of0m inability to pay Our debts its they,mature. Connection. You must provide the System with continuous access tet a tunct'oomg (d) Remedies for Scria Default. If a Seller Default occurs and is continuing,You internet connection withonewired Ethcrna port and stindard I ctical cutlet,at Your may: n)trmmnate tfiis Av,,r—eemem and ryuest removal of the System from You cod.-if Ybu fab to maintain hriadband Internet or electrical comiccttoit fora period of f` periv:vnitor(n)except as provided below,exereise anv other remedy available u) rime We may charge You the Shutdown Payment. (c)S•stem Afterations. You shall You m this Agreement or under applicable taw. Notwithslanding the foregoing,You not It)after,repair,or ohenvise medif>'anv component o t c 'wren coliecticrly udl have no npht to claim damages as t result of the lernnn;yuvn of this\grecinrnl, "AUerudorxy):and(i')take any acro,that cold void or impair airy warranty relating except for(s)the urinal casts to remove the System,d We fail to remove the System to the System. You will he responsible for anv damage to the System that is caused at from 1"tau Pnpperty pasuanl to Section 14,and(y')any damages to Your Property any time by You Or Your gutstc invitees,couti-cctors.. or agrnh. td)Pro ep�•ny, r_tdnng from the removal of t c Syclem by Ls or Our contmetor. (r) Ikfauh AlteratiTons, You shall(i)trim all tree'on four Proper,",qot install structures on Pavmcnts. if this Agreement is terminated for any reason,other than pursuant to tTie. Your ron4 and take orbs rcaanablc steFF>R to ensure that shading of the System is nn Notice ofof Cancellation.Section 16.ora Scaler Default,You will pa}'[o Us the Default -worst than on the Transaction Date;anJ(til maintain,in ea d condition and repair Payment. The`•Default�ymeld,shall he an amours equal u)Seven Dollars(S7a per the"A and all electrical sysleins of Your properly. (of authorizationnts. Ybu shalj Ivan inti lied,subject to a reduction of five percent(5�<,)par yea(c•.2'm year 20 the obtain tram lbnr mortgagee.hon owners'association-(r any triter j_- with nn Default Payment will hr'52-68 p,T wart installed),pIns applicable taxes, You agree interest in Your Property all:authorizations necessary'for Us,to msua ,operate.and that ere Default Pavrtient f irly reflects the value o the System.and.in the ears•of o maintain the System. Your failure to obtain these authorization,in a time]%manner Customer Default,is a fair tcpresentanun of thcdamage.and losses that We expert to may re•tilt in-termination of this Agreement. ([)"[ayes. You will pay all taxes incur. Alla You pay to lk the Default Payment:We will transfer ownership of the aS>e5�rd en or arising from installatum or operation oFth- System,unclud inc any System to You on an"As Is W11cre}s basis. genta-at,excise or sales tax on the Energy produced by the System. We shalt be 14TERMINATION. (a)Termination by Seller. Wr rimy,in Our sole discretion. responsrhie far income tax and pnip rty I&assessed to reianon to aha ownership of terminate tins Agreement(i)it pnor-to c n-.avoe Datc,upon delivery of written Lhe Svstem. (g)Chances if tau.the Utiht}•,or anv eovemmrntstl anency requires notice to You:or 60 upgn the occurrence of a Customer Detault. Within ninety(90) change to a..ostein atter its installation,You shalt pay Our sarida parts and days after termination of this.Agreement,outer than under the circumstances m which labcir charges;or iii)that WC pay any fax.tec,or other caret m relation to the Svstem Clic System is vunsfemad 10 You nndcr Section^_.Section 12,or Section 13,We will or this Aereemcnt after the In-Service Date, then Y'ou shall M1e respcvasi6le to remove the System and tri[ore ell rooftop penrlrat'ioms lbliz free limn Tears. if We reimburse Yls far such rix.fer,or other charge!except for income and prerypeny[airs elect to temimate this Agreement. W'e tell have no further liability In You. that are Our responsibility under Seetion ) ). (h)Further..uiznces. Upon Our (b)Tomnmauon h•Cummer. You may terminate this Agreeement(i)pursuant to the recptest,You shall prompptly sign nnoTrcturn(/\q any,app ication,agreement Or other terns of t e dxse o ce(latiun ux(ti)noun a Seller Default document accessary for lJs to obtain any ere its,rebates..incemki s,allowances,or 15.SYSTF M1l SIIU"IDUYYNS. (a}Safer Sht_utdoyvn In addition to Outright to shut certificates that ere attributed,allocate,or related to lire System,the Energy,or dawn the System fur mamtenanCc,We may shut down The Sv tom d•,w reasonably environmental.attributes thereof Icollectively, the "System Interests"); (it) anv believe that Pmperry amdniims or acnyities of persons on Ihr Properly.which arc not permits interconnection,net metering agreements,and other documents required by under Uur uontnil,whether or not under Your amtml,mayy'interfere wnih the safe lite Utility;and(u')any document neecssag•to verity Our ownership interest in the o oration ui the System(a".Sajety:Shutdown). Durin'tM1c pendency of a Safety System and System interests. (i)Drto Notif-. You shall pnnnpth nohf Us,if(i) Shutdown,Y'ou will pay L`s rhe Shutdown Payment (b�T'ruot. Vacated In the You notice any person or thing meet(mail wet the Operation of the Svstem (til four event that You vacate Y out Property for any rood cf time as a teen t"T an event that _ ..P-rapuay.tvcauy.u:�inaucecar-perraitrwlationscuuiwmhratx:e tlisut_mav�awgrit .t=La�w[SAL•µutteEsnntarSellc •Ypu'tv+ilcaltluuelu_payUsferait.d[c. pproper-System permitting:x(iii)You take any onerCrncy action with ssprd totheEncr'gy produced by the System. (of Interconnection Deachvandrr tflnten'on ncixurn Sstetn. Your failure w promptly ,oufy Us of such matters shall he a Customer - with the Cnlity becom•s deacuyate or reasons at arc�nM it a Forel,Majeum ISefault under Section 13 a. Event,or(ii)caused by or rehd(d m(her unexcused actino or unction,such that the 10.SALE O LA AiERGY'. (n)Supt II tfmty. Beginning with the it S):strin is no loafer able to[produce electricity or nansfer electr'cmy to Yuu or to the Service Dain, vYc will sell to You and ,y iii buy from Us all of the Energy Utdily, You will Pay is the Shutdown Pa•mcnt. (d)Shutdown Paymcm. "file r produced by'tic•Systcm. Title to and risk of loss with respcet to the Energy shall "S/rntdown PaytpertP'shall equal the sum o�p)payments of t r nergy ace that i tmnslrr Cretin Us to You at the point where the System is.interconnected with Your You would have made to Us as described in Section_.eY,fur the Ener�y that would [imperil's eleatical wiring. Energv linin the Syslem will be delivered to You in have been produced by the System during the pe•nc� he shutdown:n'J the value to i compliance with all mquiFements of the Utility. (b)Pay?tent:. You agrm that the U's ofthe__}stem ticcntivcs that We would have received with respect to the Emery - obligation to pay' any antomu due wider this Agreement shall he absolute and that the System would hsvc pmduced,liillnwmg such shutdown;and(iii)ap licabhe i unconditiotak and shall not ties to any abatem"cut.tie ill rounlerclaim.yeti f, taxes. Determination Of the amount of Energy that would have been prods during recoupment nr reduction. You and We aggee that all amounts pavable by You the period Of'the shutdown shall lac based(.4 during the First year after the In-Service hzreundcr shall be payable in all events including by Yrna heirs and estate. Except as Date.on estimated levels Of production:and(B)afts the first.pear ager tit In-Service pcimilt d by[hr Notice of Cancdl:uiun,\'un hereby w'aicc all riche You may have to Date,bnsrd on actual ct)x'•mtan of the System during the same period m the previuos miC4 or cancel this Agreement,w revoke atxeppI,nee of the Svstem,or W 'rant a "car. If a shutdown pursuant to Section 4 or this Section 15 continues for one hundred sc•rurity interest in die Svstem. (c)Limits of Ubltgation tt Qpc�C'aver.'WE D(5 NOT and nighty 1180)days(u lunger.)oma, in Our r sT discretion.term mate this WARRANT OR(AIAR:ANI EE Ili A (U T UT--ENFICf -PRODUC f.D BY' 4croemrnt and rcgqetre You to pay the Defau(i PaymenL THL'SYSTEM FOR ANY PERI OR AVY COST SAY'IN(.S We are nut a utility' 1b.FORCE MAJECRE. It-',xr a'We are unable to perform any of the obligations .x pttblte service company'and do not some any obligations of a utility or publie under this Agreement because of a Force Majeure Event,such aHectd parry will be service company to supply Y'quc enerbn•rcqutrements. We are not subiect to nuc excused$oro whatever performance is affected by the Force Ma cure Event.provided rcview'by goycmmental authontrra Dtu'ing the Tom.You undersand tial You may that Ilan suspension of such obligations is of nu ggreater scope and'of no lonea duration. rpxluire more clelltrictiv,than the Systcm may generate. If You need any such than is required by the Force b7a1eure Event. "F'orre afa/care Event"shall mean anv adduuinal energy.then Yoe shall be solely responsohie to obtain such energy from the event,conddion or cvcumsanre bevond the control of the atTecrd pang which,by the Utility at Y'onr cost.. exercise of due foresight such part,could not masemnbly have been expected to avoid, Ili.OYYNERSHIP OF SYSTEM. (a)Our(Avnershi of the Svstcm'. We shall own and which by the exercise or due diligence such partv without fault attrunrtable to itis stud hold all pmprrty rights in the SIsteT an t c System nterc5ts.�. shall have nu unable W overcome,mcludin",but not limited to,action by a governmental authority pro{icm'interest in the System i-r the Systcm Interests except lice(i die Ener�,y that the failure to acton the pan o7 any govemmenal aahority or afic Utility(prnrided that the System generates,and(it)any credits or payments available un�a Your Utility's such action has been tmcly requested and diligently pursued), failure to obtain or net mrtmng' pm�eram for the Energy that I e System,renerates. You a ure to keep maintain a permit.license,consent or approval(provided at such party has made the S}stem and System Interests free Crony all urns ancf cncumbrnees. Tb)Person.] timely and reasonable commercial ciTorts to obtain and maintain the same) labor Pr(gteov Nature of the_Svstem. Nntwiihsandin the manner in which the Svstcm rs dispute,strike.work-stoppage,slow'-down,lock-oat,flood.earthquake-rite,ltgrnming, alae-Fie-3, t u rolperiy,nor anv fixrtare tiling�v Us,Y'ou and We hereby agree that wind.epidenuc,war,Wn.ism.riot.economic sanction or embamo,civil disturbance, the Systcm and rile System.Intzrests shall remain Our sole personal properiv and shall act of god. unavathtbiliv of electricity front the Ltli[y, qunpment supplies or not be deemed or charaetenud-its a'9}lure"or all,partof the-'realty',as tb,s temps reindeers,power or vulta&su caused by someone other than the affected party,or may be defined by applicable law. It is fienher agreed that tire•installation of the failure of cgtuppmint not utilizes by or ends the control of the affected party. System shall not br a repair.remodel,alteration,conversion,modamization of or V.1"II T.ATION OF LIABILITY. You undensctnd that (a)W'e err mol an insurer addition to.Your Properly. (e)Cmc L of Access. You hereby grind to lis and Our of Your Property.personal pr(Teoy,or personal safety of persons in or on Your employers,agents,and cunuracton L}te n••it to access and ase Your Property tit that Property:(bl You arc solely responsible for providing anv insurance with respect.to We may'(il install.operate,Bull maintain the Svstem Ihrou,,*}}t1out the Tenn,(it)enlorce Your propI I ancf its contents(c)the amount You pay,'to llz is based only On rile Our rights as to this Agreement and the Syslem,and 7iiil take any other action value ol'the Energy pproduc of by the Sv'stent and not on the value of Your Property Or reasonably mcessary in-connection with the cous'truction, installation, operation. its contents:Id)(fir Systern may not ali,'ays operate properly for various reasons;(e)it nuimenonce,repair,ur removal(11`111C System.The foregoing rights of access to Your is difficult to determine in advance the value of the aiml5onaus of the System that property shall constitute a license:coupled with an interest and shall be irrevocable for might.b e lost or destroved if the Svstcm fails to opante properly:(0 it is aifficulr to tt W ninety(9o)d uvs afici this:A,rrecment expires to provide Ls Ilia'time m remove determine ill advance what portico.if any,of any property loss,personal injury or the Svstem at the cad of the Terni. td)Not:I9g'_s_4l_Systall Ownefslrip. Y oil authorize death would be proximately caused by Our failure ti perform.oust negligence,or a Us to make filings and mcordines with-relevant govalumcniaTinifi6rities as may be failure of the Systcm,or the Systcm installation. nec'evary to provide notice of Our ownership til the Systcm and the System Int.r•sts, NOTWITHSTANDING ANY BREACH OF THiS AGREEMENT, and Our ri d t to ac ess Your Property. Upon mnninatiou of this:1�rcement,cart ANY• FAILURE.OF THE SYSTEM,OR ANY NEGLIGENT ACT such 1}ling will be rnnivated. You uodentand that the Svstcm shall be marked and THAT CAUSED ANY INJURY OR LOSS (WHETHER identified`n Our propcm} 12.ASSIGNVIV.�[ S IRANSFER. (a) A si non• t. We may assign,sell,or PROPERTY DAMAGE. PERSONAL INJURY OR DEATH) TO transfer tin wbole x m part)this A eennnt ti ,Istem,or the bystc•n tntevests ANYONE. WE AND YOU AGREE THAT UNLESS SUCH without Your consent and wit[mut nonce If such assignee agrees in writing[o assume Our rights under tilt 1)a•nleat We will have uu hither Iabilrq'or obligation under INJURY OR LOSS WAS CAUSED BY A PARTY'S GROSS this tlucemcru upon the rffe incnws of such assignment abr llansfa ut 1 r I NEGLIGENCE, FRAUD, OR WiLLFUL INJURE, SUCH . You shall provide Us with thin(30)days'prior wnitrm nr lice t —a orlon c tee PARTY'S LIABILITY ARISING OUT OF OR RELATING TO simple sale of Your Property. This written notice shall include the name of the THIS AGREEMENT TUE proposed purchaser or transferee(`Propen'v Tninfeme")and.the proposed date f DEFAULT PAYMENTSIIYOU AND \'E AGREE THAT THIS salt or tmnstcr You will also pro vide.•any additional mfprm+uun rcgaidm�>Pro c Transieree that We rcli onabN request. Ynu will request.that Property Rramferec AMOUNT iS A FAIR REPRESENTATION OF THE DAMAGES stereo m writing wnh Us that pm�n) fransirrc rill assume Your obligations under _THAT YOU OR'WE EXPECT TO INCUR iN THE CASE OF ANY ifis;Agtvemenr. Pmpen•'Imrsfenc.shall enter mac:ueh me tem in or before the I date Your}'morn}•is sod. Altemativ(ly.if lVc def mine obit Prop ny rransl'eree is INJURY OR LOSS HEREUNDER. not adequately ereduworthy to nssumr Your obligations under this A"reemcnt,or NO CLAIM SHALL.BE.MADE BY YOU AGAINST US OR ANY Property Transferee refuses to assume Your obligations under this Agreement.We . The Commonwealth of Massachusetts Department of In�dustrialAccidents �'� Office of Investigations 1 Congress Street,Shite 100 Boston,MA 02114-2017 -'� www<mass.gDov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/individual): Vivint Solar Developer, LLC Address: 4931 North 300 West City/State/Zi : Provo UT 84604 Phone#: 801-704-9389 _ Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 10 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' y p ry• � 9. E] Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other _—____—_^_ comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. k Insurance Company Name:_New Hampshire Insurance Company,__ Policy#or Self-ins.Lie.#: 029342228 Expiration Date: 11/01/14 Job Site Address: 5Q eo u_ Ska 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 he forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under pains til penald • tfperlurj�pat the information provided above is true and correct Signature: _ Date: Phone tt: 01-704-9389 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): i.Board of Elealth 2.Building Department 3.City/Town Clerk 4. Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: I Ultice of Consumer Attairs find business Regulation �t 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 170848 Type: Supplement Card VIVINT SOLAR DEVELOPER LLC. Expiration: 1/5/2016 JAMES SHERMAN 4931 NORTH 300 WEST PROVO, UT 84604 Update Address and return card.Mark reason for change. SCA 1 20M-05/11 Address Renewal F] Employment F-] Lost Card 9Massachusetts-Department of Public Safety " Board of Building Regulations and Standard's Construction Supenisor License:CS-045254 JAMES R SFiER 6 Fox Hollow DriiFe s' / SAUGUS MA 01W �- Expiration 0!i/28/20a6 Commissioner ,r wowon o 4931 North 300 West Structural Group Provo,UT 84604 P: (801)234-7050 Scott E. Wyss/ing, PE Head of Structural Engineering scott.wyssling@vivintsolar.com September 17,2014 Mr. Dan Rock, Project Manager Vivint Solar 24 Normac Road Woburn MA 01801 Re: Structural Engineering Services Petto Residence 56 Bay State Road, North Andover, MA AR#3236251 5.25 kW System Dear Mr. Rock: Pursuant to your request, we have reviewed the following information regarding solar panel installation on the roof of the above referenced home: 1. Site Visit/Verification Form prepared by a Vivint Solar representative identifying specific site information including size and spacing of rafters for the existing roof structure. 2. Design drawings of the proposed system including a site plan, roof plan and connection details for the solar panels. This information was prepared by the Design Group and will be utilized for approval and construction of the proposed system. 3. Photovoltaic Rooftop Solar System Permit Submittal identifying design parameters for the solar system. 4. Photographs of the interior and exterior of the roof system identifying existing structural members and their conditions. Based on the above information we have evaluated the structural capacity of the existing roof system to support the additional loads imposed by the solar panels and have the following comments related to our review and evaluation: Description of Residence: The existing residence is typical wood framing construction with the roof system consisting of 2 x 6 dimensional lumber at 16" on center with 1 x 8 collar ties every 32". The attic space is unfinished and photos indicate that there was free access to visually inspect the size and condition of the roof rafters. All wood material utilized for the roof system is assumed to be Spruce-Pine-Fir #2 or better with standard construction components. Our review of the photos of the exterior roof does not indicate any signs of settlement or misalignment caused by overstressed underlying members. Stability Evaluation: A. Wind Uplift Loading 1. Refer to attached Ecolibrium Solar calculations sheet for ASCE/SEI 7-10 Minimum Design Loads for Buildings and other Structures, wind speed of 100 mph based on Exposure Category"B" and 21 degree roof slopes on the dwelling areas. Ground snow load is 50 PSF for Exposure"B",Zone 2 per(ASCE/SEl7-10). 2. Total area subject to wind uplift is calculated for the Interior, Edge and Corner Zones of the dwelling. VOV���o �. Page 2of2 B. Loading Criteria • 10 PSF=Dead Load roofing/framing 50 PSF=Live Load(ground snow load) • 5 PSF=Dead Load solar panels/mounting hardware Total Dead Load=15 PSF The above values are within acceptable limits of recognized industry standards for similar structures. Analysis performed of the existing roof structure utilizing the above loading criteria indicates that the existing rafters will support the additional panel loading without damage, if installed correctly. C. Roof Structure Capacity 1. The photographs provided of the attic space and roof rafters show that the framing is in good condition with no visible signs of damage caused by prior overstressing. D. Solar Panel Anchorage 1. The solar panels shall be mounted in accordance with the most recent "Ecolibrium Solar Installation Manual', which can be found on the Ecolibrium Solar website (eco libriumsolar.com). If during solar panel installation, the roof framing members appear unstable, deteriorated, structurally compromised or deflect non-uniformly, our office should be notified before proceeding with the installation. 2. Maximum allowable pullout per lag screw is 235 lbs/inch of penetration as identified in the National Design Standards (NDS) of timber construction specifications for Hem-Fir (North Lumber) assumed. Based on our evaluation, the pullout value, utilizing a penetration depth of 2 W', is less than what is allowable per connection and therefore is adequate. Based on the variable factors for the existing roof framing and installation tolerances, using a thread depth of 2 '/z"with a minimum size of 5/16" lag screw per attachment point for panel anchor mounts should be adequate with a sufficient factor of safety. 3. Considering the roof slopes, the size, spacing, condition of roof, the panel supports shall be placed at and attached to no greater than every fourth roof rafter as panels are installed perpendicular across rafters and no greater than the panel length when installed parallel to the rafters (portrait). No panel supports spacing shall be greater than four(4) rafter spaces or 64"o/c, whichever is less. 4. Panel supports connections shall be staggered to distribute load to adjacent rafters. Based on the above evaluation, it is the opinion of this office that with appropriate panel anchors being utilized the roof system will adequately support the additional loading imposed by the solar panels. This evaluation is based on information supplied to us at the time of this report and current industry standards and practices. Should you have any questions regarding the above or if you require further information do not hesitate to contact me. Ve truly yours, ��NOF MASS -P� Y o crvr . Scott E.Wyssl' PE '0 MA License N .50 90� FGis-, � FSSIpN A_ 0 0 eodonl 56 BAY STATE RD, NORTH ANDOVER MA 01845 a, U " c: v°d a�, _N W O Nu)» N PV SYSTEM SIZE: I �m<n 1 5.25 kW DC I o"oQ JUNCTION BOX ATTACHED TO Q Z I ARRAY USING ECO HARDWARE TO CL -' 5'OF 1"PVC CONDUIT KEEP JUNCTION BOX OFF ROOF FROM JUNCTION BOX TO ELEC PANEL I I F-71 F77 I I 1 I 1 PV INTERCONNECTION POINT, 1 _ ¢ LOCKABLE DISCONNECT SWITCH, ANSI METER LOCATION, a &UTILITY METER LOCATION N ¢® o I 1 v N I o " W U I � 1 > Z W m I W W Ld >m J J > I 1 z z < I SHEET NAME: 1 I ~ J �- - - - - - NUMBER:- - - - - - -� � a SHEET (21)Trina Solar TSM-250 PA05.1 B MODULES WITH Al Enphase M215-60-2LL-S2x-ZC MICRO-INVERTER PV SYSTEM SITE PLAN MOUNTED ON THE BACK OF EACH MODULE - r SCALE:3/32"= V-0" > d � r mm a Z o 0 �O m m m w� A 0n x OA C0 C m-1 A 0 O T Z N C 5; W Z 0 m Z ❑ �n OX A A O C °o °o O C HO m N �N� CD 0 T O. rDrn � m o .0 O O o n K r D 0 z m C m D = INSTALLER:VIVINT SOLAR O fl Petto Residence m ROOF F 170848 m m INSTALLER NUMBER:1.877.404.412-9-d �M`/ [��''�j] {`J��'`J 56 BAY STATE RD PV 2.0 p PLAN DRAWN BYEBRGHICAR 3236251 Last Modified: /2014 UTILITY ACCOUNT ANDOVER, VER,RA 101845 8005 CAMP MOUNTING SEALING PV3.0 DETAIL WASHER LOWER a Lu SUPPORT aLu Q�woz >oZ <zz mQ5 PV MODULES, TYP. MOUNT 1 :: �•; i.,.. ;..•::.<.,:...,• o'Fo OF COMP SHINGLE ROOF, FLASHING 4— z< PARALLEL TO ROOF PLANE / J 2 1/2" MIN 5 5/16"0 x 4 1/2" PV ARRAY TYP. ELEVATION S EIEL LAG TSCR WS NOT TO SCALE TORQUE= 13±2 ft-lbs CLAMP ATTACHMENT NOT TO SCALE CC N 0� CLAMP+ 5j ATTACHMENT CANTELEVER L/4 OR LESS GD COUPLING L=PERMITTED CLAMP ECO SPACING SEE CODE COMPLIANT COMPATIBLE LETTER FOR MAX ALLOWABLE MODULE CLAMP SPACING. o PERMITTED COUPLING 5 N CLAMP+ o - w CLAMP CLAMP U) & ATTACHMENT w u COUPLING SPACING PHOTOVOLTAIC MODULE 2 < m z w .. w y > J J Z m J J V ? J �> co fn Q SHEET NAME: L=PORTRAITL H u H U) CLAMP SPACING ? Q ECO 2 p L=LANDSCAPE MODULEIBLE PV SYSTEM MOUNTING DETAIL SHEET NUMBER: CLAMP SPACING MODULES IN PORTRAIT/LANDSCAPE NOT TO SCALE o NOT TO SCALE Inverter Ratings(Guide Section 4) Inverter Make/Model Enphase M215-60-2LL-52x-ZC Conduit and Conductor Schedule MODULE DETAIL Max DC Volt Rating 45Volts Tag Dostnplinn Wire Gauge 4 o Conductors Conduit Type Conduit Size Max Power @40°C 215 Walls 1 Enphase engage cable-THWN-2 12 AWG 4 Core N/A-Fre.Air N Nominal AC Voltage 240 Volts (/1t)� o 1 Bare Dopper Grountl(EDC/DEG) 6 AWG 1 WA-Free Air N/A-Free Air W ao Trina Solar TSM-250 PA05.18 Max Ac Current os Amps v SOLAR MODULE OCPD Rating 201 Amps 2 THWN-2 10 AWG 6 PVC 0'-1" am Max Number of Panels/Circuit 77 BAWG PVC 0'-1" cO 2 THWN-2-Ground 1 ^'❑o 3 THWN-2 BAWG 3 PVC 0,71" 0 Q NOTES FOR INVERTER CIRCUITS(Guide Section 8 and 9): of M W 3 THWN-2-Ground_.--_ BAWG 1 PVC W 1.)IF UTILITY REQUIRES A VISIBLE-BREAK SWITCH,DOES THISF<W Enphase M215-130-2iSWITCH MEET THE REQUIREMENTS? PV Module Ratings @ STC(Guide Section 5) w O Z YES NO X NA Model Make/Model Trina Solar TSM-250 PADS.16 N yQ O Z E C H MODULE,A T Max Power-Point Current(Imp) 8,27 Ams LIQ EACH MODULE,ATTACHED t m¢0 2.)IF GENERATION METER REQUIRED,DOES THIS METER Max Power-Point Voltage(Vmp) 30.3 Volts m=p WITH ECO HARDWARE SOCKET MEET THE REQUIREMENTS? O 0.5 VES NO X NA Open-Circuit Vol[age IVoc) 37.6 Volts Short-Circuit Current(Isc) 8.85 Amps +1^.-' O C 3.)SIZE PHOTOVOLTAIC POWER SOURCE(DC)CONDUCTORS Max Sense Fuse(OCPD) 15 Amps W Z H BASED ON MAX CURRENT ON NEC 690.53 SIGN OR OCPD Nominal Maximum Paver at STC(Pmax) 250 Watts O MICROINVERTER CONNECTION _ RATING AT DISCONNECT. Maximum System Voltage 1000(IECp600(Uy j TO ENGAGE TRUNK CABLE 4.)SIZE INVERTER OUTPUT(AC)CONDUCTORS ACCORDING Voc Temperature Coefficient -0.32 %PC TO INVERTER OCPD AMPERE RATING(See Guide Section 9). lJ 5.)TOTAL OF 2 INVERTER OCPD(s).ONE FOR EACH NOTES FOR ARRAY CIRCUIT WIRING(Guide Section 6 and 8 and Appendix G): PV CIRCUIT.DOES TOTAL SUPPLY BREAKERS COMPLY WITH 120%BUSBAR EXCEPTION IN 1.)Lowest expected ambient temperature based on ASHRAE minimum mean extreme 46 BARE CU GROUND NEC 690-64(B)(2)(a)? XYES NO dry bulb temperature for ASHRAE location most similar to installation location: -19°C --- (GROUNDING ARRAY) Signs(See Guide Section 7) 2.)Highest continuous ambient temperature based on ASHRAE highest month 2%dry bulb temperature for ASHRAE location most similar to installation location: 39°C Sign for inverter OCPD and AC Disconnect 3.)2005 ASHRAE fundamentals 2%design temperatures do not exceed 47°C in the United States(Palm Springs,CA is 44.1°C)-For less than 9 current-carrying conductors Solar PV System AC Point of Connection in roof-mounted sunlit conduit at least 0.5"above roof and using the outdoor design AC Output Current 18.900000 1 Amps temperature of 47°C or less(all of United States). _ Q Nominal AC Voltage 2401 Volts a.)12 AWG,90°C conductors are generally acceptable for modules with Isc of 7.68 Amps a THIS PANEL FED BY MULTIPLE SOURCES or less when protected by a 12-Amp or smaller fuse. o (UTILITY AND SOLAR) b.)10 AWG,90°Cconductors are generally acceptable for modules with Isc of 9.6 Amps m or less when rctected b a 15-Amp or smaller fuse. NOTE:NEUTRAL CONDUCTOR(S)OMITTED FOR CLARITY G� a ALL INVERTER OUTPUT CIRCUITS WILL HAVE A NEUTRAL CONDUCTOR Q o:0 N a PV CIRCUIT 1: 13 MODULES/PARALLEL ENVOY BOX oo 5m `° M 13 • • • O O N 1 RWP zuj � Q � MURRAY POINT OF DELIVERY '� uj to COMBINER AND INTERCONNECTION W Wz to PANEL 125A/240V SIEMENS Q Q U LWO04NR 60A/240V w 'PQ\�F 20 OR EQUIVALENT UNFUSED NEMA3 M I QT\� `tri 15 SREC/ANSI LNF222R OR SHEET PV CIRCUIT 2: 8 MODULES/PARALLEL o`t'tc tea` METER EQUIVALENT A\,p/ NAME: I \p /� EXISTING 200V 240V1200A ULI \ 15A LOAD-CENTER J \\ 15A M x/'1 • • • f f \ 30A SHEET --- -- --- 410 -- ---x- — NUMBER: -- — --Z---- ---- ---- ------- — --- ---- ---- \\ MILBANK VISIBLE/LOCKABLE 0, JUNCTION BOX \ 3 100A OR 3 'KNIFE'A/C 3 WITH IRREVERSIBLE \ EQUIVALENT DISCONNECT NEC 2014 Compliant GROUND SPLICE \ E 1.0 U5934-XL-BI E 1.0 E 1:6 U s Vivint Solar - PV Solar Rooftop System Permit Submittal 1. Project Information Project Name: PHILLIP PETTO Project Address: 56 BAY STATE RD,NORTH ANDOVER MA A.System Description: The array consists of a 5.25 kW DC roof-mounted Photovoltaic power system operating in parallel with the utility grid.There are(21) 250-watt modules and(21)215-watt micro-inverters,mounted on the back of each PV module.The array includes(2)PV circuit(s).The array is mounted to the roof using the engineered racking solution from Ecolibrium Solar. B.Site Design Temperature: (From Lawrence MUNI weather station) Average low temperature: -24.3°C (-11.74°F) Average high temperature: 37.6°C (99.68°F) C.Minimum Design Loads: Ground Snow Load: 50 psf (State Board BR&S) Design Wind Spced: 100 mph (State Board BR&S) 2.Structural Review of PV Array Mounting System: A.System Description: 1.Roof type: Comp.Shingle 2.Method and type of weatherproofing roof penetrations: Flashing B.Mounting System Information: 1.Mounting system is an engineered product designed to mount PV modules 2.For manufactured mounting systems,following information applies: a.Mounting System Manufacturer: Ecolibrium Solar b.Product Name: Ecorail c.Total Weight of PV Modules and mounting hardware: 903 lbs d.Total number of attachment points: 70 e.Weight per attachment point: 12.9 lbs f.Maximum spacing between attachment points: *See attached engineering calcs g.Total surface area of PV array: 369.81 square feet h.Array pounds per square foot: 2.44 lbs/square foot i.Distributed weight of PV array on roof sections: -Roof section 1: (21)modules,(70)attachments 12.9 pounds i i �17:LIU11 U 41 s `� �i 3. Electrical Components: A.Module (UL 1703 Listed) Qty Trina TSM 250-PA05.18 21 modules Module Specs Pmax-nominal maximum power at STC - 250 watts Vmp-rated voltage at maximum power - 30.3 volts Voc-rated open-circuit voltage - 37.6 volts Imp-rated current at maximum power - 8.27 amps Isc-rate short circuit current - 8.85 amps B.Inverter (UL 1741 listed) Qty Enphasc M215-60-2LI.S22 21 inverters Inverter Specs 1. Input Data (DC in) Recommended input power(DC) 260 watts Max.input DC Voltage 45 volts Peak power tracking voltage 22V-36V Min./Max.start voltage 22V/45V Max.DC short circuit current - 15 amps Max.input current 10.5 amps 2.Output Data(AC Out) Max.output power - 215 watts Nominal output current - 0.9 amps Nominal voltage - 240 volts Max.units per PV circuit 17 micro-inverters Max.OCPD rating 20 amp circuit breaker C.System Configuration Number of PV circuits 2 PV circuit 1 13 modules/inverters (15)amp breaker PV circuit 2 8 modules/inverters (15)amp breaker 2011 NEC Article 705.60(6) EcalibriumSolar Customer Info Name: Email: Phone: Project Info Identifier: 11222 Street Address Line 1: 56 BAY STATE RD Street Address Line 2: City: NORTH ANDOVER State: MA Zip:01845 Country: United States System Info Module Manufacturer:Trina Solar Module Model:TSM-250 PA05.18 Module Quantity:21 Array Size(DC watts):5250.0 Mounting System Manufacturer: Ecolibrium Solar Mounting System Product: EcoX Inverter Manufacturer: Enphase Energy Inverter Model: M215 Project Design Variables Module Weight:41.0 lbs Module Length: 64.95 in Module Width: 39.05 in Basic Wind Speed: 110.0 mph Ground Snow Load:50.0 psf Seismic:0.0 Exposure Category: B Importance Factor: II Exposure on Roof: Partially Exposed Topographic Factor: 1.0 Thermal Factor for Snow Load: 1.2 Lag Bolt Design Load-Upward: 820 Ibf Lag Bolt Design Load-Lateral: 300 Ibf EcoX Design Load-Downward:493 Ibf EcoX Design Load-Upward: 568 Ibf EcoX Design Load-Downslope: 353 Ibf EcoX Design Load -Lateral: 233 lbf Module Design Moment—Upward: 3655 in-Ib Module Design Moment—Downward:3655 in-Ib Effective Wind Area: 20 ft2 Min Nominal Framing Depth:2.5 in Min Top Chord Specific Gravity: 0.42 Plane Calculations (ASCE 7-10): R1 Roof Type:Composition Shingle Average Roof Height: 20.0 ft Least Horizontal Dimension:36.5 ft Roof Slope: 21.0 deg Truss Spacing: 16.0 in Edge and Corner Dimension:3.65 ft Snow Load Calculations Description Interior Edge Corner Unit Flat Roof Snow Load 42.0 42.0 42.0 psf Slope Factor 0.9 0.9 0.9 Roof Snow Load 37.8 37.8 37.8 psf Wind Pressure Calculations Description Interior Edge Corner Unit Net Design Wind Pressure Uplift -19.4 -31.9 -47.9 psf Net Design Wind Pressure Downforce 11.4 11.4 11.4 psf Adjustment Factor for Height and Exposure Category 1.0 1.0 1.0 Design Wind Pressure Uplift -19.4 -31.9 -47.9 psf Design Wind Pressure Downforce 11.4 11.4 11.4 psf ASD Load Combinations Description Interior Edge Corner Unit Dead Load 2.3 2.3 2.3 psf Snow Load 37.8 37.8 37.8 psf Downslope:Load Combination 3 13.5 13.5 13.5 psf Down:Load Combination 3 35.1 35.1 35.1 psf Down:Load Combination 5 9.0 9.0 9.0 psf Down:Load Combination 6a 32.0 32.0 32.0 psf Up:Load Combination 7 -10.3 -17.8 -27.4 psf Down Max 35.1 35.1 35.1 psf Spacing Results(Landscape) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 51.8 51.8 51.8 in Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 48.0 48.0 48.0 in Max Cantilever from Attachment to Perimeter of PV Array 17.3 17.3 17.3 in Spacing Results(Portrait) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 31.1 31.1 31.1 in Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 16.0 16.0 16.0 in Max Cantilever from Attachment to Perimeter of PV Array 10.4 10.4 10.4 in Layout Skirt o Coupling Warning: PV Modules may need to be shifted with respect to roof trusses to comply with 0 Clamp maximum allowable overhang. Distributed Weight (All Planes) In Conformance with Solar ABC's Expedited Permit Process for PV System (EPP) Weight of Modules: 861 lbs Weight of Mounting System: 140 lbs Total System Weight: 1001 lbs Total Array Area: 370 ft2 Distributed Weight:2.71 psf Number of Attachments: 70 Weight per Attachment Point: 14 lbs Bill Of Materials Part Name Quantity ESEG01CLASA EcoX Clamp Assembly 70 ESEG01COASA EcoX Coupling Assembly 25 ESEG01SKKTA EcoX Landscape Skirt Kit 6 ESEGOISKKTA EcoX Portrait Skirt Kit 1 ESEG01CPKTA EcoX Composition Attachment Kit 70 ESEG01ELASA EcoX Electrical Assembly 1 Location &C,51 1 No. ' Date NC^Th TOWN OF NORTH ANDOVER f � 3r • OOL � A " Certificate of Occupancy $ Building/Frame Permit Fee $ �� 3 CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ + Check # v 1 !)462 Building Inspector °f NORTH Hti 6f 4 n TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 1SSACHUSEt Permit N0:13?— O: 1 3?— APpptO E® Date Received: " Date Issued: 'G IMPORTANT:Applicant must complete all items on this page LOCATION �G u�C� )/ 5 fc,,-1-`f C.f AJr- Y-; /; n d o ve f � � Pnn PROPERTY OWNER lez /&�� ✓ Print MAP NO.: 13 A PARCEL: C5 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building 005ne family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No.of units: V'Repair,replacement ❑Assessory Bldg ❑Commercial ❑Demolition ❑Moving(relocation) ❑Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED (' /rx SCC K '-n Aa v\ce rr�2h;f o I o 1,- 4t ,§r-o ,rid ?eye ) vh *u � E oe Ce M42 , n Identtification Please Type or Print Clearly) OWNER: Name:_ /'�f114 /2 ar%CJ Phone: 9 71F-6P Address: S'C� y �'�r �12 le4 CONTRACTOR Name: �c 1 Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg.No. FEE SCHEDULE.BULDING PERMIT.$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ a 000400 x10.00=FEE: ` 6) Check No.: C9 Receipt No.: /-I Page I of 4 ■ Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding,Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) i New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPFCTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 U4 TYPE OF SEWARGE DISPOSAL Swimming Pools ❑ F1 Tobacco Art ❑ Public Sewer Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ , Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracti wit a is red contract rs do not have access to the guaranty fund � ^ Signature of Agent/Owner G%� Signature of Contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING&DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATIO;� ❑ COMMENTS w DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:RPFORM05 Created JMC.Jan.2006 Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Building Setback(ft.) Co Front Yard Side Yard Rear Yard n Required Provided Re uired Provides Required Provided s e r vation Decision: Comments Water&Sewer connection signature&date Temp Dumpster on site yes no Fire Department signature/date Building Permit Approved and Issued by: Page 2 of 4 DIMENSION Number of Stories: Total square feet of floor area,based on Exterior dimensions. iysL S, 4-r- Total land area,sq.fu NOTES and DATA—(For department use tS+,kl beck 5 +r r e fa,c�t� (� � cl. 15�c.�� n C� ✓1 - r1V, f�� �Z '-Y� 0 ZE'qp` c Ox n. J� h� n'Iq- v Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan1006 NORTH Town of I ' 4 Andover 0 No. o =- A dower, Mass., COCMICMEWICK �'A �7S RATED 7 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System � BUILDING INSPECTOR THIS CERTIFIES THAT...........P �.. ..�l. � ............................ .... ........ ......................................... . .......... . Foundation has permission to erect........................................ buildings on.....516....... . ., .... ...... .. Rough • to be occupied as...................... ..04. .&.......T..Q ... .. .t....4'1.1.I/'`. ................................................... Chimney provided that the person accep ng 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTTRUCTIOcl Rough .......................... ... ... .................. ....................... Service LDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. f f.�•• n 1 a v TT i� va ♦I WAN,111 r11\LV V UIX OFFICE OF ° BUILDING DEPARTMENT 400 Osgood Street ��'qpTFO fTP��(h North Andover, Massachusetts 01845 QSs^CSmUs�t Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: / J� JOB LOCATION: Number Street Address Map/Lot HOMEOWNER Fl ► I' PeH-q Name Home Phone Work Phone PRESENT MAILING ADDRESS Sn ff�,zf- iy,) r fkAndo oe c , M n City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 7 HOMEOWNERS SIGNATURE___�� APPROVAL OF BUILDING OFFICIAL RcvisL t 10.2005 Form Honlomners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 08-0530 530 HEALTH 08-9540 PLANNING 08- 9535 r ;. Date.91..ap'?4e19,,.d..... 2574 4 NpRTM q 3i°•s ``.-. °"0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING 49 CHUSE� This certifies that ...T. YhA . � �,4. has permission to perform ... .. .. ......(.Y..10.... x. 111111 wiring in the building of.i ..... 1! }�Q�1.................................. ' at".. .... .. . . ..... .... ..... . ............... ,North Andover,Mass. . 2SZ'Y��z ° Fee.. .............. Lic.No. ............. ........,.............::................:. O ................. ��pp�� ELECTRICAL INSPECTOR `�^•+U 1 1 �-Z�00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File i Office Use Only 01 Cnommonvira ti of 4' sal &S Permit No. 2T-v4- i r ilepm-mcd of Pubut 2-Jwu O=pancy A Fee Checked 3/90 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 C.MR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Eiectricai Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date -c,)-e _y� M� or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical) work described below. Location (Street & Number) S Owner or Tenant /V_o&_,vT YoW Owner's Address / Is this permit in conjunction with a building permit: Yes IL No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service JDO Amps /LOJ_ a Voits Overhead Undgrnd No. of Meters New Service Amps _� Volts Overhead Undgrnd No. of Meters Number of Feeders and Ampaciry Location and Nature of Precosed Electrical 'Noris I` o `� �' W0-,5e_ U1h,lf 5.'� t��'os���v,� r oral No. of Lighting Outlets � No. _f .'.et 7No. of Transformers.:cs I KVA :n- No. of Ligating =;xtures I Swimming ?_ Abover•-ct gma. — _mc. _ I Generators ICVA i No. of Emergency Lignnng No. of Recectac:e Outlets No. of Oil 3urr•ers I. Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Cones Ranges ; No. of Air Cora plat No. s Detection and No. of Ran 9 tens Ini[iung Devices !I Na.cT Heat To:at Tota Na at Disposals Pumps Tons -C.v No. of Sounding Devices No. of Salt Contained No. of Dishwashers 1 ScaceiArea r!eanrg KN Oetect;cniSounding Devices Municipal No. of Dryers i Heating Devices KN Local _ Connection 1'Other I No. of No. _-T Low Voltage No. of Water Heaters KW Sig-is Sailasts Wiring No. Hycro Massage Tubs No. cf motors •c.al �? CTHER: INSURANCE COVERAGE: Pursuant to the recutrements ct massacauserm general Laws I have a current Liaciiity Insurance Policy inctuetng C.:m::etec Ccerancris Overage or its sues:anciai ecuivaient. YES = NO _ I have supmtttee valid proof of same to the Ct!ice. YES = NO = If you have caecxed YES. :)lease indicate the type of coverage by CheCKtng the approortate Dox. INSURANCE Z/ BOND = OTHER = (Please Spec:"f) (Expiration Datel Estimacec Value of Eiectncai Work s I -3 Wprx to Start 1 — 3©-75- lnscec,,cn Date -ecuestec: Rough P;nai tit ! li Signed under the Penalties of perjury: LIC. NO_ FIRM NAME Licensee I hD�`t� MG Or'�`^ Sig awre n ,JI �(/f�J�/o�t Bus. 791. No. 7gY-r73 Address �/ r^ 5 T /VC), /lis-�"��—y alt.Tel. No. CWNER'S INSURANCE WAIVJ, . I am aware that the Lcensee Cees net have the insurance coverage or its substantial equivalent as re cutree 5y Massachusetts General taws. and that my signature on tnm cermtt application waives :his reduirement. Owner Agent ;P'ease crieex one? :eteonone No. PERMIT FEE 3 ;Signature of Owner or Agent) X-6565 i COMMONWEALTH OF MASSACHUSETTS _ - DIVISION OF REGISTRATIONi OF ELECTRICIANS AS. A REG JOURNEYMAN ELECTRICIA? ISSUES THIS LICENSE TO THOMAS J MCDONOUGH - -` 41 MOODY ST 11 p NO ANDOVER -MA 01845 17 ,I �I 25274 E 07/31/98 961774 Location 5 p No. Date I'- t R7h TOWN OF NORTH ANDOVER 1. 0 Certificate of Occupancy $ t � � t ; + Building/Frame Permit Fee $ r Foundation Permit Fee $ s�CHus t Other Permit Fe10, $ �� Sewer Connection Fee $ Water Connection Fee $ TOTAL $ G•� Building Inspector 09/28/95 13:3325 •00 PAID 34 ,- Div. Public Works PER31IT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4qO. LOT NO. 2 RECORD OF OWNERSHIP !DATE BOOK !PAGE ZONE I SUB DIV. LOT NO. I i so-LOCATION CT�Y�� ��.�„1p J>.GF/ URPOSEOFBUILDING OWNER'S NAME fCNO. OF STORIES SIZE OWNER'S ADDRESS `'7o BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD WoSTJILDER'S NAME SPAN _-- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS s PROPERTY INFORMATION LAND COST :AGE EE BOTH SIDESBT. BLDG. COST .<..f�1 FILL OUT SECTIONS i - 3 Y 7L/ EST. BLDG.COST PER SQ. FT. y V PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG.COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR As- OAT IL Z7 E F BUILDING INSP[CTOR SIGNAT OF OWNER OR AUTHORI ED AGENT �( OWNERTEL.# FEE (P�� PERMIT GRANTED CONTR.TEL.# (017/0 ( v C 19 CONTR.LIC.# H.I.C.# BUILDING RECORD 1 OCCUPANCY 12 r SINGLE FAMILY rO'F ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY FICEs LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL'K. PINE _ DRY BRICK OR STONE LAST -D PIERS PLASTER _ WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'T AREA _ '/. 1/1 1/ FIN, ATTIC AREA _ NO B M'i FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARD"",D _ ASBESTOS SIDING COMMGN VERT. SIDING ASPH.TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS.d FLOOR _ BRICK ON FRAME CONC.OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH(3 FIX.( GAMBREL MANSARD TOILET RM. (2 FIX-1 FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS B' OIL M'T 2nd _ ELECTRIC 1st (3rd NO HEATING AORTfq Town of 91. 6 Andove r No. 4 ,7 �- LATor dover, Mass., S' '�` � 19c5- COCHICHE WICK 2-1 �ADRArE D P`P�\ �� '9S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT -r........4...... .........................................................,............ Foundation has permission to-eFe ................. buildings on ..5P....... 4Aa ... ...." .......................... Rough to be occupied as.. �.!�!. .. ..... 1P.1.. ......................................................... Chimney thprovided that the personccepting this �s[lrit shall in every respect conform to the terms of the application on file in is office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough q Lft'l- �5-74 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONS U ELECTRICAL INSPECTOR Rough a .... .. ............... ...... ..... ....... .. ........ Service BUILDING INSPECTOR ' Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove F nagh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT TOWN of NORTH ANDOVER AFFIDAVIT I-bae Imgmmant Cantractcr law to lit P%Ucaticn ML c. 142 A regixes that the "taaasttirxim, alt®tim, ram eticn, repair, Adm, ca m, icpDf alt, reaval, dmDlitim, or cashirtim of an a±Utim bo any pre- existirg a wrr-ocaUied held- lrg ocntair&g at least one hit not mate thanfar delli g Units...Or to ctnrbes 4*h are adjaoatt to suz-h residkrre cr hrildirg"be dme by rEg t contractors, nth cin a ims, al,ag iuth OthEr Type of Work: Est. Cost ,-,?, 9en Address of Work U' Owner Name: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law lit Nu. Job under $1,000 ]ate Building not owner-occupied _t,-Mer pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FUR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRA- TION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed uxkr penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: g- �7 `�s Date Ow er ame