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Miscellaneous - 58 EVERGREEN DRIVE 4/30/2018 (3)
/5e Evr � rzePa �z� BUILDING FILA Date.... .:1. .. ................ I 40RT#1 3a;•: ;':�•��o� TOWN OF NORTH ANDOVER O 9 PERMIT FOR WIRING 7SS,�CHU`-��S This certifies that � t .:....t..._...... �.'. .............:.'. ...... � .. ..... . .............. has permission to perform?,.,.).. Q 6.y� ...............s wiring in the building of...,. ..i �--- ........................................................................:................. at ..........5.P,>..... !.��.. �v P. .N................................,North Andover,Mass. - Fee.... ............Lic.No z�.`?�......t.......m .....:...................................fl..,`-�......... S ELECTRICAL INSPECTOR Check# � i Commonwealth of Massachusetts offlcl I use my Permit No. I Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] ]eaveblattk APPLICATION FOR PERMIT TO PERFORMI ELECTRICAL WORK �I All work to be perrormed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT 1N INK OR TI'PE ALL INFORMATION) Date:6/2//2014 City or Town of North Andover To the Inspector of Wires.' By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 58 Evergreen dr Owner or Tenant RICHARD VALLE Telephone No. 978-685-1022 Owner's Address SAME Is this permit in conjunction with a building permit? Yes a No (Check Appropriate Box) Purpose of Building Solar Installation Utility Authorization No. Existing Service 200 Amps 120/240 Volts Overhea UndNo.of Meters 1 New Service Amps 1 Volts Overhead❑ Undgrd No.of Meters Number of Feeders and Ampacity f Af Location and Nature of Proposed Electrical Work: installation of a rooftop mounted solar arayeS Cont letion of rhe ollotvin sable nr be waived b the Ins cion o FYires. No.of Recessed Fixtures No.of CeilSusp.(Paddle)Fans o.o oto : Transformers KVA No.of Lighting Outlets No.of Hot Tubs t Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ n- ❑ o.o Emergency Lighting rad. rad. BatterUnits x No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o e echon an Initiatin Devices No.of Ranges Total No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat Pump umber Tons 17 No.of Self-Contained Totals: I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Q°Gpal ❑ Other .� Connection No.of Dryers Heating Appliances KW ecurtty : No.of Devic DDevices oi•Equivalent No.of Water KW of o.of Data Wiriri : Heaters Si ns Ballasts g No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications tang; No.of Devices or Equivalent OTHER: Attach additional detail Ifdesired,or as required by the Inspector of!Vires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has ekhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) rt Estimated Value of Electrical Work: 2500.00 (When required by municipal policy.) (Expiration Date)) Work to Start: Inspections to be requested In accordance with MEC Rule 10,and upon completion. I certify,taider the pains and penalties of periiny,that the information oil INS applicalion is trite and complete. FIRM NAME: Astrum golar LIC.NO.:A21555 �i Licensee: Jason Riley Signature LIC.NO.: I (If applicable,enter "erentpt"in the license ntrnrber line.) Bus.Tel.No.;33A-22Z- 003 Address: 15 Avenue E Hopkinton-W& 01721 Alt.Tel.Na: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not lG a the liability insurance coverage normally required bylaw. By my signature below,I hereby waive this requirement. 1 am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ V`� i r •tt � t ' • � ,- .e ,. a. J 'tom _ _ _ + - ! � ,- . , r,' _ s i , I 1 'r? Y .—.... ..._.. •"t L �f�1.j as f i I.• . ' I ASTRU-1 OP ID: SJ CERTIFICATE OF LIABILITY INSURANCE DATE(M7/20 01107120 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(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Diversified Insurance NAME: PHONE FAX Industries,Inc. A/C No Ext): A1C No): Suite 155 West,2 Hamill Road E-MAIL Baltimore,MD 21210-1873 ADDRESS: Steven K.Johnston INSURER(S)AFFORDING COVERAGE NAIC q INSURER A:Ohio Casualty 14613 INSURED Astrum Solar,Inc. INSURERS:Cincinnati Insurance Co. 10677 8955 Henkels Lane Ste 508 INSURER C:Chesapeake Employers Ins Co 11039 Annapolis Junction,MD 20701 INsuReRD:Zurich/American Ins.Co. 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 TYPE OF INSURANCE L R POLICY NUMBER MMILDDY EFF MMI POLICY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY BKS55683248 08/0112013 08/0112014 PREMISES a occurrence $ 300,000 CLAIMS-MADE FRI OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ B X ANY AUTO EBA0054872 1212012013 12120/2014 BODILY INJURY(Per person) $ X ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS-MADE US055544923 08101/2013 08/01/2014 AGGREGATE $ 10,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION OR LIM 0TH- AND EMPLOYERS'LIABILITY TORY LIMITSER C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N 4640926 01/01/2014 01/01/2015 E.L.EACH ACCIDENT $ 500,000 (Mandatory NIA A D EXCLUDED? ❑N WC673295600 01/01/2014 01/01/2015 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Commercial Package BKS55683248 08/01/2013 08/01/2014 BusPrsPrp on file A Inland Marine IM8950782 08/01/2013 08/0112014 ContrEqup on file DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION INFORM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts fi Department of InllnstrialAccidents I Office of In vestigations l Congress Street,Siiite.100 ,t Boston,MA 02114-2017 tvtvlv.rtrrrss.gov dia Worleers'Compensation Insurance Affidavit:Builders/Conti actor s%Electricians%Plumbers AnmlicantInfortnation Please Print Legibly Name (Business/Organiiatiot%individual): ASTRUM SOLAR Address: 15 AVENUE E 1 Ci /State/ZI ; HOpKINTON,MA.01748 339227-2003 'hone#: � " - Are you an employer?Check the appropriate box: Te yp of project(req " uired)c l. I am and 1 a employer with 15 4.0 i,am a general"contractor. 6.:0 New construction employees(foil-and/or part-"time). Have hired the sub-contractors 2.Q fain a sole proprietor or-partner- fisted on the attached sheet. lj 7. Q Remodeling shinand have no em lo:ees These sub-contractors have p y 8 Demolition working forme in any capacity. employees and have avorket s' 9 13uildin addition [No workers' cutup.insurance comp. insurance g regttired.] 5.;[� We;are a corporation and its 10.(]Electrical repairs-or additions I 3.© I am a homeowner doing all work officers have exercised thea 11.(]Plumliing repairs or additions myself. [No workers'comp, right of exemption per"MGL insurance requirdd.1 f c. 152, §1(4);and we have no 12[ Roof repairs employees. [No.workers, 13 0 Other_PV SOLAR INSTALLATION i comp insurance requucd., *Any applicant that:cheeks box tt 1 mwt also till otit the section below showing their workers'crnnpensation policy information. t wort.aridYlien hire outside•contractors n+ust suliinit a new affidavit indicating such. Homeo+vners+vho-submit this affidavit md�catmg.they are doing all tContractors that check this box nmst attaclied an additional sheet sIvd ing the name of the sub-contractors and state whether orinot those entities nave employees. If the subcontractors have employees,they nunt,provide their workers'comp.policy,number. lu urn to )at))an employer that isproviding workerszontpensnflon lustrrattce for my employees. Below.1s llrepo/icy ntulJob site j f tat n. Insuranee Company Name: ZURICH AMERICAN INSURANCE CO, Policy p or_Self__Ins..lis.#: 4$40926 Expiration Date 1-1-2015 E z Job Site Address �_� .0.7 Re_W1 _..DZ City/state/Zip: Attach a copy of the workers'compensation,policy declaration page(showing"the policy number and expiration date). 1 aiture to secure coverage"as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties:of a fine"up to V,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 vidlator. lie advised that.a eopy.of this statement may?be for warded to the Ofiice of: f `Investigations.ofthe DIA fo insurance coverage verification: "I rlo ltereb cerli f y fy rrrtrle 1k l pettnllles ojperJur��!/rrrt the 1"fornialloit provldled above is trite and correct. S' natu ate• l 339-227 TOW Phone,##: I . Of clnl Use 0111J. Do not ivrlte fit this area,to he comp/ete�lGy.c11J>OF town afjlclnl. City or Town: Permit/License issuing Authorlty.(crcle.one): 1.Board of Health 2.Building Depat tment 3.Ctty/Town:Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - Contact Person: Phone t#: Please visit our web site at http:/%www.mass.gov/.dpi/boards/EL ASTRUM SOLAR :INC JASON P RILEY (Et) 18 HOPKINS S1 I. LM I NGTON MA 01,887=2210 i I `T.IOMMONWEALTH OF;MA$$aGHIfSETTS :::.,; EL :TP*lC1ANS : ISSUES THE FOLLOWING AS to REQ .1'OURNEYMAN ELEG1 R I G1 AN .lA QN P R1Lt-Y ,18 H0Pam, ,Sl iZ f { al$ kl0pltJNS ST ' ,, II ' NGTON Mit` 4188]=2210 } 13463 t> f U7I3V.800zb Fold,Then Detach Along All Perforations OOMMONWEALTH OF M ELCTR1 C!'ANS SUES THE FOLLOWING 1l 1:NSE AS ; PJ STREb MASTER IrLECTR I C I Ald' a ASTRU)1 SOLAR 18 fiOPKAI ""S`f 4A s fi W .L111 N'GTQN � 0118$7' 2210 t 21555k.J� .. 0713: �t ,�.k. , . 8001,9 • a .. a YL255P-296 YGE 60 YL25OP-29b CELL SERIES YL245P-29b YiN c �l SOLAR YL240P-29b YL235P-29b U.S.Soccer Powered by Yingli Solar COMPANY Yingli Green Energy(NYSE:YGE) is one of the world's largest fully vertically integrated PV manufacturers.With over 4.5 GW of modules installed globally,we are a leading solar energy company built upon proven product reliability and sustainable performance. Founded in 1998,Yingli Green Energy serves customers through our U.S. subsidiary, Yingli Americas, co-headquartered in New York and San Francisco. We are the first renewable energy company to sponsor the U.S. National Soccer teams and the FIFA World Cup'" I, PERFORMANCE -Industry leading in-house manufacturing of polysilicon, ingots, wafers, cells and modules ensures tight control of our material and production quality. 1 -High performance, multicrystalline solar cells deliver a module series i efficiency of up to 15.6%, reducing installation costs and maximizing kWh the p p t area. 's output per uni i . ea. -Tight positive power tolerance of-OW to+5W ensures modules are delivered at or above rated power, improving system performance through the reduction of module mismatch loss. QUALITY & RELIABILITY -Robust, corrosion resistant aluminum frame independently tested to:withstand wind and snow loads of up to 50 psf and 113psf, I. respectively, ensuring mechanical stability. -Manufacturing facility certified to IS09001 Quality Management System standards. Module packaging optimized to protect product during - - transportation and minimize on-site waste. B CK♦ LA AM E WARRANTIES -Leading limited power warranty*ensures 91.2%of rated power for . ,. o _. 10 ears-and 80.7 /o of rated ower for 25 y p years. -10-year limited product warranty. *In compliance with our warranty terms and conditions. QUALIFICATIONS & CERTIFICATES UL 1703 and ULC 1703,UL Fire Safety Class C,CEC,FSEC,ISO 9001:2008, ISO144001:2004,BS OHSAS 18001:2007,SA8000 c@ us LISTED - (PHOTOVOLTAIC MODULE) - 4400 -. ..... YINGLISOLAR.COM/US j Yingli Americas .m . YGE6SERIES Powered by YINGLI ELECTRICAL PERFORMANCE GENERAL CHARACTERISTICS Module type YL255P-296 YL250P-29b YL245P-29b YL240P-29b j YL235P-29b Dimensions(L/W/H) s 64.96 in(1650 mm)/38.98 in(990 mm)/ Power output P... i W '•. 255 250 245 240 j 235 1.57 in(40 mm) Power output tolerances AP.°.', W -0/+5 Weight 42.1 lbs(19.1 kg) Module efficiency - q. % j 15.6 15.3 15.0 ij 14.7 14.4 Voltage at Pm.„ V.pp V is 30.6 30.4 30.2 29.5 j! 29.5 Current at P... Mpr, j A 8.32 8.24I8.11 e:14 -7.97 PACKAGING NG SPECIFI ATI ONS - Open-circuit voltage V« i V j! 38.7 38.4 j 37.8 ;1 37.5 37.0 Number of modules per pallet : 26 I Short-circuli current L. l A 8.88 8.79 8.63 8.65 j 8.54 Number of pallets per 53'container r 34 ' STC:1000W/m'irradiance,25°C cell temperature,AM 1.5g spectrum according to EN 60904-3 Average relative efficiency reduction of 5.0%at 200W/m2 according to EN 60904-1 ... - Packaging box dimensions(L/W/H) 67in(1700 mm)/45 in(1150 mm)/ 47 in(1190 mm) _ - •. • Bo - - •' - � `, x weight � 1177 lbs(534 kg) Power output P... W 184.7 181.1 177.9 a 174.3 -1 170.7 - Voltage at P... Vmpp V 2 Units:i 27.9 27.6 27. 26.6 I 26.6 - _ _ J inch(mm) Current at Pm.. Impp A I' 6.63 6.56 6.54 1! - 6.56 6.42 .. '�1; 38.98 990 Open-circuit voltage P V« V 35.7 35.4 - 34.5 34.2 33.8 - - - I37.24(946) 40)- 1.57( Short-circuit current Ix A I' 7.19 7.12 6.99 7.01 6.92 g 0 NOCT open-circuit operating cell temperature at 800W/m2 irradiance,20°C ambient temperature,1 m/s wind speed v P- THERMAL CHARACTERISTICS dNominal operating cell temperature i °C -- 46+/-2 - - 00 Temperature coefficient of P... y %/°C Ii -0.45 a Temperature coefficient of V« C -0.33 Temperature coefficient of 6. aK %/°C j 0.06_ Grounding holese ED .6-o0.236(6) o• Temperature coefficient of Vmpp GG e c d yVmpp %/°C! - -0.45 - - c o• M O � OPERATING CONDITIONS Max.system voltage 600Voc Mounting holes - 4-0.256x0:315(6.5x8) Max.series fuse rating 15A Limiting reverse current - - 15A n Drainage holes 8-0.12x0.315(3x8)- m d Operating temperature range - -40 to 194°F(-40 to 90°C) LLI . ! ... Max.static load,front(e.g.,snow and wind) 113 psf,(5400 Pa) _ _ 3.94(100) Max.static load,back(e.g.,wind) 50 psf(2400 Pa) - -------- _ x'//0.47(12) \\� Hailstone impact -- 1 in(25 mm)at 51 mph(23 m/s) CONSTRUCTION MATERIALS 1 Front cover(material/type/thickness) ! Low-iron glass/tempered/3.2 mm j n .n SECTION B-B I Glass may have anti-reflective coating t � Cell(quantity/material/type/dimensions/ Y 60/polysilicon/multicrystalline - area/#of busbars) 156 mm x 156 mm/243.3 cm2/2 or 3 1.26(32) � - Encapsulant(material) Ethylene vinyl acetate(EVA) Frame(material/color) Aluminum alloy/anodized silver or black Warning:Read the Installation and User Manual in its entirety Junction box(protection degree) a11`65 Aibefore handlin g,installing,and operating Yingli modules. Cable(type/length/gauge/outside diameter) PV Wire/43.31 in(1100 mm)/12 AWG/0.244 in(6.2 mm) .. Plug connector Amphenol/H4/IP68. (manufacturer/type/protection degree) -! - Our Partners - - - The specifications in this datasheet are not guaranteed and are subject to change without prior notice. This datasheet complies with EN 50380:2003 requirements. Yingli Green Energy Americas, Inc. info@yingliamericas.com Tel: +1 -(888)686-8820 YI NGL140 OIAR YINGLISOLAR.COM/US ) NYSENGE ©Yingli Green Energy Holding Co.Ltd. I YGE60Cel]Series2Ol3_EN_201301_V01 U.S.Soccer Powered by Yingli Solar solar = o o 9 0 SolarEdge Power Optimizer Module Add-On For North America o P300 / P350 / P400 / P405 ,.. WU I' ,imp 4 PV power optimization at the module-level " - Up to 25%more energy Superior efficiency(99.5%) Mitigates all types of module mismatch losses,from manufacturing tolerance to partial shading - Flexible system design for.maximum space utilization . l Fast.installation with a single.bolt a_— Next generation maintenance with module-level monitoring N- Module level voltage shutdown for installer and firefighter safety USA GERMANY ITALY FRANCE JAPAN CHINA ISRAEL AUSTRALIA www solaCedge.uS solaro o SolarEdge Power Optimizer Module Add-On for North America P300 / P350 / P400 / P405 P800 P350 P400 P405 (for 60 cell modules) (for 72-cell modules) (for 96-cell modules) (for thin film modules) INPUT' Rated Input DC Power►tl 300 350400 405 W ............ ...............:.......... .......................... ............. Absolute Maximum Input Voltage 48 60 80 125 Vdc (Voc at lowest temperature) ....................................................... . ........................ .......................... .........::............... .......................... ...:.:...I... MPPT Operating Range 8-48 8-60 8-80 12.5-105 Vdc .........I.p.......g.....g.. ...... ................... .......................... .......................... .......................... .......................... .....I....... Maximum Short Circuit Current(Isc) 10 Adc Maximum DC Input Current 12.5Adc ....................................................... ........................................................................................................... ............. Maximum Efficiency 99.5 % .................... ............................................... .................................................:.:........ .. Weighted Efficiency 98.8 % ............................. ................................ .................................. . . .......................... ........: ............. Overvoltage Category II OUTPUT DURING OPERATION(POWER OPTIMIZER CONNECTED TO OPERATING INVERTER) Maximum Output Current 15 Adc Maximum Output Voltage EE 60 85 Vdc OUTPUT DURING STANDBY(POWER OPTIMIZER DISCONNECTED FROM INVERTER OR INVERTER OFF) Safety Output Voltage per Power Optimizer 1 Vdc STANDARD COMPLIANCE EMC FCC Part15 Class B,IEC61000-6-2,IEC61000-6-3 .................... ..................................................... .................... .................. ............. Safety IEC62109.1(class II safety),UL1741 Yes INSTALLATION SPECIFICATIONS Maximum Allowed System Voltage 1000 Vdc ..................................................... .............................................................................................................. ............. Dimensions(WxLxH) 141x212x40.5/5:55x8.34x1.59 .: mm/in .. . .. .. . .. ..... . . . ... ........................ .................................... . . .. . . ... . . ... . ..... . . ... ............ .................:. ............. Weight.(including. .cables. ..... . .. . . ) 950 2.1 gr/Ib ....... .......... . .. .... Input Connector MC4/Amphenol/Tyco MC4 ................:...............:..................... .......................... ......:...... Outputut Wire.Type e Connector .... Double Insulated;Amphenolhenol . ....... ........... ................................. ...................... OutpuWire Length 0.95 3.0 Operating Temperature Range -40-+85/-40-+185 .0/'F ............................. .................... .................................................................. ..............:................::........ ............. Protection Rating IP65/NEMA4 . . .................. ................................ ..............................I.......................... . Relative Humidity 0-100 ...................... .....%...... ..... .............................. .....:........................ Rated STC power of the module.Module of up to+5%power tolerance allowed. - - - . PV SYSTEM DESIGN USING SINGLE PHASE THREE PHASE 208V- "THREE PHASE`480V A SOLAREDGE INVERTER►z►: Minimum String Length g 10 18 (Power Optimizers) ....................................................... ................................... .............:..................... ........ ............................ ............. Maximum String Length 25 25 50 (Power Optimizers) ..................................................... ................................... ................................... ................................... ............. Maximum Power per String 5250 6000 12750 W ...................... ...,........ ................................... ................................... Parallel Strings of Different Lengths .,........... or Orientations Yes . ..:.................................................... ...................................................:...................................................... I;)It is not allowed to mix P405 with P300/P350/P400/P600/P700 in one string. - - .-.. .-.,..,r.... ... _ t . ..,_......e - �.�.,....,.. 3 solar ° W09- SolarEdge Single Phase Inverters For North America ] SE3000A-US/ SE380OA-US/ SE500OA-US/ SE6000A-US 7 r� 'ry e r tee R d Veats �.G�,Warran�l z 1 M r r a The best choice for SolarEdge enabled systems Integrated arc fault protection(Type 1)for NEC 2011690.11 compliance(part,numbers ending in"-U") 'Superior efficiency(98%) Small lightweight and easy to install on provided bracket Built-in module-level monitoring Internet connection through Ethernet or Wireless „ - Outdoor and indoor installation. Fixed voltage inverter;DC/AC conversion only i Pre-assembled AC/OC Safety Switch for faster installation USA GERMANY ITALY - FRANCE JAPAN CHINA. ISRAEL AUSTRALIA WWW.SOIaredge.us solarSingle Phase Inverters for North America 0 0 SE3000A-US/SE3800A-US/ SE5000A-US/ SE6000A-US SE3000A US SE380OA-US SESOOOA-US' SE6o00A-us OUTPUT, Rated AC Power Out ut 3000 3800 5000 6000 VA p...................... .. ... .. Max.AC Power Output 3300 3800 5200 @ 208V p6000 VA ......I.......... ....................... ........................... ../.5500,Pa 240Vr 277V, AC Output Voltage Min.-Nom.-Max.* 183-208-229 Vac ...........................:................. ....... AC Output Voltage Min:Nom.-Max.* 211-240-264 Vac ......................................:...... ...... ........ ............. AC Output Voltage Min.-Nom.-Max..* ✓ 244-277-294 Vac ............................................. ........................... ................ .I........ ........................... ............. AC Frequency Min.:Nom.:Max;* 59.3:60-605(with HI country setting 57-60:60.5) Hz 25 @ 208v.,i Max.Continuous Output Current 16 @ 208V/ . 16 @ 240V 23 @ 240V/ 25 @ 240V/ A 14 @ 240V ......22 @ 277V ........?Q.�°.277V....... ............. GFDI 1 A .............tonin......ndin.... tect...... ........:...................................................................................................... ............. Utility Monitoring,Islanding Protection, Country Configurable Thresholds Yes INPUT: Recommended DC Power**(STC) ., 3750 4750 6250 7500 W . Max..... ..... . Transformer-less,Ungrounded Yes ... ................ . .................... :......:..............................................500.......................... ........................... ............. Max:Input Voltag?.......................... .........: Vdc Nom.DC Input Voltage 325 @ 208V/350 @ 240V/400 @ 277V_ Vdc . ................. ......._..... . Max.Input Current ......... 11.. .....:..�:..:...,.. 115.... ......I... 18............L...:.......18 Adc ............ Reverse Polarity Protection Yes roun.-FauI... ........Dete..on*......... .........................................:..................................................................... ............. Ground.Fault Isolation Detection 600ka Sensitivity .Maximum Inverter Efficiency .... .97:?.. . ..........98:? 4i'3 48*98.3 % ........................... ..... o...... CEC Weighted Efficiency 97,5 98 97.5 @ 208V/.: 97.5 @ 240V J ..............I..............I.............. . ........................... ....98 240V,277V 98,@.277V Nighttime Power Consumption <2.5 ADDITIONAL FEATURES Supported Communication Interfaces RS485 RS232 Ethernet ZlgBee(optional) 'S'TANDARD COMPLIANCE -' Safety .. UL1741 UL1699B(Part numbers en In U"), UL1998 CSA 22 2 r. . ....... . ..h....... ................. ......... ............. Grid Connection Standards IEEE1547 ................ ........... ................................................................................ .............................. ............. Emissions FCC part15 class B INSTALLATION SPECIFICATIONS':-' AC out ut conduit size/AWG ran a 3/4 minim um G DC input conduit size/#of strings 246 AW P....................................._ ................,..................... . ....... ....../. ......... ......... ......... ..:................ ............. / AWG ran a 3/4"minimum/1-2 strings/24-6 AWG Dimensions with AC/DC Safety Switch 30.5 x 1 2.5 x 7/775 x 315 x17 2 30.5 x 12.5 x 7.5/775 x 315 x 191 in/mm �HxWx.................. .. ........... ............. i .Weight with AC/DC Safety Switch.•..••.•. ,...., - 51.2/23.2 547/24.7 Ib/kg . ............... ........ .... Cooling... ......... ........ Natural Convection ..................................I.........50.........................................I........I.. Noise d..... .........** .... ..... .................................. ..:.:.............................................:..................................................::,....... Min.-Max.Operating Temperature *** 13 to+140/-25 to+60 CAN version 40 to+60 'F/'C Range.................... Protection Rating...... .................... .........:. NEMA 3R ............................. 'For other regional settings please contact SolarEdge support - - - "Limited to 125%for locations where the yearly average high temperature is above 772F/254C.For detailed information,refer to htto//www sola /61 /dr/inverter do ove CAN P/Ns are eligible for the Ontario FIT and microFIT - - - - P Gfdllrmuner�tivr�lfll"�'fil'• 'ice•' -L�°•',F• •� �• - •� - Valle Residence 58 Evergreen dr North Andover,MA 01845 meter System Ratingsf Roof A 9.75 kW DC Photovoltaic Solar Array 10 kW AC Photovoltaic Solar Array �/ —Roof B Eauioment Summaryo 39 Yingli 250 Poly Black Frame Modules 1 SolarEdge SE10000A-US Inverters 97 Roof Penetrations w Sheetindex \ AV a \ / PV-1 Cover / 4 � PV-2.1 Description of Work and Load Calculations Roof A `�. �j' J w� bn PV-2.2 Description of Work and Load Calculations Roof 8 `. �"{ 7 PV-3 Electrical Diagram � N PV-4 String and Conduit Layout a PV-S Equipment Ratings and Sinage a A.0 +* Tr 4 � � GoveminirCodes 2014 National Electric Code ' " *4- 2012 International Building Code11,7 . Underwriters Labratories(UL)Standards OSHA 29 CFR 1910.269 ASCE-7-10 y d � t± o bT 41 PV-1 Roof A Typical Section 9 kW VC Photovoltaic Solar Array . This solar array is comprised of 36 yingli 250 Poly Black Frame solar panels.The panels are mounted using the Unime Solar Mount solar mounting rail to the building's 2x6,spaced at 16 oc Each solar panel is attached to a SolarEdge Optimber also mounted to the Unirac Solar Mount rail directly beneath the panel PnC\tt't� • co N The solar panels produce DC power when struck by sunlight.The M power is convened to 240 V AC power at the Inverter. Theoptimizers 'p, 11 C Q n are connected in strings that connect to the inverter. to W p N C y C o This system will he grid-tied. If the solar panels produce more power than is used by the building,the excess power flows back into the E > c v utility grid through a net meter to be available for other power users. `' Q a W W N = H All metal parts including solar panel frames,micro-inventers,and mounting rags are grounded using the manufacturers recommended grounding method and WEEB technology along with x6 AWG grounding wire. The building was constructed in 1985. / n ao`6� Q C?NO /Ate' J L� G a N �\ Q Parcel Lamut Panel Dimensions 64.96 in x 38.98 in System Weight 2292 lbs 3c� Panel Weight 40.8 lbs System Distributed toad 3.6 psf System Square Footage 633 sq ft Roof Support 2x6 -4E Racking Weight 665 lbs Actual Point toad Max Spacing 4 ft Mfcro4nverter Weight 158.4 lbs Total number of Roof Penetrations 90 Max Allowable Rail Overhang 16 in Members are Hem,Fir(North)allowing 235 lbs per inch thread depth Note 1:Use 5/16"x 4'Her Head Stainless Steel Lag Screws Variables Note 2:RoofSKrport Members arc 2v6 h 20 ft a 5 ft Ipnet Downforce 10.4 pSf Note 3:UnimcSolar Mount Radrinp H 50 ft Wind Downforce 10.4 psi P'et Uplift -42.4 psi set Ali Roof Pitch 22 degrees Wind Uplift -42.4 psf B 5.4 toad Combinations wMax 145 pif V 100 mph It1t 1 IDI ID2 ID3 jUplift Max Span 3 h p Snow Load 50 psf Exposure Category B ELoadD 3.6 3.6 3.6 2.2 f Actual Span 4 ft Q RoofZone 3 A 1 S 50.0 0.0 37.5 0.0 sf Rd 580lbsPnet 0.0 10.4 7.8 -42.4 sf Ru 436lbs Qjp•• 53.6 14.0 48.9 40.2 sf Required Thread Depth 1.85 in y w o w vw•• 145.1 37.9 132.4 108.9 H Actual Thread Depth 2.25 in 'o' m c o w Q 'DWL-Design Wind Load a ey --Absolute values are ImRcated for the calculated quantities of P-Uplift and WWOO > N Z Glossary of Terms for Load Calculations p R N h Building Height 1 Adjustment Factor for height CO O H suttdmg Least Hwizonml O_ RoofPftrtr Roof Pitch I Importance Factor of for a single family residence 4•+ t9 c Q. C V Basic Wind Speed •` M O Sm.Loud Snow Load B Module length perpendicular to beams U d U Roofz- Roof Zone Rd Point Load-Maximum Downforce O E Effective Roof Area Ru Point Load-Uplift 3 L, Roof Zone Setback Length Exposure 6-Suburban single lam@/dwelling Rte,Doemfwcr Net Design Downforce Pressure category Pnet Uplift Net Design Uplift Pressure Ili E_'1 L.'1 1. Krt Topographic Factor r V Roof B Typkal section 0.75 kW DC Photovoltaic Solar Array This solar array is comprised of 3 Yngh 250 Poly Black Frame molar panels.The panels are mounted using the Univac Solar Mount solar mounting rail to the building's 2x6,spaced at 16 oc.Each solar panel is attached to a SolarEdge Optimizer also mounted to the Unirac Solar Mount rail directly beneath the panel. 00 N The solar panels produce DC power when struck by sunlight.The DC power is converted to 240 V AC power at the inverter. The optimizers no� 4so C N are connected in strings that connect to the inverter. g rp W cc O C C N � Y This system will be grid-tied. D the solar panels produce more power than is used by the building,the excess power flows back into the E j utility grid through a net meter to be available for other power users. Q tl w 0 H All metal parts including solar panel frames,micro-mverters,and mounting rails are grounded using the manufacturels remmmended grounding method and WEER technology along with gG AWG grounding wire. The building was constructed in 1985. P �Zti Q Pastel Layout cn.40 Panel Dimensions 64.96 in x 38.98 in System Weight 191 lbs .rG Panel Weight 40.8 lbs System Distributed Load 3.6 psf 1, System Square Footage 53 sq ft Roof Support 2x6y�) Racking Weight 55 lbs Actual Point Load Max Spacing 4 it Micro-Inverter Weight 13.2 His Total number of Roof Penetrations 7 _�s Max Allowable Rolf Overhang 16 in °- allowing lbs per inch thread depth None 1:the 5/16"x 4"Her Head SroiMess Steel Lag Screws Variables Note S RoafSupport Members are 2x6 h 18 ft a 5 it Pnet Downfarce 10.4 psf Nate 3:UniracSolar Mount Racking H 171t Wind Downforce 10.4 psi Pnet Uplift 42.4 psf sn Roof Pitch 22 degrees Wind Uplift -42.4 psf B 5.4 Load Combinations wMax 145 pif a V 100 mph K2t 1 IDI ID2 ID3 JUplift I Max Span 3 ft o Snow Load 50 psf Exposure Category 8 Dead load D 3.6 3.6 3.6 2.2 psi Actual Span 4 ft Q Roof Zone 3 d 1 Snow toad S 50.0 0.0 37.5 0.0 psi Rd SBOlbs E 18 ! 1 DWL' Pnet 0.0 10.4 7.8 42.4 s1, Ru 436lbs Total Load P++ 53.6 14.0 48.9 40.2 sf Required Thread Depth 1.85 in y o V Distrib TL w++ 145.1 37.9 132.4 108.9 R Actual Thread Depth LIS in o `a 6 N L 7 +DWI.:Design Wlrtd Load t! 00 O •+Absolute values are indicated for the calculated quantities of P-Uplift and w-Upfi t > rn z Glossary of Terms for Load Calculations p h Building Height A Adjustment Factor for height C J 0 H Building least Horizontal Roof Pferh Roof Pitch ! Importance Factor of for a single family residence 1C CL r 12 V Bask Wind Speed •L M 3 Snow load Snow load B Module length perpendicular to beams V Y V Roof2one Roof Zone Rd Point Load-Maximum Downforce U E Effective Roof Area Ru Point Load-UPlift � a Roof Zone Setback Length frposaro 8-Suburban single family dwelling Hmtoowniores Met Design Downforce Pressure category Peet Uplift Net Design Uplift Pressure V lot Topographic Factor "_ Electrical Diagram for 58 Evergreen dr-9.75 kW DC Photovoltaic Solar Array N Grid Account Number-66085-08001 Nrrw„.r Q [ Yasa83R,xb•r ltxrttyrart,WnW[aMe,nr wetea 'Osm. txx cap%mr NnYxaa.WV � 'wa eW ro[.e 2•cfY'se-PX 9a,rwmr ew.M Wr.eeM nva.M M+.e mala a„rpn t)r r,wut ��]•s •q uMl.w rmwAt.e [ameri.n �wr.a�n�wwMe M rrJ4Oaw e[Ou.ptrt RSa6e �.r�z<Jna aN wnrrw frrr e.wn.+er er et,c[<,Mt4m Ne"fn..t-. OwDm m a/wntm AJM vK' OpeJetMr aupm YMa4."Rv Nle. [ JJJJ'Jaw W � ril� .p`` ream coyer wm x0.a�O no V �I t-mMietr rJe wtwv mner� .row..*.a+•�� -_ rna.ewn ca.r,.w ,.t.w 5 wmr rarer _ � ,ay Jer.w..w xx t•.e,e[/upehar,•w as sme.wtee.ne,.m an>'.a•a,e ! C3 N O iso �t /Joo�ss w •a• ,c.w.w mwc... mnow y C a t ,t,wu atiY• i J > �[ 1 1 ntw. " n.e,.,.t ttww-zcecwe.' 1 Q car o W .�-i S H ree..smt acct-n...a ! wMra we..m.me.s.e. ;t:s,a,.M.we.a".h e.: �ow�a wrw ,"an m m, rc sues.cwt uw> 1 ! rm,asw�,al�seevhe i, t Q 0 Gteu.xtww M PV Circuit Cunducturas H PVinwartur LUAstay _ Calculation for PV Breaker Mmlmum car 90 AVuG PV Circuit Conductors Q Calculation for Mab PV Breaker®CirwiLs VMZ SMHG CALCULATION P'V Discon n act to Inverter System Current= 10000 / 240 = 41.67 Amps 2014 NEC fh[BArrticle 310 Minima m#8 A CU tligt raft 4ngiP.ralja '11 +Ng2E 5�0VG CALCULATION Design Amperage- 41.667 X 12S% - I 52.08 Amps tinurrn Vn1mCa 2014 NEC Artide 31'0 Mann Buss Sating 2001 X120% = I 240 Amps 1 engtn'eat Hun(fPRr) "411 Full Load Amperage.............:42 Existing Mab Breaker = 200 Amps Load uuty......................:Cormnuous Smirrm VnBagn '740 Max Solar Breaker 240 (-( 200 = 40 Amps Conductor Application..........:Conductors in Raceway,Cable or Earth Len or Run(Feet)...._......:25 Conductor Atrpecity Table.......:NECTable 39'0.15(8)(16) LundDuly.......................CunWwutrs String If 1= 5250 / 3SOV = 15 Amps ConductorType............--:THHN Copper Conductor Application._.......:Conduotora in Raceway,Cook:or1arth 15 X 1.25 = 18.7S Amps Conductor Location.............:DryMamp CunduciorAmpacily7abla.......:NEC Table 310-1 S(B)(i6) String#2= 45W / 3SOV 12.86 Amps Conductor Insulation Temperature:90'C 'Cnnrhtrinr Type 'THHN rmpppr 12.857 x 1.25 = 16.07 Amps Amhiant Temperature............:26 WC-7886'F 'CailaUCl0r LOCagOn..............:DrylDalrlD Tam pnalTenpernture Rating....:60'C Conductor Insula0on 7enpera lum:90'C Ciraui Type':Single Maac 2 Wkc(2 phone eonductora,or phone&neutral> Amblant rcmperature...........:2630 IC-78-8 IF Electrical ed Notes Qty.of Circ ul Cumat-Cnnying Can duotom:2 9 11 All equipment to be listed and labeled for its app9otbn. Terminal Te rtpemturp Rahn g....::60'C Additional Current-Currybtg Can .....:2 i;0o0rt type::Smgle FHlaae:i yyre('L:phase cOnt7uctor9 ffi neUttaO 2)Ali conductors shall be copper,rated for 90C and wet environment,unlessO Qty.of r Re Current-CafMna C0n0u[tors:2 otherwisenoeed. Total Qty.Current-Carrying CorMuctara.....:.4 Conductor12equ'rament 3)World"dearanon around at new and existing electrical equipment shall Conductor Requirement Full Load Amps............:42.0 comply with NEC110.26 Fug Load Antm............13.0 Load Duty lAuttiplie r.....:'.7.25 4)AO wire tedrraaoshall be appropriately labeled and readily tdcabie. Lund Duly fduly6ei......123 mm t:ieul Tau4a.Idugtpaer..1.0 Amplest lem0.MUgg:lnlr.:1.0 lun01 V Qty.Cuirduelurs ftluMilani.1.25 Qty.Cundusdares�UuUplen'.1.0 a m s)Module grounding dips to be installed between monde frame and Required conductor Ampacdy:62.5 w > module support nit per grounding dip manufacturers instrucdon. Requtaa Conductor AMOr54:23.44 TPr1r11r1AI RPg11kPTPRi' W as 0 Terminal Requirement Fail Load Aps.........._:4ZO Amps > Q Nodule Support nil to be bonded to continuous copper GEC via WEEK lug His Pasta A min .1%11 y Null I nod l ktty Lint.bar "1'J4 Lund Duty µr&sn /.25 ....... per NEC 690.41C). 71 N used PV power source breaker to be bated at bottom of bus per NEC Nequrecs ienwalAmpacey:la./7 .Required TerminsdAmpacty:525 690.64(9)(7). Selected Conductor: SatariPd r.nminrtnr (p Conaucter Arroacny.......:55.0 u B)AC combiner panels shall be labeled as"Inverter AC Combiner Panel•. Condu LKor.Anpecdy.......:40.0 Ambieud'Tem Derate.....:1.0 AmbientTemp.Derate.....:7:11 p' }r OD Qty.Ca nductore Derata.._•0.8 Qty.Condudpra lDerate...:1.0 U 9)Listing agency name and number to be indicated on Inverters and modules W per NEc 110.3(9) Adpanted ACOcly 3ZO AdIusteOAmpatltlr........:'.bb.0 wper NEC SELECTED tJJ 10)PV pourer source breaker to be suitable for backfeed SELECTED CONDUCTOR S[ZE:6 AWq 2st 2 x OhmsINltlFt x Lcngttr x Ampa 2 x 9.08 x SD x 15 2 x OltmaiMflrt x Length x Amps 2 x 0.770 x:25 x 42 VD- - -1.86 VD_ _ _1A3 1000 x Qty Wirca per Phoac 9000 x 9 1000 x Qty Wire 9per phase 1000 x t Volts At Load Terminals.-...:340.14 Volts At Load I ermvnals..-..:Z30-4r PV-3 Actual Pu41 Ise rnt Vottage,Drop.:0.61 Au PCr unnt Vottago th p 0: Wirine Descri tp ion (39)Yingli 250w Poly Black Panels with(39)Solaredge(OP300-MV)DC optimizers nverter:SE10000A-US V meter type:Locus Lgate 120 mu location:N/A CO N nternet Connection:Power Line Bridge with a multiport switch o Main Electrical Panel:Murray(200 Amp) ai c d � Q N nverter Calculations: m W A W c nverter#1)10000w/240v=41.66 Amps x 1.25=52.08 FLA c o '; c 2 ¢' a Interconnection Calculations:N/A(Line-Side-Tap) ,n o Interconnection will be a line-side-tap in a junction box by the existing main electrical panel.From the LST,install wiring to a 60 Amp fused disconnect switch with 60 Amp fuses mounted near the main electrical panel.From the fused disconnect switch,wire outside to a 60 Amp,non-fused disconnect switch that will be mounted under the existing utility meter.(Wire for the LST must be at least#4 HHN-2.)From the 60 Amp non-fused disconnect switch,wire into the house and then out to the back side of the house and then thru the PV meter and into the AC disconnect terminals of the inverter. See picture for meter and inverter location).From the DC terminals of the inverter,run exterior conduit straight up the back corner to a penetration thru the soffit and into the attic.From the enetration,run interior conduit across the attic to the two soladecks located under the solar arrays.There will be two strings to the roof.String#2 is split between roofs and will need to be combined n series.Standard wire size and type for the array wiring is#10,THHN-THWN-2 0 9 CD +t � Inveter:SE1000A-US a Panols:Yngfr 260w meter String 1(21)DC Optimizers String 2(18)DC Optimizers El Soladeck(2) Jumper Interior Conduit yr f a v 0 00 > Ul Z Z3 0 r A J ttott -L 0 PV-4 Date....... �3..... fAOR TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. .............................................................................................................. has permission to perform ( 7—o�qe7f-1 ............... .................................................................................... of wiong in the building U E . . .................................................................................. at ....Q.1 ...........................North Andover Mass. Fee. Lic.No. 3 ZI�7 .............. ......................... ............ ............... EimmicAL,INSPECTOV Check# t 7L/� 11768 Commonwealth o�Vag.4.4.erb Official Use Only 1 2.parEment o�}ire�ervicee Permit No. . -11169 v Occupancy and Fee Checked N BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank i 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 INFORM4 TION) Date: =C)O City or Town of: ,n4lk AT To the Inspector of Wires: r By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) S7— Owner or Tenant Telephone No. 1 Owner's Address Is this permit in conjunction with a building permit? Yes ff No ❑ (Check Appropriate Box) Purpose of Building ��(� Utility Authorization No. Existing ServiceDOO Amps J,) / t(p Volts Overhead Z" Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the ollowin table maybe 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 ❑ Jul- ❑ o.of Emergency Lighting rnd. grnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of SwitchesNo.of Gas Burners No.o Detection and Initiating Devices a No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers eat PumpNer Tons o.o Self-Contained Totals: ................... ....................... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW f 5 biD Local❑ Connection 11 Other No.of Dryers Heating Appliances KW ecurity Systems: No.of Devices or Equivalent No.o Water KW No.of No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Winng. No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 1\ Estimated Value of Electrical Work: ,6'00-60 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. ` INSURANCE COQ RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [" BOND ❑ OTHER ❑ (Specify:) I certify,under the atns andenaln of perjury,that the information on this app ' anon is true and complete FIRM NAME: LIC.NO.: Licensee: Signature LIC.NO.: (Ifapplicable,a ter "exe t"in the license number line.) Bus.Tel.No.: .s.3 Address: Alt.Tel.No.• *Per M.G.L.c. 147,s.57-61,security work requires Dep ent of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that th icensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: i � ' `. � J �/� � �f /v SOY &. G _. � . . t ' .t . .. .. < , �, . .t t .__ _ .. . � � , _ , . . , r ._ .. ,. ., .., . , � � � .� �., , � _ S: .�. � � ' _ � r .. , a I 10145r� 13 Date . . . . . . \� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . . . . . . has permission to perforin r�o pluVt inthe 'uillddings of. . . . . . .t. . . . . . . . . . . . . . . . . . . . . . . . . . . e� at . . . ,North Andover, Mass. i a Fee . . . . . . . . . Lic. No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check.# }° M MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK W I F F - CITY 4 _ MA DATE PERMIT# JOBSITE ADDRESS OWNER'S NAME POWNER ADDRESS _ �A TEL _ I FAX _ k TYPE OR OCCUPANCY TYPE COMMERCIAL ( EDUCATIONAL El RESIDENTIAT- PRINT `tel CLEARLY NEW: Q RENOVATION: REPLACEMENT: 0 PLANS SUBMITTED: YES N0�( FIXTURES 7 FLOOR-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM T_I .-.._........_J m I ! ........_.__.,I l I I ..___.f f __..Tf DEDICATED GAS/OIL/SAND SYSTEM .,f DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM f _....__..__I I -► _-.._.-....._I __- __I _( ! _.,-- ---...._.I DEDICATED WATER RECYCLE SYSTEM DISHWASHER _`Mi DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK .......... J LAVATORY ROOF DRAIN ( ----._._� ( f I v._.J ---- € J= SHOWER STALL SERVICE/MOP SINK TONTURINAL f _.__._-__I ---.-- ---.___.f .___. _._ _..f ._-___( .-____J __T ._.__._...! ._,_-._' ___ _•_ _.._.. _.I .___-- -_.._..l VVA 5{HING MACHINE CONNECTION - WATER HEATER ALL TYPES _( WATER PIPING I ------_If L- -! ' f .__.._.. _._..t _._1 ( _( OTHER I ' 1 _. INSURANCE COVERAGE: I have a current liab- ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ,_-E NO 0 OF YOU CHECKED YES,PLEASE INDICAT,SE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLIC�',�f) OTHER TYPE OF INDEMNITY D( BOND Q OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT �[] SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to th best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com Fie h all Pert' t rovision of the K4assachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Ga� I LICENSE# -,./ l SIGNATURE MIP, JP�-I CORPORATION 0# PARTNERS PD# _ ;LLC #i = COMPANY NAME , J,:�A tjkLl( ADDRESS LI � — Rp CITY ( � __.__.._..._.......__!STATE ! ZIP TEL ill ? . _- i -al bl- FAXL CELL 1 i EMAIL - d.vi�r -_ __ ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No --/3 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES I i Q . 4 i sachuseUs o Mas The Commonwealth f . - Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia 'workers' Compensation insurance Affidavit: Builders/Contractors/El Please Print Le umbers Apbly plicant Information Of �n��f Name(Business/Organization/Tndividual):, !`� fA- 171 We VC<5 ILL Address: Fc:l/-►.+� City/State/Zip: Phone Are on an employer?Check the appropriate box: Type of project(required): 1.( I am a employer with t/ 4• ❑ I am a general contractor and I 6. E]New construction ployees(full and/or part-time).* have hired the sub-contractors 7 ,Remodeling 2. I am a sole proprietor or partner- listed on the attached sheet. ees These sub-contractors have 8. E]Demolition ship and have no employees p Y workers' comp.insurance. 9, (]Building addition working for me in any capacity. [No workers'comp.insurance 5. ❑ We are a corporation and its 10.[]Electrical repairs or additions required.] officers have exercised their 11. Plumbing repairs or additions 3.F1 am a homeowner doing all work right of exemption per MGL ❑ myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they Are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: L/1 U �h R 77 � ���� Expiration Date: l Job Site Address: �,c f � City/State/Zip: �f Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well.as civil penalties in the form of a STOP.WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cov age verification. Ido hereby cert1 er the p ' sand e alties of perjury that the information provided above is ue and correct. Date: /� -5- Si ature: hone#: Offic' use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: fi 'i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire,• express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing'agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not producedacceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents gftice of Investigations 600 Washington Street Boston.,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www-mass,govfdia tCOMMONWEALTH OF MASSACHUSETTS LICENSED AS A MASTER PLUMBER, ISSUES THE ABOVE LICENSE T0: r '14SON W THOMAS 1, . JACKMAN RIDGE RD WINDHAM: NH 03087-1670 ` 1 i 1015' os:olil .. 162624 . .