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Miscellaneous - 76 PUTNAM ROAD 4/30/2018
N O O N (J r 8 N O O Date ..... ....1..� ............ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.::.: l� ........................ l �'�L ... ....................... has permission to perform S2A........P �.+rt I .At 1>,%��. ��CS �. ........... L-�^� t................................I............ wiring in the building of ........ �..i��, P, v+ 1 �1.."� ............................................................. at..... ....... i.: ...� f .!...1...... � � •................"Nndover,...Fee!Q�...... Lic. No�.��.. ...................... r Check # " Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK 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 electrical work described below. Location (Street & Number) 36 (auTAI AA Ka. i Owner or Tenant GAN,, ( Q.,-rw 0 X Telephone No. W y , ,f'5�j� Owner's Address 5h - Is ' Is this permit in conjunction with a building permit? Yes ;] No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No.—/V,4— Existing o./V,4—Existing Service UV Amps i2a / 2k4fWolts Overhead.Q Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity o- Qi ",f -1X ley 4 Ic /clp Location and Nature of Proposed Electrical Work: f4 Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- El rnd. grnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. To sl No. of Alerting Devices ' No. of Waste Disposers eatump Number I I Tons KW I No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW o. of No. o Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications firing No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Wor S -Z b (When required by municipal policy.) Work to Start: y --,2i '- �� Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE WL BOND ❑ OTHER ❑ (Specify:) I certify, under thepains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: -0 t 7 c Ar'x e%( Q,L,r t c(-• � J t c -,es LIC. NO.: t 1L i g l ,S -4- Licensee: • A/tip AVa // Signature LIC. NO.: A& -i& (If applicable, enter. "exempt" iy, the license number line.) Bus. Tel. No.: 2$/ /` GG yid Address: i'a ND • 1 ZA4 . 40ICiC62�.Alt. Tel. No.• *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ a6,--1 All Tlie Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Sheet, Suite 100 'l d Boston, MA 02114-2017 .� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A hcant Information Please Print Legibly Name (Business/Organization/individugl): Address: City/State/Zip: &) Phone 0: ? W ( Are you an employer? Check tie, appiropriate box: am a employer with _ 'r�'. employees (full and/or part-time).* 2.FJ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required] 3. ❑ I am a homeowner doing all work myself [No workers' comp. irisurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.T 6.FJ We are a corporation and its ofF ers have exercised their right of'exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] r:. o 62 Type of project (required): 7. [] New construction 8. Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. F1 Plumbing repairs or additions 13. [] Roof repairs 14. ❑T Other 1 *Any applicant that cheeks box#1 must alsofill out the section below showing theirworkers' 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. tConfractors 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-cb&adors have e' mployees, they must provide their workers' comp. policy number. y afn an employer thai is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Name: (j uJ JL CG Z 1 �{ �- ' Policy # or Self -ins, Lie. #: U Expiration Date: Job Site Address: (, PyT N o`"- (Z -T:,'>• City/State/Zip: IV A N r AM Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 7 do hereby certifyyt�rler the pay'nrs anAenalties of pe jug) that the information provided above is true and correct 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. CityJTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: r _N 0 m0 7 � 2 D CA O m >=. 3 'fin • M K W p o m Go » p� A y1Ld O A rn a m D - l7 r _N 0 m0 7 � 2 D O m coon o N O ID M K W p o m O m �m p� A y1Ld O A ACORO® CERTIFICATE OF LIABILITY INSURANCE �°'�`"""`°°'"""'/' 4/16/15 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 policypes) 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 endorsemen s . PRODUCER John J. Lamb Insurance Agency 24 North Street Hingham, MA 02043 CONTACT NAME: PHONE 781 749-6960 0jaFAX N ; (781) 749-6822 E AIL ADDRESS: karin @ ' lambinsurance . com GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1-1 OCCUR INSURERS) AFFORDING COVERAGE NAIC# INSURERA: The Hartford- S&D Ins Agency 11/30/14 INSURED INSURER B: DAVID CAMPBELL 19 POND STREET PEIABRORE, MA 02359 I NSURER C I NSURER D INSURER E: I NSURER F: GEN'LAGGREGATE LIMITAPPUES PER POLICY PROZCT LOC 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 LTR TYPEOFINSURANCE ADDL SUER POUCYNUMBER POLICY EFF MIDDY POLICY EXP MM/DDIYYYY UMTS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1-1 OCCUR 08SBAPV1826 11/30/14 11/30/15 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEDREMISE $ 100 ,000 MED EXP (Ary one person) $ 10,000 PERSONAL &ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPUES PER POLICY PROZCT LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABIUTY ANY AU70 ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS ,_ AUTOS CO eOCcNEE S NGLE L M T $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ eraccidem UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRIE70R/PARTNER/EXECU' OFFICERIMEMBER EXCLLDED? (Mandatory in NH) If yyes, desaibe under DESCRIPTIONOFOPERATIONS below N / A 08WECCI0144 11/30/14 11/30/15 X WCSTATU-OTH- EL. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L.DISEASE- POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is regri red) Town of Cohasset 41 Highland Avenue Cohasset, MA 02025 %o 14" 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 N ACORD ACORD 25 (2010/05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: (781) 383-1561 E -Mail: riahts reserved M (D M Q N CU aU u Q Q u Z Q >` O C O ?� 7 riLn O ri N N N F- n 11 `° 0 3 N O 0 3 (7 O 0 C C II CL 3 O. 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W C) O TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 1 �,%�^"� -......................-i-�-- �-- -�- .................................,, .. ..... .... L /- - - has permission to perform ... A....:!r ::r ..... �.:-j�`',e.— ............. wiring in the building of..--" %`......................................... -�, North Andover, Mass. Fee,`gn........ Lic. No..�-.1. �:L:........ ! timc gl�WECr Check # 9267 DO 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance-with the provisions of M.G.L. c. 143 3L the ✓� Permit application form to provide notice of installation of wiring shall be uniform throughout' § ' 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 the Commonwealth, and applications shall be filed 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 construction activity, and maybe_deemed_by_the,lnspector_of_Wires abandoned_and_inivalid.ifhe__ . 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 acti i Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No.� Occupancy and Fee Checked [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 03-16-2010 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) 76 PUTNAM ROAD Owner or Tenant Owner's Address BERNICE SUBACH 76 PUTNUM ROAD Is this permit in conjunction with a building permit? Yes Purpose of Building Existing Service 100 New Service RESIDENCE Telephone No. No ❑ (Check Appropriate Box) Utility Authorization No. none required Amps 120/240 Volts Overhead ❑ Undgrd ® No. of Meters 1 Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: REPAIR OEVERHEAD SERVICE & METER No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of To—t571-- otalTransformers KVA Transformers No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above [i In- ❑ rnd. gmd. o. ot Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. o -Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: .N.m er . To.ns K.W........... .......... No. o Self -Contained Detection/Alerting Devices No. of Dishwashers 1.Connection Space/Area Heating KW Local ❑ Municipal El Other Ido. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. o Water KW Heaters No. o BNo.al o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydro massage Bathtubs No. of Motors Total HP Te ecommumcations Wirmg: No. of Devices or Equivalent OTHER: INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licen- ., see provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certi- fies that such coverage is in force, and has exhibited proof of same to the permit issuing office. ,CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) 09-31-2010 1 Estimated Value of Electrical Work: $800. (When required by municipal policy.) (Expiration Date) Work to Start: 03-16-2010 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: WILLIAM J. IANNAZZI, INC. LIC. NO.: 13592A Licensee: WILLIAM J. IANNAZZI Address: 191 CHANDLER ROAD ANDOVER, MA 01810 ____) OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liab By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner Owner/Agent Signature Telephone No. Z� LIC. NO.: 13592A Bus. Tel. No.: 978-686-7300 Alt. Tel. No.: ility insurance coverage normally required by law. ❑ owner's agent. PERMIT FEE: $ �� _.... Date ..`.�.1 .-7 1`%...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that. .................! ! ^-1�� . { .", � c l�h..STc9 . ..................................................... has permission for gas installation in the buildings of ..lJt 1 ti Ar't at ...... `i,{.N A-^ ....... .c�.�.... Fee .3 k �..... Lic. No... .� Check # l to I- I� 9329 Y..a--.. .... V..:.. .................................1 ................... t ...................... North Andover, Mass. .....�� ................................................................ GASINSPECTOR MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I North Andover MA DATE 5/22/2014 PERMIT # JOBSITE ADDRESSI 76 Putnam Rd OWNER'S NAME GOWNER ADDRESS I Same I TEL— IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL ® RESIDENTIALE] PRINT CLEARLY NEW:F_] RENOVATION: El REPLACEMENT: PLANS SUBMITTED: YES❑ NO[j] APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/ SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER Re lace I Gas Meter x 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ❑ NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ 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 the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in pliance with all Pertinent provision of t Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASF ITTER NAME I Joseph Marino LICENSE # 8736 SI AT RE MP ❑ MGF ® JP ❑ JGF ❑ LPGI ® CORPORATION # 3285C PARTN HIP®# LLC ®# COMPANY NAME:j RH White Construction Co ADDRESS 41 Central St CITY I Auburn STATE LLAJ ZIPI 01501TEL (508) 832 3295 —� FAX 508-926-4347 CELL 508-832-4614EMAIL JMarino@RHWhite.com W F O z z 0 H U W P. Q z w f C ❑ a z z o U)❑ } w � ~ w o o W F a z U w Q a W x W a W d cn zz a a a U x J F a a Q � � w x w f- LL F O yzy O FH F U W A. z Q x 0 a • +n'i :�;�3Af]jLu�IS'r' :::; ,::.. 5• y ;5`•' � •'� '� i•tl I••1' 1 !='';�t_ ii{:.•'; t4; ;r;, fir:: I!' ci,! i' lilt; - llu5f,t�•(f•"':��,I•: it ; ii.,f 1 - ;ixiittll •!.• tr.. ::4'ii �:.lii• .I" ';.o .;tl{.. Ii''Ulc I� LLW wi t19 Z. LL Z m ..U)• \ co .. F- LU w C� E i►„�'.: ��._:,�l;r •:ty li• L:�II:: l(/3!!i� �i�tl � .� 'y1-:lSMii' 4i11!.:.:tti5iix,: IL:'•hi S;`�.;•..,,,q't. ta: !:; ��I;iS•`; ';1 }'1}; ;l. i.,, �': _���I�}n• Ian}ti r!'•q�.jj.:ilr'�`�rfl•' � ...f t<�fitQ ,,p'j •'t. J+tr,,. _i iii: i�r. '•`: � : trr: •Jrn .:• r!;!.....'.r.,(1::, ','+;r;!''�'•"r;t;'.'�",r,r •;F .:, . rt,rr'.'•t:r •-�. .. ...._.. ....J. .. ...' tl fir,.. rte. ?in. il,'l:.:.i ' •:pi ! +i r.l:r'�,'��'.I k a.1 10 U3 w <7 ' ¢.• . L. CDE2. ..� , O - ©d .o o- F-• - Q Ln W l LU MU) 6 • k .�LU r1Y! 'r rail • '; •j:�`�'ii �,�•'77�N''+� �' L.:.,r"' , °ii�'t 1;';i':'��:�i:•`,t,•'l.ii�li�''?r�;:':!?:i.lr�::•:i%rl:,,,�. 0 ��-- CERTIFICATE OF LIABILITY INSURANCE Page 1 of z 08/29/20 31 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TyIS CFRTIFleATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGF; AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT EETWEEN THE IS INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)murt 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 Certifleate does notconferrights to the Certificate holder in Ileu of such endorsement(s). willia of Maeaaehueetts, Inc. c/o 26 ecmtlx Blvd. P. 0. Box 30$191 Na9hville, TN 37230-5191 R. $. White Construction Company, Inc. 41 Central Street P. 0. Box 257 Auburn, MA 01501 Le aW.W.1m -- .•,..., �wvr.Rn�c NAICm INBURERA:The chartor Oak firs) Sneuraneg Company 25619-001 INSURERS:TrIlValoXe property Casualty oo gany oi' Am 25674-003 INSURERC:Nati0nA.1 Union Firs) Inauranca Compeny o£ 7.9445-001 INSURERD;Travelers Indamility Company 25658-001 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE A I GFNERALLIA6ILITY IW.RCIAL GENERAL LIABI I.ITY CLAIMS^MADE OCCUR LIMITAPPLIES PER; B AUTOMOBILE LIABILITY X117C ANYAUTO ALI.OWNED 8011011LE[ AUTOS AUTOS X HIREDAUTOS X NON•OWNEI Ca Defl AUTOS i.p V Cox1 fed VTC2000 977X9948 -1a 19/1/2013 0/1/2014 977K955.A-1.3 9/1/20.13 19/1/2014 LIMITS EXP (Any one PERSONAL &ADV INJURY GF_NERALAGGREGATE PRODUCTS-COMPIOPAGO BODILY INJURY(Perpemon) S 13COILY INJURY(Peraceldcnt) B C D D UMBRELLA41AB EXCESS LIA6 I X I OCCUR CLAIMS -MADE N/A 1330766140 VTRKUEI 8205.'4.7.85-13 VTC2"" A203A71A-13 9/1/2013 9/1/201.3 9/7/2pZ3 9/1/2014 9/1/207,4 9/j /a 014 EACHOCCURRENCE 1G AGGREGATE 11 DED I V IRETENTIONS ;L0, 000 WORIKERTION AND AND EMPLOYERS'LIABILITY YERS`LSAILIT ANYPROPRIETOR/PA0LUDI! 7 CUTIVErX (O(FFICERnnMttIEMBEREXCLUDED7 LJ Ifre deactlbeundnr U is Kil+I ION Uh QPkRATIONS below X TOR U O F E.L.EACHACCIDENT E.L.DIAEA9E-EAEMPI,pyF. Evidence of xnmurance F L. DISEASE • POLICY LIMIT more epeea 2,000,000 1,000,000 1,000,000 1,000,000 SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZEDREPRESENTATNE COAI:4197604 TPI:1694012 Gea:t,20287680 ©1988-2010ACORD CORPORATION. All rights CORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Location �(� ?U'/U/I lc/ No. 916 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 6 4 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 9 9q3 3 1565) Building Inspector Ma rn X Z O TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING y BUILDING PERMIT NUMBER: DATE ISSUED: ` J y` " SIGNATURE: Building Commissioner/I for of Buildings Date SECTION i- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 7G Z Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.Q40.34) 1.5. Flood Zone Information: Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal ❑ Public ❑ Private 0 System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record �u�ti/cam �y �''Ae, A r.4 -A �-- Name (Print) Address for Service Signature Telephone � ;> 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ JiaA �vg�o+ Licensed Construction Supervisor —1— d `�� s r� ' qa License Number O k4,4,� 4 10, U' Addres t ,�q �^ v t r Expiration Date Sig re Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ RAJ C Company lqame A'�f d ^ A V ��� Registration Number f^' Address Expiration Date Si re 11 Telephone Ma rn X Z O SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 & 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction Existing Builkg ❑ Repair(s) ❑ Alteratidps(s), ,0 Addition 0 Accessory Bldg. 0 Demolition ❑ Othefry 0,, Specify ' Brief Description of Proposed Work: , . 3kfx�!ar SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by pennit applicant OFFICIAL USE ONLY 1. Building Q�(y (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) owm- 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all natters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief i Print Name f Signature of Owner/A ent Date of NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TlrvMERS 1 2ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS Hl?IGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Sign ure of Permit Applicant v1 2 -- Mite NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Phone am a homeowner performing all work myself. �1 am a.sole proprietor and have no one working in any capacity an employer providing workers' compensation for my employees working on this job. >.Y i�i f - l YY(j Address Farulre to seEUM cacrerage as requite! undue Sectroa 2!V or NIGL t52 can tead to tlw ,. and/or one years' kMdsorunent as'well as d of penajties. of afire W> to $1;500.00 penalties In "form rrrr of a Si oP WOtIC Oft and a fine of 3'106k00) a day against rne. 1 understarhot that a copy of this statement may be fonrvarded to the Office of k� of the uk for coverage verillcafion: / do herby cert"nder the pains and pena*les of perfury Print S i 1b"nation provided above a bue ant} correct I, Official use only do not write in this area to be completed by city or town official - D.Ch--Ck it'fmmediate response is required Building Dept Contact person: Phone #- 'QRtCMAN'S COMPS SATION 0 0 Building Dept- ' 0 Uconsing 80ard 0 Salect6an's off,e6 Q Health Department 0 other C/) m M m cn0 m M y _d CO)CD C7 n Z y CL r ? O CZ a y o CD o v CD o r•M CL a� =r d CD CD O CCD ov oo �. C CD U; CD CL O y CD S v Cos O CD 74 O CD 0 CD _C C p d = 0 �• H o Q CA a om = N3 _ :2m CD C! o y c� no a m Z • � =ro H CD In ? n O m y C y N � o _ O m n o ti• � 7 W CD -�-r, �• C• ? N ' r%to:_ C Cry �c CL o � ?:.Nh CDcn co y cn ►b c L n m �S C A O Q.. H O , W �1 Cn a .� a .cam: rt < :� N CD �• cn yMAQ = V+ O m CD, .� O O�c- aao%� n 1••- j V 0 d ar • i/) ? 0 1 Ell_� o Z _ S y: c V 70C o ' y w o W O b �' o Crl n Z ?? ti. roni G w n�� ` G OQ C O C/) b C CA 0 x n O I lu NO )Nei 0 9 0 c Permit NO Date Issued: BUILDING PERMIT "'0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINA ON o Date Received 21 4p t[K..KM.wt,y7` �.4sc Arco— 'ANT: rco— 'ANT: Applicant must complete all items on this LOCATION P J -T N -,Ptm (z6 Print PROPERTY OWNER ��46V rc TW6 IS J-,4 y Print MAP NO: 07-1 PARCEL:M2-y ZONING DISTRICT: Historic District yesno Machine Shop Villaqe Vest no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition gOther 61AP- PAN r',,CS ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer STA -11 sr ew- 1 P�t'- Kye-6- 1&Is s e kc s St 000- (l nil l+.('1 S Identification Please Type or Print Clearly) t OWNER: Name: Phone: LIS -1 Address: CONTRACTOR Name: Phone: `791 6660 Address: IMA�SN��EID Supervisor's Construction License: CS -G% 3011 S�- Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Mee E b&tQ©C S (,(-C- • Phone: 60 5S/( '4 Address: Sq M A w 5• , A 12-igwAJ A..i', Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.PO PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 30340r FEE: $ 3(A�� Check No.: Receipt No.: NOTE: Persons contracting 4Ah unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner - �lylep Signature of contractor CaI/-,,e lfr-T I Permit No#: BUILDING PERMIT OFtiyeO ,bryHd ..:1,,, xa TOWN OF NORTH ANDOVER 3 APPLICATION FOR PLAN EXAMINATION o R ^ Date Received �q�°RATED ">A Date Issued: IMPORTANT• Applicant must complete all items on this page LOCATION'• ... Print PROPERTY'OWNER ;Print 100 Year Structure yes' no MAP PARCEL:ZONING,DISTRICT: Historic District yes no # Machine' -Shop Village. yes no TYPE OF IMPROVEMENT ❑ New Building ❑ Addition ❑ Alteration ❑ Repair, replacement ❑ Demolition PROPOSED USE Residential ❑ One family ❑ Two or more family No. of units: ❑ Assessory Bldg 11 Other Other Non- Residential ❑ Industrial ❑ Commercial ❑ Others: ❑Floodplain O'Wetlands�❑ DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: . Address: Supervisor's Construction License: Exp. Date:. ` Home Improvement License: Ex p. Date: ------- ARCH ITECT/ENGINEER ARCHITECT/ENGINEER Phone: �- Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ EE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund I, r Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Ari ❑ Swunming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On COMMENT'S Signature. CONSERVATION Reviewed on Sianature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes f�=lanning Board Decision: Comments vonservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEP`i, 4R«T�II�ENgT°' Tem Durngpso�n. s -e2 Located of 124 Main Streetz `�""� �� �'�` Fire Departments ger. afurne%clave} � , ��_ _ 4�� Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.:, ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA -- (For department use ❑ Notified for pickup Call Email Date Doc.Building Permit Revised 2014 Time Contact Name 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 Engineering Affidavits for Engineered products DTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4 Building Permit Application Certified Surveyed Plot Plan 4 Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses 4 Copy Of Contract 6 Floor/Cross Section/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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 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 2012 IECC Energy code 4. Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit 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: Building Permit Revised 2014 Location_ !� �G �%��� i'�y/ NJ'24- Date i Check #,3 h.'"'.�. e.s.Uv� TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fees Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector V < O_ < a fn W. C M m NO ' Z c N. 0,a; c m opo �a m �- `�° co o U) c cn N SDID m 2 C Ci O �� CD oo C COD z �, C �.CD CD 0-0 Z ZCL 0 co ��o b �� �,N��' Cl) �� y —1 �_ off, Cr 0 M o =m CLrt '� -0Z < aonCD� Q CD in1 CD m CD Q� r� �v ACD o O z F U)" :t W CD Z @o� Er U) --I .CL0 N cn ,� o CO CD zr v U) O c '0 Z CD CD0 r 0 � o 0, O CD _ y CD O m CD rt p a) o ;u = = C 00 y 0 W T .i7 T N Z7 T -n LLn Z7 T n :;o N T rD7 R N G v C p�j C C -O O '�-r rD S S m > 0- N N 0 < G 0 N n �m W fD T m C 3 ' C WO m N v W 2 zv z D N O z 7O0 A A O O O 2 :0 :0 m SOLAR PV INSTALLATION CONTRACT THIS AGREEMENT is made and entered into this 21st day of November, 2014, by Brookline Solar Electric Inc, ABA Great Sky Solar, (hereinafter called "Contractor") and ErnestTrey -blay-(hereinafter called "Owner'l living at 76 Putnam Rd, North Andover.,, for the purpose of installation of solar photovoltaic panels. The Owner and Contractor agree as follows: ARTICLE I - THE WORK: 1.1 The Contractor shall complete all work on the installation of solar photovoltaic panels at the address 76 Putnam Rd, North Andover, MA as specified in Addendum A. ARTICLE 2 - TIME OF COMMENCEMENT AND COMPLETION: 2.1 The Work to be performed under this contract shall not be commenced prior to receipt of a notice to proceed from the interconnecting utility. 2.2 Contractor shall notify Owner at least two weeks prior to intended Start Date. 2.3 Except as otherwise required for the safety or protection of persons or the Work or property at the Work Site or adjacent thereto, all Work at the Site shall be performed between the hours of 7:00 AM and 5:30 PM, Monday through Friday, unless otherwise authorized by Owner. ARTICLE 3 -CONTRACT AMOUNT AND BASIS: 3.1 The Owner shall pay the Contractor the amount specified in Addendum B for the satisfactory performance of the Work, subject to additions and deductions by Change Order. ARTICLE 4 - CONTRACTOR: 4.1 The Contractor shall perform the work as an Independent Contractor pursuant to this Agreement. 4.2 The Contractor shall supervise and direct the Work, using Contractor's best skill and attention. The Contractor shall be solely responsible for all construction means, methods, techniques, sequences and procedures and for coordinating all portions of the Work under the Contract. 4.3 Unless otherwise specifically noted, the Contractor shall provide and pay for all labor, expertise, materials, freight/delivery equipment, tools, construction equipment and machinery, and services necessary for the proper execution and completion of the Work. 4.4 The Contractor shall at all times enforce strict discipline and good order among his employees, and shall not employ on the Work any unfit person or anyone not skilled in the task assigned. 4.5 The Contractor shall comply with all OSHA and all applicable trade -related rules and regulations. 1 Initial Here: C.r k— ADDENDUM A SCOPE OF WORK: Contractor shall complete the installation of a 5.88 kW solar photovoltaic electric power system at 76 Putnam R_ Norih AndoygrN(A. The system will be composed of twenty-one (21) 280 -watt photovoltaic (PV) collector panels, cabling, racking, wiring, and conduit Optimized solar strings will then be brought directly into the inverter, which will in turn be wired into the main panel. The inverter will assure that the PV generated power is compatible with the power supplied by the utility grid and will disconnect from the electrical system in the event of a utility power outage to prevent "back feed" to the utility grid. The proposed system is sized to supplement and offset the existing electric load during periods of sunshine only, as it will not store power. In periods of excess power creation the utility meter will run backwards, enabling net metering for overall energy consumption. The proposed system will be interconnected with the electrical system and controlled to "follow" the existing systems' electrical characteristics. ADDENDUM 8 PAYMENT SCHEDULE The Total Payment for services will be $30,340. At or before the time this contract is made valid through signature, Owner shall pay Company an initial deposit of $500. Two weeks prior to Start Date, Owner shall pay .$1s,t�Pa3r SO% of the Total Payment due. Upon completion of work, Owner shall pay the remaining $AKW. #1Y, GIC) "(` A- lf owner is unable to succesfully aquire adequate financing, on or before January 31st of 2015, the $500 deposit will be fully refunded. If owner is no unable to obtain the $3,250 rebate made available by the Massachusetts CEC, final payment will be reduced by an additional $2,000, bring the new total for the final payment down to $ Ial.lCiD 'E_ t- L/ 8 Initial Here: 12.4 The cost or credit to the Owner, if any, from a Change in the Work shall be determined by mutual agreement. ARTICLE 13 - PERMITS: 13.1 Contractor shall obtain and pay for all necessary permits and licenses relative to the Project. ARTICLE 14 - SAFETY: 14.1 Contractor shall be responsible for initiating, maintaining and supervising all safety precautions and programs in connections with the Work. The Contractor shall take all reasonable safety precautions and provide all reasonable protection to prevent damage, injury, or loss to all employees and Subcontractors at the work site and all other persons affected by the Work, all materials and equipment in the care and custody of the Contractor or Subcontractor, all Work, and all property at the work site. CONTRACTOR: *VWU kil Aaron Katz Chief Executive Officer November 21st, 2014 OWNER: Signature: 4' 1VV Printed Name: . Ernp5t Tremblay— Date: 11=201A- 7 Initial Here: Cr _ir� I December 17, 2014 Ms. Katherine Fisher Great Sky Solar 55 Sewall Avenue Brookline, MA 02446 RE: Ernie Tremblay Residence Solar Installation 76 Putnam Road North Andover, MA 01845 Structural Assessment of Roof Framing MPP Project No: 14-1758 Dear Sir or Madam: Pursuant to your request, MPP Engineers has performed a limited structural evaluation of the roof framing at the above referenced site to determine if the roof has adequate capacity to support the proposed solar panels. Our analysis was based on the framing information and configurations provided by Great Sky Solar. It is our understanding that the structural components of the existing roof framing are in good condition. It is further understood that all existing connections between the various roof framing members, including ceiling joists, rafters, and collar ties, are adequate to resist the current loading conditions and behave in the manner that a typical rafter and ceiling tie system is intended to behave prior to installation of the solar panels. Structural Data and Code Information Our analysis was performed in accordance with the requirements of the 780 CMR 51.00: Massachusetts Residential Code which has adopted the 2009 International Residential Code with Massachusetts amendments. Per Table R301.2 (1), the ground snow load to be used for each town is in accordance with Table R301.2 (5). Similarly, the wind speed for each town is in accordance with Table R301.2 (4). The roof framing was analyzed in accordance with Section R104.11 of the 2009 International Residential Code which allows for alternate approved design such as using the ASCE 7 code for determining actual snow loads on roofs (e.g., deriving flat or sloped roof snow loads from the specified ground snow load referenced in Table R301.2(5)). Wood members are analyzed and designed in accordance with the NDS 2005. The roof area for the solar panels of this residence is framed with conventional roof rafters and collar ties in a gable configuration. The existing roof structure is in good condition and is assumed to have one layer of asphalt shingles. The pertinent data is listed below: MPP Engineers, LLC 134 South Main Street, Suite D Allentown, NJ 08501 609-489-5511 (Phone) I www.mppengineers.com ( 609-489-5916(Fax) Ernie Tremblay Residence Solar Installation 76 Putnam Road North Andover, MA 01845 Roof l: Roof Rafters: Spacing: Roof Slope: Horizontal Projected Length of Rafter (Horizontal Projection): Ceiling Joists: Collar Ties: Roof Sheathing: Condition of Framing: Roof Covering: Ground Snow Load, Pg: Importance Factor, I: Exposure Factor, Ce: Thermal Factor, Ct: Design Snow Loads On sloped roof. Basic Wind Speed: Importance Factor: Exposure: Analysis Results: General Considerations 2" x 6" (#2 Hem Fir Assumed) 16" O.C. 26 Degrees 14.50 feet Present Present @ 32" O.C. Plywood Sheathing Good Asphalt Shingles 50 PSF from Table 8301.2 (5) of Massachusetts Residential Code 1.0 1.0 (Conservatively taken as Partially Exposed) 1.1 with Panels (Cold Roof) 1.0 existing condition (Warm Roof) 35.00 PSF (Existing — Unobstructed Warm Roof) 28.23 PSF (New Condition — Slippery Surface on Cold Roof) 100 MPH from Table R301.2 (4) of Massachusetts Residential Code 1.0 B ➢ The proposed solar panels consist of solar panels which impose a total weight of approximately 2.5 to 3 pounds per square foot (PSF) on the roof surface. From a practical standpoint, the International Residential Code allows up to 2 roof coverings on a residential dwelling. Each layer of roofing imposes a net load of about 2.5 to 3.0 PSF on the roof. From this perspective, since the existing roof has only a single layer of shingles, a second layer is allowed to be added by the code without analysis. This 2"d layer of shingles essentially weighs the same as the proposed solar panels. ➢ Materials such as metal roofs or solar panels are considered slippery surfaces. Since the solar panels are mounted slightly above the roof line, it would be conservative to consider a thermal factor Ct of 1. 1, treating the panel surface as a cold roof rather than as a warm roof. Based on the roof slope and considering it as a slippery surface, the snow load is reduced by 19% compared with the snow loading directly on the existing shingled roof surface. This reduction equates to 6.77 PSF which completely offsets the weight of the solar panels. Page 2 a Ernie Tremblay Residence Solar Installation 76 Putnam Road North Andover, MA 01845 Gravitv Loading: Given the size, spacing, and configuration of the existing roof framing, we have determined that the existing framing of Roof 1 is NOT adequate to support the proposed solar panels. In addition to the existing collar ties, it is recommended that new 2x6 collar ties be installed for Roof 1 at every rafter pair (i.e. 16" on center). The collar ties shall be approximately 6-7 feet long and attached to each rafter using (5) SDS 1/4" x 3" wood screws as manufactured by Simpson. It is our understanding that the panels will be installed using Unirac racking (or equal) with L -feet (or equal) at approximately 48 inches on center (e.g., every two to three rafters). The leveling feet will be fastened directly into the existing rafters with 5/16" diameter lag screws with a minimum embedment of 3". In addition, it is important that the leveling feet support locations be staggered between adjacent panels so that no single rafter supports more load than under the existing conditions. Wind Loading: Based on our calculations, the net wind loads imposed on the roof framing with an attachment spacing as indicated above will be less than the current loading on the roof framing. In addition, provided that the leveling feet are attached to the roof framing members in a typical staggered fashion, the overall wind loading imposed on the structure and the individual framing members will not be impacted to any great extent. Conclusions: Given the size, spacing, and configuration of the existing roof framing, we have determined that the existing framing of Roof 1 is NOT adequate to support the proposed solar panels. In addition to the existing collar ties, it is recommended that new 2x6 collar ties be installed for Roof 1 at every rafter pair (i.e. 16" on center). The collar ties shall be approximately 6-7 feet long and attached to each rafter using (5) SDS 1/4" x 3" wood screws as manufactured by Simpson. If you have any questions regarding this matter, please feel free to contact my office at 609-489-5511. We appreciate the opportunity to assist you with this evaluation. Page 3 Sincerely, MPP Engineers, LLC Asma Farugi Ashutosh Patel, P.E. MA Prof. Eng. Lic. No. 48235 MPP Engineers, LLC 34 South Main Street Allentown, NJ 08501 Project No. By: Tel: 609-489-5511 I Fax: 609-189-5911 Page: 1 Date: nmEM■aM�mMMMEMn MEMO ME■■■O■ NIVEMMMMEMOE■ 0 E■■■E ■NF W % ■n■■R ONO ■■■ ,E�if/■ PENSEE i9■■ ■E■ MENEM■■■M IMMIRM IEE MEMO WHE■■ENIN, ��'lI©�>■ 200 11IMME■E■MM■E ERIN E■M■/%EI/J■I■■■MMS/■ENEEE ■1�■■i,,/■■�/■iNME■/■EMEEEE■ ■E.E■%■/1■■1■E11►.immmmoomM Nay■■ ERNE MUMM MEMO= E111MA■ EM%,►,�!�/■1■■_�%��NN■■EMM■■ ■�■ NE h"G...HIM101. MME■MM■MMMME No ■■���M►11■■■M■■■ME■■■■EMEm■■ ON■M�n�E■iEE■�■■iEEEMEE ■ I■■ M■■EWHOI�■f■ME■■■MM■E■■ ■MI■■ MrrENE►Iii�IEN■ ■■ME■NE�!ME 031100 M■n■ L�icnlq■nm■■■mMm ■WI■■ O■eM■■E■e1INES ■Moi M EM ONION�I©l'',IM■M■ ►QMH ■ N ■ , ■M ■/!"mm bW l ME ME MEEEME■■■MME ■ � �EME■E ► MM0MMEME■■d■ ,l qE■ME..!:EEE7■■■■E■Igm MUMMUMOMM■I■ MMM■ No EIRIIEE■Mm Ee�EM■ME■M\ll■■MEMO■■E NONE NEEM IU MM V��''1 ImWE■■mmmE0 W ■E■■ 9\1110111 III IRS I OWIN ■■E WHIM EMME■01■■■■■■r! EMM■ ONE EW : ■EEM■■EE■E■ ■. ■■■■■■■■■■■■EEE■■■■■■ 0E■■ SolarEdge Single Phase Inverters For North America SE3000A-US / SE380OA-US / SE5000A-US / SE6000A-US / SE760OA-US / SE10000A-US / SE1140OA-US i The best choice for SolarEdge enabled systems Integrated arc fault protection (Type 1) for NEC 2011690.11 compliance 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 Pre -assembled AC/DC Safety Switch for faster installation Optional — revenue grade data, ANSI C12.1 USA -GERMANY -ITALY -FRANCE -JAPAN -CHINA -AUSTRALIA -THE NETHERLANDS -ISRAEL www.solaredge.us sola r 0 0 Single Phase Inverters for North America 183 - 208 - 229 Vac SE3000A-US / SE3800A-US / SE5000A-US / SE6000A-US / SE7600A-US / SE1000OA-US / SE1140OA-US SE3000A-US I SE380OA-US I SE5000A-US I SE6000A-US I SE760OA-US I SE10000A-US I SE1140OA-US OUTPUT 211- 240 - 264 Vac AC Frequency Min. -Nom. -Max.* 59.3 - 60 - 60.5 (with HI country setting 57 - 60 - 60.5) Hz Max. Continuous Output Current 12.5 I 16 I 24 @ 208V I 25 I 32 ( 48 @ 208V I 47.5 A 21 @ 240V I ` 42 @ 240V l GFDI 1 9980 @ 208V Utility Monitoring, Islanding Nominal AC Power Output 3000 3800 5000 6000 7600 11400 VA (STC) 3750 4750 6250 7500 9500 12400 14250 W Transformer -less, Ungrounded 10000 @240V Max. Input Voltage Max. AC Power Output 3300 4150 5400 @ 208V 6000 8350 10800 @ 208V 12000 VA I 15.5 @ 240V 30.5 @ 240V Max. Input Short Circuit Current 5450 @240V Adc Reverse -Polarity Protection 10950 @240V Ground -Fault Isolation Detection AC Output Voltage Min. -Nom. -Max.* Maximum Inverter Efficiency 97.7 98.2 98.3 98.3 98 98 98 % CEC Weighted Efficiency 97.5 98 97.5 @ 208V 97.5 97.5 97 @ 208V 97.5 % 98 @ 240V 97.5 @ 240V Nighttime Power Consumption ✓ W ADDITIONAL FEATURES Supported Communication Interfaces RS485, RS232, Ethernet, ZigBee (optional) 183 - 208 - 229 Vac AC Output Voltage Min. -Nom. -Max.* V 211- 240 - 264 Vac AC Frequency Min. -Nom. -Max.* 59.3 - 60 - 60.5 (with HI country setting 57 - 60 - 60.5) Hz Max. Continuous Output Current 12.5 I 16 I 24 @ 208V I 25 I 32 ( 48 @ 208V I 47.5 A 21 @ 240V I ` 42 @ 240V l GFDI 1 A Utility Monitoring, Islanding Protection, Country Configurable Yes Thresholds INPUT Recommended Max. DC Power** (STC) 3750 4750 6250 7500 9500 12400 14250 W Transformer -less, Ungrounded Yes Max. Input Voltage 500 Vdc Nom. DC Input Voltage @ 208V / 350 @ 240V Vdc Max. Input Current*** (325 9.5 13 16.5 @ 208V I 18 23 I 33 @ 208V I 34.5 Adc I 15.5 @ 240V 30.5 @ 240V Max. Input Short Circuit Current 30 45 Adc Reverse -Polarity Protection Yes Ground -Fault Isolation Detection 600koSensitivity Maximum Inverter Efficiency 97.7 98.2 98.3 98.3 98 98 98 % CEC Weighted Efficiency 97.5 98 97.5 @ 208V 97.5 97.5 97 @ 208V 97.5 % 98 @ 240V 97.5 @ 240V Nighttime Power Consumption < 2.5 < 4 W ADDITIONAL FEATURES Supported Communication Interfaces RS485, RS232, Ethernet, ZigBee (optional) Revenue Grade Data, ANSI C12.1 Optional STANDARD COMPLIANCE Safety UL1741, UL1699B, UL1998, CSA 22.2 Grid Connection Standards IEEE1547 Emissions FCC part15 class B INSTALLATION SPECIFICATIONS AC output conduit size / AWG range 3/4" minimum / 24-6 AWG 3/4" minimum / 8-3 AWG DC input conduit size / # of strings / 3/4" minimum / 1-2 strings / 24-6 AWG 3/4" minimum / 1-2 strings / 14-6 AWG AWG range Dimensions with AC/DC Safety 30.5 x 12.5 x 7 / 30.5 x 12.5 x 7.5 / in/ 30.5 x 12.5 x 10.5 / 775 x 315 x 260 Switch (HxWxD) 775 x 315 x 172 775 x 315 x 191 mm Weight with AC/DC Safety Switch 51.2 / 23.2 54.7 /'24.7 88.4 / 40.1 Ib / kg Cooling Natural Convection Fans (user replaceable) Noise < 25 < 50 dBA Min. -Max. Operating Temperature 13 to +140 / -25 to +60 (CAN version**** 40 to +60) 'F/'C Range Protection Rating NEMA 311 " For other regional settings please contact SolarEdge support. Limited to 125% for locations where the yearly average high temperature is above 77'F/25'C and to 135% for locations where it is below 77'F/25'C. For detailed information, refer to htto://www.solaredee.us/files/odfs/inverter do oversizine euide.odf "•" A higher current source may be used; the inverter will limit its input current to the values stated. * CAN P/Ns are eligible for the Ontario FIT and microFIT (microFIT exc. SE11400A-US-CAN). n BIDH93 i+..1, r n .Y A", 1, 0 I . 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Dow cc,R � % ( - °%� 2 2 Ln §\/\ \ S 2 o E Ln 7 \ k u § 7 \ 0 \ tn m / 0 k u k / o m = 2 e @ 2 x 2 f 41 m o a ƒ 2 2 C { g 7 4-1 / J-_ / E I \ $ Ln \ % § m M § $ � £ J $ � ƒ 2 « @ m / — 0 _f M m § 5 Z = $ 0 2 \ \ \ \ N x a ^ 2/ ' / W 3 2 @ E_ 5 • x r a$ _ k { f « 8 % 0 2 / \ k 2 J J 0 G CC 7 « I 2 w w C6 4 � E a 4E R 0 a a$ Sunmodu1e;-/P/usSW280 mono Ss TUV Power controlled: B TOVRhemlantl Lowest measuring tolerance in industry i ,O 000002p131 r I u�� J Every component is tested to meet 3 times IEC requirements J Designed to withstand heavy accumulations of snow and ice J rQ� Sunmodule Plus: Positive performance tolerance J t7i 25 -year linear performance warranty _- -� and 10 ear product warrant Y P Y J ' F Glass with anti -reflective coating J World-class quality .ye" Cueled, IEC 61215 3 �+ •Ammonia reshUnc< = Fully -automated production lines and seamless monitoring of the process and materialPul,d Y P g P eeta"dl :'"* a P n.d &VE:emwmg sa g' ; v,a comr°N1ea " ensure the quality that the company sets as its benchmark for its sites worldwide. a essla nQ,,.,a SolarWorld Plus -Sorting • ` PERFO MANE FS ED ��® Plus -Sorting guarantees highest system efficiency. SolarWorld only delivers modules that P o; aC' PAMDUL c us have greater than or equal to the nameplate rated power. UL 1703 25 years linear performance guarantee and extension of product warranty to 10 years SolarWorld guarantees a maximum performance degression of 0.7% p.a. in the course of Fo 25 years, a significant added value compared to the two-phase warranties common in the industry. In addition, SolarWorld is offering a product warranty, which has been extended to 10 years.` In accordance with the applicable SolarWorld Limited Warranty at purchase. www.solarworld.com/warranty h"I SOLARWORLD solarworld.com We turn sunlight into power. Sunmodule;--lPlusSW280 mono PERFORMANCE UNDER STANDARD TEST CONDITIONS (STC)' Maximum power Pa. 280 Wp Open circuit voltage V 39.5 V Maximum power point voltage V m 31.2 V Short circuit current 1 Ic 9.71 A Maximum power point current Im"" 9.07A *STC: 1000 W/m�, 25•C, AM 1.5 1) Measuring tolerance (P ,x) traceable to TUV Rheinland: +/- 2% (TUV Power Controlled) THERMAL CHARACTERISTICS NOCT 46'C TC ix 0.04 %/'C TC vac -0.30 %/'C TCP -0.45 %/°C Operating temperature -40°C to 85'C a € 1000 W/mZ 1.22 4 65.94 Module voltage (VI V eC 3(288) !rsion i fra me ,ttom ounting des PERFORMANCE AT 800 W/m=, NOCT, AM 1.5 Maximum power P 209.2 Wp a, Open circuit voltage V 36.1 V Maximum power point voltage V« 28.5 V m"" Short circuit current I 7.85 A Maximum power point current Imm, 7.33 A Minor reduction in efficiency under partial load conditions at 25•C: at 200 W/m=,100% (+/-2%) of the STC efficiency (1000 W/m') is achieved. COMPONENT MATERIALS Cells per module 60 Cell type Mono crystalline Cell dimensions 6.14 in x 6.14 in (156 mm x 156 mm) Front Tempered glass (EN 12150) Frame Clear anodized aluminum Weight 463 lbs (21.2 kg) SYSTEM INTEGRATION PARAMETERS Maximum system voltage SC 11 1000V Max. system voltage USA NEC 1000V Maximum reverse current 16A Number of bypass diodes 3 UL Design Loads' Two rail system 113 psf downward 64 psf upward UL Design Loads' Three rail system 170 psf downward 64 psf upward IEC Design Loads' Two rail system 113 psfdownward50 psf upward 'Please refer to the Sunmodule installation instructions for the details associated with these load cases. ADDITIONAL DATA Powersorting' -0 Wp/+5 Wp J -Box I P65 Module leads PV wire per UL4703 with H4 connectors Module efficiency 16.70% Fire rating (UL 790) Class C Glass Low iron tempered with ARC VERSION 2.5 FRAME Compatible with both "Top -Down" and "Bottom" mounting methods ♦Grounding Locations: 4 corners of the frame 4locations along the length of the module in the extended flanget x4 C`A/ D (107)t N C VY I Independently created PAN files now available. Ask your account manager for more information. All units provided are imperial. Sl units provided in parentheses. SolarWorld AG reservesthe right to make specification changes without notice. SW-01-6006US 01-2014 CERTIFICATE OF COMPLIANCE Certificate Number 20140204-E359313 Report Reference E359313-20140201 Issue Date 2014 -FEBRUARY -04 Issued to: SNAPNRACK STE 200 775 FIERO LANE SAN LUIS OBISPO CA 93401 This is to certify that MOUNTING SYSTEMS, MOUNTING DEVICES, representative samples of CLAMPING DEVICES AND GROUND LUGS FOR USE WITH PHOTOVOLTAIC MODULES AND PANELS USL — Series 100 Mounting and Bonding Systems for use with Photovoltaic Modules Have been investigated by UL in accordance with the Standard(s) indicated on this Certificate. Standard(s) for Safety: UL Subject 2703 -the Outline of Investigation for Mounting Systems, Mounting Devices, Clamping/Retention Devices, And Ground Lugs for use with Flat -Plate Photovoltaic Modules and Panels Additional Information: See the UL Online Certifications Directory at www.ul.com/database for additional information Only those products bearing the UL Listing Mark should be considered as being covered by UL's Listing and Follow -Up Service. The UL Listing Mark generally includes the following elements: the symbol UL in a circle: ® with the word "LISTED"; a control number (may be alphanumeric) assigned by UL; and the product category name (product identifier) as indicated in the appropriate UL Directory. Look for the UL Listing Mark on the product. iLawtf47 Wlillarn R. Camey, Director, North American Codification Programs ){ ) UL LLC �J Any information and documentation Involving UL Marls services are provided on behalf of UL LLC (UL) or any authorized licensee of UL. For questions, please contact a local UL Customer SeMcs Representative at w .ul.comlcontactus Page 1 of 1 The Commonwealth of Massachusetts M Department of Industrial Accidents X Congress Street, Suite 100 °< Boston, MA 02114-2017 ,:y't www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leaitbly Name (Business/Organization/Iudividual): -D) (wtb • C A --n e6d Address: - (Cp V -V N 4,A (Z City/State/Zip: N 1�1.-QCT-- Phone #: �i (r�5� 0 Are you an employer? Check the appropriate box: Type of project (required): 19" am a employer with employees (full and/or part-time).* 7. [] New construction 2. Q I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity. [No workers' comp. insurance required.] 9. F1 Demolition 3. [JI am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 (] Building addition ensure that all contractors either have workers' compensation insurance or are sole 11. [] Electrical repairs or additions proprietors with no employees. ` ' 12.0 Plumbing repairs or additions 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These 13. Roof repairs sub -contractors have employees and have workers' comp. insurance.$ 6.FJ We are a corporation and its officers have exercised their right of 'exemption per MGL c. 14. Q Other 152, § 1(4), and we have noemployees. [No workers' 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 state whether or not those entities have employees. If the sub-cbritrac`tors have employees, `they must provide their workers' comp. policy number. Iain an employer thai is piovidiing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Name: -� [4 (+Ir s1 tAJLCc 4 Policy # or Self -ins. Lic. #: G U Expiration Date: ((-30 r ('3 Job Site Address: 7(2- City/State/Zip: Af A /\i %a-r,R I M'f Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA. for insurance coverage verification. I do hereby certify 'er thepafnas anAenalties ofpgjurAthat the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # --.J-/—1 Issuing Authority (circle one): ; 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and 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 ofliire, 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 commonv.�ealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority" Applicants Please fill -out the workers' compensation affidavit completely, by checking the'boxes that apply to your situation and, if necessary, supply sub=contractor(s) name(s), address(es) and -phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required 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 foi• 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 -i'n'sured 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia ACORV CERTIFICATE OF LIABILITY INSURANCE ( 4/16/)15 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 rewire an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER John J. Lamb Insurance Agency NCONTACT AME: PHONE 781 749-6960 AlaFAX N (7S1) 749-8822 24 North Street Hingham, MA 02043 E-MADDAJ : kariny@jlambinsurance.com INSURERS) AFFORDING COVERAGE NAIC# INSURERA: The Hartford- S&D Ins Agency EACH OCCURRENCE $ 1,000,000 INS UREDI NSURER B, INSURER(: DAVID CAMPBELL 19 POND STREET INSURER 0: PEMBROKE, MA 02359 INSURER E: I NSURER F: LIABILITYOMBq ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS —AUTOS 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 LTR TYPEOFINSURANCE ADDL SUER POLICY NUMBER POLICY EFFPOLICY MA)DIY EXP MM/DDVYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—I OCCUR K Doucette 08SBAPV1826 11/30/14 11/30/15 EACH OCCURRENCE $ 1,000,000 DAMAENTED GE TO R $ 100 ,000 MED EXP (Ary one person) $ 10,000 PERSO HAL & ADV I NJU RY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER POLICY PRo- LOC JECTAUTOMOBILE PRODUCTS - OOMPIOPAGG $ 2,000,000 $ LIABILITYOMBq ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS —AUTOS SINGLE L M T $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ eracddent UMBRELLA LIAR ELCESSLIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ Dm RETENTION $ $ A WDRKERSCOMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTNE OFFICERMIEMBER EXCLUDED? Mandatory in NH) If yyes, describe under DESCRIPTIONOFOPERATIONS below NIA, 08WECCI0144 11/30/14 11/30/15 XWCSTATU- OTH- I TORY I FJR— E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE -EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, ifmore space Is regWred) Additional Insured: Dana B Junior CERTIFICATE HOLDER CANCELLATION © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The AC ORD name and logo are registered marks of ACORD Phone: Fax: (781) 383-1561 E -Mail: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Cohasset ACCORDANCE WITH THE POLICY PROVISIONS. 41 Highland Avenue AUTHORIZED REPRESENTATIVE Cohasset, MA 02025 K Doucette © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The AC ORD name and logo are registered marks of ACORD Phone: Fax: (781) 383-1561 E -Mail: pA qyr