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HomeMy WebLinkAboutMiscellaneous - 96 PALOMINO DRIVE 4/30/2018 (3)ill January 13th, 2017 Inspectional Services 120 Main Street North Andover MA 01845 Notice of Cancellation This letter is to certify our proposal to install Solar (PV) at the property listed below has been moved into a cancellation status. Danis Lui 96 Palomino Road North Andover MA 01845 Permit #: 833-2016 & 13054 SolarCity Corporation and Danis Lui will not be moving forward with the proposed installation. We would greatly appreciate reimbursement for the permitting fees paid. If you have any questions/concerns, please contact myself directly. Sincerely, 4j -.,o UN Allison Kelley Permit Coordinator T: 978-215-2383 E: Allison. kelley(c-Dsolarcity.com 800 Research Drive, Wilmington, MA 01887 T (888) SOL - CIN solarcity.com AL 05500, AR M-8937. AZ ROC 24377VROC 245450, CA {SLB 888104, CO EC8041, CT H 0632778/ELC 0125305. DC 410514000080/ECC902585. DE 2011120S06/ TI -60S2, FL ECi3006226, Hl CT -29770. IL 15-0052, MA HI 168572/ EL-1136MR. MD Hl 12894 8/11805. NC 30801-0, NH 0347C/i2523M. NJ NJHIC#13VH06160600/34EB01732700. NM EE98-379590. NV NV20121135172/C2-0078648/82-0079719, OH EL.47707, OR CB180498/0562 PA HICPA077343. RI AC004714/Reg 36313, TX TECL27006, LIT 87269505501, VA ELE2905153278, VF EM -05829, WA SOLARC'91901/SOLARC•905P7. Albany 439. Greene A-486, Nassau H2409710000. Putnam PC6041, Rod -land H -11864-40-00-0Q Suffolk 52057-H. Westchester WC -26088-1-113. N.Y.0 #2001384 -DCA SCENYC: N.Y.C. Licensed Electrician. #12610. #004485.155 Water 8L 6th Fl.. Uni t 10. Brooklyn. NY 11201. #2013%6-0 Gk All loans Provided by Sol arCity Finance Company. LLC. CA Finance Lenders Llcense 6054796. SolarCity Finance Company, LLC is licensed by the D el aware State Bank Com m issioner to engage 1n business In Delaware under license number 019422 MD Consumer Loan License 2241. NV Installment Loan License IL 11023 / 1LM24. Rhode Island Llcensed Lender #20153103LL, TX Reqs tared Creditor 1400050963-202404, Vr Lender license *67" This certifies that Date ....... ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING OA �L ... 6 .............. i ......... has permission to perform ... ....... 5. A... wiring in the b ilding of....... L—u I .. .......... ...... ..... at PA... .4 1!1! 15� .................... Fee ........ �< .......... Lic. No.1.... Check,, 13054-/ ............................................ ..... . North Andover, Mass. ELECTRICAL INSPECTOR _ �►nnnwrawoadtic o� Isla aa�ruaa a djj flzciai Use Only 11�� ff Permit No. t 2epad'6o.n.y O/Jim S mico4 Occ upancy and Fee Checked dBOARD OF FIRE PREVENTION REGULATIONS ReVv. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Mork to be performed in accordance with the NUssachusetts Electrical Code (MEC), 527 CMP, 11,00 (PLEASE PRINT IN INK OR TYPE ALL 1 r � O TION) Date: I las /16 City or Town of: ilOV' t, Ah d Q j e r To the Inspector of Wires: By this application the undersigned gives notice of his or Iter intention to perionn the electrical work described below. Location (Street & Number) Owner or Tenant [)CA171:,5., LU jTelephone No. Owner's Address Palomino1" LQJ ItIs this this permit in conjunction "ith a�V- ilding permit? Yes No El (Check Appropriate Boa) Purpose cif Building _501(AY) Utility Authorization No. Existing Service Amps / Volts OverhePd ❑ Undgrd ❑ No. of Meters New Sciiiee Amiss / Volts Overhead ❑ Und grd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install Solar Electric - Photovoltaic (PV) system (I} panels rated r 1.731 kW (a- STC Grid Tied. In coniunction with a Building Permit No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans al No. of al Transformers K to No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- ❑ rnd. rad. o. o►Emergency ag ung Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. OF electron an Initiating Devices No. of Ranges No. of Air Cond. 'fetal Tons No. of Alerting Devices g No. of Waste Disposers eat pump Totals: umber I 'barns I K I No. o e ontaine Detection/Alerting Devices No. orbishwashers Space/Area Heating KIVN' Local ❑ Munk tal on E] Other ConNo.-of-Dryers­ - - Heating. Appliances -� - ecuri of ystems: Devices or Equivalent No. of ater �W Heaters o. of o. o No. Signs Ballasts Bata Wiring. - No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivilent OTHER: 11,73 � Q RV LEM+ - n [anal WX11onal detail f dostred, or as required by the Inspector of (fires. Estimated Valu'0,000 e of Electrical Work: (When required by municipal policy.) Work to Start: ASAP 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 sante to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certif},, under thepains and penaltMes ofperjuty, that doe dstfonnation oth Lois application is true and complete. F1RM.NAME: SOLARCITY CORPORATION LIC, NO.:1136MR Licensee: MATTHEW T. MARKHAM SignatureLIC. NO.:1136MR ie— {if applicable, enter 'c� elrlpr" in rine license n1m ber line.) - Bus. Tel, 1\lo.,.L4 "1110 Address" 24 ST MARTIN DRIVE (BUILDING 2- UNff 11) MARMROUGH, MA 01752 Alt. Tel. No.: 774-258-8m *Per M.G.L. c. 147, s. 57-61, security work requires Department ol'Public Satbty "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) [3 owner owner's a ent. Owner/Agent Signatnre UTelephone No. %y3- %t? % q q.SCo PERmu FEE.- $ / 2S 7,;), 610 PI hPti',111 ft If7f11 / ( f 4 a 11?7ilj4rlCf�" Jelli p 'r 0i1-1cc of l;ojjsj nc r At fiah.i .tint g_�usijiess Regulation 1 {) 1' II Plaza - Suite 5170 Boston, Massach LISWS 021 16 Home Improvement Contractor Re ;istration Registration, 168572 Type: Supplement Card f_xpiration: 3/812017 SOLAR CITY CORPORATION MATT MAI"tKHAMi 3055 CLFARVIE-W WAY SAN MATED, CA 994402 Update Address nsid return curd. Marls reason for 63aage. Address Renewal Employment Lost Curd t, ,. eft•. } n M. M IYi� � � f • • 1 . +re d 011lee ort:unsuu,cr .1 Hairs A Ilnsinc+s Rr,tulu:ion I leense or rckictrativam %-Wid for inttiridul use only t f0 HOME I.P.PROVENIEN'r CON" RACTOR before the expiration state. If found rclurn to: y Office of Consumer Affairs and Business Repulution E!s xiL;lrat:nnr 4F;R672 Type: 10 Park Plaza - Suite 5170 Supplement Catd Roston, %1 A 02116 SVLARC i MATT MAIV:1 ..%1 24 ST MARTIN S*I;-LL, 13LD2UNI IUlMMOROUGH, MRA 01757. __.. * re 3T. of valid iwithout lltldtrxffr@Y�7) a iti9t valid 4Y it11[iat signature r' w a117k111i t. f:0it'.t iw1.c:= r � � � • !, • .......,.._ � �,..-.,may: . r' w � r Tke Conintortwealtlr oftilassach'usefits Department of IndustrialAccidents Office ofInPesdga&w I CongressSftelr Shite 1GO Rasa n XX 021.14 2WF7 ivww.mass>gov1dm' Workers' Compensaltion Insaranue Affidavit.- Buiidera/ContracturdElectricisns/Plumbers APRjLqntjnLormaflIm Please Priultt Legibly Ntutte (6usincss OWnizationfludividua!): Sol arCity Corp. ,Address: 3055 Clearview Way Phone#: M$?J-/100-C4M-1 Are you an employer? Check the appropriate box. 1.0 no a employer with 5, 000 't- 0 I am a general contractor and I empittes (full and/or part -dine).* usvc biredr the sub -contractors 2. ❑ i am a sole proprietor or parrtner ship and have no employees working for ane in any capacity. D16'workets' comp. insurance required.1 3. ❑ 1 ani a htimeawner doing all work snybelt: [No workers' Comp. insurance retlaired,j t listed on the attached sheet. Thew sub -contractors have employees and have woikersa comp. insutmtce? 5.0 We are a corporation and its officers have exercised their ASt`ifok' exem-phots ptr IML c. 152, § 1(4), and we have no employees. [No workers' eomp. insurance required.] Type at project (required)- 6.13 required)-6.13 New construction 1 ❑ Remodeling S. ❑ Demolition 9. Q Building addition 10.0 Electrical repairs or additions 11.0 Plumbing rapairs or additioas 12.(l Roof repairs l3r,/-�ther Solar/PV *Any applicant that e1=ksbox N ( mast aisa fat out the section below showing their woticas' matppssation pW#uy infaratatiort. I Momeownco who suhmii this affidavit indicatixgthey are dbing all wort: and then Ifimoutside contrBetm mast subank a new affidavit Indicating, such. =Contractors that cheek this box must tmaohed on additional sheat showing the Hume of the sub-contranars and state whether or not those eniuies have onployms. ff the sub•eontMors have employees, they most provide their workers' comp policy number. Yafn art etnFrrinYer pilar isprotMJWff workers' CONWensation insurwwo or my employees. Below is tirepo&y and fob site - - infornratla». titsurance coinpatlyName: Zurich American Insurance Company Policy -9 or Salt=ins. iris. #-: WC0182015-00 Explratian Date: 9/1/2016 A� d .lob Site Address: vl 1 � I �o �� �QT 1 � CityfStatc/Zig: nloq� ,trove, , MA 01 9 T U G Attack a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure ro secure coverage as rcquired tinder section 25A of MGL c. 152 Can lead to the itnpasition of criminal penalties of a fire up to S 1,500.40 anrllor one-year imprisonment, as well as civil penaltles in the form of a STOP WORK ORDER and a fine of up to $250.00a day against the violator. lac advised that a ropy of this statement maybe forwarded• to the Office of Investigations of the DTA for insurance coverage verification. I do hereby eerie y under Ale pants and penallles o f perjure that the information prorided bave is true and eorreet. tee' ,&r, - lett:: I7 5/I iY Qj, dal U•se ondy. Do not tori:a drr lards area, 10 he csertpIMd by oily or taa+n aj}7d4i. City or Torre: Perznxt/L1e4aase ;l Issuing Authority (circle on*. i. Board of Health 2. Randiag Department 3. CityMwn Clerk 4, Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone 4; a �10 CERTIFICATE OF LIABILITY INSURANCE °0170°x°"""' CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL, INSURED, the poticy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT rrgm MARSH RISK& INSURANCE SERVICES _.._....._.._. PHONE'--..._..................... .....,.FAX..,_... .......--•--•---.._.. 345 CALIFORNIA STREET, SUITE 1300 !et&. txtlt.... _.. _ .._ . _ _ ... .......... ..........i V!fc. NPl� ...... _ ......................_ ..._ CALIFORNIA LICENSE NO. 0437153 E-MAIL APL>R€ SAN FRANCISCO, CA 94104 ..... ..... .......................................... .................... Atin Shannon SCott415743$334_..... _............INSURER(S]AFFORDINGCOVERAOE.. ... . .. ._ ......._._.} ... NAIC.U.... ... 998301STND43AWUE-15.16 (INSURER A, Zurich American Insurance Company 116535 — —.. _ ..._ .. _. ...... - INSURED INSURER B : NIA NIA SoarCity Corporation . _ .. +_ - ....... .... 3055 Clearview WayINSURER. C: NIA NIA _.._ ..... ._..._.._.. F - San Mateo, CA 94402 INSURER D : American Zurich Insurance Company 40142 ' INSURER E.-.... _..... _ 6,000,000 ............ NISURER F: i COVERAGES CERTIFICATE NUMBER: SEA -002713836.08 REVISION NUMBER:4 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VVHICH 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. ACCORDANCE WITH THE POLICY PROVISIONS. ..... UOLSIIBR INSitT.._ .. ...POLt6YEPF AUTHORIZED REPRESENTATIVE TYPEOFINSURANC£.. LTR 11 POLICYNUMRER M D�EXY LIMITS Charles Marmole{o0-�-- — A X COMMERc7ALGENERALLIABILITY iGLOO182016.00 bMI/2015 0910112016 EACH OCCURRENCE S 3,000,000 CLAIMS -MADE. .00CUR 3,000,000 _. X SIR. $250,000 I ; i .. O EXP (Anyone person) S 5,000 PERSONAL 8 ADV INJURY S3,( K101000 GEN'L AGGREGATE LIMIT APKIES PER I FGENERALAGGHEGATE $ 6,000,000 X 'I PRO• , POLICY I JECT .. ;LOC ? - i. PRODUCTS - COMPIOP AGG : $ ............. ... 6,000,000 ............ OTHER I--....-.—._ i $ A AUTOMoeILEuAsiuTY 'BAP0182017--00 :0910112015 t!110112016 COmBINEDSINGLE LIMIT $ 5,000,000 r X, ANY AUTO t : BODILY INJURY (Per person) : $ �..... ..... r I• X ALL OWNED I X SCHEDULED ;AUTOS AUTOSL130DII-Y .. INJURY (Per accident); S ,._.. .... _.... ....... _ ... .. •• ,.... t_ .. NON -OWNED X ; HIRED AUTOS X AUTOS : - - ..... I : PROPERTYDAMAGE ...... I .......... {PerecGldeod) . ..... _.. • 8 +.. .. ...... _.. _._.......... F. .. F COMPICOLL DED: : $ $5.000 UMBRELLA LIAR OCCUR ( EACH OCCURRENCE S ' .r... _. __._..._. _. _ .. ........ .....+ ._..... .. .... .. .. _.. ..... EXCESSLIAB CLAIMS MAAE� .' AGGREGATE $ OED RETb IONS $ D 'tntoRNERSCOMPENSATiON ': tWC0182014-00(AOS} '0910t12015 :0910112016 X PTATU O (.._...i r�....... TE. i......i �R ..... j. _ . I AND EMPLOYERS LIABILITY YIN; A WC0182015.00(MA) ,ANY PROPMETORIPARTNERIEXECUTIVE N :NIDI .. . '0910112015 ;09101/2016 ' E.L EACH ACCIDENT S ,.. f- -----._..._._............ .....i. • •• , , • 11000,000 :OWC9_ MEM9EREXCWDEOT (Mandatory In NHlWC DEDUCTIBLE' $500,000 E L DISEASE - EA EMPLOYEE' S 1,000,000 N yes. descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT I S 1.000,000 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additlonal Remarks Schedule, may be attached If more space Is required) Evidence of insurance. r1c:0r41=rrA1= trnt nt=o I e'AMCFI I ATInN SolarCity Corporation SHOULD A14Y OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3055 GeapAew Way THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN San Mateo, CA 99402 ACCORDANCE WITH THE POLICY PROVISIONS. ' AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services i Charles Marmole{o0-�-- — ©1888-2014 ACORD CORPORATION. All rights reserved. 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