HomeMy WebLinkAboutBuilding Permit #143-14 - Permits #143-14 - 38 TURNPIKE STREET 8/13/2013 ....
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Permit NO: I . e�- I q Date Received :
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Date lssued:A 1 41�-� .
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E-IMPROVEMENT CONTRACTOR
k:<Reg i tratio.ry:..1 . 848 Type:
Expirat16fi-. .. .l 1 01 Supplement 11'
VIVI NT SOLAR 1 1 � .. .
144 4931 NORTH 300 WE81-
PROVO,UT 84604 ri� tar
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2781 Fries Mill,Road,'Wiffiamstown,NJ 080,94
Tel.* 856.770.4471- rdeipollagverizonmet
I I n Solar August 28, 2013
24 Normac Road
Woburn, MA J 018,01
Attu Mr. Paul, Greene, Operations Manager
Re Structural Post-Installation Cerfificat:log Letter-Roof Mounted Photovoltaic
(Solar)Panels,at AugustinResidence,38 Turnpike Street, North Andover,MA
.AR# 3315,7'87
Dear Paul:
This is the structural post-installation certification, letter for Vivint Solar's recent photovoltaic
(solar) panel roof mount installations completed at the above referenced site. This letter shall be
used in, conjunction with, Au the gust 9, 2013 Structural, Assessment, Report prepared by this
1%, 11
engineer, root pnotograph fled "
s,, and Sheet No. PV 2.0, t1 . Roof Plan.", dated June 25, 2013 and
verified by Vivint, during and after installations, This sheet shows panel, as-built support
locations in I d deletion, of' p,anels at
spac g, minor changes to panel positions an add"tio n an,, d
various roof locations not affecting the roof s structural integrity. A representative photo of the,
spacings and copy of the roof plan are attached, showing conformance to maximum 32,E1� o/c
support spacing, specified in the report.
Based upon the site specific information provided to me by Vivint", and recent correspondence,,
this, engineer hereby certifies that the structural related installations are in ,general conformance
to our Structural. Assessment Report., ZEP 'Products Company installation criteria, and the
attached roof plan. Please note that this letter pertains only to structural/panel support
attachments to root bra in, members, etc. and, not for any PV panel products, or components,
panel positioning, electrical related installations connections tie-ins,to existing equipment, 'etc.
This, structural certification is based on applicable Massachusetts building codes,, professional
engineering assessment experience.., opinion,judgments, and covers this dwelling's assessment
for only the areas mentioned for solar panel installations. This letter conforms to accepted
Massachusetts State and National practices, for,current building code standards for construction
ds and
uses and was prepared ac cording to generally recognized structural review Standar
procedures. The normal structural engineering industry standard of care utilized for this type of
work was used for this letter"s preparation. The assessments,, opinions and recommendations in.
this letter were reviewed,to ensure a proper level of quality and uniformity.
If you have any questions or require further information, plea$,jrA not hesitate
WIN
Res ctfully s lb itt
Russell. Cipolla, Re ester r
MIA
Structural Engineer, Owner (.;I1 f3 T'R U,G T()Fl.A L
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1. Proit Information:
Project Marne: Marie Augustin
Project Address: 38 Turnpike St North Andover,M
A, System Description:
The system consists of a 3.12 l W DC roof-mounted Photovoltaic power system operating in parallel with the
utility grid.``here are 1 2 -watt modules and 1 -wattmicro-inverters,mounted on the back of each
PV modLAe.The system includes 1 PV circts .This circuit contains 1 micro-inverters and interconnects
with the utility grid through the existing main load center.
B, Site Design Temperatures:. rom 2009 A.S.HRAE Handbook-Fundamentals(Lawrence MUNI weather station)
Record low temperature - 4.3°
Average high temperature 37. O
. Minimum Design Loads: (From State hoard
Ground snow load 50 ps
'find speed 10 mph
2. Structural Review of Pal Arraying Mounting.System,
ffhe array will be mounted on a defined,permitted roof structure
A. Road'Information:
1. Roofing type is lightweight Composite Shingles
2. Roof has a single roof covering
. Method and type of weatherproofmg roof penetrations: Comp mount fla hin s
B. Mounting System Information:
1. Mounting system is an engineered product designed to mount PV modules
. For manufactured mounting systems, following information.applies:
a. Mounting System Manufacturer:acturer: Zep Solar
.Product Name: Zep System III
c.Total Freight of PV modules and rams: 582.4 pounds
d.Total number of attacliment points: 26
e.XVeight per attachment point: 22.4 pounds
. Maximum spacing between attachment points: See attached Zep engineering specs
.Total surface area of PV a ra r: 228.93 square feet
.Array Pounds per square foot: 2.54 pounds per square foot
i. Distributed weight of PV array on roof-
roof section 1: (13 Modules,26 Attachments) 2 .4 pounds per attachment point
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3. Electrical Components:
A. Module l As te d Quality
Trina TSM 240-PA05-18 1
Module St).ccs
Primax. - nominal maximum power at STC 240 watts
Vmp - rated voltage per nodule 30.4 volts
Voc - open circuit voltage 37.2 volts
Imp - rated current 7. 9 amps
Ise - short circuit current 8.37 amps
8
. Invert f r listed)............ Quan * -
----------------
pase M21 -60-2LL- 22 13
Inverter .
1.Input Data(DC)
Recommended input power(DC) 260 watts
Max. input DC voltarte 45 volts
Peak power tracking voltage 22V-36V
Min. Ma . start voltage 22V -5V
Max. DC short circuit current 15 amps
Max. input current 10.5 amps
2. Output Data(AC)
Max. output power 215 watts
Normal output current 0.9 amps
Nominal voltage 240 volts
Max. units per PV circuit 17 inverters
Max. OCPD rating 20 amps
C. System m Configuration
Dumber of PV circuits
Modules/Inverters in PV circuit I 1
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D. Electrical Calculations
1. Circuit current
PV circuit nominal current 11.7 amps (9 amps/inverters x#inverters)
Continuous current rule x 1 % 2011 I E. ;Article 705• 0
V circuit continous current rating 14.6 amps
2. Overcurrent protection device rating
PV circuit continous current rating 14.6 amps
Next standard size fuze/breaker to protect conductors 15 amps
Use 15.Amnrated fuse or breaker
. Conductor conditions of use Amp eit r derate
a.ILm er tur adder 2 11 NECTable 31 A 5( c
Average high temperature 37.6°C
Conduit uit is installed .1"above the roof surface Add 22°C to ambient
Adjusted maximurn temperature 59.6 °C
b. Ampacity adjustment for new ambient tem erat r 2011 NE.0 'able 10.15 B )
berate factor for 59.6 OC 71%
Adjusted circuit cond uoos arnpacity 20.57 amps
c.Am aci adjustment for conduit fill 2011 NEC 'able 310.1 3 a
Number of current-carrying conductors 3 conductors
Conduit FtU derate factor f %
Adjusted circuit continuous ampacity 20.6 amps
Total detect ampacity for PV circuit 2 .6 amps
Conductor must be rated for a minimum of 20.6 amps
` HWN-2 9 ° 10A%VCR conductor is rated for 40 amps 2011 NECTable 10.1 B)(1
.Voltage drop
arts:
.Voltage crop across longest PV circuit micro-i.tiv rters from modules to junction box)
'.Voltage drop across AC conductors (from junction box to paint of interconnection
. Mcr -inverter voltage drop: 0. %
The largest Number of micro-inverters in a row in the entire array is 13 its Circuit 1
According to manufacturer's specifications this equals a voltage drop of 0.48%.
2. AC conductor voltage drop:
= I x R x :240 x 100 to cotivert to a percent)
(Normal current of largest circuit) (Resistance of#10AWG copper) x Total wire run)
11.7 x 0,00129 x 100 20 x 1 0. 2
Total system voltage drop: 1.1%
3
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E.AC point of interconnection
nnection
Interconnection Method: Supply Tap
Existing load center bulbar rating 100 amps
An electric power production source shall be permitted to be connected to the supply side of the service disconnecting
means as perr tted in 230.82(6).The sum of the ratings of all overeurrent devices connected to power production
sources shall not exceed the rating of the service.
Existing load center main disconnect rating 100 amps
= Available a m aeity for PV circuits: 100 amps
Unless the panel boards in rated not less than the sum of the ampere ratings of all over-current devices supplying it,a
connection in a panelboard shall be positioned at the opposite Goad} end from the input feeder location or main circuit
location. . .A permanent warning label shall be applied to the distribution equipment with the following or equivalent
Nvording:
2011 NEC 705.12( )( )
WARNING
INVERTER OUTPUT CONNECTION,
DO NOT RELOCATE THIS OVERCURRENT PROTECTION DEVICE
F. Grounding
. System Grounding(GEC)'
Each inverter is connected with a#6 AWG bare copper grounding electrode conductor that is irreversible spliced
in the roof-mounted junction box to a#8 AWG stranded green insulated copper conductor,which is then
connected to the ground busbar inside the main load center panel.
2. Equipment Grounding(E )
All exposed non-current-carrying metal parts of nodule frames,equipMent and conductor enclosures are
grounded using a#t 0 AWG conductor.AR modules are bonded through the UL 1703 listed ZEP Solar PV
mounting and grounding systems.
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81l13 , epulator V2
ZepSolar
Engineering Calculations
Project Details
Name 3315787
Project Contact Information
Narne Street address
Email Suitell?0 box
Phone City,State Zip 01345
Country United States
System Details
Module Manufacturer Trine Solar Mounting System Manufacturer Zep Solar
PV Module T %240-PAOb.13 Mounting System Type ZS Comp
Quantity of PV Modules 13 Roof type Composition Shingle
Array Size(DC Watts) 3120 Attachment Type Comp Mount,Type
Module-Level Electronics Enphase Energy- 15-
Engineering Calculations
Design Variables
Description(Symbol) Value Unit
Module Orientation Portrait
Module Weight 44•8 l
bs
Average Roof Height(H) 15.0 ft
Least Horizontal Dimension(Ihd) 36.0 ft
Edge And Corner Dimension"A" 3.
Roof Slope(0) 2 .0 deg
Rafter/Truss spacing 16,0 in
afterlTrt�ss dimension Miry.nominal framing member depth of
4
Basic Wind Speed 105 mph
Exposure Category B
Ground Snow load(Pg) 50 psf
Importance Factor i) 1.
Topographic Factor( ) .0
2
Thermal factor for Snow Load( t) 1.
vv. epulator, orp'of ects 01surrarengneeri ngi nt 1
_pr 3
15J epulator�
Exposure factor for Snow Load ,) 0•
Effective Wind Area 10 fk
Snow Load Calculation(Using Calculation Procedure Of ISLE 7-05 Section )
Description(Symbol) Interior Edge Corner Unit
Flat Roof Snow Load(Pf) 37.8 37.8 37.8 psf
Slope Factor ) 0.8 0.8 0.
Roof Snow Load 30,9 30.9 30.9 psf
Wind Pressure Calculations(Using simplified procedure of AS E 7-05 Section 5.4)
Description(Symbol) Interior Edge Corner Unit
Net Design Wind Pressure uplift PnetW-Lip) -1 . -31.7 -40.9 psf
Net Design Wind Pressure downfor (P,, down) lt5 11.5 11.5 p f
Adjustment Factor For Height And Exposure Category(A), 1.0 1.0 1.0
Net Design Wind Pressure uplift( up) -18.2 -31.7 -46.9 psf
Net Design Wind Pressure downforce down) 11's 11,5 11.5 psf
A D Load Combinations(Using calculation procedure of A -05 Section ,4)
Description(Symbol) Interior Edge Corner Unit
Dead Load D 2.5 2.5psf
Snow Load ) 8.0 28.0 28.0 psf
Load Combination 1 (D+0.78*S)*co 8)+0.7 *Wdown) 30.0 30.0 30.0 psf
Load Combination 2 D*oo (0)+1I do n) 13.8 13.8 13.8 psf
Load Combination 3 (D+S)*cos(0) 27.7 27.7 27.7 psf
Uplift Design Load(0.0*D*co G)+Wup) -10,8 -30.3 -45.5 psf
Maximum Absolute Design Load(Pabs) 0.0 0.3 psf
Spacing Calculations
Description Interior Zone Edge Zone Corner Zone Unit
Max allowable spacing between Leveling Feet 36.0 36.0 31.0 its
r Max spacing between Leveling Feet given a rafterltruss spacing of 16.0 32.0 32.0 16.0 in
i
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Max Allowable Cantilever from Leveling Foot to Perimeter of PV Array 12,0 12.0 10.0 1n
Distributed Weight and Weight per Attachment Point Calculations In conformance with Solar ABG's Expedited Permit Process
for PV System( PP))
f Description(Symbol) Value Unit
} 82, Ibs
�. Weight of Modules
f
k Weight of Nbuntinq S stem 25.07 Ibs
7;
www.zepulator.c;oWprciects/25106/summarVengineering_print 213
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81 113 Zepulator 1
a
Total System Weight 607 447 1bs
Total Array Area 228.97 ft
Distributed Weight ht •6 psf
Total Number of Atta€ohments 26
Weight ht per Attachment Point 23.36 psf
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PV 2.0 M--i --' MA LICENSE:MAHIC VOW North Andover,MA
PLAN Di BY-1 T—G AR 3315787 Last Modified.81512013 UTILITY ACCOUNT NUMBER.16294-66012
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PV MOL)ULE I IYBRID INTERLOCK �
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l I PHOTOVOLTAIC MODULE
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Inverter Ratings(Guide Section )
Inverter Ma€eff odes 1!n}cnase M215'6O.2L 2, Conduit and Conductor Schedule
MODULE DETAIL flax DC Vat Rating 45 Vo€ts Tag Description Wire Gauge 9 of Conductors Conduit Type Conduit Size � x
Max Power Q 4(7 215 W2tts
9 Enphase engage cable-THWN-2 12AWG 4 N/A-Free Air N/A-Free Air
for in2€AC 110€t2 E 240 V01ts 9 Bare Capper Ground(EGC/GEC) 6 AWG 1 NIA-Free Air N/A-Free Air
Trina olar T - PA0 ,18 Mw AC Current .9 a
2 TG rvv-2 10 A G 3 PVCSOLAR M 3DULE �12%OCP�Ratir«g �� i THW-2-Ground 8 AVVG I PVC
Max Number at PanelstCircult 71
i 3 THWN-2 8 A G 3 PVC "_.. }
3 THWN- -Ground MPWM
8 A PVC 4
NOTES FOR INVERTER CIRCUITS_(Quide_Section 8 and ft [LL
1)lF UTILITY R EQ U IRES A 11IS1I3 LE-BR IwAi'C SWITCH,DOES T H I SPV Module Ratings @ STC(Guide SeGfion 5)
SWITCH MEET THE RE=QIREIMENTS I
Fnph a "I -6Q- Ll.- x� YES NO N Model RrAakelM�d�E Trirta nlarTsM-aoPA05,1s � Z
MICRO-INVERTER AT I Max Power-Point Current(Imp) 7.89 Arrkps to
�
.)IF GENERATION METER REQUIRED,DOES THIS METSR Max Power-Point Voltage(Vmp) 30.+4 Vo€t-S
EACH MODULE,ATTACKED SOCKET MEET THE REQUIREMENTS? Open-Circuit Voltage(Vac) 37.E VOIts
WITH ZEP HARDWARE YES NO X NA Short-Circuit Current(Ise) 8.37 Amps
.)SIZE PHOTOVOLTAIC POWER SOURCE(DC)CONDUCTORS Max Series Fuse(OCPD) 15 Amps
BASED ON MAX CURRENT ON NEC 690.53 SIGN OR OCPD Nonni")Maximum Power at STC(Pmax) 240 watts �
..__ RATIIV AT 0 ISCO N NEOT. Maximum System Voltage 1000(IEC)/840(UL)
4.}SIDE IIVIRTR OUT PETAC CON D1CTORS AOOORDEEQ 1laC Tepr'dturecet'ficiet -0.321 °
#6 BARE O GROUND TO INVERTER OCPD AMPERE RATING(See Guide Section 9).
(GROUNDING))MODULE 5.)TOTAL OF 1 INVERTER OCPD(s).ONE FOR EACH NOTES FOR ARRAY CIRCUIT WIRING aide Secticn 6 and 8 and Appendix D
&INVEF TER) PV CIRCUIT-DOES TOTAL SUPPLY BREAKERS COMPLY
t WTH 1 0%BUS BAR EXCEPTI0N IN 1.)Lowest expected ambient temperature based on ASHRAE minimum mean extreme
NE 690.64(8)( )(a)? X YES NO dry bulb temperature for ASHRAE location most similar to installation location: -19"C
MICROINVERTER CONNECTION , Sign (See Guide Section ) .)Highest continuous ambient temperature based on ASH RAE highest month #lo dry bulb
TO ENGAGE TRUNK CABLE temperature for ASH RAE location most similar to instaliaflon location-. 39°C
-----.. ign for inverter OCPD and AC Di=nnect: 3.)2005 ASHRAE fundamentals 2%design temperatures do not exceed 47°C in the
United States(Palm Springs,CA 1s 44.I'C).For Iess than 9 current-carrying conductors
Solar PV System AID Point of Connection in roof-mounted sunlit candu€t at least 0.5"above roof and using the outdoor design
AC Output Current 11,700000 Amps temperature of 470C or less(all of United States).
Nominal AC Voltage 241DI Volts
a.)1 AV VG,900C conductors are generally acceptable for modules With Isc of 7,68 Ari1�]5 i
or less when protected by a 1 -Amp or smaller fuse. <Y
THIS PANEL FED BY MULTIPLE SOURCES
bb)10 AW ,90'C conductors are generally acceptable for modules with Isc of 9.6 Amps
(UTILITY AND SOLAR) or less when protected by a 15-Amp or smaller fuse.
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ALL INVERTER OUTPUT CIRCUITS WILL HAVE A NEUTRAL CONDUCTOR LLI
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'REFERENCES: &
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Business: T SOLAR DEVELOPER LLB
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ELECTRICIANS
REGISTERED MASTER ELECTRICIAN
>: ISSUESTHE ABOVE LICENSE T-0.
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V VI IT SOLAR DEVELOPER L L
4931 N 300 ;
PROVO OJT + - 900
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�11 D Cipolla, P.E., Consulti.no E-ngineer
F2781 Fines Mitt Road,Williamstown,NJ 08094
'el: .770. 7 ; d z l * eri o .net
Vi int Solar August 9, 2013
24 Normae Road
Woburn MA, 01 0
Attn: Mr. Paul Greene, Operations Manager
Ike: Structural Engineering Services for Roof Mounted Photovoltaic(Solar)Panel
Installations at Augustin Residence,e, 'urnpi Street, forth Andover, NI.
Dear Iaul:
We are providing you with this structural assessment report of Vivant Solar's photovoltaic (solar)
roof installations to be completed at the above referenced dwelling. The following assessment
criteria is based upon Vi int's recent dwelling site {visit including roof framing photographs and
Field notes. We have also reviewed Vivint's PV Bolas Permit Submittal, calculations, installation
layouts and notes, PV 1.0 "Site Plan",PV 2. "Roof flan"', and PV 3.0., "Mounting Details". All
were supplied for information on the proposed solar panels installation on the dwelling's roof
framing members. The following is our assessment summary.
The dwelling is timber framed of older construction age with a "A"' framed main roof, 4� �
high, built from nominal 2" x " dimensional lumber joists at 1 " o c, typical. There is
lover over-framed "X' roof in the front, assured to also be built from 21)' x "joists at 1 " o/c.
There are no other attached roof receiving solar panels. Materials are assumed to be minimum
Hem-Fir #2 grade, most conservative (low allowable stresses), with standard construction
components. However, better grade lumber may have been used. There are no collar ties
installed on the j oists, below the 2" x 8" dge beam in the main "N' roof's attic's full length, i
panel installations areas, to reinforce the roof There are no other significant intermediate vertical
ridge beam or roof joist supports,to framing below. The rain attic and roof framing were mostly
accessible at the inspection and evaluation, so a complete assessment and confirmation of
framing spacing, sizes and condition was able to be performed in this goof:
No architectural drawings were available at the time of this report preparation. Refer to plans
and docwnents prepared by Vi vint for dwelling dimensions, locations and sizes of solar panel
units. The roof framing members were reviewed and checked for their capacity of new loadings.
A. CAPACITY EXISTING ROOF TO SUPPORT PROPOSED SOLAR PANELS.
1. Our assessment included using the proposed solar panels dead load that were given to
us in the ZEP calculation sheets and the live and dead loads described below. Our
review of the roof information shows that there are no visible undulations or
unevenness indicating that the roof framing members are not visibly overstressed
}
or weakened by past heavy snow loads.
r
S
2. riven the d rellin 's roof structure construction and condition we have concluded
that the existing roof'oists load carrying capacitor should be able to sustain the
f
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k
Mr.. Paul Greene August 9, 2013 'age 2
additional dead and redistributed live loads from the new solar panels if installed
correctly. The dwelling's roof members will be able to also redistribute the snow
live loads, and additional dead load from the solar panels to the adjacent framing
members. These additional loads should not produce stresses beyond the allowable
stress range for these roof framing members assumed as Henn-Fir#2 materials.
Considering the roof slopes, array sizes; full access for roofjoists' size, spacing,
condition; and collar ties,the panel supports shall be attached to e eKy second as
panels are installed over joists. No panel sMort spacing .11 be greater than two
(2).roof joists aces or 32" + - c as wecified in Zepulator framing support L
1 that was submitted for review. No revisions are required to the layout, and this
layout can be used for permit submittals and given to installers for their field use.
All panels shall be installed as shorn on the layout plans with 32" o/c maximum
um
panel.sunnort soacig& or two i oist spaces, s shown in Z P Lqyout#1 and stated
Fr
aming raining member sizes, spacing and condition must be properly verified
by Vivint's installers, by non-destructive means, prior to any installations. Send any
differing information to this engineer for review and approval, prior to continuing
with any installations.
3. This assessment meets current Massachusetts Building Code, 8ffiEdition—Residential
—Amendments to International Residential Code, (IC), 2009 Edition, for one and
two family dwellings.
I . SOLAR PANEL ATTACHMENT TO ROOF STRUCTURE-
1. The solar panels shall be mounted in accordance With the latest"� Company's
Code Compliant Installation Manual"' found on the ZEP website and not included
herein. No additional reinforcing requirements are required for these installations.
However if during solar panel installations,the roof framing members feel unstable,
or show interior or exterior evidence of minor or excessive movement,then this
engineer should be notified as soon as possible prior to proceeding with installations,
} 2. Vivint should notify the homeowners that long terra build-up of accumulated snowin
'
#
the event of extreme snowfall conditions,may produce some roof deflections.
These deflections will be temporary in nature and will not affect the roof's structu�r .l
p �
integrity. The solar panels do not need to be cleared of such.accumulated snow.
r
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s
} C. wfND UPLIFT LOAD.
i
1. Refer to attached ZEP calculation sheet for ASCEIS 'I 7-10 Minimum Design Loads
For Buildings and Other Structures, for wind speed at this location of 100 miles per
hour's for Exposure Cate "B", and 25 degree roof slopes on the dwelling's roof
Category
{ areas. Ground snow load is 5 o p.s.f* for Exposure "B",,done I per ASCEISE1 7- 10)
r. of the roof s interior portion, and effective wind speed of 100 mph*, uplift is show.,
i'
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` "� s .Mr. 9, 2 3 Page 3
. Total area,subject to,wind upfift is calculated for the Interior,Edge and Corner Zones.
A maximum and user selected support(foot) spacing is shown for each location zone*
D. PANEL ANCHORAGES,
�P
1. Maximum wa l pullout per lag screw 235 #/inch from,National Design
Standards DS timber construction specifications for Hem-Fir -North lumber
assumed . Using lag screws, the pullout value .1''s less than 235 Winch of screw
thread and OIL, Considering variab,le factors for the existing roof framing,
members,, and installation tolerances, use a 2 1 "threaded depth with a minimum
5A6��' lag screw per attachment Dims in roof ioi is("afters'') m `components r panel.
anchor mounts. This should give a sufficient factor of safety.
E. LIVE, DEAD AND SNOW LOADS:
Live load� 5 .s.f� &pro , snow loads ,s. ` c storage (trusses,
Dead Load .s.f* roo,ng/ rarr in 5 . .f. -panels, mounting hardware
TotalLive load= 510 p.s.f Total Dead Load 15 p,s, "
2. These values are within acceptable ,limits of recognized industry standards, for similar
structures* The roof members+ors will,he able to sustain the solar panel attachments without
damage, if installed,in a workmanship like manner according to the above criteria.
e have based .r structural .paritydetermination n applicable building codes, professional
engineeringinspection,end desexperience, opinions njudgments, This,report covers this
l l
dwelling's assessment for only the areas for solar panel installations that were made according
generallyrecognized structural. analysis standards and procedures. The normal structural
engineering i .0 r standard of careutilized for this type of work was used during this report
preparation. The assessments and recommendations in this report were reviewed to ensure
roper level i, Mortadheres accepted State .and National
practices for current building code standards and can be used for construction purposes.
f you have anyquestions or require further Information, please do not hesitate to contact me.
I Resubm tte l/e eptlffifu y
04
dof ' ,
Structural Engineer, Owner „Y
Mass. License No. EN-47'41781,ST
RUSSELL D.
CIPOLLA
RI
r as specified lured r the State Board, f Bldg. . and St s. whichever No. 47
R,DC/rdc
IQ
ONAL
,I
DATE JMM1DDfYYYY)
AC" CERTIFICATE OF LIABILITY INSURANCE 011161013
THIS CERTIFICATE IS ISSUE} AS A MATTER F INFORMATION ONLY AND CONFERS NO FLIGHTS UPON THE CERTIFICATE MOLDER. THIS
CERTIFICATE ATE 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 IH URE# ( )o AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is are ADDITIONAL INSURED,the polio (Ies) must be endorsed. If SUBROGATION IS WAIVED,subject t
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 endor ement(s).
CONTACT
PRODUCER NAME:
MARSH USA INC. PHONE M FAX
122517TH STREET,SUITE 1 [(AIG-No, xtl: AID No
DENVE ,CO 80 0 - 34 E-MAIL
ADDRESS:
Attn: anver. :rtrequest@rnarsh.cam,Fax-:212.948.4381 w
INSURER AFFORDING COVERAGE _ NAI #
4627 38-11S- PIED-1 -14 IN URER A:Evan ton Insuranc ompa n W 78
INSURED � INSURER B:Commerce And Industry Ins Co --- 1 410
Vivint Solar,Inc.
4931 N 300 W INSURER : w.
Provo,UT 84604 INSURER D
INSURER IE: m
INSURE E:
COVERAGES CERTIFICATE NUMBER: SEA-00 368004-03 REVISION NUMBER:I
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW W HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
D
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 CE 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 CLAIMSw
IL R TYPE of INSURANCE ME&WVD POLICYNUMBER MM DDIIYYY MMIDWYYY ILIMITS
LTR
A GENERAL LIABILITY 13P1 WOW 011011 013 01/011 014 EACH OCCURRENCE w. 1,��0,��0
DA A.... E TO REN 0,000
COMMERCIAL GENERAL LIABILITY PREMISES E Ea occurrience)... $
CLAIMS-MADE OCCUR
itiAEwD E}CP{An one persons 000
'�,
PERSONAL&ADV INJURY 1,000,000
GENERAL AGGREGATE mm 2,GOO,000
..m �I N'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-GOMPIOP , OaWO
POLICY PRO- LOC
jECZ
COMBINED SINME LIMIT
AUTOMOBILE LIABILITY Ea acoidgq
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJUR Per accident)
AUTOS AUTOS
PR
NON OWNED PROPERTY DA{� �
HIRE ALTOS AUTO
Fier a dent)
UMBRELLA LIAB OCCU 13EF W0 11 01101/ 013 01101l 014 EACH OCCURRENCE 10,000,000
AGGREGATE $ 10,0 ,0w
r=XCESS LIAR CLAIMS-MADE
LDED=RETENTION$
B WORKERS COMPENSATION 664 4 ��I141 013 111�11 013 WI�STAT�U- OTH4 m
1 ER
AND EMPLOYERS'LIABILITY Y I IV 1,000,000
AN`�`PROP RIETOR/PARTNERI XEI�UT�1lI� �{A EL EACH ACCIDENT
OFFI EI fh+1EMBER EXCLUDED? 1,000,000
Mandatory In I H E.L.DJ EASE-E EMPLOYE
If xes,describe€,radar 1,000,000
D RIPTION OF OPERATIONSbelowE.L.DISEASE"Y POLICY LIMIT $
Errors Omissions 13PKGWO00 01 011 0130110112014 LIMIT1,000,000
000
Contractor's Pollut{o DEDUCTIBLE ,
--------------
Or=SCRIPTION OF 0PE RATION S I LOCATIONS I VEHI CLES (Attach AC ORD 101,Additional Re ma rks Schedule,if more space Is required)
The Certificate Holder and others as defined in the written ag fee ment are included as add i onal insured where required by wdRen contract with respect to General Liability.This insurance is primary and non-
con t6butory over any existing insurance and limited to Iiabllity arising out of the opera ons of the named insured and whore required by written contract.Waiver of subtogatton is applicable where required by written
} contract with respect to General Liabiiity and Workers Compensation.
}
CERTIFICATE HOLDER CANCELLATION
Town of Andover SHOULD ANY OF THE-ABO E DESCRIBED POLfDIES BE CANCELLED BEFORE
36 Bartte€t Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Andover,MA 0 810 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Kathleen M.Parsloe
#.: 1988-2010 A CID CO RPO RATION. All rights reserved.
ACORD 01 1 ) The ACORD name and logo are registered marks of ACORD
4
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PhotovoltaicRooftop Solar System Permit Submittal
. Project Information:
Project Name: Marie Augustin
Project Address: 38 Turnpike St North Andover,MA
A. System Description:
The system consists of a 3.12 k V DC roof-mounted Photovoltaic power system operating in parauel xvith the
utitity grid.There are 13 2 -Nv tt modules and 1 2 3-watt micro-inverters,mounted on the hack of each
PV module.The system includes 1 circuit .This circuit contains micro-inverters and interconnects
with the utdity grid through the existing main load center.
B. Site Design Temperatures:(From 2009 ASHRAE Handbook--Fundamentals OLawrence MUNIweather station))
Record low temperature -24.3°C
Average high temperature 37.6 o
C. Minimum Design Loads: (From State Board
Ground snow load 50 ps
ind speed 100 mph
2. Structural Review of PV Arrayinv Mounting., stem:
(The array will be mounted on a defined,permitted roof structure)
A. Roof Information:
1. Roofing type is lightweight Composite Shingles
2. Roof has a single roof covering
3. Method and type of Nveatherproofing roof penetrations: Comp mount l shin s
B. Mounting System Information:
1. Mounting system is are engineered product designed to mount PV modules
2. For manufactured mounting systems, following information ation applies:
a. Mounting System Manufacturer: Zp Solar
b. Product Dame: Zep System III
c.Total weight of PV modules and rafls: 582.4 pounds
d.Total number of attachment points: 26
e.Weight per attachment point: 22.4 pounds
i; Maximum spacing between attachment points: See attached Z p engineering specs
.Total surface area of PV array: 22 .93 square feet
h.Array Pounds per square Foot: 2.54 pounds per square foot
i.Distributed weight of ITV array on roof:
roof section : 13 Modules,26 Attachments) 22.4 pounds per attachment point
1
4
�. Electrical Components:
. Module 703 As Led u "
Trina TSM 240-PA05.18 1
Module Specs
P nax - norninal maximum power at STC 240 watts
mp - rated voltage per module 30.4 volts
oc - open circuit voltage 37.2 volts
Imp -- rated current 7.89 amps
Ise -- short circuit current 8.37 amps
! . Inverter(micro) 741 fist ua
nphase M215--60-2LL-S22 1
Inverter
1. Input Data DC
Recommended input power DC 260 Nvatt
Max.input DC volt to 45 volts
Peak pourer tracking voltage 22V-36
Min./ fax. start voltage 22 /45 T
Max.DC short circuit current 15 amps
Max.input current 10.5 amps
. Output Data(AC)
Max. output power 215 watts
Nominal output current 0.9 amps
Non'Mal voltage 240 volts
Max. units per PV circuit 17 inverters
Max. OCPD rating 20 amps
C. System Configuration
Number of PV circuits
Modules/Inverters in PV circuit 1 13
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D. Electrical Calculations
1. Circuit current
pV circuit nominal current 11.7 amps (.9 amps/inverters x##inverters
Continuous current rule x 12 % 20 1 I'IC Article 705.60 B
Pal'circuit continous current rating = 14.6 amps
2. Over current protection device rating
PST circuit continous current rating 14.6 amps
Next standard size fuze/breaker to protect conductors 15 amps
Use 15 Amp AC rated fuse or breaker
. Conductor conditions of use pcity cera►te
a.Te eratur adder 2011 NEC Fable 1 .15 B c
Average high temperature 37.6 °C
Conduit is installed 1" above the roof surface Add 2 "C to ambient
Adjusted maximum temperature 59.6 °C
b....Am2acAty adjustment for new ambient temperature 2011 1 E Table 1 •15
berate factor for 59.6'C 71%
Adjusted circuit continuous ampacity 20.57 amps
c.Arn acity adjustment for conduit 2011 l={,C Table 10.15 B a
Number of current-carrying conductors 3 conductors
Conduit Fffl derate factor 1 %
Adjusted circuit continuous a rapacity 20.6 amps
Total derated ampacity for PV circuit 20.6 amps
Conductor must be rated for a minimum of 20.6 amps
THWN-2 ° # 1 OAWG conductor is rated for 40 amps 011 NECTable 10.1 B 1
.Voltage drop
arts:
1.Voltage drop across longest PV circuit micro-inverters (from modules to junction box)
2.Voltage drop across AC conductors (from junction box to point of interconnection.)
1.micro-inverter voltage drop: 0.48%
The largest number of micro-inverters in a row in the entire axray is 13 in Circuit t
According to manufacturer's specifications this equals a voltage drop of 0.48%.
.AC conductor voltage drop:
1 x R x :240 x 100 to convert to a percent)
(Normal current of largest circuit) x(Resistance of##1 A%SIG copper) x(Total Nvire run
= 11.7 x 0.00129x 100 240 x 100 0.62%
Total system voltage drop: °
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E.SIC point of interconnection
InterconnectionMethod: Supply Tap
Existing load center busbar rating 100 amps
An electric power production source shall he permitted to be connected to the supply side of the service disconnecting
means as permitted in 230.82(6).The sum of the ratings of all overcurrent devices connected to power production
sources shall not exceed the rating of the service.
Existing load center amain disconnect rat g 100 amps
ailable ampacity for PV circuits: 100 amps
Unless the panel boards in rated not less than the sun of the ampere ratings of all over-current devices supplying it,a
connection in a paelboard shall be positioned at the opposite load) end from the input feeder location or main circuit
location. . .A permanent warning label shad be applied to the distribution eq ipment with the following or equivalent
wording:
-2011 NEC 0 .1 (D)( )
DARNING
INVERTER OUTPUT CONNECTION.
DO NOT RELOCXIE THIS OVERCURRENT PROTECTION DEVICE
F. Grounding
1. System Grounding(GEC)
Each inverter is connected with a##6 AVG bare copper grounding electrode conductor that is irreversibly spliced
in the roof-mounted junction box to a#8 AWG stranded green insulated copper conductor,which is then
connected to the ground busbar inside the main load center panel.
. Equipment Grounding(EGA}
A11 exposednon-current-carrying metal parts of module frames,egLdpme t and conductor enclosures are
grounded using a#10 A%SIG conductor. All modules are bonded through the UL170 listed ZEP Solar P
mounting and grounding systems.
4
M
81 113 Zepulator V
ZepSolar
Engineering Calculations
Project Details
Name 3315787
Project Contact Irnformation
None Street address
EmailSuite/PO box
Phone City,State,Zip 01845
Country United States
System Details
Module Manufacturer Trina Solar Mounting System Manufacturer ep Solar
PV Module T M- 40-PA0 .18 Mounting System Type ZS Comp
Quantity of PV Modules 13 Roof type Composition Shingle
Array Size(DC Watt 3120 Altachment Type Comp Mount,Type
Module-Level Electronics Bnphase Energy-N 15-
Engineering Calculations
Design Variable
Description(Symbol) Value Unit
Module Orientation Portrait
Module Weight 44.3 Ib
Average Roof Height( ) 15.0 ft
Least Horizontal Dimension ion(1hd) 36.0 ft
Edge And Corner Dimension"A"' 3.6 tt
Roof Slope(0) 25.O deg
F after/Trus spacing `1 . in
Rafter/Truss Rafter/Truss dimension Min.nominal frarning member depth of
4
Basic Wind Speed� � 10 mph
Exposure Category
Ground Snow load(Pg pf
Importance Facto' i) 1.
'r
i
Topographic Factor(Kzt
.g
Thermal factor for Snow Load( t) 1.2
�1
v . epulato�r.corrVproje t l 1 O Isummar engine ring_print
f
3
f13 Zepulator V2
Exposure factor for'Snow Load e 0.9
Effective Wind Area 10
Snow Load Calculation(Using Calculation Procedure Of AS E 7-05 Section 7)
Description ription(Symbol) Interior Edge Corner Unit
Flat Roof Snow Lead(Pf) 37.8 37.8 37.8 psf
Slope Factor( .) 0.8 0.8 0.8
Roof Snow Load 30.9 30.9 30.9 psf
l nd Pressure Calculations(Using simplified procedure of ASCE 7-05 Section .4)
Description( yrnbol) Interior Edge Corner Unit
Net Design Wind Pressure uplift Pn t a-up) -18. - 1.7 -46.9 psf
Net Design Wind Pressure downforoe Tneffl down) 11.5 11.5 11,5 psf
Adjustment Factor For Height And Exposure Category(A) 1.0 1.0 1
Net Design Wind Pressure uplift 1up) -1 . -31. -46.9 PSf
Net Design Wind Pressure downforce Mdo n) 11.5 11.5 11.5 psf
ASD Load Combinations(Using calculation procedure of ASCE 7-05 Section .4)
Description(Symbol) Interior Edge Corner Unit
Dead Load(D) 2.5 2.52.5 psf
Snow Load ) 28.0 28.0 28.0 psf
Load Combination 'I (D+0.7 *S)*co (9)+0.7 *Wdo n) 30.0 30.0 30.0 psf
Load Combination 2(D*co 0}+Wj0wn) 13.8 13.8 13.8 psf
Load Combination 3((D+S)*oos(0) 27.7 2T7 27.7 psf
Uplift Design Load(0. *D*ros(G)+ II,P) -16.8 -30. -45,5 psf
Maximum Absolute Design Load(Pats) 30.0 30.3 45,5 psf
Spacing Calculations
Description Interior Zone Edge Zone Corner Zane Unit
Max allowable spacing between Leveling Feet 36.0 36.0 31.0 in
Max spacing between Leveling Feet given a rafter truss spacing of 16.0 32.0 32.0 16,0 in
Ma x Allowable Cantilever from Leveling Foot to Perimeter of PV Array 12,0 12.0 10.0 in
Distributed Weight and Weight Per Altachment Point Calculations(In conformance with Solar AB 's Expedited Permit Process
for PV System(EPP)
Description(Symbol) Value Unit
. height of Modules 582.4 lbs
1leight of ountinq S stem 5.07 1bs
f
vow. epul ator.conVproj ect l 106/s mmar Veng i n eer i ng_pr€rat
f
e
8/5/13 , epulator\12
Total System Weight 607.47 I s
Total Array Area 228.97 ft
Distributed Weight 2.65 p f
Total Number of Attachments 26
Weight per Attachment Point 23.36 psf
vv . ep l tor. orrrlproje tsl2510 / ummrVengino ring_print 3/
-
PV SYSTEM SIZE:
O'OF 1"PVC CONDUIT
/JUNCTION BOX ATTACHED TO 9=
USING ZEP ZS-GAB TO
KEEP JUNCTION BOX OFF ROOF
CD CID
Uj
V INTERCONNECTION POINT, w to
ANSI METER LOCATION, Enphase M215-60-2LL-S2x-ZC MICRO-INVERTER _j _j 0
MOUNTED ON THE BACK OF EACH MODULE
SHEET
SHEET
PV SYSTEM SITE PLAN
38 Turnpike St, North Andover MA
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INSTALLER,VIVINT SOLAR Augustin Residence
mINSTALLERI M u .'{ 38 Tumpike St
� :;` �� �:�,� ;< �� �< �� ��� �� `�
. to� f p
rn
PV �4 LICENSE,N1AF�I � }88 :: T.f M: North Andover,MA
PLAN DRAWN BY;T a AR 331 787 Last Modlied;BT512013 UTILITY ACCOUNT NUMBER 1 294 8Al2
5
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[NE
MOUNTING UJ
P1l3.#} DETAIL CL i
5116"0-19xl"STAINLESS -or
LEVELING FOOT{ZS-LF STEEL M,B.;TORQUE_16t fk-ft. 2
mo
COMP MOUNT(S-CMA) #..i z
WASHER PACKAGED U
WATERPROOFING SEALA T WITH COMP MOUNT
Plf MUDDLE,TYP.MOUNT
AS NEEDED
TO RAFTERS OF COMP.
SHINGLE ROOF,PARALLEL
WITH PLANE OF ROOF
ELEVATION 4I NIMU4P ARRAYTYP. STAINLESS STEEL LAG SCREW
TORQUE=13t2 RAbs.
NOT TO SCALE
LEVELING G FOOT ON COMP MOUNT
PERMITTED LEVELING NOT TO SCALE �.
FOOT SPACING
co
LEVELING I`DOT(ZS-LFB) r`
FRAMING BELOW SHOWN
VA SHED FOR CLARITY
CEP COMPATI8LE
Pv MDOULE kIYSRIR INTERLOCK to
� �•
I w L)
CANTL I l IR LESS SPACING
ST SEE ODE COMPLIAN E LETTER F�
O ALLOWABLE SPACING
I PHGTGVOI.'�A3O MODULE
[7 cn -
I =L
l SHEET
INTERLOCK(S-IL I-lYBRI I TERLOCK fVAIV�E;
7LEVEUIC FQOT(S-I.F$} ROOF FI�CAMIhIG
co
LEVELING FOOT(ZS-LFS)
� I I
INTERLOCK(ZS-IL.B) PERMITTED]LEVEUNG
FOOT SPACING P SYSTEMMOUNT DETAIL MEET
UnsER:
SCALE:3Z'=l'-U'
MODULES IN PORTRAIT/LANDSCAPE
CIO
NOT TO SCALE
Inverter Ratings(Guide Section 4)
Inverter Mawmodei E rphase M216-60-LL-s -Z Conduit and Conductor Schedule
DETAILMODULE Max VC Val Rating 45 VOS Tag Descr3ptlon Wire Caa�ge #of or�d�,Ctors onduit Type Candr�kt Size
Max Power Q 400C 215 waft
11oEt � 4E] olt~s i 9 Er�pl�ase eengageC.EI bls-Tk�VYt�- 12 AWE 4 NIA-area Air NIA-Free Air
Nominal A
1 Bare Copper Ground(EGCJGEC) 6 AWG l WA-ties Air N JA-Free Air
TrinaSolar TSM 40PA0 .18 Max AC Current .9 Amps 7 THWiN-2 10 A G 3 PVC
M QP bating 2Arp SOLAR MODULE THWN- -Ground t
Max Number of PanelsJCifcuit 17 � 3 THWN-2 9 AWG 3 PVC
3 ] N- -Ground 8 A PVC '-1" _ 'r
NOTES FOR INVERTER.CIRCUITS,_� �(de_ e�tiio��„ard 9�:_ � w
= ..__.....__................................. ._._..._.._..... ......_............. ............ ....... ............ .......__.........
1.)1 UTILIr REQUIRE A 118LE�-SRE=AK SWITCHr DOES THIS PV oduIe Ratite S @ T (guide Section a��
SWITCH MEET THE REQUIREMENTS? 0
Model MaKe/Model TrinaSokarTSM-240PADS.18 <..,
Enphase M21 0- LL-S2- D YES NO NA Max Power-Point CUT-rent(imp) 7,89 Amps a~o
MICRO-INVERTER AT ,..�►.» o 0
.)IF GENERATION METER REQUIRED,DOES THIS METER Max Power-Point Voltage{Vrnp) 30.4 Volts .,�,..� 0
EACH MODULE,ATTACHED SOCKET MEET THE REQUIREMENTS? Open-Circuit Voltage(Voc) 37,2 Volts
WITH CEP HARDWARE IRE YES NO X NA short-Circuit Current(Isc) &37 Amps
3.)SIZE PHOTOVOLTAIC POWE R SOURCE(IBC)CONDUCTORS Max Series Fuse(OCPD) 15 Amps
SASE D ON MAX CURRENT ON NEC 690.53$1GN QR OCPD Nominal Maxc num Power at STC{Prnax) 240 Watts �
RATING AT DISCONNECT. Ma�ornum system Voltage 1000(IEC)1600(t�L� �
�+ -- 4,)SIZE INVERTER OUTPUT(AC)CONDUCTORS ACCORDING VocTerrrperature Coefficient -0,3 %rc
#6 BARE CU GROUND TO INVERTER OCPD AMPERE RATING(See Guide Section 9).
(GROUNDING DING MODULE 5.)TOTAL 0 F 1 1NVERTER OC PD(s),ONE FOR EACH NOTiES FOR J AY CIRCUIT VA ( uido Section 6 and 8 and Appendix )..
&INVERTER) PV CIRCUIT.DOES TOTAL SUPPLY BREAKERS COMPLY ..-Y_�.._..,..
l VVITI~I 0 BUS BAR EXC1=PTIOf I IN 1.)Lowest expected ambient temperature based on ASH RAE rninimum mean extrerne
NEC 590.54(8)( )(a)? X YES NO dry bulb temperature for A HRAE location most similar to installation locat on- -190C
.i
Mi ROIINVERTER CONNECTIONSigns(See Guide Section 7) 2.)Highest continuous ambient temperature based on ASH RAE highest month %dry bulb
TO ENGAGE TRUNK CABLE temperature for ASH RAE location most similar to installation location. 390
Sign for inverter OCPD and AC Disconnect: 3,)2005 ASH RAE fundamentals %design temperatures do not exceed 47°C In the
Ignited States(Palm Springs,CA is 44.1 Q.For less than 8 current-carrying conductors
Bohr PV System AC Point of Connection in roof-mounted sunlit conduit at least 0,5"above roof and using the outdoor design
AC Output Current 11,700000 Amps temperature of 47'C or less(all of United States).
Nominal AC VoEtage 2401 VOKS
a�.)1 AVVG,904 C conductors are generally acceptable for modules with Isc of 7,68 Amps
or less when protected by a 1 -Amp or smaller fuse.
THIS PANEL FED BY MULTIPLE SOURCES cv
(UTILITY AND SOLAR) b.)10 AV VG,90'C conductors are generally acceptable for modules with Isc of 9.6 Amps �c
or less when protected by a 15-Amp or smaller fyse, �; �Ilk Qo
�1
C�1
r
Q �
POINT OF DELIVERY
AND INTERCONNECTION o
c
M T:
VISIBLE/LOCKABLE ac
SRE /ANSI 'KNIFE'A/C FUSED FUSED LL W z M
PV CIRCUIT"I w 1 M DULE IPAI ALLEL UJI
METER DISCONNECT �I NN T EXISTING ENTRANCEL)
CONDUCTORS �
DATED:'IDEA SKEET
SUPPLY-SIDE NAME:
-- --- SOLAR TAP
law,r+ -*
NEC 705.12(A)
I 24OVl1 I OA
------ ---- ---- — -- ------ ------------ -------- 7777 � �__ .�— — ------ — --- P NEL
VisionMetering Siemens I '"
V2S-2S #LNF222R
2 3 60AI240V 3 3 TO EXISTING SHEET
E 1,0 ,UN TI I I! E t. E 1.0 FUSE VT 1.0 LOAD-CENTER NUMBER:
BOX NEMA3
C)
NOTE:NEUTRAL CONDUCTOR(S)OMITTED FOR CLARITY �
ALL INVERTER OUTPUT CIRCUITS WILL HAVE A NEUTRAL CONDUCTOR LLJ
The Commonwealth o `Ma ssachusetts Priont Form
D ep artm en t of Its dusida I A eciden ts
Offlce of Investigations
I Congress Street,Suite 100
Boston MA 02114-2017
www.mass,gov1dia
Workers' Compensation Insurance Affidavit: Buflders/Contractors/Electric*lans/P lamb ers
Apl2Hcant Information Please Print L2giblv
DevelpeC
Name(Business/Organization/indi'vidual)*. Vivint Solar o r,LL
.........
Address'., 4931 North 300 West
Provo,. UT 84604 801-704-9389
City/State/Zi Phone#:
IP
... ........
Are you an employer.?Check the appropriate box:
Type of project(required):
4. 1 am a general contactor and I
1. 1 am a employer with 10
i
6. New constructon
employees(ill and/or part-time).
have hired the sub-contractors*
2. am sole propri r or partne
listed on the attached sheet. 7. Remodeling
0 1 a etor-
'
sMp and have no employees fhese sub-contractors have 8- E]Demolition
employees and bave workers"
working for me in any capacity.
9. E]Building addition
com 3k
p.msurance.
[No workers'comp.insurance
required.] 5. E] We are a corporation and its 10.El Electrical repairs or additions
3
officers have exercised their. 1 am a homeowner doing all work ILEI Plumbing repairs or additions
right of exemption per MGL
myself [No workers"comp. C. 152,§1(4),and w e have no 12.0 Roof repairs
insurance required-]t employees.[No workers' 13. %( ethersolar
comp, insurance required.]
t*Any applicant that checks box#1 must also fill out the wtion below showing their workers!compensation policy infonnation.
Homeowners who s ubmil ibis a Mi davit indic a tin g they are doing all work and then him outside contractors must submit a new a fridavit indicating such.
3-
Z Contmetors that check th 1 s box must attached an additional sheet A ow ing the naive of the sub-contmctors and state whether or not those entities have
employees. If the s ub-c o ntmcto rs have empi oyees,they must prov 1 de their workers'comp.polio: n u mber.
I am an employer that is providing workers'compensation insurance for my employee& Below is thepolky and jai ske
informadoft.
Insurance Company Name. Marsh USA Inc.
.66464896 11-01
Policy#or Self-Mis.Lic.#. Expiration Date: -13
Job Site Address: A P"I LY CitylS tate/Zip: I?q 5
Attach a copy of the workers'compensation policy declaration page(showing the poKey number and expiration date).
Failure to secure coverage as requircd under Secdon 25A of MGL c. 152 can lead to the imposition of onimmial penalties of a
fme up to$1,500.00 and/or one-year imprisonment,as well as civfl penalties mi 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 ILIA for insurance coverage verification.
Ido he und b or thepalns�and penalties that the in ad provided above true and correct
f
re, qrm on
S iair ...........
Phone#. 1- 4-
Official use only. Do not write in this area,&be completed by city or town offleial
City or Town: Permit.lit cens e#
Issuing Authority(circle one),
I.Board of Health 2.BuOding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: IN.* Phone#90 OMM,
np*�