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Home My WebLink About- Permits #13261 - 137 HILLSIDE ROAD 4/27/2015 f i Date...•p•• r: �.:- t O�,NORtM q� `v t o3? °09 TOWN OF NORTH ANDOVER PERMIT FO WIRING 8�1CHU5�� q E i This certifies that ? 6�......... s9 .1 l has permission to perform a ' .. wiring in the building of � r i ........................... �® �4 at F North And over,mass. .Fee C Lic.No r ,.................. ,t..� y ,� ELECTRICAL INSPECTOR :� e Check# J 7�J!` f F. n/� Bd11 �j Print Farm C..olnmonwea&o f/J(a�dac%ueefta Official Use Only �m i Permit No. ` �.Z�Pk �[JeParfinenl o�.}ire�grviced Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07] ticavc blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ail work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INF,�ORMf TI4N) Date: City or Town of: /UO,4b 00,L'JAe To the Inspector of Wires: By this application the undersigned gives not•ce of*his or her intention to perform the electrical work described below. Location(Street&Number) '3� Oct Owner or Tenant ob t' 'Put e Telephone No. Owner's Address Is this permit in conjunction with a building permit'.! Yes Q No ❑ (Check Appropriate Box) Purpose of Building w/Solar-PV Utility Authorization No. n/a Existing Senice Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd® No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install Solar Electric-Photovoltaic(PV)system ]2lo panels] rated fa,7(e kW-DC @ S.T.C.Grid Tied. In conjunction with a Building Permit. Gom It<7rnn a 7heollan•!n�table muv hu rvcrivecl 6•1/rc•!ns ce•1or u 'i•Virer. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of i.urninaire Outlets No.of Hot Tubs Generators KVA Above n- o.o Emergency Lighting No.of luminaires Swimming Pool rnd. Elrnd. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zoncs No.of Switches No.of Gas Burners u o etendInitiating Devices Total No.of Ranges No.of Air Cond. Tons No,of Alerting Devices No.of Waste Disposers eat Pump Number Tons o.o el- onta ne Totals:I I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municippi ❑ Other Connection No.of Dryers Heating Appliances Key SecuritySystems: No.of Devices or Equivalent No.of Water KW o.o o.o Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No.Ilydromassage Bathtubs No.of Motors Total HP a ecommun cations ringg: No.of Devices or Equivalent OTHER: Artach additional detail if desired,nr•as required lw the Inspector nj'wires. Estimated Value of Electrical Work: 12 , 000 (When required by municipal policy.) Work to Start: A.S.A,P. 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 ❑✓ BOND ❑ OTHER ❑ (Specify:) I cerdfy,under the pains and penaldes of perjury,that the information on dds application is true and complete. FIRM NAME: SOLARCITY CORPORATION LIC.NO.: 1136 MR Licensee, Matthew T.Markham Sigristure �� -� LIC.NO.: 1136 MR (1('applicahle,enter"exempt"in the licence rnauher tine.) Bus.Tel.No.:774-258-8180 Address: 24 St.Martin Drive(Building 2/Unit 11).Marlborough,MA,01752 Alt.Tel.No.:774-258-8505 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.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.$ �71 i•l� I vv)Al " tafiiee of Consumer Affair+&BuRims Regulation .' tfFAE IMpROVEMrN7 CONTRACTOR Registration: 16 8572 TYPE Expiration: 3/8J2017i Supplement SOLARCITY CORPORATION " MATTHEW MARKHAM 24 ST MARTIN STREET BLD 2UNi -- 'AAkLBOROUGH,MA 01752 Undersecretary COMMONWEALTH O ups Or Et-ECTRICIAHS ISSUES THE FOLLOWING LICENSE AS A REGISTERED MASTER ELECTRICIAN SOLARCITY CORPORATION � :s MATTHEW T MARKHAM ! 24 'SA I N`1' MART I N DR BLOC 2 UNIT 11 MARLBOROUGH MA 01752-3060 � Itt401 ? .07 3106ML , The Commonwealth of Massacltttsells Department of IndustrialAccidents 4 v Osce of Investigations 1 Congress Street,Suite 100 ,j Boston MA 02114-2017 www.mass govltlia Workers'Compensation Insurance Affidavits Builders/Contractors/Electricions/Plumbers Applicant Information Please Print Legibly Name(busineWOrganizationlindividual): SOLARCiTY CORP Address:3055 CLEARVIEW WAY City/State/Zip:SAN MATEO,CA 94402 Phone#:888-765-2489 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 5000 _ 4. ❑ 1 am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors d. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7, ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp. insurance.t required.) 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I i.❑Plumbing repairs or additions myself [No workers' comp, right of exemption per MGL 12.❑Roof repairs insurance required.)t c. 152,§1(4),and we have no SOLAR/PV employees. [No workers' 13. Other comp. insurance required.) *Any applicant that checks box HI must also fill out the section bcibw showing their workers'compemation policy information. t I lomeowners who submit this affidavit indicating they are doing all work and then(tire outside contractors must submit anew affidavit indicating such. IContractors that check this box must attached an additional sheet showing the name of the sub-contractors and stale whether or not those entities have employees. Iriho subcontractors have r:mployces,they must provide their workers'comp.policy number. i am art employer flint Is providlog workers'compensation hssuraece jar sty employees. Below is Ilse policy and fob site Information. Insurance Company Name:LIBERTY MUTUAL INSURANCE COMPANY Policy#or Self ins.Lic. H::WA7.66D-066265-024 _ Expiration Date:09/01120115,,,� Job Site Address:—J3~I !Ti 1 ��i R o/ City/State/Zip: /�r� r�i(�I,cu er Attach a copy of the workers'compensation polity declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DiA for insurance coverage verification. i do hereby cer160 neuter lire pales artd eltalties of perjury that the hiforntallon provided above is trite and correct. gnature: -�:, hni. Phone N: - -- O f7clat use only. Do not write lit this area,to be completed by city or town ofJtelal. City or Town: Permit/License N Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: ®R®� DATE(MM/DbIYVYI) 1lh - � n C ' aWa9r7a14 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: it the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER CONfA NAME: T NAME: MARSH RISK S INSURANCE SERVICES PHONE 1 FAX 345CALIFORNIA STREET,SUITE 1300 (AIC,No,Eat): (AIC,No): CALIFORNIA LICENSE NO.0437153 EMAIL SAN FRANCISCO,CA 94104 ADDRESS: i INSURERS)AFFORDING COVERAGE NAIC e 998301-STNB-GAWUE•14.15 INSURER A,Liberty Moual Fire Insuranco Company 16586 INSURED Ph(650)963.5100 INSURER D:LtbOtty Insurance Corporation 42404 - SolarCity Corporation INSURERC:NIA iNIA 3055 CleaMew Way INSURER D: San Mateo CA 94402 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-00244026M2 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. NOIWtHSTANDING ANY RLQUIRtML:N1, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VVITH 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. E XCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN RE DUCFO BY PAID CLAIMS, IN SR TYPE OF INSURANCE �ADDLISUSR Y_POLICY EFF POLICY EXP POLICY NUMBER IMMMD!YYYYI IMMtDDfYYVYILIMITS A GENERAL LIABILITY TB7.664-066265.014 09t1112014 0Q11 N2015 EACH OCCURRENCE S 1,000.000 X COMMERCIAL GENERAL IIAHII ITY DAMAGE REMISES(Faoccdine�co) S 100,000 r I CLAIMS MADE X (OCCUR I MED EXP(Any,orlo poison) S 10.000 PERSONAL a ADV INJURY S 1,000000 'GENERAI AGGREGATE S 2,000.000 GEN'L AGGREGATE I IMII APPLIES PER PRODUCTS•COMP/OP AGG $ 2,000.000 X I POLICY X PHO• LOC IDetlttGliblc S 25,000 A AUTOMOBILE LIABILITY �AS7.661.066265.044 09/01/2014 109.00112015 COMBINED SINGLE LIMI I 1000000 (Ea occidonr) S X 1 ANY AUTO i HOUiI Y INJURY(Par porsonl ALLOYMIFO SCHLb UU1E 3 ,AUTOS jAUTOS ff BODILY INJURY(Par accdant) S X I IIIREDAU105 X :NO �ED f i PROPERTY DAMAGE I OS �3 1 (Poraccwon) X Phys Daman COMPICOU DER $ $1,000/51,000 UMBRELLA LIAO OCCUR LACK OCCURRENCE S EXCESS LIAO I CI AIMS MAOF. AGGREGATE S DEG_I I RETENTIONS + S WORKERS COMPENSATION WA7.6604613265-D24 091)112014 010112015 X Wt:STATU- o AND EMPLOYERS'LIABILITY f ,TORYLIMITS ER , B ANY PROnRIETOR!PARTHF Fitt xtcu+iv(: YIN ( iWCI-66 1-066 26 5.034(WI) }09•-10112014 09A)112015 1,000,000 OFVICERM.EMO=_REXCLUOEO� ( NJ NIA I EL EACIIACCIDENT S B i(Mandatory in NH► WC DEDUCTIBLE:$350.000 I E 1 DISEASE•EA EMPLOYEES 000.000 I A yes desexroo under DESCRIPTION OF OPE.RAIIONS tow t I DISEASE. POLICYLIMIT S I0W.000 i + DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addlltonal Remarks Schedule,If more apace Is required) I vdiiim of Insunnoe CERTIFICATE HOLDER CANCELLATION W&CIty Ctxperduat SHOULD ANY OF THE ABOVE UESuklatu NULICILS Ut(:ANCLLLEU Mtt-okE 3055CIcalvi0WW8y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN San Mateo.CA 94407 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED RPPRESENTATIVE or Mamh Risk&Insurance Services ChSrIDs Marrtto1010 .� �`jic-"'�•oG�.---..--=-� ®1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD