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HomeMy WebLinkAboutBuilding Permit # 5/6/2015 } BUILDING PERMIT °,76 TOWN OF NORTH ANDOVER ..� APPL.ICATION FOR PLAN XAMINATIC A ��» Permit NO._ , _ tate Received * CH � bates l ul!(� .._ . IIVTiC' ictant must t,rxiaa lctc ali rt�n3�can tla�, ��7� �a�E*� d » � � o�''n'`° �xo���� ��� � ��+'Sa'f��f"'3°� an ��sza"`�i�^'x3'S x�Dnp"�r' k��2✓���� r' ���x £��� t� Y �o. � v�f' r�S'�k6.dt�',I � ,+ s r rr A"� ����`�✓�y� la�E" dCyr?''` '�� �, � .I �� ��"; �"���� '' �.,,•aJ��;� A'�� ��'r;�TM".+����fi< 'r-h, ,ry-'v^�a�°��.i��1���+.a�;ri��,r � "" � �r��"�r,t. I TYPF b I PR_OV M iT» PROPC) FD t1 aF ftesrdentra4 hts?n mmResidential New Building "","One family Addition Two or more family Industrial i , :Alteration No of units Commercial__,..__... ....._.._ Repair, replacement Assessory Bldg Others: Demolition { OOther ..„x r�,.L���n�...,yb.�rN'�"�4,�Z�.��,ry��.y��°}r+?°#^`�xF z afi�1Qr,rs34Arer f"r.''� `..r".r.Fr.ws,.+'r^�R t ua....r.,�,�W?��4 5�a'a4,aafrFi;xx,�``A'"�h4��� �!r rR.�t�firo hf+�4'Yd,�....P1 a �✓',xn:.�Mpx:d H F" �sPr�s.�i,kti7aW ft 'MrRiCN�d d N�4"%4a�r,a J.4R „W, 9es d'x t m, lctettllflc tic�t� Ple ase Tyl pe or Print C livarly) OWNER: Name• Phone. * "�..,��� � s r AdCrSu. . i a� rfi s d u���xd* x "' lx"�a� w . z� 4 rj`�bu 2x /'�f��:✓�e x'+�"'',.a1'ry ,a.4`;� Pf�� �'""�", a � n �.f°, � r�iF � 7 +� !� r ✓ ti 9 'r-r:� m� a,�erg ��""',;s. r a R�` ,�„� "'S yx,� � 4.`` 7", f1x a^ ra'Jg r t�"��r+tri �" � '� ,� Mkt',, x �d i✓ d' d" ➢� , � itx'"'„�°* Y+' "' ,. � " "' ,>� r>.�',�x ,","`�",F� �a,ek"m. � �✓r'"` a > a "s �u"�.Ir r�"'�'ear-�`�' ,� � a, � r �� r r ��x a •*�"�^x;; ��^. ��/ aa��r���'ai��'r � v d�"a'd�f w �' :"a� dx�4,a4 did ��p +�� x' "� .f� �"�b y4 a t .4a ✓^ a ,� r N a l l J ;ry d E &.4 a � ���r Nx�$r^t���Iro✓�<�`�>'` � rr + /`4:�a Yr � ��'��"'�� 4���r�� ��a�,�`�'�' '�4� 'a Sir, re d� �a Y,,`�,f"M �dq, r fix. ��, d'`y i����y^�y3#��"�,�rFtsx✓,,�a(�awP f� �u �+� Fd .^h�.,x�4�1 d��,�° ��' x `�'� � d � r �' k'wr�i.+ dh:.' rt" r+i.,„a^ (r" ��xo � }✓�� �,��, r S.x'. 4dra�& � �Pt,Ypr d fd ..........,�yp��f R. ARCNITF,CT/ENGlNEFR __ Phone:_,. Address: . iec, Na. FES'SCHEDULE.,BULLING PERMIT,-$12.00 PER$1000,00 OP THE TOTAL ESTIMATED COST BASEL)ON$125.00 PER SY, Taal Project Cast: ...,. FEF: �._ _ Check No ." b1th- _ Receipt NaP C ' E:: d cat�ra�s t� artrta4"Xa���� rzrr'r ,Yss rtrex cnaltrractors do not have rata ,� M, jaar�d oCtott" t%ORTH q Town of t T.", ndover s * - No. . b SAKE h ver, lVVlass, cOc MIc"awfl: ��' A04'+TE D P.v C.) S u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .................... ....... .................................. BUILDING INSPECTOR has permission to erect .......................... buildings on .....H1.11-SAA. ................................. Foundation Rough to be occupied as ........ .�. . . .... 4............. .a��..... .1 ..:.........: ...................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION-of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT E I E IN 6 MONTHS ELECTRICAL INSPECTOR ® UNLESSCONSTRUC NT ARTS Rough Service ............. . ........... ............................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy PuildinRough Islay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. .,,.. BRIGHTSTAR SCHEDULE OF ROOF-MOUNTED MATERIALS April 24,2015 JOB:317 HILLSIDE RD.,NORTH ANDOVER,MA CALCULATION OF SYSTEM AREA: ARRAY'A'(newly built) ARRAY'B'(original) MODULE WIDTH(inches) 39.41 39.41 MODULE LENGTH(inches) 65.94 65.94 AREA PER MODULE(square feet) 18.05 18.05 QUANTITY OF MODULES 18 13 TOTAL MODULE AREA(square feet) 324.84 234.60 INTER-ROW SPACING(inches) 0.60 0.60 ROW LENGTH(inches) 199.45 239.46 NUMBER OF SPACES BETWEEN ROWS 2 1 TOTAL AREA BETWEEN ROWS(square feet) 1.66 1.00 INTER-COLUMN SPACING(inches) 0.60 0.60 COLUMN LENGTH(inches) 65.94 65.94 NUMBER OF SPACES BETWEEN COLUMNS 15 10 TOTAL AREA BETWEEN COLUMNS(square feet) 4.12 2.75 TOTAL MODULE AREA(square feet) 324.84 234.60 TOTAL AREA BETWEEN ROWS(square feet) 1.66 1.00 TOTAL AREA BETWEEN COLUMNS(square feet) 4.12 2.75 TOTAL ARRAY AREA(square feet) 330.62 238.35 CALCULATION OF SYSTEM WEIGHT: WEIGHT(lbs.) QUANTITY WEIGHT(lbs.) WEIGHT(lbs.) QUANTITY WEIGHT(lbs.) SOLARWORLD SW275 SOLAR MODULE 46.7 18 841 46.7 13 607 PRO SOLAR ROOF TRAC RAILS 16.0 9.0 144 16.0 6.5 104 TOTAL WEIGHT(lbs.) 985 711 TOTAL ARRAY AREA(square feet) 330.62 238.35 SYSTEM WEIGHT(lbs.)/SQUARE FOOT 2.981 2.98 NUMBER OF ATTACHMENT POINTS 36 26 SYSTEM WEIGHT(lbs.)/ATTACHMENT POINT 27.35 27.35 RAFTER SIZE 2x8 2x8 RAFTER SPACING 16" 16" ROOF PITCH 28` 28' HORIZONTAL SPAN 10'0" 12'6" COLLAR TIES NONE 1/2 RAFTER PAIRS Residence Solar Installation 317 Hillside Road North Andover,MA Gravity Loading: Roofs A&B—adequate to support the proposed solar panels It is our understanding that the panels will be installed using Pro Solar Roof Trac Rail(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 joists 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. 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. Sincerely, MPP Engineers, LLC Asma Faruqi N OFAI�� ` ASHD G N C1 -{ --1 NV 4 9� o �rOF- N ALaCa Ashutosh Patel, P.E. MA Prof. Eng.Lic.No.48235 Page 3 Residence Solar Installation 317 Hillside Road North Andover, MA condition and is assumed to have one layer of asphalt shingles.The pertinent data is listed below: Roofs A&B (31 Panels Total): Roof Rafters: 2"x 8"(#2 Hem-Fir Assumed) Spacing: 16"O.C. Roof Slope: 28 Degrees Horizontal Projected Length of Rafter (Horizontal Projection): 10 feet(Roof A), 12.50 feet(Roof B) Ceiling Joists: Present Collar Ties: Not Present(Roof A), 1"x 10"@ 32"O.C.(Roof B) Roof Sheathing: Plywood Sheathing Condition of Framing: Good Roof Covering: Asphalt Shingles Ground Snow Load,Pg: 50 PSF from Table R301.2 (5)of Massachusetts Residential Code Importance Factor,1: 1.0 Exposure Factor,Ce: 1.0(Conservatively taken as Partially Exposed) Thermal Factor,Ct: 1.1 with Panels(Cold Roof) 1.0 existing condition(Warm Roof) Design Snow Loads On sloped roof. 35.00 PSF(Existing—Unobstructed Warm Roof) 26.95 PSF(New Condition—Slippery Surface on Cold Roof) Basic Wind Speed: 100 MPH from Table R301.2(4)of Massachusetts Residential Code Importance Factor: 1.0 Exposure: B Analysis Results: General Considerations ➢ 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 that will be added instead. ➢ 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 23%compared with the snow load acting directly on the existing shingled roof surface.The reduction equates to 8.05 PSF which completely offsets the weight of the solar panels. Page 2 N:*z. N I111:; I l l iij ::- I/IIS ;�. Illn4 1111 1■It ■t 1t: 111; STRUCTURAL ENGINEERS April 30,2015 Town of North Andover Building Department 1600 Osgood Street Building 20, Suite 2035 North Andover,MA 01845 RE: Residence Solar Installation 317 Hillside Road North Andover,MA Structural Assessment of Roof Framing MPP Project No: 15-0767 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 Brightstar 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. Results Roofs A&B—adequate to support the proposed 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 RI 04.11 of the 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 areas for the solar panels of this residence are framed with conventional 2x wood rafters in a gable configuration.Additionally,Roof B consists of collar ties.The existing roof structure is in good MPP Engineers, LLC 34 South Main Street, Suite D I Allentown,NJ 08501 609-489-5511 (Phone) 1 609-489-5916(Fax) S Customer Information: Contractor Information: Chris&Suzanne Nobile BRIGHTSTAR Brightstar Solar,LLC 317 Hillside Rd. 0 i. ,q, R «ovtiv.brightstarsolar.net North Andover,MA 01845 (617)564-0050 (978)686-8814 611 Hosmer St. Marlborough,MA 01752 GENERAL CONTRACT FOR SERVICES MA#166783 Parties: This Construction Agreement("agreement")is entered into by and between Chris&Suzanne Nobile,hereinafter referred to as"Customer",and Brightstar Solar,LLC,hereinafter referred to as"Contractor". Scope of Work: The scope of Contractor's work includes the complete turnkey installation of a grid-interconnected photovoltaic system as specified below at the Customer's residence: Photovoltaic(PV)System for the Nobile Residence: System Size(t)iG STC):8;525 kilowatts(kW) Modules: (31)SolarWorld SW275(Black-on-Black) Inverters (3i'}Enphase M250 Location.Southeast.and Southwest facing ritofst front of resldettce Monitoring&.Meter ; En haseEnli"htenMonitnrin '&Anal "itevenu67 rade.,oer. Contract Price and Progress Payment Schedule: The cast for the project specified in the Scope of Work shall be$31.207,subject to additions and deductions pursuant to authorized Change Orders and allowances. The project cost includes permitting fees and structural analysis by a Massachusetts Professional Engineer. Our installation carries a 5-year warranty as outlined in the Minimum Technical Requirements section of the MA CEC application package. Total Project Cost: $,. 31,267 100% State PV;Rebate:. 3 250 100/0 Contract Price Net to Ctistomer: $ 27 957 900/0 Pa. , en — _ % Est:Date Milestone Initiai Deposit: $ 500, 2% 12,/16/14 Due when Agreement signed and returned to 000actor Customer's 2nd:. $13,729 44°% 5/18/15 I)oe updwwmmencement of work at Customer`s iestdence Cuswiner's Final: -$13,729 44°% 5/29/13 Due upon substantlal completion of work.at Customers residence, Final(Rebate): 3.250 100k 5/29/15• Payable by MA CEC to Contractor upon,inspection.and approval .Total Project Cost: $31,207 100% Notice of Right to Cancel and Key Milestones: You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction. Agreement Transaction Date: December 16,2014 Estimated Start Date: May 18,20I5 Estimated Completion Date: May29,2015 Chn'V&Suzanne Nobile,Customer Date i 12/16/2014 Jon Reese,President,Brightstar Solar LLC Date Copyright 2010 Brightstar Solar,LLC CONFIDENMI,and PROPRIETARY I a;.. ' ■? Sunmodule;// Plus SW 275 MONO BLACK PERFORMANCE UNDER STANDARD TEST CONDITIONS(STC)' PERFORMANCE AT 800 W/mz,NOCT,AM 1.5 Maximum power P.,,,, 275 Wp Maximum power _ P— 203.1 Wp Open circuit voltage V„r 39.4 V Open circuit voltage V1,, 35.7 V Maximum power point voltage V-r 31.0 V Maximum power point voltage V,,,r,, 28.1 V - ---__.....------ Short circuit current I„ 9.58 A Short circuit current I, 7.75 A Maximum powerpoint current I8.94A Maximum power point current L7„ 7.22A Module efficiency qT 16,40% N1'iinor reduction in effic.ency under partial load conditions at25°C at 200 W/mi 100% (+/-2%)of the STC effoency(1000 W/m2)is ach eyed. 'STC:1000 W/m',25"C.AM tS 1)AAeasufing tolerance(P,,,,)traceable to TLJV Rhe-nland:+/2%(TLJV flover Controlled). COMPONENT MATERIALS THERMAL CHARACTERISTICS Cells perrnodule 60 Cell type Mono crystalline NOCT 48'C —------ - --- -- -- Cell dimensions 6.14 in x 6.14 in(156 mm x 156 him) TC 1, 0.044%/°C Front Tempered glass(EN 12150) TC v,� ---- -0.31%/°C - Frame Black anodized aluminum TCP,,, -0.43%/`C ----- -- - -------- —..--._.. ----- --- Operating temperature -40°C to 85°C Weigh, 39.5 lbs(179 kg) ..__. ............. SYSTEM INTEGRATION PARAMETERS 1000 W/m' Maximum system voltage SC 11/NEC 1000 V Maximum reverse current 16 A 800 W/m' Number of bypass diodes 3 I — _-. .._.....__. - _.._._...__.. ...._.... psf downward a 600 W/m' Design Loads' Two rail system 64 psf upward _... -__. - -- --- Design Loads' Three rail system 170 psf downward -- 400 W/m' 71 psf upward Design Loads' Edge mounting 30 psf downward 200 W/mz 30 psf upward _ - 100W/rW "Pea serefer tot he5unmoduleinstal fat ion:nstruct.onsfort hedetxisassociatedwith -- - -- these load cases. I Module voltage[VI V�r ADDITIONALDATA Powersorting' -0 WP +5 Wp 1-x.4 37.44(9S1) 1-Box IP65 — Module leads PV wire per LIL4703 with H4 connectors ---------------- -- Module type(UL 1703) 1.33(288) Glass Low iron tempered with ARC 0.605.3) 39.37(1000) VERSION 2.5 FRAME Version Compatible with both"Top-Down" J1 2.5 frame and"Bottom"mounting methods 65.94(1675) bottom N iGrounding Locations: mounting 4 corners of the frame holes 4locations along the length of the module in the extended flanget .D 1.34(34) x4 4.20(107)1 (�) tom-39.41(1001)—� A'':I units prov:,ed are:mperial,SI units provided in parentheses. SolarWorld AG reservesthe rITI-tto make specification changes witnoutnotice. SW-01-6025LJS 08-2014 771 Usl'� SOLARWORLCr o u P1, 1 ,Oom " i. W27 ON - Kl ALVALUE TUV Power controlled: 1uv11oin1 d Lowest measuring tolerance in industry I X00002 Every component is tested to meet 3 times IEC requirements � J Designed to withstand heavy j accumulations of now and ice � J I Sunmodule Plus: Positive performance tolerance I *� L 25-year linear performance warranty and 10-year product warranty J lr ; • S Glass with anti-reflective coating J World-class quality U a,r9e3.1Ep5<S,5 `f •Safe}zee .EEG Wll _ .e=.. Fully-automated production lines and seamless monitoring of the process and mate- r ate o e rial ensure the quality that the company sets as its benchmark for its sites worldwide. SolarWorld Plus-Sorting = - Er: 5- E::TIfJ"r;,r:T �c r jE[ Plus-Sorting guarantees highest system efficiency.SolarWorld only delivers modules that have greater than or equal to the nameplate rated power. UL 1703 25-year linear performance guarantee and extension of product warranty to 10 years SolarWorld guarantees a maximum performance digression of 0.7%p.a.in the course of 25 years,a significant added value compared to the two-phase warranties com- mon 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 m Armor iN RTE of us solarworld.co AN]iMY0TED Y7.^nYs v......... ..........,.. E Bulk packaging means easier stocking abilities,less packaging waste and quicker,more convenient installation.Everything in the photo below is shipped in a recloseable box for storage of extra parts. FastJack Fa:rr tE3t+:. T111f1fil a9' I I The Fast Jack®is available in four convenient sizes. All sizes are packaged in quantities of 18 per box: k � cr 18 - 1 Round Posts(3",4-1/2", b"or 7-1/2"tall)w r1' 18 Threaded bases 18 3/8"x 3/4"SS Hex Bolts i � &M 18 3/8"SS Flat washers �? � 18 5/16"x 3"SS Lag bolts a h 18 5/16"SS Flat Washers Easy Installation: s, a F a o r a s • e e a a • • p �NI1!I• E,f7p,, .s • ••• ®. a =• o •o • " a • e n e e • •ti Flashing Template i Available for Oatey (Pictured)and standard flashings.Makes cutting in j a perfect flashing easy and t painless! M. Kit includes Fast Jack post threader with knob a -• a • • a • •• o • - o e• � "hc, " ©Professional Solar Products,Inc.March 2006. Laborrrtory Tested t{ 2,359 Is ®N> T irtir zl Pullout! 808 lbs Side.11.x l Pullout.' Patent#6,360,491 Flashable rRoof Stanchion Fastlack® FJ-300-18 The patented design of the Fastlack®can he easily expressed as the most innovative,efficient For Onley®style flashings and cost-effective tool of it's kind! a Between the precision(N(machined base and stanchion along with strict engineering and material standards,the Fost.lack®has been laboratory tested to provide 2,359 pounds of t strength using only a single lag bolt(included)! 00 f Four Sizes Available! �C 3"High Part# FJ-300-18 .. <<. For low profile installations using Ootey®flashings(for composition shingle roof-tops) FastJack® 17J-450-18 ' 4-1/2" High Part# F1,450-18For standard F For installations using standard flashings(for composition&flat rooftops) 6" High Part# FJ-600-18 ` • • •• •• For standard flashings(for flat tile rooftops) 7-1/2" High Part# FJ-750-18 x • • • • • Sr, X •• For standard flashings(sized for S-(urve tile roofs and/or double flashed installations) - The Fast Jacko design is covered under Pat.#6,360,491 Using leo.5/16"x 3-1/2"log Balt ,'s „' r + ' r I Commercial Fastlack® also available (rated at 4,250 lbs )........ ..... ..... ....l , , ', • Benefits of the Fastlack® Easy installation of flashingss on 318"x 3z4" ss r r r • Removable post makes installation'on existing , SS Hex BoltFlat Washer roofs/retrofitquickand easy(refertothe illustration existing roof-tops to the right) See res,a tee€€:5P ila(r3.3°i7enr; • Patented design locates the lag bolt directly The post can be under the stanchion providing superior strength values Standard&Oate}")Flashings installed through e ® • Fast & easy to install saves time and labor slip over the base and under the the top of the costs delicate shingle flashing • •• 21 • Precision machined from extruded aluminum, there are no welds to corrode or break Significantly lighter than steel for installer • convenience and reduced shipping costs. " ' ' • Integrated drill guide insures perfect pilot holes �golt ► N every time- minimizes the possibility of splitting 1 ssz r roof rafters r • Base design allows virtually any roof flashing to install flat on the roof deck Einail zis•far more izzfoz•nwhon o �rosolas-�prosolar.coin I I i f 3 i t Array '13' 13 Modules . rray'A 1S Modules 1 f c G Roof Plan for Rooftop PV System CONTRACTOR: 31 Panels,8.5 kW BRIGHTSTAR SOLAR 257 Maple St.Unit 2. Site Name:Nobile Residence 7 3 �^C1L�,�Yy� Marlborough,MA 01752 Site Address:317 Hillside Rd., North Andover, MA BRIGHTS i .; L ii f`. Drawn By:Jon Reese SCALE DATE DWGNO I REV NTS 5/5/2015 001 Z The Commonwealth of Massachusetts Print Form ,4 Department of Industrial Accidents }' �> ^�' Office of Investigations fi > I Congress Street, Suite 100 yY Boston, ALL 02114-2017 wwtiv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Organization/Individual): Brightstar Solar Address:611 Hosmer St City/State/Zip:Marlborough, MA 01752 Phone#:617-564-0050 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 2 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ 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 13.❑✓ OtherSolar PV Installation employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'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. :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-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Harford Casualty Insurance Company _ Policy#or Self-ins.Lic.#:84WECBL5407 Expiration Date: (A 1 Job Site Address: 2>K1 `c§.sz k City/State/Zip: (1 Attach a copy of the workers' compensation policy 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. J .fy_ p._. p_ fp J y______ p and correct. Ido hereb cert- iin er th it rind! enalties o er ur that the information provided above is true `R� Si nature: Date: S Phone#•617-564-0050 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. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ 015 PRODUCER THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ASSET ONE INSURANCE SERVICES HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 575 Anton Blvd 3rd Fl ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Costa Mesa, CA 92626 _ INSURERS AFFORDING COVERAGE NAIC# (714) 625INSURED Brightstar Solar, LLC INSURER A: Preferred Contractors Insurance Co. INSURER B: Progressive Insurance Co. 257 Maple St, Unit 2 INSURER C: Hartford Casualty Insurance Company Marlborough, MA 01752 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTEDBELOW 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 ISSUBJECT TOALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE MWDD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 000 000 tfuHtNItIl X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ 100 000 CLAIMSMADE B—d OCCUR MED EXP(Anyone person) $ 5.,000 A X PCIC5009-PCA6878 6/1/14 6/1/15 PERSONAL&ADV INJURY $ 1 ,000,000 GENERAL AGGREGATE $ 2 ,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2 .000,000 PRO- POLICY ElJECT El LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ 1,000,000 ALLOWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) B X X HIRED AUTOS 04732516-0 6/1/14 6/1/15 BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accidenQ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ IOCCUR CI CLAIMSMADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ WC STATU_ OH_ $ WORKERS COMPENSATION AND X TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE C OFFICER/MEMBER EXCLUDED? 84 WEC BL5 4 0 7 6/1/14 6/1/15 E.L.DISEASE-EA EMPLOYEE $ 500 000 Ifyes,describe under SPECIAL PROVISIONS below E.L-DISEASE-POLICY LIMIT $ 0c)f000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD25(2001108) ©ACORD CORPORATION 1988 Massachusetts D partr ent of Public Safety Hoard of Budding Regulations awl Standards License: CSFA-105995 JONATHAN REE$E 6111 HOSMERSTREET' Marlborough MA t117S2 Expiration ;s n3a;ts l£se2 3 02/07/2016 ,�i/IF �,tl7Jt7JPf?ftIU�PXtfft Q .:lLf1.3:ffldfilU�ELttF Office of Consumer Affairs&Business Regulation tHOME IMPROVEMENT CONTRACTOR Registration: 66783 Type: } h� Expiration: 7!2/2016 LLC BkI HTSTAR SOLAR,LLC.`' JONATHAN REESE 97 STRATHMORE RD 98 — BRIGHTON,MA 02135 Undersecretary