HomeMy WebLinkAboutBuilding Permit # 7/7/2015 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 4 Date Received r _
Date Issued: w` "
IMPORTANT:A plicant must complete all items on this page
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TYPE OF IMPROVEMENT. PROPOSED USE
Residential Non- Residential
ew Building ane family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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DESCRIPTION OF WORK TO BE PERFORMED:
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OWNER: Name: l J Phone: - `f 0.*
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aHome%fm rovement License /' r!/ /;;rJ, r ,,; ; ( % if;;'/ / %Ex
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ARCHITECT/ENGINEER Phone:
Address - - - - - Reg. Na.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Coat:
$ - FEE: $ as
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Check Na.. f Receipt Na.: 0 ,
NOTE: .Persons contracting with a istered contractors do not have access to the guaranty f "ii r w
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Signature of Agent/Owner , Signature of contractor
Plans Submitted Plan aived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ”
AM tkORTH
Town of 0.1dly V ur
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5.
No. � 2ool � -
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COCMICKEWICK y1.
ORATED I'Q¢�,`5
U BOARD OF HEALTH
PERMIT �T LD Food/Kitchen
Septic System
THIS CERTIFIES THAT ......... .. BUILDING INSPECTOR
has permission to erect .......................... buildings on ... .. ......
l.l'/f�.vL ............................ Foundation
I�---....................................................................... Rough
to be occupied as ........ ..�.�.. ...�r�.. .....r,��........6!.... Chimney
provided that the perso 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 EI IN 6 MONTHS ELECTRICAL INSPECTOR
LESS CONSTRUCTIOS S Rough
Service
................. ... ..... ................................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Rsquired t® Occupy Building Rough
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 Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
4931 North 300 West,Provo,UT 84604 Employer Identification No.: 80-0756438
\ ®UAW ® solar"'
Phone:(877)404-4129 Fax:(801)765-5758 Massachusetts HIC License No: 170848
E-Mail: support@vivinlsolanc°m 2 S
www.vivintsolar.coni AR No.: —1
RESIDENTIAL POWER PURCHASE AGREEMENT
This RESIDENTIAL POWER PURCHASE AGREEMENT(this"Agreement")is entered into by and between VIVINT SOLAR DEVELOPER,LLC,a
Delaware limited liability company("We","Lis","Our")and the undersigned Customer(s)("You", Your"),as of the Transaction Date set forth below.
Full Name(Fitt% ).L-t) k + /� i` Full Name(First,aa[,L-y
e.r Y. ❑l'n ^\ e /� 1 1 t t Pron ry D,i iter: ❑Yu ON-
Telephone
r i-.n a `c�S-- ! ���-� — _ — -- ---
Telephone No.: 20 j 2 25 FS E-Matt., , 1,_� tJ LvoO Geo
Property Street Address: G iM I C e 5 C
Address: City,County,State,lip: )_ ACJ ✓�� N(� Q( �{ S
L SF,RY`ICES
A. DESIGN AND INSTALLATION. We will design,install,ser%fce and maintain a solar photowolraie sy,stcm on Your Property,%khich%kill include all
solar panels..iner
icrts,meters,and other components(cullecoycly,the"System"),as titrther described Ili the Customer Packcl and the Work Order[hal We
will prmide Io You hereaher. ;111 material portion;of the System will be ntstalied by Our employed technicians and elcurici urs,and not subcontractors.
With Your coo ation, We will It)desien, Iisti I and connect the System in material compliance with All applicable lims; 0i)complete all required
inspeclions::m,�d(iii)n[piain all requitred certthcahons and ptnnits In order to design❑S stem that ntecls four n'eds,Y'nu t:,rce dear 11t may obtain 1 our
eleuncal us[ge,luatory hum Your electric utility lthe"Wrlu1'')and You shall proktde Us%vith copies of Your C.fility bills as We may reasonably request,
Other than the ictkauon Ice described in Section 1.13.We will desist and install the System at nu cost to You.
B. ACTIVATION. You agree to pay Us a one-time activation fee in the amount ofS ,__hAVc\%ill interconnect the System with the Utility,and
cause the System to generate energy measured in kilowatt hours(`11Ylr" (the "Energgyyy), ufallation of the System o
generally takes title day anti is
anticipated to begin and he substantially complete between two(2)and six(6�weeks hereaRcr
C. OWNERSHIP OF SYSTEM. We shall own the System as Our sole personal property. You will have no property interest in the System.
D. OPERATIONS AND MAINTENANCE. We will operate and maintain the System(i)at Our sole cost and expense;(ii)in good condition;and(iii)in
material compliance with all applicable laws and permits and the Utility's requirements.
E. INSURANCE. We carry commercial general liability insurance,workers'compensation insurance,and property insurance on the System. For more
information concerning Our insurance,and to obtain a copy of Our certificate of insurance,please visit: %vww.vrvuttsolar.com/insurance-
2.'I"ERM,PRICE,PAYMENTS,AND FINAi ISCLOSUI2ES
A. ENERGY PRICE. For all Energy produced by the System,You s I pa s$0. per kWh he"Energy Price"),plus,applicable taxes.
The Energy Price shall increase each year by two and nine-tenths Pere t(2.9 Y, Ago es,Me or the System output,measured to kilowatt hours,
will be provided to You in the Customer Packet. THIS AGREEMENT 1 E SA F ENERGY BY US TO YOU AND NOT FOR THE SALE OF
A SOLAR ENERGY DEVICE.
B. TERM. This Agreement shall be effective as of the Transaction Date and continue until the twentitil(20"')a niversary of the In-Service Date(the
"Term"). The"In-Service Ante"shall be the first day after all of the following have been achieved: (i) m has been installed and is capable of
Sencmting Encrt,v,(ii)all pctmits necessary,to operate the System have been obtained,(iii)the System has been Interconnected with the Utility,and(iv)all
utspections and ctatificalcs required under Applicable law or by the Uuiny have been completed or received.
C. PAYMENTS. Be imting with the first month lirllo%eiug the hi Scr%ice Date and throughout the Term,We will send You an invoice reflecting the
charges torr Lnerhy produced by the System in fire previous month. You shall make numthly payments to Us by atnornauc p'ayntcnl deduction from Your
designated checkntg account or credit card. It is Your responsibility to ensure that there are a equate funds or adequate credo Imus. Ibere is no financing
chane associated with this Agreement. For all ptyntettts more[holt ten(10)da)s past(]tic We uhly impose a late chanx equal to Twenty-Five Dolly,62))
and interest at'air annual rate often percent 00'v;),0.i),plus applicable taxes. 11 N ou continue to fail to make tiny payment within ten(1 tl)days alter We give
You written notice.then We may exercise all remedies Available to Us pursuant to Section 13,x.
D. RENEWAL. At the end of thc'ferm,You may elect to(i)continue wills this Agreenient on it year-to-year basis.(u)enter inup a new :lrrecnpcnt with
its and cancel this Agreenrmt(in)purchase the Sy,lent at the end of tile'ferm amI cancel fins Agreement(Ile"Purchase Option"),or(rv)cancel this
Agreernent And have the System removed at no co,t to You. You gill need lit notify Us in writing conccrr iny'Your election sixty(ii0)drys prior to tilt-cad
of the Term. '.It'You elect the Purchase Option, die"Purchase Option Prier' will be the then-current Parr market value of the System based on air
independent apo rmser's valuation of similarly sized photmollaic systenls in Your geographic region, the appraiser's caloation will he pi-mided to You in
%vriune and wi) he hmdmg If We receive Your paymem of tilt'Purchnne Option Price,cos[,orthe Appraisal,applicable taee's.and all other amounts Then
owing and mppaid hereunder,We w 111 transfer ownership of the Sysicnp to You at the end of the'l-erns on an 'As Is,Where Is"basis IfYou ou elect to have the
Sv tent 1,11110%ed.Ak`e will remove the System front N`oln Pro�J %wI hill
ninety(`)I))(Java aller file end of the Rrm. IF YOU DO NOT'NOTIFY IIS OF
YOUR ELECTION 'f0 CANCEL 11Y SENDING A W�2Tf'I'EN NOTICE 1'0 (IS, THEN 'THIS AGREEMENT WILL AUTOMATICALLY
RENEW ON A YEAR=1'0-PEAR BASIS LIN'CIL YOU NOTIFNUS IN WRITING OF YOUR ELECTION TO CANCEL AT LEAST SIXTY(60)
DAYS PRIOR TO THE END OF THE RENEWAL•TERM.
E. CREDIT CHECK. In connection with the execution of this Agreement and at any time during the Term,You hereby authorize Us to(i)obtain Your
credit rating and report from credit reporting agencies;(ii)to report Your payment performance under this Agreement to credit reporting agencies;and
(iii)disclose this and other information to Our affiliates and actual or prospective lenders,financing parties,investors,insurers,and acquirers.
WE MAY HAVF,PRESCRE.F.NFD YOUR CREDIT. PRESCREENING OF CREDIT DOES NOT IMPACT YOUR
CREDIT SCORE. YOU CAN CHOOSIF TO STOP RECEIVING"PRESCREENED"OFFERS OF CREDIT FROM
US AND OTHER COMPANIES BY CALLING TOLL-FREE (888) 567-8688. SEE PRESCREEN & OPT-OUT
NOTICE(SECTION 29)BELOW FOR MORE INFORMATION ABOUT PRESCREENED OFFERS.
3.LIMITED I,1 ARRAN 1`Y
A. LIMITED INSTALLATION WARRANTY. We provide a workmanship a taint that the Sx t m shall hc hee I'r nn atenal d Ices it ,1 sten and
workmanship¢poder normal operating conditions for theTerm. We further warrant that alt ruoiiop penctr inions N install sh he v.aterb ht a,13f,
f the(late,)[,
installation, kVe do not provide any warranty to You with respect to any coinpnnent orlhe Cvstem. Anv munul'ai mrcr's wart uv is in n(Jdrnon .not in lieu
of,this limited installation warranty. This warranty does not cover problems icsuhine From exposure to hmmful mutetla s td_auntirt s, Ira, ill d.
earthquake,or other acts of god,vandalism,alteration of system by anyone not,twhoriledlpy f's,or any other cause hctond Our control.
B. MANUFACTURERS' WARRANTIES. The System's solar modules carry a minimum manutacturer's warranty of twenty(20)years as 101iows:
(a)during lite first ten(10)years of use,the modules'electrical output will not degrade by more than ten percent(10%)from the originally rated output;and
(b)during the first tvcnty(20)years of use,the modules'electrical output will not degrade by more(him twenty percent(20%)trom the originally rated
output The System's inverters carry a minimum manufacturer's warranty often(10)years against detects or component breakdowns. During the Term,We
will enforce these warranties to the fullest extent possible.
C. DISCLAIMER OF WARRANTY. EXCEPT AS SET FORTH IN 'PHIS SECTION 3, WE MAKE NO 01 HER WARR 1NI-Y TO
YOU OR ANY OTHER PERSON, WHETHER EXPRESS, IMPLIED OR SI,AfLYfORN'. AS TO I HE MERCHANTABILITY OR
FITNESS FOR ANY PURPOSE OF THE EQUIPMENT, INSTALI..ATION, DI SIGN, OPERATION, Olt MAINILNANCE OF Till:
SYSTEM, THE PRODUCTION OR DELIVERY OF ENERGY, OR ANY OTHER ASSOC IAI ED SERVICE OR MAITER
HEREUNDER, ALL OF WHICH WE HEREBY EXPRESSLY DISCLAIM. OUR LIABIL1)N FOR ANY BREACH OF ANY
WARRANTY IS LIMITED TO REPAIRING THE SYSTEM OR YOUR PROPtRTY "EO HIE IXILN'f REQUIRED UNDI-A '11IIS
AGREEMENT. YOU ACKNOWLEDGE THAT WE ARE RELYING;ON 1-1115 SFCTION 3.C. A's A CONDITION AND M 11-1=.RIAL
INDUCEMENT TO ENTER INTO THIS AGREEMENT. THERE: ARE NO WARRANTIES WHICH EXTEND BEYOND Tilr
DESCRIPTION OF TME FACE HEREOF-
4.REMOVAL OF THE SYSTEM
)'on shall not make any Alterations(as defined in Section 9(c))to the System. If You want to make repairs or insprovements to Your Property that require
the temporary removal of the System or that could mterterc watch its performance or operation,You must give Us at least thirty(30)days'prior written notice
(a"Gec
ster/Shutdorvu"). You agree that any repair or rrnprovement to Your Propertyshall not materially alter Your root where the System is
instalalooforOur removal,storageandreinstllation otheSystem,You agree to pay to Us a fee equal to Four Hundred and Ninety-Nate
Dolls We remove til SystYshall be required tpaSuaymentasdefined m Section l5 tC the Syystem is not reinstalled
iys ofrmovalIn the event of anemergncyaffeun the System,Youshall contact Us immc rate y. IfWe are unable to timely
respoatYurownxpensecotactithainsd and qual -d solarnstaroremovethe System as necessary to make repairs required by
he eshall be responstble for any damage to the System that results from actions taken by Your contractor.
S.ARBITRATION OF DISPUTES
Most customer concerns call ht resolved quiddi and omitablV M' calling Our customer service depatlmenCa877) 404-4129. Our
4ustomei scl-Vice depal hook is unable to resolve Your concern,fou and We agree to resolve anyy Dispute.(as de, below)through riding
arbitration or small claims court instead of courts of generaljurisdiction, BY SIGNING BELOW, N OLS ACKNIbw.1 F1)(;h ANI)AGREE
THAT(I)YOU ARE HEREBY WAIVING THE RIGHT TO A TRIAL BY JURY;AND(11)YOU MAY BRING CLAIMS AGAINST US
ONLY IN YOUR INDIVIDUAL CAPACITY,AND NOT AS A PLAINTIFF OR CLASS MEMBER IN ANY PURPORTED CLASS OR
REPRESENTATIVE PROCEEDING. You and We agree to arbitrate all disputes, claims and controversies arising out of or relating to
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(i)any aspect of the relationship between You and t Is,whether based in contract,hod,statute or any other legal theory;(ii)this Agreement or
any other agreement concernnig the subject matter hereof; (iii) any breach, defladt or termination of this Agreenicnt; and (iv)the
hhlcrptetation,validity,or enlitreeabilny of this Agreement,including the determililt ion 01-111C Scope Or,tpphcability of this Sectilm 5(each,a
"nrspule"). Prior to commencing arbitration a tarty must first send it written"Notice ofDiS)nvi
itC" a Certified mall to the other )arty. The
Notice of Dkpute must describe.the.nature and basis Rtr the Dispute and the relief sou�,ht. II You and We are unable to resolve t�e Dispufc
within thirty (10) days, then either party may continence aihitation. The ail)iiri ion shall be administered by JAMS pursuant to its
Streamlined Arbitration Rulcs and Procedures(at-mlable ar hit rb'whsw,jamsudr.convrules streamlined-arbitration,the"./AMS Rides")and
under the rules set Birth in[tis Agreem1 lie c arbitrator shall c bound by tile, terms of this Apree.ment. No matter the circumstances,tile.
arhii ntoi shall not award punitise,stecial, exentpl try, indirect,or consequential damages to either party. I1'You initiate arhitration. You
shill be respo>nsiblc to pa} $250All anontcyys' Ices, uavvl expenses, and other costs of tlhc arbitruinn shall he borne by )*()a and Its in
accordance with the.IANIS Rules and applicable lase, file arbitration shall be conducted at a mutually agreeable location near Your Property.
o
Judgment n an arbitration award may he entered in any court of competent jurisdiction. Nothing in this Section 5 shall preclude You or We
I'rum seeking provisional remedies in aid of arbitration tiom a court of competent jurisdiction.
NOTICE:BY INITIALING IN THE SPACE BELOW YOU ARE AGREEING TO HAVE ANY DISPUTE ARISING OUT OF THE
MATTERS INCLUDED IN THE"ARBITRATION OF DISPUTES"PROVISION DECIDED BY NEUTRAL ARBITRATION AS
PROVIDED`BY APPLICABLE LAW AND YOU ARE GIVING UP ANY RIGHTS YOU MIGHT POSSESS TO HAVE THE
DISPUTE LITIGATED IN A COURT OR JURY TRIAL. BY INITIALING 1N THE SPACE BELOW YOU ARE GIVING UP
YOUR JUDICIAL RIGHTS TO DISCOVERY AND APPEAL. IF YOU REFUSE TO SUBMIT TO ARBITRATION AFTER
AGREEING TO THIS PROVISION, YOU MAY BE COMPELLED TO ARBITRATE. YOUR AGREEMENT TO THIS
ARBITRATION PROVISION IS VOLUNTARY. YOU HAVE READ AND UNDERSTAND THE FOREGOING AND AGREE T'O
SUBMIT DISPUTES ARISING OUT OF THE MATTERS INCLUDED IN THE "ARBITRATION OF DISPUTES" PROVISION
TO NEUTRAL ARBITRATION. nsl rlllll.a.
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I/WE AGREE TO ARBITRATION AND WAIVE THE RIGHT TO A JURY TRIAL:
6.NOTICE TO CUSTOMERS
A. LIST OF DOCUMENTS TO BE INCORPORATED INTO THE CONTRACT: (i)this Agreement,(ii)the Additional Terms and
Conditions,(Iii)the Customer Packet,and(iv)the Work Order. These documents are expressly incorporated into this Agreement and apply
to the relationship between You and Us.
B. IT IS NOT LEGAL FOR US TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE
TO REMOVE GOODS INSTALLED UNDER THIS AGREEMENT.
C. DO NOT SIGN THIS AGREEMENT BEFORE YOU HAVE READ ALI,OF ITS PAGES. You acknowledge that You have read
and received a legible copy of this Agreement,that We have signed the Agreement,and that You have read and received a legible copy of
every document that We have signed during the negotiation.
D. DO NOT SIGN THIS AGREEMENT IF THIS AGREEMENT CONTAINS ANY BLANK SPACES. You are entitled to a
completely filled in copy of this Agreement,signed by both You and Us,before any work may be started.
E. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO THE LATER OF: (1)MIDNIGHT OF THE THIRD
(3RD)BUSINESS DAY AFTER THE TRANSACTION DATE,OR(II)THE START OF INSTALLATION OF THE SYSTEM. SEE
THE NOTICE OF CANCELLATION BELOW FOR AN EXPLANATION OF THIS RIGHT.
VIVINT SOLAR DEVELOPER,LLC CUSTOMER(S):
By: � Ct&4==n— By: C _
Printed Name: q, . AA C.r- (e_ Printed Name: -
Title: By:
Printed Name:
Transaction Date: 2-' ( S
FOR INFORMATION ABOUT CONTRACTOR REGISTRATION REQUIREMENTS, CONTACT THE MASSACHUSETTS
OFFICE OI?CONSUMER AFFAIRS AND BUSINESS REGULATION: TEN PARK PLAZA,SUITE 5170,BOSTON,NIA 02116,
(617)973-8700 OR 888-283-3757.
--------- --------------------------------------------------------
NOTICE OF CANCELLATION
Transaction Date: AR No.:
YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE(3)BUSINESS
DAYS OF THE ABOVE DATE, OR (IF LATER) UNTIL THE START OF INSTALLATION OF THE SYSTEM. IF YOU
i CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY
NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS
FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST
ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO
THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS
DELIVERED TO YOU UNDER THIS CONTRACT OR SALE, OR YOU MAY, IF YOU WISH, COMPLY WITH THE
INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE
AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEY[UP
WITHIN TWENTY(20)DAYS OF THE DATE OF YOUR NOTICE OF CANCELLATION,YOU MAY RETAIN OR DISPOSE
OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE
SELLER,OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN
LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION,
MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN
NOTICE,OR SEND A'TELEGRAM,TO VIVINT SOLAR DEVELOPER,LLC,AT 4931 N 300 W,PROVO,UT 84604 PRIOR TO
THE LATER OF: (1)MIDNIGHT OF THE THIRD(3 )BUSINESS DAY AFTER THE TRANSACTION DATE,OR(II)THE
START OF INSTALLATION OF THE SYSTEM. I HEREBY CANCEL THIS TRANSACTION:
Date: Customer's Signature:
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NOTWi'T'HST\NDING ANY BREACH OF THIS AGREEMENT, ;I
ANY FAILURF. OF THE SYSTEM,OR ANY NEGLIGENT ACT
THAT CAUSED ANY INJURY OR LOSS (WHETHER
PROPER'T'Y DAMAGE, PERSONAL INJURY OR DEATH) TO I
ANYONE. WE AND YOU AGREE THAT, UNLESS SUCH
n INJURY OR LOSS WAS CAUSED BY A PARTY'S GROSS
NEGLI(iENC 1,, FRAUD, OR WILLFUL INJURY, SUCH
PARTY'S LIABILITY ARISING OUT OF OR RELATING TO ;
THIS AGREEMENT SHALL IN NO EVENT EXCEED THE
DEFAULT PAYMENT. YOU AND WE AGREE THAT THIS
AMOUNT IS A FAIR REPRESENTATION OF THE DAMAGES
THAT YOU OR WE EXPECT TO INCUR IN THE CASE OF ANY
INJURY OR LOSS HEREUNDER.
NO CLAIM SHALL BE MADE BY YOU AGAINST US OR ANY
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60 Middlesex St, North Andover MA 01845
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Structural Group Lehi, LJT 84043
: (8G1) 234~7050
Scott E. Wyssling, PE
Head o/Structural Engineering scot1m9ma0rg9mivinbao6nxoonv
June 29. 2Ol5
Mr. [Jan Rock, Project Manager
�
V\vintSo|er
24Norm8oRoad
Woburn ;WAO18O1
Ng: Structural Engineering Services
Allard Residence
GOMiddlesex St, North Andover K8A
S'4288O5G
4.18kVVSystem �
Dear Mr. Rock:
�
Pursuant to your request, we have reviewed the following information regarding solar panel installation on the roof
ofthe above referenced home: �
1. Site ViGiKVerihceUion Form prepared by a Vivint Solar representative identifying specific site �
information including size and spacing f rafters for the existing roof structure.
2. Design drawings of the proposed system including 8Si\e plan, roof plan and connection details for
the solar panels. This information was prepared by the Design Group and will be utilized for
approval and construction of the proposed system.
3. Photovoltaic Rooftop Solar System Permit Submittal identifying design parameters for the solar
system.
4. Photographs of the interior and exterior ofthe roof system identifying existing structural members
and their conditions.
Based on the above information we have evaluated the structural capacity of the existing f system to support
the additional loads imposed by the solar p@ng|u and have the following comments related to our review and
evaluation:
Description ofResidence:
The existing residence is typical wood framing construction with the roof system consisting of two attic section(s):
* Roof Section 1 (Main House): Roof section is composed of assumed 2x6 dimensional lumber at
16" on center. The attic space is unfinished and the photos indicate that there was limited access
to visually inspect the size and condition of the roof rafters. Based on the span of the existing
radtam, n knee wall or purlin must be installed prior to installation of solar panels. The interior knee
vvBU orpur|in shall be placed within 12''ofan interior wall below the attic space.
• Roof 800bon 3 (Garage): Roof is composed of �xGdimeneion8| lumber 1G" �
` ' �
on center.
The attic space is finished and the photos indicate that there was no aoouoe to visually inspect the size and �
condition of the roof rafters. All wood material utilized for the roof system is assumed to be Spruce-Pine-Fir#2 or |
better with standard construction components. The existing roofing mo1ari8| consists of composite asphalt �
shingles. Our review nf the photos of the exterior roof does not indicate any signs of settlement or misalignment �
caused byoverstressed underlying members.
�
Stability�Emm&abon/
�
A. Wind Uplift Loading
1. Refer to attached Eoo|ibrium Gn|a/ calculations sheet for,4SCEISE/ 7-/0 Minimum Design Loads
for Buildings and other Structures, wind speed of 108 mph based on Exposure Category "B" and
G, 17' & 32degree roof slopes onthe dwelling areae. Ground snow load is 50 PGFfor Exposure
"B", Zone 2per(AGCEISEI7-/0).
V ill �� i In ��
�
Page 2Df2
2. Total area subject to wind uplift is ookw|oted for the /nb»hn[ Edge and Corner Zones of the
dwelling.
B. Loading Criteria
10PSF ~ Dead Load roofing/framing 50 PSF= Live Load (ground snow load)
5 PSF= Dead Load solar panels/mounting hardware
Total Dead Load=15PSF
The above values are within acceptable limits of recognized industry standards for similar structures and in
accordance with the 20O9International Residential Code. Analysis performed ofthe existing roof structure utihzino
the above loading criteria indicates that the existing rafters will support the additional panel loading vvitho -
demage' i/ inot8Undonrreo1|y.
C. Solar Panel Anchorage
1. The au|8r panels shall be mounted in 8000ndonoo with the most recent ^Ernlibnbn7 Solar
Installation Manual', which can be found on the Ecolibrium Solar website (ecolibriumsolar.com). If �
during solar panel inotaUo1ion, the roof framing members appear unstable or deflect non-
uniformly, our office should be notified before proceeding with the installation. �
2. The solar panels are 1 Y2'thick and mounted 41/2'off the roof for atotal height off the existing roof
�
of 6". Atnotime will the panels bemounted higher that G^above the existing plane ofthe roof. �
3. Maximum allowable pullout per lag screw is 205 lbs/inch of penetration as identified in the �
National Design Standards (NDS) of Umber construction opeoiOo8bnna for Spruce-Pine-Fir �
aaaunnpd Based on our evaluation, the pullout value, utilizing e penetration depth of 2 W' is less
than the maximum e||nwmb|e per connection and therefore is adequate. Based on the variable
factors for the existing roof framing and installation tolerances, using a ihnaGd depth of 2 1/2' with e
minimum size of 5/1G" lag aonevv per attachment point for panel anchor mounts will be adequate
with esufficient factor of safety.
4. Considering the roof m|opoo' the size, spacing, oondition of rnm[ the pane( supports shall be
placed at and attached to no greater than every fourth roof rafter as panels are installed
perpendicular across rafters and no greater than the panel length when installed pura||o| to the
rafters (portrait). No panel supports spacing shall be greater than four (4) rafter spaces or 64" o/c,
whichever iuless.
5. Panel supports connections shall be staggered to distribute load to adjacent rafters.
Based onthe above evaluation, with appropriate pane|GnuhorobeinguU|izod8ndtheadditionofeknoevvaUorpur|in,
the roof system will adequately surttha additional loading imposed by the solar panels. This evaluation is in
conformance with the 2009 International Residential Code' current industry standards and practice, and based on
information supplied to us at the time of this report.
Should you have any questions regarding the above orifyou require further information dnnot hesitate hocontact
me.
OF
�
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CIVI two
ruly? 0 50
2
Scott E. Wyssli , PE GIST
MA License No. 505 SSIONA
� ��
EcolibriumSoler
Customer Info
Name:
Email:
Phone:
Project Info
Identifier: 34882
Street Address Line 1: 60 Middlesex St
Street Address Line 2:
City: North Andover
State: MA
Zip: 01845
Country: United States
System Info
Module Manufacturer: Trina Solar
Module Model: TSM 260-PD05.08
Module Quantity: 16
Array Size (DC watts): 4160.0
Mounting System Manufacturer: Ecolibrium Solar
Mounting System Product: EcoX
Inverter Manufacturer: SolarEdge Technologies
Inverter Model: SE380OA-US (240
Project Design Variables
Module Weight: 43.0 lbs
Module Length: 65.0 in
Module Width: 37.0 in
Basic Wind Speed: 100.0 mph
Ground Snow Load: 50.0 psf
Seismic: 0.0
Exposure Category: B
Importance Factor: II
Exposure on Roof: Partially Exposed
Topographic Factor: 1.0
Wind Directionality Factor: 0.85
Thermal Factor for Snow Load: 1.2
Lag Bolt Design Load - Upward: 820 Ibf
Lag Bolt Design Load - Lateral: 288 Ibf
EcoX Design Load - Downward: 722 Ibf
EcoX Design Load - Upward: 765 Ibf
EcoX Design Load - Downslope: 297 Ibf
EcoX Design Load - Lateral: 233 Ibf
Module Design Moment—Upward: 3655 in-Ib
Module Design Moment—Downward: 3655 in-Ib
Effective Wind Area: 20 ft2
Min Nominal Framing Depth: 2.5 in
Min Top Chord Specific Gravity: 0.42
Ecoiibr6urs Sola
Plane Calculations (ASCE 7-10): Roof 3
Roof Shape: Hip Edge and Corner Dimension: 3.0 ft
Roof Type: Composition Shingle Stagger Attachments: Yes
Average Roof Height: 25.0 ft Include Snow Guards: No
Least Horizontal Dimension: 16.1 ft
Roof Slope: 17.0 deg
Truss Spacing: 24.0 in
Snow Load Calculations
Description Interior Edge Corner Unit
Flat Roof Snow Load 42.0 42.0 42.0 psf
Slope Factor 0.97 0.97 0.97
Roof Snow Load 40.7 40.7 40.7 psf
Wind Pressure Calculations
Description Interior Edge Corner Unit
Net Design Wind Pressure Uplift -19.4 -31.9 -47.9 psf
Net Design Wind Pressure Downforce 11.4 11.4 11.4 psf
Adjustment Factor for Height and Exposure Category 1.0 1.0 1.0
Design Wind Pressure Uplift -19.4 -31.9 -47.9 psf
Design Wind Pressure Downforce 16.0 16.0 16.0 psf
ASD Load Combinations
Description Interior Edge Corner Unit
Dead Load 2.6 2.6 2.6 psf
Snow Load 40.7 40.7 40.7 psf
Downslope: Load Combination 3 12.1 12.1 12.1 psf
Down: Load Combination 3 39.7 39.7 39.7 psf
Down: Load Combination 5 12.1 12.1 12.1 psf
Down: Load Combination 6a 37.6 37.6 37.6 psf
Up: Load Combination 7 -10.2 -17.7 -27.3 psf
Down Max 39.7 39.7 39.7 psf
Spacing Results(Landscape)
Description Interior Edge Corner Unit
Max Allowable Spacing Between Attachments 53.5 53.5 53.5 in
Max Spacing Between Attachments With Rafter/Truss Spacing of 24.0 in 48.0 48.0 48.0 in
Max Cantilever from Attachment to Perimeter of PV Array 17.8 17.8 17.8 in
Spacing Results(Portrait)
Description Interior Edge Corner Unit
Max Allowable Spacing Between Attachments 40.2 40.2 40.2 in
Max Spacing Between Attachments With Rafter/Truss Spacing of 24.0 in 24.0 24.0 24.0 in
Max Cantilever from Attachment to Perimeter of PV Array 13.4 13.4 13.4 in
Ec libriurn Sdar
Layalut
Skirt
Coupling Note: If the total width of a continuous array exceeds 35 ft, break array to allow for thermal
expansion and contraction. See Installation Guide for details.
Clamp Warning: PV Modules may need to be shifted with respect to roof trusses to comply with
Bonding Jumper maximum allowable overhang.
Cc;Qiibrium Sdar
Roof Weights
In Conformance with Solar ABC's Expedited Permit Process
Module Quantity: 6
Weight of Modules: 258 lbs
Weight of Mounting System: 88 lbs
Total Plane Weight: 346 lbs
Total Plane Array Area: 100 ft2
Distributed Weight: 3.45 psf
Number of Attachments: 44
Weight per Attachment Point: 8 lbs
Ec libriur Sdar
Plane Calculations (ASCE 7-10): Roof 1
Roof Shape: Gable Edge and Corner Dimension: 3.5 ft
Roof Type: Composition Shingle Stagger Attachments: Yes
Average Roof Height: 25.0 ft Include Snow Guards: No
Least Horizontal Dimension: 35.0 ft
Roof Slope: 32.0 deg
Truss Spacing: 24.0 in
Snow Load Calculations
Description Interior Edge Corner Unit
Flat Roof Snow Load 42.0 42.0 42.0 psf
Slope Factor 0.7 0.7 0.7
Roof Snow Load 29.4 29.4 29.4 psf
Wind Pressure Calculations
Description Interior Edge Corner Unit
Net Design Wind Pressure Uplift -20.7 -24.3 -24.3 psf
Net Design Wind Pressure Downforce 19.4 19.4 19.4 psf
Adjustment Factor for Height and Exposure Category 1.0 1.0 1.0
Design Wind Pressure Uplift -20.7 -24.3 -24.3 psf
Design Wind Pressure Downforce 19.4 19.4 19.4 psf
ASD Load Combinations
Description Interior Edge Corner Unit
Dead Load 2.6 2.6 2.6 psf
Snow Load 29.4 29.4 29.4 psf
Downslope: Load Combination 3 14.6 14.6 14.6 psf
Down: Load Combination 3 23.3 23.3 23.3 psf
Down: Load Combination 5 13.8 13.8 13.8 psf
Down: Load Combination 6a 26.8 26.8 26.8 psf
Up: Load Combination 7 -11.1 -13.3 -13.3 psf
Down Max 26.8 26.8 26.8 psf
Spacing Results (Landscape)
Description Interior Edge Corner Unit
Max Allowable Spacing Between Attachments 65.2 65.2 65.2 in
Max Spacing Between Attachments With Rafter/Truss Spacing of 24.0 in 48.0 48.0 48.0 in
Max Cantilever from Attachment to Perimeter of PV Array 21.7 21.7 21.7 in
Spacing Results(Portrait)
Description Interior Edge Corner Unit
Max Allowable Spacing Between Attachments 43.7 43.7 43.7 in
Max Spacing Between Attachments With Rafter/Truss Spacing of 24.0 in 24.0 24.0 24.0 in
Max Cantilever from Attachment to Perimeter of PV Array 14.6 14.6 14.6 in
Ecoli rit. mSdw".
Layout
.....................
I�V
® Skirt
Coupling Note: If the total width of a continuous array exceeds 35 ft, break array to allow for thermal
expansion and contraction. See Installation Guide for details.
Clamp Warning: PV Modules may need to be shifted with respect to roof trusses to comply with
Bonding Jumper maximum allowable overhang.
EcolibriumSolar
Roof Weights
In Conformance with Solar ABC's Expedited Permit Process
Module Quantity: 8
Weight of Modules: 344 lbs
Weight of Mounting System: 88 lbs
Total Plane Weight: 432 lbs
Total Plane Array Area: 134 ft2
Distributed Weight: 3.23 psf
Number of Attachments: 44
Weight per Attachment Point: 10 lbs
Ecoiibrium dar
Plana Calculations (ASCE 7-10): Roof 2
Roof Shape: Hip Edge and Corner Dimension: 3.0 ft
Roof Type: Composition Shingle Stagger Attachments: Yes
Average Roof Height: 25.0 ft Include Snow Guards: No
Least Horizontal Dimension: 6.4 ft
Roof Slope: 6.0 deg
Truss Spacing: 24.0 in
Snow Load Calculations
Description Interior Edge Corner Unit
Flat Roof Snow Load 42.0 42.0 42.0 psf
Slope Factor 1.0 1.0 1.0
Roof Snow Load 42.0 42.0 42.0 psf
Wind Pressure Calculations
Description Interior Edge Corner Unit
Net Design Wind Pressure Uplift -21.2 -32.6 -45.5 psf
Net Design Wind Pressure Downforce 8.3 8.3 8.3 psf
Adjustment Factor for Height and Exposure Category 1.0 1.0 1.0
Design Wind Pressure Uplift -21.2 -32.6 -45.5 psf
Design Wind Pressure Downforce 16.0 16.0 16.0 psf
ASD Load Combinations
Description Interior Edge Corner Unit
Dead Load 2.6 2.6 2.6 psf
Snow Load 42.0 42.0 42.0 psf
Downslope: Load Combination 3 4.6 4.6 4.6 psf
Down: Load Combination 3 44.1 44.1 44.1 psf
Down: Load Combination 5 12.2 12.2 12.2 psf
Down: Load Combination 6a 40.9 40.9 40.9 psf
Up: Load Combination 7 -11.2 -18.0 -25.8 psf
Down Max 44.1 44.1 44.1 psf
Spacing Results(Landscape)
Description Interior Edge Corner Unit
Max Allowable Spacing Between Attachments 50.8 50.8 50.8 in
Max Spacing Between Attachments With Rafter/Truss Spacing of 24.0 in 48.0 48.0 48.0 in
Max Cantilever from Attachment to Perimeter of PV Array 16.9 16.9 16.9 in
Spacing Results(Portrait)
Description Interior Edge Corner Unit
Max Allowable Spacing Between Attachments 36.2 36.2 36.2 in
Max Spacing Between Attachments With Rafter/Truss Spacing of 24.0 in 24.0 24.0 24.0 in
Max Cantilever from Attachment to Perimeter of PV Array 12.1 12.1 12.1 in
Ecol ibriurn Sd,,ir
Layout
Skirt
Coupling Note: If the total width of a continuous array exceeds 35 ft, break array to allow for thermal
OP Clamp expansion and contraction. See Installation Guide for details.
Warning: PV Modules may need to be shifted with respect to roof trusses to comply with
Bonding Jumper maximum allowable overhang.
Ecolibrium Bela,,
Roof Weights
In Conformance with Solar ABC's Expedited Permit Process
Module Quantity: 2
Weight of Modules: 86 lbs
Weight of Mounting System: 88 lbs
Total Plane Weight: 174 lbs
Total Plane Array Area: 33 ft2
Distributed Weight: 5.21 psf
Number of Attachments: 44
Weight per Attachment Point: 4 lbs
EcolibriumSdar
Bill Of Materials
Part Name Quantity
ECO-001_101 EcoX Clamp Assembly 44
ECO-001_102 EcoX Coupling Assembly 7
ECO-001_105B EcoX Landscape Skirt Kit 5
ECO-001_105A EcoX Portrait Skirt Kit 1
ECO-001_103 EcoX Composition Attachment Kit 44
ECO-001_116 EcoX Flat-Tile Flashing 0
ECO-001_117 EcoX S-Tile Flashing 0
ECO-001_118 EcoX W-Tile Flashing 0
ECO-001_363 EcoX Lower Support-Tile 0
ECO-001_109 EcoX Electrical Assembly (optional) 3
ECO-001_106 EcoX Bonding Jumper Assembly 12
ECO-001_104 EcoX Inverter Bracket Assembly 0
ECO-001_338 EcoX Connector Bracket 0
ECO_001-359 EcoX Lower Support- Low Slope 0
The C'®ttaMon eadt6a of Ma ssac msetts
Department of Indaasta iad Accide; is
Office of Investigations
r I Congress Street Smite 100
Boston,M4 02114-2017
w wrap mass.gov1 dia
Workers' Compensaliion_(isanrannce Affidavit: Buflders/Contractors/Ei lec$riciansfifu>a hers
� �ct;�zttan�aa.il�at Plcasc lin~irnt, .c n
Name (Business/Organization/Individual): Vlvint Solar Developer, LLD
Address: 3301 North Thanksgiving Way, Suite 500
ity/58ate;Zip:Lehi, UT 84043 Phone#:801=377-9111
.Are you aro employer?Check the appropriate box: Type of project(required):
1.. I am employer with � 4. E] I am a general contractor and 1
employees (full and/or part-time).`' have hired the sub-contractors 6• ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have
$. ❑ Demolition
working for me in any capacity. employees and have workers'
insurance.t ❑Building addition
comp.[No workers' comp, insurance p•
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 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 Solar Installation
employees. [No workers' 13. Other
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.
tContractors 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 am an employer that is providing workers I compensation iWsurance for my employees. Below is the policy and job.site
information.
Insurance Company Name:Zurich American Insurance Company
Policy It or Self-ins. Lic #:WC 509601300 Expiration Date: 11/1/2015
Job Site Address: (oO) City/State/Zip:_
Attach a copy of the workers' compensation po➢icy 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 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 certify under the pains andpenalties ofperjury that the information provider!afi.9ve is true and correct
Sizrlature: �'"?� - -`'� Date:
Phone#: 801-2296459
®fficial use only. Ido not write in this area,to 5e completed by city or 1®swot official.
City or 'own: Permit/License #
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3. City/'Town Clerk 4. )Electrical Inspector a.Plumbing Inspector
6.Other
Contact Person:, Phone#:
'`' CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY)
01/0512015/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
MARSH USA INC. NAME:
1225 17TH STREET,SUITE 1300 PHONE FAX
AIC No Ext): AIC No
DENVER,CO 80202-5534 E-MAIL
Attn:Denver.CertRequest@marsh.com Fax:212-948-4381
INSURERS AFFORDING COVERAGE NAIC#
INSURERA:Evanston Insurance Company 35378
INSURED Zurich American Insurance Company 16535
Vivint Solar Developer LLC INSURER B: P Y
3301 North Thanksgiving Way INSURER C:American Zurich Insurance Company 40142
Suite 500
Lehi,UT 84043 INSURER D
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: SEA-002524287-01 REVISION NUMBER:2
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR I TYPE OF INSURANCE ADDLUBR SPOLICY EFF POLICY EXP
LTR POLICY NUMBER MM/DD MMIDD/YYYY LIMITS
A GENERAL LIABILITY 14PKGWE00274 11/01/2014 11/01/2015 EACH OCCURRENCE $ 1,000,000
DA-MAGE TO X PREMISES(EaEoccur ence $
COMMERCIAL GENERAL LIABILITY 50,000
CLAIMS-MADE M OCCUR MED EXP(Any one person) $ 51000
X $5,000 Ded.BI&PD PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
POLICY X PRO- LOC $
B AUTOMOBILE LIABILITY BAP509601500 11/0112014 11/01/2015 COMBINED SINGLE LIMIT 1,000,000
Ea accident
Ix
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULEDBODILY INJURY Per accident $
AUTOS AUTOS ( )HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ '..
AUTOS Per accident
$
A UMBRELLA LIAB X OCCUR 14EFXWE00088 11/01/2014 11/01/2015 EACH OCCURRENCE $ 5,000,000 '..
X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
DED RETENTION$ $
C WORKERS COMPENSATION WC509601300(CA,HI,MD,NJ,NY,OR,UT) 11/01/2014 11101/2015 X I WC sTATU- OTH-
AND EMPLOYERS'LIABILITY TORY L ER
B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WC509601400(MA) 11/01/2014 11/01/2015 1,000,000
EACH ACCIDENT $OFFICER/MEMBER EXCLUDED? N NIA E.L.
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
A Errors&Omissions& 14PKGWE00274 11/01/2014 11/01/2015 LIMIT 1,000,000
Contractors Pollution DEDUCTIBLE 5,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
CERTIFICATE HOLDER CANCELLATION
Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
1600 Osgood St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Building 20 Suite 2035 ACCORDANCE WITH THE POLICY PROVISIONS.
North Andover,MA 01845
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Kathleen M.Parsloe '� 7)t. IQtalsG
@ 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010!05) The ACORD rj.
Ime and logo are registered marks of ACORD