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Home My WebLink AboutBuilding Permit # 7/27/2015 V%ORTFf BUILDING PERMIT "'9. " -16 0 to TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Arm C Date Issued: IMPORTANT: Applicant must complete all items on this page r g�"- p/g" 10 /000102/1" ZA ......... TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ®One family 11 Addition E]Two or more family 11 Industrial Alteration No. of units:2 F1 Commercial 11 Repair, replacement 11 Assessory Bldg 11 Others: 11 Demolition R]Other Solar/PV ❑ Septic eO,QJ 'c '0 'q i o/" o'52"MMA stri it ",/am Install solar electric panels to roof of existing home, to be interconnected with the homes' electrical system 21 panels @ 5.46 kW. Identification Please Type or Print Clearly) OWNER: Name: Arthur Allen Phone: 978-360-4563 Address: 369 Waverly Road 5 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 14,000 FEE: $ Check No.: 13 t41 Receipt No.: 7""00 NOTE: Persons contracting with unregistered contractors do not have access's)ie guuc yantyfund Signature of A9 enVOwner - Signature",- of contra , rl ...tet �"I 'rYw-\--A SORT#1 Town of ndover 0 .0 t� ® o01c) - . �O V.LANE h " ver, Mass, �Jd• 2�1 CO CNICHEWICK �®Q00AT E D S U BOARD OF HEALTH ERMIT Food/Kitchen Septic System THIS CERTIFIES THAT ......... . .t . r A�T AA i LD BUILDING INSPECTOR .... ..... ........................................... ... ............. ....................................... g „ , 4 ... . Foundation has permission to erect .......................... buildings on . ..... ...... ..,�.................. �j�J� � ...... Rough to be occupied as ._ ........ .....IBJ".... �.�. s15k ....... l. ..... ........... Chimney provided that the person accepting this permit shall in every respect co�form 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 PERMITEXPIRES6 ON �+ ELECTRICAL INSPECTOR UNLESSC ST S Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building R®ugh Display 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. Version#48.2 "","SolarGty July 23,2015 Project/Job#0182215 RE: CERTIFICATION LETTER Project: Allen Residence 369 Waverly Rd North Andover, MA 01845 To Whom It May Concern, A jobsite survey of the existing framing system was performed by a site survey team from SolarCity. Structural review was based on site observations and the design criteria listed below: Design Criteria: -Applicable Codes = MA Res. Code, 8th Edition,ASCE 7-05, and 2005 NDS - Risk Category= II -Wind Speed = 100 mph, Exposure Category C -Ground Snow Load = 50 psf - MP2: Roof DL= 14 psf, Roof LL/SL= 35 psf(Non-PV Areas), Roof LL/SL= 35 psf(PV Areas) - MP4: Roof DL= 14 psf, Roof LL/SL= 35 psf(Non-PV Areas), Roof LL/SL=35 psf(PV Areas) Note: Per IBC 1613.1; Seismic check is not required because Ss = 0.33365 < 0.4g and Seismic Design Category(SDC) =C < D On the above referenced project,the components of the structural roof framing impacted by the installation of the PV assembly have been reviewed. After this review it has been determined that the existing structure is adequate to withstand the applicable roof dead load, PV assembly load, and live/snow loads indicated in the design criteria above. I certify that the structural roof framing and the new attachments that directly support the gravity loading and wind uplift loading from PV modules have been reviewed and determined to meet or exceed structural strength requirements of the MA Res.Code,8th Edition. Please contact me with any questions or concerns regarding this project. JAS014 WIL IAM ,n T QMAN 5TIRKTURALCn �J�.X1554 Jason W.Toman, P.E. ° G`�S Jp. ` Professional Engineer T: 480-553-8115 x58115 Di Jason Toman email: jtoman@solarcity.com Date:201 .23 12:37:45-07'00' 3055 Clearview Way San Mateo, CA 94402 T(650)638-1028 (888)SOL-CITY F(650)638-1029 solarcity.com 07.23.2015 11 r Version#48.2 V',5olarCity, Design r PR03ECT INFORMATION &TABLE OF CONTENTS Project Name: Allen Residence AHJ. North Andover Job Number: 0182215 Building Code: MA Res. Code,8th Edition Customer Name: Allen,Arthur Based On: IRC 2009/IBC 2009 Address: 369 Waverly Rd ASCE Coder ASCE 7-05 City/State: North Andover, MA Risk Category: iI Zip Code 01845 Upgrades Req'd? No Latitude/'Longitude: 42.692359 -71.335518 Stamp Req'd? Yes SC Office: Wilmington PV Designer: Dustin Calhoun Certification Letter 1 Project Information,Table Of Contents, &Vicinity Map 2 Structure Analysis (Loading Summary and Member Check). 3 Hardware Design (PV System Assembly) 4 Note: Per IBC 1613.1; Seismic check is not required because Ss= 0.33365 < 0.4g and Seismic Design Category(SDC) =C< D 12-MILE VICINITY MAP 369 Waverly Rd, North Andover, MA 01845 Latitude:42.692359,Longitude: -71.135518,Exposure Category:C STRUCTURE ANALYSIS- LOADING SUMMARY AND MEMBER CHECK- MP2 Member Properties Summary MPZ Horizontal Member Spans Rafter Properties` Overhang 0.99 ft Actual W 1.50" Roof System Properties San 1 12.51 ft Actual,D 9.25" Number of Spans w/o Overhang) 1 Span 2 Nominal Yes Roofing Material Comp Roof Span;3 A 13.88 in^2 Re-Roof No Span 4 SX 21.39 in.^3 Plywood Sheathing Yes San 5 IX 98.93 in.^4 Board Sheathing None Total Span 13.50 ft TL Deffn Limit 120 Vaulted Ceiling Yes PV 1 Start 1.58 ft Wood Species SPF Ceiling Finish 1/2"Gypsum Board PV 1 End 12.08 ft Wood Grade #2 Rafter,Slope 180 PV 2 Start Fb 875'psi Rafter Spacing 16"O.C. PV 2 End F„ 135 psi Top Lat Bracing Full PV 3 Start E 1400000 psi Bot Lat Bracing Full PV 3 End Em;,, 510000 psi MemberLoadieg Summary'; Roof Pitch 4/12 Initial Pitch Adjust Non-PV Areas PV Areas Roof Dead Load DL 14.0 psf x 1.05 14.7 psf 14.7 psf PV Dead Load PWDL 3.0 psf x 1,05 3.2 psf Roof Live Load RLL 20.0 psf x 1.00 20.0 psf Live/Snow Load LL/SLi12 50.0 psf x 0.7 1 x 0.7 35.0 psf 35.0 psf Total Load(Governing LC TL 1 49.7 psf 1 52.9 psf Notes: 1, ps=Cs*pf;Cs-roof,Cs-pv per ASCE 7[Figure 7-2] 2, pf=0.7(Ce)(C0(Is)Pg; Ce=0.9,Q=1.1,I5=1.0 Member Design Summary(per NDS) Governing Load Comb CDCL + CL - CF Cr D+iS 1,15 1.00 1,00 1 1.1 1.15 Member Analysis Resulft SUmmary, Maximum Max Demand @ Location Capacity VCR Load Combo Shear Stress 46 psi 1.0 ft. 155 psi 0.30 D+S Bending(+)Stress 762 psi 7.3 ft. 1273 psi 0.60 D+S Bending(-)Stress -20 psi 1.0 ft. -1273 psi 0.02 D+ S Total Load Deflection 0.3 in. 518 7.3 ft. 1.32 in. 120 0.23 D+S LOAD rTEMIZATION - MP2 PV System Load PV Module Weight(psf) 2.5 psf Hardware Assembly Weight(psf) 0.5 psf PV Sy stem Weight s 3.0 psf Roof Dead°Load Material Load Roof Category Description MP2 Existing Roofing Material Comp Roof, (2 Layers) 5.0 psf Re-Roof No Underlayment Roofing Paper 0.5 psf Plywood Sheathing Yes 1.5 psf Board Sheathing None Rafter Size and Spacing 2 x 10 @ 16 in. O,C. 2.9 psf Vaulted Ceiling Yes 3.0 psf Miscellaneous Miscellaneous Items 1.1 psf Total Roof Dead Load 14 psf(MP2) 14.0 psf Reduced Roof LL Non-PV Areas Value ASCE 7-05 Roof Live Load Lo 20.0 psf Table 4-1 Member Tributary Area At <200 sf Roof Slope 4/12 Tributary Area Reduction '! Rl 1 Section 4.9 Sloped Roof Reduction RZ 1 Section 4.9 Reduced Roof Live Load Lr 4= Lo(RI)(112) Equation 4-2 Reduced iRoof Live Load Lr 20.psf(M1132) 20.0 psf Reduced Ground/Roof Live/Snow Loads Code Ground Snow Load p9 50.0 psf ASCE Table 7-1 Snow Load Reductions Allowed? Yes Snow Guards to be Installed? No I Effective'Roof Slope 180 Horiz. Distance from Eve to Ridge W 14.0 ft Snow Impbrtance Factor Is 1.0 Table 1.5-2 Snow Exposure Factor Ce Fully 9posed Table 7-2 Structures kept just above freezing Snow Thermal Factor Ct 1 1 Table 7-3 Minimum Flat Roof Snow Load(w/ Pf-m'" 35.0 psf 7.3.4&7:10 Rain-on-Snow Surcharge) Flat Roof Snow Load Pf pf=0.7(Ce)(Ct)(I)pg; pf>_pf-min Eq: 7,3-1 I. 35.0 psf 70% ASCE Design Sloped Roof Snow Load Over Surroundin Roof Surface Condition of Surrounding Roof Cs-roof All Other Surfaces Figure 7-2 Design Roof Snow Load Over Ps-roof Ps-roof= (Cs-root)Pf ASCE Eq:7.4-1 Surrounding Roof =35.0:psf 70% ASCE Design Sloped Roof Snow Load Over PV Modules Surface Condition of PV Modules C -. Unobstructed Sli0ppery Surfaces Figure 7-2 1. Design Snow Load Over PV PS-PV= (Cs-PJ Pf ASCE Eq:7.4-1 Modules Ps P° 35.0 psf 70% CALCULATION OF DESIGN WIND LOADS- MP2 Mounting Plane Information Roofing Material Comp Roof PV System Type SolarCity SleekMountTm Spanning Vents No Standoff(Attachment Hardware) Comp Mount Type C Roof Slope 180 Rafter Spacing 16"O.C. Framing Type/ Direction Y-Y Rafters Purlin Spacing X-X,Purlins Only NA Tile Reveal Tile Roofs Only NA Tile Attachment System Tile Roofs Only NA ,Standing Seam/Trap Spacing SM Seam Only NA Wind Design Crlteria Wind Design Code ASCE 7-05 Wind Design Method Partially/Fully'Enclosed Method Basic Wind Speed V 100 mph Fig. 6-1 Exposure Category C Section 6.5.6.3 Roof Style Gable Roof Fig.6-11B/C/D-14A/B Mean Roof Height h 15 ft Section 6.2 Wind Pressure Calculation Coefficients Wind Pressure Exposure KZ 0.85 Table 6-3 Topographic Factor Kt 1.00 Section 6.5.7 Wind Directionality Factor Kd 0.85 Table 6-4 Importance Factor I 1.0 Table 6-1 Velocity Pressure qh qh =0.00256(Kz)(Kzt)(Kd)(V^2)(I) Equation 6-15 18.5 psf Wind iPressure Ext. Pressure Coefficient U GC -0.88 Fig.6-11B/C/D-14A/B Ext. Pressure Coefficient(Down) GC. Dawe 0.45 Fig,6-116/C/D-14A/B Design Wind Pressure p p=qh(GC) Equation 6-22 Wind Pressure UP(UD) -16.2 psf Wind Pressure Down " do 10.0 Psf ALLOWABLE STANDOFF SPACINGS X-DirectionY-Direction Max Allowable Standoff Spacing Landscape 64" 39" Max Allowable Cantilever Landscape 23" NA Standoff Configuration Landscape Staggered Max Standoff Tributary Area Trib 17 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at Standoff T-actual -251 lbs Uplift Capacity of Standoff T-allow 500 lbs Standoff Demand Ca` aci DCR 50.1% X-Direction Y-Direction Max Allowable Standoff Spacing Portrait 32" 66" Max Allowable Cantilever Portrait 14" NA Standoff Configuration Portrait Staggered Max Standoff Tributary Area Trib 15 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at Standoff T-actual -211 lbs Uplift Capacity of Standoff T-allow 500 lbs Standoff Demand/Capacity DCR 42.1% STRUCTURE ANALYSIS - LOADING SUMMARY AND MEMBER CHECK- MP4 Member Properties Summary MP4 Horizontal Member Spans Rafter Properties Overhang 0.99 ft Actual W 1.50" Roof System Properties Span 1 12.69 ft Actual D 9.25" Number of Spans w/o Overhang) 1 Span 2 Nominal- -Yes Roofing Material Comp Roof Span 3 A 13.88 in.^2 Re-Roof No Span 4 S. 21.39 in.^3 Plywood Sheathing Yes San 5 IX 98.93 in.,A4 Board Sheathing None Total Span 13.68 ft TL Defl'n Limit 180 Vaulted Ceiling Yes PV 1 Start 1.50 ft Wood Species SPF Ceiling Finish 1/2"Gypsum Board PV 1 End 11.17 It Wood Grade #2 Rafter Slope 160 PV 2 Start Fb '- 875 psi Rafter Spacing 16"O.C. PV 2 End F„ 135_psi Top Lat Bracing Full PV 3 Start E 1400000 psi Bot Lat Bracing Full PV 3 End E,„;,, 510000 psi Member Loading Summary Roof Pitch 4/12 Initial Pitch Adjust Non-PV Areas PV Areas Roof Dead Load DL 14.0 psf x 1.04 14.6 psf 14.6 psf VV Dead Load PV-DL 3.0 °psf x 1.04 3.1 psf, Roof Live Load RLL 20.0 psf x 1.00 20.0 psf Live/Snow Load LL/SL1,2 50.0 psf x 0.7 1 x 0.7 35.0 psf 35.0 psf Total Load(Governing LC TL 1 49.6 psf 52.7 psf Notes: 1. ps=Cs*pf;Cs-roof,Cs-pv per ASCE 7[Figure 7-2] 2. pf=0.7 NO(Ct)(IS)pg; Ce=0.9,Ct=1.1,I5=1.0 .,Member Design Summary(per NDS) Governin Load Comb CD CL + Cl. - CF Cr D+'S 1.15 1.00 1 1.00 1 1.1 ' 1:15 Member Analysis Results Summary Maximum Max Demand @ Location Capacity DCR Load Combo Shear Stress 47 psi 1.0 ft. 155 psi 0.30 D+S Bending(+)'Stress 780 psi 7.4 ft.' 1273 psi 0.61 D+S Bending(-)Stress -20 psi 1.0 ft. -1273 psi 0.02 D+S Total Load Deflection 0.31 in. L/505 7.3 ft. 0.88 in. L/180 0.36D+ S LOAD ITEMIZATION - MP4 PV System Load PV Module Weight(psf) 2.5 psf Hardware Assembly Weight(psf) 0.5 psf PV System Weight s 3.0 psf Roof Dead Load Material Load Roof Category Description MP4 Existing Roofing Material Comp Roof (12 Layers) 5.0 psf Re-Roof No Underlayment Roofing Paper 0.5 psf Plywood Sheathing Yes 1.5 psf Board Sheathing None Rafter Size and Spacing 2 x 10 @ 16 in. O.C. 2.9 psf Vaulted Ceiling Yes 3.0 psf Miscellaneous Miscellaneous Items 1.1 psf Total Roof Dead Load 14 psf(MP4) 14.0 psf Reduced Roof LL Non'-PV Areas Value ASCE;?-05 Roof Live Load Lo 20.0 psf Table 4-1 Member Tributary Area At <200 sf Roof Slope 4/12 Tributary Area Reduction Ri 1 Section 4.9 Sloped Roof Reduction RZ 1 Section 4.9 Reduced Roof Live Load Lr 4=Lo(Ri)(Rz) Equation 4-2 Reduced Roof Live Load Lr 20 psf(MP4) 1 20.0 psf Reduced'Ground/Roof Live/Snow Loads Code Ground Snow Load pg 50.0 psf ASCE Table 7-1 Snow Load Reductions Allowed? Yes Snow Guards to be Installed? No I Effective Roof Slope 160 Horiz. Distance from Eve to Ridge W 14.1 ft Snow Importance Factor Is 1.0 Table 1.5-2 Snow Exposure Factor Ce Fully 9posed Table 7-2 Structures kept just above freezing Snow Thermal Factor Ct 1 1 Table 7-3 Minimum Flat Roof Snow Load (w/ Pf-m." 35.0 psf 7.3.4&7.10 Rain-on-Snow Surcharge) Flat Roof Snow Load pf pf=0.7(Ce)(Ct),(I)pg; 'pf?pf-min Eq:7.3-1 35.0 psf 70% ASCE Design Sloped Roof Snow load Over Surrounding Roof Surface Condition of Surrounding Roof CS_roof All Other Surfaces Figure 7-2 Design Roof Snow Load Over P.-roof=(Cs-roof)Pf ASCE Eq:7.4-1' Surrounding Roof' Ps-roof 35:0 psf 70% ASCE Design Sloped Roof Snow Load Over PV Modules Surface Condition of PV Modules CS_PV Unobstructed Sli0ppery Surfaces Figure 7-2 1. Design Snow Load Over PV ps-pv (Cs-pv) pf ASCE Eq:7.4-1i Modules ps°° 35:0 psf 70% CALCULATION OF DESIGN WIND LOADS - MP Mounting Plane Information Roofing Material Comp Roof PV System Type SolarCity SleekMountTm Spanning Vents No Standoff(Attachment Hardware) Comp'Mount Type C Roof Slope 160 Rafter Spacing 16"O.C. Framing Type/Direction Y-Y Rafters Purlin Spacing X-X Purlins Only NA Tile Reveal ' Tile Roofs Only NA Tile Attachment System Tile Roofs Only NA Standing Seam/Trap Spacing SM Seam Only NA Wind Design Criteria Wind Design Code ASCE 7-05 Wind Design Method Partially/Fully Enclosed Method Basic Wind Speed- V 100 moh- Fig. 6-1 Exposure Category C Section 6.5.6.3 Roof-Style Gable Roof Fig.6-11B/C/D-14A/B Mean Roof Height h 25 ft Section 6.2 Wind Pressure Calculation Coefficients Wind Pressure Exposure KZ 0.95 Table 6-3 Topographic FactorKzt 1.00 Section 6.5.7 Wind Directionality Factor Kd - 0.85 Table 6-4 ...... .. ........... . .. . Importance"Factor I 1.0 Table 6-1 qh=0.00256(Kz)(Kzt)(Kd)(V^2)(I) Velocity Pressure qh 20.6 psf Equation 6-15 Wind Pressure Ext. Pressure Coefficient U GC u -0.88 Fig.6-11B/C/D-14A/B Ext. Pressure Coefficient(Down) GC.(Dom) 0.45 Fig.6-11B/C/D-14A/B Design Wind Pressure p p=qh(GC) Equation 6-22 Wind Pressure Up a 48.0 psf Wind Pressure Down down 10.0 psf ALLOWABLE STANDOFF SPACINGS i X-Direction Y-Direction Max Allowable Standoff Spacing Landscape 64 39" Max Allowable Cantilever Landscape 23" NA Standoff Configuration Landscape Staggered Max Standoff Tributary Area Trib 17 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind Upliftat Standoff T-actual -282 lbs Uplift Capacity of Standoff T-allow 500 lbs Standoff Demand/Capacity DCR 56.4% X-Direction Y-Direction Max Allowable Standoff Spacing Portrait 32" 66" Max Allowable Cantilever Portrait 14" NA Standoff Configuration Portrait Staggered Max Standoff Tributary Area Trib ' 15 sf, PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift'at Standoff ` T-actual -237 lbs Uplift Capacity of Standoff T-allow 500 lbs Standoff Demand/Capacity DCR 47.4% ovvunignEnvelope ID:4sw1ono2-6nrn-4o4a-84noeonxacocn000 SolaCitvm PPA . . Customer Name and Address Installation Location Date Arthur Allen 369Waverly Rd 6/29/2015 369Waverly Md North Andover,K0AU1845 North Andover,K8AO1845 Here are the key terms of your Power Purchase Agreement $0 15e04c 20yrs System installation cost Electricty rate v%kWh Agreement Tgrn Initial her Initial her 1�i The S�DlarK�ity Promise »* °VVeguarantee that ifyou seUyour Home,the buyer vviUqualify toassume your Agreement. -__-.----._-_-----_ mmuxr,pl~�—.__ � "VVpwarrant all ofour roofing work. oo °VVereyoomyour mofotthe end nfthe A8/ emen� °VVowar/an� insun� maintain and mpairthe 5y�em. ____-_______'-_'--.-'-.__.-. -._. -.-'- -.-'-. -. _.--' m/ua/he � °VVefix orpay for any damage vvemay cause toyour property. °VVeprovide 24/7web-enabled monitoring atnoadditional cost. � °The rate you pay uswill remain fixed for the term ofthe Agreement. "The pricing inthis Agreement isvalid for 3Odays after 6/29/201I � � •You are free tocancel any time prior toconstruction otnocharge. Your SolarCitwPower Purchase Agreement Details Your Choices atthe End ofthe Initial Options for System Purchase: Amount due at contract signing Tenn: °Atcertain times,as specified in ^%o|an]tywill remove the System otno the Agreement,you may � t.amount due at installation cost toyou. purchase the System. ' "You can upgrade toanew System with "These options apply during the ZO Est.amount due at building inspection ' the latest solar technology under anew year term ofour Agreement and � contract. not beyond that term. � > "You may purchase the System from Est.first year production 3o|anCityfor its fair market value as 9,457 kWh specified inthe Agreement. °You may renew this Agreement for upto ten(10years intwo(2)five(5)year increments. 305-5 CkemrviemmWay,San Mateo, CA 94402 | 888.765.2489 | sm|anoWs.monm 903729 Power Purchase Agreement,version eu1,June zs.m15 sxpoSEpAc"mplum Contractors License wxxIC 16xs2/ �1uomn ^ Document generated"nwuo/zozs N|U The COHIy 011wealthof assuallut?tts Deparintent ofIndustrklAce dents Office of Inveslfgadons ' 1 Congress Stt-eet,Suite Ilio Bvstan,AM 02114-2#17 n ww mass gov1dirt Workers't✓'ompansalion Insurance Affidavit;Builders/Cont)reactors/glectriciat>ns/plumbers AMIftilut Iuforitn tion Please Print L< ibl NtatXlB Corp_� . ...._...__ _.._... ..._.. Address;,- 3055 Clearview Way City/8tatelzi : 402 t'bome . 888- 65-248 Are you an employer?Chetic the appropriate box: Type of project(required); I, Ian a employer with 000 I ant a geAcrAl vontractor and I � �Now Gonstraction employees(filll and/orpart-time).* have himd the subcontractors 2. I am a sole proprietor or}partner- listed on the attached street, 7. n Remodeling ship and have no eraployees These sub-contractors have g, �Demolition working far me%any capacity, employees and have workers' S. �Bullt3iag;addition [No worken'comp, insurance Comp.atsurance. nluired.] We are a corporation and its 10. Electrical repairs or additions 3.13 t aril a borneowner doing all'work officors have exercised their l l,II Plumbing repaks or additions myself.[No workers'comp. 1191 of t tem tion par iv11GL l2.® t Roof rairs insurance:rrgniredl t' C. 152;&1M;and we have no � employees.[No workers' 13Re 4thera)Ltd -I comp.insurance required.] Any applicant that checks boxfl must also fill out the section bolo v shoe ttg their workers'compcnsgtion pnllcy lnforrnation. t HOmcowners who submit thIsailidsvit indicatingWrY are doing all work arta then him outside aantractors must subntiix new airidavttindicaCrngsuch, tCoAtriwiom that cheek this hex must attached ail additional sheetshowing ilia name ofths subcontractors and state whether or not those entities have arnpluYets, if thasub ContraCltxs have employces,lhCy must provide their workers'comp.policy number. /mit an smployea 1lr(ri isproutdlpig workers'compensation insurancefor my etitp information. loyees. ,8eloty is floe policy arirl Joh srfe Insurance Company game: Liberty Mutual Insurance Co Policy ff or ScIC ins. Lic,H-MIA766DOQQ / 1024 Expiration Date; 9/1/15 Job Site Add--s � Ist�C t`��r l iityiStatelzip, �� i� t�I��C ,� IM fi 0/J qT Attach s copy of tate workers,eampensatian rUicy dwinration page(showing the policy number and expiration date). Failure w secure average as required tinder Section 25,x,of MGT.e, 152 can lead to the imposition of mminal penalties of a fine UP to 51,500.00 andlor one-year imprisonment, as%vall as civil penalties in the forth of a STOP WORK ORDER and a fine of up to S250,OD-a day against the violator, Be,advised that a copy of this statement may be forwarded to the office of CnveStigations of the DIA for insurance coverage verification, X do hereby certify 1111dar ..��re polus atrtipenatties ofperfttr��thattffile inform ation pranidad rtbnv is trite1 and correct. v - Phone I ofiNelai--ss only, Do not write in this arca,to be completed by city or town vfciad JJ City or'L•crm• -- II PerQairfd.ieeytse issuing Authority(circle true); 1,Board of Ucallb 2,Building Department 3,City/lt'vwn Clerk 4.Electrical Impactor 5.Plurttbing Inspeetor fi,Other Centaet Person," Phone#; Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 168572 Type: Supplement Card SOLAR CITY CORPORATION Expiration: 3/8/2017 DAN FONZI 24 ST MARTIN STREET BLD 2UNIT 11 MARLBOROUGH, MA 01752 Update Address and return card.Mark reason for change. Address ::] Renewal !7 Employment "-1 Lost Card Office of Consumer Affairs&Business Regulation License or registration valid for individul use only 'i4OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to; Office of Consumer Affairs and Business Regulation Registration: 168572 Type: 10 Park Plaza-Suite 5170 Expiration: 3/8/2017 Supplement Cerd Boston,MA 02116 SOLAR CITY CORPORATION DAN FONZI 3055 CLEARVIEW WAY SAN MATED,CA 94402 Undersecretary Not valid without signature 0-- j� CS-ID1687 DANIEL D FORM- 15 KELLEY RD '414 WELWHNGTON NA 0107, 0911312016 nn M � p1�/ Office of Consumer Affairs n Business Regulation.*g 10 Park Plaza -- Suite 5170 Boston, Massachusetts 021. 16 Home Improvement Contractor Registration Registration: 168572 Type: Supplement Card SOLAR CITY CORPORATION Expiration: 3!812017 JAYMIE STANTON 24 ST MARTIN STREET BLD 2UNIT 11 — - _....... _ - MARLBOROUGH, MA 01752 Update Address and return card.Mark reason for change. IN A y �� , �.��,q� [] Address FI Renewal (� Employment L.,ost Card Jry Tice of Consumer Affairs&Business Regulation License or registration valid for individul use only before the expiration date. If found return to: VIE IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation egistration; 168572 Type: 10 Park Plaza-Suite 5170 Expiration; 3/8/2017 Supplement Card Boston,MA 02116 SOLAR CITY CORPORATION JAYMIE STANTON 3055 CLEARVIEW WAY SAN MATEO,CA 94402 Undersecretary lVotut signature