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Kass Building Permit ApplicationCity of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 Department use only Status of Permit: Curb Cut/Driveway Permit ____________________ Sewer/Septic Availability______________________ Water/Well Availability________________________ Two Sets of Structural Plans___________________ Plot/Site Plans_____________ Other Specify__________ APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office Map _______________ Lot __________________Unit_________ Zone ________________ Overlay District______________ Elm St. District__________________ CB District______________ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ______________________________________________________ Name (Print) _____________________________________________________ Signature _____________________________________________________ Current Mailing Address: ______________________________________________________ Telephone 2.2 Authorized Agent: ______________________________________________________ Signature ______________________________________________________ Current Mailing Address: ______________________________________________________ Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be completed by permit applicant Official Use Only 1.Building (a)Building Permit Fee 2.Electrical (b)Estimated Total Cost of Construction from (6) 3.Plumbing Building Permit Fee 4.Mechanical (HVAC) 5.Fire Protection 6.Total = (1 + 2 + 3 + 4 + 5)Check Number This Section For Official Use Only Building Permit Number:_______________________________ Date Issued:______________________________________________ Signature: ______________________________________________ Building Commissioner/Inspector of Buildings _______________________________ Date Please see attached ______________________________________________________ Name (Print) 48 Moore Street, East Longmeadow, MA 01028 413-203-9088X 16000 39000 55000 Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side Rear L:______ R:______ L:______ R:______ Building Height Bldg. Square Footage % Open Space Footage (Lot area minus bldg & paved parking) % # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House Addition Replacement Windows 0r Doors Alteration(s) Roofing Accessory Bldg. Demolition New Signs [ ] Decks [ ] Siding [ ] Other [ ] _________________________________________________________________ Brief Description of Proposed Work:________________________________________________________________________________________ Alteration of existing bedroom ______Yes ______ No Adding new bedroom _______ Yes _______ No Attached Narrative Renovating unfinished basement _______ Yes _______No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a.Use of building : One Family _________ Two Family _________ Other __________ b. Number of rooms in each family unit:______________ Number of Bathrooms_____________ c. Is there a garage attached? _________ d. Proposed Square footage of new construction._____________________ Dimensions __________________________________ e. Number of stories? ________________________________ f. Method of heating? ________________________________ Fireplaces or Woodstoves ___________ Number of each ______ g. Energy Conservation Compliance. _____________________ Masscheck Energy Compliance form attached? _______________ h. Type of construction _______________ i. Is construction within 100 ft. of wetlands? ______ Yes ______ No. Is construction within 100 yr. floodplain ______Yes _____No j. Depth of basement or cellar floor below finished grade __________________________ k. Will building conform to the Building and Zoning regulations? ________ Yes _______ No . l. Septic Tank _____ City Sewer _______ Private well _______ City water Supply _______ SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, _______________________________________________________________________________________, as Owner of the subject property hereby authorize ________________________________________________________________________________________________ to act on my behalf, in all matters relative to work authorized by this building permit application. ______________________________________________________________________________________________________________ Signature of Owner Date I, _______________________________________________________________________________________, as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Signature of Owner/Agent Date Please see attached Trinity Solar ______________________________________________________________________________________________________________ Print Name X SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ___________________________________________________________________________ Signature Telephone Not Applicable ! 9.Registered Home Improvement Contractor: __________________________________________________________________________ Company Name __________________________________________________________________________ Address _________________________________________________Telephone_________________ _ Not Applicable ! _________________________________ Registration Number SECTION 10- WORKERS’ COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... !No...... ! 11.- Home Owner Exemption The current exemption for “homeowners” was extended to include Owner-occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such “homeowner” shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers’ Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned “homeowner” certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature ________________________________________________________ Name of License Holder : __________________________________________________________ ___________________________________________________________________________ Address ____________________________________ License Number ____________________________________ Expiration Date 170355 ________________________________ Expiration Date X 413-203-9088 Trinity Heating & Air Inc. DBA Trinity Solar 20 Patterson Brook Road - Unit 10, West Wareham, MA 02576 413-203-9088X x NJ, Electrical Contractor business permit number 34EB01547400NJ, HIC reg. # 13VH01244300For other jurisdictions, please visit: http://www.trinity-solar.com/about-us/locations-and-licenses Corporate Headquarters 1-877-SUN-SAVES 2211 Allenwood Road Ph: 732-780-3779 Wall, New Jersey 07719 Fax: 732-780-6671 www.trinity-solar.com FOR INFORMATION ABOUT CONTRACTORS AND THE CONTRACTORS’ REGISTRATION ACT, CONTACT THE NEW JERSEY DEPARTMENT OF LAW AND PUBLIC SAFETY, DIVISION OF CONSUMERS AFFAIRS AT 1-888-656-6225. Date __________________________________ PrintName __________________________________ Customer Signature __________________________________ Name on Electric Utility Account: __________________ ElectricUtility Account No.: ______________________ ElectricUtility Company:________________________ given for my own convenience and benefit in order to expedite the approvals processes. solar transaction and are not a condition of the related solar agreement included herewith but are being and effect until revoked. I acknowledge that these authorizations are not required to proceed with the ApprovalsPaperwork when submitted.Myauthorizationsmemorializedhereinshallremaininfullforce signatures to Approvals Paperwork for purposes of the foregoing. Trinity Solar will provide copies of herewith for my signature, in furtherance of the related solar transaction, and I am providing any certification documents (“Approvals Paperwork”), including those for which signature pages are included documentation to, date, submit, re-submit, revise, amend and modify application, submission and populate technical details, fill-in, edit, compile, attach drawings, plans, data sheets and other Without limitation to the generality of the foregoing I specifically authorize Trinity Solar et al. to permits on file for the purpose of updating/applying with an alternate subcontractor. This authorization includes the transfer/re-administering, and/or cancellation of any existing with any state and/or local solar incentive program. obtaining permission and approval for interconnectionwith the electric utility company, andregistration Jurisdictionasrequired fortheinstallationof aPhotovoltaicSystem located onmy property, applyingand limited purpose of applying for and obtaining local building and other permits from the Authority Having subcontractors, including without limitation, _______________________, to act as my Agent for the I hereby authorize Trinity Heating & Air, Inc. DBA Trinity Solar and its employees, agents,and (print address) _____________________________________________. am the owner of the property located at address: (print name) I, _____________________________________, HOMEOWNERS AUTHORIZATION FORM Northampton, MA December 1, 2021 212 Main St. Northampton, MA 01060 Trinity Solar No. 87 Pioneer Knolls 2021-08-620487 Northampton, MA 01062 Trinity Solar | 4 Open Square Way, Suite 410 | Holyoke, MA | (413) 203-9088 Regards, Ihor Bojcun, PE Structural Engineer - Trinity Solar MA License No. 56687 RE: KASS, FREDERICK D; KASS, JENNIFER L To the Building Official: The following information constitutes a summary of the relevant design criteria and recommendations for the support of a new photovoltaic [PV] system on the existing roof framing components at the above-referenced location. Criteria is as follows: 1. Existing roof framing: Roof R1: Conventional roof framing is 2x8 at 16 o.c.; existing rafter span= 13' 0"; (horizontal projection) Roof R3: Conventional roof framing is 2x8 at 16 o.c.; existing rafter span= 12' 6"; (horizontal projection) 2. Roof Loading: • 4.33psf dead load (pounds per square foot - PV panels, mounting rails & hardware) • 6.3 psf - existing roof loads (2.3 psf - 2x8 framing, 1.5psf roof sheathing, 2.5 psf shingles) • Ground Snow Load - 40psf - per ASCE Hazard Tool • Wind criteria - Exposure Category B, 117 mph wind 3. Existing Roof modification - none required; existing roof framing is acceptable for PV installation. This installation design is in general conformance with the manufacturers’ specifications and complies with all applicable laws, codes, and ordinances – specifically the International Building Code (2015 edition) and the International Residential Code (2015 edition), including all Massachusetts regulations and amendments. The spacing and fastening of the mounting brackets is a maximum of 48” o.c. between mounting brackets (staggered) and is secured using 5/16” diameter corrosive-resistant steel lag bolts. A minimum of 2½” of penetration (embedment) per lag bolt is required, which will resist all stated loads above – including wind shear. Per NDS Section 12.1.4, clearance holes - equal to the diameter of the shank - need to be bored into a primary framing member for the full-length of the threaded portion of the bolt to avoid splitting of the framing member. INSTALLATION OF NEW ROOF MOUNTED PV SOLAR SYSTEM 87 PIONEER KNOLLS NORTHAMPTON, MA 01062 42.320793,-72.685769 PIONEER KNOLLS P1 ISSUED TO TOWNSHIP FOR PERMIT 11/29/2021 NO.DESCRIPTION DATE KASS, FRED- TRINITY ACCT #: 2021-08-620487 87 PIONEER KNOLLS NORTHAMPTON, MA 01062 42.320793,-72.685769 PROPOSED PV SOLAR SYSTEM DRAWING DATE:11/29/2021 DRAWN BY:MS REVISED BY: DC SYSTEM SIZE:12kW AC SYSTEM SIZE:10kW MODULE COUNT:30 MODULES USED:HANWHA 400 MODULE SPEC #:Q.PEAK DUO BLK ML-G10+ 400 UTILITY COMPANY:NAT'L GRID UTILITY ACCT #:5146217017 UTILITY METER #:74573308 DEAL TYPE:SUNNOVA P1 2211 Allenwood Road Wall, New Jersey 07719 877-786-7283 www.Trinity-Solar.com ROOF 1 MODULES: 24 PITCH: 33 ORIENTATION: 209 ROOF 2 MODULES: 0 PITCH: 33° ORIENTATION: 29° ROOF 3 MODULES: 6 PITCH: 33 ORIENTATION: 209 ROOF 4 MODULES: 0 PITCH: 33° ORIENTATION: 29° ROOF 5 MODULES: 0 PITCH: 20° ORIENTATION: 120° ROOF 6 MODULES: 0 PITCH: 20° ORIENTATION: 300° ROOF 7 MODULES: 0 PITCH: 20° ORIENTATION: 210° UD DC AC EPMDP NS270 90135225 4531542.320793,-72.685769 30 HANWHA 400 (Q.PEAK DUO BLK ML-G10+ 400) 1 SE10000H-US0SHBNC4 INSIDE OUTSIDE. OUTSIDE (UTILITY ACCESSIBLE)OUTSIDE. P1 ISSUED TO TOWNSHIP FOR PERMIT 11/29/2021 NO.DESCRIPTION DATE KASS, FRED- TRINITY ACCT #: 2021-08-620487 87 PIONEER KNOLLS NORTHAMPTON, MA 01062 42.320793,-72.685769 PROPOSED PV SOLAR SYSTEM DRAWING DATE:11/29/2021 DRAWN BY:MS REVISED BY: DC SYSTEM SIZE:12kW AC SYSTEM SIZE:10kW MODULE COUNT:30 MODULES USED:HANWHA 400 MODULE SPEC #:Q.PEAK DUO BLK ML-G10+ 400 UTILITY COMPANY:NAT'L GRID UTILITY ACCT #:5146217017 UTILITY METER #:74573308 DEAL TYPE:SUNNOVA P1 NOTES: 1.) ALL EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE WITH THE MANUFACTURER'S INSTALLATION INSTRUCTIONS. 2.) 3.) ALL LOCATIONS ARE APPROXIMATE AND REQUIRE FIELD VERIFICATION. ALL OUTDOOR EQUIPMENT SHALL BE RAIN TIGHT WITH MINIMUM NEMA 3R RATING. M UD SP P DC AC ep D DC 2211 Allenwood Road Wall, New Jersey 07719 877-786-7283 www.Trinity-Solar.com SD TS CALCULATIONS FOR CURRENT CARRYING CONDUCTORS REQUIRED CONDUCTOR AMPACITY PER STRING [NEC 690.8(B)(1)]: (15.00*1.25)1 = 18.75A AWG #10, DERATED AMPACITY AMBIENT TEMP: 33°C, TEMP DERATING FACTOR: .96 RACEWAY DERATING = 4 CCC: 0.80 (40*.96)0.80 = 30.72A 30.72A >_ 18.75A, THEREFORE WIRE SIZE IS VALID TOTAL AC REQUIRED CONDUCTOR AMPACITY 42.00A*1.25 = 52.50A AWG #6, DERATED AMPACITY AMBIENT TEMP: 30°C, TEMP DERATING: 1.0 RACEWAY DERATING <_ 3 CCC: N/A 75A*1.0 = 75A 75A >_ 52.50A, THEREFORE AC WIRE SIZE IS VALID CALCULATION FOR PV OVERCURRENT PROTECTION TOTAL INVERTER CURRENT: 42.00A 42.00A*1.25 = 52.50A --> 60A OVERCURRENT PROTECTION IS VALID ARRAY CIRCUIT WIRING NOTES 1.) LICENSED ELECTRICIAN ASSUMES ALL RESPONSIBILITY FOR DETERMINING ONSITE CONDITIONS AND EXECUTING INSTALLATION IN ACCORDANCE WITHNEC 2020 2.) LOWEST EXPECTED AMBIENT TEMPERATURE BASED ON ASHRAE MINIMUM MEAN EXTREME DRY BULB TEMPERATURE FOR ASHRAE LOCATION MOST SIMILAR TO INSTALLATION LOCATION. LOWEST EXPECTED AMBIENT TEMP = -16°C 3.) HIGHEST CONTINUOUS AMBIENT TEMPERATURE BASED ON ASHRAE HIGHEST MONTH 2% DRY BULB TEMPERATURE FOR ASHRAE LOCATION MOST SIMILAR TO INSTALLATION LOCATION. HIGHEST CONTINUOUS TEMP = 33°C 4.) 2005 ASHRAE FUNDAMENTALS 2% DESIGN TEMPERATURES DO NOT EXCEED 47°C IN THE UNITED STATES (PALM SPRINGS, CA IS 44.1°C). FOR LESS THAN 9CURRENT-CARRYING CONDUCTORS IN A ROOF-MOUNTED SUNLIT CONDUIT AT LEAST 0.5" ABOVE ROOF AND USINGTHE OUTDOOR DESIGN TEMPERATURE OF 47°C OR LESS(ALL OF UNITED STATES) 5.) PV SYSTEM CIRCUITS INSTALLED ON OR IN BUILDINGSSHALL INCLUDE A RAPID SHUTDOWN FUNCTION THATCONTROLS SPECIFIC CONDUCTORS IN ACCORDANCE WITHNEC 690.12(A) THROUGH (D) 6.) PHOTOVOLTAIC POWER SYSTEMS SHALL BE PERMITTEDTO OPERATE WITH UNGROUNDED PHOTOVOLTAICSOURCE AND OUTPUT CIRCUIT AS PER NEC 690.41 (A)(4) 7.) UNGROUNDED DC CIRCUIT CONDUCTORS SHALL BEIDENTIFIED WITH THE FOLLOWING OUTER FINISH: POSITIVE CONDUCTORS = REDNEGATIVE CONDUCTORS = BLACK NEC 210.5(C)(2) 8.) ARRAY AND SUB ARRAY CONDUCTORS SHALL BE #10 PV WIRE TYPE RHW-2 OR EQUIVELANT AND SHALL BE PROTECTED BY CONDUIT WHERE EXPOSED TO DIRECT SUNLIGHT. SUB ARRAY CONDUIT LONGER THAN 24” SHALL CONTAIN ≤ 20 CURRENT CARYING CONDUCTORS AND WHERE EXPOSED TO DIRECT SUNLIGHT SHALL CONTAIN ≤ 9 CURRENT CARRYING CONDUCTORS. 9.) ALL WIRE LENGTHS SHALL BE LESS THAN 100' UNLESS OTHERWISE NOTED 10.) FLEXIBLE CONDUIT SHALL NOT BE INSTALLED ON ROOFTOP AND SHALL BE LIMITED TO 12” IF USED OUTDOORS 11.)OVERCURRENT PROTECTION FOR CONDUCTORS CONNECTED TO THE SUPPLY SIDE OF A SERVICE SHALL BE LOCATED WITHIN 10' OF THE POINT OF CONNECTION NEC 690.9(A)(3)(2) 12.) WHERE TWO SOURCES FEED A BUSSBAR, ONE A UTILITY AND THE OTHER AN INVERTER, PV BACKFEED BREAKER(S) SHALL BE LOCATED OPPOSITE FROM UTILITY NEC 705.12(B)(3)(2) 13.) ALL SOLAR SYSTEM LOAD CENTERS TO CONTAIN ONLY GENERATION CIRCUITS AND NO UNUSED POSITIONS OR LOADS 14.) ALL EQUIPMENT INSTALLED OUTDOORS SHALL HAVE A NEMA 3R RATING SQUARE D DU222RB 60A UNFUSED DISCONNECT ISOLATED NEUTRAL 240V 1Ø B LOCKABLE 60A DISCONNECT FUSED W/ 60A FUSES SQUARE D PN: D222NRB ISOLATED NEUTRAL 240V 1Ø B NOTE: INTERNAL REVENUE GRADE MONITORING CONTAINED WITHIN SOLAR EDGE INVERTER SOLAR EDGE PN. RWND-3D-240-MB SMART METER PRODUCTION METER M ISOLATED NEUTRAL LINE SIDE LOAD SIDENEUTRAL EXISTING MAIN BREAKER LOAD CENTER INSULATED LINE TAPS INSTALLED ON MAIN FEEDERS NEC 705.12(A) M 2p200AMAIN240V 1Ø 200A MAIN BREAKER 200A BUSBAR EXISTING 1Ø 120/240V UTILITY METER EG INVERTER #1 - SE10000H-US0SHBNC4 DC AC Imp 27 Pout 10000 Vmp 400 Imax 42 Voc 480 OCPDmin 52.5 Isc 30 Vnom 240 PV MODULE SPECIFICATIONS HANWHA 400 (Q.PEAK DUO BLK ML-G10+ 400) Imp 10.77 Vmp 37.13 Voc 45.3 Isc 11.14 A #6 THWN-2 GEC TO EXISTING GROUND ROD B 3/4'' CONDUIT W/ 2-#6 THWN-2, 1-#10 THWN-2, 1-#10 THWN-2 GROUND C 3/4'' CONDUIT W/ 4-#10 THWN-2, 1-#10 THWN-2 GROUND D 3/4'' CONDUIT W/ 4-#10 THWN-2, 1-#10 THWN-2 GROUND E 3/4'' CONDUIT W/ 2-#6 THWN-2, 1-#10 THWN-2, 1-#10 THWN-2 GROUND F #10 PV WIRE (FREE AIR) W/ #6 BARE COPPER BOND TO ARRAY G 3/4'' CONDUIT W/ 2-#6 THWN-2, 1-#6 THWN-2, 1-#8 THWN-2 GROUND NOTE: CONDUIT TYPE SHALL BE CHOSEN BY THE INSTALLATION CONTRACTOR TO MEET OR EXCEED NEC AND LOCAL AHJD REQUIREMENTS INVERTER #1 PV+L1 L2 N PV-D SOLAR MODULES MOUNTED TO ROOF ON 2 ARRAYS 30 - 400W MODULES W/ 1 SOLAR EDGE P401 PER MODULE 15 ADC MAX PER STRING 2 STRINGS OF 15 MODULES IN SERIES - 400 Vmax *2 STRINGS TO BE TERMINATED IN PARALLEL INSIDE INVERTER 1 f 8"x8" JUNCTION BOX P1 ISSUED TO TOWNSHIP FOR PERMIT 11/29/2021 NO.DESCRIPTION DATE KASS, FRED- TRINITY ACCT #: 2021-08-620487 87 PIONEER KNOLLS NORTHAMPTON, MA 01062 42.320793,-72.685769 PROPOSED PV SOLAR SYSTEM DRAWING DATE:11/29/2021 DRAWN BY:MS REVISED BY: DC SYSTEM SIZE:12kW AC SYSTEM SIZE:10kW MODULE COUNT:30 MODULES USED:HANWHA 400 MODULE SPEC #:Q.PEAK DUO BLK ML-G10+ 400 UTILITY COMPANY:NAT'L GRID UTILITY ACCT #:5146217017 UTILITY METER #:74573308 DEAL TYPE:SUNNOVA P1 2211 Allenwood Road Wall, New Jersey 07719 877-786-7283 www.Trinity-Solar.com 10/11/21, 11:04 AM Office of Consumer Affairs & Business Regulation - Mass.Gov https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=170355 1/2 HIC Registration Complaints Registration # 170355 Registrant TRINITY SOLAR INC. DBA TRINITY SOLAR Name BRIAN MACPHERSON Address 20 PATTERSON BROOK ROAD UNIT 10 City, State Zip WEST WAREHAM, MA 02576 Expiration Date 10/11/2023 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Mass.govMass.gov Office of Consumer Affairs and BusinessRegulation (OCABR) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 5/20/2021 Arthur J.Gallagher Risk Management Services,Inc.4000 Midlantic Drive Suite 200MountLaurelNJ08054 Mark Grasela 856-482-9900 856-482-1888 CherryHill.BSD.CertM@AJG.com Gotham Insurance Company 25569 TRINHEA-03 National Union Fire Insurance Company of Pittsburg 19445TrinitySolarInc.4 Open Square Way,Suite 410Holyoke,MA 01040 Endurance American Specialty Ins Co 41718 Liberty International Underwriters 206332321 A X 2,000,000 X 100,000 5,000 1,000,000 2,000,000 X GL202100013378 6/1/2021 6/1/2022 2,000,000 B 2,000,000 X CA 2960145 6/1/2021 6/1/2022 ACD X 5,000,000 X EX202100001871ELD300069891001000231834-05 6/1/20216/1/20216/1/2021 6/1/20226/1/20226/1/2022 5,000,000 Limit x of$5,000,000 19,000,000 B WC 13588107 6/1/2021 6/1/2022 1,000,000 1,000,000 1,000,000 B AutomobileComp/CollusionDed.CA 2960146 6/1/2021 6/1/2022 All Other UnitsTruck-TractorsandSemi-Trailers $250/500 $250/500 Evidence of Insurance. Evidence of Insurance 6/1/2022 Holyoke MA, 01040 WC13588107 4 Open Square Way, Suite 410 JOB NAME:YOUNG, SUZANNE- ADDRESS:220 Elm Street East Longmeadow, MA 01028 42.0767175,-72.510005 38.96 ESTIMATED PERSONNEL HOURS 1.62 DAYS 1.22 DAYS 0.81 DAYS •14 HANWHA 400's (5.6KW)(CREW OF 3)(CREW OF 4)(CREW OF 6) •2 SEPARATE ARRAYS •20' PEAK TO GROUND •10 PORTRAIT & 4 LANDSCAPED •1 INVERTERS INSTALLED OUTSIDE •NO TRENCH ESTIMATED SENT TO JOB USED □HANWHA 400 (Q.PEAK DUO BLK ML-G10+ 400)14 ______ □P401 SE OPTIMIZERS 14 ______ □SE5000H-US0SHBNC4 1 ______ □60A OUTDOOR FUSED DISCONNECT W/ (2) 30A FUSES 1 ______ □60A OUTDOOR NON-FUSED DISCONNECT 1 ______ □SOLADECK BOX(ES) & HAYCO CONNECTOR(S)2 ______ □PV LEAD WIRE 50'______ □INSULATED BUG BITES (LINE TAPS)2 ______ □CASE(S) OF BLACK SPRAY PAINT 1 ______ □CASE(S) OF TAR 1 ______ □ECOFASTEN 2012021 CF STD RAIL MLL AL 165.4 10 ______ □ECOFASTEN 2012013 CF RAIL SPLICE 7 ______ □ECOFASTEN 2099017 CF END CLAMP 32MM BLK 16 ______ □ECOFASTEN 2099022 CF MID CLAMP SHORT BLK 20 ______ □ECOFASTEN 4011011 MODULE JUMPER 2 ______ □GROUNDING LUG (NOT PROVIDED BY ECOFASTEN)2 ______ □ECOFASTEN 2012022 CF UNIV L-FOOT MLL 3 41 ______ □ECOFASTEN 3012020 GF-1 FLASHING GLV BLK 8 x 10 41 ______ □ECOFASTEN 2012019 CF MLPE MOUNT 14 ______ □ECOFASTEN 2012020 CF WIRE MGMT CLIP 14 ______ □ECOFASTEN 2012024 CF END CAP 16 ______ MATERIAL LIST (FOR INTERNAL USE ONLY) 2211 Allenwood Road Wall, New Jersey 07719 877-786-7283 www.Trinity-Solar.com INSTALLATION OF NEW ROOF MOUNTED PV SOLAR SYSTEM 220 ELM STREET YOUNG, SUZANNE- 220 ELM STREET EAST LONGMEADOW, MA 01028 42.0767175,-72.510005 APPENDIX CONTENTS LABELS, STICKERS, AND PLACARDS EQUIPMENT DATA SHEETS 2211 Allenwood Road Wall, New Jersey 07719 877-786-7283 www.Trinity-Solar.com