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32C-230 (3) XRS Rail for Flush Mount SPAN CHART & ENGINEERING GUIDE XRS Maximum Spans (feet) Wind Speed 0 psf Snow 10 psf Snow 20 psf Snow 30 psf Snow 40 psf Snow Exposure (mph) Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 90 mph 13.5 13.5 10.5 12.5 12.5 10.5 10.5 10.5 10.5 10.0 10.0 10.0 9.0 9.0 9.0 100 mph 13.5 12.0 9.5 12.5 12.0 9.5 10.5 10.5 9.5 10.0 10.0 9.5 9.0 9.0 9.0 110 mph 13.5 11.5 9.0 12.5 11.5 9.0 10.5 10.5 9.0 10.0 10.0 9.0 9.0 9.0 9.0 Category B 120 mph 13.5 10.5 8.5 12.5 10.5 8.5 10.5 10.5 8.5 10.0 10.0 8.5 9.0 9.0 8.5 130 mph 13.5 9.5 7.5 12.5 9.5 7.5 10.5 9.5 7.5 10.0 9.5 7.5 9.0 9.0 7.5 140 mph 12.5 9.0 7.0 12.5 9.0 7.0 10.5 9.0 7.0 10.0 9.0 7.0 9.0 9.0 7.0 150 mph 11.5 8.5 6.5 11.5 8.5 6.5 9.5 9.5 9.5 10.0 8.5 6.5 9.0 8.5 6.5 90 mph 13.5 11.0 8.5 12.5 11.0 8.5 10.5 10.5 10.5 10.0 10.0 8.5 9.0 9.0 8.5 100 mph 13.5 9.5 8.0 12.5 9.5 8.0 10.5 9.5 8.0 10.0 9.5 8.0 9.0 9.0 8.0 110 mph 13.0 9.5 7.5 12.5 9.5 7.5 10.5 9.5 7.5 10.0 9.5 7.5 9.0 9.0 7.5 Category C 120 mph 12.0 8.5 7.0 12.0 8.5 7.0 10.5 8.5 7.0 10.0 8.5 7.0 9.0 8.5 7.0 130 mph 11.0 8.0 6.5 11.0 8.0 6.5 10.5 8.0 6.5 9.5 8.0 6.5 9.0 8.0 6.5 140 mph 10.0 7.5 6.0 10.0 7.5 6.0 10.0 7.5 6.0 9.5 7.5 6.0 8.5 7.5 6.0 150 mph 9.5 7.0 5.5 9.5 7.0 5.5 9.5 7.0 5.5 9.0 7.0 5.5 8.5 7.0 5.5 LOAD CONDITION ASSUMPTIONS • Flush roof mounting installations only • Roof pitch must be 27 degrees or less • Module length is 67.5" or less • Building height must be less than or equal to 15 feet • Clearance between roof and rail is at least 2 inches • End cantilever span not to exceed 40% of the adjacent interior span • No rail splice permitted within the middle 1 of the span For installations that do not conform to the load condition assumptions, please contact your local distributor or refer to www.ironridge.com for a more complete engineering analysis. 'CAI& I RO N April 2010 April www.ironridge.com • A A f 4 $1 4 in SPECIFICATION SHEET Quick Mount PV T"' is an all-in-one waterproof flashing and mount to anchor photovoltaic racking systems, solar thermal panels, air conditioning units, satellite dishes, or anything you may need to secure to a new or existing roof. It is made in the USA of all aluminum and includes stainless steel hardware. It works with all standard racks, installs seamlessly and saves labor by not needing to cut away any roofing, will out live galvanized 2 to I, and is a better low-profile mount (2) Hex Nuts Flat Washer (B) 1" x 5/16" 5/16" Rubber Gasket 60 Durometer EPDM Sealing Washer (A) 3/4" x 5/16" Hanger Bolt 5/16" x 6" 1-1/2" Machine, 1-1/2" Spacer, 3" Lag Mount & Flashing Aluminum --.. Mount 2-1/4"l x 1-1/4"w x 1-1/4"h Flashing .05" thick. For standard composition roofs: flashing is 12" x 12", mount is attached 3" off center. For shake roofs: flashing is 18" x 18", mount is A6 attached 6" off center. Patent Pending Page 10 of 10 err. OI3 6 d Jo a S XIUK1ddV , .,. ., ' 6 68 6 n1 52- 6 m (51-, 4,..v.co unLy - ,,. ,,,..,„ vo auickm° V,'':','i'", H ' ww - • ' ‘., 1-,.,/,„,-.:' \_;.:`,,-,'? un - ri '',., : K MOUNT IC :'.s.. ...,', - -U1CK ,-, slide ,,,,'".V.".1;11,"•lial:::::4;i!:"..i;7-,-,1 II■ITLEAtQCileUEa lace, .„..... ' • -",;:"...:„.;,,, ,,,,;,..- Lift c int i _- S , ,,, . - , , ,, ,,,...., , , ,,, ..,,, , INSTALLATI TION -',- INSTR „,...i,, .,,,,,,,,,.,,,,,,,..,„„, N EEDED roofers i.044`-fir. ii-fvi'v ,4.v.6" ....,z,... .i, ,., 1"''':.; 0 L '41'''''''' ''.-c4" .. ,,,,,..!v„-i,"*F;, • ',....,, ;a . . , ...v:v.,, i y ir- -- -- BOLT, HANGER B & TOOLS sut i riNg takpelinoro, ostuid S SLID h tri..„4.V".t.,.V V",,Z,v:„,,t,,c_f ..,..aiitil, NA.. ER mea r chalk _II wit ft .-, ! _- „ ' ..'-'"•.' 6. sET WASH © ,..4 flat 0a" caulking gun with 441,...4 „."-Pv....r..,-„ „*. ' '.' s...4,,,1„,,, • .,-- .•7:4. SEALING cau t_ drill ,, :-_,Vz,. i 4 ''‘,- 047-' .....,.v vf-, . , ' _•fre.f.V.-v.,.., deep finder, sealant ..,- .th 1/2" . o drill with 1 / 2 , .c . t . i."` . -A7.."'4',As'i,Pet'i,..j.--wati'4. NUT drill wi ing s4:621..,..tv Using ,,. set seal . Go roofing ri.14,-: „,$,,,,,i: Us socket, side long cu -I/4” s_cket. _ --„,..,, , .k"..V4.A.N.; de ..-h ru .... -, 4.2,.,,,. --.A.73,-..,-'41v..:•:.- h r wiL and t,0 cl deep o - , - ...sow* =,.,,,',% ...;..„.: s e nut, ER ..rt.--0."tr. . , zp,....?..4. w- then - .....,"1,I.,,A. v.' , ,v-7,1,K,:,..,:,:ii n, pl ace, LOCA RAFT bit, v...... N UT '*A.4„,_..ktri4r1-'1" .....,..,7•Pc:14-..it,":.,F.-4,4.7.-Irrif d°w into LOCA- tal and _ i", , • ,,,•...,'.' ,",,,fi,,,'"..'-" 1. horizon • es to HER tria16,ii!':7,441.12*t;liZil tig „/ A T WASHER ' .,,,L,„,...."04-1,4„4„- , - ' Using h lines placement v,;":-.1,,,,'"..,x„, „...., I-- • T •-,; 1- --°' vertical chalk ,lace , - ...1-4.1.' !.,.! :: ------F GASKET SKE .1.- -. ,,,,,,.,,,,,.0..;„ veil hale for v , ',.r..0..;'-i'li..1 'Irli- BLACK uA . .....„...,.... t- ER align each Quick M ount .4),, ,tv ',V0-0.„*-1.- RDSB of eac 47.-4..."-'';;:',; ,...,,a!-1:7 .7...AI'''''` ,‘ ADD 7. ..r. HOLE Tf ,0,_„,,ki, ,.- -t.,.....- ' -.,Zo.„,-*.f, 03 NUT R SKET sket into a a PILO ” HO w,..24-...,1.,i,,,It.,...-....,.',-,-.' WASHE GA k ga G „.. - - .... v P black • ,_ top 0 D RILL with 1.4 .s. ti.*...---ii.?„,:ts,,,,,'7':;-.1"--,--' ----_sEALIN ...Ifi,..4Postif*..4.7..,t,: ,... opsn h witn grl•-‘Askr=-1.'''''' -,,.'... . lc 2. D drill wit ,7,. 4-.6' 1 Using dri, ill pilOt hole 7,;-7,' , 01'17 4 i-;,',:',...' place Mount bloc `--141)fargt. ...,:, -.- , ,' -`2'--4 '',=.. 4,41 ,...„, Us hit drill , rafter, z,..,-.0vi',f,:;4■41,,.... ..,....,3----1'.4-..cAti°, QUI". Ion roof ariu'll IF ti.7,,V--,V''..:„.".-"Vi.e.V4"",".*I1-11'‘,1 rou-h to drt th a are of,, HANGER BD LT---- 4 ... taking c the r° .4 4.•%:: '.-- ''.1'''''''"4' , to stiod e ' :''' NT ..,--ur* .9-,--"...,, •-:::,,,,,--,i,v '444'4- H IcK MOUNT = INTO Q - FLASHING RACK - FLAa B LOCK — CU RE FLAT • ,w...'":'th.'"..''..".7.:- - -.- SE-- W ITH , AND B AN ..-...' .1r., . r.:,-..2-'4'..... .,,,....1--, 0 LACE/ Q. NuT . .-r kr -----......k-rw..1,;..:".' ....-;::.. .- i.IER mr.. y ” deep 4.44,i,----- t . . ,-,-;',;:-_---1, w AS " . with 2 over bo d ill w rack ov ,..2, i ' xv. ,,k. ",,,I"." --. Using -I', t up ra then nut, ,u.. ,..,,,,,,-KOR; 4-77;,';7:Filf, #‘ ' . ''. " '' ' socket, -e h r the „,?,,,,_%-tvi`i,'",V,v",- ' ' ' ..,:....,t. . t,'• . v.31,', ---, ---- - flat wa -lace. )008 t 0 3' r ' s - rs:-.-kr.,-.41%-.4 ...raw,-,,711'2,V7.1,777.- I ' ' 4::::,4, .,, , 1i-:-,Ki.,,,*4- ';:„....' ,: with tighten into P and , ,kw 41---S„,.- ---'t , ',v21-....-.; „..3,.."- TILE f tile 1...k-`. -.Y.tro,'. f. °:;44:Al . -' 'Ir. - 2,-V:1'-.,..41-J-1....1.-irr-:' - 3. LIFT roo • st r PI fla bar, . .Lir,,,,-.‘ ,',„.'--4,,i,,,,,.,„,.., .,..,...„ ..,..,..-- ,, ,''' ',Xifik- -, - ..., Lift co Fars fla Qu .,,,,.l„P",-,..." ..,,.... ya 477-, ' Z.., 4 „,‘..... 7T17,r -., ,,, . with Too: placement of a-4 _ .1...,--, ioti,..: ....,„;;‘,,,....,,:*,,,,,, ..,:,,,A above pia sto,"m ' 2,,,:,,,v. o'.4._ G Using .-,, ., - :,..'.°4'5.k.tk,., .1...-:, _ pENDIN Mount. H OLE roofing , . .- . ,t. - , ',-.'t,."-- ,----, PATENT SEAL H - with roe of .-a....::..„,1,,i....,— 4.ulking gun squeeze a dab of ktyg„ ,,,_- sealant, squ la e nt into ho roofing sealant OT 3 L 0 V XIQI\laddV FIGURE 2 QUICK MOUNT PV TYPIC FAILURE MODE PR NUMBER 10 r a. Shear Failure - 'i c b, . � f H,„k. H 4 t , 'i. V f iw. �SU� W4w ' Yf 'Fl b '� J „„, ''.:„..,',,:, ,,,,,i,..,,,:,.,,,,,,,,. „.,,,,,.,,,,,,t,..,..,..,,,,..7.„;,:,* 4,1;,ttk,„ i% � U` Sao � �`�K�'i id £,, d* i� Y -0 J,ryH � ''.-4- # N to t . k . ,'...; ' r).z.„,,,,-.„,-. c,',..„3-..,' a. Tension Fa page 6 o f 10 FIGURE I QUICK MOUNT PV LOAD TEST SETUP PROJECT NUMBER 108443C a Shear Test b Tension Test 11.1 1 l W al p r «� Vi i- 4`411 I - "`«:,tea ` 4 f rr .. p -_, . AB Page 5 of 10 TABLE II QUICK MOUNT PV- 5/16 "X6" HANGER (LAG) BOLT SHEAR LOAD TEST RESULTS PROJECT NUMBER 108443C SAMPLE ID WOOD SPECIES ULTIMATE LOAD FAILURE MODE IN SHEAR (LBS) S -DF -1 Douglas Fir 4306 Bent lag bolt S -DF -2 Douglas Fir 3990 Bent lag bolt S-DF-1(A) Douglas Fir 4799 Bent lag bolt Average ... 4365 ... S -C -1 Cedar 3214 Bent lag bolt S -C -2 Cedar 3456 Bent lag bolt S -C -3 Cedar 3268 Bent lag bolt Average 3313 Page 4 of 10 , ' TABLE I QUICK MOUNT PV- 5/16 "X6" HANGER (LAG) BOLT TENSILE LOAD TEST RESULTS PROJECT NUMBER 108443C SAMPLE ID WOOD SPECIES ULTIMATE LOAD FAILURE MODE IN TENSION (LBS) T -DF -1 Douglas Fir 3963 Lag bolt pulled out T -DF -2 Douglas Fir 4074 Lag bolt pulled out T -DF -3 Douglas Fir 3764 Lag bolt pulled out Average 3934 T -C -1 Cedar 2096 Lag bolt pulled out T -C -2 Cedar 2004 Lag bolt pulled out T -C -3 Cedar 2543 Lag bolt pulled out Average 2214 Page 3 of 10 Mr. Stuart Wentworth Project Number 108443C QUICK MOUNT PV Quick Mount PV Load Testing October 28. 2008 b. Shear Strength Three samples each of the two types of wood were tested for shear strength on October 24 8: using a United Universal testing machine. Samples were rigidly attached to the testing machine and a shear load was applied to the 2-1/4"x1-1/4"x1-1/4" aluminum mount at a displacement rate 0.1 inches per minute without shock until failure. Detailed results are provided in Table U. Based on these results. the average shear strength of the hanger bolt in Douglas Fir and Cedar wood species were determined to he 4365 lbs and 3313 lbs. respectively. Photographs illustrating typical setup and typical failure modes are shown in Figure 1 and II. If you have any questions regarding the above, please do not hesitate to call the undersigned. Respectfully Submitted. APPLIED MATERIALS & ENGINEERING, INC. Reviewed By: m ined WI:az Arrn Taj Ph D P.E. Laboratory Manager Princi 4,e • .1.',;4," ,53 No 35K Exp 9,301,1 * ACCREDITED CC: 1CC-ES. Mr. Yamil Moya. P.E.: vmova(kiec-es.ori4 File 108443C Page 2 of 10 • A/if APPLIED HATC °'O /L3 83 C IOOKC CG° OKC� MC o 980 41 Stree Tel: (510) 420 -8190 Oakland, CA 94608 FAX: (510) 420 -8186 e -mail: info @appmateng.com October 28, 2008 Mr. Stewart Wentworth Project Number 108443C QUICK MOUNT PV ICC - ES FILE # 08 - 09 - 16 1483 67th Street Emeryville, CA 94608 Subject: Quick Mount PV Load Testing ICC -ES AC13 & ASTM D 1761 Dear Mr. Wentworth: As requested, Applied Materials & Engineering, Inc. (AME) has completed load- testing Quick Mount PV system anchors for shear and tensile strength. The purpose of our testing was to evaluate the tensile and shear load capacity of the Quick Mount PV system in a high density (Douglas Fir) and a low density wood (Cedar). SAMPLE DESCRIPTION Twelve (12) 12 "x12" samples were delivered to our laboratory on 10- 16 -08; six each for Douglas Fir and Cedar. A copy of the installation instructions is provided in Appendix A. Typical sample photo is provided in Appendix B. PROCEDURES & RESULTS Since an acceptance criterion (AC) has not been developed for this product, the samples were tested under the direction of Mr. Yamil Moya, P.E. with ICC -ES, and in general accordance with applicable procedures outlined in ASTM D 1761 and AC13. a. Tensile Strength Three samples each of the two types of wood were tested for tensile strength on October 24 & 27, 2008 using a United Universal testing machine. Samples were rigidly attached to the testing machine and a tensile load was applied to the 5/16 "x6" hanger bolt at a displacement rate 0.1 inches per minute without shock until failure. Detailed results are provided in Table I. Based on these results, the average tensile strength of the hanger bolt in Douglas Fir and Cedar wood species were determined to be 3934 lbs and 2214 lbs, respectively. Page 1 of 10 NrthEast Sol r .,.going Green is easy HOMEOWNER WORK AUTHORIZATION FORM By signing this form, I hereby assign NorthEast Solar and its representatives authorization to act on my behalf to file permits and attend to administrative duties associated with my project. CUSTO E' PRINTED NAME DATE „. ,Iii _ . i • . s , r q n CUSTOME - NED NAME North East Solar Design Assoc. info @northeastsolar.biz 136 Elm St. Hatfield, Ma. 01038 413 - 247 -6045, Fax 413 - 674 -0006 • "• `lassachusctts - Dei trtntcnt of Public afct� Board of Buildin2 Rc2ulatinns and Stand:(I, Construction Supervisor License License: CS 104454 DONAVIN GRATZ'` 90 LINSEED ROAD -'' ">` WEST HATFIELD, MA 01088 Expiration: 4/18/2014 ( nnmi..i airr Tr #: 104454 -67—ecta 4 " / 4 t Office of Consumer Affairs and usiness Regulation QH� 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169641 Type: Partnership Expiration: 7/14/2013 Tr# 214858 NORTHEAST SOLAR DESIGN AS ANN BRONNER 136 ELM ST HATFIELD, MA 01038.. it Update Address and return card. Mark reason for change. Address ri Renewal El Employment Lost Card DPS -CA1 CI 50M- 04/04- G101216 ����� �� Office' ' o u'm�' 'er Affairs BVBiCsiuess egu� License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: — Registration: - 169641 Type: Office of Consumer Affairs and Business Regulation Expiration: 7/14/2013 Partnership 10 Park Plaza - Suite 5170 r � Boston, MA 02116 HEAST SOLAR DESIGN ASSOC. ANN BRONNER 136 ELM ST � HATFIELD, MA 0108 Undersecretary v id i ut signature • • Design 1: Design Properties: Month Design 1 Module Manufacturer: Custom AC (kWh) Module Model: 0 ge G Z Yc) ,- Inverter Manufacturer: Custom Jan 224.8 Inverter Model: Enphase M215- 60- 2LL- S22/S23 Feb 352.8 (Due to spacing constraints, only the manufacturer and model of the first inverter is include in this report) Derate Factor 0.80 Mar 496.9 Apr 431.7 Design Result Chart: May 491.4 I L f Jun 403.5 — — f Jul 430.0 Aug 424.4 30 �_ € Sep 446.3 € Oct 448.3 Nov 303.7 — l — — Dec 118.1 Annual 4571.9 ,ar, Fet Ma Mav -vm 3u mug [x G:t Id,. C Layout View: Length: 30.00 ft VUdth: 20.00 ft rt 1,A 1,1 f,H,l 1,1 ,.E.i ! t.l 1.I :.t 1 Azimuth: 163.00 ° Slope: 45.00 ° k ' 1 1 �i1 07 tat j1 4 ) . 1 3 z t L 2 1 ilro 8 tar ' "• 1 16 Cad 3 1 2 .,41, 419 t 015 t slz 4 t 1 41 10 t i ' r 1 16 t o c 1 5 c!_• 1 11 ty ' ..1 17 '4,1. 6 i 1 /12 t !•1 Sc)Imetric • g ' ,: - § . 9 S T 3a' Location of Solar Array _ mo ' , , , ,t. ..,''!•:. ..t:'*:'''' '''''''''';'. :,,, 4°'-':'":',.'li-**'?'"-' ocation of 2 AC Disconnects 4 ,,, ,, Revenue Meter��2 ", , Both AC Disconnects will be labeled that " are one of two disconnects and that Y � they � s disconnects must off position to bring the system be in o the ffline both Catherine Hinard Solar PV Array 4.08 KW Date: 9/21/11 25 Hancock St, Northampton MA East Solar 36 E Street g: Location Drawn by: , 5 re9 Ha field, MA 01038 View: Drawin Normal View overview ale: 1/4 "= 1' Sc Gregory Garrison ...... 3902 " ......... ., .. - s- p . 6r + + IV CHARACTERISTICS 235W MODULE , b , i . . 1 ,,.._ �_.,. 9 1000Wsgm 7 800 Wsgm �� _ �.,- 600Wsgm 1 5 3 400Wsgm ' 4 g «... 200 Wsgm I i ' ` 0 0 5 10 15 20 25 30 35 40 � VOLTAGE (VI I < ', i EFFICIENCY i ; , : °' MONTHS WORKMANSHIP WARRANTY I i . 1 1 + + YEA POWER OUTPUT WARRANTY '.1.5" ......... ..... ......... ELECTRICAL DATA @ STC REC215PE REC220PE REC225PE REC230PE REC235PE REC240PE GENERAL DATA (BLK) (BLK) (BLK) (BLK) (BLK) (BLK) Peak Power Watts P (W 215 220 225 230 235 240 Cell Type 60 REC PE multi - crystalline cells AX p) 3 strings of 20 cells - 3 by - pass diodes Watt Class Tolerance - P 0/ +5 07+5 07+5 0/ +5 0/ +5 0/ +5 Glass High solar glass wit h Watt Class Tolerance - P °%) 0/ +2 07+2 0/ +2 0/ +2 0/ +2 07+2 ant 'reflection surface treatment Maximum PowerVoltage- V 28.3 28.7 29.1 29.4 29.8 30.4 Back sheet bySunarcTechnology Maximum Power Current - I 7.6 7.7 7.7 7.B 79 79 ce st er high performance polyester Open Circuit Voltage - V (V) 36.3 36.6 36.8 371 374 377 Frame Black anodized aluminium Short Circuit Current - l 81 8.2 8.2 8.3 8.3 84 Cable Radox4mm2solercables Module Efficiency(%) 13.0 13.3 13.6 13.9 14.2 145 35 in 4 in Values atStandardTestConditionsSTC( AirMassAM1. 5, Irradiance1000W /m2,Celltemperature25 °C) Connector l�adOX4nlm'tW15t10Ci CIng connect Or TEMPERATURE RATINGS (235 W RATED MODULE) WARRANTY Nominal Operating Cell Temperature (NOCT) 47.9°C (±2°C) 10 years limited warranty of 90 %power output Temperature Coefficient of fP - 0.46 % / °C 25 years limited warranty of 80% power output Temperature Coefficient of V -0.32 % / °C 63 months workmanship warranty Temperature Coefficient of l 0.011 % / °C CERTIFICATION MECHANICAL DATA MAXIMUM RATINGS OE ♦ ❑ Dimensions 65.55 x 39.02 x1.5 in Operational Temperature - 40... +80 °C E Area 17.76 ft Maximum System Voltage 600V LISTED Weight 39.6lbs Design Load (U1-1703) 75.2 lbs/ft Certified accordingtouu703, Maximum Load (IEC 61215) 551 kg /mt`(5400 Pa) ,.. Maximum Wind Speed 122 mph (safety factor 3) IEC61215 and IEC61730 Max Series Fuse Rating 15A� Max Reverse Current 15A REC is a leading vertically integrated player in the solar energy industry. REC is amongthe world's largest producers of polysilicon and wafers for solar applications, and a rapidly growing manufacturer of solar cells and modules. REC is also engaged in project deve activities in NotelSpecifications subject to change without not selected PV segments. Founded in Norway, REC is an international solar company, employing more than 4,000 people worldwide. R had revenues in excess of NOK 9 billion in 2009, approximately EUR 1 billion and approx USD1.4 billion. Please visit www.recgroup.com REC REC Solar US LLC PO Box 3416 San Luis Obispo, CA 93403 USA www.recgroup.com .9 A ` ° RO ® CERTIFICATE OF LIABILITY INSURANCE 9/22/2011YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 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EACH ACCIDENT $ 500 , 000 OFFICER /MEMBER EXCLUDED? N I A (Mandatory in NH) HN5715134 4/8/2011 4/8/2012 E.L. DISEASE- EA EMPLOYEE $ 500,000 It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Catherine Hinard ACCORDANCE WITH THE POLICY PROVISIONS. 25 Hancock Street Northampton, MA 01060 AUTHORIZED REPRESENTATIVE William Dowd /NO1JR1 () wy�,,, L. - ..4&A3c - ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts -i , t Department of Industrial Accidents . Office of Investigations r " , 1 600 Washington Street a , Boston, MA 02111 ¢ - r - www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): /0 ( Aa<I jok _ Address: / 3 6 /i,, City /State /Zip: ti e Id / a/oz Phone #: /3- Y - X a Xs" Are you an employer? Check the appropriate box: Type of project (required): 1.1,26 I am a employer with 7 4. ❑ I am a general contractor and I 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 8. ❑ Demolition working for me in aci employees and have workers' g any capacity. 9. ❑ Building addition No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no , employees. [No workers' 13. EN Other Saar shJ4.// comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: get", of L nci r Policy # or Self ins. Lic. #: / /���� / /39 Expiration Date: '/ 6 Job Site Address: � �'' Y C1 C -. LP-. City /State /Zip: /0i /,//, i /12/7-0%0 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and /or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u ' 'r the I : • s and penalties of perjury that the information provided above is true and correct. Sisnat, e: _n/ �7 t i . / Q . ,�/ Date: g /..2// Phone 1/ 0? Y 7 ` .f3 '(J Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit /License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : I Q no. V t li 6(6... Z / U ! 9 5 License Number v// VZ C1 Address Expiration Date Signature Telephone -y /3. y7 9. Resist- • - ome Improvement Contractor: Not Applicable ❑ jelo (('' l . ` Company Name Registration Number x.3 / m . 7 i y /2o/3 Address Expiration ate �� 7 6 // 9 d�� Telephone' /7-2yM ` — 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 7 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) r7 Roofing i l Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [ 1] Decks [Q Siding [p] Other [0] Brief Description of Proposed S Work: Install 17 solar PV panels on south facing roof 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 . I. 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 4164_ aG jCJI e .h.# 9 , 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, 4/7 Yc)/'f74 , ' , as Owner /Authorized Agent declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Sign-d under - - ■ains and penalties of perjury. • 1 � n✓ _)6 c1�� fi e )CJ I r.4 /" Print Name Signature of Owner /Age Date • 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 L: R: L: R: Rear 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 0 DON'T KNOW 0 YES C IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO (3 DON'T KNOW Q YES IF YES: enter Book Page and /or Document #'' B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO Q 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 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. x 2 S SO!! • ECENVED Department use only C ty of Northampton Status of Permit: S C p e� 1 'e" B ilding Department Curb Cut/Driveway Permit �•T G • 12 Main Street Sewer /Septic Availability Room 100 Water/Well Availability DEPT- or ►�n - - ampton, MA 01060 Two Sets of Structural Plans phone 413 587 - 1240 Fax 413 587 - 1272 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 iC('C j,/ Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Catherine Hinard 25 Hancock St. Northampton, MA. 01060 Name (Print) Current Mailing Address: 413-320-3158 U!/ .24 e;L /) lJ y L' . 3 /.,, A C9/7 7C T lephone Signature / �! 2.2 Authorized Agent: /64 r`�� d/ Lid ,, hr2 rC�ln -E'�/ 1 ' - ,J3-6 /E/»7 - /// 1f�e /cl Name (P r Current Mailing Address: mi U/O 4 y 413-247-6045 Signature r Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 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) ' 26,234 Check Number dQa e`� This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date r • • . File # BP- 2012 -0299 APPLICANT /CONTACT PERSON NORTHEAST SOLAR DESIGN ASSOCIATES LLC ADDRESS/PHONE 136 ELM ST HATFIELD (413) 247 -6045 () PROPERTY LOCATION 25 HANCOCK ST MAP 32C PARCEL 230 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out C�� ��'r Fee Paid ( P Typeof Construction: INSTALL SOLAR PANELS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 104454 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Peimit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management 1 oli . - R. y 7 -.. ----)11.1.4ri°11" ti 7 ((-- 7Z- 177 _nature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. . • 25 HANCOCK ST BP- 2012 -0299 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C - 230 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: SOLAR PANELS BUILDING PERMIT Permit # BP- 2012 -0299 Project # JS- 2012- 000486 Est. Cost: $26234.00 Fee: $156.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NORTHEAST SOLAR DESIGN ASSOCIATES LLC 104454 Lot Size(sq. ft.): 10280.16 Owner: HINARD CATHERINE Zoning: URC Applicant: NORTHEAST SOLAR DESIGN ASSOCIATES LLC AT: 25 HANCOCK ST Applicant Address: Phone: Insurance: 136 ELM ST (413) 247 -6045 0 Workers Compensation HATFIELDMA01038 ISSUED ON:10/12/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL SOLAR PANELS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 10/12/2011 0:00:00 $156.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner