31C-030 (6) professional Rooffrav
�OLAR
products Installation Manual
Date Modified:08/13/07
Step 5: Installing Modules
I J_
1
n
Slide the two end clamps near the end of the After the first module is secured, slide two inter-
support rail and install your end module (first). module clamp sets onto the first module side
Carefully square the module to the frame and frame. They are designed to stay in place,freeing
tighten the clamps using a 1/2" box wrench or you up to slide and align the next module into place.
drive socket. We recommend a maximum torque Repeat this procedure until all modules are in-
of 12-15 foot pounds to prevent damage to the stalled onto the support rail.
module.
'I J
_ r
r
-
P
Upon installation of the last module in the panel, To complete the installation, cut off any excess
install the module end clamp to the end of the last support rail not used with a reciprocating saw.
module. Before fully tightening the bolts, make You may want to use an extrusion blade.
any adjustments needed to create a square and
even array.
Page 7 of 7
COPYRIGHT PROFESSIONAL SOLAR PRODUCTS 2007: All information
contained in this manual is property of Professional Solar Products(PSP).
TileTracO is a registered trademark for PSP and is covered under U.S.patent
#5,746,029.RoofTrac®and FastJack®is a registered trademark for PSP and is
professional
SOLAR RoofTrac
produc Installation Manual
Date Modified:08/13/07
For convenience, it is advisable to pre-assemble the bolt, lock washer and clamp into the
sliding insert prior to bringing them up to the roof.
Fig. 2
Fig. 1
Attachment and clamping of the solar modules to NOTE: Clamping hardware is not engineered or
TileTrac@ or FastJack® attachments works exactly the intended for use on support rail/strut other than
same. After the support rails have been fastened, you the Professional Solar Products brand.
are ready to install the solar modules. There are two
sets of clamps; the outside clamps (end clamp) (Fig.
1) and the inter-module clamps (Fig. 2)that install
between the modules.
Please note that all module end clamps are specially
extruded to fit a specific brand of module as specified
in the ordering guide.
Page 6 of 7
COPYRIGHT PROFESSIONAL SOLAR PRODUCTS 2007: All information contained in this manual is property of Professional Solar Products
(PSP). TileTrac@ is a registered trademark for PSP and is covered under U.S.patent#5,746,029.RoofTrac®and FastJack®is a registered
trademark for PSP and is covered under U.S.patent#6,360,491.
professional Rooffrav
SOLAR
productsyA, Installation Manual
Date Modified:08/13/07
Fast,lack®
Unibit#10
Drill bit
Standard Flashing
2 Ce
Use of a Unibits will de-
crease drill time to approxi- Rafters
mately 3 seconds per hole
Installation of the Rooffrac®support rails to the drill a 1/2" hole through the rail. After drilling the hole
Fast.lack®. in the support rail, place the rail over the attachment
feet, make any necessary final adjustments and tighten
After the FastJack® has been installed (refer to the the 3/8" Bolt&Washer combination to attach the
respective installation guide), lay the support rail support rail to the FastJacks. Your support rails are
(upside down) next to the attachments. Mark the now secure and ready for installation of the modules.
channel adjacent to the attachment devices. Align
and mark the intersecting "V" groove on the rail and
Page 5 of 7
COPYRIGHT PROFESSIONAL SOLAR PRODUCTS 2007: All information contained in this manual is property of Professional Solar Products
(PSP). Tilerrac®is a registered trademark for PSP and is covered under U.S.patent#5,746,029.RoofTrac®and FastJack®is a registered
trademark for PSP and is covered under U.S.patent#6,360,491.
professional Rooffrar-
SOLAR
produc_ Installation Manual
Date Modified:08/13/07
Step 2: Attaching Support Rails to TileTrac®/FasUacke
O r
T-wrench
2 , TileTrac Device
Nut/Washer combo
Installation of the Roof rrac®support rails to the over the attachment feet, install the 3/8" washer and
TileTrac®. nut and tighten using a 9/16" deep socket wrench.
Your support rails are now secure and ready for
After the TileTrac® has been installed (refer to the installation of the modules.
respective installation guide), lay the support rail
(upside down) next to the attachments, step 1, as
illustrated above. Mark the channel adjacent to the Use of a Unibit@ will decrease drill
attachment devices. Align and mark the intersecting time to approximately 3 seconds per
"V" groove drill guide on the rail and drill a 1/2" hole hole
through the rail. After drilling the hole, place the rail
Page 4 of 7
COPYRIGHT PROFESSIONAL SOLAR PRODUCTS 2007: All information contained in this manual is property of Professional Solar Products
(PSP). TileTrac@ is a registered trademark for PSP and is covered under U.S.patent#5,746,029.Roof rrac61 and FastJack®is a registered
trademark for PSP and is covered under U.S.patent#6,360,491.
professional Rooffraco
SOLAR
productsvA, Installation Manual
Date Modified:08/13/07
APPLICATION:
The RoofTrac mounting system consists of sup-
port rails and top-down clamping hardware which
is integrated with either a TileTrac or Fastlack
attachment device. The RoofTrac mounting sys-
tem can be utilized on virtually all standard con-
struction residential roof-tops, mounting 4' on
center, to install the majority of popular framed
solar modules.
AAWARNING Legend
All Professional Solar Products (ProSolar) are engineered
and tested to withstand stated specifications (as stated on
published specification sheets) when installed properly. Fail- Explanation or Install Tip
ure to install properly may decrease the performance of in-
stallation.
® SAFETY Important product
All regional safety requirements should be followed when performance information
installing Professional Solar Products. All tools and equip-
ment located on the roof should be secured to avoid failing
object hazards. All equipment/tools should be properly
maintained and inspected prior to use. Any exposed studs Critical for Safety
should be protectively capped to help avoid injury.
This installation manual is intended for use by professional
installers with a working knowledge of construction princi-
ples.
Tool
• Chalk line
• 3/16" carbide masonry drill bit
• 3/8" masonry drill bit(for tile roof)
• Cordless drill
• Cordless impact wrench with 1/2"socket
Page 1 of 7
COPYRIGHT PROFESSIONAL SOLAR PRODUCTS 2007: All information contained in this manual is property of Professional Solar Products
(PSP). TIIeTrac®is a registered trademark for PSP and is covered under U.S.patent#5,746,029.RoofTrac®and Fastlack®is a registered
trademark for PSP and is covered under U.S.patent#6,360,491.
so I a r ' • • SolarEdge Power Optimizer
Module Add-On for North America
P300 / P320 / P400 / P405
P300 P320 P400 P405
(for 60-cell modules) (for high-power (for 72&96-cell for thin film
60-cell modules) modules) modules)
INPUT
Rated input DC Power1 ) 300 c.20 400 405 W
_ _ _
Absolute Maximum Input Voltage 48 80 125 Vdc
(Voc at lowest temperature)
MPPT Operating Range 8-48 8-80 12.5-105 Vdc
Maximum Short Circuit Current(Isc) 10 11 10 Adc
Maximum DC Input Current 12.5 13.75 12.5 Adc
Maximum Efficiency o/
Weighted Efficiency 98.8 %
Overvoltage Category
OUTPUT DURING OPERATION(POWER OPTIMIZER CONNECTED TO OPERATING SOLAREDGE INVERTER)
Maximum Output Current 15 Adc
Maximum Output Voltage 60 85 Vdc
OUTPUT DURING STANDBY(POWER OPTIMIZER DISCONNECTED FROM SOLAREDGE INVERTER OR SOLAREDGE INVERTER OFF)
1
Safety Output Voltage per Power
Optimizer Vdc
STANDARD COMPLIANCE
EMC FCC Part15 Class B,IEC61000-6-2,IEC61000-6-3
Safety IEC62109-1 class Il safety),
..........
RoHS _.
Yes
INSTALLATION SPECIFICATIONS
Maximum Allowed System Voltage 1000 Vdc
Compatible inverters All SolarEdge Single Phase and Three Phase inverters
Dimensions W x L x H 128 x 152 x 27.5/ 128 x 152 x 35/ 128 x 152 x 48/
( ) 5xS.97x1.08 5x5.97x1.37 Sx5.97x1.89 mm/in
Weight(including cables) 770/1.7 930/2.05 930/2.05 gr/lb
Input Connector. MC4 Compatible
Output Wire Type/Connector Double Insulated;MC4 Compatible
Output Wire Length 0.95/3.0 1.2/3.9 m/ft
Operating Temperature Range -40-+85/-40 +185 -C/-F
Protection Rating IP68/NEMA6P
Relative Humidity 0 100
"Rated SfC power of the module.Module of up to+5%power tolerance allowed.
PV SYSTEM DESIGN USING
A SOLAREDGE INVERTER(') SINGLE PHASE THREE PHASE 208V THREE PHASE 480V
Minimum String Length 8 10 18
(Power Optimizers)
Maximum String Length _..
(Power Optimizers) 25 25 50
Maximum Power per,String 5250 6000 12750 W
Parallel Strings of Different Lengths -
or Orientations Yes
"'It is riot allowed to mix P405 with P300/P400/P600/P7001n one string.
rC E &� "MMM7
•
solar=@e
SolarEdge Power Optimizer
Module Add-On For North America
P300 / P320 / P400 / P405 •
K y
i X F 7, •
x �
s t ' rA�t x r'
r r, a s ,..
9 L P
t
.,iaN , 4 t •
fS
s ' c w � v
a o
r,
PV power optimization at the module-level
Up to 25%more energy
- Superior efficiency(99.5°x)
— Mitigates all types of module mismatch losses,from manufacturing tolerance to partial shading
- Flexible system design for maximum space utilization
- Fast installation with a single bolt
— Next generation maintenance with module-level monitoring
— Module-level voltage shutdown for installer and firefighter safety
�J -,r�.� �f, �,,.���cF ;E�r;�;a c!�irvfa ��p�� w w w so are e,us
LG NeON ' 2 Block
Mechanical Properties Electrical Properties(STC
Cells 6xI0 300 W
Cell Vendor LG M PP Voltage(Vmp p) 325
Cell Type Morrocrystalline/N-type MPP Current(1-pp) 926
Cell-Dimensions 156.75 x 156.75 mm/6 x 6 inch Open Circuit Voltage(Voc) 39,7
.-Of Busbar 12(Multi Wire Busbar) Short Circuit Current(Isc) 970
Dimensions(L x W x H) 1640 x 1000 x 40 mm Module Efficiency 18,3
64.57 x 39.�7x f,57 inch Operating Temperature('C) -40- 90
p
Front Load 6000 Pa/125 sf
Maximum System Voltage(V) 1000
Rear Lo-ad 5400 Pa/1-I-3 ps f 0 Maximum Series Fuse Rating(A) 20
Weight 17.0:L 0,5 kg 37.48--t 1.1 Ibs Power Tolerance(%) 0-+3
Connector Type MC4,MC4 Compatible I P67
Junction Box iP6 7 with 3 Bypass Diodes 'Th---pl—;,--sutput--,dd by LG
Length of Cables 2 x 1000 mrn/2 x 39.37 inch
Glass High-Transr-nission Tempered G-lass Electrical Properties(NOCT*)
Frame Anodized Aluminum
300 W
Certifications and Warranty Maximum,Power- (Pmpp-),, 2-18
MPP Voltage(Vmpp)
Certifications(in Progress)
EC61215,!EC61730-1/-2,ULl703, MPP Current(Impp)
- 73P
ISO 9001,IEC 62716(Ammonia Test),- Open Circuit Voltage(Voc) 36 5
IEC 61701(Salt Mist Corrosion'rest) Short Circuit Current(Isc) 83
Module Fire Performance 2(UL.170 3)
Product-Warranty-- 12 years
Output warranty of Pmax L
(measurement Tolerance±3%) in ear wat rarity' Dimensions(mm/in)
Temperature Coefficients P r �� j
NOCT 46+3'C
Pmpp -0 38%/'C
Voc 0-28 C
Isc 002%/'c
Characteristic Curves
lomw
frowoIN w it(h
it(h
bmw
-G WV
t
ITT, '12") lorill 'ITT; r_00 JS OG
s
T
Nor th Amour a Solar Business Team
t vp�rih-itnon v are subject to hAnge,,v i*,hunt notice.
(9 LG LG Fle tron[c,I-)S A in, DS N260 K G-F EN 504127 RE"Mm
Uok G—d 1000 Syl✓a;i Ave,Engtewood Cliffs,NU 0763 2 -j"r 6�—"
Copyrig?It��)e U 15 L(r Flectr onics All Tights resorved Innovation for a Better Life
Contact igsotar(agec-orn
wv—Igsolanusa Coal
(9 LG
Life's Good
LG Ne® ask
LG's new module,NeCN"`2 Black,adopts Cello technology.
Cello technology replaces 3 busbars with 12 thin wires 00.
p� to enhance power output and reliability.NeONT" 2 Black DVE S
h® cell demonstrates LG's efforts to increase customer's values
beyond efficiency.It features enhanced warranty,durability, Intertek
performance under real environment,and aesthetic design '"
suitable for roofs.
r 14 Enhanced Performance Warranty •� High Power Output
LG NeONr"2 has an enhanced performance warranty. Compared with previous models,the LC,NeON"2
The annual degradation has fallen from-0.7%/yr to has been designed to significantly enhance its output
-0.6%/yc Even after 25 years,the cell guarantees 2.4%p efficiency,thereby making it efficient even in limited space.
more output than the previous NeON'"°modules.
Aesthetic Roof ® Outstanding Durability
LG NeON'"^2 has been designed with aesthetics in mind, With its needy reinforced frame design,LG has extended
thinner wires that appear all black at a distance.The the warranty of the NeON T'2 for an additional 2 year s.
product may increase the value of a property with its Additionally I-G NeON'"'2 can endure a front load up to
modern design. 6000 Pa,and a rear load up to 5400 Pa.
Better Performance on a Sunny Day Double-Sided Cell Structure
�•� LG NeONI 2 now performs better on sunny days thanks The rear of the cell used in LG NeON'"2 will contribute to
to its improved temperature coefficiency. generation,,just like the front,the light beam reflected from
the rear of the module is reabsorbed to generate a great
amount of additional power.
About LG Electronics
LG Electronics is a global player who has been comrnitted to expanding its capacity,based on solar energy business as irs future growth enyme We embarked on a solar energy source research program in
1984,supported by LG Group's rich experience in semi-conductor,LCD,c hernistry,and materials industry,wo suctessrully rcleasrd the first Mono X"senes to the market in 2010 which vxce exported to 32
countries in the folloe+,ing 2 years,thereafter.In 2013,NeON'"(previously known as Mono Xm NeON)won"IntersMar Award';which proved LG is the leader of innovation in the industry.
So I a r " • • Single Phase Inverters for North America
SE300OA-US/SE380OA-US/SE500OA-US/SE600OA-US/
SE760OA-US/SE10000A-US/SE1140OA-US
SE3000A-US SE380OA-US SESOOOA-US SE6000A-US SE760OA-US SE1000OA-US SE1140OA-US
OUTPUT -_- _
Nominal AC Power Output 3000 3800 .5000 6000 7600 ; 9980 @ 208V 11400 VA
10000 @240V
Max.AC Power Output 3300 4150 5400 @ 208V 6000 8350 10800 @ 208V 12000 VA
0 @240V 10950,@240V
AC Output Voltage Min.-Nom.-Maxi" ✓ ✓
183-208-229 Vac
AC Output Voltage Min.-Nom.-Max.i'i : ✓ ✓ ✓ ✓
211-240-264 Vac
AC Frequency Min.-Nom.-Max.111 59.3 60-60.S(with HI country setting 57-60 60.5) Hz
Max.Continuous Output Current 12.5 16 24 @ 2 ! 25 32 48 @ 208V 47.5 A
21 @ 240V V _ 42 @ 240V
GFDI Threshold 1 A
Utility Monitoring,Islanding Protection,Country Configurable Thresholds Yes Yes
INPUT
Maximum DC Power(STC) 4050 5100 6750 8100 10250 13500 15350 W
Transformer-less,Ungrounded Yes
Max.Input Voltage 500 _ Vdc-
Nom.DC Input Voltage 325 @ 208V/350 @ 240V Vdc
16
Max.Input Current'''s 9.5 13 18 23 34.5 Adc
.5 @ 208V 33 @ 208V
_ i..... 15.5 @ 240V 1 30.5 @ 240V
Max.Input Short Circuit Current 45 Adc
Reverse-Polarity Protection Yes
Ground-Fault Isolation Detection 600ko Sensitivity
Maximum Inverter Efficiency 97.7 98.2 98.3 98.3 98 98 98 % -
CEC Weighted Efficiency 97.5 98 97.5 @ 208V 97.5 97.5 97 @ 208V SITS
98 @,240V 97.5 @ 240V
Nighttime Power Consumption <2.5 <4 W
ADDITIONAL FEATURES
....._.._._
Supported Communication Interfaces RS485 RS232,Ethernet,ZigBee(optional)
Revenue Grade Data,ANSI C12.1 Optonal"s
Rapid Shutdown NEC 2014 690 12 Functionality enabled when SolarEdge rapid shutdown kit is Installed a'
_._ _..__ ._...._,._.___
STANDARD COMPLIANCE
Safety UL1741,UL1699B,UL1998,CSA 22.2
_
Grid Connection Standards IEEE1547
Emissions FCC partlS class B
INSTALLATION SPECIFICATIONS
---------
._..._
AC output conduit size/AWG range 3/4"minimum/16-6 AWG 3/4"minimum/8-3 AWG
DC input conduit size/#of strings/ 3/4"minimum/1-2 strings/
AWG range 3/4' minimum;1-2 strings/16-6 AWG 14-6 AWG
Dimensions with Safety Switch 30.5 x 12.5 x 7.2/775 x 31S x 184 30.5 x 12.5 x 10.5/ in/
(HXWXD) .. _. 775 x 315 x 260 mm
Weight with Safety Switch
51.2/23.2 54.7/24.7 88.4/40.1
lb/kg
_ .
Natural
convection
Cooling Natural Convection and internal j Fans(user replaceable)
fan(user
replaceable)
Noise <25 <50 dBA
Min.-Max.Operating Temperature
Range -13 to+140/-25 to+60(-40 to+60 version availabl0l) F/°C
Protection Rating NEMA 313
For other regional settings please contact SolarEdge support.
vi A higher current source may be used;the inverter will limit its input current to the values stated.
"Revenue grade inverter P/M.SExxxxA-US000NNR2(for 760OW inverter SE7600A-1JS002NNR2).
10j Rapid shutdown kit P/N SE1000-RSD-S1.
40 version P/N:SExxxxA-US000NNU4(for 760OW invertecSE7600A-1J5002NNU4).
SUfISPEC RoHS
r _
solar=ee
SolarEdge Single Phase Inverters
For North America
SE30OOA-US / SE380OA-US / SE50OOA-US/ SE6000A-US /
SE7600A-US / SE10O00A-US / SE114OOA-US
.
r.
a
y
.0
t
3
The best choice for SolarEdge enabled systems
Integrated arc fault protection(Type 1)for NEC 2011690.11 compliance
Superior efficiency(98%)
Small,lightweight and easy to install on provided bracket
Built-in module-level monitoring
Internet connection through Ethernet or Wireless
Outdoor and indoor installation
Fixed voltage inverter,DC/AC conversion only
Pre-assembled Safety Switch for faster installation
Optional—revenue grade data,ANSI C12.1
':-R;,M N - Ilal" -Ff �� -.Fw,,:>AnJ-l�I!>.A-10, STRAL, A, TH-, NU �i ER LA N�� - l�RAEE_ LJUV1N.St?li�f'£.C���'.1..15
Roof
Snow load summary: Roof 13'-6" Span
Roof framing is 2x8 @ 12"o.c.
Array : ASCE 7-05 Sloped roof snow loads, Ps - Roof pitch is 45 degrees
Existing- Ps= Cs * Pf
Pf= Pg at time of construction is taken as I * 50= 50 psf
Cs= 1.0 per Figure 7-2 ASCE 7-05 for non-slippery surfaces.
Ps =Cs * Pf=0.79 * 50= 39.5 psf
Proposed - Ps=Cs * Pf
Pf= Pg at time of construction is taken as I * 50= 50 psf
Cs= 0.73 per Figure 7-2 ASCE 7-05 for slippery surfaces.
Ps=Cs * Pf=0.47 * 50=23.5 psf
Snow load on rafters at panel sections
CONCLUSION: Total Design Load : (15+3.5)psf+23.5 psf live load =42 psf versus
Original load of 39.5 psf+ 15 psf= 54.5 psf.
The panels can be added without increasing the gravity load on the roof structure.
fir+OF
Respectfully submitted, "� Structural Response, LLC
Scott E. Nelson En ineers License#41457
` vt�ISF g
ss'f
www.structuralresponse.com snelson@structuralresponse.com
Page 2 of 2
Structural Response, LLC
Structural Engineering Services
30 Shedd Lane, Chelmsford Ma 01824
Structural Observation Report
Job#15161
10-05-15
CLIENT: Transformations, Inc.
323 West Main Street
Ayer, Ma 01432
SITE LOCATION: Residential Structure
112 Moser Street
Northhampton,Ma
SUBJECT.-
Review of panel loading conditions requirements on rafters.
FINDING:
Superimposed Weight:
Panel Component Weights: Calculated per module
Total (PSF) 3.40 (Use 3.5 psf)
Roof Dead Loads: Approximated at 15 psf+ 3.5 psf= 18.5 psf
Roof Live Loads: As listed in ASCE 7-05 as directed by 81" Edition and IEBC
Use design live load based on ASCE roof calculations listed on next page
Per Attached Calculations:
The addition of the solar panels and the re-calculation of the roof snow load under
the current Building Code indicates that the stress in the existing members is not being
increased by more than 5%. Therefore the panels may be added per the allowances of
The IBC 2009 and the Massachusetts Amendments. A review of the existing and
proposed loading conditions is warranted. Existing design gravity loads are used per
code.
www.structuralre.ponse.com 978.8664249 snelson@structuralresponse.com
Page I of 2
PV Layout Plan — Robert Harris — 112 Moser Street Northampton, A
ltrNr>r;rtxR.fM _.
Rk1KF.tih - wwr,:FlwKi n.INI A.Itwtt.u,env qM..I.WAIL*KKAM
M.. 't#'+Ih FMt N:.IFIt A non' '
2 Rows of 10 LG 300 Watt panels - Southern Roof—Elevation Drawing
Statement of Work: The Photovoltaic system is composed of 20 LG 300 Watt panels. The STC rating for the system is
6.0 kW. The Photovoltaic system will be affixed to the roof structure with Professional Solar Product's(Pro-Solar)
Roof7rac mounting system in accordance to the manufacturer specifications. ProSolar's rail enhancers(part#ARE-20)
will be added to further reinforce the racking system. The lag bolts will penetrate the rafters by a minimum of 3.5". The
fast Jacks or mounting feet will be spaced 4'on center and the static load will be distributed equally among associated
rafters. We will not exceed the manufacturer's recommendations for cantilever distance or deviate from the installation
guide in any way. This installation will exceed local static load and wind load requirements.
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership, association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 7-2010
Fax # 617-727-7749
www.mass.gov/dia
The Commonwealth of Massachusetts Print Form
_-4.\ Department of Industrial Accidents
Office of Investigations
t 1 Congress Street, Suite 100
Boston, MA 02114-2017
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Transformations,Inc-Benjamin Cumbie
Address: 323 West Main Street
City/State/Zip: Ayer, MA 01432 Phone #: 978-597-0542
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 9 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. E] 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 g, ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.*
required.] 5. ❑ We are a corporation and its 10.F] Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.]t c. 152, §1(4), and we have no Solar PV ststem
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.
*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: Travelers Insurance Co.
Policy#or Self-ins. Lic.#: 6 KUB-0326N39-A-15 Expiration Date:4/2/2016
Job Site Address:112 Moser Street City/State/Zip:Northampton, MA 01060
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 under the pains and enalties of erjury that the in ormation provided above is true and correct.
Digitally signed by Benjamin Cum ie
Signature: Date:2015.10.0612:08:48-04'00' Date 10/6/2015
Phone#:978-597-0542
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 S-COINST M#UCTMQlM SEAYICU
Nd AppharbMe 0
NWO Benjamin Cumbie - Transformations, Inc. CS-107968
t
46 Old Orchard Road, Groton, MA 01450 11/19/2017
Additu EVftWft Dft
802-760.7192
No Applicable ❑
Benjamin Cumbie 108293
QRM9MMM as
Transformations, Inc. 10/3012016
n
46 C?rchard ro n, AAA 01450 802-760-7192 elephone
SECTION 10-1A O MMM' NMATION INSURANCE AFFMVff(&#.tt,L c.IM I 25q8)?
Workers Comwsation wauraratas affidevil must be ctarrspleted and sutamiftd with tha appi"ticsn,fakwe to provide V" will result
in the denisi of ove`issuence of the
AfFit ovd Altered Yes, Nor — 0
The current exemption for"hos iwnerv"was extended to include ci(°case(1) kw twcr(2)families
and to allow such homeowner to cagage an individual for hire who does not possess a litx: se.
as UMMWK,CAUL 28, Simb 9"M stwas Maj
Plasidu Of If Person(s)who own a partl of land on which he/she insides or intends to reside,on w=hich there
is,or is intende d to be,a one two family dwelling.attached or stttwtures ac to such use and/or farm
,rux:ttttres.
Such-homeowner"shall submit to the Building Official.can a forth acceptable to the Building C>tftcial,09 ke0dre Ad Mrs
As acting CgUV31CM AgMiernar your presence can the job site will be required from time to time.during amt upon
(j completion cif the%ork for which this permit is issued.
Also be ad,*iced that with refe ixx to Chapter 152 Morters`C" tion) and Chapter 153(i.tahility of EmMoyers to
F.rnplove c's for injuries not resulting in Dmth)of the Sias chusews(kneral haws Annotated,jgo jry l�V&bk fear person(s)
! you hire to perf'4m work for you under this permit.
the undersigned"homeowner"r"certifies and assumes responsibility for comphawx with the:State Building Code,City of
Northamptcin Orditsancvs.Swe and t x cal pining l.aw°s and Mate of Massachusem C>ieneral laws Annotmed.
Hoamvwser Signaftre __ �
��♦ Mgt t. *:d, !
�.., � �rs4 i �iN ,rt •.,
!
-y r♦.. �.i. F t.
r ri i,t-w+ c 11 s .:f.; *
Robewt
me Oww of tho #,,.
# {#
hwsoy a&win Ted Sawyer - Transformations, Inc.
i i • y
Signo"co OMW Deft
.
s Transformations,
s w
• ':w':.a.. Y. i^ m OW I StMerwft 6 • ,• on 0* 'a ..f 4 s {! ,..a vue . •♦ . : Y. to ( ': be*of 1 :.:y.{'.
.• b"
Ted
10-06-2015
f
Section 4. ZONING All atf Mixt Be Campieted.Per it Can Be Denied Due To lacottstplete Wormation
IV*cdom to be r4led m by
soldles NPWURM
i
[A)t Sirs
Frxvtagc
Setbacks LM
L—R:�
Ruik ing Height
Bldg.SquArc RKsage `
Open Space Fo(uge
(IA-A arts miaatm bWg&raved
ekin )
t oaf'Tkarkin ti
Fill:
(vaalatM&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO * DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO U OONT KNOW 0 YES
IF YES: enter Book Page anti/or Document #
B. Does the site contain a brook,body of water or Wetlands? NO kV DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date issued:
I
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 0 140 +�
IF YES, describe size, type and location:
E. Will the construcbm activity disturb( atlon,or t tg)over t acre or is it part of a oorc►amon plan
toad will disturb over 1 acre? YES' NO
IF YES,then a Northampton Storm Water Management Pelmet from the DPW is required,
DopwirwO use orAy
T ity of Northampton $9"of Pam*
#ding Department Cwb CWDlrihro+lway
212 Main Street SewwMeok A
OCT , 3 2015 Room 100 Wateu►M%l Avo
�pp p#or►. MA 0t06fl ofra1
DEPT.OF BUILDING ;K�7°1240 Fax 413.587-1272 PWSM
NORTHAMPTON MA 01060 100W Spodfy_
APPLICATION TO COI*STi#WT,Af`TW REPAIK RENOVATE OR DEM(XISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INIR RMATION
This"c"M to be ooatpkAod by offk*
112 Moser Strut ► w vn+t-
Northampton, MA 01060 zone overloy owbic t
Eft St ftbi6! CID Cft tkt
SECTION 2-PROPER V 0WWl9lSMVAUTMOIWW AGENT
2.1 Owl
Robert Hanis 112 Mow Streit.Northampton,MA 0 1060
tai Cwrent Address
413-'—)'50-1.304
r 4axxl� r.
141k"
Ted Sawyer-Transformations,Inc. 323 West Main Street, Ayer, MA 01432
t ( ). - - " _ CwreM Ma"Addrfts
978-772-1380
To*-ftm
ttwn EoWns ed Cost( )to be offidw Use Cloy
oqMpWfed!�f
1. SuAdOV 22 0)() (a)BukWV Permit Fee
2 E*cfty. i (b)E ToW Cost of
Crtruction from 6
3. PtumbvV Su***Pwntt Fee
i
I
4 Medvivu (HVAC)
&Fire Protection
t 6. Total-(1 +2+3+4+g) 22.800 1 Ctredc r4umbw '
TALI Sedgy For Om"U"
[we
&A rg Prdrrnit Ntmrdw- tom:
SOMA":
Of
File#BP-2016-0499
APPLICANT/CONTACT PERSON TRANSFORMATIONS INC
ADDRESS/PHONE 8 COPPERSMITH WAY TOWNSEND01469(978)597-0542
PROPERTY LOCATION 112 MOSER ST
MAP 31C PARCEL 030 ZONE PV
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT 72 r/127
Fee Paid /®
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL 6KW ROOF MOUNTED SOLAR ARRAY
New Construction
Non Structural interior renovations
Addition to Existiny,
Accessory Structure
Building Plans Included:
Owner/Statement or License 107968
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR ION PRESENTED:
pproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit 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
of ' y
Signature of Bui ding Of cial 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.
112 MOSER ST BP-2016-0499
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block: 3 1 C-030 CITY OF NORTHAMPTON
Lot: - 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-2016-0499
Project# JS-2016-000837
Est. Cost: $22800.00
Fee: $75.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TRANSFORMATIONS INC 107968
Lot Size(sq. ft.): 5967.90 Owner: HARRIS ROBERT S&JEANNE C
Zoning: PV Applicant. TRANSFORMATIONS INC
AT. 112 MOSER ST
Applicant Address: Phone: Insurance:
8 COPPERSMITH WAY (978) 597-0542 WC
TOWNSENDMA01469 ISSUED ON.10115120-15 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 6KW ROOF MOUNTED SOLAR ARRAY
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 10/15/2015 0:00:00 $75.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
112 MOSER ST BP-2016-0499
GIs#: COMMONWEALTH OF MASSACHUSETTS
MAR Block: 31 C-030 CITY OF NORTHAMPTON
Lot: - 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-2016-0499
Project# JS-2016-000837
Est. Cost: $22800.00
Fee: $75.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TRANSFORMATIONS INC 107968
Lot Size(sq. ft.): 5967.90 Owner: HARRIS ROBERT S&JEANNE C
Zoning: PV Applicant: TRANSFORMATIONS INC
AT: 112 MOSER ST
Applicant Address: Phone: Insurance:
8 COPPERSMITH WAY (978) 597-0542 WC
TOWNSENDMA01469 ISSUED ON.10 11512015 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 6KW ROOF MOUNTED SOLAR ARRAY
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 10/15/2015 0:00:00 $75.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner