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16B-001 25 MARK WARNER BP-2019-0695 GIS#: COMMONWEALTH OF MASSACHUSETTS a : lock: 16B-001 CITY OF NORTHAMPTON Lot:-031 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Catezom SOLAR ELECTRIC SYSTEM BUILDING PERMIT Permit# BP-2019-0895 Proiect# JS-2019-001494 Est Cost,$22000.00 I`=s75.0o PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License., Use Group: SKYLINE SOLAR LLC 027047 Lot Siu(sa.ft.), Owner: JINKS ROY Zoning: SR/URA/Rl/WSP Applicant. SKYLINE SOLAR LLC AT. 25 MARK WARNER ApplicantAddress., Phone: Insurance., 4 CROSSROADS DRIVE- SUITE 116 (732)3 54-31 1 1 Liability HAMILTONNJO8691 ISSUED ON.212212019 0.00:00 TO PERFORM THE FOLLOWING WORK:ROOFTOP SOLAR 38 MODULES- I'I AKW 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: Fbal: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy slensture: FeeType: Date Paid: Amount: Building 2/22/2019 0:00:00 $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner gP- (4- Ms-- sa�zr' Department use only City of Northampton Status of Permit: Building Department Curb Cut/Dnveway Permit 212 Main Street Sewer/Septic Availability .. :1 Room 100 Water/Well Availability ' Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PlottSite Plans Other specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I -SITE INFORMATION RECEIVED 1.1 Prooenv Address: hie action to be completed by office 20 Bridge Rd-25VAWLWojA-1X FEB 1lAp2 yaf 60/ unit Overlay District DEPT OF Blj f INVE NOR HAMPT CB District SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Roy Jinks 20 Bridge Rd 25 Name(Print) Current Mailing Address: Attached (413)728-3384 Telephone Signature 2.2 Authorized Aught: Z) Y�ry Ryan Lane 4 Crossroads Dr. #116 Hamilton NJ 08691 Name(PnnCurrent Meiling Address: 7323543111 Signature 7323543111 SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 6000 (a)Building Permit Fee 2. Electrical 16000 (b)Estimated Total Cost of Construction from 6 3. Plumbing Building PermR Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) 22000 1 Check Number Ig This Section For Official Use Only Building Permit Number: Issued:Dee Signature: 21 lI Bulking Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) UtFl Ot[f III D:.:3 Idctt�LOM8 I EES ; : soa i �CcIAPD Sectlon 4. ZONING Alt 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 Sim Frontage Setbacks Front Side L: R: I.: R: Rear Building Height Bldg,Square Footage Open Space Footage h Itat mea minus bldg dt paved parkin) #of Parking Spaces Fill: volumc a location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION S DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing Or Doors 17 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding 1=3] Other[EQ Brief Description of Proposed Inslallnfions of a safe and code m nplianr,grid fied,W solar system on a msidenGal rooftop.38 Modules 1114 kW Work: Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _Yes No Plans Attached Roll -Sheet its.If New house and or addition to existina housing, complete the following: a. Use of building :One Family Two Family Other to 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? In. 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 regulators? Yea 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 Roy Jinks as Owner of the subject property Skyline Solar hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. ATTACHED 2/1/19 Signature of Owner Date 1. Ryan Lane ,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. Ryan Lane Prim Name 2/1/19 Signature OmPVWt Dale SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder Phil ChOUinard CS-027047 License Number 79 Oak St Unit#101 Ashland MA 01721 1119/19 Address Expiration Date 7313543111 Signature Telephone 9.Realstered Home Improvement Contractor: Not Applicable ❑ Skyline Solar/ Ryan Lane 172284 Company Name Registration Number 4 Crossroads Dr. #116 Hamilton NJ 08691 6/6/20 Address , yExpiration Dale Telephone 7323543111 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.o.152,¢2SC(8)) 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...... ❑ City of Northampton ..(f Massachusetts \' DEPARTMENT OF BUILDING INSPECTIONS 212 Hain str t • H icipal sending NovNampton, Hx 01060 'hryvyj(� AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the`reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Nate:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Est.Cost: Address of Work: Date of Permit Application: 1 hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 _Owner obtaining own permit(explain): _Building not owner-occupied Other OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: hereby apply for a building permit as the agent of the owner: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature it City of Northampton � ,.+A Massachusetts �. �';' � DEPAa1?IENT OF BUILDING INSPECTIONS ' 212 Nein street a Municipal Bullfrog ;? NorNm ton, M 01060 Massachusetts Residential Building Code Section I IO.R5.1.2 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. Section I IO.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5,provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. 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. City of Northampton Massachusetts tta Yf :.' M1p4 c�` �' A ® i DEPARTMENT OF BUILDING ZNSP&CTIONS 212 Main Street Municipal auiltling Northampton, M 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 20 Bridge Rd 25, Northampton MA 01062 (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: EOMS 318 Manley St. West Bridgewater, MA 02379 (Company Name and Address) SignatLIW of At or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth oJMassachusens p� Department of Industrial Accidents OfficeWashington Street ons 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/OrgmimtioNtndividni): Skyline Solar LLC Address:as Blown Drive Suite 3 Ci /State/Zip: Phone#: r.+a ecu-1111 Are you an employer?Check the appropriate box: Type of project(required): 1.® 1 am a employer with 85 4. ❑ I am a general contractor and 1 employees(full and/or part-time).• have hired the sub-contractors 6. New construction 2.El am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contracmrs have g, ❑Demolition working for me in anY capacity.citY• employees and have workers' 9. E] Building addition workers'comp.insurance comra p.insunce? req required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12❑Roof repairs insurance required.]I c. 152,§1(4),and we have no employees.[No workers' 13.El Other PV Solar System comp. insurance required.] Any applicant that checks box gl must also all out the section below showing their workers'compensation policy information, 1 Homeowners who submit this affidavit indicating they arc doing all work and then hire outside coast amors must submit a new affidavit indicating such. =Convectors that check this box most attached an additional shat showing the name of the sub-contractors and state whether or act those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy numher. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: NY Marine 6 General Insurance Policy N or Self-ins.Lic.#: WC20IBM13247 Expiration Date:1/30I2019 Job site Address:20 Bridge Rd 25, Northampton, 01062 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 ofthe DIA for insurance coverage verification. /do hereby eonf a vler rhe p s nd penalties of perjury that the information provided above is true and correct. Signature: Date:2/1/2019 Phone N: 54-3111 Official use only. Do not write in this area,to be completed by city•or town afftetat City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Citytrown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: 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 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-contractors)name(s),address(es)and phone number(s)along with their certificates)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 maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the andaviL 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 bosom 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/icense 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 v w .mass.gov/dia Skyline Solar LLC 3C.;a D J :t, 3 ,, ',4C a , .�. ,131-., k<< 1 ,; 31 .c.. z, t City of Northampton 210 Main St. Northampton MA 01060 2/1/2019 To Whom It May Concern: This letter is authorized to of Skyline Solar LLC to obtain building permits on behalf of Ryan Lane, owner of Skyline Solar LLC, Phil Chouinard, Skyline Solar's Construction Supervisor and James Leavitt, Skyline Solar's master electrician.The project is located on 25 Mark Warner Dr. The homeowner's name is Roy Jinks. The proposed project is a roof top solar system for purpose of net metering. Ryan Lane HIC - 172284 6 Phil Chouinard CS-027047 ;--I- &-M James Leavitt ELC-21667 ;•�h,I i C. I1w,,d on N R,;nl=z Ni , j V),,11, 'J. ClPio I rua=. I;i DATE: January 29, 2019 RE: 25 Mark Warner Drive, Northampton, MA 01062 To Whom It May Concern, As per your request, we have conducted a structural assessment of the building at the above address that included a she inspection on January 23, 2019. This inspection included an examination of the roof structure and condition as well as any structural drawings that were available. PV solar panels are proposed to be installed on roof areas as shown in the submitted plans. The panels are clamped to rails which are attached to the roof with a lagged mounting system, and installed per manufacturer's specifications and recommendations. It was found that the roof structures as noted on PVS-1 can satisfactorily withstand the proposed additional loads and will meet the applicable standards included in the Massachusetts State Building Code (Ninth Edition)and 2015 IRC. Design Criteria: Wind speed = 117 MPH Ground snow load =40 psf Roof dead load =9 psf Solar system dead load = 3 psf The roof was determined to have asphalt shingles atop half-inch plywood sheathing. Overall the roof area is structurally adequate to support the additional load of the solar panels and their framework. Acknowledged by: O� G f CHRIS H. KIM `F^ CIVIL 5243300 Chris Kim, P.E. DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: E.O.M.S Name of Waste Facility 318 Manley St.West Bridgewater, MA 02379 Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renmaien, .habiliwion ar aher altsntion of a buiNug or.ms,cmre, MGL c.40 s. 54 requires that the debris mulling therefrom shall Inc,disposed of in a pmperly,licensed solid waste disposal facility as defied by M G.L.c. 111 s. 150 A.Sigtature of the pemtit applicant, data ad number of Me building fiction to be annual shall be idicated on a form pmvidd by the Building Department and amchcd to the office copy of the building permit retained by the Building Departmont. If the debris will not be diapouN of as indicated, the holder of the pemdt shall notify the building official,in writing,as to the location wbcm the debris will be dispwd. 780 CMR—0'Edition r1 1 e of Permit Applicant 2/1/19 Date E-\ The Commonwealth ifMassachu,eux Department of Industrial Accidents Office of Investigations US 600 Washington Street Boston,MA 01111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aa0licant Information Please Pnnt Le Ibly Name(Businessiorgmimtionqndividual): Skvli e-qnlnr LLC Address:sS Rifaa Drivet coltsolter a CitY/Sta1C/ZiP:Radgnbam,MA 02ZOZ Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 85 4. ❑ I am a general contractor and I employees(full and/or pan-time).- have hired the subcontractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity, employees and have workers' q ❑Building addition [No workers'comp.insurance comp. insurance? required.] 5. ❑ We ere a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 I.❑Plumbing repairs or additions myself, [No workers'comp. right of exemption per MGL 12❑Roof repairs insurance required.]t c. 152,§I(4),and we have no employees.(No workers' 13.®Other PV Solar System comp. insurance required.] "Any applicant Thal checks box xi most also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors mus(submit a new affidavit indicating such. Contractors that check this box moustached an additional shat showing the mare of the sub<antractors and state whether or not those anises have employees. If the sub-contractors have employees,they must provide(heir 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: NY Marine&General Insurance Policy#or Self-ins.Lia It: WC201800013247 Expiration Date:lPMM1a Job She address:20 Bridqe Rd 25, Northampton, 01062 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 cert der the Is bds Pit pen allies ofperjury that the information provided above is nue and correct. Signature Date 2/l/2019 ' Phone#: 2.354.3111 Official use only. Do not write in this area, to be completed by chy or town official. City or Town: Permit/License It Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspec(oi 6.Other Contact Person: Phone#: ,4coed CERTIFICATE OF LIABILITY INSURANCE 1!!02019 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 INSUREFf AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the carttflcate holder Is an ADDITIONAL INSURED,the polleytles)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this Certificate does not confer rights to the ceHlRcate holder In lieu of such endorsements). PRODUCER CONTACT RAMS. - The Hamilton Group,LLC PNONRIE� 973-•282.�.92 FAR 3 Wing Drive E.Ma DID.Nal: Cedar Knolls NJ 07927 MORESS IN9UR AFPoRgNo COVERAGE NAGS INSURE.A:NY Manne8 General Ina Co. INSURED Bml`1 INSURER B:Gotham 1115 Co Skyline Solar LLC Skyline Solar RI,Inc. MORENO SELECTIVE INS CO OF AMER 12572 4 Crossroads Drive,Ste 116 IxsuRERo:Selective ins Co of Ne S.ErMt 39928 Hamilton NJ 08691 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER:316929597 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EILCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MR TYPEOFINSURANCE MUCYNUMBER MMMVYYYI PoIILY EFF POWYF2P LYIB B OEMERAL WBIIIrY YY PK4J19YGG " 9JUR019 1AQZJ30 EACH OCCURRENCE E1 OBm , a X COMMERCIPL GENERP1 LNaILITY EB Ee 5100030 CIAIMSANDE O OCCUR MED EXP("m WSW m SSO X MMCaPm Ieo PERSONALS AOV INJURY 5101003 ,0 GENERALAGGREWTE $2,OOJ000 GEML AGGREWTELIMIT APPLIES PER: PRODUCTS-COMPQP AGS 52.0ODURD POLOy X Po0. LOC %daefiwwl lrMt. $1='. C AYOMOBBELWB Y Y 5231281 1rMO019 11102WOINE051N 0 A9DXQW 62019 1OOR03O b°"I 18 ANYAUTO BODILY INJURY(Per plew) f �OSMED X SCHEDULED BODILY INJURY(Perv1HM) f X NPEOAUTOS X NMChAumsNMED PROPERTY DNMGE f f B ULBRELL Me X OCCUR Y Y 11M201AYOOBEm 18132019 1857410 EACH OCCMNERCE 5IOOOJO 0 X ERCEs6MB CLU.ISMAOE AGGREGATE E1,m0W0 DED I X I RETENTION a IONTO $ A WORKERS COMPENMTION VECM190D(IU47 1120'N1B VJW20M X I V`CSTATU I OTH AND EMPLOYERS'LIABIUIY YIN My PROPRIETMI'MMERIEKECUIIVE EL.EACHACCEY:NT 51,000,003 OFFICEILMEMBER EXCLUDED? ❑ NIA ni n EL DISEASE-EA EMPL 51.Og000 Nyet de.. i UESCRIFFIONOFOPERATIORSezM EL.DIDEASE-POLICY LIMIT 1 61030030 B 1.1.11m F.. pKZO15CWWMB 1M201s 1IN)CON Prt Oau,wuM1M. f1m.0YYf2.sC0 `w ,tY SPPMO. f103,ONMt,WO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AXFch ACORO 101,AEEWPntl Rmuks SNMuie,If TOnepce is rpWNee This Certificate does not afford coverage for Additional Insureds. The Certificate is only evidence of insurance coverage for the Named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY DPTME ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH ME POLICY PROVISIONS. Evidence of Insurance AUTHORIZED REPRESENTATIVE arw�p ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201605) The ACORD name and logo are registered marks of ACORD I Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration (� Type: LLC SKYLINE SOLAR, LLC. ''1 Registration: 172284 Expiration: 06/06/2020 4 CROSSROADS DRIVE SUITE 116 HAMILTON, NJ 06691 Update Address and Return Card. SCAI O 2W-O17 �/in 1/nnonrnrnrn�/�n�"'�� Of eof Conmu Affaim6eesalasf Ropulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE: LLC before the expiration data. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 172284 W062020 One Ashburton Piece-Suite 1301 SKYLINE SOLAR,LLC. Boston, MA 02108 �'�/j/�T�ar RYAN LANE R, �-- / '`-'��^"`e'...�- 4 CROSSROADS DRIVE SUITE 116 HAMILTON, NJ 08691 Undersecretary Not valid without Signature comm,nwea Pft of MaSS..fmfatts Divlrinn of professional U,:ensae Board al Building RegW+llons and SIadW ds Constr4C A1$0pgrnsar I CSL27047 , 4piras IIIM019 ASMMDM ■ 79 OAK ST.UAY 91 ASNUWD6IA 01To. �4f♦\11 IEMJ Commissioner r1hice of consumer Aliairs >�ri'Susiness gul`atlnn 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improveme�Gontractor Registration Registration: 172284 _ Type. Supolemenl CeN SKYLINE SOLAR,I.I.C. raplmlbn 6Y2020 PHILIP CHOUINARD 4 CROSSROADS DRIVE SUITE 116 HAMILTON. NJ 08691 '4w? Updale Addras and raum ori Mary reason for a6engr. 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