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Northampton Building Permit Application - Berenson
City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 Department use only Status of Permit: Curb Cut/Driveway Permit ____________________ Sewer/Septic Availability______________________ Water/Well Availability________________________ Two Sets of Structural Plans___________________ Plot/Site Plans_____________ Other Specify__________ APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office Map _______________ Lot __________________Unit_________ Zone ________________ Overlay District______________ Elm St. District__________________ CB District______________ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ______________________________________________________ Name (Print) _____________________________________________________ Signature _____________________________________________________ Current Mailing Address: ______________________________________________________ Telephone 2.2 Authorized Agent: ______________________________________________________ Signature ______________________________________________________ Current Mailing Address: ______________________________________________________ Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be completed by permit applicant Official Use Only 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5)Check Number This Section For Official Use Only Building Permit Number:_______________________________ Date Issued:______________________________________________ Signature: ______________________________________________ Building Commissioner/Inspector of Buildings _______________________________ Date Please see attached ______________________________________________________ Name (Print) X Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side Rear L:______ R:______ L:______ R:______ Building Height Bldg. Square Footage % Open Space Footage (Lot area minus bldg & paved parking) % # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House Addition Replacement Windows 0r Doors Alteration(s) Roofing Accessory Bldg. Demolition New Signs [ ] Decks [ ] Siding [ ] Other [ ] _________________________________________________________________ Brief Description of Proposed Work:________________________________________________________________________________________ Alteration of existing bedroom ______Yes ______ No Adding new bedroom _______ Yes _______ No Attached Narrative Renovating unfinished basement _______ Yes _______No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family _________ Two Family _________ Other __________ b. Number of rooms in each family unit:______________ Number of Bathrooms_____________ c. Is there a garage attached? _________ d. Proposed Square footage of new construction._____________________ Dimensions __________________________________ e.Number of stories? ________________________________ f.Method of heating? ________________________________ Fireplaces or Woodstoves ___________ Number of each ______ g. Energy Conservation Compliance. _____________________ Masscheck Energy Compliance form attached? _______________ h. Type of construction _______________ i. Is construction within 100 ft. of wetlands? ______ Yes ______ No. Is construction within 100 yr. floodplain ______Yes _____No j. Depth of basement or cellar floor below finished grade __________________________ k. Will building conform to the Building and Zoning regulations? ________ Yes _______ No . l. Septic Tank _____ City Sewer _______ Private well _______ City water Supply _______ SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, _______________________________________________________________________________________, as Owner of the subject property hereby authorize ________________________________________________________________________________________________ to act on my behalf, in all matters relative to work authorized by this building permit application. ______________________________________________________________________________________________________________ Signature of Owner Date I, _______________________________________________________________________________________, as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Signature of Owner/Agent Date Please see attached ______________________________________________________________________________________________________________ Print Name X SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ___________________________________________________________________________ Signature Telephone Not Applicable ! 9. Registered Home Improvement Contractor: __________________________________________________________________________ Company Name __________________________________________________________________________ Address _________________________________________________Telephone_________________ _ Not Applicable ! _________________________________ Registration Number SECTION 10- WORKERS’ COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... !No...... ! 11. - Home Owner Exemption The current exemption for “homeowners” was extended to include Owner-occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such “homeowner” shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers’ Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned “homeowner” certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature ________________________________________________________ Name of License Holder : __________________________________________________________ ___________________________________________________________________________ Address ____________________________________ License Number ____________________________________ Expiration Date ________________________________ Expiration Date X X NJ, ElectricalContractor business permit number34EB01547400 NJ, HIC reg. #13VH01244300 For other jurisdictions, please visit: http://www.trinity-solar.com/about-us/locations-and-licenses HOMEOWNERS AUTHORIZATION FORM I, , (print name) am the owner of the property located at address: . (print address) I hereby authorize Trinity Solar Inc.(“TrinitySolar”)and its employees, agents, and subcontractors, including without limitation, , to act as my Agent for the limited purpose of applying for and obtaining local building and other permits from the Authority Having Jurisdiction as required for the installation of a Photovoltaic System, Battery System, roofing or other Trinity Solar offerings located on my property, applying and obtaining permission and approval for interconnection with the electric utility company, and registration with any state and/or local incentive program(s). This authorization includesthe transfer/re-administering, and/or cancellation of any existing permits on file for the purpose of updating/applying with an alternate subcontractor. Without limitation to the generality of theforegoing Ispecifically authorize Trinity Solar et al. to populate technical details, fill-in, edit, compile, attach drawings, plans, data sheets and other documentation to, date, submit, re-submit, revise, amend and modify application, submission and certificationdocuments(“ApprovalsPaperwork”),includingthoseforwhichsignaturepages areincluded herewith for my signature, in furtherance of the relatedtransaction, and I am providing any signatures to Approvals Paperwork for purposes of the foregoing. Trinity Solar will provide copies of Approvals Paperwork when submitted. My authorizations memorialized herein shall remain in full force and effect until revoked. I acknowledge that theseauthorizations are not required to proceed withthe transaction andare not a condition of the related agreement included herewith but are being given for my own convenience and benefit in order to expedite the approvals processes. ElectricUtility Company: ElectricUtilityAccount No.: Name on Electric Utility Account: Customer Signature PrintName Date CorporateHeadquarters1-877-SUN-SAVES 2211AllenwoodRoadPh:732-780-3779 Wall,NewJersey07719Fax:732-780-6671 www.trinity-solar.com FORINFORMATIONABOUTCONTRACTORSANDTHECONTRACTORS’REGISTRATION ACT, CONTACT THE NEW JERSEY DEPARTMENT OF LAW AND PUBLIC SAFETY, DIVISION OF CONSUMERS AFFAIRS AT 1-888-656-6225. Ronald Berenson 1 High Meadow Rd Northampton 90710-82006 National Grid MA Hannah Berenson Berenson Ronald Ronald 11/14/2022 Florence, MA November 22, 2022 212 Main St. Northampton, MA 01060 Trinity Solar No. 1 High Meadow Road 2022-11-794268 Northampton, MA 01062 MA License No. 56687 RE: BERENSON, RONALD; BERENSON, HANNAH Trinity Solar | 4 Open Square Way, Suite 410 | Holyoke, MA | (413) 203-9088 To the Building Official: The following information constitutes a summary of the relevant design criteria and recommendations for the support of a new photovoltaic [PV] system on the existing roof framing components at the above-referenced location. Criteria is as follows: 1. Existing roof framing: Conventional roof framing is 2x6 at 24 o.c.; existing rafter span= 14' 0"; (horizontal projection) 2. Roof Loading: • 3.0psf dead load (pounds per square foot - PV panels, mounting rails & hardware) • 5.7psf - existing roof loads (1.7 psf - 2x6 framing, 1.5psf roof sheathing, 2.5 psf shingles) • Ground Snow Load - 40psf - per ASCE Hazard Tool • Wind criteria - Exposure Category B, 115 mph wind 3. Existing roof modification - provide new 2x6 collar ties at all rafters at 1/3 of the ridge-eave height down from the roof ridge elevation opposite of each existing collar tie. Collar ties are to be connected to each rafter using a minimum of (6) 10d common nails. Alternatively, provide 2x4 (@24" o.c.) "knee wall" reinforcing to limit the maximum span of the existing rafter to 11'-0". Locate bottom of "knee wall" within one foot of existing bearing wall below. This installation design is in general conformance with the manufacturers’ specifications and complies with all applicable laws, codes, and ordinances – specifically the International Building Code (2015 edition) and the International Residential Code (2015 edition), including all Massachusetts regulations and amendments. The spacing and fastening of the mounting brackets is a maximum of 48” o.c. between mounting brackets (staggered) and is secured using 5/16” diameter corrosive-resistant steel lag bolts. A minimum of 2½” of penetration (embedment) per lag bolt is required, which will resist all stated loads above – including wind shear. Per NDS Section 12.1.4, clearance holes - equal to the diameter of the shank - need to be bored into a primary framing member for the full-length of the threaded portion of the bolt to avoid splitting of the framing member. Regards, Ihor Bojcun, PE Structural Engineer - Trinity Solar INSTALLATION OF NEW ROOF MOUNTED PV SOLAR SYSTEM 1 HIGH MEADOW ROAD NORTHAMPTON, MA 01062 42.3200325,-72.6724443 HIGH MEADOW ROAD P1 ISSUED TO TOWNSHIP FOR PERMIT 12/12/2022 NO.DESCRIPTION DATE BERENSON, RONALD TRINITY ACCT #: 2022-11-794268 1 HIGH MEADOW ROAD NORTHAMPTON, MA 01062 42.3200325,-72.6724443 PROPOSED PV SOLAR SYSTEM DRAWING DATE:12/12/2022 DRAWN BY:RM REVISED BY: DC SYSTEM SIZE:5.6kW AC SYSTEM SIZE:5kW MODULE COUNT:14 MODULES USED:HANWHA 400 MODULE SPEC #:Q.PEAK DUO BLK ML-G10.a+ 400 UTILITY COMPANY:NAT'L GRID UTILITY ACCT #:90710-82006 UTILITY METER #:31680982 DEAL TYPE:SUNNOVA P1 2211 Allenwood Road Wall, New Jersey 07719 877-786-7283 www.Trinity-Solar.com ROOF 1 MODULES: 0 PITCH: 37° ORIENTATION: 322° ROOF 2 MODULES: 14 PITCH: 37 ORIENTATION: 142 ROOF 3 MODULES: 0 PITCH: 37° ORIENTATION: 142° ROOF 4 MODULES: 0 PITCH: 37° ORIENTATION: 322° DC AC D ep M N S270 9013522545315 42.3200325,-72.6724443 14 HANWHA 400 (Q.PEAK DUO BLK ML-G10.a+ 400) 1 SE5000H-US000BEi4 BASEMENT OUTSIDE. OUTSIDE (UTILITY ACCESSIBLE)OUTSIDE. P1 ISSUED TO TOWNSHIP FOR PERMIT 12/12/2022 NO.DESCRIPTION DATE BERENSON, RONALD TRINITY ACCT #: 2022-11-794268 1 HIGH MEADOW ROAD NORTHAMPTON, MA 01062 42.3200325,-72.6724443 PROPOSED PV SOLAR SYSTEM DRAWING DATE:12/12/2022 DRAWN BY:RM REVISED BY: DC SYSTEM SIZE:5.6kW AC SYSTEM SIZE:5kW MODULE COUNT:14 MODULES USED:HANWHA 400 MODULE SPEC #:Q.PEAK DUO BLK ML-G10.a+ 400 UTILITY COMPANY:NAT'L GRID UTILITY ACCT #:90710-82006 UTILITY METER #:31680982 DEAL TYPE:SUNNOVA P1 NOTES: 1.) ALL EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE WITH THE MANUFACTURER'S INSTALLATION INSTRUCTIONS. 2.) 3.) ALL LOCATIONS ARE APPROXIMATE AND REQUIRE FIELD VERIFICATION. ALL OUTDOOR EQUIPMENT SHALL BE RAIN TIGHT WITH MINIMUM NEMA 3R RATING. M UD SP P DC AC ep D DC 2211 Allenwood Road Wall, New Jersey 07719 877-786-7283 www.Trinity-Solar.com SD TS CALCULATIONS FOR CURRENT CARRYING CONDUCTORS REQUIRED CONDUCTOR AMPACITY PER STRING [NEC 690.8(B)(1)]: (15.00*1.25)1 = 18.75A AWG #10, DERATED AMPACITY AMBIENT TEMP: 33°C, TEMP DERATING FACTOR: .96 RACEWAY DERATING = 2 CCC: 1.00 (40*.96)1.00 = 38.40A 38.40A >_ 18.75A, THEREFORE WIRE SIZE IS VALID TOTAL AC REQUIRED CONDUCTOR AMPACITY 21.00A*1.25 = 26.25A AWG #10, DERATED AMPACITY AMBIENT TEMP: 30°C, TEMP DERATING: 1.0 RACEWAY DERATING <_ 3 CCC: N/A 40A*1.0 = 40A 40A >_ 26.25A, THEREFORE AC WIRE SIZE IS VALID CALCULATION FOR PV OVERCURRENT PROTECTION TOTAL INVERTER CURRENT: 21.00A 21.00A*1.25 = 26.25A --> 30A OVERCURRENT PROTECTION IS VALID ARRAY CIRCUIT WIRING NOTES 1.) LICENSED ELECTRICIAN ASSUMES ALL RESPONSIBILITY FOR DETERMINING ONSITE CONDITIONS AND EXECUTING INSTALLATION IN ACCORDANCE WITH NEC 2020 2.) LOWEST EXPECTED AMBIENT TEMPERATURE BASED ON ASHRAE MINIMUM MEAN EXTREME DRY BULB TEMPERATURE FOR ASHRAE LOCATION MOST SIMILAR TO INSTALLATION LOCATION. LOWEST EXPECTED AMBIENT TEMP = -16°C 3.) HIGHEST CONTINUOUS AMBIENT TEMPERATURE BASED ON ASHRAE HIGHEST MONTH 2% DRY BULB TEMPERATURE FOR ASHRAE LOCATION MOST SIMILAR TO INSTALLATION LOCATION. HIGHEST CONTINUOUS TEMP = 33°C 4.) 2005 ASHRAE FUNDAMENTALS 2% DESIGN TEMPERATURES DO NOT EXCEED 47°C IN THE UNITED STATES (PALM SPRINGS, CA IS 44.1°C). FOR LESS THAN 9 CURRENT-CARRYING CONDUCTORS IN A ROOF-MOUNTED SUNLIT CONDUIT AT LEAST 0.5" ABOVE ROOF AND USING THE OUTDOOR DESIGN TEMPERATURE OF 47°C OR LESS (ALL OF UNITED STATES) 5.) PV SYSTEM CIRCUITS INSTALLED ON OR IN BUILDINGS SHALL INCLUDE A RAPID SHUTDOWN FUNCTION THAT CONTROLS SPECIFIC CONDUCTORS IN ACCORDANCE WITH NEC 690.12(A) THROUGH (D) 6.) PHOTOVOLTAIC POWER SYSTEMS SHALL BE PERMITTED TO OPERATE WITH UNGROUNDED PHOTOVOLTAIC SOURCE AND OUTPUT CIRCUIT AS PER NEC 690.41 (A)(4) 7.) UNGROUNDED DC CIRCUIT CONDUCTORS SHALL BE IDENTIFIED WITH THE FOLLOWING OUTER FINISH: POSITIVE CONDUCTORS = RED NEGATIVE CONDUCTORS = BLACK NEC 210.5(C)(2) 8.) ARRAY AND SUB ARRAY CONDUCTORS SHALL BE #10 PV WIRE TYPE RHW-2 OR EQUIVELANT AND SHALL BE PROTECTED BY CONDUIT WHERE EXPOSED TO DIRECT SUNLIGHT. SUB ARRAY CONDUIT LONGER THAN 24” SHALL CONTAIN ≤ 20 CURRENT CARYING CONDUCTORS AND WHERE EXPOSED TO DIRECT SUNLIGHT SHALL CONTAIN ≤ 9 CURRENT CARRYING CONDUCTORS. 9.) ALL WIRE LENGTHS SHALL BE LESS THAN 100' UNLESS OTHERWISE NOTED 10.) FLEXIBLE CONDUIT SHALL NOT BE INSTALLED ON ROOFTOP AND SHALL BE LIMITED TO 12” IF USED OUTDOORS 11.)OVERCURRENT PROTECTION FOR CONDUCTORS CONNECTED TO THE SUPPLY SIDE OF A SERVICE SHALL BE LOCATED WITHIN 10' OF THE POINT OF CONNECTION NEC 690.9(A)(3)(2) 12.) WHERE TWO SOURCES FEED A BUSSBAR, ONE A UTILITY AND THE OTHER AN INVERTER, PV BACKFEED BREAKER(S) SHALL BE LOCATED OPPOSITE FROM UTILITY NEC 705.12(B)(3)(2) 13.) ALL SOLAR SYSTEM LOAD CENTERS TO CONTAIN ONLY GENERATION CIRCUITS AND NO UNUSED POSITIONS OR LOADS 14.) ALL EQUIPMENT INSTALLED OUTDOORS SHALL HAVE A NEMA 3R RATING LOCKABLE 60A DISCONNECT FUSED W/ 30A FUSES SQUARE D PN: D222NRB ISOLATED NEUTRAL 240V 1Ø NOTE: INTERNAL REVENUE GRADE MONITORING CONTAINED WITHIN SOLAR EDGE INVERTER SOLAR EDGE PN. RWND-3D-240-MB NEUTRALEXISTING MAIN BREAKER LOAD CENTER INSULATED LINE TAPS INSTALLED ON MAIN FEEDERS NEC 705.12(A) M 2p200AMAIN240V 1Ø 200A MAIN BREAKER 200A BUSBAR EXISTING 1Ø 120/240V UTILITY METER EG INVERTER #1 - SE5000H-US000BEi4 DC AC Imp 13.5 Pout 5000 Vmp 380 Imax 21 Voc 480 OCPDmin 26.25 Isc 15 Vnom 240 PV MODULE SPECIFICATIONS HANWHA 400 (Q.PEAK DUO BLK ML-G10.a+ 400) Imp 10.77 Vmp 37.13 Voc 45.3 Isc 11.14 A #6 THWN-2 GEC TO EXISTING GROUND ROD B 3/4'' CONDUIT W/ 2-#10 THWN-2, 1-#10 THWN-2, 1-#10 THWN-2 GROUND C 3/4'' CONDUIT W/ 2-#10 THWN-2, 1-#10 THWN-2 GROUND D 3/4'' CONDUIT W/ 2-#10 THWN-2, 1-#10 THWN-2 GROUND E 3/4'' CONDUIT W/ 2-#10 THWN-2, 1-#10 THWN-2, 1-#10 THWN-2 GROUND F #10 PV WIRE (FREE AIR) W/ #6 BARE COPPER BOND TO ARRAY G 3/4'' CONDUIT W/ 2-#6 THWN-2, 1-#6 THWN-2, 1-#8 THWN-2 GROUND NOTE: CONDUIT TYPE SHALL BE CHOSEN BY THE INSTALLATION CONTRACTOR TO MEET OR EXCEED NEC AND LOCAL AHJD REQUIREMENTS INVERTER #1 PV+L1 L2 N PV-D SOLAR MODULES MOUNTED TO ROOF ON 1 ARRAY 14 - 400W MODULES W/ 1 SOLAR EDGE S440 PER MODULE 15 ADC MAX PER STRING 1 STRING OF 14 MODULES IN SERIES - 380 Vmax *TERMINATED INSIDE INVERTER 1 f 8"x8" JUNCTION BOX P1 ISSUED TO TOWNSHIP FOR PERMIT 12/12/2022 NO.DESCRIPTION DATE BERENSON, RONALD TRINITY ACCT #: 2022-11-794268 1 HIGH MEADOW ROAD NORTHAMPTON, MA 01062 42.3200325,-72.6724443 PROPOSED PV SOLAR SYSTEM DRAWING DATE:12/12/2022 DRAWN BY:RM REVISED BY: DC SYSTEM SIZE:5.6kW AC SYSTEM SIZE:5kW MODULE COUNT:14 MODULES USED:HANWHA 400 MODULE SPEC #:Q.PEAK DUO BLK ML-G10.a+ 400 UTILITY COMPANY:NAT'L GRID UTILITY ACCT #:90710-82006 UTILITY METER #:31680982 DEAL TYPE:SUNNOVA P1 2211 Allenwood Road Wall, New Jersey 07719 877-786-7283 www.Trinity-Solar.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 5/13/2022 Arthur J.Gallagher Risk Management Services,Inc. 4000 Midlantic Drive Suite 200 Mount Laurel NJ 08054 Mark Grasela 856-482-9900 856-482-1888 CherryHill.BSD.CertM@AJG.com Gotham Insurance Company 25569 TRINHEA-03 National Union Fire Insurance Company of Pittsburg 19445TrinitySolarInc. 4 Open Square Way,Suite 410 Holyoke,MA 01040 Liberty International Underwriters 1260165960 A X 2,000,000 X 100,000 5,000 1,000,000 2,000,000 X GL202100013378 6/1/2021 6/1/2023 2,000,000 B 2,000,000 X CA 2960145 6/1/2022 6/1/2023 A C C X 5,000,000 X EX202100001871 ELD30006989101 1000231834-06 6/1/2021 6/1/2022 6/1/2022 6/1/2023 6/1/2023 6/1/2023 5,000,000 Limit x of $5,000,000 19,000,000 B XWC135881086/1/2022 6/1/2023 1,000,000 1,000,000 1,000,000 B Automobile Comp/Collusion Ded.CA 2960145 6/1/2022 6/1/2023 All Other Units Truck-Tractors and Semi-Trailers $250/500 $250/500 Evidence of Insurance. Evidence of Insurance JOB NAME:BERENSON, RONALD ADDRESS:1 High Meadow Road Northampton, MA 01062 42.3200325,-72.6724443 37.84 ESTIMATED PERSONNEL HOURS 1.58 DAYS 1.18 DAYS 0.79 DAYS •14 HANWHA 400's (5.6KW)(CREW OF 3)(CREW OF 4)(CREW OF 6) •1 ARRAY •23' PEAK TO GROUND •14 PORTRAIT & 0 LANDSCAPED •1 INVERTERS INSTALLED OUTSIDE •NO TRENCH ESTIMATED SENT TO JOB USED □HANWHA 400 (Q.PEAK DUO BLK ML-G10.a+ 400)14 ______ □S440 SE OPTIMIZERS 14 ______ □SE5000H-US000BEi4 1 ______ □60A OUTDOOR FUSED DISCONNECT W/ (2) 30A FUSES 1 ______ □60A OUTDOOR NON-FUSED DISCONNECT 1 ______ □SOLADECK BOX(ES) & HAYCO CONNECTOR(S)1 ______ □PV LEAD WIRE 50'______ □INSULATED BUG BITES (LINE TAPS)2 ______ □CASE(S) OF BLACK SPRAY PAINT 1 ______ □CASE(S) OF TAR 1 ______ □FLASHINGS ______ □1P20A SIEMENS BREAKER 6 ______ □1P15A SIEMENS BREAKER 7 ______ □1P15A AFCI SIEMENS BREAKER 2 ______ MATERIAL LIST (FOR INTERNAL USE ONLY) 2211 Allenwood Road Wall, New Jersey 07719 877-786-7283 www.Trinity-Solar.com INSTALLATION OF NEW ROOF MOUNTED PV SOLAR SYSTEM 1 HIGH MEADOW ROAD BERENSON, RONALD 1 HIGH MEADOW ROAD NORTHAMPTON, MA 01062 42.3200325,-72.6724443 APPENDIX CONTENTS LABELS, STICKERS, AND PLACARDS EQUIPMENT DATA SHEETS 2211 Allenwood Road Wall, New Jersey 07719 877-786-7283 www.Trinity-Solar.com