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BP-79910 Permit No. BP-79910 BUILDING PERM) Gist15294.00 Colnrnonweatth bf9Pia,*satfiusetts Map: 0070 TO OFpAR TOC1QliTHAr Lot: 0013 -4003Wocurq oadparhitlmth MPc 0747 Sub-Lot: 0035 ,Phornh.(508)910 1820 s-,.) e(5a8)7110 1838 Category: . SOLAR PANELS q `Project# JS-2016-001829 PERMISSION IS'LfEItEHT(;RA l!ED TO: °r' Est.Cost:. $21116.00 Contractor: > fcense ' Phone'# '- Fee: $75.00 PHILIP MCCAR*ON ";' , Z s f (S08)9301405 Const.Class: , 9. , jaw, , Use Group: R3 - Engineer - ,-2 R j T. a Phone# Lot Size(sq.ft.) 3:37A a s. ,ca4lc.-:-.-ai:.:-;.2. ': Zoning: SRB Applicant: <, �,< 33 ^�'� *,t� , P&one# Aquifer Zone: N/A BAY STATE SOLAR a_ ' Te'-` -,"4e acl(508)93b-1405 Flood Zone: ZONE X ONTER: - New Coast.: N/A Y' ,;X,4 ,. '�, , BARBOSA ROGERAi�'� a �tii 1 i1s + :: Alt.Coast: N1A - t!<x ` _, , ' °�* i Date Typed: 12-22-2015 . DATE ISSUED . 3. :- `: { TO PERFORM THE FOLLOWING WORK: Install a thirty five panel photovoltaic array on existing rooftop --"9 625 KW . _ �/Prroject Location: 94 JJ)/M�/ILLERS DR Approved/Issued By: A.c: iiHlQ. .i.cc_i DAVID BRUNE LOCAL BUILDING INSPECTOR All work shall comply with 780 CMR 8Tu Ed.(MGL Chap.143)and any other applicable Mass.Laws or Codes and plans on file. Schedule appropriate inspections as required. Upon completion,final inspection is required. I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his agent and to receive this permit, I further understand other a rin ies may have reason to STOP WORK if items under their jurisdiction are not met; not withstanding the issuance of this Build' ' g Perm:t. (��JJJ,/ Signature of Owner/Agent: 11� "Persons contracting with unregistered contractors do not have access to the guaranty fund(as set forth in MGL c.142A)" Inspector of Inspector of D.P.W.Inspector Building Inspector Inspector of Gas I Fire Department Plumbing Wiring Water Service#: Footings: Underground: Oil: Underground: Service: Foundation: Rough: Smoke: Rough: Rough: Sewer Service#: Rough Frame: Insulation: Final: Final: Final: Cross Connection Final: Final: Board of Health E-911 Additional Comments: Planning Board Prior to issuance of Certificate of Occupancy/Completion,this card must be returned to the Building Department with all necessary inspections signed off. Department phone numbers are listed on the white"Required Inspections"document provided with the issuance of the building permit. POST CARD SO IT IS VISIBLE FROM THE STREET Y TOWN OF DARTMOUTH -$JJILDJNG DEPARTMENT RECEIPT 79910 PHONE: 508.910.1820 FAX: 508-910.1838 /3G iv it - /°rat ' Name ProperryOwn r: �� Dat : e Job Location: / 'Cf Map: 7/ Lo/3 ,a-S Description General Ledger#' ah^ou Ref. # Amount Building&Building Misc. 01000-441 zF � i itt'-- 2c:6r Electrical 01000-44 1O Plumbing & Gas 01000-44 07 0��' 1 v.9 n '', ' Trench Safety 01000-4412N' ',',,. ° Other Department Revenue 01000-424207 ` V , -� �_ ii white-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Budding Department Received y •THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS Y • RESIDENTIAL • • O Phased Approval(R106.3.3) ppe�rr ivi $25.00 APPLICATION FEE IS NON RE•FIINDAIILE &NON f_ri uiH� ,::.,. ,-n DATE REGEQll ,.:. '/ �Ko�•n." DARTMOUTH BUILDING DEPARTMENT !or 4:. fio A. r<_r =I 400 Slocum Road Dartmouth,MA 02747 1DI5 DEC I I AM IC: 3 I =_ c • `lc -`="r'J Phone: 508-910-1820 Fax: 508-910-1838 www.town.dartmoufh.ma.us APPLICATION TO CONSTRUCT,REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING .+A'"... x ..a3 '# w�,t''" `'xb`.lsw"c�S-s � � e ihf+,e ' �0..ate'-'�wm ,r..:;;Q .4 ' -4" . '`s :l ' r: tt'Fir ` ".�.. "> ".:.esf 1 e-.. ti iw. ".r'-e'�s',,.'S.-"17 -� h "a3'ht- tax tr g s .B is ti : ��z L D MG I TN•UMBER"� / �S— �.,. yC^L sat. �F ' r.(. t A I a�' `� n a5 , t. )",'.`r.A 1 2't`'iv .5 kws y s 'ri44" y,,atr 3;45mrh"vxv <itft, 'is`. .'> fir ,: i k'i` r C_,� rr S �, s y ' � y S 1�.•SS r� tr� ' ' � Iry N DAB / / b bn" ar. i yh'.. t$r • i. kt, rn'1 .,�`-I' .0 7 1 - o h� x e 'rvr. .o sz > p dlis rr w A sF'Aqu'ifer',�(Qr1 ,47-4 t .fr-04 2R h ^JY' ..f� t h 4 - >tr of . 1 Oo s r°'"Y ait�bt t'S ° ti i d. a, [TEngineenng [; Gross +Ti. w '< p it r�L f'r'' ttr �f Xi" - '• 0 ,;.c ' .' a w*r �,�40a l Sr i b`x-`t e .,-.n" i;ECo n,% r. ' r� ui i ��y L4 4'y 0 �`ieli H FO,,�tgj�e! Sr. 2 x+11i y .7. ..rW'9' 1,uyria O j r E�.W fl a7l� f?;0, ,,erf: „. Cut''o f ' .Cut Qfr Cut Off r;a AZA. -1 -4 y « rr .;....-, z ay b�.. yr t. a xc � ^::.s's..+as��.r." �."S'�s�d Y'�}�rt'" ���'C'c.-:.,�, .... , - � ., . - Board of Health: Signature: Date: Conservation Commission: Signature: Date: D.P.W.: Signature: Date: Fire Chief: Signature: Date: Other: Signature: Date: Brief description of work being performed: UV I a it r 1.1 Property Address: 94 Millers Drive 1.2 Assessors Map&Lot1 Number: Contact Person: Philip McCarron Map U lot • Phone Number: 508-930-1405 1.3 Historical District D Yes ❑No 1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposal System: Year Built O Municipal 0 Municipal ❑Altering more than 25%per side of building ❑ Private Well p On Site Disposal System Has application been submitted to the Historic Commission? Q Yes 0 No Date: Revised 5113 fl r_fNCTPI If'-TIf1N PI ANC f CITP PI AMfl PMCPf2Y RGPnRT llis.--..•IA. • `v ,fli`''�z'� 'S2 ?ir-criC.,s n',kr ilit.. ,;_. , .. it4R- .spec ° '1. ,-* M. 2.1 Owner Record: Roger Barbosa • 94 Millers Drive . 508-994-8700 Name(print) Contact Address Phone Number 2.2 Authorized Agent:, Philip McCarron 2 Shaylee Ln Lakeville, Ma 02347 508-930-1405 Name(print) Contact Address Phone Number ;Wit. � C 3.1 Licensed Construction Supervisor/Specialty License: Philip McCarron License Number. 71992 Company Name/Contractor Name: Bay State Solar Address: 2 Shaylee Lane Lakeville, Ma 02347 Expiration Date: 05/09/16 Signature: Telephone: 508 930 1405 3.2 Homeowner Exemption-One&Two Family Only Section 110.R5:1.3.1 Exception: FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN.PROJECT Exception: Any Homeowner performing work for which a Building Permit Is required shall be exempt from the provisions of this sedan;provides that if a Homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor, For the purposes of this section only,a'Homeowner Is defined as follows: Person(s)who owns 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, if you are applying under this sections sign below: Signature: w ssy`(.::'�"a-Fi 10_:IV Wriarp, 5-_ atFrr ti ei t n aT.t Wl in.bibt;e is h - as_ Worker's 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 • 0 Deck 0 Pool 0 Repairs 0 Alteration Cl Chimney/Fireplace 0 Woodstove/Pellet Stove 0 New Construction* 0 Accessory Bldg. .D Addition C] Roofing/Siding ❑ Replacement window/door (Energy report required) (Shed/Garage) (Energy report required) No.of windows Doors • • ❑ DEMOLITION(specify): Location of debris removal(per MGL C.40 Sec 54): 0 Dumpster on site 0 Dumpster On Street Facility Name: Cleanway Fall River, Ma 02720 Location: *If new construction,please complete the following: Single Family: No.of Bedrooms No.of Baths Two Family: No of Bedrooms Unit 1 No.of Baths Unit 1 • No of Bedrooms Unit 2 No.of Baths Unit 2 O Furnace(hot air)-fuel gas(natural or propane),fuel oil,electricity,other(specify): Boiler(heating)-fuel gas(natural or propane),fuel oil,electricity,other(specify): ❑HVAC(combined unit)-primary fuel,natural gas,propane,electricity,other(specify): ❑Air conditioning-(separate unit) 0 None of the above to be provided O Hot Water. Gas Electric Fuel Oil Other Y �y •ter' i-��. �`. ♦..: ,p y��.WY Item Estimated Cost($)to be completed by permit applicant _ 1. Building $ 2,500.00 2. Electrical $_7,000.00 3. Plumbing • '7 4 Mechanical(HVAC) 5 Total=(1 +2+3+4) $ 9,500.00 rQ . � � r tr 79+4ac• 2 1 rn s gat'—Wt d,' "14/444144I I �s• ` } zr C <�� n pEd �. '� �if. 3,F ;: : vjX�4P: ) . - (Please Print) Roger Barbosa Philip McCarron ,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. See Attached 12/11/15 Signature of Owner • Date Philip McCarron ,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. /y'"�- 12/11/15 Signature of Owner/Aurized Agent Date ��///�• Less Application Fee:$25.00 Remaining Balance: $ Total Permit Fee:$ Other$Amount$ Gross Area-New Construction total sq.ft. .. Gross Area-Alteration total sq.ft. �� Permit Issued to:, 4'7 �LXq—� 35 ' Yyyr•�� t454, � ct&2g7 • F* E 1y'. 'ref' .'+,'- t.a' `y.w i 7 i r `';`, T`c:'imint j z r f e..S'Y ax 3 z- i - ffk Y� �i:u:,r. � 2�....efw.� 4 < ..�� ,. .y� � tr'... ..ji.,, rn." �.rya...na�� "i-�e,�., grvt�.'. I stall 12 solar panels to existing roof. 9.625 kw • Permit No. BP-79910 Project Location: 94 MILLERS DR Commonwealth o !Iasachusetts TOWNm OF D OUTH 13 P !§! ti: p- ,a�'bra .,�..� , „ v e r. !�. � €�' 3#"-;-x a''x 400 Sylocurn ko d Dartttnouth A 0274 ''00 s max 110149,008)�910-1820 'Fax (508)'S 10 183 1i12 z a.OU 5 $; N I' r $ sticlyettstrift.t4P 'PM .Rt K '- ° Atela 6 d, a1/4 p 3 so-a w .`%s �? to a `•'y,'��lT 3 �� 1 4� �� t " ". , ,yn, ri tot—.� • a,a .. xIfilitla a l 't i I ij EM, Contractor- - } ,,� � tense Phone#: PHILIP OC RRON � ,' -0 n199241 ,(508)930-1405 . ` ', N' � l' ' II II''4 t'Y 1 Si'79404 j Pr-tie e 1 �"1 IFS.. S 1 P 1.�� 'Vat Y {*f�e`y} Ti h{ 1 1 ta+ Engineer -} se : Phone#. - i d, < t , r, a ' � I.NI , . Applicant: r , , rya ,„'�4 '' Phone #: I?' F m B i kr*Vita �l BAY STATE SOLAR; 4 61 � (508) 930-1405 K:S' l, - ;i,16 OWNER: s t.Cu 'NIA 4 n BARBOSA ROGER A& AiTst,• r �DATE ISSUED: / D TO PERFORM THE FOLLOWING WO U p Install a thirty five panel photovoltaic array on existing rooftop - 9.625 KW DATE TIME TYPE OF INSPECTION&REMARKS INITIAL �St DocuSign Env_elo a ID:C9B95812-CAD7_-46DE 9CF3-17F24DD0436F ar` sk.R- i :, fr. ,Ytl w v 7 .. 1,1. n `i h`" s+. x i � � u4 i' OWNER'S AUTHORIZATION FORM For Permit Application(s) The sole purpose of this form is to provide Sun Run Inc with the Necessary permission from the Owner to file Permit Application(s) for such Project work as agreed upon between the Owner and the Owner's Authorized Company and its designated subcontractors. Roger Barbosa Owner's Name: Solar Project Address: 94 Millers Dr.Dartmouth,MA 02747 Signature: Owner's Authorized Company: Sun Run Inc. Company's Address: 595 Market St 29th Floor, San Francisco, CA 94105 Affiliation: Contractor Applicable License: State: MA G^ ;1 eci to ` amlrwntzlea, i /C% ctJ ac/%1ti.e { ;' Office of Consumer Affairs and Business Regulation <. 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 179404 Type: Individual Expiration: 7/28/2016 Tr# 255733 PHILIP MCCLARRON PHILIP MCCARRON 2 SHAYLEE LANE LAKEVILLE, MA 02347 --- --. Update Address and return card.Mark reason for change. -'. Address Renewal Employment i Lost Card SCAt C 10M-05/ 1 — . Office orConsumer A frairsi &e Business Regulation'fit License or registration valid for individul use only „, ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: eea egistmtion:- 179404 Type: Office of Consumer Affairs and Business Regulation tie `xpIretion- 7/28/2016 Individual 10 Park Plaza-Suite 5170 gip" Boston.MA 02116 PHILIP MCCLARRON PHILIP MCCARRON ^ 2 SNAYLEE LANE +„f� .. LAKEVILLE,MA 02347 <sr.a rsecr G't ,�.,.:.. -_ .f,.-,._ —_..:,.:_ _,_,._.. Undersecretary Not valid without signature ��.e0td�,Laii a#_% a . n r DIVISICDN or, PROFESS tdAL GICENSLIF{E / I i1'1 sl)IV SION OF PROFESSIONAL L C i . t ISSUES TIIE FOLLOW I'� ' S . ISSUES'THE F LOWI LI Nit{ .. R€G•?� MASTER E ECTRICIAf . = B � U r �Y��,y mi� �Bt.Ef.TR?CidF1�`t` F. Lli ^� S Ft�i �� d v , t :sso-i 'z cd 2 SHAYLEE �; ± 2 SHAYLEE Y'^. 3ANE Y J,r '"` 'i„ 1 --<cnL.LE ma 029441852y i L%-Ax v11.4 At k 14068 «-4 07/31/1 .6'y3fi?s" 'J698T :, .j11-1{{t` ':` Y':.. /31 19 :alP -- 't :wn�. .wNi6..%vroa.iry -s "'• .t eLY.,,`,�!'i�e4:. Y`, 0 err r .P ..an.....,.r.m ^4ba,..Y.+—_ M+rm•..m.aa.._..i.._..... �.aw.yFe.... , IgtMassachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License CS-071992 ,/ PHILIP MCCARION C. .. tam r"'!„ 2SHAYLEELN S ,,.a cs,, LAI�VII,I,E M.f � { 4 jr ✓./.....,-a Ati.- ."rn Expiration Commissioner 05109/2016 A RORo o® CERTIFICATE OF LIABILITY INSURANCE DATE(MNw°"Yn' 8/3'1/2015 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) 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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Hadley Insurit Group PHHOONN Fluty508-678-5267 FAX,No):508-673-0322 246 Durfee St Fall River MA 02720 E-MAIL E-MAILADDRESS:chadley@hadleyinsurit.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Scottsdale Insurance Company INSURED MCCAR-1 INSURER B:Pilgrim Ins Co Philip McCarron DBA INSURER C: Bay State Solar 2 Shaylee Lane INSURER D: _,- Lakeville MA 02347 INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER:796962432 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL WUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WYD POLICY NUMBER (MWDD/YYY1) (MM/DD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY CPS2195257 8/24/2015 8/24/2016 EACH OCCURRENCE $1,000,000 AMAGE TO CLAIMS-MADE X OCCUR PREM SES(EaENTED occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ R AUTOMOBILE LIABILITY P0000001018678 4/2/2015 4/2/2016 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL SCHEDULED I UT ' AO BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY YIN S EH STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? - (MandatoryinNH) E.L.DISEASE-EA EMPLOYEE $ 0 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Builders Risk CPS1898681 8/24/2015 8/24/2016 Installation Floater 50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Bay State Solar ACCORDANCE WITH THE POLICY PROVISIONS. 2 Shaylee Lane Lakevill MA 02347 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Rightfax C3-2 9/21/2015 6:08:29 AM PAGE 2/002 Fax Server •"" 1' " [DATE(MM/DD/YYYY1 �t 3rtf CERTIFICATE OF LIABILITY INSURANCE L D9(210015 • T IFICATE 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. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(Ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: HADLY INSURIT GROUP PHONE FAX 246 DUFEE ST. (NC,No,Ext): (A/C,No): E-MAIL FALL RIVER,MA 02720 ADDRESS: 7827S INSURER(S)AFFORDING COVERAGE NAM N • INSURED INSURER A: HARTFORD UNDERWRITERS INSURANCE COMPANY 0 1 MCCARRON,PHILIP DBA BAY STATE SOLAR INSURER B: INSURER C: INSURERD: 2 SHAYLEE LANE INSURER E: LAKEVILLE,MA 02347 i INSURER F: COVERAGES CERTIFICATE NUMBER: 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 NSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMAD\YYVY) (MMDD\YYYY) LIMITS GENERAL IJABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL_LABILITY Y DAMAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES(Ea occurrence) ED EXP(Any one person) $ I— - hPERSONALBADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ED POLICY 0 PROJECT D LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE UABILTrY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ ram SCHEDULE AUTOS (Per person) HIRED AUTOS _ Fir BODILY INJURY $ (Per accident) NON-OWNED AUTOS - �� PROPERTY DAMAGE $ I. _ ' (Per accident) amra UMBRELLA LIAB OCCUR EACH OCCURRENCE $ .r— EXCESS LIAB - CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ rt.. RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABIUTY YIN UB-9975A282-15 09/19/2015 09/19/2016 CMITS ANY PROPERITORIPARTNER/EXECUTIVE ICI N/A E.L.EACH ACCIDENT $ 1,000,000 R/MEMBER EXCLUDED? I I (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 II yes describe uncer DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. MCCARRON,PHILIP IS COVERED BY THE WORKERS'COMPENSATION POUCY. CERTIFICATE HOLDER CANCELLATION . BAY STATE SOLAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 2 SHAYLEE LANE BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIOVB.,,,, AUTHORIZED REPRESENTATIVE ''„_ J+f"t.' , LAKEVILLE,MA 02347 `� i ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPOSATSCi'AfI`il'tPubs reserved. The Commonwealth of Massachusetts Department of Industrial Accidents /r.....: MIR it Office of Investigations � i1 Congress Street,Suite 100 4.4%�� Boston,MA 02114-2017 � www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Philip McCarron DBA/ Bay State Solar Name (Business/Organization/Individual): Address: 2 Shaylee Lane City/State/Zip: Lakeville, MA 02347 Phone #: 508-930-1405 Are you an employer? Check the appropriate box: Type of project(required): 1.® I am a employer with 5 4. ® I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ®New construction listed on the attached sheet. 7. ® Remodeling 2.® I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ® Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. $ 9. ® Building addition required.] 5. ® We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs oritii*ieq ' er c. 152, §1(4), and we have no 13.® Other Solar PV employees. [No workers' bljT comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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: The Hartford Policy#or Self ins. Lie. #:6S60UB-9975A28-2-14 9/19/16 Expiration Date: 94 Millers Drive Dartmouth, Ma Job Site Address: City/State/Zip: 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 penalties of perjury that the information provided above is true and correct. 12/11/15 Signature: Date: Phone#: 508-930-1405 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#: a DocuSign Envelope ID:C9B95812-CAD7-46DE-9CF3-17F24DD0436F , d w NEC Tiff,R A. A RfaOROUS LoAO ANALYSIS .,, ,ra 146 San Jost,Court;San Luis Obsipa,CA 93405 C2 Ph:805.215.8865 3`+`: Fx:845.544-0883 DATE: 10-08-2015/Rev A FOR: Sunrun JOB: ROGER BARBOSA Garage 775 Fiero Lane Suite#200 94 Millers Drive San Luis Obispo, CA 93401 Dartmouth, MA 02747 To Whom It May Concern This letter is to certify that we have performed a structural analysis of the existing roof members that are to support photovoltaic panels, as shown on the attached report.The calculations were performed in accordance with the latest editions of IBC, NDS, ASCE/SEI, CBC, and IRC, and the 8th edition 2009 Massachusetts building code. Our analysis was based on the following design criteria: Ground Snow(psf) 30 psf Sloped Snow(psf), reduced per ASCE, Sect. 7.4 18.9 psf Basic Wind Speed (mph): 110 mph ASCE Code: 7-05 The PV module orientation: Portrait The maximum horizontal roof mount spacing: 4 ft. The maximum vertical roof mount spacing: 2.75 ft. Staggered roof mounts required? Yes Based on this analysis, we can certify to the best of our knowledge;that the individual existing roof framing members that support the PV panels;along with strengthening of those roof members if indicated;and the individual roof members as described in the attached report;are adequate to support the design loads as required by the various codes. This includes Dead Loads (including the weight of the PV panels), Live Loads, Snow Loads, and Wind Loads, on the roof members that support the PV panels, combined as required in the codes. If you have any questions on this or need further clarification, please contact us at your convenience. Sincerely James A. Adams, S.E. 447; OF S I'` v STRUCTURAL Prod /otAL Exist!:06130/2016 Digitally Signed by James A.Adams,S.E. 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