15 CHURCHILL STREET - BUILDING JACKET -p� CITY OF SALEM
` PUBLIC PROPRERTY
DEPARTMENT
:.Ivtnrata=r uata:uu
M\Ytta 12C V&%&Ne-T0KSfttettTT a SAalat,lt�sAUA tt't7ti 01973
At-97et7e5-959S a FAX:97L740.98e6
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridaru/PMmben
-knallcant Information Print Leeibly
Name lanuunatstOryni:atiavltulrvldtnl):
Address:-:1] `rye CC e cz�zir
City/StatciZip r� '. Phone H:
Are you as employer?Cheek the appropriate bone
1.❑ 1 am a employer with 4. Q 1 am a general coauaetor and 1 6. [ of Protons(►coon )
6. Q Now construction
ernpluyaros(full aruLw part-time)• have hired the tub-cunerat:tors
2. 1 am a sole proprietor or partner- listed on the attached sheet t 7. ❑ RemodelinS
ship and have no employees These wb.eonpaetma have s. Q Demolition
working for me in any capacity. workers' comp instance. 9. Q Budding addition
(too workers'camp, insurance S. Q We am a corporation and its 10.❑Electrical repair or additions
required) officers have exercised their
3.ElI am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or addition
myself.(Ko workers'comp. C. 152,41(4),and we have no 12.HRuofrepairs
insurance required.) t :mploycea. [No workers' 13.❑Other
comp. ittwrance requrexl.]
Ant+ppbKmol Ole dwcas boa el mice alto its aW ale seelian babuw ttewiYa their MWkia'tonippW{ya pdKy ioamn uioa,
Itwwownes who submit the smdwit indksehla te.y aw doing at conk and nice Mai out"eanumm wAw.ubmin a saw anhhvit inJiakina cosh.
=romrxvxa the chat Otis boa mot aexhad On additional AM Jmwuy Me name otne old skein wurkma'camp•policy whim adoa
I am on employer that Is providing workers'compensadon i saroncefor cry employeex Below Is the polity and Job site
hrformatitna
Insurance Company Name•.
Policy 0 or Self-its. Lie.ri: _ .. Ecpirdtion Date:
Job Site Address: Cilyistawzip:
.%ttach a copy of the workers'compensatlon policy declaration page(showing the policy number and espirativa date).
Failure to saute coverage as required under Section 25A of NGL c. 152 can lead to the imposition of eriminal penalties of a
ri ae up to S1,300.00 and/or one-year imprisonment,as well as I:ivil punallics in the form of a STOP WORK ORDER and a fiat
of up to S250.00 a day against the violator. Ile advised that a copy of this slaement muy be forwarded to the Office of
Im sttgauotts of the DIA for insurance covcngc vcrificaliun.
I do hereby certify under the paink,-titliteenuilks of perjury that the lafarmatloa provided above is Irmo and correct
tii�:taturer Date- \OIIN 10-7
09kial mse aalA DO ea write IN Ak area,to be completed by My or town off eAui
City or'rown: Permid1.1ccnse k __
hsuing Authority (circle one):
1. Iluard of health Z. Building Department 3.Civrowo Clerk 4. Electrical Inspector S. Plumbing Inspector
6. Other
Contact Person: _ Phone M•
Information and Instructions
,%lustchusetts General taws chapter 152 requires all employers to provide workers' compensation for their employe&
Pursuant to this game.an employ"is defined as"..'every person in the service of another under any contract of hits,
eaptess or implied,oral or written"
.%n eA*y4r is definer as"an istdividtu(,partnership,anocianea,corporation or odor Ingal entity,or any two or mom
of the foregoing engaged in a joint enterprise.and including the legal representatives of a deceased employer,or the
association or other legal entity.employing employees However the
receiver arm— of an individual,of moperum s6tR and who reside thaeieo fir the ocertps0 of rho
owner of a dwelling house having not more than throe maintapartenance.
dwelling house of another who employs Persons to do maiateasace,construction or repots work a such dwelling house
or on the grounds or building appurtenant thertan shall not because of such employment be deemed to bean employs."
1`tGL chapter l52 af25C(6)also antes tint"every stab or local licensing agency shall withhold the Issuance or
renewal of a&COO or permit to operate a business at b construct be lldtngs In the commoeweattY for any
appBeaat"be has ant produced aeeeptablo avideoee of eompganee with the insurance coverage required"
sha
Additioaally.MGL chapter 152.625C('7)states"Neither the coaurmnwealth mar any of its political subdiviaioos ll
moat into any conasct 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 affWevit completely.by checking the boxes that apply to your situation and.if
necessary.supply sub-cone aerot(s)name(s).address(es)and Phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLQ or Limited Liability Partnerships(LLP)with no employees other than the
members of punners,am 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
lndusaial Accidents. Should you have any questions regarding the low 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 thew
self-insurance license number on the avoropriatc line.
City or Town Offklab
picase he 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
lalcase be sure to till in the pertitllicetue number which will be used as a reference number. In addition,an applicant
that must submit multiple PermiUlicense applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)ant tinder"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 she
;applicant as proof that a valid affidavit is on file for fume permits or licenses. A now affidavit must be filled out each
year. Where a hone owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.it dog license or permit to barn leaves etc.)said person is NOT required to complete this affidavit.
I'hc Ofiicc of lnvestigatiuns 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
Depatament of Industfial Accidents
Oaks of Iavesillptlea
600 WashingM Stied
Boston, MA 02111
Tel. p 617-727-4900 ext 406 or 1-977-MASSAFE
Pax 0 617-727-7749
Zeroed 5-26-05 www.num.gov/dia
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
NLMIL t3C 1.tstew-:o►.i 7saT*&'Ai 1.A%VLKaSL*L-ls.:+1.
To;y7t•7aY>!tM�f.Ve 9RJ�69tN
Construction Debris Dispossf Affidavit
(required fat all demolition and renovation worst)
In=otda= with the sixdt edition of rht State Building Code.7SO Cb1R section 111.5
Debris,snd the provisions of MOL c 40.S Sk
Suil "s Permit 0 - _ is issued with the condition drat the debris resulting horn
this wort shall be disposed of in a property licensed wash disposal tbcility as dented by MC L c
It1.S130A.
The debris will be transported by:
tnawt alr haut+el
rhickbtis will be disposed of in :
Nlaaw or�rxd,ty)s -
Errrop- r.M�
PUBLIC PROPERTY
DEPARTMENT
••� r`•••t7Y�C{11J,
a/Atae
13��AW{►/CtI7M Yitiq�SM�y�'stms 01970
TW-f7eIUMN pAtV&7469W
D
�UCP[JA>t ORB m.nrlvn
• 1.0 SITE INFORMATION '
LOM*M Name
Property Addromac----
-- -
Property 15 beabd In a;Come Add Am YM Hblorb DNtk!YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Lan"
Name:
yam` �
Telephone;
3.0 COMPLETE THIS SECTION FOR WORK IN 9XMMNp BUILDINGS ONLY
Addition
Renovadon Number of stories Renovated
Change in Use New
DemoGtlon Existing
Approximate yew of Area per floor(st) Renovated
construction or renovation
of existing buildup New
Brief Dewiption of Proposed Work;
�-r:� c4- �t✓�o�
--- -- ---Mail Permit to: -
E
What h a**mot use of the ouildi 7 M dM,eMkq.Aow nmM�4-----
�Aaterial d 8u 7 AsboOm?
we the auk**Conftm to L.aw7
Atchftds t
Addro*and Phan
MeIAddress and Ptu"Nama _
�r
�sbud w supervisors lkenN HIC Ragwbabon 0 ` h l
Estimated PerrrrY Fee Cala+IaMan
Es*nated Coat X$741000 Residenllal
Permit Fee Es*nated CaR X:11/:1f10A Cormwdd -- -
- An Add lonml:0.00 is added so an
Admin ve dwge
make wh that all flelde are Property and lopibly wmm to avoid dslaYa In processing.
The undwslpned dose hereby a"fbr a Suitding Pwn*to WWI the abow stated
spedlatlorm signed undo►penalty of Penury
Date 4
vl
3
�C a `a
F c� $
� The Commonwealth of Massachusetts INSPECTION
° Board ofBuilding Regulations and Standards 'Qt ERyQt�k1'��
Massachusetts State Building Code, 780 CMR �'
� 1014 DEC �p �,�Seatirarzoll
' Building Permit Application To Construct, Repair,Renovate Or Demolish a 2 4
One-or Two-Family Dwelling
_.• This Section For Official Use Only
�jC\1 Building Permit Number: Date Applied:
�{�J ��• ��.,� ��5�«\
V Building Official(Print Neme) Signa re � Date
:�
SECTION 1:SITE iNFORMAT[ON
� 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
� 15 Churchill Street 26 0153
�'' l.la Is this an accep[ed stteet?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Proper[y Dimensions:
R1 residence-no change
Zoningbisficl Proposed Use Lot Area(sq R) Frontage(R)
1.5 Building Setbacks(ft) n/a
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.4Q§54) 1.7 Flood Zone Informallon: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: Outside Flood Zone? Municipal � On site disposal system ❑
Check if yes�
SECTION 2: PROPERTY OWNERSHIP�
2.1 Owner of Record:
Kristofer Carlson Salem, MA 01970
Narne(PrinQ City,State,ZIP
15 Churchill Street 401-651-5557 tofercarlson@me.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other I� Specify: solar
Brief Description of Proposed Work2: Installation of a 4.95kW roof mounted solar array using 18 SolarWorld SW275
Mono modules, 18 Enphase M250-60-2LL-S22 micro inverters,and all associated electrical work.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 5,000 1. Buildi�g Pernii[Fee: $ Indica[e how fee is determined:
� ❑Standard City/Town Application Fee
2.Electrical $ 18,000 ❑Total Projec[CosC�(Item 6)x multiplier x
3.Plumbing $ 2. Otl�er Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Su ression Total All Fees:$
Check No. Check Amount Cash Amoun[:
6.Total Project Cost: $ 23,000 ❑paid in Full ❑Outstanding Balance Due:
s�v,- , � � ► �S c�c- c9�� � -l� �- �
SECTION 5: CONSTRUCTION SERVICES
5.1 Constructlon Supervisor License(CSL) 101487 11/7/16
Gary Beals License Number Expiration Date
� Name of CSL Holder
61 Turnpike Road List CSL Type(see below)
No.and Streel Type Dcscription
� Ashby, MA 01431 U Unrestricted Buildin s u to 35,000 cu. ft.
R ResMcted 1&2 Famil Dwellin
ity own ate,ZIP M Mason
RC Roofin Coverin
WS Window and Sidin
� SF Solid Fuel Buming Appliances
97 -855-8568 gary.beals@rgsenergy.com I Insulation
Tele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 162709
Alteris Renewables dba RGS Energy 4/6/15
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
32 Taugwonk Spur,Al2 kimberly.hendel@rgsenergy.com
No,and Streel Email address
Stonington, CT 06378 860-5353370
Ci /Town Stflte ZIP Tele hone
SECTION 6: 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 Affidavi[Attached? Yes .......... C� No........... ❑
SECTION 7e:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
[,as Owner of the subject property,hereby authorize Alteris Renewables dba RGS Energy
[o ac[on my behalf,in alI matters rela[ive[o work authorized by this building permi[applica[ion.
see signed authorization form attached 1a�1 bll�
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER� OR AUTHORIZED AGENT DECLARATION
By entering my name below,1 hereby attest under the pains and penal[ies of perjury that all of the infottnation
contained�plication is true and accura[e to[he best of my knowledge and understanding.
I��I1.�14
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Ow�er who obtains a building pertnit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Con[ractor(HIC)Program),will not have access to the arbitration
program or guazanty fund under M.G.L.c. 142A.O[her important information on the HIC Program can be found at
www.mass.eov/oca Informa[ion on the Construc[ion Supervisor License can be found a[www.mass. oe v/dos
2. When substantial work is planned,provide[he information below:
Total floor area(sq.ftJ (including gazage,finished basemenUat[ics,decks or poroh)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halflbaths �
Type of heating system Number of decks/porches
Type of cooling sys[em Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project CosP'
\ �
. I
�►%. RG S � ��ER,GY
�
,•,/��,`
Property Owner Consent Form
Owner: I���'s�� '` �;'c<<n
Address: Is Ca„��h.�i ���,}
Town: � ��"'
State: M�'
Zip: O�q� �
Phone: (4���- cs, - Sss�
1 hereby give permission to RGS Energy and their
representatives to pull the required permits for a solar
installation on my property.
� �° 2l ='v
Property Owner Date
32l'�uqwon\Spv.A1:.Slomnglm,(Tp6i76 � tcl.Btq.pi333T0 f f�si136Y}.un f t,. F,o. ,rrt
APEX Engineering www.thestructurals.com � !'�� .
281 East Hamilton Avenue • Suite 5 • Campbell • CA • 95008-0232 AVe��°j
' Telephone: 408.379.2068 • apex@thestructurals.com `�Ace
PF. o
, Friday, December 12, 2014 ; ..�, �
5613-14 Carlson 10238904 MA M.Morrison RGS ' � �
��
ROOF Photovoltaic (Mwarey
,a�a
�����
�
DC Rating: 4.950 kW
Carlson, Toper E�^��^��� —� �
15 Churchill Street ����
(NI/6wnWiFu loiamimd
EaWmimt m hnMa Woll'
Salem, MA 01970 �nE'�E��a�.�: � �
.` Rpwaccmme.swa d � -,,
Jurisdiction: City of Salem
, , ,
� � � .
To: Building Department,
The aforementioned structure has been examined and it has been determined that the roof
rafters can support the proposed 4.950 kW PV system. We have verified the structural
integrity of the roof trusses and found that the installation will satisfy design loading
requirements of governing codes: MA 780 CMR, 8th Edition -including 2/4/11 revisions to
Tables R301.2(4) & R301.2(5) ASCE/ANSI 7-OS Minimum Design Loads for Buildings and
Other Structures.
The design is based on wind speed of 705 mph, exposure C, ground snow load of 30.8 PSF
and PV Panel of 3.37 psf. The PV attachment at 48" OC staggered, maximum has been
approved by APEX Engineering. The photovoltaic system and the mounting assembly comply
with the loading requirements. The roof rafters are adequate to support self-weight of roof, PV
panels and snow loading conditions and wind pressures.
Sincerely,
�,tH OF��
� C�+, Rait&A�echor Assembiy
� TNOMAS J. G • UniRac Top-Ctamp
,7 YATES ^' . UniRac SolarMount Rail
� CML � • UniRac Standard Lfoot
No.51039 --� . Eao-Fasten Gree�Fasten
^� 9 ,�,T s" wilh CP-SQ-Slotted Bradcei
9q`�/STEQ Q�. and Aluminum Flashing
�/onn►.� oc. • �>>�+�s-:��rrs.s.�y
�1fi Boft with 2-12"Minmt�ntn
' s: 0613 6 �Eta� Embeement
; �xg
f177 I�SJ yf�"�S
APEX Engineering www.thestructurals.com � �j+-
281 East Hamilton Avenue • Suite 5 • Campbell • CA • 95008-0232 �Averc°j
• Telephone: 408.3792068 • apex@thestructurals.com `�ca°�
� o
Friday, December 12, 2014 ;..� �
5613-14 Car/son 10238904 MA M.Morrison RGS < �J �
��
ROOF Photovoltaic 'mw�Y
,e�
������
�
DC Rating: 4.950 kW
Carlson, Toper E�,���.wm� � �
15 Churchill Street �E���
(N)AC 30A U�vsal0ismiretl
eumm mm�men«won� �'
Salem, MA 01970 M E'�W���P��e� ,'
.\ M)wncra�mm.rs�n-rm,d � ,:
Jurisdiction: City of Salem
, . , ,
� � � .
To: Building Department,
The aforementioned structure has been examined and it has been determined that the roof
rafters can support the proposed 4.950 kW PV system. We have verified the structural
integrity of the roof trusses and found that the installation will satisfy design loading
requirements of governing codes: MA 780 CMR, 8th Edition -including 2/4/11 revisions to
Tables R301.2(4) 8 R301.2(5) ASCE/ANSI 7-OS Minimum Design Loads for Buildings and
Other Structures.
The design is based on wind speed of 105 mph, exposure C, ground snow load of 30.8 PSF
and PV Panel of 3.37 psf. The PV attachment at 48" OC staggered, maximum has been
approved by APEX Engineering. The photovoltaic system and the mounting assembly comply
with the loading requirements. The roof rafters are adequate to support self-weight of roof, PV
panels and snow loading conditions and wind pressures.
Sincerely,
�`'t"���''�
�` P Rail&Anchor Assembly
� THOMA8 J. yG • UniRac Top-Clamp
o YATES � • UniRac SolarMauit Rail
au
� c� CIVIL w '�� • UniRacStandardL-Foot
No.51039
, . Eoo-Fasten Green-Fasten
9� � i� with CP-S�Stotted Bracket
/BTEP �J and fUuminum Flashmg
AL� pG- • (1)5J16"x31/2"S.S.Lag
�1fi gdt wRh 2-12"Minimwn
' s: 0613 6 �U�Ra�' Em6edmern
g"R°Ug�
1x
�rro �ts.i Y/�TES
� FOR CONSTRUCTION �\,1�0�
ii� �`
� � � RGS
(E)Accessory Buifding �
� � ENERGY
.:i«��.���,��,.�s�,ns.,�.�23
� �� 32 Taugwonk Spur,Al2
j� �� Stonginton,CT 06375
�� .\ Phone(860)535-3370
/. , Fax(413)683-2225
\
\ / `.:`�:�V..•::r� � (E) Property Line GRID-TIED
`�\\ / �";;; ;. ;'..,` � /'� PHOTOVOLTAIC SYSTEM
\ \ / �:.;.:c:._,`:; '`; ".',.� �� / �, �� 4.950kW DC�STC
\,�� / �'`` . `
��� (E) Driveway / � (E) Single Famity Dw�Gng j � CARLSON, TOPER
/.:;:..,,,::.:.'':':,�',,�
�� rC; � 15 CHURCHILL STREET f��l � 15 CHURCHILL STREET
, /�'�< '..,'. :)-:," ::",,:',..;:� \ F .' ,` SALEM, MA 01970
'�� �� �'`::,�.,::;,�'';,�':`�:�::._�� \ � � \ Project# 10238904
��\ �,� /� ,.; ::-.�-.: ... r�
lo.. ..>.. �:.. /
.\
/.'x'.'.•..:. �•. ..�.:.:�:....'':� \ 'j�� � �� DESiGNER: ASFI BOWB�SOCIC
\ ,� (E) Property Line / � ::::...:'.'�:'.::.�.,:�.:'.:.,r �
� � \ / , � / � � / a��R: Mike Morrison
` � / � i
�`.. \ �� / f� � �Rs�or,ca.e 2014-12-11
/ ,.. ... /
..,\ . .:�i�;s. �''.;��-;;'�d"�.�' jJ \ �� j�� � REVISIONS
� \ / ,' A /
��\ � � ,.,-.� �� # BY Date Notes
� /�. :::'.'i;.°`:�,..'_.:;,�<:'� �,
� / /:.,;-.,,;'-',.`'�:''..:`.�.:;...:.' (N) PV Array : � / ;' +
\ \\� .� �.";� 'I B Solarworld / �
�� � �/ Plus SW 275 Mono Black / � 2
�',:.!,�,`F•:'," `'.% f F' 3
�, �� � .,,;. '�� Modules / � i
.. ' <
\ `� ;;t'
���„ �,� /
%
� � \\`i;,,:<? ;:./ � � 5 ;
`a � �' / / , /{ ,
� \,\ \� � Equipment on Exterior Wall: � � � ' i
� � � (E) Utility Meter (N) Labelled"Rapid i�
�,� �� (N)AC 30A UnFused Disconnect i Shutdown" /
_ \
Equipment on Interior Wali: / /�
L `� � (E} Main Load Panel (POI) / /! //
\ `., (N) Enphase Envoy/RGMeter
o � � � (N) PV AC Combiner Sub-Panel �
� � i f"� /
8 \ �,` � /. /� /
= \ / / �
D \� �. \ / � f
m Equipment Specifications: � � � '
LL Module: (18) Solarworid Plus SW 275 Mono Black �� �� � / /, ,!
a Inverter 1: (18) Enphase Energy M250-80-2LL-S22 `� � / j �'
Racking: UniRac SolarMount �, ��
Attachment Flashing: Eco-Fasten Green-Fasten with �` ��\\ � / � � / j
CP-SQ-Slotted Bracket and Aluminum Flashing \\ /
o �\ \�� j �, /
,� \ �_ .
= Roof Specifications: \` , � r
Roof 1: \ /'� w
AsphalUComp. Shingle � �,� � 1/16"= 1'-0"
(Single Layer)
2°X s° RoU9n-c�t �l , x SITE PLAN
Rafters @ 16"O.C. 1,
Pitch: 16° � Azimuth: 225° ! \
Array Size: 18 Modules � `, w E
,- `�, PV-A01
S
FOR CONSTRUCTION `�rt//�
PV ARRAY 1 -MECHANICAL LOADS UniRac SolarMount Mounting Notes: ���10�`
Array Area: 326.9 ft' Total Photovoltaic Dead Load: 3.37 psf . Integrated FuII System Grounding and Bonding to UL 2703 RGS
Artay Weight: �102.9 Ibs Avg. Dead Load per Anchor: Z7.61bs • Total Quantity of Attachments=40 E N E RGY
Anchor Qry.: qp • Roof Zones are defined by dimension, a= 3.0 ft. c�:,:P�>E�.a�;;n:,:u�.,,�.
• Maximum Allowable Cantilever for UniRac Rail is y the Maximum Rail Span 3z Taugwonk spur,niz
Design Values by Roof Zone: Comer Egde Interior • Racking and Attachment: UniRac SolarMount with Eco-Fasten Gree�-Fasten with CP-SQ-Slotted Bracket and Aluminum Flashing Stonginton,CT06378
Max. UniRac Rail Span: 42 in.O.C. 60 in. O.C. 60 in. O.C. attached with 5/16"x 3-1/2" Lag Bolt, Hex Head, 18-8 SS phone(a5o)535-3370
" • All Dimensions shown are to module edges, including 1/4 in. Spacing behveen Modules required when using the Top Clamp Method. Fax(a13)5s3-z2z5
Max. UniRac Rail Cantilever: 14 in. O.C. 20 in. O.C. 20 in. O.C. . The SolarMount Rails will extend 1-1/2 in. beyond the Module Edge in order to support the End Clamps.
Adjusted Anchor Span: 32 in. O.C. 48 fn.O.C. 48 in. O.C. � GRID-TIED
-- - --- - --- -- - ---- --- - - - UniRac requires one thermal expansion gap(4 in.)for continuous sections of rail greater than 40' in length
Downforce Point Load: 255.3 Ibs 382.9 Ibs 352;9 Ibs . Array Installed according to the UniRac SolarMount Design& Engineering Guide PUB14NOV03 PHOTOVOLTAIC SYSTEM
Uplift Point Load: -346.9 Ibs -321.4 Ibs -221.9 Ibs . Attachment Locations, If shown, are approximate. Final adjustment of attachment location may be necessary depending on field 4.950kW DC �STC
Minimum Anchor Strength: 707 Ibs conditions.All attachments are staggered amongst the framing members.
Average Safety Factor. p.7g CARLSON, TOPER
'15 CHURCHILL STREET
SALEM, MA 01970
Project# �0238904
oEs��+Ea: Ash Bowersock
R��R Mike Mornson
VERSIONOATE. ZQ�Q-�2���
REVISIONS
32'-6"
# By Date Notes
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'18 Solarworld Plus SW 275 Mono Black Modules
18 Enphase Energy M250-60-2LL-S22 Micro-Inverters
g AsphalVComp. Shingle Roof
� 2"X B" Rough-Cut Rafters @ 16"O.C.
� Pitch:16° Azimuth:225°
�'� 3/16"_ 'I'-0"
MODULE LAYOUT
� Q
a � PV-A02
The Commonwealth of Massachusetts
� Board of Building Regulations and Standards :ei� ]
Massachusetts State Building Code, 730 Cb(R
:en
'1 Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Tivo-Family Divelling
This Section For Official Use Only
Building Permit Number: Data plied'
Building Official(Print Name) . 'Signature Date.
SECTION l:SITE'INFORNIATIO
I-( epty A mess' 1.2 Assessors D4 p 3c Parcel Numbers
1.1 a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building SetbacIts (ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private ❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yesO
SE/C/TION2:, PROPERTY�O/W ERSHIN
/ set Rec V. �l�
Name(Print) ity,State P
'rNo.an Street Yelephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building ❑ 1 Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Num Units_ Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTENLATED CONSTRUCTION COSTS
[tern Estimated Costs: Official Use Only,Labor and Nfaterials y
L Building ; L Building Permit Fee S Indicate how fee is determined:
❑ Standard.City/Town Application Fee
2. Electrical $ s
❑"Total Pioject Cost (Item b)x multiplier x
3. Plumbing S 2. Other Fees:'S
t. Mechanical (IIVAC) S List:
5. Mechanical (Fire $
Sup ression) "Total All Fees: $
Check No. Check Amount: Cash Amount
6. fntnl 1'rnject Cost, S���Y% ' "` OP aid in Full 0 Outstanding Balance Due:
SECTION 5: CONS'rRUC'PION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL holder
List CSL Type(see below)
No. and Street TYPe - . - j1&2FJ1y
cription -
U Unrestrict s u to li,000 cu. tt.
R RestrictedDwellinCityfrown, State, ZIP NI �-lasonrRC Rootin CWS Window aSF Solid FueppliancesI InsulationTele hone Email address D Demolitio
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
IIIC Company Name or IIIC Registrant Name
No.and Street Email address
City/Town, State, ZIP Telephone
SECTION 6: 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........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property,hereby authorize
to act on any behalf, in all matte relative to work aut ized by this building permit application.
L�rc%��Cr
Print Owner's Name(E ctronic Signature) Date
SECTION 7b: OW ERt OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Autlwrited:\gzut's N;une(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration
program or guaranty tint!under M.O.L. c. 142A. Other important information on the IIIC Program can be found at
tt ww.m;us. 'ov/ocu Information on the Construction Supervisor License can be found at www.mass.,'oy v:'dL
2. When substantial work is planned, provide the information below:
Total floor area(sq. tt.) _(including garage, finished basement/attics,decks or porch)
Gross living area(sq. ft.) _ Habitable room count
Number of tireplaccs._. Number of bedrooms _-- —.- --
Number of bathrooms Number of half baths
----------
I'%pe of healing systcut - -_ - ---- --- Number of decks/ porches
fgpe of cooling sy;tcm_-----__--.—__.--- Enclosed _ ---Open _
1 "fot,tl Project 5( uurc Footage" may he iub,titutcd ti)r Prujzct Cott„
15 CHURCHILL •A �
���.c Falrlb
{ Chit nttlenz, C �z �zrlTuett
Fire department �irabguarters
kFl.l,n��
'38 '�GIIfgcttr '�itrvct
Joseph F. Sullivan �m, tt. 01970
Chicf
Date: June 18 1986
City of Salem RE: 15'Churcfiill Street,
�
Board of Appeal ETi`sabeth—J—. Reckis
One Salem Green
Salem, MA •01970
Sirs:
As a result of the notice received concerning the Board of Appeal hearing for
the above listed name and address, the Salem Fire• Department requests the
following items to be placed on record:
The Salem Fire Department has no objection to the granting of a Special Permit
to allow an existing addition to remain. This property is currently in compliance
relative to the installation of automatic smoke detectors.
pectfully, r
orman P. LaPointe
Fire Inspector
cc: Appellant
Building Inspector
File
Form #105
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1
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Public rn Prt ttr#men#
a ;fg p UP
°� '`� �LTTIZTLT$ �P;JMT�T:tPYTt
I
William H. Munroe
One Salem Green
745-0213
January 27, 1986
H. Drew Romanovitz, Esq.
25 Lynde Street
Salem, MA 01970
RE: f15"Churchill7St:
Dear Mr. Romanovitz:
As per your request, I have researched department records with
regards to the property_ located at 15 Churchill St. Although our
records date back to 1900 and beyond, I can find no record of work
being done under permit at this location, nor can I find any record
of any variances being granted by the Zoning Board of Appeal.
In the r absence of any further information, (1 .e. date the house
was erected) I can only advise you that the property is currently non-
conforming by reason of setbacks.
Sincerely, �
William H. Munroe
Inspector of Buildings
Zoning Enforcement Officer
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Romanovitz & Manning
Attorneys & Counsellors At Law
25 Lynde Street r r2t�
Salem, Massachusetts 01970
Fr;:CFi VEJ
CITY Ur Sot '`:ASS.
H. Drew Romanovitz Moses Hill Road
Charles F. Manning Manchester, Mass. 01944
(617) 745-5151 (617) 526-1354
(617) 745-0261 January 16, 1986
Mr. William Monroe
Building Inspection Department
1 Salem Green
Salem, Massachusetts 01970
Re: Elizabeth J. Reckis
15 Churchill . Street
Salem, Massachusetts
Dear Mr. Monroe:
Pursuant to my conversation with you this date, I am en-
closing a Plot Plan and recent Mortgage Inspection. As
you will note, there appears to be a violation of the
30 foot setback requirement.
Further, the Plot Plan dated August 6, 1980 reflects that
the area of the building in question predates the Salem
Zoning-By=laws.--.
Please advise with respect to your position as to whether
the attached storage shed is . in violation of any zoning
by-laws , or in the alternative, that it is in compliance
with same.
Thank you very much for your cooperation and assistance in
this matter.
Very t my yours ,
h �
/H D
HDR: amd
Enclosures
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MORTGAGE INSPECTION
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BAY STATE SURVEYING SERVICE INC. I,, :ii��?"
234 CABOT ST.,BEVERLY, MA. y,, ;i';�; 'J
LOCATION NOTES + �' i i ^ }��,B�•�y�;�'pi
it A�6M�DATE '`?iYS�x___•----__........... • This is a Mortgage ins y 1 l� il;
SCALE i'1 30 �. DATE ',1k,G/.G ._i.��s.'....... Inspection
REFERENCE s r an instrument survey,therefore this plot plan is for i,
mortgage inspection purposes only.
" • This survey is based on survey marks
�s ____
_________ Pd" others.
Torel.._„_.._.._ a Bushes,shrubs, fences and free linea do , 'x� -I
I hereby certify that I have examined the premises and that the not necessarily indicate property-lines.
building(s)shown on this plan are located on the ground as
shown and that they conformed to the zoning setbacks of the • The building(s) are not located in the special i
..._rsz'y.o. . SFI�yJ___ when const c ed, flood hazard zone,as defined by H.U.D.
WHENEVER AN OFFSET IS
1':OR LESS AN INSTR. SURVEY IS ,
RECOMMENDED TO DETERMINE
PROP. LINES,
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