29 VALLEY ST - BUILDING INSPECTION (5) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
0 Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct,Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
{ This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature - Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
29 Valley Street 14 0092
I.I a Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 :Property Dimensions:
R1 residence-no change
Zoning District Proposed Use Lot Area(sq B) Frontage(It)
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.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 yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Ginima Barua Salem,MA 01970
Name(Print) - City,Stale,ZIP
29 Valley Street 978-745-7948 shivadoul@yahoo.com
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units I Other 0 Specify: solar
_Brief Description of Proposed Work': Installation of a 5.5kW roof mounted solar array using 22 Canadian Solar
CS6P-250P modules,22 Enphase M215-60-2LL-S22 micro inverters,and all associated electrical work.
SECTION 4c ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: .
Labor and Materials Official Use Only
I. Building $ 5,000 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical g ❑Standard City/Town Application Fee
18,000 ❑Total Project Cost'(Item 6)x multiplier. x
3. Plumbing $ 2..Other.Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 23,000 13 Paid in Full 0 Outstanding Balance Due:
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SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 102054 10/6/14
Michael Rotondo License Number Expiration Date
Name of CSL Holder
61 Gellette Road List CSL Type(see below)
No.and Street Type Description
U Unrestricted Buildin s u to 35.000 cu.ft.
FairhaveyrNA 02719 City o S ZIP
R Restricted 1&2 FamilyDwelling
' w ,
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
401-215-7056 michael.rotondo@rgsenergy.com I Insulation
Telephone 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
No.and Street kimberly.hendel@rgsenergy.com
ess
Stonington, CT 06378 860-535-3370 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 .......... 6 No........... ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize Aliens Renewables dba RGS Energy
to act on my behalf,in all matters relative to work authorized by this building permit application.
see signed authorization form attached 6p
Print Owner's Name(Electronic Signature) I Dale
SECTION 7b:OWNERS 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 th/i Ppli/cc tio�n is true and accurate to the best of my knowledge and understanding.
Print Owner's br Authorized Agent's Name(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 fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) - (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
6/10./2014 Ginirna Barua Property Consent Form.jpg
RGS { ENERGY
Cleen Power,Wight Sevingi
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Property Owner Consent Form
Owner: lr inimo, BW-uq _
Address: ZS VatN Sk
Town: SCA, 2 ti 1
State: M {�
Zip:
Phone: ?Gt4g
I hereby give permission to RGS Energy and their
representatives to pull the required permits for a solar
installation on my property.
F4 '
4
Property Owner Date
Ilk
32'ruug"nk Spur;A 12,Sttmingwn,COWS I Ie1,860.53.5.3370 I. ras 413.683.2225 I
r
6
https://drive.google.coMa(realgoods.cOM?usp=chrome_app#Folders/OB_n7MCa8izidalpFNXQlbUtVa28 1/1
ACC>o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDIYVYY)
L� 11112015 1 12/30/2013
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 Lockton Companies,LLC Denver NAME
ACT
8110 E.Union Avenue PHONE Ax
Suite 700 ac No,
E-MAIL
Denver CO 80237 ADDRESS:
(303)414-6000 'INSURERS AFFORDING COVERAGE NAIL#
INSURER A:First Specialty Insurance Corporation 34916
INSURED Alteris Renewables,Inc. INSURERS: an n 535
1344665 dba Rea]Goods Solar INSURER C:James River Insurance Company 12203
dba RGS Energy INSURERD:Starr Indennnity&Liability Companyn
32 Taugwonk Spur,Unit A 12
Stonington,CT 06378 INSURER E
INSURER F
COVERAGES REAG001 CERTIFICATE NUMBER: 12688213 REVISION NUMBER: XXXXXXX
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.
ILTR TYPE OF INSURANCE AI DO wvO SUER POLICY NUMBER MMIDDYEFF MPIOMLDIDYEXF LIMITS
A GENERAL LIABILITY N N IRG200052801 1/1/2014 1/1/201$ EACH OCCURRENCE
X MERCV\L GENE BILITY DAMAGE TO RENTED
PREMISES(Ea occurrence) $ 50 000
_JM
CLAIMS-MADE X OCCUR MED EXP(Any one arson $ xxxxxxx
PERSONAL a ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2.000.000
GEN-L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s 2,000,000
POLICY J{ PRO-.
ECT LOC $
B AUTOMOBILE LIABILITY N N BAP5852403 1/l/2014 1/l/2015 COMBINED INGLE LIMIT
(Ea accident) $ ]
,000,000
X ANYAUTO BODILY INJURY(P.,person) $ xxxxxxx
x ALL O SCHEDULED
AUUTOSS AUTOS BODILY INJURY Pera¢ident $ XXXXXXX
X HIRED AUTOS X NNSWNED PROPER TYDAMAGEAmo $ XrXX.Xr}LrXX
$ XXXXXXX
C X UMBRELLAL1AB X OCCUR N N 000557241 1/l/2014 1/l/2015 EACH OCCURRENCE $ 10000000
D XEXCESS LIAR CLAIMS-MADE1000020609 1/l/2014 1/l/2015 AGGREGATE $
10,000,000
OED I I RETENTION$ $ xxxxxxx
B WORKERS COMPENSATION N W STA - TH-
ANDEMPLOYERS'LIABILITY Y/N WC5852405 I/l/2014 1/1/2015 X TORY LIMIT ER
ANY PROPRIEfORIPARTNERIE](ECUTNE E.L.EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED7 NIA 000
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
IT yes d—be under
DESCRIPTION OF OPERATIONS W. E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Arlsch ACORD 101,Adddional Remanke Schedule,if more space is repaired)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
12688213 AUTHORIZED REPRESENTATIVE
For Evidence Only
arse I� � ILl
The ACORD name and logo am registered marks of ACORD p 1 88.2010 ACORD CORPORATION,All rights reserved
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): Alteris Renewables, Inc. dba RGS Energy
Address: 32 Taugwonk Spur Unit A-12
City/State/Zip: Stonington CT 06378 Phone#: (860)535-3370
Are you an employer?Check the appropriate box: Type of project(required):
I. x❑ I am a employer with 120 4. ❑ I am a general contractor and 1 6. ❑New construction
employees(full and/or part-time),* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑Building addition
[No workers'comp.insurance 5. ❑ We are a.corporation and its
required.] officers have exercised their
]0.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL l LF] Plumbing repairs or additions
myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers'
13.❑x Other solar panels
comp, insurance required.]
•Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
=Contractors that check this box must attached an additional sheet showing the name of the sub-contactors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Zurich American Insurance Co.
Policy#or Self-ins. Lic,M WC5852405 Expiration Date: 01/01/2015
Job Site Address: 29 Valley Street City/State/Zip: Salem, MA 01970
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 �rielrthe pat nd penalties of perjury that the information provided above is true and correct.
Sign; .IM Date' tt I COI
Phone#: (860) 535-3370
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#:
June 12, 2014
To: Code Enforcement Division
From: James A. Marx, Jr. P.E.
Re: Engineer Statement for Barua Residence, 29 Valley St., Salem, MA
- Solar Roof Mount Installation
I have verified the adequacy and structural integrity of the existing roofing Main Roof 1
(one layer composition): 2" x 6 rafters at 16"o.c., having roof slope distance 15'-5" with
approx. rafter span 13'-5"; pitch 23 deg.; for mounting of solar panels and their
installation will satisfy the structural roof framing design-loading requirements of the
Massachusetts building code—780 CMR Residential Code 8th Ed.
For the installation of the solar mounting, the Unirac Solarmount rails will be anchored to
the rafters with L-foot supports having EcoFasten Green-Fasten with CP-SQ Bracket and
flashing or equal to be located on the center of the rafters and will be securely fastened to
the rafters at 48" sp. with 5/16"x 3 1/2" SS lag bolts. The mounting system has been
designed for wind speed criteria of 100 mph Exp. B and ground snow criteria of 40 psf.
All attachments are staggered amongst the framing members.
The Photovoltaic system and the mounting assemblies will comply with the applicable
sections of the Residential Code and loading requirements of roof-mounted collectors.
Thereby, I endorse the solar panel installation and certify this design to be structurally
adequate.
�OF MASSgCyG,
Sincerely,
3 npX,O §p.
MEShM N
J NC\'G,Cr,4� W
P �
James A. Marx, Jr. °FFssioNr ��y y
Professional Engineer
MA 36365
10 High Mountain Road
Ringwood, NJ 07456
cc: RGS Energy
June 12, 2014
To: Code Enforcement Division
From: James A. Marx, Jr. P.E.
Re: Engineer Statement for Barua Residence, 29 Valley St., Salem, MA
- Solar Roof Mount Installation
I have verified the adequacy and structural integrity of the existing roofing Main Roof I
(one layer composition): 2" x 6 rafters at 16"o.c., having roof slope distance 15'-5" with
approx. rafter span 13'-5"; pitch 23 deg.; for mounting of solar panels and their
installation will satisfy the structural roof framing design-loading requirements of the
Massachusetts building code—780 CMR Residential Code 8th Ed.
For the installation of the solar mounting, the Unirac Solarmount rails will be anchored to
the rafters with L-foot supports having EcoFasten Green-Fasten with CP-SQ Bracket and
flashing or equal to be located on the center of the rafters and will be securely fastened to
the rafters at 48" sp. with 5/16"x 3 '/2" SS lag bolts. The mounting system has been
designed for wind speed criteria of 100 mph Exp. B and ground snow criteria of 40 psf.
All attachments are staggered amongst the framing members.
The Photovoltaic system and the mounting assemblies will comply with the applicable
sections of the Residential Code and loading requirements of roof-mounted collectors.
Thereby, I endorse the solar panel installation and certify this design to be structurally
adequate.
tk
Sincerely, MASS,,CyGS�
p
E
o G\ C�r'S
James A. Marx, Jr. A �Fcisj�� c
Professional Engineer ROFFssioNn\-��
MA 36365 ��
10 High Mountain Road
Ringwood, NJ 07456
cc:RGS Energy
RECEIV ED
<SPECt1A L SERVICE5
nrg 2016 MAA 10 A Ill 05
Home
SOLAR'
NRG Home Solar
101 Constitution Blvd
Franklin MA 02038
508-545-0989
To Whom This May Concern,
This letter is to notify the City of Salem of NRG Home Solar's cancelation as
Contractor and Electrician of a PV solar project at 29 Valley St.
Kind Regards,
Tyler Wyld-Chirico
Permitting Specialist
508-315-6663
Tyler@NRGHomeSolar.com