5 WITCH WAY - BPA (002) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
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 A plied:
Building Official(Print Name) Signature Date
1 SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
5 Witch Waw
I.I a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: - 1.4 Property Dimensions:
RESIDENTIAL
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(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 yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
Jacques T Mathieu SALEM, MA. 01970
Name(Print) City,State,ZIP
5 Witch Way 781-277-1206 Itmathieuc(�gmail.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 ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify:SOLAR PV
Brief Description of Proposed Work:Install Solar Electric panels on roof of existing home to be interconnected with the
home's Electrical System(27 panels at 7.155 kW)
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I.Building $6,000 1. Building Permit Fee: $43-3--indicate how fee is determined:
2.Electrical $13,000 ❑Standard City/Town Application Fee
❑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: $ 19,000 ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
101687 9/13/2016
SOLARCITY CORP./DANIEL D. FONZI License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
800 RESEARCH DR
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
WILMINGTON MA.01887 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
978-215-2383 allisonkelley@solarcity.com I lnsulalion
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
168572 3/8/17
SOLARCITY CORP. HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
800 Research Dr allison.kelley@solarcity.com
No.and Street Email address
Wilmington Ma.01887 978-215-2383
Cit /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 ..........F71 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 solarcity/Daniel D Fonzi
to act on my behalf, in all matters relative to work authorized by this building permit application.
*See Contract/OwnerAuthorization 8/23/16
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my"hyer the pains and penalties of perjury that all of the information
contained in thito the best of my knowledge and understanding.
8/23/16
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. 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. oR v/oca Information on the Construction Supervisor License can be found at www.mass.gov/des
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"
i CITY OF S.U.&M. -LkssACHUSETTS
BUILDNG DEPART\MNT
' 130 WASHIINGTON STREET,3w FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
ICIJtBERLEY DRISCOLL
MAYOR THOMAS ST.PmARH -
DIRECTOR OF PUBLIC PROPERTY/HL'IIDING CONMUSSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40,S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
SolarCity
(name of hauler)
The debris will be disposed of in
SolarCity Wilmington
(name of facility)
800 Research Dr. Wilmington Ma
(address of facility)
signature of permit applicant
8/23/16
date
dcbrisatfdm
The Comrnonlveadth ofMassachusetis
Department oflndush4alAccddents
Office oflnvesdgaddens
I Congress Sired, Suite I00
Boston,MA 02JI4-2017
www.massgov/dda
Workers'Compensation Insurance Affidavit:Builders/Contracters/ElectrieiwisMIumbers
Ai)R!cant Information Please Print Legibly
Name (ausinesstorg8dlaationnndi id W): SolarCity Corp.
Address: 3055 Clearview Way
City/State(Zi : San Mateo CA. 94402 Phone#: 888-7_65-2489
Are you an employer?Check the appropriate box: Type otprof ect(required),
,/
t. 1 am a employer with 5,000 4. E] I am a general contractor and
6. ❑New construction
employees(fill]and/or part-time)., have hired tate sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees 'these sub-contractors have ti. ❑Demolition
working for me in gay capacity. employees and have workers' 9. []building addition
[No workers'comp, Insurance comp. insurance.
retluirefl,I 5. Q We are a corporation and its 10.0 Electrical repairs or additions
3.❑1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp, right of oxewytion par VTGL 12.E]Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees.[No workers' 130Other Solar/PV
comp.insurance required.]
*Any upplicaa dim checks box Of must also hal ow the section eelowsaowing auir worker'compensation policy in@rmaaon.
I Homeawnen who submit this aftidavk indicating they ata doing all work and then hire outside contractors must submit a new ettidavil indicatingsach.
tConttaawa that cheek this box musts attached on additional sheat showing rhe nano of the sub-contraetorand state whether a not thoseernitim have
employees. If the sub<ontractots have employees,they must providethdr worker'comp policy number.
lain an employer that is ptapldfag workers'compensaUen hlsarancefor my employees. Below is the policy and job stile
Igformrrtion.
Insurance Company Name: Zurich American Insurance Company
Policy#or Self-ins.Ljcc.#: WC0182015-00 Expiration Date:9/1/2016
Job Site Address: 5 1 Cky/State/Lip:
Attach a copy of the workers'compensation policy duel ration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 andlerr tae-year imprisalumm,as well as civil penalties In the form of a STOP WORK ORDER and a fine
of up to$250.00a 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 a Ute pains and penalties ofperjury that the
informatlo r provided above it use and correct.
Signature: ei�- �;��./ Dale: Ei c�1233
Phone M
Official ore only. Do net write hr this area,to be compieted by city or town ofiicidl.
City or Town- Permit/Ucenae#
Issuing Authority{cirde one)
t.Board of Health 2.Building Department 3.City/Town Clerk 4,Electrical inspector S.Plumbing Inspector
6.Other
Contact Person; Phone#:
A`& CERTIFICATE OF LIABILITY INSURANCE °=I70M"5°Y�""
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLQER. THIS ,
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICI.V
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 poNcy(les)must be endorsed If SUBROGATION IS WANED, 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 endorsements .
PRODUCERACT
MARSH RISK& INSURANCE SERVICES NAMEL.._........_
AAAA. AAAA.. ..
345 CALIFORNIA STREET.SUITE 1800 .111011 311:.._ . AAAA. AAAA ........ . :_LANC.Ne1
CALIFORNIA LICENSE NO.0437153 E.MAR _..._
SAN FRANCISCO,CA 941D4 .APPRE&6: AAAA AAAA -AAAA ._. ....... _ AAAA.._.
Atm:Shannon Scott 415.743-6334 INSURER(S)AFFORDING COVERAGE, _ _ ,. NAIC 0
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998301-STND-GAWUE-15.16 VISUIRER A:Zurich American Insurance Company _ 116535
_AAAA AAAA. ...AAAA... ... AAAA . . . .._.. ...
INSURED DISURER B:NIA !WA
SolarCii9 Corporation . . AAA A. .... ... .. .... .._ .. .. _. 4.. AAA A
3°55 Clearvlew Way INSURER c:NfA. .. AAAA. ........ AWA
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San Mateo,CA 94402 INSURER D:American Zurich Insurance Company 40142
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INSURERE:..
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COVERAGES CERTIFICATE NUMBER: SEA-002713636.09 REVISION NUMBER:4
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. _
_ ... _. �.. ............ ._..._. . .__ AAAA.
OPF
INSIi� TYPE OF INSURANCE _ TADDL'SUBa POLICY NUMBER lmmorym POLICY EXP LIMITS
LTA
A X COMMERCIAL GENERAL LIABILITY i IG1.00182016M 091 IM15 !09)0112016 EACH OCCURRENCE S _ 3,900,000
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PERSONAL b ADV INJURY :3 3000,00D
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GENL AGGREGATE LIMIT APPLIES PER i GENERAL AGGREGATE '$ 6.0m,000
POLICY i!EC °LOC i
PRODUCTS AGO $ 6,000.000
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A AUTOMOBILE LIABILITY : BAP016201T00 '0910112015 :090112016 B E SINGLE.LIMIT
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X ANY AUTO _ ! BODILY INJURY IP.person) $
X ALL OWNED '.x (SCHEDULE➢ : BODILY INJURY(Per nWentI $
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UMBRELLA LIAR :OCCUR
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AND EMPLOYERS'LIABILITY "' ."""
A ANY PROPRIETURfPARTNERIE.XECUTNE Y®N/AI : 01&2015-OO(MA) '.09f01/1015 11910112016 FE L.EACH ACCIDENT 15 _ 1000,000
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DESCRIPTION OF OPERATIONS Imiwv EL DISEASE-POLICY LIMIT' $ 1,OOQ000
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DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES WORD 101,AddH{onal Remark,Sahedul,,may be a lached Smote Mace Is required)
EVIdenco of Insurance.
CERTIFICATE HOLDER CANCELLATION
SdarCdy Corporation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
3055 Cleam wWay THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
San Maim,CA 99902 ACCORDANCE WITH THE POLICY PROVISIONS.
A.UTRORRED REPRESENTATIVE
of Mareh Risk&Issuance Services
Charles Marmolejo
®JSBB-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered merits of ACORD
Version#61.7-TBD
0.5olarCity. RU
® Digitally signed by Hussein
Hussein kazan�ka=an
August 18, 2016 4 j Date:2016.08.18 18:07:37-04'C
RE: CERTIFICATION LETTER
ASN OF A/q �c
Project/Job # 0192301
Project Address: Mathieu Residence
5 Witch Way HUS$EIN A".' w
Salem, MA 01970 Ki4ZAN �+
AH] Salem NO.52612.
SC Office Wilmington
Design Criteria: 9FQI TE��O���Q
�'SJpNAL 2�G
-Applicable Codes = MA Res. Code, 8th Edition, ASCE 7-05, and 2005 NDS
- Risk Category = II
-Wind Speeds = 100 mph, Exposure Category C
- Ground Snow Load =40 psf
- MP2: 3x6 @ 16"OC, Roof DL = 11.5 psf, Roof LL/SL = 28 psf(Non-PV), Roof LL/SL = 28 psf(PV)
- MP4: 2x10 @ 16"OC;Roof DL = 11 psf, Roof LL/SL= 28 psf(Non-PV), Roof LL/SL = 28 psf(PV)
- MPS: 2x10 @ 16"OC, Roof DL = 11 psf, Roof LL/SL= 28 psf(Non-PV), Roof LL/SL = 28 psf(PV)
Note: Per IBC 1613.1; Seismic check is not required because Ss = 0.31364 < 0.4g and Seismic Design Category (SDC) = B < D
To Whom It May Concern,
A jobsite survey of the existing framing system of the address indicated above was performed by a site survey team from SolarCity.
Structural evaluation was based on site observations and the design criteria listed above.
Based on this evaluation, I certify that the existing structure, with upgrades specified in the plans, directly supporting the PV system is
adequate to withstand all loading indicated in the design criteria above based on the requirements of the applicable existing building
and/or new building provisions adopted/referenced above.
Additionally, I certify that the PV module assembly including all standoffs supporting it have been reviewed to be in accordance with the
manufacturer's specifications and to meet and/or exceed all requirements set forth by the referenced codes for loading.
The PV assembly hardware specifications are contained in the plans/docs submitted for approval.
Hussein A. Kazan, P.E.
Professional Engineer
T: 609.642.9016
email: hkazan@solarcity.com
3055 Clearview Way San Mateo,CA 94402 T(650) 638 -1028 (888)SOL-CITY r(650)638-1029 solarcity.com
ALO55DJ.MN-Pv3i.A2flOC 1i3)1VROC 215450,CA 1'510800%4.CO E00041.LT NIC 0832P0,£LC 012Si05.00 iW51a0W0P0/ECCa0359`v,OEMR20We/I1-4U12R ECI0 224.MCL-2%;0.11.3{052.MAHIG150571/
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PITCH: 22 ARRAY PITCH:22
MP2 AZIMUTH:216 ARRAY AZIMUTH: 216
MATERIAL:Comp Shingle STORY: 2 Stories
Front Of House
Z"OF M.4A PITCH: 22 ARRAY PITCH:22
as1 qCy MP4 AZIMUTH: 126 ARRAY AZIMUTH: 126
p --- G MATERIAL:Comp Shingle STORY: 2 Stories
HUSSEIN A. m
� PITCH: 22 ARRAY PITCH:22
KAZAN
MPS AZIMUTH:306 ARRAY AZIMUTH:306
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01 N 612 —4 7'-110-
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(E) LBW AL ��\ (E) LBW
D . SIDE VIEW OF MP4 NTS E SIDE VIEW OF MP5 NTS
MP4 X-SPACING X-CANTILEVER Y-SPACING Y-CANTILEVER NOTES MP5 X-SPACING X-CANTILEVER Y-SPACING Y-CANTILEVER NOTES
LANDSCAPE 64" 1 24" STAGGERED LANDSCAPE 64" 1 24" STAGGERED
PORTRAIT 48" 1 17" PORTRAIT 48" 17"
RAFTER 2x10 @ 16" OC ROOF AZI 306 PITCH 22
ARRAY AZI 126 PITCH 22 STORIESOOF AZI 126 PCH 22 : 2 RAFTER 2X10 @ 16" OC ARRAY AZI 306 PITCH 22 STORIES: 2
CJ. 2x6 @16" OC Comp Shingle C.J. 2x6 @16" OC Comp Shingle
PV MODULE
5/16°x1.5" BOLT WITH
5/16" FLAT WASHER
INSTALLATION ORDER U
ZEP LEVELING FOOT 2x6 SPF/2 (N
LOCATE RAFTER, MARK HOLE Sl 2-7}
ZEP ARRAY SKIRT (1) LOCATION, AND DRILL PILOT �.
HOLE.
ZEP MOUNTING BLOCK *LOWEST
(4) ATTACH FLASHING INSERT TO
(2) MOUNTING BLOCK AND ATTACH -a
ZEP FLASHING INSERT (3) TO RAFTER USING LAG SCREW. (E) Lew
(E) COMP. SHINGLE CA E7L ��1 SIDE VIEW OF MP2 NTS SISTER UPGRADE INFORMATION: RAFTER UPGRADE INDICATED BY HATCHING
INJECT SEALANT INTO FLASHING pINSERT PORT, WHICH SPREADS UPGRADE NOTES:
(E) ROOF DECKING ) (3) MP2 X-SPACING x-CANTILEVER Y-SPACING Y-CANTILEVER NOTES 1. CUT AND ADD (N) SISTER AS SHOWN IN THIS SIDE MEW AND REFERENCED TOP NEW.
SEALANT EVENLY OVER THE 4'. 24" STAGGERED 2. FASTEN (N) SISTER TO (E) MEMBER W/ SIMPSON SOW 22300 (IF 2-PLY) OR 22456
ROOF PENETRATION. PORTRAIT 48^ v"5/16" DIA STAINLESS (IF 3-PLY) SDW SCREWS AS SHOWN AT i6' O.C. ALONG SPAN AS SPECIFIED, IFE SUBSEQUENT MODULES RAFTER 2x6 @ 16'OC ROOF AZI n6 PITCH 22 STORIES:2 WOOD SPLITTING IS SEEN OR HEARD, PRE-DRILL WITH A h' DRILL BIT.
STEEL LAG SCREW CH 22
INSTALL LEVELING FOOT ON TOP C.J. 2x6 @16 OC ARRAY A21 216Comp Shingle ALT. OPTION FOR FULL LENGTH MEMBERS ONLY- FASTEN (N) SIDE MEMBER TO
(2-1/2" EMBED, MIN) (4) OF MOUNTING BLOCK & (E) RAFTER W/ 10d (IF 2-PLY) OR 16d FROM EACH SIDE (IF 3-PLY) COMMON
SECURELY FASTEN WITH BOLT. NAILS AT 6° O.C. ALONG SPAN.
(E) RAFTER STANDOFF SISTER ALL RAFTERS ON THIS MP SECTION INTO WHICH THE ARRAY IS LAGGED
Scale: 1 1/2" = 1'
CONFIDENTIAL- THE INFORMATION HERON UOB NUNBERJB-0192301 00 PREMISE OWNER: DESCRIPTOR: DEAGN:
CONTAINED SHALL NOT BE USED FOR THE MATHIEU, JACQUES MATHIEU RESIDENCE Ryan Lindquist 5o1ar�'}"
BENEFIT OF ANYONE EXCEPT SOLARGIY INC., MDUNURG SYSTEM: �.• 1 I.y
NOR SHALL IT BE DISCLOSED IN WHOLE OR IN ZS Comp V4 w Flashing-Insert 5 WITCH WAY 7.155 KW PV ARRAY ►h
PART IZ OTHERS OUTSIDE IN THE CONNECRECIPIETION
T MEDM� SALEM MA 01970
ORGANIZATION, EXCEPT IN CONNECTION WITH ,
THE SALE AND USE T. THE RESPECTIVE 27 TRINA SOLAR # TSM-265PD05.18 24 SL Martin pHA Building 2 Unit 11
SOLARCItt EQUIPMENT, WITHOUT THE WRITTEN PACE NAME SHEET.- REV: DAIS Mgdbwou8h,MA 5D)
PERMISSION OF SOLARCITY INC. DeliINVERTER: - T: (650)638-1028 8 (650)638-1029
Delta saliYia 5.2 TL STRUCTURAL VIEWS PV 3 8/ls/2o1s (868T)-SOL-CITY(765-2489) ....,olmmItY.cop,