45 BELLEVIEW AVE - BUILDING INSPECTION (2) The Commonwealth of Massachusetts RECEIVEf y OF 1,
W
Board of Building Regulations and Standards INSPECTI NAL §kEWXES'
Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Dert�4�h�� 2 b A 2
One-or Two-Family Dwelling
This Section For Official Use Only
BuildingPennitNumber: - Dat Applied:
O Building Official(Print Name) Signature - ---- Date
SECTION 1:SITE INFORMATION
LI Property Address; 1.2 Assessors Map&Parcel Numbers
L l a Is this an accepted street?yes_ no Map Number Parcel Number
1 n 1.3 Zoning Information: 1.4 Property Dimensions:
U '
Zoning District Proposed Use Lot Arco(sq ft) Frontage(ft)
! 1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
\\1 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 Ownerruf Re
Carlene Dipietro Salem, MA. 01970
Name(Print) City,State,ZIP
45 Belleview Ave 978-744-4471 Mdmd45@aol.com
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction Nr Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specily:
Brief Description of Proposed Work': to .-wina
SfI1PA.A
�a as
S
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item
Estimated Costs: _- - --Labor and Materials) Official Use Only
1. Building $ %i laa Ob 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical - - $, oo ❑ 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 $ --
Su ression Total All Fees:$
Check No. . Check Amount Cash Amount: -
6.Total Project Cast: $ 'p�$ Q�jQ OF
t ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
J GIYYI Q S SY�Q r t,�e� n 0—� Expiration Date
License Numbzr Ex nation Dale
Name of CSL Holder
` � ��,��, 'e ^ Lis[CSL Type(see below) y
No.and Street W` Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
/1/`�✓ t I lY/l l R _ Restricted 1&2 Family Dwelling
City/Town,-State,ZIP' - -- - - M Mason - -
RC Roofing Covering
WS Window and Siding
_ SF Solid Fuel Buming Appliances -
�)30S1PJ M�S( � U\VIYlFr �1Y 1 Insulation
To hpnc Email address D - Demolition._.
5.2 Registered Home Improvement Contractor(HIC)
'J\y;\nt SCXCxr \�v��-1t6
HIC Registration Number ExpiFa[ion Dale
Inc Corpgtry1 m�rRegist(ant Name
No.and-Street r.J`� U�(,`�[J W � y x. Email address
Ci /Town,State,ZIP t. 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 ...:......)a No..........:O�
- -- - 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 V\V vo t S,-)\Qky-
to act on my behalf,in all matters relative to work authorized by this building permit application.
*� 06/22/15
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' 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 Authorized Agent' me(Elec nic 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.mas'seov;oca Information on the Construction Supervisor License can be found at www.mass.�ov/dps
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"
r .a
4931 North 300 West,Provo,UT 94604 Employer Identification No.: 80-0756438
VIVInt. solarr"Phone:(877)404-4129 Fax:(801)765-5758 Masmchusettsjjj{��(C License No. 170848
E-Mail: support@vivinMolar.com ' Z J z�
J
www.vivintsolaccom AR No.:
RESIDENTIAL POWER PURCHASE AGREEMENT
This RESIDENTIAL POWER PURCHASE AGREEMENT(Ihis"AgreemenP')is entered into by and between VIVINT SOLAR DEVELOPER,LLC,a
Delaware limited liability company("We","Us","Our')and the undersigned Customer(s)("Fou", Your'),as of the Transaction Date set forth below.
Full Name(F-'.w—, a�,..I��e Full Name IF;m.An,c o
GU5tmmer(F): PrnMr4'N"'�r'0 ref'°N^ tkm'0".-: D re,CA•
Telephone No.: — —
Property Street Address: a (,�
Address: City,County,State.-Lip: , D
1.SERVICES
.\. DESIGN AND WSRALLATION. We will design.install.service ad maintain d solar pnomvoliair sYsiem rid Your Property,which will include all
solar panels;invencm;meters,and other components(collectivelj•.the"Sysrem'") w Pother described in the Customer Pucker and the Work Order that We
will provide to Ynu hercmller. All material pomm�s of the Sysmm will be insml�ed by Our employed technicians and dtt:vicimis,and at subcontractors.
(f)complete all
With Your cooperation, We will (i)design, ins:dl and connect the SVsizm in meTenal compliance with till.applicable laws; required
inspections;and(iii)obtain all rtquired ecnrfications and pznnivs. In order m design a 5yystemrthat meets Your needs,You.agree that We may obtain Your
electrical usage history from Your%teem%utiliry(thz Utility%')and You shall provide Ut wrth copias of Your Utility bills as We may reasonably request.
Other than the atxivaihon fee dzscrihed in Section I B R e wilt design and install the Sysmm_at oat m Ypu.+
e. ACl'IVATION. Ymu agree to pay Us uono-time achvotion fee in[hc amount of S. We will interconnect the System with the Utility,and
ratio the System to generate enemrgyy measured m Inlnwmt hours("k1Vh"J (Ihe"Energy ). nstallation of the System generally takes one day and is
anticipated m begin and Ixxsubstvnially rumpletcbetween taro(?)and sin(b weeks hereafter.
C. OWNERSHIP OF SYSTEM. We shallbwri the Syewm asOtu sole personal property.;You will have no property interest in the System
D. OPERATIONS AND MAINTENANCE..'.Wcwill opem[eand mnintuin the System(i)at Our sole cost and expense;(ii)In good condition;and(in)in
material compliance with all applicable laws end permits and the Utility'-s requirements.
in INSURANCE. We insure
mean general liability insurance;workers'compensation insurance;and property insurance on the System.'For more
information concerning Our insurance,and to obtain a copy oPOur certificate ufinsuram e,please visa: www.vrvm(solar.corminsurance.
2.TERM,PRICE,PAYMENTS,AND FINANCIAL DISCLOSURES
A. ENERGY PRICE. For all Energy produced by the System.You shall pad,s$0. per kWh(the"Energy Price"),plus applicable taxes.
The Energy Price shall increase each year by two and nine-tenths ppeercent((2.9/0. Ago en estimate of the Syystem output,measured in kilowatt hows
will be provided to You in the Customer Packet THIS AGREEMENT IS FOR'1 HE SALE OF ENERGY BY US 1'O YOU AND NOT FOR THE SALE OF
A SOLAR ENERGY DEVICE.
B. TERM. This Agreement shall be effective as of the Transacien Date and coodnue until the-twentieth(20'")anniversary of the In-Service Date(the
Terri'). The"In�Servlre DaK'shall be the first day after all of the following have been achieved: (i)the System has been installed and is capable of
generating Energy,{ii)all permits necessary to operate the System have been obtained,(ui)the System has been interconnected with the Utility,and(iv)all
inspections and cemficates reymred under applicable law or by[he Utility have been completed or received.
C. YAYMEMIS.a Beginning with the first month following the In-Service Date and throughout the Term,-We will send You an invoice reflecting the .
charges for Energy pro aced bgy the System in the previous month. You shall ruake monthly paymeors[o Us by automatic payment deduction fora Your
designeced checking aceount or credit Gerd. I[is Your responsibility[o enmm that there are adequate funds or adequam credo limit There is nu financingg
charge associated wrth this Agreement. For all paymants more than ten(1 U)days past due,We may impose a late charge equal to Twenty-Five Dopers($25)
and interest at an annual rate often percent(10°0),plus applicable taxes. If You continue to fail to make any payment wtlhin an(10}days after We give
You wn[ten notice,then We may exermse all remedies available[o Us pursuant to Section 13fb).
D. RENEWAL. At[he end of the Temp,You may zlect m((i)continue with this Agrcemat on a year-to-yea bay;(ii)enter into an ew Agreuent mith
Us and cancel Nis Agreement;.(iii)purchase the System ar[fie end of the Tenn and mncel this Agreement(the Pyrcbare Option") m
;or(rv)cancel this)
A meta and have the System removed at no cost[o You.'Yuu mill mail m nmify Us in writing concerning Yaur election siny(60I days prior to the end
of Tenn. If You el ra the Purchase Option, the"Purchuae Option Price" will he the then-current fair market value of the System based on an
indcpcndeni appmiser's valuation of similarly sized photovohaic systems in Your N@ rognpbiu mmun. The opPrarscr'a valmtion will h provided to You in
writing and wall Ix binding. If We receive Yonr payment of the Puichasc Option Prcz,costs of the appraisal,applicable taxcs.and all omcr amounts[bell
owing and unpaid hereunder,We will transfer ownership ofthe System to You at the end nfthe Term on tin"As Is,Where Is"basis. If You elect to have the
SyySiam removed,We will remove the System from Ymir Pro within oinery((90)dayys a0er the end of the Term. IF YUO DO NOT NOTIFY US OF
VOUN ELECTION TO CANCEL BV SENDING A WRITTEN NOTICE TO US. 'THEN THIS AGREEMENT WILL AUTOMATICALLY
RENEW ON A PEAR-TO-YEAR BASIS UNTIL YOU NOTIFY US IN WRITING OF YOUR ELECTION TO CANCEL AT LEAST SIXTY(60)
.DAYS PRIOR TO THE END OF THE RENEWAL TERM.
E. CREDIT CHECK. In connection with the execution of this Agreement and at any time during the Term,You hereby authorize Us to(i)obtain Your
credit rating and report from credit reporting agencies; (if)to report Your payment performance under this Agreement to credit reporting agencies;and
(in)disclose this and other information to Our at unites and actual or prospective lenders,financing parties,investors,insurers,and acquirers.
WE MAY HAVE PRESCREENED YOUR CREDIT. PRESCREENING OF CREDIT DOES NOT IMPACT YOUR
CREDIT SCORE. YOU CAN CHOOSE TO STOP RECEIVING"PRESCREENED"OFFERS OF CREDIT FROM
US AND OTHER COMPANIES BY CALLING TOLL-FREE (888) 567-8688. SEE PRESCREEN & OPT-OUT
NOTICE(SECTION 29)BELOW FOR MORE INFORMATION ABOUT PRESCREENED OFFERS.
3.LIMITEU WARRANTY
A. 'LIMITED-INSTALLA'I'ION WARRANTY. We provide a workmanship warranty that the System shall be free form material defects in design and
workmanship under normal operating conditions for the Term.'We full warrant further that all rooftop penetrations We install shall be watertight as of the dace of
(insmllmom..We do not provide any warranty to You with respect to any component of the Sysrem. Any manufacturer's warranty is in adtlition to,not in lieu
of,this limited installation warranty. This warranty does not cover problems resulting from exposure to harmful materials and chemicals, fire, flood,
earthquake,or other aces orgod,vandalism,alteration of system by anyone not authorized by Us,or any other cause beyond Our control.
B. MANUFACTURERS' WARRANTIES. 'rhe Sastzm's solo modules carry a rninimum manufacturer's warranty of twenty,(20)years as follows:
((al during the Ors[ten(10))'ears of use.the modules'electrical output will not degrade by more than ten percent(10%)from the a-C ley rated output,and
(b)during the Ors1.ttventy(2D)years of use,the modules'electrical output will not degrade by more than twenty percent(20%)from the originally rated
owpuL " eSysmm's inverters car,Uy mmimum�mmaciun:rsawrrantyoften(10)years against defects orcomponentbmakdowns. During the'1'enn,We
will enforce these war sties to The idlest extent possible.
C. DISCLAIMER OF WARRANTY. EXCEPT AS SET FORTI4 IN THIS SECTION 3, WE MAKE NO OTHER WARRANTY TO
YOU OR ANY OTI4PR PERSON, WHETHER EXPRESS, IMPLIED OR STATUT RY, AS TO THE MERCHANTABILITY OR
FITNESS FOR ANY PURPOSE- OF THE EQUIPMENT; INSTALLATION, DESIGN, OPERATION, OR MAINTENANCE OF THE
SYSTEM, THG PRODUCTION OR DELIVERY OF ENERGY', OR ANY OTHFR ASSOCIATED SERVICE OR MATTER
HEREUNDER, ALL OF WHICH WE HEREBY EXPRESSLY DISCLAIM. OUR CIA DILITY FOR ANY BREACH OF ANY
WARRANTY IS LIMITED TO REPAIRING THE SYSTEM OR YOUR PROPERTY TO THE EXTEM RE�UIRF..D UNDER THIS
AGREEMENT. YOU ACKNOWLEDGE THAT WE ARE RELYING ON THIS SECTION 3.C. AS A CO
ON AND MATERIAL
INDUCEMENT TO OF
INTO TV IS AGREEMENT. THERE ARC NO WARRANTIES WHICH EXTEND BEYOND THE
DESCRIPTION OF THE FACE HEREOF.
4.REMOVAL OF THE SYSTEM
Y'ou shall not make any Alterations(us defined in Section 9 c to the Sysfem.'ll'You want to make rcpairsror impmvcments to Your Property[halrequire-'
the temporary removal of the System or[hot could mtertem+vet its performance or operation,You must rive Us at least thirty(36)day. pnor written.notice
{p"Customer-Reyuevrrd.Shur own"). You agree that any repair or improvement to Your Property%hall not materially ahcr Your ro f unccm the System is
+rnudled. As earn ensation for Our removal,storage,and reinstallation of the System,You agree to pay to Us a fee equal to Four Hundred and Ninety-Nine
Dollars(S499�before We remove the System. You shall be required to pay the Shutdown Payment(as defined in Section IS ifi Syyswat is not reinstalled
I shiny 30)days of removal. In the.event of an emergency affecting the System. You shall%unmet Us ' rare y. If We are unable to timely
respond,You may at Your own expense)contract with a licensed and qualified safer installer to remove the System as necessary to make mpaiisrequired b'y
The emergency. You shall be responsible for any damage to the System that results from actions taken by Your contractor.
+ 1 5.ARBITRATION OF DISPUTES
Most customer concerns can be resolved quickly and amicably by calling Our customer service department at(877) 404-4129. If Our
customer service department is unable to resolve Your concern,Von and We agce to resolve any Dispute(as definedd below)through binding
arbitration or small claims court instead of coons of&cneml jurisdiction. BY SIGNING BELOW YOU ACKNOWLEDGE AND AGREE
THAT(q YOU ARE HEREBY WAIVING THE RIGHT T�A TRIAL BY JURY;AND HI)YOU MAY BRING CLAIMS AGAINST US
ONLY IN YOUR INDIVIDUAL CAPACITY,AND NOT AS PLAINTIFF OR CLASS MEMBER IN ANY PURPORTED CLASS OR
REPRESENTATIVE PROCEEDING. You and We agree to arbitrate all disputes, claims and controversies arising out of or relating to
ronn4am•mi,u'n.oa,on,n...u.i„-.ur wain...
OP OUR AFFILIATPS, DIRECTORS. EAIPLOYEFS, AGENTS, malifieJ by nn numnmmmwri:nrg eitmai by bmlf Yuu vn,t Us.
OR CONTRACTORS FOR ANY SPECIAL. r. -IMPEARY 'ij PVIRt t4NLt Nkt'I Ihn At,nem m4 th tntlw rnaF Trnne mu1
E I \L. lONSLFI FN Olt PUNITIVE ll rh luJ m:r p kcr dr• Na qJv and ury Mher vgn1s,i bald UDAMAGES(WI1ErFLIR ORMLCLAIM IHCRF.',ORL wy IS whl npu+xJedlr»daru JnnJ ran [ m.ulas cam mmiuxnmq alauzsran..vuJ
H ASFD GV CON 1R\C-C,TURT.DITTY IMPOSED BY LA\t OR unm .Hnn pu wuu r¢u rh xm.)rcl nu hcmn
OTII ERWISF).11'CONNECTION WIT)1,ARISING OUT OF,Olt Z2 N`�nYul\c FkTk Cf Thix ay{aernan.hall Fr.hm Finn ampo, m the
hnnm f Anr ura L+turd Ipn wul tort resPcnn'c hi. I.•�vI apnvnrwLLtek
IN ANY WAY RL'L.\'CID TO "CHL• TRANSACTIONS udeJ in dux
CONTEMPLATED BY HIS AGRLE NIENT OR ANY' ACl OR \�r n h I t n r Ina.ne, cr Nra •termrni oar xu of the pghu,
OMISSION OR FAIT OCCURRING IN CONNECTION u Ilrrt r �r nu a4r mull hu axsi�uN Fy A'ou hhrwr cjur lmnr unuvn
am,rnr 1 r n w n n 1 h 1 w IcrNnut r)arpriw.inhm cwrmmehxll he rTrJ.
CIILRI'WII•H. YOl IIF.RHHY W'AIbL,RL"Lf ASG.AND \GRL4 z�.cto pN�inC t \\\ rnrs \�m.•emenr, +nJ wry ns[rvmrnt �x npmernmt
NOT TO SUE LION ANY SUCH CLAIM FOR. ANY SUCII rcqunvJ h.xunJu.dwllh nnc.�+`y and dmwrwdu do rh mlrmnl hnspfrhe
DAMAGES. W HETHFR OR NOT ACCRUED AND W HETHFI2 ��'�i�}je)Eo l�l' ��Rq r u.,Jimmda.xnd�rher•mmn un m r r rc uinA ar
OR NOI KN'O%VN OR SUSPECTED TFD CO 17XIST IN YOUR term rtm a M•y)ssn ntl r rhi. \tyJ tmrrnt ilnll ht m nrning dWhcre� m(he
FAVOR. YOU FURTHFR AGREE THAT NO CLAIM. dlg6 ub4 fmm xr rh Wan- n f+nit in the,ADveui•nrm In. ql"r rofdwM
LAWSUIT, Olt, ANY OTHER LEGAL OR ARMTRA"HON snv m im I[.gout fm rm 1 mn h1 nueri nee todremher p:my,
PROCCLDING IN C ONNLCTION WI'CH.ARISING OUT OF OR 2K•�1. \ft\I Vi t r I r t m csprzmr I nl'This Haan n wa a ' nr
NI r h.hs nc� ran rc arc r J J w u+h h mnninvu m ar nrwr)Id I'I xhill
IN ANY WAY RCI ATHU l0 THIS AGRCLM HA MAY BF uni meh f tl nI ml r t Is„.,war ) t.IyU n 7 $nrrd V.
HRGI GFfT. CbSItIFNCIiU OR I'ILI:U MORE THAN ONE O) i&tih\kN\tllttif\ II n p pn ramrhs ngismmr ii'Ir�o he awwal
YLAR AFTER THL INCIULN C GIVING RISE CO SUCH CLAIM pro6 h r A M MFcra ar ur dwccvhl ht I vrhnmtw r mm� or amPuun
YOU ACKNOWLEDGE 'CHAT WE ARE RELYING ON THIS
ilead,Ir rino au he esimniuestl rt cd r�rl'A 1pn hlhue`d,or unminiccalhic
SEC' TUN IT AS A (.oNOrrR:iF AND MATFRIAL nndu nllm+� n:per h is norm+!tell nro m(idl foncandrlth4:Pmvda-.l.
INDUC 'h1EN TO ENTER INTO TIIIS AGRLF-MENT. !room d+n»m) +u 4 pi ilm m h nmde eniumrnUlc ppv� imtnhon drvtr:Ii.
I A.1]UEYINLIIGV'P ION, fn ,hc lirllcxt "nl.nl mrinad he than udr pn 9i I Itdl be dµmnt to&;a hmi4a and shr 7l h�cnlumedble uo the
pc Inx rmwl v r nn r ud Ns upPliwhl +.'
applicable taw-. You Ncrebc agree if, nulentu r, ndvunee ex eases n.crJtN'IEt<( Ux rs 'lhia .tgneurmn mac tw rmund m ane ur own•.
r• u dmI xfI wch:mm4 n.JInII h Jnm�d w cauavlwe ane inatm l for
yy �p1 cnun.rp n+.
and ht1ld 1talIMILs11rachns a 11nd t, s al)lltdlc3. td as5lu i kcuACI'}, A !cnnmle m nrttuMe duNrw l li+mmr 1•'P`ICI .hall camxti[ule 'dv nnNtvvl fitr
a•emJ, contractors, and Our S»ecestlrn:r and as;iens (cuelt. ¢ par mcs hr.ma
I
"�nvered Pemn- Cmm in, and all aunt pan' clHims. .rctionx, 2N.pPtuuCIT1-. A'uu lrcnmy.,urhamaG muar Yourmw\nm pmpeny-.wax,
I ) and l:krr '-m nntnmWln,r¢dm,Irlcvisirm amvil..aexl mcJ u.
dunn t+h.sides uv
rnsls• uxI?coos mdudin rcusonuble:nLLrrne > Ices:uxl eN cioind.
) � schmu4xinti.and arvmWin.nrfdix+rxOrdin}:P M•drh;n(Ve xpm•Ihul We mdl
dmturges,liahiliucs, peon Ilcn.xluSSCA. oblik+auuns, mjuri 4t n 11,os not.l6.gnr.am of 1'uw Ixvs.maa} iJwtnf.inp iu�nrrrunwr IG«cPI++Pn++rdnl br
and liert'hC any kinJ ar nxwrC in r:onnccuan wish,nosing oul nl;or �tlglr rteIr tibu swc and fvfna rcicrsF is Ibr Huy U:epmc rd:mng roar nnxmp
in mq•way related to(i)Ymu orcach of!hie Agr�emeni,or(iil Your dw.al dos ire g",
nc_Iieencc or wdl Cul nuynmduti: puivrrleQ dt•n Your 29 PRN SCBEEN tNU OI I fIC'f \U11(.C. THIS
intTcmntticatiun obligtnions un[ler Thu S�e[iun IN +hall nnl.apply it "PI C 4 ) r%SCD I IN
the ht+rot ur damage lhnl �c du bass log sud-i thuJ pxn)> Claint 1AI ORM A'IION' IN Y(IUR I IU UI I FI I OR i INDIC A I Itir
twcuned while one of Our entpk tvq or 0ecn15 wa,¢t Your Prnpcm THAT A OL M(I I I LRl AI.N ( RI I LRI A. 1 HIS OH F IflR IS NO I
G DO '
and auctl han»or Jumabe w'us so�ely caused by the anivc negligence LAVAATFED IF vOt: NOT MIEC OII2 CRFrF.RIP.. IF
or o'tll Pd misconduct nt'such employes or uprnl. 1'Ol )O ',Of WANT RJ RI C LIV F I M SCREENED E NED OF FI92S
19.SUHR06.\TIOK. Y»u 1�tti. nt rele:+<'a all Covered Petxons OI ( 1?1 UI'f PROM ( S 4.;U OI fll i COMPANIES. CAI I. I'lIP
C'ONSUMI-P RI'I OkUT'Ai AC FNf IFS "COI I hRI1 (Xhhl 567
I'rum ¢ny dnims of um parties aura¢ through Youraullwrily or in +?
Ycrw' nirme, ;uch as &'mr ursurnncc `ompany, anJ Yuu a�rC, On XdX6 )F V\Rllt 1 \!F.21AN f)I 1 r H 'C.I'O 8OS I9 \LLEN
(IckndOU Us amm)Y an uch clurm 1'OU AGREE TO NOTIFY I'V 5011z PLANS( MON AA❑ REMOVAL OPTION. P.O.
YR INSU A;10E pONIPANI'OI'"THIS RI?LEASE, BOX s(b AYOVUI A N, PA I)(JN: EQUIFAX OPTIONS, P.O.
20.nMENDNIENI'S ANTI IVAB ERS 'Thu ngminrnr may rm.y lK abwrulcd or HOX WUI'i A LA\TA,GA }p 11.1-Ill"_i.
t
rc.d• n.r,...a+v'rn,.hm. .. au w. ,.a,.,.,ni m...• maa.wa ..
(i)nny aspect of the relationship between You and Us,whether baud in contract,tort,statute or any other legal theory;(if)this Agreement or
any other agreement concerning the subject matter hereof; (iii) any breach: default or termination of this Agreement; and (iv)the
interpretu[ion,validity,or enforceabdiiy of this Agreement,including the determination o('the scope or applicability oY this LSecti—n 5(each,a
'Dispute"). Prior to commencing nrbitration,n pp,rty must first send a written"Notice of Disp mfi ute"via ceed mail to the other Party. The
Notice of Dispute muss describe the nature and basis for[hc.Dispute and the relief sought. If You and We are unable to resolve the Dispute
within thin), (30) days, then either pony may commence arbitration. The arbitration shall be administered by JAMS pursuant to its
Sheamline Arbitration Rules and Procedures mwiluhle a1: hitpWwww.,I'amsadr.com/mles-streamlined-arbitration,the`JA, S Rules')and
under the rules set fonh in this Agreement. The arbitrator shall be bountl by the terms of this Agreement. No matter the circumstances,the
arbitrator shall not award punitive,sppecial,ecemplary,indirect,or consequential damages to either pain. If You initiate arbitration, You
shall be responsible m pa 5250. All attorneys' fees,travel expenses,and other costs of the arbitration shall be home by You and Us in
accortJance wttn the JAMS Rules and applicable law. The arbitration shall be conducted at a mutual[),agreeable location near Your Progeny.
Judgment on tin arbitration award may a entered in an oourt ofcmnpetent jurisdiction. Nothing in this Section 5 shall preclude You or We
from seeking provisional remedies in and of arbitration rom a court ofcompetent jurisdiction.
NOTICE: BY INITIALING IN THE SPACE BELOW YOU ARE AGREEING TO HAVE ANY DISPUTE ARISING OUT OF THE
MATTERS INCLUDED IN THE"ARBITRATION OF DISPUTES"PROVISION DECIDED BY NEUTRAL ARBITRATION AS
t PROVIDED BY APPLICABLE LAW AND YOU ARE GIVING UP ANY RIGHTS YOU MIGHT POSSESS TO HAVE THE
DISPUTE LITIGATED IN A COURT OR JURY TRIAL. BY INITIALING IN THE SPACE BELOW YOU ARE GIVING UP
' YOUR JUDICIAL RIGHTS TO DISCOVERY AND APPEAL. IF YOU REFUSE TO SUBMIT TO ARBITRATION AFTER
AGREEING TO THIS PROVISION, YOU MAY BE COMPELLED TO ARBITRATE. YOUR AGREEMENT TO THIS
ARBITRATION PROVISION IS VOLUNTARY. YOU HAVE READ AND UNDERSTAND THE FOREGOING AND AGREE TO
SUBMIT DISPUTES ARISING OUT OF THE MATTERS INCLUDED IN THE`ARBITRATION OF DISPUTES" PROVISION
TO NEUTRAL ARBITRATION. cusmmrn�t mauls,
1/WE AGREE TO ARBITRATION AND WAIVE THE RIGHT TO A JURY TRIAL: ® ❑
6.NOTICE TO CUSTOMERS
A. LIST OF DOCUMENTS TO BE INCORPORATED INTO THE CONTRACT: (i)this Agreement,(ii)the Additional Terms and
Conditions,(in)the Customer Packet and(iv)the Work Order. These documents are expressly incorporated into this Agreement and apply
to the relationship between You and Os.
B. IT IS NOT LEGAL FOR US TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE
TO REMOVE GOODS INSTALLED UNDER THIS AGREEMENT.
C. DO NOT SIGN THIS AGREEMENT BEFORE YOU HAVE READ ALL OF ITS PAGES. You acknowledge that You have read
and received a legible copy of this Agreement,that We have signed the Agreement,and that You have read and received a legible copy of
every document that We Rave signed during the negotiation.
D. DO NOT SIGN THIS AGREEMENT IF THIS AGREEMENT CONTAINS ANY BLANK SPACES. You are entitled to a
completely Bled in copy of this Agreement,signed by both You and Us,before any work may be started.
(F.. )YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PBUSINESS DAY AFTER THE TRANSACTION DATE,ORRRIOR TO THE LATER OF: (I)MIDNIGHT OF THE THIRD
T 3RDART OF
HE NOTICE OF CANCELLATION BELOW FOR AN EXPLANATION OTHEF THIS
RIGGHTTALLATION OF/THE
...SYSTEM. SEE
VIVINT SOLAR BE E$ L l CUSTOMER(S):—;i B /L< /�Luicw
Y B
i
Printed Name: Printed Name: Mhb&iwlO
Title: a.{ BY
Printed Name: _ ^�
Transaction Date:
FOR INFORMATION ABOUT CONTRACTOR REGISTRATION REQUIREMENTS, CONTACT THE MASSACHUSETTS
OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION: TEN PARK PLAZA,SUITE 5170,BOSTON,MA 02116,
(617)973-8700 OR 888-283-3757.
NOTICE OF CANCELLATION j
Transaction Date: _O_AR No.:
YOU MAY CANCEL THIS TRANSACTION,'WITHOUT ANY R PENALTY OBLIGATIONS WITHIN THREE(3)BUSINESS
DAYS OF THE ABOVE DATE, OR (IF LATER) UNTIL THE START OF INSTALLATION OF THE SYSTEM.' IF YOU
CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY
NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS
FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST
ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO
THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS
DELIVERED TO YOU UNDER THIS CONTRACT OR SALE, OR YOU MAY, TF YOU WISH, COMPLY WITH THE
INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE
AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP
WITHIN TWENTY(20)DAYS OF THE DATE OF YOUR NOTICE OF CANCELLATION,YOU MAY RETAIN OR DISPOSE
OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE
SELLER,OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN
LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION,
MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN
NOTICE,OR SEND A TELEGRAM,TO VIYINT SOL,k�d DEVELOPER,LLC,AT 4931 N 300 W,PROVO,UT 84604 PRIOR TO
THE LATER OF: (I)MIDNIGHT OF THE THIRD(3 ) BUSINESS DAY AFTER TILE TRANSACTION DATE,OR(11)THE
START OF INSTALLATION OF THE SYSTEM. I HEREBY CANCEL THIS TRANSACTION:
Date: Customer's Signature:
1 Y- .li.i tl_ I.po.l:li' I :yI.e R_.,:uti tt..v iir.; 11`.1,:N
ADDI'11ONAL TF,RbIS AND CO.NDI HO_NI, ,
7. REPRESt'N I%PIONS ANO WARR tNT1E5. 1'r1u rtprcau,rvwwm ind may Iwnnnme IN, Aermm ml nn vrnuen mutt to 1}w and Vic oIll So.elbllgmeJ 1.
g at Ul : h YNcI 11. i-uI ant umt (lnll+n nswtio wl m n4 Ymr pre r L' n amnl ci al A.F rr IAJh",(SO per Au invmlkJ ohyel I.A
Serino :trot I I 1 cumJ I t (IIA w An N I my Ibe mpl r I'}..1 the rCd uw el 1 I+n hr(. 1 pr )n ( b in I n.UI Im+nler PgoVin will be
PnxpcLL)ti 1 I ha i11 I v i+ I. Ire/:pip n>)hn Ih p ysny 1.ull)1 u 5151 pv n uAI b PI /puLubl ens•v 1U Tenn/ Prri�m Aft Ali,,1'ub
are Jii xa i nIIS�y ntf xl s\w cannon haeu It.c:•Il marnwm pa t L do,lms6rPtm. l We will trli lr ,tedp,flhe Ssiem to 5•.A,
v"nun prvi cIi,Vol h 1 ly n:u I ce uah"nsl to Tv+v M Penn; ,it J I i You vn i Is,Wh i iw k x Ulv4ntl'ng m that m r n r n U rs \¢rv-nnglr,it
ha e low I P nun sy I. a nJ d at4 5 des Apour mn A A(err xt1.5 l clo Ihr pmpA sl A r r I Y yr ition t o PrUfAM) m L I c Is a lclite IV outer
a ui +i mbu A tr 1 w n uv d hex m ul You unJav:mnd IImI u s 1 r lurk•. the I-tl m ry nnr A I♦ mirk "1 1 m will rcnn n res, :hlr Nr(md'ontrunce,f
n peter Alien.. till .n Ns\ cn'm rimleh Yx .Ante ISra<h r Vou ,Meganus and li A4 •+mil. Yw aprm Thal the Jrsdh,l all C'nsmmers
Ihi. tgr en n and wnb II III tit min�+,punt In In w.'unIJ JChI R• Scent I I hall fic dI,,ined a t m ter of)bur pripul5.vW We ,III uolk with four
Make no nnnkn(vnrn tt wxmmuv except a'<sprv+l)vat funh rn TitE.\Wernwn4 -ua ¢va•r1 Alai hir, revtsiv Uri+Aprcennnt Proteinin the wrens vnd aVditions of
8. DPR,LR\'ICES la.,\.LSf�l, , we sIII asullI Initial m mtelr Shunt h/ r
m mlasum l.+c 1 vmy p 'v I r. h n N, a 11 t•Ihu Iwmm <dnu U.h\F\1'g Oh Ut I \LI i' ! [{ rtVataUCI;W(. A-Cuvrxmer Uhall'shall
too,wlv or Arse OA,Ara xmel to cnilan um-l�da We wdl prmudr Alit,Atlu.x You rrxe t the aww.v+n.m In) o(I f Ihiv nu;ii our iedure,to mvl.v any pnyrumt
nmm Yaur nvmn,lhk reinem Yun ngrec IV ulna"(her purvnnel too a ohm m unajer Ihm-termrnmi wvhm on I In days or,he.due and 5onh tniltne in not cured
Yanrc Pnnwny ur enllc(I sn<h Jme. m0trd+xeetw..We VIA,led thcacrumry x nonce
orlhu .+then tin I in) tk. h,v\m nnen of'An,F.11um ii)Yaur raflure
pMnr vnc 'Ian I t I m w lie II 11, ndwous thin the mUen.nnaeurnte to p rfm Ih,, bh,f..n wu1I x Ae eurnow Ind wch Sol . ov cure) Ihiv
a nun thna - > `A JI It PANIV and n shhrur Alm lance Jt Its nav In)'.u, Ihmv III))r.'b. 11 r\1 a go e t u arhThin awl<e of such Imlure op%'on dcu} UL
And lil mak, mA a tsn ur 1polown \o ry'monn Msn in AIrreelil mete You Ou rool'o rY or dn a Incn lrmn lel nwt A'. Lub D ."'Al,a lotx
Air I� n m
I Iont P xluh A r c we n it the nmm' o,"coSto I r e I t r I Wmg Pn Ixeo Ind Inch orient,a not 5i a 1th t It tyy f(ool)duos Ann We n it You
Yt ur Arlo In ono ruAn x rkr g bna iho nl nun(y•,t or clew t �e 51 Alt ekeunit n t of Ihc r II r t p d h n •e.,In710 r ha kmptvv.mmheacy
re chly Tnu tv lit Shand Il'arpnt ihi-TFlllr"L1e l If theto m+s cube r IS Your N•dly m run,. lxr Jv nEtheymm(rc ur(tl Your Pnr un
davit der eco dbv lw own iio conlop r t onra au.r ur 'InI haxn ey trl til r+ fxeel ...AccvNng. Ihi R<IR4d_.�2 hlfSuslR0.p M-',hA
k.h.n-C /rl h v rl I rNA Sy Out Ana oI Wv w I P'_mplly BT -t e. .v �A lawl occurs. tt +m rise a Ihn v�ihhr uw r 3iet.
Iryrlu tb Jan v4.J m r urns 1 N S 1 1 a. Ie '+an r insure n 'und s uxl t (u teen nu II rs \gin n to JAI Jcnra I N r,NY she 0.fuub P tin t.- I u the
A f u If no S}r A•.Jnmsyvd or U m of In a L c rulr)Et r 1 r t n od h Sa I pl y r }n r Itoprn but du a Ynu i s tmA up. d I n now T Ir
Rur htran Wa ma ut On,rpii rI❑ tI r rW I r rh S)wA Ing d i.A h 1 in,,he rd Arbil m+l oil] tour c4<I n Bill drv.'ourrnc nr eike
v, rk V antl I en w 1 s a n u u h \grv<ant aJ,m 1 wr ccl n Il. r Fu'k he sw m :prmfu nl by aPyII J 1 l (a I'I'w a lion In You,pml4ny,
cr n r Ih S lent In t h ql Y+tin} and t+ rr. 1 l i\here i U Y.1 0 1\I rllt�e n ILY1 r Ue Y 1.rod Rn meet.-Co."t In (tiiY reRnfl Y Ira)lfnuh
nA ht 'naI n sl 1.rm r rtm .Nv y ae t n Ynv f pm a)OI, Ann sn o, 13 r p n ,"eIrs nn 4n t 1 �) v r lr•An or It" n cxh mnduNv to U.c in
I\y n We may m dIv Sa�tuu rohv lib-vet-vlrl frwt ih t All r in n.w`si{ Oil,
hi tggncn cut r n 1 tppl ulhiv 1 I Jai r liturl1.. 1'&Uu Oe' oi'.lull
Ill., min...h Jtw nrtel`��� TW an- .IrrN to do Ind ApPi lfhic law mvr llm mclnmd of vw of tl1 61m Inn, bl , WlI la peinrm:In,ul'CT.r
Y. V( LR OUIIhS ( If 1Ih G},Irr, feu 1111 use ❑ rtrn J van n I i hiiyttnma mil OI >4'vlllaW we cf(el.f?uvb fliumu Mll.von zl
purer nl I I l r r I g a a e r g(I of \ II t a Y :h II n re;tl rh n l)nl Inn an } u Fiv l I n ra of aei (.lu fill OAr
IhI Ih Ir pen ens gnrF nvW1 ib. 411u 1� S f@t;J1lan in5r0.0 Icuuknpl) nrlrnsu ado --I nAfVu illbii lr'R YOun�chts ss lhaa mown.
}ny�NR 1 t'r mt t I 1 UI Sy r n t6 a iA u u rev I tl I t n rig (JI Llt•C"�3J�r ui r lkJit.11 If Seil 0.1 ttll u nr:and onumim5.You
I n l r nt nn rlh mJ fd A I nr nit W d J am-al naI I l Nine,
e, m+ I uun lax d Zy m t i royual n al oI Nt G}Ylcm (late lien- i
« I bT (Allan aauh fly J innnl Ittr II en s n(r M 1,1 Pml nJ err(uf,. Pr p ahH itl vrtl e.an) .N rannlY m14h�e Ir i
:il Wem yeharP<1u tH ihtll rFaym ur 1:11a tb al f: 111 hull ten n11'v Ayrtvnm uu tirapp tnbl a \mxuhsl nitop the lo"Ju'AnIt.You
nnr In Ut r r pan r alhrn wdn y nppnuTu{` 1 ill Ii ci) w1i1 hat no r�WIttI t ntvim 4rm putt U.m resu0.nt the term irpui n of IhIS Agrc Alvin.
':I/emNnm h.r1 b i +k am omen Ina vi W saN.0 IN nY o rtnm r i4nnF na pl l r ia1 di<'rtuml n.o rcnma<Nu Swrrmn.If We fa l ro nett•v the Sysem
m Ihc. tcni 1'nu II hr spmnlSl.1'r n Intnvpr t ah St r m then I,nu..0 I,, 1 Y M spcny I m'aaal rt by yn IS Jn(1 I am Uunu¢s m lour pmpen
u) tin 1 Ion w 1 vI yve:.w n I mt u I V 1 y i@ rJl Pr xt} n I IJA ft m II r•m al 'I Ii yearn by t•e n bur ennlm<u+r in)
\ISsLO_VIA .u Ilya➢1'I u n 11 rues un Yt. mprny tan ne all Ira It
YArrc nn 1 and ukeel r r I. xetSl I S1s I r ri+ Ilnt JinF f Ih 1y.r n -- MIAMI to I
n a Is e
the ftchult
+any)hit m Ih< i r t u+ n Dm.o 1 'm nn n.n rl mtl nJ n II Jbd An V. Penn n i ❑I "n jr h P j nI flail Scan arm rim<iIual w Se en Dallas 671 Aar
the Anil and all erne r 1 vR r. of\Mir ry.ny is) )r yam,s. S w hull -h tannin,eull<•,t loot n f li pttumt(evyl pi[)�ar re,y,i11 year r_rl,the
uheJn(lam Tnur m n rL. h nI rn nn J. rrrhim r m tMt Irc.t I it an L>•la It(m neno x.11 he a>.t R Irer q mst•rll dl plus vpl l rnFIt ma Y You ogee
mle't5i n 1'em Pre II m III authnrum+ s t son 1 4 s I a m,r I +p ,anJ thin the Damon p sin va E Tij l c1_s Nc li I the S>It,m sunpp,,m Inn rn c At x
mtrw nine yysrem Yrwhilu-w hunNw ih r t noun 1",,`Ien ne l'c tamrO fA h a( rnpnacnwwu INc dnmayxz anA lauvihnl We "prnN
Andy moult in linen Ina An Al tlns Au.,-.-I I. ID,Law \t III pw� air lava Incur Alien N u pi Y I L. ih<IYIuWt 15ymrnt,luu rill Iranvfer uwIlenh1,.1 the
a? s ti(n u r nnr fmm Inswlim i anY d Ih }zl n IIn NI g ny Svslem m T n an \t 1. Whrn p•dlsis
get 51 ci -.alas I un d En Js pnJu v'J h the ky t W vl 11 M la, ILRAiIS UIRN i 7lcrtnnv h Sclier Re mny -I O rv+k decrctimo
mp,s bit fen n.nm Ice f property mt a -v'd n 1-u tv OvAnner,hip of I•enamor[N tg n m UI p 6f i IhT�en Iv<Om ufn r d heel)of wnuen
the S sI r 151 t�'�anEo 11 Ynu d l 111 c g r nPwl flan eat null t rY. r 011 ulmn dre rmarmm e.fu(Ill men IkfaulL W tlbn nwety Ivn) '
nl urns vhmrherol+Tc Sv ten R 'I msw la+ n \r shalij )tlrr ahrrJp r. IJ Iv aBvt rent Un Ilhi Agrxianrnt rUrathal udorUrc eircwnxw net inwhid, i
la rchar{ -or(tlthdAALpry myu - hr rNa cTwrgtmnllEfnnNe Syten the Sa lrm -Ignsf mvl wAou mxkr S{N[jyJL, girrg_ly.ur ,Wex11 '
.r sb+s 4urcamml ➢ Ii. s Sr ro D m, than 1 x i 11 h p. hl r r m ae Ih Aewm nnJ ra)nrc all rim@p pmmm�w,v kr Fe Irco Iram ry s. If We
mnnbrrr L's lie.roll ui I or xha ahnr� {-v�n f r m n I pre pm I cs hu w lammmnle lhrs \hmemlwt. N'r wr11 Saxe no father IlnbRin, w You
nhn arc Our mmm h I g A $mvpl,v11)h d I f-fnl \. u n c t.po n Our urlfu not I. be
myu s l r hell p amdl gr J s�rtt m 1 1 appl r h nun Am or nth
II a lean ol'hmrer al ten, . m Ul)vPa n Svller DefauiL
da m rn 'aryfr snitrt -tan nvlii Ih. m I II ur right In shot
em fical N rib-I or; N b I rL Iloa I ti( n Ien I R N S t m N t cr An dnxn the Synnn Cnr m Inw ear ma)n n the bygCni rY W e or bly
lam ,Anal ter Sena a m( (.II (al the S. /rr r 1 (1ii snY hl rlwt lktlsrny< nJUns nevvl Iparwxm.n Ne thuP.vv,uhmhwcnol
par tits imenonnxuen, net mmm�e�yreament.,a ❑ ❑u tlovurmnls rcywiretl ba under Om conWl,wbaher or not do Your voowl.mn mwrfere wnh the sail
N W ry 1(hill env Jcewmem E t ifi[y Ip im t Ih o nmi 1 Ih S)stcm Ia 'S lrq Sh lQ.xn') Wit p e pendeony 1 a SafeO
Syat f Srs m 1 Ilerots. m DmY1>nt Y.n d n I pU)nni r 'it,-rn S�n1 I v -JI pu,U. ma Set It Ion 1 arnr<m N�]in m me
n t 1 riv>n or,,hmg nn'nen (, n t opemt 1 tl le. li)1 t t r 'c I rhos\ v orate Y a r Prolxeny for any pemW of time v.a csu r o an ea cut Nat
rrgmnr the mlycxa+nmm orpnvnt indatmnx err enn:mi•rm r tear mny trsvenl rim nFanvMv care E.rnr+rc 5oily Ikfauh:Ypvariilanrimreto "ri me- '---
nmpe,Symrm llc.niufng,A,Ili ll l'VY wke Al,uil=m T0,se pion with n5pca'I m dIC. Putn4_)'Pmduuel�V Nc Seamen. (el imefem nee[lor�cv_is'ultn i hnt<mlama'tlon
$5 Wm. YJW ruluN to p m(xhv IVAN Us or lu Ir rnaln'n'Sh:JI I)2:1 CI IIInV 'iJr 11r IJtlln) bi'C'rnvs dexclnnttd tOr rcaionti r wt 1(i)a PaNe III
Ocfavh urrhNS.vlinn I&aS F.vtml.•x lii)am+sad 6 or relnle'd to Our uneacusal acUw ur inacrian,such shut the
10.SALE OF Sb�R F.'NERGYI W Sate�u�'L'la•(ri g Rip nnine.on6 lhr in- Sa;;:cm n ao Ienl.•rr ab)I<tn vmda<e clarouirity or vvusfer elxtricity m You m to the
Service Duw. W< I'll yell ,,Ynu and TlIt wtli Fuv urn U,All of the Ene:gv Ulihw, Ynu nili pm Us Nc ShuWmvn Pa:menr. (J)�ew''r aayLp .a The
ppmdo«d by the System. Title to And risk of Iasi vi➢+rppact to the Enrrav aNdl SM1uiJnwn P J'rnr'nf shall equal Ne turn n((i)paYmnits o mIv_ry
Imnsior iSin Ua I.You aI Ibe point gherc the Sestom is Imrl•mnncold eaifi Your 1'au s.'oulJ Suer made to CIs us desrnhul in Sv n \,for the linm•y NmvtiaWd
lioupcny'v IIII xl airing• Energy Ir,m he Sjslun will be delilere i to Yau in. have Env pnducN by ie Sy'm<m d.ing Ne aJ of the shuubun;(ul the value In
cn u'len.with All nnwinmrcotn o: he Oillin, 0,L11,,r�is. Ynu.,go iII the Us of the System Inecpuve?that q'r uvw1A Wnr neehed with rcsparl 1.oho fun
ecuy
uhlig:.inn m pnn 1> nI nr Jue under Ilde aye meet shall Ire aMniute wrJ NAr Ahe SYalem wnvlA hedptWuerJ Ibllawinb'ach shmduwn-and pnn ap flnuhfe
uncondaional,And AntI not let snbjcm to almwm<m.Jvlbna<.cowmalnms,xur0: alas. Uccerinin;m(mof@c nmwm of"Fncr�ry lhv would have biirt pr+xhrec�during
recwupmenl < bcduconn. You And W"e-.;tree Aid All mount, payable by Yon We period of the shuWa+avn shall ne hxsW l/al durin6 Ne fist year after Nc lo-Scrvice
he.I.I.,shall hr parsFle in All events inclnJinS by Your 6ein anJ exam. [xceptas Dace,on♦stimaled levels of przduaion;And(R)a0n she rirst year crier the hlService
prrmiucd by Nc Nnui'e oR:nnceliminn.Yw hereby wane vll nphw Ynu may hive w Iymc.S,veeJ nn aa'wal oprrauon of Ih<Svncm durine Ne same period In the prwlt+.
writer or cancel this Aweenent.to N%oke itc,coun u'<of the$"lynx ur I T a y'r.P 6 -huWnwn Pvr3tunt la�i then J m Aha b IS amu'nuc,flu nnr hundred
i seaur'Iyy r I raYl r Ih �y t (.. LI L r (O,�x'I••sAs1r.I ti p aS INT DO NOT vnu i(.I t (13O)Jays n mvar�e mny.m ur n c JrsnnYiml, tcrmimdc this
WAR AN¢T OR Gh ARtYi Fly (�fI' \\I✓JI'\R DI F\CRTS' 1R000ClD BY A•rnmlmt wd nyyu relnl)p'Yt g.ynu'I Pannenl
)yIL sts(EAI FOR \N1 PERIOD OR Asp COS SAVINGS Wester not a oil hy I� FORCE AhWEURF It\v n Wa me unable pr peribrm anv.f Alit sdrl'gAGram
or puhiw y sn,c v.ntunt and du pal AI.Arrin amy obb,oinn,orb wilily or no h in antler 16 s Agnenrenl hennuse of.FAmd Mnieur<Gem.well n rienied puny will be,
stnv`e e,smpuny to wppply Your eneruY mmmmcnts. We am not snbjat to rote •teased Il in ohatever pvrfumwnce is Affected by the Fine hinjrum Event,proo-VI l
mslaav by gowmmrnml unthonoa. D'nnng the l'wnt Face nrWnswnJ Nat Yi.Art- Rrm Ne sown,ion efstuhobbuntions isofno tW�a'lar sn.peund ofn.lcnkka Jumuon
m uirc nurvn uls¢ienv limo Ahc tiyeiaan may enwww. If Ynn m'N Y .itrh rhml is raywml by the fume 1fx'curc Fvem_ "F'n v.lfryelrc F,veni'ehuli n any
nd5itimral ennSy,themY'nu shall M:3+8c1)'n'spanSible W,burin lath nnrpy fmrn Ihc vvwt.cradiliannrcitcumwan¢llrewnd th<e,ntmh.f theulTatd pang which bylpv
Utility at Tour rest. pxecim or duc feaight such C re......ttl ,III res'Nu d,bmc Seen<s"osl w avoid.
11.(}\t1NLRSHIP OF 51'S'I'EAI. tan fLti C)aeneraiiQil'rh.•Svsta n. We elwll eon And enicb by the eveniv-unto,816}enee such Puny,with..funh vurihwAMr Io it is ,
eetl hull all prupyny rigl+ti in\Ile S}strut an31Ti2'SN-stun mer�.•sti PmuhAll heirs uo unable In ce ome.nwludirtt but Al IimitW In,n.ton by n gr•'rmmeo:d amhurhv,
prv(`ny mtamst m Ihc Svshm ur r Systrns Inwnsu evicepi fur nil den Energy then Nr.fallum v vmon the prm o rev euvemmrnml vurh.dty an a Clilily(Frravfder/Urht
I Ne.:yuunr yrnemus,and lii)ant cm)its nr hp`nnwu AwJnbk mrrka Ywr lIn limo, wvh vep+m)rut Sermon umeh rayirelN mW Jili}nvlly plAswdt. e+iNre m Swin...
f v I mereri 6 P Fmm Inn N 1 I r5r Ili t t •Svsvn 5anrmlrs \b utrter to kea'p "A' A on n,liv r n em au ppm al fY v/rl tbat etch pony hers made
Nc Sy'[In u ui S rem b I rOL fee fen n ail it ns un nl vmhm m (M r 1, unmly anJ rt anabl Ponce al Runs t Uu n an I IlLlmwilr Nc seem), Gahm'
Prep n Wurc I the S .rem NrI iths.wWr N•men r Inah due Sett m I drpyutc sA -IIrk-maRpag, luv-dmn i C 1 ➢ W.amhyuvkv,flu,li^Mnmg.
ima rlT mpenY Iram uxwm holing Fa Us.1 w vnA N e hereby,lane than. sa nJ.n.;dunrc
.war.tenonsm,nnL¢I nwric wneuun nr a nhnrgrr,a rJ d sw`Frvncc.
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PV4.0 M LOGIC MA LICENSE:MAHICI]DS48 Salem,MA01970
DRAM BY:Jerry S AR 4103739 Last Modified 121512014 UTILITY ACCOUNT NUMBER'13279-53007
Vivint Solar - PV Solar Rooftop System Permit Submittal
1. Protect Information
Project Name: Marlene Di Pietro
Project Address: 45 BELLEVIEW AVE,SALEM MA
A. System Description:
The array consists of a 5.61 kW DC roof-mounted Photovoltaic power system operating in parallel with the utility grid.There are(22)
255-watt modules and (22)215-watt micro-inverters,mounted on the back of each PV module.The array includes (2) PV circuit(s).The
array is mounted to the roof using the engineered racking solution from Ecohbrium Solar.
B.Site Design Temperature: (From Boston Logan INTL ARPT weather station)
Average low temperature: -21.1 °C (-5.98°F)
Average high temperature: 38.4°C (101.12°F�
C. Minimum Design Loads:
Ground Snow Load: 40 psf (State Board BR&S)
Design Wind Speed: 100 mph (State Board BR&S)
2. Structural Review of PV Array Mounting System:
A. System Description:
1. Roof type: EcoX Comp. Shingle
2. Method and type of weatherproofing roof penetrations: Flashing
B. Mounting System Information:
1.Mounting system is an engineered product designed to mount PV modules
2. For manufactured mounting systems,following information applies:
a.Mounting System Manufacturer: Eeolibriurn Solar
b. Product Name: Ecorail
c.Total Weight of PV Modules and mounting hardware: 1034 Ibs
d.Total number of attachment points: 48
e.Weight per attachment point: 21.54 1 bs -
f.Maximum spacing between attachment points: * See attached engineering talcs
g.Total surface area of PV array: 387.42 square feet
h.Array pounds per square foot: 2.66 Ibs/Square foot
i. Distributed weight of PV array on roof sections:
-Roof section 1: (22)modules,(48)attachments 21.54 pounds
VM-r �. solar
3. Electrical Components:
A. Module (UL 1703 Listed) Qty
Trina TSM 255-PA05.18 22 modules
Module Specs
Pmax-nominal maximum power at STC - 255 watts
Vmp-rated voltage at maximum power - 30.5 volts
Voc-rated open-circuit voltage - 37.7 volts
Imp-rated current at maximum power - 8.36 amps
Ise-rate short circuit current - 8.92 amps
B. Inverter (UL 1741 listed) Qty
Enphase M215-60-2I.I.S22 22 inverters
inverter Specs
1. Input Data (DC in)
Recommended input power(DC) - 260 watts
Max. input DC Voltage - 45 volts
Peak power tracking voltage - 22V-36V
Min./Max. start voltage - 22V/45V
Max. DC short circuit current - 15 amps
Max. input current - 10.5 amps
2. Output Data (AC Out)
Max. output power - 215 watts
Nominal output current - 0.9 amps
Nominal voltage - 240 volts
Max. units per PV circuit - 17 micro-inverters
Max. OCPD rating - 20 amp circuit breaker
C. System Configuration
Number of PV circuits 2
PV circuit 1 - 11 modules/inverters (15) amp breaker
PV circuit 2 - 11 modules/inverters (15) amp breaker
2011 NEC Article 705.60(B)
vivinl.solar
D. Electrical Calculations
1.PV Circuit current
PV circuit nominal current 9.9 amps
Continuous current adjustment factor 125% 2011 NEC Article 705.60(B)
PV circuit continuous current rating 12.375 amps
2.Overcurrent protection device rating
PV circuit continuous current rating 12.375 amps
Next standard size fuse/breaker to protect conductors 15 amp breaker
Use 15 amp AC rated fuse or breaker
3. Conductor conditions of use adjustment(conductor ampacity derate)
a.Temperature adder
Average high temperature 38.4°C (101.12°F)
Conduit is installed 1" above the roof surface Add 22°C to ambient 2011 N EC Article 705.60(B)
Adjusted maximum ambient temperature 60.4°C (140.72-P�
b. PV Circuit current adjustment for new ambient temperature
Derate factor for 60.4°C (140.72°F) 710,. 2011 NEC Article 705.60(B)
Adjusted PV circuit continuous current 17.4 amps
c.PV Circuit current adjustment for conduit fill
Number of current-carrying conductors 6 conductors
Conduit fill derate factor 800,a 2011 NEC Article 705.60(B)
Final Adjusted PV circuit continuous current 13.9 amps
Total derated ampacity for PV circuit 13.9 amps
Conductors (tag2 on Mine)must be rated for a minimum of 13.9 amps
T14WN-2(90 °C) #14AWG conductor is rated for 25 amps (Use#14AWG or larger) 2011 NEC Article 705.60(B)
4.Voltage drop (keep below 3%total)
2 parts:
1. Voltage drop across longest PV circuit micro-inverters (from modules to j-box)
2.Voltage drop across AC conductors (from j-box to point of interconnection)
1.Mirco-inverter voltage drop: 0.35%
The largest number of micro-inverters in a row in the entire array,is 11 mCircuit 1.According to
manufacturer's specifications this equals a voltage drop of 0.35%.
2.AC conductor volt c drop:
:P
= I x R x D (-240 x 100 to convert to percent)
_ (Nominal current of largest circuit) x (Resistance of#14AWG copper)x Cl'otal wire run)
_ (Circuit 1 nominal current is 9.9 amps) x (0.0031952)x (100) . (240 volts) x (100) 1.31%
Total system voltage drop: 1.66%
.viv , solar
EcolibriumSolar
Customer Info
Name:
Email:
Phone:
Project Info
Identifier: 19725
Street Address Line 1: 45 Belleview Ave
Street Address Line 2:
City: Salem
State: MA
Zip: 01970
Country: United States
System Info
Module Manufacturer: Trina Solar
Module Model: TSM-255 PA05.18
Module Quantity: 22
Array Size (DC watts): 5.61
Mounting System Manufacturer: Ecolibrium Solar
Mounting System Product: EcoX
Inverter Manufacturer: Enphase Energy
Inverter Model: M215
Project Design Variables
Module Weight: 44.8 Ibs
Module Length: 65.5 in
Module Width: 39.625 in
Basic Wind Speed: 100.0 mph
Ground Snow Load: 40.0 psf
Seismic: 0.0
Exposure Category: B
Importance Factor: II
Exposure on Roof: Partially Exposed
Topographic Factor: 1.0
Wind Directionality Factor: 0.85
Thermal Factor for Snow Load: 1.2
Lag Bolt Design Load- Upward: 820 Ibf
Lag Bolt Design Load- Lateral: 288 Ibf
EcoX Design Load - Downward: 493 Ibf
EcoX Design Load - Upward: 568 Ibf
EcoX Design Load - Downslope: 353 Ibf
EcoX Design Load - Lateral: 233 Ibf
Module Design Moment— Upward: 3655 in-lb
Module Design Moment—Downward: 3655 in-lb
Effective Wind Area: 20 ft2
Min Nominal Framing Depth: 2.5 in
Min Top Chord Specific Gravity: 0.42
EcolibriumSolar
Plane Calculations (ASCE 7-10): roof 1
Roof Shape: Gable Edge and Corner Dimension: 3.0 ft
Roof Type: Composition Shingle Stagger Attachments: No
Average Roof Height: 20.0 ft Include Snow Guards: No
Least Horizontal Dimension: 25.0 ft
Roof Slope: 23.0 deg
Truss Spacing: 16.0 in
Snow Load Calculations
Description Interior Edge Corner Unit
Flat Roof Snow Load 33.6 33.6 33.6 psf
Slope Factor 0.86 0.86 0.86
Roof Snow Load 28.9 28.9 28.9 psf
Wind Pressure Calculations
Description Interior Edge Corner Unit
Net Design Wind Pressure Uplift -19.4 -31.9 -47.9 psf
Net Design Wind Pressure Downforce 11.4 11.4 11.4 psf
Adjustment Factor for Height and Exposure Category 1.0 1.0 1.0
Design Wind Pressure Uplift -19.4 -31.9 -47.9 psf
Design Wind Pressure Downforce 16.0 16.0 16.0 psf
ASD Load Combinations
Description Interior Edge Corner Unit
Dead Load 2.5 2.5 2.5 psf
Snow Load 28.9 28.9 28.9 psf
Downslope: Load Combination 3 11.4 11.4 11.4 psf
Down: Load Combination 3 26.8 26.8 26.8 psf
Down: Load Combination 5 11.9 11.9 11.9 psf
Down: Load Combination 6a 27.9 27.9 27.9 psf
Up: Load Combination 7 -10.3 -17.8 -27.4 psf
Down Max 27.9 27.9 27.9 psf
Spacing Results(Landscape)
Description Interior Edge Corner Unit
Max Allowable Spacing Between Attachments 61.8 61.8 61.8 in
Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 48.0 48.0 48.0 in
Max Cantilever from Attachment to Perimeter of PV Array 20.6 20.6 20.6 in
Spacing Results(Portrait)
Description Interior Edge Corner Unit
Max Allowable Spacing Between Attachments 38.9 38.9 38.9 in
Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 32.0 32.0 32.0 in
Max Cantilever from Attachment to Perimeter of PV Array 13.0 13.0 13.0 in
EcolibriumSolar
Layout
Skirt
e Coupling
O Clamp Warning: PV Modules may need to be shifted with respect to roof trusses to comply with
Q Bonding Jumper maximum allowable overhang.
EcolibriumSolar
Distributed Weight (All Planes)
In Conformance with Solar ABC's Expedited Permit Process for PV System (EPP)
Weight of Modules: 986 Ibs
Weight of Mounting System: 96 Ibs
Total System Weight: 1082 Ibs
Total Array Area: 397 ft2
Distributed Weight: 2.73 psf
Number of Attachments: 48
Weight per Attachment Point: 23 Ibs
Bill Of Materials
Part Name Quantity
ECO-001_101 EcoX Clamp Assembly 48
ECO-001_102 EcoX Coupling Assembly 34
ECO-001_105B EcoX Landscape Skirt Kit 5
ECO-001_105A EcoX Portrait Skirt Kit 2
ECO-001_103 EcoX Composition Attachment Kit 48
ECO-001_116 EcoX Flat-Tile Flashing 0
ECO-001_117 EcoX S-Tile Flashing 0
ECO-001_118 EcoX W-Tile Flashing 0
ECO-001_363 EcoX Lower Support-Tile 0
ECO-001_109 EcoX Electrical Assembly 1
ECO-001_106 EcoX Bonding Jumper Assembly 3
ECO-001_104 EcoX Inverter Bracket Assembly 22
ECO-001 338 EcoX Connector Bracket 22
V ivoi 1 l So I a r 3301 North Thanksgiving Way,Suite 500
Structural Group Lehi, UT 84043
P: (801)234-7050
Scott E. Wyssling, PE
Head of Structural Engineering scott.wysslingC vivintsolar.com
January 6, 2015
Mr. Dan Rock, Project Manager
Vivint Solar
24 Normac Road
Woburn MA 01801
Re: Structural Engineering Services
DiPietro Residence
45 Belleview Ave, Salem MA
S-4103739
5.61 System
Dear Mr. Rock:
Pursuant to your request, we have reviewed the following information regarding solar panel installation on
the roof of the above referenced home:
1. Site Visit/Verification Form prepared by a Vivint Solar representative identifying specific
site information including size and spacing of rafters for the existing roof structure.
2. Design drawings of the proposed system including a site plan, roof plan and connection
details for the solar panels. This information was prepared by the Design Group and will
be utilized for approval and construction of the proposed system.
3. Photovoltaic Rooftop Solar System Permit Submittal identifying design parameters for the
solar system.
4. Photographs of the interior and exterior of the roof system identifying existing structural
members and their conditions.
Based on the above information we have evaluated the structural capacity of the existing roof system to
support the additional loads imposed by the solar panels and have the following comments related to our
review and evaluation:
Description of Residence:
The existing residence is typical wood framing construction with the roof system consisting of 2x6
dimensional lumber at 16" on center with 1x8 collar ties every 48". The attic space is unfinished and the
photos indicate that there was free access to visually inspect the size and condition of the roof rafters. All
wood material utilized for the roof system is assumed to be Hem-Fir #2 or better with standard
construction components. Our review of the photos of the exterior roof does not indicate any signs of
settlement or misalignment caused by overstressed underlying members.
Stability Evaluation:
A. Wind Uplift Loading
1. Refer to attached Ecolibrium Solar calculations sheet for ASCE/SEI 7-10 Minimum Design Loads
for Buildings and other Structures, wind speed of 100 mph based on Exposure Category "B" and
23 degree roof slopes on the dwelling areas. Ground snow load is 40 PSF for Exposure "B", Zone
2 per (ASCE/SEl7-10).
2. Total area subject to wind uplift is calculated for the Interior, Edge and Corner Zones of the
dwelling.
vivi t. solar
Page 2 of 2
B. Loading Criteria
10 PSF= Dead Load roofing/framing 40 PSF= Live Load (ground snow load)
5 PSF= Dead Load solar panels/mounting hardware
Total Dead Load=15 PSF
The above values are within acceptable limits of recognized industry standards for similar structures
and in accordance with the 2012 International Residential Code. Analysis performed of the existing
roof structure utilizing the above loading criteria indicates that the existing rafters will support the
additional panel loading without damage, if installed correctly.
C. Roof Structure Capacity
1. The photographs provided of the attic space and roof rafters show that the framing is in good
condition with no visible signs of damage caused by prior overstressing.
D. Solar Panel Anchorage
1. The solar panels shall be mounted in accordance with the most recent "Ecolibrium Solar
Installation Manual', which can be found on the Ecolibrium Solar website (ecolibrium solar.com). If
during solar panel installation, the roof framing members appear unstable or deflect non-
uniformly, our office should be notified before proceeding with the installation.
2. The solar panels are 1 1/2"thick and mounted 4 1/2" off the roof for a total height off the existing roof
of 6". At no time will the panels be mounted higher that 6" above the existing plane of the roof.
3. Maximum allowable pullout per lag screw is 235 Ibs/inch of penetration as identified in the
National Design Standards (NDS) of timber construction specifications for Hem-Fir (North
Lumber) assumed. Based on our evaluation, the pullout value, utilizing a penetration depth of 2
1/2", is less than the maximum allowable per connection and therefore is adequate. Based on the
variable factors for the existing roof framing and installation tolerances, using a thread depth of 2
W' with a minimum size of 5/16" lag screw per attachment point for panel anchor mounts will be
adequate with a sufficient factor of safety.
4. Considering the roof slopes, the size, spacing, condition of roof, the panel supports shall be
placed at and attached to no greater than every fourth roof rafter as panels are installed
perpendicular across rafters and no greater than the panel length when installed parallel to the
rafters (portrait). No panel supports spacing shall be greater than four (4) rafter spaces or 64" o/c,
whichever is less.
5. Panel supports connections shall be staggered to distribute load to adjacent rafters.
Based on the above evaluation, it is the opinion of this office that with appropriate panel anchors being
utilized the roof system will adequately support the additional loading imposed by the solar panels. This
evaluation is based on information supplied to us at the time of this report and current industry standards and
practices.
Should you have any questions regarding the above or if you require further information do not hesitate to
contact me.
Ve tr`yours, � �
!Yss
//\/J
civ
Scott E. li PE
MA License No. 505 9�FFSg10-IST P
dodunt. solar
A�R CERTIFICATE OF LIABILITY INSURANCE °1nrelag0;rI
<°°"""
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(les) must be endorsed. N 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
MARSH USA INC. NAM :PHO --"-----
122517TH STREET,SUITE 1300 I=.N F NO:
DENVER CO 80202-5534 e-one
Atin:Denver.cenrequs Qnsirsh.DJm,Fast:212.9QA381
INSU S AFFORDING COVERAGE HAIGa
46273B-STND-GAWUE-W15 INSURER A:Evanston Insurance Company 35378
INSUREDVwint Solar,Inc: INSURER B:Zurich American Insurance Company 16535
Vfvint Sole Developer LLC INSURER c:ArlMrran Zurich Insurance Company 40142
3301 North Thanksgiving Way INSURER D:
Suite 500
Lehi,UT 84M INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: SEA-00236803MI) REVISION NUMBER:0
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.
rNSR TYPEOFINSURANCE POLICYNUMBER PONCY EFFnIV0112015
LIMITS
R
A GENERALUABn 14PKGWE00274 11/0112014 EACH OCCURRENCE _ $ 1'OW'000
X COMMERCIAL GENERAL DABILITY PREMISES 8 �'gUg
CLAIMS-MADE OCCUR MEDEXP are .n) S 5,000
X $5.000 Dad.BI&PD PERSONAL&AOV INJURY $ 1,000,000
GENERALAGGREGATE $ 2,000,0D0
GEN-L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPX)PAGG $ 2,000,I700
POLICY X JECT LOC a
B AUMMMIME lUTY BAP609601500 11/0112014 Mecder I LE OMIT 1,000,000
e a tides
ANY AUTO BODILY INJURY(Perperson) $
ALL OWAUTOSNED SCHEAUTOSDULED BODILY INJURY(Per accident $
X HIRED AUTOS X NOWO MED PROPERTY°AMA $
X
HAUTOS Pera�denl
S
A UMBRELLA LIAB % OCCUR 14EFXWE000BS 11/0112014 1110112015 EACH OCCURRENCE S 5,000,000
X EXCESS UAB CLAIMSAIAUE AGGREGATE $ 5,000,000
OEO I I RETENTION 3 $
C WORKERSCOMME nON WC509601300 11/01/2014 11101 15 VVCSTO oTH-
AND EMPLOYERS'14A UW
B ANY PROPRIETORIPARTNEWE%ECUTNE YIN WC509601400 1110112014 11/01 015 E.L.EACH ACCIDENT $ 1,000,000
OFFICEWMEMBER EXCLUDED? O NIA
(Mandatory,to NH) E.L DISEASE EA EMPLOYEE $ 1,000,000
WU yyes,descrite under 1,000,000
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S
A Errors&Omissions& 14PKGWE00274 11/01/2014 11/01/2015 LIMIT 1,000,000
Contractors Pollution DEDUCTIBLE 5,000
DEWM"CNOFOPERATIONS/LOCATWNBIVEHICLES IASmcn ACgeO 101,AddlUwnal Remadm 9chedula,I/morw apace UregWradl
The Certificate Holder and others as defined in he written agreemenlam included as additional insured where required by written contract with respect to General Liability.This insurance is primary and non-
contributory over any eushng insurance and limited to liability arising outof the operations of the named insured and where required by written contract Waiverof subrogation is applicable where myuired by wmten
contract with respect to General Liability end Workers Compensation.
CERTIFICATE HOLDER CANCELLATION
City of Salem SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
93 Washington Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Salem,MA 01970 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORUED REPRESENTATIVE
M MMah USA Inc.
I
Kathleen M.Parsloe ./�,aflovm br. JQv/k
01988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 170848
Type: Supplement Card
' VIVINT SOLAR DEVELOPER LLO: Expiration: 1/512016-
JAMES SHERMAN
4931 NORTH 300 WEST
PROVO, UT 84604
Update Address and return card.Mark reason for change.
scA i 20M-o5nl Address ❑ Renewal 0 Employment Lost Card
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supen isor
License: CS-045254
JAWS R SHER*N
6 Fox Hollow Dr We {
SAUGUS MA 01406 g
•st*'""' ' Expiration
Commissioner
OB/26/2016
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston,MA 02114-2017
y v
www.mass.govIdia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/individual)] Vivint Solar Developer, LLC
Address:3301 North Thanksgiving Way, Suite 500
City/State/,Zip:Lehi, LIT 84043 Phone#:801-377-9111
Are you an employer? Check f the appropriate`box: - Type of project(required):
L m 1
I a a employer with .(D 4. ❑ I am a general contractor and i
employees (full and/or part-time).
have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.t 9. Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their I LL Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] r c. 152, §1(4),and we have no Solar Installation
employees. [No workers' 13.0 Other
comp. insurance required.]
'Any applicant that checks box#i 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 anew affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the subcontractors 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:Zurich American Insurance Company
Policy#or Self-ins- L'i1c. #:WC 509601300 Expiration Date: 111112015
Job Site Address: 45 �elleVlew Ave City/State/Zip: SAIAn mN )Lqp-O
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.
l do hereby certify under the pains and penalties ofperjury that the information provided above Is true and correct.
Sipnature: Date (a —
phone#: 801-2296459
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):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: