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25 FLINT ST - BUILDING INSPECTION (2) z34y� $1I The Commonwealth of Massachusetts.. SRECiiQNAI $ ® Board of Building Regulations and Standards' FOR Massachusetts State Building Code, 780 CMR11((�� .' . USE LITY Building Penn it Application To Construct,Repair,Renovate F)ilmmoolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Ap ied: N 4crw Building Official(Print Name) Signature Date I SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 25 Flint Street 1 Lla Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building 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: Eleanor Meadowcroft Salem, MA 01970 Name(Print) City,State,ZIP 25 Flint Street (978) 745-6336 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ I Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units I Other pecify: PV Solar Brief Description of Proposed World:The installation of 17 PV solar panels mounted on the roof. 4.42 kW SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $2000 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $15000 ❑Standard City/Town Application Fee ❑ Total Project Costs (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: $ 1 7000 0 Paid in Full 13 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 093115 4/1/2016 Joseph Wyld-Chirico License Number Expiration Date Name of CSL Holder Lis[CSL Type(see below) U 11 Hillcrest Ave No.and Street Type Description Seekonk MA 02771 U Unrestricted(Buildings u to 35,000 cu. ft. R Restricted 1&2 family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 401-574-6684 I 1 Insulation Telephone Email address D I Demolition 5.2 Registered Home Improvement Contractor(HIC) 170279 10/5/17 NRG Home Solar HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 101 Constitution Blvd No.and Street Email address Franklin MA 02038 508-315-6663 City/Town, State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ......... No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize Joseph Wyld-Chirico to act on my behalf, in all matters relative to work authorized by this building permit application. 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 5#penalties of perjury that all of the information contained in this application i ue and knowledge and understanding. Pr Owner's or Autho zed Agen nic Sig ure) 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.vov/dps v/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" v ,yam \ The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Orgmization/Individual): NRG Home Solar Address: 101 Constitution Blvd. City/State/Zip: Franklin MA 02038 Phone #:508-315-6663 Are you an employer?Check the appropriate box: Type of project(required): 1,M 1 am a employer with 70 employees(full and/or part-time).• 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8, ❑Remodeling any capacity.[No workers'comp. insurance required.] 3.❑I am a homeowner doing all work myself. [No workers'comp.insurance required.]t 9. El Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole I LEJ Electrical repairs or additions proprietors with no employees. l2.❑Plumbing repairs or additions 5.n 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.�Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other PV Solar 152,§1(4),and we have no employees. [No workers'comp.insurance required.] •Any applicant that checks box Ht must also fill out the section below showing their workers'compensation policy information. +Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the time of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Federal Insurance Co. Policy#or Self-ins.Lic.#:0044727794-01 Expiration Date:4/1/2016 Job Site Address:25 Flint 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 MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un er the pains en al ' oJpec' t _ _ -on provided above�is tru nd correct. Sienature: !�_ Date: Phone#:50 -545-0989 Offcial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: A ® DATE / Y) CERTIFICATE OF LIABILITY INSURANCEIii 07/01/01/20152015 -THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Destiny Soria NAME: MCGRIFF,SEIBELS&WILLIAMS,INC. -0 -2211 !FAX No7:( CP.O.Box 10265 oExt: E-MAIL dsona@mogriff.com AL 35202 mrin.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Klnsale Insurance Company 38920 INSURED INSURER S:Liberty Mutual Fire Insurance Company 23035 Roof Diagnostic Solar Holdings LLC;Roof Diagnostics Solar and Electric LLC;Root Diagnostics Solar and Electric of NY,-LLC;Roof Diagnostics Solar and Electric of INSURER C:Federal Insurance Company 20281 Connecticut,LLC; INSURER D:Travelers Property Casualty Company of America 25674 Roof Diagnostics Solar of Mass,LLC;Restoration Design LLC;RDI Consulting,LLC 2333 Highway 34 INSURER E:Navigators Specialty Insurance Company 36056 Manasquan,NJ 08736-1423 INSURER F COVERAGES CERTIFICATE NUMBER:RKPgRUNX REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Y EXP INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DD/YYYYY MMIDDIYVYV LIMITS LTRNSO MD A X COMMERCIAL GENERAL LIABILITY MSW45968 07/01/2015 04/01/2016 EACH OCCURRENCE $ 1.000,000 DAMAGETO ENT 50,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,660,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY rX7 PRO- LOG PRODUCTS-COMP/OP AGG $ 2,000,000 ECT OTHER: $ B AUTOMOBILE LIABILITY SISIPCA08335015 07/01/2015 04/01/2016 COMBINED tSINGLE LIMIT $ 1,000,000 I ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DA MAGE $$HIREDAUTOS AUTOS Pere dent Deductible: Comp/Coll $1.000 E UMBRELLA LIAB X OCCUR MSV74841 07/01/2015 04/01/2016 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DEDT I RETENTION$ $ C WORKERS COMPENSATION 0044727794-01 07/01/2015 04/01/2016 X I PER oTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRtETOWPARTNER/EXECUTIVE YIN E L.EACH ACCIDENT $ 1.000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE EAEMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Installation QT6601 F654654TIL15 07/01/2015 04/01/2016 Installation Limit 50000 In Transit $ 200,000 Deductible $ 1,000 Leased/Rented from others $ 50,000 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be atlaahed If more.pane Is.quired) 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. AUTHORIZED REPRESENTATIVE For Evidence Purposes Only Page 1 of 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD l r Massachusetts -Department of Public Safety I Board of Building Regulations and Standards C+m.truction tiuprr.iwr � 7 License: CS-093115 ., JOSEPH M WYLDCHMICO 11 HILL CREST AVENUE, _ Seekonk MA 02711 ,3 Expiration Commissioner 0 5/1 412 01 7 r .` r?d / 17rt'' l(%(.��/l %?1(J-I�rUG�C(•1 11. 0/ I 14K-1'.Ija('fl(C.1G i y Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02 116 Home Improvement Contractor Registration Registration: 170279 Type: LLC Expiration: 10/5/2017 Trtt 269777 ROOF DIAGNOSTICS SOLAR OF MASS, LL PETER LACAMERA 2100 HIGHWAY 35 ` SEA GIRT, NJ 08750 tipdate Address and return card. Mark reason for chvn,:e. Address Renewal Employment Lost Card SCA t 0 2061•05l11 / —71,,. .(,,, rr•Itlr r0�/� r%'�l�riarrt'�rL.r�� t)Tice of Consumer Afftirx& Itusiness Itc;III13tino License or rcgisumtio❑ valid for individul use onh HOME IMPROVEMENT CONTRACTOR before the expiration slate. If found return to: Il.. Registration: 170279 Type: office or Consumer Affairs and Business Re;;ul;uion Expiration: 10/5/2017 LLC 10 Park Plaza -Suiwil711 "r Boston. ,NIA 02116 ROOF DIAGNOSTICS SOLAR OF MASS, I.I.C. NRG HOME SOLAR PETER LACAMERA 2100 HIGHWAY 35 _ (y SEA GIRT, NJ 08750 L'udcrsecrclary• ! 'ot valid without signature DacLSign Envelope ID:2248DF97-F669-4509-BOF8-594FC9FE20FA ,j �i• nrg Home SOLAR POWER SYSTEM LEASE ' SOLAR Between NRG Home Solar and Eleanor Meadowcroft DATE: October 22, 2015 TERMS AND CONDITIONS OF YOUR SOLAR POWER SYSTEM LEASE Estimated annual kWh Consumption Year One:5721.00kWhs Pdorto Solar. Property Owner: Eleanor Meadowcroft Year One:4610 kWhs Estimated Solar ElectrldtyOutput Term(20Yeam):82021 Wits Email: meadowcrofteleanorna,amail.com Estimated Solar Electricity rate per kWh: Year Onc$0.154 Phone: 9787456336 Fax: Monthly Lem PaymerlYs: Year One:$59.16 per month,fo r 240 lots I monthly lease payments. Lease Escalator. 0% Property Owner Mailing Address: 25 Flint St Optlonai Buy Down Payment $0.00 Street Address Line i Total Lease Payments aver20 years: $14198.40 Street Address Line 2 Each year we will measure cumulative production and reimburse you for Salem MA 01970 Perfommnce0uarerdee underproduction according to Exhibit 4.You city state Zip will not pay extra for any surplus energy Installation produced by the system. Address: 25 Flint St Amount Due at Leese Signing: $0 Street Address Line 1 Street Address Line 2 DotNery/Installation Fee: $0 Other Chargers(notportofyourmonthly $0 payment,H any): Salem MA 01970 city state Zip Amount Due at Delivery(production $_ date): Cost to Insure the Solar System* $0,see section 12. NRG Home Solar Lease Quick Facts You have the option to purchase the Solar System at the seventh(7th) NRG Home Solar insures,maintains and repairs the Solar System at no additional anniversary of the Production Date or at the expiration of the Lease Term as cost to you,as described in the Lease. described in the Lease. NRG Home Solar will man itorthe Solar System at no additional cost to you,as If you move,you may transfer the Lease to a purchaser of your Property or you described in the Lease. can prepaythe remaining balance,as described in the Lease. NRG Home Solar guarantees the Solar System's kWh production,as described in the At the end of the term of the Lease you will have the option to:renew the Lease, Lease. purchase the Solar System or request removal of the Solar System from your See remaining sections of this Lease for other important temis. Property as described in the Lease. The monthly Lease payment does not include taxes,If applicable.See Section 2.3 for more information on taxes. Description of Leased Solar System The Solar System is a 4.42 KW DC(STC)photovoltaic system,consisting of photovoltaic modules,inverter(s),mountingsystem(s)and monitoring system(s) 1000 N.POSrOAKROA0,SU11E240, HOUSR)N TR77055 I (P)600-757-6527 I WWW.NRGHOMLSOLAR.COM Lease Number. [10-0049295326-000-00001; Lease Version.01 NRG Residential SolarSolutions LLC,d/b/a NRG Home Sola4 isa whollyowned subsidiary of NRG Energy,Inc.®2015 NRG Energy,Inc.Alirights reserved. / RECi"1VEti NSPEC9'I611MUL SERVICES nrg 1011) MAfl 10 A i1= OS 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 25 Flint St. Kind Regards, Tyler Wyld-Chirico Permitting Specialist 508-315-6663 Tyler@NRGHomeSolar.com