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HomeMy WebLinkAboutBLDE-23-002983 -err!,r- Commonwealth of Official Use Only T?j, Massachusetts Permit No. BLDE-23-002983 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:12/1/2022 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 29 RUN POND RD Owner or Tenant MAZZONE JOHN M Telephone No. Owner's Address MAZZONE DENISE E, 2 MEADOW DR, UPTON, MA 01568 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of solar PV system (28 Panels 10.36 KW)(NO ESS) Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to start: Inspection to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Philip Mccarron Licensee: Philip Mccarron Signature LIC.NO.: 14068 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:2 SHAYLEE LN, LAKEVILLE MA 023471852 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally required by law.But my signature below,I hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $150.00 (Pf\& (PLO) _�RECEIV_ � * ��b ^� �����t �� eta 0 icial Use Wye? =rNl— t NOV 3 O 2022 �radment o�7b.Servicaa Permit No. "� j� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _ BUILDING DEPARTMENT [Rev. 1/07] A —. (leave blank) OR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code AL WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION 11/17/20222),527 CMR 12.00 City or Town of: � Date: By this application the undersigned .gives no ice ceAof his or her intention to perform the elA To the ectrical Inspector of Wires: Location(Street&Number) 29 Run Pond Road trtcal work described below. Owner or Tenant John MaZZone Owner's Address Same Telephone No. 508 81- 247 Is this permit in conjunction with a building permit? Yes Purpose of Building Residential ® v0 (Check Appropriate Box) Utility Authorization No. Existing Service 150 Amps 120 / 240 Volts Overhead Ei Undgrd New Service_ Amps / g ❑ No.of Meters Volts Overhead❑ Undgrd Number of Feeders and Ampacity g ❑ No.of Meters Location and Nature of Proposed Electrical Work: Installation of 28 solar PV modules of existin roof. 10.36 kW NO ESS Com.letion o the ollowin_ table ma be waived b the Inspector o Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total No.of Luminaire Outlets N Transformers KVA No.of Hot Tubs Generators KVA Above No.of Luminaires � In- Swimming Pool `o.o mergency ig mg No.of Receptacle Outlets rnd' rnd. Batte Units No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges Initiatin! Devices No.of Air Cond. Total Heat Pump ......Tons No.of Alerting Devices Number .TonsWill No.of Self-Contained Totals: ........................... ................ . No.of Dishwashers Detection/Alertm Devi No.of Waste Disposers ces Space/Area Heating KW Local A Di Municipalon No.of Dryers HeatingConnecti Appliances Security No.of Water s KW KW Systems:* ❑ Other No.of No.of No.of Devices or E I uivalent HeatSi'ns Ballasts Data Wiring: No.Hydromassage Bathtubs No.of Devices or E uivalent No.of Motors Total HP Telecommunications Wiring: OTHER: Solar PV Installation No.of Devices or E i uivalent Estimated Value of Electrical Work: 10,000 Attach additional detail if desired,or as required by the Inspector of Wires. Work to Start: (When required by municipal policy.) INSU Inspections to be requested in accordance with RANGE COVERAGE: Unless waived by the owner,noMEC Rule 10,and upon completion. the licensee provides proof of liability insurance includinge permit for the performance of electrical work may issue unless undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit"completed operation"coverage or its substantial equivalent. The CHECK ONE: INSURANCE I rtif under theN0 BOND OTHER 0 (Specify:) P t issuing office. painsa and in perjury,that the information on this application is true and complete FIRM NAME: Beacon Solare Construction • Licensee: Philip McCarron p (If applicable,enter "exempt"in the license number line.) Signature X LIC.NO.: Address: ` LIC.NO.: A14068 *Per M.G.L. c. 147,s.s7-6I Sha lee Lane Lakeville MA 02347 Bus.Tel.No. 401-203-4854 OWNER'S INSURANCE security work requires Department of Public SafetyAlt.Tel.No. --requ ---------- OWNER'S b ]IN, B WAIVER: I am aware that the Licensee does not have he liability insurance coverage normally y Amy,signature below,I hereby waive this requirement. I am the(check one cense: Lic.No. Owner/Agent ` ) Signature 401 203 4854 owner ❑owner's a:ent. Telephone No. PERMIT FEE: $ s bsszo dw' a a as 4NOda3ni Nfla 6zssd y I �PIOZ7.F N �xor �ro a�=. /Gd y W 0 a � Vs!(11,4132T a m W _a. l , rn W F m LL' :„ a ct f00 ! o o s r : W" mw n n s 4 w wi 8 " $ _ ;-I' a g 2 $ wzig(ct ro o _ E eE — .1n T oz - 6 gz< ' T F o r . . 0 - RLQ 8 U k - L. E4 z Y o3 u ivagiwsFu" r 3 s ao zF x i o .. o wa g WmN www5o u CD N E' . c FWo m W i rca JlmE x z WQ7-; w m maE wi a § & 4 w 9 s� rm n Z N n z fiW S 4 w a aaaaa ao ° 5 € $ F aaW O irc = r z m o G t ' < < m m u F. 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OPTIMIZER BRANCH CIRCUIT CONDUCTORS ARE MANUFACTURED PV WIRE LISTED.THEY ARE ROHS,OIL RESISTANT,AND W RESISTANT.THEY CONTAIN 10 AWG CONDUCTORS OF TYPE THHN/THWN-2 DRY/WET AND CERTIFIED TO UL3003 AND UL 9703.THE CABLES DOUBLE INSULATED RATING REQUIRES NO NEUTRAL OR GROUNDED CONDUCTOR. CONTACT.s0Sa3S-S112 AMBIENT TEMPERATURE-28°C NEC 310.15(8)(3)(c) 1GT REVOLUTIONARY DRIVE,UNIT TEMPERATURE DERATE FACTOR-(1) NEC 310.15(B)(2)(a) 2,EAST TAUNTON,MA DnIS.USA GROUPING FACTOR-(1) NEC 310.15(8)((a) 3. ALL METAL ENCLOSURES,RACEWAYS,CABLES AND EXPOSED NON CURRENT-CARRYING METAL PARTS OF EQUIPMENT SHALL BE GROUNDED TO EARTH AS REQUIRED BY NEC 250.4(B)AND PART III OF NEC ARTICLE 250 AND EQUIPMENT GROUNDING CONDUCTORS SHALL BE SIZED ACCORDING TO NEC 690.45.THE GROUNDING ELECTRODE SYSTEM SHALL CONDUCTOR AMPACITY. ADHERE TO 690.47(A) =(OPTIMIZER 0/P CURRENT)x 1.56/A.T.F/G.F ...NEC 690.8(B) 4. PV SYSTEM DISCONNECT SHALL BE READILY ACCESSIBLE. =[(15 x 1.561/0.96/1 co =24.37A 5. POINT-OF-CONNECTION SHALL BE MADE IN COMPLIANCE WITH NEC 705.12 z 0 N SELECTED CONDUCTOR-#10 THVVN-2 ...NEC 310.15(B)(16) C a 6. UTILITY HAS 24-HR UNRESTRICTED ACCESS TO ALL PHOTOVOLTAIC SYSTEM COMPONENTS LOCATED AT THE SERVICE N (B) AFTER INVERTER: ENTRANCE. N Z 2 O 7. MODULES CONFORM TO AND ARE LISTED UNDER UL 1703.OPTIMIZERS CONFORM TO AND ARE LISTED UNDER UL d TEMPERATURE DERATE FACTOR-(1) 1741. Z Z j GROUPING FACTOR-(1) x D 8. CONDUCTORS EXPOSED TO SUNLIGHT SHALL BE LISTED AS SUNLIGHT RESISTANT PER NEC ARTICLE 300.6(C)(1)AND C N CONDUCTOR AMPACITY ARTICLE 310.10(D). N co =(TOTAL INV 0/P CURRENT)x 1.25/096/1...NEC 690.8(B) Q 9. CONDUCTORS EXPOSED TO WET LOCATIONS SHALL BE SUITABLE FOR USE IN WET LOCATIONS PER NEC ARTICLE 310.10 =[(32 x 1.251/0.96/1 =41.66 A (C)' SELECTED CONDUCTOR-#6 THWN-2...NEC 310.15(13)(16) 10. UNE SIDE TAP DISCONNECTS MUST BE LOCATED NO MORE THAN 10 FEET FROM THE TAP POINT PER NEC 690.15(A) -. PV OVER CURRENT PROTECTION ...NEC 690.9(B) 11. ALL DC WIRING RUNNING THROUGH THE BUILDING SHALL BE ENCLOSED IN METALLIC CONDUIT IN COMPLIANCE WITH SIGNATURE WITH SEAL NEC 690.31(G).THIS REQUIREMENT SHALL APPLY TO OPTIMIZER-BASED SYSTEMS,BUT SHALL NOT APPLY TO =TOTAL INVERTER 0/P CURRENT x 1.25 MICROINVERTER-BASED SYSTEMS. =(32 x 1.25)=40 A SELECTED OCPD IS 40A 12. A 10 AWG CU EQUIPMENT GROUNDING CONDUCTOR SHALL BE USED TO BOND RAILS AND OTHER ROOFTOP EQUIPMENT. THIS CONDUCTOR SHALL BE PROTECTED FROM PHYSICAL DAMAGE BY RUNNING UNDERNEATH THE ARRAY.IF THIS SELECTED EQUIPMENT GROUNDING CONDUCTOR(EGC)=#10 THWN-2...NEC 250.122(A) CONDUCTOR IS UNPROTECTED FROM PHYSICAL DAMAGE,THE CONDUCTOR SHALL BE INCREASED TO 6 AWG CU. GROUNDING NOTES: PV MODULE AND RACKING GROUNDING AS PER APPROVED INSTALLATION PRACTICE AND IN LINE WITH MANUFACTURE'S GUIDELINES. 8 H • • PERMIT I4IVE2A,PER DATE 11AAR022 DESIGNER DNA REVIEWER ELECTRICAL CALCULATIONS PV-7 I / =ig 499ZO V W'2i]AIa SSd9 - s ? 02i ONOd Nf12f 6Z - ,, co -og . 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C 7 r � BASS RIVER,MA 02664 me 1 • Power Optimizer BEACON T For North America CONTACT'508-)3b1112 Power Optimizer v O P320/P340/P370/P400/P401/P405/P485/P505 .t REVOLUTIONARY DR VE UNIT AST TAUNTON,IAA 02718,USA P370 For North America Optimizer model P320 (for high- It°r higher- P400 poi-high P405 P485 rh)g (typical module (for 60-cell power (for 72& (tor hlyh- (for high- (for higher P320/P340/P370/P400/P401/P405/P485/P505 6OWOS W and 72- %ceR Powerti0 votage voltage current compatibility) modules) cell modules) and72�5,1 modules) modules) modules) modules) modules) m - Nt m INPUT fill CD z oN 25 _... � '_ 40 E0 7' 11 83 Wk._ N O o ro r rqe e s J a,9 R ac e t s w 1 Q YEAR , x c,..n c„iNr,tT Z 2 of wAkeANty 70 O O �.._ aw z �> OUTPUT DURING OP ERA TION(POWER OPTIMIZER CONNECTED TO OPERATING SOLAREDGF INVERTER) vo _-_ 51.9 ' ct DI CO ZOUTPUT DURING STAN DOY(POWER OPTIMIZER DISCONNECTED FROM SOLAREDGE INVERTER OR SOLAREDGE INVCRTER OFf) r3 STANDARD COMPLIANCE r_ - c.tIOIX;E-2 ECTO%IE3 �Vr,l. NMa:, E, ey 11 r ,;A } -E SIGNATURE`MTH SEAT. 10,) I ,M m INSTALLATION SPECIFICATIONS f orchatoe nvcrts All Sol5rEege Single hree•P8888 inverters .,._ri.ry r, :L*J 53 5 V9 3 195 129 ,59 9,•9,83."9 r'r, •fimens v,lrlll IN / /Str Its S 6r,.s x, w.99t(n.91858 eablexr 830/le ! ,t, i 55S 11:9.1/,_ ,rJ! lope Conv, AK,' x 0uH Ingo Wig sonyle Skew Wire type/Connect/ Ih,Ne lnadr..,� /MCd Output W 9M1 n9/ 9 I.. 2 39 ._... _ --C a.r;v,9 P 9R 3 PV power optimization at the module-level Protectx5.515599 IP68/NNW —. .- RNxrver4rvs7 4 Yp • A.... / Specifically designed to work with SolarEdge / Fast installation with a single bolt 7 xa9" `... inverters / Next generation maintenance with module- / Up to 25%more energy level monitoring .. "`°ane..•, r'"W..,a.e r... ", `e a,. A..n:'a,'R.N.,w,'.^"•;e.,.,4,,^,A•'.RRAN RTY ..0 e,,Tv,TSr s u 0 • / Superior efficiency(99.5%) / Meets NEC requirements for arc fault � � Single Phase Thu a Phase I« Three Phase for Single phase protection(AFC!)and Photovoltaic Rapid 1 d..Edg' HD Wave 208V grid 277/480V•rid / Mitigates all types of module mismatch losses, Shutdown System(PVR55) from manufacturing tolerance to partial ' 1 es.r 05 1 s -- _-- e a -- shading / Module-level voltage shutdown for installer ro 1 H,yd;,wMr,Pu _ ,e. and firefighter safety SAW(hlC MI, ,x / Flexible system design for maximum space Moon x+Smrq r SUE.. eg." vse 1 ELbry 12750" 1 W — -- • 's- -—rz — --- -—1—utilization --- ng m0m tel/ :... s,. a ,u,r,,,,w, _.. __ ......_ ... PERMIT DEVELOPER mm DATE 110I01022 � yes'. r��1 solzredge.Com solar • , .Ra""R..,,."7"" 'A ..4.,nt't,,,... "Z... ,,.n- .ea.,rw:•. e.»w,.bw�,., u'W ".°'-`°-"` .\�" orswET: w2 RoFl8 Inlertek REVIENER OPTI\ttZER UAT.ASH I,'f PV-10 -'-d b99Z0 VIN'HAARl SSV9 0 -7`>§ 'O2i GNOd Nn i 6Z i E._ ' r §.Agill S F- 86 3i'OZZb'6V.vHOl Q 3"0 aoaenasaa Ma L _ s SNOIS:Vaa 3 11 C. . < lY 1 < i'1 1 , ,' �. ril , Ij I...... �f g a) . H v W �i t o s - - 1'1 �1 ' I Yj R I 3 VDgg y lg ut 8 ea ® . . : .• - 5 ; .. - a! - 4 ' § OIo ; ... 1 1 , � s y1 �-. a1 1 5 r I Ooo � s / ' ; - •!• 1 ry 8 L'n w ; S vCD Wi - ---- ,tg [ 1- 1 1 Q) Q) V) D = S;. I 1 .s7 > D I $ B a'S 0 ♦ 2 a -.,„�$ - 1 I .� o �, I � I 1 s@ > 0 o -- 1 ..-1 � c) > N N § 1 % li a I 1 1 1 I 41 t I iI I I q a p � � a t r { f , alsoo i i E 4 IIt • sg r '1 qiu a i l C s 3�1"6 tE ig iEi r I°I.i,l at 1 '1. ,f irk' $ L • INVERTERS Nob V Vf L IA {/�^ z 0 3 i t O O cN O � g o - a o L w O T E �j •. t ., T v o 0 l— V 2 s I:: .. C 1-1 W w vWi , ° a A' V1 :O W co ? F .. v m rn LA 2 • • • • • 3 O I > o o O 0 o ;a A� 11 o oq .. I tp N v ^ N M N •• Nii Q a.a a) _L. to V . a l 9 I:, •`= a'y °' .'..,, i, 0)� i I I 6 s tJ q c. av 0 O O ,Lr a D o m m ai w 9 - - O 8 'i+ s 3 ar ,, E y ` L m 1` a• . • o o 5 i'i 1 is =•Z 5 $ 'o V) 0 W W • _........ ii ._ DESCRIPTION. DRAWN BY: . _ BI;A('ON SNAPNRACK,UR-40 RAIL mwatkins " REVISION._...... CONTACT SON.T3e.auz •PART NUMBER(S) 147 E7Asr�nuNTouAranozIne,UNIT 232-02449,232-02450,232-02451 _4.,7=7.. v _..... IEJ c0 UR-40 RAILco PROPERTIES I Z _CC o SKU FINISH N 0 Q 232-02449 MILL - O Mot _ 232-02450 CLEAR -' .... .... . dd' 232-02451 BLACK 1 ! UJ �iJ i' / m i/ /T !�1��/!�/ . r _................ 1.500 __.............Y I"' .750 i I. .832 W a SECTION PROPERTIES _ 1.624 -. ......._._. :.... A 0.357 in' Ixx 0.125 m° CENTROID ;n g$ IYY 0.132 in° — Sx(TOP) 0.150 in3 .792 s 5 Sx(BOT) 0.158 in3 Sy(LEFT) 0.175 in ' i Sy(RIGHT) 0.175 in3 �, i • ALL DIMENSIONS IN INCHES MATERIALS: 6000 SERIES ALUMINUM OPTIONS: rIJ3Nm•DEVELOPER DESIGN LOAD(LBS): N/A .CLEAR/BLACK ANODIZED I DATE ++nwmu ULTIMATE LOAD(LBS): N/A MILL FINISH 1 TORQUE SPECIFICATION: N/A LB-FT '..BUNDLES OF 144 DESIGNER 0n3 . CERTIFICATION: UL 2703,FILE E359313 BOXES OF 8 J REVIEWER WEIGHT(LBS): _....._. i 5.85 i -_....._ i;.4:•r;t^:u D.\TASIII-L t PV-12 BEACON DESCRIPTION DRAWN BY DESCRIPTION'. DRAWN BY CONTACT SOS 738 eve '.. 1E7 REVOLUTIONARY DRIVE,UNIT SNAPNRACK,ULTRA RAIL SPEEDSEAL FOOT mwatkms SNAPNRACK,ULTRA RAIL SPEEDSEALT'^FOOT mwatkins AST TAUNTON,Nu o2718.USA SPEEDSEAL. Solar Mounting Solutions Solar Mounting Solutions REVISION. REVISION: _ PART NUMBER(S): A R».7«e,„m.00.,..I,mlwm ,w Js. PART NUMBER(S): A AwR ,.,.RA.ox 10" 242-02163,242-02167 242-02163,242-02167 :4 m z o co IYo I N ❑ < ,-«i. ' r 1.37 N Z 2 fYt `.\ \\ .30 = ~� .38 .` 0 - 1t — 1.86 — — 1.08 1 2 LU 1 rl) \ ��1 •,--,, cc / 1 - 1 N ai 1.00 f, �u^ �pp SLOT :�d1�iI96,,I m r 111 Es* 3.05 _ \i. 2.78 5 • 1.78 / )''g '<. < '1 _'�.: 1_ .25 SIow,MAE NM SEAL 1 i L 1 1 1 . �'�. 02.24 — 3.20 II i` ,.� .17 ice. 3 y*l 0.33 ` '- RI 12 t a! 2 / 1 1 ' PARTS LIST 1.99\ / z 8 ITEM QTY DESCRIPTION J 1 1 SNAPNRACK,SPEEDSEAL FOOT,BASE,SEALING,SILVER/BLACK 1 '—"' 2 1 BOLT,: FLANGE,SERRATED,5/16IN-18 X 21N,ES 1 �./-- --- 3 1 SNAPNRACK,RL UNIVERSAL,MOUNT SPRING,SS 4 1 SNAPNRACK,ULTRA RAIL MOUNT THRU PRC,CLEAR/BLACK 5 1_SNAPNRACK,ULTRA RAIL MOUNT TAPPED PRC,CLEAR/BLACK 1.50 MATERIALS: DIE CAST A380 ALUMINUM,6000 SERIES ALUMINUM,STAINLESS STEEL PERMIT IRF1'F:L(II'LS DESIGN LOAD(L85): 802 UP,1333 DOWN,357 SIDE OPTIONS: ULTIMATE LOAD(LBS): 2118 UP,4006 DOWN,1331 SIDE CLEAR/BLACK DATE ++m8/2022 TORQUE SPECIFICATION: 12 LB-FT DESIGNER Ga CERTIFICATION: UL 2703,FILE E359313;WIND-DRIVEN RAIN TEST FROM SUBJECT UL 2582 REVIEWER WEIGHT(LBS): 0.45 ALL DIMENSIONS IN INCHES_... __... ___... _..... _...... .VI T.1'11\111:T -- 11ATASIII'E F PV-13 The Commonwealth of Massachusetts I tr. _ �'!, Department of Industrial Accidents 1 Congress Street,Suite 100 me � t � ': Boston,MA 02114-2017 Iv Is,,a ;r www mass.govldia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY, Applicant Information Please Print Legibly Name (Business/Organization/Individual): Beacon Solar Inc./Bay State Solar Construction Address: 2 Shaylee Lane Lakeville,Ma 02347 401-203-4854 City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): I. x©I an a employer with 20 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 1 am a homeowner doing all work myself.[No workers'comp.insurance required.)i 9 Demolition 10❑Building addition 4.0 lam a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.O Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 1 ain a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.0 Other Solar pv module install 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'cowp msation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. 1 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: The Hartford — Policy#orSelf-ins.Lic.#: 6S60UB5R99184222. Expiration Date: 07/21/2023 29 Run Pond Road City/State/Zip:Job Site Address: Yarmouth , MA 02664 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 violationpunishable 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 under the pains and penalties of perjury that the information provided above is true and correct: Signature: c i�— Date: 11/17/2022 Phone#: 401-203-4854 _ Official use only. Do not write en 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#: it COMMONWEALTH OF M CHUS DIVISION OF OCCUPATIONAL LICENSURE BOARD Or ELECTRICIANS ISSUES THE FOLLOWING LICENSE W REGISTERED ELECTRICAL BUSINESS Cr BEACON SOLAR CONSTRUCTION INC -65 147 REVOLUTIONARY DR EAST TAUNTON, MA 02718-1 6: U 8345 Al 07/31/2025 372465 LICENSE NUMBER EXPIRATION PATE SERIAL NUMBER o `..E 5 -a . 6 Ts 3 '- c r--- CD u 0 cc u cr? 3 a) 3 as .13 al 3 C\I ttl >, T c 0 >-• a) ii.- co 0 mi CD a) co c_cr)co • Cr) c E >.4) . 1... 2 f•-•T 2 0 c a a z ..- 0 - 0. 0 E Iii a <10- 8 fa = a c al ---D cc r-z_- 0. c 2 '0 j 2 E ,-50,5: .... 4) *t w 0 12 cv— 76 c 0 ..i 2 7,5 2 8 gmco 0. 0 E •W " U) — '- '- CC ,a s 22 2 0 0 0 0 u ,) - ;"0 u) 0 4- C 0 i3 Z -in 1-.•,a) E, >, A 1/2 (i) •••• Ai 1..• • 0 a '.., 0 c b--_-• -, w co •= t..r.._ a a. (,) coQC 2 ,i2 >- ct0 ‘,1261.7) 8-0- , w .ta c c ° 2 .1; 8 Q lWC 4:..1 ›. / .... „ . ,, COMMONWEALTH OF AS ACHUS TT DIVISION OF OCCUPATIONAL LICENSURE BOARD OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE , REGISTERED ELECTRICAL BUSINESS MCCARRON ELECTRIC ” 2 SHAYLEE LN d _ x LAKEVILLE, MA 02347-1852 4 z ' 3534 Al 07/31/2025 267295 .i LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER ,;_ _ ,vr .#' .+COMMONWEALTH OF MASSACHUSETTS DIVISION OF OCCUPATIONAL LICENSURE BOARD OF ELECTRICIANS ''� � 1. ISSUES THE FOLLOWING LICENSE REG JOURNEYMAN ELECTRICIAN PHILIP MCCARRON ; 2 -,,- °; „,.� 2 SHAYLEE LN u.i. LAKEVILLE, MA 02347-1852 v 34460 E 07/31/2025 269018 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER f '„E.1. _ ALTH .•, MA 1T SACHUSE DIVISION OF OCCUPATIONAL LICENSURE BOAR3O ELECTRICIANS ISSUES THE FOLLOWING LICENSE REGISTERED MASTER ELECTRICIAN Z PHILIP MCCARRON z _ co 2`SHAYLEE_LN =7 LAKEVILLE, MA 02347-1852 z . i, . u 14068 A. 07/31/2025 272336 e I. e rE NUMBER EXPIRATION DATE SERIAL NUMBER; ; .. r, .�� BEACO-3 OP ID: DE ACC)/2 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE bO 022 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 have ADDITIONAL INSURED provisions or 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 508-673-5808 CONTACT Jason Rua, NAME: LIA, CIC,AAI Rua-Dumont-Audet Ins.Agcy.In PHONE 508-673 5808 FAX 508-677-4828 155 North Main Street (A/c,No,Ext►: (A/c,Not: Fall River,MA 02722 E-MAILSS: Jason M. Rua, LIA,CIC,AAI INSURER(S)AFFORDING COVERAGE NAIC# _ INSURER A:MAPFRE Insurance 34754 NSURED INSURER B:Nautilus Insurance Company 17370 Beacon Solar Construction Inc. HisCOx Pro 2 Shaylee Lane INSURER C: Lakeville,MA 02346 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR ALSD WVD, (MM/DD/YYYYI ,(MM/DDIYYYYI 1,000,000 B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE X OCCUR NN1295010 08/03/2022 08/03/2023 I DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 'If LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY - (Ea accident) - $ ANY AUTO BQZ650 02/13/2022 02/13/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSE� ONLY X AUTOS BODILY INJURY(Per accident) $ X AUTOS ONLY X AUTO WOT)NLY (Perr aPcEciidentDAMAGE $ B X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 EXCESS LIAB CLAIMS-MADE AN1 244595 08/03/2022 08/03/2023 AGGREGATE $ 3,000,000 DED RETENTION$ .$ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N PER ERH ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C professional ANE470779122 08/03/2022 08/03/2023 occur 1,000,000 aggregate 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Solar Heating System Installation Subject to actual policies'terms, conditions, definitions, coverages & exclusions. 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" ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ® DATE(MM/DD/YYYY)AC� CERTIFICATE OF LIABILITY INSURANCE 08/04/2022 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 have ADDITIONAL INSURED provisions or 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 NAME: Desirae Mitchell RUA DUMONT AUDET INSURANCE AGENCY INC (n/c°."o,E=tl; (508)673 5808 (A/C,No):_ E-MAILDSS: dmitchell@rda-insurance.com 155 NORTH MAIN ST INSURER(S)AFFORDING COVERAGE NAIC# FALL RIVER MA 02720 INSURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: BEACON SOLAR CONSTRUCTION INC INSURER C: INSURER D: 2 SHAYLEE LN INSURER E: LAKEVILLE MA 02346 INSURER F: COVERAGES CERTIFICATE NUMBER: 801045 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. INSR ---- - ---- __- ,ADDL'SUBR, --- -- -_-- POLICYEFF POLICY EXP ------ -- - -- - - LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ' POLICY PRO-JECT LOC PRODUCTS-COMP/OPAGG $ OTHER:AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO '. BODILY INJURY(Per person) $ OWNED SCHEDULED F BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS N/A HIRED NON-OWNED PROPERTY DAMAGE i $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR j EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE N/AI AGGREGATE $ DED RETENTION$ S WORKERS COMPENSATION F OTH- AND EMPLOYERS'LIABILITYY X STATUTE ER _ A OF IC RMEMB REXC UDED? N ECUTIVE E.L.EACH ACCIDENT $ 1,000,000 N/A N/A N/A 6S60UB5R99184222 07/21/2022 07/21/20231. (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under --- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence ACCORDANCE WITH THE POLICY PROVISIONS. Only AUTHORIZED REPRESENTATIVE Evidence MA 00000 Daniel M.Cro4vjey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD BEACON SOLAR Property Owner's Agent Authorization Form I, John Mazzone am the property owner/authorized representative of the property located at address: City/Town Yarmouth State MA Zip Code 02664 • I hereby authorize Beacon Solar access to my property and to act as my agent for the limited purpose of applying for and obtaining local building, electrical, and other permits from the Authority having jurisdiction as required for the installation and service of a Photovoltaic System, and all components associated, located on my property. I authorize Beacon Solar access to my monitoring and optimization accounts to view my solar array and to continue monitoring my system from this date forward. Customer Name: John Mazzone John, hlaaso,ae Customer Signature: 373a7c9ad469e0398a7131e5533f7449aec23c41f7f( Date: October 21, 2022