HomeMy WebLinkAbout62 Midstream Dr - building permit solar wolfRECEIVED
0 7s22
ING D PARTM E NT
This Scction For Official Usc Ooly
Appli€d:
Building Official (PriDt Name)Signsturc Datc
SECTION 1: SITE ATORMATION
l.la Is this an accapted street? ycs_ no--
1,2 Assessors Map & Psrcel Numbcrs
Map Numbcr Pa.ccl Nnmbcr
1.3 Zoning Information:
ZoniryDistdct ProposcdUsc
1,4 Property Dimensions:
Lot Arca Gq ft)Frontagc (ft)
1.5 Buitdirg Setbacl$ (ft)
Fmnt Yard Sidc Yards Rear Yard
Rcquircd Provided Requircd Providcd Requirri Providcd
1.6'lvater Supply; (M.C.L c. ,$, {5a)
Public tr Privatc C
1.7 nlood Zone Information:
Zone: _ Outside Flood Zonc?
Grcck if ycstr
SECTION 2r PROPERTY OWNIRSHIP'
2.1 Orvnerr ofRecord:
WLLIAM KENNEDY
Namc (Print)
62 MIDSTREAM DRIVE. S, YARMOUTH. MA 0266,I
No. ard Strca
City, Statc, ZIP
760-828-3101
Tclcphone
SECTION 3: DtrSCRIPTIoN OF PROPOSED WORK'1 (check eU tLat apply)
Ne$, Constuction B Existing Building tr Owner-Occupied o lnepairslsl o Addition tr
Demolition tr Accessory Bldg. tr Number of Units Other tr Speci!;
Brief Description of Proposed WoTK,: INSTALLATIQN OF 26 SOIABfANELS Tq ].OTAL A4,3 KW
ROOFTOP SOLAR SYSI EM Wl I H A SMATi I ME I ET< SOUKE I
SECTION 4; ESTIMAT.ED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Mate.ials)
t. Building 1. Building Permit FEe Indicatc how fee is detcuuincd:
tr StaDdard City/To\rn Applic.fiou Fee.
tr Total Project CosC (Item 6) x mu@lia
-
x
2. Other Fces: S_
Li*:1ld rsa.@
-l'otal All Faes: $
Check No.Check Amou :C€sh A-Bount:
tr Paid iD Fu[tr O,:tst-dioG;rno oo"
s €ai
4. Mechanical ([IVAC)$
5. Machanical (Firc
SupDrcssio!)$
6. Total Proj€ct Cost:$
ONE & TWO FAMILY ONLY. BUILDING PERIVIIT
TowD of Yrrmoutb BuildhS Department
I 146 Route 28, South Yarmouth, MA 026644492
508-398-2231 ext. 126l Fax 508-398-0836
Massachusotts Statc Building Codc, 780 CMR
Building Permit Applicatiol To Construct, Repab', Renovale Ot Defiolish
a One- or Two-Fanily Dwelling
Builditrg Pemit Numb€r: ,
1.1 Property Address:
62 I.IIDSTREAM DRIVE. S. YARMOUTH, MA 02664
1.8 Sewage Dispostrl System:
Mutlicipaltr On sitc dis?osal system E
WKENNEDYCHC@YAHOO,COM
&nail Addrcss
Alteralionc) tr
ALSO ROOF REPLACE BEFORE SOLAR
Official Use Only
2. Etcarical
3. Plumbing $
SECTION 5. CONSTRUCTION SER]IICES
Lisr CSL Typc (scc bolow) lJ
2-19-2024cs-08 7491
LictnscNumber Expitation Drtc
Type Desc.iption
U Uruesticicd 35 000 cu. ft.
R Rcstrictcd I &2 D
lvl
RC Roofr'
WS Window and S
SF Solid Fucl Bumiog Applianccs
i Insulation
5.1 ConstructloD Suporvlsor Llccnse (CSL)
Ted Strzelecki
perations@solarwolfenergy.com
CiV/To\rn, Staq ZIP
Emsil addr.ss
508-538-9445 o
Nahc ofCSL Holdcr
582 Wauwinet Road
No. strd Strco(
Barre, MA 01005
D Dcmolitioo
5.2 Registercd Eom. Improycnent Contractor (IIIC)
Solar Wolf Energy
HIC Company Namc or HIC RcgisEant Narnc
771 Washinqton Skeet
-50!:51e944!-zw T
A 01501
No. and Stlct
HIC Rcgistration Nudrbcr Expnarion DiG
Email addrcss
larwolfenergy.comooerations@
186400 1,1-A-.O2) _
SECIION 6: WORI(ERS' CoMPENSATION INSI/RANCE AI'TIDAVIT (M.c.L c. rs2. ! 25c(O)
Workqs Compeusation Iaswaoce affidavit must be completed ald
this afEdsvir will rEsult i! the detrial ofth6 Issuance ofthe buildiDg
subEitted wift this application. Failwe to provide
pcrmit,
SECIION 7a: OWNER AUTEORIZATION TO BE COIVIPLTTED WI{.EN
OWNER'S AGEM' OR COMRACTOR AIPLIES FOR BIIILDING PERrVfr
to act olt r[y hhali in all mattlrs rclative to y,,o* authoriz€d by this building pcrmit applicatioo
7-17-2)
Pdnt Owrlcr's Narnc (Elcdronic SiFaturc)
I, as Owuer offie subject Foperty, hereby xu$qd7s '-"*
Please see attached owner auth
SECTION 7b: OWNE* OR AUTEORIZSD AGENT DECLASATION
By cntering my uame beloiv, I hereby attest under the pains and peualties of pcrjury that all of the information
coatained h this applicatioD is tue aod accurate to the best ofBy loolyledge alld understaldio&
P!i1t Owner's ot zrd Agcot's Najnc (Elcctonic Siguaturc)Da(e
-/o/3-17-22
NOTES:
An OwDcr wbo obtsim a building perEril
(rct registerpd in the Home Improvamcnt
progran or guaranty fuDd uoder M.
wt*w. maJs. sov/oca Loformatios oo
to do hia/her o$,n worlq o, an owner who hfues atr unregistercd cotrtactor
Confactor (HIC) Program), will 44 have access ro the arbitatiotr
G.L. c. l42A Other inporta irfo[!8tion on the I{lC Prograrn can be found at
the Co$kuctioa Supervisor License can be fou[d fi www.mass.cov/dps
Nuuber of
2. W}eu substmtial woric is plamed,providc the information bclow:
Number ofbatbrooms
(includi:rg garage, finished basemeDt/attics, d€cks or porch)
Etrclosed
Total floor rca (sq. ft.)
Gross living area (sq. ft.
Typc of beatiDg sy$em
Type ofcoolirE system
Habitable rooEr coult
Number of be&ooms
Number of halfbaths
Number of deckJ oorchcs
"Total Proje{i Square Footage" may be substituteC for .,Total3 Project Cost''
SignedAffidavitAtached? Yes.......,.-E No.,..,...... tr
Datc
The Commonwealth of Massaclr//,sefis
D ep artment o{ fndustrial Accldenls
1 Congress Street, Suite 100
Boston, MA 02114-2012
www, mass, gou/d.la
lYorkers' compcnsation Irsurance Affid0vitr Buildrrs/contrrctors/Electricirns/plumbers.
TO BE FILED WITH TgE PERMTTTING .{, TTHORITY.
AoDIicont Info.m,on e Print bly
Name Gusincsyorgnnizqtiory'lnd ividus.t) :
Address:
City/State/Zip:Phone #
Art you rn .mploylr? C'hrcl( ti. lpproprlatc bor:
l.! I r.i r dnploy.r witl _cdploy.es (ftll and/or pan tim.)..
2.! I rm a solc popricor or IErll|lrship rnd havc no cmpjoyc.s working fo, oc inany capacily. [No workcrs' comp. irlruflnct rlquircd.]
3. f] I am a horneo*ocr doint lll v/ork mysclf [No workcrs' comp. insmnc. nquircd.j I
4. E t lrn . homco.Mrr rnd will bc hirint coot-datoG to conduct all work on my prop.rry. t eillcnsura that rll conFactors cittrlr hevr \{ork.as, coDpcnsation irsunncc ot}c sole
-
propricto{s with no cmgloyccs.
J.[ I .lh E garreral contrdctor lnd I hav. hircd thc sub-conuaclors lisicd on thc ltached 3hc4
Thcac auuco raatols havc cmploycc! md havr wo*.ers' conp insuraicc.t
6.fl Wc rrt r corpoEtion ard its omcc.. havc cxcrcis.d rhcir.ighr oflxcmption p.r )VIGL c.
152, ! l(4). tnd wc havr no cnployecs. [No wo*.rs' comp. insqanc. trquir.d.]
ny @plic.nt dl€t ctEcks box #I mult also lill out rhc scrtion bclow showing rhci, u/arkcrs'compensation policy informario[Horncowncrs who subml n\is aftidavit indacaring thcy arc doing a work and rhcn hirc outsid. con!&rors mllst $bmit r nc\r,/ afiidlvit indi:ating srlr-lconra.to6 t!a! chrct this box mu$ a(achcd en additional shccishow ing the naft. of lhe sub-contrelor5 ud state whcth€r or nor thosc .ntitics tEv.
Type of project (required):
?. ! Ncw construction
8. f] Remodeling
9. fl Demolition
t0 [ Building addidon
I t.E Eleokica.l repain or additions
12.I Plumbing repain or additions
I 3 . fl Roof repairs
t4.n Other
lf th. sub-contracrors hEve thcy oust providc thcir workcr!'comp. poticy number
et thal is providing workers' compensation itrsurance lor my entployees- Below is the policy andjob site
lnsurancc Company Name
I an an euploy
b{ormalion
Policy # or Sclf-ins. Lic. #Expiration Date:
I do hereby certify tuulet the pains and penalties of perjury ihot lhe inlomlation provi.ded above is true and correcl
,oO t* OO*$, ,, ,, , , . City/StateZip:_AtbchacoPyofthe*o;ku@owingthePolicynumberrndcrpiratondate).
Failure to secure coverage as required. under MGL c. 152, $25A is a oriminal violation punisbable by a finc up tc s 1,500.00and/or one-ycar imprisonmcnt, as well as civil penalties in the form of a STop WoRKbRDER anja fi;; ot'rp,o $zso.oo ,day against thc violator. A copy of this statement may be forwarded to the office of tnvestigations ottrre D6,io, iosu.ancecovcragc vcrification.
Pho e#:
Do hot ttrite in this arcq, to be coxlF)leled b) cily ot tavL ofrtcial
l' Board ofHealth 2' Building Dcparhnent 3. city/Town clerk 4. Electrical lnspcctor 5- plumbiog Itrspestor
Permit{,icense #
Phone #:
Ollicial use only.
Cont ct Person:
Issuing Authority (circle one):
City or Towr:
l)rt..
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 lloute 28, South Yarmouth, MA 02554 508-398-2231 ext. 1261
HOMEOWNER L]CENSE D(EMPTION
PLEASE PRNT:
DATE:
JOB LOCATION:
NAME STREET ADDRESS SECTTON OF TOWN
"HOMEOWNER"
CTryORTOWN STATE ZIPCODE
The current exemption for 'Homeowner' was extended to include owner - occupied dwellinss of one or two units
aad to allow such homeowners to engage an individual for hire who does not possess a license, provided that such
homeowner shall act as supervisor, (State Building Code Sectioo i10 R5.1.3.1)
Defi nition of Homeowner:
Penon(s) who owns a parcel ofland on which he/ she resides or intends to reside, on which there is or is intended to
be, a one or two family attached or detached stmcture assessory to such use and / or farm suuctures. A person who
constructs more than one home in a two-year period shall notbe considered a homeowaer; such "homeowner" shail
submit to thebuilding official, on a form acceptable to the building official, that he / she shall be responsiblefor all
such work oerformed under tlle buildins per4iJ. (Section 110 R5.1.3.1)
The undersigned 'homeownet' assumes responsibility for compliance with the Snte Buildiag Code and other
applicable codes, by-laws, rules and regulations.
The undersigned 'homeowner' certifies that he / she understands the Town of Yamouth Building Department
minimum inspection procedures and requirements and that he / she will comply with said procedures and
requi.rements.
HOMEOWNER''S SICNATURE
APPROVAI OF BUILDING OFFICIAL
Signalure of or Owner's Agent
Check one:
Owner xAgent
h:horlGowruliccremp
NAIVIE HOI\,IEPHOM WORKPHONE
PRESEM MAiUNG ADDRESS
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGLCh.142. x Yes No
If you have checked ves, please indicate rhe type coverage by checking the appropriate box.
A liability insurance policy * O6er type of indemnity Bond
OWNER'S INSURANCE WAIVER: I arn aware that the licensee does not have the insurance coverage requLed by
ChnPter 142 of the Mass. General [,aws and that my signature on this permit applicatiot waives this requiremeni.
-/a/ Saj&zA2
$TOWN OF YARMOUTH
1146 Route 28, South Yarmouth, MA 02664
508-398-22311 ext. 1261 Fax s08-398-0836
Office of the Building Commissioner
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Ch. 40, $54 and 780 CMR - Section 105'3'l' #4'
I hereby certiff that the debris resulting from the proposed worlc/demolition to be
conducted at
Work Address
Is to be disposed of oat the following location:771 Washington Street, Auburn, MA 01 50'1
Said disposal site shall be a licensed solid waste facitity as defined by M.G.L.
ch. lll, $1504.
/oZ 3-17 -22
Signature of lication Date
Pennit No.
BUILDING DEPARTMENT
*:
FROOIIGEiLaib raauranc.
537 P.!k Av.nua
CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE NUMBER:
Y
CANCELLATION
COVERAGES REVISION NUMBER:
woRxERS COI/FEXlArlOtl
AI{O €TPLOYERS' IIABIU'Y
!IYPROPEETOi/PARTI{EIVD€CUTIVE
of acEa/nEtB€iExcLlJo€o?E
CERTIFICATE HOLOER
ro/1 2021
BELOW, THIS CERTIFICATE OF INSURANCE DOES t{OT CONSTITUTE
REPRESENTATIVE OR PROOUCER, A D THE CERNFrcATE HOLDER.
MATTE INFORMANON LY AND CONFERS
E'(TEI{O bR ALFFIRMATIVELNEGATTVELY BY.
THISETNRIGHTSoPONuCERTIFICATHEFRTITEtcatssutsDEASOFRONCETHISlcPOTlEsRTEcovETHERAGEAFFOROEOFICACERTIDOESTENOTORYAMENO.
N THE INUG AUTHORIZEOBETWECONTRACTtssEs),NSURER(
lf suBRooATloN ls watvED, rubl.ct to lh. t.rm. rnd condltions o, th. pollcy. c.rt ln pollcl.r nay n qulr. an .ndort.mcnl. A ttrlem.nl onONAL INSURED, th. pollcy(i.3 ol ba andoraad.l3 anIMPORTANTT lf the ce
to tha c.rtiflclt! holder ln llcu of auchthl! cartltlcatq do.a not conllor
506-792-0411FtlollE
- lx!!lnE](!-) tF,Eo!91!G cgv!!!^qq . _ _-
UtsuREt ^.
NlualLug
3uREn E : I,IAFBTY HITTUAI.
$ISURER ':
NOTWTHSTANDING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT
MAY BE ISSUEO OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIE
ANO CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY }IAVE EEEN REDUCED BY PAID CLAIMSCERTIFICATE
EXCLUSIONS
TO THE INSIJR€D NAN4ED ABOVE FOR THE POLrcY PERIODTHAT THE POUCIES OF INSURANCE LISTEO BELO\ HAVE SE€N ISSUEOTHIS IS TO CERTIFY
OR OTHER DOCUMENT WITH RESPECT TO WHICH THISINDICATEDS OESCREEO HEREIN IS SUEJECT TO ALL THE TERMS
dA[,lAGE IOIIENYEO r 1, 000,0o
! 100, 000
t 5,000MEO EXP (Any d PoE4)! 1,O0O.00oPERSONAI & ADV INJURY
r 2,000,000GENERA! AGGREGATE
r 2,00o,0o0PROOUCTS - COMP/OP AGG
$
NN1207?23
GENI AGGREGATE LIMIT APPUES PER:
"o.., Iffi [.].o"
x
s
BOOILY IaJURY lP.t p.M)s
aoo[Y TNJTJRY (Ft ,@lbno I
3
T(REO
AI,'OIOULE UAAILTTV
SCtlEDIJLED
t
tDED
EXCE3s LnA
PEi I OItt
s 1,O00,000
51,000,000oa/Lo/a1J22 FI OISEASE . EA EMFTOYE€
E L. OISEASE. POLICYLIUII r 1,000,000
rc2 - 31S- 61{935 - 020 oalto/7o2t
DCScaPnOXOFOPER IIONS,IOCAIIOXS/VEHrcLESIACORD101.Ardlllo.ElR.nEt.S.tdua...yb..tt.h.dil|llfr.e.oLr.qdrd)
SH(I.llI) AI{Y OF TTTE AAOVE OESCRBEO POLICIES A€ CAXCELI.ED BEF(RETHE qPlRAItON DATE TflEREOF, llOTtCE WILL BE OETryEREO !t
ac@RoaxcE wTH THE POTJCY PROVTS|O|{S.
TllrcUII TIOTII EILL
1145 norrrt 28
t}toIrTE totT, ItA 0265{
ACORD 25 (2016/03)
Al righb ro..rved-
ro-r-c!.. j!I, I1- .0-lJ!1 -IT!UiID
SOLIR llOr.t. A,llROY
7?1 raASArXOmr BT
AI'BT'RII XI
The ACOiO n.m€.rd logo a r.gLtand m.rk ot ACORD
N
cr [ir8- ^DE E j occuR
3
9
Commonwealth of Massachusetth,
Division of Professional LicensurelFBoard of Building R ulations and Staocj*,a
Cons isor\l
cs-097491 *,
TED C STRZFLE
JE+P
;f,
/01\
4
ires: 02llgtZAZ}
582 WAUWI
BARRE MA s
Comrnissioner K dU,-frt*
t
t
n
I
0^
)
Massachusetts of Coytlpl"efrLowContractors Academy C
A PDi{ AcademyCompany
Ted Strzelecki
cs-087 49r
has completed the
Massachusetts Contractor Classroom Renewal Course Part L
Approval # CS-0102L2
Code Review 2 hours
Workplace Safety 0 hours
Business Practice t hour
Energy_.1l hours
Lead Safety_lhour
Elective 2 hours
02117 /2022
Coordinator: Annie Schultz, Program Manager Coordinator Number: CD-000102
lf you have any comments about this course offering, please mail them to the Boord of Building Regulations ond Standards, CSL,
Continuing Educotion, One Ashburn Place-Room 7307, Boston, MA 02708
24t7
,7/b 7o-ror*rr"*o,Zr/
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 021 18
Home lmprovernent Contractor Registration
Tvpe:
Registration:
Expirationl
Corporation
186400
11t06,t2022SOLAR WOLF ENERGY INC
771 WASHINGTON STREET
AUBURN, MA 01501
sca 1 0 mM.ot17
a, /,..,.,,., -.,.,,, -../ ,,/,,...../,?',,..,, //.
Omco of Conium€rAfirlE & Busln.3. Rogul8tlon
HOME IMPROVEMENT COiITRACTOR
TYPE: Co.DorationR.olstntion Exolration
1 86utOO 111c6no22
SOLAR WOLF ENERGY INC,
ta-na /.**
Updato Addross and Retum Card.
RegisEation valld for individual usa only
before the expiration dale. lf found roturn to:
OItrce of Conaumer Affairs and Busin€ss Rogulation
1000 Washington Streot - Suit.710
Boston, MA 02118
Nol valid without signature
TED STRZELECKI
771 WASHINGTON STREET
AUBURN, MA 01501 U n dersecretary
.-
-.
f projects@evenBineersnet.com
http://www.evengineersnet.com
276-220-0064I
3/27/2022
RE: Structural Certification for lnstallation of Resldentlal Solar
WlLtlAM KENNEDY:62 MIDSTREAM DR, SOUTH YARMOUTH, MA 02664
Attn: To Whom lt May Concern
This Letter is for the existing roof framing which supports the new PV modules as well as the attachment of
the PV system to existing roofframing. From the field observation report, the roof is made ofAsphalt Shingle
roofing over roof plywood supported by 2x8 Rafters at 24 inches. The slope ofthe roof was approximated to
be 14 degrees.
After review of the fleld observation data and based on our structural capacity calculation, the existing roof
framing has been determined to be adequate to support the imposed loads without structural upglades.
Contractor shall verify that existing framing is consistent with the described above before install. Should they
find any discrepancies, a written approvalfrom SEOR is mandatory before proceeding with install. Capacity
calculations were done in accordance with applicable building codes.
Design Criteria
201s rRc (AscE 7-10)-cMR 780 9th Ed
I
Dr 10 psf
DPV 3 psf
Lr 20 psf
5 30 psf
lf you have any questions on the above, please do not hesitate to call.
STRU
ONL
Sincerely,
(component and Cladding)
V 141 mph
Exposure C
VINCENT
MWUMVANEZA
crvlL
7/t
EV
ENGINEERS
Code
Risk catesorv
Roof Dead Load
PV Dead load
Roof Live Load
Ground Snow
Wind Load
Vincent Mwumvaneza, P.E.
EV Engineering, LLC
oroiects@evensineersnet.com
httor//www.evensineersnet.com
-!tEV--.t Eicrr,rerns projects@evengineersnet.com
http://www.evengineersnet.com
27 6-220-0064'
Structural Letter for PV lnstallation
3/21./2022
Job Address: 62 MIDSTREAM DR
SOUTH YARMOUTH, MA 02564
Job Name: WlttlAM KENNEDY
Job Number: 22O12LWK
Scope of work
Table of Content
Sheet
Cover
Attachment checks
Snow and Roof Framing Check
Seismic Check and Scope of work
Engineering Calculations Summary
1
2
3
4
References
201s tRc (AscE 7-10)-cMR 780 gth Ed
Dr 10 psf
DPV 3 psf
Lr 20 psf
S 30 psf
(component and Cladding)
V 141 mph
Exposure C
STRUCT
ONL
Sincerely,VINCENT
MWUMVANEA
ctvtt
$0r
Llt
This Letter is for the existing roof framing which supports the new PV modules as well as the attachment of
the PV system to existing roof framing. All PV mounting equipment shall be designed and installed per
manufacturer's approved installation specifications.
Code
Risk catesorv
Roof Dead Load
PV Dead Load
Roof Live Load
Ground Snow
Wind Load
NDS for Wood Construction
Vincent Mwumvaneza, P.E.
EV Engineering LIC
proiects@evengineersnet.com
htto://www.evensineersnet.com
:-I.I EV
ENGINEERS
projects@evengineersnet.com
http : / /www.evengineersnet.com
276-220-0064
Wind Load Cont.
Risk Category =
Wind Speed (3s gust), V =
Roughness =
ExPosure =
Topographic Factor, Kzr =
Pitch =
Adjustment Factor, L =
ASCE 7-10 Table 1.5-1
ASCE 7-10 Figure 26.5-14
ASCE 7-10 Sec 26.7.2
ASCE 7-10 Sec 26.7.3
AscE 7-10 Sec 26.8.2
141 mph
c
c
1.00
14.0 oegrees
1.27 ASCE 7-10 Figure 30.5-1
3.60 ft AScE 7-10 Figure 30.5-1
Where a: 10% of least hori2ontal dimension or 0.4h, whichever is smaller, but not less than 4% of least
horizontal dimension or 3ft {0.9m)
Upllft (0.6W1
Pnet30=
Pnet = 0.6 xl,x l(zTx Pnet3o)=
DownDressure l0.6Wl
zone 1 (psf)
-29.1
21.59
zone 1 (psf)
15.9
17.57
zone 2 (psf)
-41.9
30.42
zone 2 (psf)
15.9
11.57
zone 3 (ps0
-55.1
47.95
zone 3 (pso
15.9
t7.57
Figure 30.5-1
Equatioh 30.5-1
Pnet30=
Pnet = 0,6 x lx l(ZTx Pnet3ol=
Rafter Attachments: 0.6D+0,5W (CD=1.51
Connection Check
Attachement max. sPacing=
Lag Screw Penetration
Prying coefficient
Allowable CaPacitY=
Table 12.2A - NDs
DFL Assumed
0.6D+0.5W DPvro.5W
Zone Trib width Area (ftI Uplift (lbsl Down (lbsl
L 4 11.0 217.7 160.3
2 4 11.0 374.A 150.3
3 3 8.3 380.8 L2O.7
Max= 380.8 < 760
cor{r{EcfloN ts ol(
1. Pv seismic dead weight is negligible to result in significant seismic uplift, therefore the wind
uplift governs
2. Embedment is measured from the top of the framing member to the tapered tip of a lag screw'
Embedment in sheading or other material does not count.
717
5/15" Lag Screw Withdrawal Value=
Figure 30,5-1
Equation 30.5-1
4ft
266 lbs/in
2.5 in
L.4
760
-!,EV--.t irrrcrrrreens
projects@evengineersnet.com
http://www.evenBlneersnet.com
Vertical Load Resisti System Design
Roof Framing Rafters
Pg= 30 psf
Ce= 0.9
Ct = 1.1
ls = 1.0
Max Length, L =
Tributary Width, Wr =
Dr=
PvDL =
ASCE 7-10 , Section 7.2
ASCE 7-10 , Table 7-2
ASCE 7-10 , Table 7-3
ASCE 7-10, Table 1.5-1
11.5 ft
24 in
10 psf 20 plf
3 psf 6 plf
46.7 plf
Load Case DL+0.5W
Pnet+ppvcos(e)+poL= 49.1
Max Moment, Mu =
Pv max Shear
Max Shear, V,=wL/2+Pv Point Load =
Load Case: DL+o.75(0.6W+Sll
0.75(Pnet+Ps)+ Pevcos(0)+po,= 7g
Moo*n= 1.L49
Mallowable = Sx x Fb' (wind)= Z4Lg
Load Case: DL+S
ps+ pe,cos(e)+pDr=
Mao*r=
Mallowable = Sx x Fb' (wind)=
plf
722
150.3
310
plf
tb-ft
tb-ft
tb-ft
lbs
lbs
Conservatively
1149 lb-ft OK
> 106s lb-ft oK
72 pll
1065 tb-ft
1738 lb-ft
Member Capacity
DF-L No.1
2X8 Deslgn Value cr cr cj c 0
Fr=1000 psi 1.0 1.7 1.0 1.15 2.54 0.85 0.8 1380 psi
F,N/A N/A 1.0 N/a 2.88 o.75 180 psi
E=1700000 psi N/n N/A 1.0 N/A N/a N/A N/A 1700000 psi
E-i 620000 psi N/e N/A N/e 7.76 N/A 620000 psi
Depth, d =
width, b =
Cross-Sectonal Area, A =
Moment of lnertia, lxx =
Section Modulus, S,q =
Allowable Momen! M.1= F6'go =
Allowable Shear, V,,= 2/3F",A =
7.25 in
1.5 in
10.875 in2
47 .6348 tn
13.1406 in3
1511.2 tb-ft
130s.0 tb
0.58 < 1
0.34 < 1
Satisfactory
satisfactory
u1
276-220-OO6t
Pr = 27 Psf
P1.1n. = 25.0 psf
p, = 25 psf
Cs 0.933
Max Shear, Vu=wli/2+Pv Point Load = 450 lbs
Kf I Adjusted Va lue
180 psi 0.8
1.0 0.85
DCR=M,/M"rr =
DCR=V,/V",, =
i-II
EV
ENGINEERS
projects@evengineersnet.com
http://www.evengineersnet.com
276-220-0064
Roof Dead Load 10 psf
% or Roof with Pv
Dpv and Racking
Averarage Total Dead Load
lncrease in Dead Load
t8%
3 psf
10.5 psf
2.2% OK
The increase in seismic Dead weight as a result of the solar system is less than 10% of the existing structure and
therefore no further seismic analysis is required.
7h
Siesmic Loads Check
Limits of Scope of Work and Liabilitv
We have based our structural capacity determination on information in pictures and a drawing set titled PV
plans -WILLIAM KENNEDY. The analysis was according to applicable building codes, professional engineering and
design experience, opinions and judgments. The calculations produced for this structure's assessment are only
for the proposed solar panel installation referenced in the stamped plan set and were made according to
generally recognized structural analysis standards and procedures.
bSoLARWoLF
100 Davis Street
Douglas, MA 01516
Ollice 1: (888) 8784396
Office 2: (508) 839-2222
Owner Autho rization Form
We the undersigned, hereby authorize Solar Wolf Energy Inc to act on our
behalf in alt manners relating to the installation of a photovoltaic system
at the location 62M m Dr S. Yarmouth Ma . This
includes but is not limited to financing paperwork, interconnection
documents, building & electrical permit applications, applicable rebate
applications, etc.
This authoization is valid only for items pertaining to the installation
and commissioning of a solar power system to be installed by Solar
Wolf Energy Inc.
Signed under the pains and penalties of ped.rry.
t{,1t,;n ",il (.rvr.+1110112021
Signature of Owner Date
Doc lD: E835bbl 24ef6c598571 550a07 885aaa12aaec7 a
SOLAR WOLF 771 Washington Street
Auburn, MA 01501
Toll Free: (888) E78-4396
www.solarwolfenergy.comrnc.
Contact lnformation
Home Improvement Contract
Sales ConsultantCustomer
Nrme
Address
City, State, Zip
Phone
Email
William Kennedy
62 Midstream Dr
South Yarmouth MA 02664
(760) 828-3101
wkennedychc@yahoo.com
Yasmene Badereldin
771 Washington Steet
Auburn, MA 01501
(508) 583-s451
Yasmene. b@solarwolfenergy.com
Svstem rmation
System Size:8.71
Module Make & Model: SUNPOWER 335
Module Count: 26 Inverter Count: 26
Include l0 Year Online Monitoring YES NO
Connection method ifnot standard offering
Electrical Panel Upgrade: YESENO
Roof Replacement:
Tree Removal:
YESENO Full roof replacement: $1 1 ,875
IYESENO Howmany:
fl$d3flaflrl83:ll"nt for the purpose of solar. lncluded in total cost. oversized system to
meet tuture neeos
PAYMENT INFORMATION
Total Project Cost ($):34 434
Financed Amount: ($): N/A
0f DifiEd 6e Torl C..l):
Loan Term: N/A Years
Cash Payment Schedule (Not Applicable IfFinanc
. 30% Due at Signing of Conhact * S
. 30% Due at Filing of Permits S
. 30% Due at Start of Installation $
. 10% Due at System Commissioning $
2:ix:i;i::+!frfr
"urro
o^nur-il'-rflf
a*onertnitiar-il*(t
Payment Method:
Finance Company:
Cash Finance
N/A
Interest Rate (%):N/A
1
:
330.20
10 330.20
10,330.20
3,443.40
.(initial deposit trot to exceed l/3 ofthe Contract Price or the cost of special-order items' whichever is greater).
A failure to make paymeot for a period in excess ofteD (10) days ftom the due date shall be deemed a material bleach
of this Contsact. Ii iayment is not made when due, Contractol may suspend work on the job until such time as all
p"y."ot, au" nru" Lesn mado without brcach of the Contract pendilg payment or resolution of any dispute. OwDcrs
iviil be responsibte for any and all costs resulting from the delays or stoppage including but not limited to any increase
Doc lD: 3a490946047dgaeoec{9a67ad6efdb267e40cfaf
Cunent Annual Etecric Use (kWh): 4.302
Inverter Manufactuer: ENPHASE lQ 7+
771 Washington Street
Auburn, MA 01501
Toll Free: (888) 878-4396
www.solarwolfenergy.com
cost ofsubcontractd stoppage aIId remobilization, potential need to replace con&acts and increases in ovgrhead costs
to Contractor.
Owner(s) shall pay Contractor interest at the rate ofoDe aod one-halfpercent (1.50%) per month on the total portion
of the price that remains unpaid seven (7) days or more after the date upon which paymelt is due. If the Owner(s)
refuse to pay for any progress payment which is more than 30 days past due, the Owne(s) shall be deemed in breach
of this Ageement and the CoDtractor may stop work at any time and recover the amounts owed and shall be entitled
to recover its costs ofcollection, including its reasonable attomey's fees.
If Owner does not pay auy portion of said contract, Owner agrees to forfeit aoy alrd all solar incentives and agrees to
award them to Solar Wolf Energy. Ifall payments are not rcceived, Solar Wolf Energy rescrves the right to disconnect
lhe solar array ultil all payrnents are brought current.
PROPOSED START DATE AND END DATE: The Scope of Work shall commence on or about
12122121 . Contractor will not begin the Wo* or order materials before the third day following the
SOLAR WOLF
signing ofthis Agreement, unless specifiod in *riting. The commencement date is subject to permit and variance issue
dates, completed architectunt drawings and specifications- All installation schedules are weathet pemritting. Should
snow rain, wind, or cold weather coincide with scheduled installatiou day, the installatiol will be moved to the Dext
date available. Any contact signed after S€ptembq lst is susceptible to weather conditions and may not guaraDtee
installation before year end.
The Work shall continue on a regular basis except for delays beyond the Cotrtactor's conhol and is anticipated to be
substantially comple te on 01122122 . Contractor agrees to keep Owner informed ofany delays that
may interfere with substantial completion within the estimated period set out abovo.
The Contractor shall not be liable for any consequential, incidental, delay, ernotional distress or contingent damages
arisirg from this Contract. Nor shall the Ownel reduce or holdback fimds in the event of, auy delay or nonperformance
causei by natural disasters, pandemics, acts of God, strikes, sho ages of labor or materials, holidays, delays caused
by compietion of other jobs, rtelays in detivery of items selected by the Owner, inclement weather, accidents,
aiterations or modifications agreed to by the Owner(s), delays caused by the Owne($, delays by statc or mrmicipal
govemmental offices, "Hidden Conditions" or any other contingency beyond the CoDtactor's contol. In addition to
iny other extensions provided for in this Agreemeut, Contractor shall receive a reasonable extensioD of time to
commence and/or complete its wo* hereunder fotlowing the cessation of any delay and such extension shall be set
forth in a writlen change onler In the event the Contractor is unable to complete thc performance of its obligation
under this Ageement lue to acts of God, stikes, unavaitability of supplies or materials, or any other contingency
U"yona it "o-ntof "ner 30 days, either party may cancel this contracl in which event the Owne(s) shall be liable to
pay tne Conta*or Ue amount of laboi ani maieriuls already fumished as well as reasonable profit aad overhead
3u"h par-*t it to bs made within seven (7) days after the riate of such cancellation'
PERJvIITS: The Contsactor, under provisions of M.G.L. c. l42A is requt€d to apply for and obtain all constructio!-
,"f.:iJp".-ii". conua"to, ,hall obtain all permits required by gov-emment bodies' unless othenvise specified, as the
Or,oo(i) ug"nt. ffr" cost of sai6 permits #tt Ue part ofOe Cosi of Work as defined herein and charged to Owueds)'
O*rr"r(, ino secure their own constructionlrelrt€d pcrmits or deal Mth unr€gktercd conlrsctorc shdl bc
ercluded from access to the Guaranty iuld provision of M'G'L' c' l42A' The Owne(s) shall obtain and pay for
the necessary approvals, eusemeots aoi/o ariances rcquired for th€ project. said costs are lrot included in the total
Agr€ement Price.
ACCESS TO pROpERTy: The work caDnot proceed uutil this agreement has beeB fulty signed and-exegyed bf
both parties. Untess it i, otn"oir. ,p".ln-a i" foting hoein, it is inderstood that the Owrer is ready for this work
to begin. Owner shall gant """"tt i"'l"to"** if, 'g"ott' leprese[tatives' and authorized subconbactors and
vehicles. A refusal to permit the Contractor or its iepresentati"es io proceed with the work herein will be desmed a
breach of this ageement.
2
Doc lD: 3a49o946c47dgaeoeco9a67ad6efdb267 e/.Oc,al
tnc.
771 Washington Street
Auburn, MA 01501
Toll Free: (888) 8784396
www.solarwolfenergy.com
The Owner or the Owner's rspresentative must be at the property during all installation work and has full authority to
make decisions on the Owner's behalfshould any problerns arise. This includes but is not limited to module placement
wLe managemsnt, equipment management, and more. If the Ownsr is fmancing the system, the Own€r agrces to be
present for the duration ofthe installation to sign the frnancing completion cedificate upou completion ofthe work. If
the completion certificate is rot signed upon completion of installation, final inspections will not be scheduled.
Ownff authorizes Contractor the right to disptay signs and advertise at the jot, site ftom date of oxecution of this
contract and continuing until 60 days after completion.
CIIANGE ORDERS: Upon reasonable request of Owners, Contractor may, at Contactor's sole discretion, make
changcs, additions, or alterations of the Work, and the Conlract Price and Substantial Completion time will be
modified and set out in a written Change Order signed by both Owners and Contractor. Such Change Orders shall
become part of this Contract. Owners agrees to pay any increase in tle cost ofthe Project as a result ofa Change
Order. ln the event the cost of a Change Ordsr is not known at the time a Cha[ge Oder is executed, lhe Contractor
shall estimate the cost thseofald Ownels shall pay the actual cost whether or uot it is in excess of the estimated cost.
Ow11ers agree to make requcsts conceming atry changes, additions, or alterations in the Work, direc0y to Cotrtractor
and not to workers, including subcontractors, on the Work Site.
Change order work witl be billed at $ 120 per hour plus materials and will be due at the time of hnal invoice.
Ifthe Owner(s) refuse to pay for any Change Orders by the palment due date, the Owne(s) will be deemed in breach
of this Agreement and the Conhactor may stop wo* at any time aud recover the amounts on ed and shall be entitled
to r€cover its costs ofcollection, including its reasonable attomey's fees.
Any inctease in the Scope of Work set forth in this Agreement which is rcquired by plan checkers or field inspectors
witi city or county buildinyptannlng deparunents or requiEd due to any "Hiddan Conditions" as defined below, will
be treatid as additional work to this Agreemoot for whicb thc Contractor will issue s change order. lf any sauctural
upgrades are deemed necessary Uy a third-party engineer, there witl be an additional cost assessed, discussed and
agreed upon with the customer. Prices may also fluctuate due to govemment-enforced tariffs'
Any increase in the cost of materials of ten (10%) or more from the date the contract is signed, shall entitle the
Contractor to issue a change order that increases the Cootract Price.
LEDGE OCCURRENCE (GROUND MOIINTS): This agreement does not include an amount to be assessed for
the presence of ledge. 6dge is identified as any rock that is larger than I cubic yard in size. Ledge wilt impact cost
and time since wiin grouuO mouuts, the need to excavate the material is unseen and undergrotmd. If ledge is
discovered, it w.ilt be shown to the ov,,ner and a cost estimate fol its removal will be made at that time.
EIDDEN OR ITNFORSEEN CONDITIONS : The parti€s hercby acknowledge that in certain remodeling work, the
a.iAitl", "i p"nl""s ofthe pre-existing stucture m;y reveal additional defects, conditions or the need for additional
.,oo* tt ut .ouia oot t ave been i6entifrei'by Contractoi with reasonabte diligence ("Hiddsn Defects') which must be
6;A'fi";;;;;"d out in order to commence or to complete the Scope of work t**:':f 111l]l,tlyh
Hidden berects, tne substantial comptetion date aod total Ageement price may need to be modified. Auy additional
*"ii*q.ir"J ,i" r result in the issua,nce of a written change order. The parties agree such modifications are not
avoirtabli and shatl not be considq€d a breach ofthis Agreement'
SolarWolfEnergyisnotresponsibleforanypletxistingcotrditions.th€tarenotincompliancewithapplicattle
building and enerly codes. Any necessary upgrades are the sole responsibility ofthe Owner'
ONLINE MOMTORING: For online monitoring, Solar Wolf Energy uses the SolarEdge, Sunpower, a19 factory
i.r]aJ-"lfrrr", ni" *itt utt iort"tt"tioor. This deiice updates every two to six hours. Ifowner requests a dtecl wire
SOLAR WOLF
3
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rnc.
SOLAR WOLF 771 Washington Street
Auburn, MA 01501
Toll Free: (888) 8784396
www.solarwolfenergy.comtnc.
4
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or any difforont type of connection, there will be an additional time and material charye, Solar Wolf Eneryy reserves
the rights to the ouliDe modtoring platform until final payment has been received from the Owner. Upon receipt, Solar
Wolf Energy will release the online monitoring platform to the Owner.
INSURANCE: The Contractq agrees to carry liability insurance as is necessary to protect the Contactor, his
employees, subcontractors and the Owner(s) from claims for bodily injury, including death, which may arise from the
performance of this Agreement by the Contractor. The Contraclor hereby warrants that all employees and
subcontractors under its suporvision performing Work at th€ Premises are covered by worken' compensation
inswance. ConEactor shall fumish certificales of insurance to Olvne(s) upoo request.
The Owne(s) will purchase, effect and maintain propedy insurance for all the Work to be performed undo tbis
Agreement, The policy shall be a Homeowner's or Conhactor's Risk type on a replacement cost basis, "Special Form."
The policy shall be equal to the full insurable value ofthe Work. The coverage shall not necessarily extend to tools
and €quipment ofthe Contactor, subconhactors of any lier, or property owned by employees ofany of them, vchicles
of any kind, or drawings or specifications. However, the Owner(s) agree to use ordinary care in the stotage of lools
and equipment of the CoDtractor, subcontactors of any tier, and job materials and supplies located on the Prernises
for thi duration of this Project. This Iasurance shall include the interests of the bank, or other mortgage holder, if
applicable, and the Owner shall insure against "all risks" ofphysical loss or damage.
In addition to O\l.tre(s) usual property and liability insuanca, Owne(s) agree to carry ilsurance i[ amouuts sumcient
to cover claims, of any natue, arising out ofor rolating to existing or newly comtructed stuctures, or ary podions
thereof. Said insurance shall also include, but is not limited to, coverage for materials and fixtures, delivered, installed,
placed or erected at the Premisos or at any temporary location. Such iosurance shall provide complete rcplac€m€nt
for damaged or lost property due to fire, theft, vandalism and all "extended petils-"
ARBITRAIION
The Contractor and the Owner(s) hereby mutualty agree in advance that in the event that one ofthe parties herelo has
a dispute conceming this Agreement, either party submit such dispute to a private albitsation service which has been
approved by the Odce ofConsumer Affairs and Business Regulation and the other party shalt b€ rcquired to submit
to such arbitation as provided in MGL c.l42A
To the fullest exteDt permitted by law, each of the parties hereto shall be entitled to have any claims sgainst it decid€d
in arbitration, even iione party initiates an action in the couts. In such eveDt, at either party's option, the court action
shatl be stayed while the matter is decided in artitration. The prevaiting party in auy arbitratiou may pctition a Coun
of competent jurisdiction for enforcement of such decision.
Aslongasbothpartiesagre€,theymayatanytimeandwithoutconsequencaoptoutofthisAlbitatioDagleement
and seek redress in any cout of comPeteDt jurisdiction.
Notwithstandingtheforegoing,tothefullestextentpermittedbylawany.contovgrsyorclaimarisingoutofolrelated
to this AgreemJnt involving an amount of less than $7,000 (o; rhe maximum limit of the court) may be head in the
Small C6ims Division of the Municipat Court in the coutrty where the Premises are located and judgment upon an
award in Small Claims Court may be intered in any Court having jurisdiction thereof
NoTICE:ThesignafuIesofth€paltiesapplyonlytotheagleementofthepartiestoalternatedispuleresolution
ini,iuiJty tf," C;nhactor. The Owne(sfmay initiate altemative <lispute resolution even where this section is not
signed separatelY bY the Parties.
We, Solar Wolf EDergy, Inc. and the Owne(s), have read the above Arbitation Ageement and utrderstand its tems
and both have signed it as our free act and deed
SOLAR WOLF
il,lLr,,L J'l (rnu!09 t26 I 2021
Owner Name Date
O\sner Name:Date
-^/4,-09 t24 t2021
Sales Consultant Name
COVID.I9 RELATED CLAUSES
The Parties acknowledge that the ongoing COVID-I9 epidemic/pandemic and the evolving situation surounding the
ssme may trigger stoppages, hhdmnces and/or delays in Contractor's (or its subcontractors' or suppliers') ability or
capacity to perform the contracted work and./or to produce, deliver, install or serrrice any applicable producs,
irrespective of whether such stoppages, hiadrances and/or delays are due to measules imposed by authorities or
deliberately implemented by Contactor (or its subcontacton or suppliers) as preventive or curative measures to avoid
harmfirt contamination or exposure of Contractor's (or its subcontacto$' or suppliers') employees. The Parties
therefore recognize that such circumstances shall be considered as a cause for excusable delay and shall not expose
Contractu to contractual sanctions (including without limitation delay penalties, liquidated damages or other
damages) or terminatiou for default, provided that Contaclor shall take all reasonable efforts to mitigate such delays
or impacts.
Should the Contractor be detayed, obstructed, hindered or interfered with io the commencement, prosecutioo or
completion of the Work by any govemmental dircctive or order in no way chargeable to the Contractor, or by any
exkaordinary conditions arising out of war, govemment regulations, state or national emergency, global health
pandemic, additional health or safety regulations, or by ally oth€r cause boyond the cotrtsol ofatrd not due to aDy fault,
neglec! act or omission ofthe CoBhactor, its officers, agents, employees, subcooFactors or suppliers, then Coatraclor
shall be entitled to an exteosior of time.
Contractor remains responsible for compliance with all appticable federal, state 8nd [oca[ laws, rules, regulations and
guidance involving health and safety, including, but Dot timited to, those [aws, rules, regulatious and guidance issued
by the Center for Dsease Contol, OSHA and other federsl, state and local govemmental authorities in rcsponse to
iOVIO-IS. This includes, but is not limited to, implementing social distancing measures and acquiring, Providing
and pmperty using auy personal protective equipment, as matrdated by federal, state ard local laws. Coltractor shall
implement such safety measlres to fight the sprcad of COVID-l9 dudng the entire duration of the Project without
additional compensation.
The parties waive all claims fo! transmission of COVID-19 against each other.
RIGHT OIr CANCELLATION: Owne(s) may cancel this Agreement at any time prior to miclnight of the third
business day after the date ofthis hansaction. Such canceltation mustbe done in writing by executing the Notices of
Cancellation attached hereto.
The Contactor may lhereafter recover the cost of atl unpaid tabor and materials for all Work incorporated into tie
Project (whether invoiced or not) plus reasonable overhead and profit.
owNER'S RIGHT TO REGISTRATION INQIIIRY: Subject to certain excoptions, all home imprwement
contractors aod subcontracton shall be rcgistercd and any inquiries about a contractol oI subconEactor Ielating lo a
registration should be directed to:
5
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ffi E{ffiFqffiY inc.
771 Washington Street
Auburn, MA 01501
Toll Free: (888) 878-4396
www.solarwolfenerry.com
Date
The Commonwealth of Mossachusetts
Dcpoaaent oJ Industrial Accidents
Oficc of Invesligalions
LaJayette City Cenler
2 Avenue de Lafayette, Boston, MA 02lll-1750
www.mass,gov/dia
Address: 771 Washinoton St
Are you an employer? Check the appropriatc boxr4.8
5.8
employces (fu ll and/or part-timc).r
2. ! I am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.l
3. E I am a homeowner doing all work
myse lf. [No worliers' comp.
insurance required.] i
I an a general contractor and I
have hired the subconsacto$
listed on the attached sheet.
These suucontractors have
employees and have workers'
comp. insurance.l
We arc a corporation and its
offcers have exercised their
right of exemption per MGL
c. 152, $ l(4), and we have no
employe€s. [No workers'
comp. insurance required.]
1.ffi I am a employer with 6
Ci lstatelZi : Auburn, Ma 01501 Phone #:
.Any applicanl lhal checks box ,l must also fill out tlre scctix Horv showitrg thair !ro*crs' coop.nsrlion policy info.rnatioo.t Hotncowncrs who submil this alfidayit indicsting thc, rrc doing all wo.k and thcn hire ouBidc coltriclors must submit a new rmdlvit indicaing such
lcontracto6 that check this box must attschcd.n addhioflal shcct shorying tttc nrnrc ofthc sub-corlraclors and state whclher or not dloso enliti€s have
emplolrcs. lf &e sub{ontra.lors hsve employees, lhcy mun providc thek \rorkcrs' conrp. policy numbcr.
I om an emploler lhat is providitrg workers' corrrpensollon insurdncc lor ,rr! employees. Belot! ls lhe pofic! ond Job sile
inlomolion.
lnsurance Company Name: Leib lnsurance
Job Site Address:City/State/Zip S Yacnufr.naslwy
Attach 8 copy ofthe workers' compensstion policy declarrtio[ prge (showing the policy numbcr and erpirstiotr datc).
Failure to secul.e coverage as required under S€ction 25A ofMCL c. 152 can lead to the imposition ofcriminal penalties ofa
fine up to $ I ,500.00 and/or one-year imprisonm€nt, 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 Ofiice of
Investigations ofthe DIA for insurance coverage verification.
I do hercb! cenily under the pqlns of peiury lhal lhe inJonnolion prcvided abote h lrue and corrcclj,t .Z
Phone #:
O;fficlal use onty- Do nol wtlte in this srec,lo be comPldett bt ci9 or town oliclol
lffi3rlJ'ji,ljl,1infiX',?;,,* o"r"rrment 3fhiry/rown crerk 4.E Ekcrricar rnspcctor 5Ehrumbirg
Phone #:Contacl Persotr:
PermiUlicense #City or Towr:
-
lnrpcctor 6.Eothet .-..........-.....-
Workers' Compensation Insurnnce A[Iidnvit: Builders/Contractors/Electricians/Plumbers
Anolicant Information Please Print Lesiblv
Name (Businesyorgani?rtion/tndividuat): Solar Wolf Energy
Policy # or Self-iru. t-lc. *: WC2-3 1 5-6 1 4936-020 Expiration Date: 08/1 0/2022a
Type of project (required):
6. n New conslruction
7. ! Remodeling
8. E Demolition
9. I Building addition
I O.D El€ctrical repaim or additions
I l.E Plumbing repairs or additions
t2.E Roofrepairs
l 3.8 otherselAl!ns'!a!!a'!ien