- 1. Solar Solutions92 Gardner St.Worcester, MA
01610(508)459-5410AbsoluteGreenEnergy.com
2. Absolute Green Energy & Solar PV About Us Solar Energy
Solar PV in your home 3. Commercial Residential 4. Coal NuclearGas
Oil 5. Why Solar Powered Electricity? Smaller Electric BillReduce
Carbon footprint by Government Return onInvestmentSubsidies:moving
towards sustainable Rebates through SREC programs
developmentFinancial Incentives 6. Before Choosing to go Solar. 7.
EnvironmentEconomicsSocialSustainable Development 8. Site
Assessment DesignDB ACDATEDATEDRAWING SHEET1 OF 1 6/12/12 / / 92
Gardner Street, Worcester, MA 01610 USAT: +1 508-459-5410 / F: +1
508-792-9646D Absolute Green Energy
CorporationSIZEwww.absolutegreenenergy.com IT Communication
CableCUSTOMER / PROJECT INFORMATIONLOCATION 15 Rear Juniper St,
Wenham, MA 01984 PROJECT 2012 Solar PV System - Pizzo 9.88 kW Gray
Common Green Ground 1 1Pizzo 3 Line Electrical LayoutBlack L1 Pizzo
3 Line Electrical LayoutSEALS / ENDORSEMENTSRed L2DRAWING NUMBER
CUSTOMER Diane Pizzo DRAWN BY W. Lanpher DRAWING
TITLENTSAPPROVALSBYREV BYREVISIONSKEY PLANCHECKED BY NOTES:CAD
FILEPV300SCALEREV Electrical Service AreaSide of Residence PV
Circuit 1 Envoy Communication ModuleCustomer Broadband RouterWired,
Wireless or EthernetRoof 2 2 Over PowerM215M215Utility PowerM215 PV
Circuit 2 Main Service Panel - 200 Amp BusbarM215 End Cap Installed
At End150A Main Breaker M215 Micro-Inverter Of Branch
CircuitUtility MeterBackfeed Breaker PV Circuit 3PV Circuit
4M215M21550 Amp 3 3M215M215M215M215M215M215M215M215AC Disconnect -
Near Utility MeterM215M215M215M215 Revenue Grade
MeterM215M215M215M215 UL Listed Surge ProtectorM215M215M215M215 4 4
1 #10 AWG Ground, Copper, THWN-2M215M215M215M215 20 Amp 6 #10 AWG,
Copper, THWN-2 20 AmpLoad Center 100A Combiner
PanelM215M215M215M215 1 1" PVC ConduitRoof Mounted Junction Box20
Amp 20 Amp 3 #8 AWG, Copper, 1 #8 AWG Ground, 1 1" PVC Conduit
Copper, THWN-2M215M215M215M215 THWN-2 5 51 1" PVC Conduit 6 #10
AWG, Copper, THWN-21 #10 AWG, Ground, Copper, THWN-2 6
6DBACPaperworkInstallation/Maintenance Exhibit A - Simplified
Process Interconnection Application and Service Agreement The
Commonwealth of MassachusettsContact Information (PRINT):Department
of Industrial AccidentsCustomer or Contact Name : Diane
PizzoCompany Name: Office of InvestigationsMailing Address: Rear 15
Juniper St. 600 Washington StreetCity: Wenham State:MA Zip Code:
01984 Boston, MA 02111Telephone (Primary): (978)317-4216 Telephone
(Secondary): www.mass.gov/diaFax: Email: [email protected]
Compensation Insurance Affidavit:
Builders/Contractors/Electricians/PlumbersAlternative Contact
Information (e.g., system installation contractor or coordinating
company, if appropriate): Applicant Information Please Print
LegiblyContact Name: : Charles CadyCompany Name: Absolute Green
Energy Corporation Absolute Green EnergyMailing Address: 92 Gardner
StreetName
(Business/Organization/Individual):_________________________________________________
_City: Worcester State: MA Zip Code:01610 92 Gardner
St.Address:__________________________________________________________________________Telephone
(Daytime): 508-459-5410Telephone (Evening):5087337208Fax:
508-459-4277 Email: [email protected] Worcester, MA
01609(508)459-5410City/State/Zip:_____________________________
Phone #:________________________________Electrical Contractor
Contact Information (if appropriate): Are you an employer? Check
the appropriate box:Type of project (required): 1. x I am a
employer with _________ 6 4. I am a general contractor and IName
(Print): L.J.Grace Electric LLChave hired the sub-contractors 6.
New construction employees (full and/or part-time).*Mailing
Address: 694 Main St. Telephone: 50821002232.I am a sole proprietor
or partner- listed on the attached sheet.7. Remodeling ship and
have no employees These sub-contractors have 8. DemolitionCity:
Holden State: MAZip Code: 01520 working for me in any
capacity.employees and have workers 9. Building additionOwnership
Information (include % ownership by any electric utility): 100 [No
workers comp. insurance comp. insurance.Confidentiality Statement
(MA only): I agree to allow information regarding the processing of
my application (without my name and address)5. We are a corporation
and its 10.Electrical repairs or additionsto be reviewed by the
Massachusetts DG collaborative that is exploring ways to further
expedite future interconnections. YesNo required.] 3.I am a
homeowner doing all workofficers have exercised their11.Plumbing
repairs or additionsFacility Information:myself. [No workers comp.
right of exemption per MGL 12.Roof repairsAddress of Facility: Rear
15 Juniper St. insurance required.] c. 152, 1(4), and we have
noemployees. [No workers13. x Other____________________Solar
PVCity: Wenham State: MAZip Code:01984comp. insurance
required.]Electric Service Company: National Grid Account
Number:50130-67005Meter Number:43694087 *Any applicant that checks
box #1 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.Work
Request Number (For Upgrades or New Service):MTC ID: Contractors
that check this box must attached an additional sheet showing the
name of the sub-contractors and state whether or not those entities
haveInverter Manufacturer: Enphase Model Name and
Number:M215Quantity:38employees. If the sub-contractors have
employees, they must provide their workers comp. policy
number.Nameplate Rating: 215 (kW) .90 (kVA) 240(AC Volts) Single or
ThreePhase I am an employer that is providing workers compensation
insurance for my employees. Below is the policy and job
siteinformation.System Design Capacity: 9.88 (kW)9.88 (kVA) For
Solar PV provide the DC-STC rating: 9.88 (kW)The HartfordInsurance
Company
Name:____________________________________________________________________________Prime
Mover: PhotovoltaicReciprocating Engine Fuel CellTurbine
Other:Energy Source: SolarWind Hydro DieselNatural GasFuel Oil
Other:08WECLI6161 12/03/12Policy # or Self-ins. Lic.
#:__________________________________________ Expiration
Date:____________________IEEE 1547.1 (UL 1741) Listed? Yes No
Generating system already exists on current account? YesNo Job Site
Address: 90 Page Brooke Rd.Carlisle, MA 01741
City/State/Zip:______________________Estimated Install Date:
06/25/2012Estimated In-Service Date:06/25/2012Attach a copy of the
workers compensation policy declaration page (showing the policy
number and expiration date).Customer Signature: Failure to secure
coverage as required under Section 25A of MGL c. 152 can lead to
the imposition of criminal penalties of aI hereby certify that, to
the best of my knowledge, all of the information provided in this
application is true and I agree to the Termsfine 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 fineand Conditions on the following
page: of up to $250.00 a day against the violator. Be advised that
a copy of this statement may be forwarded to the Office
ofInvestigations of the DIA for insurance coverage
verification.Interconnecting Customer Signature:Title: OwnerDate:
06/1/2012I do hereby certify under the pains and penalties of
perjury that the information provided above is true and
correct.Please attach any documentation provided by the inverter
manufacturer describing the inverters UL 1741
listing-----------------------------------------------------------------------------
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-------------------------------- Signature: Date:
06/18/2012Approval to Install Facility (For Company use
only)Installation of the Facility is approved contingent upon the
terms and conditions of this Agreement, and agreement to any
systemPhone #:(508)459-5410modifications, if required (Are system
modifications required? YesNoTo be Determined ): Official use only.
Do not write in this area, to be completed by city or town
official.Company Signature: Title: Date:Application ID
number:Company waives inspection/Witness Test? Yes No City or Town:
___________________________________ Permit/License
#_________________________________ Issuing Authority (circle one):
9. 92 Gardner St.Worcester, MA
01610(508)459-5410www.absolutegreenenergy.comQuestions? Contact
[email protected]
