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46-056 (7) 04/10/14 04 : 14PM EDT Megawatt Energy Solutions -> Town of Northampton 413587127 2 Pg33/33 1"'a (,,,,.k ATf SOLIUTIONI revp y Owner Consent Foy Owner: Lin&PtAnssn AddmSS: 96lsImd Rd Town: Nathan+ wn State. MA Zip; 01460 Phone: 413.584.4241 Z hereby give permission to Megawatt Energy Solutions and their representatives to pull the required permits for a solar installation on my property. Property Owner Date Megawatt Energy Solutions, LLC P.O.Sox 23437 Providence, RI 02903 03/31/14 04 : 44PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg12/17 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.rnassgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/E lectricians/Plrumbeirs Applicant Information Please Print Legibly, Nanne(Business/Organization/individual): M e21+ti-'4 j &!eLt y (a j't y,,.5` L L C. Address: 2 Z r.Ca' Fl=o 2 o City/State/Zip, P P-LOO 0199 Phone#. c)l -63'� —7- Are you an employer? Check the appropriate box: . I am a general contractor and P Type of protect(required): 1.,, ] F am a employer with �1 _ ❑ g G, ❑New construction employees(full and/or part-tirne).* have hired the sub-contractors 2.❑ P am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.t 9• Building addition required.] 5. ❑ We are a corporation and its 10,❑ Electrical repairs or additions. 3.(l I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. (No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance d.re re ui t c. 152, §1(4),and we have no required.] employees. [No workers' 13.[S Other cvl,*,7- V019 e( comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy intbrmation. tHo meowners 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 subcontractors and state whether or not those cntities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name, _ 12 E'- L5 .Lei SST Policy#or Self-ins.Lic. #: 000 t00 906.66 0X Expiration Date:_ Job Site Address: $ C� �' J City/State/Zip: Ne ,_ 4,-6 - a 10 d d Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct. Si ature• r.---- Date (Je1- ? a� Phone#• �a/ .30i - Offlcial 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.plumbin g Inspector G.Other Contact Person, phone#: 03/31/14 04 : 44PM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pg13/17 City ' of Northampton Massachusetts DEPARTANST OF EUSBDXMG XNS,PFCTXONS alp Main Street • Maniaipal Building �J Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Ouiiding Commissioner Assistant Commissioner TOME OWNER EXEMFT70N ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor.The state defines"Homeowner"as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two- year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations.The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes(before pour), a rough building insaectio_n_ (before work is concealed), insulation Inspection (if required) and a final_building Inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result In failure to obtain a certificate of occupancy until the work can be Inspected. If the homeowner hires other trades to perform work (electrical, plumbing &gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required Inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building Inspections necessary for the building permit issued to me. Date Address of work location 03/31/14 04 : 44PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg17/17 SECTION 8-CONSTRUCTION SERVICES 8.1 Licepeg_d ConstructiomStIverylsor; Not Applicable Z LICerwe Number Address Expiration Date sigature Telephone 4 J74— b I it"41119W Not Applicable E Company Name Registration Number Address Expiration Date Telephone_ SECTION 10-WORKERS'COMP5NSATION INSURANCE AFFJUAVlT,(M.G,L,c:162,§25Q(8)) 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 6. E No...... E "4q.. UA The current exemption for"homeowners"was extended to include Owner-occityled Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,Provided tlt,%t the oAZIL_ac_tJ as sugerylsor.CMR 780, Sixth Edition Section Definition o,(-Hewweowne :Person(a)who own a parcel of land an which helshe resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use a.-ndt or farm structures.A person whQ constructs more than One home Ina two-year garloti-511ail not be considered a homeowne . Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official.that e/she sbalLbe res,ponsible for all 111A work Verformckimder the build g liermit. As acting Cons0astlon Supervisor your presence on the job site will be required horn,time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you p gjay be IlAble for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature, - -------- 03/31/14 04 : 44PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg16/17 SECTION 5-DUCRIPTION OF PR POSED WORK'(check ali'anollcablel New House C] Addition © Replacement Windows Alteration(s) Roofing Or Doors Accessory Bldg, ❑ Demolition ❑ New Signs (❑] Decks [q Siding(p] Other(lo Brief Description of Proposed Work: �j (....S Alteration of existing bedroom Yes_.X _No Adding new bedroom Yes - No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet r' >a y rnti a*^u� ,� wr,u�r v'sw i ���;rrnnn cp a- c�r;,r: rcCrY"i^ip^e+7rinrrFarrc .1�77rn•..m;1^m• R1 r^MYrI. a. Use of building.One f=amily_X Two Family Other b. Number of rooms in each family unit: Nl Number of Bathrooms M c. Is there a garage attached? N4IA_ d. Proposed Square footage of new construction. N�r'� Dimensions e, Number of stories? �i� f. Method of heating7 t,/42 Fireplaces or Woodstoves f' Number of each g. Energy Conservation Compliance. i✓64 Masscheck Energy Compliance form attached? h. Type of construction 4v4'0 I. Is construction within 100 ft,of wetlands?—Yes No, Is construction within 100 yr. Floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? ��C Yes No. 1. Septic Tank City Sewer Private well; CIty water Supply SECTION 7a-OWNER AUTHORIZATION'-;TO BE COMPLETED WHEN .OWNERS AGENT OWCONTRACTOR APPLIES"FOR.8UILDING PERMIT 1, as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this bullding permit application. Signature of Owner Date I, as Own er/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date 03/31/14 04 :44PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg15/17 Section 4. ZONING All Information Must Be Completed,Permit Can Be Denied Due To lacemptete Information Existing Proposed Pequired by Zoning ?ilia column to be filled in by !! Building Department Lot Size Frontagew� Setbacks front Side L:= R ia: RE-- ear Building Freight Bldg.Square Footage % � Open Space Footage �^----� (Lot Ana minus bldg&paved t —71 arlcin #of Parking Spaces Fill: YOlume QC LOCatlO A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DQNT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DQNT KNOW 0 YES (D IF YES: enter Book Page and/or Document #_ B. Does the site contain a brook, body of water or wetlands? NO 0 DON7 KNOW 0 YES a IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date issued: C. Do any signs exist on the property? YES 0 NO t IF YES, describe size, type and location: f � � D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO�]0 IF YES, describe size, type and location: E. Will the construction activity.disturb(clearing,grading,excavation,or filling)over 1 acre or Is it part of ia common plan that will disturb over 1 acre? YES 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 03/31/14 04 : 44PM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pg14/17 City of Northampton Building Department 212 Main Street Room 100 , Northampton, MA 01060 a phone 413-587-1240 Fox 413-587-1272 „ APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 •SITE INFORMATION 1.1 Property Address; ' t /(,I�R i�j�a'��1 d nJ � •S m � 'h t; '�����h�;;�c';:�r�'��?�za R,, k�.� r�'� P•�, wl �' ,�,a��,�� l�uv, xl •TIC l'il���� ,ql�r��*a,,Ja':.Yh SECTION 2.•PROPERTY OWNERSHioiAUTk,6*ED:AIGEN.T',". ,. 2.1 Ownor.A.Record: Name(Print) Current Mailing Address: Telephone Signatul 2.2 Authorized-Agent: 111 f2 A elllp�-r7" 611-e,v y o"ar " r $/�— AQep u rT' Name(Print) Current Mailing Address: ??-,5- -62 y 9 5,3 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION-COSTS, Item Estimated Cost(Dollars)to be Official Use•Only com leted by ermit apelicant 1. Building (aj l3ullding`iaetYnjt Fete 1 Electrical of ' '�.:'Cdnatructlon irom'8 ' 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total lilli(1 +2+3+4+5) Check NunI " This:Section For Officiil Use Onl Building Permit,11umber: issued, Signature: ...__ Building CommissfonerilgspecZor,`o(6uudings -Data 86 ISLAND RD BP-2014-0670 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:46-056 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: SOLAR PANELS BUILDING PERMIT Permit# BP-2014-0670 Project# JS-2014-001110 Est.Cost: $14000.00 Fee: $84.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MEGAWATT ENERGY SOLUTIONS LLC 57187 Lot Size(sq. ft.): 47044.80 Owner: PUTNAM LINDA Zoning: Applicant: MEGAWATT ENERGY SOLUTIONS LLC AT. 86 ISLAND RD Applicant Address: Phone: Insurance: PO BOX 282 (781) 935-8480 WC PROVIDENCER102903 ISSUED ON.121512013 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALLATION OF A 3.25W ROOF MOUNTED SOALR ARRAY POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType• Date Paid: Amount: Building 12/5/2013 0:00:00 $84.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner