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37-022 (15) 04/14/14 09: 05AM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pg 2/2 soLOTIONS Properly Owner Consent Form Owner: Diane Liebert Address: 4 Mountain Laurel Path Town: Florence State: M, Zip: 01062 Phone: 413-586-6050 Y hereby give permission to Megawatt Energy Solutions and their representatives to pull the required permits for a solar installation on my property. Property Owner Da/to Megawatt Energy Solutions, LLC P.O.Box 23437 Providence, RI 02903 03/31/14 04 : 33PM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pg34/39 Wd*j* r Department of Industrial AccidentsV Office of Investigations 600 Washington Street Boston, MA 02111 www-mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Legibly Name(Business/OrganizatiorAiidividual): Address:`` City/State/Zip:- / A- 200, ,_ 0Zs;,% ' Phone _-- Are you an employer? Check t PA_appropriate box: Type of project(required): 1.14 I am a employer with.___ -. 4. E] I am a general contractor and I employees(full and/or part-time),* have hired the sub-contractors 6, Q New construction 2.❑ I 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' comp.insurance.l 9 Building addition [No workers' comp, insurance p• required.] S, ❑ We are a corporation and its 10.D Electrical repairs or additions 3.[1 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 required.]t c. 152, §1(4),and we have no employees. [No workers' 11M Other I,-¢12: comp.insurance required.] 'Any applicant that checks box#1 must also till out the section below showing their workers'oompensation policy information. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those enfifies have employees. If the sub-contractors have employees,they trust provide their workers'comp,policy numbor. I am an employer that Isproviding worker's'co»rpensation insurance for my employees. Below is thepolicy and job site information. n C �t Insurance Company Namepe�/�h1�!/ l 5 /7-°I Policy#or Self-ins.Lic. #: ..-_ Expiration Date: Y lob Site Address: lY Iold", .��',y�,. ��ht�/�G �.�i� I C ty/State/Zip: 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 MGT e. 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'17U'ORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of The DIA for insurance coverage verification, I do hereby certify under the pains ame�nd penalties of perjury that the information provided above is true attel correct. Signature: Dater _-- Phone#: O Official use only. Do not write in this area,to be completed by city or town official City or Town, PermitlLicense# Issuing Authority(circle one): 1.Board of Health Z.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 03/31/14 04 : 33PM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pg35/39 City ' of Northampton K' Massachusetts •,Yr"� r (y! y ,^ DSPUTAENT OF ,BUSLDXW INSP$CTTONS 5� 212 main Street • Municipal Building Northampton, KA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EKEIvIP'1;Z N ACKNOWL,EDGBMENT 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." i 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 our a rough building ins ection before work is concealed Insulation ins ection if re ulred 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. (Nome 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 :33PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg37/39 SECTION 8-CONSTRUCTION SERVICES 8.1 Ligensad Construct �u^ervlso : Not Applicable £ Name of License-Holder: 1 �sl �l Is '7—It License Number Address Expiration Date Slgneturo Telephone ! �1,��Yf94 NA 1i1 I l: 1O ( Pry MAI �"iRn 13 0 A';Itt� h 1, bdtPh"' u9»Y,_:.i NOtApplicable E pp Cam and v Nar4a Registration Number ��,�i� CSAO -05-� d'� 7 Address / f Expiration Date � o V ?-.y^ �i C)3 Telephone 0/5, SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c:l62,§25C(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... .. £ No...... E syh�,"w The current exemption for"homeowners"was extended to include Owner-occuytgd_Dwelliness 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 gLFL t the caner t as su e v s QT.CMA 780 k th Edition Sec 1 08.3.5.1 Definition Qf Homeowuot:Person(s)who own a parcel of land on which he/she 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 and/or farm structures.AA person who constructs mQre than one ho ie in a two-year perlad shalN_ ot be eonsido ed ltomeowtter. Such"homeowner"shall submit to the Building Official,an a form acceptable to the Building Official that he/she_shal1be responsible for all such work 1]e formed under th!b building normit• As acting Construction Superyts your presence on the job site will be required from 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,Yom mayle 1 able for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility fbr 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 : 33PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg36/39 SECTI ESCRIPTION Or PR6PQ0iE WORK(chock All a !!cable) New House © Addition Q Replacement Windows Alteration(s) Q Roofing Or Doors Accessary Bldg. ❑ Demolltlon ❑ New Signs [Ci] Decks 10 Siding[01 Other[ Brief Description of Proposed Work: Alteration of existing bedroom _Yes—.K No Adding new bedroom Yes �C_No Attached Narrative Renovating unfinished basement Yes , , No Plans Attached Roll -Sheet °rY� i •��;°r"N•�!Irn 4"7�Y7a"i"r rm;��n7Y`ir': Yr,•tKxY{ran i*•nna•w. •are^rrryc v�i-•r�:�G;�r�+i� ^cam• a—r r„”^erg "fir, 'r�r y�f'tiPlijVt►:'ho�1�.e!:'�artt��acr�tdt�t�ioi�•t.t"o�exi�tirt�l�ih��i�ins� `c�"ii�l3'�ei'�; �.�fol[i�ui�,li�r�: a• Use of building:One Family . .... ...__...... Two Family Other b. Number of rooms in each family unit: Num r of Bathrooms_­-,... ^, e. Is there a garage attached? d. Proposed Square footage of new co tr ctio Dimensio e. Number of stories? f. Method of heating? laces kood Number of each Q, Energy Conservation Compliance. Mass pliance form attached? h. Type of construction i. Is construction within 100 ft, tlands7 Yee cn 100 yr. floodplain.. .............Yes No J. Depth of basemen cellar floor below finished grade k.'buil onform to the Building and Zoning regulations? Yes No. I. k City Sewer Private well City water Supply SECTION 78-0WN9R AUTHORIZATION 'TO,6E COMPLETED:WHEN OWNERS AGENT OR'CONTRACTOR APPLIESTOR,BUILDING PERMIT` 1. as Own or of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date 1, as Own or/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 :33PM EDT Megawatt Energy Solutions —> City of Northampton 4135$7127 2 Pg39/39 Section 4. ZONING Ail information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Tliia column to be filled in by Building nepanrment Lot Size ._ Fronts e Setbacks Fron L:=R:t_r.,....1 L.=R:= �- L-- Building Height Bldg.Square Footage % Open Space Footage % � (r_ot arcs minus bldg 8c paved arkin #of perlcin S aces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been Issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:L-. IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON r KNOW 0 YES 0 IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YE$, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained I Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size,'type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES C) NO 0 IF YES, describe size, type and Location: —A E. Will the construction activity,disturb(clearing,grading,excavation,or filling)over 1 acre or Is it part of a 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 : 33PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg38/39 City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR IDEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 •SITE INFORMATIQN T•1._� �ropertvAddress: Y 7adr"l�hw l-Sij E ! ' ,���tr� ,�'' Bbl. ! 'fl�f, � . 1. "�'+�4 .J,,�a 'i�'•;7>;Y1a'i cf� . SECTION Z.;-PEtOpERT`((�1NNEF�SyIPlAU�"NORi�ED�aO�NT:� 2.1 Owner of Record: Y Name(Print) Current Melling Address: Telephone - Signature Authorized Acient, 't 903 9 Name(Prlr&y Current Melling Address; Signature Telephone S ECiLON 33.-ESTIMATED CONSiR ktlb.N O5TS: Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building '('a)•8ul10ing'Perjn(t Feb' 2. Electrical (b)' 9tlmated Total'Cos;of Constructlon`frorn'8 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total-(1 +2+3+4+5) Lj OCI L�`'"' Check Number Thisc$ectlon tor.afflclarUse'Onl Building PermltN'umber: �l ^ ©�4/'-^ �/ psuea Signature: BuIlding Comm3ssionein�speetOt Of BUlldinge; Data 4 MT LAUREL PATH-600 FLORENCE RD BP-2014-0648 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 37-022 CITY OF NORTHAMPTON Lot:-000 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-2014-0648 Project# JS-2014-001096 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.): Owner: LIEBERT DIANE E zoning: Applicant: MEGAWATT ENERGY SOLUTIONS LLC AT. 4 MT LAUREL PATH - 600 FLORENCE RD Applicant Address: Phone: Insurance: PO BOX 282 (781) 935-8480 WC PROVIDENCER102903 ISSUED ON.1112112013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALLATION OF A 3KW ROOF MOUNTED SOLAR 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 11/21/2013 0:00:00 $84.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner