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13-032 (6)
414 NORTH KING ST BP-2019-0463 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 13 -032 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 ELECTRIC SYSTEM BUILDING PERMIT Permit# BP-2019-0463 Proiect# JS-2019-000739 Est.Cost: $3300.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use row : SUNRUN INC 080034 Lot Size(sq.ft.): 38507.04 Owner: WILLIAMS DANIELLE K Zoning Applicant: SUNRUN INC AT. 414 NORTH KING ST Applicant Address: Phone: Insurance: 7_34 FOREST ST STE 400 (978) 793-8584 WC MARLBOROMA01752 ISSUED ON:10/18/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP AND SHINGLE ROOF 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: o 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: Fe Tg vne: Date Paid: Ain2ypt. Building 10/18/2018 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fay: (413)587-1272 Louis Hasbrouck—Building Commissioner oC) �= Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability. Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Gf SECTION 1 -SITE INFORMATION e, 1.1 Property Address: This section to be completed by office Map 13 Lot 032-001 Unit 414 North King St Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Matthew Hine 414 North King St Northampton MA 01060 Name(Print) Current Mailing Address: 859-312-5065 Telephone Signature 2.2 Authorized Agent: Craig Orn 734 Forest ST STE 400 Marlborough MA 01752 Name(Print) Current Mailing Address: 978-793-8584 Signbos Telephone C -ESTIMATED CONSTRUCTION CQ§Tj Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3300 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) ✓H� 5. Fire Protection 6. Total=(1 +2+3+4+5) 3300.00 Check Number This Section For Official Use Only Date Building Permit Number. Issued: Signature:,5—,C10r 7 el -T Building Commissioner/inspector of Buildings Date OCT 1 2 2018 DEPT.OF BUILDING INSPECTIONS NORTHAMPTON,MA 01060 Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L:-R: L• R• Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved amici #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DONT KNOW ® YES IF YES, date issued:. IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT 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 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q 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 Q 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 a common plan that will disturb over 1 acre? YES Q NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [p Siding[p] Other[dJ Brief Description of Proposed Work:S trip and Re-roof Install water sheild and GAF shingles Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If New house and or addition to existing housing,complete the followina: a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 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? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner 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 I, Craig Orn as Owner/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. Craig Orn Print Name Signature of Owner/Age Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:rraml3.Orn CS-080034 License Number 734 Forest ST STE 400 Marlborough MA 01752 01/22/2019 Address Expiration Date 978-793-8584 Signature Telephone 9.Registered m r em t Contractor: Not Applicable ❑ Sunrun Installation Services 180120 Company Name Registration Number 734 Forest ST ST 400 Marlborough MA 01752 10/13/2018 Address Expiration Date Telephone978-793-8584 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) 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.......X No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied 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 that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: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.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor 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,you may be liable 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 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: 414 North King St The debris will be transported by: Dumpster The debris will be received by: Graham Waste Services Cohassett MA Building permit number: Name of Permit Applicant Craig Orn to i 1 Z18 (f e—I Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents - 1 Congress Street, Suite 100 d Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aaplicant Information Please Print Leeibly Name (Business/Organization/Individual):Sunrun Installation Services, Inc. Address:775 Fiero Lane, Suite 200 City/State/Zip:San Luis Obispo,CA 93401 Phone#:978-549-9438 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.[:]1 am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.E)I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E)Building addition 4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.a I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.E]We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] IL *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation 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. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:Zurich American Insurance Company Policy#or Self-ins.Lic.#:WC013696004&WC013696104 Expiration Date: 10/01/2019 Job Site Address:414 North King St City/State/Zip:Northampton MA 0106 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 violation punishable 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 thepains andpenalties ofperjury that the information provided above is true and correct. Si nature: Date: 101 it ( 8 Phone#:978-549-9438 Official 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.Plumbing Inspector 6.Other Contact Person: Phone#: AC�® DATE(MM/DD/YYYY) `� CERTIFICATE OF LIABILITY INSURANCE 9/12/2016 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(les)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: Arthur J.Gallagher&Co. PHONE 415-546-9300 a/c No):4I5-536-8499 Insurance Brokers of CA. Inc. License#0726293 E-MAIL 1255 Battery Street#450 ADDRESS: San Francisco CA 94111 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Zurich American Insurance Company 16535 INSURED SUNRINC-01 INSURER B:Navigators Specialty Insurance Company 36056 Sunrun Installation Services, Inc. 775 Fiero Lane,Suite 200 INSURER C: San Luis Obispo, CA 93401 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:899243400 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. IPLICY EFF PICY EXP LTR TYPE OF INSURANCE J=Wvp ADDL SUBR POLICY NUMBER MM/DD/YYYY MMIDDIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY LAIOCGL2303211C 10/12018 10/12019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTE9__ CLAIMS-MADE F71 OCCUR PREMISES Ea occurrence $1,000,000 X $50,000Retention 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 JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: I I Total Policy Limit $10.000,000 A AUTOMOBILE LIABILITY BAP915542505 10/12018 10/12019 COMBINED SINGLE LIMIT $2000000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WC013696004 10/12018 10/12019 X PEATUTE H A AND EMPLOYERS'LIABILITY OT - YIN WC013696104 10/12018 10/12019 ANYPROPRIETOR/PARTNER/EXECUTIVEa N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (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 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) WC013696004-$25,000 Deductible;WC013696104-FL,HI,MA,NJ,NY,OR,VA,WI only.Named Insureds:Sunrun Inc.,Sunrun Installation Services Inc., Sunrun South LLC,AEE Solar,Inc.,Clean Energy Experts LLC,Sunrun Solar Electrical Corporation Evidence of Insurance. 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. City of Northampton 212 Main St Northampton MA 01060 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE 0812512018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO MONTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BErEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: N the cartllkals holder is an ADDITIONAL INSURED,the pollcy(ks)must be endorsed. If SUBROGATION 18 WAIVED,subject to the terms and conditions of the poky,certain policies may require an endorsement. A stat vi nt on this certificate does not confer rights to the aNlcate holier in Leu of such e s PRODUC a 0011TACT WASLLA SWOS FOCUS N48URANCE PLUS INC 978-344•x000 FAX978-703-0052 271 HIGH ST UNIT B LOWELL,MA 01852 "AMP NOXIERA: WES WORLD INSURANCE CPAMPANY 13196 pauaeo wmw&x&: ARBELLAt52MCTION INSURANCE EVOLUTION ROOFING CORP SNUFAR C: NAUTI INSURANCE COMPANY 17370 206 PRATT AVENUE,APT N21 NNW 0: AMGUARD INSURANCE CO LOWELL MA.01851 1111IMME. P: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 16 TO CERTFY THAT THE POLKA OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOIXi NSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTwMSTAN[11NG ANY REOU NT.TERM OR CONDITION OF ANY CONTRACTHER DOCUMENT WITH RESPECT TO WHICH TUTS CERTIFICATE MAY BE ISS ED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLK3EHERON IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY CLAIMS am Tyra OF POLIMNUISM mpum umm eaNaRALUANIM SACH000MM1anCE f 1.000.000 X ee1MNE11CM1OMdNLNNAaeITy s 100,00 wan-woE 0 oc" MIOOiP w s 31000 NPP8524030 08/17/2016 MM712019 1.000,000 eBHIRALAoatswTt : 2,000.000 a MAGOrAWTELMTAPPue PWL PnoouCTs•C MPOOFAoo 6 �( Poucy LOC s AVTOMOS LE UARMT I,wrAM 9O[Kywwty"P—" $ 100.000 ftL wro ){ 1020074406 0611112018 1112019 sooty ftPjUtyp«awM::p S 300.000 AUTOS X HMAUs X �O : 100,00o X uNaaaN.ALw 000Ae EACH CCLwitweE s WtcmURS CLAN04AADE AN053975 0610612018 1712019 AINOREeATE S 3.WQ.0W S 3.000.000 wOaloRNtOarM'WIMTNON w A . Aral�LONat'LNaalry Y 1 N AwOFMEXCwo 1 N NIA 117110 08125/2018 05125/2019 tx EACH AcaoaHr S 1.000.000 obad m b rM E.L.DmEm•SA SmftOyu S 1.000,000 unmrWIMPAM-4 bow 1.0011.000 E.L.oieEASE•Paxw ware 1 TF I- I OMCOWIM OF OMAMO I LON:A=M I VHeCLn~AXM101e1.Add1S*"ftMft edrdub,a man spa , CERTIFICATE HOLDER CANCELLATION1 SHOULD ANYE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXMRAOF DATE THEREOF, NOTICE WILL BE OWWXED IN SUNRUN ISTALLATION SERVICE ACCORDANCE WITH THE POLICY PROVISIONS. 734 FOREST ST SUITE 400 AUTHORIZED RSPKSS ATNF 019162 ACORD 25(2010/05) ®1!U -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered mania of ACORD