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32A-116 (4) 90 MARKET ST BP-2019-0797 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A- 116 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-2019-0797 Proiect# JS-2019-001325 Est.Cost: $3384.00 Fee: $40.00 PERMISSION IS HEREB Y GRANTED TO: Const. Class: Contractor: License: Use Group: SUNRUN INC 080034 Lot Size(sq. ft.): 9321.84 Owner: WHEELER MARY L&MELANY THOMPSON-WHEELER Zoning:URC(100)/ �plicant: SUNRUN I N C AT. 90 MARKET ST Applicant Address: Phone: Insurance: 734 FOREST ST STE 400 (978) 793-8584 WC MARLBOROMA01752 ISSUED ON.1/31/2019 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: 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 Occupant Signature: FeeType: Date Paid: Amount: Building 1/31/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner u'� v 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 SECTION 1 -SITE INFORMATION b '0— /q- '77 1.1 Property Address: This section to be completed by office Map 0) d Lot Unit 90 Market Street Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Mary Wheeler 90 Market Street Northampton MA 01060 Name(Print) Current Mailing Address: (413) 230-6997 Telephone Signature 2.2 Authorized Agent: Craig Orn 734 Forest Street, Suite 400, Marlborough, MA 01752 Name(Pring_-, Current Mailing Address: (978) 793-8584 Signature Telephone SECTIOWI'.ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3,384.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee /� 4. Mechanical(HVAC) l 0 5. Fire Protection 6. Total=(1 +2+3+4+5) 13.384.00 1 Check Number 16 This Section For Official Use Only Building Permit Number: Date Issued: Signature: �- I Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW © YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained O , Date Issued: C. Do any signs exist on the property? YES © NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO O 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 ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) 1 01 New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[0] Other[O] Brief Description of Proposed Strip existing roofing materials and install six feet of ice and water Work: shield from the eave to the ridge. Finish with new asphalt composition shingles. Alteration of existing bedroom Yes_\/_No Adding new bedroom Yes No / Attached Narrative Renovating unfinished basement Yes V No Plans Attached Roll -Sheet 6a. If New house and ora clition to existina housina complete the following: 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, Mary Wheeler as Owner of the subject property hereby authorize Sunrun / Craig Orn to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 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 c' 1/ 10 t Signature of Own Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:Cralg Orn CS-080034 License Number 734 Forest Street, Suite 400, Marlborough, MA 01752 01/22/2019 Address � Expiration Date 6�5 978) 793-8584 Signature Telephone 9.Registered Home Imorovemenit Contractor: Not Applicable ❑ Sunrun 180120 Company Name Registration Number 734 Forest Street, Suite 400, Marlborough, MA 01752 10/01/2019 Address Expiration Date Telephone(978) 549-9438 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....... V No...... ❑ City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS y; 212 Main Street •Municipal Building Jy. O Northampton, MA 01060 Js -•. `�4 Debris 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. The debris from construction work being performed at: 90 Market Street (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Graham Waste Services, Inc. 215 Chief Justice Cushing Highway Cohasset, MA 02025 (Company Name and Address) Signature of Per Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of lndustrialAccidents I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):Sunrun 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.(D I am a employer with 40 employees(full and/or part-time).* 7. ❑New construction 2.F1 I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.❑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.M I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[Z]Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑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.] *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 the policy 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:90 Market Street 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 the pains and penalties QfperyfuW that the information provided above is true and correct. Signature: Date: I 0 9 Phone#:978-793-8584 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#: Craig Orn 734 Forest ST STE 400 Marlborough MA 01.752 ---- - --Tel-#: 978=793=4584 -- -- - - Email: mapermits@sunrun.com OR Craig.orn@sunrun.com Massachusetts Department of Public Safety Construction Supervisor Board of Building Regulations and Standards Restricted to: Unrestricted-Buildings of any use group which contain License: CS-080034 less than 35,000 cubic feet(391 cubic meters)of Construction Supervisor enclosed space. CRAIG M ORN 73 WALNUT ST OXFORD MA 01540 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Expiration: OPS Licensing information visit:WWW.MASSGOV/DPS Commissioner 01/22/2019 C:I�C�►1C�M09Vl4 O�VNtaJJacIUJ@lIJ Office of Consumer gain do business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:3uoolement Card before the expiration date. If found return to: R2g[ F.Wration Office of Consumer Affairs and Business Regulation 180120 10/13/2020 1000 Washington Street-Suite 710 SUNRUN INSTALLATION SERVICES INC. Boston,MA 02118 CRAIG ORN 775 FIERO LANE SUITE 200 SAN LUIS OBISPO,CA 93401 Undersecretary N lid without signature ,a►`�oma® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/12/2018 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(ies)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). CONTACT PRODUCERNAME:ME: Arthur J. Gallagher&Co. PHONE 415-546-9300 n/c No):415-536-8499 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 INSURERC: 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. INSR TYPE OF INSURANCE i . SUBR POLICY NUMBER MM/DD /YYYY LICY EFF M LTR MIDDY/YYYY LIMITS B X COMMERCIALGENERALLIABILITY LA18CGL2303211C 10/1/2018 10/1/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED__ CLAIMS-MADE FX]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 Z JECT F LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: Total Policy Limit $10,000,000 A AUTOMOBILE LIABILITY BAP915542505 10/1/2018 10/1/2019 COMBId.rit)NED SINGLE LIMIT $2,000,000 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 acc dent UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ PR $ A WORKERS COMPENSATION WC013696004 10/1/2018 10/1/2019 X STATUTE OERH A AND EMPLOYERS'LIABILITY Y/N WC013696104 10/1/2018 10/1/2019 ANYPROPRIETOR/PARTNER/EXECUTIVE NIA 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$1,000,000 DESCRIPTION OF OPERATIONS I 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 AUTHORIZED REPRESENTATIVE Northampton MA 01060 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD