22D-051 (2) 34 RYAN RD BP-2021-0125
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:22D-051 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-2021-0125
-T
Proiect# JS-2021-000198
Est.Cost:$14552.00
Fee:$75.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: EARTHLIGHT TECHNOLOGIES 15611
Lot Size(sg. ft.): 37766.52 Owner: HATHAWAY CHARLOTTE
Zoning: URA(100)/WSP,100)/ Applicant. EARTHLIGHT TECHNOLOGIES
AT. 34 RYAN RD
Applicant Address: Phone: Insurance:
92 WEST RD (860) 871-9700 WC
ELLINGTONCT06029 ISSUED ON.8/3/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-ROOF MOUNT SOLAR 3.270KW
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:
FeeTyue: Date Paid: Amount:
Building 8/3/2020 0:00:00 $75.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
IVE
' JUL ;; n 2020
bPAT OP BUI(
ILI The Commonwealth of Massachusetts ON.MA 01061 Ns OR
l Board of Building Regulations and Standards
Q./ Massachusetts State Building Code,780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: ]—Datp Applied: 07/26/2020
Ke-L)10 Voss 6-3-Z070
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
34 Ryan Road, ,� 20
LIS I
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 13 Private 13Zone: _ Outside Flood Zone?Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Charlotte Hathaway Northampton,MA 01062
Name(Print) City,State,ZIP -- — ------
34 Ryan Road, (413)667-5611 lchadotte.hathaway@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) 0 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work2:Installation and wiring of a roof mounted 3.27okw grid tied
solar PV system consisting of(10)SunPower SPR-E20-327-E-AC module and inverters. Located on the Southwest roof of house
tied into the existing 100A electrical service panel.ext hero
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $4552 1. Building Permit Fee: $75 Indicate how fee is determined:
[3 Standard City/Town Application Fee
2.Electrical $10000 ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees: $
City of Northampton
Massachusetts
c
L� A.
DEPARTMENT OF BUILDING INSPECTIONS 2
212 Main Street • Municipal Building
Northampton, MA 01060 �S�'w 3�X
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING,ADDITIONS,POOLS,DECKS,ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR,ETC.
1. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specification of proposed work(digital and hard copy).
3. Site Plan with location of proposed structure(s)and setbacks.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/replacement windows).
8. Home Owner's License Exemption Form filled out and signed by homeowner(if applicable).
9. Note any Conservation and/or Special Permit requirements (if applicable).
10. Driveway Permit(if applicable).
11. Proof of Water and Sewer entry fees paid(if applicable).
12. Trench Permit-public land by DPW/Private land by Building Dept.
13. Stretch Energy Code—all new construction will require a HERS Rater Affidavit to be submitted with
permit application before issuance of permit.
6.Total Project Cost: $ Check No. Check Amount: Cash Amount:
14552 ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
15817A 7/31/2020
JAKE SCHNEIDER License Number Expiration Date
Name of CSL Holder
92 WEST ROAD List CSL Type(see below) U
No.and Street Type Description
Ellington CT 06029 U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Coverin
--- - - - WS Window and Siding
SF Solid Fuel Burning Appliances
860-871-9700 resprojectmanagement@earthlighttech.com 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
180432 11/16/2020
Earthlight Technolgoies-Jake Schneider HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Nan1e
92 West Road resprojectmanagement@earthlighttech.com
No.and Street Email address
Ellington CT 06029 860-871-9700
Ci /Town,State,ZIP Telephone
SECTION 6: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 .......... ❑ No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S 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.
6&lyptte T h&h&1 a
Charlotte T.Hathaway(Jul 28,2020 10:40 EDrr 07/26/2020
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and acc to to the best of my knowledge and understanding.
07/26/2020
Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass. ovg /oca Information on the Construction Supervisor License can be found at www.mass.gov/dpss
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms _
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
r
t •' Massachusetts
(J x. 4
} ! DEPARTMENT OF BUILDING INSPECTIONS
\�* 212 Main Street • Municipal Building
Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: 92 West Road. Ellington, CT 006029
The debris will be transported by:
Name of Hauler: Earthlight Technolgoies - Jake Schneider
Signature of Applicant: Date: 07/28/2020
The Contntntttt'cralth of 1laysachu ells
t Departtnettt u,Intlu.vtrial Accidents
6� t ('regrew.Street,Suile IOD
Butitonr ,11.4 02114-2017
r Ivor.torevv.gottJ'din
11 when'( outpensalion In%urancr Affidatit:8uildct t'�ntrarlorsl't:IretriciYnsrl'lunll►rrs.
()Rt.1-114-1) 1111 1 111'_PER1111 1 ING Al 11101(111.
-11►1tlicaut Infos utation Pleaw Print Levibl%
Name CBusi 0[l antrattonlndn�idual):
Address:
City/Statelzip:__.___.__ ___ O _
.ira tnu an cntpltr.Nrr"t.hari the algavpriatc IHa: Type of project p'equired►:
I.0 I ant a en pluy.i Adb taplaryco iIu11 and arc part tura F..' 7. D Ncw'construction
-".`-3 I ant a y&prxrtrricaar Or FmnLi-�hi\p�rMl 6axr nr crnpb,.xt�+Mar uvr larr nk in 8. 0 Remodeling
'n!avpartty_[NO Mrxkcrs'nmtrp.m%u at mquir.z!_I
9. 0 Drnwltlitin
1�1 ant a IrmaYr%nes tltnnLe all%nrk mys lt. o workais'c T_ircweaswe n�rd..l"
4.0 1 am a latmat%tar and%ill be hiamw aunt W c ret all Mash a my Ilbpetty I%tl1 n
10 Q Building addition
,mum dot all c'onlra tw%6t6Lr lave%orkcet' tub mL nr uranai w amlale I i C]Eleancal repair's or additions
m1prictots U 11 no anpluvru.
12_[:]Plumbing repairs or atklititms
50 I am a pal cxmttacwt and l lave hitrr! -1
n
-% tucrom hstej as The anadwil 4X-C1 1 �RIWf rcp.Yira
1 kax wh-cun[radors lave v�npin_yees mord Ya arrkcr+ .tanp-msucerae.
6.0 We are artnpuratitwanJ its offiken hatc .tcixdl6cu rrg6lotwacn"itax pr'r hi(:I.C. 14.E]OtiM
152,11(4).and Mc have no aWluyw..I %urkm'caanp.in an"rcyutmd.l
*/illy apph.at►t dal dk+cks bav;rl mint alar - tut da-sccloort trelu%sha inp 16or%takers'compt'nsaq.m I%LfLwy ittimmalmm-
t Mbmv%nLm%bo utdnnal flus affxb,.n in caung tlry an*taring alt Ma+rk d tome hue uutxitle casttractur>mm�a aubnwt a ta%atlrtla,it itdi.�ting such.
=Cuntraclom flat check dwi tru:roust at •d as aildlimmal Jkx-1%bowing t ��r or eta u,-cawractmn and stale*lather ur mot dww aatliti.:.lavc
. rluvice?. If Ilre sub-ctmtrachrs lave t{rlxrvccs.day muat provide thou %u -ts'vinup.polay ntanbet.
I ata an emplayrr that is &liniV wort rs'emoopen%ation in.surtt for tort'empla)'tres. Blow is the p die)r and fob stark
inlirrnudian.
h,tur.urcc t'wnpany Njo ne: ---- ---- - --_�
Policy#or Self-ins.Lic.#:— Expiration Date:- -- — --
.lab Site Address: _ tylState zip.
Attacr a copy of ore workers'ruulpcn,atiuu pulic� drrlaratimi pa;c(,huwiag policy nrmber mW expiration date►.
Failto secure coverageas required realer NIt w L c. 152, 25A is a l ritttirial viulati wlishable by a fine up to$1,5(lU.(NI
and`or otic-year imptisonnicut,as:well ai.civil itcnalties in the form of a STOP WORK RDER and a fine of up to$250.00 a
day against the violater_A copy of this staletrxnt may be forwarded to the Office of investigations of the DIA for insurance
cuacrage verification.
i do herebt•certifi'under the Intim,and prnultira of jrrriuri-that lire information provided ahove is tray and correct.
�ucttatw:_ I).atc:
f'Eustua.
011it ial inic unlY. De not wrNr in this arta,to he completed bl'citr or town uffi-cittl
Cite ur Tutt IN: PrrtnilTicenw#
1„uimg-Authoril% (circle one):
1. Hoard of Health 2. Iluildin;r Department 3.( its i7%loon( lerk 4. l':Ieetrical Inspector 5. I'luntl►ing Inspector
G.Olhcr
Conlact Person: 1'lurnc ik:
\ The Commonwealth of Massachusetts
Department of Industrial Accidents
a
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.
Aomlicant Information Please Print Leeibly
Name(Business/Organization/Individual):EARTHLIGHT TECHNOLOGIES
Address:92 WEST ROAD
City/State/Zip:ELLINGTON, CT 06029 Phone#:860-871-9700
Are you an employer?Check the appropriate box: Type of project(required):
1. 1 am a employer with 52 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. Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3.O 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t
Q4.E]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition
ensure that all contractors either have workers'compensation insurance or are sole 1 1.❑Electrical repairs or additions
proprietors with no employees.
12.E]Plumbing repairs or additions
5.❑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.: SOLAR
6.O We are a corporation and its officers have exercised their right of exemption per MGL c. 14.D 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:TM BURGESS CO
Policy#or Self-ins.Lic.#:BNUWC0151614 Expiration Date:07/01/2021
Job Site Address:34 Ryan Road, City/State/Zip:Northampton, MA0106
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 cern under the pai and penalties of erjury that the information provided above is true and correct
Si nature: Date:
Phone#: 0 71-9700 x 125
Official use onlj% Do not write in this area, to he 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#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another.who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to cant'workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
City of Northampton
•' Massachusetts ���S•S S,�'`i
j
L�, c
i..l DEPARTMENT OF BUILDING INSPECTIONS
\ 212 Main Street • Municipal Building gip. cD.
Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
1 Charlotte Hathaway (insert full legal name), born _ (insert month,
day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a
parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which 1 am seeking the aforementioned homeowners'exemption,
does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeoumer"as defined at 780 CMR 110.R5.1.2:
Person(s)who owns 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 home owner.
4. 1 do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for
and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work
on my parcel, I am not engaged in construction supervision in connection with any project or work involving
construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any
provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my
parcel, I acknowledge that 1 am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this 28 day of July — 20 20
Cl X_14tte T hI&LMay
Charlotte T.Hathaway(Jul 28,2020 10:40 ED
(Signature)
1 & 2 Family building Permit 2020_2020072212
40029448
Final Audit Report 2020-07-28
Created: 2020-07-28
By: Gina Schneider(gina@earthlighttech.com)
Status: Signed
Transaction ID: CBJCHBCAABAATKIoLyOg3VXgXQDQtphxloojMEmWQ5Hj
"1 & 2 Family building Permit 2020_202007221240029448" Hist
Ory
Document created by Gina Schneider(gina@earthlighttech.com)
2020-07-28-2:16:35 PM GMT-IP address:96.95.186.221
C� Document emailed to Charlotte T. Hathaway (lcharlotte.hathaway@gmail.com)for signature
2020-07-28-2:21:51 PM GMT
Email viewed by Charlotte T. Hathaway(lcharlotte.hathaway@gmail.com)
2020-07-28-2:39:10 PM GMT-IP address:66.102.8.120
6� Document e-signed by Charlotte T. Hathaway (l charlotte.hathaway@gmail.com)
Signature Date:2020-07-28-2:40:27 PM GMT-Time Source:server-IP address: 174.192.14.164
Signed document emailed to Charlotte T. Hathaway (lcharlotte.hathaway@gmail.com) and Gina Schneider
(gina@earthlighttech.com)
2020-07-28-2:40:27 PM GMT
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