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45-010 127 COMBS RD- ARCADIA SANCTUARY BP- 2010 -0994 GIs #: COMMONWEALTH OF MASSACHUSETTS Mai :Bloc 45 - 010 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- 2010 -0994 Project # JS- 2010- 001318 Est. Cost: $50670.00 Fee: $306.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ALTERIS RENEWABLES INC 152709 Lot Size(sq. ft.): 14427072.00 Owner: MASSACHUSETTS AUDUBON SOCIETY Zoning: GI /SC(100)//U"(2) //WP Applicant: ALTERIS RENEWABLES INC AT: 127 COMBS RD- ARCADIA SANCTUARY Applicant Address: Phone: Insurance: P O BOX 51924 (413) 734 -1456 Workers Compensation SPRINGFIELDMA01151 ISSUED ON :512112010 0:00:00 TO PERFORM THE FOLLOWING WORK: I NSTALLATI ON OF GROUND 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 5/21/2010 0:00:00 $306.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo e File # BP- 2010 -0994 APPLICANT /CONTACT PERSON ALTERIS RENEWABLES INC ADDRESS /PHONE P O BOX 51924 SPRINGFIELD (413) 734 -1456 PROPERTY LOCATION 127 COMBS RD- ARCADIA SANCTUARY MAP 45 PARCEL 010 001 ZONE GI/SC(100)/tJRB(2) //WP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INSTALLATION OF GROUND MOUNTED SOLAR ARRAY New Construction Non Structural interior renovations Addition to Existin Accessory Structure Building Plans Included: Owner/ Statement or License 152709 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay Signature of Building fficial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. Version] .7 Commercial Building Permit May 15, 2000 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 2 2 Main Street Sewer /Septic Availability Room 100 Water/Well Availability 1Vorthampton, MA 01060 Two Sets of Structural Plans phone 413- 587 -1240 Fax 413- 587 -1272 Plot/Site Puns Other specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Pro ert Address: This section to be completed by office �v� fyl�jS �Ol(G( Map Lot Unit BAST - try} rn P r`?)n,r MA 6102-7 Zone Overlay District .W A&)R /j-rv-, Pnom/ �i�cP�yJ Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record �s AM 4z t lJCZ P G' n,/ �'C - M O1/J1,+ a� �� Ci�/2�1 .�lJ / 4 - CJ Name (Print) Current Mailing Address: //������ 41/4 i, 17 Signature �� "° Telephone 2.2 Aut Aoent: & n Name (Print) Current Mailing Address: alb - 73 Fa (o Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building ,fl { �D (a) Building Permit Fee 2. Electrical lU / (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number Q This Section For Official Use Onl Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOS SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Bu(Iding ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other Brief Description Enter a brief description here. ,r Of Proposed Work: 1A1STAufiT2 i ' Q /`' WelWI) ��/� n 9 S6 SECTION 5 - USE GROUP AND CONSTRUCTION TYPE ('/ USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A ❑ A -4 ❑ A -5 ❑ 113 ❑ B Business ❑ 2A ❑ E Educational Cl 2B I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (so 1 St 1 2nd 2nd 3 rd 3rd 4 th 4 th Total Area (so Total Proposed New Construction (so Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ I Zone Outside Flood Zone❑ Municipal ❑ On site disposal system[] t t . Version 1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING 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 p arkin g) # of Parking Spaces Fill: volume & Location A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DON'T KNOW © YES IF YES, date issued: IF YES: W the permit recorded at the Registry of Deeds? NO DON'T KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO © DON'T KNOW O YES` IF YES, has a permit been or need to be obtained from the Conservation Commission? l Needs to be obtained 0 Obtained , Date Issued: ls/(G, /A) 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 Q NO 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 P IF YES, then a Northampton Storm Water Management Permit from the DPW is required. t , Versionl .7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Reg' tered Architect: /,//A Not Applicable Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): NC L5oe 011067M-Af Name Area of Responsibility W X73 ?c6— Address Registration Number IT Wd" Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 y1 / /l General Contractor , / ( X6171. , '4X 1927 C p IS t'L 6:' Not Applicable ❑ Company Name: A A�l l� Ci AD �I1e Respons"ble In Charge of Construction A s Signature Telephone Versionl.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes ® No SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, A/ AaullXW L " as Owner of the subject property hereby authorize AG to act on my behalf, in all matters relative to work authorized by this building permit application. Q 1 7 Signature of Owner Date I, /l/ Z&- r �5 A�EGG�14 � � 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. All 6 F J��_ C�� l��? /✓ ���l� i � .t S /L1/-/L if: � Print Name _ Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder 7 0 License Num er Addre s j Expiration Oate ignature Telephone SECTION 13 - 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): S /q/V�Gt)A�31c -S Address: pG City /State /Zip: 114A i/ 1 Phone #: 7 6 - 7 3 y / Ar an employer? Check th "ppropriate box: Type of project (required): am an employer with T ) 4. L I am a general contractor and I 6. L New construction employees (full and/or part time).* have hired the sub - contractors 7. J Remodeling 2. I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub - contractors have 8. 1 Demolition working for me in any capacity. employees and have workers' 9. L Building addition [No workers' comp. insurance comp. insurance. # required] 5.L We are a corporation and its 10. L Electrical repairs or additions 3. % I am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4), and we have no 12. L Roof repairs employees. [no workers' 13. Other ��.k tpf7'jllt�� S comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach 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' compensatign insurance for my employees. Below is the policy and job site information. 7 I nsurance Company Name: A Policy # or Self -ins. Lic. #: &)eA c2 7 13,5 - 2 - / t Expiration Date: �i, D t Job Site Address: C or" 6s 6 City/State / Zip: 44 A y to Z7 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 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 $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above, is true and correct. Signature: ' L �v7s� C iZJ Date: Z /` /D 2 l Print Name: / G ttz Lt, ���12C t l Phone #: 3 7 3 / Y,5 ? 2 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): I.Board of Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact person: Phone #: . `