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32C-029 (6) t`` The Commonwealth of Massachusetts t .. - r ` Department of Industrial Accidents Office of Investigations t =r __ ' > 600 Washington Street Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers Applicant Information Please Print Legibly i I Name (B usin essiOrganization/Indi vidual): t.\ Qma ¢ Co' C 1l c e Address: 3 kff 4, U�2inJ 1 S +A c', ,i ,41' "I 01 oo)7 Cit /State /Zip: � • U►m #: `f/ 3 5a °► 0c CN Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I �mployees (full and/or part - time).* have hired the sub - contractors 6. [1] 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 8. ❑ Demolition capacity. employees and have workers' working for me in any P tY. 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. r] We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. repairs or additions 3. El I am a homeowner doing all work ❑ Plumbing P. myself. No workers' comp. right of exemption per MGL 12.IWRoof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.0 Other 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: _ Policy # or Self-ins. Lic. #: Expiration Date: Job Site Address: City /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 MGL c. 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 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 • ti ' un'••r the pains and penalties of perjury that the information provided above is true and correct. Signature: J , I Date: 6)- -6-)-- C Phone #: Official use only Du 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 #: 4* ' Version 1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No Q SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize to act on my behal��. - - elaf = - • •rk authorized by this building permit application. U / signature of Owner Date , 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.,, Print Name Signature of Owner / Agetnt Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ 4 s - i _._ License Number f ! _ . /c) Address Expiration ate Signa 4.11PN 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 0 No 0 • oes , Version1.7 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 Registered Architect: Not Applicable ❑ Name (Registrant): w . .. ,.._...,. „.... -_.. _., _ _ _- ....„... .._ Registration Number Address .............. _..._. Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): 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 t Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature e Telephon Expiration Date 9.3 General Contractor 1 U>nc ...... ie '� C011 s o!1 _.. Not Applicable ❑ Company ame: n rr, .....etc �...._.-... -.- ..._..... ___ ..__. _..... __...- .. .._..__- Responsible In Charge of Construction N TecreL, (./ r,.., t. ill 4•,I•a n.. Address i . .baci-os-(1.1 ......_......, ._ Signature Telephone PIP Version1.7 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 parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO (3 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO (9 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 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: C. Do any signs exist on the property? YES 0 NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 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 0 NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. .. sr ■ Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs Vidditions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing hange of Use ❑ Other ❑ Brief Description lic Enter a brief description here. Of Proposed Work: A �.., SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑ A -4 ❑ A -5 ❑ 18 ❑ B Business ❑ 2A ❑ E Educational ❑ 2B P ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I 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 I ❑ 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 (sf) 1 st 1st 2 nd 2 3 d 3 d 4 Total Area (sf) Total Proposed New Construction (sf) 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 ❑ Zone Outside Flood Zone❑ Municipal 0 On site disposal system[] .111 - Versionl.7 Commercial Building Permit May 15, 2000 Department use only ^ - - - City of Northampton Statoof,F Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well AVallai:Iility \ 3 Northnpton, MA 01060 TWO Sets of tructural Plans 0 phon.04 Fax 413-587-1272 Plot/Site Plans Other SPecify APPLIC0104 TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING ', --- ,.._ ---- ECTION 1 - SITE INFORMATION This section to be completed by office /1.1 Property Address: // greiA/yier a, f-- Map Lot Unit 11) el" t1,4"pi (II/4 0‘0620 Zone Overlay District -- -- Elm St. District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 4 ,.... 3 eN 3 - - - - - .. ' 6 - - G 4 2.K\ Name (Print) Current Mailing Address: _ lc( /13 — 5-'-3 '-7 .-- 5-3 . 1( Signature 7111. Telephone 2.2 Authorized Agent: 1 A 1 2. ( 1 rl 1-eCCi)rd s . I 3 Terratt t,4, 6 Inti 01027 .. .. . Name (Print) Currentpailing Address: / ' - Signature ‘11/ _ Telephone SECTION 3 - ESTIMA D CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 1 7 1 5 - ° () ' 4" : (a) Building Permit Fee 2. Electrical (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 --,.... " ,.9 1 .I55 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date 4 BP- 2010 -0196 GIS #: COMMONWEALTH OF MASSACHUSETTS -029 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP-2010-0196 Project # JS- 2010 - 000239 Est. Cost: $4500.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SEAN JEFFORDS 074539 Lot Size(sq. ft.): 4268.88 Owner: L 0 R T INVESTMENTS C/O NORTHAMPTON BREWERY Zoning: CB(100)/ Applicant: SEAN JEFFORDS AT: 11 BREWSTER CT Applicant Address: Phone: Insurance: 13 TERRACE VIEW (416) 529 -0544 EASTHAMPTONMA01027 ISSUED ON:8/19/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:REROOF 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 8/19/2009 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ` Boston, MA 02111 `' www. mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers A t t licant Information Please Print Legibly Name ( Business /Organizationllniividual): 5 t) N) G t2 EE -1 C t-(. S Ta.L. t, T1 o»4 _ Address: k ..- \ e r`� - ` `/ >r City /State /Zip: 5 i 1-1 N lk. eTo r V1 \ &lo'l1 Phone #: ` 1 s r2 (,r; *Lf Are you an employer? Check the appropriate bog : 2- 4. Type of project (required): 1. 1 am a employer with ❑ I am a g eneral contractor and I employees (full and/or part- time).* have hired the sub - contractors 6 ❑New construction 2. ❑ I am a sole pmprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub - contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' g 0 Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] 1 c. 152, §1(4), and we have no 13.0 Other employees. [No workers' comp. insurance required.] *Any applicant that checks box tit 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. tContractors that check this box must atta-hed 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: V! f\1t'_ iL PE i _a_i y`-k-5u l �a– f v^� atr'1 c.-` — C 1 - 1\ - 1' 4 l S Policy # or Self -ins. Lic. #: 4)' G 7 `A 2. (,v > 2 G Expiration Date: ' (1 2 1 [ i t Job Site Address: City /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 MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one -y ear 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. 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 un - e . . "' andpenalti r of perjury that the information provided above is true and correct Signature: s ,• Date: _- - 1 /2. {/ 4 Phone #: 4t 52 -O + 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 Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 131279 Type: Individual Expiration: 6/29/2012 Tr# 297765 SEAN JEFFORDS _ • • SEAN JEFFORDS 13 TERRACE VIEW i EASTHAMPTON, MA 01027 _ _ Update Address and return card. Mark reason for change. Address Renewal Employment Lost Card ops.cm 0 SOM.OVO4-G101216 OftleefeeektMerk License or registration valid for individul use only Mem 11,5t HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to; Registration: 131279 Type: Office of Consutner Affairs and Business Regulation Expiration: 6/29/2012 Individual 10 Park Plaza - Suite 5170 Boston, MA 02116 S JEFFORDS SEAN JEFFORDS 13 TERRACE VIEW _ EASTHAMPTON, MA 01027 _ _ Undersecretary Not valid without signature SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Stti a Misti . Not Applicable ❑ Name of License H !d ;.r _ S>t S - 145 c � License Number --r- I I zz) 2.0 ' -> %"J_..4,= �C�``.. �`r �- ��=ivw' �.- Y vi-t yri Y'�� eon.:: �. Yt- (=�1 t i Address 2 s , Expiration Date Signature Te:ephon3 9. Retriste ed.Ffo e 1 s vemen c for: Not Applicable ❑ C VL.,-t f,+ TO. t c r4 / 3 7 9 Company Name Registration Number L 3 Tt -limy k P k, r.; M f\ d (A, Z 7 J2'7 1 . Address ( c Expiration Date Telephone t �` t Ski SECTION 10- WORKERS COMPENSATION INSIJFIAI CE AFFIDAVIT (M.G.I : 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 ET No ❑ vikertxvniption 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 784, 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 tune, 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 f � [ crno N 'er 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition Replacement Windows Alteration(s) Roofing El Or Doors 0 Acoessory Bldg. 0 Demolition 0 New Signs [DI Decks [Q Siding [DI Other [0] W o r k : -f (0 � lion of Proposed r e st4 Work: ''�� ' Alteration of existing bedroom Yes no No Adding new bedroom Yes no No Attached Narrative Renovating unfinished basement Yes no No Plans Attached Roll - Sheet 6a. 0 NevutioitSe cat athitiorito to€#stit aitoji totiozdate the tali owing: 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. floodpiain Yes No { j. Depth of basement or cellar floor below finished grade t k. VIfiil building conform to the Building and Zoning regulations? Yes No . 1. Septic Tank City Sewer _ Private well City water Supply SECTION la - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT A Niel 0. G G( LS i O P , as Owner of the subject property hereby authorize r- sf o . € 4 CO NS (0-- 0C"{16r to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of a -r f Date 1, ,j E /0 :) is Fw Of' >S �ors11 aV.- Cc S n 4 , as Owner /Authorized Agent hereby dedare 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. SE i■l- t)CL t7S Print Name ANN. I / I / Signature of Owner/Arent Date l 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 0 DON'T KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW C) YES 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 W YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 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 IF YES, describe size, type and location: E. Witi 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 a NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. , - - - $x r ' City of Northampton Status o �iw_ y -2�f .v.`.� � Building Department Y` oc4- l ''` JAN 2 1 2 011 Room 100 212 Main Street :''''''',..!_;"'---J-:',':' �� ,� rt a t*Avs tit Northampton, MA 0'1060 �tsrc� phone 413 - 587 -1240 Fax 413 - 587 -1272 i� -- APPUCATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION1- .SITE#NFOR 1.1 Property Address. T>� bi> y�. f. Zone �y diet e 0 s t p ct SECTION 2 - PROPERTY- OWNERSHIPiAUTHORIZED 2,1 Owner of Record: Sgtkef el Ski (t p,ews hr- c �✓ Name (Print) Cu i iitin es ; ,� 0 9 f D Telephone Signature �� 2.2 Authoriz Aaent: Tae • n e -tv NI s`c��j c e r~,7o, e ft ,,,' t T nPZt � 4.6 21 Name (`n � � Curre nt Malt ng Address — 4t3 52 - O 54LI Signature Telephone T SECTi . - ESTf MATED RUCTION t,9STS I Item Estimated Cost {Dollars} to be "5 aai Use Only com pleted by permit applicant 1. Building 000 (a) B u ii t3mg Permit Fee, 2. Electrical J {b) ti Te at' of - Constructio from 3. Plumbing Staidirlrg Pcrm t F ee 4. Mechanical (HVAC) 5. Fire Protection - 6. Total = ( + 2 + 3 + 4 + 5 u h er o Ctuat =lc Nimmt her e This Sec F or Official Use Budding Peer rnit Num rued: sued' Signature: ....... 1 ". f suitd'in Commiss ft ectar of twangs t?ate BP-2011-0650 Gs #: COMMONWEALTH OF MASSACHUSETTS v 9' # CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP-2011-0650 Project # JS-2011-001049 Est. Cost: $3000.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SEAN JEFFORDS 074539 Lot Size(sq. ft.): 4268.88 Owner: L 0 R T INVESTMENTS Zoning: CB(100)/ Applicant: SEAN JEFFORDS AT: 11 BREWSTER CT Applicant Address: Phone: Insurance: 13 TERRACE VIEW (416) 529 -0544 WC EASTHAMPTONMA01027 ISSUED ON :1/24/2011 0 :00 :00 TO PERFORM THE FOLLOWING WORK: REPLACE FLOOR 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 1/24/2011 0:00:00 $60.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner M solar • thermal a lt e r iS TM 3 RENEWABLES mild �L City of Northampton Louis Hasbrouck, Building Inspector 212 Main Street Northampton, MA 01060 RE: Building Permit Janet Egleston, Northampton Brewery Dear Mr. Hasbrouck, Attached please find a building permit application for the Northampton Brewery, Northampton, MA. The following supporting documents are attached. . 1. Original building permit application 2. Building permit application fee 3. MA HIC License, Robert Jenen, Project Manager 4. MA CSL License, Robert Jenen, Project Manager 5. MA Worker's Compensation Insurance Affidavit 6. Certificate of Insurance 7. MA Electrical License, David Tremblay 8. Certificate of Insurance, Adams Power Services 9. Site Plan of work to be completed at the Northampton Brewery 10. Specification sheets on equipment to be installed at the Northampton Brewery 11. Owner's consent form for work to be completed at the Northampton Brewery In addition to the above information, the following is true. The total project costs are $22,937.01. The project has a total square footage of 427 and a total weight of 8611bs. Adams Power Services has an approved electrical permit from the City of Northampton for this project. Alteris has included the MA electrical license as additional information. Should you require additional document verification, please do not hesitate to contact our office at your earliest convenience. Thank you for your assistance in the project. Sincer Miche le Evere Oper ions Manager 34 Front Street Suite 321 1 P.O. Box 51924 1 Springfield, MA 01151 1 t: 413.734.1456 1 f: 440.445.4054 1 www.alterisinc.com ;5£13ar thermal CL_.) J a lt er i s TM RENEWABLES wind CC.) Owner Consent Form Owner: Northampton Brewery Address: 11 Brewster Court Town: Northampton State: MA Zip: 01060 Phone: 413.559.1395 I hereby give permission to Alteris Renewables, Inc. and their representatives to pull the required permits for a solar installation on my property. Signed, Jane Egleston ate 34 Front Street Suite 321 1 P.O. Box 51924 1 Springfield, MA 01151 1 t: 413.734.1456 1 f: 440.445.4054 1 www.alterisinc.com 0) Solar Works Inc kz. aOreill VNFRite Installation Manual 201.1 SolarMount® Top Mounting Installing the modules , Prewiring Modules. If modules are the Plug and Play type, no prewiring is 1 ' ' required, and you can proceed directly to "Installing the First Module" below. � z' minimum w If modules have standard J- boxes, each module should be prewired with one e end of the intermodule cable for ease of installation. For safety reasons, module r iillduie bolt N i f i - flange nut prewiring should not be performed on the roof.F - ' ° Leave covers off J- boxes. They will be installed when the modules are installed on the rails. Rail Installing the First Module. In high - profile installations, the safety bolt and End clamp flange nut must be fastened to the module bolt slot at the aligned (lower) end of , each rail. It will prevent the lower end clamps and clamping bolts from sliding out of the rail slot during installation. Figure 15 If there is a return cable to the inverter, connect it to the first module. Close the J -box cover. Secure the first module with T -bolts and end clamps at the aligned end of each rail. Allow half an inch between the rail ends and the end clamps (Fig. 15). Finger tighten flange nuts, center and align the module as needed, and f I i" securely tighten the flange nuts (15 ft lbs). / " > Installing the Other Modules. Lay the second module face down (glass to glass) on the first module. Connect intermodule cable to the second module and -'�:.: ':K> " y close the J -box cover. Turn the second module face up (Fig. 16). With T-bolts, mid clamps, and flange nuts, secure the adjacent sides of the first and second I-1 boxes ■ modules. Align the second module and securely tighten the flange nuts (Fig. 17). For a neat installation, fasten cable clamps to rails with self- tapping screws. Figure 16 Repeat the procedure until all modules are installed. Attach the outside edge of ; the last module to the rail with end clamps. ° Module frames Trim off any excess rail, being careful not to cut into the roof. Allow half an inch between the end clamp and the end of the rail (Fig. 15). a nuts on T -bolts are securely fastened. 1 /a "module bolt Check that all flange y :, ' and flange nut Mid clamp '4^ 44, Figure 17 MIN High - lipped module ...... z. Spacer Low- lipped module (cross section) (cross section) SolarMount rail with G clamps and spacer SolarMount rail with Size H clamps i Figure 18. Size G clamps (for modules with high lips) ules with low lips) are identical and employ hexhead include a spacer for the end clamps but are otherwise bolts in place of T- bolts; their heads slide into Solar - identical. Size H mid clamps and end clamps (for mod- Mount® rails. U NRAC THE STANDARD IN PV MOUNTING STRUCTURES" UniRac, Inc. 3201 University Boulevard SE, Suite 110 505.242.6411 6 www.unirac.com Albuquerque NM 87106 -5635 USA 505.242.6412 Fax UNIRAC Installation Manual 201.1 SolarMount Top Mounting - Installing SolarMount rails Keep rail slots free of roofing grit or other debris. ,---- Foreign matter will cause bolts to bind as they !0 ."" slide in the slots. - Installing Splices. If your installation uses s - SolarMount splice bars, attach the rails together ./' r .: 4^ (Fig. 11) before mounting the rails to the foot - , '1' ings. Use splice bars only with flush installations or those that use low- profile tilt legs. ra If using more than one splice per rail, con- - - tact UniRac concerning thermal expan- A sion issues. Figure 11. Splice bars slide into the footing bolt slots of SolarMount rail sections. -,-*: Mounting Rails on Footings. Rails may be Clamping , attached to either of two mounting holes in the bolt slot footings (Fig. 12). Mount in the lower hole for a low profile, more aesthetically pleasing instal- lation. Mount in the upper hole for a higher � profile, which will maximize airflow under the o f Mounting modules. This will cool them more and may Footing 4 1 slots enhance performance in hotter climates. bolt slot t Slide the 3 /e -inch mounting bolts into the footing ��, bolt slots. Loosely attach the rails to the footings ( +? with the flange nuts. 0 11i e Ensure that the rails are oriented to the footings as shown in Figure 6, 7, 9, or 10, whichever is Figure 12. Foot -to -rail splice attachment appropriate. Aligning the Rail Ends. Align one pair of rail ends e to the edge of the instal- lation area (Fig. 13 or Fig. l 14). 1 The opposite pair of rail @I ends will overhang the side of the installation area. Do not trim them . off until the installation is 1 ° complete. r_ In low- profile mode (Fig. R " 13), either end of the -- -- Edge of installation area \ Edge of installation area rails can be aligned, but the first module must be Figure 13. Low - profile mode Figure 14. High- profile mode installed at the aligned end. For the safest high - profile installation (Fig. 14), the aligned end of the rails must face the lower edge of the roof. Securely tighten the flange nuts on the mounting bolts after alignment is complete (28 -32 ft lbs). Mount modules to the rails as soon as possible. Temperature changes may © bow the rails within a few hours if module placement is delayed. Page 5 Installation Manual 201.1 SolarMount® Top Mounting UNIRAC Laying out standoffs Standoffs (Fig. 8) are used for flashed installations, such as those with ! tile and shake shingles. .; 144 Use Figure 9 or Figure 10 to locate and mark the standoff lag bolt ' holes within the installation area Consult UniRac's SolarMount Code - Compliant Planning A and Assembly to determine foot spacing that will meet code. Download the version for the applicable building code at El . ae e www.unirac.com. Remove the tile or shake underneath each standoff location, exposing the roofing underlayment. Ensure that the standoff base lies flat on Figure 8. SolarMount standoff choices: alumi- the underlayment, but remove no more material than required for the num 2 -piece (left), steel flat -top (center), and steel ra flange. Two -piece standoffs allow flashings to be installed properly. flashings to be precisely placed over bases pri- Use the standoff base as a template to mark lag bolt hole locations on or to installation of the standoff itself. Raised underlayment above the center of the rafters (Fig. 9 or Fig. 10). flange standoffs do not require L feet. In low- profile layouts, stagger standoffs on rafters (Fig. 9) to distrib- ute the load. When determining the distance between the rails in high - profile mode, keep in mind that the center of each rail will be offset from the standoff lag bolt holes by '/ a of an inch. If multiple high - profile rows are to be installed adjacent to each other, it will not be possible for each row to be centered above the rafters. Adjust as needed following the guidelines in Figure 10 as closely as possible. Overhang -- -.- Foot Installing standoffs ,r spacing i ' "'^-"� ' Drill 3 /16 -inch pilot holes \ r, 25% typical each end through the underlayment into 13/4 _ ti, } t the center of the rafters at each 0 50% typical standoff location. Securely fas- A ten each standoff to the rafters \ " with the two 5 /16' x 3 lag Lower roof edge —'� "— bolts provided with it. Stagger standoffs on rafters Verify that the lag bolts you use are adequate for your installa- Figure 9. Low - profile layout tion by following procedural steps 4A or 4B (pp. 5, 8) in SolarMount Code - Compliant 50% typical 25% typical -. 1-,- Planning and Assembly. / li / ' � 1 each end P- i If you are using raised -flange - _ / 1 1 standoffs, ensure that they face 7/ w ,. -� _ 4 / 1� �,> � as shown in Figure 9 or Figure !T, -� , _ _� ( /�;j _�� Y j 10. Steel flattop standoffs N. / should also be lagged at oppo- / I f site corners. i I zs f Foot - I+ 7 /1 b " SolarMount steel standoffs are e spacing designed for installation with � . collared flashings available from j � % UniRac. Aluminum flashings -.„ L_..-- I _ { take all metal flashings, also available from UniRac. Lower roof edge ■ ,I Overhang Install and seal flashings and l II� Rafters 4, standoffs using standard build- ing practices. Figure 10. High- profile layout Page 4 Installation Manual 201.1 SolarMount® Top Mounting UNIRNIC Laying out L -feet P L -feet (Fig. 5) are used for installation through existing l roofing material, such as asphalt shingles or sheet metal. 1 4 Use Figure 6 or Figure 7 below to locate and mark the L -feet lag bolt holes within the installation area. Consult UniRac's SolarMount Code - Compliant Planning and Assembly to determine foot spacing Figure 5 A that will meet code. Download the version for the applicable building code at www.unirac.com. Overhang_.. Foot 25% typical r i ii -.- spacing -. each end In low- profile layouts, stagger feet on /' II I I rafters (Fig. 7) to distribute the load. i / ,---, \ II I I i 0 4 u I I If multiple high profile rows are to be 3 /4 - w . 1 � 1 , ii installed adjacent to one another, it -'t'_ " l� 50 %t ical will not be possible for each row to be \ ! L� I ,, _____I Yp centered above the rafters. Adjust as \ __ needed, following the guidelines in ''' °`' 1. Figure 7 as closely as possible. Lower roof edge f Stagger feet on rafters Figure 6. Low - profile layout 25% typical --1. '..re--/ 50% typical each end 1 3/4 II - 13 /a„ `- I I ( 4, I II Foot V F 1 } yl II spacing I I H l- .. - I � I .._ � _ ./ I i II 1_1- , 1 II ii r Lower roof edge 1 u Overhang I I Rafters Figure 7. High- profile layout Installing L -feet Drill pilot holes through the roof into the center of the rafter at each L -foot lag bolt hole location. Consult procedural step 6 and Table 4 (p. 8) in SolarMount Code Compliant Planning and Assembly to select the lag bolts that meet building code wind load requirements. Lag bolts are not provided with SolarMount rail sets. Apply sealant into the hole, and on the shafts of the lag bolts. Seal the underside of the L -feet with a suitable weatherproof sealant. Securely fasten the L -feet to the roof with the lag bolts. Ensure that the L -feet face as shown in Figure 6 or Figure 7. The single - slotted square side of the L -foot must always lie against the roof with the double - slotted side perpendicular to the roof. Page 3 IINORAC Installation Manual 201.1 SolarMount® Top Mounting Installer responsibility • Using only UniRac parts and installer- supplied A The installer is solely responsible for: parts as specified by UniRac (substitution of parts • Complying with all applicable local or national may void the warranty); building codes, including any that may supercede • Ensuring that lag screws have adequate pullout this manual; strength and shear capacities as installed; • Ensuring that UniRac and other products are ap- • Maintaining the waterproof integrity of the roof, propriate for the particular installation and the including selection of appropriate flashing; and installation environment; • Ensuring safe installation of all electrical aspects of • Ensuring that the roof, its rafters, connections, the PV array. and other structural support members can sup- port the array under building live load conditions. Laying out 1 the installation area I „ I I I I I The installation can be laid out with rails �� 1___ I parallel to the rafters (high - profile mode) I T _ or perpendicular to the rafters (low- profile mode). Note that SolarMount rails make ex- cellent straight edges for doing layouts. Center the installation area over the rafters as much as possible. Low - profile High - profile I mode Leave enough room to safely move around the J mode 1 I — array during installation. The width of the installation area is equal to the length of one module. The length of the installation area is equal to: 1 1 • the total width of the modules, 1 • plus 1 inch for each space between r I modules (for mid - clamp), 1 • plus 3 inches (11/2 inches for each set Lower roof edge of end clamps). Figure 4. Rails may be placed parallel or perpendicular to rafters. 10 year limited Product Warranty, 5 year limited Finish Warranty UniRac, Inc., warrants to the original purchaser the practices specified by AAMA 609 & 610 -02 If within the specified Warranty periods the ( "Purchaser ") of product(s) that it manufactures — "Cleaning and Maintenance for Architecturally Product shall be reasonably proven to be ( "Product ") at the original installation site that Finished Aluminum" (www.aamanet.org) are not defective, then UniRac shall repair or replace the Product shall be free from defects in material followed by Purchaser.This Warranty does not the defective Product, or any part thereof, and workmanship for a period of ten (10) years, cover damage to the Product that occurs during in UniRac's sole discretion. Such repair or except for the anodized finish, which finish its shipment, storage, or installation. replacement shall completely satisfy and shall be free from visible peeling, or cracking or This Warranty shall beVOID if installation of discharge all of UniRac's liability with respect to chalking under normal atmospheric conditions this limited Warranty. Under no circumstances the Product is not performed in accordance for a period of five (5) years, from the earlier with UniRac's written installation instructions, shall UniRac be liable for special, indirect or of I) the date the installation of the Product is or if the Product has been modified, repaired, consequential damages arising out of or related completed, or 2) 30 days after the purchase of or reworked in a manner not previously to use by Purchaser of the Product. the Product by the original Purchaser ( "Finish authorized by UniRac IN WRITING, or if the Manufacturers of related items, such as PV Warranty"). Product is installed in an environment for which modules and flashings, may provide written The Finish Warranty does not apply to any it was not designed. UniRac shall not be liable warranties of their own. UniRac's limited foreign residue deposited on the finish. All for consequential, contingent or incidental Warranty covers only its Product, and not any installations in corrosive atmospheric conditions damages arising out of the use of the Product by related items. are excluded.The Finish Warranty isVOID if Purchaser under any circumstances. Page 2 U NGIllitcl THE STANDARD IN PV MOUNTING STRUCTURES " SOLARMOUNT Installation with Top Mounting Clamps Installation Manual 201.1 U.S. Des. Patent No. D496,248S. Other patents pending. This manual details the procedure for flush mounting 0 SolarMount to a itched roof.` If your installation includes tilt ' ; ` legs, see also the instructions , shipped with the leg kit. :4 Contents �� Installer reponsibility 2 ��,�� \ \� 41 6 ' ' , ! �� fig out the ' 1► ��,�` La n installation area 2 T - bolt slot for module 11 '' �;-� Laying out L -feet 3 V � �� 3' g mounting i ►� Installing L -feet 3 ` �� Laying out standoffs 4 Installing standoffs 4 • Installing SolarMount -4 . 414107000T.°4° rails 5 1 clamp Installing the modules 6 Footing bolt slot ��, Part quantitie ?' SolarMoune Rail Sets \ ' No. of ' /e "" footing '/8 � flange L f t " .,. End p Rail length (inches) rails L -feet bolts nuts -, _ 0 clam 48 -106 2 4 4 4 120 -180 2 6 6 6 � 192 -216 2 8 8 8 �; 226 -288 (w/ splice) 2 10 10 10 300 -336 (w/ splice) 2 12 12 12 348 -408 (w/ splice) 2 14 14 14 420 - 432 (w/ splice) 2 16 16 16 Figure 3. Exploded view of a low - profile installation mounted flush to the roof with L-feet. Top Mounting Clamp Sets, Sizes A —F, G *, Ht, and J Modules End Mid /" module / "x 5 /a " 1/4"" flange Wrenches and torque per row clamps clamps T -bolts safety bolts nuts 2 4 2 6 2 g Wrench Recommended 3 4 4 8 2 10 size torque (ft -Ibs) 4 4 6 10 2 12 y, " hardware 7 /16" 15 5 4 8 12 2 14 ? /8" hardware 9 /6 " 30 6 4 10 14 2 16 7 4 12 16 2 18 8 4 14 18 2 20 9 4 16 20 2 22 © Stainless steel hardware can seize up, a process called galling.To significantly re- 10 4 18 22 2 24 duce its likelihood, (I) apply lubricant to 11 4 20 24 2 26 bolts, preferably an anti -seize lubricant, available 12 4 22 26 2 28 at auto parts stores, (2) shade hardware prior to * In size G, end clamps and mid damps are identical, except that end clamps installation, and (3) avoid spinning on nuts at high include spacers. For illustration, see page 14. speed. See Installation Supplement 9 10, Galling f In size H, end clamps and mid clamps are identical. Hexhead bolts replace and Its Prevention, at www.unirac.com. Tbolts. For illustration, see page 14. UniRac welcomes input concerning the accuracy and user friendliness of Pub ()5 1 1 i C 2005 by UniRac, Inc. this publication. Please write to publications @unirac.com. tit a rt II 2005 All rights reserved. • o 4�„ i . evergreensole II 7, Electrical Characteristics Mechanical Specifications Standard Test Conditions (STC)' PANEL ID LABEL ES -A -200 ES -A -205 ES -A -210 1 1 1 1 -fa2* -fa2* -fat* .- 2.2 4.9 • Pmp 200 205 210 W ' • •/ o �m Pt °,eranc° 0/ +4.99 0/ +4.99 -0/+4.99 W J UNCTION BOX �� " � ' (IP65) PANEL GROUNDING Pmp, max 204.99 209.99 214.99 W SERIAL NUMBER HOLE o ° Pmp, min 200.00 205.00 210.00 W 11min 12.7 13.1 13.4 % m 0 ° Pptc 180.6 185.2 189.8 W CABLES • (10 AWG, Vmp 18.1 18.4 18.7 V PV -WIRE) Imp 11.05 11.15 11.23 A a V ° 22.5 22.8 23.1 V ° 2 \ 0.26 12.00 12.10 1 2.20 A PANEL MOUNTING HOLE Isc D LABEL FOR Y" BOLT Nominal Operating Cell Temperature Conditions (NOCT) ° MC° LOCKABLE TNOCT 44.8 44.8 44.8 °C i } (TYPE 4) CONNECTORS e i ° Pmax 146.4 150.1 153.7 W ° ( -) ( *)� ° Vmp 16.7 16.8 17.0 V ' 1 I CLEAR ANODIZED 1 Imp 8.76 8.93 9.04 A i 72z FRAME - ® ALUMINUM FRAME °DRAINAGE HOLE V° 20.5 20.7 21.0 V - ' • T %. ° ° 35.9 Is° 9.60 9.68 9.76 A .4-1.8 (+0.02/-0) 37.5(./ -o.1) .."'.1 ' 1000 W /m 25 °C cell temperature, AM 1.5 spectrum; All dimensions in inches; panel weight 41 Ibs i Maximum power point or rated power At PV -USA Test Conditions: 1000 W /m', 20 °C ambient temperature, Product constructed with 114 of c stalline silicon solar cells, anti - reflective 1 m/s wind speed p y ry ° 800 W /m', 20 °C ambient temperature, 1 m/s wind speed, AM 15 spectrum tempered solar glass, EVA encapsulant, polymer back -skin and a double - walled ' f - framed, a - low voltage, 2 - matt blue (textured) cells anodized aluminum frame. Product packaging tested to International Safe Transit Association (ISTA) Standard 2B. All specifications in this product information sheet Low Irradiance conform to EN50380. See the Evergreen Solar Safety, Installation and Operation The typical relative reduction of module efficiency at an Manual and Mounting Design Guide for further information on approved installa- irradiance of 200W /m both at 25 °C cell temperature and tion and use of this product. spectrum AM 1.5 is 0 %. Due to continuous innovation, research and product improvement, the specifica- tions in this product information sheet are subject to change without notice. No Temperature Coefficients rights can be derived from this product information sheet and Evergreen Solar P assumes no liability whatsoever connected to or resulting from the use of any a Pmp 0.45 %/ °C information contained herein. J a Vmp - 0.43 %/ °C Partner: a Imp - 0.02 %/ °C ~ a Ni,, ° - 0.32 %/ °C a I. -0.003 %/ °C System Design Series Fuse Ratings 20 A Maximum System Voltage (UL) 600 V ' Also known as Maximum Reverse Current. Q ELECTRICAL EQUIPMENT ES -A_ 200_ 205_ 210_ US_ 010908; effective September 1" 2008 CHECK WITH YOUR INSTALLER Worldwide Headquarters Customer Service - Americas and Asia 138 Bartlett Street, Marlboro, MA 01752 USA 138 Bartlett Street, Marlboro, MA 01752 USA Evergreen Solar, Inc. T: +1 508.357.2221 F: +1 508.229.0747 T: +1 508.357.2221 F: +1 508.229.0747 www.evergreensolar.com info @evergreensolar.com sales @evergreensolar.com .ar -4,„ 1mor∎ w ^' , may vr ran Think Beyond. :-T, _` l j i ES -A SERIES 200, 205 & 210 W photovoltaic panels Best power tolerance available A range of high quality String RibbonTM solar panels offering exceptional performance, cost effective 1 installation and industry- leading environmental credentials made with our revolutionary wafer . technology. • No power below nameplate Never pay for power you're not getting • Get up to 5W more than nameplate* For enhanced field performance • Industry's lowest voltage per watt rating Delivers the most cost - effective installs • UL4703 certified cables • For use with the highest efficiency transformer -less inverters - • New extended length cables • Eliminates home -run wiring • • New MC® Type 4 lockable connectors ** Complies with the latest codes for accessible arrays • Most extensive range of mounting options Allows installs virtually anywhere and anyhow • Smallest carbon footprint of any manufacturer For the greenest of the green • 100% cardboard -free packaging Minimizes job site waste and disposal costs • 5 year workmanship and 25 year power warranty * ** .,,,,,„ _. „ ,„,.... i, . ,.., , , ,,_ ,. Born in the USA . "Maximum power, up to 4.99 W above nameplate rating; * *Locking sleeve not supplied with the panel. ***For full details see the Evergran Solar Limited Warranty available on request or online. This product is designed to meet UL 1703, UL 4703, UL Fire Safety Class C, IEC 61215 Ed.2 and IEC 61730 Class A standards. String Ribbon is a trademark of Evergreen Solar, Inc. Evergreen Solar's wafer manufacturing technology is patented in the United States and other countries. PROFILE VIEW OF T -E ROO= CHIMNEY EVERGREEN MODULES STEAM 1 VENT 76' 11111 - '41 • - ,5' r ) ,„._ UNIRAC ILL TELESCOPING LOW- PROFILE LEGS ► VENT i UNIRAC 4° TALL STANCHION WITH ► i L - FOOT AND oATLEY FLASHING 11 1114 ASPHALT SHINGLE ROOFING �1 a r . S UNIRAC L -FOOT WITH 9-51 CLAMP ON 73 T0° STANDING SEAM METAL ROOFING 6 7 /., ----..."/ Se SYSTEM SUMMARY DRAWING TITLE 4.41 kW (DC) at Standard Testing Conditions Photovoltaic Array Layout — 2 • �� ' M ■ 1 reen ES - A - 210 PV Modules CUSTOMER DRAWN 2 Eve g CAR RENEWABLES 1 Solectria PVI - 4000 Inverter scALE UniRac SolarMount Rail System with TLL Low Profile Legs Northampton Brewery 3/8" = r 0° (LETTER) 13 Old South St. DATE ORIGINAL Roof Pitch (Module Tilt) = 22° Northampton, MA 01060 6/4/09 ALTERIS RENEWABLES, INC. Module Azimuth = 172° Magnetic DATE REVISION (7 0 17 B 0 Bris 02809 • • PERPENDICULAR VIEW OF THE ROOF a a a a a a a o x a a a a a a a � r( - 5) 1 _ BOX VENT 1 CHIMNEY STEAM VENT ,-) 5 FT TALL 36" TALL I a a a a a a a o = U 4 a a a a a a a 4.0 VENT 16" TALL i� \ t 1 a a a 1 1 1 a 16" 28' -0" SPECIAL CONDITIONS: _ - 0 - 51 CLAMPS TO BE DISTRIBUTED ACROSS ALTERNATING STANDING SEAMS ith SPACING OF REAR STANCHIONS AND TILT - LEGS � TO MATCH THE TOP ROW OF S -5! CLAMPS A SYSTEM SUMMARY DRAWING TITLE UniRac SolarMount Standard Rail System C USTOMER DRAWN S -5i Clamp and Rail Layout ■ ' �� ' SM U 35 S Clamps with 7 per Rail CAR RENEWABLES 7 UniRac 4 "" Tall Stanchions on North Roof ( Not Shown) SCALE Northampton Brewery 3/16 = r 0 (LETTER) 13 Old South St DATE ORIGINAL Roof Pitch (Module Tilt) = 22° Northampton, MA 01060 6/4/09 ALTERIS RENEWABLES, INC. Module Azimuth = 172° Magnetic DATE REVISION 17 B n 3 990 B FIS 001, I -99 02809 9 1/7/10 PERPENDICULAR VIEW OF THE ROOF 45' - 7" 22' -9 1 /2" . r x • BOX VENT 1 CHIMNEY STEAM VENT 5 FT TALL 36" TALL o 0 8 . _ 0 VENT hi 16- TALL ■ J 1 . STANDING SEAM METAL ROOFING WITH 16" PAN f n R SPECIAL CONDITIONS: STANDING SEAM METAL ROOFING TO BE -1,--- ei INSTALLED PRIOR TO INSTALL OF PV ARRAY - S - 5! CLAMPS WITH L - FEET USED TO ANCHOR PV ARRAY TO THE METAL ROOF SYSTEM SUMMARY DRAWING TITLE 4.41 kW (DC) at Standard Testing Conditions Photovoltaic Array Layout — 1 �� ' • �_ 21 Evergreen ES PV Modules CUSTOMER DRAWN 1 Solectria PVI - 4000 Inverter CAR RENEWABLES Northampton Brewery scA UniRac SolarMount Rail System with ILL Low Profile Legs P Y ails' = r o" (LETTERI Liii) 13 Old South St, DATE ORIGINAL Roof Pitch (Module Tilt) = 22° Northampton, MA 01060 6/4/09 ALTERIS RENEWABLES, INC, Module Azimuth = 172° Magnetic DATE REVISION 17 Burnside , s St., Bristol, RI 02809 9 1/7/10 • • ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 10/12/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PAYCHEX INSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 150 SAWGRASS DRIVE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ROCHESTER, NY 14620 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (877) 362 SV996 70A INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A:THE TRAVELERS INDEMNITY COMPANY OF AMERICA ADAMS POWER SERVICES INC 19 FAMILY LN INSURER B: WESTFIELD, MA 01085 INSURER C: INSURER D: I INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR INSRC TYPE OF INSURANCE POLICY NUMBER DATE M/ EFFECTIVE TE (MDD LT R INSRC /YY) DATE (MM/DD/YY) LIMITS LT GENERAL LIABIITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS MADE I OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ — 1 POLICY II J CT II LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS — PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ H ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ I OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND UB- 3245T845 -09 09/22/2009 09/22 /2010 X TORY LIMITS % EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 100,000 If Peal cribe under SL es PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS IN THE EVENT OF NON - PAYMENT OF PREMIUM, ONLY TEN(10) DAYS NOTICE OF CANCELLATION SHALL BE GIVEN. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ALTERIS RENEWABLES DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 28 WOLCOTT STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL PROVIDENCE, RI 02908 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE //1 I ACORD 25 (2001/08) o ACORD CORPORATION 1988 a iA *>,vr vcaunvcvi COMMONWEALTH OF MASSACHUSETT This is to certify that DIVISION OF PROFESSIONAL LICENSURE • DAVID L TREMBLAY OF is e/an REGISTE S TE ELECTRICIAN Master Eketrirlas ISSUES THIS LICENSE TO from 02/21/08 for the period t �. Waal ADAMS POWER SERVICES, INC 1S DAVID L TREMBLAY as provided in Y$A. 19 FAMILY LANE License Number "' °' / � � - t NOT VALID UNTIL (14/ OFFICIALLY STAMPED / WESTFIELD NA 01085 -4456 — DIVISION OF r SAFETY L& t -0; 1311 Us ROUTE 302 • BERLIN SUITE 600 13846 A 87/31/18 345352 HARRE. VERMONT 05641-2351 LICENSE NO. EXPIRATION DATE SERIAL NO. ..< I ; S F VI I. 01 ( 0\4\1 ( 1 1(1 1 le ANDIMINVINDOmmES TtL4T {3 t ELECTRICAL UNLIMMDt,O DAVID L TREMBLAY NAM: L , y 4 I 19 P ILY f..14 X k WESTFIE , tiA 01085 SLICT&Hamt / 1161-4 M wow Norsaw , $ LIC. / REG NO l EFFECTIVE , EXPIRES TENS CAM *MST as vassammt TO ililE i IA EL -E1 I ) Cr. � =81 01f � ;° 09/30/2010 S IGNED ,, / " ^ `� i + STATE Of MAINE OF POOFESSIONAL i FINNCAL REOMMION , r � �NG BOARD DAVID L. TREMBLAY MASTER ELECTRICIAN Feb 11, 2008 EXPRIMS Jan 31, 2010 • • ACORD,. CERTIFICATE OF LIABILITY INSURANCE 1 DATE 8 o ) PRODUCER (860) 928 -7771 FAX: (860) 928 -7144 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gerardi Insurance Services Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 16 Pomfret St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Putnam CT 06260 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:ACadia Insurance Co 31325 Alteris Renewables Inc INSURER B: aka Solarwrights Inc & Solar Works Inc INSURER C: 17 Burnside Street INSURER D: Bristol RI 02809 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR JNSRD TYPE OF INSURANCE POLICY NUMBER POLICY E (M !DD YY) POLICY DATE (MM/DD/YY)) LT R INSRD LIMITS LT GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREM SES occurrence) $ 100,000 A CLAIMS MADE X OCCUR CPP0241356 2/1/2009 2/1/2010 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 G AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 X I POLICY f JE& f LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 A ALL OWNEDAUTOS CAP0241357 (CT & RI) 2/1/2009 2/1/2010 BODILY INJURY SCHEDULED AUTOS Per person) $ • HIRED AUTOS MAA0249941 (MA Auto) 2/1/2009 2/1/2010 BODILY INJURY NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 X OCCUR CLAIMS MADE AGGREGATE $ A DEDUCTIBLE CUA0241359 2/1/2009 2/1/2010 $ RETENTION $ $ A WORKERS COMPENSATION AND WC ST ER EMPLOYERS' LIABILITY TORY LIMITS ER ANY PROPRIETOR /PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER /MEMBER EXCLUDED? WCA0241358 2/1/2009 2/1/2010 E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER • DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Alteris Renewables Inc EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL AKA Solarwrights & Solar Works Inc 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 17 Burnside St FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Bristol, RI 02809 INSURER, ITS AGENTS OR REPRESENTATIVES. rA AUTHORIZED REPRESENTATIVE Matthew Desaulnier ACORD 25 (2001/08) © ACORD CORPORATION 1988 IMCn9c inl nog no., Pone 1 of ') • 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 4 -� Please Print Legibly Name ( Business /Organization/Individual) : ! ' L ✓ E l /?I4 -is - Address: PO /36)X 5/4 2-cf City /State /Zip: Pr--60 /'4A 0/to/ Phone#: 37 3 Lj/ v ' Are you an employer? Check tha e propriate box: Type of project (required): 1. >1 am an employer with _ 4. L I am a general contractor and 1 6. L New construction employees (full and/or part time).* have hired the sub - contractors ❑Remodeling 7. 2. C I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub - contractors have 8. L Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers comp. insurance comp. insurance.. required] 5.L We are a corporation and its 10. I 1 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. L] 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. ❑I Roof repairs employees. [no workers' 13. Ather 8Z/ le Pf9IVEGS 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' compensation insurance for my employees. Below is the policy and job site information. //�� Insurance Company Name: f fe -41/4 /\&ZL Gl Policy # or Self -ins. Lic. #: " 74 C� / 3 Expiration Date: 07/// .Q/(� Job Site Address: / /R -)sTEK' ai=G2T City/State /Zip: Ai OR1217 ,77A1 44/9" c 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 cert' nder the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: / d Print Name: f U CYr ' . ` r Phone #: ` 4 3 7 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 Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact person: Phone #: Boir4ot 'ejai And ltredania Construction Supervisor License License: CS 81308 Expiration: 2/4/2010 Tr# '7207 Restriction: 00 ROBERT M JENEN PO BOX 158 " HOUSATONIC MA 01236 (' ommiasaunc+ N 01 O O 0 O Cu m z m � z Jhe / / /I / I ' I Board o • uild egula ons and tandar. s =~ -� One Ashburton Place - Room 1301 — Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 163252 Type: Individual Expiration: 5/27/2011 Tr# 284599 ROBERT N. JENEN ROBERT JENEN P.O. BOX 158 HOUSATONIC, MA 01236 Update Address and return card. Mark reason for change. Address Renewal pi Employment E Lost Card DPS -CA1 0 40M•08108- DBSLIFORMCA108212008 ' p\ Jlte �iommanweedlii /`faau�c%eueee - Board of Building Regulations and Standards License or registration valid for individul use only + =t HOME IMPROVEMENT CONTRACTOR before the expiration date. 11 found return to: N Registration: 163252 Board of Building Regulations and Standards 8 One Ashburton Place Rm 1301 Expiration: 5/27/2011 Tr# 284599 � Roston, Ma. 02108 N Type: Individual ROBERT N. JENEN ROBERT JENEN 1066 MAIN ST HOUSATONIC, MA 01236 Administrator Not valid without signature • Version1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 4 No Q SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Janet Egleston, Northampton Brewery I, , as Owner of the subject property Alteris Renewables, Robert Jenen, Project Manager hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. «' cUS. n.u.. ►7 ze -v-N., 01/11/2010 Signature of Owner Date Michelle Everett, Operations Manager, Alteris Renewables 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. Michelle Everett, Operations Manger, Alteris Renewables Print Na e i C- �� 01/11/2010 Signature of O er /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Robert Jenen, Project Manager 81308 License Number PO Box 51924, Springfield, MA 01151 02/04/2010 Address Expiration Date (413) 734 -1456 Signature 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 0 No • Version1.7 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 Registered Architect: N/A Not Applicable o Name (Registrant): N/A Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): N/A 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 Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor fA Not Applicable o Company Name: Responsible In Charge of Construction Address 5E( fPu A �E Signature Telephone Version1.7 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 f Side L: R: L: R: rp a 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 Q DON'T KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW 0 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 Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Q , Date Issued: C. Do any signs exist on the property? YES O NO Q 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 Q 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. Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other Brief Description Installation of 21 solar panels on the roof of the Northampton Brewery. Of Proposed Work: SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A-3 $] 1A 1 ❑ A-4 ❑ A ❑ it -la- 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B 1 ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I 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: Commercial Proposed Use Group: Commercial 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 (sf) 1st 1st 427 2 nd 2 3 rd 3rd 4 th 4 Total Area (sf) Total Proposed New Construction (sf) 427 Total Height (ft) Total Height ft 1e5.5 i 1 7. Water Supply (M.G.L. c. 40, §. 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public p Private ❑ Zone Outside Flood Zone p Municipal 12 On site disposal system El Version1.7 Commercial Building Permit May 15, 2000 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 Othe r specs ° 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 ` n i 1 ' 2010 1.1 Property Address: This section to be completed by office Northampton Brewery Map Lot Unit 11 Brewster Court Zone Overlay District Northampton, MA 01060 Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Janet Egleston 11 Brewster Court, Northampton, MA 01060 Name (Print) Current Mailing Address: ,, (413) 559 -1395 Signatures Cf- A 4-1 Telephone 2.2 Authorized Agent: Alteris Renewables, Robert Jenen, Project Mgr PO Box 51924, Springfield, MA 01151 Name Current Mailing Address: (413) 734 -1456 Signatu = 1% — Telephone SECTION 3 - ES - ` ' CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building $22,937.01 (a) Building Permit Fee 2. Electrical (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 1/11 9 r/ 31"'- This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0656 APPLICANT /CONTACT PERSON ALTERIS RENEWABLES INC ADDRESS /PHONE P 0 BOX 51924 SPRINGFIELD (413) 734 -1456 PROPERTY LOCATION 11 BREWSTER CT MAP 32C PARCEL 029 001 ZONE CB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid uil.int Permit Filled out _ w ' -e Paid 1 t( ere, , Typeof Construction: Install 4.4 KW utility interactive P system New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan THE ' 1 LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON ' 1 RMATION 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 ?,old Sign ure of Building Official Dat 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. 11 BREWSTER CT BP -2010 -0656 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block 32C - 029 CITY OF NORTHYMPTON 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 ILDING 1 E L MIT Permit # BP- 2010 -0656 Project # JS -2010- 000952 Est. Cost: $23000.00 Fee: $138.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ALTERIS RENEWABLES INC Lot Size(sq. ft.): 4268.88 Owner: L 0 R T INVESTMENTS C/0 NORTHAMPTON BREWERY Zoning: CB(100)/ Applicant: ALTERIS RENEWABLES INC AT: 11 BREWSTER CT Applicant Address: Phone: Insurance: P 0 BOX 51924 (413) 734 -1456 SPRINGFIELDMA01151 ISSUED ON :1/11/2010 0:00:00 TO PERFORM THE FOLLOWING WORK :Install 4.4 KW utility interactive PV system 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: C ``' S Y1, Rough Frame: lii I // 10 ?CI( / fk ? Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: O i ". €i to ic4.1S 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 1/11/2010 0:00:00 $138.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo v <� • The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): � ►1 Tj r ' Address: / /„e Y4• ek_c /tG„,O;h /2//9 6142 - City /State /Zip: C c„_ o 44 f} c) d?-7 Phone #:_ t j �� c 3 Y Are yo an employer? Check the appropriate box: Type of project (required): 1. �1 I am a employer with y 4. D I am a general contractor and I 6. ❑New construction employees (full and/or part- time).* have hired the sub - contractors listed on the attached sheet. 7. ❑ Remodeling 2. ❑ I am a sole proprietor or partner- sub-contractors These sub t h ship and have no employees 8. Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 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 per MGL 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no J employees. [No workers' 13.0 Other (9 1.. (\Tc, r comp. insurance required.] 11 *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 time 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: h L / ' r `Pe-fr.,/ Policy # or Self-ins. Lic. #: / o. Co 5 a ✓ Expiration Date: Q y,/.� / /.G o, Job Site Address: // Zite Cr City /State /Zip: 1 , 1 dL€,,4 M4 0/0Z 7 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 c. 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 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 p ins and penalties of perjury that the information provided above is true and correct. Signature: ' Date: 0 ' III / 0 Phone #: y!? - S () 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 #: Version1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ril _ , as Owner of the subject property hereby authorize 104. J " ,, .... - ,.. - SP" i act on my behalf, in all matte . relative to work authorized by this building permit application. ,I� Signature of Owner 4i .o. I j�� / C— � V Date 1, ..._.. 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 an p nal ties_of perjurer _ _ Print Name 1 -ff2 -/o _ .- __.._ Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : A rrd _ - ...._�.,. . __. .. �.e. 4 . ., .e_ ...., . , ' �� Cr t. . .1. .. License Number e 02- Address Expirat n Dat Signature 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 0 No e) Version1.7 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 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address ! " ' ` Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): 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 Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor C __. _._._.__.._._.._ Not Applicable ❑ Compan N me: Responsible In Charge of Construction T vccf ... c r •.:.. _ _ aJ f ..'7__. ......... . ... . Address 4111 .1' = yi p - raj_ Signature 1 1 .. Telephone Versionl.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 parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO (3 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 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES NO 0 IF YES, describe size, type and location: fox b / �� ! fr A g fr t/, J D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 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 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs L✓J (Additions ❑ Accessory Building ❑ Exterior Alteration 0 Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Enter a brief description here. Of Proposed Work:. , SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business 9' 2A ❑ E Educational ❑ 2B _ r ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 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 J ❑ 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 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 (sf) 1st 1s 2nd 2nd rd 3 4 th Total Area (sf) Total Proposed New Construction (sf) _ _ 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 ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system El • Version1.7 Commercial Building Permit May 15 2000 De art tnertt use on1� � City of Northampton Sttatusafgt �� s` r ; Building Department :Curb Gut/Dtveway Fertt 212 Main Street '.'.Seaver /SepticAvatral tlftp x ' 210 Room 100 UUater/WeQ Avarra tftty North4mpton, MA 01060 Up Sets of,Streicturat Plans AFL phone 413 -58, 1240 Fax 413- 587 -1272 Plot/Stt Frans Other Spear �, 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 Property Address: This section to be completed by office t ejr _e w fie .• ,t � 1 Q . r Map Lot Unit I�.or4(/t.cMr.' `t Zone Overlay District I ..... Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 'avt e q t � -aN_ .. 1/_.. 11 _ . _ 1 c . M otaP • D Name (Print) Current Mailing Address far Signature �� - ---- -. Telephone 2.2 Authorized Agent: Name (Print) Current Mailing Address Signature Telephone SECTION 3 - ESTIMATED C NSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building / (2/1113 (a) Building Permit Fee 2. Electrical - (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) ( O O C heck Number 49 5 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0863 APPLICANT /CONTACT PERSON SEAN JEFFORDS ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTON (416) 529 -0544 PROPERTY LOCATION 11 BREWSTER CT MAP 32C PARCEL 029 001 ZONE CB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 3 3 �j 6 5-- Fee Paid YP Typeof Construction: INSTALL VENTILATION FOR DISHWASHER New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 074539 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN F9MATION PRESENTED: ir 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 -6.1) 041 od to 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. 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C r � � T w � " ,. a { k �, `� � a K � 5 ? 5 /�+y� a �r { P . . , ' , }'k. ul# $:• D OTX r . k - I ` y &' E TO E ; • L c. 4 ) ;M 3 ° ;i ` "a,. 7 5 S '' � ' ' t rr � a ti" `.. w rt n' sri ,a .T tie w � x r ' w a ,{�a� r`�� ' } 'Burt ,r4,-'' .. # $� � � :#-p. � :«# �+ s Category: ; Permit . # BF 2010(3863 Projec # : J S - 2 010 - 001284 = Est. Cost $6200.00 Fee $55 PEI�IVIIS.SION IS HEREBY GRANTED T • Const. Class Contractor: L use gr oup . SEMI' JEFFORDS 074539 Lot S ft) 426 $ . 8$ t Owner:: L O if T' BSTME C /01�70 BRBWE Znnix g: CB (3i► f Apo t c a nt SEAN JEFFORDS AT- 11 BREWSTE C T App licant Add Phone: Insurance: I3 TERRA , (416) 529 -0 544 E sTHAM PTON1J1A0 . 1027 - ;' S U1' 011 4 ✓8J201n ©;x:11!! ' TO PERFORM T LIE F OLLOWING WORK:INSTALL VENT ILATION FOR DISHWASHE POST THIS CARD SO IT' IS VISIBLE FROM THE Inspector of Plumbing Inspecto of Wirin D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation. - Driveway F inal: Final: Final: i " lM,..5 Rough Frame. Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: 0 }� CI ) O y THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF 40 * /4..140 ANY OF ITS RULES AND REGULATIONS. 2•�� Certificate of Occupancy 3 lo 4_,,,(j Snature: FeeType: ate Paid: Amount: Building 4/8/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo