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36-224 (2) gS k The Commonwealth of Massachusetts Department of Industrial Accidents _ _ M "=" Office of Investigations ■ _ '�= 600 Washington Street Boston, MA 02111 wwx.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name (Business /Organization /Individual): Alteris Renewables, Inc. dba Real Goods Solar Address: 32 Taugwonk Spur, Unit A -12 City /State /Zip: Stonington, CT 06378 Phone #: (860) 535 -3370 Are you an employer? Check the appropriate box: Type of project (required): 1. © I am a employer with 120 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part- time).* have hired the sub - contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7 • ❑ Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL. 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §I(4), and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13. © Other solar panels comp. insurance required.] Any applicant that checks box #1 must also fill out thc section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they arc 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 thc name of the sub - contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Zurich American Insurance Co. Policy # or Self -ins. Lic. #: WC5852405 Expiration Date: 01/01/2014 Job Site Address: 64 Winterberry Lane City /State /Zip: Florence, MA 01062 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 certi, y under re pains and penalties of perjury that the information provided above is true and correct. Signature: iv iA Ct ` (' — Date: lit / /3 Phone #: (860) 535 -3370 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 #: 3/8 -16 X 3/4" SS HEX BOLT 3/8 -16 7 J� SS FLANGE NUT 4 6105-T5 ' ALUMINUM • N ' 000 � 00 _ SolarMount/SunFrame © 2008 UNIRAC, INC. 2" Aluminum 1411 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 USA Serrated PHONE UNIRAC.COM 505.242.6411 L -Foot UNIRAC- 310068 0: \AutoCad Detail Library \CAD \UNOAC- 310058_21n Serrated L Loot.dwg, 6/24/2008 1: 4 32 00 SOLARMOUNT Technical Datasheets :P U N I RAC SolarMount Beams Part No. 310132C, 310132C -B, 310168C, 310168C -B, 310168D 310208C, 310208C -B, 310240C, 310240C -B, 310240D, 410144M, 410168M, 410204M, 410240M Properties Units SolarMount SolarMount HD Beam Height in 2.5 3.0 Approximate Weight (per linear ft) plf 0.811 1.271 Total Cross Sectional Area in 0.676 1.059 Section Modulus (X -Axis) in 0.353 0.898 Section Modulus (Y -Axis) in 0.113 0.221 Moment of Inertia (X -Axis) in 0.464 1.450 Moment of Inertia (Y Axis) in° 0.044 0.267 Radius of Gyration (X -Axis) in 0.289 1.170 Radius of Gyration (Y Axis) in 0.254 0.502 SLOT FOR T -BOLT OR SLOT FOR T -BOLT OR 1.728 4° HEX HEAD SCREW 1" HEX HEAD SCREW 2X SLOT FOR 1 SLOT FOR BOTTOM CLIP 2.500 BOTTOM CUP ir 01141 3.000 PP! T 1.316 a 1 SLOT FOR 3 /6" HEX BOLT SLOT FOR 1.385 3 /8" HEX BOLT 11 I i I 387 1 .750 al L 1.207 Y Y I 1.875 ►X ►X SolarMount Beam SolarMount HD Beam Dimensions specified in inches unless noted 4 I SoLARMouNT Techn Datasheets ::' U N I RAC SolarMount Beam Connection Hardware SolarMount L -Foot Part No. 304000C, 304000D • L -Foot material: One of the following extruded aluminum alloys: 6005 - T5, 6105 -T5, 6061 -T6 �- - • Ultimate tensile: 38ksi, Yield: 35 ksi 1 • Finish: Clear or Dark Anodized • L -Foot weight: varies based on height: -0.215 Ibs (98g) • Allowable and design loads are valid when components are Bea .- '"!r assembled with SolarMount series beams according to authorized Bolt UNIRAC documents 1 L -Foot • For the beam to L -Foot connection: • Assemble with one ASTM F593 % " -16 hex head screw and one 1 errated ASTM F594 % "serrated flange nut Flange Nu ,/' • Use anti -seize and tighten to 30 ft-Ibs of torque / • Resistance factors and safety factors are determined according to part 1 section 9 of the 2005 Aluminum Design Manual and third -party test Y results from an IAS accredited laboratory NOTE: Loads are given for the L -Foot to beam connection only; be °" X sure to check load limits for standoff, lag screw, or other attachment method )01 Applied Load Average Safety Design Resistance )K SIUT FOR Direction Ultimate Allowable Load Factor, Load Factor, wRawKar Ibs (N) Ibs (N) FS Ibs (N) 0 t t 101 .. Sliding, Z± 1766 (7856) 755 (3356) 2.34 1141 (5077) 0.646 Tension, Y+ 1859 (8269) 707 (3144) 2.63 1069 (4755) 0.575 Dimensions specified in inches unless noted Compression, Y- 3258 (14492) 1325 (5893) 2.46 2004 (8913) 0.615 Traverse, X± 486 (2162) 213 (949) 2.28 323 (1436) 0.664 3 t S0 ARMouNT Technical Datasheets : U N I RAC SolarMount Mid Clamp Part No. 302101C, 302101D, 302103C, 302104D, 302105D, 302106D ,� Bolt • • Mid clamp material: One of the following extruded aluminum " • alloys: 6005 -T5, 6105 -T5, 6061 -T6 Mid la •e N ` ` Ultimate tensile: 38ksi, Yield: 35 ksi Clamp �..,. -,,,, • Finish: Clear or Dark Anodized tl \\ -. • Mid clamp weight: 0.050 Ibs (23g) 1* -,„, • Allowable and design loads are valid when components are assembled according to authorized UNIRAC documents • Values represent the allowable and design load capacity of a single mid clamp assembly when used with a SolarMount series beam to retain a module in the direction indicated • Assemble mid clamp with one Unirac' /4 " -20 T -bolt and one' /< " -20 ASTM F594 serrated flange nut Beam Use anti -seize and tighten to 10 ft -Ibs of torque • Resistance factors and safety factors are determined according to part 1 section 9 of the 2005 Aluminum Design Manual and third- party test results from an IAS accredited laboratory Applied Load Average Allowable Safety Design Resistance ioocavor Direction Ultimate Load Factor, Load Factor, errwren MooULrs Ibs (N) Ibs (N) FS Ibs (N) cD Tension, Y+ 2020 (8987) 891 (3963) 2.27 1348 (5994) 0.667 Transverse, Z± 520 (2313) 229 (1017) 2.27 346 (1539) 0.665 Sliding, X± 1194 (5312) 490 (2179) 2.44 741 (3295) 0.620 ► X Dimensions specified in inches unless noted SolarMount End Clamp . Part No. 302001C, 302002C, 302002D, 302003C, 3020030, 302004C, 302004D, 302005C, 302005D, 302006C, 3020060, 302007D, 302008C, 302008D, 302009C, 302009D, 302010C, 302011C, 3020120 • End clamp material: One of the following extruded aluminum alloys: 6005 -T5, 6105 -T5, 6061 -T6 • • • Ultimate tensile: 38ksi, Yield: 35 ksi • Finish: Clear or Dark Anodized -- ..-- End clamp weight: varies based on height: —0.058 Ibs (26g) I - d Clamp • Allowable and design loads are valid when components are Serrated assembled according to authorized UNIRAC documents Flange Nut • Values represent the allowable and design load capacity of a single end clamp assembly when used with a SolarMount series beam to retain a module in the direction indicated • Assemble with one Unirac %"-20 T -bolt and one' / " -20 ASTM F594 ` �1 serrated flange nut yy' Bea • Use anti -seize and tighten to 10 ft -Ibs of torque .-' "" • Resistance factors and safety factors are determined according to part 1 section 9 of the 2005 Aluminum Design Manual and third- Y 4 i , party test results from an IAS accredited laboratory A • Modules must be installed at least 1.5 in from either end of a beam .x �.s Applied Load Average Allowable Safety Design Resistance PIPOIAJM - Direction Ultimate Load Factor, Loads Factor, i PY Ibs (N) lbs (N) FS Ibs (N) m TH Tension, Y+ 1321 (5876) 529 (2352) 2.50 800 (3557) 0.605 MODAE THICKNESS Transverse, Z± 63 (279) 14 (61) 4.58 21 (92) 0.330 1 Sliding, X± 142 (630) 52 (231) 2.72 79 (349) 0.555 Dimensions specified in inches unless noted 2 % SoLARMouhrr Technical Datasheets :F U N I RAC SolarMount Technical Datasheet Pub 110818 -ltd V1.0 August 2011 SolarMount Module Connection Hardware 1 Bottom Up Module Clip 1 Mid Clamp 2 End Clamp 2 SolarMount Beam Connection Hardware 3 L -Foot 3 SolarMount Beams 4 SolarMount Module Connection Hardware SolarMount Bottom Up Module Clip Part No. 302000C -- Washer • Bottom Up Clip material: One of the following extruded aluminum Bottom ,i., (hidden..se alloys: 6005 -T5, 6105 -T5, 6061 -T6 t` Up Clip no = • Ultimate tensile: 38ksi, Yield: 35 ksi it . ' • Finish: Clear Anodized Bottom Up Clip weight: —0.031 Ibs (14g) Beam Bolt Allowable and design loads are valid when components are "�` ' assembled with SolarMount series beams according to authorized UNIRAC documents • `<� • Assemble with one '/4 " -20 ASTM F593 bolt, one 1 /4 " -20 ASTM F594 • serrated flange nut, and 9 one' /4 flat washer Use anti -seize and ti hten to 10 ft -Ibs of torque /00 10 1 Resistance factors and safety factors are determined according to ,. �. �,___ part 1 section 9 of the 2005 Aluminum Design Manual and third- — _.Y party test results from an IAS accredited laboratory • Module edge must be fully supported by the beam * NOTE ON WASHER: Install washer on bolt head side of assembly. DO NOT install washer under serrated flange nut Applied Load Average Allowable Safety Design Resistance Direction Ultimate Load Factor, Load Factor, Ibs (N) Ibs (N) FS Ibs (N) m Ile Tension, Y+ 1566 (6967) 686 (3052) 2.28 1038 (4615) 0.662 Y Transverse, X± 1128 (5019) 329 (1463) 3.43 497 (2213) 0.441 iv, X Sliding, Z± 66 (292) 27 (119) 2.44 41 (181) 0.619 Dimensions specified in inches unless noted II +.fin k 'b5;' a d 4Mr tom} . i,, 5: _ z i ,, ,'dam„ !.r. ,, w 4 �` 3"a �F�. �'�: '"' s u '-'-" 4 .., ,d, , ^a °"" ^ * ?" f�y r �' Z;71;"1 kp t 7Is �+r t Lc 3 . �k'*., . 4 K+wem , � .F ''' s , � * ° ,r r '*^�^�a a f" .a x, c` � s. w . 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Temperature Characteristics Nominal Maximum Power (Pmax) 235W 240W 245W 250W I 255W Optimum Operating Voltage (Vmp) 30.1V 30.2V 30.3V 30.4V 30.5V Pmax -0.45%/ Optimum Operating Current(Imp) 7.82A 7.95A 8.09A 8.22A 8.35A Temperature Coefficient Voc -0.35 VC Open Circuit Voltage (Voc) 37.2V 37.3V 37.4V 37.5V 37.7V Isc 0.060 %/t Short Circuit Current (Isc) 8.34A 8.46A 8.61A 8.74A 8.74A Normal Operating Cell Temperatur 45±2t Module Efficiency 14.61% 14,92% 15.23% 15.54% 15.85% Operating Temperature - 40t - +85t Performance at Low Irradiance Maximum System Voltage 1000V EEC) /600V( - ) Industry leading performance at low Irradiation Maximum Series Fuse Rating 15A environment, +95,5% moduleefficiency from an Application Classification Class A irradiance of 1000w/m to 200w/m Power Tolerance 0 - +5W (AM 1.5, 25' C) Under Standard Test Conditions (STC)ot irradiance of 1000W /m', spectrum AM 1.5 and cell temperature of 25•C Engineering Drawings rut ` : ' 061 I' f> 4,t s' . - 200M W Nominal Maximum Power (Pmax) 170W 173W 177W 180W 184W i Optimum Operating Voltage (Vmp) 27.5V 27_5V 27.6V 27.7V 27.8V ILL __� Optimum Operating Current(Imp) 6.18A t 6.29A 6.40A 6.51A 6.62A Open Circuit Voltage (Voc) 34_1V 34.2V 34.3V 34.4V 34.6V Short Circuit Current (Isc) 6.75A 6.85A 6.97A 7.08A 7.18A 111M111111111111111111 Under Normal Operating Cell Temperature, Irradiance of 800 W /m', spectrum AM 1-5, ambient temperature 20C, �� wind speed 1 m/s Mechanical Data 111111111111111111111 Cell Type Mono- crystalline 156 x 156mm, 2 o 3 Busbars ' 1 ...gui Cell Arrangement 60 (6 x 10) I„' �, Dimensions 1638 x 982x 40mm (64.5x 38.7 x 1.57in) 1 '�,,I 1 Weight 19kg (41.9 Ibs) I"'I"In111"'ll"II"1 Front Cover 3.2mm Tempered glass - - - 111111111111111111111 Frame Material Anodized aluminium alloy _ J -BOX — - IP65, 3 diodes i Cable 4mm'(IEC) /12AWG(UL), 1000mm 98r Connectors MC4 or MC4 Comparable i Standard Packaging (Modules per Pallet) 24pcs - -- Module Pieces per container (40 ft. Container) 672pcs (40'HQ) d I -V Curves (CS6P -250M) , _... __ , 1 i ‘ 35 0 i 1 -_ i k \ 11 _� l 'Specifications included in this datasheet are subject to changewithout prior notice. About Canadian Solar Canadian Solar Inc. is one of the world's largest solar Canadian Solar was founded in Canada in 2001 and was companies. As a leading vertically- integrated successfully listed on NASDAQ Exchange (symbol: CSIQ) in manufacturer of ingots,wafers, cells, solarmodules and November 2006. Canadian Solar has module manufacturing solar systems, Canadian Solar delivers solar power capacity of 2.05GWand cell manufacturing capacity of 1.3GW. products of uncompromising quality to worldwide customers. Canadian Solar's world class team of professionals works closely with our customers to provide them withsolutions for alltheir solar needs. Headquarters 1 545Speedvale Avenue West Guelph i OntarioN1K 1E6 (Canada Tel +1 519 8371881 Fax' +1 519837 2550 inquire.ca @canadiansolar.nom www.canadiansolar.com EN -Rev 3.50 Copyrighl0 2012Cenatlian Solar Inc. 4 ' r' CanadianSolar • • • CS6P • + +• • + + • + 235/240/245/250/ + + + + • ■ + + + • + 4 • + + 4 + 4 CS6P isa robust solar module with 60 solar cells. • + + + + 41 These modules can be used foron -grid solar + , + + J applications. Our meticulous design and production techniques ensure ahigh- yield, long -term * + • 4 performance for every module produced. Our rigorous quality control and in -house testing facilities 4 guarantee Canadian Solar'smodules meet the highest quality standards possible. Best Quality • 235 quality control points in module production Key Features • EL screening to eliminate product defects • Current binning to improve system performance • High module efficiency up to 15.85% • Accredited Salt mist /Ammonia resistant • Positive power tolerance: 0— +5W Best Warranty Insurance • Robust frame to up to 5400 Pa load • 25 years worldwide coverage • 100% warranty term coverage • Anti - reflective with self-cleaning surface • Providing third partybankruptcy rights • Non- cancellable • Outstanding performance at low irradiance • Immediate coverage • Insured by3 world topinsurance companies • High energy yield at Low NOCT Comprehensive Certificates • Backed By OurNew 10125 Linear PowerWarranty • IEC 61215, IEC 61730, 1EC61701 ED2, UL1703, Plus our added 25year insurance coverage KEMCO, CEC Listed, CE, JET and MCS • IS09001: 2008: Quality Management System loot • ISO/TS16949:2009: The automotive quality so% , Added Value Fro KEMCO, management system • IS014001 :2004: Standards for Environmental management system 5 10 15 20 25 • QC080000 HSPM: The Certification for Hazardous Substances Regulations • 10 year product warranty on materials and workmanship • OHSAS 18001:2007 International standards for • 25 year linearpower output warranty occupational health and safety • Reach Compliance /� !ti C EC 0 SGS ^9-,- it /c \ � www.canadiansolar.com March 6, 2013 To: Code Enforcement Division From: James A. Marx, Jr. P.E. Re: Engineer Statement for Krakowski - Parsky Residence, 64 Winterberry Ln., Forence, MA - Solar Roof Mount Installation I have verified the adequacy and structural integrity of the existing Roof 1 - 2 "x 8 "roof rafters @ 24" c -c, roof slope distance 12' -9 ", and pitch 18 deg., and Roof 2 - 2 "x 8 "roof rafters @ 16" c -c, roof slope distance 10' -7 ", and pitch 41 deg. for mounting of solar panels and their installation will satisfy the structural roof framing design- loading requirements of the Massachusetts building code — 780 CMR Residential Code 8th Ed. For the installation of the solar mounting, the Unirac Solarmount rails will be anchored to the rafters with L -foot supports with Ecofasten GF -1 -BLK -0812 flashing and ECO -CP- SQ 2 "x2" Anchor Compression Bracket located on the center of the rafters and will be securely fastened to the rafters at 48" sp. with 5/16 "x 3 1/2" SSTL lag screws. The mounting system has been designed for wind speed criteria of 90 mph Exp. B and ground snow criteria of 40 psf. All attachments are staggered amongst framing members. The Photovoltaic system and the mounting assemblies will comply with the applicable sections of the Residential Code and loading requirements of roof - mounted collectors. Thereby, I endorse the solar panel installation and certify this design to be structurally adequate. Sincerely, y�v�t! OF MAS JAMES A. m . O MARX, JR. James A. Marx, Jr. NO. 1 36365 Professional Engineer 'Po � �c/sTER� ° e MA 36365 S'si, AL �N `t . . 10 High Mountain Road Ringwood, NJ 07456 - 6 //` cc: Real Goods Solar G 0 011) Property Consent Form Owner: 1 /0 C 4-7644e W5 /(I 7 di, /4 /2 jcY Address: 6 y A7 Town: fO State: Zip: 0/66 2 Phone: 4 j f ! 3 C t / V6 7 1" I hereby give permission to Alteris Renewables, Inc., dba Real Goods Solar and their representatives to pull the required permits for a solar installation on the above stated property. Signed, z A.,, Csu 1 J44, .3/ Homeown, Date '� i5 1G( ? yr, i= 12 ni Fali_'f(t to <<6t1 a ,- ,.�) E . - 112-G8.3.2225 «-,rttr.FA - cr<> i ;°ti1; ,;; • R �� coops x-� l��` �� March |l"20l3 City of Northampton Building Department 212 Main Street Northampton, MA 01060 Hello, 1 have enclosed a building permit application, applicable fee and supporting documents for a residential solar installation in your town. Please let me know if a g else is re ired to approve our permit. Once the permit is ready please use the enclosed self-addressed stamped envelope to send to the foreman. Thank you and let me know if you need anything elec, 160. 4,1,14dij Kim Hendel Permit Specialist Real Goods Solar Formerly x|teuancn,wxh\eaInc. 32 Taugwonk Spur Rd. Al2 Stonington CT 06378 Ph 860-535-3370 Fax 413-683-2225 Kimberly.hendel@realgoods.com 32 Taugwonk Spur Rd Al Sfoningion CT 0)3/8 860-535'337O www Real( ;oodsS i/oum SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name 0 License Holder : Dan McLean 105675 License Number 481 Kennedy Drive, Leeds, MA 01053 7/22/2013 Add i Expiration Date (w 413- 588 -2252 Signature i Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Alteris Renewables dba Real Goods Solar 162709 Company Name Registration Number 32 Taugwonk Spur, A -12, Stonington, CT 06378 4/6/2013 Address /;1 Expiration Date 7 .te Telephone 860 - 535 -3370 — SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes IN No ❑ 11. - t Home Owner Exemp The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780. Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) 0 Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [Q Siding [D] Other WA Brief Description of Proposed Work: Installation of a 3.43kW roof mounted solar array using 14 Canadian Solar CS6P -245M modules, 14 Enphase M2I5- 60- 2LL -S22 micro inverters, and all associated electrical work. Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll - Sheet ea. If New house and or addition to existing housing. complete the following: a. Use of building : One Family X Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Wolf Krakowski , as Owner of the subject property hereby authorize Alteris Renewables dba Real Goods Solar to act on my behalf, in all matters relative to work authorized by this building perm't application. See signed authorization form 1([ ( 3 Signature of Owner Date Alteris Renewables dba Real Goods Solar , 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. Kim Hendel Print Name Signature f Owner /Agent Date 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 Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 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 DONT KNOW Q YES 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 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 ® NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only • ` ' ` City of Northampton Status of Permit; -- I C 1 0 4 % uilding Department Curb Cut/Driveway Permit -c NS 212 Main Street Sewer /SepticAvailabitity a -e%,°,3 a Room 100 Water/Well Availability , Northampton, MA 01060 Two Sets of Structural Plans 0- No phone 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plana Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office 64 Winterberry Lane Map Lot Unit Florence, MA 01062 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Wolf Krakowski 64 Winterberry Lane, Florence, MA 01062 Name (Print) Current Mailing Address: (� 413- 584 -4672 3. -- j , 9 r,t t't1 u rt 7_A.. +, L vi r i'1 Telephone Signature !! 2.2 Authorized Anent: n f ! t n 1 � / c j I4,.r, s 12L Jwi lk' S (, ;Y� ' 6 cJ 3.10,( 3 14 f, / h k 4 i °l cr71%i/ j16r1 Ci G 37e Name (Print) r� r , i Current Malting Address: ty670_5-3S--337o Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 4,000 (a) Building Permit Fee 2. Electrical 15,000 (b) Etf Construction stimated To from al Cost (6) o 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 19,000 Check Number 0933 ( 4/Pt This Section For Official Use Only Building Permit Number: I sssuu ed: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0824 APPLICANT /CONTACT PERSON ALTERIS RENEWABLES INC DBA REAL GOODS SOLAR INC ADDRESS/PHONE 32 TAUGWONK SPUR RD UNIT Al2 STONINGTON (860) 535 -3370 0 PROPERTY LOCATION 64 WINTERBERRY LN MAP 36 PARCEL 224 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 09t,/ otif Fee Paid / Typeof Construction: ERECT ROOF MOUNTED SOLAR ARRAY New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 105675 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMA N PRESENTED: roved 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 ...„,/! ►, .3 — /543 S : • e of : uilding Official 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. 64 WINTERBERRY LN BP- 2013 -0824 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 224 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 PANELS BUILDING PERMIT Permit # BP- 2013 -0824 Project # JS- 2013 - 001420 Est. Cost: $19000.00 Fee: $114.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ALTERIS RENEWABLES INC DBA REAL GOODS SOLAR INC 105675 Lot Size(sq. ft.): 57934.80 Owner: PARSKY PAULA F Zoning: Applicant: ALTERIS RENEWABLES INC DBA REAL GOODS SOLAR INC AT: 64 WINTERBERRY LN Applicant Address: Phone: Insurance: 32 TAUGWONK SPUR RD UNIT Al2 (860) 535 -3370 0 Workers Compensation STONINGTONCT06378 ISSUED ON:3/15/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:ERECT ROOF 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: 3J/ 212 Main Street, Phone 413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner