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07-024 (3) EVALUATION REPORT UN f Report Number: 0248 Originally issued: 09/2012 Valid Through: 09/2013 TABLE 1: ALLOWABLE LOADS FOR EZ ROOF MOUNT L-FOOT KIT(ibs.)1.2'3'4'5 Load Direction Allowable Load Test Load at Test Load at Calculated Allowable (see figure below) Test Value 0.250 inch 0.125 inch Fastener/Metal Design Load F.S.=3.0 deflection deflection Strength Uplift(Withdrawal) 7I5 1,800 695 340 340 Lateral 260 240 130 153 130 Notes �.� 1. Allowable load values are based on the least value from the ultimate load of three tests(strength limit),tested load at 0.125 inch deflection(deflection limit),calculated fastener capacity(withdrawal or lateral)for wood with a specific gravity of 0.55(Southern Pine)or allowable stress of the aluminum L-foot connector. 2. Allowable load values are based on lumber with all of the following characteristics: a. Located in dry service conditions where the moisture content does not exceed 19%for an extended period of time such as in most covered structures. b. Located where it does not experience sustained exposure to elevated temperatures that exceed 100°F. For any other conditions,allowable table values shall be multiplied by the related adjustment factor(s)(Cm and/or C,)in accordance with the National Design Specification for Wood Construction(NDS-05). 3. Allowable load values are based on lumber with a specific gravity of 0.55(Southern Pine or equal). 4. Allowable load values for withdrawal are based on a minimum penetration of 2''A inches into the roof rafter by one 5/16 inch x 4 inch long stainless steel lag screw. 5. Allowable values may not be increased for load duration in accordance with Section 10.3.2 of the NDS-05. Lateral EVALUATION REPORT Report Number: 0248 Originally Issued: 09/2012 Valid Through: 09/2013 TABLE 2:MATERIAL PROPERTIES ° Component Material Shoe Aluminum alloy ANSI/AA A380.0 Waterproof Washer EPDM with durometer rating of 60 Lag Bolt 304 stainless steel ASTM A 240 L-foot Aluminum alloy 6063-T6 ASTM B221 Hex Cap Aluminum alloy ANSI/AA A380.0 _Flashing Aluminum alloy 1060 ASTM 13209 EZ ROOF MOUNT COMPONENTS ° Figure I:Shoe Assembly Figure 4:Flex Cap : ri----0 ,,... _ ( ---,) // ..., , .....,--' , LO '-'"---............ .'''•''', ..7.. / V ---'"..-..-•-.„,,.,..C 4 I tr.,. / Figure 2:Lag Bolt Figure 5:Flashing -1 , 4,:.,. . ,, ,1 - , , Figure 3:L-foot Page 4 of 4 EVALUATION REPORT u> rt -r Report Number: 0248 Originally Issued: 0912012 Valid Through: 09/2013 TABLE 1: ALLOWABLE LOADS FOR EZ ROOF MOUNT L-FOOT KIT(lbs.)14.'4,5 Load Direction Load Test Load at Test Load at Calculated Allowable Test Value 0.250 inch 0.125 inch Fastener/Metal figure below) F.S.=3.0 deflection ` deflection Strength Design Load Uplift(Withdrawal) 715 1,800 695 340 340 Lateral 260 240 130 153 130 Notes I. Allowable load values are based on the least value from the ultimate load of three tests(strength limit),tested load at 0.125 inch deflection(deflection limit),calculated fastener capacity(withdrawal or lateral)for wood with a specific gravity of 0.55(Southern Pine)or allowable stress of the aluminum L-foot connector. 2. Allowable load values are based on lumber with all of the following characteristics: a. Located in dry service conditions where the moisture content does not exceed 19%for an extended period of time such as in most covered structures. b. Located where it does not experience sustained exposure to elevated temperatures that exceed 100°F. For any other conditions,allowable table values shall be multiplied by the related adjustment factor(s)(Ca, and/or C,)in accordance with the National Design Specification for Wood Construction(NDS-05). 3. Allowable load values are based on lumber with a specific gravity of 0.55(Southern Pine or equal). 4. Allowable load values for withdrawal are based on a minimum penetration of 2'/: inches into the roof rafter by one 5/16 inch x 4 inch Iong stainless steel lag screw. i 5. Allowable values may not be increased for load duration in accordance with Section 10.3.2 of the NDS-05. i Uplift Lateral • 1 � , , , � oaa f 1 Page3of4 EVALUATION REPORT .._ vii Report Number: 0248 Originally Issued: 09/2012 Valid Through: 09/2013 4.2 Installation Rain test data and thickness of aluminum flashing submitted is in conformance with Acceptance Criteria EZ Roof Mount must be installed using the 5/16 inch for Roof Flashing for Pipe Penetrations (ICC-ES AC diameter stainless steel lag screw at each bracket 286-2008). Rain test conformed to Underwriters location as described in the manufacturer's installation Laboratory Standard for Gas Vents, UL 441-96 Section instructions. Lag screw must penetrate into the roof 25, rafter a minimum of 2 % inches. Prior to installation,the ar roof rafter shall be bored with the required lead and Test results are from laboratories in compliance with clearance hole for the unthreaded and shank portions ISO/IEC 17025. of the lag screw as required in Section 11.1.3 of the NDS -05. Threaded portion of the lag screw shall be 7.0 IDENTIFICATION inserted into its lead hole by turning with a wrench and not driving by a hammer. A die-stamp label in the flashing bearing the name and address of the manufacturer, the model number, Use of auxiliary holes in the Shoe other than the use of IAPMO Uniform ES Marks of Conformity, and this an extra fastener to stop the shoe from rotating during Evaluation Report Number(ER-0248). installation is outside the scope of this report. Flashing should be installed full under the shingle up to I A the raised portion of the flashing to prevent water P M ingress under the shingle. No portion of the flashing should be bent upward; the flashing must rest fully ES against the roof shingles. Otherwise the water and wind performance may be impaired. TM IAPMO#0248 ='. 5.0 CONDITIONS OF USE EZ Roof Mount L-Foot Kit for Shingle Roofs described in this report complies with the codes listed in Section 1.0 of this report subject to the following conditions: 5.1 EZ Roof Mount shall be installed in accordance with . this report, manufacturer's installation instructions and the codes listed in Section 1.1. 5.2 Calculations to verify the imposed loads on the EZ Roof Mount assembly do not exceed the allowable loads contained in Table 1 of this report shall be submitted to the code official when requested. Calculations shall be prepared by a registered design professional when required by the statues of the jurisdiction where the work is constructed. 6.0 EVIDENCE SUBMITTED Testing and analysis data submitted is in conformance with Evaluation Criteria for Joist Hangers and Miscellaneous Connectors (IAPMO ES EC 002-2011). Page 2 of 4 EVALUATION REPORT Report Number: 0248 Originally Issued: 09/2012 Valid Through: 09/2013 7 Division: 06—WOOD AND PLASTICS 3.0 DESCRIPTION Section: 06060—Connections and Fasteners 3.1 General Description REPORT HOLDER: EZ Roof Mount L-Foot Kit consists of 5 basic SunModo Corporation components: (1) shoe assembly with captive waterproof 1905 SE 5th St,Suite A washer, (2)lag bolt to fasten through the shingles to the Vancouver,WA 98661 roof rafter, (3) flashing that is placed under the row of shingles above the shoe and then over the shoe, (4) L- ", EVALUATION SUBJECT Foot that is placed over the protruding shoe threads and (5) hex cap that is secured on to the shoe. See SunModo EZ Roof Mount L-Foot Kit for Shingle Figures 1 to 5 in Table 2. Roofs 3.2 Materials 1.0 EVALUATION SCOPE: EZ Roof Mount is fabricated from aluminum. Shoe 1.1 Compliance with the following codes: assembly is fabricated using casting aluminum alloy with dimensions of 2.80 inches in diameter and 1.00 • 2009 International Building Code® inches in height. It is held in place using one 5/16 inch • 2009 International.Residential Code® diameter lag bolt that is 4 inch in length and made of • 2006 International Building Code® stainless steel. Flashing is fabricated from sheet • 2006 International Residential Code® aluminum with dimensions of 10.0 inches in width, 12.5 inches in length and 0.04 inches in thickness. 1.2 Evaluated in accordance with: L foot is a 2.00 inch long unequal leg angle made from • Evaluation Criteria for Joist Hangers and 6063-T6 aluminum with dimensions of 3.00 inches in Miscellaneous Connectors (IAPMO ES EC002- depth, 2.00 inches in width and 0.24 inches in 2011),Approved March 2011 thickness. It contains a 0.375 inch diameter round hole • Acceptance Criteria for Roof Flashing for Pipe with a 0.83 inch diameter chamfer (in base) that is Penetrations(ICC-ES AC286),Approved April 2010 located in the center of the base leg. One slot measuring 1.64 inch long by 0.40 inch wide occurs in 1.3 Properties Evaluated: the center and is located 0.30 inches from the top edge of the vertical leg, which has a scallop front and rear • Structural face. See Table 2 for component material properties • Weather Protection and figures. 2.0 USES 4.0 DESIGN AND INSTALLATION EZ Roof Mount L-Foot Kit for Shingle Roofs is used to 4.1 Design mount solar systems and other rooftop devices such as Tabulated allowable loads shown in Table 1 of this satellite dishes on asphalt shingle roofs with wood report are based on allowable stress design (ASD). rafters underneath. Adjustments to these values are required for wet EZ Roof Mount is specifically designed to be used for service conditions, sustained exposure to elevated installation of solar panels for electric or hot water temperatures, use with fire retardant lumber or with production on roofs with slopes from 3 to 12 units lumber whose specific gravity is less than 0.55 vertical in 12 units horizontal. (Southern Pine). Allowable values based on fastener strength may be adjusted for duration of loading. See footnotes of Table 1 for more detailed explanation. Page 1 of 4 Copyright d12012 by International Association of Plumbing and Mechanical Officials.MI rights reserved.Printed in the United Stales.No part of this publication may be reproduced,stored in an electronic retrieval system,or transmitted,in any form or by any means,electronic,mechanical,photocopying,recording,or otherwise,vitbout the prior written permission of the publisher.Ph:1-877-4IESRPT•Fax:909.472.4171•Web:wwwdaomoes-org•5001 East Philadelphia Street•Ontario,California 91761-2916—USA "gex.'°`w"cvtk o P! M �r . ,� _ ➢ Ca a) ' a : -F-+ wir i+v ° a (13 f Lem • (13 _� ' U 0 N - c Q 3 i"a t, := . , .: ‘ , , ,„ ,,It a .,41,... 4t,,4, ....,,, s Qa ..� :';'''-,!'-,-.''';'..',..',',,'4'.'",.':') '4,',4":�� � s a u g� r s'q �a �,�±?, CO VJ���y e n S � a€�v 1 v p L O M O iL 7t.� I. e vi �v =s ::.�� ; s-_ma SPECIFICATIONS •'n,;'"` -�, � °�'..; . � � "� Cells Monocrystalline silicon solar cells 156mm x 156mm Cells NQmber 60(6x10) Dimensions(mm)/(in) 1652 x 990 x 50/65 x 39 x 2 -. Weight(kg)/(lb) 24/53 990 mm ( 39in1 . ... ��' rte , NOCT(°C) 50 ` I " `` Current Temperature Coefficient also (%/°C) +0.09 MOUNTING 3 oal -a HOLE Voltage Temperature Coefficient (3Voc (°/°C) -0.37 1 ti Temperature Coefficient yP,,q, (%/°C) `0.48 MOUNTING I —HOLE see ro ., j - m ? I ,o l000w/m' GROUNDING ! E - -- HOLE 1 g E 9 9 _ E E I o E E N ... ..m,.. .. o 800W/m`- ‘ 7 ? -- = _ — t �"" 4 a 6 _,MOUNTING I_IU10�.1 — 6 — HOLE 5 600W/m. i '' 5 MC-4 CONNECTORS d 4 U 4 IE.c ,MOUNTI HOLE 3 /m'- 'Ci gc ti I 940 mm I( 37 in 1 1 _ gg 0 0 t. 5 10 15 20 25 30 35 40 45 50 5 10 15 20 25 30 35 40 45 50 Voltage IV) Voltage(V) 0 3 Section A-A Warranty: 3 5-years product warranty — 10-years performance warranty at 90%power output 35mm 25-years performance warranty at 80%power output NOTE: 1.ACS:Irradiance 1000W/m2,Module temperature 25°C,AM=1.5 2.Deviation of Vm(V),Im(A),Voc(V)and Isc(A)of±3% 3.Modules are ETL approved under UL-1703 standard 4.Modules are fire rated:Class C 5.Modules are listed under CEC 300-2008 .A °b .. * AMERICAN CHOICE r c .. ARRA Intertek. S O L A R P A N E L S COMPLIANT Made in the U.S.A. '—.:�•= Assembled in Texas 4 PV Cell Fab in Georgia b Home Office in Massachusetts U S A D I S T R I B U T O R RENEWABLE SALES , 16 EVERETT STREET , HOLLISTON , MA 01746 OFFICE : 5 0 8 . 3 0 9 . 4 4 3 7 FAX : 508 . 302 . 1070 w w w . r e n e w a b I e s a I e s . c o - m t ,: it„„ _ . , . , ,..,_...:,..,..,_„,„ ,. „..,. , „ , ...„,„. , , ,,,, , , :. ,. . . , p __<.., , ,:.AMERICAN CHOICE � � � ��s �� O L A P A E LS Made in the U.S.A. �.': Assembled in Texas4 PV Cell Fab in Georgia Home Office in Massachusetts MONOCRYSTALLINE PV MODULE 60 CELLS ELECTRICAL CHARACTERISTICS �''` 4 - Model ACS-235 ACS 240 ACS 245 ACS-250 Max Power Pm(W) 235 240 245 250 Max Power Voltage Vm(V) 29.3 29.7 30.2 30.7 ! a•Max Power Current Im(A) 8.02 8.07 8.10 8.15 Open Circuit Voltage Voc(V) 37.0 37.1 37.2 37.3 y t + i 4' Short Circuit Current lsc(A) 8.54 8.58 8.62 8.66 Cell Efficiency 17.4 17.5 17.6 17.8 Module Efficiency 14.4 14.7 15.0 15.3 Maximum System Voltage(V) 600(UL) # # " # * # Power Tolerance ±3% ` •.. t COMPONENTS&MECHANICAL DATA t 0 # + •# • Front Glass Low iron,4mm tempered Junction Box MIM Slim,IP 65 rated,UL approved • • - ,# Diode 15A Output Cables 1m cable(393/8 in),12AWG,UL approved # • # # # 4� . Connectors MC 4,IP-67,UL approved • Frame Anodized aluminum alloy type 6063-T5 + 4 # d Encapsulation Material EVA(0.46 thickness) Back Foil Black or White(UV Protected) Temperature Range -40°C to+90°C Cells Suniva® ARTisun®Series,3bus,Monocrystalhne ° .��K'r AMERICAN CHOICE S O L A R P A N E L S U S A D I S T R I B U T O R RENEWABLE SALES , 16 EVERETT STREET , HOLLISTON , MA 01746 OFFICE : 5 0 8 . 3 0 9 . 4 4 3 7 F A X : 5 0 8 . 3 0 2 . 1 0 7 0 w w w r e n e w a b I e s a I e s c 0 ` m . .......... ............ ........._. „......... ....._... ...... _ .. . ......._..... _.. _ ...... _____ ... _ __ il • ■ la 1 /, ; ; i . g A 1 iii ,, .,,,. ,, ;■ ■J ;, filii . . , , .,--, t ol r:,, if 0 - 1:;•:,, 1 ,, ,,,, ,I,,11 , ) k6'. ii/ i ilikli'HIL:iilli:11 1 111 1 1 11 61 'iill, !HHH Miir:ii ! ii f i i II i i; — hi gi i 1 14•=•i••:4••,••;i;4)i•i :•1•-•,-,..,,-i.i. 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'i 'III !..) 11 A 0 CC ) Tli; i .52 III' I I I 1;1;11 I:I :-.!'.. 111 1 III • • .1i n‘ ;.:: u.. 0 1 . 0 :1, s .. ,..; u_. i . .ii , , _ — I ea tal i 1-- 1 MINIMMOMMMEINIMIn '-''Z ' g 7 ' f•- -- 11111111111111111 U)el 14" e) I I MIIIIMINIMIWINI SMINA I 1 • • i . . . • _ . Vreeland Design Associates An integrative approach to design, engineering and site planning Date: September 22, 2013 Re: Rothenberg, 489 N Farms Rd, Florence, MA: Structural assessment and reinforcement detail of existing roof to support proposed solar array. Note: The existing rafters are 2x6 @ 16" o.c. spanning 14'-6"with a 4112 slope. The proposed reinforcement is for the installation of vertical 2x4 struts, 5'-O" in from the exterior wall, supported on the attic 2x6 @ 16" o.c. floor joists that are supported on the exterior wall and an interior wall 7'- 2" in from the exterior wall. See the reinforcement details below. Based on the specified PV panel unit weight of 41 lbs; the proposed reinforcement details will be adequate to support the proposed PV array. 2.7,f,RAFTEX_ r- v:',,______ PitoPor-pi STR.Lrr "Ze.).C.142.t. 4; 0. of 3-m4,6ER-wk.. St.A., ,,Qs intro R415Tte„. .---• .....--- ..--- L WO"ALL vaPsu„ Slit.4,1,4 --N <.___Itz,J35.1112A(.. zx4x16,,,_ e fc,"cht, C.Le.car To ATrACIA STIVr -7 - Tz3 / / 2. 1 2-MtneEILLOK. '4 scluvro 1+470 STRari I-SLREW ASSUMED 21,S 2 A4 STKLIT DZIPI L MAy tir 21\itliots'i5, , . Irni;:,..11'156'1"C 3/5".--i'-oh / tOt--4c 1 , 3--Z.X i o gEAM A 3 y, LA i.1,1 cv. I I k .L....1 ZECT i ON( 0,„-t‘A OF Atgas,...4 ' VREELAND (1' cl I CIVIL No.41:317 -----,1 k - ‘, „......,_,—V cil z 5/1 3 116 River Road, Leyden, MA 01337 Phone: (413) 624-0126 Email: dvreeland@verizon.net Fax: (413) 624-3282 Northeast 136 Elm St. Hatfield, Ma 01038 September 23, 2013 Re: Building permit for 489 N. Farms Rd. To the Building Inspector: The residence at 489 North Farms Rd. has two roof structures the proposed array will be mounted on. The new addition on the south side of the house has 2x10" SPF rafters @ 24" on center.This roof section has a span of 11'6" and is adequate to support the proposed photovoltaic array with no additional upgrades.The main house roof has 2x6" SPF rafters @ 16" on center with a span of 14'6" this roof section needs to be reinforced per the structural letter included by David Vreeland. Sincer- Phillip Baunsgard Jr. MA-CSL#CS-106113 Installation Supervisor Northeast Solar Design (413)247-6045 136 Elm St. Hatfield, Ma 01038 Visit us on the web www.northeast-solar.com 6.5kW American Choice-Alt: Design Properties: Month 6.5kW Module Manufacturer:Custom American Module Model:American Choice ACS 250 Choice•Alt Inverter Manufacturer:Custom AC(kWh) Inverter Model:Enphase M215-60-2LL-S22/S23 (Due to spacing constraints,only the manufacturer and model of the first inverter is include in this report) Jan 193.2 Derate Factor:0.81 Feb 368.6 Mar 609.9 Apr 629.6 Design Result Chart: May 782.8 • Jun 675.5 Jul 706.0 a .' Aug 639.9 we. ' #� t ` �.,v.� �s, Sep 594.4 Oct 513.1 ` Nov 277.1 Dec 108.4 „ Annual 6098.5 lair Feb �.Ifar .1pr Ma'r �i 3ul Any .<p OK Nov Dec Layout View: Length:50.00 ft „ VVidth: 16.00ft ,3��ili. tb�i,.ilif�,ILI:li .it.r,,i_I�.i �,ili-filif�li,�i.lilt,,.lily,,il�lili..��,., Azimuth: 110.00° Slope:26.60° 'E.-114 4�{•'-�FDA L ',. al4 .'.I ®3s x. ,t 11I 414 ,1 t9 1.4 - 123 tp '.� 12L ,a, m'�s Yt SYi toi4, •.t 9u •Ia _t lI21A -I a t :..a t X11 ,.t fu "r. _ iytt q '. ..t o7re t,s ar tr 3,'.I at�.t., 126 t.3. `- a,dd, h� ° rd olmetric CU . a) NM Lan a. W cn 0 1- :a) 2 0 - ,; ..e,,,,---,.........,A, -,- , . k' a H za as� iT.• ' . � ` ,cam r CO 5� ':rte ' s " N`i,, .1 . ' a The Commonwealth of Massachusetts Department of Industrial Accidents Iii g_ t Office of Investigations d , 7,r, 600 Washington Street �`- Boston, MA 02111 *-er o www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): NorthEast Solar Design — Address: 136 Elm St . City/State/Zip: Hatfield, Ma . 01038 Phone #: 413-247-6045 Are you an employer? Check the appropriate box: Type of project(required): 1. © I am a employer with 9 4. ❑ 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- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers' comp. insurance comp. insurance.t required.] 5. n 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.n Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.n Roof repairs insurance required.] t c. 152, §1(4), and we have no Solar employees. [No workers' 13.n Other comp. insurance required.] *Ally applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t I lomeowners 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: Hanover Insurance Policy# or Self-ins. Lic. #: WHN 5715134-02 Expiration Date: 4/8/15 489 N. Farms Rd. City/State/Zip:Florence, ma 01062 Job Site Address: 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 • d penalties of perjury that the information provided above is true and correct. Signature: , G'17,f ' Date: 9/19/13 Phone#: 413-247-6045 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#: Aion SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) r7 Roofing r7 Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [p Siding[D] Other[D] Brief Description of Proposed Work: �/'),j cc// tL ,,_FO�( i' /26£/,7( /J GA—) fv(J Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Barry Rothenberg as Owner of the subject property hereby authorize Northeast Solar to act •• my behalf, in all matters relative to w• • .uthorized by this building permit application. Signature of Owner Date I nn (3f 017,7 ,-- A/3 PCro J (i.s , as Owner/Authorized Agent h reby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and bel. f. Signed under the pains .•• p- alties of perjury. Print Name �A'n".. ~I f ^_ �3 Signatur • Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Heider: Phillip [ Baunsgard CS 106113 License Number 11 Edward Ave . Southampton, Ma. 01073 6/7/15 „, ., fir, Expiration Date � 413 247-6045 ;'ature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Northeast Solar 169641 Company Name Registration Number 136 Elm St . Hatfield, Ma 01038 7/14/15 Address ; Expiration Date Telephone 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 X0 No ❑ 11. - Home Owner Exemption 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 Department use only City of Northampton Status of Permit: 1� Building Department Curb Cut/Driveway Permit u SEP 252013 212 Main Street Sewer/Septic Availability L_ J Room 100 Water/Well Availability Electric, '' r r,pections Northampton, MA 01060 Two Sets of Structural Plans NO" it.. pirtrrn, 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit 489 N. Farms Rd. Florence Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Barry Rot henberg 489 N. Farms Rd. Florence,Ma 01062 Name(Print) Current Mailing Address: 413-586-4129 Telephone Signa ure 2.2 Authorized Agent: Northeast Solar 413- 47-6045 Northeast Solar 413-247-6045 Name P �,�;v Current Mailing Address: / Northeast Solar 413-247-6045 Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS, Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (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) 25,875 Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: 7 1 3 Building Commissioner/Inspector of Buildings Date /k/ov_eolt. .4- ex7r. 489 NORTH FARMS RD BP-2014-0373 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 07-024 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-2014-0373 Project# JS-2014-000640 Est.Cost: $25875.00 Fee: $155.25 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NORTHEAST SOLAR DESIGN ASSOCIATES LLC 106113 Lot Size(sq.ft.): 250034.40 Owner: ROTHENBERG BARRY C&AMY S WOLPIN TRUSTEES Zoning: RR(100)/WSP(100)/ Applicant: NORTHEAST SOLAR DESIGN ASSOCIATES LLC AT: 489 NORTH FARMS RD Applicant Address: Phone: Insurance: 136 ELM ST (413) 247-6045 () Workers Compensation HATFIELDMA01038 ISSUED ON:9/30/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL ROOF MOUNTED SOLAR PANELS 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 9/30/2013 0:00:00 $155.25 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner