31A-297 tL -Zf 7=
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Owner Consent Form
Owner: Cheri & Stephen Butler
Address: 94 Vernon Street
Town: Northampton
State: MA
Zip: 01060
Phone: 413.586.9042
1 hereby give permission to SolarWrights, Inc. and their representatives to pull
the required permits for a solar installation on my property.
Signed,
ZS-dg'
Owner _-, Date
-�7E7Y' �Lt ��
I lie c ommonwetath (?I Allassirienusems
Department of lwhisifial A ecidems
Q/ -q ons
fic� f lnvi�wigath
600 Winhingttm Street
Boston, 1-hiss. 02111
)tNT'Or-kers' Compensation Insurance Affidavit: Builtiet-s/C'ont.ractor.,,/Electricians/Plui'til)ers
Applicam Information Please Print Le
----------
Name fi 41,,;
Address: 711:
atel,iv
C,Ivlt
s ,
,kre I ott, all criii;i()Net-*?Check t tlllttxipl iate hffx: Ti fle ol'imkiect I requ ire(j):
I < I alit Ills clliploi ter ii fill
ClilploNees trull and!or part UmO." lllz tiub-commctor,,
dill;i'snit: proprictor or parliter- hsled off lhc ,fllach�d
ship pm-id lime iio employees Fhosc L 'Illolilloll
x%orkm Rif-file ill anit cap ai iii.
toil
f work-l-rS,WHIP. M-SIM111CO Comp.
cir�sit
required) Wc it9 -s comomnoii itrtl nik its L1ccfrw.;il rcpaiis or jid(ji
I tam ltomeoi' tier domo all t4orlk of fice-s halve eNcroscd their
i Pliltilbill- repairs oraddillons l
im sell' I No NN oiicrs C0111P. right ctl'�2xeillplioll I)CI-11-1)AGI
111SUrtlice if-b- azid Lie bai c ilO j i 12. kooficpairs
,mpfo.-, lit 1t Of�lers
Other
klivapplic-s"I that 41terks hir"t!l must also Hit taut itic�cctitm lwi,w tiior",rhvv,`compensat4m P,*HCV inful-1111-it2-ol,
HookrWitcl,who Submit thi-S affld.l%il iflifiva-hig lht,.N ;Ary dijjm°all rorharld fiwit hire otitsit(C cuwnadm�flitA Submit a veu of it ijvffi•aligt�
that dwh this Nix must attact)all addiliwial khret htm hig the name oftlw still ciwiti-aetors and scale whethrr w-not thtse entm"lia%e empi.t.*vvs. it,
the slits contracw"-huN e vniploveir-,,thex mast pro%ide their 11 torkvir"Comp.Poliev rfumb(-n
I am an emphqer thal is providing insurance.for m)!emph)•ees. Beifewis the police'and joh sire
111suralicc colllpa)IN __Namz:
Polic\ r or Self-inss. Lic- -7-fi
xpiraiioii Wici
Job Site Address:
j, H w c(Cv(
Attach a copy of the workers' compensation policy declaration pagge kshowing the policy number and k
expiration clate).
i
Fajlurt; Losccujik: wki;rage as rcquircut urld-c-f-ScCoWn 2ia of AIGE 1 �_7 Call Lad to th': Imposition of,cf-1111111al ponallics of"I
1� J\-1 poiall Q-S 'I] 01s2 forii of-a S')P VVORK ORDER aril, a hale oF
S_1 I0.00 a dw.- cfgprist �.lolator_ Be adviscd tbat a cops of this statcmcnt malk bc fomarcied to the Offiec of ilit.:
DIA for co%crai_,c wrificatioll.
I tit) hei-hY cerr{ft under the paimi undpenaltics qfpei,�jurY that the infomielthm 1_7rw-idWahr,,ve is true andvorrecl.
'fivial use on/v Do not wrile in this area he va"llpteted kj-Citi-, al-tmvn (I.ficial
Cit% or'Yoluv
Issuing Awthoril� (circle otie'y-.
I.Board of Heall) 2. Building Department 3. Cit-01 oei n Clerl, 4. Electrical frispim0l• 'S. Plumbitig Inspector
6. Other
Contact persmi: Pholle 4:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
c
Company Name Registration Number
Address Expiration Date
A/i A Telephone t�1 7 `l tQ
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....... 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 permi L
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, S to and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature �(�• ���' / Lt
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition Replacement Windows Alteratron(s) Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [p Siding[p] Other[a
Brief Des ription of Propose $
Work: l74Ctt-d t �-r �fl�, t'c� � cr�1 G % of llt,o
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 APPUES FOR BUILDING PERMIT
1 r� as Owner of the subject
property
hereby authorize �.?t-L G�'r'i �`f` �/�6=
to act n y behalf, in II matters relative/to work 6uthorized by this building permit application.
Si ature of O ner Date
l &I e c f`�G'�'�( !/Ci2<SK � l>t- fc c,B���CtJ G rL� as Owner/Authorized
Agent hereby declare that the statemen 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. i
i4'p16/ ;i�
Print Name `
L'
Signature of Owne ent Date
a
Department use only
City of Northampton Status of Permit:
Alding Department Curb Cut/Driveway Permit
i
n ''x,12 Main Street Sewer/Septic Availability
Room 100 WaterMetl Availability
Nof"a'mpton, MA 01060 Two Sets of Structural Plans
phone 413-58740 Fax 413-587-1272 PlottSite Plans
Other Specify
`
APP ON-TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Prooertv Address.
-. T j�. 6 It - Map Lot Unit
t�j �,: w1 c i-,,a S
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Records
� .-17C- X. � '" ��'/ Z-�.:'.ZV /�G.t r L CT!�. .j i 1 G ,t'iy!t,1.1 _�yT�-�:::'t �a`;"'l Ct"►��'�tf:''t��'`a ��f4
N (Print) Current Mailing Address: f
t Twn , Telephone
Signatu e
2.2 Authorized Accent:
iucl
Name,k") Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building q (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
//4 Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =0 +2+3+4 +5) Y L1 Q Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2008-0963
APPLICANT/CONTACT PERSON SOLAR WRIGHTS INC
ADDRESS/PHONE P O BOX 51924 SPRINGFIELD (413)734-1456
PROPERTY LOCATION 94 VERNON ST
MAP 31A PARCEL 297 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL SOLAR PANELS ON ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 14581
3 sets of Plans/Plot Plan
THE FO,PLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN O ATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
Signature of Buildi O icial 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.
t �
S
BP-2008-0963
GIs#: COMMONWEALTH OF MASSACHUSETTS
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-2008-0963
Project# JS-2008-001447
Est. Cost: $8465.00
Fee: $126.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SOLAR WRIGHTS INC 14581
Lot Size(sq. ft.): 11979.00 Owner: BUTLER STEPHEN&CHERYL A
Zoning: URB Applicant: SOLAR WRIGHTS INC
AT: 94 VERNON ST
Applicant Address: Phone: Insurance:
P O BOX 51924 (413) 734-1456 WC
SPRINGFIELDMA01151 ISSUED ON:51212008 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL SOLAR PANELS ON ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 5/2/2008 0:00:00 $126.001033
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo