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30A-019 (2) 04/16/14 04 :03PM EDT Megawatt Energy Solutions -> Linda 413587127 2 Pg 2/2 � Property Owner Consent Form Owner: Lydia Kapeu Address: 20 Bottoms Road Town: Florence State: MA zip: 01062 'hone: 413-320-1853 I hereby give permission to Megawatt Energy Solutions and heir representatives to pull the required permits for a solar installation on my property. ,f �// Property err Date Megawatt Energy Solutions, LLC P.O,Box 23437 Providence, RI 02903 03/31/14 04 :33PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg18/39 The Commonwealth of Massachusetts (GPr f( 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 Le ibl Name(Business/Organizat on/Individual): __w el Address: �. C.'.t r L'Fp--r10 City/State/Zi p aZr 022Lf Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with -1r" 4. ❑ 1 am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6, ❑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 S. ❑Demolition working for me in any capacity. employees and have workers' P �'� 9. []Building addition [No workers' comp. insurance comp. insurance.: required,] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3. ] 1 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.❑Roof repairs insurance required.]t a 152, §1(4),and we have no employees. (No workers' 13.[� Ot1ler�o/f�i� comp,insurance required.] 'Any applicant that checks box#1 trust also fill out the section below showing their workers'compensation policy information. tHo meowncrs 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 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 its the policy and job site information. Insurance Company Name: C'S'AWC f wiS Policy#or Self-ins.Lic.#: D4'�c�C> >�$~� � e'er Expiration Date: Job Site Address: ��' (3�% %��� d2 q__--�f`a/�.f�4�N City/State/Zip:_/1'IZ,2S 0 6 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 rder thepains andpenalties ofperjury that the information provided above is trite and correct. late: D! Phone 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#: 03/31/14 04 :33PM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pgl9/39 City ' of Northampton Massachusetts ' c DZPARTMNT Of BCrXLDrfiG AVSPECTTO476 ?� 212 Main Street • Municipal Building Northampton, KA 01060 e .•.""��C INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HQ=QNEREXEk"TYON ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines"Homeowner"as, " Person(s) who owns a parcel on which he/she resides or Intends 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 home owner." I The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages,which include foundationifootin s before baekfill sonotube holes before our a rough building Inspection (before work Is concealed), insulation Inspection (if required) and a final building Inspection, The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be Inspected. If the homeowner hires other trades to perform work (electrical, plumbing &gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required Inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made 1, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location 03/31/14 04 :33PM EDT Megawatt Energy Solutions City of Northampton 413587127 2 Pg21/39 SECTION 8-CONSTRUCTION SERVICES §,J I-Icansod Construction Sups Not Applicable f- Licame Number r Address Expiration Date F"&A—K 41Nv fu Y4 Signature Telephone J Not Applicable E Comimny Naina Registration Number CNN e—-VF,4—0S-71 7 Td-dress Expiration Date Telephone – 7- ,?f — 2c!lr' SECTION 10-WORKERS`.COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e,162,S 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 Affldavit Attached Yes .. E No...... F- ............. ........ W The current exemption for"homeowners"was extended to include pr WiL ik!2w -occulpied DwAllof one(1) or two(2)families L, and to allow such homeowner to engage an individual for hire who does not possess a license,prgyldad that thtp!yner acts as su,&Tvisor.gMR Sixth Edition Sectloll 108.3-5.1. Defin It. f HoEneo r: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 constrpg;more than one II QMq Ili a two-yea period shall not be considered a hQA_eowner. Such"homeowner'shall submit to the Building official,on a form acceptable to the Building Official,that.he/she 11110 be resporksibb,for all such)yQrk performed under timbuilding pern - AL As acting C.Qnstruction Supgrylisor 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($) you hire to perl(orm,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 03/31/14 04 :33PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg20/39 PEPTIOU. ESCRIP-rm OF PRO OSEO WOK check Il a t ) New House © Addition © Replacement Windows Alteratlon(s) Roofing Or Doors Q Accessory gidg. ❑ Demolition ❑ New Signs [l:]) Decks [lam Siding(a) Other[p] Brief Description of Proposed d� 2 Work: Alteration of existing bedroom Yes) No Adding new bedroom_Yes -W� No Attached Narrative Renovating unfinished basement �.-.. ........Yes _ No Plans Attached Roll -Sheet tV.r.. -r•t .:,. Inh Il�'�Cf r��i t :"w�Y P ror".r �^. -•t wd ��`�V�r, .,�.� rr,rr: a '!f N®w°hotaJSe�nc�lbrtaddttivr�to�e;>4Wif6tiR oirsin ,co a e:tl t3..fdflovtitni : a. Use of building:One Family ,_ Two Family Other b. Number of rooms In each family unit: Y� Number of Bathrooms r A c, Is there a garage attached? r"/A d. Proposed Square footage of new construction. W Dimensions e. Number of stories? Yv4t f. Method of heating?_ �`'I�/ _ Fireplaces or Woodstoves ti" r4 Number of each g. Energy Conservation Compliance. r Masscheck Energy Compliance form attached? h. Type of construction N� I. Is construction within 100 ft.of wetlands? Yes —)s—No. Is c onstruction within 100 yr. fioodplain YesNo j. Depth of basement or cellar floor below finished grade 11-14 k. WIII building conform to the Building and Zoning regulations? W Yes No, I. Septic Tank City Sewer _.___ Private well City water Supply SECTION 7a•OWNER AUTHORIZATION'.TO 81=COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject properly hereby authorize to act on my behalf,in all matters relative to work authorized by thle building permit application. 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/Agent Date 03/31/14 04 :33PM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pg23/39 Section 4. ZONING All Information Must be Completed,Permit Can Be Denied Due To Incomplete Information Usting Proposed Required by Zoning This colmn,to be filled in by Building Deputment Lot Size Frontage - — Setbacks runt Side, z,=R:= Building Height Bldg.Square Footage w� open Space Footage % 11 (Lot area minus bldg&paved � � I parking) #of Parking Spaces l I Fill: volume&Location ..- A. 14as a Special Permit/Variance/Finding ever been issued for/on the site? NO C) DONT KNOW 0 YES 0 IF YES, date issued:�� .� IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES 0 IF YES: enter Book page and/or Document#� B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 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 NO 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. WIII 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 o IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 03/31/14 04 : 33PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg22/39 City of!Northampton Building Department X 212 Main Street Room 100 Northampton, MA 01060 IOUGLA phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION Wt." 1111 Hall''+I le� 1.1 Property C$ Add *$: )y4�11 �11,�r II�h�E��li�.,I y��i I����I,ry�1��Q r 16�i�t I�� � rrk�riil i�ti l�,,rr lfldrrt�i dr' w��i�l'y�'M1i 4 sit �, �/j{F'� y-- lad Iy61f, 2 ,Qor/ c i f�, la ryl$ It a r.IFn anlM. , rl O, s WI�SMh Ixl4r9��, dti u t q. �� orstrlCtk��II �yi4 ill,•'I'I{�rlrl'q'i'h!Y�f(`igr����I,CY���.�.+i5fiyfnl�^„r .3�rorv/iavF�� 1 SECTION 2,-PRO PIERTY OWNERSHIP/AUTHORIZEi AGIENT' 2.1 Owner of Record: 6 Jr” k&5_1 ��✓ r ,a '� y�,��a jl,�r� c� c� QarrC„mss �21� Name(Print) Current Mailing Address: Telephone Signature 22 A.uthorizWAaent: Name(Print) Current Mailing Address: Sfgnature Telephone SECTION 3-ESTIMATED CONS C Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total'C'ost of Cons6uction'rrom Ea 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection a. Total=0 +2+3+4+5) Check Number Thls'Section For O'Mclal Use'Onl ' Building Permit Number: Palo Signature: Building Commissipner llnspector; 20 BOTTOMS RD BP-2014-0769 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30A-019 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-2014-0769 Project# JS-2014-001320 Est. Cost: $19000.00 Fee: $139.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MEGAWATT ENERGY SOLUTIONS LLC_ Lot Size(sq. ft.): 118483.20 Owner: FERRERA JAMES M&LYDIA A KAPELL Zoning-: SR(100)/ Applicant: MEGAWATT ENERGY SOLUTIONS LLC AT. 20 BOTTOMS RD Applicant Address: Phone: Insurance: PO BOX 282 (781) 935-8480 PROVIDENCER102903 ISSUED ON.11712014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 6.5KW 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: Building 1/7/2014 0:00:00 $139.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner