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23A-135 (2) 04/16/14 11 :57AM EDT Megawatt Energy Solutions -> Linda 413587127 2 Pg 2/2 E NIT SOLUTIONS Property Owner Consent Form Owner: Maryi.Stanley Address: 85 Pine street Town: Florence State: 1vrA Zip: 01062 Phone: 413-586-7101 I hereby give permission to Megawatt Energy Solutions and their representatives to pull the required permits for a solar installation on my property. 9��' 1a I Z61 Prope4 Owner Dat Megawatt Energy solutions, LLC P.Q.Box 23437 Providence, RI 02903 03/31/14 04 :54PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg12/17 N 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 ,W� Please Print Leeibly NaMe(Business/Organization/Individual): .�LLTV s,,Y Address: City/StateM : 4 Z j 0 Phone#: Are you an employer? Check the a propriitte box: 4. �] I am a general contractor and I Type of project(required): 1.9 1 am a employer with 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. 7. E]Remodeling ship and have no employees These subcontractors have $, ❑Demolition workirig for me in any capacity. employees and have workers' comp. insurance.t 9, ❑Building addition [No workers comp,insurance p• required.] S. © We are a corporation and its 10.0 Electrical repairs or additions 3,❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MQL insurance required.]t c. 152, §1(4),and we have no 12.E] Roof repairs employees. [No workers' I3.[� other .J comp, insurance required.] *Any applicant that checks box#1 must also rill out the section below showing their workers'compensation policy information. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContraetors that check this box must attached an additional sheet showing the name of the Bub-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 polley and job site information. Insurance Company Name: Policy 0 or Self-ins.Lic. #: Oo�� fir', r ? .__ Expiration Date;_ Job Site Address: ' t f d e 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 MOL e. 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 ODDER 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, .Ida hereby certify under thepains andpenaldes of perjury that the informatlonprovided above is true ant-1 correct. Date: h 1M re: --- a 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. Cityrrown Clerk 4,Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person- Phone#: 03/31/14 04 :54PM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pg13/17 City of Northampton ♦M 'r Massachusetts a� M awl y DEPARTAWM OOP' BUXWZNa XJV9FZCWX0NS 714 Main "treat • mmiaipal Building ,y Northampton, M,A 01060 s' '� INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEbYMNT 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." 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 foundation/footings before backfill 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 I, 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 : 54PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg16/17 srzOTION 8-CpNSTRUCTION.Sr=RVICES 6.1 Licensed Constructlon Supervlsor; Not Applicable £ Name of License Holder: _ License Number Address Expiration Date Signature Telephone �:Sl ®gl$ta"rBd 1;1prI19itrilbP()lrgtfrlgl7r�4brlLr$CtO:>'"4rrC'. tN ay 9gnf nV,O�fj"f,,��Y��r r14r I�nR�i ,�ii �''ft Ci" .,�••M:t.,���u.,�,.alRk,.�,���.t,...>_,��...Ml�l�s�.,�:il��.�lr�� Not Applicable £ Company Nama Registration Number Address Expiration Date Telephone SECTION 10-WORKERS. COMPENSATION INSURANCE AFFIDAVIT iM.G.L,c..162,§.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...... £ ILA rrljV-.Q�Y.,�,vX�I;h..i,fin rt�i,f�P�1ti�5r,F1'v.. %rT�( IY'Hi i��l�T4�Li:tl'1 The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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 th owner acts as superYlsor.CtYtii 78 Slxt Ld1 t n 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 donne i. a two-Year period shall not be considered s lromeow>ter. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that Ile/s fe shall A responsible for sill such_wox perfoxmcsf nor the bullet ng permit. As acting Construetion.bncrvls—g 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,v.Qu inay be lit le 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 Annotate d. Homeowner Signature. 03/31/14 04 :54PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg17/17 SECTION d-DESCRIPTIO O ,PROP D WO heck all apollcable) New House Addition © Replacement Windows Alteration(3) Roofing Or Doors El I Accessory Bldg. [ Demolition ❑ New Signs (0) Decks (© Siding(a] other 11' Brief Description of Proposed Work: Alteration of existing bedroom Yes--�No Adding new Yes Nq Attached Narrative Renovating unfinished baseent _Yes 74_._No Plans Attached Roll -Sheet a. Use of building;One Family Two Family Other b. Number of rooms in each family unit: Num I ber of Bathrooms -- c. Is there a garage attached? d. Proposed Square footage of now con ru is Dimension e. Number of stories? f. Method of heating? F aces or Woodstoves Number of each g. Energy Conservation Compliance. Mas he k Energy Compliance form attached? h. Type of construction L Is construction within 100 ft.of ands? Yes o. Is onstruction within 100 yr. fioodpiain Yes No J. Depth of basement o ar floor below finished grade k. Will bulldin nform to the Building and Zoning regulations? Yes No. 1. S Tank," . _.. City Sewer_ Private well City water Supply SECTION la-OWNER AUTHORIZATION..,TO�E CoMPLETED'.WHEN OWNERS AG ENT OR"CONTRACTOR APPI:IE$-Fog,E)UILDING PERMIT I, as Owner of the subject property hereby authorize to act on my behalf,In all matters relative to work authorized by this building permit application. Signature of Owner Date I as Own erlAuthorized 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 :54PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg15/1? Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning 1 is COMM to bo tilled in by Building Department Lot Size f � Frontage Setbacks F ant " r�- Side L:= R:I_......,1 L:��,R: _ ear Building Height " Bldg,Square Footage Open Footage 6 (Lot ma minu s bldS&paved � parking) #of Parking Spaces— Fill: volume&Locafion A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter ;Book Page and/or Document /f B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: t C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size,'type and location; E== 0, Are there any proposed changes to or additions of signs intended for the property? YFS 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 0 IF YES,then a Northampton Storm Water Management Permit from the DPW Is required. 03/31/14 04 :54PM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pg14/17 City of Northampton Building Department 212 Main Street Doom 100 Northampton, MA 01060 " phone 413-587-1240 Fax 413-557-1272 ' APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE.JNFORrV XTION 1.1 Proopaily Address: 'N 1 . SECTION 2 PROPERTY OWNERSHIPlAo*oRIZED,AGENT', 2.1 Owner of Record: v. Name(Print) f Current Mailing Address; Telephone Signature 2.2 AuthorizedAaent; �y Af-eg4C✓,47-7- C-wcoe 4if Solo t'o- C�D 49yP.,/ Name(Print) Current Mailing Address: Signature Telephone SECTION 3­ESTIMATED CONSTRUCTION'COSTS. , Item Estimated Cost(Dollars)to be Official Use Only nom leied by ermit applicant 1. Building ("a)Building ReI n't Fed 2. Electrical (b)E4timgted Total`Cost of . ';: Canstrucilon'from't# ' 3. Plumbing Building Permit pee 4. Mechanical(HVAC) / 5.Fire Protection 6. Total=(1 +2+3+4+5) JT (goo Check Number This Section Fpr Otflcta!Use Ont ato Building Permit Number: {��`"'dt� �t ©�� Dued; / f ' Signature; Building Commfssfoiierlinspect6r,'of'8ulidings' .Date 85 PINE ST BP-2014-0669 GIs#: COMMONWEALTH OF MASSACHUSETTS Mg.-Block: 23A- 135 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-2014-0669 Project# JS-2014-001109 Est. Cost: $8000.00 Fee: $80.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MEGAWATT ENERGY SOLUTIONS LLC 57187 Lot Size(sq. ft.): 7187.40 Owner: ABRAMS MAURY Z&JENNIFER E Zoning URB(100)/ Applicant: MEGAWATT ENERGY SOLUTIONS LLC AT: 85 PINE ST Applicant Address: Phone: Insurance: PO BOX 282 (401) 312-4678 O WC PROVIDENCER102903 ISSUED ON.121512013 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALLATION OF A 7.5 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 Si nature: FeeType: Date Paid: Amount: Building 12/5/2013 0:00:00 $80.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner