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23C-060 04/10/14 04:14PM EDT Megawatt Energy Solutions -> Town of Northampton 413587127 2 Pg32/33 U W cq QQ C J �@ m oz e [W(� C W e y U7N U m ti Cj O O ay2Zij a� d N ly E N �� g S V q � JAI 1211 . ill! .� Eel zl'2P1lOZ .4�100'(l%OG«�PIOtlMIONM 000004 04/10/14 04:1.4PM EDT Megawatt Energy Solutions -> Town of Northampton 413587127 2 Pg31/33 3 o a IL I LLJ N d y' p r w n • n " W z � a v '1r 8 �� 1 1px az F U 0 0 1.2 ZV..06 aNWU100'Ll%00'Vl BVNNRNRiIBNV oNaoB, 04/10/14 04:14PM EDT Megawatt Energy Solutions -> Town of Northampton 413587127 2 Pg30/33 ctY¢YSL'OB4....- NIX OC , COMOVw13116Ad LiS9"L9GM LL, AIM 1I(OE LZOU 00'QITI n°'1 ! t wog osaaidAHS roW 0'r 3014313103k OW 11nDV N 1p CC P­u-R-a qj^S'm tit t111 '�1 V-ELI-E-OinO O'ClAd-0 d(L) S30N9H3J3N V SKON rv09Dd880 LN08 WIP�wo(BU �� w�rwq C C D! 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Ulf 0 CC Y dY e� - y$C € ' Y/ � ylt a� :�cono nWUIW'Ll%OPLt YPOMY1N�19NY DRODO 04/10/14 04 : 14PM EDT Megawatt Energy Solutions -> Town of Northampton 413587127 2 Pg24/33 AATT UTIONS Property Owner Consent Form Owner: Pauline Bassett Address: 165 Willow Street Town: Florence State: MA Zip: 01 062 Phone; 413-586-4232 Z hereby give permission to Megawatt Energy Solutions and their representatives to pull the required permits for a solar installation on my property. arr'�e M. �asset� April 8, 2014 Property Owner Date Megawatt Energy Solutions, LL,C P.Q.Box 23437 Providence, RI 02903 04/10/14 04 : 14PM EDT Megawatt Energy Solutions —> Town of Northampton 413587127 2 Pg19/33 ` Department of Industrial Accidents Of,fine of Investigations 600 Washington Street 9 Boston,,VIA 02111 www rnass.gov/dia Workers' Compensation Insurance Affidavit: builders/Coxa tractors/Electricians/Plumbers Applicant Information Please Print Legibly NaTne()3usiness/Organiza6urdindividual):__,&122 P9W,4-/% i5iv 0"?-2 EC,A/7-h&,5 Address: 93 DU000;u1, S 7 City/State/Zip: /LO 0, 04 0129 Phone#: 6-S%--,2 Are you an employer? Check the appropriate box; Type of project(required): . 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. []New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. [J Remodeling ship and have no employees These sub-contractors have S. ❑Demolition workiatg for me in any capacity, employees and have workm' [No workers'comp.insurance comp.insurance.$ Building addition required.] 5. ❑ We are A 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 MOL 12,[]Roof repairs insurance required.]t c. 152, §1(4),and we have no (p employees.(No workers' �3 E Other Sd/,1 comp.insurance required.) *Any applicant that checks box#tl must also trill out the section below showing their workers'compensation policy information. t1lo•mcowners who submit dais affidavit indicating they are doing all work and then We outside contractors must submit a new affidavit indicating such. 3Coinractors that check this box must attached an additional sheet showing the flame of the subcontractors and state whether or not those entities have employees. rf 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 pellcy and fob site information. Insurance Company Name: &LOAC c't t*&, 7-4 4. Policy#or Self-ins.Lie.#: 04 D CV O 2d d Expiration Date: 10 ,�! If Job Site Address: 166 44,11 W 5 City/3tate/Zip: A/vf�'we /self ep1�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 MOL 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$250.00 a day against the violator, Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. _T do hereby certify under the pain nd penalties ofperfury that the Information provided above is true and correct. Signature: ate r Phone#: C �"� c?9 9"&"- Official use only. Do not write in this area$to be completed by city or town q f fcial, City or Town; Permit/License# Issuing Authority(circle one); 1.Board of Health 2.Buildiing Department 3. City/Town Clerk 4,Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: _ 04/10/14 04 : 14PM EDT Megawatt Energy Solutions —> Town of Northampton 413587127 2 Pg22/33 SPICTION,B.-CONBTRUCTION.SERVICES Licensed Construotioq Sutzqrvisor `�, Not Applicable £ Name of L(cepse Hotdor: Jr*Wf �r� ` License Number �2 GocA-%cc Ste' GS 1/S7 Address Expiration hate Signature Telephone ?R Not Applicable £ f� G✓�I� �w P2__ �'d lv�'i L7N mnanv ame Registration Nurnber av o�. r S P2oV a-r 02900 cSiIQ -CAS"21?7 Address Expiratlon Date Telephone �s�'� 3y• 9 7 z� w z� /S SECTION 10-WORKMR4!.'CgMFENSATION 114$URAN96-A� IT Workers Compensation(nsurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result In the dental of the Issuance of the building permit. Signed Affidavit Attached Yes. r No...... £ The current exemption for"homeowners"was extended to include Owner-occuuled 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 108,15-1. . 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 arid/or farm structures.A ReisoyAQ constructs more 1hap-oze 11ame in a two-year erlod sligli not be consider i n ho eowne . Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that a/she sh la 1 be respoonsible for all such work Igerforod undor Oe building a t. As acting Constraction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for wbioh this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Bmployees to. Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,You may e 11a a for Person(a) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility fbr 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 04/10/14 04 : 14PM EDT Megawatt Energy Solutions —> Town of Northampton 413587127 2 Pg23/33 SECTION s-tiESCR1p71oN oF.,P KO nJiED WORKJAsick ill-doollcabiel' New House © Addition Q Replacement Windows Alterations) © Roofing ED Or Doors Accessory Bldg. Demolition New Signs [[3] Decks [q Siding[©] Other[W1 Brief Description of Proposed 'Q Work; Alteration of exieiing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _ No Plans Attached Roll -Sheet 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. ,Dlmenslo e. Number of stories? f. Method of heating? places or Woodstoves Number of each g. Energy Conservation Compliance. Ma;ch nergy Compliance form attached? h. Type of construction I. is construction within 100 ft. tlands?—Yes -._._.. . __N Is c nstruction within 900 yr. tloodplain Yes No J. Depth of basemen ellar floor below finished grade_ k. Will build conform to the Building and zoning regulations? —Yes—No. t. tic'fank_ City sewer_....._.._. Private well City water Supply SECTION 7a-0WN9k A0T (ORI:ZAT16N .;TOM;¢O14lPk��'ED;;WHEN .OWNERS AQEN�UR C01�f1�ACTQR APpf lE3"F�7Ft.J3t7[l�p1NO.p�RMi"( 1, 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 1, as Own er/Authorized Agent hereby declare that the statements and Information an the foregoing application are true and accurate,to the best of my knowledge and ballaf, Signed under the pains and penalties of perjury. Print Name Slgnatura of Owner/A ant Date 04/10/14 04 : 14PM EDT Megawatt Energy Solutions —> Town of Northampton 413587127 2 Pg21/33 Section 4. ZONING All information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by zoning This coluim'to be tilled in by Building bepanment Lot Size Fronts a I — Setbacks Amt Building Height Bldg,Square Footage % Open Space Footage % (l.ot nea minus bldg do paved Q skin # of Parldas Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 PONT KNOW 0 YES .0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 lF YES, describe size,'type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 0 IF YES, describe size,type and location: E. Will the construction act IIvity.disturb(clearing,grading,excavation,or tilling)over 1 acre or is it part of a common plan that will disturb over i a=7 YES a NO' O 0 IF YES,then a Northampton Storm Water Management Permit from the DPW Is required. 04/10/14 04 : 14PM EDT Megawatt Energy Solutions —> Town of Northampton 413587127 2 Pg20/33 City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SIXE.IN�OFiMA�i'ION, � •- ' 7.7 P//roAartv Address: •, ,�' S140TION 2.=PRORERT` Q4ERSHIP/Ai T'61�IZED ?AQv_net of Record; e /�t%t,f�' 6r➢SS /(o$�(x!1,1/04a -S/ ©I z Name(Print) Current Mailing Address: Siynatura Telephone Z Authorized!Agent: /Zt 'q W Af-rr Name(P t) Current Mailing Address: Slgnatura Tele one . SECTION 3,-'ESTIMA'TED' CONS7RUC1�lON COSTS. -* --„ Item Estimated Cost(Dollars)to be ' O(nclal Ua&Only Cam feted b permit applicant t. Building faj BUildin�'Pe[mite�' , 2. Electrical itbj'te�tl�eted�ote'I'P'bs of " - t6ristrbctiohWotn'd " 3. Plumbing Building Permit Fee 4, Mechanical(HVAC) 5.Fire Protection 8.'Total=(1+2+3+4+5) CI}eck N•urriW' - f ` 'this Sectldn ilQr dfFfeEal`Use'OnI Building Permit•Numb®r: _ Signature: Building Commies(onerltrlspectoi,`nt Buildfnda_; '�',;`',1'• ..Data 165 WILLOW ST BP-2014-0894 GIS#: COMMONWEALTH OF MASSACHUSETTS MW:Block: 23C-060 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-2014-0894 Project# JS-2014-001552 Est. Cost: $12000.00 Fee: $72.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MEGAWATT ENERGY SOLUTIONS LLC 57187 Lot Size(sq. 111 65340.00 Owner: KATZ ALAN M&PAULINE M BASSET Zoning: (100)/WSP(100)/ Applicant. MEGAWATT ENERGY SOLUTIONS LLC AT. 165 WILLOW ST Applicant Address: Phone: Insurance: PO BOX 282 (781) 935-8480 WC PROVIDENCER102903 ISSUED ON:212112014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 2.75 KW 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 2/21/2014 0:00:00 $72.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner