35-282 (7) 04/09/14 10:27AM EDT Megawatt Energy Solutions -> Town of Northampton 413587127
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ATT
SOLUTIONS
Property Owner Consent Form
Owner: Susan Addis
Address: G Sylvan Lane
Town: Florence
State: MA
Zip: 01062
Phone: 413-587-0881
Y hereby give permission to Megawatt Energy Solutions and their
representatives to pull the required permits for a solar installation on
my property.
Property Owner Date
Megawatt Energy Soiutions, LLC P.0-Box 23437 Providence, RI 02903
04/04/14 02 :35PM EDT Megawatt Energy Solutions -> City of Northampton 413587127
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City ' of Northampton
Massachusetts . .
AEPAli'lMAr'1' Or JWXLDI'N[# XAMPECTIONS
212 b1[aln Street • Municipal Building
North wvton, MA 01060 t' "
IMPECTOR'
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OYMR EXEtVR TION A O1&JkQGEbffl
The State of Massachusetts allows the homeowner the right under 780CMR,108.34 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 fain'lly 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 ae 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 es their own construction supervipor, to be aware that by doing so you
become responslbre for compliance with state building codes and regulations, The Inspection
process requires that the building department be called toinspect work at various stages,which include
foundationlfootings_(befdre backfiiil,sonotube holes libefore pour).a Cough buildlnsl Inspection
(before work is concealed),Insulation Inspection (if regulred)and a final bulldillq Inspection..,
The building department requires these inspections bef Sre the work is concealed, failure t o seCUre
these inspections can result in falluib.#o obtain a c4irtificate of'occupancv until the work can be
Inspected. --�
If the homeowner hires other trade's to perform work(el�ictrical,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 Inspectlolns, Failure of the individual trades to secure
the pormits'and inspections as required can DELAY the protiect 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.
y
Date
Address of work location
t!r
y ,
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.Department of Industrial Accidents
Office of Investigations,
600 Washington Street-4
Boston,MA 02111
www.mass govMa
Workers' Compensation Insurance Affidavit:Builders/ContsactorsfElectricions/Plumbers
Applicant Xuformation please print Y,e bl
Name(Business/Organization/Individual): �V��G1i4-�7�
Address: ' rf' 'a �J 3
city/state/zip: Ur 022!E3 Phone#:
Are you an employer?Check the appropriate box: hype of protect(required):
1.K I am a employer with 4- Q 1 am a general contractor and I 6. Q Now construction „
employees(full and/or part time).* have hired the sub-contractors
2.Q I am a sole proprietor or partner-
ship listed on tlaetached sheet. 7. Q Renaadelimg
and have no employees These sub-cbntractors have S.,Q Demolition.
worsdAg for me in any capacity. employees:and have workers' 9. ,Q Building-addition
[No workers' comp.insurance comp.insomce.t
Q W e are ,'corporation and its 10.[ .Electrioal repairs or additions,
required.] 5.
3.Q 1 am a homeowner doing all work offibere have exercised their 11,Q Plutabing repairs or additions
myself.[No workers'camp. ribrll"f of exemption per Ur L 12,E)Roof repairs
insurance required.]t c. 152,§1(4),and we have:no 1
employees.[No workers' . .Other �C9
Oprap.insurance regt ed.]
*Any applicant that chicks box#1 must also M out the section belq av showing their workers'cwr pcwad.ar.001iey informatiOn-
tHo•mcswnen who submit this affidavit indicating they ace doing all.wotk end'than hire outside contractors trust submit a new affidavit indicating such.
$Contractpa that check this box trust attached an additional sheet il mAng the name of the sub-cortactors and state whether or not those entities have
employees. If tho slob-contractors have employees,they must provide tfhelr workers'comp.policy number.
A am an employer that is providing workers'coipensa pon i urance for my employees Below is the policy and Job site
Information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: 60-0,00 Expiration Date:4 1- 710 1
Job Site Address;
�. VAW �., , - Gity/state/Zip: a'2 1 � �•d•
Attach a copy of the workers' compensation polhey declaration page(showing the policy number and EApiration date).
Failure to secure coverage as required under,Se*on 25A of MQL c. 152 can lead to the imposition of ctinainal penalties of a
fine up to$1,500.00 and/or one-year imprisonmeiat,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 DIP,for insurance coverages verification.
Y do hereby certify under the pains and penalties ofperfury that the information provided above is true anal correct
ate: .
Phone M
Official use only. Do not ltirite in this area,to he completed by city or town official
City or Town: w Permit/License#
issuing Authority(circle wae):
1.Board of Health 2,Building Department 3,City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person. #:
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SECTION 6-CONSTRUCT.ION.SERVICES '
8.1 Licensed Construction Supeerrvlsor: t^ I Not Applicable £
Name of License-HO ^`� ea ✓
�+ r^� License Numbsr y�
2 C�V � 3 ( GSAA —
Address Expiration Date,
l�`,t, rrY,4S S a C O
Signature Telephone 7°- ZO
Not Applicable
£
iZtt° TT- r5V4r" Y SAL,7 0 g G G G
Company NaM Registration Number
Sr OVR(7v, /2-r (,964 -057ig7
Address Expiration Date
SECTION 10•WORKIERS'.COMPEN8ATIQN dNSUt?ANCE AFFIDA VIT(NI.d.L 0.162,§28C(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...... £
IrT i�,I
The current exemption*for`homeowners"was extended to include Owner-oceuglledUwallin4s of one(1) or two(2)families
and to allow such homeowner to engage an individual fbr hire who does not possess a license,groy ded that the ogggr acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.L•
Deflnitlon 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 ona or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person wlto contracts more titan o>w It�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 sh i be
responsible for all such work perfor gd under the building permit
As acting Cott t uction 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 0eneral Laws A motated,you May e liable for person(,)
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,
04/04/14 02 :35PM EDT Megawatt Energy Solutions —> City of Northampton 413587127
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SECTION 5•pE$CRIPTIdN OF PROPOSED WORK;16 ck All agolicable)'
New House [] Addition ❑ Replacement Windows Atteratlon(s) Roofing []
Or Doors
Accessory Bldg, ❑ Demolitlon ❑ Now Signs [II} Decks [M Siding(p] Other tit
Brief Description of Proposed
Work;
Alteration of existing bedroom_Yes No Adding new bedroom Yes /10 No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
�kW'�' ii �ah rIr � t°$ i�tsln"g ` �1" :
a. Use of building:One Family rwo Family Other
b. Number of rooms In each family unit: N bar of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage pf nqw con r t n, DI Ions
e. Number of stories?
f. Method of heating? Fireptac or Woodstoves. Number of each
g. Energy Conservation Compliance, Mas hec En rgy Compliance form attached?
h. Type of construction
1. Is construction within 100 ft,of ands? Yes No, Is co truction within 100 yr. floodplain Yes No
J. Depth of basement or r floor below finished grade
k. Will building c rm to the Building and Zoning regulations? Yes_No.
1. Sept nk_ City Sewer Private well City water Supply
SECTION 7a-OWNER AUTF(ORIZATION".TO,BE COMPLETED.",WHEN`
OWNERS AGENT OR°CONTRAcTok'4PpLIES'FOR,BUl4DING OF-RMIT,
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
as Own edAuthorized
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
5lgnaturs of OwnsdAgent Date
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Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
'1`iiia eolumn to be filled in by
A161ding Department
Lot Size —• �
Frontage
Setbacks nit
L' R: L; R:
LOT
Building Height
Bldg.Square Footage %
Open Space Footage �^-^�-� %
(Lot not minus Will;dt paved
arkin
#of Parking Spaces
Fill:
volume&Location
A. Has a Special.Permit/Yariance/Finding ever been issued for/an 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 C DONT KNOW 0 YES 0
IF YES: enter Book Page= and/or Document #
B. Does the site contain a brook,body of water or wettands? NO 0 DONT 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: i
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size,'type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 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 s common plan
that will disturb over i acre? YES 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW I$required.
04/04/14 02 :35PM EDT Megawatt Energy Solutions -> City of Northampton 413587127
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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 .SITE INFORMATIQN
1.1 Proge&Address;:
, 81;CTION 2.=PROR.ERTY PWNERSHIP/AI!THORI�Eb•,A ENT;
2.1 Owner of Record: "r• -
G .S y Zvi. Low
Name(Print) Currant Mailing Address:
Telephone
Slgnature
2.2 Authorized Aaa t;
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATE[)CONSTRUCTION COSTS.
r s.
Item Estimated Cost(Dollars)to be Of lal Use Only
completed by ermit applicant
1. Building (aj.Buiidlni�'P.ennit�e8
2. Electrical ,(bj' $'timated Total'Cost of"
• .'.:•Construction from'S " - '
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6, Total-(1 +2+$+4+5) ei.7 0.0 Check NUmbe.r
this��9ectlon For O'fflclal Usa'Onl
Da
Building Permlt•Number: ��' . �• C su
Signature:
Building Commis§ioneiflnapedtbr,'ot Buildings
•r,n.
6 SYLVAN LN BP-2014-0821
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 -282 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Catepory: SOLAR PANELS BUILDING PERMIT
Permit# BP-2014-0821
Project# JS-2014-001392
Est.Cost: $28000.00
Fee: $168.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MEGAWATT ENERGY SOLUTIONS LLC 57187
Lot Size(sq.ft.): 42383.88 Owner: ADDIS CRAIG E&SUSAN LYNN WILLIAMS ADDIS
Zoning: Applicant: MEGAWATT ENERGY SOLUTIONS LLC
AT. 6 SYLVAN LN
Applicant Address: Phone: Insurance:
PO BOX 282 (781) 935-8480 WC
PROVIDENCER102903 ISSUED ON:112312014 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 7KW 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 1/23/2014 0:00:00 $168.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner