Loading...
25C-099 (5) 04/09/14 10 : 27AM EDT Megawatt Energy Solutions -> Town of Northampton 413587127 2 Pg 3/5 at II. � ` ATT SOLUTIONS Properly Owner Consent Form Owner: Deborah Haas .A.ddresS: 55 Grant Avenue Town: Northampton State: MA Zip: 01060 Phone: 413.695-8272 I 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 Solutions, LLC P.Q.Box 23437 Providence, RI 02903 TO/Z0 novi 98YE$96E1b 96:01 v10Z/80/00 03/31/14 04 :33PM EDT Megawatt Energy Solutions –> City of Northampton 413587127 2 Pg 4/39 .Department of Industrial Accidents ` Office of Avestigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Flectriclans/klumbers Aplylleant Information Please Print Legibly NaMe(Business/Organization/Individual): , t�n''qA fir¢.%j_ c7i"f Z2 Y .504,7zek,-o � '.• Address: 7 2_ e.t `X: owz S'/' City/State/Zip: 12011 0�9'v 3 Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.�g I am a employer with 5— 4. ❑ I am a general contractor and I employees(full and/or part-tirzre).* have hired the sub-contractors 6 [1 New construction 2.0 1 am a sole proprietor or partner- listed on the attached.sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity, employees and have workers' comp.insurance.t 9• E]Building addition {No workers' eonrlp. insurance p' 10. Electrical repairs or additions. required.] 5. [� We are.a corporation and its ❑ p 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' cornp. right of exemption per MOL 12.© Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. (No workers' 13.1M Other -50 jJHZ comp,insurance required.] •Any applicant that checks box#1 must also 1111 out the station below showing their workers'compensation policy inforroation. rHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new af'fldavit indicating such, tContraotors 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 is the policy and;ob site information. Insurance Company Name, be Isr4�1/ci Policy#or Self-ins.Lic.#: 00000223744 e m _ Expiratim Date,,.& 32a,J/Y Job Site Address: 67,O, ml 7– .-.City/State/zip; "Olt i71 Attach a copy of the workers'courpensatian policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required tinder 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 under the pains and penalties of perjury that the information provided above is true and correct. iatlatrlre: Date: Phone#: Offieial use only. Do not write in this area,to he completed by city or town offeciaL 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 Pg 5/39 City' of Northampton Massachuvet:to h .DZMaT11 ZIM OP sVSLnaRa ZUSpE MOM 217 Main Street 0 Municipal Building U � Northampton, X& 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner 14ONS OWNER EXEN TION ACKNOWLEDGEtVI,ENT 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 foundation/footings (before backfill), sonotube holes(before pour), a rough building inspection before work is concealed insulation Inspection fif re ulred) 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 Ins_ Rected. 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 tca 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 exemptlon) I will calf 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 Pg 8/39 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Sunervisorr. e a 1 Not Applicable £ Name of License _ License Number Address Expiration Date Signature Telephone 7""2 ! ti ?a,(5 ltd iFt�glgtred��l't0rr`f'i���1�rQ�lfny� ���it?r,ngr� lbr.,�q�X13"�S7j�'�1fta�r!;1 Ji' q;'i�'1T";`l�io" ����. nr�"^Yi'u ''!;l'u L aq .,i�1��./.t.G >:ftt�! ;.s�a�..�;a_ra.i�<�f3rti�yrx NatApplicabie £ Company Name Registration Number Address Expiration Date Telephone ? Z C112o f SECTION 10-WORKERS!COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.-,162,5 25C(6)) Workers Compensation Insuaance 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 armit. Signed Affidavit,Attached Yes:-;K- E No...... £ jitz R The current exemption for"homeowners"was extended to include_0 u-I"- gugled Dwellinag 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 tlia owner nets as supervisor.CMR 780, Sixth Edition Section ldg.3,6.1. 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&Dd/or farm BtilietllCes.A pgisg --wlxQ constructs more than one home in a two-yeAr_l2glod sltall not be considered n homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official.-that he/she shall„bQ responalbie for all such work performed under the ltttI101a permit. 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,yo9_mav he IlAkle 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, 03/31/14 04 :33PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg 9/39 SECTION 6-DESCRIPTION F PROPOSEI? ff0RK•6heck all auulicable) New House [] Addition Replacement Windows Alteration(s) EJ Roofing Or Doors I] Accessory Bldg, Demolition New Signs [q] Docks CQ Siding t01 Other[ Brief Description of Proposed So work: �7 Alteration of existing bedroom Yes_�° No Adding new bedroom.._____.__Yes _(—' No Attached Narrative ( Renovating unfinished basement Yes 2t No Plans Attached Roll -Sheet r•k s 'n N� �- F iz A.r, n• g2r'Y'7r u Y," rry u"�, 7�W� •F rr 4' Y' �iC rCd"� a. Use of building;One Family Two Family Other b. Number of rooms In each family unit: Number of Bathrooms c. 13 there a garage attached? d, Proposed Square footage of new constructio n. ulmenslo e. Number of stories? 0ex f, Method of heating? plat or Woodstoves Number of each g. Energy Conservation Compliance. Maa he k Energy Compliance form attached? h. Type of construction i. Is construction wlthln 100 ft. etlands7 Yes No. I construction within 100 yr. floodplain Yea No j. Depth of basemen cellar floor below finished grade k. Will build conform to the Building and zoning regulations? _Yes No, I. is Tank_,_„_.. City Sewer. _..___ Private well City water Supply SECTION la-OWNER AUTHORIZATION'.;TO BE COMPLelFD.WHEN .OWNERS AGENT 0R°CON71 tACT0A AP�LIES`FOR,HI)It.DINO 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 er/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 Pg 7/39 Section A. ZONING All information Must Be Completed,Permit Can Be Denied Out To Incomplete Information BxWng proposed Required by zoning This column to be filled in by Building Department Lot Size ___— plrotata a Setbacks ont Ide L: Building Height Bldg.Square Footage - % � Open Space bldg Footage payed (Lot area minus bldg&paved arkfn r---� #of Parking 3 acts 1 Fill: volume&Location A. Has a Special Permit/Variance/Flnding ever been issued for/on the site? NO 0 DON'KNOW C) YES 0 IF YES, date issued:r 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 # 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: G, 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 i acre or is it part of 9 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. A n. •, 03/31/14 04 :33PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg 6/39 City of Northampton Building Department 212 Main Street Room 100 gli 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'-51TE.INPORMAT 11N �' T 1.1 Pr izortyAddress: _ i ('' �J N IA SECTION 2,-PRC)PERIY OWt�t>=RSHtPlAttx}iOKt�El7 AG1;NT, 2,1 Owner of Raaord: P-qT —hPE.r 1r'�C^' Name(Prino Current Mailing Address: Telephone elephone Authorized Agent: PevC/ c4�, -` �vp2��" S�l�i;o • ' /�S'" f��,l��, ,r;-� p 131 Name(FIrinij, Current Mailing Address: Signature Telephone S>anoN 3.-ESTtMATEb PON-sTRUSP-TIOR COSTS. Item Estimated Cost(Dollars)to be Official Use Only com leted by ermit a licant 1. Building ;(a)Building Permit fee' , 2. Electrical (b)Estimated Total`Cost of .•Obnsiriact3on`from 6)'' 3, Plumbing Building Fermat Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total-(1 +2+3+4+5) 19 Check Numbdr, Thls$ectlon For d6wal'U'se'Onl Building Permit'Number:- `+2d F' " tom. Cfr pat@ j �� p t Issued:_` Signature: Buhding Commtsslonar/lnspector,a Bulidinae;' note 55 GRANT AVE BP-2014-0704 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25C-099 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-2014-0704 Project# JS-2014-001178 Est.Cost: $19000.00 Fee: $114.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MEGAWATT ENERGY SOLUTIONS LLC 57187 Lot Size(sq. ft.): 8319.96 Owner: HAAS MATTHEW K&DEBORAH K KRISTEN Zoning: URB(100)/ Applicant: MEGAWATT ENERGY SOLUTIONS LLC AT. 55 GRANT AVE Applicant Address: Phone: Insurance: PO BOX 282 (781) 935-8480 WC PROVIDENCER102903 ISSUED ON.1211012013 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL 4.5 KW ROOF MOUNTED SOALR 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: FeeTvpe• Date Paid: Amount: Building 12/10/2013 0:00:00 $114.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner