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24C-158 (12) 04/09/14 10:27AM EDT Megawatt Energy Solutions -> Town of Northampton 413587127 2 Pg 2/5 Aff SatuT10NS Property Owner Consent Form Owner: WC Ell Town: State: Zip: Phone: 1-5 ry I hereby give permission to Megawatt Energy Solutions and their representatives to hull the required permits for a solar installation on my property. V Property Owner Date Megawatt Energy Solutions, LLC P.O.Box 23437 Providence, RI 02903 03/31/14 04 : 54PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg 4/17 Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Iluiiders/Contractors/Electricians/PXumbers Apnlicant Information Please Print Le ibl Name(Business/Organization/Individual): 4,�7_ 67"�y Address: City/State/Zip: Lm, . 0� 0,3 Phone t "63 Y-, 2< Are you an employer? Check the appropriate box: Type. �pe of project(required); S__ 4 1. 1 am a employer with � ❑ I am a general contractor and Y 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 g. E]Demolition working for me in any capacity, employees and have workers' comp.insurance.t 9. Building addition workers comp, insurance p' 10,El Electrical repairs or additions required,] S. ❑ We are a corporation and its 3.C3 I am a homeowner doing all work officers have exercised their 11.[I plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[]Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.x'Other-� G'WZ comp,insurance required.] *Any applicant that checks box#1 must also All out the section below showing their workers'compensation policy information, tHo meowners who submit this affidavit indicating they axe doing all work and then hire outside contractors must submit it new affidavit indicating such. #Contractors 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 trust provide their workers'comp.policy number. .I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information, Insurance Company Dame: L)(°S&4rz_5 ,fig c_c/ Policy#or Self-ins,Lic.#: ' '�-1 70 S-- Expiration Date: le) S/ ev/ Job Site Address: �LY f$r l!M��✓� /1/y - '1 P al City/State/Zip: D/D Cv C3 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 25.A,of MUL 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 DTA for insurance coverage verification, p do hereby certify under the pains and penalties of perjury that die information provided above is true and correct. Lure: Date: 6 c P 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 :54PM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pg 5/17 City of Northampton .M.. I b. Massachusetts �•-�rr. "' as DE'PART=WT OP BUXkPXWG INSP90'1` 000 212 Main strut • Municipal Building Northamptonf MA 01060 Y INSPSCTO'R Louis Hasbrouck Chuck Miller Ouilding Commissioner Assistant Commissioner HONE OWNER EXEMPTION ACKN'OWLEDGEMBNT 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 foundationlfootinas (before backflll) sonotube holes (before pour), 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 :54PM EDT Megawatt Energy Solutions —? City of Northampton 413587127 2 Pg 6/17 SECTION S-..CEgCRIPT.ION OF PROP_Q$EO—YORK(check all applicable)' New House © Addition Q Replacement Windows Alteration(s) ID Roofing or Doors C3 Accessory Bldg. © Demolition ❑ New Signs ([O] Decks [lam Siding[❑J Other[ Brief Description of Proposed Work: Alteration of exl®ting bedroom Yes Plans Attached d o ll -Sheet No Adding new bedroom Yes _No Attached Narrative Renovating unfinished basement --._ �m Yes No Roll r,�?r7,T����n , , �,n•m'4"p, 'S"'ire rani '.t 'Y V'X;0.;Y?�1 r�, � u ,,y,.r7,".� y t„ y�Yrilltt.'tw7ti '"•"�. r'�. �,� �,,.Mfahq, r3 i 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 cons u Ion. Dimensions e. Number of stories? f. Method of healing? Fir ces or Woodstoves _Number of each g. Energy Conservation Compliance. Masse orgy Compliance form attached? h. Type of construction i. Is construction within 100 etlands? Yea .__._....N Is con ruction within 100 yr, fioodplain Yes---No J. Depth of baseme r cellar floor below finished grade k. Will bui ' conform to the Building and Zoning regulations? Yes No. I. eptie Tank City Sewer Private well City water Supply SECTION la-OWNER AUTHORIZATION'-,`PO BE COMPL,RTED;WHBN OWNERS ADEN r OR CONTRACToR ApPLiRs'FOR,BUILDING 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 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 04:54PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg 7/17 SECTION 8•C0N6TRUCTION.$EP.VICE3 8.1 License Construetlon-SLI12orvisor: 7_ Not Applicable £ _ License Number Address Expiration Date signature - ?Telephone 71 z� ' Fe,/3 ,� - &,,,, A-r r,r or r••q .k..r gar i c t m � t r:'Y'"Y�•)n^. rt>= � '1"!"" .'" 1 FI'r�•t $'r�r.F..he o rY.. f taatt' t1�F;iOinai"iiprai/ 'm r�i? arctPir rar'c�'ufi.t^ y,��c" i, ! +"1.1t�,'a„ �•. Not Applicable A a £ eq A"r r C'2 ' 5e 5o vii acv-5- GGG CYrII9--C>5-W$' Comoan ame V I Registration Number 0 a,1r 12/ 7-21 - Z.olS Address Expiration Date P(20 y (2~"r Telephone SECTION 10-WORKERS''COMPENSATION INSURANCE 4141FIDAVIT jM.d.L.c;.,162,§260(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 parmit. Signed Affidavit Attached Yes. £ No...... E iY'tit "NO t � � 9'19 r"57 r-r�Fax �*•art^ 3, ry�^w'�" The current exemption for"homeowners"was extended to include Owner ecuoied 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,provldod that the owner acts a�suuerylsor&.NR 7$0, Sixth Ad1 ion Section 10$,1 .1, f?efinition of UM owner: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 ard/or farm structures.A Person wlt�constructs more that►one home to a two-Year period shall not be eons dered &homeoylaer. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,09 he/sloe shall.� resgQAlsible for all su h work perrormed under the bullcl nr vermit, As acting ConstruOlon 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,You may be liable for person(s) you hire to perform work for you under this permit. The undersigned`%omeowner"certifies and assumes responsibility for compliance with the State Building Coda,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated, Homeowner Signature, 03/31/14 04 : 54PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg 9/17 Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing proposed Required by Zoning This column to be tilled in by nuilding Aepertmant Lot Size Frontage Setbacks Fro � � Side L,, R:= L:= Building Height Bldg.Square Footage �� % Open Space Footage (Lot arse minus bldg&paved #of Parking Spaces Fill: volume&Location A. Has 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 DON'T 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 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: 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 a IF YES,describe size, type and location: E. Will the construction activltydisturb(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 Pg 8/17 r City of Northampton Building Department 212 Main Street ' Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-5871272 9 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 •SITE,INFORMATION,'," ; 1.1 Property Address: L11 I�:.I. M S, 1 r t.tqq rig is. SECTION 2.'-PROPERTY OWNERSHIPlAUTk1ORIZED,,AGENT', 2.1 Owner of Record: 4• /0 Name(Print) Current Mailing Address; Telephone Signature 2.2 Authorized Agent: Mel /7 G✓I' `6 /J!/��r'-/ S Name(Print)/ Current Mallino Address: Signature Telephone SECTION 3• ESTIMATED CONS TRUCTION'COSTS. Item Estimated Cost(Dollars)to be :' Official Use,Only com feted by ermit a2plicant 1, Building (a)8uildin P.e(rnit F01 2. Electrical (b)'Estlmgted Total"Cosl of ' t6nstruction froriti'6 3, Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total 0 +2+3+4+5) a0ce Check Nurribpr,' This Section Fof O`fflciaf Use Onl Building Permit Number: r �'� I ©sued: Signature: — Building Comrnlssionerllnspector,`of 9ulldings DatQ 28 ARLINGTON ST BP-2014-0720 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24C- 158 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-2014-0720 Project# JS-2014-001215 Est.Cost: $8000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MEGAWATT ENERGY SOLUTIONS LLC 57187 Lot Size(sq. ft.): 12501.72 Owner: HUNTER CATHERINE J Zoning: URB 100)/ Applicant: MEGAWATT ENERGY SOLUTIONS LLC AT. 28 ARLINGTON ST Applicant Address: Phone: Insurance: PO BOX 282 (781) 935-8480 WC PROVIDENCER102903 ISSUED ON.•1211612013 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL 1.5KW SOLAR ARRAY TO ROOF 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 12/16/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner