Loading...
17C-051 (4) 04/14/14 04 : 09PM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pg 3/3 c ATT SOIOTIONS Property Owner Consent Form Owner: Jodi Kaufman Address: 50 Strawberry Hill Town: Florence State: MA Zip: 01062 Phone: 413585-0340 I hereby give permission to Megawatt Energy Solutions and their representatives to pull the required permits for a solar installation on my property. ap r erty Owner Date Megowait Cr)ergy soiulions, LLC P.O.B ax 23437 Providence, PI 02903 03/31/14 04 : 33PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg26/39 - - __......-......... .. _._.. __...-- -- !� `" 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 /� / Please Print Legibly Name(Business/Organization/Individual): At,-,--,* / e,1 J°/' :j41 74a n,,5 4 Lc. V _--—,� AddreSS: 7 c i ac f f� City/State/Zip: tpe,OV aT_ 0��C Phone#: g<�' '" � - e 9 9,q Are you an employer? Check the appropriate boar: Type of project(required): 1.tt'" I am a employer with 4. 1 am a general contractor and]: employees(full and/or part-time).* have hired the sub-contractors New construction 2.[l I am a sole proprietor or partner- listed on the attached sheet. 7. ()Remodeling ship and have no employees These sub-contractors have S. Demolition working for me in any capacity. employees and have workers' 0 Building addition [N o workers'com p. insurance com p•insurance.l required.) 5• © We area corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.[1 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 employees.(No workers' 13.0 Other So ba ,e comp.insurance required,) "Any applicant that checks box 01 must also fill out the section below showing their workers'Compensation policy information. No meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name or 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. lain an e►nployer that isproviding lvorkers'compensatlett insurance for my employees. Below is the policy and job site information. Insurance Company Name: De s.4,n e r,y Policy#or Set#-ins.Lic,#: d 7 e Expiration Date: c� 0(0 C- Job Site Address: / �ey5' t� 0 ��°��"' City/State/zip: Xt'! S'r 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 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. ,f do hereby certify nder the pains and penalties of perjury that the information provided above if true ancz correct . lone_# 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 Healtb 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 Pg27/39 City of Northampton Massachusetts Y DEPARTMNT OP BUXLDXNG TfvaeacxsorTS 212 Main Street • municipal Building Northampton, 14A 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEWTION ACKNOWLEDGEMENT 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 pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building ins ectlon. 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 QFFLAY 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 :33PM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pg3l/39 SECTIONS•CQNSTRUCTION.SERVIOeS 8.1 Licensed.,Cons kuction Super Not Applicable E Harn.9 of Licen!%g Holder; 'T Sh/tr�.J ITI?_ License Number r CC CL Address Expiration Date sIgnature Telephone �/'?�/ ,?o (JAkWfiff Not Applicable E Comps rO Np V if Registration Number Address Expiration Date 0�i?90_3' —Telephone V 9'_9_?i22ff SECTION 10•WORKSAP!.'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.cl,162,9 26C(0)) Workers Compensation Insurionce 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.. E No...... E The current exemption for"homeowners"was extended to include Owne"ecupled Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess it license,provided that the ow&er act as supervisor,CMU80— Sixth Editl.Qn Section 108.3.5,L PeOnitlon of Homeowner:Person(a)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 Vho coat 4iets more tan ott�_Ijome in a ft q g r criod sitall A.qbge considered z homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building OfficiaL that he/she shall be respqnsIble for all suclk work performed under_the bulldina Pgrinit. 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 Erhployers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,Xou Ins!Y be IJM&1e for person(s) you hire to perform work for you under this permit. The undersigned"homcowner"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 04:33PM EDT Megawatt Energy Solutions —> City oi° Northampton 413587127 2 Pg30/39 §CTION ti-05SCRIPTION OF PROPOSED WORK(check all applicable)' Now Mouse © Addition Replacement Windows Alteratlon(s) { Roofing or Doors i] Accessory Bldg. Demolition El New Signs [©) Decks [QI Siding[p) Other[ Brief Description of Proposed Work; Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement es �_No Plans Attached Roll Sheet ,,,�;,—. ,T,..•_.�,gn.rF'f<bT 4n• T:1;14 N1:'"C. IIMf¢5 ":a�n,:7zr7"W'•' ["''lNr1;v'+;{;,,.�DMpu: n:rtq'-:7r*r 'i t F nY -0Y { 'ajf NerhY,�iot�se, r c rtsr.,adrlt on�toaexi�tina'il ou tnh;'rcc�miYlet >>t�i fdllciwm 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 str ction, Dim ons e. Number of stories? f. Method of heating? replaces dstoves Number of each g. Energy Conservation Compliance. Mess ck Ener y Compliance form attached? h. Type of construction 1. Is construction within 100 ft. tlands?—Yes N Is constru lion within 100 yr, floodplain Yes No j. Depth of basemen cellar floor below finished grade k. Wili build conform to the Building and Zoning regulations? Yes .No. 1. is Tank City Sewer Private well City water Supply SECTION 7a•OWNER AUTKORI7.ATION,TO Be COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIESTOR,pUJIMDING PER 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 Owner/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/A ant Date 03/31/14 04 :33PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg29/39 Section 4. ZONING All information Must Be Completed,Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Ais colmnn to be tilled in by Building Department Lot Size Frontage Setbacks From E Building Height Bldg,Square Footage Open Space Footage �—y % ("t area minus bldg&paved #of Parking S aces 17;11: T volume&Location A. Has a Speciat Permit/Vari'ance/Ffnding ever been Issued for/on the site? NO 0 DON7 KNOW Q YES 0 IF YES, date issued:1 IF YES, Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES ; IF YES: enter Book page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 Dow KNOW a YES 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 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 :33PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg28/39 I City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413587-1240 Fax 413-587-1272 a APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE!OR TWO FAMILY DWELLING SECTION 1-SITE.INFORIVIAT10N ' 1.1 PraaertyAddresi: i� i. ;N°�':: ,• . �'2�6✓C���Z/d (7 ,Lr� V rrr I rt 14: r I� I^I' 'rll�ti.1�.•�'a..�..I.,i.. '2TA / 1 r� ', .i V' .I r"�f�,•dre��iK tin�•'t,,:�.i �/! �f ll/iPlGa[' MS'S I „I'IiM�,`•htfi'rP�r °'i'_i°iJr' St:CTION 2.:-PROPSRTY OWNERSHIP/Ayj(i3ORizr:dAgG NX:,- <.. 2.1 Owner of Record; _ / ��t4(�a-'/ Av 5D Si-0,1 Gv Name(Print) Current Mailing Address: Telephone Signature - 2,2 Authorized Aunt. -� Nerve(Print) Current Mailing Address: _6j. 9 Signature Telephone SEC710fJ 3 ESTIMATBP CONSTRt1C7'IONCgSTS, . Item Estimated Cost(Dollars)to be OfflGlal Use'Only completed by ermit applicant 1. Building (a),B,ullding"Permit(=e6 2. Electrical (b)' tlmated Total'Cost of" i; c6nstructforl from'6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=0 +2+3+4+5 p °c' C, eck Numb @r 7his:3ectlon Doi'Official'Use Only ' Dst$ p-` Building Permit•NUmb6r: Signature: Building-Commis8(oiler/lrtspector'o�Bugdln s' ost� 50 STRAWBERRY HILL BP-2014-0721 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-051 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-2014-0721 Project# JS-2014-001216 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.): 48787.20 Owner: KAUFMAN JODI&DAVID Zoning. URA000)/ Applicant: MEGAWATT ENERGY SOLUTIONS LLC AT. 50 STRAWBERRY HILL Applicant Address: Phone: Insurance: PO BOX 282 (781) 935-8480 WC PROVIDENCER102903 ISSUED ON.1211612013 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 Occupant Siznature: FeeType• Date Paid: Amount: Building 12/16/2013 0:00:00 $168.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Louis Hasbrouck—Building Commissioner