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31A-248 (4) al"! ATT UTIONS Property Owner Consent Form Owner: Ron Miller Address: 50 Dryads Green Town: Northampton State: MA Zip: 01060 Phone: 413-348-2371 I hereby give permission to Megawatt Energy Solutions and their representatives to pull the required permits for a solar installation on my property. r Prop er Date Megawatt Energy Solutions, LLC P.O.Box 23437 Providence, RI 02903 03/31/14 04 :44PM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pg 4/17 M G(�P2, Department of Industrial,accidents Office of Iravestigations 600 Washington Street kip Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: )3uilders/Contractors/Eiectriciains/Plumbers Applicant Information Please Print Leeibly Name(Business/Orgenization/Individual): &e214w17-r Address: 7 z 0,�I, City/State/Zip: ��U -' Phone#: Are you an employer? Check the a propriate box: Type of project(required): 1.P I am a employer with— 7 4. E] I am a general contractor and I employees(full and/or part-time). «< have hired the sub-contractors 6. El 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, D Demolition working for me,in any capacity. employees and have workers' g ❑ }3uilding addition [No workers' comp.insurance comp,insurance. required.) 5. [] We area corporation and its 10.❑Electrical repairs or additions 3.E1 I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGT 12.❑ Roof repairs insurance required.] r c. 152, §1(4),and we have no employees, [No workers' 13JA Other 50L,,�2-. comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information, tHo meowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must subunit a 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 must provide their workers'comp,policy number. I am an employer that is prowling workers'compensation insurance for my employees. ,Below is the policy and job site information. Insurance Company Name: ' S � � -ri,'S, z4 I Policy#or Self-ins.Lice.-^#: Expiration Date: Job Site Address: J D dl2e 4 OS r?—eo�gl t-171,fo,117"ty/State/Zip; f?�f15' !�/©6 C) 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. Y do hereby certify under the pains and penalties of perjury that the information provided above is true anil correct. Si ature- Z2L Date: ' Z-0 cvv Phone#: ` - 3 a (J Of use only. Do not write in this area,to be completed by city or town official. City or Town: PermittLicense# 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 :44PM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pg 5/17 C3ty " of Northampton Massachusetts {+ DZPARTMUT OP BUXZDXM XKffP :CTX01S x� 212 Main Street • bS=ioipal Building Nlorthamyton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION 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 13ouo, 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 trad es 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) 1 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 : 44PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg 9/17 SECTION B•CONSTRUCTION,SERVICI~9 ' 8.1 Licensed_Construction SuPervtsor: Not Applicable £ Name o. License HDlder: .T r�PS J-"Shy^EL s7t License Number r c�(J� T"C�trz,4r✓fG vA- Address Expiration Date Signature Telephone i' 4 Not Applicable £ r.� �/q•'�""1"� ty✓Can � S�ly�'i art/ �, t1 C-- Company NAml r Registration Number 98 rr� � � 5 e-�� Address Expiration Date SECTION 10«WORKER4?.COMPENSATION INSURANCE AFFIDAVIT(M.O.L.c.162,§25C(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 Yea.. £ No...... £ The current exemption for"homeowners"was extended to include Owr e - ecu ied Dwellin of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license provid d that wner 801 As e isor.CNR 780, Sixth Edition Spection 108.3-5.1, Rohniflon of Homo c :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&md/or farm structures.A poison who eonatr re than one Ito e i a two- ear r d shall not be eo ered 1 omeow c . Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/sltr be resoonsible for all suel► performed under th t b-411dine Rennit, As acting Construction S.tkpgy s r your presence on the job site will be required from time to tithe,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 rnaXjILLiible for person(s) 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 Annotate d. Homeowner Signature, 03/31/14 04 :44PM EDT Megawatt Energy Solutions -> City of Northampton 413587127 2 Pg 8/17 SECTION S-DESCRIPTION OF PROPOSED WORK(check ail'aoglicable) New House [7 Addition Replacement Windows Alteration(s) Roofing EJ or Doors O Accessory Bldg. Q Demolition New Signs [©] Decks (q Siding(p] Other(0 Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes ,_ --No Plans Attached Roll -Sheet J �h 7*r,T uwrr.-,pM,y r,t r,v;W7 r 5c�'T' as r r• x •r cr rro Aa s�� yr s7t de x;r r rirR r. �§g;oy>�xN�VW3�iot}se,ant��Or���l��ior�y ����tlnsl�h�o�ts�nsl:�,cd a. Use of building:One Family Two Family Other..._. . b. Number of rooms In each family unit: of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construct n. Dimension e. Number of starias? f. Method of heating? aces or Woodstoves Number of each g. Energy Conservation Compliance. Masse a Energy Compliance form attached? h. Type of construction I. Is construction within 100 ft.o ands? Yes -No. s co struction within 100 yr. floodpiain Yes-No j. Depth of basement ellar floor below finished grade k. Will bulldi nform to the Building and Zoning regulations? Yes No. I. is Tank, City Sewer Private well City water Supply SECTION 7a•OWNER AUTHORIZATION:-:TO 8E COMPLETEp•:WHEN OWNERS AGENT OR CONTRACTOR'APPLIES'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 I, as Own erfAuthorized 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 :44PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg 7/17 Section 4. ZONING All information Must Be Completed,Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This aoltomn to be filled in by Building Department Lot Size ^^ . .._._. i Lam......... lronte C Satbacks R:= L:L F,: Xcar �l L Building Height Bldg.Square Footage % Open Space Footage % ..� � (J_ot area minus bldg&paved Arkin #of parkin S aces Fill: "• volume&Location A, Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON7 KNOW 0 YES 0 IF YES, date issped:E IF YES. Was the permit recorded at the Registry of Deeds? NO ( DON7 KNOW 0 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 C) 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 IF YES,describe size,'type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 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 a common plan that will disturb over i acre? YES C) NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 03/31/14 04 : 44PM EDT Megawatt Energy Solutions —> City of Northampton 413587127 2 Pg 6/17 City of Northampton Building Department 212 Main Street l Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 t APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATIdN 1.1 PrOPerty Addreaa: //``!! �j V I4 �� �� •'.All 7,�"„l� F • '�;Tr � rhf 04 C'JN f� � ♦9I! iJ i �g; Il;+,jw?'. �f�J'e;Sl:°.{,, �1,, �' 1 tl! .' 5i4i�pt�'a fi j'• fS u..W% SECTION 2.=OROPERTY OWNERSHIP%AUT OR Zrzl7.AGF.NT: 2.1 Owner of Record; r. Name(Print) Current Meiling Address: Telephone Slgnature 12 Auth_Qrl;:0 Ascent: p Name(Print)V v I Current Malting Address: r7 ¢ Q 0 b �”'\�L•���"d'��O U Signature Telephone SECTION 3-ET ,$ CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ;ta)Bullding'P,e�mtt Fed 2. Electrical (b)'Ettimated Totdl'Cost of ';•Cbnstricction'from 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) 000 Check Numb6r Lk This,Sectlon PotO'fficial U$6'Only Building F'ermitNUmbee l7at@ lssued'' Signature: •• , , • : . . ; , .,`.• .• , 84ilding Commfsslonern,ispector'af Buildings; Date :.7N� 50 DRYADS GREEN ST BP-2014-0747 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A-248 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categoa: SOLAR PANELS BUILDING PERMIT Permit# BP-2014-0747 Project# JS-2014-001272 Est. Cost: $21000.00 Fee: $151.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MEGAWATT ENERGY SOLUTIONS LLC 57187 Lot Size(sq. ft.): 5009.40 Owner: MILLER ALEXANDER RON&DEBORAH JEAN MARKS Zoning: URB(100)/ Applicant.• MEGAWATT ENERGY SOLUTIONS LLC AT. 50 DRYADS GREEN ST Applicant Address: Phone: Insurance: PO BOX 282 (401) 312-4678 O WC PROVIDENCER102903 ISSUED ON.1212012013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALLATION OF A 4.94 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: FeeTvpe• Date Paid: Amount: Building 12/20/2013 0:00:00 $151.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner