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06-017 (8) PERGALA r �o 00 711 /1 A ol j I � '1 FERUALA { �x y X(0 T-10 Sts PERGALA 0 .2x y Cc'oSS 30 ALL 1 ICII 1Po s*' P m t,�.V r- s�O-n4+-j\e, t4oac 16 1; ALL ENERGY All Energy Solar 664 Main St Ste 598 Amherst, MA 01002 800-620-3370 customer info Margaret M Ryan 357 Haydenvdle Rd. Leeds,MA 01027 (413)320-6891 5&6 SITE MAP 2 3 System Details 1 4 -Electrical Meter/Bi-Directional Meter located outside 9 -AC Disconnect located outside -Inverters located outside underneath solar panels -Main electric service located inside System Orientation Call Outs 1 : Main Service Panel W < E Z: AC Disconnect 3: Utility Meter S 4: PV Sub Panel Array 1:True orientation 180` 5: Inverters 6: Solar Panels DATE: 10/03/14 The Commonwealth of Massachusetts Department of Industrial.9eeidents ` Office of Investigations 1 Congress Street,Suite 100 Boston,.K4 02114-2017 - nvrw.mass.gor/dia Workers'Compensation Insurance Affidavit:Builders/Contractois/Electr'icians/Plumbers applicant Information Please Print Legibly Name(Bu sines,Organization-bidilidual): All Energy Solar Address:83 Batchelor St. City State Zip:Granby,MA 01033 Phone 413.427.2050 Are you in employer?Check the appropriate box: Type of prolert(required): am a euployer with 35 4. E]I am a general contractor and I 6. ❑New construction employees f full and or part-tulle).° have hired the sub-contractors ❑I art a ole proprietor or partner- listed on the attached sheer 7. E]Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for nne in auy ca P acin' employees and have tyotkers' 9. []Building addition (No workers'comp.insurance comp.hnsarauee. required.] 5.❑Rve are a corporation and its t0.❑Electrical repairs or additions ❑I tiro a homeou-ner doui2 all pork officers have exercised their 11.❑Phmrbing repairs or addition: myself[No workers'comp. right of exemption per NIGL 12.❑Roof repairs insurance fecI tired.]' c 152.§l(d).and we have no sdar employees.[No worker' 13®Other comp.hrsuuance required.] 'Any appheaut Bret checks box d1 most also fill mt the>ectwa below 1tmvra then uoikets'c nupensaam policy mfomtation. ,Hoineownas w10 subtwt flu,affidant indmituig they are doing all nmi wd that hire mtside cmtraaon must subaut a new of id iv mdrealma wch. :Cmnnctor>that Check this box must anached w adda mal sheet showing the name of the sub-,mtracton and state ornerier—.t these eetw-ill enyHoyee.m the sttb-coutraeten Ws a mtpimees.tiro.'nnnst punrde their works>'c mtp.policy munbet. r I am air entpivrer that is providing workers'compensation Msurance for mp employees. Below is the policy and job site information. Insurance Counparty Name,Ace American Insurance Company Police=or Self-his.Lic.=C4820241 Expiration Date: 9/3012015 Job Site Address: 357 EiawdpnyillP Rd. Cin State Zi[;f;eedS A 01053 Attach a copy of the workers'compensation policy declaration page(showing the polky number and expiration date). Failure to secure coverage as requred Ruder Section 25A of MGL c.152 can lead to the imposition of ututnal penalties of a fire lip to S 1.500.00 and or one-year hnprisommeut.as well as civil penalties in the form of it STOP\PORK ORDER and a fore of up to S_50.00 a day against the violator. Be advised drat a copy of this statement may be forwarded to the Office of Investigations of the DIA for imstramee coverage verification. I do hereby certij (perjury that the information prorided above is trite and correct. Sisablure: _Date: 11/12/14 Phone^ 413.427.2050 Official use only. Do not write in this area,to be completed by city or town official. Westhampton.MA 0102 City or Town: Permit'License# Issuing authority(circle one): 1.Board of Health 2.Building Department 3.City-flown Clerk a.Electrical Inspector 5.Plumbing luyiector 6.Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: K q r!:�`7 C)to r n 1 C J 0-5 ;,)r 70 —�— License Number Addr s < Expiration Date Signature 0 Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ ;A �1 -7 S ic(4 Company Name J Registration Number Address I Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§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 buil ing permit. Signed Affidavit Attached Yes....... No...... ❑ 11, Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied 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,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. 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 and/or farm structures.A person who constructs more than one home in 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 shall be responsible for all such work performed under the building 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,you may be liable 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 Annotated. Homeowner Signature EW SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing El Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs (C]) Decks [E] Siding[Oi Other[04 % 5 Brief Description of Proposed �h Work: 55-, e Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If New house and or addition to existing housing, Complete the following: 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 construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? V" h. Type of construction 0 j P/.\ °�O�--3 e-,'� i. Is construction within 100 ft.of wetlands? Yes No. Is I/s(construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade /u' I k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, M(n rv11 h l Tin a as Owner of the subject property /) So hereby authorize to act on my behalf,in all matters relative to wo uthorized by this building permit application. Signature df Owner Date I, P(( Fo-r",-Ir (All Ft-4 O �� 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. k e rf, FU rn i e>>r Print Nam 4 fly Signature of Owner/ gent Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning V, �� This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: J5 R: -7S- Rear CS Building Height 11 Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Sp ial Permit/Variance/Finding ever been issued for/on the site? NO F DON'T KNOW © YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Or/- DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained ® , Date Issued: C. Do any signs exist on the property? YES ® NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,ex tion,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. DepartnvW use only City of Northampton Status of Permit: Building Department Curb CutlDdveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Ava ability Northampton, MA 01060 Two Sets of Structural Plans � o phone 413-587.1240 Fax 413-587-1272 Pk*Site Plans c `! Other Specify to 6 N APPUCA71ON TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Oz s °Z O �► 65 A N SE 1-SITE INFORMATION This section to be cmvieted by office 1.1 rW AddMa: Map Lot Unit ` e C S Zone Overlay Cfttrict Elm St CS District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2,1 Owner of Record: H h dratyi llr Name(P Mt)t) CurrenttAailing�dn"; e3 �ii3 lYtcLUn .S,y Telephone Sign"e 2.2 Authartzsd Agent: S No Print) + Current Mailing Address. ��— Signatur Telephone §,Ig,CCTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by rmit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Pennit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) i.SC Check Number 5 61 This Section For Official Use Only Date Building Permit Number: sued: Signature: Budding Commissioner/Inspector of Buildings Date V` aY File#BP-2015-0611 ' APPLICANT/CONTACT PERSON ALL ENERGY SOLAR INC ADDRESS/PHONE 83 BATCHELOR ST GRANBY (413)427-2050 PROPERTY LOCATION 357 HAYDENVILLE RD MAP 06 PARCEL 017 001 ZONE SR(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Cam'#' �5,�i it 4 • too Building Permit Filled out Fee Paid Typeof Construction:_PRESSURE TREATED PERGALA New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 052870 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: LApproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management D lif ela Signa ure of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. 357 HAYDENVILLE RD BP-2015-0611 GIs#: I COMMONWEALTH OF MASSACHUSETTS Map:Block: 06-017 CITY OF NORTHAMPTON Lot:-00 L PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Building BUILDING PERMIT Permit# BP-2015-0611 Project# JS-2015-001092 Est.Cost: $2500.00 Fee: $48.60 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ALL ENERGY SOLAR INC 052870 Lot Size(sq. ft.): 51705.72 Owner: THRANE MARY ANN zoninjz: SR(100) Applicant: ALL ENERGY SOLAR INC AT. 357 HAYDENVILLE RD Applicant Address: Phone: Insurance: 83 BATCHELOR ST (413)427-2050 WC GRANBYMA01033 ISSUED ON.1211012014 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 9 X 27 PERGALA 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 12/10/2014 0:00:00 $48.60 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner