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29-014 (3) E l i { i i 16 HICKORY DR EA=2015-0314 COMMONWE>4LTH OF MASSACHUSETTS CITY O� NORTHAMPTON Mup 29 Lot:01,1 ELECT ICAL PETIT Permit: Electrical Category: INSTAL.I,9.9KW ROOF MOUNTED SOLAR ARRAY Permit;; Electrical j pERMJSS/ON IS HER4BY GRANTED TO. Project JS-2015-000692 Est,Cost: Contractor: License: Pce. $60,00 REAL GOODS SOLAR IN MASTER ELECTRICIAN 14005 0%wer: WARAWKA EUG NE E&JULIA M Applicant: REAL GOODS OLAR INC AT: 16 HICKORY DR Applicant Address Phone I Insurance 32 TAUGWONK SPUR RD UNIT Al2 (860) 535-330{) Liability, I RG200052801 { STONINGTON CT06378 ISWED 0N:I0111201d 0:00:011 i y TO PERFO)?M'THE F`OLLOWNG WORK. INSTALL 9.9KW ROOF MOUNTED SOLAR ARRAY Call In Date: hate Requested inspection Datt Signofli Reinspect?, rrenchltz(": t t Special Instructions Rau h Y s Special Instructions: i Final: SRE Called In: f, f Sienatu�re: i 1 Fee Type-.'. Amount: DatePaid _ I 3 Electrical $60.00 10/112014 0:0000 8263 a 212 Main Streei,Plione(d 11)587-1244_t,ax(413)587-i2�2-Inspector d Wires -Roger Malo 1 APEX Engineering www.thestructurals.com 281 East Hamilton Avenue • Suite 5 • Campbell • CA •95008-0232 Telephone:408.379.2068 • apex @thestructurals.com Friday, September 19, 2014 X 5483-14 Warawka 10223559 C.Roberts MA RGS >� - ROOF Photovoltaic DC Rating: 9.900 kW Warawka, Michael 16 Hickory Drive Florence, MA 01062 Jurisdiction: City of Northampton To: Building Department, The aforementioned structure has been examined and it has been determined that the structure can support the proposed 9.900 kW PV system. We have verified the structural integrity of the roof framing and found that the installation will satisfy the structural roof requirements of governing codes: MA 780 CMR, 8th Edition -including 2/4/11 revisions to Tables R301.2(4) & R301.2(5)ASCE/ANSI 7-05 Minimum Design Loads for Buildings and Other Structures. The design is based on wind speed of 90 mph, exposure B, ground snow load of 40 PSF and PV Panel of 3.32 psf. The PV attachment at 48" OC staggered, maximum has been approved by APEX Engineering. The photovoltaic system and the mounting assembly comply with the loading requirements. The roof structure is adequate to support self-weight of roof, PV panels and snow loading conditions and wind pressures. Sincerely, OF y1 tN -`+I Ground WEES& THOMAS J. G Module Clare YAT Unirac Solammount 0 0 CIVIL n Rail w/L-foot No.51039 Green Fasten Flashing: ISTEp`�o Q _.__ _ EC0-GF Comp With Module(TY'P.) — ECO-CP-S(]Compression Bracket. OVAL E Rooftop r 5/16"x 3 5"S.S_Lag Bolt Expires: 05/gr Qj,`x 6 ®,�. - Seale w/Approved Penetration •?41�G� �6 Sealed w!Appraved Sealant 0 /1 l Attachment Detail f 2 i Scab: 1"= 1'4. FOR CONSTRUCTION 32 Taugwonk Spur,Al2 Stonginton,CT 06378 Phone 1860)535-3370 Pax(413)683-2225 GRID-TIED PHOTOVOLTAIC SYSTEM N WARNING I 9.900kW DC @ STC ARE PRESENT AT THIS LOCATION: ELECT RIC SHOCK HAZARD i WARAWKA,MICHAEL IF GROUND FAULT IS INDKCAIED 1.UTILITY GRED 16 HICKORY DRIVE NORMALLY GROUNDED CONDUCTORS --2.-PH-OTOVOI-TAIC FLORENCE, MA 01062 NEC Article 690.64(B)(4) Project E 0223559 &705.10 oesorvER DKN NEC Article 690.5(C) CR NE%oN a 2014-09-18 REVISIONS Every 10'on all conduit,j-boxes,& # BY Date Notes NEC Article 690.14(C)(2) raceways CEC Article 690 x 3 ,y, ELECTRIC SHOCK HAZARD CONNECTION DO NOT RELOCATE a d O II 8 NEC Article 690.64(B)(7) I GAD SIDES MAY BE ENERGIZED IN THE OPEN POSIHON NEC Article 690.17 &705.22(4) 8.94A RATED MAX POWER POINT Vol TAGE: 3 MAXIMUM 19 MAXIMUM I I� „V SHORT(IR(UTE CURRENT: 11.98A System Specifications System Specifications NEC Article 690.54 NEC Article 690.53 NTS SIGNAGE PV-G01 FOR CONSTRUCTION MODULE SPECIFICATIONS TEMPERATURES Solarworld Plus SW 275 Mono Black Ambient Low Temperature: .20°C ................................................................................................... STC Rating;; 275 W Height: 65.9 in. Ambient High Temperature: 32-C 32 Taugwonk Spur,Al2 ........ ..............................I--............................................................... 3tonginton,CT 06378 ................ PTC Rating. 240 W Width: 39.4 in. Temp.Rise for Voltage Calculations: 31-C Phone(860)CT 03370 .........................................................I.............. ........... ..................... .................................-....................... V rap: 31:0 V Depth: 1.22 in. Temp.Rise for Exposed Conduit on Roof: Fax(a13(683-zzzs ... ......... i ap Area: 18...tN ..........................................................Ight......................... SYSTEM LABELING SPECIFICATIONS GRID TIED .......................................................o39..V Weigh: 46.7 Ibs """Max.Fuse:"16.*6°°'°° Max.DC Voltage(-20°C): 44.7 V DC Max.Current: 11.98 A PHOTOVOLTAIC SYSTEM I sc: 9.58 A Max.Fuse: 16.00 A .................................................. ............ ....................... Operating Voltage: 31.0 V DC Operating Current: 8.94 A 9.900kW DC(B STC Temp.Cceff..N.�);...-0.3000%/°C ...................................................................................................................... AC Nominal Voltage: 240 V Max.AC Current: 36.0 A WARAWKA,MICHAEL 16 HICKORY DRIVE INVERTER 1 SPECIFICATIONS INVERTER 1 CURRENTS INVERTER 1 LABELING SPECIFICATIONS FLORENCE, Project#102222 3559 559 Enphase Energy M250-60-2LL-S22 DC Max.Current: MODULE Isc x 1.25 Max.DC VoRage(-20°C): 44,7 V DC Max.Current: 11.98 A ...ax.......................................... DKN Nominal V Ac: 240 V 9.58A x 1.25 = 11.98 A DC Operating Voltage: 31.0 V DC Operating Current: g.g4 A ....................................................................... ....................................................................................................................................................................... .......................................................................................................................I.................................. era CR Max.W Dc: 300 W DC Operating Current: MODULE Imp AC Nominal Voltage: 240 V Max.AC Current: 36.0 A Max.......................................... E���� 2014-09-18 Max.W Ac: 240 W 8.94A 8.94 A ....................... ........9.................. ............................................................................................................................................................................... INVERTER 1 VOLTAGES Startup Voltage: 22 V Source Current,I Dc: MODULE Isc x 1.25 x 1.25 REVISIONS °'-"'°'°"°'"""'"°°""•"°..... '° "'°''°° DC Max.Voltage MODULE Voc x TEMP DELTA x TEMP COEF Voc Min:V ap: 16 V .....................................................9:SSA.._X...x:25..X..�:25....=....14;97 A........ (-20'C): 39.4V x 45 x 0.003 = 44.7 V # By Date Notes Max.V Mp: 48 V Output Current,I Ac: INVERTER lac x INVERTER QTY x 1.25 ....................................................................................................................................................... ................................................................... _ DC Operating MODUI E Vmp Max:V Dc: 48 V................. 1A x 1.25 x 36 45.00 A Max.I Dc: ..................... Voltage: 31%1 31.0 V 2 ........................ 15.A................. 9 Max. Ac: 1.00 A ...................................................................... CEC Efficiency: 96.5% 6 d °a s �• N/A ELECTRICAL CALCS PV-E02 FOR CONSTRUCTION 4)"o Notes: WIRE SCHEDULE ,J,o Tag Qty Size Wire Type Ground Size&Type Conduit Length ✓ a_ 1. All conduit to use water-tight expansion fittings. z 2. All Rooftop conduit to be a minimum of 1"above the roof surface. .A...._., 3 #12 ,,ENGAGE.CABLE #6 AWG BARE Cu FREE AIR € N/A R G S ............_.................. ...................................... ................................................................ 3. PV Connection into Load Center shall be positioned at the opposite end from the Utility Input feeder location.(Where applicable) B 9 #10 THHWTHWN-2 #8 AWG THWN-2 1"EMT [ 50 Ft ....... ....._............._........................................................_................................................................................... 4. All equipment to be rated NEMA-3R unless otherwise noted. C. .......... #8 THHWTHWN-2 #8 AWG THWN-2 3/4" MT 10 Ft ......... ............................ 5. Lowest expected ambient temperature based on ASHRAE min.mean extreme dry bulb temperature for ASHRAE location most °"'°p°'°'r' 3' """' 3z raugwonk spur,Alz similar to installation. .-.3 „#6 THHN/THWN-2 '.................NA 3/4"EMT 10 Ft .................. ......_. ............................................._. ........................ ...................... Ston-Inton,Cr 06378 6. Highest continuous ambient temperature based on ASHRAE highest month 2%dry bulb temperature for ASHRAE location most Phone(860)535-3370 similar to installation. WIRE SIZING F_(413)683-2225 7. All conductors to be copper unless noted otherwise. 90°C Derated Amapacity 75°C GRID-TIED 8. Conductor sizing shall limit Voltage drop to 2%DC&1.5%AC(2%for Enphase Systems). Tag Size (Allowable Amps x Temp Derate x Fill Derate) Ampacity PHOTOVOLTAIC SYSTEM #12..._.........................._30A X 0.76 =:22.80 A..........s........25:�.A.. @STC A.....,...#12 ..................._.22.8 8.900kW DC #10 40A X 0.76 X 0.7 =:21.28A 35.00 A .8.....,............._.................................................................._......................................................... WARAWKA,MICHAEL #8 55A X 0.96 X 1 = 52.80 A..........:........... .......... 16 HICKORY DRIVE C....._............._............................-....................................._.............. D #6 .................. _.........................:................................ Project#10223559 SYSTEM LABELING SPECIFICATIONS oesoueR DKN Max.DC Voltage(-20°C): 44.7 V DC Max.Current: 11.98 A CR ..................................................................................................................... eR DC Operating Voltage: 31.0 V DC Operating Current: 8.94 A e�a o.� 2014-09-18 AC Nominal Voltage: 240 V Max.AC Current: 33366.00A REVISIONS # BY Date Notes z 3 6 5 a R r-----------------------+ ;EXTERIOR (MEnphase Envoy 36 Solarworld Plus SW 275 mono black Modules with m<mN I 36 Enphase Energy M250-60-2LL-S22 Micro-Inverters ENV-120-01 Branch of 12 zov mose< (N)Fused r r s (M PV AC COMBI dd Kw rtCrnzoaot> v — _— __ Square D (M PV Meter AC Disconnect Square D D222NRB ----- 240VAC Enphase(OEM:GE) 60A RGM-MTR-01 240VAC Branch of 12 I J-Box 4x4x4 240VAC 15A M 45A 15A 15A — — N Branch of 12 1 D WS B -- ELECTRICAL DIAGRAM #P A UX c-ROUN' I r , PV-E01 Rooftop 11ctrical__________ Interior Electrical I Roof Zones for Enclosed Buildings Suggested Bill of Materials "M' NO�TE.UM.1.Is Listed below are subject to change dunng final I nstaffation. SOLARWORLD Plus SW 275 mon,black : Plus SW 2�9** : Phone(860)535-3370 Pax(413)693-2225 IWERTERS a M250 : AGWMTR�l 16 HICKORY DRIVE Project#10223559 CR ET-TERM-01 4 ET-CLI"l 164 NutSIS 10115) 62 SBC.St, 110 T* VARIES FOR CONSTRUCTION Ground WEEB& ��y Module Clamp R�a S Unirac Solarmount ogVack,j Rail wl L-foot fop 2T5 Green Fasten Fleshin : 32 7caugwonkspur,al2 g 5 glnton,Cr 06378 p\us �ti�\e ECO-GF1-BLK 812 With Phone(860)535-3370 --' Cep• Module(TYP.) --__,, ECO-CP-SQ Compression Bracket Fax(413)683-2225 �,E 0C. Rooftop -'� 5/16'x3.5"S.S.Lag Bolt GRID-TIED Rsf�O� w/2.5'Minimum Penetration PHOTOVOLTAIC SYSTEM ` l 2X6 @ 1fi Sealed w/Approved Sealant VATLOIs 9.900kW DC STC 2 Xfi OG. WARAWKA,MICHAEL 16 HICKORY DRIVE FLORENCE,MA 01062 Project#102235559 Attachment Profile 'f Attachment Detail �g Ea DKN 1 Scale:3/4"=V-0" G Scale:1"=V-0" " CR 2014-09-18 20"Max 20"Max REVISIONS Roof Framing PV Module Rail Overhang Rail Splice Rail Overhang # By Date Notes Tr Roof it~ T° 2 Attachment 3 4 Anchors located ii 11 i; s on aIternate roof framing members Stagger splice locations Min of 2 supports SolarMouM Rail within the each row of modules on either side of splice with a max spacing of 60" nc or patio 3 Sta ered Attachment Detail T . 4 Rail Splice Detail NTS NTS X _ WEEBLug SS Washer Module Frame Ground Wire �\ \ &Nut SS Bolt �_ ® Unirac Rail \ SS Bolt Nib ° Unirac UGC-1 SS Flat Washer SS Bolt w VARIES Unirac Rail DETAILS 5 Grounding Clip & Module Grounding Lug & Rail Scale:N.T.S. V Scale:N.T.S. PV-A03 CONSTRUCTION 4M, PV ARRAY 1-MECHANICAL LOADS "�Qfl Array Area 666.2 ft' I Total Photovoltaic Dead Load: 3.32 psf R G S ArrayWeight] 2212 1(bs AV .Dead Load per Anchor: Anchor Qty.:1 80 32 Taugwonk Spur,Al2 Design Values by Roof Zone: Comer Egde Interior Stonginton,CT 06378 Phone(860)535-3370 Downforce Point Load: 378.5 lbs 378.5 lbs 378.5 lbs Minimum Anchor Strength: 707 lbs WARAWKA,MICHAEL Average Safety Factor: 5.12 16 HICKORY DRIVE FLORENCE,MA 01062 W'-7" Project#10223559 DKN REVISIONS By Date Notes Total Quantity of Attachments=80 Roof Zones are defined by dimension,a=3.0 ft. Maximum Allowable Cantilever for UniRac Rail Is Y3 the Maximum Rail Span Racking and Attachment:UniRac SolarMount with Eco-Fasten Green-Fasten with CP-SQ-Slotted 3116" I'-(r Bracket and Aluminum Flashing attached with 5/16'x 3-1/2'Lag Boft,Hex Head,18-8 SSs • All Dimensions.shown are to module edges,including 1 in.Spacing between Modules required when using the Top Clamp Method.The Rails Extend 3 in.Beyond the module edge. MODULE LAYOUT • UniRac Requires one thermal expansion gap for every run of rail greater than 4(y PV-A02 • Array Installed according to the UniRac SolarMount Code-Compliant Installation Manual ver.227.3, Pub 110616-1cc,June 2011 • Attachment Locations,If shown,are approximate.Final adjustment of attachment location may be necessary depending on field conditions.All attachments are staggered amongst the framing members, ' FOR CONSTRUCTION ' 3Q % I RGS % I ♦ j i 1 32 Taugwonk Spur,A32 / 1 Stonginton,CT 06378 (E)Property Line Phone(860)535-3370 Equipment Location:Exterior % 1 Fax(413)683-2225 (E)Utilty Meter Equipment Location:Interior j 1 GRID TIED (E)Main Service Panel-POI j PHOTOVOLTAIC SYSTEM (N)Fused PV AC Disconnect 1 (N)PV Production Meter/Monitor ! 9.900kW DC STC (N)PV AC Combiner Panel j I WARAWKA,MICHAEL j I 16 HICKORY DRIVE ♦ I FLORENCE,MA 01062 i a I Project#10223559 i DKN ♦ I jr+e�e�rr CR j �'4 '• (N)PV Array: 1 2014-09-18 % 36 Solarworld Plus SW 275 Mono Black Modules (E)Driveway %♦ A.•.: ,�•; ';•. 36 Enphase Energy M250-60-2LL-S22 Micro-Inverters j REVISIONS AsphalUComp.Shingle Roof j 2"X 6"Rafters 16"O.C. 1 # BY Date Notes Azimuth:235° 2 'd ..•q .:.. . . e \ /i \ (E)Single Family Dwelling \ i \\ i/ ••. 1116"=1'-(Y, \\•\ e N SITE PLAN \v/ W E s PV—A01 FOR CONSTRUCTION Grid-Tied Photovoltaic System RG DC Rating: 9.900 kW Warawka,Michael 32Taugwonk Spur,A32 16 Hickory Drive Stonginton,cr 06378 Phone 13) 535-3370 Florence,MA 01062 Fax(413)663-2225 Jurisdiction: City of Northampton GRID-TIED Sheet list PHOTOVOLTAIC SYSTEM Sheet No. Sheet Title 9.900kW DC @ STC Scope of Work: General Notes: PV-000 COVER WARAWKA,MICHAEL RGS Energy shall install a 9.900 kW Grid-tied Photovoltaic CPV")System 1. System follows any/all Fire Code Setbacks per Ordinances of the City PV-A01 SITE PLAN 16 HICKORY DRIVE totaling(36)Solarworld Plus SW 275 Mono Black Modules with(36)Enphase Of Northampton. FLORENCE,MA 01062 Energy M250.60-2LL-S22 Micro-Inverter(s).The Modules shall be flush 2. All projects will comply with the Ordinances of the City of PV-A02 MODULE LAYOUT Project#10223559 mounted on the asphalt/comp.shingle roof and interconnected via supply side Northampton. PV-A03 DETAILS DKN tap, 3. Construction Hours:7am-8pm Monday-Friday,9am-8pm Saturday, No time on Sunday or legal Holidays. PV-A04 MATERIALS R CR Equipment$ Clficatlo115' 4. Product Data Sheets shall be included E�w"o fr 2014-09-18 5. Rooftop penetrations shall be completed and seated per code by a PV E01 ELECTRICAL DIAGRAM Module:(36)Solarworld Plus SW 275 Mono Black licensed contractor. PV-E02 SYSTEM CALCS REVISIONS Inverter 1:(36)Enphase Energy M250-60-2LLS22 6. All Photovoltaic modules shall be tested and listed by a recognized # By Data Notes Racking:UniRac SolarMount laboratory. PV-G01 SIGNAGE Attachment Flashing:Eco-Fasten Green-Fasten with 7. Certifications shall include UL1703,IEC61646,IEC61730. CP-SQ-Slotted Bracket and Aluminum Flashing 8. A continuous ground shall be provided for the Array and for all 2 Photovoltaic Equipment. 3 9. DC Wiring shall be run in metal conduit or raceways within enclosed < Roof Specifications: Spaces in a building. Roof 1: 10. Conduit,Wire systems and Raceways shall be located as close as a Asphalt/Comp.Shingle possible to ridges,hips,and outside walls. (Single Layer) 11. Conduit between Sub Arrays and to DC Combiners/Disconnects shall 2"x 6"Rafters @ 16" use guidelines that minimize the total amount of conduit by taking the O.C. shortest path. Pitch:23' 1 Azimuth:235' 12. Space Requirements for electrical equipment shall comply with NEC Array Size:36 Modules Article 110. 13. Equipment grounding shall be sized in accordance with Table o250.122. Site Specifications: Occu an II 14. Connectors that are not readily accessible and that are used in the p �' circuits operating at or over 30V AC or DC shall require a tool for Design Wind Speed:90 MPH Exposure Category:B opening and are required to be marked"Do not disconnect under Mean Roof Height:25 It load"or"Not for current interrupting",per 690.33(c)&(e). Ground Snow Load:40 PSF(Reducible) 15. All signage to be placed in accordance with local building code. Adj.Roof Snow Load:30.8 PSF 16. Signs or Directories shall be attached to the electrical equipment or located adjacent to the identified equipment. t All Work to be in Compliance With' 17. Signs should be of sufficient durability to withstand the environment. r. 2014 National Electrical Code(NEC) 18. Any plaques shall be metal or plastic with engraved or machine / printed letters,or electro-plating,in a red background with white !. 2009 International Residential Code QRC) 4 2009 International Binding Code(IBC) lettering,a minimum of 318"height and all capital letters. 2012 International Fire Code(IFC) �° w 2012 Uniform Mechanical Code(UMC) 2012 Uniform Plumbing Code(UPC) t, MA 780 CMR,8th Edition rot N/A -including 2/4111 revisions to Tables R301.2(4)&R301.2(5) ASCE/ANSI 7-05 Minimum Design Loads for Buildings and Other Structures `` COVER As amended and adopted by City of Northampton R - PV-000 i 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 homeowner." The building:department for the City of.Northampton wants persons)who seek to use the home owner exemption,-to act as their owir construction supervisor,to be aware that by doing so you become responsible for compliance with state building codess and regulations. The inspection process requires that the.building department be called to inspect work at various stages, which include foundation/footings(before backfdl), 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-t e 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 �ermits 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 L 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 tome. Date Address of work location ,0 a T L • s � LThe Commonwealth of Massachusetts Department of Industrial Accidents Office of lnvestigations 600 Washington Street Boston,MA 02111 www mass govldia -Workers' Compensation Insurance Affidavit:.Builders/Contractors/Electricians/PIumb.ers Applicant Information ,.� �, / Please Print LegibIy Name(Business/orgmizarion/lndividuai):. Z'7j= `::?A.+>?Mt1 010"Z! Address at �Cl� City/State/Zip: 1�//IOJ A ��� u. f Phone.#: J49 Are you an employer?.Check the appropriate box: . .T of project(required):. 1. I am a employer with / 4.. E] I am a general contractor and I ❑ employees(fall and/or part�ti'me).* have hired the sub contractors 6. New corist�uction. 2.0 I ani a'sole proprietor or_partaer- listed oa the-attached sheet. 7. Ej Remodeling ship and have no employees These sub-contractors have. .8. 0 Demolition wo for-me liras =Vlo-gees and-have workers' . y cap�ty. 9 `O�utl mg addition [N wot�ecrs'comp-;,sur-in e comp. _._ required]] 5. E We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing aIl work officers have xercised their 11.0 Phi Bing repairs or additions myself-[No workers'comp. right 6f exemption per MGL 12:0.Roof repairs insurance required]r c. 152,§1(4),and'we have no . employees:[No workers'- 13.0 Other, comp_insurance required.], *Any applicant Shat checks box#1must also fill out the section bolo -showing theeirw0r1=-..co1mpensarion policy information_ t Homeowners who submit this afdavit:indicating they are doing all work and thm.has outside contractors must submit a mew affidavit mdicaung such. IC�that check this box mostam hed an additional s7ueet showing the name of the sub-contractoes and state whetlierotnot�ose entities bave Io `Ifthe sub-cone-.tors have I must . deth=�mi=s' li numbe. emp Pees• employees,�3` prow de comp-.Po cY;tam an employer that a providing workers'compensation insurance for my employees Be&w is the policy gnd job site information. l // ,y / Insurance Company Name: !�/Ut9G O///1/w Policy#or Self-ins.Lic.#: LAS 21S 36.4L t 49- 033 Expiration Date: Job Site Address: � 1 S , (' hZ—r Attach a copy of the workers'-compensation_policy declaration page-(showing the p9hcy number.:and_ex iration date). Failure.to,secure coverage.asreclu red'imdeer.Sechnn`25F%of1GIGL c:152 can lead'to ffie imposition ofcnm=V penalties of a fine tip to$1,500.00 and/or one-ycar.imprisonment;,as well as civil.penalties int the form of a STOP W©RK URD£R ar?cI-a£tee of up to$250 00 a_day against the violator Be advrsed'that a copy of this statement maybe forwarded:to the,0ffi'ce of, Tnve tiQa ions of the bIA for insurance coverage Verification. I do hereii e7t1 under h pains gip. - Si tare: . of_Perfury:that-the rnfornratznn provrdedsrbavgrs�rur_andcvrrert' . - ate.Z.zd Phone# Official use only. Do not write vi this area,tb be completed by cgy or town offuiaL .City or Town: PermitUcense# Issuing Authority(circle one): J.Board of Health 2.BuRdina Department 3.City/'Town Clerk .4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisory Not Applicable ❑ Name of License Holder: License Number Address Expiration Date G -1-6:4�91' SignatuYe Telephone S,`;legisterett..Hnnie lmptoveiiietit GtiriraC>}rfr.. .:` � � Not Applicable ❑ /n J.Yay Company a Registration Number :210z j-017-110 Address 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 buildo permit. Signed Affidavit Attached Yes....... No...... ❑ 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 buildine 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicablel New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[O] Other[❑] Brief Description of Proposed `�0 Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ba,ff�f�rnlsncisacf � zis"tin .. IVC�s�no�i effoffow 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? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade 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, Idt4� NU as Owner of the subject property hereby authorize to act on my b If,in all matters relative to work authorized by this building permit application. Signature of r Date 25aas Owner/Authorized Agent hereby declare that t e 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 ner/Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Ibis column to be filled in by Building Department Lot Size t _ Frontage Setbacks Front 1�' Side L:= R:= L:= R:= I Rear --) Building Height s—? Bldg.Square Footage % Open Space Footage % ;�� -----I (Lot area minus bldg&paved paffing) #of Parking Spaces �— Fill: i volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES,date r issued•�4� : 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 wetlands? NO 0 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 0 NO 0 IF YES, describe size, type and location: I 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. #ty r -i lirthampton .B-ui)8i g epartment 212 in Street MAY 15 100 Northa pt n, MA 01060 , Electric. Pluq�pt��g1 0 Fax 413-587-1272 Nortf� r n, 1 5 •��� APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION=1-SITE rINFORMATION ._ 1.1 Property Address: This section to be completed by office b H t G�p rte) Map Lbt UnrY xZ:o�e ' s OverlayDlstcict }.o e *t,,e 1rYl k t? I o b3.. Eirn St:'District'' CB'Qistrict SECTION 2-.:PROPERTY OWNERS FIIP/AUTHORIZED AGENT 2.1 Owner of Record• 444&, Name(Pri Cu trren Mailing Address aim Telephone Signatu — V3-7-1-711-3 2.2 Authorized A ent: Name(Print) Current Mailing Add s : !Y13-S��iy 5�16T_ Signatund Telephone SECTION 3-E$IIMATED}.CONSTitEiCTION_Cg= Item Estimated Cost(Dollars)to be Official Use Orrly completed by ermit applicant 1. Building G (a)$uilding`Permit Fee 2. Electrical (b)Estimated Tote!Cost of �0 0 Construction from_6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) S. Fire Protection 6. Total=(1 +2+3+4+5) 4 Ctiedc Number This Section ForbfffcialUse On Date Building Permit Number Issued: Signature: BuildtrigCommissionerlirispedor of Buildings Date 16 HICKORY DR BP-2015-1122 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-014 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: electrial BUILDING PERMIT Permit# BP-2015-1122 Project# JS-2015-000692 Est. Cost: $24750.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: THOMAS DOLAN 039281 Lot Size(sq. ft.): 18556.56 Owner: WARAWKA EUGENE E&JULIA M Zoning: Applicant: THOMAS DOLAN AT. 16 HICKORY DR Applicant Address: Phone: Insurance: P O BOX 297 (413) 585-0612 Workers Compensation CHESTERFIELDMA01012 ISSUED ON.511512015 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL 9.9KW 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: FeeType: Date Paid: Amount: Building 5/15/2015 0:00:00 $25.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner