17B-013 (6) 384 BRIDGE RD BP-2016-1227
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17B-013 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-2016-1227
Project# JS-2016-002110
Est.Cost:$19000.00
Fee:$75.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: SOLARCITY CORP 107663
Lot Size(su.ft.): 9408.96 Owner: DAWSON-GREEN TRACY
Zoning: RI(100URR(100)! Applicant: SOLARCITY CORP
AT: 384 BRIDGE RD
Applicant Address: Phone: Insurance:
604 SILVER ST (978) 215-2369 () Workers Compensation
AGAWAMMA01001 ISSUED ON:4/21/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL ROOF MOUNTED 7.54 KW 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: /..O/�,b
n, Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: -
filial - c
THIS PERMIT MAY BE REVOK BY THE CITY OF NORTHAMPTON UPON VIOLA ION OF
ANY OF ITS RULES AND RE ;/I 040 S.
id-cwo• j
Certificate of Occupancy 1 ��� Signature:
FeeTv�ne: /Date Paid: Amount:
Building 4121/2016 0:00:00 $75.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
City of Northampton Mail-CSL L.fo_ ation h ps:f/L,ail.google.com'maiUu/O;?ui=_&±=3°711�r
City of
Charles hillier<cmiller@northamptonma.gov>
CSL fricormma fon
1 message
Victoria Junck<vjunck@solarcity.com> Tue, Jun 7, 2016 at 12:11 PM
Tc: "Charles Miller(cmiller@northamptonma.gov)" <cmiller@northamptonma.gov>
Good morning Cheri,
I am emailing you in regards to several permits that we have open with the City of Pittsfield. We need to get the
CSL information changed on the building permits for the following addresses:
60 Lake St (Florence)
11 Acrebr••.
386(8ridge Rd
25 Hinckley St
20 Fruit St
The CSL information that the above need to be switched to is:
Jeremy Graves
604 Silver St
Agawam, MA 01001
CSL # 108706
Type: U
Expiration Date: 02/23/2019
Contact number. 774-279-7650
Victoria Junck
Permit Coordinator I SolarCity
oft 6!7/7f)16 1;: PM
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ZThe C'ununanwealkh of'Massaclinsrlls �'r
Department o f Industrial Accidents
ul=rlr `r O(Jic•e oJlltvestignlinns
s =1...41 600 EI'as1ingfoa�Street
rem Boston, MA 02111
-.....,00 tt ww.»lms.gnv/ilia
Workers' Compensation insurance Affidavit: Buikler•s/C(mar;actors/rlectrkia iis/Plumbers
Applicant information Please Print Legibly
NameItiusiutccs&Urganizukwnndividual): SOLARCITY CORP.
Address: 3055 CLEARVIEW WAY
City/Statc/Y.ip: SAN MATEO, CA 94402 l'l�ctne tl: 888-765-2489 _
Are you an employes.? Cheek the appropriate bud: Type of project(required):
1.0 I ant a employer with 5000 _ 4. Li I ant a general contractor and I 6. n New construction
employees(full and/or purr-time).* have IOW the sub-contractors
2.❑ 1 am a WIC pn)prielot or partner- listed on the attached sheet. i 7. 0 Itenuxldittl;
ship and have no employees These soh-contractors have K. EI Demolition
working Iia Herr in any capacity. workers'comp. insurance. 4. [1 Building arklition
INu workers' comp.insurance 5. [1 We are a corporation and its
required.] officers have exercised theirIOU lacctricnel repairs in additions
3.11 I anti a Idnucownet duiug all wint, right ofefmrnption per MGI. 11.0 Plumbing repairs or additions
III)set t. INo workers'cottap. c. 152,§1(4),and t\e have no 12.0 Roof repairs
insurance required.)r employees.1 No workers'
et ii insurance iequireul.J 13.11 t)tuc r
n
`Any grill icant that c iris box 41 WWI also till lit the%eeliwt helms.1111M int their ttutl.eet:coo it0.'tioii.,o policy ininuna iu.n.
I th.nio antis..hi,.nfmlil anis aRilka ii itttlitzlting they uie rkunp all urn).:motilin hire outside contractor:.struNi submit.1lactctilTictat it)Mirk Mitre such
ktuiltaticirs that chili this box lust aunt-lied illi ehkiliuuual.lutea Aim ingthe morn ell lilt'\etat.enitiz.ak .ualeft their tclxkc:.'mop.tubby? inlilrnnation.
1 erne un employer that is proriding warners'compensation sationt insurance for no.employees. Belong is the polity mud,/oh site
information.
Insurance Company Name: r
ich Arher,e►an frtstrrdnce C°inpa.r3
Policy 0 or Sell-ices. i.ie. /r: WC 01g2.0)-14 - _ _.. .__. ....._ Expiration 1).alc: 061-01- Hp
.Int}Site Address:. _ Ai‘ ur 1d ('ity/Slaate1/ip: U/ l 1 Ck.i1(.4 ., ' c
Attach a copy of the workers' compensation policy declaration page(showing;the policy number anti expiration delle).
Failure to sceaur cmt't•alre as required under Section LSA of nun.e. 152 can lead Io the imposition of criminal penalties ofa
line up In 51.5119./11 and/or one-year imprisonment.as well as civil penalties in the limn of ti STOP WORK t)I(l)hK and a Line
of up to S250.00 a day against the violator. lie advised tuna a cops of this statement nin) he forwarded in the t))lice of
Investigations of the I)IA for insurance coyer.0 a verification.
•—
/do hereby certify under Me polo-:nu'termiticl of perjury dice the information f,roehlyd abate is true and correct.
Simau >s;... /1 1-t_ ._/yc-.`d.•... -Cts... . .. I)nte: •
r
t itt.nt
i Official use only. 1)o rang write in this arca,to he completed hr ebbe or tuner official. f
City or Town: Permit/License 11
t.ssuittg Authorit) (circle cute):
1, Board of Health 2. Itttildittg Department 3.('ilvl fawn('leek 4. Electrical inspector S. &9iia[.)ting Inspector
f6. Other•.
(bnlaet l'er•,l,q: l'hune II:
___ _ __ _ - <, --- ----- ,----l- --_ - -�»-- :-- •-
___-- —_--
3
I
At✓D CERTIFICATE OF LIABILITY INSURANCE DATJ„J 0/MYYY) I-
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy.certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
Pit,OUCER CONTACT
MARSH RSK S MISURANCE SERVICES p
345 CALIFORNIA STREET,SUITE 1530 WC.No.t Mk jlARstfpl:.__....... ...__..___.__.
C.AL.=ORx7'A LICENSE NC.0437'53 EMAIL
SANFRA>hCIS O,CA 94IG= -"6—RtSI•— - --- - .. _.
Ati,:Shaman Soott415-1438334 . .. . _. t JRE SIRFFORDNGcovERAGA._._.,.•—__a_. NAtc0 -
996307_STfO_GAWUE 15.16.-_. - - _ -.tsURER A_Llddi Amino ilnuelwe(bnpery 111653,5 5
INSURED INSURER B; t4i1
INSURER C t WA14A
J55 C aalview Way t.....
San Mateo,CA 944)2 II1e11RBR D_AiNukaa•Zwick IIxgNance Canpeny 40142
'INSURtER F; I
COVERAGES CERTIFICATE NUMBER: SEA-0D2'13836-ca REVISION NUMBER:4
IHIS IS 10 CERTIFY THAT THE POLICIES Or INSLRANCE LISTED BELOW iIAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INCICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TC WI-ICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSJRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMPS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
PIER - 'AaOiisuel - —E POLICY EFFMPOLKY[XP _ .._ .. .
LTRJ TYPE OF INSURAYCE MD'yiVD I POLICY NUMBER 111441001YYYYI 1 t OACTIO YYYY1,1 UNITS
A 1 X 'COMMERCIAL GENERAL LIABILITY 0.00182016-CC (9A1/2015 1:t1601t2016 EACH OCCURRENCE $ 3,000,!00
(. .*... '-1 -04.4An1=TORiEt.if6 -' - -
J C I... : pR>:AesEs.[Ea«� .. . . .._ 3,°00.000
X SR$250,000 _..- --•--._... .__. I ,NED,EJtP(11-tly_mMprrsen_•'S__ 5,000
_..__. _._.. PERSONAL AIN INJURY S 3 .6.
ER
GEL AGGREGATE LW APPLES PER
GENERAL AGGREGATE _.__..s_.._......- 8..00.0°
1 PAD- I.
__
,X J L JECT I. ..1l Loc PROCUCTS-DCI PIOP AGO t . ... 6.939,999.
OTHER. I S
A AUTO/MOBLE UABS.ITY BAP018?017.00 09101f2D15 memo/1018 OMeNE061NGLE LIMIT
X :AUTOS _ Og I BODILY INJLUtY(Perpetecn) E
ANY AUTO _
x ..ALL OWNED x SCHEDULED I BODILY INJURY(Per ICCI944 $
-x x NCNOWt U I -PROPERTY DAMAGE _ ..._$_...__._ ... ........
... HIRED .... AUTOS .tP.@r.AC6gBP1L._................__._..._......
COMP OLL DED: s SCOW
UMBRELLA LJAe i .� I I EACH OCCURREICE E
excess UM $41
-MADE AGGREGATE ti
DEG T 1RETENTtONS IS
D WORKERS COMFENSA710N tWC0182C14-30(AOS) 010U2015 09411/2018 1.x I I oomti-
A I
AND EMPLOYERS'LARILITY YIN' W 182015.00 XA 09,41/2015t19A1J20'tI
ANYPROF2IETOMPARTNER,OCEC1mVEl ) ,EL EACHAOCILta.r $ 1,OOgtt00�
CFFICER'VEUCER E7iCUJDED9 nI N i A L' -. _. .. -.... ..
lV,ndatery It:NH) WC DEDUCT BLE:5500,E0 i Et DISEASE•EA EMPLOYEES 1.04000
� aes�+oe!Ada ba --- -----
1 DESGRIPT1CN OF OPERATIONS be 'E I.DISEASE•PCLICY LIMIT $ 1,000,000Cbl I ' i
DESCR,PTION OF OPERATIONS I LOCATIONS I VEHICLES IACORO lel,Additional Remarks Schedule,may be attached-f more space Is required'
Fr Lcce uI!I'LL-or-A!
CERTIFICATE HOLDER CANCELLATION
`o"` ;(^''=-a."1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED HEFORE
5055 CI:a^,c-r,K'ap THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
SicYAW, T ?9,%< ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh Risk&Inel:ran:o Services
Clair esMarnok:;o j- . ,�/(_z;
71988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
=` 111 le 0 IP • /1119(;/di (2t-'1.41,5.5rir /t/jr'ili
Office of Consumer Affairs sand BusinessRegulation
-` 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 168572
Type: Supplement Card
SOLAR CITY CORPORATION Expiration: 318/207
VICTORIA JUNCK - -
3055 CLEARVIEW WAY -
SAN MATEO, CA 94402 _.
Update Address and return card. Mark reason for change.
0 AAA -? Address Renewal Employment Lost Card
SCAOffice of Consumer Affairs Si Business Regulation License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
Registration: 168572 Type: 10 Park Plaza-Suite 5170
Expiration: 3.!812017 Supplement Card Boston,MA 02116
SOLAR CITY CORPORATION
VICTORIA JUNCK
24 ST MARTIN STREET BLD 2UNI ��•�--,�. _ L^C/t! �� 7 ./
IWIRLBOROUGH,MA 01752 Undersecretary Not valid without _ ature
I
i r ////1/ ' /i!/'r rI //,
Office of Consumer Atlairs and Business Regulation
I 0 Park Plaza - Suite 5170
Boston, Massachusetts 02116
110111C Improvement Contractor Registration
Registration: 168512
Type Supplement Card
SOLAR CITY CORPORATION Expiration: 3!811.017
JEREMY GRAVES
3055 CLEARVIEW WAY
SAN MATEO, CA 94402
Cpdatc Address and return card. %lark reason for change.
Address Remiss' Finploymcnl Lost Card
Office of Consumer Affair%e.Business kegulatenn License or registration solid for indi.idul use only
+•OME IMPROVEMENT CONTRACTOR before the es piration d,rtc. I r found return to:
Office of Consumer Affairs and Business Reguialion
Registration: 168572 Type: 111 Park Plaza-Suite 51711
Expiration: 3/8/2017 Supplement::ard Boston.MA 02116
SOLAR CITY CCHP.)k' . P N
JEREMY GRAVEL
24 ST MARTIN STREET BL()2UNI %�✓-�--�`; -
KrALBOROUvH.MA 01752 I'ndencecretan. Not valid Ns ithout signatcrc
•
'dassacnusetls Departo,e•nt Sa•
Board of Budding Regt.lations rno Sranaaros
ce^- CS-108706
JEREMY GRAVES -44
179 BRIGHAM STREET
Marlborough MA 01752
02/2312019
tee(14-5—Q/
SECTION 8•CONSTRUCTION SERVICES .
t
8,1 Licensed Construction Supervisor: Not Applicable 0
Name of license Holder:SOLARCITY/JEREMY GRAVES 108706
License Number
604 SILVER ST AGAWAM MA 01001 02/23/2019
Address Eviration Date
774-279-7650
Signature Telephone
9:Registered Horne tmprovementContrattor:_ : Not Applicable 0
SOLARCITY CORP/VICTORIA JUNCK 168572
Company Name Registration Number
604 SILVER ST AGAWAM MA 01001 03/08/2017
Address Expiration Date
Telephone 978-215-2367 J
J I
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 building permit.
Sig^.ed Affidavit Attached Yes 0 No O
11..-.Home•.Owtler..Exei iption
The current exemptior.for"homeowners"was extended to include Owner-occupied Dwellines alone(I) or two(2)families
and to allow such homeowner to engage an individual for hir who does not possess a license,provided that the owner acts
as supervisor.CMR 780. Sixth Edition Section 108.3.5.
Definition of Homeowner:Person(s)who own a parcel of land on which heishe resides o: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 fit a two-year period shall not he considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official.that he/she shall he
responsible for all such work performed under the buiidine permit.
As acting Construction Supervisor your presence cn the job1 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 Zonine Laws and Slate of Massachusetts General Laws Annotated.
1-lomeovsner Signature
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1