Colson_BPA
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address This section to be completed by office
Map Lot
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
2.2 Authorized Agent:
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Building Permit Fee
This Section For Official Use Only
_______________________________________________________________@ ____________
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Aaron Simms - SunBug Solar 66 Westfield Ind Park Rd, Westfield, MA 01085
413-884-1000
7 Rust Ave, Northampton, MA 01060
Rick Colson
617-413-5343
15 Laurel St, Northampton, MA 01060
6,000
15,000
21,000
DocuSign Envelope ID: CFBF3779-4676-4513-BC0B-EF10AFA9FA18DocuSign Envelope ID: 10520068-EF6A-40AB-8849-1F3DA2D59DFD
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side
Rear
L:______ R:______ L:______ R:______
Building Height
Bldg. Square Footage %
Open Space Footage
(Lot area minus bldg & paved
parking)
%
# of Parking Spaces
Fill:
(volume & Location)
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DocuSign Envelope ID: CFBF3779-4676-4513-BC0B-EF10AFA9FA18DocuSign Envelope ID: 10520068-EF6A-40AB-8849-1F3DA2D59DFD
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House Addition Replacement Windows
0r Doors
Alteration(s) Roofing
Accessory Bldg Demolitio New Signs ] Decks Siding Other
6a If New house and or addition to existing housing, complete the following
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Solar
SunBug Solar
Aaron Simms
Rick Colson
Install 6 kW solar on roof, per attached documents. 20 panels
X X
X
SunBug Solar
DocuSign Envelope ID: CFBF3779-4676-4513-BC0B-EF10AFA9FA18
1/17/2020
DocuSign Envelope ID: 10520068-EF6A-40AB-8849-1F3DA2D59DFD
1/17/2020
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:
Name of License Holder
!
9. Registered Home Improvement Contractor:
Company Name
!
SECTION 10- WORKERS’ COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
! !
SunBug Solar, LLC
411A Highland Ave, St 312
Somerville, MA 02144 413-884-1000
X
Aaron Simms
66 Westfield Ind Park Rd, Westfield, MA 01085
413-884-1000
CS-109144
07/21/21
163091
05/10/21
DocuSign Envelope ID: CFBF3779-4676-4513-BC0B-EF10AFA9FA18DocuSign Envelope ID: 10520068-EF6A-40AB-8849-1F3DA2D59DFD
●
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
(Please print house number and street name)
Is to be disposed of at:
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
Debris Disposal Affidavit
7 Rust Ave, Northampton, MA 01060
66 Westfield Ind Park Rd, Westfield, MA 01085
DocuSign Envelope ID: CFBF3779-4676-4513-BC0B-EF10AFA9FA18DocuSign Envelope ID: 10520068-EF6A-40AB-8849-1F3DA2D59DFD
1/17/2020