46-037 (4) 178 ISLAND RD BP-2020-1145
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:46-037 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 ELECTRIC SYSTEM BUILDING PERMIT.
Permit# BP-2020-1145
Proiect# JS-2020-001916
Est.Cost: $24248.00
Fee:$75.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY SOLAR LLC 077279
Lot Size(sg. ft.): 7143.84 Owner: SIERAKOWSKI JOHN
Zoning: Applicant. VALLEY SOLAR LLC
AT. 178 ISLAND RD
Applicant Address: Phone: Insurance:
PO BOX 60627 (413) 584-8844 WC
FLORENCEMA01062 ISSUED ON:5/21/2020 0:00:00
TO PERFORM THE FOLLOWING WORK-22 PANEL ROOF MOUNT SOLAR ARRAY -
7.26KW DC
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 5/21/2020 0:00:00 $75.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northampton �`��' Status of Permit
Building Department, Curb Cut/Driveway Permit
212 Main Street 4? 9 Sewer/Septic Availability
�t ` Room 10Q�- 1?0,911 Water/Well Availability
Northampton, MA 61060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
o_ ` Other Specify
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 / Unit
178 Island Rd., Northampton, MA 0160
Zone Overlay District
Elm St. District CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
John Sierakowski and Sofia Szamosi 178 Island Rd., Northampton, MA 0160
Name(Print) Current Mailing Address:
,rte 646 553-7101
Telephone
Signature
2.2 Authorized Agent:
Valley Solar LLC PO Box 60627, Florence, MA 01062
Name(Print) Current Mailing Address.
Q. 413-584-8844
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) 7
5. Fire Protection
6. Total= 0 + 2 + 3+4+ 5) 24 248 Check Number
This Section For Official Use Only
Building Permit Number. br" ` f wf J Date 6-j--XJ
X71
Issued: !✓�
Signature:
Building Commissioner/Inspector of Buildings Date
Ihasbrouck @ northamptonma.gov
info@valleysolar.solar.
EMAIL ADDRESS (REQUIRED; lOR
CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %,
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T 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 DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q Date Issued:
C. Do any signs exist on the property? YES 0 NO
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 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [tom] Decks [Q Siding [O] Other[X solar
Brief Description of Proposed
Work: Installation of a 22 panel roof mounted Solar array. System Size 7.26kW DC
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa. If New house and or addition to existing housing, comalete 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?
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
I, John Sierakowski and Sofia Szamosi as Owner of the subject
property
hereby authorize Valley Solar LLC
to act on my behalf, in all matters relative to work authorized by this building permit application.
.0— 04/06/2020
Signature of Owner I UJ UR Date
l Valley Solar LLC as /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.
Steven Silverman
Print Name q
C'.- x�'&gAM&n, 04/02/2020
Signature of Owner/Agent Date
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder Steven Silverman
License Number
PO BOX 60627 Florence, MA 01062 CS-077279
Address Expiration Date
0— 6/21/2020
Signature Telephone
413-584-8844
9. Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
Valley Solar LLC 186338
Address Expiration Date
PO Box 60627, Florence, MA 01062 _Telephone 413-584-8844 10/27/20
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.
Signed Affidavit Attached Yes....... No...... ❑