Northampton_MA_Bldg
The Commonwealth of Massachusetts
Office of Public Safety and Inspections
Massachusetts State Building Code (780 CMR)
Building Permit Application for any Building other than a One- or Two-Family Dwelling
(This Section For Official Use Only)
Building Permit Number: ____________ Date Applied: ______________ Building Official: _______________________
SECTION 1: LOCATION
_________________________________________________________________ _________________________________________
No. and Street City /Town Zip Code Name of Building (if applicable)
________________ __________________
Assessors Map # Block # and/or Lot #
SECTION 2: PROPOSED WORK
Edition of MA State Code used _____ If New Construction check here or check all that apply in the two rows below
Existing Building Repair Alteration Addition Demolition (Please fill out and submit Appendix 2)
Change of Use Change of Occupancy Other Specify:___________________________________________
Are building plans and/or construction documents being supplied as part of this permit application? Yes No
Is an Independent Structural Engineering Peer Review required? Yes No
Brief Description of Proposed Work:__________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
SECTION 3: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION, ADDITION, OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed (See 780 CMR 34)
Existing Use Group(s): __________________________________________ Proposed Use Group(s):__________________________
SECTION 4: BUILDING HEIGHT AND AREA
Existing Proposed
No. of Floors/Stories (include basement levels) & Area Per Floor (sq. ft.)
Total Area (sq. ft.) and Total Height (ft.)
SECTION 5: USE GROUP (Check as applicable)
A: Assembly A-1 A-2 Nightclub A-3 A-4 A-5 B: Business E: Educational
F: Factory F-1 F2 H: High Hazard H-1 H-2 H-3 H-4 H-5
I: Institutional I-1 I-2 I-3 I-4 M: Mercantile R: Residential R-1 R-2 R-3 R-4
S: Storage S-1 S-2 U: Utility Special Use and please describe below:
Special Use Description:
SECTION 6: CONSTRUCTION TYPE (Check as applicable)
IA IB IIA IIB IIIA IIIB IV VA VB
SECTION 7: SITE INFORMATION (refer to 780 CMR 105.3 for details on each item)
Water Supply:
Public
Private
Flood Zone Information:
Check if outside Flood Zone
or indentify Zone:__________
Sewage Disposal:
Indicate municipal
or on site system
Trench Permit:
A trench will not be
required or trench
permit is enclosed
Debris Removal:
Licensed Disposal Site
or specify:_____________
______________________
Railroad right-of-way:
Not Applicable
or Consent to Build enclosed
Hazards to Air Navigation:
Is Structure within airport approach area?
Yes or No
MA Historic Commission Review Process:
Is their review completed?
Yes No
SECTION 8: CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: __________ Use Group(s): __________ Type of Construction: ________
Does the building contain an Sprinkler System?: _________ Special Stipulations: ___________________________________________
Design Occupant Load per Floor and Assembly space: _________________________________________________________________
Install 17.6kW solar on roof, per attached documents. ( 44 panels )
X
SolarX
Hilltop Apartments35 Village Hill Road Northampton 01060
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
__________________________ ______________________________ ____________________________________________ ___________
Name (Print) No. and Street City/Town Zip
Property Owner Contact Information:
_______________________________ _____-_____-___________ ____-_____-___________ _______________________________
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable, the property owner hereby authorizes:
_________________________________ ____________________________________ ___________________ ______ _____________
Name Street Address City/Town State Zip
to apply for and act on the property owner’s behalf, in all matters relative to work authorized by this building permit application.
SECTION 10: CONSTRUCTION CONTROL (Please fill out Appendix 1)
If a building is less than 35,000 cu. ft. of enclosed space and/or not under Construction Control then check here .
Otherwise provide construction control forms (see section 107 in the code) as required.
10.1 Registered Professional Responsible for Construction Control (the professional coordinating document submittals)
______________________________ ____-_____-___________ _________________________
Name (Registrant) Telephone No. e-mail address
______________________________ ______________________________ ______ _________
Street Address City/Town State Zip
_____________________
Registration Number
_______________ _______________
Discipline Expiration Date
10.2 General Contractor
__________________________________________________________________________________________________________________
Company Name
_________________________________________ ____________________________________________________________
Name of Person Responsible for Construction License No. and Type if Applicable
______________________________________________ __________________________________ ______ _____________
Street Address City/Town State Zip
____-____-_______________ _____-_____-_____________ ____________________________________________________
Telephone No. (business) Telephone No. (cell) e-mail address
SECTION 11: WORKERS’ COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6))
A Workers’ Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes No
SECTION 12: CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor
and Materials)
Total Construction Cost (from Item 6) = $_________________
Building Permit Fee = Total Construction Cost x ____ (Insert here
appropriate municipal factor) = $________.
Note: Minimum fee = $________ (contact municipality)
Enclose check payable to __________________________________
(contact municipality) and write check number here ______________
1. Building $
2. Electrical $
3. Plumbing $
4. Mechanical (HVAC) $
5. Mechanical (Other) $
6. Total Cost $
SECTION 13: SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to the best of my knowledge and understanding.
______________________________________________________ ____________________________ ____ -_____- ________ _________
Please print and sign name Title Telephone No. Date
____________________________________ _______________________ ______ _____________ ____________________________
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: ____________________________________ _____________
Name Date
Rachel Bruso Project Manager 413 884 1000 09/16/2020
66 Westfield Ind Park Rd Westfield MA 01085 rachel.bruso@sunbugsolar.com
43,000
13,000
30,000
X
aaron.simms@sunbugsolar.com413 884 1000
66 Westfield Ind Park Rd Westfield MA 01085
CS-109144 HIC - 163091Aaron Simms
SunBug Solar
X
SunBug Solar 66 Westfield Ind Park Rd Westfield MA 01085
Julia Scannell 413 586 5065 julia.scannell@tcbinc.org
The Community Builders 35 Village Hill Rd Northampton 01060
CITY OF NORTHAMPTON
SETBACK PLAN
MAP:_______ LOT:________
LOT SIZE:____________
REAR LOT DIMENSION:_____________________________
FRONTAGE_____________________
REAR YARD _____________
SIDE YARD______________ SIDE YARD______________
FRONT SETBACK_______________
Not Applicable
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ● Municipal Building
Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number ________________ is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: ___________________________________________________
The debris will be transported by:
Name of Hauler: ______________________________________________________
Signature of Applicant: __________________________________Date: ___________
09/16/2020
SunBug Solar
35 Village Hill Rd, Northampton, MA 01060