36-390 (4) BP-2021-2248
156 EMERSON WAY COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
36-390-001 CITY OF NORTHAMPTON
Permit: Solar Build
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2248 PERMISSIONIS HEREBY GRANTED TO:
Project# SOLAR -2021 Contractor: License:
Est. Cost: 53000 TESLA ENERGY OPERATIONS INC 101687
Const.Class: Exp.Date:09/13/2022
Use Group: Owner: HASELKORN MARK& SUZANNE L TRUSTEES
Lot Size (sq.ft.)
Zoning: SR Applicant: TESLA ENERGY OPERATIONS INC
Applicant Address Phone: Insurance:
24 ST. MARTIN DRIVE BLDG 2 UNIT 978-570-6622 WC 1074584-04
11
MARLBOROUGH, MA 01752
ISSUED ON:12/01/2021
TO PERFORM THE FOLLOWING WORK:
INSTALL 17KW 40 PANELS TO ROOF @ 2 POWERWALL BATTERY IN GARAGE
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.
Signature: Is ► 52 '9 t
Fees Paid: $75.00
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
CS!
The Commonwealth of Massachus•tts
Board of Building Regulations and Stindar.is NOV 3 O 20 ICF PALITY
Massachusetts State Building Code, 7$0 C R 21
Building Permit Application To Construct, Repair, lieno?iitt � e • • a • ised�'Mar 2011
One- or Two-Family Dwelling---- "22"-+,;^,a; <ir'' sPEc oNs
This Section For Official Use Only
Building Permit Number: glp-)f $ Date Applied:
vir-) �/j55 //12 1/- •ZOZ/
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numr
156 Emerson Way
1.1 a Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Residential
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone-
Outside Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Mark Haselkorn Northampton, MA, 01062
Name(Print) City, State,ZIP
156 Emerson Way (413) 531-7411
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:Solar
Brief Description of Proposed Work':
Install solar electric panels to roof of existing home, interconnected with the electrical system
17 kw 40 panels
2 Tesla powerwall battery( rated @ 27 kwh total) installed in garage
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 16,000 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2. Electrical $37,000 ❑Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) Total All Fees:
Check No?70 'Check Amount: Cash Amount:
6. Total Project Cost: $53,000 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
,s 5 f
Massachusetts h
.e
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 4Ytl f Northampton, MA 01060 31, ,, �,1
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work. (Digital and hard copy)
3. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/ replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW/ private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
Install solar electric panels to roof of existing home, interconnected with the electrical system
17 kw 40 panels Tesla powerwall battery( rated @ 13.5 kwh total) installed in garage
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
101687 9/13/22
Daniel Fonzi License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
24 St. Martin Dr. Bldg 2 Unit 11
No.and Street Type Description
Marlborough, U Unrestricted(Buildings up to 35,000 Cu.ft.)_
MA, 01752 o State,Z R Restricted 1&2 Family Dwelling
City/ M Masonry
eafiel P6 G RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
774-281-0377 eoutslay@tesla.com I Insulation
Telephone Email address D Demolition
- 5.2 Registered Home Improvement Contractor(HIC)
168572 3/7/2023
Tesla Energy Operations HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
24 St.Martin Dr.Bldg 2 Unit11 eoutslay@tesla.com
No.and Street Email address
Marlborough, MA, 01752 774-281-0377
City/Town, State,ZIP Telephone
SECTION 6: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 0 No 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
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.
Emilie Outslay 11/15/21
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
r
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' Massachusetts Iwo '
' ` DEPARTMENT OF BUILDING INSPECTIONS x
er 212 Main Street • Municipal Building s,� a
Northampton, MA 01060 :r nr j‘'‘
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: 24 St.MAatin Dr.Marlborough, MA,01752
The debris will be transported by:
Name of Hauler: E.L.Harvey& Sons
Signature of Applicant: Z7Cdt Pte.; Date: 11/15/21
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston, _41402114-2017
www.mass.govidia
Workers"Compensation Insurance Aflida%it: Bo iklers/Contractors/Electricians/Plumbers.
TO BE FILED WITH TIIL PERMEITING AUTHORITY.
Applicant Information Please Print Levity's
Name 113 us Ines, Pr.2 L on Individual): Tesla
Address: 901 Page Ave.
City/State/Zip: Freemont, CA, 94538 - 888-765-2489
_ .
Art you an employee Cheek thr appropriate butt I pt.of project(required):
1.E1 I am a employer with 5,000 tk On and part-tinort.• 7, a New construction
1 ara sok proprietor or partnership and have no empkvytvs working for me in 0 Remodeling
any capacity,[No workers'camp.Insurance required"
9. 0 Demolition
lam housevv.Thet doing all wink myself.[No workers'comp,mturanor my:Until'
10 13 Building addition
3.0 I arn XIhomeowner and will be hiring contracors 10conduct all wurk on rrri property. I will
ensure that all etintractors either hare workers compensation insurance in are sole I 1i ] Electrical repairs or additions
pruprrelors V.ith ix.erriployet _
12.0 Plumbing repairs or additions
!I:3 I am a iteneral cumnsetot and I have.hired the sub-contractom un the attached sheet
13.0 Roof repairs
Thrw mtb-tarntraclum bzur L-Inployon,,and hate workers'comp.insuramL.:
14.0 Other solar
6.E3 we an:a oorporation and its officers have exercised their right of exemption per MIGL c.
152. 1(4).and we have no employers.[No workers'comp.insurance requited.]
'Any applicant that r1oeIrs bo:tVI must also fill out the section below shiniving dark i kt.7 17;Films alit!n potic!, intormahLso.
Fklinell Wilco.who submit this affidavit indicating the!,art doing all ucurk and Men hoe outside contractors:mast submit a new affiriat it inclicaltnE snek
(70ntractor:that cbmk this box must attaebed an akhuonal sheet hivwm Eibt:nanie of the mt1,-4.:L'atInk..'turl and state ss hettici us not[hum:cmlatu.s./hats:
estiplu:•.o.-. If the suh-contracitam have employ ees.OW, MU NI pro,Id c then *uri.er; nor r i snurnher
Jean an employer that is providing workers compensation insurance for my employees. Below is the policy and job site
information.
Insurame Company Name: Zurich American Insurance
Pokey#or Self-ins.Lic. 1074584-04 Expiration Date: 10/31/2022
Job Site Address: 156 Emerson Way city,statezip: Northampton, MA
Attack a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1500.00
andOr one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of!Injury that the information provided above is trait and correct
a41-i;
Signature: —411011 21 11/15/21
Phone 774-281-0377
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2. Building Department 3.Cftyfrown Clerk 4.Electrical Inspector 5. l'Iumbing Inspector
6.Other
( (intact Person: Phone*:
City of Northampton
j43, SIC
f Massachusetts '*
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 9J� �
Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born _ (insert month,
day, year),hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a
parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption,
does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns 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 home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for
and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work
on my parcel, I am not engaged in construction supervision in connection with any project or work involving
construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any
provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my
parcel, I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this day of , 20_.
(Signature)