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30A-052 (2) B -2023-0113 61 LIBERTY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30A-052-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0113 PERMISSION IS HEREBY GRANTED TO: Project# SOLAR Contractor: License: Est. Cost: 9000 TRINITY SOLAR 116655 Const.Class: Exp.Date: 09/10/2025 Use Group: Owner: WATSON DAMIAN A Lot Size (sq.ft.) TRINITY HEATING&AIR INC DBA TRINITY Zoning: URB Applicant: SOLAR Applicant Address Phone: Insurance: 4 OPEN SQUARE WAY, SUITE 410 (413)203-9088(1522) WC13588107 HOLYOKE, MA 01040 ISSUED ON: 02/01/2023 TO PERFORM THE FOLLOWING WORK: strip and re-roof 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VI ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner \\ '- / c` The Commonwealth of Massachusetts Led a „4 ) Board of Building Regulations and Standards �� 4 FOR Massachusetts State Building Code, 780 CM: \ ! RUNIC PALITY �, USE Building Permit Application To Construct, Repair,Renovate&� 4 olish Related Mqr 2011 •One-or Two-Family Dwelling ;%tip `%� This Section For Official Use Only '�qo ��,�, Building Permit Number: 6 n A 3' /13 Date Applied: `�°�y6, //// 4" Os, / ..7 2-i-zzz ' Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 61 Liberty Street.Northampton,MA 1.1 a Is this an accepted street?yes 0 no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Residential-Roofing 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 Flood Zone? _ Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Damian Watson Northampton MA 01062 Name(Print) City,State,ZIP 61 Liberty Street (857)919-9623 damian.watsonAgmail.com 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 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ESpecify: Roofing Brief Description of Proposed Work': Remove and reinstall 2.4 kW DC solar on roof( 6 panels) Strip and reroof 1600 square feet of roof.Install architectural shingle,ice and water shield and underlayment. Replace rotted plywood if needed. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $11,000 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ CIStandard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Vi,) Total All Fees:`$ Check No.I '(heck Amount: O Cash Amount: 6.Total Project Cost: $11,000 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-116655 09/10/2025 Sean G o'Brtkis License Number Expiration Date Name of CSL Holder List CSL Type(see below) u 1434 14th Ave No.and Street Type Description Dorothy,NJ 08317 U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-203-9088 applications.westma@trinity-solar.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(H IC) 170355 10/11/2023 Trinity Solar HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 20 Patterson Brook Rd,Unk 10 applicadons.westma@trinity-solar.com No.and Street Email address West Wareham,MA 02576 413-203-9088 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 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 Please see attached to act on my behalf,in all matters relative to work authorized by this building permit application. 8/12/2022 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. r-- 8/12/2022 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" K0/71,120- 1 0.74 Laeleec)e,/4- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card TRINITY SOLAR INC. Registration: 170355 Expiration: 10/11/2023 D/B/A TRINITY SOLAR 2211 ALLENWOOD ROAD WALL, NJ 07719 Update Address and Return Card. SCA 1 0 20M-05117 Offi`KeroMenstimerafialryti If sfgass:6tegniSGon HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 170355 10/11/2023 1000 Washington Street -Suite 710 TRINITY SOLAR INC. Boston,MA 02118 D/B/A TRINITY SOLAR "f SEAN O'BRIKIS %�J 20 PATTERSON BROOK ROAD UNIT 10 ,,,,,,�'a.(4G(n4' WEST WAREHAM,MA 02576 Not valid without signature Undersecretary ®� Commonwealth of Massachusetts Division of Occupational Licensure • Board of Building Re ulations and Standards Cons ionfS rvisor tP CS-116655 _ spires:09/10/2025 ti SEAN G O'BOJKIS"• ,11101 ,p 1434 14TH AVE , DOROTHY Nt0831 11? }}, •Vr)I.1,Vd1.13a Commissioner di t K. VE441112.... AC� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/13/2022 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(ies) must have ADDITIONAL INSURED provisions or 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). PRODUCER CONTACT NAME: Mark Grasela Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX 4000 Midlantic Drive Suite 200 (A/C.No.Eat:856-482-9900 (A/c,No):856-482-1888 Mount Laurel NJ 08054 ADMDRESS: CherryHilI.BSD.CertM@AJG.com INSURER(S)AFFORDING COVERAGE NAIC A INSURERA:Gotham Insurance Company 25569 INSURED TRINHEA-03 INSURER B:National Union Fire Insurance Company of Pittsburg 19445 Trinity Solar Inc. 4 Open Square Way, Suite 410 INSURER C:Liberty International Underwriters Holyoke, MA 01040 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1260165960 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRL TYPE OF INSURANCE ADDL SUBRV POLICY NUMBER POLICY EFF POLICY EXP LIMITS ,(MM/DD/YYYY] (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY GL202100013378 6/1/2021 6/1/2023 EACH OCCURRENCE $2,000,000 CLAIMS MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 MED EXP(My one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY CA 2960145 6/1/2022 6/1/2023 OaM aBNEDINGLELIMIT $2,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) _ _ A UMBRELLA LIAB X OCCUR EX202100001871 6/1/2021 6/1/2023 EACH OCCURRENCE $5,000,000 C X EXCESSLUIB ELD30006989101 6/1/2022 6/1/2023 CLAIMS-MADE 1000231834-06 6/1/2022 6/1/2023 AGGREGATE $5,000,000 DED RETENTION$ Limit x of$5,000,000 $19,000,000 B WORKERS COMPENSATION WC 13588108 6/1/2022 6/1/2023 X PER OTH- 'AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? n N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 Ryes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Automobile CA 2960145 6/1/2022 6/1/2023 All Other Units $250/500 Comp/Collusion Ded. Truck-Tractors and Semi-Trailers $250/500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Insurance AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations i 7 Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 • www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Trinity Solar Inc. Address:2211 Allenwood Road City/State/Zip:Wall, NJ 07719 Phone #:732-780-3779 Are you an employer? Check the appropriate box: Type of project(required): 1.111 I am a employer with 1800 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. (l Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.. required.] 5. ❑ We are a corporation and its l0.11I Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' right of exemption per MGL y comp. 12.x Roof repairs insurance required.] i- c. 152, §1(4), and we have no employees. [No workers' 13.0Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: National Union Fire Insurance Company of Pittsburg Policy #or Self-ins. Lic. #:WC 13588108 Expiration Date:6/1/2023 Job Site Address: 4 Open Square Way City/State/Zip: Holyoke, MA 01040 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insuranc covera cation. I do hereby certify nde the pai a penalti of perjury that the information provided above is true and correct Signature: ,� Date: 8/17/2022 Phone#: 732-780-3779 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 3.❑City/Town Clerk 4.❑Electrical Inspector 5.alumbing Inspector 6.0Other Contact Person: Phone#: