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23D-148 (5) BP-2023-0183 111 HINCKLEY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23D-148-001 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-2023-0183 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS 2023 Contractor: License: Est. Cost: 13000 TRINITY SOLAR 116655 Const.Class: Exp.Date: 09/10/2025 Use Group: Owner: ALISE WILL, Lot Size (sq.ft.) Zoning: URB Applicant: ALISE WILL, Applicant Address Phone: Insurance: 111 HINCKLEY ST FLORENCE, MA 01062 ISSUED ON: 02/15/2023 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: aI 4 A Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Massachu efts 7 FEB E6 � � 2023 FR I-- t Board of Building Regulations and S and ds 11PALITY \ii, Massachusetts State Building Code, 80 i y .PT cps SE Building Permit Application To Construct,Repair,Renova !(lMu Ol �cri NSevise Mar 2011 One-or Two-Family Dwelling �'�-' 07cs This Section For Official Use Only Building Permit Number: ov- Z --/d Date Applied: : I' . j � mil►►� e3 Building Official(Print Name) 1 Signature Da SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map &Parcel Numbers 111 Hinckley Street,Northampton,MA 1.1a Is this an accepted street?yes 0 no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Residential-Roof 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 CI Private 0 Zone: _ CheOutsck if yes❑Flood Zone? Municipal 0 On site disposal system 0 Check SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Alise Will Northampton MA 01062 Name(Print) City,State,ZIP 111 Hinckley Street (818)209-8838 lisawi1l27(ihotmail.com No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building Cl Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other ESpecify:Roof Brief Description of Proposed Work': panels) Strip and reroof 1700 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 $13,000 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ' ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $_Id 974 Check No. LY3 heck Amount: Cash Amount: 6.Total Project Cost: $13,000 0 Paid in Full 0 Outstanding Balance Due: i SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-116655 09/10/2025 Sean G o'Bnkis 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.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling �� 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(HIC) 170355 10/11/2023 Trinity Solar HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 20 Patterson Brook Rd,Unit 10 applications.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 B No ❑ 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. 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" • s NJ,Electrical Contractor business permit number34E801547400 NJ,HIC reg.#13VH01244300 SO LA R For other jurisdictions,please visit:http://www.trinity-solar.com/about-us/locations-and-licenses HOMEOWNERS AUTHORIZATION FORM Alise Will (print name) am the owner of the property located at address: 111 Hinckley Street Northampton,Massachusetts 01062 United States (print address) I hereby authorize Trinity Solar Inc. ("Trinity Solar") and its employees, agents, and subcontractors, including without limitation, , to act as my Agent for the limited purpose of applying for and obtaining local building and other permits from the Authority Having Jurisdiction as required for the installation of a Photovoltaic System, Battery System, roofing or other Trinity Solar offerings located on my property, applying and obtaining permission and approval for interconnection with the electric utility company, and registration with any state and/or local incentive progra m(s). This authorization includes the transfer/re-administering, and/or cancellation of any existing permits on file for the purpose of updating/applying with an alternate subcontractor. Without limitation to the generality of the foregoing I specifically authorize Trinity Solar et al.to populate technical details,fill-in,edit,compile, attach drawings, plans, data sheets and other documentation to, date, submit, re-submit, revise, amend and modify application, submission and certification documents ("Approvals Paperwork"), including those for which signature pages are included herewith for my signature, in furtherance of the related transaction, and I am providing any signatures to Approvals Paperwork for purposes of the foregoing.Trinity Solar will provide copies of Approvals Paperwork when submitted. My authorizations memorialized herein shall remain in full force and effect until revoked. I acknowledge that these authorizations are not required to proceed with the transaction and are not a condition of the related agreement included herewith but are being given for my own convenience and benefit in order to expedite the approvals processes. Electric Utility Company: National Grid Electric Utility Account No.: 5073407016 Name on Electric Utility Account: Alise Will ae. L-J Customer Signature Alise Will Print Name February 2, 2023 Date Corporate Headquarters 1-877-SUN-SAVES 2211 Allenwood Road Ph: 732-780-3779 Wall, New Jersey 07719 Fax: 732-780-6671 www.trinity-solar.com FOR INFORMATION ABOUT CONTRACTORS AND THE CONTRACTORS' REGISTRATION ACT, CONTACT THE NEW JERSEY DEPARTMENT OF LAW AND PUBLIC SAFETY, DIVISION OF CONSUMERS AFFAIRS AT 1-888-656-6225. City of Northampton gip` Massachusetts I 4; '� DEPARTMENT OF BUILDING INSPECTIONS b ; _� 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: Casella- 295 Forest Street, Peabody, MA 01960 The debris will be transported by: Name of Hauler: Trinity Solar 0:5-2 Signature of Applicant: ` Date: 2/13/2023 7)(_/2?-/1/0,??t(.,%(e £%Yr7'/(ram Oj /i!� t./ac,3,4 ,e 1 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 170355 TRINITY SOLAR INC, Expiration: 10/11/2023 D/B/A TRINITY SOLAR 2211 ALLENWOOD ROAD WALL, NJ 07719 Update Address and Return Card. SCA 1 (S 26M•05/17 . , cle-offConsumerAffair�/8,B'usmass Regui/a6on 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 SEAN O'BRIKIS - 20 PATTERSON BROOK ROAD UNIT 10 ,` , a,;x/�tr t WEST WAREHAM,MA 02576 ` , , Not valid without signature Undersecretary Commonwealth of Massachusetts 1175 Division of Occupational Licensure Board of Building Regqulations and Standards `T � Const fotIfSkti%rvisor CS-116655 , fi;pires:09/10/2025 SEAN G O'BE iKIS + 1434 14TH AVE 4. DOROTHY Nt,08317 ti it Commissioner Baia f;. J(en DATE(MM/DD/YYYY) ACCMC) CERTIFICATE OF LIABILITY INSURANCE 1/12/2023 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 g56-482 9900 4000 Midlantic Drive Suite 200 (NC.No.Ext): (A/c,No):856-482-1888 Mount Laurel NJ 08054 ADDRESS: CherryHill.BSD.CertM@AJG.com INSURER(S)AFFORDING COVERAGE NAIC# 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. LTRINSR ADDL TYPE OF INSURANCE INSD SW VD POLICY NUMBER POLICY EFF POLICY EXPN LIMITS (MM/DD/YYYY) (MM/DDYYY) 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(Any 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 COMBINED SINGLE LIMIT $2,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per $ AUTOS ONLY AUTOS accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ A UMBRELLALUU3 X OCCUR EX202100001871 6/1/2021 6/1/2023 EACH OCCURRENCE $5,000,000 C X EXCESSLU►B 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 ST TUTS ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE 0 E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,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 I 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 c :7-.. ......) Vidt It...... ©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 ' (0 Office of Investigations 41 600 Washington Street Boston,MA 02111 k,t www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrician/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.Ei 1 am a employer with 2,100 4. 0 I am a general contractor and 1 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. 0 Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers 0 Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.E 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other _ comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors 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: 06-01-2023 Job Site Address: 4 Open Square Way, Suite 410 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 insurance coverage verification. I do hereby cert' rder the pains and penalties of perjury that the information provided above is true and correct. Signature: + t_,___- Date: 1 4 ?i3 Phone#: 73 -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(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone #: •