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29-513
BP-2023-0767 21 TARA CIR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-513-001 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-2023-0767 PERMISSION IS HEREBY GRANTED TO: Project# 2023 SOLAR Contractor: License: PIONEER VALLEY Est. Cost: 23200 PHOTOVOLTAICS CS106329 Const.Class: Exp.Date: 03/14/2024 Use Group: Owner: GATTI ELIZABETH M&NANCY E FAMIGLETTI Lot Size (sq.ft.) Zoning: WSP Applicant: PIONEER VALLEY PHOTOVOLTAICS Applicant Address Phone: Insurance: 311 WELLS ST - SUITE B (413)772-8788 375928710105 GREENFIELD, MA 01301 ISSUED ON: 06/12/2023 TO PERFORM THE FOLLOWING WORK: INSTALL 15 PANEL 6.075 KW ROOF MOUNT SOLAR SYSTEM 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 NO HAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Q . 9- 1 . Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commiss ner V 00� �G� �/v The Commonwealth of Massachusett 20 oT .c Board of Building Regulations and Standar 9G/ R -,m i Massachusetts State Building Code,780 CM o'ti� M CI LITY 3� US Building Permit Application To Construct,Repair,Renovate Or ' h a Revise ar 2011 o One-or Two-Family Dwelling a' o This Section For Official Use Only �� Buildin Permit Number: eP?•3-• 70 7 Date Applied: `• Via ) 0->s // yZoZ c /C�� 3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 21 Tara Cir,Northampton,MA 01062 1.1 a Is this an accepted street?yes no Map Number Parcel Number 13 Zoning Information: 1.4 Property Dimensions: 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 OWNERSHIP1 2.1 Owner'of Record: Elizabeth Gatti Northampton,MA 01062 Name(Print) City,State,ZIP 21 Tara Cir. - (413)320-1286 bethnsierra@aol.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK' (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 0 Specify:Solar PV Brief Description of Proposed Work2:Installation of a 15 panel roof mounted PV array.System size 6.075kW DC!6kW AC. SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item 1 Official Use Only (Labor and Materials) 1.Building $8,120 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $15,080 ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: ii PP ) � Check No. I ch // eck Amount: Cash Amount: 6.Total Project Cost: $23,200 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-106329 03/14/2024 MAYA FULFORD 4 F7- License Number Expiration Date Name of CSL Holder List CSL Type(see below) u 159 CLARK DRIVE No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) GUILFORD VT 05301 R • Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-772-8788 BUILDINGPERMITS@PVSQUARED.000P I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 140077 9/15/2023 PIONEER VALLEY PHOTOVOLTAICS COOP HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 911 WELLS STREET,SUITE B BUILDINGPERMITS@PVSQUARED.COOP No.and Street Email address GREENFIELD MA 01301 413-772-8788 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 p 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 Pioneer Valley Photovoltaics Coopertive to act on my behalf,in all matters relative to work authorized by this building permit application. SEE ATTACHMENT (A) SEE ATTACHMENT(A) 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. 6/6/2023 Print Owner's or Auth iofzed 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" DocuSign Envelope ID:37C56466-8882-4659-B187-9C9E6B335656 Attachment A: AUTHORIZATION TO PROCEED AND SERVE AS AUTHORIZED AGENT I hereby agree to the Project as set out above, and I agree to pay the contract price according to the Terms of Payment. I further agree to the Terms and Conditions attached hereto as a part of this Proposal and Agreement. I hereby authorize Pioneer Valley PhotoVoltaics Cooperative to proceed with the above-referenced Project in accordance with this Agreement. I further authorize Pioneer Valley PhotoVoltaics Cooperative, or its designated representative, to obtain required permits for this project on behalf of the Owner. I will allow any photographs or videos of this project to be used by Pioneer Valley PhotoVoltaics Cooperative for marketing purposes. A check for the First Payment is enclosed and I am returning this Agreement within 14 days of the Proposal date. Elizabeth Gatti 5/15/2023 I 12:57 PM EDT Printed Name Date f—DocuSigned by: 6/5414 tlfti System Owner(s) '-----4DC07751 B 1 A2417... Signature Title Proposal and Agreement#00017824 Page 7 of 13 Beth Gatti-May 9,2023 ® DATE(MM/DDIYYYY) AC� �..-- CERTIFICATE OF LIABILITY INSURANCE 01/05/2023 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 Kathy Parker NAME: Alera Group,Inc. IC,PHONE,E:t): (413)586-0111 FAX No): (413)586-6481 Webber&Grinnell Division E-MAIL kparker@webberandgrinnell.corn ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: Ohio Casualty/Liberty 24074 INSURED INSURER B: Ohio Security/Liberty 24082 Pioneer Valley PhotoVoltaics Cooperative,Inc. INSURER C: Continental Indemnity/AUW 28258 Attn:Kim Pinkham INSURER D: 311 Wells Street,Suite B INSURER E: Greenfield MA 01301 INSURER F: COVERAGES CERTIFICATE NUMBER: CL231519687 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. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE 10 RENTED 300,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 A BKS57072282 01/01/2023 01/01/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n PRO- 2 B0 DBB JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED BAS57072282 01/01/2023 01/01/2024 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY (Per accident) Underinsured motorist $ 300,000 X UMBRELLALIAB _ OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE US057072282 01/01/2023 01/01/2024 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y N STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA 375928710105 01/01/2023 01/01/2024 E.L.EACH ACCIDENT $ 1,000.000 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , Blanket BPP $1,483,977 Commercial Property A BKS57072282 01/01/2023 01/01/2024 Transportation $25,000 Installation $75,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Worker's compensation includes MA and NY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. 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