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31A-102 (4) BP-2023-1011 21 FEDERAL ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-102-001 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-2023-1011 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: TRINITY HEATING&AIR INC DBA Est. Cost: 10000 TRINITY SOLAR 116655 Const.Class: Exp.Date: 09/10/2025 Use Group: Owner: BENSON ELIZABETH 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) WC 13588107 HOLYOKE, MA 01040 ISSUED ON: 07/31/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF 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: . I ' ' • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner r� The Commonwealth of Massachusett `A, l /� . ........f • Board of Building Regulations and Stands °T e�� „•� FOR Massachusetts State Building Code, 780 C Building Permit Application To Construct,Repair,Renovate 0 c,".••lish Rev': d M, 2011 One- or Two-Family Dwelling .y t94. o� This Section For Official Use Only Building Permit Number: g��/�'J" to Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map.&Parcel Numbers 21 Federal Street,Florence,MA 1.l a Is this an accepted street?yes ✓ 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 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: Andrew Judge Florence MA 01062 Name(Print) City,State,ZIP 21 Federal Street (413)320-3801 ainliz(lyahoo.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 ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other ESpecify:Roof Brief Description of Proposed Work': Strip and reroof 1600 square feet. Install new architectural shingles. Install drip edge, underlayment,&ice and water _ shield. Replace any rotted wood with new 3/4"plywood if needed. Ice and water shield is 1 layer,6 feet wide at eaves, 3 feet wide at rakes,valleys and around penetrations. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $10,000 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/To Application Fee ❑Total Project Cos (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) Total All Fees: $ ,{� Check No. eck Amount: `r Cash Amount: 6.Total Project Cost: $10,000 0 Paid in Full 0 Outstanding Balance Due: *a SECTION 5: CONSTRUCTION SERVICES k 5.1 Construction Supervisor License(CSL) CS-116655 9/10/2025 Sean G O'Brikis w License Number Expiration Date Name of CSL Hold ,i' ``VV'' 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 r M Masonry RC Roofing Covering X WS Window and Siding SF Solid Fuel Burning Appliances 413-203-9088 x 1524 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 Inc DBA Trinity Solar HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 20 Patterson Brook Road-Unit 10 applications.westma@trinity-solar.com No.and Street Email address West Wareham MA 02576 413-203-9088 x 1524 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 El 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. 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 aeation is true and accurate to the best of my knowledge and understanding. X 7/27/2023 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" • , NJ,Electrical Contractor business permit number34EB01547400 NJ,HIC reg.#13VH01244300 SOLAR For other jurisdictions,please visit:http://www.trinity-solar.com/about-us/locations-and-licenses HOMEOWNERS AUTHORIZATION FORM 1, Andrew Judge (print name) am the owner of the property located at address: 21 Federal Street Florence,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 program(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.: 8815512002 Na on Electric Utility Account: Elizabeth Benson f,,,,,,, ....,, Customer Signature Andrew Judge Print Name July 18, 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 Massachusetts {, ni Gj DEPARTMENT OF BUILDING INSPECTIONS ° 212 Main Street • Municipal Building SOb r ! 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 .. r Signature of Applicant: Date: 7/27/2023 .74 �o-iz;eyzethwe III o/ ezt-44,cx?/e 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 D/B/A TRINITY SOLAR Expiration: 10/11/2023 2211 ALLENWOOD ROAD WALL,NJ 07719 Update Address and Return Card. SCA 1 CS 20M•05/17 .Z:6 ee'4of+ tsatmat' ai91i E sRriCssAegataflon HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Rggistratlon Expiration Office of Consumer Affallrs 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 1 J 20 PATTERSON BROOK ROAD UNIT 10 •, .3f l �r/ ,% / WEST WAREHAM,MA 02576 Not valid without signature Undersecretary Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re ulations and Standards Cons tiatfiTS,rvisor CS-116655 i spires:09/10/2025 tad �;i,.; SEAN G O'BtJKIS , -' 1434 14TH AVE DOROTHY N,,0831774 411 Commissioner ( jc iF,. fendo— CERTIFICATE OF LIABILITY INSURANCE DATES/26/2o23�Y) ACORO 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: Arthur J. Gallagher Risk Management Services, LLC PHONEN ExU:g56 482 9900 FAX No):856 482-1888 4000 Midlantic Drive E-MAIL Suite 200 ADDRESS: CherryHill.BSD.CertM@AJG.com Mount Laurel NJ 08054 INSURER(S)AFFORDING COVERAGE NAICM INSURER A:Gotham Insurance Company 25569 INSURED TRINHEA-03 INSURER B:National Union Fire Insurance Company of Pittsburg 19445 Trinity Solar Inc. INSURERc:Endurance American Specialty Ins Co 41718 4 Open Square Way, Suite 410 Holyoke, MA 01040 INSURERD:Liberty Insurance Underwriters Inc 19917 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:129732996 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) UMITS A X COMMERCIAL GENERAL LIABILITY GL202100013378 6/1/2023 6/1/2024 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 EC LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY CA 2960145 6/1/2023 6/1/2024 COMBINED SINGLE LIMIT $2,000,000 (Ea accident) 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 6/1/2023 6/1/2024 EACH OCCURRENCE $5,000,000 C D X EXCESS LIAB ELD30006989101 6/1/2023 6/1/2024 CLAIMS-MADE 1000231834-06 6/1/2023 6/1/2024 AGGREGATE $5,000,000 DED RETENTION$ Limit x of$5,000,000 $19,000,000 g WORKERS COMPENSATION WC 13588107 6/1/2023 6/1/2024 x PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-FA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Automobile CA 2960145 6/1/2023 6/1/2024 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 ©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 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.• 1 am a employer with 2730 4. ❑ 1 am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' aP tY 9. ❑Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.11 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' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] e c. 152, §1(4),and we have no Solar Installation employees. [No workers'! 13.0 Other comp. insurance required.] *An\ applicant that checks box#1 must also till 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 contractors must submit a new affidavit indicating such. tContractors 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 Ins. Co. .._ Policy#or Self-ins. Lic. #:WC 013588107 Expiration Date:06/01/2024 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 ins-trance coverage verification. I do hereby certify and the pa:tts and penalties of perjury that the information provided above is true and correct. Signature: Au` _ Date: S 1-7 ,, - '7a:'7 Phone#: 732-780-37 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 3.0City/Town Clerk 4.0 Electrical Inspector 51:3Plumbing Inspector b.❑Other Contact Person: Phone#: ei, KO ,:.. TECHNICAL DATA SHEET IwPF STOCK NO. 4220XXX Sept, 2020 CAMBRIDGE This heavyweight, laminated shingle is composed of a dimensionally stable non-woven glass fiber mat, which is thoroughly impregnated with stabilized waterproofing bitumen. Cambridge is distinguished by its random shake- look design, unique dual band shadow coloration, and superior thermally activated shingle sealant. Colored, ceramic granules surface the top of both layers of this shingle to protect the asphalt from ultraviolet radiation. Each shingle has release tape and mineral powder applied to the underside, thus preventing any sticking in the bundle. Special algae-inhibiting granules have been added to provide long-lasting algae resistance. Suitable for application on roof slopes greater than 4:12. Underlayment is strongly recommended for slopes below 6:12. They may also be applied on low slope roofs (2:12 to 4:12) providing the deck is covered with two plies of felt or one ply of any IKO Ice & Water Protector. This shingle conforms to requirements of, ASTM D3018, ASTM E108 Class A, ASTM D3462, ASTM D3161 Class F, and ASTM D7158 Class H. CHARACTERISTIC UNITS NOMINAL TEST STANDARD VALUE METHOD LIMITS QUANTITY PER PALLET: - 56 - N/A PALLET SIZE: cm (in) 101 x 135 (40 x 53) LENGTH: mm (in) 1038 (40 7/8) - ±6 (± 1/4) WIDTH: mm (in) 349 (13 3/4) - ± 3 (± 1/8) HEADLAP: mm (in) 50 (2) - MIN: 50 (2) BUNDLE QUANTITY: - 20 - - COVERAGE PER BUNDLE: ft2 (m2) 33.3 (3.1) - - EXPOSURE: mm (in) 149 (5 7/8) - - TEAR STRENGTH: g PASS ASTM D1922 MIN: 1700 HEAT RESISTANCE: - PASS 90°C (192°F) STABILIZED BITUMEN WEIGHT: g/m2 (lbs/100 ft2) PASS ASTM D228 MIN: 2000 (41) GRANULE RETENTION: % PASS ASTM D4977 MIN: 86 FIRE RATING: - CLASS A ASTM E108 MIN: CLASS A *Sample shows no sliding or dripping of the bitumen coating when suspended vertically in an oven at 90°C(192°F)for 2 hours. See also Material Information Sheet— MIS#1513, MIS# 1713, MIS# 1813 The information on this Technical Data sheet is based upon data considered to be true and accurate, based on laboratory tests and production measurements, and is offered solely for the user's consideration,investigation and verification. Nothing contained herein is representative of a warranty or guarantee for which the manufacturer can be held legally responsible. The manufacturer does not assume any responsibility for any misrepresentation or assumptions the reader may formulate.