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11C-027 (3) 126 FLORENCE ST BP-2019-1200 GIS N: COMMONWEALTH OF MASSACHUSETTS I,yoj ftk: I IC-027 CITY OF NORTHAMPTON Lot. "001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGLLcc.1144/2�A) Cateaory�SOLAR ELECTRIC SYSTEM BUILDING PERMIT Permit# BP-2019-1200 Proiw JS-2019-001937 Est.Cost: $21000.00 Foo,$75.00 PERMISSION IS HEREBY GRANTED TO: Cost,Clms• Contractor. License: Use Group: VIRIDIS ENERGY SOLUTIONS LLC 107795 Lot Simian,ft.): 9278.28 Owner., FERGERSON JAMES Zonina;URA(100)/ Applicant: VIRIDIS ENERGY SOLUTIONS LLC AT. 126 FLORENCE ST Applicant Address: Phone., Insurance: ISLANCASTERAVE (617)669-5534 WC REVEREMA02151 ISSUED QM4126170I9 0.-0#.- TO PERFORM THE FOLLOWING WORK.ROOF MOUNTED SOLAR 48 PANELS 7.25KW POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Sent": Meter: Footings: Rough: Rough: House Foundation: Driveway Final: Final: Final: Rough Frame: Gas: moire Department Fireplace/Chimney: Rough: Qil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Sienabire: FeeType: Date Paid: Amount: Building 4/2620190:00:00 $75.00 212 Main Street,Phone(413)587.1240,Fax:(413)587.1272 Louis Hasbrouck—Building Commissioner Department use only City of Northamp /-� Slaws" of Permit: � .> Building Depe ant R EC E 'E(futDrive ay Permit 212 Main Str pticti1% Room 100 Waternv 11ANorthampton, MA 105 APA2 5 Se of Snsphone413587-1240 Fax 13 7-1272 PlouSiis lan e N APPLICATION TO CONSTRUCT,ALTER NEnOR TWO FAMILY�1DWELLING SECTION t -SITE INFORMATION 1.1 Property Address'. This section to be completed by office Map Lot Unit 126 FLORENCE STREET zone Overlay District Elm SL District Ca District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: JAMES CHARLES FERGERSON Name(Prim) Cuff"Ma" g r `ass: 507-213-8065 Telepbone Signature 2.2 Authorized Agent VJ�ScpYM 1,,.f:r:1' — s 7�- LCencoc;'pmw Aun , are, H.4- Name(Print) Current Mailing Address: /� ye� - 69- S s Signature Telepinrle SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by rmtt applicant 1. Building //09e ,r.7 (a)Building Permit Fee 2. Electrical O - (b)Estimated Total Cost of Construction from 8 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection S. Total=(1 +2+3+4+5) Check Number This Section For OlRclal Uss On Date Building Permit Number Issued: Signature: �/9SI ITS Building Canmissioncr/Inspector of Buildings Delp W @ ��fio�AS .Y1PYR4 . CD Wl EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Mn,cdumn to h filled in by Building Deyu nave Lot Sim 0 0 � Frontage Setbacks Front Side L:= R:= L:= R= 0 Rear Building Height Bldg.Square Footage :1 Yo E O Open Space Footage % __ O (W ansa minor bldg a paved I. #of Parking Spaces Fill: volume a lncniun A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES,date issued:__ IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Pagel and/or Document#', B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW Is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New Nouse ❑ Addition ❑ Replacement Windows Albration(s) ❑ Roofing ❑ Or Doom ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [❑I Decks [O Siding[OI Other[Ell Brief Description Of Proposed Roof Mounted Solar Army 7.25 M Work: Alteration of existing bedroom_ _Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached ROTI -Sheet ea. If New house and or addition to existina housina, complete the followino. a. Use of budding: One Family Two Family Other b. Number of rooms in each family und: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? I. Method of heating? Fireplaces or Woodstuves Number of each g. Energy Conservation Compliance. Masschedc Energy Compliance form attached? h. Type of construction I. Is construction within 100 fl.of wetlands?_Yes _No. Is construction within 100 yr. floodplain_Yes No j. Depth of basement or caller floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank_ C"Sawer Private well City water Supply SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS 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. Signature of Owner Date I, Wissem Taboubi as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Wissem Tabouk PoM Na AgnKre of OwmkIA Data SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: CralgPederean Uceme Number 4 MEADOW LN, FRAMINGHAM, MA 107795 Atltlnx� Espkelbn Date .z 978-729-0492 10/2/19 Teleptiare 9.Reaistamd Home Improvement Contractor: Not Applicable ❑ VI 1i ti zrs � so� ��)or�1s 1 � 592s- Campanv Name Registration Number JS Lnnrock-o. Ave- 1_' e„eng 1') AX121c ) 01 - 0I - 2v2J Address ' v Eviration Date TelephoneQ7-9 -SS Z SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.182,§28C18)) 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....... A No...... ❑ City of Northampton •'F Massachusetts �C. `- v (1 � i rBPdBD 7 OF BUILDING IHSPSLTI®S 212 Main etrwt • I zm pal B ildi g ;r Y Northaepton, to 01060 Popo AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor most be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the`reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owneroccupied building containing at least one but not more than rourdwelling units.._or to structures which are adjacent to such residence or building"be done by registered contractors. Note.Ljthe homeowner kas contracted with a corporation or LLC,that entity must be registered Type of Work: Est.Cost: Address of Work: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 _Owner obtaining own permit(explain): _Building not owner-occupied _Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBH.ITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: X19 VkVt,� ii fEr 18S9zS Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts c z 118 OF BUILDING INSPECTIONS 212MainStreet 212 • Mw 010 Building Northampton, !9 01060 Massachusetts Residential Building Code Section I IO.R5.L2 Homeowner: Person(s)who own 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 homeowner. Section 110.85.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.85,provided that if a homeowner engages a person(s) for hire to do such work,then such homeowner shall act as supervisor. Such homeowner shall submit to the Building Official, on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation)and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for peison(s)you hire to perform work for you under this permit. City of Northampton •p Massachusetts DEPARIHENS OF 80ZIDING INSPECTIONS 2 + 212 Maio 9te *Municipal Builtling " Northampton, Mu 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a property licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 1'Z� r�`em{`oticQ YET' (Please print house number and street name) Is to be disposed of at: A *7 9,11an� o ,2d (Please pnnt name and location of facdly) ./ Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) �` 0cf- 2)= i9 Signature of Permit Applicant or Owner Date If,for any reason, the debris will not be disposed of as indicated,the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. i S"\ The Commonwealth of Massachusetts Department oflndustrialAccidents / Congress1,Suite 100 Boston,MAA 02 02111-20177 9 www.mossgowi is O orkers'Compensation Insurance Affidavit:Builders/Contraeton/EimtHcians/Plumben. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lesdbly Name(Bwitlrss/Organimior✓Individw):Vndis Errergy Solutions LLC Address:15 Lancaster Ave City/State/Zip:Revere, MA 02151 Phone#:817-689-6534 Arcyoa ae employer?Caerk Ike appeoprhh hoax Type of proJM(required): I.Q I an a employer with 14 employes(fill end/orlart-time).' 7. New construction 2❑I min asole proprietor or partai ip and have an employes working for me in 8. Remodeling any capacity.INo workers'comp.insurance required.] 3.M I am a homeowner doingall work myself No wuhers'e s insurance returned.] 9. ❑Building r I p.im ,eye, ]' 4.M I am a homeowner and will be hiring contractors m conduct all work w my propety. I will 10❑Building addition ease that all contuctan enter have workers'compeamioni ss.or are In I IQ Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 501 an a general contractor and I love hired the sub-convenors IistM an the it4chad sheens 13.0Roof repairs 1Mse sub-correctors have enployess=it have workers'cdnp.insurance &[]We R a corporatum and in oRars have exemiud their right ofexemption per MGL c. 14.0✓ Other Solar 152,§I(4),end we have nc employees.[No workers'worn.insumnee requand) •Am apPliwnt Net checks box ql must also fill out the section below showing their.wrkeri cenpeneation polity infarmuwn. s Homeowners who submit Nis andavit indicating they we doing aft work arM Then hire owMe wntracmrs moat whmit a nesv affidavit indisning such. IContmetors that check this box must attached an additional sheet showing the name ofthe subcontractors and state whether or not thou entities have emplovees. If the subcontramors M1ave employees.thry must provide their workers e,mp.policy number. 1 am an employer that is providing worken'rompemandon insurance for my employees. Below is the policy and job site informoaon. Insurance Company Name:TRAVELERS INDEMNITY CO OF AMERICA Policy#or Self-ins.Lic.k:6HUSSH27554918 Expiration Date:08/17/2019 Job Site Address:126 FLORENCE STREET City/State/Zip: NORTHAMPTON,MA Attach a copy of the worken'compensation policy declaration page(showing the policy number and expiration date} Failure to secure coverage m required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one�year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify ander rhe pains and peeral ies of perju y that the informant,provided above is true and correct. Signature' ,�.,J�.�ic Date: 04=019 Phone#:617-6695534 Official use only. Do not write in this area,to be completed by city or town i iciat City or Town: Permit/License# lasing Authority(circle one): 1. Board of Health 2.Building Department 3.City/ o"Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: eco d CERTIFICATE OF LIABILITY INSURANCE 7AU�� """19THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICTHISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EITEND OR ALTER THE COVERAGE AFFORDEDLICESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTIME A CONTRACT BETWEEN THE ISSUING INSURERI2E0REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N tM cMMcate holder M an ADDmONAL INSURED,the pollcy(les)must De entlwsed. N SUBROGATION IS ject toiha terms and contlttlona of the policy,cerMin policies may rpulro an antloroerrleM. A eMMmeM on MIs cedMeale dose not to Ole thrtl8ote holder In lieu of such entiorsemen s). PRIONOCER EONTNANE�cr Julanne Jessup JOHN E MCLAUGHLIN INSURANCE AGENCY L P PHO"No_�p., (Tei)ssszns _ FAX x.N EJI%JL AOOREesu jlesshhnusurancemoo: p�mclau 9 828 LYNN FELLS PARKWAY cow a AFamwarAWeaAGE NAN; MELROSE MA 02176 xMalLA: TRAVELERS INDEMNITY CO OF AMERICA 256M MwIRO Mx11mt8: VIRIDIS ENERGY SOLUTIONS LLC xxrmlc: xweexo: 15 LANCASTER AVE aauRm E: REVERE MA 02151 x MRF: COVERAGES CERTIFICATE NUMBER: 391910 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.LIMBS SHOWN MY HAVE BEEN REDUCED BY PAID CLAIMS. has TYPE OF xwRAMce PoIICY MIYBFA SUNR PaJCYEFF -POLICY ENPMIL Ilia Cp1YERCNLOBIfAALYRYIIY EACHOCCURRENCE a Mkh(LWMe#N[IE �OCLUR AG T6REN PREMISEstEe.Fcwnnxa { dI .Pare(aan S NIA PERaow,L&A muR a GENLAGGREGATE UNIT APPLIESPFR OEHERALAOGIEfi m a PoIKr❑Ter ❑LOC PIt000C18-CpiAPIfiO f O HER' f ADmM09aELMYIry a ANYAUTO BLOILY WAXtY1PFr Mnm) $ ALL OWNED StlIEO111H1 WA BOgLY NMiY1PFrv10eN1 a AUTOS AUTOa _ HIREDAUTOSAUTOa ALT03 Im E f f UNIRELLA. OCCUR EACH OCCURRDarE a EXOras LMB pAMgM,1pE WA AGGREGATE S DED RETEAMONS S WORHERSCOMPENBAIION x $fA ER MO MPLOYERT W Wb ,WYPROPRIETOWPARIIERENEWIIVE YrR EL EACH ACCNENT S 1,000,000 A OFFICENIMEMBENEXCUIDED/ ❑"M NA NM 6HU88H27554918 08/17/2018 08/7/2019 Phoenix,In NH) ELEH;AaE-EAEMPLOYE S 1,000.000 a ype wU,LL DESLRIPTIONOFOF1RATorts Id.wv El OISEA9E-IgLCY WR f 1.000.000 NIA eeaCRIMXKOPFA/,1pM8/LDC/,1NMIal YENCIFI MCMO1x.AJBbW Rw„�a e,BMu4 mrybaOMwe NnNw qpp 4nNPIM) Waken'Comp urd ation benefits will be paid to Massachusetts employees only.Pursuers to Endorsement WC 20 03 06 B,no auNonzation is given to pay claims for benefits to employees in states other than Massachusetts H the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows Me policy in force on the data that this oedficate was issued(unless the expiration date on the above policy precedes the issue data of this cadificots of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verfl ion Search lad at www.mass.govlMWworkersranpe mbonfinwsbgatio W CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOME WILL BE DELMERED IN City of NorthHampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street AUTxareao REPRE9ENTArnE Norinhamplon MA 01060 -\`M Daniel M..Chd Craw y,CPCU,Vice President-ResidualMarket-WCRIBMA 9)1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered modes of ACORD DATE: March 13, 2019 RE: 126 E Florence St, Leeds, MA 01053 To Whom It May Concern, As per your request, we have conducted a structural assessment of the building at the above address that included a site inspection on March 1,2019.This inspection included an examination of the roof structure and condition as well as any structural drawings that were available. PV solar panels are proposed to be installed on roof areas as shown in the submitted plans. The panels are clamped to rails which are attached to the roof with a lagged mounting system, and installed per manufacturer's specifications and recommendations. It was found that the roof structures as noted on PVS-1 satisfactorily meet the applicable standards included in the Massachusetts State Building Code(Ninth Edition), 2015 IBC/IRC and 2016 IEBC. Design Criteria: Wind speed = 117 MPH Ground snow load =40 psf Roof dead bad =9 psf Solar system dead load = 3 psf The roof was determined to have asphalt shingles atop board sheathing. Overall the roof area is structurally adequate to support the additional load of the solar panels and their framework. Acknowledged by: 'A 0 3 o`' c Digitally signed f CH RIS H. KIM Nm Chris by Chris Kim CIVIL Date: .� 5243300 Ki m 2019.03.13 FGI Er` 12:36:41 -04'00' Chris Kim, P.E. Wice of Consumer Ma &Business Ryule n ROM E IM PROVEM ENT CONTRACTOR TYPE:LLC Hgglsligt(g9 E Irnaon 185925 09/91/2020 'IRIDIS ENERGY SOLUTIONS LLC WISSEM TABOUSt 15 LANCASTER AVE C� REVERE,MA 02151 Undersecretary Comnlonwea9h of Massachusetts 1.1 Division of Professional Licensure Board of Building Regulations and Standards Construction SOpe isor CS-107795 Uyires: 10/07/2019 i CRAIG PEDENS a MEADOW LANE FRAMINGHAM MA 01`7e.01 Commissioner ✓"'� Construction Supervisor Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current editim of the Massachusetts State Building Code is cause for revocatim of this license. For inforrrMtan about this license Call(917)72742M«visa www.nnasal.gciv/dpl