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
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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
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DED RETEAMONS S
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,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
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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