30A-050 67 LIBERTY ST BP-2021-1393
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A-050 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: SOLAR ELECTRIC SYSTEM BUILDING PERMIT
Permit# BP-2021-1393
Project# JS-2021-002320
Est.Cost: $12892.00
Fee: $75.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: FREEDOM FOREVER MASS LLC 110253
Lot Size(sq.ft.): 11979.00 Owner: SELIG DANIEL
Zoning: URB(100)/ Applicant: FREEDOM FOREVER MASS LLC
AT: 67 LIBERTY ST
Applicant Address: Phone: Insurance:
68 GOLD ST (413) 291-5992 () WC
AGAWAMMA01001 ISSUED ON:5/25/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:ROOF MOUNT SOLAR 3.400KW, 10 PANELS
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. • >2 CP'
i
a I •
Certificate of Occupancy Signature: i !
FeeType: Date Paid: Amount:
Building 5/25/2021 0:00:00 $75.00
•
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis,Hasbrouck—Building Commissioner
rl ° ?
• MAY 2 4
I
The Commonwealth of Massachus s 2Q(9/
Board of Building Regulations and Stara
`FOR
•
1 j Massachusetts State Building Code, 78f}' 1tUni-p/NG,�,� MUIICIPl1LITY
'', ,3 j
��` USE
Building Permit Application To Construct, Repair,Renovate O De MS43 guN Reused Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number:10 ml). / 5e?3 /Date Applied:
vIIJ Z'5', i�''/� 5 2S-202/
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessor Map& Parcel Numbers
67 Liberty St, Northampton, MA 01062 �"(
1.1 a Is this an accepted street?yes X no Map umber Parcel Number
1.3 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❑ Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Daniel Selig Northampton,MA 01062
Name(Print) City, State,ZIP
67 Liberty St 413-584-1495 danjselig@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2 (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 10 Other 0 Specify:install roof mounted PV solar panels
Brief Description of Proposed Work2:
Install roof mounted PV solar panels.System size-3.400kW,10 panels,200amps
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $2578.56 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $10314.24 ❑Total Project Costa (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: S 12,892.80 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts ,
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building , �`-
� Northampton, MA 01060 �J
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS,DECKS,ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR,ETC.
1. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specification of proposed work(digital and hard copy).
3. Site Plan with location of proposed structure(s)and setbacks.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/replacement windows).
8. Home Owner's License Exemption Form filled out and signed by homeowner(if applicable).
9. Note any Conservation and/or Special Permit requirements (if applicable).
10. Driveway Permit(if applicable).
11. Proof of Water and Sewer entry fees paid(if applicable).
12. Trench Permit-public land by DPW/Private land by Building Dept.
13. Stretch Energy Code—all new construction will require a HERS Rater Affidavit to be submitted with
permit application before issuance of permit.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-110253 12/01/21
Daniel Kelley License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
323 Highland ST.
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
Holden MA 01520 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-335-0270 permitsma@freedomforever.com _ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
198080 3/1/22
Freedom ForeverMassachusetts,LLC HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
68 Gold Street permitsma@freedomforever.com
No.and Street Email address
Agawam,MA 01001 413-335-0270
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 0 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 Daniel Kelley
to act on my behalf,in all matters relative to work authorized by this building permit application.
Z7Cc � 5/21/21
Print Owner's Name(Electronic gnature) 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.
Z7aiz 4 /l /! 5/21/21
Print Owner's or Authorized Age 0(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"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
Massachusetts
VA4 fir, r
DEPARTMENT OF BUILDING INSPECTIONS 7e I
xt
212 Main Street • Municipal Building 2�r
Northampton, MA 01060 v a_S�`
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:
The debris will be transported by:
Name of Hauler:
Signature of Applicant: Date:
The Commonwealth of Massachusetts
Department of Industrial Accidents
--.' 7.
,,,
1.1 I Congress Street,Suite 100
'.1 Boston,AlA 02114-2017
wwiltnass.giri,/dia..,...,:is..........,t,i%-- ,..„,„...-,
1%ur kers'Compensation Insurance iffida‘it: Iluilders!(•tottractorslElertricians/Plumhers.
To)BF.Flit:!)vk lin I IIE 1'i R111 I I l'st;.1.1-111()RITN.
Applicant Information Please Print Leeilils
Name llusinesvOrganizationinclividual I:
Address:
City/State/Zip: Phone#:
, ,. ...
Art yea an arophiy tr.'Cheat the appropriate hot: Type of project(required):
I 4:3 1 arn a employer with erisphisees ilia'eautor part-timet.• 7 D New construction
2.E3 I am a sole proprietor or partneolop and have no employees working for int in 8. ED Remodeling
any,,,,p-eity,„[No workers'*amp.imatrance ntlitio..d.,]
9.30 I am a homeowner doing all work myself.isb,workers"comp.insuranot required 0 Denvolinen.]*
I 0 0 Building addition
4.0 I am a horneowmar and will he lining onntractors to conduct all work on my property. l will
ensure that all inliaracium either have Vonatten:6`ontpaliatsosi insurance or aft Nei& I I a Electrical repairs or additions
proprietors with no employees.
1 ID Plumbing repairs or additions
am a general oaatravata and I have hoed the sab-contraeults kishati on the studied sheet.
I 3.0 Root repairs
These sith.contractors knot employees and haVe WtniCrS"comp.inatitance;
14.El Othei
(1,[j We are a eorporatturt and Its officerik have atm-tied their nghi of etemotion per liliGL c.
352,§Ital..and we Mist no employees.[No workiett*comp.insurance required.]
'.AJI),applicant that checks h.... , ,;;,i.1,t also 1111 OM the 5;eCtion belou showing their workers*compensation polscV information,
t theinisiwoms is tio submit tic,.a tibia irit indscafing they art d .,.ring all work and Mtn hat outside contractors must-submit a nekk affklak is indicating such.
ICOniractem,that check this box must aliaChvit:iza additional sheet show inc the nue.of the suis-controziors and site .,%-ttelher ot oat those col-ties has e
cunik,ces if.the sub-conirActim,luvt eligibly CC...S.ILA'must provide thee workers"oarim.policy ritisra,:i
„ .
I am an employer that is providing rwrAell compensation insurance for my employees. Below is the polity mu!job site
information.
Insurance Company Name: _
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City eStateZip:
Attack a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requited under MGL c. 152,*25A is a criminal violation punishable by a fuse 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.A copy of this Nt,Itcmcnt may be forwarded to the Offict. 01 Investigations of the DI"., for insurance
ci.o..cr,p..!e+.erirication.
I do hereb) erritl.ander the pains and penalties of perjury that the information providcii erili)VT i.,/ride II Ild ce4Ti Ct.
Signature: Date:
Phone#:
IOffitial use only. Do not write in this urea.to In.completed hj.city or town olliciaL
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#:
City of Northampton
Massachusetts
} DEPARTMENT OF BUILDING INSPECTIONS y'
212 Main Street • Municipal Building �f b�_
Northampton, MA 01060 Se, iti�,�`
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born (insert
month, day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a
parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption,
does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s)who owns 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 home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for
and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work
on my parcel, I am not engaged in construction supervision in connection with any project or work involving
construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any
provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my
parcel,I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this day of , 20_.
(Signature)