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31C-081-017 BP-2023-1068 117,OLANDER #18B COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31C-081-017 CITY OF NORTH 'MPTON Permit: Solar Build PERSONS CONTRACTING WITH UNREG STERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUA NTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1068 PERMISSIO IS HEREBY GRANTED TO: Project# 2023 SOLAR Contractor: License: PIONEER VALLEY Est. Cost: 29500 PHOTOVOLTAICS CS106329 Const.Class: Exp.Date: 03/14/20.4 Use Group: Owner: J. B TZ, BARBARA Lot Size (sq.ft.) Zoning: Applicant: PIONE R VALLEY PHOTOVOLTAICS Applicant Address Phone: Insurance: 311 WELLS ST - SUITE B (413)772-8788 375928710105 GREENFIELD, MA 01301 ISSUED ON: 08/10/2023 TO PERFORM THE FOLLOWING WORK: INSTALL 21 PANEL 8.505 KW ROOF MOUNT SOLAR SYSTEM (NO STRUCTURAL NO BATTERY) 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 THAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: .>2 • T1 1 al 0 Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commissisner RAC itis The Commonwealth of Massa huse s AU Board of Building Regulations a d S dards G `9 ��yy��,,��,,, FOR w Massachusetts State Building C e, `Oa M ICIPALITY a. OF© USE Building Permit Application To Construct, Repair, NO Ut "Id ' a R ised Mar 2011 One-or Two-Family Dwelling °N.^fAofo °n+s This Se ti For Official Use Only Building Permit Number: IP'vZ 3-, jQ u Date Applied: 410 <JCoss 1747 8- io-Zozz Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 117 Olander Dr#18b,Northampton,MA 01060 1.1a Is this an accepted street?yes no Map Number 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 0 Zone: Outside Flood Zone? — Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Barbara Baatz Northampton,MA 01060 Name(Print) City,State,ZIP 117 Olander Dr#18b (617)909-0591 beejay_baatz@yahoo.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 Other 0 Specify:Solar PV Brief Description of Proposed Work2:Installation of a 21 panel roof mounted PV array.System size 8.505kW DV 7.6NW AC. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $10,325 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $19,175 ❑Total Project Cost(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No./40'eck Amount: Cash Amount: 6. Total Project Cost: s 291j00 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-106329 03/14/2024 MAYA FULFORD 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 City/Town,State,ZIP R Restricted I&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-772-8788 BUILDINGPERMITS T PVSQUARED.COOP 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 311 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. �cJ*' ./►ti 1 /i - � 8/8/2023 Print Owner's or Auth ized 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:5E3B291D-345B-432D-8BEC-131061676D15 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. Barbara Baatz 6/30/2023 I 1:10 PM EDT Printed Name Date r—DocuSigned by: 78A1 E25B465F40F... Signature Title Proposal and Agreement#00017946 Page 7 of 13 Barbara Baatz-June 23,2023 AC€® DATE(MM/DD/YYYY) 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. PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Est): (AIC,No): Webber&Grinnell Division E-MAIL kparker@webberandgrinnell.com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC it 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,DAMAGE TO REN rED 000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 300,000 MED EXP(Any one person) $ 15,000 A BKS57072282 01/01/2023 01/01/2024 PERSONAL&ADV INJURY $ 1'000.000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- ^I I 2,000,000 JECT I ILOC PRODUCTS-COMP/OPAGG $ 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 XHIRED v NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY I(Per accident) Underinsured motorist $ 300,000 X UMBRELLA LIAB — 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 YIN STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA 375928710105 01/01/2023 01/01/2024 .E.L.EACHACCIDENT $ "1000000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 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/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. AUTHORIZED REPRESENTATIVE ills!.-3 y-:./ I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD