17A-294 (2) BP-2024-0978
110 HILLCREST DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17A-294-001 CITY OF NORTHAMPTON
Permit: Solar Build
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-0978 PERMISSION IS HEREBY GRANTED TO:
Project# 2024 SOLAR Contractor: License:
PIONEER VALLEY
Est.Cost: 42528 PHOTOVOLTAICS CS106329
Const.Class: Exp.Date: 03/14/2026
Use Group: Owner:
Lot Size (sq.ft.)
Zoning: URA Applicant: PIONEER VALLEY PHOTOVOLTAICS
Applicant Address Phone: Insurance:
311 WELLS ST -SUITE B (413)772-8788 6S62UBOW82800424
GREENFIELD, MA 01301
ISSUED ON: 08/01/2024
TO PERFORM THE FOLLOWING WORK:
INSTALL 38 PANEL 15.39 KW ROOF MOUNT SOLAR SYSTEM (NO STRUCTURAL UPGRADES OR BATTERY, DECK
MOUNT)
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
I nderground: 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: /Z.
Fees Paid: $125.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
7 //..&,,,..„.,?ef-c--...,/
The Commonwealth o/ husetts `
Board of Building Regulatt a#j dards (t FOR
Q Massachusetts State Building Co B' R USE
'fr''tir i MUNICIPALITY
Building Permit Application To Construct,Repair,Re t, lish Revised Mar 2011
One-or Two-Family Dwelling A070104,,s
This Secti For Official Use Only
_nn Building Permit Number:g P ' q Date Applied:
ham-u,,J &f. n J�2 a-i-zzY
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Asse sor ,Map&Parcel Numbers
110 Hitlaest Dr.Florence.MA 01062 / f--11 ll
l.la 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 El _Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Ann Hinckley Florence,MA 01082
Name(Print) City,State,ZIP
110 Hillcrest Dr. (413)559.1589 hinckleyann@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other El Specify:Solar PV
Brief Description of Proposed Work2:Installation of a 38 panel roof mounted PV array.System sire 15.39kW DC/10kW AC.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $14,884.20 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $27,643.20 ❑Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No.lr i s t6 Check Amount:tt'(L Cash Amount:
6.Total Project Cost: S 42,528 0 Paid in Full 0 Outstanding Balance Due:
SEOON 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
C9.106329 03/14/2026
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
Restricted 1&2 Family Dwelling
City/Town,State,ZIP M ' Masonry
RC Roofmg Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413.772-0766 BUILDINGPERMITSQPVSOUARED.COOP I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
140077 9/15/2025
PIONEER VALLEY PHOTOVOLTAICS COOP HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
311 WELLS STREET.SUTE a BUILDINGPERMITSQPVSOUARED.COOP
No.and Street Email address
GREENFELD►A 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 O No l7
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 Pholovollaics Coopertve
to act on my behalf,in all matters relative to work authorized by this building permit application.
SEE ATTACHMENT (A) SEE ATTACHMENT IA)
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.
7/29/2024
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"
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/P In in hers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly'
Name (Business/Organization/Individual): Pioneer Valley PhotoVoltaics Cooperative Inc. DBA PV Squared Solar
Address:311 Wells Street, SuiteB
City/State/Zip:Greenfield MA 01301 Phone#:413-772-8788
Are you an employer?Check the appropriate box: l ype of project(required):
I.0 I am a employer with 48 employees(full and/or part-time).* 7. ❑New construction
2 1 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.(No workers'comp.insurance required.)
9. ❑Demolition
3.Q 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
5.0 i am a general contractor and i have hired the sub-contractors listed on the attached sheet. 13. p
❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
14. ei Other Solar PV
6.0 We arc a corporation and its officers have exercised their right of exemption per MGL c.152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors 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:ACE AMERICAN INSURANCE CO
Policy#or Self-ins.Lic.#:6S62UB0W82800424 Expiration Date:01/01/2025
Job Site Address: 110 Hillcrest Dr. City/State/Zip:Florence, MA 01062
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as 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 of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cer r t e a' s nd penalties of pedury that the infi rmation provided above is true and correct.
Signatu . Date: 7/29/2024
Phone#:413-7 -87 8
Official use on y. Do not write in this area,to be completed by city or town official.
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#:
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.
/zylk/2/
Printed Name Date
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nature Title
Proposal and Per cement I 00011179/ Page 7 of 13
bonne and Ann Wncltey-11nrenre-June 13.2024