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23D-029 (4) B -2023-0107 460 ELM ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23D-029-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0107 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 5567 GREEN COLLAR LLC 108817 Const.Class: Exp.Date: 08/31/2024 Use Group: Owner: LEOPOLD REBECCA A Lot Size (sq.ft.) Zoning: URB Applicant: GREEN COLLAR LLC Applicant Address Phone: Insurance: 570 NEWTON ST (413)532-1817 R2WCI182010 SOUTH HADLEY, MA 01075 ISSUED ON: 02/01/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION 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 NORTHAMPTON UPON VI li LATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I >2 . � i Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner ! `� �_ 5 3 / � l0 5 - uit_r JgZlS The Commonwealth of Massachuses. �� W Board of Building Regulations and Sta f CIP ALITY yn FOR MUNICIPALITY Massachusetts State Building Code,780 C` Il , >,,�s� USE Building Permit Application To Construct,Repair,Renovate Orr pd a Revised Mar 2011 0 One-or Two-Family Dwelling ,/� This,.Section For Official Use Only, Building P it Number: 6f� ?' iv 7 Date Applied: 10.4✓-1 tan,.-1 /, ems /C Z-l-ZLZ3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address:�I 1.2 Assessors Map& Parcel Numbed IA 40 rn �� 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 1 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 CIPrivate 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2. Owner'of Reco d: Ke,iC C fi .Co pc)( d. Wckkr)oum i(r a • Name(Print) City,State,ZIP Lk ISO E\m Sk • yt3- lo5F%-5$15 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) I 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 al Specify:Insulation/Weatherization Brief Desclption of Propos Work2: Insulation/Weatherization Ln-ylcr X1 �- o LA.nre.&cr is -c.d. - Se.-4 le.d c.e`I la kosr_br .ccbuiv21� A- cn cL -cc - (josa\ . SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 5,5 toi . ski, 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fe Suppression) Check Nt Check Amount: Cash Amount: 6.Total Project Cost: $ '3,5 1.0- 8� ❑Paid in ull 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 8/23/2024 CS-108817 Robert Calhoun License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 390 Newton St. No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) South Hadley,MA 01075 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413 532 1817 Support@greencollarma.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 181415 3/3l/20 3 Green Collar,LLC HIC Registration Number Expiration Date HIC Comnanv Name or HIC Registrant Name 570 Newton St Support@greencollarma.com No.and Street Email address South Hadley,MA 01075 413 532 1817 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 MI 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 Green Collar,LLC to act on my behalf,in all matters relative to work authorized by this building permit application. SEE ATTACHED DOCUMENT i a(o I a3 Print Owner's Name(Electronic Signature) ate 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 ' ation is true and accurate to the best of my knowledge and understanding. Print wner's or Au prized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who ob ins 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/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,fmished 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" Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Rei Cations and Standards Constion Srvisor CS-108817 Y E pires:08/23/2024 ROBERT C ,g 8 UPPER R RRD am SOUTH HADCFY MA 181 7i% Con:miss:6 =r ;a,. I Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 181415 GREEN COLLAR LLC. Expiration: 03/31/2023 570 NEWTON ST SOUTH HADLEY,MA 01075 Update Address and Return Card. scA 1 0 20M-051- Office of Consumer Affairs&Business Regulation • HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 181415 03/31/2023 1000 Washington Street -Suite 710 GREEN COLLAR LLC. Boston,MA 02118 STEVEN ECKMAN 570 NEWTON ST SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Green Collar, LLC _ Address: 570 Newton St City/State/Zip: South Hadley, MA 01075 Phone #: 413 532 1817 Are you an employer? Check the appropriate box: Type of project(re i uired): 1.® I am a employer with 15 4. ❑ I am a general contractor and I 6. New construe ion employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addi ion [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical rep irs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing rep:irs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.1X1 OtherInsulati n/Weatherization 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 are doing all work and then hire outside contractors must submit a new affidavit i i dicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those ntities 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:_ AmGUARD Insurance Company - A Stock Co. Policy#or Self-ins.Lic.#: R2WC182010 Expiration Date: 9/23/2023 Job Site Address: 'girl Ek i • City/State/Zip: WOc-E-hOSO kOn • fl— Attach a copy of the workers' compensation policy declaration page(showing-the-policy-number-and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 10 to a 3 Phone#: 413 532 1817 Official use only. Do not write in this area, to he 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. Plumbin Inspector 6. Other Contact Person: Phone#: DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: Republic Services Name of Waste Facility 845 Burnett Rd, Chicopee MA Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, M.G.L.c..40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. III s. 150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official,in writing,as to the location where the debris will be disposed. 780 CMR—6th Edition Robert Calhoun Signature of Permit Applicant t �aQ 3 Date City of Northampton jMassachusetts �� ` `� DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �'� � ‘1. �e Northampton, MA 01060 :::46 Property Address: 460 Elm St Contractor Green Collar, Ilc Name: Address: 570 Newton ST City, State: South Hadley, Ma 413-532-1817 Phone: Property Owner Name: Rebecca Leopold Address: 460 Elm St City, State: Northampton, Ma I Green Collar,LLC (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature 9?o-6ent C'aMRoun Date 2/1/23 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alteration(s) Roofing n Or Doors E Accessory Bldg. ElDemolition IIINew Signs (p] Decks [Q Siding[p] Other[p] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction, Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I 1 6 0 6 cc iq L e O 1'L, j'i? , as Owner of the subject property hereby authorize to actin q,y behalf, in all matters relative to work authorized by this building permit application. <� / /�- � ��-/ // — i6 ..c2 2 . Signature of Owner Date I, (;•--Oce.c.4 L1.=6 14, 4. r 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. 0 ln L'2<A- L-k Pcc, 12 Print Name Signature o Owner/Agee Date r