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31B-311 (26) BP-2023-0686 42 GOTHIC ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-311-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0686 PERMISSIO IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 7288 GREEN COLLAR LL 108817 Const.Class: Exp.Date: 08/31/202' Use Group: Owner: NORT I AMPTON CITY OF CITY PROPERTY Lot Size (sq.ft.) Zoning: CB Applicant: GREEN COLLAR LLC Applicant Address Phone: Insurance: 570 NEWTON ST (413)532-1817 R2WCI182010 SOUTH HADLEY, MA 01075 ISSUED ON: 05/30/2023 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 NOR HAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: . (NT Fees Paid: $ 212 Main Street,Phone(413)587-1240,Fax: 413)587-1272 Office of the Building Commissi er Nt^C49—te-raF7t latc;IF2i1-,4 I VO The Commonwealth of ks4assachusetts i W Office of Public Safety an Inspections Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling r_ (This Section For Official Use Only) Budding Permit Numb•r:A 3.,..(//iftlItate Applied: I Building Official: II-- SECTION 1:LOCATION le ,:-Lk..___CauitiLL — ‘4., No.and Street City/T vn Zip Code Name of Building(if applicable) 11141/kataisssors Map tt " Block ft and/or Lot tt SECTION 2 PROPOSED WORK Edition of MA State Co,e used If New Construction check here 0 or check all that apply in the two rows below _ . ......._... Existing Building 0 Repair 0 1—Alteration 0 I Addition 0 Demolition i0 (Please fill out and submit Appendix 2) Change of Use 0 i Change of Occupancy 0 Other -Elf specify:._\11,. or% Are building plans and,f or construction documents being supplied as part of this permit application? Yes 0 No, Is an Independent Styli(ural Engineering Peer Review required? Yes 0 No Ok Brief Description of Proposed Work VISsr-rt13- 1 1 1a :1'141 C&-_41- .331.\S4-t 1 1.1 v? *Cf,LA:flL\LhpLtt31-qf SECI1ON 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 78.0 CMR 34) 0 Existing Use Group(s): I Proposed Use Group(s): SECTION k BUILDING HEIGHT AND AREA Existing Proposed -I•No.of Floors/Stories(i clude basement levels)&Area Per Floor(sq.ft.) I Total Area(sq.ft.)and-otal Height(ft) I SECTION St USE GROUP(Check as applicable) A:Assembly A-1 0 4-2 0 Nightclub 0 A-ID A-4 0 A-5 0 B: Business 0 E: Educational 0 1 F: Factory F-1 0 F2 0 ' H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 -2 0 1-3 0 1-4 0 M: Mercantile 0 I R: Residential R-10 R-2 0 R-3 0 R-4 El 5: Storage S-1 0 5-2 0 U:UtilityIlr 1 Special Use 0 and please describe below: Special Use Description SECTION&CONSTRUCTION TYPE(Check ad applicable) • IA 0 IB 0 I1A 0 JIB 0 IIIA 0 MB 0 IV 0 1 VA 0 Yfii.452 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) 1 Debris Removal: Water Supply: i F ood Zone Information: I Sewage Disposal: Trench Permit: 1 trench will not be Li Licensed Disposal Site 0 Public% I Check if outside Flood Zone 0 ! Indicate municipal 0 .. , _ retpinre?b01 or trent li specify: Private 1 or itdentify Zone: 1 or on site systemp,rmiris enclosed 0 ,,..k.A,L., Railroad right-of-way: Hazards to Air Navigation: MA Historic COMIlliSSiOri Review Process: i Not Applicabh FrIs Structure within airport ap roach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No Yes 0 No' SECTION 8:CONTENT Of CER11FICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contan an Sprinkler System?: ._,..Special Stipulations: : Design Occupant Load ter Floor and Assembly space: _ __......... _.... RECER. , r________________........_. 7. I MAY 2 3 2023 ' / 1 L._ .r.,1-0-17-BUILDING INSPECTIONS 1‘.-,gTHAMP (DN.MA 01060 _. . _. _....--_______ • Green Collar,LLC Contract For 570 Newton St South Hadley,MA 01075 Services (413)532-1817 support@greencollarrna.co greencollarma.com Chris Mason James House Northampton i antral Services 42 Gothic St. 210 Main St Northampton MA 01060 Northampton, A 01060 -Tay 1540 09/3 1 12022 SALES REP Brian Tierney CR AIR SEALING 62.5 CF 4 130.13 520.52 Provide labor and materials o air seal attic plane-Estimated 150 sq inches of air sealing opportunity Install Catwalk 30 29.00 870.00 Build Catwalk using 2X8 fra ing topped with plywood DAMMING 12 3.45 41.40 Provide labor and materials or additional damming ATTIC FLOOR 9" 1,176 2.59 3,045.84 Provide labor and materials o install 9"R-33.3 class one cellulose to open attic floor CET ATTIC FLOOR ENCL. ED 6"DP 1,176 2.39 2.810.64 Provide labor and materials o dense pack a 6"cavity in an attic floor TOTAL $7,288"40 Accepted By Accepted Date SECTION R PROPERTY OWNER AUTHORIZATION -Name and Address of Property Owner „, ,,..}o,o0,ems 1_,4..k .,,A: ,. z i{4 f,`1.(:›thit_ S-- .,.�i ""f° , )Y1 1 Y\a (i t OkSD 0_ __ Name(Printl No.and Street City/Town Zip Property Owner Contact information: Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Robert Calhoun 570 Newton St Sou Hadley,Ma 01075 Name Street Address Cit./Town State Zip to apply for and act on the Xroperty owner's behalf,in all matters relative to work au rized by this buildin ermit a lication. ECTION 10:CONSTRUCTION CONTROL(Please fill Out Appendix I) If a building is 1•ss than 35,000 cu.ft of enclosed space and/or not undo-Construdtion Control then check here❑ Otherwise provide galsit u,ti a,control nami(see section 07 in code as re aired, _ 10.1 Registered Professions Responsible for Construction Control(the professional c rdinating document submittals) Robert Callioun 413-532-1817 info greencollarma.cohs 151415 Name(Registrant) Telephone No. e-mail address Registration Number 570 New St South Hadley ma 01075 L� 3/31/25 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor GREEN COLLAR,LLC Company Name Robert Calhoun CS-108817-U Name of Person Responsible for Construction. License No. and Type if Applicable 570 NEWTON ST SOUTH HADLEI MA 01075 Street Address City/Town State 7ip 413-532-1817 LNFOS1 EENCOLLARMA.COM one No.(b Telephone one No. _..(_el I tStZAclN e-m_..._._._ Telephone (business) 3sQKERGephtne NS.\{Tt(cell) ; CE AFFIDAVIT 1 e-mail address SECTIO"V 11: (IyLG.L c.152§25C(ti)) A Workers'Compensation insurance Affidavit from the MA Department of industrial Accidents 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, Is, signed Affidavit submitted with this application? Yes 0 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor I and Materials) Total Construction C t(from Item t?)=9 ..411, 1.Building $ .'. .)fir - - - Building Permit Fee=I ta(Construction C.. x � (Insert here 2.Electrical $ appropriate unicipal factor $ . 3.Plumbing $ 4.Mechanical(HVAC) $ Note:Minimum f =$ out •nicipality) 5,Mechanical(Other) $ Enclose check payable to _ ti.Total Cost $ -7,,) "(- i (contact municipality)and write check number here _. SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below 1 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. Robert Calhoun Albeit ea&iawi owner 413-532-1817 5/19/23 PleRoa Newton St si'n name South Hadle• Title Telephone No. Date y ma 01075 infortgreencollarma.com Street Address City/Town State Zip Email Address Municipal Inspector to fill lot this section upon application approval: E�L _.—.—..._.�__.__ 7 Vane Date 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 Informati ni Please Print Legibly Name(BusinessOrganizaton;individual): Green Collar,LLC Address:570 Newton St Cit '/State'7i S uth Hadley,MA 01075 Phone 4: 413 532 1817 Are you an employer?Ct eck the appropriate box: Type of project(required): 1.M I am a employer with 15 4. ❑ I am a general contractor and I employees(full and'cr part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no env oyecs These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑guiding addition [No workers'comp.insurance cotnp.insurance.t required.] 5. El We are a corporation and its 10.0 Electrical repairs or additions «l � 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers' right of exemption per MGL Y comp. 12.0 Roof repairs insurance required.]* c. 152.§1(4),and we have no employees.[No workers' 13.1sl Otherinsulation/Weatherization comp.insurance required.] 'Any applicant that checks box#1 trust also till out the section below showing their workers'compensation policy information. Homeowners who subunit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContraetors 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 employers they must preside their ssorkaa'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.Lie.#: R2 WC 182010 Expiration Date: 9123/2023 Job Site Address: 11 a L"li1 i('v t c— k City State/Zip: lOr s cr f . Attach a copy of the workers'compensation policy declaration page(showing-the policy-masher-andexpiration date). Failure to secure coverage al 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 done-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 he forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under tire pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 413 532 1817 Official use only. 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#: City of Northampton od n.. �o .', ��s . s Massachusetts �w`� : DEPARTMENT OF BUILDING INSPECTIONS �y 212 Main Street • Municipal Building Northampton, MA 01060 fly r, MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: ' - C--)Otic L- Contractor Name: Green Collar,LLC Address: 570 Newton ST City, State: South Hadley, Ma Phone: 413-532-1817 Property Owner Name: t�l(YlC S (1.tS'� Address: I - �v� t'" S-k City, State: \k.) � - jtit n^ , Robert Calhoun (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 52c1ett ea!ftotue Date 3