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17A-030 (10) BP-2024-1566 17 STERLING RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17A-030-001 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-2024-1566 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 6644 GREEN COLLAR LLC 108817 Const.Class: Exp.Date: 08/31/2026 Usc Group: Owner: H COFFEY JOHN M&MARY Lot Size(sq.ft.) Zoning: RI/WSP Applicant: H COFFEY JOHN M& MARY Applicant Address Phone: Insurance: 17 STERLING RD FLORENCE, MA 01062 ISSUED ON: 12/19/2024 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/Chimne : 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. Signature: ( /� Fees Paid: S75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner g nr-)Ez-c-'• - s� f NOV 2 S , The Commonwealth of Massachusetts / 2 2024 Board of Building Regulations and St ndards` FO r�>f MUNICIPLITY Massachusetts State Building Code,7 0 CI Kok OP n,.,,�r t "'� --,.; US c. Building Permit Application To Construct,Repair,Renovate r ti a,,,,, "�P o v#Slued Afar 2011 One-or Two-Family Dwelling � / This Seectio For Official Use Only Building Permit Number: Ag'?`7 ' /S&s l Date Applied: — /i%le j (2 /9.27 1uilding Official(Print Name) Si Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers (`1 sicoirT5 fhb 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�e Disposal System: Public] Private 0 Zone: _ Outside Flood Zone? Municipar u On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' /� 2.1 O�w�1) o_f Rccc�rd: TIOr-ei\c e t A Name(Print) City,State,ZIP 1-1 Stirlic'g ylb.a-105 3145 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 ❑ Demolition 0 Accessory Bldg.0 Number of Units Other Da Specify:Insulation/Weatherization B ' f Description of Proposed Work2 C Q� Ott t. ....0,,,,,,,..„_. S ntil u \Y - 114 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ lX .W 44 I. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (IlVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees:$ P Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ , b k 0 Paid in Full 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 3/31/2025 Green Collar,LLC HIC Registration Number Expiration Date HIC Comoanv 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 El 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 Green Collar,LLC to act on my behalf,in all matters relative to work authorized by this building permit application. SEE ATTACHED DOCUMENT 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 ap lication is and accurate to the best of my knowledge and understanding. /10/04/ Print Owner's or uth me(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 1Q have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the IIIIC 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 - sir i_ Office of Investigations 600 Washington Street ',ia1IV 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(required): 1.® I am a employer with _15 4. ❑ I am a general contractor and I employees(full and/or 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 employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P h' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We arc a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs 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.N OtherInsulation/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 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. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A.I.M Mutual Insurance Company Policy#or Self-ins. Lic.#:WMZ-800-8008323-2023A(1) Expiration Date:_9/23/25 Job Site Address: I f SkrfAV g Cl . City/State/Zip:3 1 CR.A L- `U11- Attach a copy of the workers'compensation policy declaration page(showi nd 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and2ofp jury that the information provided above is true and correct. Signature: Date: + (ONLt Phone#: 413 532 1817 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Commonwealth of Massachusetts Construction Supervisor ilDivision of Occupational Licensure Unrestricted-Buildings of any use group which contain less than Board of Building Re ulations and Standards 35,000 cubic feet(991 cubic meters)of enclosed space. Const i rAil rvisor CS-108817 s i tpires: 08/23/2026 ROBERT CA$HOUN 8 UPPER RJR RD :" SOUTH HAD Y MA 01075 �'' • `�i7 f'LY`I`�J Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner __I.,4-P i.,-- Contact OPSI:(617)727-3200 or visit www.mass.gov/dplWopsi THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration (-jz ) tl;J!* Type: LLC GREEN COLLAR LLC. (4\,...„ = Registration: 181415 570 NEWTON ST -" M Expiration: 03/31/2025 SOUTH HADLEY, MA 01075 "C Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 181415 03/31/2025 Boston,MA 02118 GREEN COLLAR LLC. ROBERT CALHOUN 7 570 NEWTON ST ,.n'4.1'? " /0-96ei teal-dGUL SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature 0 GREEN COLLAR Permit Authorization Form I, John Coffey , (Owner's Name) Owner of the property located at: 17 Sterling Rd Florence, MA (Property Address) (Property Address) Here by authorize Green Collar, a certified Mass Save Independent Insulation Contractor, to act on my behalf to obtain a building permit and to perform work on my property. (Owner's ig ature) 11/1/24 (Date) 351 Newton St.Unit B South Hadley,MA 01075 Phone:413.532. 1817 Email: support©greencollarma.com City of Northampton ri t Massachusetts -+M Ak DEPARTMENT OF BUILDING INSPECTIONS • - j 212 Main Street • Municipal Building Af•..� ,pCa Northampton, MA 01060 3 .� Property Address: 17 Sterling Rd Northampton, MA Contractor Name: Green Collar Address: 570 Newton St. City, State: South Hadley,MA 01075 Phone: 413-583-1817 Property Owner Name: John Coffey Address: 17 Sterling Rd Northampton, MA City, State: I, 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 /ee6 Date 12/18/24 City of Northampton Massachusetts• k DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 sS 4,,3C‘ In accordance with Chapter 40, Section 54, Towns are required to issue a building permit for the new construction, demolition, renovation, rehabilitation or other alteration of a building or structure. This is to assure that the debris resulting the above will be disposed of in a properly licensed solid waste facility, as defined by Section 150 (A) of Chapter 111. The debris from construction work being performed at: 17 Sterling Rd Northampton, MA (Please print house number and street name) Is to be disposed of at: Republic Waste 845 Burnett Rd. Chicopee, MA (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Republic Waste 845 Burnett Rd. Chicopee, MA (Company Name and Address) /C�CJPi2���ti:(/T,bGCyL Signature of Permit Applicant or Owner/Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed.