24C-148 (4) 19 ARLINGTON ST BP-2019-0160
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:.Block:24C- 148 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2019-0160
Proiect# JS-2019-000268
Est Cost$3471.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group GREEN COLLAR LLC 108817
Lot Size(sp.ft.): 8015.04 Owner: TOPAL SAMUEL&CATHY W
Zoning, URB(100)/ Applicant. GREEN COLLAR LLC
AT. 19 ARLINGTON ST
Applicant Address: Phone: Insurance:
3 MAIN ST UNIT B (413) 532-1817 WC
SOUTH HADLEYMA01075 ISSUED ON:8/9/2018 0:00:00
TO PERFORM THE FOLLOWING WORIGADD R-40 & R-49 CELLULOSE TO ATTIC
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
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.
Certificate of Occupancy slenature:
FeeType: Date Paid: Amount:
Building 8/9/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
MN -q6)(, 147-1,041
..Department use.only
City of Northampton status of Permit:
Building Department Curb CuUDriveriay ParmII
212 Main Street Sewer/Seped Avallahiaty
Room 100 Water/Well Availebplily
Northampton, MA 01060 Two sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 ProtiSits Plein
Other Specify. .
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR
TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION ru/r I q '' 0
1.1 Property Address: This section to be contr yoffice
Map a!lC, Lot I-f Unit
1•� + Zgte Overlay District
Eke St Dedric CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
S mane To Oa( Q clt
Name(Prot)
/� Curre4�ilJrgAtlQre
pqe(Jii Telephone
Signature
2.2 Authorized Anent:
Green Collar,LLC 3 Main St.Unit B.South Hadley, MA 01075
Name(Print) % Current Mailing Address'.
_ 413 532 1817
Sign ra,l Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building '3/ c' (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from S
3. Plumbing Building Permit Fee !'
4. Mechanical(HVAC)
5. Fire Protection �•l
6. Total=(1 +2+3+4+5) -7 t- Check Number
This Section For Official Use Only
Date
Building Permit Numbe ' Issued'
Signa re:
Building missionerllnspector ofS ldings Date
$ectwo 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
Tniscolumn In In filh,d in by
Building D,,,mmcnt
Lot Siu
Frontage
Setbacks Front
Side L R: L R'
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot arca minus bldg&pawl
Ln
#ofParking Spaces
Fill:
volume&Loc,"on)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON7 KNOW OX YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YM enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW OX YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it pad of a common plan
that will disturb over 1 acre? YES O NO g X
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(Check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ Now Signs IC31 Decks jp Siding=1 Other[MOX
Brief Descripplion of PrUosed
Work: INTLATIN/WEATHERIZATION H& FJb + 9Ai /t
l4J1C
Alteration of existing bedroom_Yes X No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes _ANO
Plans Attached Roll -Sheet
Be.If Now house and or addition to existina housing complete the following
a. Use of building 'One Family Two Family Other
o 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. No miner of stories?
f. Method of heating? Fireplaces or W oodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
In. 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, SEE ATTACHED DOCUMENT 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
Signature of Owner Date
, as Owner/Authorized
Agent hereby declare at the statements and in ormation on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed un a pains and penalties of perjury.
Print Name
Sigratu /Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name ofc Holder CS-108817
License Number
Robert Calhoun 8/23/2018
Address Expirafion Dale
390 Newton St. South Hadley,MA 01075
Signature Telephone
413 532 1817
9 Repislered Nome ImerovemeM Contra ler. Not Applicable ❑
Company Name Registration Number
Green Collar,LLC 181415
Address Expiration Date
3 Main St. Unit B. South Hadley, MA 01075 Telephone 413 532 1817 3131/2019
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(III 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....... N No...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellines atone(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than n home ia two-year period shall not be considered a homeownen.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall be
resumpasible for all such work performed under the built ine permit,
As acting Construction Supervisor your presence on the job site will be required from Lime to time,during and upon
completion of the work for which this permit is issuul.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)ofthe Massachusetts General Laws Annotated,you may be Eablc for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature_
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work:
The debris will be transported by: A/ A
The debris will be received by: �� s
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
Columbia Gas
of Massachusetts 60 Shawmut Road, Unit 2 Canton, MA 02021
A NlS .Co .Y
OWNER AUTHORIZATION FORM
I, Simone Topal _
(Owner's Name)
owner of the property located at:
19 Arlington Street
(Street)
Northampton, MA 01060
.(Town, State, Zip)
hereby authorize �� �.�� ` d ' (OL(—
(Subcontractor)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property. This form is only valid with a signed contract.
The Permit will be secured by the insulation contractor, at no additional cost. It is the homeowner's
responsibility to dose out this permit by contacting their municipality at the completion of this work.
-Customer Sig \
-Sign Date
5/412018