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37-058
236 GROVE ST BR-2022-0038 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 37-058 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-2022-0038 Project# JS-2022-000062 Est.Cost: $5053.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: GREEN COLLAR LLC 108817 Lot Size(sq.ft.): 25656.84 Owneri GALLAGHER KELLY A Zoning: Applicant: GREEN COLLAR LLC AT: 236 GROVE ST Applicant Address: Phone: Insurance: 351 NEWTON ST (413) 532-1817 WC SOUTH HAD LEYMA01075 ISSUED ON:7/13/2021 0:00:00 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: 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. 1 I Cr) Certificate of Occupancy sienatu s2 1 ' ✓� FeeType: Date Paid: Amount: Building 7/13/2021 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner / Department use only FF City of Norha •ton t.,� �tatus of•Permit �• � Building Dep. me �� /� ut/Driveway Perm.# 212 Main .tree e -,. e cAvailability ' f oo OOoF 1 ,Wale , eli A ilability z pNorthamton, c , �; �c7 Two ets o tructural Plans phone 413-587-1240 `Fax 4 T,� , ' PI'• Site ans TOti 4—F0 other 3 =,eclfy`1 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVA r-bRi5EM a LISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION a_ Ts sebtion't o be completed by office 1.1 Property Address: ; `Map 37 Lot C% Unit ' 3l9 (otoue sir Zone Overlay;District Elm St.District • i;' 'CB District . SECTION 2=PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 142 i Gglicck2r el gto (,rook, sf- Name(Print)! Current Mailing Address: L,L - Ala- oR SEE ATTACHED DOCUMENT Telephone Signature 2.2 Authorized Aaent: , Green Collar,LLC 570 Newton St South Hadley, MA 01075 Name(Print) Current Mailing Address: \e-e •z 413 532 1817 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be `Official Use Only ` completed by permit applicant . 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated.Total Cost of Construction from(6) 3. Plumbing Building Permit Fee ' 4. Mechanical(HVAC) - ii 5. Fire Protection 6. Total=(1 +2+3+4+5) A 5-, a s-- Check Number . 0417 This Section'For Official Use Only Date V-� 1 Q �� Bui ' . lding Permit Number: 3 •U,• Issued: • Signature: JDll ' - . ' - ' / 7 ' ' Building Commissioner/Inspector of Buildings .Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size C ______ __ _ _...,,__,,__ --- 1_____ .__,..__.._._..... I Frontage ..-----.- Setbacks Front .... HrvJ..............v I... . .__... ill Side L:L. .1 R: .. L: .... R:E= .......T..I..._, , ._.m___, Rear L0 ..._.... .. Building Height [171 rill _^ Bldg.Square Footage - Open Space Footage _ (Lot area minus bldg&paved _ _ ( _____ parking) #of Parking Spaces -- Fill: (volume&Location) —_____�_.,______ .,,__._.._._. __._._.----- __ _....._.J._.-_.__________ .,_..._.. Imi A. Has a Special Permit/Variance/Findin• ever been issued for/on the site? NO 0 DON'T KNOW ij`4 X YES IF YES, date issued:L I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book , 1 Pa a and/or Document# B. Does-the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW t:',4X YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained0 , Date Issued: C. Do any signs exist on the property? YES 0 NO w$ IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO (35 IF YES, describe size, type and location: r-- -7 E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO `� X IF YES,then a Northampton Storm Water Management Permit from the DPW is required. , City of Northampton rrµ[HAM >o, ...rv. , s !�' `� Massachusetts A4?5�-, 'r i�„ ,W DEPEI2TMENT OF BUILDING INSPECTIONS �� ? 212 Main Street • Municipal Building 9J. sD Northampton, MA 01060 sj ��C i AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes.Prior to performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Ih ScAn.1 i c4,/(Al 0c.ill 4)r i za.i r t h Est. Cost: 31 S,n,S—j Address of Work: '. 3(n (,rou.e cs+ Date of Permit Application: (,„/a ct/A I I hereby certify that: I Registration is not required for the following reason(s): _Work excluded by law(explain): Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: (0/1 47,1 ! C�rv,eh C0/1Gr Mill Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts - ) . #,.., ..I. 1.1 * s DEPARTMENT OF BUIWING INSPECTIONS 1afar ' 41ws 212 Main.Street •Municipal Building Jb Q� 1:01— ; Northampton, MA 01060 fsNW ~b/ Debris 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. The debris from construction work being performed at: —13( 6r,iLi.e s+ (Please print house number and street name) Is to be disposed of at: 6ra4:41 (Win( 1cl fgrid o sa Sn�-11, I14r ,- ''4 olds (Please Print name and'location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signatur 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. . wtH hi , City of Northampton Massachusetts r,/ * 'ccyy a a 6 s 73 La I w �6 DEPARTMENT OF BUILDING INSPECTIONS ; � ^ r�Y 212 MainN Sthamptontreet • Mu ci01060uilding Jb&J. 4 frilsr `^afar , MA MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 'a,Sk, C,cooQ 5�1- Contractor Name: ( c oph CollG,'- Address: S-lo U Qe.k)Ach S-k City, State: Soc)l-h kAcsr) t(, NAM,-Sur 1%6. 4 Phone: £// - S fit- /&f-7 Property Owner • Name: 1,4 IL, 6,ei Ilc,2 Ito r Address: T SC roux s+ City, State: AUar4kovhah , A/tA sc4 ctirr%,4-15 I, h Cu/hct vl (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 Date C/ay/a The Commonwealth of Massachusetts Department of Industrial Accidents EA p`,I (I Office of Investigations 'E a600 Washington Street € 4 ' " 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.M I am a employer with t S 4. Ei 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. 0 Demolition working for me in any capacity. employees and have workers' 9. ['Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. 0 We are 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.© 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. tContractors 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: AmGUARD Insurance Company -A Stock Co. Policy#or Self-ins.Lic. #: R2WC 182010 Expiration Date: 9/23/2021 Job Site Address: ` ,'Sly Gtc.L.o s4 City/State/Zip:000116vri 1 , A^IV atate 6 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 er the pains and penalties of perjury that the information provided above is true and correct Signature: :-'4`'Z Date: G/ac✓ a i 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#: • ' ' -..' ' „.• •••• ::::. ,_7.4 Kvi2nio-rkebeead.10/ 0:JJ-excAle4,e/41:. .. . . z Office of Consumer-Affairs and Business-Regulation .., e : 1000 Washington Street- Suite 710 • \ Boston, Ma.p.. husetts 02118 • . . Home Improvemekg9ntractor Registration .=, : . ..............-........:—.7.-,....= :. . ,---- .fr-,. ,..—......,__ . ., Type: LLC...... , • ; ,,,,, "4 ::;4.........,=W IT''''';74.1-7; x : Registration: 181415 ,' . ' GREEN COLLAR LLC. ' 1: Expiration: 03/31/2023 - 570 NEWTON ST • ts1 tz=;:r...)., 1:,------ t-, .:.:-; , SOUTH HADLEY,MA 01075 Mr=.....-- io . --- d :. ' • . . .., , IN ....t...-....--0 - , . .• -.^ v=-••,:.= 'i 1.,,r ' - . '* =,•-gi---,), • :" : ..:• •L:.'„ ......_.:_.-- 4"1 . - • 1Ar 1„,s0" : -,. 1: Update Address and Return Card. SCA 1 0 20M-05/17 .Ve7 W0,12/7kaaid.Gyez,3J0-4439141, Office of Consumer Affairs&Business Regulation •::: HOME IMPROVEMENT CONTRACTOR ;Sy Registration valid for Individual use only .:.g ; :.•': ,.7pE:LLC , before the expiration date, If found return to: JR eglitkatlan Expiration 1,. Office of Consumer Affairs and Business Regulation •,. : ....._-.. 03/31/2023 ., 1000 Washington Street -Suite 710 GREEN Cpl. =1:7? ' Boston,MA 02118 2 • :: "' -If*: sil ..' , • , • -:: •„_:,st ii.__,::: 4._, ,..' . .• , • :1 .. STEVEN ECKMA IF-4!.. /h• ,,, , .. .: , 570 NEWTCN ST`yc."‘‘.,-117 m.,7.4or a.1 ae4teA. • Undersecretary $Q0T191:1AOLEY.AW. • ' :Not valid without signature ' • : •.• ',`:..i . , . :: •. • • /". 1-, . . i . Commonirealtiv of Massachusetts • • tip Division of Professional Licensure::, . ' Board of Building Regulations and Standards , , . • . . ' ConstsrO'hAriiipp.3ivisor . . • • Cs-108817 • ,t: ' . tis: .. pires:08/21/2022 ' • . ,..., ,,iL•i:i,,,,;,LN,.:;,,,,:,... , - ROHERT CA000 , . • • . . 8 UPPER RIIIR RO141/131 :/ -. ..0 . / .,,,. SOUTH HADLgy IgIfykirkfy:42.''. - ', ' •.-.7., - , . 5 5 • . . 1),.:4-/.. .,;,',\;9.:V.;, • ,‘, .N, :..,,.. • Otwa0-13 , ,.. . . • • •,-,A- :. • ... :', Commissioner,cla.ia K. litlandirx..- • . .. -• ', ' •". • .. • , . • • . . ' . . . • • • . , . ' •. . , . .. . . ' . , • ' ' • . • . , • • • • . ' . . ' . - . • • . , . • ,1 • • ' . • ' . .. , • • " . . . . • • DocuSign Envelope ID:850BD465-868C.4E58-BE65-46150D4FED90 RISE ENGINEERING" OWNER AUTHORIZATION FORM. I, Kelly Gallagher (Owner's Name) owner of the property located at: 236 Grove Street (Property Address) Northampton, MA 01060 (Property Address) hereby authorize Subcontractor(to be filled in by office) 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 subcontractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. e —DocuSigned by: O► Tr retralf c'rre 5/10/2021 1 12:04 PM EDT Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut.Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com . L" Worker's Compensation and Employer's Liability Policy e�/ AmGUARD Insurance Company- A Stock Co. i, Berkshire Hathaway Policy Number R2WC182010 AU GURD,� Insurance Renewal of R2WC053509 �•q Companies NCCI No. [21873] Policy Information Page (AR) [1]Named Insured and Mailing Address Agency ' GREEN COLLAR LLC AMHERST INSURANCE AGENCY INC 370 Newton St PO Box 48 South Hadley, MA 01075 Amherst, MA 01004 Agency Code: MAAHER10 Federal Employer's ID XX-XXX1086 Insured is Limited Liability Co. (LLC) Risk ID Number 1038965 [2] Policy Period From September 23, 2020 to September 23, 2021, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident- each accident $500,000 Bodily Injury by Disease - each employee $500,000 Bodily Injury by Disease - policy limit $500,000 C, Refer to Residual Market Limited Other States Insurance Endorsement-WC200306B D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium $ 21,496 Total Surcharges/Assessments $ $728.00 Total Estimated Cost $ $22,224.00 INTERNAL USE Xx Page- 1 - Information Page MGA : R2WC182010 WC 000001A Date :09/11/2020 MANOTE Issuing Office: P.O.Box A-H,39 Public Square,Wilkes-Barre, PA 18703-0020 •www.guard.com