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44-096 (4) BP-2024-136I 430 ROCKY HILL RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 44-096-001 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-2024-1361 PERMISSION IS HEREBY GRANTED TO: Project# HVAC HEAT PUMPS 2024 Contractor: License: Est.Cost: 20971 GREEN COLLAR LLC 108817 Const.Class: Exp.Date: 08/31/2026 Use Group: Owner: B MADERA REBEKAH E&ANDREW Lot Size(sq.ft.) Zoning: SR ,applicant: GREEN COLLAR LLC Applicant Address Phone: Insurance: 570 NEWTON ST (413)532-1 S 17 WMZ-800-8008323 SOUTH HADLEY, MA 01075 ISSUED ON:10/18/2024 TO PERFORM THE FOLLOWING WORK: HVAC FOR HEAT PUMPS 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: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: /7----/-7) Fees Paid: $157.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner S. The Commonwealth of Mas achus is Oei Wf Board of Building Regulations nd SE. ards i 6R Massachusetts State Building Co 7E4 �0�� ] LJNI LITY )//. "0// Building Permit Application To Construct,Repair,Ren �'i; ash a Rev ed Mar 2011 One-or Two-Family Dwelling ': ^cr ThisSection For Official Use Only oiOso�Ns Building Permit Number:Y-4" S`€`. fl Date Applied: S mg - ,/r2 ./`..-// /0-/�- Buil Official(Print Name) Si y;..1 Datc SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 430 Rem {t;11 Rd. 1.1a Is this an accepted street?yes no Map Number Parcel Number 13 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Usc 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 0 Private 0 Zone: _ Outside Flood Zonc'' Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2� e%nerl f th UQck(q NoAtarrytm. Ida Name(Print) ~1 City,State,ZIP oc tb Il_'R0L- Llt3•a►o• Lloos No.and treet Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other W Specify:l\kVft lqf Descri do f Prgposad gorCl -LtlP 5,044T- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1O,Q- ( 1. 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 (I-lVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fes• ' (� Check N . Check Amount: I_ ' Cash Amount: 6.Total Project Cost: S ao, �'11 I CI 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 3/31/2025 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 .❑ 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 pertnit 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 app• atio is true d accurate to the best of my knowledge and understanding. xf !/ / MMo lag Print Owner's or g(Gthonze A t (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 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.rnass.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 Office of Investigations —~�.= 600 Washington Street ' = O.. Boston, MA 02111 www.rnass.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 ty 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ 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.❑ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ 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. 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. I 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:_9/23/2,5 Job Site Address: 'U30 Roc-V-4.3 t\, d • City/State/Zip:Norma ylptun , 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and pe ti pe ury that the information provided above is true and correct. Signature: • Date: IC)I 0 Phone#: 413 532 1817 Official use only. Do not write in this area, to he completed hr city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ® Commonwealth of Massachusetts Construction Supervisor Division of Occupational Licensure Unrestricted-Buildings of any use group which contain less than Board of Building RegNulations and Standards 35,000 cubic feet(991 cubic meters)of enclosed space. Const Fonf$t5ip svisor CS-108817 A r gtplres: 08/23/2026 ROBERT C NOUN 8 UPPER flIR RD SOUTH HAD[EY MA 01075 1 ,`,,,, T ?ix_ lam, •t. r,li• ���.&. `I`1 1 Farure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner �E I+i s•.__ Contact OPSI:(617)727-3200 or visit www.mass.gov/dpl'opsl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration r7 _ ,, 4. tr' Type: LLC Tit �•—— I LL Registration: 181415 GREEN COLLAR LLC. �i ----- Expiration: 03/31/2025 570 NEWTON ST —1 SOUTH HADLEY, MA 01075 �, _ w .- 7r .1A4 si 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 03131/2C25 Boston.MA 02118 GREEN COLLAR LLC. ROBERT CALHOUN ,)570 NEWTON ST r,,"^"^4.i';,e4s,k' /6;'dQ/2 r!_GalA Gat- SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature 0 GREEN COLLAR Permit Authorization Form Rebekah Madera (Owner's Name) Owner of the property located at: 430 Rocky Hill Road (Property Address) Northampton, MA (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 Signature) 9/23/2024 (Date) 351 Newton St.Unit B South Hadley,MA 01075 Phone:413.532. 1817 Email: support@greencollarma.com Green Collar,LLC Contract For 570 Newton St GREEN South Hadley, MA 01075 Services (413) 532-1817 finance@greencollarma.com greencollarma.com ADDRESS SHIP TO Rebekah Madera Rebekah Madera 430 Rocky Hill Rd 430 Rocky Hill Rd Northampton, MA 01062 Northampton, MA 01062 CONTRACT FOR SERVICES# DATE: 3767 09/19/2024 SALES REP Garrett Demers ACTIVITY OTC RATE AMOUNT Samsung Max HeatAJ030CXS4CH 2-4Zone 30,000 BTU condenser 1 11,595.00 11,595.00 Price includes: all permitting,wiring, ground stand or wall bracket, and triple evacuation of system during setup. Line set, line hide,wiring of indoor units to be included on proposed indoor evaporator pricing. AH R 1213353369 EER - 13.5 I SEER2-22.5 I HSPF2 - 10.4 Samsung ARI5CSDAFWKNCV 15,000 BTU High Wall Evaporator 1 1,620.00 1,620.00 Install wall hung evaporator. Price includes all piping, wiring, and line hide associated with the installation for this zone of heating/cooling. Samsung RNSO7AFC 7,000 BTU 1-Cgh Wall Evaporator 2 1,153.00 2,306.00 Install wall hung evaporator. Price includes all piping, wiring, and line hide associated with the installation for this zone of heating/cooling. Main Electrical Panel Upgrade 1 5,450.00 5,450.00 Remove existing electrical panel and replace with 200AMP service Please make checks payable to Green Collar,LLC.and mail to 570 Newton TOTAL $20 971_.00 Rd.,South Hadley,MA.If you'd like to pay by credit card please reply to this i email and a 2.9%processing fee will be added to your total. Payments in full due upon completion of work.Accounts owed over 30 days are subjected to a finance charge of 1.50%per month, 18%annually.After 60 days buyer agrees to pay all collection fees including a reasonable attorney's fee Accepted By Accepted Date / 2 f Level 1 Bath 17.5k l.1k �� Hall Liv-Kitcf 3. C)fficc Job#: Scale: 1 :72 Performed for: Green Collar Page 1 570 Newton Street R01-Sui eA Universal 2022 South Hadley.MA 01075 22.0.03 RSU30692 Phone:413.532-1817 2024-Sep•19 09'40'03 www.greencollarma.com garre8@grreencolarma corn Project1.rup City of Northampton ` Massachusetts ..e., .1.._• ' • �, h• * ". . DEPARTMENT OF BUILDING INSPECTIONS 6. ;; 212 Main Street • Municipal Building yvi s ��,° Northampton, MA 01060 'r ' ����`�` 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: 430 Rocky Hill Rd (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: (Company Name and Address) /676o.M,t('�alieue. 10/18/24 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.