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.