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08-034 349 COLES MEADOW RD BP-2017-1000 GIS4: COMMONWEALTH OF MASSACHUSETTS Map:Block:08-034 CITY OF NORTHAMPTON 1.ot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGLLc.1144/2�A) Category: INSULATION BUILDING PERMIT Permit4 BP-2017-1000 Project JS-2017-001729 Est.Cost:S2503.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: GREEN COLLAR LLC 108817 Lot Size(sq. ft.): 28357.56 Owner: MORGAN PATRICIA Zoning: RR(100)/WSP(72)/RI(28)/ Applicant: GREEN COLLAR LLC AT: 349 COLES MEADOW RD Applicant Address: Phone: Insurance: 7 WARNER ST (413) 532-1817 WC SOUTH HADLEYMA01075 ISSUED ON:3/7/2017 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 a 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 signature: FeeType: Date Paid: Amount: Building 3/7/2017 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-1000 APPLICANT/CONTACT PERSON GREEN COLLAR LLC ADDRESS/PHONE 7 WARNER ST SOUTH HADLEY (413)532-1817 PROPERTY LOCATION 349 COLES MEADOW RD MAP 08 PARCEL 034 001 ZONE RR(100)/WSP(72)/RI(28)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST EFJCW^YED REQUIRED DATE ZONING FORM FILLED OUT C/ /\ Fee Paid * 6 1 Building,Permit Filled out / Fee Paid Typeof Construction: INSULATION/WEATHERIZATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 108817 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOJMATION PRESENTED: A/Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance' Received& Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management oli '.n Delay / Airprier Signature of to ding Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances arc granted only to those applicants who meet the strict standards of MGL 40k Contact Office of Planning&Development for more information. Pec Ce bL ,`7/4 '/ gryn:f Co ‘ACLC na:.1 .5-7, oe�,d-g. 5>, l4 dcty ,w4 •bepartment ueaonly .:. City of Northampton status of Permit Building Department Curb Cut/Driveway Perms 212 Main Street Sewer/Septic Availability. Room 100 WaterrWell Availability Northampton, MA 01060 Two Sets of Structural Plane, phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans. Other Specify . . APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address. This section to be completed by office 3H3 COI e t' 11/1 a /oW g / Map Lot Unit l l I• \ C' f�O Zone Overlay District Elm St District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Q Mcn�un 34ct files (✓V9_� Cc s ct cu Name(Pont) /1/��7/ ., ,, /1 Gurtve9t Mating Atltlress q p p See- Y� �`46 �C vA�� � Telephone 303OrO Signature 2.2 Authorized Agent: Green Collar, LLC 7 Warner St. South Hadley,MA 01075 Name(Print) Current Mailing Address'. ride — 413 532 1817 Sign. e- Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building .2fL /5-0 3 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) ZS03 Check Number /1// G(J This Section For Official Use Only Building Permit Number: Date Issued: Signature: 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 Frontage _.... _. _. Setbacks Front Side C.. R: L . R: ._. Rear Building Height Bldg. Square Footage n/o Open Space Footage (Lot arca minus bldg&paved parkin& 14 of Parking Spaces Fill: _ .__. (volume&Location) A. Has a Special Permit/Variance/Finding++ ever been issued for/on the site? �5 NO 0 DON'T KNOW [X YES 0 IF YES, date issued: /�- IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW 0 YES O IF YES: enter Book Page : and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW ex YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO 0 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 part of a common plan that will disturb over 1 acre? YES O NO ,ry $ IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aooiicable) New House n Addition ❑ Replacement Windows Alteration(s) pi Roofing ❑ Or Doors 0 Accessory Bldg. El Demolition ❑ New Signs [0] Decks ED Siding OD] Other[MIX Brief Description of Pro osed Work: INSULA TION/W EATHERIZATION Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet Ga.If New house and or addition to existing housing. complete the following: a. Use of building: One Family Two Family Other b. 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. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. 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 1, 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 IIIIIIIIC Steven Eckman ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Steven Eckman Pnnt Name �� Sig re of Owner/Agent Date z/zc 8/7 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: CS-108817 Robert Calhoun License Number 8/23/2018 Address Expiration Date 390 Newton St.South Hadley,MA 01075 Signature Telephone 413 532 1817 9.Registered Home Imprpvemerd Contractor: Not Applicable 0 Company Name Registration Number Green Collar, LLC 181415 Address Expiration Date 7 Warner St.South Hadley,MA 01075 Telephone 413 532 1817 4/1/2017 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GI.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 W No ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 faun structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner'shall submit to the Building Official.on a form acceptable to the Building Official that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which tins permit is issued. 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)of the Massachusetts General Laws Annotated,you may be liable 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 The Commonwealth of Massachusetts Department of Industrial Accidents nif Office of Investigations 600 Washington Street .- J., 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: 7 Warner 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 3 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance 5. corporation and its l0.❑ Electrical repairs or additions required.] ❑ We are a 3.El I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL 2.0 Roof repairs insurance required.] c. 152, §I(4),and we have no employees. [No workers' 13.® Otherinsulation/Weatherization comp. insurance required.] *Any applicant that cheeks box 81 must also fill out the section below showing their workers'compensation policy information. r 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 subcontractors and state whether or not those entities have employees- If the sub-contractors have employees,they must provide their workers'comp.policy number- 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name_Berkshire Hathaway Guard Insurance Company Policy#or Self-ins. Lie♦q.4/: R2WC727792� q / Expiration Date: 9/23/2017 Job Site Address: 34-t ( (e g S 1• me ,d(,L,d' £ City/State/Zip:ry p:10Gr • _LA. a 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 tine 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 S250.00 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 o-pains , • .^—alties of perjury that the information provided above is true and correct I� 7 SiSignature: ---11rre: ---11r — 1/Date: - Phone#: 5321817 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#: e Worker's Compensation and Employer's Liability Policy /Berkshire HathawayAmGUARD Insurance Company- A Stock Co. ■war % Insurance Polity Number R2WC7277g2 Fie!A %i fl Companies RenewalCCI No. (21873) Policy Information Page(AR) [1]Named Insured and Mailing Address Agency GREEN COLLAR LLC TIERNEY INSURANCE AGENCY, INC. 7 WARNER STREET 16 NORTH ELM ST SOUTH HADLEY, MA 01075 Westfield, MA 01085 Agency Code: MATIERIO Federal Employer's ID 47-1041086 Insured is Limited LiabilityjC $tLC) [2] Policy Periodad From September 23, 2016 to September 23, 2017, 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 m each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident 5500,000 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-WC20O306B 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 $ 5,749 Total Surcharges/Assessments $ 299.00 Total Estimated Cost $ 6,049.00 oracnairow XX Page- 1 - Information Page MGA R2WC727792 WC 00000IA Date 09/14/2016 MANOW Issuing Office: P.O.Box A-H, 16 5.River Street,Wilkes-Barre,PA 18703.0020•www.guard.com uassacnusetts ueoarunent ui rumor oarety &lard of Building Regulations and Standards License: CS-188817 Construction Supervisor 1111 - ROBERT CA1HOUN 380 NE4YTON 3:L ..: - SOUTH Expir R Commissioner 08123/2018 7..±7/: G 1J'Z Jy(G;'l f,L�T'ilf�l� /��': -it"Lfl;,�UCfldl.�E;�t� Office of Cothumer ConsumerAftatrs arid Busmtss Regulation "'= 4 10 Park Plaza - Suite 5170 Boston. Massachusetts 02116 Home Improvement Contractor Registration Registration: 181415 Type. LLC Expiration: 4/1/2017 Tr# 264.318 GREEN COLLAR LLC. STEVEN ECKMAN 7 WARNER ST SOUTH HADLEY, MA 01075 -- - - — ----- Update Address and return card.Mark reason for change. Address -' Renewal Fmplesmmd — Lost Card Orfw of Canceller Afton, Basiosss kepi loan License or registration salid for individ ut use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 181415 Type: Office of Consumer Affairs and Business Regulation Expiration: 4/1/2017 LLC 10 Park Plaza-Suite 5170 Boston.MA 02116 G REEN COLLAR LLG EVEN ECKMAN ▪:r '.^rARNERST SOUTH HADLEY.MA 01075 Undersecretary. Not♦otvalid without signature Permit Authorization mass a Form ngRTICI,m111c swipe a. Pnenmsewwley CONTRACTOR Site ID: 500050270032 Customer: Patricia Mangan I, Patricia Mangan ,owner of the property located at: (Owner's Name,printed) 349 Coles Meadow Rd Northampton (PropeM street Address) (CAW hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. l Owner's Signature: eta, 4.i.. 1, • grfr Date: ad Le I 20 • FOR CLEAResult OFFICE USE ONLY CLEAResult has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: • C>–ce-er\ C ((CV— Z7z f1' Participating Contractor Date tag CLEAResult • SO Washington Street,Suite 3000 • Westborough,MA 03583 • 1600.E80.4472 • For OMse Use Only Rev.102015 �� � _