36-054 (5) 57 REDFORD DR BP-2017-1054
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 36-054 CITY OF NORTHAMPTON
l,ot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeoly: INSULATION BUILDING PERMIT
Permit s BP-2017-1054
Project# JS-2017-001810
Est.Cost:$3131.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Groan: GREEN COLLAR LLC 108817
Lot Size(sq. tt.): 12501.72 Owner: STEELE KELLI
Zoning: Applicant: GREEN COLLAR LLC
AT: 57 REDFORD DR
Applicant Address: Phone: Insurance:
7 WARNER ST (413) 532-1817 WC
SOUTH HADLEYMA01075 ISSUED ON:3/22/2017 0:00:00
TO PERFORM THE FOLLOWING WORK INSULATE VINYL SHED WALLS
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. R 44410 />` a
Certificate of Occupancy Signature: !L
FeeTvpe: Date Paid: Amount:
Building 3/2212017 0:00:00 $65,00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck- Building Commissioner
File# BP-2017-1054
APPLICANT/CONTACT PERSON GREEN COLLAR LLC
ADDRESS/PHONE 7 WARNER ST SOUTH HADLEY (413)532-1817
PROPERTY LOCATION 57 REDFORD DR
MAP.36 PARCEL 054 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ZONING FORM FILLED OUT
//ENCLOSED REQUIRED DATE
Fee
Paid
Bui
Buiidinc Permit Filled out
Fee Paid
T meofConstruction: INSULATE VINYL SH D WALLS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 108817
3 sets of Plans I Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
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
Demolition Dela
ie ,�
Signature of B 1.Idi 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 are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information,
P4ayG Cyriaift Motel An )4. ,/_ie Green Collar, LLC
N3Main St. Unit B.
outh Hadley, MA 01075
• City of Northampton Status f, ,�"z"
- - ta. ..w.,
1.41 \\ Building Department 'vew .ay
.\\..„,
pR 2,1 \ 212 Main Street ')ewer/SepUCAvara lhty
Room 100 WatedWall Avaiability
Northampton, MA 01060 Two Sats of "Pians
\, Phone 413-587-1240 Fax 413-587-1272 PIo4$(te PGue' �.
.i Offer Speedy
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property This section to be completed by office
7- (€eIA' 1 Dr Map Lot Unit
t ,0 ate, MAI— O e 074,2_ Zone Ovellay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: D _
K i Sk,2e- 3l OP—e---dr—Ore, 7;e— 77.0(r—o4 1✓Y4b15/06.2_
Name(Print) Curren fi Address:
en
/ ) S 7S. 22C1
�'G enet-z"^'-te_s Telep e
Signature
2.2 Authorized Anent: 3 MC't S4- C)AN- Si
Green Collar,LLC q.4/41er^ar S. South Hadley,MA 01075
Name(Pn Current Mailing Address:
--alt--- 413 532 1817
Signet a Telephone
SECTION 7-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 3(3 ( 9,) (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) 1 CPS—
5. Fire Protection
6. Total= (1 +2+3+4+5) 3 / 3 / - q4, Check Number /350
This Section For Oficial Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING Ail Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be fillet In by
Building Department
Lot Size _. __... .
Frontage
Setbacks Front --"
Side L R. L: R ��
Rear .-
Building Height
Bldg.Square Footage
Open Space Footage
[Lot area mnus bldg&paved
parking)
of Parking Spaces
Fill: ._._ ...._... .
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW fox YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book '. Page and/or Document tt'
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW XX 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 ® 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,gradingvation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO 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 n Addition ❑ Replacement Windows Alteration(s) n Roofing ❑
Or Doors ❑
Accessory Bldg. tEl Demolition ❑ New Signs [0] Decks IQ Siding[❑] Other[OM
Brief Description of Prooposed ' ,r �/A
Work: INSULATION/WEATHERIZA'I'ION ts..Yu-k- visey( Sheet paty,(/j
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
ea.If New house and or addition to existing.,housina.completlethe 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 APPUES FOR BUILDING PERMIT
SEE ATTACHED DOCUMENT ,as Owner of the subject
properly
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 3/2o/zo/ 7
Signature of Owner Date
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
Print Name 4
3� 7
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder' CS-108817
Robert Calhoun License Number
8/23/2018
Address Expiration Dale
390 Newton St.South Hadley,MA 01075
Slgnatu - Telephone
413 532 1817
9.Reolstered Home Improvement Cordran 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.G.t.c.152,4 28C(8l)
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 IK No 0
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 781.), 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 one home in a two-vepr 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 this 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 persons)
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 Jand Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature j1f(>� .,,
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,itpas defined by MGL c 111 , S 150k
Address of the work: 5 7 ped1vr c1 Or.
The debris will be transported by: Co / Ls-
The debris will be received by: drec. Co LCA
Building permit number:
Name of Permit Applicant (g,rwil Co (LL
340/2A it)
Date Signature of Permit Applicant
NJ melons crop"-, p9c)i--c . _ .
:r
City of Northampton
-
< 4 Massachusetts "" L. iii_.
Id a' "' DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street o MunicipalBuilding SJ as
r �r � Northampton,
01060Sampton. MA pR Jo%
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner he right under 780CMR 1083.4 to act as his/her
construction supervisor. The state defines "Home._i -r" as, " Person(s) who owns a parcel on which
he/she resides or intends to be, a one or Iwo faint y ening, attached or detached structures
accessory to such use and/or f. structures. A p•rso ho constructs more than one home in a two-
year period shall not be consi.-r:d a home owner"
The building department for e Ci of Northa pt.•n wants - person(s)who seek to use the home
owner exemption, to act as eir o n construct n Isupervisor;d. be aware that by doing so you
become responsible for c•mplia e with st e •uilding coed and regulations. The inspection
process requires that the b ilding d-•artment b caled to inspect ork at various stages, which include
foundation/footings (bef re backfi I. sonotu e oles (before o• r). a rough building inspection
/before work is conceal d). insulat •n insoe lin (if required) a • a final building inspection
The building department r-quires thest inspectio before the work is oncealed, failure to secure
these inspections can r:suit in failur. to obtaM - certificate of occ• •ancy until the work can be
inspected.
If the ho eowner hires otIYer trades to pe 'orm work. -lectrical, plumbing . gas)the homeowner will be
responsi e to make sure at the trades hi -d secure eir proper permits conjunction to the building
permit is ed, and that th y get their requ ed inspe,tions. Failure of the .ndividual trades to secure
the perm s nd inspections as required can LAY t • •roject until such tim: as the proper permits
and insp cti ns are made
understand the above.
(Hom owner/resident's ignature requesti g exe •tion)
I will call t schedule all require building inspections necessary for the building permit issued to me.
Date
Address of work location
The Commonwealth of Massachusetts
"" Department of Industrial Accidents
Office of Investigations
600 Washington Street
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: N7nrasz51 —5 V Nk 51, . ( ) „ A. g
City/State/Zip: South Hadley,MA 01075 Phone#: 413 532 1817
Are you an employer? Check the appropriate box:
n Type of project(required):
L® I am a employer with 4. ❑ I am a general contractor and 1
employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
listed on the attached sheet 7. ❑ Remodeling
2.LI I am a sole proprietor or partner-
ship and have no employees These sub-contractors have S. ❑ Demolition
working for me in any employees and have workers'
Y 'ca acPitY 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.
t
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 11.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] '' c. 152, §1(4),and we have no
employees.[No workers' 13.® Othednsulation/Weatherization
comp. insurance required.]
'Any applicant that checks box kl must also fill out the section below showing their workers'compensation policy information.
±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. I f 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: Berkshire Hathaway Guard Insurance Company
Policy#or Self-ins. Lic. #: R2WC727792 Expiration Date: 9/23/20172
Job Site Address: ear.,--z 4Z 0 r . City/State/Zip: azij , Z7O6 2
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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under .'Ins and penalties_
7 / z0��7
ofperjury that the information provided above is true and correct
Si mature: Date:
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#:
RISE60 Shawmut Road, Unit 21 Canton,MA 02021 1339.502.6335
ENGINEERING' www.RlSEengineering.com
OWNER AUTHORIZATION FORM
(Owner's Name)
owner of the property located at i t- __-._ , I
L
(Property Address) j J_
rc� m4 . D ) o ro
(Property Address)
hereby authorize i9�SG C-0L-C pre_
(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 homeowners
responsibility to close out this permit by contacting their municipality at the completion of this work.
tf
Ovi+her s Signature _-
i
117 2
Date
6.2016
* • Worker's Compensation and Emolover's Liability Policy
/Berk�� AmGUARD Insurance Company -A Stock Co.
GInsurance UARD Sell
shire Hathaway Policy Number R2WC727792
t + Companies
RenewalNCCI No. [21873]
Policy Information Page (AR)
[1]Named Insured and Mailing Address Agency
GREEN C011AR LIC TIERNEY INSURANCE AGENCY, INC.
7 WARNER STREET 16 NORTH ELM ST
SOUTH HADLEY, MA 01075 Westfield, MA 01085
Agency Code: MATIERIO 27
Federal Employer's ID 47-10410E6 Insured is Limited tiabH7tt LLC) >'
epA frt":77
[2] Policy Period -_._ `.. _.... _...
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. Employers 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-WC2003068
D. This policy includes these endorsements and schedules:
See Extension of Information Page - Schedule of Forms
141 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 Cast $ 61048.00
11I6E9546L 6564. 55 Page-1 - information Page
MGA :R296727792 WC 000001A
Date :09/14/2016
MANOTE.
Issuing Office: P.O.Box A-H, 16 S. River Street,Wilkes-Barre,PA 18703-0020 •www.guard.com
massacnu'a4St5 uoparLIIit:n1 V{ ruuuu J diet)
VHoard of Building Regulations and Standards
License:GS-188817
2onstruclfon SLJoe 5G'
ROBERT CALNOLIN
388 NEWTON BT 4 =,'x,
SOUTH HADLEY .r
Expiration:
Commissioner OS/23t2818
��'1Ae T4?Il/C1/U 4?!? to
Office ofConsunla,r 1111-drs and Business Regulation
10 Palk t'laza - Suite 5170
Boston. Massachusetts 02116
Home Improvement Contractor Registration
Registration 18141$
lype LLC
ExDration' 4/112017 Tek 2(}4310
GREEN COLLAR LLC-
. . .._.- _. -_ .... _ . ...
STEVEN ECKMAN
7 WARNER ST - ..- -. ................ .
SOUTH HADLEY. MA 01075 - -- -- ------ -- -
Update kddress and return mrd.Mark reason tot change
Address -'- Renewal Employment Lost Card
t ff c of Consumer orfaws&nus ss Rerumnon Liam or registration alid for indivldul use only
.k$OME IMPROVEMENT CONTRACTOR beforethe espilnCitrn dale. if#nurtd return to
Negtstration: 181415 Type Office.of Consumer Affairs and Blaioess Regulation
:Expiration; 4/1/2017 LLC 10 Park Plata-Suite 5170
Bosmn,MA 02116
C EEN COLLAR LLC.
. .EVEN E.0 MAr:
YARNED
Ji4 Muhl'. MAO1075 -
t d eci etan. vot.aldwitPnut signature