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24D-279 (4) 161 CRESCENT ST BP-2017-1135 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D-279 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 Pennit# BP-2017-1135 Project ft JS-2017-001929 Est.Cost: $1972.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: GREEN COLLAR LLC 108817 Lot Size(sq.ft.): 12937.32 Owner: ORR WILLIAM ee JOANNE MONTGOMERY Zoning: URB(100)/ Applicant: GREEN COLLAR LLC AT: 161 CRESCENT ST Applicant Address: Phone: Insurance: 7 WARNER ST (413) 532-1817 WC SOUTH HADLEYMA01075 ISSUED ON:4/10/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATION//AETHERIZATION 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 IS 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 4/10/2017 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2017-1135 APPLICANT/CONTACT PERSON GREEN COLLAR LLC ADDRESS/PHONE 7 WARNER ST SOUTH HADLEY (413)532-1817 PROPERTY LOCATION 161 CRESCENT ST MAP 24D PARCEL 279 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid ,c3 (.,e S 0 Typeof Construction: INSULATION/W AETHERIZATION 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 INFO ATION PRESENTED: pproved 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 ti te411 —astall-- 5470a Sign. a of Bu'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 are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. 6epadment ustro Iy t "fl City of Northampton Status of Permit: rBuilding Department Curb CutDnveway Permit APR ( 0 2017 212 Main Street GeweriBep110 AY020111112 Room 100 Weden*Ea Avalabdiiy - — - Northampton, MA 01060 Tw& of Strt4+tual _.:. _. :.pbonk 413-587-1240 Fax 413-587-1272 PkkV$ite Plant Other Spee ':.. 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 1L ( CIQSC,e.et 1- 5 1 '+-- Map a L. Lot1 a 1 Unit No rt-p,„,^n`ph-o N i ' • t Zorn Overlay O stdcf bf GYote Elm St District CB District SECTION 2•PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: c )5 yE LCf2rir--r CH-M*C Name(Print) Current MaiIir Addresss' Ct / 1710-2-- .ee_ R-±ttc d-o C. Telephone Signature 2.2 Authorized Agent: Green Collar, LLC 7 Warner St.South Hadley, MA 01075 Name{7e647Current Mating Address. ---- 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 / C 7 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechankal(HVAC) 5.Fire Protection { 6. Total=(1 +2+3+4+5) /77/ - r7 / Check Number /3tcyi P (,4/C TMa3acBon For Official Use Only --' - Building Permit Number: Data issued: Signature: Building CommissionerNnspector of Buildings Dale Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Duel'()Incomplete Information Existing Proposed I Required by Zoning fl cot¢mn to be 6;kd n by Building Department Lot Size _.. .. _ __. .. Frontage .. . . _. __. . .. . . Setbacks Front Side C: ._. R. _..:_ I.: it Rear Building Height -- Bldg.Square Footage Open Space Footage ( m area minus bldg&paved _. parking) • 4 of Parking Spaces .. - ... . Fill: _ _..... _-.... .... —..,. ... (votume&Lecationt A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW OX YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW (3 YES O IF YES: enter Book Page. and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW OX 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 O 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 0 __ 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 I acre? YES a NO O X IF YES,then a Northampton Storm Water Management Permit from the DPW is required SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing pi Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs 117] Decks IC Siding 01 Other(MIX Brief Descsi tion of Pro used work: INSULATION/W EATHERI ZATION Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes __No Pians Attached Roll -Sheet sa.If Newhouse 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, Massch_eck 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 70-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 DOCUMENTimimmommommumir�f{oy� a( "l Signature of Owner Date Steven Eckman ,as OwnerAuthorized 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 .ter 11/G /7-pdt Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.7 Licensed Construction Supervisor: Not Applicable C name of License Holder: CS-108817 RobertLicense Number Calhoun 8/23/2018 Address Expiration Nate 390 Newton St.South Hadley,MA 01075 Sig n/akbutz, Telephone 413 532 1817 9.Rockland Nome hnurovement Contr00tov Not Applicable C Company Nam@ Registration Number Green Collar,LLC 181415 Address 3 jylc,.n 51- Un rr 3 Expiration Date 9-Wacaec.i, South Hadley,MA 01075413 532 1817 ,_,,,,-:2414. 3 t 31 Tebphonel SECTION 10-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 $J 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.CM R 780, Sixth Edition Section 10$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-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 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 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 Annotated. yning Laws and State of Massachusetts General Laws Homeowner Signature //'/ 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, as defined by MGL c 111 , S 150A. Address of the work: /6 / r -1 f- 31- The rThe debris will be transported by: 1 / The debris will be received by: Building permit number: Name of Permit Applicant retC42 ( 1 cr Vo/2--o 7 Date Signature of Permit Applicant The Commonwealth of Massachusetts a . Department of Industrial Accidents �., ...5. ', (7, Office of Investigations &l it Washington Street Toe r Boston, MA 02111 p ; 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: " 3 t• , n S f Gin 1 1 th City/State/Zip: South Hadley, MA 01075 Phone N: 413 532 1817 Are you an employer? Check the appropriate box: Type of project(required): 1.M I am a employer with / 4 0 1 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 any capacity. employees and have workers' 79. 0 Building addition [No workers' comp. insurance comp. insurance] 0 corporation 5. We are a co ration and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plutnbing repairs or additions myself.[No workers' comp. right of exemption per MGI.. 12,0 Roof repairs insurance required.] l c, 152, §I(4),and we have no employees. [No workers' 13.0 Otherinsulation/Weatherization comp. insurance required.] 'Any applicant that checks box 41 must also 611 out the section below showing their wnrken 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, tConaactors 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 Alb'contractors have employees,they must pvruk their worters'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 it or Self-ins. Lie, #: R2WC727792 Expiration Date: 9/23/2017 Job Site Address: /Le ( lam!ec ens4 f'„ 5.' City/State/Zip: ' ' • at ,. ft 17'J1- 0000 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 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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, Ido hereby certify un r t pains and penalties of perjury that the information provided above is true and correct. Signature: ' Date: , Yf(¢(/2-v t 7 Phone#: 413 532 1817 Official use only. Do not write in this area, to be completed by city or town official City or Town: i,,,,,, Permit/License# Issuing Authority(circle one): I. 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 020211339-5024335 ENGINEERING www.RtSEengineering.com OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at: ' t CRP SC5� (Property Address`) 1lP1. ,k-wAsoto tkft o t m (1:C) (Property Address) hereby authorize �[f � � (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 homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. Owner's Signa ure I3 2-017 6.2016 Worker's Comoensatlon and Emdlover's liability Policy I/Berkshire HathawayAmGUARDInsuranceCompany-A Stock Co. Policy Number R2WC727792 GUARDInsurance Companies RenewalNCC/No. [21893) Policy Information Page (AR) [1]Named Insured and Mailing Address Agency GREEN COLLAR LLC T[ERNEY INSURANCE AGENCY, INC. 7 WARNER STREET 16 NORTH ELM ST SOUTH HADLEY,MA 01075 Westfield, MA 01085 Agency Code: MATIER10 • Federal Empi0yer's ID 47-1041086 Insured is Limited LIab16._..V 71C) [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. 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 0. 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 $ S,149 Total Surcharges/Assessments $ 299.00 Total Estimated Cost $ 6,048.00 INTERNAL U g.. xj Page- 1 - Information Page MGA :R2WC727792 WC 000001A Date : 09/14)2016 MANOTE Issuing Office:P.O.Sax A-H, 16 S.River Street,Wilkes-Barre,PA 18703.0020 a www.guard.com •'aaanvxLLb uvpol OuPo0[Ui rUOnc'0dl Ct7 Board of Building Regulations and StandafdsC License: CS-logan w Gorstruction S✓perviso • RJ9�7tT CN:.AOtW "' 390 NEWfOM9S . s" SOVftf �N_/jzt l� Exptra tt. Commissioner O8R3/2oSfl /f�,� (rf<?1L?l/fS�lt(lP.UL�i'? G/ '� .iif{Lf21( vrr Office of Consumer Affairs and Business Regulation z�i�' 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration 181415 5 (3 //Zti / Type' LLC Expn,...,,�. 4/1/2017 TW 264318 GREEN COLLAR LLC. STEVEN ECKMAN --- ------ - --- - 7 WARNER ST --._------- SOUTH HADLEY. MA 01075 'Update Address and return card.Mark reason for change. - Address Renewal °- Employment — Lost Card ..--\ Office of Consumer Affairs&Rosiness Regulation License or registration valid for Indic idul use only 2 . ROME IMPROVEMENT CONTRACTOR before the expire[ion date. If found return to; 17 Registration. 181415 Type: Office of Consumer Affairs and Business Regulation j.. --4�Expiration: 41/2017 LLC 10 Park Pla>s-Suite 5170 `EEN COLLAR Boston,MA 02116 GREEN CLLC. STEVEN ECKMAN 7/VARNER ST 5.^,W N WiDLEY, MA 01075 Underiecrerars Not valid without signature 3/242017 My Registrations p�{9 lbtt i/ww messcovaaerco,uhm.•<mlrsoas..,.rssmantnnmatin-a�..urmasTamercertl wa .�a.�rsem mym. Mass.fier Ihttp:nmasgoal My Registrations • Your company Registrations and/or Applications with their statuses are displayed in the list below. • To manage or view any Registration.click on the appropriate Task button. • To register a new company as a Home Improvement Contractor.click the Start New Application button. Start New Application(/HICIRegisterICheckListrcontractorld=08applicatIonid 0) Contractor HIC Registration Effective Expiration Application Application Create task Name Number Status Date Date Type Status Date GREEN Registration COLLAR,!l816 5.ACBve 04/01/201703/31/2019•enewal issgetl 03/22/2017 Manage Registration(/HIC/Regster/RegDetal?contra tord 388538registratir LW. \ 2 GREEN Registration Initial COLLAR 181415 Active 04/01/201503/3112017 niia! tion Issued 03/31/2015 Manage Regishation(IHIGRegister/RegOeiail?conwatlotld=388538regisUstic AppliCaLLC ©2017 Commonwealth of Massachusetts https://hic.oca.state.ma.us/HIC/Register/RegList 1/1 mw Co>mass save - - ofM� 7J,,dCS SAVE FRE-WEATHEPRATION HARMER 'NCENTIVE 201 , CONTRACTOR EVA!UATnOPIi REPORT CUSTOMER INFORMATION Raa'gtSS 445022 Dateof Assessment 1-132017 Ere Spetisiist JOn Patton Customer Name Susie bipart Phone zraw«niCr2 Email alcOmt376311GOLOm Account it senice mot=161 Crescent St Gam.Northampton sage MA LP'°7060 Rebate Recipient Of different from the Cusomer): Maass Address Of different from the..ni._Address): OW: State: the Alone' Contractor is to enk,axe me selected locations below whole weM}rowlmtlen recommendations have been mean m ' votesIf theree Is ayactzve Snob&tubewinng L:It�c ❑E,tenor Walls I Etennent I 0A2tic Roar I ONne Floor ❑Attic 90P MECHANICAL SYSTEM,HIGH CANON MONOXIDE EVALUATION ['Contractor Is to evaluate the selected mechanical systamis)below and provide service,If possible.to reduce high carbon monoxide tevets as measured in the unmarredSue gas to below100 pprr.. '❑Heating System ®Hot Water System I0 Other. DRYER VENT EVALUATION ❑COntaCtOrIStoevaluate the dr g vent end provide service to properly exhaust the vent to the extant IOIOUTi1BEYIR4IIG ..... ., j]t$on ca of my Inspection I have found that t^e 1s no active knob tube whew In the stems)chested off Pettier [mux prmeriorWalls pTiasernent I DAnte Soar I [knee Wall Root ❑A span CONTRACTOR INFORMATION I Gorma nn Name Micnec. C-v- , • f 0. Acitet4fltibiPmetiemstie ,�V/�� City t"�-r Statz�y[1 -,ryZp�i.L{,G.Th3 Contractor Nan* ' : ! r flrV)ft ..-1Y. t i&3) Federal ID tl✓f'Ot'FstS q ^ .• t - &Conditions of the ire-Vfeathaizetian Barrier Incentive. Contractor SignatureSigna / Dae: 4$47. MECHANICAL ',HIGH CARBO • •WOEEVALUATION 011ie selected mechanical system __..v:-. x�uated and serviced.Testing resolla of carbon mamtide in to undiluted nue galas es foam= alerting System _Co ppm OHOt Water System CO ppm ry.OPler. COP)xn DRYER VENT EVALUATION Dihe pryer vent has been exhausted to the tenor CONTRACTOR INFORMATION Carman'Name Address Cit, Gats.' Lp. Colt actor Name License 4*: Federal lD it 91 have read.and agree to,the Terms&Conditions of the Pre- eathenzation Barrier Incentive. Contractor Signature. Date: CUSTOMER INSTRUCTIONS Submit signed and completed copierse`f this Cmnracto Ruston Report and a ahoy of the paid Contactor Invoice to: Pre WeathecZatlOn Barrier Incentive/Cy) Engi ri 60 Shag/mut Rd,Unit 2.Canton,MA 02021 �`\t\��`� Customer SgrwNre = / Date. Customer C n)-ynae r- -vsuwe EerCy5peciast-t+%nk Cattacw-Golden Tea I/16