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32C-204 (6) 7 KARY ST BP-2017-1457 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32C-204 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 Permit a BP-2017-1457 Project# JS-2017-002421 Est.Cost: $1475.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: GREEN COLLAR LLC 108817 Lot Size(sq.ft.): 3005.64 Owner: ROSEN KIMBERLY F&CARA M TAYLOR 70166 :ti Applicant: GREEN COLLAR LLC AT: 7 KARY ST Applicant Address: Phone: Insurance: 7 WARNER ST (413) 532-1817 WC SOUTH HADLEYMA01075 ISSUED ON:6/16/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:ADD 8" CELLULOSE TO 88 SQ FT ATTIC SPACE 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. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 6/16/2017 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck--Building Commissioner File#BP-2017-1457 APPLICANT/CONTACT PERSON GREEN COLLAR LLC ADDRESS/PHONE 7 WARNER ST SOUTH HADLEY (413)532-1817 PROPERTY LOCATION 7 KARY ST MAP 32C PARCEL 204 001 ZONE URC(I00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid �J Building Permit Filled out Fee Paid Typeof Construction: ADD 8"CELLULOSE TO 88 SQ FT ATTIC SPACE 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 INF RMATION 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 Nan 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 Delay /1-29 b ffaj,-7 Signature of Building 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. Department use only r- - -- City of Northampton StatuS Of Permit: I Building Department Curb Cut/Driveway Permit JUN 6 ' i!'r i 212 Main Street Room 100 Sewer/Septic Availability Water/WellAvailability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Ste 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 y office \< 0.r 1/ 54-re-eMap J7 Lot Unit Y- Zone VV Overlay District Bim St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 1<;(.4 0521 7 ICcey cf €af Name(Print) Current Mailing Address: ,A�'���I� ��`/ / ��//�� / Cyr r9 / oCr2 SEE ,4 LC.c40` p cc.4tt't.+ Telephone Signature 2.2 Authorized Agent: Green Collar,LLC 3 Main St Unit B. South Hadley, MA 01075 Name(Print) Current Mailing Address: 413 532 1817 Sign a Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building /r/7 7 (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 ife 6. Total=(1 +2 + 3+4+5) /j 4/ 75 Check Number /y0� GAS 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 Pas column to be filled in be Building Department Lot Size Frontage Setbacks front Side I.: R: I.: R Rear Building Height 131dg.Square Footage ,a Open Space Footage lot area minus bldg&paved parking) #of Parking Spaces Fill: (solume&location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW X YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'T KNOW © YES O IF YES: enter Book Page and/or Document N B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW ex YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained ( , Date Issued: C. Do any signs exist on the property? YES O NO 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 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 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 ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [❑ Siding[❑] Other[GU Brief Description of Pro osed 1 Work: INSULATION/WEATHERIZATION /}dd W Cc(Gf se n /wit san 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 sc. 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 A 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 I, 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 ., r Date " ' �� 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. She &/crki eVA Print Name Signature caner/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 Date 390 Newton St. South Hadley,MA 01075 Signature Y` Telephone 413 532 1817 9.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Green Collar,LLC 181415 Address Expiration Date 3 Main St. Unit B. South Hadley, MA 01075Telephone 413 532 1817 3/31/2019 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 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 1083.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which hashe 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 he considered a homeowner. Such"homeowner"shall submit to the Building Official,on a fonn 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 he 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 Iaws Annotated. 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 def ed by MGL c 111 , S 150k Address of the work: The debris will be transporte. by: / The debris will be receivedb : Building permit number: Name of Permit Applic t ' Date Signature of Permit Applicant RISE60 Shawmut Road,Unit 2 j Canton,MA 02021 j 33g-502-6335 ENGINEERING' www.RlSEenglneedng.com OWNER AUTHORIZATION FORM Kim Rosen (Owner's Name) owner of the property located at 7 Kary St (Property Address) Northampton MA 01060 (Property Address) hereby authorize V !" EC N (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my propertyy/. This form is only valid with a signed contract. -/Owners Signature - ZZ- 1 -1 Date The Commonwealth of Massachusetts Department of Industrial Accidents IT',, Offic600 e ofWashington Invest/gationStreets .: trtl Boston,MA 02111 `-?'i gb W www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Bminess/OrganizatioNlndividual): Green Collar, LLC Address: 3 Main St. Unit B. City/State/Zip: South Hadley, MA 01075 Phone 4: 413 532 1817 Arc you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 1 4. ❑ I am a general contractor and F employees(full and/or part-time).* have hired the sub-contractors G. ❑ 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 working forme in any capacity. employees and have workers' comp.insurance., 9. ❑ Building addition [No workers'comp. insurance required.] 5. ❑ We arca corporation and its 10.0 Electrical repairs or additions officers have exercised their 11.❑ plumbing repairs or additions 3.❑ I am a homeowner doing all work myself. [No workers comp. right of exemption per MGI. I2 ❑ Roof repairs insurance required.] ' c. 152,§1(4),and we have no employees. [No workers' 13.0 Otherinsulation/Weatherization comp. insurance required.] *Any applicant that checks box#1 must also till out the section below showing their workers compensation policy information r Homeowners who submit his affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 3(2(infractors 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. It the sub-contractors have employees_they must provide their workers'comppolicy number_ lam 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 0 or Self-ins.Lie.b: R2WC727792 Expiration Date: 9/23/2017 7 Job Site Address: K0.cys F _ city/state/0p: tw40/"4 0Io6o 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 MGI.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 S10 WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may he forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Dale /T//i7 Phone*: 413 532 1817 Official use only. Do not write in this area,to he 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 a: 7* Worker's Comoensatlon and Employer's Liability Policy (Berkshire Hathaway AmGUARD Insurance Company - A Stock Co. ♦pt y Policy Number R2WC727792 V Jf I% ri i Companies RenewalNCCI No. [21873] Policy Information Page (AR) (1]Named Insured and Mailing Address Agency GREEN COLLAR u,C TIERNEY INSURANCE AGENCY, INC. 3 Main St. Unit B. 16 NORTH ELM ST SOUTH HADLEY, MA 01075 Westfield, MA 01085 Agency Code: MATIER10 K Federal Employer's ID 47-1041086 Insured is Limited LiabilityrC LQt �Jai j [2] Policy Period From September 23, 2016 to September 23, 2017, 12:01 AM, standard time at the insured's mailing address. [3] Coverage — --._i 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 (3jA. 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-WC2003o68 D. This policy includes these endorsements and schedules: See Extension of Information Page- Schedule of Forms r[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 $ 6,048.00 i64,46AL.USC__YA Page.- 1 - Information Page MGA k2WC727192 WC 000001A Date :09/142016 MANOTE Issuing Office: P.O. Box A-H, 16 S.River Street,Wilkes-Barre, PA 18703.0020•www.guard.com 'assachusetts Department of Pebuc Sale*so Soard of Building Regulations and Standards.. License CS-108817 ROBERTCALHOUN •r 300 NEWTON ST *, SOUTH HADLEY MA 0't-76 • 1"*".1.-un `Cain is a Commissioner 08123)2018 ' ;?:- A cAe •(c>n Bic nraertlf� c �l�u uccLir.�. e � �V Office of Consumer Affairs and Business Regulation "`5. 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: LW GREEN COLLAR LW. Registration: 181415 3 MAIN ST.UNIT B. Expiration: 03/31/2019 SOUTH HADLEY,MA 01075 Update Address and return card. Mark reason for change. ay'- 0 Address 0 Renewal 0 Employment 0 Lost Card Office of Consumer Affairs a Business Regulation ', r HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. It found return to: `', - WMt 13 on Eagimtlel Officeof Consumer Affairs and Business Reguiatlon 181415 03/3112019 10 Park Placa-Suite 5170 GREEN COLLAR LLC. Boston,MA02_116 STEVEN ECKMAN cte ? �C c ± S MAIN ST.UNIT B. / SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature City of Northampton , Massachusetts t. DEPARTMENT OF BUILDING INSPECTIONS .$ 212 Main Street • Mun.cpal Bu ldang Northampton, MA 01060 Property Address- J -' J K : k �C 1 r1 { ' I i-r Contractor _ Name: Address: T> IC'. , , City, Stale: Phoney i / 2 St Property Owner a,. Name: 11:,,7„, Address: 7 frri-y Sc City, State: 1U C rt iL .,, „ T > �'?rt Cil I h -4 t r "'.crw. � (contractor) attest and affirm that the building I intend to insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature P. Date