Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
32C-286 (9)
114 WILLIAMS ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1943 Map:Block:Lot:32C-286- 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-2021-1943 PERMISSIONIS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 1154 GREEN COLLAR LLC 108817 Const.Class: Exp.Date:08/31/2022 Use Group: Owner: BROWNE, LUKE & GRAZIELLA DIRENZO Lot Size (sq.ft.) Zoning: URC Applicant: GREEN COLLAR LLC Applicant Address Phone: Insurance: 570 NEWTON ST (413)532-1817 R2WCI 182010 SOUTH HADLEY, MA 01075 ISSUED ON:09/24/2021 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERIZATI ON • 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. Signature: I . >49 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner Department use only City of Northampton /N NC atus of Permit: Building Department;7 s cut/Driveway Permit 212 Main Street, e,,O S ).Septic Availability Room 100 ��r Wa a ailability phone 41i3 587-1240 Fax 413- �T .►orthampton, MA 0-1-04s,&/ � Se Two�IP ot/ Str tural Plans Pla 4!;°!4o Ot,er Spe APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVA ' .EMOVSH A ONE OR TWO FAMILY DWELLING N i SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: �i Map 3�Cr Lot , Unit lip( 4,;114,rr,; '�l Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: L(1L"4 &own k11-i (Ail llicoS S4 Name(Print) Current Mailing Address: q Rc — —1(04—/"%,f i SEE ATTACHED DOCUMENT Telephone Signature 2.2 Authorized Agent: Green Collar, LLC 570 Newton St South Hadley, MA 01075 Name(Print) Current Mailing 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 (a) Building Permit Fee 2. Electrical (o) Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee '(J2 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2+3 +4+ 5) Check Number 117 'J✓ g This Section For Official Use Only Building Permit Number: (3vfd) /1 93 ate Issued: Signature: / / e q- 2 1-1- 202) 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 L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW OX YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 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 © 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 © 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 C) 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 © NO g 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) ❑ Roofing ❑ Or Doors l] Accessory Bldg. El Demolition ❑ New Signs [D] Decks [p Siding [0] Other[MIX Brief Description of Proposed Work: INSULATION/WEATHERIZATION 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 6a.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 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 t\ l� ,as Owner/Authorized C r� �+' ","_ Yl 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. 'Rob ( Gi111och Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: CS-108817 License Number Robert Calhoun 08/23/2022 Address Expiration Date 8 Upper River Rd, South Hadley MA, 01075 Signature Telephone 413 532 1817 9.Registered Home Improvement Contractor: Not Applicable 0 Company Name Registration Number Green Collar, LLC 181415 Address Expiration Date 570 Newton St, South Hadley, MA 01075 Telephone 413 532 1817 03/31/2023 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 No ❑ 11. — Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) 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 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 Laws and State of Massachusetts General Laws Annotated. Homeowner Signature --' DocuSign Envelope ID:3951C186-9D1F-4403-A39C-138D89498DD2 RISE ENGINEERING" OWNER AUTHORIZATION FORM Luke Browne (Owner's Name) owner of the property located at: 114 Williams Street (Property Address) Northampton, MA 01060 (Property Address) hereby authorize Subcontractor(to be filled in by office) 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 subcontractor, 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. �DocuSigncd by. ttAtt, f rewvk Ovine 'S'grOgdre 8/25/2021 1 1:46 PM EDT Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com YH City of Northampton oa oy sus r i � . Massachusetts *� r M q DEPARTMENT OF BUILDING INSPECTIONS y tl w` .a'"/ 212 Main Street • Municipal Building f. + SN Os Northampton, MA 01060 W w"? MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: Contractor Name: Gsoeh Co1lc, r Address: A.)v�\c� b� City, State: Sou. \-k o 1/4�& /hA Phone: 5',1- \8 i1 Property Owner Name: Lv Lie Rc c t-J r Address: rV-\ ci City, State: Al of J kc,A,r It-TN M A I, (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 Date c: /i3/ai 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: \\L\ The debris will be transported by: GFOQ h couC, r The debris will be received by: G r e e k c o uo r Building permit number: Name of Permit Applicant ' oh Cot lhcc v (GroQh colgr ? 9//3/ ► Date Signature of Permit Applicant The Commonwealth of Massachusetts 1 Department of Industrial Accidents _,1-7 i14.4 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: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 4. ❑ I am a general contractor and I S 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.D 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 for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ 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.]t c. 152,§1(4),and we have no employees. [No workers' 13.® Othednsulation/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:_ AmGUARD Insurance Company -A Stock Co. Policy#or Self-ins.Lic.#: R2WC 182010 Expiration Date: 9/23/2021 Job Site Address: 1%1.1 cu i b i cyn$ cs1 City/State/Zip:N or-iKevne4rh iw4 c kc(o c 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: (72Leele..°:.....c Date: 9/3/. l Phone#: 413 532 1817 Official use only. /)o not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: �7 �.m �eoed1 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, M husetts 02118 Home Improveme �ss°�c,_;C tntractor Registration l- Type: LLC },�n� ' taf: , Registration: 181415 GREEN COLLAR LLC. x '�'` `- w ,♦cl ~ Expiration: 03/31/2023 - 570 NEWTON ST 'l �•- sa SOUTH HADLEY,MA 01075 -0 ., 0 ,,,,,r7f,--;-o-pit:47 0 a�lK`m... 54p v Update Address and Return Card. SCA 1 0 20M-05/17 ✓/ate romd a.miver dege✓Xaddexate eat Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only YP�'E:LLCM before the expiration date. If found return to Re9 1st Io iration Office of Consumer Affairs and Business Regulation • 4 03/31/2023 • 1000 Washington Street Suite 710 GREEN COLD` ' Boston,MA 02118 STEVEN ECK 4 570 NEWTON ST"�, -.,J%/ ,,x`°YCG laG,.,4.. SOUTH HADLEY,MA- 75 - Not valid without signature • Undersecretary Commonwealth'of Massachusetts Division of Professional Licensure . Board of Building Re ulations and Standards . Constsrbf?h��45' rvisor v CS-108817 q�' ' �' ires:08/23/2022 ' • ROBERT CA01OU14 s ,* 8 UPPER RIVER -. Y 'fibs I p SOUTH HADL$Y AIFA1` �`,.. Commissioner diau G g. `t7CrmdLta. d e :A Worker's Compensation and Employer's Liability Policy /BerHathawaykshire AmGUARD Insurance Company - A Stock Co. �V' Policy Number R2WC182010 tjtA4t Insurance Renewal of R2WC053509 G UA RD Companies NCCI No. [21873] Policy Information Page (AR) [1]Named Insured and Mailing Address Agency GREEN COLLAR LLC AMHERST INSURANCE AGENCY INC 370 Newton St PO Box 48 South Hadley, MA 01075 Amherst, MA 01004 Agency Code: MAAHER10 Federal Employer's ID XX-XXX1086 Insured is Limited Liability Co. (LLC) Risk ID Number 1038965 [2] Policy Period From September 23, 2020 to September 23, 2021, 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 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 $ 21,496 Total Surcharges/Assessments $ $728.00 Total Estimated Cost $ $22,224.00 INTERNAL USE xx Page - 1 - Information Page MGA : R2WC182010 WC 000001A Date : 09/11/2020 MANOTE Issuing Office: P.O. Box A-H, 39 Public Square, Wilkes-Barre, PA 18703-0020 • www.guard.com