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24C-124 (4) BP-2021-2057 . 118 FRANKLIN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24C-124-001 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-2021-2057 PERMISSIONIS HEREB y GRANTED TO: Project# 2021 INSULATION Contractor: License: Est. Cost: 2771 GREEN COLLAR LLC 108817 Const.Class: Exp. Date:08/31/2022. Use Group: Owner: HENSON, DEBORAH M. Lot Size (sq.ft.) • Zoning: URB Applicant: GREEN COLLAR LLC Applicant Address Phone: Insurance: 570NEWTON ST • (413)532-1817 R2WCI182010 SOUTH HADLEY, MA 01075 ISSUED ON:01/13/2022 • TO PERFORM THE FOLLOWING WORK: • INSTALL 10 MILTO 542 CRAWLSPACE, 12"CELLULOSE TO 402 SQ FT ATTIC 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: • Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. • Signature: C , Fees Paid: $65.00 • 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner SJ ED gi-r AFF,nnuli 5-65 CAu.er> io-16-Z1 C'Rl.[.e0 i2-I4-24 - CALL-0 1-I0-22 The Commonwealth of Massachusetts ��� Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR , MUNICIPALITY' u _ USE i c:, --B ilding Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 - I One-or Two-Family Dwelling Section For Building Permit Number: B P-Zo21-ZO 5 7 Date Applied:O)o(24 1202) V"u1 4 JSogg ��� C 1'-12-2OZZ Building Official(Print Name)- ° .'' Signature i Date SECTION 1:SITE INFORMATION -1:1 Pryope�/r``ty Address: ` 1.2 Assessors Map&Parcel Numbers ' 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIPI 2.1 Owners of Record: eebortt.h ORnsOi City, r-hr�vwh ,`1 MGM 016lan Name(Print) State,ZIP 1(6 Trandcn S+ 60 )L32 -EaCci iJ) 1, No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(checkjall that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0 Demolitipn 0 Accessory Bldg. 0 Number of Units Other 51 Specify:Insulation/Weatherization Brief Description of Proposed Work: Insulation/Weatherization rnL /0 Mel i) s/2 Ch2(..D IS pia C�, WT Instea/1 IL" CP(lc.iJ0S-e tO (/c 34-{ o C. '-SECTION 4':ESTIMATED CONSTRUCTION COSTS Etimated Costs: (Labso and Materials) Use Only Item Official 1.Building $ 2 (TN 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ CI Totals Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ I 4.Mechanical (HVAC) $ List: - 5.Mechanical (Fire $ Suppression) Total All Fees: $ !. Check No.4/75 Check Amount rp l Cash Amount: 6.Total Project Cost: $ ` 2(� I 0Paid in Full ❑Outstanding Balance Due: UI SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 8/23/2022 CS-108817 Robert Calhoun License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 390 Newton St. No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) South Hadley,MA 01075 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413 532 1817 Support@greencollarma.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 18 3/31/2023 Green Collar,LLC 1415 HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 570 Newton St Support@greencollarma.com No.and Street Email address South Hadley,MA 01075 413 532 1817 City/Town, State,ZIP Telephone SECTION 6: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 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,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 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name belo ,I hereby attest under the pains and penalties of perjury that all of the information contained' this ppli i is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/Iporches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" , City of Northampton o�n H ,o 1 «z« SI ti Massachusettsa?�'° - ��<< z� ` ,),,,i,„ ' DEPARTMENT OF BUILDING INSPECTIONS �;sy, r �(�, ! 212 Main Street • Municipal Building vy �? 'x r /. Northampton, MA 01060 k sJ'fr : P CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal:facility, as defined by MGL c 111, iS 150A. The debris will be disposed of in: Location of Facility: Ile KI1i n '-" The debris will be transported by: Name of Hauler: Grr-Cfl CrAlcic-, ae , Signature of Applican : Date: %b/7 City;1 of Northampton /YA „ P f ,> Massachusetts ��,?SAS == S 4,,;1 4� DEPARTMENT OF BUILDING INSPECTIONS �� a igi 212 Main Street • Municipal Buildingw �� Northampton, MA 01060 -.5. k•W0� HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, Z'2l h ,' (insert full legal name), born _ (insert month, day, year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemptions to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s)who owns 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 home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. r 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains a ena of perjury on this ? day of act l' r I , 20,-1. (Signature) DocuSign Envelope ID:17A2216C-8FF9-445F-AEAB-A108978EFE14 RISE ENGINEERING OWNER AUTHORIZATION FORM Deborah Henson (Owner's Name) owner of the property located at: 118 Franklin Street (Property Address) Northampton, MA 01060 (Property Address) / hereby authorize G! lei 6/( f C(C 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. DocuSigned by: Pere . 4kutisew Own6P,Vg1Mre 9/13/2021 i 9:28 PM EDT Date RISE Engineering, a Division of Thielsch Engineering1 Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com 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: 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 LC. 4. ❑ I am a general contractor and I 61 ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑ Remodeling 2.El I am a sole proprietor or partner- 1 ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition comp.insurance.$ [No workers' comp.insurance 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its I ❑ p 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.© Otherinsulation/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. tContractors 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. 1 Insurance Company Name:_ AmGUARD Insurance Company-A Stock Co. Policy#or Self-ins.Lic.#: R2WC182010 Expiration iDate: 9/23/2022 Job Site Address: 11/' Thlf7fr/Ir1 81/1-- City/State/Zip:7VU 1 MG, 01Ow Attach a copy of the workers' compensation policy declaration page(showi nd 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 uLp 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: Date: I Phone#: 413 532 1817 E 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#: , / .. Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, M .s chusetts 02118 Home lmprovemOtx .:ntractor Registration • I Type: LLC tr) Registration: 181415 GREEN COLLAR LLC. x - w o •- _ �. Expiration: 03/31/2023 :' - 570:NEWTON ST M •--- :r4J 4w SOUTH HADLEY,MA 01075 t ., j�,Tr w.. �c - • Update Address and Return Card. SCA 1 0 20M-05/17 :...' • .✓A F:ovn.YlOfCi!/E L/G.O�✓Ol'IIWoO G7e/-6, Office of Consumer Affairs&Business Regulation • HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only 7Y. E:LLC before the expiration date. If found Ireturn to: :.:E Regliti*Ithl, Expiration Office of Consumer Affairs and Business Regulation 03/31/2023 1000 Washington Street-Suite 710 GREEN COL +4 — r Boston,MA 02118 STEVEN ECKMA , 570 NEWTON ST'��M`a> 8/ a(rx� SOUTH•I�ADI-EY,M, z� • - :Not valid.without signature ' Undersecretary • / 'T Comm'onwealtheofMassachusetts • Division of Professional Licensure':. . Board of.Building Re ulations and Standards . Cons r f kigi' Isor ' • CS-108817 `Y s, ires.:08/23/2022 ' • ROBERT CA 1OU 5- Nli,.',:I Y ' 8 UPPER RIV R Ri7.I `~Ifni i 0 , SOUTH HADL@Y I'vlA4wit'?' . •' , _ •_ .. Commissioner(1a a K. e` 1t A . • • • • I �,�- City o°f Northam tom = '� Ma achusetts , 't �* DEPARTMENT.OF BUILDING INSP2gcTIOrS S s , 21£2 -Main Street • Municipal Bu,ildinr • ,f _ ` � s` Northampton, MA 101060 �P4— % � I 1 N A.TORY FOR MOUSES B L T BEFORE 1945 ( fi Property Addr�e . 1 ';, 11 Contractor g : „ 6 C Name: �; " o/:1, ' , LL.-l.- Address: City, State. 044. r'"t l" 4,, 7 / Old 7 . 3 :� . ,4 " 1 Phone: 1 1 Property owner ,, - Name: 1O H'PIf Address ) tl) f/� .City, State: 1� 4M. �} 9 '1 % ( 14 1 1, �'1 Qi f r (contractor) attest and affii m that the building I intend to insulate1d9 a copy ofE,tes,not have any open air(knob and tube) wiring in he spades ,to be insulated and that I have provided t e property owner with his affidavit. • , I Contractor signature ` I • - Date • - • /( / I i • , A £: £ t P { i / i £ I. 1 t 1