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17C-060 (7)
BP-2022-0982 183 CHESTNUT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-060-001 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-2022-0982 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 3950 COZY HOME PERFORMANCE 102169 Const.Class: Exp. Date: 12/10/2022 Use Group: Owner: CAROLINA ARAGON, Lot Size (sq.ft.) Zoning: URA Applicant: COZY HOME PERFORMANCE Applicant Address Phone: Insurance: 180 PLEASANT ST#200 4135290200 46-845373-01 EASTHAMPTON, MA 01027 ISSUED ON:08/15/2022 TO PERFORM THE FOLLO WING WORK: INSULATION/WEATHERI ZATI 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ( !r >9 .11 I • • ' • • Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner BP-2022-0982 183 CHESTNUT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-060-001 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-2022-0982 PERMISSION ISHEREBYGRANTE TO: Project# INSULATION Contractor: License: Est. Cost: 3950 GREEN COLLAR LLC 108817 Const.Class: Exp.Date:08/31/2022 Use Group: Owner: CAROLINA ARAGON, Lot Size (sq.ft.) Zoning: URA Applicant: GREEN COLLAR LLC Applicant Address ,Phone: Insurance: 570 NEWTON ST (413)532-1817 R2WCI182010 SOUTH HADLEY, MA 01075 ISSUED ON:08/15/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ER IZATI 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF N RTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I 51- 11 • Fees Paid: $65.00 212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Buildine Commissioner I -e/ /6) ,.....‘ The Commonwealth of Massachu efts AEG ` ' 14,47 Board of Building Regulations and S't rds \ `_,, •-•.FOR r Massachusetts State Building Code, T , ��Q�� MUNICIPALITY Building Permit Application To Construct,Repair, Renovkt , molish ised Mar 2011 ,CA One-or Two-Family Dwelling '90�ci. This Section For Official Use Only 50 '"s Building Permit Number: g,—�� -1/ g a-- Date Applied: _ 41)►,-/12>s /// 8 -,15-zoz Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Number I 5 Oke5m41t ST, Kiel- A►vkPicrt /7G 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 i 1.6 Water Supply: (M.G.L c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Crwoki►,et. Amen lie e ► +cn ill 4 WO( 2. Name(Print) City.State,ZIP 14'3 'e,nesant&t- * 6t7-755-495Q Cart net. urcv1cri@ +yta;1, (cm No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other Specify: In Sit(ei f-tc n Brief Description of Proposed Work: MAAS Sctj e. ? 1 S " c pQn bic tv. C e((u(os e - t.,, c 1 fo+er- tk;,ti" Sec..(i+ 1 Pr pewerrt-S . R..trr ,G't5T - + 3(ASS ,bet4 rni a-'5oc -;+ v -s SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ -30 50 - 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee 0 Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fed/ibes::$ i Check No�p Check Amount. 6.Total Project Cost: $ ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES ^� 5.1 Construction Supervisor License(CSL) CsS L"i Oal bg 1 t o\a. . illft h K L J9 IV i Z License Number Expiration Date Name of CSL Holder ! List CSL Type(see below) No and Street Type Description � U Unrestricted(Buildings up to 35,000 Cu.ft.) CA �. �l�O�� it SJj 0 a i R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding q� SF Solid Fuel Burning Appliances '1i3"5d10 Qi AIvij'ererrly032yktre .clt I Insulation Telephone Email address D Demolition 5.2 Registered Home improvement Contractor(HIC) i Ls 1 a y Co z'-7 !*)vY)t Q er icf m 41i C'e- HIC Registration Number Expiration Date iI Co pName or HICRegistrant Name Zr 0Str�et i e ti S A r1 If' ZOO itio0�.csief' e.i"�'N y C.t327 Kc1'tK1 ..C,v , iA w{�54:NsA� -tc1V,/ ('RA 0i0�'1 411-Ski.-U � Email address City/Town,Start,ZIP Telephone SECTION 6:'6't•'ORKEIt/'COMPENSATION INSURANCE AFFII A3,IIT(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, SY ( TION'i:.:OWNER AUTHORIZATION TO RE COMPLETED WHEN t.4 r. 'F kitii t,ON G l'tR NER'S AOOEN"T APPLIES FOR IRUL.DING PERMIT I,as Owner of the subject property.hereby authorize C.ti 21 bTtyvt Q C-‘( '4{,/t. to act on my behalf.in all matters relative to work authorized by this building permit application. • tat 5 tcpe4 Ault • F--erh, (hG(kc/e vie/aa Owner's Signature • Date t • �ii'A"I'ION 71):APPLICANT DECLARATION . By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. CA �..., /I° s>//e /a a Contractor//Owner s Agent/Owner ignature Date I. 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 fifil have access to the arbitration program or guaranty fund under M.G.L.c. I 42A.Other important information on the HIC Program can be found at www.muss.a w/ocg 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/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Permit Authorization mass save Form Site ID: 4512131 Customer: CAROLINA ARAGON Carolina Aragon (� ,owner of the property located at: (Owner's Name,printed) 183 Chestnut St Northampton, MA 01062 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: Casa* t Date: 06/ 19/2022 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Orly Document Ref OTT5K-ZXDVR-VQQN9-ZYWAZ Page Tot 7 _ mass save Weatherization barrier incentives Based on your Energy Specialist's tocerrimonderions,your name can benefit from orogrerrt-ellgIble Insulation anther air sealing improsiaments.Before moving forward,Please follow all the instructions below to roofer:fiats,your weetherleation barriers cusTpmeRINSTRUClONS 1.turtle tic--••••-:*.tontractor to elate and/or remediate the weatherization berrier(s). &thine ilated,,-)PI et of this fdrrn and a copy of the paid contractor invoice(s)within 60 days of your Home Energy Ass/isms-id x ortriteco C • 60 gilaseauten titers Suite 36,00:• , • MA mbar : Ace ricteersavity.astsi. 3,The Weether c • ' cloducter:from the°Ai st o r co-payment amount of the westherization work.A rebate check wd! he iiisueo in ttr. . exceeds the CJstorne,S co-payment amount. 4.Complete the*car- ..nerication improverrients. &Tfifitru Sett're ••--•% •7 interest-free financing opportunities that may be used to rerriediate ,tolathelzation barriers. Lea more at rriarasevecornirentsavingiresidential-rehateeheatoan-program • Gusto ar Carolina Aragon Chant ri or Site ID: 4512131 NVatne S 183 Chestnut St Florence MA State. Z01082 ite Aridness: Phonelfeumber. 817765495b ' E carolinaaragonftgmail.com • Dolor To deb, he If there is any active knob end tube wiring.the contractor wit waiver,:the fallowing areas where eligible Mass Save' weamerization reicommenontioar net*been made. II Attic Moor Attic well Attic Stem Exterior Wail 74r.Basement Other Other Aevs performed my trupection and daterindried there is no active knob and tube wiring In the antes selected below. ofoor Attic Wall Attic Slop Exterior WallleirrezelTlent Other ...L._ Other Contractor Name: J h T 1cSrYJ Addre ‘14.1) /C-'t ire 1,"" City All r tame • State41/AL 2114) • Company Name 'T ht f iit1 ,Fice TrWi°License Number I Ce Casemate,Signature" Date: 6.,401P My signaure coreirrns-u-set have performer:my irispection of the etectrical systems listed above and have corrected any barriers as Imitated My signature bac confirms that i rime reed end agree to the'terms and Conditions outlined on the bock of this form. ' • CAL"7 YSIrM BAFr, High Carbon monads*:contractor is to service and re-evaluate the selected mechanical system(s)and reduce the Carbon monoxide level,es:nonfatal in the anditrted flue sees,to below 100 parts per million(Pam). tart F%ittera Contractor is to correct the draft In tne seiectett rhic,$) Refer t;', ebe on reverse for accrefstokria draft ranges carbon Monoxide ••• Seating CO me.- Revised CO mrm: Existing Draft Pa: Revised Draft Pa: Meeting hyatern Nell Watet keeol Other: Spilleser:Contractor lm tt,correct the soldage&flue.geses in the selected mechanical%storm's).Must not spill after 60 seconch;orope,Ation Heatipp System 4,Hot Water Heater Other Contractor Andress: aty: Stater ZIP: CantittaitY Name: t.,lcanste Number. Centmeter taw :iy Date: sigronee conforms that re,o performed rn Inspection of the mechanics,systems Immo above and have corrected any barriers at ,ndicatoo.My signeture also corfirms that I have reed end agree to the Terms end Conditions outlined on the back of this form The Commonwealth of Massachusetts ''`— 1�,` Department of Industrial Accidents • =:is= 1 Congress Street,Suite 100 Boston,MA 02114-2017 _ y' www.mass.gov/dla Workers'Compensation Insurance Affidavit:Buildetra/Contractors/Electrlcianti/Piambers. TO BE FILED WITH THE PERl1 I FFING A[TrHORITY. Applicant Information name Print Ledbly Name(BuMness/Orgaaizaion/lndividnal): (; 'y i.61u1 its apt k6 a Address: l g 0 r'I ea a r- Sr ;LOCI City/State/Zip: FA•k t rryit 6 f b Z2 rl Phone#: f//3 • 5.,1 y --0.2 00 Are yen au employer?Cheek the appropriate hot: Typeof project(required): 1. t a a employer with _ employees r , p ( eq ): [ t y l _ employees(Reif and/or part time). 7. 0 New construction 2.01 am a sole pmprietor or partnership sod have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.) 3.01 em a homeowner doing all work myself.[No workers'comp.iosrrraaee required.)t 9• El Demolition 4.01 am a homen ar wo and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have worked t:umpenaaiion insurance or are sole MO Electrical repairs or additions proprietor with no employees. 12.0 Plumbing repairs or additions 5 Dun a general contractor and I have hired the sub-contractors listed on the attached sheet 13.0Roofrepairs These sub-contractors have employees end have workers'comp.itssurtwce.l 6.O We are a corporation and it officers have exercised their right of exemption per 141GL c. 14. ©thee ; 152,*1(4),and we bavc no aaipinyces.[No workers'comp,insurance require d.1 *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Hotawvraars who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit tadieeting inch. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors end state whether or not those entities have employee.. lithe tutb•contrsetors have employees,they must provide their workers'camp.policy nun s TWA �s,�.._.. .__:,�__._._ I am an employer that isproviding wardress compensgkc..Iarxrrrcmr.t.roe r t'employees. Below is the policy and job site Information. Insurance Company Name:_ CO n 41 h.141 14__bad r ,i,rt?, (0 Policy II or Self-ins.Lic.#:_ 1/6. yS3j,3 ` C / _/rf` // d, .. �...-_..�...�.....,.,.._.�.__ Expiration Date: ,� .� 1,2 e,;44 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL c.152,f 25A is a criminal violation punishable by a fine up to S 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.A copy of this statement may be forwarded to the O ce of Investigations of the DIA for insurance coverage verification. I do hereby ce under the pains , /f,+fskies ry that Mrs information provided above is due and correct Si / �° Date: i /C f,`L Phone#: Official use only. Do not snits is this area,to be cityor town cotarpletsd byofficial, City or Town: Permit/License# Issuing Authority(circle one). 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EketrIcal Inspector 5.Plumbing Inspector , 6.Otbaer 1 Contact Person: Phonic 4. 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: i The debris will be transported by: Cozy /i'o The debris will be received by: L�`p2 .i- , , Building permit number: Name of Permit Applicant aAk., ph., c►Zy Altx. '9* t 1151 tki444— Date Signature of Permit Applicant