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24A-228 (12) BP-2022-0984 46 PILGRIM DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24A-228-00I 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-2022-0984 PERMISSIONIS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 4947 COZY HOME PERFORMANCE 102169 Const.Class: Exp. Date: 12/10/2022 Use Group: Owner: COMEAU JEANNE &JOAN BARBER ICH 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 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: 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 VIOL TION OF ANY OF ITS RULES AND REGULATIONS. Signature:g • 1' . �'1 • I0 Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner BP-' 022-0984 46 PILGRIM DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24A-228-001 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 Penn it # BP-2022-0984 PERMISSION IS HEREBY GRANTE.I TO: Project# INSULATION Contractor: License: Est.Cost: 4947 GREEN COLLAR LLC 108817 Const.Class: Exp.Date:08/31/2022 Use Group: Owner: C U MEAU JEANNE &JOAN BARBERI H Lot Size (sq.ft.) Zoning: URA Applicant: GR EN COLLAR LLC. Applicant Address Phone: Insurance: 570NEWTON ST (413)532-1817 R2WC1182010 SOUTH HADLEY, MA 01075 ISSUED ON:08/15/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/W E ATH ER I Z AT I 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 VIOL' TION 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 /}ri/4� / �, '�3OiLT )% 4& �`r, The Commonwealth of Massachusetts,,, �' \ �' , ' Board of Building Regulations and Standar 0„ c� .f Massachusetts State Building Code, 780 C y�o,,, c�p)c� M ',IUIPA�LITY \LZBuilding Permit Application To Construct, Repair, Renovate O w. I a 'evise Oar?011 One- or Two-Family Dwelling `'�o �';,N /j T"hi S tion For Official Use Only \6 , /� Building`Permit Number: l� 3+? / (� Date Applied: / 1 i ) ham (/�Ko55 _� 6-0-Zozz Building Official(Print Name) Signature 'Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers Lkle ' At-r~mm br 3 Ncc<1-kc.rr-p icy) ..)....1 4-- _ a Li a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: s 1.4 Property Dimensions: Zoning District Proposed Use s Lot Area(sq ft) Frontage(ft) I�I 1 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 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' t 12.1 Owner'of Record: -`S•? � e..t,-rteAAA, )4c 4kmlo40n , Ar\A- 0106 C Name(Print) City.State.ZIP Ltio Pi( a:tm1)r. tub -ZVI-37Llt/ 3t:errmec 4. c No.and StreetTelephone EmaiiAddress SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) 1 I 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 IX Specify: iy‘ c;,lct„ttn Brief Description of Proposed Work'-: )k&ss ' ,vZ - 15' edouez Ce t'/t tost% 4 c • /eer Pr- uen+s , barnrrv+43 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Official Costs: Official Use Only (Labor and Materials) 1. Building $ 1.4 i yrt cc I. Building Permit Fee: $ Indicate how fee is determined: ' Cl Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fees: $ pp 6.Total ProjectCheck No,4JU� Check Amount:4 Cost; $ 0 Paid in Full Cl Outstanding Balance Due: SECTION 5: CORNTRUC ION SERVICES 5.1 Construction Supervisor License(CSL) (55`.-i oa,i Se9 ‘a `®\ ° m il�,K L A f;j Z. License Number Expiration Date Name of CSL Holder d /k 1 0 t154n f't s )- t�ld D 0 List CSL Type(see below) No,and Street 7 Type Description [� r� U Unrestricted(Buildings up to 35,000 Cu.ft.) f A-5 T HA(e� hi Thut C1©rk ) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding �g SF Solid Fuel Burning Appliances 13-5t 1 OW() MA infer{my co z y h©mr.a wl I Insulation Telephone Email address D Demolition 51 Registered Home Improvement Contractor(HIC) i Cs a.1-1 0 9\5 I 4;13 Z Ntim ir O �/� Q- HIC Registration Number Expiration Date Fjl C p sine or HIC e ' t Name No and strlet e S S d3 oU rYta.o..ole r Q rtijct12.'i hOm2_G A \. • 5 - -1(814 'tt'D ) m t 0%0 r) �113'S a►'-Cl .. `) , mail Gress City/Town,Suitt,ZIP ' Telephone SECTION a:WORlt EIt.S°COMPENSATION INSURANCE AFFIDAVIT'I 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. SECTION 7u:OWNER AUTHORIZATION'1'01W COMPLETED WHEN t.'ON'I'&tAU TOI1 ON OWNER'S AGENT APPLIES F&fl BOLDING PERMIT I,as Owner of the subject property.hereby authorize Coil 1"1 ht)T��, Q r' �{'�t;,n 'L to act on my behalf, in all matters relative to work authorized y this building permit application. Owner's Signature • Date t ilA"1'ION 7h: APPLICANT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained inthis application is true and accurate to the best of my knowledge and understanding. ��"G rao.... ,5=//e / Gt Contractor//Owner s Agent/Owner,ignature Date 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 rig 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 Dammuss,401/4,10 Information on the Construction Supervisor License can be found at www.mass.govldps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,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: 4504384 Customer: JEANNE COMEAU I, Jeanne Comeau ,owner of the property located at: (Owner's Name,printed) 46 PILGRIM DR NORTHAMPTON, MA 01060 (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. JP,akke Cot yeah Owner's Signature: as#e. 08/02/2022 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: t -``l. Aln'AQ e1ti UYit,ttCA $19 i - Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only Document Ref MSNJS-QMU5G-U5UB6-8H5UJ The Commonwealth of Massachusetts 1* '7 Department of IndustrialAccidents • =,,:il'il= 73 1 Congress Street,Suite 100 ` Boston,MA 02114-2017 ;, ,,,'` www.mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Coutraetore/Etectridam/Plhunbere. TO 13E FILED WITH THE PERMITTING AITI'HORITY. Aoulica t Informatiuu. _Please PrIn�1, ibl' Name (Busiacseftkitartiaatiollfiediv#dual): t HOhi �)L r -�d `c 4/i t 1 Address: I is d el f easaa 7 '7` :zoo, City/State/Zip: l=r& tit y, fJ i'r.,t NI6 G(6 v2 rI Phone#: f J!3 Are you en employer?Check tits appropriate box: I Type of project(required): t Ina e employer with r. employees(full end/or time)! � . w��' tom- l 7. New construction 2 Q I as a sole proprietor ctprmtanahip and have no employees working forme in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.inswsnce required.]t 9. ❑Demolition 4.01 am a homeowner and will be hiring contractor's to conduct all work on my property. [will 10 El Building addition ensure that all coons:farm-fiber hours wnrkcrz.'ccvaycasatioo insurance or are sole 11.0 Electrical repairs or additions proprietors with no emetevem. 12.❑Plumbing repairs or additions 5.0 1 am a general connector and I have hired the sub-contractors listed on the attached sheet 13. Roof repairs 'rtiaae sub-coahnctors have employees and have workers'comp.insurance.: ❑ 6.D We are a corporation and its officers bays exercised their right of exemption pet MC1L e. 14.Q©thee / , 132,#1(4),and we have no employees.[No workers'comp,insurance required.] *Any applicant that checks box 01 mutt also fill out the section below showing their workers'compensation policy information. t Homeownm who submit this affidavit indicating they ere doing all work and then hire outside contractors must submit a new affidavit indicating Mesh. :Contractors that check this box must attached an additional sheet cowing the name of the eab-corhaotots end state whether or not those entities have employees. If the sub-cr olactots have employees,they roust provide their workers'comp. 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 Cen fr�te.{ /nw� 1 Jet?, rr Icy eo.. .__..___ _.._ a Policy#or Self--ins.Lic.#; yb ' l:+'`I S,�1�.� ` �/ 1 r Expirationi' /'a- c.Date: / .;1 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,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA fbr insurance coverage verification. I do hereby under the palm altles o rq that the information provided above is true and correct Sienatniai : Imo: 1/O (? Phone#: Official use only. Da not write in this area,to be completed by city or toWn oMIA City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Departmee/ 3,City/Tovan Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#� City of Northampton 212 Main Street, Northampton, MA 01 060 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: LI6, Pat 1)t iA.leL 1it G 2.1n The debris will be transported by: £o ( ./i'2 n& ' - 7 , The debris will be received by: (lei I-&.n Building permit number: Name of Permit Applicant i` Q,&k. ( thf�.., t..a Z Arm, Date Signature of Permit Applicant