30B-052 (3) BP-' 022-1250
183 RIVERSIDE DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30B-052-001 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-2022-1250 PERMISSIONIS HEREBY GRANTEI TO:
Project# INSULATION Contractor: License:
Est. Cost: 5065 GREEN COLLAR LLC 108817
Const.Class: Exp. Date:08/31/2024
Use Group: Owner: CLARK HUNKINS ALAIN & MARY L
Lot Size (sq.ft.)
Zoning: URB Applicant: GREEN COLLAR LLC
Applicant Address Phone: Insurance:
570NEWTON ST (413)532-1817 R2WC1182010
SOUTH HADLEY, MA 01075
ISSUED ON:09/30/2022
TO PERFORM THE FOLLO WING WORK:
INSULATION/WEATHERIZATION
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:
t
1
Fees Paid: $65.00
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RP
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The Commonwealth of Massac setts `
8
Board of Building Regulations`and tan rds &0 2 F R
W Massachusetts State Building Cod ,780p R 9 2022 I SPALITY
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Building Permit Application To Construct,Repair,-Rcno+u Qrit ish a evise Mar 2011
One-or Two-Family Dwelling h4MnroN lNsf3 c
This Section For Official Use Only
Building ermit Number: $n't.)-+ / Date Applied:
xu jKI20.„
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Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro a Address: 1.2 Assessor Map&Parcel Numbers
153�'iv-ersi Le -Pr( a �j � �,
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 OWNERSHIP'
2.1 Owner'of Record:
N ;'e(Pri tO.Y; CAD-re-- City,State,r ZIP
IX3 ktf r .k GIL -Dr. 113-536 - RCM'
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other Ca Specify:Insulation/Weatherization
Brief Description of Proposed Work2: Insulation/Weatherization
ir‘S-4a.j c rl\ 1.)S-e a.o0d SQ x &iJS
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ c 0 til S 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ CIStandard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing , $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees $�
6.Total Project Cost: $ '. D(o Check No.�j.2; Check Amount: t6 Cash Amount:
�f 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 8/23/2024
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)
181415 3/31/2023
Green Collar,LLC
HIC Registration Number Expiration Date
HIC Comnanv 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 W 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:OWNER'OR AUTHORIZED AGENT 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 i e and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's 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.massgovhips
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"
Sign Envelope ID:0737BF2B-ACFE-4432-8DBD-B97783DD747F
RISE
ENGINEERING'
OWNER AUTHORIZATION FORM
I, Mary Clark
(Owner's Name)
owner of the property located at:
183 Riverside Drive
•
(Property Address)
Florence, MA 01062
(Property Address)
hereby authorize C—lrt.4..Y� CoUC r, L. C
•
(Subcontractor)
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.
cA
DoouuySSuigned by:
1
Own8f66id1 P 1 re
6/15/2022 i 10:24 AM EDT
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335
www.RISEengineering.com
i*K .
2018 WEATHERIZATION
mass save BARRIER INCENTIVES
Savings through energy efficiency
Based on your Energy Specialist's recommendations,your home can benefit from program-eligible insulation and/or air eating
improvements.Before moving forward,please follow all the instructions below to remediate your weatherization barrier-.
CUSTOMER INSTRUCTIONS
1. Hire a qualified,licensed contractor to evaluate and/or remediate the weatherization barrier(s).
2.Submit signed and completed copies of this form and a copy of the paid contractor invoice(s)within 60 days of your Home Energy
Assessment to:Pre-Wx Barrier Incentive,c%CLEAResult,50 Washington Street,Suite 3000,Westborough MA 01581
or email to prewxofferaclearesuit.com.
3.The weatherization incentive will be deducted from the customer co-payment amount of the weatherization work.A rebate check will
be issued in the event the amount exceeds the customer's co-payment amount.
4.Complete the recommended weatherization improvements.
CUSTOMER INFORMATION / ,�J q
Customer Name: !I i`a (V Ili.r�. Client#or Site ID: '1 f/i 7
Site Address: /J 3 'Zr. (1-.31((-C '`- City: -7/0 n State: MA ZIP:
Phone Number: YI3 -- -54.; - i - Email:���Lf�L�1ij air' CL[ / Cl Iles._
Customer/Homeowner Signature: Date:
KNOB AND TUBE WIRING
To determine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save'
weatherization recommendations have been made:
,Attic Floor Attic Wall EjAttic Slope DExterior Wall E1Basement 0 Other: 0 Other:
bI have performed my inspection and determined there is no active knob and tube wiring in the areas selected below.
XI Attic Floor Attic Wall 2-Attic Slope 'D'Exterior Wall CI Basement 0 Other: 0 Other:
III have read and agree to the Terms and Conditions on the back of this form.
Contractor Name: NIVX u.rl f.lVAN—e__i
Address: -!3 U'\l es 4 t)rbc -. Cl City:S. .-E Wi,6k Q y State: ma,ZIP: yG l U^1-'
Company Name: ' r-� n\L) 1'1 �(((NAP License Number: S 11 �! .� q K p
Contractor Signature: g illt/L. ` it /t. Date:
MECHANICAL SYSTEM BARRIERS
High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbon monoxide level,
as measured in the undiluted flue gas,to below 100 parts per million(ppm).
Draft Failure:Contractor is to correct the draft in the selected flue(s).Refer to table on reverse for acceptable draft ranges.
High Carbon Monoxide Draft Failure
Existing CO ppm: Revised CO ppm: Existing Draft Pa: Revised Draft Pa:
Heating System .
Hot Water Heater
Other:
Spillage:Contractor is to correct the spillage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation.
❑ Heating System 0 Hot Water Heater 0 Other:
0 I have performed my inspection and have corrected the items noted in the areas selected above.
0 I have read and agree to the Terms and Conditions on the back of this form.
Contractor Name:
Address: City: State: ZIP:
Company Name: License Number: —
Contractor Signature: Date:
Continued on back
(page 1 of 2)
The Commonwealth of Massachusetts
Department of Industrial Accidents
-.- ,lit,- Office of Investigations
=�=- 600 Washington Street
- =tti=
. Boston,MA 02111
4.4, to4. 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 lS 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. El 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 for me in any capacity. employees and have workers'
9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. 0 We are a corporation and its 10.0 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
Y 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.1X1 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.
*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.#: R2WC182010 Expiration Date: 9/23/2022
Job Site Address: 18-?J V.V Q YS t&.t_ P r City/State/Zip: NG r-i +- , ma•-
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 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: Date:
Phone#: 413 532 1817
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#: