36-116 (6) BP-2023-0636
4 OVERLOOK DR COMMONWEALTH OF M SSACHUSETTS
Map:Block:Lot:
36-116-001 CITY OF NORTHA PTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGIS ERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2023-0636 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
Est. Cost: 3155 GREEN COLLAR LL 108817
Const.Class: Exp.Date: 08/31/202
CONN R, KATHLEEN M. &CONNOR-THOMAS,
Use Group: Owner: MEGAN & CZARNIECKI,PAULA C.
Lot Size (sq.ft.)
Zoning: WSP Applicant: GREEN OLLAR LLC
Applicant Address Phone: Insurance:
570 NEWTON ST (413)532-1817 R2WCI182010
SOUTH HADLEY, MA 01075
ISSUED ON: 05/16/2023 •
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATHERI ZTI 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:
V 1_
i
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: :413)587-1272
Office of the Building Commissioner
mac ;.
uu_T 1 q G7
The Commonwealth of Massachusetts efr 'f '' '�
Board of Building Regulations and Stand ds o FOR'
FOt ;, CIP ITY i'
Massachusetts State Building Code,780 CMR.. , do oke "US 1
lift, 9Ty l/2
Building Permit Application To Construct,Repair,Renovate Or Dem$lns$t''lt•;94/� evised ar 2011
One-or Two-Family Dwelling M`� o-/ s
This Section For Official Use Only
Building Permit Number: CP-?3 - U xi Date Applied:
Ye�,1.-) % j/77 6-/to 2023
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
1.1a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
1
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 ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
[1 i e_ Tea(e5es) t ~rh ptnri,rncc.
Name(Print) City,State,ZIP
4 OVerlooK Dv qa.a- a79-14969Co
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other MI Specify:Insulation/Weatherization
Brief Description of Proposed Work2: Insulation/Weatherization
1ns 5 cextudlabe io 1'3 a Se-4- 0 4tc. 4toOt
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 3 I SS 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ CIStandard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
II 3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Tota Feed!$
Suppression) E
Check Check Amount: GT lash Amount:
6.Total Project Cost: $ 2 1 SS 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) 3/31/2025
Green Collar,LLC 81415
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:OWNER1 OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties cf perjury that all of the information
conta' ication is true and accurate to the best of my knowledge and understanding.
Print Owner's • Agent's e(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or ai 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,fmished 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 Enclos,d Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
Permit Authorization
mass save Form
Site ID: 4822350 Customer: BILLIE TEDESCO
Billie tedesco , owner of the property located at:
(Owner's Name,printed)
4 Overlook Dr 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. BILLIE
7-���(�/�/�
BILLI E ! E E C
Owner's Signature:
04 / 27 / 2...
Date:
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 Cfifice Use Carl..
The Commonwealth of Massaehusetts
Department of Industrial Accidents
t? Office of Investigationsi
- ,i 600 Washington Street
Boston, MA 02111
77-`,-- 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):
LE I am a employer with 15 4. ❑ I am a general contractor and I 6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached she t. 7. ❑ Remodeling
ship and have no employees These sub-contractors ha a 8. ❑ Demolition
working for me in any capacity. employees and have wor ers' 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 it 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per M L 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we hav 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'coiipensation 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-c¢ntractors 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 joh site
information.
Insurance Company Name: AmGUARD Insurance Company - A Stock Co.
Policy#or Self-ins.Lic.#: R2WC182010 Expiration Date: 9/23/2023 �n
Job Site Address: 9 Ow- �� 'It', City/State/Zip: Q n t` t -c -'
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
I
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#:
Commonwealth of Massachusetts
7 Division of Occupational Licensure
8card of Building RegulI 1
ations and Standards
i .
Cunt ton S Gf visor
CS-108817 spires.08/23/2024
ROBERT CAVHOUN
8 UPPER RIVER RD
SOUTH HADLEY MA 01076
fit. �
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: LLC
Registration: 181415
GREEN COLLAR LLC. Expiration: 03/31/2025
570 NEWTON ST
SOUTH HADLEY,MA 01075
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs 8,Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE;LLC Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
181415 03/31/2025 Boston,MA 02118
GREEN COLLAR LLC.
ROBERT CALHOUN )
570 NEWTON ST 1l/10l4.4
SOUTH HADLEY,MA 01075
Undersecretary Not valid without signature