10B-094 (11) BP-2023-0685
20 FLORENCE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
10B-094-001 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-2023-0685 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
Est. Cost: 20341 ROBERT CALHOUN 108817
Const.Class: Exp.Date: 08/31/202
NORT AMPTON CITY OF LEEDS GRAMMAR
Use Group: Owner: SCHOO
Lot Size (sq.ft.)
• Zoning: URA Applicant: GREEN COLLAR LLC
Applicant Address Phone: I Insurance:
390 NEWTON ST (413)532-1817
SOUTH HADLEY, MA 01075
ISSUED ON: 05/30/2023
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATH ERI 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 NOR HAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I o
10
• . TAIT
Fees Paid: $
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissi ner
1.1.4306-16vr-
act-if/m.7 it
• ----
The Commonwealth of Massachusetts
, ;03
Office of Public Safety and Inspections
\lassathusetts State Building Code(780 CMR)
xir-- Building Permit Application for any Building othet than a One-or Two-Family Dwelling
...„, (This Section For Official Use OnlY)
Building Permit NIttifftW124,4...L'I Date fhpplied: __ Building Offkial:SECTION 1:LOCATION
''(_9 5:Ai- ) ,,:)'7., ?.. -, ,_.e
No.aticlStreet ......, City/Town Zip Code I Name of Building(if app el
Assessors #
Block#and/or Lot a
SECTION 2.:PROPOSED WORK ,
I
Edition of MA State Cede used_......_ it New Construction check here 0 or check all that apply in the two rows below Existing Building 0 Repair CI ! Alteration 0 1 Addition 0 I Demolition 0 (Please fill out and submit Appendix 2
I—
Change of Use 0 Change of Occupancy 0 Other 17'Spec it t
Are building plans anu/or construction documents being supplied as part of this permit application? Yes 0 No 0
Is an Independent Stnx:tural Engineering Peer Review required? Yes 0 No 0
Brief Description of Proposed Work: -
---11 -- ik 2 CE" Lcuj11- _ "I'S ' - aiass,.1)-ce OA LLS.
(km LC cAtslki4-1.orl quintr •,a.k77(,:i., m , c i...\ --)s i s-
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existi ig Building Investigation and Evaluation is enclosed(See 780 ChIR 34) 0
Existing Use Group(s): • I Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(.triode basement levels)&Area Per Floor(sq.It)
•
. .
Total Area(sq.ft.)and Total Height(ft) I .
•
t .
SECTIONS.USE GROUP(Check as applicable)
A:Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 I B: &Airless 0 1 E Educational 0
F: Factory F-1 0 F2 0 1 H: Hioc.,h Hazard H-ID 13-2 0 H-3 0 H4 0 H-5 0
I: Institutional I-1 0 1-2 0 I-3 0 1-4 0 M: Mercantile 0 1 R: Residential R-10 R-2 0 R-3 0 R-4 0
S: Storage 5-1 0 S-2 0 U:Utility?"I Special Use 0 and please describe below.
Special Use Descriptioi.:
.
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB 0 IIA 0 IIB 0 I IIIA 0 IIIB 0 IV 0 VA 0 VBAI
S XTION 7:SITE INFORM (refer to 760 CMR 105.3 for details on each item)
Debris Removal:
Water Sup ly: I lood Zone Information: Sewage Disposal: ! Trench Permit: I
Public Check if outside Flood Zone 0 Indicate municipaLFP TA.trench will not be I Licensed Disposal Site 0
eqn . •
Private or ndentify Zone: 1 or on site system 0 1
1 penn;ritedisPen°ctiotsreednc011 _sPecifY:
Railroad right-o'-wAy: Hazards to Air Navigation: MA I Iisli,Ti:Conurikiiiicin Review Process:
Not Applicahl I Is Structure within airport approach area? Is their review completed? I
or Consent to Build enclosed 0 i Yes 0 or No , Yes 0 No C
1
SECTION 8:CONTENT OF(... FICATE OF OCCUPANCY
Edition;Ti Code: Use Groupfs): Type of Construction:
Does the building coot in an Sprinkler System?: _Special Stipulations: . _.............-
Design Occupant Load per Floor and Assembly space:
i 1 i MAY 2 3 1 I— 2023 1
;
,Fs,-----7:0t_Hr3-----,yit.DING"—INspE7-2710Nis
[ '
!_ ,-.'yi-T:.)r,;.mA 01060
Green Collar,LLC Contract For
570 Newton St
South Hadley,MA 01075 Services
(413)532-1817
support@greencoAarma.co
greencollarma.com
Chris Mason Leeds Elementary
Northampton I entral Services 20 Florence St
210 Main St Leeds MA 01053
Northampton, A 01060
1539 09/3 1/2022
SALES REP
Brian Tierney
SPRAY FOAM 3,575 3.96 14,157.00
Install 2"of closed cell spra foam to crawispace walls
Intumescent Paint 3.575 1.59 5,684.25
Apply 15 minute ignition ba ier paint to spray foam
Window Cover 2 250.00 500.00
build plexiglass window cov•ring to be weather stripped,insulated with 2"insulation
board,and affixed to close rrent opening
TOTAL $20,341.25
Accepted By Accepted Date
! !
SECTION 9: PROPERTY OWNER AUTHORIZA ION
Name and Address of Property Owner
k...ted S 47-Ltrtv_n
Name(Print) 'eltreet City/Town Zip ,
Property Owner Contact 11 fmmation:
••---
Title Telephone No.(business) Telephone No, (cell) e-mail address
, If applicable,the property owner hereby authorizes:
Robert Calhoun 570 Newton St South iadley,Ma 01075
i—.--•
Name ----- - -
Street Address Ciqi Town State Zip
to apply for and act on the 3operty owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10;CONSTRUCTION CONTROL(Please fill out Appendix 1)
It a building is esk than 35.000 cu.it.of enclosed space aridjor not undo Construction Control then check here 0
Otherwise provide constwinn control forms(see scalier 107 in the iode)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
Robert Calhoun 413-532-1817 infotkgreencoilarma.com 181415
Name(RegMrant) Telephone No. e-mail address Registration Numbeso i 1,5
570 New ron St South Hadley ma 01075 U
Street Address City/Town State Zip Discipline Expiration Date
10,2 General Contractor .
GREEN COLLAR,LLC
Company Name
Robert Calhoun CS-1.08817-Id
Name of Person Responsiblefor Construction License No. and Type if Applicable
570 NEWTON ST SOUTH HADLEY MA 01075
Street Address City/Town State Zip
413-532-1817 - - INFO4CREENCOLLARN•LA.COM
Telephone No.(business) Telephone No,(cell) mmail address
SECTION 11.1 WORKERS COMPENSATION*ISLIRANCELUIDAVII(M.G.L.c.152.4 25C
A Workers"Compensa ion Insurance Affidavit from the MA Department of Industrial Acc idents must be completed and
submitted with this appliaition. Failure to provide this affidavit will result in the denial of the issuance of the building permit..
Is I signed Affidavit submitted with this application? Yes CI No Cl
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs:(Labor
Item
and Materials) Total Construction Colt(from Item 6)=$
1.Building S-70-75344 i
1 Building Permit Fee=Total Construction Cost x_ (Insert here
2.Electrical $ appropriate municipal factor)-S____.
• 3.Plumbing S.
•d•Mechanical (MAC) $ Note:Minimum tee-5 (contact municipality)
5.Mechanical (Other) $ I
Enclose check payable M
6.Total Cost S •,?c.), 3c/ i (contact MU n ii ipalitv)and write'check number here _
SECTION13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below I hereby attest under the pains and penalties of perjury that all ot the information contained in this
Iapplication is true and accui ate to the best of lily knowledge and understanding.
Robert Calhoun Rafiett&Arun owner 413-532-1817 5/19/23
Please print sign name
South Hadley Title Telephone No. Date
ma 01075 inIe@greettcollartna,com
Street Address City/Town State Zip Email Address
Municipal Inspector to fill nit this section upon application approval: 192/ 5-ao-pz-5
I Name , Date
City of Northampton
Massachusetts•
��;� '• r°�
DEPARTMENT OF BUILDING INSPECTIONS e'
212 Main Street + Municipal Building re.
Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of th• provisions of MGL c 40, 554,a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed :ste disposal facility,as defined by MGL c 111,S 150A.
The debris will be d sposed of in:
Location of Facility: 3 N ( ,
The debris will be t .nsported by:
Name of Hauler: s'jvu
Signature of Applic.nt: Date:
City of Northampton
Massachusetts jai,
`1"# DEPARTMENT OF BUSLDINC, INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLI'17ON AND RENOVATION PROJECTS)
In accordance of th• provisions of MGL c 40, 554,a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed :ste disposal facility,as defined by MGL c 111,S 150A.
The debris will be d sposed of in:
Location of Facility:
The debris will bet nsported by:
Name of Hauler: A
Signature of Applic.nt: Date:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
n'ww.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(iiusinessiOrganizat on/Individual): Green Collar,LLC
Address:570 Newtot St
City/State/Zip: South Hadley,MA 01075 Phone#: 413 532 1817
Are you an employer?Ch eck the appropriate box: 'type of project(required):
1.® I am a employer with 15 4. 0 I am a general contractor and I
employees(full and/Q part-time).* have hired the sub-contractors 6. New-construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in arty Y•ca acit employees and have worker's'
P t 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 1 1.0 Plumbing repairs or additions
myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]' c.152,§1(4),and we have no
employees.[No workers' 13.N Othednsulation/Weatherization
comp.insurance required.]
*Any applicant that checks box all*lust also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affi davit indicating they are doing all work and then him outside contractors must submit a new affidavit indicating such.
:Contractors that check this box moth attached an additional sheet showing the name of the Nub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they Hurst provide their workers'comp.policy number.
I am an employer that is prt riding workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Com an Name: AmGUARD Insurance Company-A Stock Co.
P y
Policy#or Self-ins.Lie.#: R2WC182010 Expiration Date: ......9/23/2023
Job Site Address: `"' F FU 1`47.. -C - .r-. City:State.`Zip:_
Attach a copy of the workers'compensation policy declaration page(showing-the-policy-number-and expiration date).
Failure to secure coverage a;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 line
of up to$250.00 a day agairst the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA fo-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(circl one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
1HA;pr City of Northampton
40", 1% ��5` �.,���,
'" Massachusetts ``
,
x
DEPARTMENT OF BUILDING INSPECTIONS y, a?.:.
4 212 Main Street • Municipal Building �ap�� ���.�`
Northampton, MA 01060 _..
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address: (DC- PLOrQn CAl c)
Contractor
Name: Green Collar,LLC
Address: 570 Newton ST
City, State: South Hadley, Ma
Phone: 413-532-1817
Property Owner
Name: 1 'PCB E tCrr)fo-tc" -J<
Address: () C) l or—e rt C S1-
nt
City, State: -- Cl S , m c...
I Robert Calhoi n (contractor) attest and affirm that the building I intend to
insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have
provided the prope ty owner with a copy of this affidavit.
Contractor signature 5io4entCaMow
Date i 30