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17A-116 (4) BP-2023-1706 18 CLAIRE AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17A-116-001 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-2023-1706 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 7401 GREEN COLLAR LLC 108817 Const.Class: Exp.Date:08/31/2024 Use Group: Owner: RYAN MAUREEN Lot Size (sq.ft.) Zoning: RI/URA Applicant: GREEN COLLAR LLC Applicant Address Phone: Insurance: 570 NEWTON ST (413)532-1817 WMZ-800-8008323 SOUTH HADLEY, MA 01075 ISSUED ON: 12/06/2023 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 NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I II ♦ I V I Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner oec f� ,Q)11-7 1Q13 • °A' .,N ST Commonwealth of Massachusetts =1�- :oard Building Regulations and Standards FOR I /° ass husetts State BuildingCode, 780 CMR MUNICIPALITY e..`1 ?'ti� USE .. •t P; it plication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 4'��o5o'oNs One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number:'' f P'a 5- (7 7`( Date Applied: eo, ` 255 // I Z- G ZO2.3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 18 Claire Ave 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 II) 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 El Private 0 Zone: _ Outside Flood Zone? Municipal El On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Maureen Ryan Northampton,MA 01060 Name(Print) City,State,ZIP 18 Claire Ave 413-270-5030 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other Da Specify:Insulation/Weatherization Brief Description of Proposed Work2 R60 Cellulose Attic-912 sq ft Clapboard shingles dense pack-992 sq ft SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $7401 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) Total All Fees: _ Check No.(.O(/kheck Amount: Cash Amount: 6.Total Project Cost: $7401 ❑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. Type Description No.and Street 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 3/31/2025 Green Collar,LLC HIC Registration Number Expiration Date HIC Comoanv 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 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 is true and accurate to the best of my knowledge and understanding. Robert Calhoun 11/28/23 Print Owner's or Authorized Agent's Name(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.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" 1 ne uommonweaun of ivfassucnuseus Department of Industrial Accidents •111111111111P.P t Office of Investigations • =1:0,, 600 Washington Street '� .' Boston, MA 02111 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 15 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction listed on the attached sheet. 7. ❑ Remodeling 2.El I am a sole proprietor or partner- 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. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.1=1 Roof repairs insurance required.] t c. 152, §1(4), and we have 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'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: A.I.M Mutual Insurance Company Policy#or Self-ins. Lic.#:WMZ-800-8008323-2023A(1) Expiration Date:_9/23/24 Job Site Address: 18 Claire Ave City/State/Zip: Northampton, MA 01060 Attach a copy of the workers' compensation policy declaration page(showing-the-policy-number-and 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. JarSignature: Date: 11/28/23 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#: GREEN COLLAR Permit Authorization Form I Maureen Ryan (Owner's Name) Owner of the property located at: 18 Claire Ave (Property Address) Northampton, MA 01060 (Property Address) Here by authorize Green Collar, a certified Mass Save Independent Insulation Contractor, to act on my behalf to obtain a building permit and to perform work on my property. (Owner's Signature) 11/28/23 (Date) • 351 Newton St.Unit B South Hadley,MA 01075 Phone:413,532. 1817 Email: support@greencollarma.com Commonwealth of Massachusetts Division of Occupational Licensure Board of Building ReteuIations and Standards Const004t04 Srvisor +'a r CS-108817 e tpires:08123;2024 ROBERT CALHOUN 8 UPPER RIVER RD SOUTH HADLEY MA 01075 COMMIS riot cr THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Horne Improvement Contractor Registration Type: LLC GREEN COLLAR LLC. Registration: 181415 5/0 NEWTON ST Expiration: 03/31/2025 SOUTH HADLEY, MA 01075 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&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 101415 03/31/2025 Boston.MA 02118 GREEN COLLAR LLC. ROBERT CALHOUN &?&iw 570 NEWTON ST 1;(„,,r_% SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: Republic Services Name of Waste Facility 845 Burnett Rd, Chicopee MA Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, M.G.L.c.40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. 111 s. ISO A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official, in writing,as to the location where the debris will be disposed. 780 CMR—6th Edition Robert Calhoun Signature of Permit Applicant Date