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16A-020-032
BP-2024-0362 302 FAIRWAY VILLAGE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 16A-020-032 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-2024-0362 PERMISSION IS HEREBY GRANTED TO: 2024 Project# INSULATION/WEATHERIZATION Contractor: License: Est. Cost: 2419 GREEN COLLAR LLC 108817 Const.Class: Exp.Date: 08/31/2024 Use Group: Owner: LISSAUER JOAN Lot Size (sq.ft.) Zoning: URA Applicant: GREEN COLLAR LLC Applicant Address Phone: Insurance: 570 NEWTON ST (413)532-1817 WMZ-800-8008323 SOUTH HADLEY, MA 01075 ISSUED ON: 04/01/2024 TO PERFORM THE FOLLOWING WORK: INSULATE BASEMENT OVERHEAD AND RIM JOISTS 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: Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massacl use t Board of Building Regulations and Standard ,, _ ?OR Massachusetts State Building Code, 780 FM't ` 1 USEIPALITY Building Permit Application To Construct,Repair,Rep0Ft8ac em iljs �sevisSdMar 2011 One-or Two-Family DweNing ar�,q,,,�,,, aTfC,:)„ MA w,- This Section For Official Use Only • Building Permit Number:RP 202N-0362. Date Applied: ZU L, /zV," um J ` 1`c3�5 / /leAam �"Z(7' Z7 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers _ 3� Ol t mom Vt9 I649- O2D--037- 1.1 a Is this an accepted street. yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Mia )110S _ 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 p( Private❑ Zone: _ Outside Flood Zone? Municipal On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Jo -is a e.r , tub 01053 an Name(Print) City,State, 3 tA vg yea 58-voin No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) 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 50 Specify:Insulation/Weatherization Brief Description of Proposed Work' ealra ��o- a0o s�11- • last - 55sq SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ e.2� U I9 1. Building Permit Fee: $ Indicate how fee is determined: Z.Electrical $ ❑Standard 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 ces: b Q Check N .heck Arno Cash Amount: 6.Total Project Cost: $ g 1 y 1 0 Paid in ull 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 3/31/2025 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 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 of perjury that all of the information contained in t is application is true and accurate to the best of my knowledge and understanding. 40/a5/Print Owners 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. I42A.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 Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts Department of Industrial Accidents >.-MAIL— Office of Investigations 600 Washington Street ,6,. 't Boston, MA 02111 -- "rt www.mass.gov/dia 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 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' [No workers' comp. insurance comp. insurance.t 9• ❑ Building addition 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 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.[XI 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. 1Contractors 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 fir 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(I) Expiration Date:_9/23/24 Job Site Address: 3, Fairway Ul q City/State/Zip: ,-o , LI A- 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. Mace. Signature: Date: R al0 PI • Phone#: 413 532 1817 Official use only. Do not write in this area, to he 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 Division ut Occupational Licensure Board of Building Regulations and Standards ',.:�t Ir, t:e?rtstCu��lr�et',�tt)gr'vrsar CS-108817 t cpires:08/23/2024 ROBERT CA 41OUN .! 8 UPPER RIVER RD SOUTH HADLY MA 09075 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 ' „Raffl4ftt Calhoun 570 NEWTON ST i"aa'eay.4. SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature G GREE COLLA NR Permit Authorization Form I, Joan Lissauer (Owner's Name) Owner of the property located at: 302 Fiarway Village (Property Address) Leeds, MA (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. )ea_ii.- Le....1.4‘tua_n, (Owner's Signature) 3/26/24 (Date) 351 Newton St.Unit B South Hadley,MA 01075 Phone:413.532. 1817 Email: support©greencollarma.com 44-CTIoti5- SCRIPTION OF PROPO ED OR—c e—ac a ----ticable Na%v 0 I—I Addition Replacement Windows Alteration(s) Roofing Accesso Or Doors 0 llf Bldg, CD DemolitionLJ0emo11tio , J New Signs ID] Decks ICI Siding 101 Other;fa, Bnef Description of Proposed Won( Alteration of exisvteing bedroom_Yes Attached Narrat Adding new bedroom Yes No Plans Attached Roil -Sheet Renovating unfinished basement Yes No Sa._ addition to existing horng,corn Iota the following New house and or . a. Use of building:One Family Tv,o Fa Other b. Number of rooms in each family unit: Number of Bathrooms C. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stones? I. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction I. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No I. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ,as Owner of the subject property hereby authorize to act on mYbehal_fL,i49,11nalters relative to work authorized by this building permit application. S - of Owner Date ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. r-- Date LSigna r for*gear imagariggliiiiMM/a