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23A-247 (3) 31 MANN TER BP-2020-0700 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A-247 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: woodstove BUILDING P E RM I T Permit# BP-2020-0700 Proiect# JS-2020-001196 Est.Cost: $3200.00 Fee:$40.00 PERMISSIONIS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: STACY LAVERTU - 103963 Lot Size(sa.ft.): 7666.56 Owner: ELIZABETH VIZENTIN Zoning: URB(100)/ Applicant: STACY LAVERTU - SAL-CZAR AT: 31 MANN TER Applicant Address: Phone: Insurance: 106 FLORENCE RD (413) 561-3093 O WC EASTHAMPTONMA01027 ISSUED ON.121412019 0:00:00 TO PERFORM THE FOLLOWING WORK.WOODSTOVE 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date I'aid: Amount: Building 12/4/2019 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner City of Northampton Massachusetts ,, DEPARTMENT OF BUILDING INSPECTIONS ?; 212 Main Street • Municipal Building Northampton, MA 01060 � -ao - 706 RECE/V 3� �p /f — P c/7 SIN LE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION SEC 4 X019 FOR OOD, COAL, PELLET,CORN, STRAW OR SIMILAR STOVES, OR FIREPLACES oFr3uri Check# -17-6 2 P10 NORTHA.h,6IOG INSpECr N.MA01060�Ns Please fill in all appropriate information 1. Name of Applicant : /�- G'�2T�� Address: /O(o /=l�2' �i9 1WIiefephone: / — / -30?3:0 2. Owner of Property : �G/ Z/7�/JG/�f XJ'z G017-1A/ Address: ! /VAlvl"" %03 Telephone: 3. Status of Applicant : Owner P--c—o ntracctorr 4. Type or Brand of Stove : 5. UL Listing : Ay u 6. Estimated Cost : 7 3nZOd 7. Email : L-tr L ✓/ Z C`-?l/fij Co'e', If applicant is not the homeowner:: Contractor name �T � ` �'�� Email : sz,4//L "TL e CZ/! Ei `�Scu/rTd� Construction Supervisor's License Number — �a 9,(2 Expiration Date Home Improvement Contractor Registration Number �(a jam, ,6 Expiration Date 7- 7=5V All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit 8. Certification: I hearby certify that the information contained herein is tru and accurate to the best of my knowledge. DATE: / 2 ' i r APPLICANT'S SIGNATURE DATE: �� HOMEOWNER'S SIGNATURE -� APPROVED DATE: 1 BUILDING OFFICIAL 0 CZARENE-01 JCHOINIEI CERTIFICATE OF LIABILITY INSURANCE OAT49/2 OIYVYV) 4/9/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 'RODUCER IcClure Insurance Agency, Inc. NAMEAN .TAcr N 03 Van Deene Ave. AMCC,"No,Ext): (413) 781-8711 (FA c,No ):(413) 731-8548 test Springfield,MA 01089 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE I NAIC# ISURED INSURER A:MSA Group 29939 Sal-Czar Inc. DBA Czar Energy Solutions INSURER e:Safety Insurance Co. 39454 &Victoria Lavertu INSURER C:Associated Employers Insurance Company 53 North Elm Street INSURER D: Westfield,MA 01085 INSURER E INSURER F: OVERAGES CERTIFICATE NUMBER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rR TYPE Of INSURANCE ADOL SUBR POLICY EFF POLICY EXP LIMITS POLICY NUMBER -L IMMIDDIYYYYI 1,000,001 1 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCURMA DA BPO8688T 3/10/2019 3/10/2020 GE TO RENTED 500,001 PMA z - rr n S MED EXP(Any one Person) S 10,001 1,000,001 PERSONAL&ADV INJURY 3 2,000,001 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 3 2,000,001 X POLICY a PRO- LOC PRODUCTS-COMP/OP AGG S JECT OTHER: $ AUTOMOBILE LIABILITY COMBINEDtSINGLELIMIT $ 1,000,001 ANY AUTO 6209399 3/10/2019 3/10/2020 BODILY INJURY PerPerson) s OWNED �( SCHEDULED BOOIIv INJURv Per accident S _ AUTOS ONLY AUTOS PROPERTY DAMAGE S x HIRED X NON-OWNED Per accident AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAR OCCUR OCCURRENCE $ -- EXCESS LIAR CLAIMS-MADE AGGREGATE R DEO RETENTIONS _ WORKERS COMPENSATION x PTA7 T ORH AND EMPLOYERS'LIABILITY 100,00C ANY PROPRIETORIPARTNER/EXECUTIVE YIN WCCSCOSCO98312019A 3/26/2019 ;:fEACH /2020E.L.EACH ACCIDENT _ $ pFFICER/MEMBER EXCLUDED? N/A 100,000 (Mandatory m NH) E.L.DISEASE-EA EMPLOYEE S $00,000 If yes,describe under E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS below I SCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) RTIFICATE HOLDER CANCELLATION SHOS BE ELLED THEUEXPIRATIIONH DATE THEREOF. NOTCEIEWI WILL BEC BEFORE DELIVERED IN To Whom It May Concern ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. .ORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD https://businesscenter.synchronybusiness.com/portal/saleslipSubmit 2/2 rofe Division of Pwealth of Massachusetts / ssional Licensure Divission Board of Building Regulations and Standards Const \\"LEt 06 fSdP�rvisor CS-103963 STACYA _ a 4pires: 05/18/2021 TU 106 FLORENCE RD 'L EASTHAMPTON MA'b Commissioner Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Qantractor Registration Type: Corporation { f' 'M Registration: 163596 SAL CZAR INC . t � 3 l Expiration: 07/07/2021 D/B/A CZAR ENERGY SOLUTIONS ? / [ 53 N. ELM ST WESTFIELD, MA 01085 s "tom r SCA 1 Co 20M-05/17 Update Address and Return Card. �� irrnao-icu�-a�`i a�./�wyi2c��lella Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TY>3E:,Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 163596 ' 07/0712021 1000 Washington Street •Suite 710 SAL-CZAR INC Boston,MA 02118 D/B/A CZAR ENERGY SOLUTIONS STACY LAVERT&� ' 53 N ELM STS(� WESTFIELD.MA 01085 Nnt valid wi+hnrit cirnnn+'