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35-273 (5)
58 WOODLAND DR COMMONWEALTH OF MASSACHUSETTS BP-2021-1764 Map:Block:Lot:35-273-001 Permit: Alts Renovations CITY OF NORTHAMPTON Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1764 PERMISSION IS HEREBY GRANTED TO: Project# Contractor: License: Est. Cost: $4483 MARK LANTZ 102169 Const.Class: Exp.Date: 12/10/2022 Use Group: Owner: PRUSS SARA B& DAVID C DESWERT Lot Size (sq.ft.) Zoning: WSP Applicant: COZY HOME PERFORMANCE Applicant Address Phone: Insurance: 180 PLEASANT ST#200 EASTHAMPTON, MA 01027 TO PERFORM THE FOLLOWING WORK: ISSUED ON:08/20/2021 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: 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. Signature:, y �.1 61 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 19 / f\ 0 The Commonwealth of Massacl (setts / t r, - Board of Building Regulations and`Stan•.rdss 9GC / ICIO �' PALITY R Massachusetts State Building Code,,,* J ' �a N'11.)0,4, 6 USE d 13uilding Permit Application To Construct, Repair, Re ; i. DemodA a vise' . ar 2011 One-or Two-FamilyDwelling '�,0°'tir n >, 2 nn This Section For Official Use Only 4,ti,�`0 1'✓/! " 1l� Date Applied: �°'°s'oti Buildin Permit Number: 7 pp o KE-00 Zs ///g--- 6-17-Zoz) Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 5g, Nt., oocl(mod A)rlve , N hti►119 1.1 a Is this an accepted street?yes no Map Number Parcel Number '1.3 Zoning nformation: 1.4 Property Dimensions: Zoning Distric Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Buildin:Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water S ppiy: (M.G.L c.40,§54) 1.7 Flood Zone Information: - 1.8 Sewage Disposal System: Public 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner' i f Record: Dc1/4v4. p Sww4- NIC a ' -101 mA C)(O�' Name(Print) City,State,ZIP 5 s wo, i.otAL b r i v& 3 to - 151 '1 i a,3 deswe(-4-qq e ke+i-nal1 •eo n No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Constru tion 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other tW Specify: I t1Sit(cif (-7 h Brief Descrip ion of Proposed Work2: M.css Sew-L. - i r\5,a4.41 Cn , fir Sec.t,5 4%4-te SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ Li Li 3 , 4 g 1. Building Permit Fee: $ (es Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanica (HVAC) $ List: 5. Mechanica (Fire $ �/ Suppression) Total All Fees: $ V� 6a Check No jCheck Amount: Cash Amount: 6.Total Pro ect Cost: $ 4 , 4 g 3. 4 g 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) csS L- 0 a i l09 140\ rn l 2 K /.,17/4� z License Number Expiration Date Name of CSL Holder L I 'd o I°kc(54n 1 S f 4)00 List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) ( 7 5! ' A NIP+01 f" T sc)t 0 .) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding �y ,`, SF Solid Fuel Burning Appliances 413-scrpy O OQ M C Q rr CO Z y IlciY1t.Lon I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Cs` a l" O i 5 I a 3_ GO 2.) Nvm t per fOf w 6 n C L HIC Registration Number Expiration Date I Co pan Name or HICRegistrant Name I W O e cis A n 1 St' ed 00 r�As\cC y td27 KONA.. No.and Str et Email address S' s4 reqkcItj Mik '1t 04.03 City/Town,Sta ,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. SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN CONTRACTOR OR OWNER'S AGENT APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize CO QV t u('t'nk IV41. to act on my behalf,in all matters relative to work authorized by this building permit application. rorm IvnC( d d_ (Ad Cc1 fr 8 /,/,'/, / Owner's Signature Date SECTION 7b: APPLICAN'T 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. ieef 6//0 Contractor//Owner s Agent/Owner ignature Date 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/oc:t Information on the Construction Supervisor License can be found at www.mass.gov/dpg 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" 41111/10111i Permit Authorization mass save Form mg;SI/0.1^,prow?off2cterk Site ID: 4256385 Customer: SARA PRUSS l� David DeSwert ,owner of the property located at: (Owner's Name,printed) 58 Woodland 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. Owner's Signature: DQUt�DP.S�P Date: 08 / 05/ 2021 ••s•••••s••0600066o.illii***0•••••OA••••••••s•assso••••r•••s••••a•••* FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Cozj /-rtht I - .-' 1 . j t, A; Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only Document Ref:CKNKC-V4HC8-6VYGM-692QF Page 6 of 7 City of Northampton „. M Massachusetts ��S�s , fF * fG {` DEPARTMENT OF BUILDING INSPECTIONS M, \*, , 212 Main Street • Municipal Building or'r=may+ Northampton, MA 01060 ssNw ArD‘'— CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: Dcu osk. (t1 I`6O Pk-ecsar+ ST , EAs o0v -fob The debris will be transported by: Name of Hauler: to, )(Af‘k,\ Signature of Applicant: Date: /rc / i _ The Commonwealth of Massachusetts J = 1, Department of Industrial Accidents fi ierr 1 Congress Street, Suite 100 . 'ettc ' Boston, MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual): 'J Cozy Ho�e, eftwi,ni nek Address: It O )1 IM54 fl-- 5 4- City/State/Zip: A t f' .J qt Phone #: 1 j3 - 5d9-06k60 Are you an employer?Check the appropriate box: Type of project(required): I.I4 1 am a employer with -7 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. El Demolition 10 ❑ Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.12 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.1=1 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.�]Other /Ali/A /r/r✓ 6.�We are a corporation and its officers have exercised their right of exemption per MGL c. `` 152.§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#l 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 ntv employees. Below is the policy and job site information.Insurance Company Name: Cahk'MI t fT s,K —TIN 1w\r Ay C 1:\)0 c y Policy#or Self-ins. Lic.#:l'i(p-$9 5-3-7 3—0 I— 0 ( Expiration Date: l i' a,-el Job Site Address: 5S (00Oc1 ipv1.1 bk City/State/Zip: )i N c c y .-j*n /r14 0 i 0 G Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DR for insurance coverage verification. I do hereby ce/rftify der the pains andddpi realties of perjury that the information provided above is true and correct. Signature: f�v'( �/ " Date: 8"/to ir7-/ Phone#: 7i3 'Sd9-0,A0U 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#: Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 162770 COZY HOME PERFORMANCE, LLC. Expiration: 04/05/2023 180 PLEASANT STREET EASTHAMPTON, MA 01027 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 162770 04/05/2023 1000 Washington Street -Suite 710 COZY HOME PERFORMANCE, LLC. Boston, MA 02118 MARK LANTZj4/4'14- 180 PLEASANT STREET ed‘r,A EASTHAMPTON, MA 01027 Undersecretary Not valid without signature c@FmmAnwoolth of M9649ptiN6Att9 PivIRiot;of Pro100 3iftnnl Wcen#SNFI RiAeFfi @f 614101110 ittliai3 anft MtIMS* ent3fnte# iil .C esiefl Al111002160 Inn{ Opitesi it/104013 MARS M t-ANTZ 7 lag >MA5AN eTReET A4114AMPTi ma/ 00111Missiener i4: Via! - Gonstruction Supervisor specialty Relitflatrd to: CACAO•Maulatiof+Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Gait(617)727-3200 or visit wan+'.mass.go vidpl (1.) A CORE, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/22/2021 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 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). PRODUCER CONTACT NAME: Diane LaFleche The Dowd Agencies, LLC PHONE I FAX 14 Bobala Road (A/C.No.Extl:413-437-1062 (A/C,No):413437-1462 E-MAIL Holyoke MA 01040 ADDRESS: dlafleche@dowd.com PRODUCER CUSTOMER ID N: COZYHOM-01 INSURER(S)AFFORDING COVERAGE NAIC 0 INSURED INSURER A:Selective Insurance of South Carolina 19259 Cozy Home Performance LLC - 180 Pleasant St. INSURER B: Easthampton MA 01027 INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:620509354 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A GENERAL LIABILITY S 2206979 4/17/2021 4/17/2022 EACH OCCURRENCE $1,000,000 • DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $500,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 POLICY X X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ A X UMBRELLA LIAB X OCCUR S 2206979 4/17/2021 4/17/2022 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DEDUCTIBLE $ X RETENTION $0 $ I WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'UABIUTY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION 30 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. To Whom It May Concern AUTHORIZED REPRESENTATIVE 777/1.1.4-4W7 )41414--- ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD