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38B-121 (11) 160 SOUTH ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1865 Map:Block:Lot:38B-121- 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-2021-1865 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est.Cost: 4289 COZY HOME PERFORMANCE 106178 Const.Class: Exp.Date:09/29/2021 SHEARER DAVID W&ALICE M&MARJORIE A& Use Group: Owner: PETER L SHEARER Lot Size (sq.ft.) Zoning: URB Applicant: COZY HOME PERFORMANCE Applicant Address Phone: Insurance: 180 PLEASANT ST#200 4135290200 46-845373-01 EASTHAMPTON, MA 01027 ISSUED ON:09/13/2021 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ER IZATI 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: I i VI02 TTO • Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner C<C>kThe Commonwealth of Massachusetts 44 W Board of Building Regulations and�Stan s 1 c` OR Massachusetts State Building Code, 704,4 O� IC ' • LITY rc O US Building Permit Application To Construct, Repair, Renova ti ., olish�I evised ar 2011 One- or Two-Family Dwelling °ti'^�sp This Section For Official Use Only �1°o o% Building Permit Number: 6Q.^' I. 18C Date Applied: j Kel)i,.._ &>> > q-I3-ZOz/ Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers Mt SoN-t-h 5-1, 1.101---141(n-p+on 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 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 El Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 4-Icce Shearer- Nor}-kAh\P-t-oh al 4- OIOCo0 Name(Print) City,State,ZIP 000 SOu ST, 4 i 3 -5gq- 955q mas rLkr\c rril • Cost No.and Street Telephone Email'A �ddress 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 )a Specify: I rt3k(44- on Brief Description of Proposed Work'-: AA cuss Sw e w\5k(ck.A-i c r, - 4-W;i c_. air Sec.(i h5 a- I hS . b se„ vero- ( b4 i kk it . Door I 1,st—k4-10„ S 1-ev r 0v e-(( t►,c k 1c.4-:o,n c b �o-Fc( Prayecf- A-m 1 Y' -8.9 /° SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1. Building $ Li, Z g k °� 1. Building Permit Fee: $ 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. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fees: L r,,� Check No.� Check Amount: l.G Cash Amount: 6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Css L- I oat' (09 1 tAvQ.\ N JAY)1112 K LA/V/1. License Number Expiration Date Name of CSL Holder'6 0 Plea s An 1 s f ¢107 O 0 List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) £44 5 T HAND I t)I! m'A O I 0 a.7 R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry , RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413"Saar 0d00 MflckQ Myca2 y kook.coM I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) . .-� O 1,1 i 5 143 3 C0 Z Nome Perrot J116/)C f_ i CsHIC Registration Number Expiration Date I-K Co p Name or�HIC Aegistrant Name d DU / Q JefiS Ckyry No.and Str et Email address i.A 544 retiON t�ik OW a.� H13"51 _a U q City/Town,Sta ,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AF1'IDAVIT(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 I,as Owner of the subject property,hereby authorize CO 211 %40 m4.. Q .t. 'r'nk A[( to act on my behalf.in all matters relative to work authorized by this building permit application. * Slt'na�re Q-t 4G‘ roc rh c JJ 8-/3//a./ Owner's Signature Date 1 SECTION 7b: APPLICANT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information containeddiin this application is true and accurate to the best of my knowledge and understanding. Contractor//Owner s Agent/Owner, gent/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 it 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.muss.goviocci Information on the Construction Supervisor License can be found at www.mass.gpv/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" DocuSign Envelope ID:482C417A-56D1-4C81-A513-CD8E0BDF7008 • RISES ENGINEERING OWNER AUTHORIZATION FORM Alice Shearer (Owner's Name) owner of the property located at: 160 South Street (Property Address) Northampton, MA 01060 (Property Address) hereby authorize Subcontractor(to be filled in by office) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. The permit will be secured by the subcontractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. ,-DocuSigned by. QGu, S(,u.art.r Owner's SigfMt-ure 6/15/2021 1 5: 36 AM EDT Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 ( 339-502-6335 www.RlSEengineering.com HAM;.,, City of Northampton Massachusetts .4. �e NFk . E - � DEPARTMENT OF BUILDING INSPECTIONS ` �,,�� 212 Main Street • Municipal Building ifs `•^ s. '" ' Northampton, MA 01060 frW '\ Property Address: Re( 5cG'1 1, / , Nbr+-4Anip h Contractor Name: C O2- 1-k•,..1me, 21 k'�xrr\G14\ (St Address: \ c6 , Q r� 'f\r\� 5� City, State: Ri: re-y1 ".J'f, .t x\t Phone: `'‘1 " ` S�°\` ',0� Property Owner Name: A-(ia Shearer Address: /(00 50 a-fi .57 City, State: iti0(-firinyiryi 44,4 I, /ndge} G-d;r774 (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 property owner with a copy of this affidavit. A/ Contractor signature 1,'/ 1/./' 17://17 e_lieo-rs. 4_-14:dew I 4- C1444C(t-e J Date $/30/2 - -110111111k pr mass save Weatherization barrier incentives Based on your Energy Specialist's recommendations,your home can benefit from program-eligibler insulation weatherization and/or airbarriers.sealing improvements.Before moving forward,please follow all the instructions below to remediate you CUSTOMER INSTRUCTIONS 1. Hue a qualified,licensed contractor to evaluate and/or remediate the weatherization barrier(s). 2.Submit signed and completed copies of this form and a copy of the paid contractor invoices)within 60 days of your Home Energy Assessment to:RISE Engineering,60 Shawmut Rd,Unit2,Canton,MA 02021 or email to Eversourcelnfo a RISEengineering.eom. 3.The weatherization incentive will be deducted from the customer co-payment amount of the weatherization work.Ai rebate check will be issued in the event the amount exceeds the customer's co-payment amount. 4.Complete the recommended weatherization improvements. 5.The Mass Save'HEAT Loan offers interest-free financing opportunities that may be used to remediate eligible weatherization barriers. Learn more at masssave.com/en/saving/residential-rebates/heat-loan-program CUSTOMER INFORMATION Customer Name: Alice Shearer __Client#or Site ID: 319663 Site Address. 160 South Street City orthampton State: MA ZIP: 01060 Phone Number: 413-584-9554 Email: masruns@gmail.com Customer/Homeowner Signature: Date: b._.-//"—el KNOB AND TUBE WIRING(up to 325o incentive) To determine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save' weatherization recommendations have been made: V Attic Floor v Attic Wall V Attic Slope KJ Exterior Wall rJ Basement (_)Other: 0 Other: 1,...4.-v-eiperformed my yininspection and determined there is no active knob and tube wiring in the areas selected below, Attic Floor ( /Attic Wall tic Slope k>elterior Wall 11><sement : Other: %Other: Contractor Name: Viilic40 e l 1J L Q2 Address: /7 pic -4,5,7 -irk( Nal f lianpia4 State:A% ZIP: O/46a Company Name: "-ehaP/ 2,.. -ir( 1444 License Number: 37:4107 F Contractor Signature: Date: 6 Y!7 I My signature confirms that I have performed,nspection of e electrical systems listed above and have corrected any barriers as indicated.My signature also confirms that I eve read and agree to the Terms and Conditions outlined on the back of this form. MECHANICAL SYSTEM BARRIERS(up to$250 incentive)(To be filled out by licensed contractor.) High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbon monoxide level, as measured in the undiluted flue gas,to below 100 parts per million(ppm). Draft Failure:Contractor is to correct the draft in the selected flue(s).Refer to table on reverse for acceptable draft ranges. High Carbon Monoxide _ Existing CO ppm: Revised CO Draft Failure _.___ _ _ — Fpm: Existing Draft Pa: Heating System _ — Revised Draft Pa: r Hot Water Heater -- Other: 1 - Spillage:Contractor is to correct the spillage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation. Heating System , ;Hot Water Heater `)Other: Contractor Name: Address: City: State: ZIP: Company Name. __ _.__,_____-___License Number: Contractor Signature: Date: My signature confirms that I have performed my inspection of the mechanical systems listed above and have corrected any barriers as indicated.My signature also confirms that I have read and agree to the Terms and Conditions outlined on the back of this form. City of Northampton o�YNaM•'o Massachusetts �? :._ '� Y DEPARTMENT OF BUILDING INSPECTIONS y � \ 212 Main Street • Municipal Building J': a Northampton, MA 01060 I' 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: 73, MeS'- Location of Facility: i -o A/-e�s4.h-f ST , Cas4 pry foh The debris will be transported by: eHP Name of Hauler: L15,A Signature of Applicant: (t-44- L Date: 2-(30 Aa ' ""_ The ('oninionwealth of Massachusetts -_ Department of tndustrirrl Accidents �� k1 Congress Street, Suite 100 ' Bostolf, MA 02114-201? wwittntass.go►tidiu ltur'hers'Compensation Insurance Allidatit:Builders/(ontractors,Electricians1Pluothers. ft)fib.FILED«'flit'1.111'.Pb:K!t11 t l'11C At 1110121 f'Y. Ainslie ant information Please Print t.eeibls dI21e(l9uimtgs,•fDryanti.tllcut.Ityrltttduutl• CC��-/ ii S'31,)t Y-.r�U c`Pi Pv1\Lk__... _.. Addrt:ss:. ` ZSQ Q.1k0S0,.r -__"\- _ City/State/Zip: \-\1:NNiNN 0 w rc 01( ,)!) Phone N: "\13 - sa °I" 0a,O6 Aire yam as aalpto)rr?('h de tIii alnlinglrlata•Wm i Type of project(required): i.531 ant a anptoyc:r with 7 .tlrpduyr:eh flail ardor part-iunel.' 7. 0 New cunstrlai.`tion 2.3 I ant aI mile proprietor or parincrshrp and haw nu enlployeirf wanking tun rile in N. Q Remodeling may capseity.(No waiters'camp.ulauraacx requitesl.l 10 I ant a homeowner doing all wink myself.(No worker.'comp.nuutwwr;ME4usnoi.1` 9. ❑ Demolition 4.0 I aut a lwsws and will he Wing cosarac1urs to conduct all work on my paop►rty. I will IU[] Building addition but .. moue that all corn'when either haw worlitra•eutltp►rlaalaun murmur in an:hole 1 I.Q Eli.vtrical repairs or additions prupneklrs w ith no anipluy.em. 12.0 Plumbing repairs or additions I ant a g is rdf.unlraetur and I twig hired tin sub•eunnuetun liated on t1w attached shed. sub-einibaetura Irene eltlpluyeia and ha►.worker,'4eonlp.iin naisee. I l4.�Roof repairs'Thew t1.D W'a arc a corp.Nairun and tLs utflctin have eaercined tlwu trglil ul exemption per MCA-a. 1 II....�JJ t.)tlut �S V���1 U r 1$2.'II41.and wit ilAW no.nnllluy'c.a.(No 44olkann•1:V11111.InawatleeSei4Yatn.) ',t,ny applieaui that eltataka boa n1 aunt alto till out the section triad show ins then wurl.at'cunlp.naatiun policy siiktcination. ' I linu.uwlreta who%attain tie.uttidutit utahi.antig they arc doing till wink and then hue autaid.cunt:st.Wes meat suhnut a new afftdaa it indicating aueh. t'miraatun'that check Zhu bog,mull altawlwd an adjltiutwl'sheet'show ing die name of the sub-contta.tors and state whether ur nut Utua.%ltirtia,Isere c alhl.0 a►l. If the m.h'etll It iatuit.trios..c11aj'luyaaa.Ihrt ❑tu.I Nos Kb:tilclt Hi+nk.ta'ocitlp.ikIJI.b w inlwn. 1 ant on employer that is pro►idinR warkera'compensation insurance for my employes. Below is the policy and Job site in/orip,alirrn. • lnsuiaiice Company Nanw: (c i fie n� OA �-S.Y>kg-WV)1-1`/ (.(11 i C t\ f — Policy 4 or Self ins. Lie. A: To a!-\S31 .- --3, \5 Expiration Date: )1'a..\�l Job Site Address:_._._I 00 SQ S-t _-_-- City/State;Gip:__.J C l' c{.tr-prl7 /14 Attach a copy of the worker'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MMGL e. 152,*25A is a criminal violation punishable by a line up to SI,501.U0 aiui;or one-year imprisonment,as well as civil penalties in the farm of a STOP WORK ORDER and a tine of up to 5250.Ot1 a day against the violator.A copy of this statement nay be forwarded to the Office ut'Ins•t:stlgatiuns ot'the DIA for insurance coverage verification. --.ram-.... I do hereby certif. rder tl /xtlna and penal les of perjury that the information provided above It tripe ail cornet. S11:latute: �,y,_. )Date: 8 131 (a{ Plturie 4: �11'J" Sa �� ',( 7 Official use only. Do not write in this nrvn,to be completed by city or town official. ('its or Town: PerntiliLicense li Issuing Authority(circle one): I. Board of health 2.Building Department 3.('ilyttotiait Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Cuntaet Person: Phone 4: /....,,, COZYHOM-01 JDODGE A�RD CERTIFICATE OF LIABILITY INSURANCE DATE 11/12IDD/YYYY) 11/12I2020 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). PRODUCER CONTACT NAME: PO Berkshire 4889 urance Group,Inc HONE I FAX (NC,Box No,Ext):(866)636-0244 (ac,No):(413)447-1977 Pittsfield,MA 01202 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Continental Indemnity Company 28258 INSURED INSURER B Cozy Home Performance LLC Foam USA LLC INSURER C Mill 180,180 Pleasant Street INSURER D: Easthampton,MA 01027 INSURERS: INSURER F: COVERAGES 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. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR JNSD WVD (MM/DD/YYYYI IMM/DD/YYYY)._. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES fEa occurrence) $ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY j LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY AUTOS Ep BODILYO INJURYp (Per accident) $ AUTOS ONLY AUTOS ONLY (Parr acEcident)AMAGE $ UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION X A AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE 46-845373-01-15 11/2/2020 11/2/2021 1,000,000 FFICER/MEMBER EXCLUDED? N NIA E.L.EACH ACCIDENT $ andatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1'000'000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cozy Home Performance LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Mill 180,180 Pleasant St Easthampton,MA 01027 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC COZY HOME PERFORMANCE, LLC. Registration: 162770 180 PLEASANT STREET Expiration: 04/05/2023 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 LANTZ 1). 11t^4- 180 PLEASANT STREET EASTHAMPTON, MA 01027 Undersecretary Not valid withou signature Cbtrif cinWealth of Massachusetts i } DIVI!i19F1 9f Professional Licerfsure Board of @uN6ing Reg Ati9115 Anti StmnOords 4gnet'ttetWolt �p�ei1l V C>t113LA02169 aping;1,1101 0U MARK M LANTZ 180 PT EASTHAMPTONEASANT S MARREET027 4'1 if�ISti<l:lt�'4 Commieoioner Construction Supervisor Specialty Restricted to: CSSL-IC-Insulation 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 Call(617)727-3200 or visit www.mass.govtdpt