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35-199 (15)
BP-2021-2243 1144 BURTS PIT RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 35-199-001 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-2021-2243 PERMISSIONISHEREBYGRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 3773 COZY HOME PERFORMANCE 102169 Const.Class: Exp.Date: 12/10/2022 Use Group: Owner: O'LEARY STEVEN J & NINA M Lot Size (sq.ft.) Zoning: WSP Applicant: COZY HOME PERFORMANCE Applicant Address P one: Insurance: 180 PLEASANT ST#200 4135290200 46-845373-01 EASTHAMPTON, MA 01027 ISSUED ON:12/01/2021 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ER I 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: .>•2 5.1.:24)V Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner QC /) ,, w 1/Pr i. The Commonwealth of Massachusetts NO VYV CC FOR Board of Building Regulations and Standards 29 <477 IC PALITY Massachusetts State Building e, 780 USE i t c11// Building Permit Application To Construct, Repair, Rene`v'.ate Ys lishrevised Mar 2011 One-or Two-Family Dwelling ti,r�q uloRoo ora NS This Section For Official Use Only ``d; Buildin Permit Number: 0 0‘. 7.l• a ?-(1) Date Applied: u,aJ �oss //& /l 30 ZD Z Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers Il of 5,,,,-1, PN- Ral , Rot-trice 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 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 1J1N# O'LEARy Flores,cc " 14 016fo2 Name(Print) City,State,ZIP 11'i4 8c4rIs Par Rd 4/3-'178-2-128 nincto 61,22ecoincyksr. hef 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 ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 'pecify: /n5 t(gf►oh Brief Description of Proposed Work': )4445 Save. Ivy(q-Con / W eCi ri2R.di'o►, 444rC, ,h4 e neelT (Rim it isr) SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 3.173 3 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ 14 Check Noa 63-Check Amount: Cash Amount: 6.Total Project Cost: $ 3,173 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 1cA , ill 112 K LA n, %Z c5s L . p + License Numbeerr b 9 Expiration Date Name of CSL Holder L 1 a 0 Plea 5 Rn s k ¢d O Q List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) (A 51 Y,R NOTQW If T 010 d. .) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry - RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Ili 3.5eJ UaOO mflclrQ my CO2.y ho/rlt.LAN! I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) i Cs a 1, O y\5 1 1)3_ Coy), NQt'Y)Q Per'r0f 1Y14Q C L HIC Registration Number Expiration Date FK Cofnpanx game or HIC Registrant Name I 0 Piec,sAn1 Stedo0 IN,est\cQr y(-( 2."/ ( �.t,•�N . No.and Str et Email address City/Town,Stat ,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 COI 2. 11li311\4. Q 'IV\14411 t to act on my behalf.in all matters relative to work authorized by this building permit application. 4, Femur 4.444 Farm ct#1-4 e,l /f/aa/2/ Owner's Signature Date t ' SECTION 7b: APPLICANT 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. pNZr� +/424-42i 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 tl.Qt 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/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" Permit Authorization mass save Form s Site ID: 4327473 Customer: NINA OLEARY Nina M. O'Leary I, ,owner of the property located at: (Owner's Name,printed) 1144 Burts Pit Rd Florence, 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: Date: 10 /27 /2021 .4i'i40.•46.*rriiriil►fi66 **Illitee•4111000041/••s••••••s•t•••••041110040000s1.011••s•••• FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: (� c2/ Home_ Yer ii-u �( 421 Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 F r Office Use Cr!? Document Ref:TQC72-ADHUU-QIONU-Q5DXZ Page 7 of 7 City of Northampton �'S----, y Massachusetts ��5 C (,) .. .r DEPARTMENT OF BUILDING INSPECTIONS ; o x, \\ ,i- � g 212 Main Street Municipal Building •yJti Cbm y:+' Northampton, MA 01060 sc`p 170° 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: Vurnps44 G /go P/ s9dir 57, 01-/oh ,$'1,4 The debris will be transported by: Name of Hauler: co2/ /-i, Pe-t- i-Ma"ct Signature of Applicant: Date: fil--4 7-2-7 The Commonwealth of Massachusetts —o— Department of Industrial Accidents —_ti Office of Investigations ° �= Lafayette City Center - i e 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): C,d,21 kkorYlrr Pt',f-cf?man Ce Address: i$0 P IP,aScwt+ 3 r , ,.tie._ ZOO City/State/Zip: (& kct /h C' ( a r7 Phone#: i1‘3 5 2 -0 2-.0 C) Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 7 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ID New construction listed on the attached sheet. 7. ❑ Remodeling 2.El 1 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. 0 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 11.0 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 13.❑Other employees. [No workers' comp. insurance required.] • *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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: C-0rVAA'Y,.r i-a.1 l►n4erA Co Policy#or Self-ins. Lic.#: L to - $45 313 '-DI -l t7 Expiration Date: It 102/ 24,27 Job Site Address: //yy /jur#5 4r ,.I City/State/Zip: F/orenea MA- afo6 2 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 certi under the pains an penalties of perjury that the information provided aboveJ is true and correct. Signature: 1 Date: /a-4-AI Phone#: / Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3.DCity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: A v- CERTIFICATE OF LIABILITY INSURANCE DATE ) 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(les) 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: Berkshire Insurance Group Inc PHONE FAX 43 East St (A/C,No,Bey (877)234-4420 ( No); (877)234-4421 Pittsfield, MA 01201 E-MAIL ADDRESS: PRODUCER (413)447-7376 CUSTOMER ID/ INSURERS)AFFORDING COVERAGE RACE/ INSURED INSURERA Continental Indemnity Co. 28258 INSURER B: Cozy Home Performance, LLC 180 Pleasant St INSURER C: Easthampton, MA 01027-1287 INSURERD: INSURER E: CTL 1273 1679258 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 ADDL SUBR POLICYEFF POLICYEXP LTR TYPE OF INSURANCE MISR WVD POLICY NUMBER (MMIDD/YYYYL(MMIDD/YYYY) LIMITS GENERAL LIABILITY EACHCURRENCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(any one person) $ _ _ PERSONAL 8 ADV INJURY $ GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ —PRO- — PRODUCTS-COMP/OP AGG $ POLICY JECT LOC • $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS PROPERTY DAMAGE (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N TORY I IMITS ER ANY OFFICER/MEMBER PROPRIETOR/PARTNER/EXECUTIVE N/A 4 6—8 4 5 3 7 3—0 1—17 11/02/2021 11/02/2022 E.L.EACH ACCIDENT $ 1,000,000 A OCER/MEMB EXCLUDED? N (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 0 If yes,describe under SPECIAL PROVISIONS below EL.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach Acord 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Cozy Horne Performance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Mill 180 180 Pleasant Street BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED Easthampton, MA 01027 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1783118 ACORD 25 (2009/09) ©1988-2009/CORD CORPORATION. All rights reserved r $1 DATE(MMIDD/YYYY) AW o CERTIFICATE OF LIABILITY INSURANCE 4l22/2421 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 NAME: Diane LaFleche The Dowd Agencies, LLC PHONE FAX 14 Bobala Road (A/c.No Ems:413-437-1062 .(A/C,Ng):413-437-1462 Holyoke MA 01040 ADDRIESS: dlafleche@dowd.com PRODUCER CUSTOMER ID#:COZYHOM-01 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Selective Insurance of South Carolina 19259 Cozy Home Performance LLC 180 Pleasant St. _INSURER B: Easthampton MA 01027 INSURER C: 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. ILTR TYPE OF INSURANCE AINSR SWVD POLICY NUMBER (MMIDDIIYYYY YYI (MM/DDIYYYY) LIMITS A GENERAL LIABILITY S 2208979 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) $18,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: • PRODUCTS-COMP/OP AGG S 3,000,000 `1 POLICY X PF o- X LOC 3 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 6 $ A X UMBRELLA LIAR 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 Sc l _ _ WORKERS COMPENSATION fLIMITS I I WCY T AND EMPLOYERS'LIABILITY ER ANY PROPRIETORIPARTNERIEXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1 N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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 /.k/4 ./ ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) 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 404' 180 PLEASANT STREET 1o<s.0'4. =U EASTHAMPTON,MA 01027 Undersecretary of valid witho gnature commonw®anti o;rdlassgr.nusetts Division ai Prr;iassipriai Licen=ure $card o;duliding RogOatiail6 and Stardaards set�'ir:e{:.N, • .re'`4it:i!r4++4t44. Qr1t7iE;' C6 {w"•ii7wln0 rogilnis11241P42622 MARK M1 LANTZ 180 KEASANT RTREET EASTHAMPTON MA 010 a..w3i.ilYi6F+�ir:ai'io4 i;g.•Ij, '.� r., i..0 ._. tr Construction Supervisor Specialty Restricted to: cSSL-10-insulation contractor • Failure to possess a current edition of ttie Massachusetts State Building Code is cause for revocation of this license. For information about this license Ca61(617)727-3200 or visit.1ww.tnass.govldpi