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31A-067
6flebiKs2 bye/ BP-2024-1536 186 ELM ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-067-001 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-2024-1536 PERMISSION IS HEREBY GRANTED TO: 2023 QUADRANGLE -EMERSON Project# ENERGY PLANT Contractor: License: Est. Cost: 100000 COZY HOME PERFORMANCE 102169 Const.Class: Exp.Date: 12/10/2024 Use Group: Owner: COLLEGE SMITH Lot Size(sq.ft.) Zoning: EU/URC :Ipplicant: COZY HOME PERFORMANCE Applicant Address Phone: Insurance: 180 PLEASANT ST#200 4135290200 46-845373-01 EASTHAMPTON, MA 01027 ISSUED ON: 11/20/2024 TO PERFORM THE FOLLOWING WORK: INSULATION FOR GARDINER DORM POST THIS CART) 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: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS.Signature: 17Z Fees Paid: $750.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts Office of Public Safety and Inspections cnV Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling nj (This Section For Official Use Only) Building Permit NumbeEintgAtlek Date Applied: Building Official: • CTION 1:LOCATION rho No.and Street City/Town Zip Code Name of Building(if applicable) 31ft—Di'i• 00l Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building K Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No Is an Independent Structural Engineeri g Peer Review uired? Yes 0 No Brief Description of Proposed Work: 7aLt_( cot plcu) k SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) • Total Area(sq.ft)and Total Height(ft) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-ID R-2 0 R-3 0 R-4 0 S: Storage S-1❑ S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB 0 IIA 0 IIB ❑ IIIA ❑ IIIB 0 IV 0 VA ❑ VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal: Public 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be Licensed Disposal Site 0 Private 0 or indentify Zone: or on site system 0 required i 0 or trench or specify: permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: - Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner 5/1.--..4)6ms. C&Ct efr" i 1-Nt-r. 4-Cir""'''' Name(Print) / No.and Street City/Town Zip Pro4erty Owner Contact Information: •i Wcv- weA\ - - _ - Title Telephone No.(business) Telephone No. (cell) e-mail address If ppl-�he property owner h ebb authorize Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here D. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Ceri.) 14 Pr4f/' 'L <— L LC ( Corn an Ne �� CCU•: L Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMpENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes Cl No D SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ (C.)` C.)-0 1.Building $ Building Permit Fee=Total Construction Cost x S(Insert here 2.Electrical $ appropriate municipal factor)=$ ?-56. 3.Plumbing $ et) 4.Mechanical (HVAC) $ Note:Minimum fee=$eht>. (contact municipality) 5.Mechanical (Other) $ Enclose check payable to // 6.Total Cost $ (contact municipality)and write check number here L?b Z SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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 un rstanding. 1,‘./(4,4__ ‘-le.A.-Ne .--- C4.e.... - _ _ qt, (L, Please print and sign name Title Telephone No. Date Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: S:2—/. -.. - //24.2-V Name Date SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Z / , c 1 C0 IL( r'i•4--, License Number ( Expiration ate Name of CSL Holder ry ‘S-1 List CSL'l'ype(see below) No.and Street Type Description _ . i " 0 j�„�.� U Unrestricted(Buildings up to 35,000 Cu.ft.) Z�rti0i-v�. /� R Restricted 1&2 Family Dwelling City/'Town.State.ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) !L Z'3'�� Co ���"''�� Per1"Urihan ,p LUC HIC Registration Number Expiration Date HIC Company Name or HIC Re 'strant Name l eEw P sw.-4 6 ,s- 9 (.1-0e vr,Y Cozy�xirr,� C�cry N d`SS_trpe \t MA- 010 Email address 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER' 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 this application is true and accurate to the best of my knowledge and understanding. Print Owner's 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. 142A. 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,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" The Commonwealth of i'4facsachusetts "` ''' Department of Industrial Accidents Ij0 fftif i' , 1 Congress Street.Suite 100 ' Boston, MA 021.I4-2017 kL.. s WWw.onasa.got/dia tlilrkerl:'Compensation Insurance Affidavit:BuilderslCuntructors+ElectrieianaiPluntbcrs. TO BE FII.F.LI wIEH'i Mt PERNIITTING At IIORIT't. nnlicant information ( .' 1):e.,p-A7-enalcdt_)Pleaiie Print t.egIhl++' Name{l3tainus t.trganizucinrulr.div:duan: ,---CJ � L L L Address: t%v f(e .k 61-- C:iryfStALetlip: k eir.AN. � Phone»: S � .r m 7 t:� . ,) Are you an employer:C:heck the apprnpriatu tint: l Type of project(required): amaatnpinter wi^t l .htq:. :;.:s:'.ull arid.u:p.In•;:m.1.' 7. ' i—i New conatnlrtion :' i tot Lxlo ptupretsrnr pertt,xbh:F a^.c:::tt:nc):^rlo cex x,xkii In-me I.^. S. ^ Remodeling any Capat,.t...[No Markers'camp•ins: arze :n;::'rc,•.' 3]i Am Cnrrx:tmnct I tr;+ I . .t 9. Dl nlU11tICS11 :U a a•U:k l:'�cal sV t t a.:r8':Cl::p.`n%tl'a^CC rtG::IrCw.:� 4 D I isms:erHuottner art trill 1...:hiring contractors to:nidti:t all work nn in'prurr.`a, I Sy 11 10 `Building addition entict theta;ce*nts::e>tuaherhavettn-k:rs' .. I.r:1:rCsu:e ! 'I.^ I.leCrritrAI repairs or additions J:nrriC:ur{:tin.:to c;tip;flNttet ..� _ Plumbing repairs or additions •1.--1 I:Inv:: l ru.iU!1.r.ietet and I Iwo ih:sui'+:.r•Ir1:;Ass Heed On ea 3rzere i slur E :3.7 Roof repairs '.t;:±s n�:,.-COn::tCtarf hero r:T:piu'yCeti Ir..: •..tt:ttr.•;•:, , :.-ttigi irr..•nirrc F]:Grxit..;..::.u%I r I• , 1.51WI.c . l+c:.s;a: •,__:IN:ii:1:1:'Igh:NcxcmpttonperaiG '#•, 'r0`ht:l �. t, 1:_.Cii4:,:r;i:1di''v:n,:C'plo c:s,'iNc.a•O:k:rD CC.^.:? .bs..mtneenar.liTea,- 'Any.r.^;,11i:1,1•Its;t'i!:'.::ay bu\+I MIA;t...:50:01 0..11 the SCc tot N:O'A'E1*','I 1 thou tl iirkerie camixnxat nit 1 is'.:n it..at'nr $n011'40411:TS Rite Sar 1a 1113 effidat it 1nJ. at:r they are dillnk'all Svrri:and than bill!ula.i.a•t nut:twitr,suet 'niter.t 1 writ I1(1:i3%11'i1,1 a;,iv will :CO:iSACIOrt thi:eiri k aii:1A- t::Srta .a.!l.1:L.'.1:ton.'.i..hers 4tuitt ii':it:mint,:ul:hr sub-c0"orators aid t'at. .:`a':t or nu;thu+c Cntiu:'S hay:: en:pin':c:s it:::,:_n•cnc.::t.tit,.. :1:1.r•:1 .•sr._ silt ^r.,•r^Tut i..i..:ir uork a'3'comp.policw m r.:b:i am an employer that is providing workers'compensation insurance fur my entpioyees. Below 1.the polity and Job rite information. ti `Tij lrsara nc Compar. Name: p lr.� - .L t r' ; �,p Pnl:;.;vr- Self-ins Liu. ' • Zf.otts-3-. 0 (L 1- Expiratinn:)arc• Lk. :.i Silt.Addrtai: (It1':'sti,Z at :l:lzl.+: MOM!a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Fsilur::to secure coverage as required under Nits:.e. 152;25A is a criminal violation punishable by a tine up to S1.500.00 ankur urti:-yi.atr i:nprisunrncrt.as Well aq civil penalties in the Corm of STOP WORK ORDER and a fine of up to S210.00 a day against the violator.A copy of this statement may he forwarded to the 011ice of lnvestigatior.s of the DIA for insurance coverage verification. I do hereby certify touter the tuna curd penalties of perjury Char the inpnrmrttlon provider!above Is true anti correct. Siw14 " luturc: "ram .__ Date: n *' (3 .5—.)\ — ©IC ) r Official use only. Do not write In tilts area.to be completed by city or town official. i City or'Fawn: PcrmitfLicense# I Issuing Authority(circle uric): 1.Board of Health 2.Building Department 3.City:Town t lerk 4. Electrical inspector 5.i'lumhing Inspector 6.Other -_ Contact Person: Phone#: