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Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 163596
Type: Private Corporation
Expiration: 7/8/2011 Tr# 286029
SAL -CAZAR INC. '
STACY LAVERTU
50 BUCKLEY BLVD
CHICOPEE, MA 01020
Update Address and return card. Mark reason for change.
j– Address j 1 Renewal i 1 Employment ;— 1 Lost Card
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Office of Consumer Affairs & Business Regulation License or registration valid for individul use only
11.---.„..41._71 i HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to:
Office of Consumer Affairs and Business Regulation
QV Registration: 163596 10 Park Plaza - Suite 5170
Expiration: 7/8/2011 Tr# 286029 Boston, MA 02116
Type: Private Corporation
SAL -CAZAR INC.
STACY LAVERTU
50 BUCKLEY BLVD C�
CHICOPEE, MA 01020 Undersecretary Not valid without signature
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12 -03 -2009 08:49 CZAR ENERGY SOLUTIONS 14135367087 • PAGE1
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : C 4) p / Y 30
License Number
aioZ 1/61/( G s r� I 1 7/ 2 6
Address /17n Expiration Da(
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
` Th CZs 1VC_ C 04
Company Name Registration Number
‘et td . - tc roc "4-0 --7 � �- o�
Address Expiratio Dat
Telephone Y S 7�7/
—
SECTION 10- 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 buildin permit.
Signed Affidavit Attached Yes 1E7� No ❑
11. - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two - year period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
F CERT�FCATE C�'TSU SCE ISSUE DATE 05/07/2009
r ,pax....... �«, ..-
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Finck & Perras Insurance CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
6 Campus Lane DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
Easthampton, MA 01027
COMPANIES AFFORDING COVERAGE
INSURED
Sal Czar Inc
dba Czar Energy Solutions COMPANY A A.I.M. Mutual Insurance Co
50 Buckley Blvd LETTER
Chicopee, MA 01013
COVERAGES
THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HA 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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MM /DD/YY) DATE (MMIDD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $
PRODUCTS- COMP /OP AGG.
= COMMERCIAL GENERAL LIABILITY
PERSONAL & ADV. INJURY $
'CLAIMS MADE I I OCCUR
EACH OCCURRENCE $
I 1 OWNER'S & CONTRACTOR'S PROT. FIRE DAMAGE (Anyone tire) $
1 _ MED. EXPENSE (Anyone person) $
AUTOMOBILE LIABILITY
COMBINED SINGLE
LIMIT
ANY AUTO BODILY INJURY
_ ALL OWNED AUTOS (Per person) $
SCHEDULED AUTOS
HIRED AUTOS
_ NON -OWNED AUTOS BODILY INJURY $
GARAGE LIABILITY (Per accident)
PROPERTY DAMAGE $
EXCESS LIABILITY - EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
0�' . ..
OTHER THAN UMBRELLA FORM � 0
WORKERS COMPENSATION AND STAT LIMITS STATE OTHER
EMPLOYERS LIABILITY X MA
THE PROPRIETOR/
A PARNERS\EXECUTIVE EL EACH ACCIDENT $ 100,000
OFFICI jRS ARE: EXCL 7023721012009 03/26/2009 03/26/2010 EL DISEASE -- POLICY LIMIT $ 500,000
EL DISEASE- -EACH $ 100'000
EMPLOYEE
COMMENTS/ DESCRIPTION OF OPERATIONS OR LOCATIONS:
STACY LAVERTU IS NOT COVERED BY THE WORKERS' COMPENSATION POLICY
CERTIFICATE J
H¢,DE`I2 f6 ( �T(y fl t
., � ,. ( _.,. � ., .).�^3� »� � d " .
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
JN DUQUETTE & SON CONSTRUCTION, INC. THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 WRITTEN NOTICE TO THE CERTIFICATE
HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION
ATTN: HELEN DUQUETTE OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
215 BARRY STREET _
1
FEEDING HILLS, MA 01030 AUTHORIZED REPRESENTATIVE
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES 0
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) E Roofing n
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [EJ Siding [O] Other[(
Brief Descriptiop 9�f Prop sed
Work: (i nr) U S t /7 - 177./0 4-1-z IY7N
Alteration of existing bedroom Yes " No Adding new bedr Yes `'"ao
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, e f c" 7 L. x'1 C( / - 7) D , as Owner of the subject
property t �q � / ✓ 5 f udo / �,/
hereby authorize / ' ( S (- fI � C'l iV C 7i <► yam, C f
1� ��c
to act on m ehalf, in all matters relative to rk authorized by this building permit application.
Signature o caner Date
I, , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner /Agent Date
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic
Room 100
I •' • f Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone,413- 587 -1240 Fax 413- 587 -1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address:
This section to be completed by office
06 too 0(� � �' Map Lot Unit
/ je n j
T ` / / (p — / (2' /r�4 0/060 c Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
c/9/0 L.Y it) s ' (5 6(7 L
Name (Print) Current Mailing Address:
i - JJ77��
Telephone
Signature
2.2 Authorized Agent:
/--/h7/77C i � c.;a 61./cCz 4it./f/
Name (Print) Current Mailing Address:
Z7( --s - ?
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection /���
6. Total = (1 + 2 + 3 + 4 + 5) �' C _J Check Number 5 y 0
This Section For Official Use Only
Permit Number: Issued:
Date
Building I
Signature:
Building Commissioner /Inspector of Buildings Date
6 EDGEWOOD TER BP- 2010 -0611
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B - 036 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -0611
Project # JS- 2010 - 000893
Est. Cost: $5200.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SAL -CZAR INC 84300
Lot Size(sq. ft.): 5227.20 Owner: SHREAD THOMAS & CAROLYN
Zoning: URB(100)/ Applicant: SAL -CZAR INC
AT: 6 EDCEWOOD TER
� LJ L Y v ^. ' '�
Applicant Address: Phone: Insurance:
50 BUCKLEY BLVD (413) 536 -7171 WC
CHICOPEEMA01020 ISSUED ON:12/17/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL WOODSTOVE & CHIMNEY
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: Fina1:0k / -„9 09
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancyc S ignature:
FeeType: Date Paid: Amount:
Building 12/17/2009 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo