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23D-154 i • • ISSUED BY THE STOCK INSURANCE COMPANY HEREIN CALLED THE COMPANY AGENT NUMBER POLICY NUMBER NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. 0090063-00 WC 009 -93 -6606 3072 013 -82- 1110 -00 INCORPORATED UNDER THE LAWS OF k V' ITEM 1. NAMED INSURED: MAILING ADDRESS IDENTIFICATION NO.: COZY HOME PERFORMANCE LLC C H A R T I S 74 LYMAN RD NORTHAMPTON, MA 01060 -4228 A Chartis company EXECUTIVE OFFICES: ?E EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 175 Water Street New York, NY 10038 MA U I#: PRODUCERS NAME AND ADDRESS KEATING GROUP OF MA LLC WORKERS COM PEN SATION AND EM PLOYERS 144 TURNPI ROAD LIABILITY POLICY INFORMATION PAGE SU ITE 150 SOUTHBOROUGH, MA 01772 -0000 INSURED IS PREVIOUS POLICY NUMBER LIMITED LIABILITY COMPANY RENEWAL 007453941 • L OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 1EM 2 POLICY PERIOD 12:01 A.M. standard time at the insured's mailing address FROM 11/02/10 TO 1 1 /02/ 1 1 :TEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MD ME MI MN MO MS MT NC NE NH' NJ NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI WV D. This policy includes these endorsements and schedules: SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE - WC99O612 ,ILM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rate Per Estimated Oassifications Code Number Total Remuneration $100 OF Re Premium © Annual ❑ 3 Year muneration © Annual ❑ 3 Year SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE - WC7754 TAXES /ASSESSMENTS /SURCHARGES $549 XPENSE CONSTANT (EXCEPT WHERE APPLICABLE BY STATE) $338 MA I MINIMUM PREMIUM $500 MA TOTAL ESTIMATED ANNUAL PREMIUM $8,729 Indicated below, interim adjustments of premium shall be made: Sarni- Annually Quarterly Ell Monthly DEPOSIT PREMIUM • D9/14/1O PARSIPPANY 82 Issue Date Issuing Office Authorized Representative WC 00 00 O1A "R31 (Pev'd 04/08) to „, • • I ,L\ The Commonwealth of lifassachusetts Department of Industrial Athitlents • , ••• =fidi=ro . .t. ' Office of Investigation ' 600 Washington Street • 71.ili/EE a Boston, M4 02111 TI,Itr,-;,--6, : • www.mass.gov/dia . • -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legiblv -: C 7z Name (Businesa/Organization/Indivienn I): C y / e_ , -. 2 4-, - , , -' if - f - C. i ,y / .h...f... "..- i I i , . Address: ° T-1 1 - Li 1 -- / , , -2- 2. • .--. [ 1 , City/Stat i p: V 0 r '-'‘ CA 1-- 1-' "T / j c/ I 7 a Phone Vi_3 _ .#: ,.. ,-, Are you an employer? Check the appropriate bo= ' Type of project (required): ,c • 1. 0 I am a employer with. f-----( 4. 0 I am a general contractor and I 6. 0 New coistruction have hired the sub-contactors employees (full and/or part-time).* listed on the attached sheet. 7. 0 Remodeling .2..0 I ani a sole proprietor or partner- These sub-contractors have ship aiw nn =p-loye -8. 0 Deiaoltion • wor3ring for me in any capacity. elaxAgYP. Noti=rs' - - " 9: MBuild* [No worms corrpc insurance - comP--ial'ulimcel: 10.0 Electrical repair' s or adaions required:1 , 5. 0 We are a corporation and its 3.D I am a homeowner ckiing all work officers have4nercised the 11.0 Plumbing repairs or additions myself [No workers' comp. ri& of exemption per MGL 12.0 Roof repairs insurance required.] t ' p. 152, § 1(4), and we have no employees. No workers' • 13.0 Other , • CO mp. insurance re:pike:1J *Any applicant -that checks box #1-must also fin out the section below showin' g their compemsation polieyinfonnation. ' 7 . 1- HomeownerS who submit this affidavit incncating they are doing all work and then hire outside contraCtors must submit anew affidavit indirzting such. contractors that check this box must attached an additional sheet showing the name of the sohkmatractors and State wietbernraotttaoseezinties have employees. If the sub-contraCtras baie employees:, they must provide their workers' co top.. poncy number. . ' • * . - • • ' Jam an employer that is providing workers' compensat insurance for my employees. Below is the policy andjob information Insurance Company Name / ',/ ‘'.". C•• -'• , L c , ,-,/ • -'■ \ l- \ -\ ,,. — t e--- ---(--, 5 ,,.__ :I- ----, -ifi. 7 Policy # or Self-ins. Lic. #: At (---- , , ,-_, - ( 1 •') , Expiration Date: - / -I i : C, eL.. ( • - . Job Site Address: City/State/'Zip:' Attach a copy of the workers' compensation policy declaration page (shovng the policy number and erpiration date). Failure to secure coverage as reqiiireiriitter Seetrolf mar; e_ 02 ..ein lead t6 the iinPOsItieni Of alining iieiialiies of a fine up to S1,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WOPIC--ORDER and a fine of up to $2,50.00 a day against the yiolatar. Be advised a copy-of tbis statement may be fcirrae to the Oiffce of EoniCif the fcir cove iiiitasiMii . -- .--_--:- . '7'77=7: -- ..,_-__-_,:.::: Ida heiebiciri67 under the pains and penalties; of_perjurythat the iriformationprovidillabitverre_____ — - 2 — 4 1 Signature: ` L_ ct ,- ,- ,_ f , ',, , ,1_ Date: et e •, , , • _ , . - / / ' rf ' Phone it: - 1 , ---' -- , , ' ---r, - -_ - _ . - __...„ --- I - Official use only. Do not write In this area, to be completed by cilyOr 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 #: F- . ....■•••■•••. • From: Mark Lantz Cozy Home <mark@mycozyhome.orq> Date: Fri, 11 Mar 2011 15:25 :07 -0500 To: < douglas (cDtdouolasarchitects.com> Subject: Thermal boundary Roof Hi Thorn, Got your message and tentatively placed your project in latter half of April. I will complete your report next week, Attached are supporting articles of interest regarding thermal boundary design / install. 2 layers of 2" of polyisocyanurate is specced in BSC retrofit article. So that is a sounds way to go. Look forward to connecting more next week. Best, Mark Mark M Lantz Principal Cozy Home Performance, LLC 74 Lyman Road Northampton, MA 01060 cell: 413.320.7611 mvcozyhome.orq <htto: / /mycozyhome.org> <irnage.pdf> <image.pdf> • ' r SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : k - C f} l d'ZZ/ -r-Le f r License Number /2-4/7e, Addr ss Expiration Date A v'L \ < 1- 0 1 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 Company Name Registration Number Address / Expiration Date Telephone - -" " f SECTION 10- WORKERS' COMPENSATION INSURANCE (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be cor 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 ,CCU 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 1083.5.1. 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 or a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under ;..._ 'utiding permit. As acting Construction Supervisor your pree. -,:. the job site will be required from time to time, during and upon completion of the work for which this permi Also be advised that with reference to Chapter 1 -, 2( WVorkers' 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 • From: Peter Wingate <PWingateE ion.us> Subject: Re: coffee Date: March 14, 2011 11:23:21 A To: "Mark Lantz 'Cozy Home" < yhome.org> Hi Mark this week has gone all to heck - nothii )t of disparate a vities filling up the days. Next week Mon/Tue or Friday - 3/21, 3/22, )od. Funding - any federal funding is subjet s of course - but pe federal grant for weatherization is level funded for 2011 as opposed to d )crate, total of 35 units for all of 2011). Our ARRA funding runs throug so that is still tf bread and butter. The 2012 proposed budget is actually an increa will hit as ARRA Ns it won't feel like an increase. On the utility side the proposed fundin - om 2011. This or, 2011, is in theory up 20% from 2010. Good news /bad news with utility fund: re yet more blac end white on what can be done in a home. Some progress on multifamily - most )f it. We are gel tg better at justifying a complex of 1 - 4 unit buildings and calling then hile using single roily protocols. This is nice but doesn't shift the bar in measure install multifamily build is (5 - 25 units). Will fatherly advise daughters to not ri )ut am sure in th own way and in their own timeline they will do their moral equivE Mark Lantz I Cozy Home wrote: hey Peter. I'm a little behind with replying maybe you can run with the bulls with your daughter? there's probably a conference over in barcelona right now. meet up / coffee (bfast, ect - basically about the food /drink) on either wed - thurs- friday this week? I want to connect in general and learn where lean MF program is at and other commercial developments. how does the funding look for wap? are the feds (repubs) threatening cuts? I look forward to connecting. best, mark Mark M Lantz Principal Cozy Home Performance, LLC 74 Lyman Road Northampton, MA 01060 cell: 413.320.7611 mycozyhome.org <http: / /mycozyhome.org> On Feb 23, 2011, at 12:47 PM, Peter Wingate wrote: • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing E Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [EJ Siding [O] Other [O] , Brief Description of Proposed Work: A ' Vr.S .2 I ut c' °` ;` ' �a Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition to existing h , i:om fete the following a. Use of building : One Family Two Far ' _ 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 regu' :,• Yes No . I. Septic Tank City Sewer _ City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT `Y , as Owner of the subject property • hereby authorize C7'2 y' ;fr. it } to act on 7 behalf, in all matters relative to work authorized by this building permit application. 26 /I: Signature of Owner t D9te I, , as Owner /Authorized Agent hereby declare that the statements and information c. roregoing 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 !' Follow up to last call Subject: Follow up to last call From: Sally Pick <sjp @crocker.com> Date: Sun, 27 Mar 2011 15:01:00 -0400 To: adin @mycozyhome.org Hi Adin, Had some thoughts I wanted to send you since our 1. For the foam insulation option, I'd be most cor:: : gat ii has a water blowing agent, to keep the Global Warming Potential to a minimum. The product that I researched b.sed on Peter Talmage's recommendations is Biobased Insulation 1701s, a closed cell product that I believe has a water blowing agent. He used Thermal House in Brattleboro to install it: 802 - 874 -7222. 2. Question about the foam: would it meet Montague fire code, or would it need to be covered with something else? I chose the iso board because it met fire code, unlike XPS, which would have had to been covered with stucco or wall board to meet fire code. David Jensen is Montague's building inspector: 863 -3200 (his assistant, Karen, is my next door neighbor). 3. Would fixing the outside molding on the north side of the house that was damaged by water /ice dams be part of the work? If not, I'd like to add that in. 4. I'd like to have you install a quiet fan with a digital control to replace the existing one in the upstairs bathroom. 5. I spoke with my friend, Kris Walter, about the plastic that you installed in her basement. She explained that she's had to remove it because her cat peed on it, not because if failed. She said it was very sturdy. Maybe I'm overly concerned about how long it'll last, but I'm still interested in looking at st_:rda, ct,tions for the floor vapor barrier, such as dimple mat (see URLs below and attached brochure of a brand recon1m r oea @ NESEA conference: http:// www .cosella- dorken.com /bvf -ca -en /products /foundation residential /index.php http: / /www.waterproofmaq.com /back issues /200801 /dimple membranes.php, Am starting to apply for pre - approval for the HEAT loan, FYI. Thanks, Sally Sally Pick 413.367.0082 Save the Earth - -it's the only planet with chocolate. Content -Type: application /octet- stream Platon- Product -Broch ure. pdf 00;:F -,t- Encoding: base64 1 of I 3/28/11 11:25 AM 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 0 DON'T KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T 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 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 , Date Issued: C. . Do any signs exist on the property: t r , 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 0 NO 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 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. .. A.0~O/✓dZL Vai°'wa., 447 -. ',.. w ' 7 0074/§,M1 r*Ce fi ,c .swa R 4 A. „, ...;e w:wonaze ✓m2` r A.. .. ,V,P k"C ,.4..« A3 MS. , > > , L , , _ . > . ASk N b"; Understanding tthe 1 Stretch I Date: March 15 2011 t ,' Time: 7:00 PM 3 4 Large Activity Room «ter,. ; Bangs Community Center ,, t Boltwood Walk p :r Learn what the stretch code is, ; , why it is a requirement of , �� becoming a << "Green Communit y „ _ and what the implications are for the Town of Amherst. v:::: « . . w ,.''c'' ` Join Jim Barry, Regional TO Coordinator of their t f ' ' Massachusetts Department o o, Energy Resources Green [ Communities Division, who will1 explain the stretch code requirement of the "Green Community" process. For more information contact Stephanie Ciccarello (413) 259 -3149 or via e -mail: ciccarellos @amherstma.gov Department use only City of Northampton Status of Permit: �� - [u i i Building Department Curb Cut/Driveway Permit ". 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability -- . — Tc '^AO'O6o Ns 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 This section to be completed by office 1.1 Property Address: I3° p; ^ ._�. J Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) t / f f/ Current Mailing Address: j (�� (� c °�C� l� Telephone r Signature 2.2 Authorized Agen Vet.. Name (Print) Current Mailing Address: »A —. - - V(3 ) tc 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) 3 ) i"J Check Number J -5—,- This Section For Official Use Only ! Date Building Permit Number: — - _ is • _d Signature /������ _.`�( —� Building Commissioner /Inspector of Buildings Date 130 HINCKLEY ST BP- 2011 -0810 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D - 154 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit # BP-2011-0810 Project # JS- 2011- 001332 Est. Cost: $3000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MARK LANTZ 102169 Lot Size(sq. ft.): 44431.20 Owner: SNYDER JOYCE ANN Zoning: URB(100)/ Applicant: MARK LANTZ AT: 130 HINCKLEY ST Applicant Address: Phone: Insurance: 74 LYMAN RD (413) 320 -7611 WC NORTHAMPTONMA01060 ISSUED ON:4/8/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:WEATHERIZATION,AIR SEALING & INSULATION REPAIR 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. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 4/8/2011 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner