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39A-053 78 LYMAN RD BP-2020-0541 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:39A-053 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 P E RMI T Permit# BP-2020-0541 Project# JS-2020-000930 Est.Cost: $4000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MARK LANTZ 102169 Lot Size(sa.ft.): 9975.24 Owner. SIMMONS SARA A Zoning: URB(100) Applicant: MARK LANTZ AT: 78 LYMAN RD Applicant Address: Phone: Insurance: 180 PLEASANT ST#200 (413) 529-0200 () WC EASTHAMPTONMA01027 ISSUED ON.10/29/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATE ATTIC 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: FeeTvpe: Date Paid: Amount: Building 10/29/2019 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Dep al? City of Northam[ to ,r Building Depa,tme EC V 212 Main Street DINSULA TION Room 100 1n Northampton, MA 01060 CT - 2019 phone 413-587-1240 ax -587-1272 ONLY �FaT of r.,u/L pmrr w. APPLICATION FOR INSULATION FOR A ONE:OR:::::�!�N LLING ONLY SECTION 1 -SITE INFORMATION INSULA TION PERMIT 1.1 Property Address: j This section to be completed by office g Map v Lot O 4�;-3 Unit n Zone Overlay District !v 0✓4ghjti Au/V Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Na (Print) Current Mailing Address: Telephone Signature 2.2 Authorized Aaent: kZ 2, f c� lSl� �Pq /a � G� f . w Namet Current ailing Address: ) So�9 'U ' �0 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant (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) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: UV Building Commissioner/Inspector of Buildings Date @ M- L4��me. • C 011y� EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: IT'vA- LA,- I I) V L I License Number adv 5 �d� I(J)d0 Addre Expiration Date yip -sa - o Signature Telephone 9.Reallstered Home Im r v ment C n r tor: Not Applicable ❑ 2 F- e C- t 9. i 6a:2-2 y Company Name Registration Number CN R1 kr.SA�� Address n Expiration Date 0 1Y1 Telephone� Ao1'��.1�� SECTION 5-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.......U No...... ❑ Brief Description of Proposed Work �A55 5MC- 3.,b '. P1�C e :\ Al�tcS ��� �" Iait Ce��vl �y P► �Cg A 5� A- -A t n�'� i as Owner/Authorized Agent hereby dheltife thatIbeents 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 Narna . 0 /K"A�X in a ignature of OwnerAA4ent Date V,J�! as Owner of the subject property herebyuthorize C� -w,.fT �c' . 1� to act n my behalf, in#fnatters relative to work authorized by this building permit application. -Signature of Owner Date v+. �.z SSS s�, Massachusetts ��� :;• '� A w i I DEPARTMENT OF BUILDING INSPECTIONS ti. 212 Main Street • Municipal Building Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation ("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has-contracted with a corporation or LLC,that entity must be registered Type of Work: W e 1:)r ;'� Est. Cost: Address of Work: e,t,� 1v A Date of Permit Application:_ I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A. SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT. SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: / ISN) ",\) m,` A L,nnL2 / Goc7-70 Date` Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date ONS ner Name and Signature 4WTt-_ 2018 WEATHERIZATION mass sav's BARRIER INCENTIVES sant im ittro 11t ana w amdair y Based on your Energy Specialist's recommendations.your home can benefit from program-eligible insulation and/or air seating improvements Before moving forward.please follow all the instructions below to remediate your weatherization barriers. CUSTOMER INSTRUCTIONS 1. Hire a qualified.licensed contractor to evaluate and/or rem"late the weatherization barner(s) L Submit signed and completed copies of this form and a copy of the paid contractor Invoice(g)within 60 days of your Horne Energy Assessment to. Pre-Wx Barrier Inceritive,clo CL€AResult,5o washinritnn St.54ine 3000,Weattiorough,MA 01581 nr email to:prewxoHeruVciearesult.corn 3.The weathenzation incentive will be deducted from the customer copayment amount of the weathenzation work A rebate check will be issued in the event the amount exceeds the customers co-payment amount- 4.Complete the recomr,ended weatltenzation improvem,ent:, CUSTOMER • Customer Name RA A SIMMONS Client#or Site ID: A55441Q Site Address. 78 Lyman Rd Unit 2 city, Northampton State MA 23p01060 At—v„x s to f>ft pW wntd PhoneNurnber _ 4" _"'' '432 Email' sasimmons75rdamail corn o Custorniar/Homeowner Signature: �: rz y(L KNOB AND TO INS To determine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save wea�th�erizabon recommendations have been made OYAttic Floor O Attic Wail C l Attic Slope D Exterior Wali -Basement i_l Other____._ —_�__.__..UOther- r.:i .:s01"t'ly rhe Eriap1Y:5� J I ve performed my inspection and determined there is no active knob and tube wiring in the areas selected below Attic Floor ❑Attic Wall ❑Attic Slope t Exterior Wall ;Basement C.Other:-_-__.____--_----------OOttter o be blew;cut by ttm ficeresd Eferc4ry w 1 have read and agree to the Terms and Conditions on the back of this font; Contractor Name. _�•: 1 Address: i.�.,r'�;s1J� S r City t'e iib' State_AL ZIP OL ___ Company Name + License Number Contractor Signature j Data. x- High Carbon Monoxide -ontra&or is tcice and re-evaluate the selected mechanical system(s)and reduce the carbon monoxide level. +4ed nvA 9,1s to beoe 100 parts per million(ppm) Draft Failure:Contractor is to correct the draft in the selected fiue(s).Referto table on reverse for acceptable draft ranges. High Carbon Monoxide Draft Failure Exisi ft CO ppm' Rrwised CO ppm'. Existing Draft Pa: Revised Draft Pa: Heating System Hot Water Heater _ Other. - Spillage:C ontractor,<to c orr?ct the spillage of Hue gases in the selected mechanical systern(s) Must not spill after 60 seconds of operation. Heatirtg System r- Hot Water Heater U Other: I ha.-e perlornwd i n; nspe(tion and ha.e corrected the items noted in the areas selected abo:e I havt,read grid ayrer to the lerrrs a,xi`_-ondthons on the pack of this form ,. Contractor Name, Addrtss �__�___ City State: ZIP Company Name _ — License Number Contractor Sionature: Data: f otlttgi ed ori tarsi (page 1 of 2) DATM/ E(MDO/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/11/2019 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 . CONTACT NAME: Mary Conroy The Dowd Agencies, LLC PHONI= — _ FAX 14 Bobala Road r ac No E:t1 413-437-1010 (A/C.Nor 413-437-1410 E-MAIL Holyoke MA 01040 ADDREss:_mconroy@dowd_com PRODUCER COZYHOM-01 CUSTOMER ID If: INSURER(S)AFFORDING COVERAGE NAIC N 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:423967460 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. INSRADDL SUBR POLICY EFF POLICY EXP LIMITS L TYPE OF INSURANCE POLICY NUMBER D/Y M A GENERAL LIABILITY S 22J6979 4/1.712019 4/17i2020 EACH OCCURRENCEI$1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) I$500,000 I MED EXP(An one person) S 16,000 I I CLAIMS-MADE OCCUR Y PERSONAL&ADV INJURY I$1,000,000 GENERAL AGGREGATE I$3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 POLICY X P:& X LOC $ A AUTOMOBILE LIABILITY A 9100582 4!'T2019 4/172020 COMBINED SINGLE LIMIT $1,000=0 (Ea accident) ANY AUTO , BODILY INJURY(Per person) l$ ALL OWNED AUTOS BODILY INJURY(Per accident) S X SCHEDULED AJTOS PROPERTY DAMAGE ,$ X HIRED AUTOS (Per accident) t X NON-OWNED AUTOS _____. S i$ X UMBRELLA LIAB X OCCUR S 2206878 4!1712019 4/17/2020 EACH OCCURRENCE 1$2,000,000 EXCESS LIAB CLAIMS-MADE' AGGREGATE 1$2,000,000 _ DEDJCTIBLE $ 1 X RETENTION $ WORKERS COMPENSATION WC STATU- 1OTH- AND EMPLOYERS'LIABILITY TORY LIMITS. I ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E L.EACH ACCIDENT $ OFFICERMEMBEREXCLUDEI N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S Ifdescribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT S i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Romana Schedule,if mora space Is required) CERTIFICATE HOLDER CANCELLATION 3C SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Cozy Home Performance 180 Pleasant St. AUTHORIZED REPRESENTATIVE Easthampton MA 01027 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD City of Northampton ,... Massachusetts :..r,��`` DEPARTMENT OF BUILDING INSPECTIONS �. \ 212 Main Street •Municipal Building Northampton, MA 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: IS >_X ryy�n fLa m-P (Please print house number and street na ) Is to be disposed of at: Yf *,j;�\ �k 1,4v,,,4 ,4 4f bm fob ir�4 oihOt G15*� �tV (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) �O�eq Signature of k6rmit Appli nt or Owner D to If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed.