Loading...
30B-058 (8) BP-2021-2121 147 RIVERSIDE DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30B-058-001 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-2021-2121 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 2772 COZY HOME PERFORMANCE 102169 Const.Class: Exp.Date: 12/10/2022 Use Group: Owner: LANE, DAVID &ZOE CAREN Lot Size (sq.ft.) Zoning: URB Applicant: COZY HOME PERFORMANCE Applicant Address Phone: Insurance: 180 PLEASANT ST#200 4135290200 46-845373-01 EASTHAMPTON, MA 01027 ISSUED ON:11/01/2021 TO PERFORM THE FOLLOWING WORK: INSULATION 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: / I C'r I , f Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Buildine Commissioner :.-i -c% „.......,„L-...._ 1 , ivE-trop The Commonwealth of Massachuse s nnr+ W Board of Building Regulations and Sta�idardsCT ?9 FOR Massachusetts State Building Code, 7 CMR c9021 M 14ICIPALITY r USE Building Permit Application To Construct, Repair, Reiiav olish a R• ised Mar 2011 .._ 'S'> One- or Two-Family Dwelling l tnn roN.!^;::P cr Mao►„601(Ns I This Section For Official Use Only Build41) ng Permit Number: `� 'A J• a-Ja, I Date Applied: ;0 -.. 7:4-2 11- i •Z02.1 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 1 L1-1 2�J e J-S\c1 c. I)e.• 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 if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ZOe, 4- -Da.]lA. Loon e N1 or- e ry,p+on MA- OIOCoo Name(Print) City,State,ZIP iy1 R\vercde biZ 495-' 773-7(S7 SfY'net 22e�rc��Q •c,,,, No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other qi Specify: /,iSet.(a-'f-ri-y, Brief Description of Proposed Work2: s5 S2 ye /ern•e c-- : $a,7 7a.36 i4w Se((‘1 a-J1r.s�(41,:,, o.F c i-lic- a- bSeur,-v-0- Joor SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ Z/1 72 30 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fee 4 Check No.� Check Amounf: Lt Cash Amount: 6. Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C.55 L low km 1 C 1o\ O, ill ft 2 K LA AITZ. License Number Expiration Date Name of CSL Holder 0 ACI 5 An 4- s f led 00 List CSL Type(see below) 196 No.and Street Type Description �T Y/y �.,` U Unrestricted(Buildings up to 35,000 Cu.ft.) f C i A p I V% M T 010 a.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding "' SF Solid Fuel Burning Appliances 41 3"sat oao0 focQ my CO Z y hone.C6)►'1 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1 Ca a.1 7 O 5 I a 3_ CO z Nom t Per'FOf lfl6A)C f_ HIC Registration Number Expiration Date HIQ Co p Name or HICRegistrant Name I' 0 p)eciSAn r St doU +titAck.Cr'1C.02=rMimi..i,t,'t�r\ No.and Str et 'Email address £AsA-N,ar kcIr.; (l1A Ok03.7 H►3-5 ) . City/Town,Sta ,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 Cox-1 1101'1\4. QR t kV(mk 11(4 to act on my behalf,in all matters relative to work authorized by this building permit application. * O ot'ec- A Foc-rv. (vnc(kJ.t2 I /0/a_s/9.( 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 inthis application is true and accurate to the best of my knowledge and understanding. ;0:',A /o / s/a,/ Contractor//Owner s Agent/Owner ignature Date I. 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 NNww.muss.ft IC:,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" DocuSign Envelope ID:A982EA04-3F99-446E-A851-506CB072308F RISES ENGINEERING OWNER AUTHORIZATION FORM 1, Zoe Lane (Owner's Name) owner of the property located at: 147 Riverside Drive (Property Address) Northampton, MA 01060 (Property Address) hereby authorize Cb24 t-1 ovule e�r t�� w.D.h c Subcontractor(to be filled in by office) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. The permit will be secured by the subcontractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. DocuSognne�d by:b Owners' ' Wgre 9/16/2021 1 2:27 PM EDT Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com "" The Commonwealth of Massachusetts 41 0• Department of Industrial Accidents ;.,1p1 -1.7 i:i. I Congress Street, Suite 100 yt 'I.f_..- Boston, MA PJ'�11'f*'i U1 Fa Art: Jay .? IWly tit fliass.go vIdia VI tokcr:,' t`4 IL/ltl•il.!Ilttion liLlnrnite:4 A.ffidas it:liuildersit'nntrlteters,/Elect l-ieirnzt'Pluothers. L•0 IBJ'.FILED H•flu'.PERMUTING ING At:11umfiir. Aimlicalit ttllrJrmation Pieakt Print 1.1:1:1tl1% Nome iltuniac•r..fD3l31iL1..11'.113Incil4aiu:et1 CQZy A 0-m 3.g.C CI('1Y'\61'R .... AddreSa: \ `t5 0 Z t c,S o,-'C gk . . . t'ity StaIL;itip: (i\ -\ 0\xcr\l, 0 ti ,('c 0\ Z) Phone fT. \A\ - 5 i..,°1- Q \() ....____......._ Are 3.IJ RH4,10111141,ar'!('tueit.file allllalu'i Mclink: ' 1.iye of p.m-lee!(required): I AU i V111111Ora ofIht 7 et1:1111}Veh 1141:1:.;1.1.t1 I1:IIt4lItiel. 7• J Ne4i•construction _.3 I aim:1:4lie ItitIF11.►C1.c ul ita:111.r1:IJl1 at11i Ii:l4e Sal►'ISirlit:Ctiy%irllow :en tr.:dL s. 3 i t nudi:bi wl';.A11a1:41y.I N;tl rkutacta'iIMIII).iiimmlu.r ea.:pi:N.J.: 9. EN:I140lltt4iil I•aa 4 I4.1:1:.,.: u.:lal.11at aLi Ntils.1I14van.',%4t H.aA.•In .'441,Alma-114.i 11:41adc.I-, ' 10 1 Budding addition :.il i.ai it a hi.;I::+:.h 111:1 anti*AI:::Itlr,1I;J fail.'ail.1:..1 Fl.iirlda:L'I ail a oil ltli 11I$ s ccs I3. 1441i. .:ita.li 1Mal.al:,LitlitLif.kith.-iCh:l ac,•..•, .::e;:l' ..cer.11.1i.alatu(1lhlasssu.x re,as:m4i. 11..1 idectrit al ripaai:+or addita cats III.l1111:h::1 m art,iifI.'liip14,•e... 12.f Plutribulp ri:paira or additions '. I,ali a aaa.t;bcliII;aeltil Wild I11.4e:I'Aef.111.:e.1IycullttaittUlt,Iir..id.ILClvalCaaa.silaLie.1- 1l.eh►9l li.e.lt:t. !'I .atii.ul llu e.. y 13.; lRoo repairs tI.0 We,ago:a rol:;:::.4latil�Wig WI,iI[iv ier,tuL...il:le.l:xLI LI.,.Is l!i.I.:l'emii.ri.11»r'.- m1,1.L. J'l �tJthea l INS V1 I V� 151..k1141.alai 44it 1144.'Iat.1GI'rluyY►h.I!Vl.%lit4gil'.i'ittll.111%1.iatle.'itt.14118Y14 I '.41-.4 i.Lllllii.:.ui Wig.i.11.vkn Ikta,a1 Itil..L.also Tilt ul.t Ill.muti4u,Ix141t%:Mum Mg il:eil'.Lutists'in1'llllitti!uli/u gtdli}in14»lliali.lti. ' i b.:u lenv.l_:if,Aim ha.ta►iii Ili.i,.,4llisl i.4 iiala:ai,r.p Ill.}:1I►d,131.r u11 wink.mid Ellen toile miE.ide wndtuikll s I1u:11-uhri,1 a I«,4•alti I s iL 4'4II.alaiag atai:b. •I.u:.l:aerr,I rill.1 cite.%Has Iv 71,an:.i:ill cat.'v Mt 41,11.i i:int hhueC!AIWA itrrt Lh:Ilalile,ti Lb.>ua`.•:1,s►aavl,:s,,wad,;air' U.liie;Pi iir4 Ilium:inllli.:,,Law __...arti1 o.... II•!I•:Fi.l 1:01.11L giiifih l++,1i.II TittSeeCa 11145 1ii:I!I yilrll ilk itICIL' Kitlkird ..ltl 1. t 1ii.l.tatmils..q 1 urn an eeiplayer that is.providing 1+rarj,'rw°t'wupt'd1 S'fl$iuiI i&sorancIliir rely 40itrp(oI'e a. Bvhiii i1 the patio and jab►im inlaro eatium. Inataia I e C'unlpalt4'Nail IC: Cc,'tN�•1'11 � OA (--�•`t1ie._Wy).1k..1 (40 INN ZG111 - Polley 0 or S�:ii iit::. Lc. ?: ��o `L As3� - -0 \ '; \S Expirat►ut:1)att:: 11/lI\ -� Joh Sue Addrehs: _ 1`1'7 fivers/di Pr' .__ c'uy.siatelip; AJcr ►l-10)1rn htA- aio 6O Attach a copy of tltt ti%kirkers'eons pt:n iatinn polio, tit:claration Bate(showing the Indic", number and e*hiradan date). i:aitl r► tsr:WA uiu 4.L'0Ler:lile as rt'A uuell LIlulu'NIIil. L'. 1°.:. P,JA.:4 a‘...1 u4IIIS +LLlfatiun punirhuhle by a lute up iu Si.0000 a1111:tar one-year I tyrINoLLLaicilt.a:t ww:it at.*wed penaltict in the fium 41:.1 STOP WORK eiilllIiit and u tine tit'up to S2,5il.413 a day :!halts(the .,,u3:IItSr, A.-1'iplf ol this^.La,telile'ttt WAY ie tttiwarded i49 the Office mt.lii3iesttltaluun:4.erl.the IJli4'+ lilr;11Nurunte t.4 4'i.4.ic4.•4elit'xali,,tlh, I do herein evrli f l' vdt'r 11 patlmtliiiti peiallI ios.of pet jiti l'dial ilk,i►L/iarinatifin prrsL'rded el l'e i;k true and correct. : /7 'I.114ne: ,4 - / . /o2Sl 2,l f1 f e'iul use rliill• Dr,ii{il 19vIY't,iii tIri,+ 'MVO,.t{1 he t pfet rl 1a•i•eitl'fir triitri{tl/h ial (it ttr limn: lai:i•n1i[iLicense 0 issuing Authltril,%Icircle.iittey: I. Board of health 2. Budding I)ep:trtnii'nt 3.{'it} t'4)33n it:'lerl. 4.Electrical inspector i. lalunthing Ins(.iect+ar (a.Other Contact Persi;t: Plume 4: or 5.06r Flg-'9J-SD•CC.atll't+t rererrirtvarsdatIOnis yzur -lame benont from progrann-eigitile ir4iL n Gind,k‘r zmr z..pro1ine form40,04 piaas fcAdjk,ei the inotr000ens below to remedial.your weetnerotation harmers. cusi-DpeER.INSTRUCTIONS I, qualified. ice1e ontractor to G.-valuate andicit iorvierlate the weatherization berrierts) 2.Submit sighed Andcmpatad r,ox.va,f.,of LS:fomm and a oopy of the paid contraMor invoice(s)within 60 Oarl or your, Home Eries95, AsSes rer to,-Rise eier.,invilleig, mop- Zsettst„,et4 or arriall to EvereNtrr-rintro r RItliervneering.cers. S.,The weetheedetieh tisedintlioe lea de dedtonted fq!..im the customer to-payrritant amoifit of the vatatherization work,A rebate cried,. wall tie ttsuied In the avant elp arnokalt-et:Gooch.the oustoners dinosyrrent arnoutit 4.Complete the rW:59•1mGrictod veGaGricrow:---on irnmrowmenits S.Tie f4ess Saw- HEAT 7,,eari cfers vitevest-froo firiancing OPPOntsiGlities that may be used to rerr.oesate oligib'e viPan-erizetion borriers. Leen)indhe at rtWilavt?K-On i/w-/.1..eviclufresedeolial-reideteatheitit-lideti...ortspram CoGtomer%sone: Zpe Lane , clielt# soc# 09 3?71 address: 147 Rivedp C)riv,c ,N,Qriampiton statz ZIP. 01000 Phvle t4kiribIr. .91, 793-7659. , , mOrfl22@9maiI.cOrfl ropaeure /Tit, , * 4e ' Iapp . . . • la determine ff tyre s al% tnne an,Itte)e w*vv..the contractor will e,ialeate the totiowelg areas whore shah)*Meet vventhentatien necoderiesitiatium have been trim*. V ASIk Fedor - evttle Sidoe Ziclieride - Basement Other', -Other V have performed rr IrscieCtieh an.d tiettemino.11-imih is no the knoll and tone wiring in the weas selected below. Mtio rloor Attic'0414 Atto Siope Exterior Wall Basement Othe Contratter Name: ritiy. R4-4,41r4 fteciq xis/4. Addrett:157.0,,f,A7- S ir Ithf CRY,: ' Zip sir. CoMpany Name 443 kfs. Lo I 41-1.1 , tilunieigs- "4; Contractor Sig, ttato My stelafore cortirrns that I have PeGfOrrnild my irtapectw ot the eleetrtai systian'is listed above and have corrected any bartiorr. inr.fir4ted My slyt:ire rns `ter..T read and,:sty4.41, the-ernn rid Chmlitio-s GYr7hriel crl!he Mi714 of this form. Nigh Caez,or.,11/41 ndez-..rinitreeter-4S-tetW.".9;r Crt0. G? C*;aitlifie thr* sy.storr.,17.) #.J.I.etiL-e,e toe carben-rnerictvide.tevel, TG.: jrrJeth-lelmit0 be'Orele0 frart,Plf.r nidieftilrOri9 Draft-Fatiisre Gentrrictry IS tO tarrarArthaliftift theeisersterilluek.sk-Reftelo table , • • • - . C.41A4,1,44.4;41Z4laz. raft f Existate-GO-orem RatoiaeatO-operp., Exattrg-Oroft bleating Systen, tint ANatar-ftea r Other, SPeolle Contractich- s-sehot%AAA trte 1-Pinigi of f OwlsesitYthe-tWocteci-mschltflicol'sYstmrc'•3).-Mmt II ofte- of OterartitioyMra 1-40t-4arizr 1-1zatcy Other _ • Ceiritunetdr-NetYW--- _ _ TI : Aoldreiot- f4arno. — Contractor Signaturtg at M.;-igrks7.,turr:zcnfi4rn:,that-1 hove petflorined zny inal:sectifthOtth tis" I " inid 'lc 1'If."'°'"i"ti°44-`'`41:41avit conrcteted onlibeinelttimr)4 ha'4146d °Dr=to thelervaluld'Cordittrood-Outlirit0 the:13110 oftlw)" tOiett 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 180 PLEASANT STREET EASTHAMPTON, MA 01027 Undersecretary Not valid withou gnature conircnweatlh o massecnusette , t DiviRIon at Pt'ofassionai Lictinaara Saud of%gliding Reguda(loos and Stewards c'•.t�rlt4trtcdti�iriipN'vfi�9+ipesi�� i C€81.•10216® A aspires;1 i tpi2 2 MARK M IANTZ 180 PLEASANT STREET EASTHAMP1ON MA 01027 d k 101# CommisaiAnOt : d t eiti4 Construction supervisor specialty Restricted to: CSSL-IC-Insulation Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license salt(617)7273200 or visit www.mass.gov;dpl "---•"'"""81 ® M'DATE(MWODYY) AW If) CERTIFICATE OF LIABILITY INSURANCE 4/22/2021 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: Diane LaFleche The Dowd Agencies, LLC PHONE 14 Bobala Road (A/c,No Extl:413 437-1062 FAX No):413-437-1462 E-MAIL Holyoke MA 01040 ADDRESS: dlafleche@dowd.com PRODUCER CUS COZYHOM-01 TO MER ID#: INSURER(S)AFFORDING COVERAGE NAIC p INSURED INSURERA:Selective Insurance of South Carolina 19259 Cozy Home Performance LLC 180 Pleasant St. INSURER B: Easthampton MA 01027 INSURERC: _ 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. I POLICY EXP LTR TYPE OF INSURANCE INSRW ADDLPOLICY POLICY NUMBER (MM/DDY/YYYY)EFF I(MM/DD/YYYY) LIMITS A GENERAL LIABILITY S 2206979 4/17/2021 4/17/2022 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $500,000 —1 CLAIMS-MADE I I OCCUR MED EXP(Any one person) $15,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: • PRODUCTS-COMP/OP AGG '$3,000,000 _7 POLICY X JFf° X LOG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS H— PROPERTY DAMAGE $ HIRED AUTOS (Per accident) j NON-OWNED AUTOS $ —- $ A X 'UMBRELLA LIAB 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 $0 _ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under i DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 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 7k,-,-4.-e" ax-rd--- ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD tv C COZYHOM-01 JDODGE ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `-� 11/12/2020 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 pollcy(Ies)must have ADDITIONAL INSURED provisions or 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 PO Box 4889 (A/C,No,Ext):(866)636-0244 (A/C,No):(413)447-1977 Pittsfield,MA 01202 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC B INSURER A:Continental Indemnity Company 28258 INSURED INSURER B: Cozy Home Performance LLC Foam USA LLC INSURER C Mill 180,180 Pleasant Street INSURERD: Easthampton,MA 01027 INSURERE: 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 CONTRACTOR 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD END (MMIDDIYYYYI (MMIDD/YYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) , $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENL AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $ POLICY joa LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILECOMBINED SINGLE LIMIT LIABILITY (Ea accident) - ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILYBODILY INJURY(Per accident) $ _ HIREDTO ONLY AUTOS ONEY PROPERTY accidentDAMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEC RETENTIONS $ A WORKERS COMPENSATION X H AND EMPLOYERS'LIABILITY STATUTE ER 46-845373-01-15 11/2/2020 11/2/2021 1,000,000 ANY / E.L OFFICER/MEMBEEREXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE Pi NIA .EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ _ I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, Cozy Home Performance LLC ACCORDANCE WITH THE POLICY P OVISIONSCE WILL BE DELIVERED IN Mill 180,180 Pleasant St Easthampton,MA 01027 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD City of Northampton Massachusetts ,c -r„, DEPARTMENT OF BUILDING INSPECTIONS 1{ `, ` v :4r 212 Main Street • Municipal Building O . a X. Northampton, MA 01060 rSbW ' ^, O 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: LK ISO PI rwd- Sr, &5 .caw-Pti-6 /nt The debris will be transported by: Name of Hauler: Lc�z,1 I�c►ry.� Pk 1 CC (P� Signature of Applicant: Date: