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30B-039
BP-2022-0983 22 LIBERTY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30B-039-001 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-2022-0983 PERMISSIONIS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 6937 COZY HOME PERFORMANCE 102169 Const.Class: Exp.Date: 12/10/2022 Use Group: Owner: KEUP LEAHY,THOMAS K& EMILY Lot Size (sq.ft.) Zoning: URB Applicant: Applicant Address Phone: Insurance: ISSUED ON:08/15/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/W EATH ER I Z ATI ON 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL TION OF ANY OF ITS RULES AND REGULATIONS. Signature: • r „ Tt • Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner BP- 022-0983 22 LIBERTY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30B-039-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UN I:I.GISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0983 PERMISSION IS HEREBY GRANTE1 TO: Project# INSULATION Contractor: License: Est. Cost: 6937 GREEN COLLAR LLC 108817 Const.Class: Exp.Date:08/31/2022 Use Group: Owner: KEUP LEAKY,THOMAS K& EMILY Lot Size (sq.ft.) Zoning: URB Applicant: GREEN COLLAR LLC Applicant Address P one: Insurance: 570 NEWTON ST (413)532-1817 R2WCI 182010 SOUTH HADLEY, MA 01075 ISSUED ON:08/15/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL; TION OF ANY OF ITS RULES AND REGULATIONS. Signature: • Fees Paid: $65.00 212 Main Street, Phone(413)587-1240.Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts q z Board of Building Regulations and�St ds �G 7 OR ' ` Massachusetts State Building Code, /gp c� I3N1 IPALITY 1` �p SE Building Permit Application To Construct, Repair, Renov ti Vr, olish. evise4Mar 2011 One-or Two-Family Dwelling r°ti;tiso >' sk. This Section For Official Use Only °'oso%,tt Building Permit Number:60- a 4-- ger 3 Date Applied: /61)/0-) ' J� ,' 8f I.-2Ozz Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessprs Map& Parcel Numbers ''.--2-. l_i e F'� 31 , F/o renc a 'f� Q 3q 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) From Yard Side Yards Rear Yard Required Provided Required Provided Required Pr+ided 1.6 Water Supply: (M.G.L c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal Systen : Public 0 Private 0 Zone. — ChOuteck ifyeFlos Zane? Municipal❑ On site disposal system 0 Check yes❑ 1 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: stikVna4 1....eikkiA ricreii cc,, ,'°)A Ct4 fr2 Name(Print) City.State,ZIP z.Z 1a6 Si- !oLnl - 733- 62)S(? - kcrncsKCer,h,i e 1Ir I- col, No.and Street Telephone Email Addr'ss SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other CA Specify: IV)5m-icc ) Brief Description of Proposed Work': I+k.t S Stet, .. . 6 t - 0 p.A ,/o cU C 4e I l 10$'e S" at,.gco r bk ,k cg(b ./Q p 7Rrnmtty' - 4+b,j(2az. tvek4.4 Ve414-((ct-4-ion alt4A ¢, SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ a q f6r - 1. Building Permit Fee: $ Indicate how fee is ' ermined: 13 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost'(item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees $ Suppression) 5 Check No.Fees.. Amount: J 6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:_l SE .711 N 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (Ss L~1 o a t (09 1t3A10 m A k K A Ai 14 License Number Expiration ate Name of CSL Holder List CSL Type(see below) No.and Street Type Description z }�l U Unrestricted(Buildings up to 35,000 cu.ft.) `A..`'I--H�YO I`J3 in-A c3I©d3 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry . RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 1113"S 9 Oa00 ggiv1/4„ke trty 0 2 /hone.(D) l I Insulation Telephone Email address D Demolition 1 5.2 Registered Hom Improvement Contractor(HIC) -).� O 45 Co Z) Nom , '&W 6n C c HIC Registration Number Expiration Date [ Co p Name or HIC Registrant Name I a 0str�ec)e t►SAtli St g 'o0 EAftt~. : er C y c.<.iZ7 htmi._(JINN. N5 t' ' w� *0Q rt\ O O �.") ii 1 1-S1,R-.01..3 Email address City/Town,Sta ,ZIP Telephone SECTION tat WQ.?REai RS°C.(II PI<N5A'FIn ' 5 V,;1 Iti,_NCE 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. SF CI l r'/t:OWNER AUTHORIZATION IO TO 1W COMPLETED WHEN ., a.,w6.',t iN, 1$a c i'tt'\EI 'S AGENT APPLIES FOR BUDDING PERMIT I,as Owner of the subject property.hereby authorize Cc)i 2 1 1+3Mt- -e f'E)('r s 4{\j' to act on my behalf.in all matters relative to work authorized ioy this building permit application. • * Sttjl1e8_ A<<4.11 . Farr. Inc(A.,/e� _ �'//r/ a Owner's Signature Date t = 'CMDN 7h: APPLICAN1'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. 0-eiC g.,,,,, 71' c' 4c //0 .' 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 tial 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 ‘vww.nruss.gov/oc0 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" RISE ENGINEERING OWNER AUTHORIZATION FORM l Thomas Leahy (Owner's Name) owner of the property located at: 22 Liberty Street (Property Address) Florence, MA 01062 (Property Address) hereby authorize COZY HOME (Subcontractor) 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. O ne s Signature 41/074(4 Da e II RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com Rased on your Fnergy Spec ial+sCc tec 011mmendations,VOW honer ran benefit from program.elreibtrr Insulation aritf/or air;Paling imprevhments Before moving fcmrw,ird•please follow all the instructions below to remediate your weathM., ti0n barriers CUSTOMER INSTRUCTIONS 1. Hire a qualified,!teemed contractor to evaluate and/or remediate the weatherization barriers) 2.Submit sigeed and eerepleted copies of this form and a copy of the paid contractor invoices)within 60 days of your Home rneray Assessment to: or email to 1. The Weather i;atron incentive will be deducted firm the customer co-payment amount of the weathenration were A rebate chece will be issued in the event the amount exceeds the customers co-payment amount. 4.Complete the recommended weatherization Improvements S. The Mass Save'H)AT Loan offers interest free financing opportunities that may be used to remediate eligible weatheriratioe barriters. Learn more at massseve.com/enjsavmgiresidential-rebates/heat-loan-program Customer Name: Thomas Leahy Client#or Site ID: 510856 Site Address 22 Liberty Street ,,. Florence state: NA ziD- �, Phone Number. fit.73 $8 s / Email: thOrnaSkteahy@amari.0 " Custosner/)fain+eowne►Signature: 7/f Yh / Date:�it;704_,_ To determine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save weatherization recommendations have been made: Attic Floor C t't/i 4 i S,f W'Attic Wall ,f Attic Slope L�Exterior Wall �Basement t0 Other Other have performed?inspection and/determined th is no active knob and tube wiri in the areas selected below. 1� Attic Floor V Attic Wall tic Slope Exterior Wail t/Basement VOther:Cfliff1^-Le- Other Contractor Name: Ia v 1-1 i Address: L tr Pear«T St. City: E.cf5r +P 'l State'/1 A ZIP. dita/ Company Name: uSt1vil, 7 Ft i / S License Number: c'(LI(2 4 1 (] ) Contractor Signature: � Z/ taste: 1 'Z l ¢ My signature confirms that I perform inspection of the electrical systems listed above and have corrected any barriers as indicated.My signature also confirms that I have read and agree to the Terms and Conditions outlined on the back of this form. High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical system(s)and reduce the carbon monoxide'eve as measured in the undiluted flue gas,to below 100 parts per million(ppm,. Draft Failure:Contractor is to correct the draft in the selected flue(s) Refer to table on reverse for acceptable draft ranges Existing CO ppm. Revised CO ppm: Existing Draft Pa. Revised Draft P.: Heating System Hot Water Heater Otner: Spillage:Contractor is to correct the spillage of flue gases in the selected mechanical systems) Must not so;',1 aher 60 seconds of ooeratio- Heating System Hot Water Heater Omer Contractor Name Address* City: State 7so Ccmpanir Name License Numte Contrsc Signature: Date: 1 l''y s anature confirms that I have performed my inspections of the mechanical systems listed above and have corrected any barriers as -.sleeted re“Rnature also conf:rrns that I have read and agree to the Terms and Cond eons out reed on the back of it's term EDCamScanner It\rz The Commonwealth of Massachusetts --....,=--. e Department of Industrial Accidenb , =T. ini= '',-' 1 Congress Street,Suite 100 °. ..z.:.= -•":' Boston,MA 02114-2017 www.massgovidia Workers'Compensation Insurance Affidavit:Bailders/Contractorsfinecisidans/Phsob,rs. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Informal-leg Please Print Ladhly Name (Busincsa/Orgaulastion/ladivideal): e-0 2/ /-1 0 Irt i; .3 t r id',)#1441 CC Address: i g 0 il feeLs4k i r- sr -*,;too City/State/Zip: &t.s.•#.k 4.t,-pf t 0-t illifi 4(t.1 7 Phone#: iii 3 • ,C.;7 -- 0,7 e0 Are you an employer?Cheek the appropriate beret Typo of project(required): LEI lam a employer with_I/ ,,,employees(full and/or part-time).° 7. 0 New construction 2.0 I am a sole proprietor or partnership sod have no employees working for Ina in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] El3.01 am a homeowner doing an work myself.[No workers'comp,insurance requirecil t 9. Demolition 10 0 Building addition 4.01 am a limner:1mm and will he hiring ctors to eoutleet ell work on my property. I will ensure that all co actors either have workers'compensation insurance or are sole MO Electrical repairs or additions proprietors With no employees. 12.0 Plumbing repairs or additions 10 I am a mew contractor and I have hired the sub-nontrattom listed on the attached sheet. 1 3 Roof.0 repairs These sub-coutractors have employees and have workers'unzip.lasurance.1 'i. 6.0 We are a corporation and its officers!nave exercised their right of exemption per MGL c. 14.InOther /fr it, (a.le 02,41(4),mid we have no employees.[No workers'camp.insurance required.] *Any applicant that checks box al must also fill out the section below showing their worione compensation policy information. 1 HOGICOW150111 who submit this affidavit indicating they are doing all work sad then hire outside contractors must submit a now affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contraders have employees,they must provide their workers'comp.p number. lees an employer that is providing workers'compensadon insurance for my employees. Below is the policy and job site information. i Insurance Company Noun,. Cis fi 4 r it en i-e411 /kid•eiii ii i)4r (/1 Policy#or Self-ins.Lic.#: lib - VI/5,1M - o f - /7 Expiration Date: // A,01- ia 8/...7 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MO Le. 152,§25A is a criminal violation punishable by a tine up to$Lsoo.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cc under the pains a entitles a sjwy that the h(fornsation provided above is true and correct Si . Date: i,' /I C IL Plume ii: leummulleni — Offidel use only. Do not write in this ate,to be completed by city or town official City or Tatra: Parosit/Lieense# lemIng Authority(circle one): 1.Board sit Health 2.Bulldog Department 3.Clty/Town Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other Contact Person:, Phone#: _ ' V. City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge thatas 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, Address of the work: iev The debris will be transported by: HOLY / elk44. ,41104 The debris will be received by: 1 Building permit number: Name of Permit Applicant J n,,t bi ti z.., t a 2 JiTit4 ,--4 4"- . ,7 Date Signature of Permit Applicant