42-015 Office of'Consumer affairs & Business RcEuiation
HOME IMPROVEMENT CONTRACTOR
Registration: 162770 Type:
Expiration: 4/6/2013
COZY HOME PERFORMANCE. LLC.
MARK LANTZ
74 LYMAN RD
NORTHAMPTON MA .? nderNecrelar.
_ SLiper\,sor Spec;a:f.j cers
•L'S S_ 102169
MARK LANTZ
74 LYMAN ROAD
NORTHAMPTON, MA 0 OFC
, 12/10/2012
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SECTION 5: CONSTRUCTION SERVICES
• 5 1 Licensed Construction Supervisor (CSL) I
4.A..- (—.4 AA- License Number Expiration Date • Name of C L- Holder y' List CSL Type (see below) i '' i • ' L '.-, I "e 4,1)}...1 I,�V �,� �._ C.)
A dr s Type Description
' Ullit.k... U i Unrestricted (up to 35,000 Cu. Ft.)
R Restricted I &2 Family Dwelling
Signature
(((� 4 Masonry Only
�! t J �U l \ RC Residential Roofing Covering
Telephone - WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
1
D Residential Demolition
5?� egistered / H , — ome Improvement Contractor (IIIC)
(..[ �Zy' t C4° �+z-r A• :r►rAe A a HIC m
/C Registration vur
opa :Warns or HIC Registrant Nam 1
( L� Y - R /Uexrk�,�, ._ mfr /
Addri s '. !
.A- '1J... ..�°� I 3).C. 1 xn. t:on Date
si Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6))
Workers Compensation Insurance affidavit !rust 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 ... No 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, & `' , 5 , as Owner of the subject property hereby
authorize ;,.)3 v ti,jr�c.. t' : '' t �i rr ►') Cr to act on my behalf, in all matters
relative to work au - zed by this building permit application ,51, i i ,r,,
Signatur Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
I. IN No\i .\c,,, L,,,,--\-- 2:._ , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf.
tNil61 .r\(�.. LU, \ 2, • '
Print /
nt \arn
Signature of Owner oitireiized Age.. Date
(Signed under the pains and penaltiesSf penury)
NOTES: 1
1. 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 Horne Improvement Contractor (HIC) Program), will n h ave access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing (CSL) can be found in 780 CMR Regulations 110.R6 and 110.R5,•respectively.
2. When substantial work is planned, provide the information below:
Total floors area (Sq. Ft.) (including garage, finished basement/attics, decks or porch)
Gross living area (Sq. Fn) Habitable room count _.
Number of fireplaces _ Number of bedrooms
Number of bathrooms Number of halvbaths
Type of heating s Number of decks/ porches
Type of cooling system Enclosed Open
1
3. "Total Project Square Footage" may be substituted for "Total Project Cost "'10 Li % c. „�
.
1s
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
i- , ,;t . , c ; Not Applicable :MT �_. licable ❑
9:::Re • istered, Home Im • rovement;Contractor^m "; p
Company Name Registration Number
Address — Expiration Date
Telephone
SECTION 1 0 - WORKERS!. COMPENSATION INSURANCE AFFIDAVIT {M.G L c ri152, § 25 C ( 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 91 No ❑
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
•
SECTION 5= DESCRIPTION OF.PROPOSED WORK all applicable)
New House ❑] Addition ❑ Replacement Windows Alteration(s) Roofing n
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [D Siding [D] Other [Dj
Brief Description of Proposed
Work: P r C -k' s 4 t - - - c . Ai( ) v 5 g n c�. tl ,�C- ��r ���►A c� r
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement ^ Yes No
Plans Attached Roll - Sheet
6a Af dew housee an _ or addition, to `existing »° oasinq;: comp ete the fat)owrnq:
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 AUTiHORLZATION , - TO ,BE COMPLET „WHEN =,
'.OWNER AGENT OR CONTRACTOR APPLIES FOR BUILDI PERM1T t
, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
, 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
R EC L _ VE D Department use only
1 Ci of Northampton Statu§ of Permit. ,
Bu !ding Department Curb Cut/Driveway Fern* `' �r)�� 12 Main Street Sewer/Septic Ava lablllty
Room 100 Water/Well Availabthty
DEPT. orBuiL 7' rEL , ro.Nort ampton, MA 01060 Two Sets of Stauc`+ta s
NORTHAMP, .. p
. hit60—.41a -587 -1240 Fax 413- 587 -1272 Piot/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
a a We a -) -�-. 5 12 A Map Lot Unit
*C, e .'N c& r - Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
f
C' , A 5 ,iL 5 3 a, CJ t 0 4 c mS 4 . �� {'fin �t
Name (Pita) Current Mailing Address:
.c. �' 3 __ b p) /-,) _ Telephone 1 I " -' 5.6 Li I .. )4)1/
Signature i
2.2 Authorized Agent:
N\"v 0 CV 1,.._6 i - z , ` ., Q) e� ‘.,,,, aC 6- ) zh .)) \ ,t, v,i , K. > r1)) '313 a
Name,(f r' t) 7 Current Mailing Address:
77 / 4 ,,,, ..„/;,:%/ it:I,./ -'‘ ) ) - 54. - 3- Cs)
Signature Telephone
SECTION 3 - ESTIMATED C STRUCTION 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) Y l i 0 a j u Check Number a t,Ar
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2012 -0971
APPLICANT /CONTACT PERSON MARK LANTZ
ADDRESS /PHONE 74 LYMAN RD NORTHAMPTON (413) 320 -7611
PROPERTY LOCATION 242 WEST FARMS RD
MAP 42 PARCEL 015 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid K'ZJ i4
Typeof Construction: AIR SEAL & INSULATE ATTIC,WEATHERIZATION & REPLACE DOOR M 1 New Construction ef i
Non Structural interior renovations l _ t
Addition to Existing �p �1 ((f 6
Accessory Structure , l gq: I
Building Plans Included: t C)IR 1 Owner/ Statement or License 102169
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
ppprroved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission - Permit DPW Storm Water Management
/1 = - +01' ion Delay
affi 5116
Signature of :uilding Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
242 WEST FARMS RD BP- 2012 -0971
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 42 - 015 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- 2012 -0971
Project # JS- 2012 - 001688
Est. Cost: $4800.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARK LANTZ 102169
Lot size(sq. ft.): 59677.20 Owner: D'ASTOUS GEORGE J
Zoning: Applicant: MARK LANTZ
AT: 242 WEST FARMS RD
Applicant Address: Phone: Insurance:
74 LYMAN RD (413) 320 -7611 WC
NORTHAMPTON MAO 1060 ISSUED ON:5/11/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:AIR SEAL & INSULATE
ATTIC,WEATHERIZATION & REPLACE DOOR- ANAL UTILITY INSPECTION REPORT REQUIRED
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 5/11/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner