29-001 BUILDING PERFORMANCE INSTITUTE, INC.
107 iitNrne fin 0d Su On 110
M„ifta NY 12020
8.71 274-1273
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BPI MARK LANTZ
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Board of J. 0 Po4,.,d itons and t'anoards
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MARK M LANTZ
180 PLEASANT STREET
Easthampton MA 01027
r7.n ,aanon
12/10/2014
Office of Consuriier tafairs&Bu sines Regulation
110h/lE IMPROVEMENT CONTRACTOR
r
4#' Registration: 162770 Type:
Expiration: 4/6/2015 LLC
COZY HOME PERFORMANCE,LLC.
MARK LANTZ
180 PLEASANT STREET -
EAST HAMPTON,MA 01027 1 ndersecretars
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:`` // Not Applicable ❑ / / ] J
Name of License Holder: CexC G i1'�'1� i�//yX�i G� t L 1: i ,C) !0 1 ((l
C License Number •
Address Expiration Date
_ L.(l 3)o ) I
Signature Telephone
9.Realstered Home Improvement Contractor: Not Applicable ❑
i(; -`
Company Name Registration Numb r
Address Expiration Date
Telephone
SECTION 10-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. A Signed Affidavit Attached Yes ❑ No ❑ /P1 A,(.;� /7 t—
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 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(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) fl Roofing E
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks in Siding [0] Other
Brief Description of Proposed � ) L. t,�/ r L e 4 Lu t-,,6ev„„ � ) /,� 1 I.
Alteration of existing bedroom Yes No Adding new bedroom Yes No v i L
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
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 AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 02041\CA-N---16\ ,(4,-/S4-00 /i2')r .1� as Owner of the subject
property
hereby authorize `S 4-1?)_' , -"t(�. 6)71erfrk../Ail-v �JY\/ 6ii( /76-1-7e._
to act on my behalf, in all matters relative to work authorized-by this building perniit application.//424
Signature owner Date 4126) /1:3 I, Obb"-AiLl.P■196-N 1/5111 / t 'egi>/1/4LY ,as Owner/Authorized
hereby declare that the statements and info tion on the fore �n application are true and accurate,to the best of my knowledge
Agent r� g g pp Y 9
and belief.
Signed under the pains and penalties of perjury.
AP,' ., t. ...-, V A. 'mall 1... ,_ Atjko r‘('
Print Name Air 0
, / 7/ 2_e)e4
SignAll Owner/Agent Date
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 O DON'T KNOW O YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
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? YE: O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department.use"1Y
- ity of Northampton Status of Perm t:
B ilding Department Curb driveway Perm
Li Ci 212 Main Street Sewer/SepticAvailability
NOV 2 0 2013 i Room 100 1lklaterlWell vaila ilt r
Nrhampton, MA 01060 Two Sew t f Structural Plaits
t ,�{, '3 587-1240 Fax 413-587-1272 PioUSite Plans
Electric, F i--- rc �,f?"L i s
N�,rtIc.- i,. 1060 OherSpecify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
Hor,,,,,,.... 1.4,6LA-5 This section to be completed by office
1.1 Property Address:
-, Map Lot Unit
164&"- 12.
Zone Overlay District
OrkL'.-,.,.p f t.A.Ni M4- Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner
)of Record: 14V)rt �C\/, C r��, (4 .,emu., C- v�.�b , )-y. Li er a (a +1._ V fi
Name/(Print) Current Mailing Address:
Telephone
Signature i ^ /L` - - ,, I',
2.2 Authorized Agent: 14 3C,' ,ric.}�c F�! (� 1 � Gam'+� ��"'lJ�'r'''"4 ' .
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building i j X. (a) Building Permit Fee
2. Electrical ' U (b) Construction from Cost
)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection /�
6. Total=(1 +2+3+4+5) Check Number 9'0 3 4Yl�
This Section For Official Use Only
Building Permit Number: Date
g Issued:
Signature:
Building Commissioner/inspector of Buildings Date
File#BP-2014-0637
APPLICANT/CONTACT PERSON MARK LANTZ
ADDRESS/PHONE 180 PLEASANT ST EASTHAMPTON (413)320-7611
PROPERTY LOCATION 178 FLORENCE RD
MAP 29 PARCEL 001 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 903 6,0 Fee Paid
Typeof Construction: INSTALL ATTIC INSULATION,DOOR WEATHERIZATION&BASEMENT AIR
SEALING(12 BLDGS)
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 102169
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFUNIATION PRESENTED:
Approved 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
i,-• .''t•' Delay
...V - , V 1 //- d -/3
Signature of gilding 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.
178 FLORENCE RD BP-2014-0637
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-001 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-2014-0637
Project# JS-2014-001087
Est.Cost:
Fee: $660.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARK LANTZ 102169
Lot Size(sq. ft.): 255697.20 Owner: NORTHAMPTON CITY OF NORTHAMPTON HOUSING AUTHORITY
Zoning: Applicant: MARK LANTZ
AT: 178 FLORENCE RD
Applicant Address: Phone: Insurance:
180 PLEASANT ST (413) 320-7611 WC
EASTHAMPTONMA01027 ISSUED ON:11/21/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL ATTIC INSULATION, DOOR
WEATHERIZATION & BASEMENT AIR SEALING (12 BLDGS)
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 11/21/2013 0:00:00 $660.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner