Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
08-057
BP-2022-0172 248 COLES MEADOW RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 08-057-001 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-2022-0172 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 10489 COZY HOME PERFORMANCE 102169 Const.Class: Exp.Date: 12/10/2022 Use Group: Owner: KUBOSIAK SHIRLEY M Lot Size (sq.ft.) Zoning: RI/RR/WSP Applicant: COZY HOME PERFORMANCE Applicant Address Phone: Insurance: 180 PLEASANT ST#200 4135290200 46-845373-01 EASTHAMPTON, MA 01027 ISSUED ON:02/22/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERI ZATI 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: • Fees Paid: $69.00 212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner Thee Commonwealth of Massachusetts b, $ 2 20?2 Board-of Building Regulations and Standards FOR lri ,F g Massachusetts State Building Code, 780 CMR USE MUNICIPALITY --��BtnldiltgPerin:Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling A This Section For Official Use Only Building Permit Number: 1'- ° - (7? 1 Date Applied: ti,A,A,„ i .1,6/7 2/2_,_22 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 149) CAe-s ine «; .`.4. 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 El Private El Municipal_ Outside Flood Zone? Municipal El On site disposal system El Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 51Air1.e,t V-Lk\pbSt'c'Llt 1Qcc^-iAcu1j1Z1!1 mRr 010J.7 Name(Print) x City,State,ZIP aql, Ceti, Ailecuziptz ( - `113.. 5gq- 30?9 A.)1A _ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other 17( Specify: /nScc(et*0in Brief Description of Proposed Work-: A,c,.'y k.Q e, y\s eat4tc r' ( t),,!c il--U zee ti, AA4-i C a- c)`AZe-'4 T SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ Jo. ,-•3q , ( 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ' ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fee§ rl Check No ' Check Amount: Ul Cash Amount: 6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CSS L.. I tAko�aa, 1?')I RK LAA T i. b + License Numberer Expiration ate Name of CSL Holder lb 0 Plitt s An s 1- Aed Q o List CSL Type(see below) No.and Street Type Description , U Unrestricted(Buildings up to 35,000 cu.ft.) { (A S I r,1�►0-I M1J� In T 010 cl r) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 1113.5a q 1^'040 Mit Kele're AI (0 Z y kol1C a Al I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) La` , 1-7 O \$ f Co Zy Norm. yet rOrm CA C. HIC Registration Number Expiration Date IIC Cofnp ame or HIC Jegistrant Name 0 piecsAn St 300 ,ravtvjer Qrycot'Kramq..Copt� No.and Str t Email address ias4rlu; 061`j I'c'A OW W7 413-5 - - 1) City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION 1NSt lIANCE 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 I,as Owner of the subject property.hereby authorize C,n 2--} tk' r,4.. Qu vC Ws &t\ to act on my behalf.in all matters relative to work authorized bythis building permit application. •PerH.�-v Owner's Signature Date SECTION 7h:APPLICANT'DECLARATION • By entering my name below,1 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. '94.:/eZ Contractor//Owner sAgent/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 nag 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 wimmass.gov/nca 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" Permit Authorization mass save Form Site ID: 4241721 Customer: SHIRLEY KUBOSIAK I, c`Shgrl'ey fl'7 , �(uJ�es,rtk , owner of the property located at: I (Owner's Name,printed) 248 Coles Meadow Rd Northampton, MA 01060 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: ,-h, y1? . Date: ,v2/ . .. 3 N..q'' !.,.C.•. 1 . r- ik ?b. .� : ... ..ri:u�. ;try 'a FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: ( Gy H OWE_ t'c,tie tit C 'I/7/-1-2 Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only Rev. 102015 City of Northampton OPY N/M p S s,. ? y Massachusetts ��S` * I- -4' if 4. DEPARTMENT OF BUILDING INSPECTIONS ♦ �r � 212 Main Street • Municipal Building Northampton, MA 01060 ssNry, gf.0‘'• 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: C NP DtAilys , 180 Pfe s4i- ST, F:As- .4.vrpff, The debris will be transported by: Name of Hauler: L62..i k,e Per. "0 t tce. (CUP' Signature of Applicant: Date: -2//7/a .. l ® DATE(MMIDDM'YY) A o CERTIFICATE OF LIABILITY INSURANCE a/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 Exl):413-437-1062 (A/C No):413-43.7-1462 E-MAIL Holyoke MA 01040 ADDRESS: dlafleche@dowd.com PRODUCER CUSTOMER ID#:COZYHOM-01 _ INSURER(S)AFFORDING COVERAGE • NAIC# 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: _ _H. INSURERE: 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. _ INSR7 ADDL SUBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE JNSR WWI_ POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY S 2206979 4/17/2021 4/17/2022 EACH OCCURRENCE $1,000,000 I X- AMA E T RE D COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $500,000 __ -1 CLAIMS-MADE OCCUR MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 POLICY n FF X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ -- (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS- BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) __ $ 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 $ X1 RETENTION $0 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR(PARTNERIEXECUTIVE Y/NI N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS/LOCATIONS I 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/-4dtOve . Q:r11.714--- ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts '"•_ ll '�/ Department oflndustrialAccidents _i:illl_ a 1 Congress Street,Suite 100 y Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): t is;.27 /f�h., t t'c Address: I s O P tee.St+u r .S r =:z_oo City/State/Zip: Gr:`may L.(t t J i ,t r� 4(0 `/ Phone#: r//3 - S Are you an employer?Cheek the appropriate box: Type of project(required): 1.®Tam a employer with._27 _employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working fur roe in 8. Remodeling any capacity.[No workers'comp.insurance required.] ❑ 3.0I am a homeowner doing all work myself.[No workers'ccri-s.insurance required.]t 9. El Demolition 4.❑I am a homeowner and wilt be hiringcontractors to conduct all work on my10[�Building addition ProPMY• I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general zontracter nod I have hired the sub-contractors listed on the attached sheet These subcontractors have employees end have workers'comp.insurance.t 13.12Roof repairs 6.0 We are a corporation and Its officers have exercised their right of exemption per MGL c. 14.©Othei O°fri SG fir,; 152,§1(4),anti we nave no employees.[No workers'comp.insurance required.] € 4 *Any aprlicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contactors that eeeck rnis oox must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors nave employees,they must provide their workers'comp.policy number. I am an rnrployer that is providing workers'ceiupensztion insurance for my employees. Below is the policy and job she information. Insurance Company Name: Ctii 41 otert f=/ _.Ihe] ;;ni Policy#or Self-ins.Lic.#: `f(n ' S'/5.3 / Expiration Date: // /e - /-2 t' t„? Job Site Address: a Z 01)6 M c Q City/State/Zip: )\1O'(`-tctw-p,LM al-- 0(060 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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 certi under the pains an.'„mollies a perjury that the information provided above is true and correct. Signature: Date: afi7 Phone/#: Official arse only. Do mot write in tlr ,area,to be comp1e,ere ny city or town official. City or Town: Permit/License#` Issuing Authority(circle one): 1.Board of Health 2.Building Department 5.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:- Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ACORC3• 11/11/2021 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: Berkshire Insurance Group Inc PHONE 877 234-4420 FAX (877)234-4421 43 East St (A/C,No,Eat): ( ) (AIC,No): Pittsfield, MA 01201 E-MAIL ADDRESS: PRODUCER (413)447-7376 CUSTOMERID# INSURER(S)AFFORDING COVERAGE MAN;F INSURED INSURER*. Continental Indemnity Co. 28258 INSURER B: Cozy Home Performance, LLC 180 Pleasant St INSURERc: Easthampton, MA 01027-1287 INSURERD: INSURER E: CTL 1273 1679258 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 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. INSR ADDLSUBR POL.ICYEFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR PRFMISFS(Faoccurrence) $ MED EXP(any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY PRa JE LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED ANY AUTO Ea accident)SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS PROPERTY DAMAGE (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAS CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STATU- OITH- AND EMPLOYERS'LIABILITY Y/N TORY IJMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE I I N/A 4 6—8 9 5 3 7 3 0 1 1 7 11/02/2021 11/02�2022 EL.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) EL.DISEASE-EA EMPLOYEE $ 1 r 000 r 000 Eves,describe under SPECIAL PROVISIONS below EL.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Accord 101,Additional Remarks Schedule,i(more space is required) CERTIFICATE HOLDER CANCELLATION Cozy Herne Performance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Mill 180 180 Pleasant Street BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED Easthampton, MA 01027 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATI 1783118 ACORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved Commonwealth of Massachusetts ! # DIVISIon of Professional Licensors BaAcd of kidding Rag jjiaation and Standards ei»1rae 9� awiia�F ssaei:ity • MARK M t ANTZ - 180 PLEASANT STREET ., EASTHAMPTON MA 01Q27 GammigaiiagprDiccciv fu 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 Call(617)7273200 or visit www.rnass.govldpl Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 162770 COZY HOME PERFORMANCE, LLC. Expiration: 04/05/2023 180 PLEASANT STREET 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 Gcs `�CL-�i�lso�c i EASTHAMPTON, MA 01027 Undersecretary Not valid without gnature