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23A-246 (3)
BBB Licensed&Insured ;'.MCSL#:10,5173 L MA Registration 75952 American Installations 130 College Street Suite 100,South Hadley,MA 01075 •Office:(413)552-0200 Fax:(413)552-0202•Email:supportLeAmericaninstallations.com Gray,Carol 8/13/2015 185 Nonotuck Street Florence MA 01062 413-297-1075 caroigray__2000 @yahoo.com 421199 15-1190 Quantity Unit Unit Cost Total lAir Sealing oy%c-e, I-JAI Total Air Sealing $ 680,00 - Total Air Sealing Incentive $ 680.00 �" 4 A Weatherization DOOR WEATHERSTRIPPING W/SWEEP I each 75.00 75.00 e ,J•fA It FLAT-12"OPEN R-42 323 sqft 1.60 516.80 INSULATE EXISTING DOOR 1 each $ 73.91 S 73.91 VENTILATION CHUTES 159 each 2.00 S 318.00 PLASTIC GROUND COVER 1,020 sqft S 0.77 $ 785.40 CRAWLSPACE WALL RIO RIGID INSL 91 ScIft 3.70 S 336,70 TEMP ACCESS THRU DRYWALL I each $ 85.00 85.00 CA ot^y at- r e-o-SO vNS. Total Incentivized Weatherization $ 2,190.81 Total Project $ 2,870.81 Total Utility Contribution $ 2,323.11 Total Customer Contribution FF--5-47,701 MiRtWr,'�:A=r,ait LILC"4!P'.'idc:..c•.1,- -th,a 2 year LLC hc:.bi proposes to urris4 all in it"tl-,ab—t and ah 1-0 d sate ova d-•r re:: ,...�,ff'r:the Total Contract Value.,:s::a:ed hcrrvn. ACCEPTANCE OF PROPOSAL:Tire above prices, TOTAL CONTRACT VALUE= $ 547.70 condition;are z.at,sfactcry and a,e hereby accepZcd.You are authorized to do work as spcoFed.Payment%0!ty-1 113 cowil pria,to Down Payment= $ - 71 s0'-'of wn'a'and Laiance due joan Completion. PAID Balance Due Upon Completion= $ 547.70 t. CaA'� It//5 115- )L4;7 C,11 A.0 -A The Commonwealth of Massachusetts Department of Industrial Accidents T � Office of Investigations 600 Washington Street Boston,Mass 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Dame(Business/Organization4iWividuai): l!1 h Pf l r'n y1 T—n eSin� Address• _ Cify/State/ZiP:! d) 5 Phone#:A 13-55 _ 0;660 Are out an employer?Check the appropriate box: Type of project(required): 1 I am an employer with__13 4.()I am a general contractor and I 6.0 New construction 2.0`employees(full and/or part time).* have hired the sub-contractors y,E3 Remodeling 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8.C1 Demolition working for me in any capacity. employees and have workers' g,O Building addition [No workers'comp.insurance comp.insurance. required] 5.0We are a corporation and its 10.❑Electrical repairs or additions 3.01 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption perm MGL insurance required]t c.152,§1(4),and we have no 12.❑Roof repairs employees.[n workers' 13.XOther t kkJd b — comp.insurance e required *Any applicant that checks box 01 must also Till out the section below showing their workers'compensation policy information. tHomeowncrs who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box most attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees.they must provide their workers'comp.po Lq number. I am all employer that Is providing workers'compensation insurance for my employees.Below Is the policy and job site information. Insurance Company Name:__ Policy it or Self-ins.Lie.#: i � Expiration Date-__7q-y Job Site Address: c`� 1� �rt 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 Section 25a of MGL 152 can lead to the imposition of criminal penalties of 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 $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby a ffly under the pains andpenalties ofperjury that the information provided above is true and correct. Signature-1 A a A J, 74 A I Date. Print to; n"..., 0,O fc, Phone#- y1� 5Q -Dg-to C7 Official use only Do not write in this area to be completed by city or town official City or Town: Permit/license#: Issuing Authority(circle one): I.Board of Heath 2. Building Department 3.Cityfrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact person: Phone#- SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Wesley Couture 'V b '� 130 College . License Number South Hadley,MA 01075 kAddre4ss6k f 413-552-0200 Expiration Date Telephone 9.Registered Home Improvement Contractor: - Not Applicable ❑ ` Company Name tullmrican Registration Number 130 College St. Address South Hadley,MA 01075 �p--ai--U 413-552-0200 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. Signed Affidavit Attached Yes....... No...... ❑ 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) Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [C] Si ing Ather[*� Brief Description of Proposed Work:_ 1'I C.-�' 1Y1P 1�" u � 1 1( l l u 1 t ) C lUf vx-- . Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.if New house and or additionlo existing housing, com lete 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, -- `am v f g4=i ,as Owner of the subject property hereby authorize P1'W iican Installations to act on my behalf,in all matters relative to work authorized by this building permit application. A 4i±� Qd' Signature of Owner Date American installation 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. American Installatio,,; Print Name American Installations Signature of Owner/Agent Date c� I 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 I Frontage Setbacks Front Side L:= R:= L:= R:= Rear Building Height �---� 1-`-� �-----1 Bldg.Square Footage L�"i —� "/o -� 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 O DONT KNOW O YES O IF YES, date issued:�~~� IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW © YES O IF YES: enter Book __— Page f and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT 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: j 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? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only AU� City of Northampton Status of Permit: Plumbing P ecuons Building Department CurbCut/Driveway Permit &Gas Ins MaoA06o 212 Main Street Sewer/Septic.Availability. E ct[Northampton' Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Siructural:Plans : phone 413-587-1240 Fax 413-587-1272 PlotSite 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 15 Map Lot Unit. Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: C �. \ - �- 195 VAO M Name(Print) ail' Curret es .v"- Telephone Signature 2.2 Authorized Agent: American Installations 130 Colleize St. Name nn South Hadley,iMet)fi5g Address: ci, _-- 413-552-0200 Sig atu Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit 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) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2016-0196 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY01075 (413)552-0200 PROPERTY LOCATION 185 NONOTUCK ST MAP 23A PARCEL 246 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT i Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INSTALL ATTIC&BASEMENT INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 106178 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF05MATION PRESENTED: pproved 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 Demolition Delay Sign re o Building 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. 185 NONOTUCK ST BP-2016-0196 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A-246 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-2016-0196 Project# JS-2016-000338 Est. Cost: $2900.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq. ft.): 9408.96 Owner: GRAY CAROL J Zoning: URB(100)/ Applicant: AMERICAN INSTALLATIONS LLC AT. 185 NONOTUCK ST Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.812012015 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL ATTIC & BASEMENT 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. Certificate of Occupancy Sisnature: FeeType• Date Paid: Amount: Building 8/20/2015 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner