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43-053 (2) i11 PY18nCIACM C1mon Oa Licensed&Insured \ www.Americaninstallations.com MAC5L#:106178 American Installations MA Registration#175982 -Efficient Home Services- 341 Newton Street,South Hadley,MA 01075 •Office:(413)552-0200 Fax:(413)552-0202 • Email:support@Americanlnstallations.com WEATHERIZATION CONTRACT Casey)Howler 91 Westhampton Rd Hlonmee,MA 01062-9715 Site Ill:500050094787 Praject TD:P00050109012 Customer TD:C00050095503 Contract TD:20151008 WORK Description Quantity Location Insulate Rim Joist With 2"Thermal Barrier Pol}Nso 84 Living Space $369.60 Install 3 5'Fiberglass Batts In Open Gable Wall 20 Living Space _ $3400 Install 2"Thermal Barrier Polyiso On Open Gable Wall 20 Living Space $88.00 Install 6"Fiberglass Batting In Open ICneewall 238 Living Space $4419.82 Install 2"Thermal Barrier Polyiso On Kneewall 238 Living Space $1,04720 Sheathing Access _ 1 NIA 536 1 d Insulation Removal 250 NIA $287.50 Propavent_2'or 4' _ 25 Aftic 2 $95.75 Sub Total: $2,408.01 Utility Incentive Share $1,590.38 Customer Contribution $817.63 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 2 year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions TOTAL CONTRACT VALUE=$ 817.63 are satisfactory and are hereby accepted. You are authorized to do work as Down Payment=$ 272.00 $] 10/8/2015 specified.Payment will be 1/3 down prior to start of work,and balance due PAID upon Completion. Balance Due Upon Completion=$ 545.63 Signature ��fml R111 Date 10/8/2015 Property Owner(Print) Fowler,Casey (Sign) Date Representative:(Print) Craig A.Dragovich (Sign) 9—z- Date 10/8/2015 THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED.THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS, LLC HEREINAFTER REFERRED TO AS"COMPANY",AND THE CUSTOMER(S)NAMED ABOVE,HEREINAFTER REFERRED TO AS"CLIENT",AND WILL BE SUBIECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS. W�u•wT�, Ilk CONT IA" OxraCT011 Licensed&Insured \ www.Americaninstallations.com MACSL#:106178 American Installations MA Registration#175982 -Efficient Home Services- 341 Newton Street,South Hadley,MA 01075 • Office:(413)552-0200 Fax:(413)552-0202 • Email:support@Americaninstailations.com AIR SEALING CONTRACT Casey Fowler 91 Westhampton Rd Florence,MA 01062-9715 Site Ill:500050094787 Project ID:P00050108012 Customer ID:C00050095503 Contract ID:2015 t008 ASEAL Description Quantity Location Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 2 Living Space $168.64 Exterior Door Weather Stripping 1 N/A $27.59 Door Sweep 1 N/A $23.18 Sub Total: 5219.41 Utility Incentive Share $219.41 Customer Contribution $0.00 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 2 year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions TOTAL CONTRACT VALUE=$0.00 are satisfactory and are hereby accepted. You are authorized to do work as Down Payment=$0.00 MR specified.Payment will be 1/3 down prior to start of work,and balance due PAID upon Completion. Balance Due Upon Completion=$0.00 Signature � "�n Date 10/8/2015 Property Owner(Print) Fowler,Casey (Sign) Date Craig A. Dra ovich �/ Representative:(Print) 4 4 (Sign) Date 10/8/2015 THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED.THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS, LLC HEREINAFTER REFERRED TO AS"COMPANY",AND THE CUSTOMER(S)NAMED ABOVE,HEREINAFTER REFERRED TO AS"CLIENT',AND WILL BE SUBJECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS. 1%0.21 The Commonwealth ofMassachuseas Department of Industrial Accidents ' Office oflnvestigations 600 Washington Street Boston,Mass 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information hftiran Please Print Legibl Name(Businesss/OrganizatiorA 4dividual): �h�5 01�j�Il�t�(1�LL1 Address: City/State/Zip:s�pU 66__9—V/ R 61615 Phone#:_ 3, Are ou an employer?Check t e appropriate box: Type of project(required): 1 I am an employer with_ `& 4.01 am a general contractor and I 6.❑New construction 2.®employees(full and/or part time)* have hired the sub-contractors 7•p Remodeling I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8.❑Demolition working for me in any capacity. employees and have workers' 9.D Building addition [No workers'comp.insurance comp.insurance.$ required] 5.OWe are a corporation and its 10,0 Electrical repairs or additions 3 I 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.El Roof repairs employees.[no workers' comp.insurance required.] 13. Otheru�q��ec� *Any applicant that checks box#1 must also rill out the section belowshowing theirworkers'compensation policy information. t1lomcowncrs 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,policy number. I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name:_ C� U .r }_ _ Policy#or Self-ins.Lic.#•_ U Rw C 1��,d"ICI —I Expiration Date iq Job Site Address: 01( WZS� ► City/State/Zip:_ `FoCe-vt Cz, MA,- Ol0 r a 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 certi under the pains and penalties ofperjury that the information provided above is true and correct. Si nature: Date. td-,30- t Print Name:rQ, 1; nnnio ��u-!��Ct Phone#• i�-55Q -02x0D Official use only Do not write in this area to be completed by city or town official City or Town: Permit/ticense#: Issuing Authority(circle one): 1.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Wesley K. Couture _ 106178 License Number 130 College St., Ste 100 South Hadley, MA 01075 9129117 Address// Expiration Date 4V�4- � — 413-552-0200 Signature Telephone 9.Recilstered Home Improvement Contractor Not Applicable ❑ Wesley Couture 175982 Company Name Registration Number American Installations 6/27/17 Address Expiration Date 130 College St., Ste 100 South Hadley, MA 01075 Telephone 413-552-0200 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) 71 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....... IN No...... ❑ 11. -Home Owner Exempfion 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 1083 51 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 C) Addition E] Replacement Windows Alteration(s) T ofing [] Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [Q Siding[[7] Other[iii Brief Description of proposed Work: Attic and basement insulation and air sealing throughout Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.it New house and or addition to existing housinci 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, Casey Fowler ,as Owner of the subject property hereby authorize American Installations to act on my behalf,in all matters relative to work authorized by this building permit application. See attached 10130115 Signature of Owner Date 1, American Installations 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 Installations Print Name American Installations 10130115 Signature of Owner/Agent Date Section 4. ZONING Alt 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:= Rear i 1 Building Height Bldg.Square Footage i �---� YO —f Open Space Footage {- (Lot area minus bldg&paved parking) #of Parking Spaces Fill: --------�;---------------- -------1 (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 O t�YESS 0 IF YES: enter Book Pagel and/or Document#i � B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW O YES O IF YES,has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES,describe size, type and location: i 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: 4 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. Depa fit'use only ` NOV -- 2 2TS kity f Northampton Status of Permit: uild g Department Curb Cut/Drneway Permit DEPT.OF RU9LD1 G iNSPECTION6 21 Main Street Sewer/Septic-Availability. NORTHAMPTON,MA 01060 Room 100 1NaterlWell'Availability Northampton, MA 01060 Two Sets of Structura l Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plan's Other;Specify.: APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 PropertyAddress: This section to be completed by office 91 Westhampton Rd. Map Lot Unit. Florence, MA 01062 Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Casey Fowler Same as above Name(Print) Current Mailing Address: 413-230-0509 See attached Telephone Signature 2.2 Authorized Agent: American Installations 130 College St., Ste 100 South Hadley, MA 01075 Name(Print) Current Mailing Address: American Installations 413-552-0200 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by emit applicant 1. Building 2408.01 (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=0 +2+3+4+5) 2408.01 Check Number Alf Z� 169 This Section For Official Use Only Building Permit Number. Date Issued: Signature: Building Commissionedinspector of Buildings Date File#BP-2016-0613 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY01075 (413)552-0200 PROPERTY LOCATION 91 WESTHAMPTON RD MAP 43 PARCEL 053 001 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 Typeof Construction: INSTALL ATTIC&BASEMENT INSULATION New Construction Non Structural interior renovations Addition to Existing Accessoa 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 INFORMATION PRESENTED: roved 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 lit' Sign re of Building O icial 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. 91 WESTHAMPTON RD BP-2016-0613 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 43 -053 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-2016-0613 Project# JS-2016-001029 Est.Cost: $2408.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq. ft.): 15986.52 Owner: FOWLER DAVID J&CASEY L Zoning: Applicant: AMERICAN INSTALLATIONS LLC AT. 91 WESTHAMPTON RD Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:111412015 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 Signature: FeeType: Date Paid: Amount: Building 11/4/2015 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner