23A-051 22 WEST CENTER ST BP-2016-1298
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A-051 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-2016-1298
Project# JS-2016-002240
Est. Cost: $2402.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sq. ft.): 10715.76 Owner: BROWN SCOTT&SIGELMAN KATHERINE
Zoning• URB(100)/ Applicant: AMERICAN INSTALLATIONS LLC
AT. 22 WEST CENTER ST
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON.511012016 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 5/10/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1298
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY01075 (413)552-0200
PROPERTY LOCATION 22 WEST CENTER ST
MAP 23A PARCEL 051 001 ZONE URB(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid <5
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL ATTIC/BASEMENT INSULATION
New Construction
Non Structural interior renovations
Addition to Existiniz
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
INFO MATION 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
Demolition Delay
S e of Building ficial 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.
— . �ti ;Department use ony
� r ® City of Northampton Status of i,"
uilding Department Curb CuU0nve4vay Pemst
' 212 Main Street SewrerlSeptica4vailab1ty
Room 100 waterMteB Avaabtjr
.
,, Northampton, MA 01060 Two Sets of$fractural Plans
phone 413-587-1240 Fax 413-587-1272 PlotlStie!?tans "`
on,er$pacify
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
22 West Center Street Florence,MA 01062 Map 'Lot Unit.
Zone Overlay District
Elm St.District. CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record•
Katherine Sigelman&Scott Brown 22 West Center Street Florence,MA 01062
Name(Print) Current Mailing Address:
(718) 775-6219
See attached Telephone
Signature
2.2 Authorized Agent:
American Installations 130 College St., Ste I00 South Hadley,MA 01075
Name(Print) Current Meft Address:
American Installations 413-552-0200
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
coinpleted by permit applicant
1. Building 2402.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
S.Fire Protection
6. Total=0+2+3+4+5) 2402.00 Check Number
This Section For Official Use Only
Building Permit Number Date
issued:
Signature:
Burl ft Commissionerlinspector of Buildings Date
f
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
Buil ft Dgmhowd
Lot Size
Frontage
Setbacks Front C�
Side L-= K-=
Rear f
Building Height
Bldg.square Footage
Open Space Footage �--� % {---- �---•
(Lot arca mines bidg&paved
parking),
#of Parking Spaces
FiII:
volume&Ucad I
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES 0
IF YES: enter Book Page and/or Document#1
B. Does the site contain a brook, body of water"wetlands? NO 0 DONT KNOW 0 YES 0
IF YES,has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
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 0
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 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required,
i,
r
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aupltcablel
New House Addition ❑ Replacement Windows Alteration(s) Roofing
Or Roots
Accessory Bidg. ❑ Demolition ❑ New Signs [Cl] Decks (C] Siding IL7] Other[f e
Brief Description ofroposed
Work: Attic and casement 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 Roil -Sheet
sa._if New h6use and' �r addition to exlsttr�cl°hosts q,.coinaiete the foll6wina-
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 farm 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 wen City water supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, Katherine Sigelman&Scott Brown
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 4/29/2016
Signature of Owner Date
I, American Installations as Ow w/Authoaed
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 pedury.
American Installations
Print Name
American Installations 4/29/2016
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Hofer:_ Wesley K Couture 1 .106178
License Number
130 College St., Ste 100 South Hadley,MA 01075 9129117
iAddress Expiration Hate
W �/1./ —'f 413-552-0200
Signature Telephone
6.Reaist+ere�i Nome imgrovemeriYContracicir, Not Applicable ❑
Wesley Couture 175982
Company Name Registration Number
American Installations 6127117
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))
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 budding permit.
Signed Affidavit Attached Yes....... IN No...... ❑
11L. 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 superybor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which helshe 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. er on 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 helshe shah be
responsible for ail such work performed under the Irnit&g 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 perm$.
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
"N_
The Commonwealth ofMassachusetts
Department of Industrial Accidents
Offu a of Xnvesflgadons
600 Washington Street
Boston,Mass 021.11
www.mas&gov/dia '
Workers' Compensation Insurance Affidavit:Buildears/Contraetors/Electricians/Plumbers
Applicant Information Please Print I.esIbly
Name(Busiztess(Qrganizatlontis;di &laal): fT ('1'it'!1Yl �1�15 t L4l_.
Address: rh
C1ty/StatelZiip-.+%ujl\, ey 8A owar Phonem 413_5o7-oaoo
Are a an employer?Check a appropriate bore Type of project(repair :
I. I am an employer with�,t,`^�� , 4.01 am a general contractor and I 6.0 New constntddott
2.0employees(full and/or part time* have hhed the sub-contractors 7.❑Remodeling
1 am a sole proprietor or partner- listed on the attached sheet.
ship turd have no employees These sab-contractors have S.E3 Demolition
working for me in any capacity. employees and have workers' 9.0 Building addition
[Na workers'comp.insurance comp.insurance.
required) S-OWe are a corporation and its 10.0 Electrical repass or additions
3.Q 1 ata a homeowner doing all work officers have exercised their
myself[No workers'compright of exemption perm MGL 11.0 plumbing repairs or additions
Insurance required]t c.IS2,f 1(4),and we have no 12.❑Roof repairs
employees.[no workers'
damp.Insurance required.I
'Any appReant that checks box#I mast abo tip out the secdon below showing their workers'computation policy b&Madou.
tHomeowners who mbmtt Ab*Mdavit hftattag they arc doing an wo*aud then bice outside eoatmaturs mast sabmk a new NRdavkiudicafisg such.
#Contactors that check thb:box must attach an addMonat sheet showing the name or the sub•eontraeters and state whether or not those sath&s have emptopm If
the subm! ntracters have am
VkYem dW not wwUe their worlxrs'emm Pftnumber.
I am an employer that b;proWdingworkers'compensation humneeformy emptoyeer.Below is drepa#cy and job site
tnfornratlorr.
Insurance Company Name•_
Policy#or Seltiins.Lia#i RwC Ul rrJ"1'"�^�,,�}
t Expiration Dattr_k,
Job Site Address: CitylstatelTp:
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 MOL 152 can lead to the imposition of criminal penalties of a fine
up to$1,500.00 and/or one year imprisonment as well as civic penalties in the form of a STOP WORK ORDER and a firm of
52.50.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of The
DIA for caveragte verificaVon.
I do herby cerh;f+under the painns and penalties ofperjury that the information provided above is true and correct
Date.-
Print
ate:Print N4,, t,--r LAA-ure, Phone#: 0
Oficial use only Do not write in this area to be completed by city or town official
City or Town: Permit/ticense#•
Issuing Authority(circle ones
l.Board of Reath 2. Building Department 3.Cityfrown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.0ther
Contact person: phone#•
City of Northampton
Massachusetts �w ctc
DEPARTWNT OF BUZZDZNG INSPECTIONS
212 Main Street + Municipal Building
Worthanpton, MA 01060 �
Property Address: 22 West Center Street
Contractor
Name: Wesley Couture
Address: 130 College Street
City, State: South Hadley,MA
Phone: _(413,)552-0200
Property Owner
Name: Katherine Sigelman &Scott Brown
Address: 22 West Center Sreet
City, State: Florence MA
1, Wesley Couture (contractor)attest and affirm that the building 1 intend to
insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that 1 have
provided the property owner with a copy of this affidavit.
Contractor signature
Date
4/29/2016
www.Americaninstallations.com
a
j auk
ten,
f ,�mmip� Licensed&Insured
MA CSL#:106178
�. MA Registration#175982
American installations
130 College Street Suite 100,South Hadley,MA 01075•office:i413J 552-0200 Fax(413)552-0202•Email:su porttAmericanlnstallations.tam
r
Sigelman&Brown,Katherine&Scott 2/12/2016
X-I) (FRH) (Dxe)
22 West Center Street Florence MA 01062
(Aft—) (CRF) (Saxe( rEW)
718.775.6219 9scott9@gmaii.com
427914 16-0273
tsRe ro) Dob O
Quantity Unit Unit Cost Total
Air Sealing
AIR SEALING 4 Iman hour 1$ 85.001$ 340.00
Total Air Sealing $ 340.00
Total Air Sealing Incentive $ 340.00
Weatherization
CRAWLSPACE WALL R10 RIGID iNSL 90 sqft $ 3.70 $ 333.00
INSULATE BULKHEAD DOOR 1 each $ 72.22 $ 72.22
KNEEWALL HATCH INSULATE 3 each $ 60.00 $ 180.00
KW FLOOR-8"DENSE R-28 228 sgft $ 1.80 $ 410.40
2"RIGID BOARD 244 5 ft $ 3.50 $ 854.00
BATH VENT THRU ROOF 1 each 1$ 118.75 $ 118.75
SHEATHING ACCESS 3 each $ 31.31 $ 93.93
Total Incentivized Weatherization $ 2,062.30
Total Project $ 2,402.30
Pre-Weatherization Incentive $ 150.00
Total Utility Contribution $ 2,036.73
Total Customer Contribution $ 365.58
WARRANTY:American installations,LLC will provide the above stated homeowner with a 2 year workmanship warranty.
American installations,LLC hereby proposes tofumish 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 TOTAL CONTRACT VALUE_ $ 365.58
conditions are satisfactory and are her Y accepted.You are
authorized to do work ass ayment will be 1/3 down prior to Down Payment= $ 121.00
start of work,and balance clue upon Completion. PP D
Balance Due Upon Completion= $ 244.58
' 4/25/2016
so Ae a, qw7 `'� Dxe
man&Brown,Katherine&: 2/12/2016
PrelHrtrihmx iPltml noyrrtrD»"erisaB oxr
Craig A.Dra ovich 2/12/2016
RMeeeMIT .�0 (-,\r y— W Dxr
THIS AGRRREEEEMMEN"F u CC`OOM/MPPOSEO OE THIS PAGE ANDTHE REVERSE SIDE OF THIS PAGE AND S"ALL BE CONSIDEREDTHE ENTIRE AGREEMENT BY THE PARTIES INVOLVED.THIS AGREEMENT IS OUMIN AMERICAN INSTAUAT10Nk UC HERE"MFTER
REFERREDTO AS-COMPANY-.ANOTHE C)STDMER(SINAMED ABOVE,HERIBNOTER REFERRED TOAS-CUINT-.AND WILL BE SURACTTO ALL APPROPRMTE LAWS.REGULATIONS AND ORDINANCES OF THE STATE OF MASSAOWSET'TSOR
CONNECTICUT RESPECTIVELY.AS WELL AS AU tArAL AIRISDICHONS.
16 -023
Mau_SnMw_
Arnaae.rar@eq,
MASS SAVE'
PPE-WEATHERIZATION BARRIER INCENTIVE 2014
CONTPACTOR EVALUATION REPOPT
CUSTOMER INFORMATION
Request#:427914 Date of Assessment 2/12/2016 Energy Specklst C M19 A,Drag-ft
Customer Name:Sigekrrn&Brown,l(asmke&Ston Phone:718,775AM9 Email 991000Ogmatl.Lvm A=wt#:2({39451028
Service Address:22 West Center Street Qty:FlorenCe State:NA pl0a zip{
Rebate Redpient(K different from the Customer):
Mailing Address(if different from the Service Address}
City, State: Zip: Phone:
KNOB&TUBE WIR1Na
Contractor 6 to evaiuete the selected toeations bebw where wea~zatlon recommendations heve been made to determine N
there is any active knob&tube wkkng:
Attic QEXWIor Wall Basement ®Attic Floor Wali Floor Attfc Slope,
MECHANICAL SYStONI HM CARBON MONOXIDE EVALUATION
OContrector B to evaluate the selected medw0caf system(s)bebw and provide servios,If possible,to reduce high carbon
monoxide krels as measured M the nandikuted Hua gas to below 100 ppm:
O Heating System ID Hot Water System IC300w
DRYER VENT EVALUATION
mor ism wAWkia ithednwwent and provideservios to properly eeirauetthe vem to ow _
i KNOB&TUBE WMING
Upon completion army inspection 1 he"found there Is no active F2 &tube wiring in the areaw:s)diecked off below.Attic O Euterior Wdis Basement {tic Floor Knee Wall Floor Attic Sbpes
CONTRACTOR INFORMATION !
Company Nacos ..
Address:�i�i�/��'f��City: Stats„Nrnx�Q �
Contractor Name:��t���Ucense#; Federal ID X.
1 read,and agree to,the Terms&Conditions of the Pre-Weathedzatbn Barrier hxenth. i
Contractor si9neture:
Dote:
I MECHANICAL MGM CARBON MONOXIDE EVALUATION
lE]The selected Kf0dil8niCA11 system has been @valuated and serviced.Testing results of carbon monoxide in the umd{alMd Hue lfas aro as follolvs: L
OHeadrq System _CO ppm OHot Water System CO ppm 100ther. CO PPm
DRYER VENT EVALUATION
OThe dryer vert hes been exhausted to the exterior. co
CONTRACTOR INFORMATION U^
Company Name:_ c!/
Address: City State: Zip: C
Contractor Neme,: License#: Federal ID#: U
O1 have reed.and spree,to.the Terms&Conditlons of the Pre-Weatherizatlon Sander Irx nti—.
Contractor signahm Dins
.�
CUSTOMER INSTRUCTIONS ,a
Submit signed and completed copies of this Contractor,evaluation Report and a copy of the paid Contractor htvold to:
Pre Weattlerization Aarrier Incentive,C/O RISE Engineering,60 Shawmut Rd Unit 2,Canton.MA 02021
Customer Signature: Date:
Q/SIHTe,r(,,,a9-1n1—Whit. --------- 'U
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