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29-279 (3)
351 BROOKSIDE CIR BP-2016-1302 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-279 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-2016-1302 Project# JS-2016-002244 Est. Cost: $2149.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size s( d. ft.): 17380.44 Owner: CURRIE WARREN E JR&CHERYL N Zonin4: Applicant: AMERICAN INSTALLATIONS LLC AT. 351 BROOKSIDE CIR Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.5/10/2016 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-2016-1302 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY01075 (413)552-0200 PROPERTY LOCATION 351 BROOKSIDE CIR MAP 29 PARCEL 279 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildine 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 INFORMATION PRESENTED: proved 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 o " el y Signature of Build ng ffic' 1 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. RECEIVED Department use only !;IhY - 9 ; ity of Northampton Status of Permit. uilding Department Cuib Cut/Driveway.Permit, DEPT.OF BUILDING INSPECTIONS 212 Main Street SewertSeptia Availability NOPTHAMPTON,MA 01060 Room 100 W&6r1We11Availability Northampton, MA 01060 T.wo$ets of'Sfructurai Plans:.: phone 413-587-1240 Fax 413-587-1272 P'0184e 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 351 Brookside Cir. Map Lot Unit. Florence, MA 01062 Zone Overlay District Elm St District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Currie, Cheryl& Warren 351 Brookside Cir. Florence, MA 01062 Name(Print) Current Mailing Address: See attached 413-584-6726 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 permit applicant 1. Building $2149 (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) $2149 Check Number 47 1 74t'-'5 This Section For Official Use Only Building Permit Number. mate Issued: Signature: Building Commissionerlinspector of Buildings Date h 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 Dcpartment Lot Size Frontage Setbacks Front . Side L:= R:= L-=R•E—� Rear Building Height -� Bldg.Square Footage Open Space Footage (Lot area minus bldg&pavcd parking) #of Parking Spaces Fill: -- _-----� —_—__ —_------I (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page= and/or Document#1 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 Q NO O IF YES, describe size, type and location: 1 D. Are there any proposed changes to or additions of signs intended for the property? YES 0 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? YES O NO 0 IF YES,then a Northampton Stone Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable New House ❑ Addition Replacement Windows Alteration(s) Roofing Or Doors 0 1 Accessory Bldg. ❑ Demolition ❑ New Signs [E3] Decks JE:3 Siding 11:31 Otherl�3 Brief Description of Proposed Work. Attic and basement insulation and air sealing throughout Alteration of existing bedroom Yes No Addingew bedroom Yes No Attached Narrative Renovating 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. Ma!sscheck 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. 1. 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 1, Currie, Cheryl & Warren 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. -5ee attached 4127116 Signature of Owner Date I, 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 4127116 -Signature of OwnedAgent Date 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 9/29/17 Address, Expiration Date 413-552-0200 Signature Telephone 9.Registered 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.GL.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....... $1 No...... ❑ 11.-. Home Owner. Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 1083,5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one h2W in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the hurtling permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. .Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for persons) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws aad State of Massachusetts General Laws Annotated. Homeowner Signature r The Commonwealth ofMassachuseas Department''of Industrial Accidents Uflice oflnvesdgadons 600 Washington Street Boston,Mass 02111 www.massgov/fila Workers, Compensation Insurance Affidavit:Builders/Contractors/Electiicians/Plumbers Applicant Information Please Print Ietely /+tame{Businesstoxganf tln�,r;�dua�l} -A—)Sii$tl ai' ons ,-LLL - Address: 13 0 b I lam: o ��,.:.�1 Gty,/State/Zip: ,r%,gAx qaev MA 616155 Phone#: q0:,;5c--�.�Q Are u an employer?Check a appropriate box: 'Type of project(required): 1. I am erupbytr with K 4.01 am a general contractor and I 6.1314ew construction employees(full and/or part tine).*).* have hired the sub-coattactars 7.CI Remodeling 2 01 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8.©Demo ition working for me in any capacity. empioytxs and have workers' 9.d Buflding addition [No workers'comp.insurance comp.insurance.t required] 5.0We are a corporation and its 10.D Electrical repsus or additions 3.Q l am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself[No workers'comp, right of exemption perm MGL Insurance required]t c.152,§1(4),and we have no 12.13 Roof repairs employees.[no workers' 13. t�ffhrx h comp.Insurance required.] G+ti3t�lffl 'Any applicant that checks boa 01 most also tilt out the action below sbowtng their workers'compeosatioo poft Ormatlon. tHoauowners who submit this at6dwit bulicadag dw ore doing anwork and thea hire outside contractors mart submit a new allidavaiodleating such. =Contactors Wet check this box must attach an addidoast sheet showing Ibe name of the subcontractors and state whether or not those oatities bave empto}T m if the subcontractors have easoloyces,they smut wovide,their workers'eo poVey number. I am an employer that Is providinguw&m'compensation btsurance for my wrloyeeL Below is tkepoAw andleb site Information. Insurance Company Name:_ "�,�, —7 Policy#or Self-ins.Lic.#:. LA RwC Coli(1 1 Facpination Date: Jab Site Address.• Ckyastatzip. 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 certify under the pal'ns and penaltles ofpedury that the inforntadon provided above is true and correct. nature: 0 DaW Print Name: re., Phone#: 0 Q,,Ttcial 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): /.Board of Heath 2. Building Department 3.CttwTown perk 4.Electrical Inspector 5.Plumbing Inspector 6.0ther Contact person: Phone& �n ONIRA llTwlfi . CONTRACTOR 0 Licensed&Insured \ I www.Americaninstallations.com MA CSL#:106178 American Installations MA Registration#175982 -Efficient Home Services- 130 College Street Suite 100,South Hadley,MA 01075 • Office:(413)552-0200 Fax:(413)552-0202 • Email:support@Americanlnstallations.com AIR SEALINCO PROPOSAL Warren Currie 351 Brookside Cir Northampton,MA 01062-3512 Site 1D:S00040161877 Project ID: P00050185557 Customer ID_COW50163196 Contract 1D:20160218 ASEAL Description Quantity Location Perform Air Sealing at Estimated 62.5 CFM50 Per Hour r 8 PIving S $674.56 Sub Total: $674.56 Utility IncentWe Share $674.56 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 specified.Payment will be 1/3 down prior to start of work,and balance due Down Payment=$ 0.00 � /�,.� PAID upon Completion. e��/ (J glance ue Upon Completion=$ 0.00 SignatureU"L Date 2/18/2016 Property Owner(Print) Currie,Cheryl&Warren (Sign) Date Representative:(Print) Craig A.Dragovich (Sign) Date 2/18/2016 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 CUSrOMER)S)NAMED ABOVE,HEREINAFTER REFERRED TO AS"CLIENT",AND WILL BE SUBJECTTO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS. (a'WLJIs PARTWAPATIRIG co " . coetancMrox 1 Licensed&Insured L www.Americanlnstallations.com MA CSL#: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@Americaninstallations.com WEATHERIZATION CONTRACT Warren Currie 351 Brookside Cir Northampton,MA 01 M2-3512 Site ID:5 00050 1 6 1 877 Project ID:P00050185557 Customer ID_('00050163196 Contract ID:20160218-1 WORK Description quantity location Hatch:Thermal Barrier Polyiso 2 Inch(Attic) 1 Livrin Space $41.71 , __> Attic Floor Open Blow Cellulose 6" 805 laving Space 183.35 Vent bath fan to roof flapper 1 Attic $129.21 Damming 55 N/A $120.45 Sub Total: $1,474.72 Utility Incentive Share $1.106.04 Customer Contribution $368.68 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 2 year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions TOTAL CONTRACT VALUE=$ 368.68 are satisfactory and are hereby accepted. You are authorized to do work as Down Payment=$ 122.00 specified.Payment will be 1/3 down prior to start of work,and balance due y 10 2/18/2016 PAID upon Completion. LA� 246.68 Balance Due Upon Completion=$ Signature Date 2/18/2016 Property Owner(Print) Currie,Cheryl&Warren (Sign)_, Date Representative:(Print) Craig A.Dragovich (Sign)_ Date 2/18/2016 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 SrATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICnONS. City of Northampton Massachusetts :G DEPARTMENT OF BUILDING INSPECTIONS St :. 212 Main Street • Municipal Building Jd4 .Ca North, ton, MA 01060 Property Address: 35 � Contractor ('^`( 1^ Name: �C QL 1 C-C-1�--� f Address: 7�)u City, State: �,� � �� Phone: Lq Property Owner Name: Address: City, State: CA(Yl(}� I,�W)k1 n'r) LC� gL *ontractpr)attest and affirm that the building I intend to insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature Date l i \( PP