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49-025 688 PARK HILL RD BP-2017-0174 GIS#: COMMONWEALTH OF MASSACHUSETTS Man:Block:49-025 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-2017-0174 Project# JS-2017-000285 Est. Cost:$3300.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(su. ft.): 79714.80 Owner: O'BRIEN TIMOTHY 3&MAUREEN A Zoning: Applicant: AMERICAN INSTALLATIONS LLC AT: 688 PARK HILL RD Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:8/II/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 8/112016 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0174 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY01075(413)552-0200 PROPERTY LOCATION 688 PARK HILL RD MAP 49 PARCEL 025 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT /� �}� Fee Paid �/p7 Of G6 Building Permit Filled out Fee Paid Typeaf Construction: INSTALL ATTIC&BASEMENT INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 10617$ 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: 4.4pproved 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 olition Delay b7` gO ��`0 Si ature Buildin teal al 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. �. (?aPadnwnl u¢euiiy City of Northampton stehis of PennM RECEIVE r 2 Department sdroicdmdveway?emtt 12 in Street Sewea'SepticAvaba$Ity 100 AUG Water/Wefi AvaSe6NIy 920 '. , ma 01060 fvx fele alstrudMel:Plaa phone 41 5 7- 240 Fax 413-587-1272 P)otl6le.Pka ' n[OF001.31NG INSPFLTGNS Otlier:SpBCIy.T— APPLICATION TO CON ,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DIYEU.ING SECTION 1-SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot LMS. 688 Park Hill Florence,MA 01062 Zone Overlay District Elm St.District - CBDUatct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 21 Owner of Record: Maureen &Timothy O'Brien 688 Park Hill Florence,MA 01062 Name(Ring Cared Mtlnp Andress: See attached (4131 585-9008 Signature 22 Authorized Agent American Installations 130 College St., Ste 100 South Hadley, MA 01075 Name(Poing - Parent Mang Mike= American Installations WU, (L 413-552-0200 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Icon Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3300.00 (a)Budding Permit Fee 2. Electrical (b)Estimated Total Cat of Cottuctlanfrom(6) 3. Plumbing Building Permit Fee 4. MedreMal(HVAC) 5.Fire Protection 6. Toter=(1 +2+3+4+5) 3300.00 Chadt Number a19f(y 7/C!5 This Section For Official Use Only Building Permit Number. Mete Dated: Signature: Building Commissioner/Inspector of Buildings Debo Section 4. ZONING Aa Adoration Must Be Completed.Permit Can Be Denied Due To incomplete Information Existing Proposed lequired by Zoning dm coWran to be Med in to *Mins Dopsnmrat Lot Size Frontage Setbacks Front Side L:_It: Li I LI I I Rear II Building Height L_J Bldg.Square Footage Open umi sbldgF ootage (Lotapp % puking) #of Parking Spaces FBI: (volume aLocation) -}�- A. Nas a Special PennitNariance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 WE 0 IF YES,date issued:) 1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES Q IF YES: enter Book Page and/or Document#( B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0 YEE 0 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 0 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 0 NO 0 IF YES, describe size, type and location: I E. Will the construction actMty disturb(clearing,grading,excavation,or tilling)over I acre or is K part of a common plan Mat will disturb over l acre? YES O NO 0 IF YES,then a Northampton Storm Water Management Permgfrom the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoalicable) New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑ or Doors O Accessory Bldg. ❑ Demolition D New Signs (01 Decks (L7 Siding ion Other[kke eclatapmp�y Work Attkc apndd asb ement insulation and air sealing throughout AttachedioNarrative bedroomYes No Adding new badman Yes No Plans Attached Nrrvel -Shec Renovating unfinished basement _Yes No self New house and or addition to existing housing..completethefollowing: a. the of buuding:One Family Two Family Other b. Number of rooms h 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 orWoadstoves Number of each g. Energy Conservation Compliance. Manche* Energy Compliance form attached? h. Type of construction I. Is construction within 100 R of wetlands?_Yes _No. Is construction within 100 yr. floodplain Yes Jlo J. Depth of basement or cellar floor below finished grade k. W B building conform to the Building and Zoning regubdons? ___Yes_No. I. Septic Tank_ (Sty Sewer_ Privatewel City water Supply__ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Maureen&Timothy as Oar ofthe subject PlePertY hereby authorize American Installations to act on my behalf,In al matters relapse to work authorized by this baMlrg permit application. See attached 8/4/2016 Signature of Oona Data I. American Installations as Osmr/Authorized Agent hereby declare that the statements and information on the foregoing application are hue and accurate,to the best of my knowledge and belief. Signed under the paha and penalties of perjury. American Installations Pond Name W LA_ f2- vim_ 8/4/2016 Signalize of OamrlAgad Dao SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of Licensee Holder: Wesley K. Couture 106178 License Number 130 College St., Ste 100 South Hadley,MA 01075 9/29/17 Address� esDate pa Da W Li 11— \t '— 413-552-0200 Signature Telephone ... . . . .. 9.Registered Home Improvement Contreefor. _ :: 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 Telephone413-552-0200 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L o.152,g 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 bang permit. Signed Affidavit Attached Yes....... S) No..._ ❑ 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 suoervhor.CMR 780. Sixth Edition Section 108.35.1. pe inition of Homeowner.Person(a)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 Buil&g Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work nerformed under the boldinenermit, 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,von may be gable for person(s) you hire be perform work kr 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 The Commonwealth of Massachusetts Department of Industrial Accidents P—=s_ / Office of Investigations g = e'= 1 Congress Street,Suite 100 =et ' - -=44'45 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/F,lectricians/Plumbers Applicant Information Please Print Legibly Name Business/Organization/Individual): American Installations, LLC Address: 130 College Street,Suite 100 City/State/Zip: South Hadley, MA 01075 Phone#: 413452-0200 Are you an employer?Check the appropriate box: 4. I am a general contractor and I Type of project(required): 27 1.0 I am a employer with ❑ employees(full and/or part-time).' have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.[ 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL 12.0Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' l3.©Other Insulation comp.insurance required.] 'Any applicant that checks box 41 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 anew affidavit indicating such. :Contractors that check this box 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 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: Guard Insurance Companies Policy#or Self-ins.Lic. #: URWC609917 Expiration Date: 09/04/2016 Job Site Address: S ? m_g_ �-ucf City/State/Zip:1RAR LIN] Mfr. 0/0(0 2— 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 c. 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature .nL9. ont ,,ere_ Date: S (S Phone#:��9/,33-5ria-®OROO t LLL 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton Massachusetts DEPARTMENT OF BOLLOOFG INSPECTIONS i 212 Main Stn .t • Ibainlpal 21111d1n0 ,/�' Northaaptan, b 01060 'V."i1)" Property Address: 688 Park Hill Florence,MA 01062 Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley,MA Phone: 43-552-0200 Property Owner Name: Maureen &Timothy O'Brien Address: 688 Park Hill City, State: Florence,MA 01062 I,American Installations (contractor)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 W r A LC. w✓ Date 8/4/2016 de r ^„ common licensed&Insured L . wWW.Americantnstallaticns.com MA al a:106178 American Installations MA Registration#175982 Efficient Home Services- 130 College Street Suite 100,South Hadley,MA01075 • Office:(413)552-0200 Fax:(413)552-0202• Email:Wpport®AmericaMrctalltiencwm WEATHERIZATION PROPOSAL Tim Obrien 688 Park Hill Rd Lot 4 Florence,MA 01062-9774 Site ID: S00050213484 Project ID:P00050245005 Customer ID: C00050214985 Contract ID: 20160721-3 WORK Description Quantity Location Install 2•Thermal Barrier Polyiso On Open Gable Wall 312 Living Space $1,372.80 Insulate Gable Wall With 4"Dense Pack Cellulose 312 Living Space S720.72 Sub Total: $2,093.52 Utility Incentive Share $1,570.14 Customer Conflation $523.38 WARRANTY-.American Installations,LLC will provide the above stated homeowner with a 2 year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL.The above prices,specifications and conditions TOTAL CONTRACT VALUE=$ 523.38 are satisfactory and are hereby accepted. You are authorized to do work as Down Payment $ 523.38 ® 7-21-16 specified.Payment will be 1/3 down prior to start of work,and balance due PAID upon Completion. A) Balance Due Upon Completion=$ 0 Signature ' I ioi " ^" Date 7-21-16 Property Owner(Print) (Sign) Date Representative:(Print) (Sign) Date 7-21-16 de sod Innis carramme Licensed&Insured • www.Americaninstallatians.com MA CSL#. American Installations MA Registration 11175981 -Efficient Home Services- 130 College Street Suite 100,South Hadley,PAW 01075• Office:(413)552-0100 Fax:(013)552-0202 r Email:supporteAmericanlnstaNtious.com AIR SEALING PROPOSAL Tim Obrien 688 Park Hill Rd Lot 4 Florence,MA 01062-9774 Site ID: 500050213484 Project ID: P00050245005 Customer ID:C000502 14985 Contract ID:20160721_ASEAL Description Quantity Location Perform Air SealirI9 at Estimated 625 CFM50 Per Hour 12 Living Space rn_ $1.011.84 Exterior Door Weather Stnpping 3 NM $82.77 Door Sweep 3 N/A $69.54 Sub Total: $1,169.15 Utility Incentive Share $1,164.15 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 are satisfactory and are hereby accepted You are authorized to do work as 0 specified Payment will be 1/3 down prior to start of work,and balance due Oown Payment=$ ❑ PAID upon Completion. /r/(��. BBaalanncce Ove Upon Completion=$ 0 Signature / "fut'I/—'0 ///� i Date 7-21-16 Property Owner(Print) (Sign) Date Yrnr' Representative:((print) Digo Date 7-21-16 TH is AGREEMENT is COMPOSED OF THIS PAGE AND THE REVERSE SIDE of THIS PAGE AND SHALL Be CONSIDERED ME PARTIES iuvaavep.m AM LLC HEREINMTEE REFERS mTO AS COMPANY-.AND THE MERlsl NAMED AOVE.SEEE'NATER REFERRED TOEAS n ENDEµo wnBESUSIECTTO ALL APPROPRIATE LAWS.REsurnnoxs axDM°Pnix WESOF THE s