11A-055 (2) 17 VILLONE DR BP-2017-0526
GIs : COMMONWEALTH OF MASSACHUSETTS
Map:Block: 11A-055 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-2017-0526
Project 5 JS-2017-000857
Est. Cost: $1866.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sq. ft.): 26920.08 Owner: FOSTER DAVID P& DIANNE M
Zoning: URA(100)/ Applicant: AMERICAN INSTALLATIONS LLC
AT: 17 VILLONE DR
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON:10/192016 0:00:00
TO PERFORM THE FOLLOWING WORK:ATTIC & BASEMENT INSULATION & AR
SEALING THROUGHOUT
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 k 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:
•
FeeTvpe: Date Paid: Amount:
Building 10/19/20160:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0526
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200
PROPERTY LOCATION 17 VILLONE DR
MAP 11A PARCEL 055 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT ,/ it
Fee Paid LI
Building Permit Filled out \
Fee Paid
Tvpeof Construction: ATTIC& BASEMENT INSULATION&AIR SEALING THROUGHOUT
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
INFQRMATION PRESENTED:
sr"-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
•- o " av
„or
-i c /rl
re of: i din fficial 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.
.-- 16-1682
�Cse.UV\ Depad mernusoay
9(\ 'City of Northampton sm(uco( ?army
Building Department Q6D Gid+D elvay Ppirat ,
/ 212 Main Street Bev4ilsep�cgyapabntty
Room 100 Gver4rMW IIAVaIIAb i}y
Northampton, MA 01060 Tw9 bets oesaiICIWtrelans_
phone 413-587-1240 Fax 413-587-1272 PIgt+Bge P,larm
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DIYELLNG
SECTION 1-SIE WIFORMATION
1.1 Property Address: This section to be completed by office
27 Villone Drive Leeds,MA 01053 Mai Lot IME.
Zone Overlay DRsttint
Dm St.Dktdct -,_ CB Dadriat
SECTION 2-PROPERTY OWNERSHIPIAUTHOR®AGENT
2.1 Owner of Record:
David d Dianne Foster 17 Villone Drive Leeds,MA 01053
Name OMNI Current
4aim Ad
13}
See attached Telephcoe
sipnan
22 Authorized Aoaot,
American Installations 130 College St, Ste 100 South Hadley,MA 01075
Name print) Corret Malang Address:
American Installations 413-552-0200
Signature Telephone
SECTION$-ESTIMATED CONSTRUCTION COST'.
Item Estimated Cost(Dollars}to be Oltdat Use Only
completed by permit applicant
1. Blddhm $1,866.90 (a)Building Permit Fee
2. Sectrkai (b)Esamtded Total Cost of
Construction torn(8)
3. PlumbIng Building Peek Fee
4. Mechanical(HVAC)
5.Fire Protection
8. Tolotm(1+2+3+4+5) $1,866.90 Check Number 3,59, (.t
Thls Section Far Official Use Only (�
Date
&Adam Permit Number. Issued:
Signature:
BuMhgCamNadmlwMapeda of Sultanas Date
Section 4. ZONING All Information Must Be completed.Permit can Be Dented Due To Incomplete Information
Existing Proposed Required by Zoning
This cow=to be filled in by
Bunts Department
Lot Size
Frontage I II
Setbacks Front
Side L: IRI I L: 1 Rk! I F-1
Rear I
Building Height 1 II
Bldg.Square Footage % I
Dia Space Footagei I %
Parkin)
R of Parking Spaces I I
(volume&Loudon) - - + ---
A. Has a Special Pemdt/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES,date Issued:I
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 Y6 O
IF YES: enter Books I Page and/or Document#L
B. Does the site contain a brook,body of water or wetlands? NO 0 DONT KNOW 0 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 0
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:
E. Will the consbuclon activity disturb(clearing,grading.excavation,orfilling)over 1 acre or is It pat of a common plan
that will disturb over l acre? YES 0 NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
RECTION 5-DESCRIPTION OF PROPOSED WORK Mack all aodlcabte)
New Howe ❑ addition 0 Replacement Windows Attention(*) ❑ Roofing 0
Or Doors 0
Accessory Bldg. ❑ Demolmbn ❑ New Signa E7] Deck. 10 Siding ID) Other fill
Boer
Wart Atm nuc ana
asemenl insulation and air sealing throughout
Atbanen of a helm bedroom Yee No Addbg new badman Yes _No
Attached Narrative Renovating unfinished basement _Yea No
Plans Attached Rot -Sled
tie.If New house and or addition toexisting housing.complete the:following:
a. LAe d WNW:One Ferny Tea Ferny Other
b. Number of mono n each Sarney unit Number of Bathrooms
c b then a grange etttdedl
d. Proposed Strums footage of row construction. Dimensions
e. Number of abodes?
f. Method of haring? Fireplaces a Woodstoves Number of each
g. Enemy Coreenettin Comptenca. Massdwdc Enwgy Compliance loon attached?
A Type of construction
I. Is awnbuction within 100 ft.of wetlands? Yes No. Ii construction within 100 yr. floodplain_Yes No
J. Depth of basement a oder floor below Meshed glade
t
WE building conform to the Building mid Zoning regulation? Yes_No.
I. 5epticTank_ Cry Sawn_ Private wet^ City water Supgy_
SECTION 7e•OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, David d Dianne Foster as Oeear of the-lathes
entherly
heathy sulfate American Installations
b act on my belW/In al molten olefin b work eufaimd by die building penal mouth:etba
See attached 10/11/2016
RQetee d Owner Date
I. American Installations as OwnerlNMorimd
Agent hereby declare that the mebnwrRs and kaarretioi on the fatgolng application me the end accent,to the best of my krwwtdge
and belief.
Signed under the pens and psrSttea deeded.
American Installations
Pmt Nemo
American Installations 10/11/2016
SgNat of OaIftQ lit Cels
SECTION 8-CONSTRUCTION SERVICES
8.1 licensed Construction Supervisor: Not Applicable 0
Name of License Nobler: Wesley K. Couture 106178
Demise Number
130 College St., Ste 100 South Hadley,MA 01075 9/29/17
Address Expiration Data
tA/ y k. CGI.I_c.a13-5s2-o2o0
SignatureJ TmwMne
9.Registered Home Improvement Contractor. - _ Not Applicable 0
Wesley Couture 175982
Company Name Regis-batten 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.0.152,§25C(e))
Workers Compensation insurance affidavit must be completed and submted with this application.Failure to provide this affidavit MI result
In the denial of the Issuance of the building permit.
Signed Affidavit Attached Yes_.._.
11.-Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)halls
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.
pefnftion 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 considers 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 ft which this permit is issued.
Also be advised that withreference 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 forperson(s)
you hire to polio=work for you under this permit.
The undersigned"homeowneC 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
City of Northampton
Massachusetts r-
rNPARffiri OF a•ILDING INSPECTIONS S.- '0
si 212 Main rtrist • Municipal Building �
_ Nuithapten, W 01060
Property Address: 17 Villone Drive Leeds, MA 01053
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley,MA
Phone: 43-552-0200
Property Owner
Name: David d Dianne Foster
Address: 17 Villone Drive
City, State: Leeds,MA 01053
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.
Contractgr sigflature
Ul-U4e(.1_ K
Date O
10/11/2016
com
we f q ww...Amen Licenstallaaonsured
• BBB. ! �
•antra. 1111 MA sed CSL
g1Ourea
essew
MA CSL M 175982
I♦ 6178
MA Registration It 175981
American Installations
130 College Street Suite 100,South Hadley.MA01075 •Office:(4133 55E-0200 Fax:OUP 55x-0202 •(mai:wppwr@4m.bnbRawtors cit
Foster,David&Dianne 10/5/2016
12 Villone Drive Leeds MA 01053
rn ww m
413-584-3035 413-320-7408 dfoster413Maolcore
438889 Iran Iwl
16-1681
wow emsQuantity Unit Unit Cost Total
Mr/Duct Sealing
AIR SEALING 6 man hour $ 85.00 $ 510.00
Air/Duct Sealing $ 510.00
Air/Duct Sealing Incentive $ (51000)
Air/Duct Seising WX Balance $ -
Weatherization
CRAWLSPACE WALL RIO RIGID INSL 50 soft $ 3.70 185.00
HATCH SEAL&INSULATE 1 each 5 60.00 60.00
INSULATED EXHAUST HOSE 1 each $ 50.00 50.00
VENTILATION CHUTES 55 each $ 2.00 110.00
DAMMING R-38 90 linear ft $ 2.05 184.50
FLAT-6"OPEN R-21 490 sgft $ 1,26 612.40
REMOVE INSULATION 200 soft $ 0.75 $ 150.00
Total Weatherization 5 1,356.90
Weatherization Incentive $ 905.18
Total Project $ 1,866.90
Total Utility Contribution $ 1,415.18
Total Customer Contribution $ 451.73
WARRANTY:American Installations,uC ww p rosde lie above stated homeowner mesa 2year workmanship warranty.
American Installations.LAC hereby proposes to furnish all material and labra rto complete the ahem scope of work in accordance with the above specifications and all Meal and state
building regola tom for Me Total Contract Value as stated herein.
ACCEPTANCE OF PROPOSAL:The above prices,specifications and TOTAL CONTRACT VALUE= $ 451.73
conditions are satisfactory and are hereby acceptedyou are
authorized to do work asspeaned.Payment will be 1/3 down prior Down Payment= $ 150.00 a 10.616
to start of work,and balance due upon Completion. PAID
Balance Due Upon Completion= $ 301.73
sn+wr ,�a �•Mi {71;:%.
71;: we 10.5.16
n Fm> »I 10-5-16
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 YOMPANW,AND THE CUSTOMER(S)NAMED ON THE REVERSE SIDE,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.
THE FOLLOWING TERMS AND CONDITIONS ALSO APPLY
1.THIS AGREEMENT IS SUBJECT TO THE APPROVAL OF A MANAGER OF THE COMPANY FOR THIS AGREEMENT TO BE EFFECTIVE UNDER ANY CONDITION.
2,SHOULD DEFAULT BE MADE IN THE PAYMENT OF THIS AGREEMENT,CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A RATE OF ONE AND ONE-HALF(1-1/2)PERCENT
PER MONTH. (18%PER ANNUM) WITH A MINIMUM CHARGE OF$2.00 PER MONTH,AND IF PLACED IN THE HANDS OF AN ATTORNEY OR COLLECTION AGENCY FOR
COLLECTION,ALL ATTORNEYS'FEES,EXPENSES AND COSTS OF COLLECTION SHALL BE PAID BY THE CLIENT.IN ADDITION,CLIENT UNDERSTANDS THAT IN FAILING TO PAY
ACCORDING TO THE ABOVE TERMS,COMPANY MAY HAVE THE RIGHT TO A LEIN ON THE PROPERTY.
3.THE COMPANY AGREES THAT WHEN DELAYS BECOME KNOWN TO THE COMPANY,THE COMPANY WILL ADVISE THE CLIENT AS SOON AS REASONABLE.
4. COMPANY AGREES THAT,NOTWITHSTANDING ANY AGREEMENT FOR MATERIALS AND/OR LABOR BETWEEN COMPANY AND THIRD PARTY,COMPANY IS RESPONSIBLE TO
CLIENT FOR COMPLETION OF ALL WORK DESCRIBED IN A TIMELY AND WORKMANLIKE MANNER.
5.ALL WARRANTIES FOR EQUIPMENT AND PRODUCTS SUPPLIED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BY THE MANUFACTURERS OF SUCH
EQUIPMENT AND PRODUCTS. UNDER SUCH MANUFACTURER'S WARRANTIES,THE CLIENT MAY BE REQUIRED TO REGISTER OR MAIL IN A WARRANTY CARD OR OTHER
EVIDENCE OF OWNERSHIP AND USE OF SUCH EQUIPMENT AND/OR PRODUCTS IN ORDER TO ACTIVATE SUCH WARRANTIES.
6.THE QUOTATION ON THE PAGE HEREOF DOES NOT INCLUDE EXPENSES OR CHARGES FOR BOND OR INSURANCE PREMIUMS OR COSTS BEYOND NORMAL INSURANCE
COVERAGE,ANY SUCH ADDITIONAL EXPENSES,PREMIUMS OR COST SHALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT.
7.THE COMPANY'S LIABILITY FOR CLAIMS ARISING OUT OF THIS AGREEMENT SHALL NOT EXCEED THE TOTAL AGREEMENT PRICE EXCEPT TO THE EXTENT THOSE DAMAGES ARE
PROVEN t0 BE SOLEY DUE TO THE COMPANY'S NEGUGENCE.
8, DURING THE DURATION OF THE WORK,THE CLIENTS HOMEOWNERS INSURANCE WILL BE RESPONSIBLE FOR ANY AND ALL DAMAGES AS LONG AS THE COMPANY HAS TAKEN
THE APPROPRIATE ACTION TO PROTECT AREAS OF WORK.
9.THE COMPANY IS NOT RESPONSIBLE FOR PREEXISTING DEFICIENCIES OR HAZARDOUS MATERIALS THAT MANIFEST THEMSELVES DURING THE CONSTRUCTION PROCESS.E.G.
WOOD ROT,MOLD,ASBESTOS,NAIL POPS,DUCTWORK ANO CONNECTIONS, PLUMBING AND VENT PIPES.DECKING DEFLECTION,ETC,IF A PREEXISTING DEFICIENCY OR
HAZARDOUS MATERIAL IS ENCOUNTERED PRIOR TO OR DURING CONSTRUCTION,AND COMPANY IS NOTIFIED IN WRITING,COMPANY WILL TRY TO ASSIST CLIENT WITHIN
THE COMPANY'S MEANS AND CAPABILITIES TO CORRECT THE PROBLEM(S)ON A TIME AND MATERIAL BASIS.CLIENT AGREES THAT SUCH CONDITIONS ARE UNAVOIDABLE BY
THE COMPANY AND SHALL NOT BE CONSIDERED A VIOLATION OF THE AGREEMENT AND THAT DUE TO THESE CONDITIONS THE DURATION OF THE WORK AND SCHEDULED
DATE OF COMPLETION MAY DIFFER FROM THAT AGREED UPON,IF APPLICABLE,UNDER THIS AGREEMENT.
10.THE COMPANY IS NOT RESPONSIBLE,AND THE CUENT AGREES TO HOLD THE COMPANY HARMLESS.FOR ANY PROBLEMS AND/OR DAMAGES,INLCUDING BUT NOT LIMITED
TO MOLD GROWTH,ARISING FROM THE PERFORMANCE OF AIR SEALING WORK BY THE COMPANY AS A RESULT OF ANY KNOWN OR UNKNOWN MOISTURE CONDITIONS.
11,THE COMPANY IS NOT RESPONSIBLE FOR.AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES RELATING TO ICE DAMMING
THAT MAY ARISE DURING AND/OR AFTER THE PERFORMANCE OF WORK BY THE COMPANY.
12 REPLACEMENT OF DETERIORATED DECKING, FASCIA BOARDS, ROOF JACKS, VENTILATORS, FLASHING, RAFTERS, JOISTS, INSULATION OR OTHER MATERIALS ARE NOT
INCLUDED UNLESS OTHERWISE NOTED HEREIN.
13.THE COMPANY WILL NOT BE RESPONSIBLE FOR THE SCRATCHING OR DENTING OF INTERIOR WALLS AND CEILINGS,FLOORS,TRIM,GUTTERS,DOWNSPOUTS,EXISTING SIDING
AND WINDOWS,DOORS,OIL DROPLETS IN DRIVEWAYS,HAIRLINE FRACTURES IN CONCRETE OR BLACKTOP DRIVES AND WALKS,OR DAMAGE TO PLANTS OR SHRUBBERY.IF
EXCESSIVE DAMAGE IS CAUSED BY COMPANY,COMPANY WILL REPAIR OR REPLACE DAMAGED AREA ONLY AT COMPANY'S EXPENSE.
14.THE COMPANY UNDER PROVISIONS OF CHAPTER 142A OF THE GENERAL LAWS IS REQUIRED TO APPLY FOR AND OBTAIN ALL CONSTRUCTION-RELATED PERMITS,THE
COMPANY SHALL NOT BE DEEMED RESPONSIBLE FOR DELAYS IN THE WORK DESCRIBED IN THIS AGREEMENT CAUSED BY REGULATORY PERMIT GRANTING OR INSPECTIONAL
AGENCIES,AUTHORITIES,OR INDIVIDUALS.
15.THIS AGREEMENT,INCLUDING THE PROVISIONS RELATING TO PRICE AND PAYMENT SCHEDULE,CANNOT BE CHANGED OR ALTERED EXCEPT BY A WRITTEN STATEMENT
SIGNED BY BOTH THE COMPANY AND THE CLIENT,
16.ANY REPRESENTATIONS,STATEMENTS,OR OTHER COMMUNICATION NOT WRITTEN ON THIS AGREEMENT ARE AGREED TO BE IMMATERIAL AND NOT RELIED ON BY EITHER
PARTY,AND DO NOT SURVIVE THE EXECUTION OF THIS AGREEMENT.
17.THIS AGREEMENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF BOTH PARTIES EXCEPT AS OTHERWISE SET FORTH HEREIN,
10.THIS AGREEMENT,AND ANY WARRANTY(S)PROVIDED HEREUNDER SHALL NOT BE ASSIGNED EXCEPT BY OR WITH THE WRITTEN PERMISSION OF THE COMPANY.
19, IF THE CLIENT FAILS TO PERFORM ITS OBLIGATIONS HEREUNDER OR TERMINATES THIS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY,THE CLIENT
SHALL BE LIABLE FOR DAMAGES FOR THE GREATER OF THE COMPANY'S ACTUAL DAMAGES OR 25%OF THE AGREEMENT FOR RESTOCKING FEE.
20 ANY CHANGES TO MATERIALS BY THE CLIENT(BRAND,STYLE,COLOR,ETC.)AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TO THE CLIENT COULD RESULT IN A
5%RE-STOCKING FEE BASED ON THE COST OF SAID MATERIALS.
21.THIS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ITS EXECUTION BY ALL PARTIES HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL.THE COMPANY
RESERVES THE RIGHT TO REVOKE THIS PROPOSAL 90 DAYS FROM DATE IT IS EXECUTED BY THE COMPANY IF IT IS NOT EARLIER EXECUTED BY THE CLIENT AND THE REQUIRED
DOWN PAYMENT RECEIVED PRIOR TO THE EXPIRATION OF SUCH 90 DAY PERIOD;AFTER 90 DAYS,AND IN THE EVENT COMPANY DOES NOT REVOKE THE PROPOSAL.
COMPANY RESERVES THE RIGHT TO REVISE ITS PRICE IN ACCORDANCE WITH ITS COSTS IN EFFECT AT SUCH TIME,
22. IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HEN TO BE INVALID OR UNENFORCABLE,THE VALIDITY AND ENFORCEBILITY OF THE REMAINING PROVISIONS OF THIS
AGREEMENT SHALL NOT BE AFFECTED THEREBY.
23.ARBITRATION'. IN THE EVENT THE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OF THE TERMS, CONDITIONS, PROVISIONS, OR PERFORMANCE OF THIS
AGREEMENT. THE PARTIES AGREE TO PLACE THE MATTER INTO ARBITRATION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION
ASSOCIATION TO RESOLVE THEIR DISPUTE.
24.ANY DISCOUNT, PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STATE SPONSERED UTILITY PROGRAM(I.E.MASS SAVE )15 SUBJECT TO THE
AVAILABILITY OF QUALIFYING STATE SPONSERED PROGRAM AND WILL BE SUBJECT TO TERMINATION IF THE STATE SPONSERED UTILITY PROGRAM IS DISCOUNTINUED.
FURTHERMORE,THE TERMS AND CONDITIONS OF STATE SPONSERED UTILITY PROGRAMS MAY BE ALTERED OR UPDATED PERIODICALLY WITH OR WITHOUT NOTICE.
25.AMERICAN INSTALLERS,LLC IS NOT AN AGENT OF ANY UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDER THE MASS SAVE ENERGY PROGRAM.
26.CLIENT IS REPSONSIBLE FOR THE PAYMENT OF ANY AND ALL FEDERAL,STATE.OR LOCAL TMES THAT ARE APPLICABLE TO THIS AGREEMENT.
The Cornnronweath of Massachusetts
Department of IndustrialAccidents
'k!= Office of Investigations
=1
*-- 600 Washington Street
�`_'- Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/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#: 413-552-0200
Are you an employer?Check the appropriate box: Type of project(required): 1
L rij i am a employer with 31....... ._ 4. CJI am a general contractor and t h. ❑New.u,stru lion
employees(Full andfor part-time).' have hired the sub-contractors I
2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7. C] Remodeling
ship and have no employees These sub-contractors have 8. [7 Demolition
working for me in any capacity. workers'comp. insurance, 9 n Building addition
filo workers comp.insurance 5_ ❑ We are a corporation and its 7 [CA Electrical repairs or additions
required.) officers have exercised their
3_D lam a homeowner doing all work right of exemption per MGG I I.L1 Plumbing repairs or additions
myself [No workers'comp. c. 152,§I(4),and we have no I I2T] Roof repairs
insurance required.)t employees. [No workers' 73 Other Insulation
romp.insurance requital.],-.J .
'Any applicant that check box kl must also 1II ounhe'Lmon below showing their workers'compensation policy inlbnnalmn.
t Iiomeowners who.subma this affidavit indicating they are doing all work nod Ihea hire outside contractors muss submit a new affidavit indicating sudr,
'Contractors that check this box must attached an additional shed showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my enlpioyeec Below Is the polity and job she
information.
Insurance Company Name: Guard Insurance Companies
Policy Y or Self-ins. Lit.#: jAMWC7311485 _ expiration Date:
09/04/2017
ic1/231
_ p� z
rob Site Address: I V14b11 K., Dj`1 e _Cih75Eate/Zip:... L.Q..(iF ri.F� 0\055
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 c. 152 can lead to the imposition of criminal penalties ofa
fox up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a fine
of up to$250.00 a Say against the violater. Be advised that a copy of this statement may he forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Pito hereby cenify under the pains and penalties rof perjury that the information provided above is true and correct
Siznatwe/art. '`L (!#W Z 5L_ Date: \S{_tyl�,..
Phone
/art
'C
l Uncial use only. Do not write in this area,to be completed by et or town official.
City or Town: Permit/License it _
t Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
ACORn CERTIFICATE OF LIABILITY INSURANCE DAAIMMDDT I
kruec---i' 9/1/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policypes)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require en endorsement A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER CONTACT Linda Powers
MN:
Webber b Grinnell PWC
Dx o Fm (413)586-0111 MVC Nc4 1413)506-64n
8 North King Street EAUDMA Ss 1powersewebberandgrinnell.corn
INSURER(S)AFFORDING COVERAGE N>ICit
Northampton MA 01060 - xsURERA Employers Mutual Casualty _
INSURED INSURER R9erkshire Hathaway GUARD Ins. Co.
American Installations, LLC INSURER c:
Attn: Wes & Suzanne Couture INSURER 0: _
130 College Street, Suite 100 teSURERE
South Hadley Ia 01075 INSURERF
COVERAGES CERTIFICATE NUMBER*Maeter Exp 9-2017 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
b
LIR
._- TYPE OF INSURANCEe
AD0LiM]BR. POLICY EF - POLICY EIIp
. VO. POLICY NUMBER I IMMIDIVYYYYI IMMiDDIGTY11 LIMITS
I COMMEROAL GENERAL LIABILITY i i I EACH OCCURRENCE i 1,000,000
A X CLAIMSMADE [I OCCUR DAMAGE TO RENTED 500,000
•
PREMISES(Ea muP on)
X Liquor Liability . 50353521? , 9/4/2016 9/4/2017 MED EXP IMy w person)_L 10,000
-__
__,,.. PERSONAL&ADV INJURY 1,000,000
•
GEN'L AGGREGATE LIMIT APPLIES PER. • GENERAL AGGREGATE 2,000,000
! i PI POLICY— JJECOT- LOC
PRODUCTS-COMP/OP AGO 2,000,000
OTHER: •
IAUTOMOEILEUAMIRY COMBINED SINGLE UMIT 1,000,000
1- , •
(Ea amaeno
A ANY AUTO BODILY INJURY Per person)
ALL OWNEDSCHEDULED
UTO$ A CN-O 543535217 9/4/2016 9/4/2017 BODILY INJURY per avltlen)
X HIRED AUTOS A 'AUTOS AUTOS FO PROPERIN DAMAGE
I(Per accident' _ 1
PIP-Basic 8,000
%I UMBRELLA LIAR I__I OCCUR EACHOCCURRENCE IS 1,000,000
A ', EXCESS LAB iCLAIMSMADe AGGREGATE IS 1,000,000
T
'DED I A RETENTIONS 10,000 533535217 9/4/2016 9/4/2017 IS
WORKERSCOMPENSAT°N I x PER DTH.
:AND EMPLOYERS'IJA uTy Y/N STATUTE R.
ANY PROPRIETOR/PARTNER/EXECUTIVE II E�L.EACH ACCIDENT S 500,000
B Mandator,ill NH)
'J NIA FDL DISEASE-EA EMPLOYES S 500,000_
OFFCEwryln ORIlC609917 9/4/2016 9/4/2017 r
!O n f
anC
IOEWRIPiN)N OF OPERATIONS below EL DSEASE-POLICY OMIT 1$ 500,000
A i Commercial Property SA3535217 9/4/2016 9/4/2017 I deductte 21.000 020,000
ded,nlcwSl am $40,000
DESCRIPTION OF OPERATIONS/L0CAnpls rVERIOES(ACORD 101,Addtonal Rmur4F Sche le.may be attached N mere space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS-
AUTNOWZED REPRESENTATIVE
Kevin Joyce/LHP L
(01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014)01) The ACORD name and logo are registered marks of ACORD
INS026 enr40n
irMassachusetts-Department of Public Safety Unrestricted-Buildings of any use group which
Board of Building Regulations and Standards contain less than 35,000 cubic feet(991m1)of
Construction Supervisor Nile enclosed space.
License: CS-106178
WESLEY COU'FUJFE S
166 NORTH MAIWS F -1
South Hadley M.Y Ole -
VFailure to possess a current edition of the Massachusetts
'I a *-
State Building Code is cause tor revocation of this license.
92........2f--4..."'s Expiration
Commissioner 09/29/2017 For DOS Licensing inhumation visit wwwmass.vov/Ovs
@97k Vonen o4uoecrr/ t i i7/7aao du6d4
z Office of Consumer Affairs and Busi- ss Reg-lation
SI 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
- Registration: 175982
Type: LLC
Expiration: 6/27/2017 TO 265206
AMERICAN INSTALLATIONS, LLC
WESLEY COUTURE
130 COLLEGE STREET SUITE 100
SOUTH HADLEY, MA 01075
Update Address and return card.Mark reason for change.
stn, 0 zan:osm 0 Address ❑ Renewal ❑ Employment 0 Lost Card
n%Ge - et //4,inif.. .heew
Office rConsum Affairs&Business Regulation License or registration valid for individul use only
51 ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
iseraaon: 175982
9 Type: Office of Consumer Affairs and Business Regulation
Expiation: .6([1/2017 LLC 10 Park Plata-Suite 5190
Boston,MA 02116
AMERICAN INSTALLATIONS,LLO
WESLEY COUTURE
130 COLLEGE STREET SUITE ix :,a..�rte„
. it ii 154— /(^/G,/
SOUTH HADLEY,MA 01075_; Undemecretary - - N valid without signature