35-125 (4) 48 CAHILLANE TER BP-2017-0747
GIS d_ COMMONWEALTH OF MASSACHUSETTS
Map:Bleck:35- 125 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit a BP-2017-0747
Project 4 JS-2017-001241
Est. cost: S2701.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Confit.Class: Contractor: License:
S)se Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sq.ft.): 11456.28 Owner: DROZDAL REGINA M
Zoning: Applicant: AMERICAN INSTALLATIONS LLC
AT: 48 CAHILLANE TER
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON::12/2/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:ATTIC & BASEMENT INSULATION & AIR
SEALING THROUGHOUT
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring R.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House it Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: 6l: 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 12/220160:00:00 $65.00
212 Main Street,Phone(413)587-1240,Far:(413)587-1272
Louis 1{asbrouck—Building Commissioner
File#BP-2017-0747
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LI,C
ADDRESSIPHONE 130 COLLEGE ST SOUTH H,ADLEY (413)552-0200
PROPERTY 1,0CATION 48 CAHILLANE TER
MAP 35 PARCEL 125 001 ZONE
THIS SEC.'ION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILI ED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction ATTIC& :A$ v ' ' TINSULATION&AIR SEALING THROUGHOUT
New Construction
Non Structural interior renovations
Addition to Existing.
AccessoraStructure
Bnildin¢Plans l�,luded:
Owner/Statement or License 106178
3 sets of Plans/Plot Plan
THE FOLLO ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION 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
„r// —2/I
Signature of Building Official 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 MOL 40&Contact Office of
Planning&Development for more information.
16-1085
/ _ Deparbnent use ordr
City of Northampton Status of Permit;
!Building Department Curb CWOrNewav Permit
((' ;It /�/ 212 Main Street Sewxrt epst-Avaitabil'rty
// ' ROOM 100 Water/yYeft Avalehility_
�/ pton,Fax
1 -4 W at sats lans hnit Plans
phone 413-587-1240 Fax 413-587-1272 PTagsite Plens
o' 9Uner.Spesi(y -
LIGATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH AONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 property Address: This section to be completed by office
48 Cahillane Terrace Florence,MA 01062 Map Lot unit.
Zone Overlay District
Elm St.District CS DIshict, `
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2-1 Owner of Record:
Regina Drozdal-McNally 48 Cahillane Terrace Florence, MA 01062
Name(PM) Current Mailing Address:
(413)575-6967
See attached Telephone
Signature
2.2 Authorized Anent
American Installations 130 College$L Ste 100 South Hadley, MA 01075
Name(Prim) - Current Mailing Address:
American Installations 413-552-0200
Signsese Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
-.-_-
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Bolding $2,701.45 (a)Bufiding Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6) .
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection G
8. Tot8l=(1+2+3+4+5) $2,701.45 Check Number 34i 5 a5_
This Section For Official Use Only
Building Permit Number.
Dat etl:
Signature:
Building Cmmrdssionecrospsctor of BiMdings Date
Section 4. ZONING MI Information Mutt Be Competed.Permit Con Be Denied Due To Ini.,iyte Information
Existing Proposed Required by Zoning
Tbh onion robe Med in by
Building D pnmmt
Lot Size �—
Frontage ) I —.—
Setbacks Front
$jde L:I IRI I L: I RL...J
Rear
Building Height I _iI I
Bldg.Square Footage i I /o I I
Open Space Footage
psi arca infant bids dr Peen I I I I I I
radiM
N of Parking Spaces Lii P ]
n _ _
(wlemeat®s ) — -- -
A. Has a Special PermitNariance/Finding ever been issued for/on the site?
NO 0 DONT KNOW O YFS
IF YES,date issued:)
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES O
IF YES: enter Book
I Page and/or DocumentllI_
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 0 , Date Issued: I '
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 7 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 0 NO O
IF YES,Cin a Northampton Storm Walter Management Permit horn the DPW Is required.
SECTION S.DESCRIPTION OF PROPOSED WORK fchack all applicable)
New House D Addition ❑ Replacement Windows Atteration(si 0 Roofing 0
Or Doors C]
Accessory Bldg. 0 Demolition 0 New Signs [p) Decks IC Siding[pi Other[IN]
Bdaf Desai q�p —....—.— _
Work: Amrtaicdril basr:4gt insulation and air sealing throughout
Alteration ofexisting bedroom V_Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
se.If New house and gr addition to existing housing,complete thefollowing:
a. Use of building:One Family Two Family Other
b. Number of rooms In each famly 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 Woodatoves Number of each
9. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
L 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. Wilt 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
Regina Drozdal-McNally as Owner of the subject
property
herebyeuthorize American Installations
to act on my behalf,in all matins relative to work authorized by this building permit application.
See attached 11/29/I6
nature of Owner Date
', American Installations as Owner/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 pains and penalties of perjury.
American Installations
Print Name
American Installations 11/29/16
Signature of Omer/Agent 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
671-1, ----473-552-0200
Signature o Telephone
9.Re'Istered Home lm•rovem rnt C•ntractor 4 _ Not Applicable 0
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 e.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 AthdavitAttached Yes df No 0
11. -Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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 10835.1.
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 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
City of Northampton
/ Massachusetts a �- '4
ryx
` + DEPARTMENT OF BUILDING INSPECTIONS ..q-
';'s
0 ;D
212 Main Street • Municipal 'Wilding m+,•e
Northampton, W. 61060
Property Address: 48 Cahillane Terrace
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley, MA
Phone: 43-552-0200
Property Owner Regina Drozdal-McNally
8 Y
Address: 48 Cahillane Terrace
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 (f /r'"_'�
141{`AXD6/i R i,ti7
Date It
11/29/16
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MACUM 106178 MA tion# 75982
American Installations MA RegiStration#175982
130 Congo Street Suite 3W,South Xamey.MA Moil•offite:NUM 5520240 7770[413f ssz'ZOz•Emai:wpnrteAmenca*s6Ianomtaro
Drozdal-McNally Regina 11/14/2016
Ta ae
48 Cahillane Terrace Florence MA 01%2
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(413)5736961 ginauvl3@concast,net
m gee)
4118 16-1085
1000001 00,0•
Quantity Unit Unit Cost Total
Aix/Duct Sealing
AIR SEAONG 10 man hour $ 85,00 5 85000
DOOR WEATHERSTRIPPING W/SWEEP 1 each S 75.00 S 7500
Air/Duct Searing $ 92500
Air/Duct Sealing incentive $ (92500)
Air/Duct Soloing WX Balance$ -
Weetherlatlon
HATCH SEAL&INSULATE I each $ 60.00 $ 60.00
DAMMING R-38 _ 110 linear ft $ 2,05 $ 2850
VENTILATION CHUTES _ 72 each $ 200 $ 144.00
FLAT-10"OPEN R-35 700 sqft $ 1.47 $ 3029.00
2"RIGID BOARD 12 sqft 5 3.50 $ 42.00
COMMON WALL-4" 12 soft $ 1.85 $ 22,20
BATH VENT THRU ROOF 1 each $ 118.75 $ 118.75
REMOVE INSULATION 180 sgft $ 0,75 5 135.00
Total Weatherization $ 3776,45
Weatherization Incentive 5 1,23109
Total Project $ Z701A5
Total Utility Contribution $ 2.156.09
Total Customer Contribution $ 545.36
Anwexani"mawnrc.urweM warm m wrnnn elhrrC w.na#w��0a<mm'awm abort rrn;<"euatp"aeomn:ewvemazennr wcwexn,.m SES"d£ to
xwatssrznatm,srame rwl Canvas waive as der,/eerern.
ACCEPTANCE or PROPOSACThe above pans>parifcatons and TOTAL CONTRACT VALUE= $ 545.36
nondrtirrns are ratniscrolyand are hereby You are
authorized to do work is specified.Payment we be 1/3 down prior to Down Payments $ 181.00 ® t1/21/15
stlKatwo'k.end bara0[e due upap Rmpktlan. { PAN
(tj'1AjjV V^AI Cy7Ia j�/ 7( fiance Due Upon Completion= $ 36436
n "I
11/15/16
nen". � 7j tea^.
+.Wyatt" ^Couture CC'— ` V �1/1a/is
THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PACE 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 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 HE MADE IN THE PAYMENT OF THIS AGREEMENT,CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A RATE Of ONE AND ONE-HALF(11/2)
PERCENT PER MONTH.(18%PER ANNUM)WITH A MINIMUM CHARGE OF$2.09 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 ANO/OR LABOR BETWEEN COMPANY AND THIRD PARTY,COMPANY 6 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 POR CLAIMS ARISING OUT OE THIS AGREEMENT SHALL NOT EXCEED THE TOTAL AGREEMENT PRICE EXCEPT TO THE EXTENT THOSE DAMAGES
ARE PROVEN TO BE SOLER DUE TO THE COMPANY'S NEGLIGENCE.
8. DURING THE DURATION OF THE WORK,THE CLIENT'S 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 AND CONNECTIONS, PLUMBING AND VENT PIPES, DECKING DEFLECTION, ETC. IF A PRE-EXISTING
DEFICIENCY OR HAZARDOUS MATERIAL IS ENCOUNTERED PRIOR TO OR DURING CONSTRUCTION,AND COMPANY IS NOTIFIED IN WRITING,COMPANY WILL TRY'10
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 CLIENT 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
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.
1_2, 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.TILE
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 RELAPNG 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 8E IMMATERIAL AND NOT RELIED ON BY
EITHER PARTY,AND DO NOTSURVNE THE EXECUTION OF THIS AGREEMENT,
17.THIS AGREEMENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF 8001 PARTIES EXCEPT AS OTHERWISE SET FORTH HEREIN,
18. 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 DR 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 RASED 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 HELD TO BE INVALID OR UNENFORCABLE,THE VALIDITY AND ENFORCEBNTY OF THE REMAINING PROVISIONS OF
THIS AGREEMENT SNAIL 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 BV THE AMERICAN ARBITRATION
24. ANY DISCOUNT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STATE SPONSERED UTILITY PROGRAM(I.E.MASS SAVE°)IS 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 UTRI Y 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 REPSONSIRI.E FOR THE PAYMENT OF ANY AND ALL FEDERAL,STATE,OR LOCAL TAXES THAT ARE APPLICABLE TO THIS AGREEMENT.
The Commonwealth of Massachusetts
A Department of Industrial Accidents
=3 _:fir Office ofinvestigations
_ � t_ =
s @1,n� q 600 Wraitingion Street
Mlh= _
c.ora—I Boston,MA 02111
. ie. www.nwss.govldia
Workers' Compensation Insurance Affidavit: Builders!Contracture/EleetricianslPlumbers
. Applicant Information _ _ Please Print Legibly
Name(Bnsmessrorganirmionllndividuap: American Installations,LLC
Address: 130 College Street,Suite 100
City/State/Zip: South Hadley,MA 01075 Phone r!: 413-552-0200
l Arc you an employer?Cheek the appropriate box: I Type of project(required):
1 1.K t ant a employer with 31 4. 0 I an:a general contractor and; b. 9 New construction
employees(full and/or pan-time),* have hired the sub-contractors
2.0 I am a sole proprietor or partner- listed on the attached sheet.t ❑ Remodeling
ship and have no employees These sub-contractors have 6. 0 Demolition
working i'hr me in any capacity. workers comp. insurance. 9. 9 Building addition
]No workers'comp.insurance 5. 0 We area corporation and its
i 160 Electrical repairs or additions
required.] officers have exercised their
3.9 I am a homeowner doing all work right of exemption per MOL 11.9 Plumbing repairs or additions
myself.[Nu workers'comp. C. 152.§1(4),and we have no , 12.9 Roof repairs
insurance required]* employees.[No workers' 1 23.M Other Insulation
comp.insurance required] —
........
:gay applicant that checks bhs HI must also fill nnl the suction Fele[shoving their workers'compensation policy information.
I lunicop ours who submit this a ardr'!tindicating they me doing oil work and Bumnine him outsidcoonmust submit n new affidavit truth: um such.
:Contractors Oral check this box must anaehed an addilinwl shca Mowing Ibe came of the sub-contractors and thein rorien"comp.policy infamnrion.
I am an employer that is providing warners'compensation insurance far rim employees. Below lc the polity and jab site
iiformmfon.
Insurance Company Name: Guard Insurance Companies
Policy it or Self-ins.Lie. URWC609917 _ Expiration Date: 09/04/2017 /�
Job Site Address: lit C", '(^U&nt et i w e .. City/StateiZip:_ lot-t 110 1 I p-1\ 0\ a (D2_
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 ofcriminal penalties of
fine up to$I.Sa0.00 and/or one-year imprisonment,as well as civil penalties in the Perm of a STOP WORK ORDER and a fine
of up to S250.00 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.
t do hereby certify tinder the pains and penalties of perjury that the information provided above is true and correct.
Sienatm'e:, •' / r �.l,� Date: 3 \ 112 9 ---
Phone F: 413-552-0200
(;%fcial use only. Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/License d
II� Issuing Authority(circle one): 1.
' I. Hoard of Health 2, Building Department 3.City/Town Clerk 4.Electrical inspector S. Plumbing Inspector
6.Other 1
' Contact Person: Phone N:
ACOREO CERTIFICATE OF LIABILITY INSURANCE DATE/1/209 °6N )
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 b an ADDITIONAL INSURED,the poticy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer tights to the
certificate holder in lieu of such endorsement(s),
PRODUCER COSTA=Linda Powers
NAME:
Webber S Grinnell PINBE , {413)586-0111 1A% .0131566-6ee1
AS
S North Ring Street AppRAA5:1Poweragwehberandgxim5e21.(Tom
, INSURER(S)AFFORDING COVERAGE NAZCA
Northampton MA 01060 stscaeRA:mployers Mutual Casualty
INSURED INSURERBaerkshixe Hathaway GUARD Ins. Co.
American Installations, LLC siSVRER c:
Attn: lies & Suzanne Couture INSURER D:
130 College Street, Suite 100 INSURERE:
South Hadley NA 01075 !INSURER F;
COVERAGES CERTIFICATE NUMBERddaster lisp 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.
Ism, CY EXP
TYPE OF INSURANCE I mylt IS*ID POLICY NUMBER IMWODPCC IMWPOUCY Ern IDGYYWI LIMITS
COMMERCIAL GENERAL LIABILITY EACH OWU9REM.E^ 5 1,000,000
A A CWMSMADE ,OCCUR PREMISES(Ea oc r6ryA1 $ 500,000
A Liquor Liability 5D3535217 9/4/2016 9/4/2017 MED EXP(Any one Room) 5 10,000
_
PERSONAL BADV INJURY 5 1,000,000
DEN_AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000
X PI:CY ]JESOT LOC PRODUCTS-COMP/OPMSG s 2,000,000
ON R' S
AUTOMOBILE LIABanT,^DY J TOMBINEDSINGLE TWIN $ 1,000,000
TEA accident)
A ANY AUTO BODILY INJURY(Per peon) S
ALLO' IEU K SCHEDULED 503535211 9/4)2016 9/4/2017 BODILY INJURY(Per oxide* S
AUTOX 58REO AUTOS _ t� PROPERTY PARADE S
AUTOS tar/robot
ERBssc 5 8,000
X UMBRELLA UAB OCCUR EACH OCCURRENCE 5 1 000.000
A EXCESS LIAR CLAM-MADE AGGREGATE $ 1,000,000
CEO I RETENTIONS 10,000 503535211 9/4/2016 9/4/2017 j 5
WORKERSCOMPENSATIN .PER DTH.
AND EMPLOYERWUA UTY YIN x STATUTE FR
AW FRCPRIETLRMARINER,EXECUTIVE E.L.EACH ACCIDENT S 500,000.
B (Mandatory In NR E%CMJOEDt n NIA DRI4C609919 9/4/2018 9/4/2011 E.L.DISEASE-EA EMPLOYEE 5 500,000
Miradesa�OMp .•...
DESCRIPTION OF OPEFAI1ONS Mow EL DISEASE.POLICY MMR S 500,000
A COamaercial Property 5.62533217 9/412016 9/4/2017 caturob S_CM $20,000
dedu2Ne51000 Soo,000
DESCRIPTOR OF OPERATORS:LOCATIONS I VEHICLES (ACORD 1a5,Additional Remarks Schedule,may be attached It mon space Is teauiwd)
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.
AUTHORIZED REPRESENTAtNE
Kevin Joyce/LMP '',.:
®1988-2014ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS02S omen
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Massachusetts-Department of Public Safety 1 Unrestricted-Buildings of any use group wbidf
Board of Building Regulations and Standards contain less than 35,000 cubic feet(991m3)of 1
Cnrutrnctinn Supervisor MIE ®
License: CS-106178 enclosed . 4
ssrnls 6,.
WESLEY COU'rga . i• -'e I
166 NOR1HMAIIF
South Hadley MAT-01
'p Failure to possess a current edition of the Massachusetts
r l' .StateBBuilding Code is cause for revocation of this license. I
fa.-rnls6fn ..311 s Expiration
Commissioner 09/29/2017 For OPS Llomsingmformaston visit www.Masseov/DP6
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I moi - L / I i i - ./4.
: — c„. Office of Consumer Affairs and Busi- ss Regrlation
e c 1- 10 Park Plaza- Suite 5170
Boston,Massac}i efts 02116
Home Improvement Ckicatig.4or Registration
---- --_- Registration: 175982
^ _"
Type LLC
1L ' I s Expiration: 6/27/2017 Ti0 265208
AMERICAN INSTALLATIONS, LLC _ ,3,,
WESLEY COUTURE '`-
130COLLEGE STREET SUITE 100 _ -' 'f , p,,
SOUTH HADLEY, MA 01075 = -=- L'i
Update Address and return card.Mark reason for change.
sem 0 ,,, 0 Address Q Renewal 0 Employment 0 Lost Card
e C m,motuaea/1 oilb&SIacLad&
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
gist
otion: '•i75982 Type: Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
pimtlon:`6l123iap1r LLC
_:_- =i_ 2 Boston,MA 02116
AMERICAN INSTAL4: 71IpNS,$t ;
WESLEY3COUTURE.E _ `/
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130 COLLEGE STREE'TSIiLTE1p0 . 6//tA///
SOUTH HADLEY,MA 01075— ' 71/
Undersecretary N valid without signature