18C-138 99 BLACKBERRY LN BP-2017-0966
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C - 138 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-2017-0966
Project# JS-2017-001667
Est.Cost: $4930.70
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Grouo AMERICAN INSTALLATIONS LLC 106178
Lot Size(sq. ft.): 14984.64 Owner: FLEISHER ISAAC&NAOMI
Zoning: URB(100)/ Applicant: AMERICAN INSTALLATIONS LLC
AT: 99 BLACKBERRY LN
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON:2/24/2017 0:00:00
TO PERFORM THE FOLLOWING WORK ATTIC AND BASEMENT INSULATION &AIR
SEALING THROUGHOUT
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Numbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House ft 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:
FeeTvDe: Date Paid: Amount:
Building 2/24/2017 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File H BP-2017-0966
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200
PROPERTY LOCATION 99 BLACKBERRY LN
MAP 18C PARCEL 138 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid ii,(16
Building Permit Filled out
Fee Paid
Tvpeof Construction: ATTIC AND 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
INFORMATION PRESENTED:
knlcgaroved 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
j/
D14I
400 -deo,
Signa ere of Building 0 meal 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.
qp 17-0432
Deparbnent Use only
,-- City of Northampton Status of Permit
Building Department Com,GWOtirexey PemuT
r el,% 212 Main Street Sewer/$epticAvailabaily _
FF-� Room 100 WetelWell Availability.
Northampton, MA 01060 Two bets of struoturaPlans
phone 413-587.1240 Fax 413-587-1272 Pbt+$IfePans '
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
99 Blackberry Lane Map Lot Una.
Northampton,MA 01060
Zone Overlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT J
2.1 Owner of Record:
Isaac er Naomi Fleisher 99 Blackberry Lane Northampton, MA 01060
Name(Pant) Current Mailing Address:
(914)584-0037
See attached Telephone
Signature
2.2 Authorized Agent
American Installations 130 College St.,Ste I00 South Hadley,MA 01075
Name(Pent) Current Mawr Add..an.
American Installations 413-552-0200
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
item Estimated Cost(Dollars)to be Official Use Only
completed by penny applicant
1. Building (a)Building Permit Fee
$4,930.70
2 Electrical (b)Fsiunrdod Total Cost of
Construction from(6)
3. PlumMng Building Permit Fee
-
4. Mechanical(HVAC)
5.Fre Protection + ,�y/
6. Totale(1+2+3+4+5) $4,930.70 Check Number 3 1} 7 & r+`t'Jl5
This Section For Official Use Only
Building Permit Number Date
Issued:
Signature:
Building CommIssionedinspector of Buildings Date
Section 4. ZONING AU Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be fined in by
Building Deponent
nrat
Lot Size I
Frontage I
Setbacks Front 1
Side L: 1 R_2, L:I_J R I I
Rear j_j II I
Building Height
Bldg.Square Footage _I % Ii I
Open Space Footage
(tot area minas bldg&paved I I I
oad:ing)
g of Parking Spaces r—!
Fill:
(volume&?oration)
A. Has a Special PermitNariance/Finding ever been issued for/on the site?
NO O 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 YES O
IF YES: enter Book ) I Page and/or Document AL
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 O 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 O NO O
IF YES, describe size,type and location:
E. Will the construction activity disturb(clearing,grading, vation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S-DESCRIPTION OF PROPOSED WORK(check all arm icabk)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
AecessoryBldg. D Demolition 0 New Signs lag Decks [9 swing[Di OBcerilf6
Brief Description of proposed
Work: Attic and basement insulation and air sealing throughout
Alteration of exisfing bedroom Yes No Addarg new bedroom Yes No
Attached Narrative Renovating urdmished basement Yes No
Plans Attached Roll -Sheet
the if New house and at addition to existing housing. complete the followinq:
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 newcons6uGian. Dknensimu
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Cayce. Masscheck Energy CJThAlance 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.
I. Septic Tank City Sewer Private well City water Supply
SECTION la OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Isaac d-Naomi Fleisher as Owner oily subject
teacart'
hereby authorize American Installations
to act on my behalf,in all matters relative to work authorized by this building permit application.
See attached 2120117
Signature of Owner Date
American Installations as Owner/Authorized
Agent hereby declare that the statements and Information on the foregoing application am true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties Of perjury.
American Installations
Pin Name
American Installations 2/20/17
Signature of Ovn er/Agent Date
SECTION 8-CONSTRUCTION SERVICES
BA Licensed Consisting.*Supervisor Not Applicable 0
Name of[Jocose Holder: Wesley K. Couture 106178
Licence Number
130 College St.,Ste I00 South Hadley,MA 01075 9134,/17
��as% �'�" /�/;� Exultance Date
(�/{�/// 1 A^t''`�' 1� Car;
signature /I Telephone
n9 Renisteredfotnelmpr yementOontractor. _ Not Applicable 0
Wesley Couture 175982
Comnanv Name Registration Number
American Installations
6/27117
Address Expiration Date
130 College St., Ste 100 South Hadley,MA 01075 Telephone 413-552-0200
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.182,§25C(6)) L�
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 penn8.
Signed AffdavitAttached Yes.._.. ffi No 0
X1. -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. Stub Edition Section 108.3,5,1.
Definition offameowner;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 fano
structures.A person who constructs more than one home In a two-year period shall pot 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 berecquired from time to time,during and upon
completion of the work for which this penitis issued.
Also be advised that with reference to Chapter 152(Workwn�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 foryou under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Buildng Cod%City of
Northampton Ordinances,State and Loral Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature_
City of Northampton
Massachusetts ¢- •�.
nseuerma.r OF BUILDING INSPECTIONS
212 Main Street a Municipal Building V`' ;CD
; "Northampton, NA. 01060 4>-16
Property Address: 99 Blackberry Lane Northampton,MA 01060
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley, MA
Phone: 43-552-0200
Property Owner
Name: Isaac d Naomi Fleisher
Address: 99 Blackberry Lane
City, State: Northampton, MA 01060
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 signtuye V C
//VV . Qbt,J,v
Date
2/20/17
WNW Ammiunlnsed&Insured
BBB. • Licensee&Insured
MA6L #175982
American Installations MA Registration#175982
L30 College sheet Suite 100.South Hadley.MA 01075•Mica:1413)552-0200 Fa:(41315529202• Email:suppart@gmerlanInmlhtlons.com
Fleisher,Isaac&Naomi 2/16/2017
Him we
99 Blackberry LaneNorthampton MA 01060
ewe
(413)230-9410 isaac.fleisher@gmall.com
iww
446827 ` lwl 17-0432
4Sne!DI 1.1
Quantity Unit Unit Cost Total
Air/Duct Sealing
AIR SEALING 10 man hour $ 85.00 $ 85000
WEATHERSTRIP DOOR&ADD SWEEP 2 each $ 80.00 $ 160.00
WEATHERSTRIP DOOR 2 each $ 58.00 $ 116.00
Air/Duct Sealing $ 1,126.00
Air/Duct Sealing Incentive $ (1,020.00)
Air/Duct Selaing WX Balance $ 10600
Weatherization
CRAWLSPACE WALL RIO RIGID BOARD 94 each $ 4.05 $ 380.70
ATTIC DOOR-INSULATE&WS 1 each $ 110.00 $ 11000
BASEMENT-INSULATE BULKHEAD DOOR&INSULATE 1 each $ 11000 $ 110.00
ATTIC HATCH-SEAL&INSULATE 1 each $ 6000 $ 60.00
ATTIC DAMMING-R-38 FIBERGLASS 128 soft $ 2.05 $ 262.40
VENTILATION CHUTES 80 each $ 2.50 $ 200.00
ATTIC FLAT-12"OPEN R-42 CELLULOSE 720 soft $ 1.68 $ 1,209.60
ATTIC FLAT-10"OPEN R-37 CELLULOSE 400 soft $ 1.56 $ 624.00
VENT BATH FAN THRU ROOF 2 each $ 118.75 $ 237.50
Air/Duct Sealing VW Balance 1 lump sum $ 106.00 $ 106.00
REMOVE INSULATION 814 sqft $ 0.75 $ 610.50
Total Weatherization $ 3,910.70
Weatherization Incentive $ 2,000.00
Total Project $ 4,930.70
Total Utility Contribution $ 3,020.00
Total Customer Contribution $ 1,910.70
WAReaxn,Arne,can Instalxins lac will provide the a be a gated homeowner with a 2 year workman ulp Warranty.
herebyAmen(an instal nooseofurmm all material and labor complete the Phone aote of work in accordance with me above ace=lheati ns and all local and state
grregulations bm
ane Total Contract Valueat etated herein.
ACCEPTANCE OF PROPOueme above prkes.specifications and TOTAL CONTRACT VALUE= $ 1,910.70
conditions tafactory and are hereby Tou are
authorized to do work as speckled.Payment will be Umto Us down priDown Payment= S 636.00 ® 2/16/17
start of work,and balance due upon Completion. Balance Due UCompletionPAID
— =9$ 0
${tom 2//16 16//20t7
Wyatt Couture 2/16/2017
THIS AGREEMENT 5 COMPOSED OF THIS PAGE AND THE REVERSE 510E 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 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 ATA RATE OF ONE AND ONE-HALF 1.1/21
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 TO BE SOLEY 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 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 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.
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.
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 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 HELD 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
24. ANY DISCOUNT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STATE SPONSERED UTILITY PROGRAM(LE.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 UTILITY PROGRAMS MAY BE ALTERED OR UPDATED PERIODICALLY WITH OR WITHOUT NOTICE.
25.AMERICAN INSTALLERS,LLC 15 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 TAXES THAT ARE APPLICABLE TO THIS AGREEMENT.
The Camnwnwealth of Massachusetts
om_ q Department of Industrial Accidents
,,€.til, Office of investigations
s: 4. MW Washington Street
-a 27.a Boston,MA 02111
'NW"^s.�.n.
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant information Please Print Legibly
Name(BasinesslaganiatioNmdividuatJ_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 hos: 'Type of project(required):
t. I am a employer with 31 4. n I am a general contractor and I
6. (i New construction
employees(full anti/or part-time)' have hired the sub-contractors I
2.7 I am a sole proprietor or tauter- listed on the attached sheet.t 7. ❑ Remodeling
ship and have no employees 'these sub-contractors have S. ❑ Demolition
working for me in any capacity. workers'comp.insurance. 9, ❑ Building addition
[No workers comp.insurance 5. 9 We are a corporation and its I O.I] Electrical repairs or additions
required) officers have exercised their
3.9 tam a homeowner doing all wort right of exemption per MGL t t_[] Numbing repairs or additions
myself. [No workers'comp. c. 152,§1(4),and we have no 12.9 Roof repairs
insurance required.'I employees. [No workers i3 Other Insulation
comp.insurance required.]
tem amnesia mar checks box el must also 611 out the section below showing their workers compensation policy information.
`Nome vibe submit this rtLdavit indicant%they as doing all work and atm hire m
outside aanemrs mow submit a new affidavit indicaixg such.
1-Contractors tractors/hat thunk this box must attached an additional sheet showing the name or the suboontracturs and their workers'comp.policy information.
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 d or Selt ins. Licit,pAMWCi731435 Expiration Dale:. 19/04/2017_ /p-y
Job Site Address. L 1 81 1„J �L^-t l'�- City/Srme/Zip:./ V Drij
Attach a copy of the workers'compensation policy deet ration page(showing the policy number and expiration date).
010690
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
line up to$4500.90 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine.
of up to S250.00 a day against the violator. Be advised that a copy of Chis statement may he forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby tenth)under the pains and penalties of perjury that the information provided above fs fruand correct.
���signature: ‘,4 di • .iat�/7/ .,_._... Date: _
Phone: / 413-552-0200
Official use only. On not write in this area,to he completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
fa Other
Contact Person: Phone#:
ACORD CERTIFICATE OF LIABILITY INSURANCE gilizDlsm
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 policyhes)must be endorsed. It 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 rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER w CONTACT Linda Pcw6r8
NAME
Webber S Grinnell PNOWc ' (413)586-0111 IMI
iAS.No EL ,10.X,NOL I413I566-5101
8 North King Street Ap11^p Rss 1poMers@webberandgrirmell.cont
INSURER(S)AFFORDING COVERAGE I WJC X_
Northampton MA 01060
amP INSURER employers mutual Casualty
N4SURED _ wsuRERaberkabrre Hathaway GUARD Ins. Ca.
American Installations, LLC INSURER C: _
Attn: Wes 6 Suzanne Couture INSURER D:
W
130 College Street, Suite 100 INSURER E:
South Radley MA 01075INSURER F:
COVERAGES CERTIFICATE NUMBER$aster Exp 9-2017 REVISION NUMBER:
1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIOIDD 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 t0 VOUCH 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.
me,
, TYPEOE INSURANCE IINSD wvo POLICY NUMBED, PAULi'kF i M LILY bail.—
NM UNITS-
1COMMERCIAL GENERALUASIUTT ' I EACH UU,URRENCa, 'S 1,000,000
ITSSAW
A I I CIA/MS-MADE I OCCUR I PREMIT NTATID4rn,n1 'S 500,000
X Li[gpr Liability 503535217 9/4/2016 9/4/201) MED EXP(Any otMOAN) IS 10,000
PERSONAL a ADV INJURY S 1,000,000
I GEN'L AGGREGATE LIMIT APPLIES PER I j GENERAL AGGREGATE r 2.000,000
X I POSIT PRO- v....� ..
kCi LOC PRODUCTS.COMMA AGO S 2,000,000
iI
' OTHER'. I T
AUTOMOBILE LIABILITY ILPDM94NED1SINGLE OMI( $ 1,000,000
A ANY AUTO i BOOL INJURY(Rerpe/son) E -- -
Au.OWNED —3('HEOULED — —
A Ut44 X AUTOS 5.53535217 9/4/201G 9/4/2010 BODILYJURY(Nels ns, $
X H:fECnJTes X IAUUITrED PROPERTY xDAMACE ,.S ..
L. - .......
PI Baso s 8,000
X UMBRELLA UAB _, I v EACH OCCURRENCE S 1,000,000
A D X RETENTIONS CLAI iD,000 AGGREGATE S 1,000,000
I 'tH _ CLAIMSMAOE
BUM Ll I 15./3535217 9/4/2014 9/4/2011S
'..
WORKERS COMPENSATION 1 .... PER H
AND£MPLOYERS UASLITY YON K ISTATJ E_ __:.ER .. i _
ANY PRWCIETORIPARTNER/CYlCUTWE — E EACH S 500,000
B nd
DFFICER,MEMUER EXCLUDED"' I NIA --
MatlnryNH _
fl
) ORWC600917 9/4/20L6 9/4/2011 EL DII_SEASE-EA EMPLOYEES 500,000
' -
IES,Rea
DESCRIPTION
uer
OF OPERATIQNS Wow I LEL DISEASE.POLICY LIMIT la soooho
A Coi ercial Property SA3515211 9/412016 914/2o11 i<lediale SLOG, $20,000
1 'ticauabtz S'I,On3 $40,000
J
DESCRIPTION OF OPERATORS I LOCATIONS VEHICLES (P[ORD tUt,AtltlNOnel RemaM1e Bcb1/11/I0.May be washed if tnor space bRPUleepl
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION GATE THEREOF. NOME WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AmNOPJIED REPNESENTAIWE
Kevin Joyce/LMP ''"' ->
151888-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INSOLSilnrenn
9 Massachusetts -Department of Public Safety Unrestricted-Buildings of any use group which
Board of Building Regylations and Standards contain less than 35,000 cubic feet(991m)of
Conetructin Supe icor enir enclosed space.
License: CS-1011h
'
WESLEY court*166 NOR1HMAI$sails,.
-G
South Hadley 141k=01 )
c; V o Failure to possess a current edition of the Massachusetts
vac arm ra -State Building Code is cause for revocation of this license.
t../.. ,d. i:. Expiration
Commissioner 09129/2017 For oFS ticesingnfomaannvis& www.Maa.cov/oeS
C— ./ e VOliViwncuea/ a 01 - aJocw%uoe-
e Office of Cons diner Affairs and Busi ss Reg dation
I 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registralion: 175982
Type: LLC
Expiration: 6/27/2017 Tiff 265208
AMERICAN INSTALLATIONS, LLC.
WESLEY COUTURE
130 COLLEGE STREET SUITE 100
SOUTH HADLEY, MA 01075
Update Address and return card.Mark reason for change.
SCAT G zauavn E Address n Renewal 0 Employment Q Lost Card
%2e'tom inn.rrr er.!/&o/Ci!f,nacArue//
.
Office orConsumer Affairs&Business Regulation License or registration valid for individul use only
III— yrffOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
fl� egistmhon: 175982 Type: Office of Consumer Affairs and Business Regulation
Expiration: 2627/201 T.
LLLC 10 Park Plazs-Suite 5170
Boston,MA 02116
AMERICAN INSTALLATIONS,[UO.:
WESLEY COUTURE
130 COLLEGE STREET SUITE 100 �/✓�/ —
SOUTH HADLEY,MA 01075- Undersecretary N valid without signature