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43-054 89 WESTHAMPTON RD BP-2018-1201 GIS n: COMMONWEALTH OF MASSACHUSETTS Mao:Block:43 -054 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-2018-1201 Proiect9 JS-2018-002148 Est.Cost:$5900.00 Fee:$65,00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group AMERICAN INSTALLATIONS LLC 106178 Lot Size(sp ft.): 30971.16 Owner. ADAMSKI JULIE tonin : Applicant: AMERICAN INSTALLATIONS LLC AT. 89 WESTHAMPTON RD Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 Liability SOUTH HADLEYMA01075 ISSUED ON:511612 01 8 0:00:00 TO PERFORM THE FOLLOWING WORKATTIC AND BASEMENT INSULATION AND AIR 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 p 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: FeeTvue: Date Paid: Amount: Building 5/16/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner RE Department use oily' No mpton stalusof Permit SHIN' D artrnent Curb CytlDrlvewey Permit MAY 1 4 201 12 an Street Se". :deeptic.Avanabnily om 00 Wetir/Wen•Ayenab* Nort n MA 01060 Two Sets of st odturel Plans �PT� MR40 Fax 413.537-1272 FmtlShe-Plehs K 0 T WimSped(y APPLICATION TO CONSTRUCT,ALTER,REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION a/ 3-1.)D 1.1 Proaarly Adtlress: This section to be completed by am" 89 Westhampton Road Florence, MA 01062 Map - I Lot U S7 Unk. Zone Overlay DistrkC But St District- CB David SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGFM 2.1 Owner of Record: Julie Adamski 89 Westhampton Road Florence, MAO 1062 Name(Print) C mea Me""'Adtlrass: (413) 210-2457 See attached Telephom signetue 2.2 Autharleed Agent- American gentAmerican Installations 130 College St., Ste 100 South Hadley, MA 01075 Name Irma) Cunmt Mating Address: WIA _Q.,. k . Gwb cz. , 413-552-0200 Signature I Telephone SECTION 3-F33MATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permite licem 1. Building 5,900.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 3. Plumbing Building PermR Fee 00 4. Mechanleel(IdVAC) 5.Fre Protection 6. Total= 1+2+3+4+5 5,900.00 Check Number This Section For Official Use Only Sutiding Permit Numb Data Signal �� �g Building hebnemnspeclorof SuMinga Date Section 4. ZONING Ali Information Most Be Completed.Permit Can Be Dentey Due IMampmte IMormatbn Existing Proposed R� •'�..mA A.,zo�.ag �}� mWMnmry be�kd m 4r B Dvnmuot Lot Size Froutoge Setbacks Front O O Side L:0 R= L:=R= L_S Rear j- 0 Building Height Bldg.Square Footage �—� �—� % O L� Opens Space Footage r� % (ren nee minor bora A peed 0 u #of Perkin S aces Fill: volume&laedoo A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES,date IssuediI IF YES: Was the permit recorded at the Registry of Deeds? _ NO O DONT KNOW O YES O IF YES: enter Book PageF and/or Documentif L_ B. Does the site contain a brook, body of water or v ttands? 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 tocation: I ` 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. Wal the construcdan activity disturb(clearing.grading,excavadon,or filling)over 1 acre or Is K part of a camman plan thatwl9dlsturboverlacre? YES NO O IF YES,then a Northampton Stoml Water Management permit from the DPW is required. SECTION S.DESCRIPTION OF PROPOSED WORK(cheek all applicable) New House ❑ Addition ❑ RaplecerdeM Windows Alteration(s) ❑ Rooting ❑ ar Doos Accessory Bldg. ❑ Demolition ❑ New Signs [M] Decks Sldingg31 Odwr[& W Desct=MProposed Work;A fisc and basemen t insulation and air sealing Throughout Atteragon of assfing bedroom_Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _Yes No Plans Attached Rog -Sheet Ga.If New house and or addiHonYo existing homing,complete the following: a. Use of buflding:One Famity Two Family Other b. Number of rooms in each family unit Number of Bathrooms Q Is there a garage atlachad4 d. Proposed Square footage M new construction. Dimensions e. Number of stodes? f. Method of heating? Fireplaces or Woodstowes Number of each g. Energy Conseweflon Compliance. Masacheck Energy Comptienm torn attached? h. Type of construction 1. IewnsWcgonwOhinlOOfLofmUands?_Yea _No. Isconsbuctionwithln100yr. goudpiain Yes_No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulatiom? Yes_No. 1. SepOc Tank_ CitySewar_ Pdvate well_ City rater Supply_ SECTION 7a-OWNER AUTHORIZATION.TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Julie Adamski .as Owner of the subject Property herebyautiwrize American Installations to act on my behalf,In all matiws rela0ve to work authorised by this building permit appgcetion. See attached 5/11/2018 Slpmlue of Owmr Dale I. American Installations as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and aocurete,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. American Installations PM1d Name A) la� -• • , 5/11/2018 SI ansa of enl 6.C `^-� Date SECTIONS-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: NotAppllcable ❑ Name of Uemue Noiaer: WesleyK. Couture 106178 Dcense Number 130 College SL, Ste 100 South Badley, MA 01075 9/29/19 areae /�� ,-,� Exwsrsom pale k - l/YLLW.V 413-552-0200 SlonaN— rem^ Tebphmm e.Reals{. ' -N.i.::.!'•�rova'inedt-.ontro,Jor... . _ Not ApOcable ❑ Wesley Couture 175982 Comoanv Name Registration Number American Installations 6/26/19 Address Expiration Oats 130 College St., Ste 100 South Hadley, MA 01075 Teleptmne 413-552-0200 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L C.152,§25C(6)) Workers Compensation Insurence affMavd must be completed and submdted with this appfcabon.Failure to provide this af8dav8will resu8 in the denial of the issuance of the building permit. SIgnedAffidwitAttechad Yes....... 21 No...... ❑ 11. Home Owner Exemption The currant exemption fur"homeowsers"was extended to include Owner-oecuoled Dwellings ofone(l) or two(2)families and to allow snob hoemownar to engage an individual for hire who dose not possess a license,provided that the owner acts es sursaybar.CMR 780, Sixth Edition Section 1083.51. DefiuDion of Homeowner:Person(a)who own a parcel of land on which he/she resides n intends to reside,on which there is,or is intended to be,a one or two family dwelling attached or detached snucbues accessory to such use and/or farm structmes.A heron who constructs more than we h In a two-year period still nothe considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building OfW 4 that he/she shag be responsible for sU each work Performed render the bu ldion permit As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion ofthe work for which this permit is issued Also be advised that with reference to Chapter 152(Workers'Compematim) and Chapter 153(1Sab0ity ofEmployers to Employees fee injuries but resulting in Death)ofthe Massachusetts General laws Aonotated,you may be liable for persons) you hire to perform work for you under this permit The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Toning laps and State of Massachusetts General Laws Amounted. Homeowner Signature City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: 89 Westhampton Road Florence, MA 01062 The debris will be transported by: American Installations The debris will be received by: Waste Managment of N.E. - Chicopee Building permit number: Name of Permit Applicant American Installations 5/11/2018 �� � t^SOAMA_. Date Signature of Permit Applicant • mass save OBinLe° PARTNER icenie ma cnv:rmrm American Installations vnrmwre a.wsxnvm,sam xEaar.Aumms.omo:w»ss:•omrra.:wv»sszuux.Exr ewwcwRrv++.wuaw•.ort Customer Name:Julie Adamski Email:Not provided Phone:413-210-2457 Premise Address:89 Westhampton Rd,Nodhampton,MA 01062 Protect ID:3404149 Date:April 24,2018 Job Description Air Sealing at Estimated 62.5 CFM50 Per Hour 6 hr $555.48 $0.00 Exterior Door Weather Stripping (with AS hrs) 3 each $90.21 $0.00 Door Sweep (with AS hrs) 3 each $75.93 $0.00 Door-2" Thermal Barrier Polyiso 1 each $90.44 $22.61 Insulation Removal 200 SF $252.00 $252.00 Basement Ceiling-9" Fiberglass Batting 660 SF $1,861.20 $465.32 Hatch - 2"Thermal Barrier Polyiso 1 each $46.28 $11.57 Kneewall Slope -6" Fiberglass Batting 174 SF $370.62 $92.65 Kneewall Slope-2"Thermal Barrier Polyiso 174 SF $831.72 $207.93 Sheathing Access 3 each $120.06 $30.01 Attic Floor- 5" Open Blow Cellulose 420 SF $646.80 $161.70 Bath Fan - Vent to Root 1 each $141.30 $35.32 Aluminum Ridge Vent drift) 22 each $684.20 $171.05 Damming 28 each $66.92 $16.73 Project Total $5,833.16 Weatherization incentive ($3,644.65) Air sealing incentive wanxAsrc.Ame°Lan irccdxxla",uc wn aoaau<aeo..nxea mn.a.n..nn a E.L.dr."n".nnq»r.arcr. na..dn m.una°xn OL"xebrpopaeam Tvria xI noaml amlava m aoniwx.cnaxoresm°e or..as harmr°xrc+.:m cl.anm w.rtsr:°enane slow ammn wlemM rc»exia"mr me.xa caertn vave�amoe mee. PCCEVIMCE 01 m..L iN aEwe sl UIDD xbM ane cmatbM d. TO LCOMM117VALVE•s atisiaLmrVaMaehaeb/aveple0.Vcuarta4M1aluC[oNwM of KKefiee Varment �N,nearmex�[ MID rxlee to sown p°"rronan or rrni4,aneeMareearty"n Cnmaeem, axaa.weu°onmowtrexn- s .Pw p"eerN Oxnn Uhl hien xme+enlavrve:l✓°mi IyrN Oxe • mass save owealnw,ffi eea cs b:rmva ` PARTNER fen xebec""""' American Installations W'e""`Ar"atclu instanaeons.c. iLColre SbM Su"MiW.SauM 1YdN.MTOIWS�01M:M131%LY}W fv:ItlA%LWOi�MaY auppldNMbMnaMafon Customer Name:Julie Adamski Email:Not provided Phone:413-2102457 Premise Address:89 Westhampton Rd,Norbampton,MA 01062 Project ID:3404149 Date:April 24,2018 Total Program Incentive -$4,366.27 Customer Total $1.466.89 WTee4NIe,N .n ImrellMlmf..L[WII I..the Aow rt.rl foroor ovora J.ve.w i—orl—.1,- Ornni—mtdar:or,LLC fareby Popo—b NniN all mlMy sH IMw to emurte the aMr Mori OiwwY n attgem[ewit tMabow 1pe[ihaeoM aM W bal ari state r,lO%-WOrsoLs for to Tool CweM Valw as s MMrfin. ACCERRNCL nF ..I.I: TM ffiOw peieeL, rooto", aM LO 1.t Ora Ip.,IM.1 VAlla-S 5.466.89 abu:wyaneuennnr+Lomme.ebuarear[mbuete eewm:a..oearwe.aamrent qe,o y,r,rc„t=s Orin rin �X WII be IA eovar pirate staRofwdY,atlbabrce We upm CaryYetlm. IPN r, aaanre Dneunmcorrpemn- s 1,066.89 Wranae 4/24/2018 ncMp gree Mintl 156nI Date uvmmomr lruntl Garrett Demers ISBN Date 4/24/2018 IThe Commonwealth of Massachusetts Department of In vestat Accidents OOffice of Investigations 600 Washinglon Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Bus'ine,s/Drgani> tioWindividuap: American Installations,LLC _ Address: 130 College Street,Suite 100 City/State/Zip: South Hadley,MA 01075 phone 4: 413-552-0200 Are you an employer?Check the appropriate box: Type of project(required) 1.Lx] I am a employer with 46 4. ❑ 1 am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).' have hired the subcontractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.: 7. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in anv capacity. workers'comp-insurance. 9, [] Building addition [No workers'comp. insurance 5. ❑ We arc a corporation and its required.( officers have exercised their 10.EJ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I L❑ Plumbing repairs or additions myself tNo workers'comp. c. 152,§1(4),and we have no 12.E] Roof repairs insurance required. t employees. [No workers' I3.®Other Insolation p cominsurance required.] '----" ^Any applicem nut checks box el most also fill ouubo section below showing their wodersomwenmtion polity inf anuaw. t I eassivnom who submit this anidevh indicating nay use duan,nll work and den has omside canaacfrs musl submit a nnv Aralavit am,aing sod,. %Cmuvitmx mat check this bon must ntuehed an additional sheet showing the name of the subKommewrs and dev workmi com,.hili y intmmoh. tam an employer that is providing workers'rompensmion insurance for my employees. Below is the policy and job site informmioa Insurance Company Name: Guard Insurance Companies Policy h or Self-im. Lis.h: AMWC731485 ___ Expiration Date: 09/04/2018___ Job Site Address: (00 Psi d City/State/Zip:�yr (a t0`R 61WZ Attach a copy of the workers'campensotida 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 of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form or u STOP WORK ORDER and a fine of up to$250.00 a day against the violates. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify 9 rtify under the pains anjd penalties ofperjury that the information provided above is true and correct Si.mature M/A. . (/ Phone h: 413-55 -0200 Official use only. Do nor write in this area,to be completed by city or town official City or Town: Permit/License h Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone M: Commonwealth of Massachusetts Construction Supervisor ®; Division of Professional Licensure Unrestricled-Buildings a any use group"Ich CDdUl Board of Building Regulations and Standards less than 36,000 cubic fast(991 cubic meters)of encbsed Construction Supervisor fie. CS-106178 Expires: 09/29/2019 - WESLEY COUTURE - 218 LATHROFrSTREET SOUTH NADLEY MI1 0107a ti Failure m possess a current edition string,Massadmsetrs State Building Cade is cause for revocations of thba flowers. For information about this license, Commissioner (�(s•• Can(917)72741200 or Ask www.rmss.goWdpl �'�J r'��� �Pa�yr�rrn�rrae{r�l� af�C��rr�.urrfr�seflt / Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: LLC AMERICAN INSTALLATIONS,LLC. Registration: 175982 130 COLLEGE STREET SURE 100 Et�lratlon: 08/26/2019 SOUTH HADLEY,MA 01075 Update Address and return card. Mark reason for cMnge. SGt O 20MLL11 0— Rene...-- rT 1 1 Addyn�e C.—__ FTn aymsM ❑mss!GPra f OaiNeeOMEE IMPFIOWMMEWBCONTIFURCpTOulRetlenuse Registration eexpens for ted . If fo only TYPE:LLC beforearefopi.Affle. ad,Bu nNm 1o: r\..vlfr. $ 75982 DW26=1Expiratio0 10Office Park Consumer Affalre sed Business Regulation --�•' 1]5982 04-28I'1019 tO Perk Name-Suite 5170 AMERICAN INSTALLATIONS.LLC. Boston,MA 02110 WESLEY COUTURE COLLEGESTREETSUITE 100 SO EV U �thbut-- SOUTH HADL ,MA 01075 Undersecretary �valld lnthout signature AcoR1Y CERTIFICATE OF LIABILITY INSURANCE DATE(MMODI III8/14/201717 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 INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certNkate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this CerlMcate does not confer rights to the ce"I icate holder in lieu of such endomement(s). PRODUCER We.E Linda Powers Nahher c Grinnell PHONE (413)586-0111 Fuc No:14131506-6481 AL B North Xing Street pppgEgg:1po3Pers@9re15herandgrinnell.com INSUREMS)AFFORDING COVERPOE NNIC II NorthaIDpton HA 01060 INSUREIRAIEsEPIPPRECS Ifutnal Casualty INSURED INSURER.Berkshire Hathansay GUARD Ina. Co. MAI... Installation., LLC INSURER G. Attn: Nes 6 Suzanne COIIture EARSPER D: 130 College Street, Suite 100 IXSURERE: South Hadley lM 0107$ INSURERF: COVERAGES CERTIFICATE NUMBERMaeter Exp 9-2018 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. MSM XMIRGIRMI� LICYEFF POLICY EVP UNTS LTR TYPE OF INSURANCE POLICY NUMBER MWO MW L GENEMLLJAMLITY EACH OCCURRENCE 5 3,000,000 AJ�OMNE AIAOE OCCUR PREM7—�) E 500,000 SD353541'1 9/4/2017 9/4 /2018 RED ) E 10,000 PERSY S 1,000,000 GEML AGGREGATE LIMIT APPLIES PER'. GENE1 21000,000 POLICY❑PROE]LOC PROAGG 1 21000,000 JECT OTHER. LIMI AUIOMOMLE LIABILITY RY,aWOenl $ 1,000,000 A ANY AUTO BODILY INJURY(Pe,Fxcon) s ALLO MED X SCHENUCS DULED 5Z353521 9/4/201] 9/1/2016 SOLELY INJURY(Pe,armI E NON-0NMEO PROPERTY WMAGE E X HIRED AUTOS 7` AUTOS Px azEml PIP-Sesk 5 8,000 R UMBRELLA LIAR OCCOR EACH OCCURRENCE E 1,000,000 A EXCESS Use CLAIMSt1AOE AGGREGATE $ 1 000 000 OEO X RETENTIONS 30 000 5J353521] 9/4/2017 9/4/2016 § WORNERSCOMPENSATONX STATPER H- UTE ER AND EMPLOYERS'UA91Utt ANY PRCPRIETOILPARLHEWE%ECUTIVE YO MIA EL EACH ACCIDENT B 500,000 H lasmaoyOFFICERAMLal NeFIOWOE% VRNC60991T 9/4/2017 9/4/2018 E.L.DISEASE-EA EMPLOYE E 500 000 X9 myo Jw uMa OESLRIPTION OF OPERATIONS EeIaw E.L DISEASE-POLICY LIMIT S 500,000 A COadercial Property 513535217 9/4/2017 9/4/2018 0-111111000 DESCWPTION OF OPERATORS LOCATIONS I VEHICLES MOORD 101,AEOMone RemeM NmSA ,may be a aechm M s— Rce Is Mum) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NONCE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE Kevin Joyce/LMP ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INSO25 mmmn