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29-316 (3) 123 BROOKSIDE CIR BP-2019-0087 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:29-316 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-2019-0087 Proiect# JS-2019-000136 Est.Cost' $400090 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(so.It.): 12632.40 Owner: BARTHELEMY MICHELLE M Zoning: Applicant. AMERICAN INSTALLATIONS LLC AT. 123 BROOKSIDE CIR Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.7123/2018 0:00:00 TO PERFORM THE FOLLOWING WORIGATTIC 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 N 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 Occuoancv Signature: FeeTvpe: Date Paid: Amount: Building 7/23/20180:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner -REGE -- peparMent use only City of Northampton Status of Perms: JUL 20 2018 Building Department Curb Cuviinviway Pemdt 212 Main Street SewerlSepticAvalleb3lry Room 100 WathdWetiAAvanebgity orvl or eunowcinsaEcnons N rthampton, MA01060 Two§etsofSlnaiurelt?lanc uoatnnnncroy,mno 587-1240 Fax413-587-1272 or Pia Plans . Other8pedfy T— APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH AONNE OR TWO FAMILY DWELLING SECTION I-SITE INFORMATION 1.1 Property Address: This seelfon W be completed by office Map aq L*J/AA -Unft 'P/�✓ G/_L�.�{'y", Zone Overlay District Elm St Ustild CB Distad SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Michelle Barthelemy 123 Brookside Circle Northampton,MA 01062 Name(Pdnt) Qment Me Address: (413) 24 2790 See attached Telephone agnstuns 22 Authorleed Anent: American Installations 130 College St., Ste 100 South Hadley, MA 01075 Na"(Pdm) - Omenl MaAYp Address: �� 2-0200 T. SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only coinplated by oemifte Icant 1. Building 4,000 (a)Building Permit Fee 2 Elecbkel (b)Estimated Total Cost of Consbuction from 3. Plumbing Building Permit Fee l 4. Mechanical(HVAC) S.Fine Protection 6. Total= 1+2+3+4+5 4,000 Check Number This Section For Official Use Only Building Permlt Number. Dale Issued: Signature: L It3 Building Commialone flnspedorol BuadMps Date Section 4. ZONING All Information Most Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning nis coiumo to be filled in by &ffdiq,D,&mmt Lot Size F— O Frontage (----� —� Setbacks Front O C� Side L:= R:= L:= R:= 0 �� Rear Building Height Bid&Squme Footage C� % Open Space Footage L� % (Cot arta ndvua bWg&pavW ukw #ofP" , S ces �� C Fill: wlume&lamfiov A. Has a Special Permit/Variance/Finding ever been issued for/on the sitz? NO O DONT KNOW O YES Q IF YES,date issrred:i_ 7 IF YES: Was the permit recorded at the Registry of Deeds? _ NO O DONT KNOW O' YES O IF YES: enter Book u Page and/or Document#i 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 i E. Wit the construction acevity disturb(deadrg,grading,excavatton,or filling)over 1 aria or is it part of a common plan that wilt disturb over lam? YES O NO O IF YES,than a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK feheck all applicable) New House ❑ Adtlfgon ❑ LN � t Windows AHeration(s) ❑ Reneas ❑ Accessory Bldg. ❑ Demolition ❑ �] Decks [Q Sldirug QD] IXher[A� Brief Description of Proposed Work: Attic and basement insulation and air sealing throughout Alteration of alaftng bedmom Yes_No Adding new bedroom_Yes _No Attached Narrative Renovating unfinished basement _ es _No Plane Attached ROA -Sheat 6e.If New house and or addition to eidsting housing-complete the following: a. Use of building:One Family Two Famdy Other b. Number of rooms In each family unit Number of Bathrooms Q Is there a garage attached? it. Proposed Square footage of new censauegon. Dimensions e. Number of Bodes? I. Method of healing? Flreplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masschedc Energy Compliance forth attached? h. Type ofwristruclion I. Is construction within IOD a.of"lands?_Yee —No. le ounsbuctian witltln IOD yr. floodplain_Yes_No J. Depth of basement or celler ft"below finished grade k. Will building conform to Ow Building and Zoning regulations? Yes_No. 1. SepOcTank_ Cly Sower_ Private well_ (Sly water Supply SECTION Ta-OWNER AUTHORQATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Michelle Barthelemy as Owner of the subject property herebyeuthodzeAmerican Installations to act an my behalf,in ail maUere relative to cork authorized by this building permit application. ,See attached 7-18-2018 SignaWre orowner Date I, Americanlnslat" U5 as OwnedAuthodzed Agent hereby dedare that lite statements and infom�ation on the foregoing application are hue and smarts,to the best of my knowledge and belief. Signed under the pains and penaNes of perjury. American Installations Print �A�'t,Na Na�me � p �� eAq.AY/t (L- , 7-18-2018 SlgwWed riAgwu Date SECTION 8-CONSTRUCTION SERVICES r 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Wesley K. Couture 106178 Unease Number 130 College St., Ste 100 South Hadley, MA 01075 9129119 Address Expiration Uses �kxa �L ( jj>�L413-552-0200 s anawre Telephone g.PeistemdHoi6elmpr6vementbonii,cior.-. . . . Not Applicable ❑ Wesley Couture 175982 Compmw Name Registration Number American Installations 6126119 Address Expiration Date 130 College St, Ste 100 South Hadley, MA 01075 Telephone 413-552-0200 SECTION 10-WORKERS'COMPENSATKIN INSURANCE AFFIDAVIT(M.G.L e.152,§2SC(8)) Wodrers Compensation Insurance affidavit must be completed and submitted with this application.Fallure to provide this affidavit will result In the denial ofthe Issuance dthe buildi IL S ned AffidavftAttechad Yes.._... 11 No...... ❑ 11.'<Home Owner E$emution The currant exemption for"homeowners"was extended m include Owner-ocwpied DweMocs ofone(1) m lwo(2)families and to allow such homeowner in engage an individual for Itis who does not possess a Bc rsse,provided thatthe owau sets M supervisor.CMR 780 Sixth FAtion Section 10035.1 Definition ofAomeowner:Person(s)who am a panel ofland on which Wain:resides or intendsm reside,on which them is,or is intended to be,a one or two family dwelling,attached or detached structures aceessury to such erne and/or farm structures.A peramis who coactrn is more than one home In a two-war period Mall not be considered a hos Such"homeowner'shall submit to the Building Official,on a fon¢acceptable to the Building Official Mat he/she ft4 be remonsible for all seek work performed under the buildipn permit. As acting Construction Supervisor your instance on Ore job site will be required from time to time,during and upw completion ofihe work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Comp rmation) and Chapter 153(f iabilityoffimployersm Employeesfor injuries not resulting in Death)ofthe Massachusetts Geocml laws Annotated,you may bell forperson(s) you him to perform work for you under this penult The undersigned"homwwner"certifies and assesses;reapomibility far compliance with the Stam Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts Genual Laws Awotmed. 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: i a 3 pT 1�5',c�c [�:rG\e ,N�kv+� MA, otos The debris will be transported by: Avr»c lr�1u� Tan��ttc��;or C . w«�� V.��=+^�c.W�^eYN- OL NGS f.✓+�iC The debris will be received by: ( t ',CGDE r_ t „tl�`I 11; Building permit number: Name of Permit Applicant W e-Aa.�, (\rLk- U e- Date Signature of Permit Applicant to 'Y'""Ye1inY PARTNER m Y:lOSlr American Installations waa.AmMuaiwaWlatlmamm saureYwmrausm,emwaxw.anvun.anx:xsx nsowec Wwra®.mea rwrewwwnxwwmn.a,: Customs,Nene:Mkhelle Balheks, y Email:Not WwAdsd Phone:413-2N-2790 Pramlea Address:123 Brookside GO,Nonh=pton,MA 01062 Project 10:3426142 Bate:June 14,2018 Job Description Air Sealing at Estimated 82.5 CFM50 Par Hour 12 hr $1,110.96 $0.00 Dori Sweep(1M81 AS tin) 2 _ each $50.82 $0.00 Estedor Door Weather Stripping(with AS hrs) 2 each $80.14 $0.00 Rim Joist-2"Thermal Barrier Polyiso 140 SF $089.20 $187.30 _ Hatch-2'Thermal Bonier Polyjw 1 each $46.28 $11.57 Attic Floor-8"Open Blow Cellulose 1178 SF $1,905.12 $478.28 Promend 30 each $124.80 $31.20 Damming 12 each $28.58 $7.17 Protect Total $3,995.80 We ithaization incentive ($2,080.58) Ar sealing incentive ($1,221.72) Total Program Incentive -$3,302.28 Customer Total $693.52 veawmr:v.:a,en amsaan su ri ao,+m r:.Yx,a aaaa ra.�am.s".a.on".:.nm+.M.. awnmxr,emaw ucti.erw.wxrmwrtawiv.vaa.exsa mrmr+.u.rer.w.er,.on:.+,vem.iwunma.w+r..swwnm.:em 4e4s aYnvex+mraeTmY tanasavwa.mMk.a. M[rrtw or rewmLL: A Axa wka aertlhalb" N Mbn an Nru CartaKivwa•s 693 57 wamr.:os,.i.,wrawarw...umneammwanammima r.r,:wrt m.:,v.r::m•y 8200.00 WIM Nm.nnlam>ar.rNma,.eAa�m Oarpeem. ry:p evw:x aauYmoa:gava.s 493.62 n>wao.mlrmu Barthelemy.Michelle os,, 6-14-18 n...wroacrren town aian i 9$� wr fi-14-t8 Zia ol The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 01111 www.m essgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Letdbly Name(Business/OrganlradnNmdlvidualy 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): I.[x] I am a employer with 46 _ 4. ❑ I am a general contractor and I 6. 0 New construction employees(full and/or part-lime).' have hired the sub-con[racrors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. r 7. ❑ Remodeling ship and have no employees These sub-conlradors have 8. ❑ Demolition working for me in any capacity, workers'comp. insurance. 9. ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 0.0 Electrical repairs orodditions 3.[] I am a homeowner doing all work right ofexemption per MGL I I.❑ Plumbing repairs or additions myself.[No workers'Gump. c. 152,§1(4),and we have no 12.❑ Raaf repairs insurance required. t employees. [No workers' I7.[ Other Insulation comp. insurance required.) - "'---- 'Any applicant tl at checks box al must also Fill out so se<tiun below showing ucu woken'campinestion W licy informvtion. t t Inmrownen who subminhb umdovit indurating NLy ore doing all work entl then him omsidu canuamun mmt submit a tww alpdavit indicaing such. tl'unbadars Not ch,,ck thrs box mml atncM1N an odditinnal ahem showing the name ol'lls subKomrattuts a,d their wmkuti comp.polity inro�nmivn. I am an employer That is providing workers'compensation insurance far my employees. Below is Poe policy and Jnb site Infurmmlon. Insurance Company Name: Guard Insurance Companies . Policy 7!ur SelFins. Lie d: AMWC897387 _ Expiration Date: 09/04/2018 _ Job Site Address: tai _isity/State/Zip:1�,_Aa_-vt•_4�N,I'A(a C;1CJj` Attach a copy ofthe 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 oferiminal penalties of a One up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of n STOP WORK ORDER and a Fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. I do hereby cyyee/rr�t��ify under the pains ofra�dgen�u//lie�s u.jp�erjury that she information provided above its true and correct S' ?�I ys+'tA qy r A � l ./1{U.f.C1 i.5�. _ Phone 4� / 413-552"0200 Official use only. Do not write in this area,to be completed by city or sown offletal. City or Town: PermiULiccnse h Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.Cityrrown Clerk 4. Electrical Inspector 5. Plumbing Inspector b.Other Contact Person: Phone h: Commonwealth of Massachusetts construction Supervtaor �• Division of Professional Licensure Unrestricted-Buadfrgs of any use group which contain Board of Building Regulations and Standards lass than 36,000 cubic Net 081 eubie meted)ofanclosed Construction Supervisor space' CS-106178 Egpires:08/29/2019 - WESLEY COUTURE . . 216uTHROF4rnOET , SOON HADLEY-MA 61075 Falture N posed,a currant edition of me Massschusetrs State Building Code is"use for fdoeWmr of this Nonse. Commissioner For Information bpout dds Scam�/"_ � Cab 1817) a727-1400 arvNS wwwmed.yoNdpl y K l', 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 SUITE 100 Expiration: 08/28@019 SOUTH HADLEY,MA 01075 Update Addrds and Mum card. Mark reason for charge. e Al o 20rn.Ov11 0 Add._ np_e_•_- El Empinyment ❑Lost Card Oekw of Ca wmw AOaina6 einem RpulNon IIOME1MPi10TYK:U-CONTRACTOR Registration for Individual R o nd u TYPE:LLC Office theexpiration We. Ubundretum to: 06/251E"Inffic019 10 Par, Conwmx Affairs and Business Regulation . ! . 175962 08/28/2019 tO Pslk%axe-Suns 5170 AMERICAN INSTALLATIONS,LLC. Bordon,MA 02116 WESLEY COUTURE ISO COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Undersecretary t"lid without Signature CERTIFICATE OF LIABILITY INSURANCE bare/i4-o 17 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 ceNficate holder Is an ADDITIONAL INSURED,the policylies)must be andomed. 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 rights to the certificate holder In lieu of such endorsement(s). PRODUCER AME;NTA T Linda POYOr3 N Webber S Grinnell PXONE . (413)596-0111 FAX N0:11131583-6161 8 North King Street ^MAZE "TPow rsgwshherandgrinnell.com INSURE 3 AFFORDING COVERAGE NAICR Northampton HA 01060 INSURBERAERSFIOVersy Mutual Casualty INSURED INSURER 8 Berkshire Hathanney GUARD Ins. Co. AmeriCtn Installations, LLC INSURER C: Attn: Wes 6 Susanne Couture INSURER D: 130 College Street, Suite 100 INSURER E $Ouch Badley No. 01075 INSURER F: COVERAGES CERTIFICATE NUMBERJUster Est, 9-2018 REVISIONNUMBER: 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 CIAIMS. ,NSR POJEYEFF POLCE%P LTR TYPE OF INSURANCE PCUCYNUMUER USIDD MW LIMITS COMMERCNL GENERAL LIABILITY EACH OCCURRENCE S 11000,000 A R CLAIMSMADE1:1OCCUR PREMISES Eamcurtence S 500,000 W3535217 9/4/2017 9/4/2018 MEDEXPA,ors,I S 10,000 PERSONAL&ADV INJURY S 11000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO JECT LCC PRODUCTS-COMPpP AGG S 2,OD0,000 OTHER. S AUTOMOBILEURINUTY Ea NYoNm S 1,000,000 A ANY AUTO BODILY INJURY(Per Poor) S ALL UTOSMED AX DIVE&DULEO 583535211 9/4/2017 9/4/2018 BODILY NRY(Bar IJUprsam, S X HIRED AUt05 X pOVUNED FeOacuEe„InpMAGE S PIP-Bast S 8,000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LIAR CLAIMS-NAGE AGGREGATE S 1,000,000 CEO X IpJ RETENT10 000 5.]353521] 9/4/2017 9/4/2018 S WORKERS COMPENSATION r PER OTH- AND EMPLOYERS'UAMUW YIN STATUTE ER ANY OFPICPROFFIMBERPXOLUOECIECUTIVE ❑ NIA EL EACH ACCIDENT S 500,000 B (Memo m'm NUB X.60991] 9/4/201"1 9/4/2018 EL.DISEASE-EA EMPLOYE S 500,000 LrEeeembe under R IWION OF OPERATIONS Calm EL. EASEPOLICYLIMIT I S 500,000 A Commercial Property SA3835211 9/4/2017 9/4/2018 mes.be E1 AW MSCMPMN OFOPEMTIONSI LOCGTIONS I VEHICLES (AMONG 101,Bombers RemeM schemes,maybe aMCNM IT mom epee Is neutral CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence Of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUIHOH2EDREPRESEMATWE /J Kevin Joyce/LMP —;*Z 3*"' � — ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 rmvml