37-022 600 FLORENCE RD-262 MOUNTAIN LAUREL PATH BP-2019-0910
GIS 9: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 37-022Jy(�a. CITY OF NORTHAMPTON
Lot: -000 / PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category INSULATION BUILDING PERMIT
Permit# BP-2019-0910
Proiect# JS-2019-001528
Est Cost: $3800.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sa.ft.): Owner. FISHMAN PETER
zoning: Applicant. AMERICAN INSTALLATIONS LLC
AT. 600 FLORENCE RD - 262 MOUNTAIN LAUREL PATH
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON:2/22/20790:00:00
TO PERFORM THE FOLLOWING WORK:ATTIC 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# 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:
FeeType: Date Paid: Amount:
Building 2/22/2019 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
- heparboeik use only.
fph:one
Ci ofNorthampton Status ofPermih
Buil ing Department CurbCuuorivewayPermit2 Main Street SewerlSepgsAybi1p fifty
oom 100 WateIrANelIAvagabilgy
rtha plan, MA 01060 Tyro Sets ofstrudural Plans
587 1240 Fax 413-567-1272lans
lPEc1t Other Spedfy _
a
O CONSTRUCT,ALTER REPAIR RENOVATE OR DEMOLISH AONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION - ( —a (O
1.1 ProoedyAddress: This section to be completed by office
262 Mountain Laurel Path Map -2 Lot Ung.
Florence,MA 01062 Zone Overlay Disfrpet
EM St Dwd CS Dlebict
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Fishman,Dara &Peter 26 Mountain Laurel Path,Florence MA 01062
Name(PdnU (415)MY 864x7e
See attached Telephone
Slg abee
7-2 Authorized AaaM:
American Installations 130 College St., Ste 100 South Hadley, AfA 01075
Nam(PMQ Cunent Nkilkg Address:
\ �(n V. 16.A=A— / 413-552-0200
SlpnaWn Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item EsSmated Cost(Dollars)to be Official Use Only
completed bpermit a Ikent
1. Building $3,800.00 (a)Building Pewit Fee
2. Eleetdcal (b)Istmated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee 7�
4. Mechanical(HVAC) �v
S.Foe Protection
6. Total= 1 +2+3+4+5) F $3,800.00 Check Number 3D Lit
This Section For ONidel Use Only
Building Permit Number. Day
Issued:
Signature: 4 2 'Z2-Zo19
BuAdkg Comrdssbnemrcepedorof BuNdings Day
SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicabi 1
New House Addition Replacement Windows Alteratlon(s) Roofing ❑
Or Doore �
Accessory Bldg. ❑ Demolition ❑ New Signs (D] Deeks M SldinglO] Otherl2Yq
Brief Description of Proposed
Work Attic insulation and air sealing throughout
Ageragon of existing bedroom_Yes_No Adding new bedroom Yes No
Attached Narrative Renowatlng unfr fished basement _Yes No
Plane Attached Rog -Sheet
Ga.If New house and or addition to existing housing complete the following,
a. Use of butidag:One Famtiy Two Family Other
b. Number of rooms In each family unit Number of Bathrooms
a Is there a garage attached?
d. Proposed Square footage of new consimction. Dimensions
e. Number of stories?
f. Method of healing? Fireplaces or Woodstmes Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type ofoonsauclion
I. IscenshuctionwithinlODfLofwegmds?_Yes No. Iscensbuctionwitldn100yr. floodplain_Yes----No
J. Depth of basement or celarilmr below finished grade
k. Will balding conform to the Building and Zoning regulations? Yes_No.
I. Septic Tank_ City Sewer_ Pdwitswell_ Citywato Supply_
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
l Fishman, Dara&Peter as Owner of the subject
property
herebyauthodze American Installations
to act on my behalf,in ail matters reledwe to work autlwdzed by this building permit application.
See attached 2/18/2019
Signature of Orman Date
I, American Installations as Owner/Authorized
Agent hereby declare that the statements and Information on the foregoing application are We and accurate,m th best of my knowledge
and belief.
Signed under the peke and penalties of perjury.
American Installations
PriyaqNemo
-1i
'L/ �' � ; 2/18/2019
Sigiwaaeof edAgent Daze
i
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: 26 Mountain Laurel Path
The debris will be transported by: American Installations
The debris will be received by: Waste Management of New England
Building permit number:
Name of Permit Applicant Wesley Couture
2/18/2019 (A�p i�y� k. (n.)1JAAJ
Date Signature of Permit Applicant
s� Up¢npeJ4lnpurM
American installations Ma Ra9latMd #ln9R2
saproueFesu..twRa s4A swnn weer,eupsms.mac:(.)1.42n1rc14v1 seam:•..M.
Fishman,Oat&Peter 12/17/2018
Z6 Mountain laurel PaN Florence MA 01062
(516)236-2453 dammO son@gmall:com
416263 wa nom. 18-3479
wn DuantM unk Unk Cost e+s Total
AS
AIIRSEAUNAUNG 14 jrnaniour) $ RS.00 $ 1,190.00
WEATHERSTRIP DOOR&ADDSWEEP 3 each $ 80.00 $ 240.00
Air Sealing $ 1,430.00
Air Sealing Incentive $ (1,020.00)
Air Selaing WXealax $ 410.00
ATOCFIAT-6"OPENR22aUULOSE 1,288 ,ft $ 1.32 $ 1,700.16
VENTRATION CHUTES 74 each $ 2.50 $ 185.00
ATTIC DAMMING-R-38 FIBERGLASS 114 spft $ 2.05 $ 233.70
ATTIC HATCH-SEAL&INSULATE 1 each $ 6000 $ 60.00
INSULATED BATH EXHAUST HOSE 2 each $ 60.00 5 120A0
Air Sealing WX Balance i lum sum $ 410.00 $ 410.00
Total Wenherinti. $ 2,708.86
WWhul,ation Incentive $ 2,031.65
Fborboew Removal $ 250.00
Total P.JM $ 3,T2BA6
Toni UUllty Contribl $ 3,301.65
Total Customer Contdbudon $ 42722
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nrgvrur. Capaop.:napEoepnea.peM —.na TOTALCONTMCTVALUEa $ 422.22
mndtialuertatlMpacry pntl.n Mnby.®pad Yw.rt
alnMma4bdpwakas.pMfxd p.ymantwalYl/iduwn Plor Down Pdym¢m= $ 142.OD 0
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Balance Duepo
Un Com0le[ion= $ 285.22
Dam Fishman(Jan 10,2019)
Fishman,Dara&Peter 12/17/2018
B.Zamer 8. ZasMu- 12/17/2018
The Commurnwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 01111
wrvw.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leaibly
Name(Business/DrganimioNlns ividua0: American Installations,LLC
Address: 130 College Street, Suite 100
City/State/Zip: South Hadley,MA 01075 Phone#: 413-552-0200
Are you an employer?Check the appropriate box: Type of project(required):
1.[X] Ism o employer with 60 4. ❑ I am a general contractor and 1 6. ❑ New construction
employees(full and/or pen-bme)- have hired the subcontractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet.i Remodeling
ship and have no employees 'Deese subcontractors 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 ME] Electrical repairs or additions
1❑ I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions
myself[No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required.]t employees.[No workers' 13.9 Other Insulation
comp.insurance required.] —
;Any applicant that eheas box al moa also fill notion section below showing their workers'cono
e am
on policy infomtion.
t Homeowoen who submit thetaRMavil uWkming flay arc doing all work an!then hire amaidc cmboeton,must submit o newaamavit indicating sad.
�Cummelms and check this boa must mWrlso m addiumod aheet showing Ihe,una or as sub-contrxtors mq aver wort rx come Nhey arum aim.
I am an employer rhm is pro idlng workers'rompensadon Imurance for my employees. Below is the poacy mulish site
information.
Insurance Company Name: Guard Insurance Companies
Policy#or Self-ins. Li,.9: URWC6099171 - Expiration Date: 09/04/2019
Job Site Address: 4-1- Mar4-'W) ucvfFJ pc f4a City/Slats/Zip: P16Yvn(y
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure m 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 of n STOP WORK ORDER and a fine
of up to 5250.00 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.
I do hereby ttpnify,under the pains ann]dpenal ieess of perjury that the information provided above is true and coma.
Signature-4 zein�z � ( .r9-fLT.ul2s>— Date,. 2II q i[q
Phone#:/ 413-55 -0200
Official use only. Do not write in this area,to be confided by city or town offiein.
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
b.Other
Contact Person: Phone#:
Corrmronwea6h of Massachusetts Constructwn supwvww
®; Division of Professional Licensure Unrestricted-Buildigs of any uses group which contain
Board of Building Regulations and Standards Was Uses 36,000 cubic f"t(991 cubic meters)of enclosed
Construe ibn SOpervisor spac.
CS-106178 Upires:09/29/2019
WESLEY COUTURE
710LATHROPSTREET
SOUTH HADL&NIA 01070
FaBus fe peaces a curers states of Me Massachusetts;
State Building Coda Is Gua for ravocrion of the ECM".
For Information abed alta Oearlaa
Commissioner Ca0(617)IV-nn or visit arlagovhip
n"//e ((�(1/J'(yY1f1I7(ltP-(Cfftl (l �? ;1:1C7-C'77LC.1P.tt.1
FY Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Horne improvement Contractor Registration
Type LLC
AMERICAN INSTALLATIONS,LLC. Rapistra9arc 175862
190 COLLEGE STREET SURE 100 06/28/2019
SOUTH HADLEY,MA 01075 -
tlpdais Adds.and Mum Card. Mark rasson for chirps.
WA1 O LJMWIl
nAdr!_ n P�.._t n.Empnymebt.❑1SM OEN
OMea M Conwmar ABMs a 9uYnaas RNulatlon
HOME IMPROVEMENT CONTRACTOR Registration valid far lndsiduai use eNy
1.. TYPE:LLC bass M in"refni Baia. E bual rahrm to:
E1gW[gl0g EOgiDg9n OMs,of Cenaumsr Allain and Mrariew,Ragula6en
175982 0612813019 10 Park Ree-9u1te 6170
AMERICAN INSTALLATIONS,LLC. Boston,MA 02118
WESLEY COUTURE
190 COLLEGE STREET SUITE 100 t valid Mthout signature
SOUTH HADLEY,MA 01075 Undersecretary 9
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A0M01®REMAMAT
N Grinnell, CICU, CIC f✓-j�-- -� Y' �
O 19•&2010 ACORD CORPORATION. All NghM nMaryal.
ACORD 26(201601) The ACORD name end logo are regllim marls of ACORD
INS01b la/arl