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02-022 (5) 639 NORTH FARMS RD BP-2020-0106 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:02-022 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-2020-0106 Proiect# JS-2020-000180 Est.Cost: $4900.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sg. ft.): 196455.60 Owner: MILLINGTON RICHARD H&NALINI BHUSHAN Zoning_WSP(103)/RR(100)/SR(3)/ Applicant. AMERICAN INSTALLATIONS LLC AT. 639 NORTH FARMS RD Applicant Address: Phone: Insurance: 130 COLLEGE ST (41 3) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.712912019 0:00.00 TO PERFORM THE FOLLOWING WORK.-ATTIC 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# 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: FeeTvpe: Date Paid: Amount: Building 7/29/2019 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner . I6� Dep OR City of Northampto tf Building Departmelht 212 Main Street JUL 2 620 9 1SULATIONRoom 1 QO i Northampton, MA 01 phone 413-587-1240 F,x 44Y Tr,�ONir;,INS F FTioNs MA ONLY,ipr;0 APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT 1.1 Property Address This section to be completed by office �_639 North Farms Road Map Lot G Unit Northampton,MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Millington &Bhushan, Richard &Nalini 639 North Farms Road,Northampton, MA 01062 Name(Print) Current Mailing Address: S (413) 320-3259 See attached Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: K. LAIU , (413) 552-0200 Signature jTelephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $4,900.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) l� 5. Fire Protection 6. Total=(1 +2+3+4+5) $4,900.00 Check Number 3 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date @ americaninstallations.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Wesley K. Couture 106178 License Number 130 College Street Ste. 100, outh Hadley MA 01075 9/29/2019 Address Expiration Date ���4 (413)552-0200 Signature JTelephone 9.Registered Home Improvement Contractor: Not Applicable ❑ American Installations 175982 Company Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 6/26/2021 Address Expiration Date Telephone (413) 552-0200 SECTION 5-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.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 Affidavit Attached Yes....... No...... ❑ Brief Description of Proposed Work NOTE: INSULATION ONLY Attic and basement insulation and air sealing throughout. ►, American Installations - Wesley Couture as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Wesley K. Couture Print ame r h � 7/23/2019 Signature of Own r/Agent Date Millington&Bhushan,Richard&Nalini as Owner of the subject property hereby authorize American Installations to act on my behalf, in all matters relative to work authorized by this building permit application. See attached 7/23/2019 Signature of Owner Date City of Northampton ✓ Massachusetts %. DEPARTMENT OF BaIZDING INSPECTIONS �. 212 Main Street • Municipal Building ,• s Northampton, MA 01060 ryjY••�\�, AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation,repair, modernization, conversion, improvement,removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Insulation Est.Cost: $4,900.00 Address of Work: 639 North Farms Road Date of Permit Application: 7/23/2019 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied .r- Other(specify): Contractor pulling permit for homeowner OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: 7/23/2019 American Installations 175982 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: 23liq Dat f Owner Name and Signature City of Northampton - s Massachusetts DEPARTMENT OF BUILDING INSPECTIONS y, \r 212 Main Street •Municipal Building Jos \,ca Northampton, MA 01060 stK Oji^ Debris 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. The debris from construction work being performed at: 639 North Farms Road (Please print house number and street name) Is to be disposed of at: Waste Management of New England, Chicopee, MA 01020 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) ov 'L4 K- Signature of ermit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. • mass save -icensed&insured PARTNER MA CSI b:7 0Fi 17R L % MA Registration a 175981 American Installations www.AmericanInstallations.com 130 College Street Suite 100,South Hadley,MA 01(Y75 • Office:(413)552-0200 Fax:(413)SSZ-0202• Email supportLIDAmericanlnstallations.com Customer Name:Nalini Bhushan Email:Not provided Phone:413-320-3259 Premise Address:639 N Farms Rd,Northampton,MA 01062 Mailing Address:639 N Farms Rd,Northampton,MA 01062 Project ID:3858212 Date:July 19,2019 Job Description Measure Description Location Quantity Unit Total Customer Cost Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Living 12 hr $1,110.96 $0.00 Space Exterior Door Weather Stripping (with AS hrs) Living 2 each $60.14 $0.00 Space Door Sweep (with AS hrs) Living 2 each $50.62 $0.00 Space Rim Joist-6" Fiberglass Batting Living 48 SF $129.60 $32.40 Space Insulation Removal Living 32 SF $40.32 $40.32 Space Attic Floor- 7"Open Blow Cellulose Living 1344 SF $2,257.92 $564.48 Space Attic Stair Cover w/Carpentry (with AS hrs) Living 1 each $289.31 $0.00 Space Whole House Fan Box - 2"Thermal Barrier Polyiso (with Living 1 each $187.70 $0.00 AS hrs) Space Bath Fan - Vent to Roof Living 2 each $282.60 $70.65 Space WARRANTY:American installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the-otal Contract Value as stated herein. ACCEPTANCE OF PROPOSA.. 'he above prices, speci"ications and conditions are TOTAL CONTRAC-VALUE- S satisfactory and are hereby accepted.You are authorized to do work as specified.Payment Down Payment=S ❑ will he 1/3 down prior to start of weak,and balance due upon Completion. PAID Balance Due Upon Completion= 5 Signature Date Page 1 of 2 Property Owner(Print) (Sign; Date Representative:(Print) (Sign) Date THIS AGREEMENT 15 COMPOSED OF THIS PAGE AND TME AEVFASE SIDE OF THIS PAGE AND SMALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARI IES INVOLVED'MIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFOIRED TO AS TOMPANY', ANOTHE CUSTOMERISI NAMED ABOVE,HE RDNAFTER REFER RED TO AS'LLKNV.AND WILL BE SUIDECT TO ALL APPROPRIATE LAWS.REGULATIONS AND ORDINANCES of THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS W ELL AS ALL LOCAL IU RISDICTIONS r • mass save -icensed&Insured MA CSI a:I(Mi IA , � PARTNER MAReglstrunon p 175982 American Installations www.America n Install ations.cam 130 College Street Suite 100,South Hadley,MA 01075• Office:(413)552.0200 ran:(413)552-0202 R Email: support(g)Americaninstallations.com Customer Name:Nalini Bhushan Email:Not provided Phone:413-320-3259 Premise Address:639 N Farms Rd,Northampton,MA 01062 Mailing Address:639 N Farms Rd,Northampton,MA 01062 Protect!^:3858212 Dote:payent'2019 Living Space 48 each $199.68 $49.92 Damming Living 120 each $286.80 $71.70 Space Project Total $4,895.65 Weatherization incentive ($2,367.45) Air sealing incentive ($1,698.73) Total Program Incentive -$4,066.18 Customer Total $829.47 WARRANTY:American installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance With the above specifications and all local and state btilding regulations for the-otal Contract value as stated herein. ACCEPTANCE OF PROPOSA_: The above prices, SPEWications and conditions are 'O'A-CONTRAC-VALUE- 5 829.47 satisfactory and are hereby accepted.you are authorized to do work as specified.Payment pawn Payment- 200.00 ® 7-19-19 will be 1/3 down prior to start of work,and balance due upon Cnmpletion_ PAID Balance Due Upon Completion= S 629.47 Signature /Z1 I)atc 7-19-19 Millin on Page 2 of 2 Property Owner(Print) Kt &Bhushan,Richard and Nalini (sign) Date 7-19-19 Representative:(Print} Jason 44m (Sign) Date 7-19-19 THIS AGREEMENT IS WMP05ED OF THIS PAGE AND THE REMISE SIDE OF THIS PAGE AND SMALL RE CONSIDERED THE ENTIRE AGAEEMENT BF TIE PARIIES INVOLVED'MIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS.LLC HEREINAFTER REFERRED TO AS'COMPANY', AMOTM[W STOMERIS)INM[D A[OK.HEREINAFTER REFER RED 10 AS'D.KNT'.AND WILLIE SLIBIECT TOALL APPROPRIATE LAWS,REGUNATOMS AND OROINANRS of THE STATE OF MASSAOIUSETTS OR COMECTICLR RESPECTftLT,AS WELL AS ALL LOCAL JURISDICTIONS The Commonwealth of Massachusetts Z Department of Industrial Accidents d 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name: 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: Business Type(required): 1.❑✓ I am a employer with 67 employees(full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishmunt 2.❑ 1 am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] g• ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, §1(4),and we have 10.❑ Manufacturing no employees. [No workers' comp. insurance required]** 11.❑ Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.❑✓ Other Insulation *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: Guard Insurance Companies Insurer's Address: P.O. Box A-H, 16 S. River Street City/State/Zip: Wilkes-Barre, PA 18703-0020 Policy#or Self-ins.Lic. # AMWC994153 Expiration Date: 09/04/2019 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 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 a 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 of the DIA for insurance coverage verification. I do hereby certify, under the pains and penalties of perjury that the information provid dove is true and correct. I Si nature: Date: Phone#: 413-55 -020 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia Commonwealth of Massachusetts Construction Supervisor Division of Professional Licensure Unrestricted-Buildings of any use group which contain Board of Building Regulations and Standards less than 35,000 cubic feet(991 cubic meters)of enclosed Construction Supervisor space. CS-106178 Expires: 09/29/2019 WESLEY COUTURE 218 LATHROP"STREET F SOUTH HADLEY MA 01075 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Commissioner J' Call(617)727-3200 or visit www.mass.gov/dpi Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 175982 AMERICAN INSTALLATIONS,LLC. Expiration. 06/26/2021 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Update Address and Return Card. SCA 1 C, 20h1 05:17 711 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 175982 06/26/2021 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LLC. Boston,MA 02118 WESLEY COUTURE 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature /1C'oRv� CERTIFICATE OF LIABILITY INSURANCE DAD �`�"�� 9 9/4/4//20 018 18 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 policy(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 rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTNAME ACT Linda Powers Webber & Grinnell PHONE (413)586-0111 rFAX (413)586 6491 (A/C. 8 North King Street ADDARES.lpowers@webberandgrinnell.Com _ INSURER�Hathawa ING COVERAGE NAIC N Northampton MA 01060 INSURERA: to rsl Casualt INSURED INSURER B:Berkshir@ GUARD Ins. Co. American Installations, LLC INSURER C: Attn: Wes & Suzanne Couture INSURER D: 130 College Street, Suite 100 INSURER E: South Hadlev MA 01075 !NSUREP r. COVERAGES CERTIFICATE NUMBER:Master Exp 9-2019 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. INSR ADDL UBR POLICY EFF POLICY EXP LTR I TYPE OF INSURANCE INSD WVQ POLICY NUMBER MMlDDNY Y /DDNYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A X I CLAIMS-MADE DAMAGE TO RENTED OCCUR PREMISES Ea occurrence S 500,000 5n3535217 9/4/2018 9/4/2019 MED EXP(Any oneperson) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY[:] PRO F7LOC JECT PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY EO BI tl Dt)SINGLE LIMIT $ 11000,000 AANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 523535217 AUTOS X AUTOS 9/4/2018 9/4/2019 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ IAUTOS P t x Coll$2,000 X comp 52,000 PIP-Basic $ 81000 X UMBRELLA UAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR HCLAIMS-MADE AGGREGATE $ 1,000,000 Qin 1 X RETENTIONS 10,000 5J3535217 9/4/2018 9/4/2019 $ WORKERS COMPENSAT,�, I x PER 0H- ANYEMPLOYERS'LIABILITY Y/N — STATUT ANY PROPRIETOR/ R/EXECUTIVE OPFICERWEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ 500,000 B (Mandatory in NH) URWC609917 9/4/2018 9/4/2019 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under - --- - DESCRIPTION OF OPERATIONS be E.L.DISEASE-POLICY LIMIT $ 500,000 =A , ercial Property SA3535217 9/4/2018 9/4/2019 deductible$1,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) 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. AUTHORIZED REPRESENTATIVE / CPCU, CIC W Grinneil, � �-- �� +� z.� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)