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46-056 (8) 86 ISLAND RD BP-2020-0787 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:46-056 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-2020-0787 Proiect# JS-2020-001367 Est.Cost: $4831.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq.ft.): 47044.80 Owner: PUTNAM LINDA Zoning: Applicant. AMERICAN INSTALLATIONS LLC AT. 86 ISLAND RD Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.1/8/2020 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 1/8/2020 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner °` DepAo z , City of NorthamptoVal? Building Departme t 212 Main Strep r INSULATION . of Room 100 �-�rygino� Northampton, MA 0106 phone 413-587-1240 Fax 413-587-12 _ ONLY APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address 4 �JThis section to be co ted by office Map_ VL Lot DUnit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Linda Putman & John Cohen 86 Island Road Name(Print) Cut ai A d s See attached 71 �3 T f?A Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: JA A.1 _ PaAbV (413) 552-0200 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 4831.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number &2- �-7 —/T7his Section For Official Use OnlBuilding Permit Number: a ` 0 Date Issued: Q Signature: Q oZ0 Building Commissioner/Inspector of Buildings Date production @ 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, South Hadley MA 01075 9/29/2021 Address Expiration Date (413)552-0200 Signature Telephone 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....... X No...... ❑ Brief Description of Proposed Work NOTE: INSULATION ONLY Attic and basement insulation and air sealing throughout. t, 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 Name Cum 1/2/2020 Signature of Owne/Agent Date I, , 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 1/2/2020 Signature of Owner Date City of Northampton +✓ Massachusetts G' DEPARTMENT OF BUILDING INSPECTIONS ro 212 Main Street • Municipal Building . > Northampton, MA 01060 rf� •• i�o 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: 4831.00 Address of Work: 86 Island Road Date of Permit Application: 1/2/2020 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 x 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: 1/2/2020 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: 1/2/2020 Date Owner Nam and Signature City of Northampton Massachusetts � 'G DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street *Municipal Building J� �a t Northampton, MA 01060 ssb .• ,0 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: 86 Island 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: American Installations (Company Name and Address) wjeu e nu&-L/- Signature of F2hrmit 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. City of Northampton rli. 2•r' Massachusetts P N x DEPARTMENT OF BUILDING INSPECTIONS yJ, A"r 212 Main Street • Municipal Building mss ASO Northampton, MA 01060 N � MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 86 Island Road Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413)552-0200 Property Owner Linda Putnam&John Cohen Name: Address: 86 Island Road City, State: Northampton,MA 01060 1, Wesley K. Couture (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 signature Date 1/2/2020 A Page 1 of 2 • mass save _icensed&Insured PARTNER MA CSt Ar:106178 , MA RegistrohonN 275982 American Installations www.Americaninstallations.com 130 College Street Suite 100,South Hadley,MA 01075• Office:(413)552.0200 Fax:(413)SS2.0202 P Email:supportL&America nlnstallations.com Customer Name:Linda Putnam Email:Lindabputnam@gmail.com Phone:413-923-2128 Premise Address:86 ISLAND RD,NORTHAMPTON,MA 01060 Mailing Address:86 Island Rd,Northampton,MA 01060 Project ID:3954107 Date:Dec.20,2019 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 4 hr $370.32 $0.00 Duct Sealing -4 Hours (not insulated, up to 200') Living Space 1 each $337.28 $0.00 Transition Air sealing Living Space 26 LF $177.84 $0.00 Vapor Barrier- 6 mil Polyethylene (with AS hrs) Living Space 1184 SF $1,160.32 $0.00 Exterior Door Weather Stripping (with AS hrs) Living Space 2 each $60.14 $0.00 Door Sweep (with AS hrs) Living Space 2 each $50.62 $0.00 Rim Joist-6" Fiberglass Batting Living Space 104 SF $280.80 $70.20 Insulation Removal Living Space 20 SF $25.20 $25.20 Attic Floor- 15"Open Blow Cellulose Living Space 288 SF $650.88 $162.72 Propavent Living Space 36 each $149.76 $37.44 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:he above specifications and all local and state building regulations for the-otal Contract Value as stated herein. ACCEPTANCE OF PRODOSAL The above prices, specirications and conditions are TOTAL CONTRAC-VALUE- 5 satisfactory and are hereby accepted.Youare authorized to dowoFk as specified.payment Down Payment=S ❑ will he 2J3 dnvm prior to start of work,and balance due upon Completion. PAID Balance Due Upon Completion= S Signature Date Property Owner(Print) (Sign} Date Representative:(Print) (sign) Date THIS AGREEMENT ISCOWOSED CF THIS PAGE AND THE REVERSE SIDE OF TNS PAGE AND SHALL RE COI151ME THE ENTIREAGAEEMEW W THE PARTIES INVOLVED-NIS AGREEMEN1i5 BETWEEN AMERICAN iN5'AL4710NS,LLC MREINAFTER REFERRED TO AS YOMPAYY', AMTMCUSTOMERISI NAMED ABOVE,HERONIIFTER REFERRED TC AS-QIENT',AND WILL BE SUBACT TOALL APPROPRIATECAWS.REGUUTIORSAND ORGITI-CES Of THE STATE OF MASSACHUSETTS OR COIMECTICUT RESP ITALY,Aa WELL AS Ail LOCAL 1UMSDICT IONS Page 2 of 2• . mass save _icensed&insured PARTNER MA CSt M:106178 , MA Regtstranon p 175982 American Installations www.Americaninstallations.com 130 College Street Suite 100,South Nedlq,MA 01075•office:(413)SS2-0200 Far;(413)552.0202• Email:supportaAmericanlnstalletionscom Customer Name:Linda Putnam Email:Lindabputnam@gmail.com Phone:413-923-2128 Premise Address:86 ISLAND RD,NORTHAMPTON,MA 01060 Mailing Address:86 Island Rd,Northampton,MA 01060 Project ID:3954107 Date:Dec.20,2019 Damming Living Space 6 each $14.34 $3.58 Attic Floor-6" Dense Pack Cellulose Living Space 432 SF $1,075.68 $268.93 Bath Fan -Vent to Roof Living Space 1 each $141.30 $35.32 Duct Insulation Living Space 84 SF $336.00 $84.00 Project Total $4,830.48 Duct insulation incentive ($252.00) Weatherization incentive ($1,734.57) Duct sealing incentive ($337.28) Air sealing incentive ($1,819.24) Total Program Incentive -$4,143.09 Customer Total $687.39 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American Installations,LLC hereby proposes to furrish all material and labor to completethe above scope of work in accordance with:he above specifications and all local and state building regulations for the-otal Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specrications and conditions are TOTAL CONTRAC-VALUE- $ 687.39 satisfactory and are hereby accepted.You are authorised to do work as specified.Payment will be 113 down prior to start of work,and balance due upon Completion. Down Payment=S 225.00 ® 12/20/2 19 Balance Due upon Completion= S 462.39 PAID Sigruture Date 12/20/2019 Property owner(Print)Linda Putnam Isigny Date 12/20/2019 Representative:(Print) Ken Vautrin Jr. (Sigh Date 12/20/2019 TMS AGREEMENT IS COMPOSED Of INS PAGE AND INE REVERSE SIDE OF THIS PAGE ANO SHALE BE CONSIOEIIED THE ENTMEAGGEEMENT h THE PM7113 INVOLVED INS AGREEMENT IS BETWEEN AMERICAN INSTALUl10N5,LLC N UMMAFTfR REFERRED TO AS'COMPANY, ANOTHE WSTOMERIS)NAMED MOVE,HERONAfTM REFENAED 70 AS'QENI'.ANO WGA BE SLPMCT TOAQ APPROPMATE LAWS,REGOIATIONS ANO ORONAN¢S Of THE STATE OF MASSAO,OSEITS 09 CONNECTICUT RESPECTIVELY,AS WELL AS AU LOCAL JURISDICTIONS The Commonwealth of Massachusetts Department of Industrial Accidents a 1 Congress Street,Suite 100 Boston,MA 02114-2017 rt www mass.gov/dia «orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print I egibly Name (Business/Organization/Individual): 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): l.[K I am a employer with 70 employees(full and/or part-tune).' 7. 0 New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]r 10 Q Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. [will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.O I am a general eontractorand I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.I 'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is thepo/icy andjob site information. Insurance Company Name: Berkshire Hathaway GUARD Policy#or Self-ins.Li//c.,,#: AMWC049875 _ Expiration Date: 09/(04/2020 Job Site Address: RUl 13) 1C/ eULf(JI City/State/Zip: U bn( Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration ate). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provide l a ve is true and correct. I Si nature: 6L,4Date: Phone#: 41 - 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.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 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 =xpires. 09/29 201' WESLEY COUTURE 139 PACKARDVILLE ROAD PELHAM MA 01002 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. CommissionerFor information about this license � � �---- Call 617 7273200visit ( 1 or www.mass.gov/dpl Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 175982 AMERfCAN INSTALLATIONS, LLC. Expiration: 06/26/2021 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Update Address and Return Card. SCA 7 8 MM-MI7 ./%r Yiiiviirlll�.- 1-1'/;'-'/-""'//' 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 / )� /J WESLEY COUTURE J /I / 130 COLLEGE STREET SUITE 100 r�{,r wlCG!mG/N.k SOUTH HADLEY,MA 01075 Undersecretary Moot valid without signature ,a►coRo® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 8/28/2019 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 Linda Powers NAME: Webber 6 Grinnell PHONE (413)586-0111I AIC NO: (413)586-6481 8 North King Street E-MAIL ADDRESS: 1powers@webberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC N Northampton MA 01060 INSURER A:Employers Mutual Casualty INSURED INSURER B:Berkshire Hathaway GUARD Ins. Co. American Installations, LLC INSURERC: Attn: Wes 6 Suzanne Couture INSURER D: 130 College Street, Suite 100 INSURERE: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER:Master Exp 9-2020 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 7ypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AX CLAIMS-MADE ❑OCCUR DAMAGE TO RED PREMISES Ea ocENTcurrence $ 500,000 5D3535217 9/4/2019 9/4/2020 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X JECT OTHER: $ AUTOMOBILE LIABILITY Ea aBINEDtSINGLE LIMIT $ 1,000,000 A ANYAUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 523535217 9/4/2019 9/4/2020 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X Coll$2,000 X comp$2,000 PIP-Basic $ 8,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB HCLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 SJ3535217 9/4/2019 9/4/2020 $ WORKERS COMPENSATIONX PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑N I B A (Mandatory in NH) AMWC994153 9/4/2019 9/4/2020 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Business Personal Property 5A3535217 9/4/2019 9/4/2020 deductible$1,000 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if 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 W Grinnell, CPCU, CIC ),ll..-- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)