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81 SANDY HILL RD BP-2021-0038 GIS#: COMMONWEALTH OF�MASSACHUSETTS Map:Block:29-407 CITY OF NORTHAMPTON. Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit:' Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Pen-nit# BP-2021-0038 Project# JS-2021-000053 Est. Cost: $3672.00. Fee: $65.00 PERMISSION IS HEREBY.GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq. 11.1 20821.68 Owner: CLAWSON ALAN zoning: Applicant. AMERICAN INSTALLATIONS LLC AT: 81 SANDY HILL RD Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.7/10/2020 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: FeeType: Date Paid: Amount: Building 7/10/2020 0:00:00 $65.00 212 Main Street,Phone(413)58771240,Fax: (413)587-1272 'Louis Hasbrouck—Building Commissioner City of Northamp on ///.,�.,.,..,. . . Building Depa t 212Wain'Strew. ��o`s �s Room 100 9TtigM�°�� M T GI \`c ✓tl Y, ` 8 % ,£" 4'2 Y5 Northampton, MA 0106 phone 413-587-1240 Fax 413=58771 ''na'� APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION T N 1 NS ULA TION PERMIT This section t, o.be completed,by offce 1.1 Property Address: /°� . �.. Unit gI su>7a y yMap Lot,�l d - -- 7-7777777777-.*, Zone Overlay District Nor4-harnpk/1- Elm St District CS bistrict SECTION 2-PROPERTY OWNERSHIPJAUTHORiZED AGENT 2.1 Owner of Record: Name(Print) / Current Mailing Address: See attached N/3 -387— 9.538 Signature Telephone 2.2 Authorized A-gent: American Installations 130 College Street Ste. 1,00, South Hadley,MA 01075 Name(Print) Current Mailing Address: (413)552- Signature 413)552-Signature �— Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only complete by permit applicant 1. Building 7 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) �j 5. Fire Protection 6. Total=(1 +2+3+4+5) A 6,72 Check Number /� This Section For Oficial Use Only Building Permit Numb r:&40- �. .3 " Date Issued: Signature: 7/d 10ozo Building Commissioner/Inspector of Buildings Date production @ americaninstallations.com EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) The Commonwealth of Massachusens a _ Department•of)ytdustrial Accidents M d I Confess Street;Suite 100 Boston,1116 02114=2017 www mass.gov/dia � Workers'Compensation Insurance Affidavit;,Builders/Contractors/Electricians/Plumbers. TO RE FILED-i fT THE PERM WING AUTHORITY. Applicant:1nforJnation Please Print:Legibly Name (Business/9rganizatiop(IndtVtdual):. American Installations, LLC Address: 1.30 College,Street, Suite 100 City/State/Zip: South Hadley, MA 01.075 Phone#: 413-552-0200. Are you atemployer Cheek the appropriate:box: Iof - ,--" _ - T -pe project(requir ) - L(K l am a etnploye,r with 70 employees(full and/o;paq-ihne)c" 7. EJ New construction 2,Q I ein a sole.propriefor of paitnership:andhave no employees working forme in 8'. 0 Remodeling any capacity;[No workerscoinp.•h.surance required.] 3:[J l dma homeowner doing all Workmysclf.[No workers'comp.insuranct-required.)t 9. El Demolition 10 13uildingeddition 4.Q i sot a homeowner and will be hiring contractors to conduct all workon my property. I will ensure that all contractors either Have workers compensation insurance or are sole 11.Q El'ectricar repairs or additions_ proprietors:with no employees, 12.0 P14mbing.repairs or additions 5.M.1 inn ii-general`contractor and I have hrred:the sub oontiactors listed on;dwattached`sheet. 13.0 Roof repairs These sub-contractors have eiitployees and,haveworkers comp,insurance_.x 6.M . We are a co oration and its officers have exercised their right of exem ion er MGL c. 14.Q Other Insulation ... IP gh. pt� p. and we have no"employees:[No workers'comp:insurance required.)! ?Any applicant that alecks box#1 must also fill-out sectibmbelowshowmg then workers'compedsation policy information. p Hoineowmi ners who subt this affidavit incltcatuig they are doing all work and then hun outside contractors must:submr anew affidavit indicating-such: ; tra Conctors that check this box must attached an Additional sheet showing the name cf the sub-contractors.and stateWhe�ther or not'those entities have einplgyces:_.if the sub-contractors havo etnployees,,they must;proyide their workeri,p mp policy number. I silt an erxployer,'thafsprovidingworkers"''compensation:insurancefor my employees Belo is the pokey arrdjob site information. Insurance Company-Name Berkshire Hathaway GUARD Policy#or Self-ins Lip:"#: AMWC049875 Expiration Date: 09/04/2020 Job SIte,Address -9).-Sand.il,l� [Y City/State/Zip,�OPr�t ol0 4 a` .. . Attach a copy of the workers?compensation policy declaration page(showing the policy ntt'i bei and expiration date). Failure to secure coverage as required under MGL-6. 152,§;5A is-a-criminal-violarion�punishable by a fine up to$1;500.00 f andlor onwllacii ,penaltiesin, vthe form of aSTUP WORK ORDEit and`a fine ofup to$250.00 a day-against the violator.:A copy,of.thls statetnept may tie forwarded to the Office of Investigatio s of the DIA for insurance coverage,verlf cation. " Lilo hereby certify wieder iltepaiii"s avidpesralties ofperjury that'die infol'niation proJided above is true and correct Signature: Date: 30 D. Phone:#: 413-552-0 00 1. " 0ff1ci41use.oeily. Do,not wkite a1#dS-area,to;be completed by city or.town.official. City or Town:. Permit/License# i Issuing.Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector .Plumbing Inspector 6.Other Contact Person:. Phone#: G s t. ® A�o DATE(MMIDDIYI(YY)CERTIFICATE OF LIABILITY INSURANCE 8/28/2019 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND 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(les)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). CONTCT PRODUCER NAME: Linda POWETS Webber & Grinnell PHD.o (413)586-0111 ac No: 14131586-6481 8 North King,Street E-MAIL 1powers@webberandgrinnell.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA:Em l0 ers Mutual Casualty INSURED INSURER B:BerkShire Hathaw i ay GUARD Ins. Co. American Installations, LLC INSURERC: Attn: Wes,& Suzann Couture INSURERD: 130 College Street, Suite 100. INSURER E]: Sough Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE WUMBER: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 - ADDL SUBR" - POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X CLAIMSMADE OCCUR DAMAGE TO RENTED 500,000 PREMISES Ea occurrence $ 5D3535217 9/4/2019 9/4/2020 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $ 2,000,000 X POLICY PRO-JECT. F-]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT• OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000, Ea accident A ANYAUTO j BODILY INJURY(Per person) $ ALL OWNED R SCHEDULED 523535217 9/4/2019 9/4/2020 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE' X HIREDAUTOS X AUTOS Per accident) $ X -Coli$2,000 X I comp$2,000 PIP-Basic $ 8,000 X UMBRELLA.LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A _ EXCESS LIAe CLAIMS-MADE - AGGREGATE $ 1,000,000 DED X RETENTION$. 10 000 5J3535217 9/4/2019 9/4/2020 l _ $ WORKERS COMPENSATION _ PER OTH- AND EMPLOYERS'LIABILITY YIN AT F I ER ANY PROPRIETORWARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑N/'A B (Mandatory in NH) AMWC994153 9/4/2019 9/4/2020 E.L.DISEASE-FA 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) j i 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. i AUTHORIZED REPRESENTATIVE W Grinnell, CPCU, CIC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD125(2014101) The ACORD name and logo are registered marks of ACORD INS025;pa14o1) I SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Constnrction 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 6.Registered Not PPlicable ❑ American Installations 175982 Company Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 6126/2021 Address Expiration Date Telephone (413)552-0200 i 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....... JM No...... ❑ Brief Description of Proposed Work NOTE:O TE: INS ULA TION ONLY Attic and basement insulation and air sealing throughout. I 1, 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 Signature of Own ent Date I, Q ,S OAI 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 Signature of Owner Date e City of Northampton �5 S� Massachusetts tY DEPARTIWNT OF BUXZDING INSPECTIONS i 212 Main street •Municipal Building Jyy� a Northampton, MA 01060 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: g1 clan (Please print houib number an�name) Is to be disposed of at: Waste f New o Manggement Chicopee, MA 01020 g England, Chcop , (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of rmit A plicant 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. 4 �p mass save Ucensed&Insured PARTNER MA CSL#:106178 AARegistrotiDn"1'5982oo►merican Installations www.Ameeicanlnstallaiians.com .130.COIleg6 5treef Suite 300,.30uth.Ftatdey,MA 01075•Office:(413)5 52-0 20 6 Fax.(413)552.0202•EMaiksupport@Americaninstallatidns.com Customer Name:Allan Clawson Email:Not provided Phone:413-387-9538 Premise Address:81 Sandy Hill Rd,Northampton,MA 01062 Mailing Address:81 Sandy Hill Rd,Northampton,MA 01062 Project ID:3737372 Date:March 4,2019 Job Description Measure Description Location Quantity lJnit Tofall;Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 12 hr $11,110.96 $0.00 Rim Joist-6" Fiberglass Batting Living Space 30 SF $81.00 $20.25 Damming Living Space 36 each $86.04 $21.51 Propavent Living Space 82 each $341.12 $85.28 Attic Floor-8"Open Blow Cellulose Living Space 1152 SF $2,027.52 $506.88 Bath Fan Hose Living Space 1 each $26.20 $6.55 Project Total $3,672.84 Weatherization incentive ($1,921.41) Air sealing incentive ($1,110.96) Total Program Incentive -$3,032.37 Customer Total $640.47 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. I 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-forthe Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE=S 640.47 satisfactory and are hereby accepted.You are authorized to do work as specified.Payment Down Payment=S 200.00 Q will be 113 down prior to start of work,and balance due upon Completion. PAID Balance Due Upon = 5 440.47 signatumsean Cla on(Mar 18,2020) Date Page 1 of 1 Property Owner(Print) (Sign) Date I I Representative:(Print) (Sign) Date) THIS AGREEMENT IS COMPOSED OFTHIS PAGEANO THEREVEASE SIDE OF THIS PAGEANO SHALL BE CM5IDERED THE ENrIREAGREEMENTEIY THE PAR7IES INVOLVED.THIS AGREEMEMB GE1-lEE1.AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERREOTOAS-COMPANY, ANOME CTSTOMER(S)NAMED ABOVE,HEREINAFTER REFERREDIOAS-QIENT-,AND WILLGE SUBIECTTOALL APPROPRLIITEUAW REGULATIONSAND ORDINANCES OFTHEMTEOF MASSACHUSETTS ORCONNECTICUT RESPEC7NELY,A5 WELLAS ALL WCALTURISDICIIONS.