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31A-009 misidentified on permit 281 ELM ST BP-2021-1303 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:35 -040 CITY OF NORTHAMPTON Lot:- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2021-1303 Project# JS-2021-002150 Est.Cost: $4600.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq.ft.): 485415.00 Owner: DENHAM LILLIE Zoning: SR/WSPI► Applicant: AMERICAN INSTALLATIONS LLC AT: 281 ELM ST Applicant Address: Phone: Insurance: 130 COLLEGE ST #100 (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:5/7/20210:00:00 TO PERFORM THE FOLLOWING WORK:INSULATIONANEATHERIZATION 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 NORTHAMPTO UP VIOLATION OF ANY OF ITS RULES AND REGULATIONS. I ,I • i • • Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 5/7/2021 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner C o / DeFOR atrt City of Northamptp"n 'I'-"` ` Building Department q)' , I: ! :_,4 _ , ;. 21 Room Street.,_. .�:.�,, / <90(2/ ,/ INSULA TION •,, 41 Northampton, MA 01060;r',,, / : ,11 On y ,,,,,,,,,,mo; .. *. phone 413-587-1240 Fax 413-587/'2 P >j APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: This section to be complete by office ^� I /m C-t Map (+ Lot O Unit O( �' ` J Zone Overlay District NorAampfort, N ) 0/O60 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: LI'IIbe-i-h EDenham r,28V ani St /i/r-iantp A-Vi Name(Print) Current Mailing Address: 1 �oa 913-3s 3 See attached Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: (413) 552-0200 Signal re Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building DD (a) Building Permit Fee 2. Electrical / (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4 Mechanical (HVAC) 0 Ltc,. 5. Fire Protection 6. Total=(1 +2+3+4+5) -/ Gov Check Number 7 001 This Section For Official Use Only 0 j9 Building Permit Number: ?I' (. 13 DateIssued: Signature: // 5-7- 20ZI Building Commissioner/Inspector of Buildings Date permits@AmericanInstallations.com @ EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 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 S ure Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 American Installations 175982 Company Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 6/26/2021 Address Expiration Date /1.4, 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 Jib No 0 Brief Description of Proposed Work NOTE: INSULATION ONL Y Attic and basement insulation and air sealing throughout. I, 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 N e fzio Signature of /Agent Date I, L1 l / he-,'i4 �n ACL KY 1 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 9—Fc2.0ao Signature of Owner Date City of Northampton i " r •� Massachusetts - .''(c I lr• 7 wE % t ` E «; ,' DEPARTMENT OF BIIILDZNG INSPECTIONS <, r 212 Main Street • Municipal Building r`�I:,. �D�. Northampton, MA 01060 si3 ice, 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: y 6 0 0 Address of Work: oS g) jJm �', ND l+A,a. eor1__ Date of Permit Application: S / -a 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: 5-17/—a4 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: Date Owner Name and Signature City of Northampton s •t-- Massachusetts �yt?,' y � : DEPARTMENT OF BUILDING INSPECTIONS a=. ►, '" ""Y 212 Main Street •Municipal Building �y.. .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: ,f S� (Please print house number and street name) Is to be disposed of at: K er W Materials &Recycling, 138 Palmer Ave, West Springfield, MA 01089 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signatur of ermit Applicant or Owner Date lf, 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. .___M-., City of Northampton %' Massachusetts tea; '` r, I -A: �}: s c , DEPARTMENT OF BUILDING INSPECTIONS 1.. i i 212 Main Street • Municipal Building �f.aj� \"'�;_ Northampton, MA 01060 fbW .s1 MANDATORY FOR/ cH1OUSES BUILT^ BEFORE 1945 Property Address: &b l l C i{/'!') cam/ �i1�7/7ll IYl iOTOY� Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413) 552-0200 Property Owner Name: /1 i'/,�beY--i Lei°n/Q rrt.. Address: d, g! g/m St City, State: /ilDr7'/1 a ny 16Y> AV C/i O 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 The Commonwealth of Massachusetts Pr Department of Industrial Accidents • �� " ,1- a 1 Congress Street, Suite 100 ,�, ,! Boston,MA 02114-2017 •� »� www.mass.gov/dia im Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly 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.®lam a employer with 41 employees(full and/or pan-titre).* 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10❑Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.E Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I ain a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.El Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We area corporation and its officers have exercised their right of exemption per MGL c. I4.®Other Insulation 152,§I(4),and we have no employees.[No workers'comp insurance required.] *Any applicant that checks box#1 must also till out the section beloy 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 slate 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 the policy and job site information. Insurance Company Name: Berkshire Hathaway GUARD Insurance Policy#or Self-ins.Lie,#: AMWC,1877177 Expiration Date: 09/04/2021' Q Job Site Address: �/i►'1'1 (7 r City/State/Zip: �d/�l/414 ira Attach a copy of the workers'compensation policy declaration page(showing the policy number and exption dale). QIO(oD • Failure to secure coverage as required under MGL c. 152,§25A is a criminal violatiompunishable 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 t i coverage verification. a (do hereby certify under the pains and penalties of perjury that the information provided above Jis true and correct. Signature: 9. („do.),,,,__ Date: e.7 1- ...— / i Phone#: 413-552-0 00 __ 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): a 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 1 6. Other i Contact Person: Phone#: Commonwealth Jr MasacT„,setts Construction Supervisor IIP 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. C S 10E 17B Expires 09/29 202 ' WESLEY COUTURE I 139 PACKARDVILLE ROAD PELHAM MA 01002 `` R Failure to possess a current edition of the Massachusetts 10 State Building Code is cause for revocation of this license. Commissioner �441.4.c_ /`�'�"`-�"�-- - For information about this license Call (617) 727-3200 or visit www.mass-gov/dpl e.74 6772/72o72C t aCK G aA g & 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 t 0 20M-O&h7 ..F7 t '/i,/,,W/V,r, "> .//),,rr/i.,�// 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 1=xoiration Office of Consumer Affairs and Business Regulation 175982 06/26/2021 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS.LLC. Boston,MA 02118 WESLEY COUTURE / 1 Ail 130 COLLEGE STREET SUITE 100 G✓F"''0(6( i' ' SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature A ® DATE(MM DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/21/2020 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 have ADDITIONAL INSURED provisions or 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 CONTACT Linda Eichstaedt,CRIS NAME: Webber&Grinnell PHONN ExU: (413)586-0111 FAX No): (413)586-6481 8 North King Street E-MAIL leichstaedt©webberandgrinnell corn ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Employers Mutual Casualty Company 21415 INSURED INSURER B: American Installations,LLC INSURER c: AMGUARD//BHGUARD 14702 Attn:Wes&Suzanne Couture INSURER D: 130 College Street,Suite 100 INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Exp 9-2021 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY), COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,DAMAGE TO RENTED 000 X CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A 503535219 09/04/2020 09/04/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED '/ SCHEDULED 5Z35352 09/04/2020 09/04/2021 BODILY INJURY(Per accident) $ AUTOS ONLY /'s AUTOS X HIRED ONLY X AUT NONOS ON-OWNEDL PROPERTY DAMAGE (Per accident) $ Y , X coll$2K X comp$2K PIP-Basic $ 8,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,- 000 A EXCESS LIAB CLAIMS-MADE 5J3535220 09/04/2020 09/04/2021 AGGREGATE $ 1,000,000 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY YIN 500,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A AMWC187717 09/04/2020 09/04/2021 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD American Installations Cdumbi'a Gas., Home Performance Contractor of Massachusetts A ANSoum CompnY 130 College Street, South Hadley,MA 01075 413-552-0200 FAX 413-552-0202 CONTRACT - YYZ Page 1 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT# WORK ORDER Lilibeth Denham (413)325-7323 09/01/2020 499722 68602 SERVICE STREET BILLING STREET PROPOSED BY: 281 Elm Street 281 Elm Street American Installations SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 100% 2020 For a limited time, Columbia Gas is offering an incentive of 100%on qualifying weatherization measures. This contract must be signed and returned within 20 days and the weatherization must be installed by November 30, 2020. ATTIC DAMMING-R-38 FIBERGLASS 50 $102.50 $102.50 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLAT-9"OPEN R-33 CELLULOSE 1,024 $1,536.00 $1,536.00 Provide labor and materials to install a 9" layer of R-33 Class Cellulose added to open attic space. ATTIC FLAT-8" FLOORED R-25 DENSE CELLULOSE 480 $1,060.80 $1,060.80 Provide labor and materials to install an 8"layer of R-25 Class I Cellulose to floored attic space. KNEEWALL-RIGID BOARD 96 $380.16 $380.16 Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to a kneewall area. ATTIC HATCH-SEAL&INSULATE 1 $60.00 $60.00 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board.Weatherstrip the perimeter. VENTILATION CHUTES 64 $160.00 $160.00 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. HOME AIR SEALING 10 $850.00 $850.00 Provide labor and materials to seal areas of your home against wasteful, excess air leakage. Materials to be used to seal your home can include caulks, foams and other products. Primary areas for sealing include air leakage to attics, basements, attached garages and other unheated areas(windows are not generally addressed.) WEATHERSTRIP DOOR 3 $174.00 $174.00 Provide labor and materials to install Q-Ion weatherstripping to door(s)to restrict air leakage. DOORSWEEP 3 $75.00 $75.00 Provide labor and materials to install a doorsweep to restrict air leakage. ,70-IsoL 9Jau American Installations Columbia Gas Home Performance Contractor of Massachusetts "S°"ce LOW 130 College Street,South Hadley,MA 01075 CONTRACT - WZ 413-552-0200 FAX 413-552-0202 Page 2 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT# WORN ORDER Lilibeth Denham (413)325-7323 09/01/2020 499722 68602 SERVICE STREET BILLING STREET PROPOSED BY: 281 Elm Street 281 Elm Street American Installations SERVICE CITY,STATE,ZIP BILLING CRY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL INSULATE BULKHEAD DOOR 1 $110.00 $110.00 Provide labor and materials to insulate the back of the door to the basement's bulkhead with rigid board at R-10 or greater with the required fire rating and seal the door's edge with weatherstripping to restrict air leakage. Total: $4,508.46 Program Incentive: $4,508.46 Customer Total: $0.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***00/ Dollars $0.00 Kristin Dardano Kristin Dardano(Sep 4,2020 09:17 EDT) COMPANY REPRESENTATIVE CUSTOMER SIGNATURE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE DAYS.