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12 GREGORY LN BP-2021-1461 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-533 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2021-1461 Project# JS-2021-002422 Est.Cost: $3700.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq.ft.): 11586.96 Owner: SINGLER MONA A Zoning: Applicant: AMERICAN INSTALLATIONS LLC AT: 12 GREGORY LN Applicant Address: Phone: Insurance: 130 COLLEGE ST#100 (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:6/8/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 10 REPLACEMENT WINDOWS 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. i Q1 Certificate of Occupancy Signature: I I FeeType: Date Paid: Amount: Building 6/8/2021 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 7, /, N moo, 1 The Commonwealth of Massac etts d Board of Building Regulations andm FOR v , rds E c , �� UNICIPALITY Massachusetts State Building Code, ti J `USE qt�a� Building Permit Application To Construct, Repair, Renna�r ,►. olish . Revised Mar 2011 One-or Two Family Dwelling 1.-;-:6'cr This Section For Official Use Only "s�1G4 Building P t7 ermit Number: N �'1"/'iVJ Date Applied: ; KEUiIDS igoss ://Z 6- 8-Zozi Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Asse sors Map&Parcel Numb rs 14 Gregory Lane,Florence � j 3 3 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Mona Singler Florence,MA 01062 Name(Print) City,State,ZIP 14 Gregory Lane 413-320-7641 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other EXSpecify: Replacement Windows Brief Description of Proposed Work': Install Qty 10-2 Lite Slider windows SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 3,700 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ ►7 6.Total3 700 Check No.'na) Check Amount: 1. Cash Amount: Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 106178 9/29/2021 Wesley Couture License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 130 College St,Suite 100 No.and Street Type Description South Hadley,MA 01075 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-552-0200 permits@AmericanInstallations.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 175982 6/26/2021 American Installations/Wesley Couture HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 130 College St,Suite 100 permits@AmericanInstallations.com No.and Street Email address South Hadley,MA 01075 413-552-0200 City/Town,State,ZIP Telephone SECTION 6: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 1f No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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. Mona Singler 4/01/2021 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. American Installations/Wesley Couture A) 6/02/2021 Print Owner's or Authorized Agent's Name(ElectronicSI� ) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.massgov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" $3,700 City of Northampton %' Massachusetts � +ar ." ��' ',its r;ct DEPARTMENT OF BUILDING INSPECTIONS y1 t� / a , 212 Main Street • Municipal Building J` Ca • Northampton, MA 01060 4' CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: K&W Materials & Recycling, 138 Palmer Ave, West Springfield, MA The debris will be transported by: Name of Hauler: K&W Materials & Recycling, 138 Palmer Ave, West Springfield, MA / t______&-, Signature of Applicant: l/(2/ Date: 6/02/2021 www.Americanlnstallations.com BBB. Licensed&Insured MA CSL#:106178 _ MA Registration#175982 American Installations 130 College Street,Suite 100,South Hadley,MA 01075 • Office:(413)552-0200 Fax:(413)552-0202 • Email:support@amerlcaninstallations.com Date: 3/5/2021 Prepared By: Proposal#: 21-W007 Singler Wyatt Couture Location: 14 Gregory Lane American Installations Florence,MA 01062 130 College Street South Hadley,MA 01075 Prepared For: 413-427-8611 Singler,Mona wbcouture@americaninstallations.com 14 Gregory Lane Florence,MA 01062 (413)320-7641 monasingler@gmail.com PROPOSAL Description Style Lite Quantity Cost per Unit Total Alside Mezzo Windows-Energy Star-U Factor 0.27 2 Lite Slider 8 $ 350.00 $ 2,800.00 Vinyl:White Interior/White Exterior,Double Paned,NO 2 Lite Slider(Medium) 2 $ 432.00 $ 864.00 Grids,Locks,Screens,Argon Gas,Low-E,White Exterior Trim Capping Remove/dispose of existing windows&Install new winodws 'New construction window removal/installation adder Remove&reinstall siding,window manufacturered with Nail TOTAL#of Windows= 10 $ 3,664.00 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 ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are satisfactory and are hereby accepted. TOTAL PROJECT VALUE= $3,664.00 You are authorized to do work as specified. Eligible for HEAT Loan= $3,664.00 Signature Date MdIRI�,RR1/ 71wL11 EDT) Apr 1, 2021 The Commonwealth of Massachusetts 7 P` Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 � wwwmass.gov/dia 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): t.®I am a employer with 41 employees(full and/or pan-tune)."' 7. ❑New construction 2.0 I 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 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.] 100 Building addition 4.❑lam 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 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.' 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.©Outer Insulation 152,§I(4),and we have no employees.[No workers'comp insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 the policy and job site information. Insurance Company Name: Berkshire Hathaway GUARD Insurance Policy#or Self-ins.Lic.#: AM WC 187717 Expiration Date: 09/04/2021 Job Site Address: 4 City/State/Zip: F`o Re AM 6/06 a Attach a copy of the workers' m sation policy declaration page(showing the policy number and expiration date). 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. I do hereby certify under the pains and penalties of perjury that the ittformation provided above is true and correct. Signature: � t +.��{, i Date: 6 -,2-a/ Phone#: 413-552-0200 tJ JJJ — Official use only. Do not write in this urea,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#: f I Commonwealth or Massachusetts Construction Supervisor IP 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: 09/29/2021 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. Commissioner 4.14. .. •. For information about this license .; Call (617) 727-3200 or visit www.mass.gov/dpl „Ore K2. a-den/no/levee z#.1)., 0/ty . , exj....)ade'erje/14 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 0 201A-05/17 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` f WESLEY COUTURE /, Z11,-/'' i� Zt 130 COLLEGE STREET SUITE 100 �i,,.•..�a'(�j s(lis+<i SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature DATE(MMIDD/YYYY) ACORD 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(les)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 (a/CNN EM): (413)586-0111 FAX Nc): (413)586-6481 8 North King Street E-MAIL leichstaedt@webberandgrinnell.com 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO XI CLAIMS-MADE piOCCUR PREMISES(EaENTED occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A 5D3535219 09/04/2020 09/04/2021 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY n PRO- 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $ ,_ ,OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A — OWNED x SCHEDULED 5Z35352 09/04/2020 09/04/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XHIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) X coll$2K X comp$2K PIP-Basic $ 8,000 UMBRELLA LIAR 1,000,000 X OCCUR EACH OCCURRENCE $ A EXCESS LIAB CLAIMS-MADE 5J3535220 09/04/2020 09/04/2021 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X STA UTE ERH AND EMPLOYERS'LIABILITY Y/N 500000 C ANY PROPRIETOR/PARTNER/EXECUTIVE NIA AMWC187717 09/04/2020 09/04/2021 E.L.ELEACHACCIDENT $ _ OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ II yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. 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