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31A-309 (11)
93 VERNON ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1806 Map:Block:Lot: 31 A-309- 001 CITY OF NORTHAMPTON Permit:Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND(MGL c.142A) BUILDING PERMIT Permit# BP-2021-1806 PERMISSION IS HEREBY GRANTED TO: Project# 2021 INSULATION Contractor: License: Est.Cost: 1000 AMERICAN INSTALLATIONS LLC 106178 Const. Class: Exp.Date: 09/29/2021 Use Group: Owner: MACK MEHAMMED A Lot Size(sq.ft.) Zoning: URA Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST (413)552-0200 AMWC187717 SOUTH HADLEY,MA 01075 ISSUED ON: 09/08/2021 TO PERFORM THE FOLLOWING WORK: insulation/weatherization 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. Signature: I I. Tpl . • iv , I II Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner JiTC ell L Lc&9 8 7S-7624 . DepPAme City of Northampton /�.,r r • Building Department ' 212 Main Room 100%treetiQ E C E I V f SULA TI4N \4tt Northampton, A 0 060 phone 413-587-1240 ax 3- 12 ONL Y AAUUe 5 202' APPLICATION FOR INSULATION FOR ON' '- a • MILY DWELLI G 0 LY ^6°T.OF t]J,u)NG IN • -SP ' ON. Ara • k PERMIT SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Preset* Address: 93 V t mo 6 Map Lot Unit /0r9ilelnY4/-00 Zone Overlay District N Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: grnrn e d 4ac)c Q3 1/erna n S i4a,v,ojzJk., Name(Print) Current Mailing Address: See9'/7-7to7-75 attached Telephone Signature 2.2 Authorized Auent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: (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 QQ (a)Building Permit Fee )) 2. Electrical D (b)Estimated Total Cost of Construction from(6) 3. Plumbing 6 Building Permit Fee 4. Mechanical(HVAC) -4 0/4 5. Fire Protection 0 6. Total=(1 +2+3+4+5) ) r) on Check Number 1 1 This Section For Official Use Only BuildingPermit Number: 11 - 1 G Date ��r Issued: Signature: q-7-z021 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 SIB Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ American Installations 175982 Company Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 6/26/2023 Addressre Expiration Date _a'N 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 so No 0 Brief Description of Proposed Work NOTE: INSULATION ONL Y 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 Name g ,3 a a / ignature ,as ChNtstiof 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 I yg.7/ate D Signature of Owner City of Northampton µ•me n�Rr Mp,'e /,� Massachusetts f j g + DEPARTMENT OF BUILDING INSPECTIONS � tc i • c ` 212 Main Street I Municipal Building �� O Northampton, MA 01060 3 j�!, 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 Et.Cost 1 0 0 0 Address of Work: q 3 Ver n n n 5+ Date of Permit Application: p a3- 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 -a7 ,, J 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 r . .r Massachusetts a '{t t FI DEPARTMENT OF BUILDING INSPECTIONS 1P1212 Main Street •Municipal Building ✓ Northampton, MA 01060 44i"r PJ 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: 93 Verno n Si (Please print house number and street name) Is to be disposed of at: K& 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) Signature of e i Applicant or Ownerate 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. The Commonwealth of Massachusetts Department of Industrial Accidents _z Office of Investigations Alt Lafayette City Center t` �t 2 Avenue de Lafayette, Boston,MA 02111-1750 xvith :, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lewibly Name (Business/Organization/Individual):American Installations LLC Address:130 College St, 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): 1.0 I am a employer with 43 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P tY 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.❑■ Other Insulation employees. [No workers' comp. insurance required.] *My applicant that checks box#1 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 the policy and job site information. Insurance Company Name: Berkshire Hathaway GUARD Insurance Policy#or Self-ins. Lic. #:AMWC262555 Expiration Date: /09/04/2022 gq Job Site Address: /$ 1�Grr7 O n 5-7";-:c- City/State/Zip:141/;4` /''�r►� ""h/MA.CV,0 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 provided above is true and correct. n I Signature: 9, ,E?��t Date: ��-3 0�.-1 Phone#: 413-552-0 00 lye Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 51'lumbing Inspector 6.00ther Contact Person: Phone#: Cornmonwttalth of Massachusetts Construction Supervisor Division of Processional Licensure Unrestricted -Buildings of any use group which contain Board of Building Regulations and Standarss less than 35,000 cubic feet (991 cubic meters) of enclosed Constructton Supervisor space. CS-106178 Expires: 09/29/202 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 For information about this license r J Call (617) 727-3200 or visit 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 AMERICAN INSTALLATIONS, LLC. Expiration: 06/26/2023 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Update Address and Return Card. 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 06/26/2023 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LW. Boston,MA 02118 WESLEY COUTURE /' 417A- 130 COLLEGE STREET SUITE 100 , n CL irk• SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature AC® CERTIFICATE OF LIABILITY INSURANCE DATE 9;2M.2o2"0 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 PHcO N ), (413)586-0111 FAX No): (413)586-6481 8 North King Street E-MAIL leichstaedt©webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 0 Northampton MA 01060 INSURER : 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 (MM/DD/YYYY) (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE b 1,000,000 DAMAGE . XI CLAIMS-MADE piOCCUR ,PREMISESO(EaENTED occurrence) $ 500'000 — MED EXP(Any one person) $ 10,000 A SD3535219 09/04/2020 09/04/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2000,000 , X POLICY 1-1 PO ri LOC 0000 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 HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) X coll$2K X comp$2K PIP-Basic $ 8,000 X UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS UAB CLAIMS-MADE 5J3535220 09/04/2020 09/04/2021 AGGREGATE 5 1,000,000 DED XI RETENTION$ 10'000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY N STATUTE -ER IT 500'000 C ANY PROPRIETOR/PARTNER/EXECUTIVE 1 1 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 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. AUTHORIZED REPRESENTATIVE I 1./ c ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD American Installations Columba Gashusetts Home Performance Contractor of""a"'Comp, 130 College Street,South Hadley,MA 01075 413-552-0200 FAX 413-552-0202 CONTRACT - WZ Page 1 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENTS WORK ORDER Mehammed Mack (917)767-7526 11/27/2020 302531 68602 SERVICE STREET BILLING STREET PROPOSED BY: 93 Vernon Street 93 Vernon Street American Installations SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures, Columbia Gas of Massachusetts is offering an incentive of 75%for insulation measures and 100%for the air sealing measures, both with no limit. You are eligible to apply for the 0% Heat Loan to finance your co-pay, applications must be submitted before the weatherization work begins. HOME AIR SEALING 2 $170.00 $170.00 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 1 $58.00 $58.00 Provide labor and materials to install Q-lon weatherstripping to door(s)to restrict air leakage. DOORSWEEP 1 $25.00 $25.00 Provide labor and materials to install a doorsweep to restrict air leakage. BASEMENT SILLS RIGID BOARD INSULATION 50 $198.00 $148.50 $49.50 Provide labor and materials to install rigid board insulation to the perimeter of the basement ceiling at the house sill. .O -aaw q-3-�i a/6,c American Installations Columbia Gas' Home Performance Contractor of Massachusetts A NISourc"ompany 130 College Street,South Hadley,MA 01075 413-552-0200 FAX 413-552-0202 CONTRACT - WZ Page 2 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT# WORK ORDER Mehammed Mack (917)767-7526 11/27/2020 302531 68602 SERVICE STREET BILLING STREET PROPOSED BY: 93 Vernon Street 93 Vernon Street American Installations SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL CRAWLSPACE CEILING RIGID BOARD 128 $532.48 $399.36 $133.12 Provide labor and materials to install R-10 or greater rigid board with the required fire rating to the crawlspace ceiling. Total: $983.48 Program Incentive: $800.86 Customer Total: $182.62 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Hundred Eighty-Two & 62/100 Dollars $182.62 paid in full 182.62 COMPANY REPRESENTATIVE CUSTOMER SIGNATURE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE DAYS. YH M r City of Northampton .� Massachusetts ar' t I 1 a ` ,. DEPARTMENT OF BUILDING INSPECTIONS yt 4 ` Y 212 Main Street • Municipal Building JS,p •4(% Northampton, MA 01060 Property Address: 93 Vernon St, Northampton, MA Contractor Name: American Installations/Wesley Couture Address: 130 College St, Suite 100 City, State: South Hadley, MA 01075 Phone: 413-552-0200 Property Owner Name: Mehammed Mack Address: 93 Vernon Street City, State: Northampton, MA 01060 I, 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 8/31/2021