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38B-298 BP-2021-2279 214 SOUTH ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-298-001 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-2021-2279 PERMISSIONIS HEREBY GRANTED TO: Project# insulation Contractor: License: Est. Cost: 1300 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date:09/29/2023 Use Group: Owner: LEE,JOHN &GA YEE PARK Lot Size (sq.ft.) Zoning: URB Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST SUITE 100 (413)552-0200 AMWC262555 SOUTH HADLEY, MA 01075 ISSUED ON:12/09/2021 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: 1640.1/4., (Y� Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Buildinu Commissioner 1/1'''4'./„.,...:&,1, 1J Of.. 04< „-`� City of Northampton D4c-6, 1y. , 7 + Building Depattment ` 9 212 Main Street 'r INSULA TION ) Room 100 ?f / `� Northampton, MA 01060��:.N c,' c� ' *'nitti. ' phone 413-587-1240 Fax 413-587-1 '1110PEc OIIL APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY �': SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: �T/hhiis section to be completed by office 6N �j p U.2/y k $1-• Map 4I/ Lot ,R/ ( Unit /VQfAaf r ,/I kV Zone Overlay District P✓V' ' Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 5ct.ra h FL,t C84(ac_K sly �$n09i Sf5 /lar ' h . Name(Print) Current Mailing Address: See attached yl3- yap ^ /30 9Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print Current Mailing Address: (413)552-0200 Sig ature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building I 3 G D (a) Building Permit Fee 7 2. Electrical (b) Estimated Total Cost of Q Construction from (6) 3. Plumbing 0 Building Permit Fee / 4 Mechanical(HVAC) j (? ' 5. Fire Protection 0 6. Total=(1 +2 +3+4+5) 1) 300 Check Number / 41479 This Section For Official Use Only �„ e €)Z9 Date Building Permit Number: Issued: Signature: ., /2 J 2 9-ZOZ i 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 9/29/2023 Address Expiration Date (413)552-0200 signature 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 6/26/2023 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 jla No 0 Brief Description of Proposed Work NOTE: INS ULA TION 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 is Signature /Agent Date r5ar&h rj e ladS , 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 l 1 /1 0 Signature of Owner Date City of Northampton ►' • A Massachusetts 11 * G 4 •.•,y f DEPARTMENT OF BUILDING INSPECTIONS R' f 212 Main Street • Municipal Building us Northampton, MA 01060 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 ' 3 0 t Address of Work: (ay.( 8 0 51 .} /00 r-"I a, P Date of Permit Application: f 42 —7-adal 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: _ 7-21/ 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 . .i Massachusetts A?,;,5cf ,1� r '•; ..'4 DEPARTMENT OF BUILDING INSPECTIONS +►.' „` , .. 212 Main Street •MuniciP 4 Ja1 Building y,` S yy• ,.a/ Northampton, MA 01060 Sbip"^:2;%j\'‘ 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: (2W- XV S6u)141 Si ., 10r1-1-vi _ (Please print house number and street name) Is to be disposed of at: K er W Materials e5"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) is Signature Permit 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 Massachusetts c� <<�. ` n DEPARTMENT OF BUILDING INSPECTIONS 212Main Street • Municipal Building P 9 s 1y ! - Northampton, MA 01060 '' MANDA TOR Y FOR HOUSES cB/BUILT T BEFORE 1945 Property Address: oZi. 0- o�7 3OLlI4 cat' . /1//r�'-A3Avte7/YYt_ Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413)552-0200 Property Owner Name: rA u 9cklaf., Address: a t L} d U 1f 1� City, State: /i 6 a4At r / 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 d'vLr/2fe Date /a-7-aaa/ Page 1 of 1 `i mass save Licensed&Insured MACSL#:106178 PARTNER MA Registration#175982 American Installations www•Americanlnstallations.com 130 College Street Suite 100,South Medley,MA 01075•Office:(413)552-0200 Fee:(113)531.0202•Eme&suppoeteAmericanlnstalfatfonscom Customer Name:Sarah Furgalack Email:Not provided Phone:413-426-1304 Premise Address:212-214 South St,#214,Northampton,MA 01060 Mailing Address:214 South St,Northampton,MA 01060 Project ID:4367323 Date:Nov. 19,2021 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Other 6 hr $555.48 $0.00 Attic Floor-9"Open Blow Cellulose Other 308 SF $560.56 $140.14 Door Sweep (with AS hrs) Other 2 each $50.62 $0.00 Exterior Door Weather Stripping (with AS hrs) Other 2 each $60.14 $0.00 Project Total $1,226.80 Weatherization incentive ($420.42) Air sealing incentive ($666.24) Total Program Incentive -$1,086.66 Customer Total $140.14 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 building regulations for the Total Contract Value as stated herein. ACCEPTANCE Or PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE=S 140.14 satisfactory and are hereby accepted.You are authorized to do work as specified.Payment 50.00 will be 1/3 down prior to art of work,and balance due upon Completion. Down Payment=S ❑ PAID Balance Due Upon Completion= 90.14 Signature Date Property Owner(Print) (Sign) Date Representative:(Print) (Sign) Date THIS AGREEMENT IS COMPOSED OF T WS PAGE AND THE REVERSE SIDE Cv THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PAATIES INVOLVED THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO 45 COMPANY, AND THE COSTOMERIS)NAMED ABOVE,HEREINAFTER REFER RECTO AS'WENT',AND WILL BE SUBJECT TOALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE Dr MASSAOIUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS. l- 1��1s-8 a-9 as The Commonwealth of Massachusetts Department of Industrial Accidents =z ► _ om _ Wli Office of Investigations ��_ � �� Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 ; www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 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.El I am a employer with 43 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 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 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulation employees. [No workers' 13.❑� Other 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 7�i / City/State/Zip: r lat�p n m./Q- OI D 6,0 Job Site Address: �-I �-� 1" ��o u , 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. 9.11b.d.dzit_Signature: Date:/ - 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(check one): 10Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0 Other Contact Person: Phone#: Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cons isor li CS-106178 Eic Tres: 09/29/2023 WESLEY COUTURE '. 139 PACKAROVILLE R . D `~ PELHAM MA 9.1002 ftW I iO Commissioner di .. K. tCtjfa., i 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: 0626/2023 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Update Address and Return Card. Office of Consumer Affairs A Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Resistralien Wellies Office of Consumer Affairs and Business Regulation 175982 06/28/2023 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LLC. Boston,MA 02118 y/ WESLEY COUTURE 74)7A- /�j 130 COLLEGE STREET SUITE 100 ,,fr.*�'a i ./ Not valid without signature SOUTH HADLEY,MA 01075 Undersecretary 9 ®A CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) _ 08/23/2021 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 endorsements). PRODUCER CONTACT Barbara Grynkiewicz NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 A/C No,EA): (A/C,No): 8 North King Street A brynkiewicz@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Employers Mutual Casualty Company 21415 INSURED INSURER B: AmGUARD/BH GUARD 43290 American Installations,LLC INSURER C: Attn:Wes&Suzanne Couture INSURER D: 130 College Street,Suite 100 INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER: EXP 9/4/22 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 ADOL SUER" POLICY NUMBER POLICY YY POLICY EXP LIMITS INSD WVD (MMIDD/YYW) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE ❑X OCCUR PREMISES(Ea of ccu ence) $ 500,000 - MED EXP(Any one person) $ 10,000 A 5D3535221 09/04/2021 09/04/2022 PERSONAL&ADV INJURY $ 1,000,000 1 2 GEN'LAGGREGATE LIMITAPPUES PER: GENERAL AGGREGATE $ , , POLICY ❑X jEa E LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED 5Z3535221 09/04/2021 09/04/2022 BODILY INJURY(Per accident) $ AUTOS ONLY /� AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) PIP-Basic s 8,000 UMBRELLA LIAB 1'000'X 1 000 000 OCCUR EACH OCCURRENCE s A EXCESS LIAB CLAIMS-MADE 5J3535221 09/04/2021 09/04/2022 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y I N 500,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE N/A AMWC262555 09/04/2021 09/04/2022 ( E.L.EACHACCIDENT $ OFFICER/MEMBER EXCLUDED? I 500,000 (Mandatory In in N NH) ( , EL DISEASE-EA EMPLOYEE $ 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 it 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