Loading...
37-128 (2) BP-2022-0765 38 BLACK BIRCH TRAIL COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 37-128-001 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-2022-0765 PERMISSION IS HEREBYGRANTEI TO: Project# INSULATION Contractor: License: Est. Cost: 2000 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date:09/29/2023 Use Group: Owner: WEBSTER KONO KIMBERLY T&TI OTHY J Lot Size (sq.ft.) Zoning: SR Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST SUITE 100 (413)552-0200 AMWC262555 SOUTH HADLEY, MA 01075 ISSUED ON:06/28/2022 TO PERFORM THE FOLLO WING 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL• TION OF ANY OF ITS RULES AND REGULATIONS. Signature: • ir • )2 ►� d' ' Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1 272 Office of the Building Commissioner 43Uiu, 2005 2+ ,` ,e,.; --,-./. ‘ , DeFoR t- City of Northampt n Cs/V � " Building Depart nt V t :;�. 4 212 Main Sta t ✓ON �, yIsISULA TI CAN ;r 9� (?022 / Northampton, MA;0 r phone 413-587-1240 Fax 1�3 m, / OIVL y . ,,,,„.„4,,,, �Mq��n��,,c),1, , APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT 1.1 Property Address: Q I This section to be completed b office �QCK &1t ��it 1 J Map 37 Lot /A ' Unit 3g �3 !-)O('el1t,'A. A J1 (� Zone Overlay District ,_v ' Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: I ember d KOiRO 3S 6lAc < gird-iraiI F/0` tz. Name(Print) Current Mailing Address: V/3 - 33.3Q - 3(o See attached Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) - Current Mailing Address: 4 ��� (413) 552-0200 ignature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building c, / oOQ (a) Building Permit Fee 2. Electrical Q (b) Estimated Total Cost of Construction from(6) 3. Plumbing 0 Building Permit Fee 4. Mechanical(HVAC) `� J 5. Fire Protection 6. Total=(1 +2+3+4+5) 066 Check Number 4,31 -7 This Section For Official Use Only Building Permit Number: �" ' A r " Date Q �]7`� Issued: Signature: /42 CO' 2S Z02Z ` 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 13) 552-0200 �� Signature Telephone 9.Restistered 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, O Expiration Date /�/�i7 � 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 No ❑ Brief Description of Proposed Work NOTE: INSULATION ONL Y Attic and basement insulation and air sealing throughout. 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 Cnetyre of cA— /Agent Date ) 01‘.c.D , as Owne 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 (Q/(0/ate Signature of Owner Date City of Northampton µt HLM,,, s. S ;' ►'' `` '" Massachusetts � - 1, I I y t41 4 DEPARTMENT OF BUILDING INSPECTIONS r, .w k 1. 212 Main Street • Municipal Building Jb �a _,,,„•""` c' Northampton, MA 01060 r3'bH, k.� AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractbrs 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, converskon, 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: a/ D 0 0 Address of Work: 3 S 61()Lac 61 ra -A-t Y l , F I o y U'L e _.. Date of Permit Application: (p•a t-aa., 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 UNREGISTE D CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE N T ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY F ND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WO 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: 6- -a t `aa 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 Massachusetts w;y� 9: .s��.Cc DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building SS.s. 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 d posed 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: 3 $ ac.K 1 I (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) Signature of P rmit 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 .y „r> Massachusetts ��, c �; x:, �., DEPARTMENT OF BUILDING INSPECTIONS "Usk 212 Main Street • Municipal Building �s�. ` - Northampton, MA 01060 SPjY `' MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 3 D 3Ictc.k Q)1 1 f (1._ Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413) 552-0200 Property Owner Name: I<,rv►.beri, I -,lO Address: �$ IQ ; h I Cap l City, State: F)0 Rer' Q. , O 1O(Q9 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 it/ Date / ,, l_ ,A American Installations Home Performance Contractor 130 College Street,South Hadley,MA 01075 CONTRACT - YYZ American installations 413-552-0200 FAX 413-552-0202 Page 1 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT# WORK ORDER Kimberly Kono (413) 330-3681 06/06/2022 509547 68602 SERVICE STREET BILLING STREET PROPOSED BY: 38 Black Birch Trail 38 Black Birch Trail American Installations SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures, Eversource 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 8 $680.00 $680.00 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 2 $116.00 $116.00 Provide labor and materials to install Q-lon weatherstripping to door(s)to restrict air leakage. DOORSWEEP 2 $50.00 $50.00 Provide labor and materials to install a doorsweep to restrict air leakage. ATTIC DAMMING-R-38 FIBERGLASS 1 $2.05 $1.54 $0.51 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLAT-5"OPEN R-19 CELLULOSE 800 $1,008.00 $756.00 $252.00 Provide labor and materials to install a 5"layer of R-19 Class I Cellulose to open attic space. asr 1059 9-7-aa American Installations Home Performance Contractor►� 130 College Street,South Hadley,MA 01075 CONTRACT - YY�/�� ZAmerican Installations 413-552-0200 FAX 413-552-0202 Page 2 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT H WORK ORDER Kimberly Kono (413) 330-3681 06/06/2022 509547 68602 SERVICE STREET BILLING STREET PROPOSED BY: 38 Black Birch Trail 38 Black Birch Trail American Installations SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL ATTIC HATCH-SEAL&INSULATE 1 $60.00 $45.00 $15.00 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board.Weatherstrip the perimeter. Total: $1,916.05 Program Incentive: $1,648.54 Customer Total: $267.51 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Two Hundred Sixty-Seven &51/100 Dollars $267.51 down payment 50.00 x paid COMPANY REPRESENTATIVE CU OMER SIGNATURE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE DAYS. The Commonwealth of Massachusetts Department of Industrial Accidents — Office of Investigations IP 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 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 h' 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.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulation employees. [No workers' 13.❑■ Other comp. insurance required.] *Any 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 e tities 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 � ' � ,/� �/ 3 Job Site Address: G c /-Jl�'Gfi .f/'� l� City/State/Zip: ~!Ore,7 e< mA,co 4 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 Signature: 9. (,E Gt.l 6 -I 9 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 31:City/Town Clerk 4.❑Electrical Inspector 5 lumbing Inspector 6.0Other Contact Person: Phone#: r> :- Commonwealth Massachusetts Divi.sion of Pro es tonLicensure gr.,, Board of n e u�lons and Stanciard , %, CS-106178 CFI{ 0 , 2023 WESLEY S, � !; 4 139 ,. , t , 1 , PELHAM M s. i1O fi r.,,, ff C m,s o r U tJ, :, Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LW Registration: 175982 AMERICAN INSTALLATIONS,LLC. Expiration: 06/28t2(323 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Update,Itddres and'Return " ., Otfotof consumer Affairs a ausiness Iteguladon HOME IMPROVEMENT CONTRACTBR mated for individualuse only TYPE.tie tabvitire alephutioA date. M found return to: Of Consumer Affairs end Business Regulation 175982 06/281023 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LLC. Boston,MA 02118 o`- fr— WI�SLEY COUTURE /2 kii:( 130 CCLLEGIE STREET SMITE too a i/4 Hotvalid without mature a SOUTH HADLEY,MA 01075 Undersecretary 1 ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) O8/23/2021 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 endorsement(s). PRODUCER CONTACT Barbara Grynkiewicz NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 A/C,No,Ext): (A/C,No); 8 North King Street EMAIL bgrynkiewicz@webberandgnnnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE 1 NAIC# Northampton MA 01060 INSURER A: Employers Mutual Casualty Company 1 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 ADDL3UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS° WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMI1rS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE , $ 1,000,000 DAMAGE RENT ED ' CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A 5D3535221 09/04/2021 09/04/2022 PERSONAL SADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY X PROT- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JEC OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A -- OWNED X SCHEDULED 5Z3535221 09/04/2021 09/04/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS NON-OWNED PROPERTY accident) DAMAGE $X AUTOS ONLY HIRED X AUTOS ONLY (Per PIP-Basic $ 8,000 X UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ 1,000,000 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 EOTH AND EMPLOYERS'LIABILITY Y/N 500 000 B ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA AMWC262555 09/04/2021 09/04/2022 E.L.EACH ACCIDENT $ , OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ , DESCRIPTION OF OPERATIONS/LOCATIONS/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