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30C-001 (3) BP-2022-1428 387 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30C-001-001 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-2022-1428 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 6200 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date: 09/29/2023 Use Group: Owner: DANIEL LIPSON, Lot Size (sq.ft.) Zoning: WSP Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance_ 130 COLLEGE ST SUITE 100 (413)552-0200 AMWC262555 SOUTH HADLEY, MA 01075 ISSUED ON: 11/02/2022 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driv ell a Final: Fireplace/Chimnep: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Q . 51"),Nii Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner JVIia- 1q55 i72A-057� DeppOR City of Northampto C„e Building Departm t �� I 212 Main Stru 1• t D I%`INSULATION ( 4 " t Room 100 y # 1 t Northampton, MA 01 1 1 � phone 413-587-1240 Fax 4134 � r' 72 ��9� ONLY APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY 61/ 1_ 1G ONLY 3 SECTION 1 -SITE INFORMATION I NS ULA TIOI\f' PERMIT This section to be completed by office 1.1 Property Address: 387 Florence Road Map 3 Lot t5( � Unit Northampton,MA Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Daniel Lipson _ 387 Florence Road,Northampton, MA p1060 Name(Print) Current Mailing Address: 708 404 6078 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 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $6,200 (a)Building Permit Fee 2. Electrical 0 (b) Estimated Total Cost of Construction from(6) 3. Plumbing 0 Building Permit Fee 4. Mechanical(HVAC) 0 5. Fire Protection 6. Total=(1 +2+3+4+5) $6,200 Check Number ?"7i95 This Section For Official Use Only Building Permit Number: /7 �_—I% D Date Issued: j7: -7 Signature: 11' 2- 202Z. 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 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 6/26/2023 Address Expiration Date ;1 ����M��'�GT� 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 x No ❑ Brief Description of Proposed Work NOTE: INS ULA TION',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 Name 7:e,..".4, " ` -- 10/26/2022 Signature of Owned Date I, Daniel Lipson , 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 10/26/2022 Signature of Owner Date City of Northampton n Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 „'b;VD��� 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: (may CA Address of Work. 387 Florence Road,Northampton, MA 01060 Date of Permit Application: 10/26/2022 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 NOT 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: 10/26/2022 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 'A DEPARTMENT OF BUILDING INSPECTIONS y: 212 Main Street •Municipal Building vy �a Northampton, MA 01060 s615;••: )%'\`� 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: 387 Florence Road (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) �; 10/26/2022 Signature of P- Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall not fy the Building Department as to the location where the debris will be disposed. o���ab City of Northampton ,''`� Massachusetts �` ' i VI; 44 DEPARTMENT OF BUILDING INSPECTIONS 9; -.. `a 212 Main Street • MunicipalBuilding- y' Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 387 Florence Road,Northampton,MA Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413) 552-0200 Property Owner Name: Daniel Lipson Address: 387 Florence Road City, State: Northampton,MA 01060 l 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 tha- I have provided the property owner with a copy of this affidavit. Contractor signature /- Date 10/26/2022 A+ www.Americanindtallations.com BBB Licened&Insuredt UTs'sofd g6.11 mass save MA erSL J/:106178 American Installations PARTNER MA Registration#175982 130 College Street Suite 100,South Hadley,MA 01075 • Office:(413)552-0200 Fax:(413)552-0202 • Email:support@AmericanInstallations.cam DANIEL LIPSON 9/28/2022 (First Last) (Date) 387 FLORENCE ROAD NORTHAMPTON MA 01062 (Address) (City) (State) (Zip) 517825 22-2574 (Site ID) (lob S) Ls�.` sip Quantity Unit Unit Cost Total l�rt&A ct ips AIR SEALING 1 man hour $ 94.33 $ 94.33 TRANSITIONS-OPEN 108 Inft $ 6.84 $ 738.72 WEATHERSTRIP DOOR 3 each $ 31.81 $ 95.43 DOOR SWEEP 4 each $ 26.11 $ 104.44 Total Air Sealing Value $ 1,032.92 Utility Air Sealing Incentive $ (1,032.92) Weathfrizatillm BASEMENT-INSULATE BULKHEAD DOOR 1 ea $ 68.83 $ 68.83 ATTIC-INSULATE ATTIC DOOR 1 ea $ 68.83 $ 68.83 KNEEWALL SLOPE-R-19 FIBERGLASS 672 sqft $ 1.93 $ 1,296.96 KNEEWALL SLOPE-21t RIGID BOARD 672 sqft $ 4.34 $ 2,916.48 KNEEWALL-31t FIBERGLASS R13 48 sqft $ 1.74 $ 83.52 KNEEWALL-2"RIGID BOARD 48 sqft $ 4.34 $ 208.32 VENTILATION CHUTES 130 ea $ 3.49 $ 453.70 Total Weatherization Value $ 5,096.64 Utility Weatherization Incentive $ (3,822.48) Total Project Value $ 6,129.56 Utility Weatherization/Air Sealing Incentive $ (4,855.40) Weatherization Balance $ 1,274.16 Total Customer Contribution $ 1,274.16 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 OF PROPOSAL:The above prices,specifications and TOTAL CONTRACT VALUE= $ 1,274.16 conditions are satisfactory and are hereby accepted.You are 400.00 authorized to do work as specified.Payment will be 1/3 down prior to Down Payment= ❑ start of work,and balance due upon Completion. PAID Balance Due Upon Completion= $ gN2OttatC $74.16 Client Signature Date Eddie Perez Al Representative AI Rep Signature Date THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED.THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS KOMPANr,AND THE CUSTOMERIS)NAMED ABOVE,HEREINAFTER REFERRED TO AS"CLIENT",AND WILL BE SUBJECTTO ALL APPROPRIATE LAWS.REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS. The Commonwealth of Massachusetts w °� Department of Industrial Accidents ;4.)11.111.91r1111M 9 MOM 1.=:VI MINNOffice of Investigations ,R;=t, , Lafayette City Center _OM MINIMAa= r 2Avenue de Lafayette, Boston, MA 02111-1750 Wit•` 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.❑■ 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. [1] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.❑ 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 12.0 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. I.Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit dicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those ntities 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. #:AMWC332951, Expiration Date:O9/04/20 .3 Job Site Address: 387 Florence Road City/State/Zip: Northampton, MA 01060 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, (:,,dt,o___Signature: Date: October 26,2026 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 2❑Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: Commonwealth of Massachusetts Division of rof al Licensure Board ofBuilding ula ons and Standards �'[ _: - ,ot , - , WESLEY CO `UR 4 , 139 P CKAR of t PELHAM A 01002 ^ „ds'r�!e fF p ' tier etwitrilissi0 = � . ..ii4c4k,,, _._ . P_.. : ., Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration • Type: LLC Registratkm: 175982 AMERICAN INSTALLATIONS,LLC. Expiration: 06/26/2023 130 COLLEGE STREET SUITE 100 SOUtH.HADLEY,MA 01075 Update Address and fietUfft Cord. Office of Cortsumer Aiaim&euiM*19,9U1edon HOME IMPROVEMENT CONTRACTOR Ri valid individual indiv use only the aa TYPE:LLC tpiRation date. It found return to: Boulstrotto, ExPirs1100 OMNoe of Cotes uiller Affairs end Business Regtla Lion 175982 06/28/2023 1000 WasMngton Street -Suite 710 AMERICAN INSTALLATIONS,(IC. Boston,MA 0211tf WE.SLEY COUTURE • 74//1/i /:t------ 1st)COLLEGE STREET SUITE 100 w.«a'(G•(w,G i SOUTH HADLEY,MA 01075 Undersecretary Not 1►ldid without signature ACCORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/30/2022 i 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,Est): (A/C,No): 8 North King Street E-MAIL s: bgrynkiewicz(gwebberandgrinnell.com ADDRE INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: 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 9/4/23 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 TERN S, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIIVIITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X CLAIMS-MADE OCCUR PREMISES(Ea occu ence) $ 500,000 X Liquor Liability MED EXP(Any one person) I $ 10,000 A 5D3535223 09/04/2022 09/04/2023 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n IMF - I ES I 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 5Z3535223 09/04/2022 09/04/2023 BODILY INJURY(Per accident) $ AUTOS ONLY /_ AUTOS HIRED NON-OWNED PROPERTY DAMAGE 1$ X AUTOS ONLY X AUTOS ONLY (Per accident) PIP-Basic $ 8,000 X UMBRELLA DAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS UAB CLAIMS-MADE 5J3535223 09/04/2022 09/04/2023 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'UABILITY YIN 500 000 B ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA AMWC332951 09/04/2022 09/04/2023 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/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