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BP-2023-0387 117 ACREBROOK DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-214-001 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-2023-0387 PERMISSION IS HEREBY GRANTED TO: Project# 2023 INSULATION Contractor: License: Est. Cost: 7600 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date: 09/29/2023 Use Group: Owner: HOUSMAN, SETH T. & HOUSMAN, ERICA L. Lot Size (sq.ft.) Zoning: WSP Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST SUITE 100 (413)552-0200 AMWC32951 SOUTH HADLEY, MA 01075 ISSUED ON: 04/03/2023 TO PERFORM THE FOLLOWING WORK: ATTIC &BASEMENT INSULATION &AIR SEALING 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: .2 cgi Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner a3-oy99 Wv‘I-1 �6,c City of Northampton Deppo Building Department 212 Main Street INSULA TION Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 QJtJ _, Y "1 APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT 1.1 Property Address: This section to be completed by office Map Z_ Lot 2i Unit 0 G f 117 Acrebrook Drive Zone W 5 r n Overlay District Florence, MA 01062 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Housman, Seth & Erica 117 Acrebrook Drive, Florence, MA 01062 Name(Print) Current Mailing Address: See attached Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) } Current Mailing Address: 12i 1 (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 7600 (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) 7600 Check Number )51-32- 17 /� This Section For Official Use Only Building Permit Number: PSP Zd23 - 0 7 0""I Date Issued: Signature: j/ .7 "3-31 2U2 3 Building Commissioner/Inspector of Buildings Date permits@Americanlnstallations.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 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 AddreFss/ /� Expiration Date /1// (h} 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 0 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 /A. M._ 3/21/2023 signatufe.46444011Date 1 Housman, Seth & Erica , 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 3/21/2023 Signature of Owner Date • City of Northampton /N°atH�° SAS '^SAC . Massachusetts - 'ee .A N *,• . I DEPARTMENT OF BUILDING INSPECTIONS e! 212 Main Street • Municipal Building �.. :. Northampton, MA 01060 rffr -• ,-NJ 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: 7600 Address of Work 117 Acrebrook Drive, Florence, MA 01062 Date of Perot Appl cat€n: 3/21/2023 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: 3/21/2023 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 'rim '' , y`s -"`"_s;�: �' ''"' Massachusetts ��} �e. DEPARTMENT OF BIIIIDING INSPECTIONS v-. x 212 Main Street *Municipal Building Sys r1�, -« -:,,r4" Northampton, MA 01060 'PI' jN� 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: 117 Acrebrook Drive, Florence, MA 01062 (Please print house number and street name) Is to be disposed of at: K& W Materials e'r 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) it)/ _ 3/21/2023 Sk9V ° "Pettnit Aunt 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. YH0./.'T City of Northampton Massachusetts t . .w ft.s.tt DEPARTMENT OF BUILDING INSPECTIONS y-, -"' "r„ 212 Main Street • Municipal Building Jos ' :wr'� _ Northampton, MA 01060 .4). MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 117 Acrebrook Drive, Florence, MA 01062 Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413) 552-0200 Property Owner Housman, Seth & Erica Name: Address: 117 Acrebrook Drive City, State: Florence, MA 01062 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 iiy.7 A. y..2.___ Dales 3/21/2023 American Installations Home Performance Contractor 6.1% 130 College Street,South Hadley,MA 01075 American Installations CONTRACT - AUDIT 413-552-0200 FAX 413-552-0202 CUSTOMER PHONE DATE CLIENT# WORK ORDER Seth Housman (319)759-7266 03/16/2023 800789 48901 SERVICE STREET BILUNO STREET PROPOSED BY: 117 Acrebrook Drive 117 Acrebrook Dr American Installations SERVICE CITY,STATE,ZIP BILUNO CITY,STATE,ZIP Florence, MA 01062 Florence,MA 01062 Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO 10 $943.30 $943.30 Seal areas of your home against wasteful,excessive 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.) 4 HOURS DUCT SEALING 1 $348.36 $348.36 Provide labor and materials to seal heating and/or cooling ducts within designated unheated areas. This work will be include materials and labor. TRANSITION AIR SEALING 24 $155.76 $155.76 Provide labor and materials to air seal the open kneewall transitions of your home against wasteful, excess air leakage. EXTERIOR DOOR WEATHER STRIPPING 1 $31.81 $31.81 Provide labor and materials to install Q-lon weatherstripping to door(s)to restrict air leakage. DOOR SWEEP 2 $52.22 $52.22 Provide labor and materials to install a doorsweep to restrict air leakage. DAMMING 32 $78.40 $58.80 $19.60 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLOOR OPEN BLOW CELLULOSE 5" 888 $1,447.44 $1,085.58 $361.86 Provide labor and materials to install a 5"layer of R-19 Class I Cellulose to open attic space. INSTALL 2"THERMAL BARRIER POLYISO ON KNEEWALL 162 $779.22 $584.42 $194.80 Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to a kneewall area. HATCH: THERMAL BARRIER POLYISO 2 INCH(ATTIC) 3 $142.11 $106.58 $35.53 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10. DOOR: THERMAL BARRIER POLYISO 2"(ATTIC) 1 $90.61 $67.96 $22.65 Provide labor and materials to insulate the back of the attic door with 2"rigid insulation board. American Installations Home Performance Contractor !tin 130 College Street,South Hadley,MA 01075 CONTRACT - AUDIT American Installations 413-552-0200 FAX 413-552-0202 CUSTOMER PHONE DATE CLIENT# WORK ORDER Seth Housman (319)759-7266 03/16/2023 800789 48901 SERVICE STREET BILUNG STREET PROPOSED BY: 117 Acrebrook Drive 117 Acrebrook Dr American Installations SERVICE CITY,STATE,ZIP BILUNG CITY,STATE,ZIP Florence, MA 01062 Florence,MA 01062 Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL INSULATE VINYL SIDED WALL WITH 4"DENSE PACK 1,088 $2,915.84 $2,186.88 $728.96 Furnish and install blown in Class I Cellulose to vinyl-sided exterior walls. Homeowner has received a copy of the EPA's Renovate Right Lead-Safe information guide explaining the potential risk of the lead hazard exposure from the weatherization work to be performed.Your signature is your acknowledgement of receipt and agreement to proceed. PROPAVENT 2'OR 4' 95 $392.35 $294.26 $98.09 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. VENT BATH FAN TO ROOF OR OTHER 1 $146.78 $110.09 $36.69 Install a 6"insulated exhaust hose to a flapper vent to exhaust existing bathroom fan(s). Fan will be vented through the roof or an acceptable alternative if contractor cannot vent through the roof. Total: $7,524.20 Program Incentive: $6,026.02 Customer Total: $1,498.18 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand Four Hundred Ninety-Eight&18/100 Dollars $1,498.18 STHousman(Mar 17,2023 16:13 EDT) COMPANY REPRESENTATIVE CUSTOMER SIGNATURE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE 30 DAYS. The Commonwealth of Massachusetts -�—�--�- Department of Industrial Accidents 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): 1.0 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. El 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' + 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 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 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. # AIVIWC332951 Expiration Date:09/04/2023 Job Site Address: 117 Acrebrook Drive City/State/Zip: Florence, MA 01062 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: Date: 3/21/2023 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): 11:1Board of Health 21:Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5EIPlumbing Inspector 6.0Other Contact Person: Phone#: i b Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards COTISk /sot- + -1 { ?8 ryspires: Og/29/2023 I ESLEY CO URE x 139 PACKAROVILL. PELHAM MA 01002 ` . .. k, 4 . ; Commissioner 0.)(b-)of Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC AMERICAN INSTALLATIONS,LLC. F e Exxpiratpuat on: 175982 190 COLLEGE STREET SUITE 100 ion: 06f2812023 SOUTH HADLEY,MA 01075 Update Address and Return CatxL Mike of Affairs fl eu mesa Regulation HOME IMPROVEMENT CONTRACTOR valid for individual use only TYPE LLC the expiration date. ff found return to: Rasiairatien Emanates OMO of Consumer Affairs and Business Regulation 175982 08/28/2023 1000Washington Street'-Stilts 710 AMERICAN INSTALLATIONS,LLC. IAA 02118 WESLEY COUTURE i Pi 130 COLLEGE STREET SUITE 100 '""ram( ' Not valid without signature SOUTH HADLEY,MA 01075 UnderBeCreY AC RI® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/30/2022 . 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 1 (A/C,No,Ext): (A/C,No): 8 North King Street E-MAIL bgrynkiewicz@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 0: 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 TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL 5UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY 1.000.000 EACH OCCURRENCE S X CLAIMS-MADE OCCUR DAMAGE IDRENIED 500.000 PREMISES(Ea occurrence) $ X Liquor Liability MED EXP(Any one person) $ 10,000 A 5D3535223 09/04/2022 09/04/2023 PERSONAL a ADV INJURY $ 1.000.000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY X PE-- LOC PRODUCTS-COMP/OP AGG $ 2.000.000 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 XHIRED v NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY (Per accident) — PIP-Basic s 8.000 X UMBRELLALIAB OCCUR EACH OCCURRENCE $ 1.000,000 — A EXCESS LIAR CLAIMS-MADE 5J3535223 09/04/2022 09/04/2023 AGGREGATE $ 1.000.000 DED X RETENTIONS 10,000 $ WORKERS COMPENSATION X STATUTE EOTH AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 500.000 B OFFICER/MEMBER EXCLUDED? Y N/A AM WC332951 09/04/2022 09/04/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 5D0.000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD