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18C-054 (3) BP-2024-I059 53 HATFIELD ST UNIT A COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-054-001 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-2024-1059 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 6300 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date:09/29/2025 Use Group: Owner: J ROY MELANIE Lot Size(sq.ft.) Zoning: URB Applicant: AMERICAN INSTALLATIONS LLC Applicant Address fluta Insurance: 130 COLLEGE ST SUITE 100 (413)552-0200 AMWC32951 SOUTH HADLEY, MA 01075 ISSUED ON: 08/21/2024 TO PERFORM THE FOLLOWING WORK: I NSUL AT I ON/W E AT H ER I Z AT I ON 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: lire Fees Paid: S125.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ze--,......... ,/4'-e4; , 24-0050-ABC - r.�-4r� City of Northampton ' � g 1� - R -4.:'"- Building Department tr. • 212 Main Street of 3 >Q� Room 100 °? 4 INSULA TION c.,..14. „-1 ' Northampton, MA 01060<y ,,;,1)/A,,,;��Sp ;' ` ,,�. phone 413-587-1240 Fax 413-587-1272_ -:,,q� 7.., / OI'.JL Y 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 53 Hatfield Street, Unit :, ' Map /t - Lot Unit Northampton, MA 010.0 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Roy, Melanie/Lawton, Katherine/Goldman, Seth 53 Hatfield Street, Northampton, MA 01060 Name(Print) Current Mailing Address: n/a 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 A (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 6300 (a) Building Permit Fee 2. Electrical O (b) Estimated Total Cost of Construction from (6) 3. Plumbing () Building Permit Fee 4. Mechanical(HVAC) i) 5. Fire Protection 6. Total=(1 +2 +3+4+5) 6300 Check Number ti — ` This Section For Official Use Only 41 izio - 460 Building Permit Number: 6•v_'2y'-7059 IDate ed: �j Signature: L _ S- 7 )-- l r 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 SteM_____ . 1100, South Hadley MA 01075 9/29/2025 L Addressiiii! . 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 6/26/2025 Address �� M---- 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 ,J No ❑ Brief Description of Proposed Work NOTE: INSULATION ONLY 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 / / 7/16/24 Signature of Owner/Agent Date Roy, Melanie/Lawton, Katherine/Goldman, Seth as Owner of the subject property hereby authorize ,1rrtcrt tiii Ili( illation: to act on my behalf, in all matters relative to work authorized by this building permit application. See attached 7/16/24 Signature of Owner Date City of Northampton 0-c75k1->r1;'.1v1-1T°A; Massachusetts DEPARTMENT OF BUILDING INSPECTIONS• 212 Main Street • Municipal BuildingNorthampton, 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: 6300 Address of Work: 53 Hatfield Street, Units A, B, C, Northampton, MA 01060 Date of Permit Application: 7/16/24 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: 7/16/24 American Installations I75982 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 • r. ii ms . DEPARTMENT OF BUILDING INSPECTIONS I ; 212 Main Street •Municipal Building Northampton, MA 01060 N :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: 53 Hatfield Street, Units A, B, C, Northampton, MA 01060 (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) VIA 7/16/24 Signature of 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 f t„ Massachusetts ��` * ••e `i.. DEPARTIEN 5 T OF BUILDING INSPECTIONS .•. I I '4 212 Main Street • Municipal Building Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 53 Hatfield Street, Units A, B, C, Northampton, MA 01060 Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413) 552-0200 Property Owner Name: Roy, Melanie/Lawton, Katherine/Goldman, Seth Address: 53 Hatfield Street, Units A, B, C Northampton, MA 01060 City, State: 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 A Date 7/16/24 rage i of Licensed&:nsurea MACSLJJ.106178 , PART111111. NER mass save MA Registration 7.5981 American Installations www.Americanlnstallations.com 130 College Street Suite 100,South Hadley,MA 01075• Office:(413)552-0200 Fax:(413)552-0202 • Email: supportg&AmericanInstallations.com Customer Name: Melanie Roy Email:Not provided Phone: 413-210-8227 Premise Address:53c Hatfield St,A,Northampton,MA 01060 Mailing Address:53c Hatfield St,A,Northampton,MA 01060 Project ID: 5110808 Date:May 21,2024 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 6 hr $639.54 $0.00 Exterior Door Weather Stripping(with AS hrs) 2 each $72.64 $0.00 Door Sweep(with AS hrs) 2 each $59.32 $0.00 Rim Joist-2"Thermal Barrier Polyiso 12 SF $66.24 $16.56 Attic Floor- 7"Open Blow Cellulose 440 SF $906.40 $226.60 Propavent 8 each $37.44 $9.36 Damming 48 each $133.44 $33.36 Project Total $1,915.02 Weatherization incentive ($857.64) WARRANTY:American iratallations,LLC wil provide the above stated homeowner with a 1-year lvorkmansiip 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 ail local and state Wilding regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE=S satisfactory and are hereby accepted.You are authorized to do work as specified.Payment CI be 1/3 down prior to start of work,and balance due upon Completion. Down Payment=S PAR) Balance Due Upon Completion=3 Signature Date Property Owner(Print) (Sign) Date Representative:(Print) (Sign) Date THIS AGMEAEN1 S COMPOSED DI THIS PAGE AND TH Ae5TNSF SCECi THIS PAGE AND SHALL EE(MIMED TIE ENTME AGAEEMEM 6V THE MATHS ANQSLO THIS AOI6L14W113 WW101 AMEArCAN INSTALLATIONS,LLC NDelllwlEx NLIW1E0 TO AS"COMPANY'. AM)THE W SrOMEMS)NAMED ABOVE,1RDEINN T1A AEIPN AID TO AS'CLNN1',AND Will It SLKIEC7 TOALL APPROPMATE LAWS,NEGUTATIONS AND OADINAN CAS Or 111E SCALE OP MASSAOIUSETTS ON COM/EC1IUT AcSPECIMIV,AS WELL AS ALL LOCAL NAISOICTIONS Z Licensed&Insured rage 01 MACSLn:106178 PARTNER mass save MA Registration p 175982 American Installations www.Americanlnstallations.com 130 College Street Suite 100,South Hadley,MA 01075• Office:(413)552.0200 Fax:(413)552.0202• Email:supporteAmericanlnstallations.com Customer Name: Melanie Roy Email:Not provided Phone: 413-210-8227 Premise Address:53c Hatfield St,A,Northampton,MA 01060 Mailing Address:53c Hatfield St,A,Northampton,MA 01060 Project ID: 5110808 Date:May 21,2024 Air sealing incentive ($771.50) Total Program Incentive -$1,629.14 Customer Total $285.88 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 conditions are TOTAL CONTRACT VALUE= S 285.88 satisfactory and are hereby accepted.You are authorized to do work as specified.Payment Down Payment- S ❑ will be 1/3 down prior to start of work,and balance due upon Completion. PAID Balance Due Upon Completion= S 285.88 Mc Si nature lanir.Ro ay 21,2024 16.47 EDT) Date g Property Owner(Print) (Sign) Date Representative:(Print) Garrett Daviau (Sign) Date 'MIS AGREEMENTS COMPOSED Or 166 PAGE AND THE REVERSE Silt CS THIS PAGE AND SMALL M CONSIDERED TIE ENTINE AGREEMENT 8T TM PMT113 RWOLYED INS AGREEMEN 16 RE1WEEN MrERICAN INSTALIANONS,LLC MREWAFTER REFERRED TO AS"COMPANY, AN01IE liI STOW RIS)MMED MOVE,HEREINAFTER R EFERRED 70 AS'CLIENT',AND WILL GE SUGIICT 7OALL APPROPRIATE LAWS,RE:LO1ATIONS AND ORDINANCES OF 716 STATE OF MASSAOIUSET 7S DR COMI(CT KLR RESPEC1NElr,AS WELL AS ALL LOCALAJ NROICII NS 1 ne c.ummunweuian of iviussucnuserrs Department of Industrial Accidents , , Office of Investigations _.= Lafayette City Center .v _ Y _� % 2 Avenue de Lafayette, Boston, MA 02111-1750 ww».mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/lndividual):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.❑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 listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ 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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulation employees. [No workers' 13.0 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. tContractors 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. #:AMWC487555 Expiration Date: 9/04/2024 55 Forbes Avenue ty p; Nortamph ton MA 01060 Job Site Address: Ci /State/Zi 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: 916-0101"--- 521461-41"— Phone#: Date: 8/7/2024 413-552-OZ00 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 3E:City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: