18C-054-002 BP-2024-1060
53 HATFIELD ST UNIT B COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18C-054-002 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-I060 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: ,E CULVER, KATAHARINE
Lot Size (sq.ft.)
Zoning: URB Applicant: AMERICAN INSTALLATIONS LLC
Applicant Address Phone: Ipsurance:
130 COLLEGE ST SUITE 100 (413)552-0200 AMWC32951
SOUTH HADLEY, MA 01075
ISSUED ON: 08/21/2024
TO PERFORM THE FOLLOWING WORK:
INSULATION/W E AT H ER I Z ATI 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: !'/r �
Fees Paid: $125.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
`%„, , 24-0050-ABC
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�City of Northamp `./oar
i �y y. Building Depart: t
212 Main Stof ~
-i,' 0 a Room 10. p, of �� ,H ULA TION
. / Northampton, M' 01g.At yql;,/ie;: ,r f
`:: ` _, y phone 413-587-1240 F- , 134'- � %'Sp /
- �qor ONLY
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APPLICATION FOR INSULATION FOR A ONE OR TWO FA ' - •.1.G • LY
n
SECTION 1 -SITE INFORMATION INS ULA TI PERMIT
1.1 Property Address: �/`This section to be completedmp' by office
53 Hatfield Street, Units : Map /l/l/ Lot 2 Unit
,
Northampton, MA 01060 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) Pi
Zt.---
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 6300 (a) Building Permit Fee
2. Electrical 0 (b)Estimated Total Cost Construction f
from(6)
3. Plumbing 0 Building Permit Fee
4. Mechanical(HVAC) 0 -4 1
5. Fire Protection ����
6. Total=(1 +2+3+4+5) 6300 Check Number
This Section For Official Use Only
,.
Building Permit Number: ,V-'029 /0(10' DateIssued:
Signature: 5'zi /�'i , F-Lat . 2 9'
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 9/29/2025
Address A � 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 vi
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 No 0
Brief Description of Proposed Work NOTE: INSULATION 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 /
v%/I// (,�f 7/16/24
Signature of Owner/Agent Date
Roy, Melanie/Lawton, Katherine/Goldman, Seth 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 7/16/24
Signature of Owner Date
City of Northampton
oa`- o
Massachusetts 0 . *�: '<e
NX
�: , '- : ;
l `"7�,f , 'C ° -� DEPARTMENT OF BUILDING INSPECTIONS �, jj -
212 Main Street • Municipal Building J� .Ai
Northampton, MA 01060 'rsVfY 13°O
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 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
°� ro ,5
f ' ' Massachusetts
/ t *:t41 y.
1 �• ~f, '� DEPARTMENT OF BUILDING INSPECTIONS • !
�s•„� 212 Main Street •Municipal Building J;:ss
Northampton, MA 01060 �NW• `^�
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)
vi zt___
A 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.
rr.-- City of Northampton
i Sir^^*::.•SAC
Massachusetts' G
. s:V DEPARTMENT OF BUILDING INSPECTIONS yv;4 l i
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.
zt___
Contractor signature A
Date 7/16/24
rage 1 UL
mass save
Licensed&insured
MACSLM:106178 PARTNER
MA Registration«175982 American Installations www-AmericanInstallations.com
130 College Street Suite 100,South Marley,MA 01075• Office:(413)S52-0200 Fax:(413)552.0202• Emait supporterAeiericanlnstallations.com
Customer Name: Katharine Lawton
Email:Katielawton87@gmail.com
Phone:413-695-2358
Premise Address: 53 Hatfield St,B,Northampton,MA 01060
Mailing Address:53 Hatfield St,B,Northampton,MA 01060
Project ID:5110872
Date:June 27,2024
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) 4 each $145.28 $0.00
Attic Floor -7" Open Blow Cellulose 442 SF $910.52 $227.63
Propavent 10 each $46.80 $11.70
Damming 38 each $105.64 $26.41
Project Total $1,847.78
Weatherization incentive ($797.22)
Air sealing incentive ($784.82)
Total Program Incentive -$1,582.04
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'oral Contract Value as stated herein.
ACCEPTANCE or 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
will be 1/3 down prior to start of work,and balance due upon Completion. Down Payment-S El
PAID
Balance Due Upon Completion- S
Signature Date
Property Owner(Print) (Sign) Date
Representative:(Print) (Sign) Date
TMIS ADREEMDIT a COMPOSED Or iris PAGE APO ire NEYDISE see MUMS PAGE AM)%NALL St CCTISMERrD ire MOOR AGREEMENT es lit Panes INVOLVED TM AGIItUMENT,S SMTWEEP MINUU INSTALUnore LLC rewriarTOI RMRNeo to AS-COMPANY.
A/OTME CUSTOMERS)WAD MOW MEAEArN1E11 AM AM TO AS'CLIENT.,PRO WRL BE SMELT TOAD APPROPRIATE LAVA REGULADONS AND OepNwras or TIE S TA 1E VI MASSAD,UMT TS OR CORE16TK1r1 AMSIECTNELT,AS eau AS ALL wcAL NAiwa*As
rays c u1
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mass save
Licensed&insured
MA CSL is:106178 PARTNER
MARtgtstrotronN175982 American Installations www.Americanlnstallations.com
130 College Street Suite 100,South Maley,MA 01075• Office:(413)552-0200 Fax:(413)552-0202 • Email:supportf/tmericanlnstallations.com
Customer Name: Katharine Lawton
Email: Katielawton87@gmail.com
Phone:413-695-2358
Premise Address: 53 Hatfield St,B,Northampton, MA 01060
Mailing Address:53 Hatfield St, B. Northampton,MA 01060
Project ID: 5110872
Date:June 27, 2024
Customer Total $265.74
WARRANTY:American nstallations,--C 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 265.74
satisfactory and are hereby accepted.You are authorized to do work as specified.Payment Down Payment=5
El
will be 1/3 down prior to start of work,and balance due upon Completion.
RAID
Balance Due upon Completion= 265.74
Katharine Lawton(Jul 14,202417I3 EDT',
Signature Date
Property Owner(Print) (Sign) Date
Representative:(Print) Garrett Daviau (Sign) Date
1r•S A6g0Es1 4 COMPOSED Cr t1V5 PASS•rc t1E wsusi Sot 01 INS PASS ANO SAX.k CON ROI111OIMt!Wet AGREEMENT TInt PARS•'1v0.140 IPM AMRUMOIT S OETWEIR Ar4•IVA 00 XJ TOMS,LLC NORMA.TOIh IEPa1Rt010 A5%mow-.
AROM wSIOMEAtsl FAMED MOSS,MEROM Mite Aertgqc TO AS"UMW.ANO W CM It SVMACI tOALL Ain SC•RM 0 LAWS RESUTA5ON1 MO 0401,4145 Or M S IATE Or M ASSA°,ustlo OR COMMtc1KU-uwv.lwtl.AS WELL AS ALL LOOMxl1MpC11010
t ne c-ummunweuun of inussucnusens
j 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. ■❑ 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 g. ❑ Demolition
workingfor me in anycapacity. employees and have workers'
P �' 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.R 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. #:AMWC487555 Expiration Date: 9/04/2024
55 Forbes Avenue p_Nortamph ton,MA 01060
Job Site Address: City/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: Date: 8/7/2024
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 3❑City/Town Clerk 4.❑Electrical Inspector 5D'Iumbing
Inspector 6.0Other
Contact Person: Phone#: