18C-054-003 BP-2024-1061
53 HATFIELD ST UNIT C COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18C-054-003 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-2024-1061 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2024 Contractor: License:
Est. Cost: 6300 AMERICAN INSTALLATIONS LLC
Const.Class: Exp.Date:
Use Group: Owner: GOLDMAN SETH K
Lot Size (sq.ft.)
Zoning: URB Applicant: AMERICAN INSTALLATIONS LLC
Applicant Address Phone: 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 NSULTI ON/W EATH 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:
Fees Paid: S125.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
24-0050-ABC
City of Northam on DepF0
___„
/0. ,./ '": Building Depart ent �'`—`�
:. 212 Main St et 2 0 ULA TIO
Room 1 ��To,
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4 t/� 6(q /
, . Northampton, MA 10
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;; ., phone 413-587-1240 Fax 413= 1 ;� "``:
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APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELL NLY
SECTION 1 -SITE INFORMATION INS ULA TION PERMIT
1.1 Property Address: O / j
This section to be completed by office
53 Hatfield Street, Units • Map l,J' Lot w 9 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) 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 of
Construction from (6)
3. Plumbing 0 Building Permit Fee
4. Mechanical(HVAC) 0 I
5. Fire Protection
6. Total=(1 +2 + 3+4+ 5) 6300 Check Number irfl9P
nn This Section For Official Use Only
Building Permit Number: 6 P- --�Ut0/ Date
Issued:
Signature: C% -Z)25 -21
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 (rt.-
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
t'
City of Northampton
ow="1"u s = - c
177
i t r Y 0 Massachusetts 4S" �c'i
,,�� ( a„(i' :i DEPARTMENT OF BIIILDING INSPECTIONS ' , j j' -�
+. r 7 212 Main Street • Municipal Building p.4
Northampton, MA 01060 ..... �,j��;c
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
'
Massachusetts
* %,
t � !' DEPARTMENT OF BUILDING INSPECTIONS ?'
-st: I!
f garF -.
sR .rave` 212 Main Street •Municipal Building •
",, 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 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 2'r 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)
1)./ it._
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.
YH-- City of Northampton
Massachusetts
�.11. :r; DEPARTMENT OF BUILDING INSPECTIONS y,. s!f` ,
•
. S'r"7- 212 Main Street • Municipal Building J`f`! jCs
'.,'^'_.,,._'-'` Northampton, MA 01060 hY 3'��
MANDATORY FOR HO USES 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:
1, 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.
m___
Contractor signatureiiyi A
Date 7/16/24
1
mass save
Licensed
01
&insured PARTNER
MA al M:206178 ,
MAReptstravon 27598.7 American Installations www.Americanlnstallations.com
130 College Street Suite 100,South Haley,MA 01075• Office:(413)552-0200 Fax:(413)552-0202 • Email supportgitAmericanlnstallations.con
Customer Name:Seth Goldman
Email:seth.k.goldman@gmail.com
Phone: 781-608-9461
Premise Address:53 Hatfield St,C,Northampton,MA 01060
Mailing Address:53 Hatfield St,C,Northampton,MA 01060
Project ID: 5110882
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
Hatch-2"Thermal Barrier Polyiso 1 each $53.96 $13.49
Attic Floor- 7" Open Blow Cellulose 624 SF $1,285.44 $321.36
Propavent 12 each $56.16 $14.04
Damming 54 each $150.12 $37.53
Project Total $2,317.18
Weatherization incentive ($1,159.26)
WARRANTY:American installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty.
American installaticns,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
bolding regulations for the Total Contract Value as stated herein.
ACCEPTANCE OF PROPOSAL: The above prices, specifications and (onations are TOTAL CONTRACT VALUE-S
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
Signature Date
Property Owner(Print) _ _(Sign) Date
Representative:(Print) (Sign) Date
TMS AMU/At/II a WMPOSW Or TNIs PAGE APO THE REVERSE SIDE CF THIS PAGE ARO SHALL IC corsio RtO THE ENTIRE AGREEMENT BY THE PMIRS MOWED 11•5 AGREEMENT i5 RUMOR AARACAN INSTAUIgrS,LLC HOPE WAFTUI REPERIKU TO AS'COMPANY.
ANOTHE W STOMIRIS)NAMU ABOVE,NERHNwTEA REFERRED TOSS'ELIENr,ARO WILL at SUBJECT 10ALL APPROPRIATE LAWS REEWIA11ONS ARO OROWAICES Or THE STATE OP M►SSAOTUSET IS 00 CONNECT UT RBPECIMLY.AS WELL AS ALL LOCAL Al RISME,IONS
rage401
mass save
Licensed&insured
MACSLp.106178 PARTNER
MA Regrstrozronl 175981 www.AmericanInstallations.com
Installations ww•Americanlnstallations.com
130 College Sheet Suite 100,South Hadley,MA 01075• Office:(413)552-0200 Fax:(413)552-0202• Email:supporteAmericanInstallations.com
Customer Name:Seth Goldman
Email:seth.k.goldman@gmail.com
Phone: 781-608-9461
Premise Address:53 Hatfield St,C,Northampton,MA 01060
Mailing Address:53 Hatfield St,C,Northampton,MA 01060
Project ID: 5110882
Date: May 21,2024
Air sealing incentive ($771.50)
Total Program Incentive -$1,930.76
Customer Total $386.42
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
braiding regulations for the Total Contract Value as stated herein.
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE= $ 386.42
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 PAID
Balance Due upon Completion= 5 386.42
5r.:5E
6/24/24
Signature Date
Property Owner(Print) (Sign) Date
Representative:(Print) Garrett Daviau (Sign) Date
'MIS AGREEMENT IS COMPOSED Or TMIS PAGE AND Sue REVERSE SIDE Of 1MIS PAGE AND SMALL OE CONSIDERED TINE ENTIRE AGREEMENT RV THE PMTSS INVOLVED THIS AGREEMENI IS BETWEEN AMERICAN INSTALLATIONS,LLC NUED NMTR RLEEMREO TO AS"COMPANY,
AMINE CUSTOviERISI NAMED ABOVE,NEREINAFTEA REFERRED 70 AS'CLIENT%AND Wit SE SURIECI TOALL APPROPRIATE LAWS,FEDERATIONS AND ORDINANCES Of THE STATE OF MASSAOIUSETIS OR EOM ELT RUT RESPECTNELY.AS WELL AS ALL LOCAL JURISDICTIONS
may\ t ne t,ummunweairn of mussucnuseres
Department of Industrial Accidents
Office of Investigations
;
,.. . , Lafayette City Center
.� fY
•— 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. 0 I am a general contractor and I 6. ❑ New construction
employees (full and/or part-time).* have hired the sub-contractors
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. 0 Demolition
working for me in any capacity. employees and have workers'
comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance
required.] 5. 0 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
employees. [No workers' 13.❑ Other Insulation
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_NortP
Northampton,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#: 413-552-010
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 3EICity/Town Clerk 4.0 Electrical Inspector 50Plumbing
Inspector 6.0Other
Contact Person: Phone#: