Loading...
17C-147 A`°R°® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDl13 12j18J2013 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 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 Van Mourik NAME: Finck & Perras Insurance Agency Inc. PHONE (413)527-5520 FAX No:(413)527-5970 6 Campus Lane ADRE :bvanmourik @finckandperras.com INSURER(S)AFFORDING COVERAGE NAIC# Easthampton MA 01027 INSURERA:Travelers 19046 INSURED INSURER B:Safety Insurance 39454 American Installations, LLC INSURERC: 341 Newton St INSURERD: INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER.-CL13121800447 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 TYPE OF INSURANCE POLICY NUMBER MWDD/YYYY MM/D fD/YYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED 300,000 X COMMERCIAL GENERAL LIABILITY PREMISE cc Ea occurrence) $ A CLAIMS-MADE 5Z OCCUR 6805D937015 9/4/2013 9/4/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY EOa S ccidentINGLE LIMIT S 1,000,000 ANY AUTO BODILY INJURY(Per person) $ 13 ALL OWNED X SCHEDULED 6225740 0/23/2013 0/23/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED Perracciid accident) $ AUTOS Underinsured motorist BI single $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION WC STATUS OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Proof of coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Denise Blais/DENISE ACORD 25(2010/05) 0 1988-2010 ACORD CORPORATION. All rights reserved. INS025 oninn5i m Tha Arr)pn nnma nnei Innn nra raniefararl mnr4c of Arf1Rr1 a CS-106178 WESLEY COUTURE —4 166 NORTH MAIN STREET A' a South Hadley MA 01075 09/29/2015 y Office of Consumer Affairs and Business Regulation ` 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 175982 Type: LLC Expiration: 6/27/2015 Tr# 242171 AMERICAN INSTALLATIONS, LLC. WESLEY COUTURE ----- -- -- 341 NEWTON STREET - - SOUTH HADLEY, MA 01075 - Update Address and return card.Mark reason for change. scA 1 0 zone os/ii Address -] Renewal ❑ Employment Lost Card s !-'��r�enurrrnuen�f�r/�`lltr;.fnc�rrir•//' '.. License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g Y F� OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - egistration: 175982 Type: Office of Consumer Affairs and Business Regulation 1`4 - 10 Park Plaza-Suite 5170 "Expiration: 6/27/2015 LLC ��' Boston,MA 02116 AMERICAN INSTALLATIONS,LLC. WESLEY COUTURE 341 NEWTON STREET g 4'17y6bQ� SOUTH HADLEY,MA 01075 - �F -- -- - Undersecretary Not valid without signature The Commonwealth of Massachusetts Department of'Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/individual) American Installations Address: 3-I I City/State/Zip: S ou±12N &Z f%t / I,� (S t b' i Phone#: 9. Are you an employer?Check the appropriate box: Type of project(required): l. l am an employer with 3 4.0 I am a general contractor and 1 6.D New construction employees(frill and/or part time).' have hired the sub-contractors 7.D Remodel ing 1 2.01 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have S.D Demolition working for me in any capacity. employees and have workers' D Building addition 9.! [No workers' comp.insurance comp.insurance. required] 5.0We are a corporation and its 10.D Electrical repairs or additions I am a homeowner doing all work officers have exercised their I 1_D Plumbing repairs or additions myself [No workers'comp. right of exemption perm MGL insurance required] c. 152.§ 1(4).and we have no 12.D Roof repairs employees.[no workers' 13.XOther J:�15 IA(A f1,0 0 comp. insurance required.] Any applicant that checks box#1 must also rill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicatingsuch. '_Contactors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have em loyees.they must rovide their workers'comp.p2licy number. 1 tuft an employer that is providing workers'compensation insurance for my etnpl ee ow is 1 poll 'at d job rte information. Alp r i , Insurance Company Name: Alp i-F7 y('l :,_iS UfCLnc.e � n 2 �j Policy or Self-ins.Lic.-: n (n as—1 69 "'t{ t J Expiration Date: I tee: — L4_ N �y Job Site Address:3C� City/State/Zip: 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 152 can lead to the imposition of criminal penalties of a fine up.tQ-$1,500.00 and/or one Year imprisonment as well as civil penalties in the forin of a STOP WORK ORDER and a fine of $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the . DIA for coverage verification. I tto herby cerio7 under the pains and penalties of perjitn1 t/rat the information provided above is true and correct. Sure: Date: Print Na Phone . ^ Official use only Do not write in this area to be completed by city or town official Citv or Town: Permit/license#: Issuing Authority(circle one): l.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: I Licensed&Insured www.Americaninstallations.com MA CSL#:106178 MA Registration#175982 `0I American Installations C] C MECo 171 CMA -Efficient Home Services- 341 Newton Street,South Hadley,MA 01075 • Office:(413)552-0200 Fax:(413)552-0202 • Email:support@Americanlnstallations.com Name: v 'T . 5 0 Date: y c Itas IHrse1 Address: �q �P�eS City: lo r @,YtC State:�Zip: V b2 Phone#:home cell Email:n(_(n y- S"FP_vt5©c7 &o kn SALES CONTRACT FOR: - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - -I` fooYC�ec-�fl1 c - -23- - - ���j 4-7- - - - - - - - - - - - - - - - - - - - - - - WARRANTY:American Installations,LLC will provide the above stated homeowner with a 2 year workmanship warranty. i r American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions TOTAL CONTRACT VALUE=$ q 3 •0Q are 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 Down Payment upon Completion. , Balance Due Upon Completion=$ ���., 00 Signature Date Property wrier(Print) (Sign) Date Representative:(Print) 1 . rChL 2 V-e (Sign Date � 1 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"COMPANY",AND THE CUSTOMERIS)NAMED ABOVE,HEREINAFTER REFERRED TO AS"CLIENT',AND WILL BE SUBJECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS. Licensed&Insured www.Americaninstallations.com MA CSL A 106178 MA Registration R 175982 ,tl [:] American Installations wMECo CMA -Efficient Home Services- 341 Newton Street,South Hadley,MA 01075 • Office:(413)552-0200 Fax:(413)552-0202 • Email:support@Americaninstallations.com Name: n 1 G L' Date: 9�y ss�m Irinn Address: Z �{sjeS ,I. City:=lo ire nice/ State: AAA zip: 510162/ Phone#:home cell ZI!2— .J�'K Email: ;n C lit YI-SlQose,17 �/y�ma r�l CO r" SALES CONTRACT FOR: Lsv[� -ivr� - - - - - - - - - - - - - - - - - - - -- - - - - - - -- - - - - - - - - - - - - - - - - - of, - - -- -- - - -- - - - - - - - - - - - - - - - - - - - - - - '�--tea„-«._ -�_ � 1- - - - - -- - -- - - - -- - - -- - - -- WARRANTY:American Installations,LLC will provide the above stated homeowner with a 2 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 TOTAL CONTRACT VALUE=$ are satisfactory and are hereby accepted. You are authorized to do work as f�t specified.Payment will be 1/3 down prior to start of work,and balance due Down Payment=$ V D_�`(, upon Completion. Balance Due Upon Completion=$ /9-3,00 . ',,' Signatures r Date jig Propert wner(Print) ` - (Sign) Date Representative:(Print) -�� c(�)71J (Sign Date f 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-COMPANY",AND THE CUSTOMER(S)NAMED ABOVE,HEREINAFTER REFERRED TO AS-CUENT",AND WILL BE SUBJECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECNCUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS. . .,x�.,'.% � _. �+'�i . rt � �f.,r a .'� t�v' tlrt' 'Fl+�' .'� f '1."taF�.l il�trj:J ii}l�rt�lL•{�l}(: •�f!f r' �1'f l I d��r SECTION 8-CONSTRUCTION SERVICES 7 8.1 Licensed Construction Supervisor: Not Applicable 0I ^ Name of License Holder: wesla K Couture C J 166 North Main Street License Number u 01075 Address �, Expiration Date ignature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ \-V:� ! Company Name Registration Number American Installations Address Expiration Date South Hadley,MA 01075 41-1-5474200 Telephone v vv� v� SECTION 10-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....... V, No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[[3] Other[tizi 1 � Brief De5c . ti o�P osed t Work �`l", �1( �.•1Cl �� t��� (' ,� �1 4 ' � C �'r1C ?, �1 iYYAC�1CXh'1G 5�cx- Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If New house and or addition to existing housing, complete the followinct: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT \f fibm �r1 as Owner of the subject property hereby authorize American Installations to act on my behalf,in avers relative to work authorized by this building permit application. Signature of Owner Date American Installations I ,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. American Installations Pr7kh�10_0_ Q— Signature n OA4bnt Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking S aces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO © DONT KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES ® NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Erec►n c Plumbing&Gas tins old rthampton, MA 01060 Two Sets of Structural Plans Northampton,M -587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address:_ This section to be completed by office k-A! e5 ';�c-z Map Lot Unit Zone Overlay District Elam St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: .,a�me((P'riin�t) � � C � M " g s : �i rl�Au= CI '\ti� ; Telephone t Signature 2.2 Authorized Agent: American Installations 341 Newton Street Name n South Hadley,MA 01075 Current Mailing Address: 413-552-0200 Sign r Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building . (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) i Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2014-1085 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 341 NEWTON ST SOUTH HADLEY (413)552-0200 PROPERTY LOCATION 29 KEYES ST MAP 17C PARCEL 147 001 ZONE URB(94)/GB(6)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tyueof Construction: INSTALL ATTIC INSULATION New Construction AI Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 106178 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO N PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management o D Signature Building Offci Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. 29 KEYES ST BP-2014-1085 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C- 147 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categoa: INSULATION BUILDING PERMIT Permit# BP-2014-1085 Project# JS-2014-001861 Est.Cost: $1900.0 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq ft.): 8624.88 Owner: CHRISTENSON MARY E&JON NELS CHRISTENSON Zoning: URB(94)/GB(6)/ Applicant: AMERICAN INSTALLATIONS LLC AT. 29 KEYES ST Applicant Address: Phone: Insurance: 341 NEWTON ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:412312014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL ATTIC INSULATION -final inspection required 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 4/23/2014 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner