12C-066 �/�`, www.AmericanlnstaIlations.com
BB& i TIN
Licensed&Insured
MA CSL#:106178
�. MA Registration#175982
American Installations
341 Newton Street,South Hadley,MA 01075•Office:(413)552-0200 Fax:(413(552-0202• Email:support@Americanlnstallations.com
Stracco,Paul&Helene&Sarah 11/29/2014
(last) (First) (Date)
21 Harold Street Florence MA 01062
(Address) (Cgy) (State) (Zip)
(802)490-8945 s.gidleystracco @gmail.com
(Home) COD (Email)
406941 14-1132
ISne IDI (lob pl
Quantity Unit Unit Cost Total
Air Sealing
AIR SEALING 6 an hour $ 75.00 $ 450.00
DOOR WEATHERSTRIPPING W/SWEEP 2 each $ 75.00 $ 150.00
Total Air Sealing $ 600.00
Total Air Sealing Incentive $ 600.00
Weatherization
DAMMING R-38 26 linearft $ 2.05 $ 53.30
2"RIGID BOARD 90 sqft $ 3.31 $ 297.90
CRAWLSPACE WALL R10 RIGID INK 70 sqft $ 3.52 $ 246.40
HATCH SEAL&INSULATE 1 each $ 60.00 $ 60.00
FLAT-7"OPEN R-25 496 sgft $ 1.24 $ 615.04
REMOVE INSULATION 56 sqft $ 0.65 $ 36.40
Total Incentivized Weatherization $ 1,272.64
Total Non-Incentivized Weatherization $ 36.40
Total Project $ 1,909.04
Total Utility Contribution—$ 1,554.48
Total Customer Contribution $ 354.56
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 TOTAL CONTRACT VALUE= $ 354.56
conditions are satisfactory and are hereby accepted.You are r
authorized to do work as specified.Payment will be 1/3 down prior to Down Payment=—$ 118.00 K=1 11/29/2014
start of work,and balance due upon Completion. PAID
Balance Due Upon Completion= $ 236.56
11/29/2014
Signature V Date
Stracco,J.P.&Sarah
Property Owner(Print) Property Z') Dale
Craig A.Dragovich 11/29/2014
Representative(Pont) Pe emali ign) Date
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 TOM"COMPANY",AND THE CUSTOMER(S)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 MALL LOCAL JURISDICTIONS.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
U9 600 Washington Street
Boston,Mass. 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information l p Please Print Legibly
Name(Business/OrganizationAndividual): T 1 Il M PC 1� 'i1� n c� 'OL�jL� 11�t�n�, L L C
Address: 3,11 &Whn St-RPe-t_
City/State/Zip: &u F-� 61615 Phone#: 413-552- Qra60
Are ou an employer?Check the appropriate box: Type of project(required):
1 I am an employer with 4.01 am a general contractor and I 6.D New construction
employees(full and/or part time).* have hired the sub-contractors 7.0 Remodeling
2.Q I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have 8.0 Demolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers'comp.insurance comp.insurance.$
required] 5.OWe are a corporation and its 10.0 Electrical repairs or additions
3.01 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself [No workers'comp. right of exemption perm MGL
insurance required]t c. 152,§ 1(4),and we have no 12.0 Roof repairs
employees.[no workers' 13. Other tjulp-41,at�
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$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 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. ` 1
Insurance Company Name: �a,(`�- f� n �,et LU{`1 eC-S r15 tA('Q n G� �;{)V►1 D a��
Policy#or Self-ins.Lic. a Expiration Date:
Job Site Address City/State/Zip:-1"1c�-ee y 0_1 ��0 o
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 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
$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 do herby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature:t Date: -ED
Print Na �t{)n nnY T. 6OtA41.tf� Phone#: 9l3_S5Q_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(circle one):
1.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Wesley Couture ' tpta I 2S
130 College St. License Number
South Hadley,MA 01075 9 -3q-
Address I
- Expiration Date
Signature ------Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑nn
Company Name `-I�`t
American n a ions Registration Number
130 College St.
Address saoiu-M Hafty,MA 01075 Expiration Date
413-552-0200
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)j
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.
9 No...... ❑
i ned Affidavit Attached Yes.......
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
Accessory Bldg. ❑ Demolition ❑ New Signs [[3] Decks [M d' Other[i
Brief D bon C Prroposed
Work: ,[ ( "t 1'if 1` 111 , ��( [On A\� � � � Ala��.t' h�}
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 following:
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
I, 2aA-u A } `-'� �� L� ,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.
Signature of Owner Date
1, American Installations
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 penaltis$of erjury.
American Insta a 1on�
Print Name
American Installatio
Signature of Owner/Agent 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
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
A. Has aSpecial /Finding ever been issued for/on the site?
�� ��
NO ��/�� DON7KNOVY �~� YES �_�
|F YES, date issue& '
IF YES: Was the permit recorded at the Registry ofDeeds?
NO 0 YES 0
| �-�l [---------� -----
IF YES: enter Book { | Page{ | and/or Document#'
B. Does the site contain abrook, body of water or wetlands? NO 0 DONTKNOVV 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tobeobtained �� ���n� �� �� ���' |-------�
^��' ��/ , ' �-'___-_-_--�
C. Do any signs exist on the property7 YES 0 NO
|F YES, describe size, type and location: ! /
.............. ������������'������������.�������
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location: |
_--'
E Will the construction activity disturb .grading,excavation,m filling)over 1 acre mis it part ofocommon plan
that will disturb over 1 acre? YES ���� NO ����
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
'ty of Northampton Status of Permit:
ilding Department Curb Cut/DrivewayPermit
Ut6 12 Main Street Sewer/Septic Availability
,�- has��sP� Room 100 Water/Well Availability.
ton,MA p10�Q orthampton, MA 01060 Two Sets of Structural Plans
ElectrjO
Northamp
phone 413-587-1240 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
t)�Clcc t Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
-''
Name P t) Cuyrerlt Mailinm Adde---•-
Telephone �
Signature
2.2 Authorized Agent: American Installations
130 College St.
Name(Print)_ a e
_ SOU y6 ing-Address:
\413-552-0200
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building IN (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) Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-0646
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 341 NEWTON ST SOUTH HADLEY (413)552-0200
PROPERTY LOCATION 21 HAROLD ST
MAP 12C PARCEL 066 001 ZONE RI(100)/URA(100)/WSP(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL BASEMENT INSULATION&AIR SEAL
New Construction
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
INF MATION 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
,Z"ay
Signature of Building Official Date G
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.
21 HAROLD ST BP-2015-0646
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 12C-066 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2015-0646
Project# JS-2015-001243
Est.Cost: $1300.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sq. ft.): 10062.36 Owner: STRACCO PAUL&HELENE
Zoning: RI(100)/URA(100)/WSP(100)/ Applicant: AMERICAN INSTALLATIONS LLC
AT. 21 HAROLD ST
Applicant Address: Phone: Insurance:
341 NEWTON ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON.•1211212014 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL BASEMENT INSULATION &AIR SEAL
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 12/12/2014 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner