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42-116 Licensed&Insured www.Americanlnstallations.com MA CSL M 106178 American Installations MA Registration#175982 -Efficient Home Services- 341 Newton Street,South Hadley,MA 01075• Office:(413)552-0200 Fax:(413)552-0202 • Email:support@Americaninsftllations.com AIR SEALING CONTRACT Margery Tetrault 30 Brisson Dr Florence,MA 01062-9709 Site 110-S8005W090 Project LD:11"5(X)99252 Customer ID:C0005M87431 Contract ID:20150917 MEAL Description Quantity Locatilm Perinrm Air!�""t,tstlTaieItI2 FP45 F!,�, Nino Ce ............_. I'll,_�Pl I-­ Door Sweep 2 N/A S45.36 Exte-dor Door Weather Stri P0 nq _4 �j� Smm V Sub Total: $1,304.74 Udlity IncentIve Share $1,304,74 Customer Contribution $0,00 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 2 year workmanship warranty. American Installations,LILC 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=$0.00 are satisfactory and are hereby accepted. You are authorized to do work as Down Payment=$0.00 El specified.Payment will be 1/3 down prior to start of work,and balance due PAID upon Completion. Balance Due Upon Completion=$0.00 9/17/2015 Signature_ ftl" Date Property Owner(Print) Tetrault,Marjorie&Peter (Sign) Date Representative:(Print) Craig A. Dragovich (Sign) - Date 9/17/2015 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, ULC HEREINAFTER REFERRED TO AS"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 AS ALL LOCAL JURISDICTIONS. auk-, www.Americaninstallations.com COKTRA" Licensed&Insured L MA CSL#:106178 American Installations MA Registration#175982 -Efficient Home Services- 341 Newton Street,South Hadley,MA 01075 • Office:(413)552-0200 Fax:(413)552-0202 • Email:support@Americanlnmliations.com WEATHERIZATION CONTRACT Nfargen-Tetrault 30 Brisuiri Dr norence,MA 01062-9709 Site ID:S0005W6790 Project ID:#'t 50099252 Custotner ID:000050087431 Contract IM 20150917 WORK Description Quantity Location $105m Inatillate Rim Joist With 2*Thermal Bomar Baar 4 rvinq'§pacIa".' ...... Insulation Removal 24 WA $27.60 ....... Lnnr .Spdce S1.28840 Hatch:Thermal Barrier Pd zso 2 i 'Veni'bath tri to roof tapper $258.42 A .... . . Sub Total* $1,796.38 Utility Incentive Share $1.326.56 Customer Contributioo 346930 WARRANTY:American Installations,U-C will provide the above stated homeowner with a 2 year workmanship warranty. American Installations,U-C hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions TOTAL CONTRACT VALUE=$ 469.80 are satisfactory and are hereby accepted. You are authorized to do work as Down Payment=$ 156.00 ELI 9/1712015 specified.Payment will be 1/3 down prior to start of work,and balance due —PAID upon Completion. Balance Due Upon Completion=$ 313.80 — Signature Date 9/17/2015 Property Owner(Print) Tetrault,Marjorie&Peter (Sign) Date Representative:(Print) Craig A.Dragovich (Sign)_ 44 Date 9/17/2015 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, U-C HEREINAFTER REFERRED TO As-compmr,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 AS ALL LOCAL JURISDICTIONS. t The Commonwealth ofMassachusetts Department oflndustrialAccidents a ' Office oflnvesligations 600 Washington Street Boston,Mass 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization4ildividual):_ AMajraya �l'��5 �� 'h�d(�C, L L Address: _CO I!� City/State/Zip: pay/ Phone#: Are ou an employer?Check a appropriate box: Type of project(required): 1 1 am an employer with 1`�. 4.01 am a general contractor and 1 6.❑New construction 2.0employees(full and/or part time).* have hired the sub-contractors 7,[]Remodeling 1 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' g p Building addition [No workers'comp.insurance comp.insurance. , g required] 5.0We are a corporation and its 10.D Electrical repairs or additions 3.©I am a homeowner doing all work officers have exercised their 11.[1 Plumbing repairs or additions myself [No workers'comp. right of exemption peen MGL insurance required]t c.152,§1(4),and we have no 12.❑Roof repairs employees.[no workers' 13. Other comp.insurance required.] 1A "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 subcontractors 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:_ C «a n Policy#or Self-ins.Lie.#:— U R\t\lC UDO R I Expiration Date—_q] I �D Job Site Address: 30 —SSq,\ Q!C i y City/State/Zip:_F1 Ore j,CK [�Z 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 cert under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date. 'Z3 •lt' Print Name: Phone#. %a-55Q 6,rw0 Official use only Do not write in this area to be completed by city or town official City or Town: Permit/license M Issuing Authority(circle one): 1.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#• SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: <_.S t u,(r License Number 130 College St. Se-t-h- mwuey,MA 0>I me q -1�1 Address 413-552-0200 Expiration Date c Signature Telephone 9.Registered Home'Improvement Contractor: _ Not Applicable ❑ Lr)sg ga Company Name American Installations Registration Number 130 College St. CP-a`-1-1 rl Address South Hadley, MA 01075 Expiration Date 413-552-0200 Telephone 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....... No...... ❑ 11. - Home Owner Exemution 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 !E—:Q_0 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 [O] Decks [Q Siding[0] Other[OV Brief Description of Proposed N C S Q�l I n i V O.pcc- �«\Px, v i M J �S 61 Ov^ c e tl,U tp SWI a kot dt Work: U 2r-lh Qk� n co-P) alnAt4 ,A, I Alteration of existing bedroom Yes_)CL_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _,Z 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, NAG'? hoc tz-t- PQ�e( -T—Z,+< Q V 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. Sc'� C:O(N+rC k Signature of Owner Date 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 penalties of perjury. American Installations Print Name American Installati— G 2—? 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 � i C-�� � c •—.._....._ - ._.__..-.� Frontage Setbacks Front `� ►� [T Side L:= R:I I L:Q R:U Rear i Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) - A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES O IF YES, date issued:f _-____._ IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O F i IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: I C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: j 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 O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department'useonly Di of Northampton Status of Permit: a 201 ing Department Curb Cut/Driveway Permit. SE� 2 2 Main Street Sewer/Septic Availability sp�eens ROOM 100 WatedWell Availability' 01 Pwmei"s&Qas Bto pton, MA 01060 Two Sets of Structural Pians one 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 This section to be completed by office 1.1 Properly Address: 36 9C l5S©'0 D 6v2 Map Lot Unit �- 6 C e'n ce,, n n A O I C)U,-J- Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: V�1ac o("I e,-� �e,}2f —� c-av Q,c�ssoC\ F)("I\4 0 cep C-2� Name(Print) Current Mailing Address: �-t/i 1-3— F>(„( �b Cf 0 4 oo—G Telephone J Signature 2.2 Authorized Accent: American Installations 130 College St Name(Print) South Hadley, MA 01075 Current Mailing 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 (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 do 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Date Building Permit Number: Issued: t ture: Building Commissioner/Inspector of Buildings Date File# BP-2016-0422 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY01075 (413)552-0200 PROPERTY LOCATION 30 BRISSON DR MAP 42 PARCEL 116 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT i Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction: INSTALL INSULATION 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 INFORMATION PRESENTED: proved 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 Demo ' ' n ay S$Pe of gui ing is 1 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. 30 BRISSON DR BP-2016-0422 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:42- 116 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-2016-0422 Project# JS-2016-000670 Est.Cost: $3101.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq. ft.): 15463.80 Owner: TETRAULT MAJORIE A& zonine: Applicant: AMERICAN INSTALLATIONS LLC AT. 30 BRISSON DR Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.912912015 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL INSULATION 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 SiSnature: FeeType• Date Paid: Amount: Building 9/29/2015 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner