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16C-035 384 SPRING ST BP-2016-1442 GIs#: COMMONWEALTH OF MASSACHUSETTS Mau:Block: 16C-035 CITY OF NORTHAMPTON Let-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-2016-1442 Project# JS-2016-002485 Est. Cost:$2925.65 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group AMERICAN INSTALLATIONS LLC 106178 Lot Size(su. 0.): 134164.80. Owner: GILBERT GLENN M Zoning: DRA1100)/WSP(271/ Applicant: AMERICAN INSTALLATIONS LLC AT: 384 SPRING ST Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:6/8/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:ATTIC AND BASEMENT 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: Uil: 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: FeeTvne: Date Paid: Amount: Building 6/8/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1442 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200 PROPERTY LOCATION 384 SPRING ST MAP I6C PARCEL,035 001 ZONE URA('00)/WSP(27)( THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Pads Typeof Construction: ATTIC AND BASEMENT INSULATION New Construction Non Structural interior renovations Addition to Existine _Accessory Structure Buil in+Plans Tn ded: Owned Statement or License 106178 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: (roved 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 Dem ti.• ael.y 7/K _ attire o : ` (J O Depadmed use'enly V` City of Northampton Status of Permit e 4ICjBuilding Department Cufb Cu y PenNt \ 212 Main Street sewerlsepticAvauabllity 4014 ,c-0s°'� Room 100 WgterlWeil Avallabilhty. or,.a, Northampton.MA 01060 Two sets ofsbuotgml`Plans #"o phone 413-587-1240 Fax 413-587-1272 PbUEte ,s Olher3pedfy- _, APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1.SITE INFORMATION 1.1 Properly Address: This section to be completed by office 384 Spring Street Map Lot Unit. Florence, MA 01062 Zone Overlay District Elm Stt,District; CB Dlebict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 7.1 Owner of Record: Glenn Gilbert er Ellen Hersom same Name(Pring cme4P1 ag%Addres : See attached 'Telerne 44 tIS5 ..5SLL(tlI ff1U144 signature 2.2 AuthoNaed Anent: American Installations 130 College St., Ste IOU South Hadley, MA 01075 Name(Print) - current Madno Address: American Installations 413-5521)200 Signature Telephone SECTIONS.ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by Woad applicant 1. Building 2925.65 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cwt of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fre Protedlon nn 1(15 6. Total=(1 +2+3+4+5) 2915.65 Check Number�trj l� -' This Section For Official Use Only Date Bolding Permit Number. Signature: at6dRg Cominlasloperitrepeffie of Buildings Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This coltmm to befilld in by rr Building Dcpatmeat Lot Size Frontage I Setbacks Front Side L: I R:1--j L: R I Rear Building Height III Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved I parking) #of Parking Spaces �� I Fill: ----_�___— (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:I IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES O IF YES: enter Book Page and/or Document ft! 1 B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0 YES 0 IF YES,has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: 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: E. Will the construction activity disturb(Wearing,grading,excavation,or filling)over t acre or is it part of a common plan that will disturb over t acre? YES O NO 0 IF YES,then a Northampton Stonn Water Management Permit from the DPW is required. SECTION b-DESCRIPTION OF PROPOSED WORK fcheck ail api4cabie) • New House 0 Mention 0 Replacement Windows AlteratKn4s) ❑ Rooting 0 Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs OD) Decks (O Siding WESa 1 Ohert Work. Atticand bpa ntit insulation and air sealing throughout Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes �No Plans Attached Rog -Sheet Ba.it New house and or addition to existing housin i,-tonlplete 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 a. Number of stories? f. Method of heating? Fireplaces or Woodstaves Number of each g. Energy Conservation Co iianoe. Masstheck 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. W N building conform to the Building and Zoning regulations? Yes_No I. Septic Tank City SewerPrivate well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PURL Gelnn Gilbert&Ellen Hersom as Owner ofthe subject properly hereby authorize American Installations to act on my behag,in all matters relative to work authorized by this building permit application. See attached 612116 SlgnoWes of Owner Date 11.111111.1.111.1111.1111.11111111111.111111C--- I, American Installations as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and acnurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. American Installations Print Name American Installations 612116 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Wesley K. Couture 106178 License Number 130 College St., Ste 100 South Hadley, MA 01075 9/29/17 Addressl Expiration Date rc-, 413-552-0200 signature Telephone 9.Registered Home Improvement Contractor! - . . _ Not Applicable 0 Wesley Couture 175982 Company Name Registration Number American Installations 6/97/17 Address Expiration Date 130 College St., Ste 100 South Hadley, MA 01075 Telephone 413-552-0200 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 tills affidavit will result in the denial of the issuance of the building permlL Signed Affidavit Attached Yes..._.. d( No 0 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 Edifion Section 1083.5.1. 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 ander 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 rcfawce 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 City of Northampton Massachusetts �2 k A N es! DEPENDENT OF BC LOING INSPECTIONS 212 Main Street • Municipal Building Ncrthaptm, Mt 01060 Property Address: 384 Spring Street Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley, MA Phone: 43-552-0200 Property Owner Name: Glenn Gilbert d Ellen Hersom Address: 384 Spring Street City, State: Florence,MA 01062 I,American Installations (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. Contractor signature ? (c.„. �- Date 6/2/16 - �. www.Anwnraninsumayytscom a • Licensed10x178 CSL MA #105982 MA Registration CSL t OriOn 17598I American Installations 130 College Street Suite 100,South Hadley.MA 01079 •Office:(41715524200 Fax:(413)S33-0}Y] • Email:wpport@AmerkanlnsGllations.com Gilbert&Hersom,Glenn&Ellen 4/30/2016 deco 384 Spring Street Fbrence MA 01062 da 413.820.1044 ggilbett326@gmail.com 424.549 run omni 16-0700 w.101 Quantity Unit Unit Cost Total Air Sealing AIR SEALING 10 man hour $ 85.00 $ 850.00 Total Air Sealing Incentive $ 850.00 WeaUxviiatlon CRAWLSPACEWALL R10RIGID INSt 120 sqft $ 3.70 $ 444.00 VENTILATION CHUTES 60 each $ 2.00 $ 120.00 FLAT-6'OPEN R-21 1,040 sqft $ 1.26 $ 1,31040 HATCH SEAL&INSULATE 1 each $ 60.00 $ 60.00 DAMMING R-38 25 linear ft $ 2.05 $ 5L25 REMOVE INSULATION 120 sqft $ 075 $ 90.00 Total Incentivized Weatherization $ 1,985.65 Total Non-Incentivised Weatherization $ 90.00 Total Project $ 2,925.65 Total Utility Contribution $ 2,339.24 Total Customer Contribution $ 586A1 WARRANT'American magnetmea,Luc will provide the above stated hnmtowner wnh a 2 year aairtmanship wan.ntla imxxantuulbtTez.tLCMte4Yam➢mal to%mitt aN material mtlpbctN 5amrle%teabM score otwtH aRnWea with the above metl£aazbm aN tllkraal aataie budding ranutk.w der abe T«n Comma Yaks al rested heaen. ACCEPTANCE OF PROPOSAL:The above prices,epefrfcations and TOTAL CONTRACT VALUE= $ 586.41 coneitlons are satisfactory and are hereby accepted.You are authorized to do work az specified.Payment will be 1/3 down prior to Down Payment= $ 195.00 Ian 4/3012016 start M work,and balance dye upon Completion PAID Balance Due Upon Completion= $ 391.41 ibert&Hersom,Glenn&EIL /1111:,., .s/� ( n• 4/30)2015 Craig A.Dragovich 4/30/2016 THIS AGREEMENT 15 COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDEREDTHE ENTIRE AGREEMENT BY THE PARTIES INVOLVED.THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS'COMPANY",AND THE CUSTOMERISI NAMED ON THE REVERSE SIDE,HEREINAFTER REFERRED TO AS"CLIENT,AND WILL BE SUB/EGET°ALL APPROPRIATE(AWS,REOWATIONS ANO ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL NRL50ICTIpNS. THE FOLLOWING TERMS AND CONDITIONS ALSO APPLY 1.THIS AGREEMENT IS SUBJECT TO THE APPROVAL OF A MANAGER OF THE COMPANY FOR THIS AGREEMENT TO BE EFFECTIVE UNDER ANYCONDITION, 2.SHOULD DEFAULT BE MADE IN THE PAYMENT OE THIS AGREEMENT,CHARGES SHALL BE ADDED FROM THE DATE THEREOF ATA PATE OF ONE AND ONEHALF(1d/0 PERCENT PER MONTH, 0.0%PER ANNUM)WITH A MIMAWM CHARGE OF$200 PER MONTH,AND R PLACED IN THE HANDS OF AN ATTORNEY OR COLLECTION AGENCY OR COLLECTION,ALL ATTORNEYS'FEES, EXPENSES AND COSTS Or COL-i£CTION SHALL 8£PAID RY THE CLIENT.IN ADDITION,DINT UNDERSTANDS' AT IN FAILING TO PAY ACCORDING 10 THE ABOVE TERMS COMPANY MAY HAVE THE RIGHT-VOA LEIN ON THE PROPERTY, 3.THE COMPANY AGREES THAT WHEN DELAYS BECOME KNOWN TO THE COMPANY,THE COMPANY WILL ADVISE THE CLIENT AS SOON AS REASONABLE. 4.COMPANY AGREES THAT, NOTWITHSTANDING ANY AGREEMENT FOR MATERIALS AND/OR LABOR BETWEEN COMPANY AND THIRD PARTY,COMPANY 15 RESPONSIBLE TO CLIENT FOR COMPLETION OF ALL WORK DESCRIBED IN ATIMELY AND WORKMANLIKE MANNER, 5.ALL WARRANTIES FOR EQUIPMENT AND PRODUCTS SUPPLIED RE THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BY THE MANUFACTURERS Of SUCH EQUIPMENT AND PRODUCTS.UNDER SUCH MANUFACTURER'S WARRANTIES,THE C3.IENT MAY SE REQUIREDTD REGISTER OR MAR INA WARRANTY CARD OR OTHER EVIDENCE OF OWNERSHIP AND USE OF SUCH EQUIPMENT AND/OR PRODUCTS IN ORDRR TO ACTIVATE SUCH WARRANTIES 6.THE QUOTATION ON THE PAGE HEREOF DOES NOT INCLUDE EXPENSES OR CHARGES FOR BOND OR INSURANCE PREMIUMS OR COSTS BEYOND NORMAL INSURANCE COVERAGE,ANY SUCH ADDITIONAL EXPENSES.PREMIUMS OR COST SPALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT. ).TI1E COMPANY'S LIABILITY FOR CLAIMS ARISING OUT OF THIS AGREEMENT SHALL NOT EXCEED THE TOTAL.AGREEMENT PRICE EXCEPT TO THE EXTENT THOSE DAMAGES ARE PROVEN TO BE SOLER DUE TO THE COMPANYS NEGLIGENCE. 8,DURING THE DURATION OF THE WORK,THE NEMS HOMEOWNERS INSURANCE WILL GE RESPONSIBLE FOR ANY AND ALL.DAMAGES AS LONG AS THE COMPANY HAS TAKEN 1HE APPROPRIATE TION TO PROTECT AREAS OFµTORKK. B THE COMPANY IS NOT RESPONSIBLE FOR PREEXISTING DEFICIENCIES OR HAZARDOUS MATERIALS THAT MANIFEST THEMSELVES DURING THE CONSTRUCTION PROCESS,E.G.WOOD ROT, MOLD,ASBESTOS,NAIL.POPS,DUCTWORK AND CONNECTIONS,PLUMBING AND VENT PIPES,DECKING DEFLECTION,ETC.IF A PRE-EXISTING DEFICIENCY OR HAZARDOUS MATERIAL IS ENCOUNTERED PRIORTO OR DURING CONSTRUCTION,AND COMPANY IS NOTIFIED IN WRITING.COMPANY WILL TRY TO ASSIS1'CLIENT WITHIN THE COMPANY'S MEANS AND CAPABILITIES TO CORRECT THE PROBLEMS)ON A TIME AND MATERIAL BAHS,CUED AGREES THAT SUCH CONDITIONS ARE UNAVOIDABLE BY THE COMPANY AND SHALL NOT BE CONSIDERED A VIOLATION OF THE AGREEMENT AND THAT DUE TO THESE CONDITIONS THE DURATION OF THE WORK AND SCHEDULED DATE OR COMPLETION MAY DIFFER FROM THAT AGREED UPON,IF APPLICABLE,UNDER INSAGREEMENT, 10.THE COMPANY 15 NOT RESPONSIBLE,AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES,INLCUUING BUT NOT LIMITED TO MOLD GROWTH,ARISING FROM THE PERFORMANCE OF AIR SEALING WORK BY THE COMPANY AS A RESULT OF ANY KNOWN OR UNKNOWN MOISTURE CONDITIONS. 11,THE COMPANY IS NOT RESPONSIBLE FOR,AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES RELATING TO ICE DAMMING THAT MAY ARISE DURING AND/OR AFTER THE PERFORMANCE OF WORK BY THE COMPANY. 12,REPLACEMENT OF DETERIORATED DECKING,FASCIA BOARDS,8004 JACKS,VENTILATORS,FLASHING,RAI'iFRS.IO6fS,INSULATION OR OTHER MATERIALS ARE NOT INCLUDED UNLESS CONERWTSE NOTED HEREIN. 13.THE COMPANY WILL NOT BE RESPONSIBLE FOR THE SCRATCHING OR DENTING OF INTERIOR WALLS AND CEILINGS,FLOORS.TRIM,GUTTERS,DOWNSPOUTS, EXISTING SIDING AND WINDOWS,DOORS,OIL DROPLETS IN DRIVEWAYS,HAIRUNE FRACTffiES IN CONCRETE OR BLACKTOP DRIVES AND WALKS,OR DAMAGE TO PLANTS OR SHRUBBERY,IF EXCESSIVE DAMAGE IS CAUSED BY COMPANY,COMPANY WILL REPAIR OR REPLACE DAMAGED AREA ONLY AT COMPANY'S EXPENSE, 14,TND,COMPANY UNDER PROVISIONS OF CHAPTER 142A OF THE GENERAL LAWS IS REQUIRED TO APPLY FOR AND OBTAIN AU.CONSTRUCTION-ELATED PERMITS.THE COMPANY SHALL NOT BE DEEMED RESPONSIBLE FOR DELAYS IN THE WORK DESCRIBED IN THIS AGREEMENT CAUSED BY REGULATORY PERMIT GRANTING OR INSPECTIONAL AGENCIES-AUTHORITIES.OR INDIVIDUALS IS.THIS AGREEMENT INCLUDING THE PROVISIONS RELATING TO PRICE AND PAYMENT SCHEDULE,CANNOT BE CHANGED OR ALTERED EXCEPT BY A WRITTEN STATEMENT SIGNED BY BOTH THE COMPANY AND THE CLIENT. 16.ANY REPRESENTATIONS.STATEMENTS,OR OTHER COMMUNICATION NOT WRITTEN ON THIS AGREEMENT ARE AGREED TO BE IMMATERIAL AND NOT RELIED ON BY EITHER PARTY,AND DO NOT SURVIVE THE EXECUTION OF THIS AGREEMENT. IT PPSAGREEMENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF80TH PARRIES EXCEPT AS OTHERWISE SETFORTH HERON. SG THIS AGREEMENT,AN1A.YY WARRANTY{S)PROVIDED HEREUNDER MOLL NOT BE ASSIGNED EXCEPT&Y OR WITH THE WRITTEN PERMISIONOFTHE COMPANY_ 19 If THE CLIENT FAILS TO PERFORM PS OBLIGATIONS HEREUNDER OR TERMINATES THIS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY,THE CLIENT SHALL BE LIABLE FOR DAMAGES FOR THE GREATER OF THE COMPANY'S ACTUAL DAMAGES OR 25%OF THE AGREEMENT FOP RESTOCKING FEE. 20.ANY CHANGESTO MATERIALS BY THE CLIENT MRAND,STYLE,COLOR,ETC.)AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TO THE CIIENI'COULD RESULT IN A 5%RE-STOCKING FEE RASED ON THE COM OF SAID MATERIALS, 21,THIS AGREEMENT SHALL RE EFFECTIVE ONLY UPON ITS EXECUTION Si ALL PARTIES HERETO,PRIOR i0 WHICH TIME IT SHALL BE DEEMED A PROPOSAL.THE COMPANY RESERVES THE RIGHT TOREYOKE TIS PROPOSAL 90 DAYSFROM DATE T'6EXECUTED BYTH COMPANY If IT IS NOT EARLIER EXECUTEDBY THE CUNT ANDTHE REQUIRED DOWN PAYMENT RECEIVED PRIOR TO THE EXPIRATION OF SUCH 90 DAY PERIOD)AFTER 90 DAYS,AND IN THE EVENT COMPANY DOES NOT REVOKE THE PROPOSAL,COMPANY RESERVES THE RIGHT TO REVISE ITS PRICE IN ACCORDANCE WITH ITS COSTS IN EFFECT AT SUCH TIME. 22.IP ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABLE,THE VALIDITY AND ENFORCERILHY OF THE REMAINING PROVISIONS OF THIS AGREEMENT SMALL NOT BE AFFECTED THEREBY. 23.ABITRA➢ON.IN THE EVENT THE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OF THE TERMS.CONDITIONS,PROVISIONS,OR PERFORMANCE OF THIS AGREEMENT,THEMATIC AGREETOPLACETHE MATTER INTO ARBORAIION BEFORE AN INDEPENDENT ARBRMIUR ASSIGNED BY THE AMERICAN ARBITRATION ASSOCIATION TORESOLVE THEIR DISPUTE. 24.ANY DISCOUNT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STATE SPONSORED UTILITY PROGRAM R.E.MASS SAVE)15 SUBJECT TO THE AVAILABILITY OF QUALIFYING STATE SPONSERED PROGRAM AND WILL BE SUBJECT TO TERMINATION IF THE STATE SPONSERED UTIUTY PROGRAM IS DISCOUNTINUED.FURTHERMORE.THE TERMS AND CONDITIONS OF STATE SPONSERED UTILITY PROGRAMS MAY BE ALTERED OR UPDATED PERIODICALLY WITH OR WITHOUT NOTICE. 25,AMERICAN INSTALLERS,LLC IS NOT AN AGENT OF ANY UTIUTY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDER THE MASS SAVE°ENERGY PROGRAM. 26.CLIENT IS REF50NS18M.E FOR THE PAYMENT OF ANY AND AIL FEDERAL STATE,OR LOCAL TAXES THAT ARE APPLICABLE TO THIS AG REEMENT. ltd The Commonwealth ofMassachuseaa Department of Industrial Accidents Office of Investigations t 600 Washington SWeef • Boston,Masa. 02111 www.masagov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PleasePriut Legibly • Name us s� A Pl ���--.nhnf��m7��ndfrieo©.9n: 11 a _ [r. ., \rd .. 1- Address:J—�}„�I tf Q S4t"-P- ., f City/State/Zip: h ♦ sat. • Ili (3)1 mond/: 40-.5.5&- naOO Ase on employer?Check a appropriate bot Type of project(regdred): 11 am au employer with_is. 4.01 am a general couturier and 1 6.ONew construction employees(full anther pantimer have hired the sub-cootracton 7.0 Remodeling 2.01 am a sole proprietor or partner- listed on the ettached died. ship end have no employees These eubcontractma have 8.0 Demolition wining for me lo any capacity. employees and have worktre 9.0 Bolding addition [No wvhen'comp.insurance comp.insurance.j required] 5.0Wc ere a corporation end is 10.0 Electrical repairs or additions 3.01 am a homeowner doing all work otLccm have exercised tet myself [No works'comp. right of exemption perm MOL ILpPlmnbiog repairs or additions insurance required]t c.152,*1(4),and we have no 12.0 Roof repairs employws.trap workers' 13.' Othcrask 4lMn comp.automat required.] 'An appanat that char boa cit mast also m sat km adieu brio ebnlog Ntlr anew'nmpmneon policy toren entre tnom®tom vibe inbuilt this 0E4011 hekraag they an doing as pork and tber bin autnde natnekn mast nbmll a an Mclean Mirada{nth. ;ammeters ams sleek eats bee mal aeneh ma.ddmoedahnl dining amaze oLLewbtnenckn ma Oak e4rber er ea lbonmtitimpaae emp4yees II the r.bankaa>n limn nmkra•sem mutt prvdea dale weans'romp policy amber. I am an employer that Ie previangworkers'compensation tna.mneefor my enplanes.Below Is the paltry end Job rite Insmmla Company Name: A Ur a at [� —1 .._.... `. . Policy for Self-las.Lie.ilk_CU1RWC LOCAC1' 1 Exp�irrMica DDettx __91I iIfI \b— ry Job She Address 74A 4 AJ' l flrRfx�\ 71 • city/state/zip: \C e ley„ r f 0 i ng U Attach a copy of the workers''common Yli6a policydeelaratiou page(showing the policy number ad expiration(date). Fallon to secure coverage as required asides Section 25a of MOL 152 can ked to the imposition of cinmml penalties of a fern op to$1,500.00 and/or one year imprisonment as well as civil penalties in the loon of a STOP WORK ORDER and time of $2.50.00 a day against violator.Be advised that a copy of Ibis statement maybe forwarded to the Office dlmestigadons of the DIA for coverage vetirlallk . I do herby en /ander the pains and penalties ofperjwy that the Information provided aboveIb•Rco true end torrent. Signana pn re/rye AL-t 9 ( /tA_. Date: 0 ig I " l PrWNaetRl wnnno T enu-lufYa Phone A: Ile,-,55Q-0900 Official use only Do net sprite in this area W be completed by dry or town official City or Town: Perrdt/leenee o: Issuing Authority(circle one): 1.Board of Heath 2, Balding Department 3.CRytl'awu Clerk 4.Rlclrinl Imparter 5.Plumbing 6speder 6.Other Contact micas Phone': A�`a1 CERTIFICATE OF LIABILITY INSURANCE DATE 9/4/2015 DAROO(Ynl THIS CERTIFICATE IS issue)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. TRIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS}, AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cemficate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer tights to the certificate holder in lieu of Such endorsement(s). PRODUCER CONTACTLynda Powers Webber & Grinnell =0 o„I. (413)586-0111 Arc.M:yiz 141313544461 "MAIL 8 North !ting Street ADDRESS:1poNara@nehberandgrinnell.nom G.,- IMBRUES)AFFORDING COVERAGE RAW Northampton TW 01060 WSUIiERASIDPlOyare Mutual Casualty IISUREO VOWRER a AnGQARDIBH GDARD American Installations, LLC INSURER C: _ Attn: Wee A Suzanne Couture NSORERD: 130 College Street Suite 100 W6URER E: South Badley NA 01075 .INSURER F: COVERAGES CERTIFICATENUMBER}caster 9-2015 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 10 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING 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, TMm TYPEOF INSURANCE WO POLICY NUMBER IPoMWUO*STYD IMINDWYTTI•• LAMES X COMMERCIAL GENERAL LAWS? I EACH OCCURRENCE. ,1,000,000 A X CIAIMSLPLE OCCUR WAAGE TO HERM/ $OODO PREMISFSIF , I 503535216 9/4/2015 9/4/2016 MED EXP(Any npprrl 10,000 PERSONALBADVINNRY 1,000,000 2,000,000 tGEM/AGGRE(GAATTEpLRORIAPP.IES PER. _ GENERAL AGGREGATE X P0LM,Y I [;ECT _ ,tOC PRODUCTS-WMPAP AGG 2,000,000 OTHER' AUTOMOBILE UABLIW COMBIREDUE.LIM SINGLE. 1,000,000 A I ANY AUTO LEE BWLLY INJURY(Ptpp/on) `AAOWNEDSCHEDULED AVT()D R AVMS 583535216 9/4/2015 9/4/2016 WELT INJURY(kr psklenE X HMO AUTOS % UTOS A D cddettMxA(It' PIP-Basic .... 9,000 X UMBRELLA UAB OCCUR EACH OCCURRENCE 1,000,000 A EXCESS LAB ^_ CLAIMS-MADE AGGREGATE 1,000,000 DEO X RETENTIONS 10,009 553535216 9/4/2015 9/4/2016 WORKERS 00APE AND EMPLOYERS' �� YIN 4 imE ORM AGE PRCPMETIXWARREREJ{ECUTNEE.L EACH ACCIDENT 500,000 B OFFICER/MEMBER EXCLUDED? I NIA IM4n6M6ry In NNl OmC609917 9/4/2015 9/4/2016 EL DISEASE-EA EMPLOYEE 500,000 CESGIPTIO O OPER 00613541m ��� EL DISEASE-POLICY LIMIT 500,000 A Cam'aero&al Property SA3535216 9/412015 9/4/2015 4adcE0bSt,W 20,000 9�'LbSLECO 40,000 PESCRIPTN)N OF OPERAIIUY$/LOCADONS I VEHICLES(ACORD 101,A6414I014N Rmuhs Sd,OMM,may be ataelutl H more pace Is TqS,W) Proof of Coverage. Workers' Compensation policy includes class code 5474 CERTIFICATE HOLDER CANCFI F ATON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AW ORIZED PEPESENTA1WE Kevin Joyce/LMP Ar---- #r--'5-- 0 r-- '5M 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS82542osmm ipMassachusetts -Department of Public Safety Unrestricted-Buildings of any use group which Board of Building Regulations and Standards contain less than 35,000 cubic feet(991m)of .^.Lost - S0 -_- BnGaOecd apa..e. License:CS-106178 e r r WESLEY COUfu 'f;' 166 NORTH MAIN South Badley Mk Ol Failure to possess a current edition of the Massachusetts ''s xra sa State Building Code is cause for revocation of tNs license. .i.....‘„_41.44.. Expiration Commissioner 89/29/2017 for DPS ucursinginrormation visit www.Mass.Gov/p3 2)Ae _ h%m/'y�U'ea t ti /1ca.' aeAt,tso J' Office of Consumer Affairs and Busi ss Reg -1ation -_ 10 Park Plaza - Suite 5170 it, Boston, Massachusetts 02116 Home Improvement Contractor Registration 1 Registration: 175982 Type: LLC Expiration: 6/27/2017 Tr/ 265208 AMERICAN INSTALLATIONS, LLC. WESLEY COUTURE 130 COLLEGE STREET SUITE 100 SOUTH HADLEY, MA 01075 Update Address and return card.Mark reason for change. SCA 1 s 20M-05,11 Ll Address ❑ Renewal E Employment fl Lost Card /7e n /, C( l.,/t Office of Consumer Affan&BusinessRegulation License or registration valid for individul use only vLLCOME IMPROVEMENT CONTRACTOR before die expiration date. If found return to: F� egislmbon: 175982 Type: Office of Consumer Affairs and Business Regulation $ ' .w zpirobon 627201] 10 Park Plaza-Suite 5170 Boston,MA 02116 AMERICAN INSTALLATIONS,ILC. 130COLWESLEY COUTURE J / _/ _ COLLEGE STREET SIBTE 100 .a s „;. —pf/'/fA�// //�(�/ SOUTH HADLEY MA 01075 Undersecretary N valid without signature